Aging in Place Home Modifications

When you’ve completed a safety checklist on your home and made all the easy fixes and repairs, you may find that problem areas still exist for safely aging in place. Some problems may be unsafe conditions, but others may be barriers that make it difficult for you or your relative to move about freely and to enjoy the comforts of home that make him want to stay put in the first place. This article covers modifications that can be made to an aging person’s current home to allow him to continue his present living arrangement.

For more information on this topic, check out the AARP HomeFit Guide Downloads, Worksheets, and Resources.

Categorizing types of home modifications

Many houses and apartment buildings were constructed before universal design features were common or in some cases required by guidelines for remodeling and new construction under the Americans with Disabilities Act (ADA), passed in 1990. Ramps in public places, doors marked for wheelchair entrance, and buses with lifts and special seating for people with disabilities have become so common that they are scarcely noticed (unless of course you’re the person with a disability who needs these accommodations). Yet the need for similar accommodations in private homes is less visible although equally important.

The Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) puts home modifications into three categories:

• Accessibility: Accessibility modifications allow a person in a wheelchair or with disabilities to move easily throughout a structure, such as with widened doorways, lowered countertops and sinks, grab bars in the tub or shower, and light switches and electrical outlets at waist height.
• Adaptability: Adaptability covers changes that can be made more quickly, without having to completely redesign the home or use different materials for essential fixtures.
• Universal design: These features are usually built into a home, including appliances, floor plans, and fixtures that are flexible, sturdy, reliable, and easy for all people to use.

These categories are important because they involve different levels of planning, implementation, and cost. For example, adapting a home is the least complicated type of modification. Grab bars and outdoor ramps are examples. Making a home accessible, however, may involve structural changes and complying with building code and ADA requirements. Universal design may come into play when you are completely remodeling a home or building a new space.

Checking out accessibility

General home safety issues (see the earlier section “Dealing with Two Major Hazards”) are important for all older people living on their own. But other specific features can make the home easy to use — or not — for people who have disabilities or are aging. Start in the kitchen and bathroom and think about the particular problems you or your parent may face in accessibility:

• Are cabinet knobs or pulls easy to use? Pulls are generally considered easier to use than knobs.
• Are stove controls easy to use and clearly marked?
• Are faucets easy to use? Universal design faucets have one lever, not two knobs to turn. This makes mixing hot and cold water easier.
• Can the oven and refrigerator doors be opened easily? Is the freezer easy to reach?
• Is the kitchen counter height and depth convenient? Most kitchen counters are too high for a person in a wheelchair.
• Is there room to move around the bathroom and a place to put towels and shampoo in easy reach?
• Is the shower faucet easy to use? Turning on the shower and getting the right temperature can be difficult. A new showerhead or faucets may be needed.
• Does the height of the toilet seat make getting up difficult? A raised seat may help.

In closets and storage spaces, check the following:

• Does the closet contain items that have just been put there to get them out of sight? Move them so that the closet is easier to access for coats, hats, umbrellas, and boots.
• Can items in the closet, like a coat on a hanger, be removed and replaced easily?
• Can the use of storage space be improved with closet shelf systems?

Doors and windows may need the following updates:

• Are the doors wide enough to accommodate a walker or wheelchair? The standard for a wheelchair is 36 inches. Most door openings are narrower.
• Are the doors and windows easy to open and close?
• Are the door locks sturdy and easy to operate?

Evaluate the electrical outlets and safety devices:

• Are electrical outlets easy to reach?
• Is the area around outlets free of clutter?
• Are the outlets properly grounded to prevent shock?
• Can you hear the doorbell in every room?
• Is the telephone readily available for emergencies? A land line may be more reliable in an emergency than a cellphone.
• Is there an alarm system? If so, is it easy to use? If not, consider whether one is needed.

The preceding information is only a partial list. The University of Southern California Leonard Davis School of Gerontology has an extensive resource list. Also see the AARP HomeFit Guide for a questionnaire to help you plan when you remodel. One part of the HomeFit guide has suggestions for remodeling for people with vision, strength, and mobility problems.

Some items that need correcting can be done by you or a friend or family member, but if you have determined that major changes are necessary — for example, widening doorways or replacing kitchen cabinets or appliances — you probably need to find a contractor to tackle the modifications. Head to the next section for advice on finding the right person for the job.

Remodeling is a messy and often frustrating experience. The first phase, demolition — even if it’s limited to one room or area — is unsettling. Delays are common. It may be a good idea to move your relative to another setting while the work is being done, especially if you expect a lot of dust, noise, and disruption.

Finding a contractor

How do you find a reliable and knowledgeable contractor? If you have already worked with a contractor and were pleased with the results, then you have a head start. Ask this person to go over the problem areas with you, suggest fixes, estimate the cost, and tell you how long it will take to do the work.

Most people with accessible homes have neither built their own houses nor undergone extensive remodeling. Ask for recommendations from friends or neighbors who have had similar work done. Check online referral sites for recommendations. Then ask a few contractors for estimates and for people to call for references. Some home builders work with certified aging-in-place specialists, a program developed in partnership with AARP. Visit the AARP's website for worksheets and more information.

Before hiring a contractor, check with the local Chamber of Commerce or other agency to see whether any complaints have been filed against the company. Make sure the contractor is licensed to perform the work and can obtain any building permits required. Finally, ask for a written agreement that stipulates a small down payment and schedule of payments, with the final payment to be made only when the work is completed and approved.

A frequent scam carried out against older people occurs when a “contractor” scans a neighborhood for a likely target and offers to do needed (or unneeded) repairs or home modifications. The person asks for a large down payment and either disappears or does only a token amount of work. If you’re thinking of home modifications for older relatives, be sure to warn them about this scam.

Attempting any major repairs, especially if they involve climbing ladders or using power tools, is dangerous. Some people want to save a few bucks by doing the jobs themselves, but they need to be reminded that the cost upfront is much less than the aftereffects of being injured.

If you or your relative lives in an apartment building or housing complex, you need to contact the management to make some changes, particularly in corridors and stairways and even within the apartment itself. Co-op or condo residents may be required to obtain approval from their governing board too.

Getting help paying for home modifications

Many home modifications, such as ramps and lighting replacements, are relatively inexpensive. But when you start widening doors and installing new kitchen equipment like a refrigerator with side-by-side doors, the costs add up. In the bathroom, installing a roll-in shower can be costly although important for someone who cannot move from wheelchair to tub. Eldercare Locator, a federal agency funded by the Administration for Aging (AoA), suggests these resources for financial assistance:

• Some funds for home repair may be available through Title III of the Older Americans Act. They are distributed through the local Area Agency on Aging (AAA). You can find your nearest AAA by calling Eldercare Locator at 800-677-1116 or going online. These funds are likely to be limited, however, and best suited for relatively small jobs.
• Rebuilding Together, Inc., a national volunteer organization dedicated to assisting low-income seniors, may be able to direct you to a local affiliate.
• Some types of home modification — those determined to be medically necessary — may be covered by Medicaid (for eligible low-income people), depending on the state you live in. For example, a roll-in bathtub or shower for a person in a wheelchair may be covered. A doctor’s order may be required, and some Medicaid programs limit eligibility to certain diagnoses or ages. Check with your state’s Medicaid office for details.
• If the home is mortgaged and has substantial equity, a home equity loan may be available from the bank. However, this loan will increase the mortgage payment.

Whether major improvements and their associated costs will substantially improve your or your relative’s safety and quality of life is a personal decision. You may decide that aging in place is not really feasible after all and that a move to assisted living or another setting is the best choice. If you do decide to stay, going through the important process of evaluating the home and making those small changes that can prevent accidents will make it much safer.