Expert Advice on Aging in Place
It all begins with an idea.
Michelle LaForme, Ageless Living Solutions
According to the CDC, “Aging in place is the ability to live in one’s own home and community safely, independently and comfortably, regardless of age, income, or ability level.” As a registered and licensed occupational therapist (OTR/L) and Certified Aging in Place Specialist (CAPS), the concept of aging in place is a very familiar one. Even after a significant health change or reduction in mobility, the majority of my clients want to stay in their current homes and age in place.
Safely Aging in Place
Your home holds many memories, not to mention a significant financial investment. The idea of leaving the neighborhood and nearby friends, beginning new routines, finding new medical professionals, or even a new grocery store or pharmacy can seem daunting. To support a senior’s desire to age in place, families are seeking out professionals to assist with modifying their current home.
There are several professionals that may assist in the process of aging in place including contractors, designers and occupational therapists. Individuals certified with a CAPS designation are trained by the National Association of Home Builders in the needs of the aging population, common remodeling projects and expenditures, codes and standards, product ideas and resources.
Through a home consult, an Occupational Therapist with a CAPS certification provides comprehensive solutions for a senior to stay in their home with increased independence and safety. A consultation to assess functional abilities is used to develop new strategies for modifying daily routines and suggest necessary home modifications.
Assessing a Senior's Functioning at Home
On a home visit, a Certified Aging in Place Specialist will work with the resident to identify daily routines and activities and the challenges that impact performing them. The specialist will suggest and demonstrate new behavioral techniques that can make essential activities easier and safer. Practiced changes in routine will help the resident develop new habits and patterns of thinking and behaving that support aging in place.
Readying the home for aging in place also involves an evaluation of the living environment for the most efficient use of living spaces and whether current furnishings and home features provide the highest level of safety, comfort, and ease of use. The home evaluation will include suggested modifications to retrofit or redesign areas within the home to remove physical barriers to mobility and incorporate assistive devices or durable medical equipment that promote independence. Modification to the home environment will focus on organization of the space and personal items as well as furniture placement in key living areas. For specific suggestions on readying these spaces in your home, visit the articles below.
Make an appointment to meet with a CAPS or Occupational Therapist for a customized session focused solely on developing a plan to make staying in a current home safer. You can find a Certified Aging in Place Specialist in your area by visiting the National Association of Home Builders website.
Browse Our Free Senior Care Guides
M
EXPERTMichelle LaFormeAgeless Living Solutions
About Michelle LaForme
Michelle LaForme is an occupational therapist with over 20 years of experience. She holds a certification as an Aging in Place Specialist (CAPS) and uses home modification, adaptations, and durable medical equipment to meet each client's unique needs and enhance their safety and independence.
Is Aging in Place Always the Best Option for Seniors?
It all begins with an idea.
As we age, most of us claim we want to age in place—to stay in the familiar homes we love throughout the rest of our lives. But many seniors don’t think this decision through and wind up unsafe, unsupported, lonely and even housebound.
“Elder orphans” is the phrase du jour in the elder care industry. It describes seniors who are single or widowed and have no children (at least locally) and no support system. They find themselves living alone in the community with no one to help care for them should they need it. This group of “orphans” will increase sharply as baby boomers age and as average life expectancy in the United States continues to stretch toward 80 and beyond.
Like most seniors, I want to age in place—a topic I cover frequently in my blogs. In two previous posts, I explored the prospects for the rest of my life. Will I be able to remain at home, or will circumstances force me to move into a senior residence?
There is no one-size-fits-all roadmap for aging. I have made preparations that will hopefully enable me to remain in my home and receive the support I need, but many seniors fail to plan accordingly. Elder orphans—and their families—surely see the concept of aging in place differently.
Aging in Place: Promoting a Senior's Independence or Isolation?
It’s easy to understand why so many of us wish to remain at home. We like our familiar surroundings and we fear institutionalization, the loss of control we feel it signifies and the financial drain it brings. We often fight to remain in homes we can barely maintain or navigate safely. However, this desire doesn’t negate the fact that almost two million Americans aged 65 and older rarely or never leave their homes. Another six million are considered “semi-homebound.”
Aging in place seems ideal, but it can be dangerous, especially for vulnerable elders who have few or no community ties. The risks they face are detailed in a case study led by Maria Torroella Carney, MD, chief of geriatric and palliative care medicine at Northwell Health in New Hyde Park, New York.
“As independent individuals, isolated seniors have functioned sufficiently well on their own and thus do not actively plan for their medical future,” explains Carney and her fellow researchers. “As they age and decline, they realize, often too late, that they can no longer complete many of the tasks that they were previously able to do. Stemming from this inability, elder orphans may no longer access the care that they need, and acute, possibly preventable, medical events occur that can easily lead to hospitalization.”
For those of us aged 80 and older, more than three-quarters still live in their own homes. This may seem inspiring at first glance, but a 2014 study found that seniors in assisted living facilities actually got outside more often compared to those who remained in their own homes.
While aging in place may bring seniors a sense of control, it requires a variety of services and supports to be a successful long-term living arrangement, especially for the oldest and frailest of us. Seeking out and managing most of these essential services requires a support team, money and flexibility among team members to manage a senior’s ever-changing needs.
A Common Aging in Place Scenario
Aging is tough. I can attest that the support of family and friends is crucial, regardless of whether one wishes to age in place or not. To highlight some of the difficulties isolated seniors often face, I decided to create a fictional character named Jim. He’s not a real person but a composite of several people I know or know about.
Now 74, Jim had been the CEO of a large manufacturing company in Cleveland. He stayed on the job beyond the usual retirement age of 65 because he enjoyed it. Tellingly, he had been known to say, “If I’m not president of this company, then I’m not sure who I am...”
Jim has had Parkinson’s disease (PD) for nine years, and the disease finally forced him to retire four years ago. He and his wife Marie enjoyed an active social life while he was CEO, but Jim’s friendships with work colleagues faded away once he retired. In time, he realized they were just business acquaintances, not true friends. Fortunately, Marie had several close girlfriends, and she and Jim continued to socialize with them and their husbands until she lost her five-year battle with breast cancer about a year ago. Not only did Jim lose his beloved wife, but he also lost his only connection to a social life.
Peter is their only child. He lives in San Francisco with his partner and their adopted daughter. They’re on good terms and speak often by phone.
Thanks to his wife and an excellent long-time executive assistant, Jim never needed to attend to many of his own personal and family needs. As a result, he now struggles to email his son and shop online for the murder mystery books he loves to read. As his PD progresses, daily tasks become increasingly difficult.
Jim and Marie designed and built their lovely home located an hour’s drive from downtown Cleveland. Unfortunately, the large house is a lot for one person to manage by themselves, even without PD. Jim was an avid gardener but now depends on a landscaper to tend to his yard and beloved plants. He recently had to stop driving as well, so he spends most of his time at home alone.
Peter is understandably worried, as his dad’s world gets smaller and smaller. He also sees some warning signs of dementia in his father, but there’s only so much he can do from afar. He has been urging Jim to move into an upscale senior living residence nearby, explaining that the move will provide him with social opportunities and activities that will make him happier and healthier. But Jim says he loves his house and its reminders of Marie and the wonderful life they shared. “I can still get around more or less,” he protests.
As in Jim’s case, the progression into “orphanhood” isn’t typically sudden and often it cannot be easily foreseen. Regardless of individual circumstances, it is important for seniors and their loved ones to acknowledge that alternatives to aging in place may be more beneficial overall.
The Truth About Aging in Place
Many seniors are adamant about remaining in their own homes, which can be a possibility for several years, but this requires careful planning and forethought. Truly aging in place is not about inaction, denial or avoiding change. In fact, for many elders, a realistic plan for aging in place requires downsizing and moving into a more senior-friendly home. But even with a proactive approach to aging, finding the proper in-home supports and putting them in place can be difficult and very costly.
Without a comprehensive plan, seniors often wind up in unhealthy and unsafe living conditions, isolated, and with a reduced quality of life. Instead of fully enjoying their remaining years with their peers and with supports designed to extend their independence, they jeopardize their health and resign themselves to struggling to maintain the status quo.
The truth is that refusing to accept help or change one’s environment or daily routines is typically what contributes to serious health setbacks, eventually forcing the move to senior living that the elder wished to avoid all along. If their condition is grave enough at that point, then it is likely that they won’t be able to fully participate in deciding where they’ll move to.
In aging, as with all challenges we face, it is best to hope for the best and plan for the worst. Without a strategy in mind, there’s no guarantee that we’ll have any control over how and where we age. This is a common, deeply rooted fear for most of us as we grow older, yet many of us allow it to become a self-fulfilling prophecy through our own inaction.
Sources: Epidemiology of the Homebound Population in the United States (https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2296016?resultClick=3); 2011 National Health and Aging Trends Study (https://www.nhats.org/)
Keeping Seniors Safe: Home Care Services and Tips for Aging in Place
It all begins with an idea.
Evaluating a senior’s ability to safely age in place is a complex process. Research shows that approximately three-quarters of North Americans age 50 and older want to continue living in their own homes for as long as possible, according to the AARP. But for this plan to work, a senior’s home must be suitable for aging in place despite the emergence of any new or worsening health issues and functional limitations.
Implementing safety measures and universal design principles is one way of ensuring an older adult’s current home will remain safe, functional, and comfortable as they age. Nanette Pfister, vice president of sales for Epcon Communities based in Dublin, Ohio, points to the importance of creating a home environment that supports one’s lifestyle now and in the future. Pfister emphasizes that every area of an existing home can be adapted to help prevent falls, injuries, and accidents.
In addition to home modifications that aim to keep seniors safe, home care services can help in several important ways — watching for environmental hazards, assisting with daily activities, providing companionship, and more. Read on to learn what you can do to ensure your elderly loved one’s safety at home and how in-home caregivers can help.
Home safety for seniors: Modifications and recommendations
To devise a customized solution for helping a loved one age in place, walk through their residence and carefully assess each room together. Jot down any current or potential hazards that should be addressed, and consider the following suggestions for modifications and improvements that will promote independent living. If you don’t feel comfortable identifying home safety issues, a home care provider can organize a professional assessment for you.
General home safety tips
Move furniture to create clear walking paths.
Ensure light switches are accessible by placing them no higher than 48 inches from the floor, and replace toggle switches with rocker switches.
Improve overall lighting in the home. Light dark pathways or countertop areas with easy-to-install rope lighting. Add task lights and night lights wherever needed.
Add grips to doorknobs or replace them with levered handles or pulls.
Mark any steps or changes in floor level with tape or paint in a contrasting color.
Remove loose carpeting and unnecessary throw rugs/mats. Secure area rugs with double-sided rug tape, making sure to focus on corners and edges.
Remove any electric and cable cords that run across or near walkways. Place all wiring behind furniture or secure cords neatly against walls with clips, cable staples, or cord covers.
Ensure that seating throughout the home is sturdy, ideally with supportive arms to make sitting and standing easier. Consider an electric lift chair as a cozy and helpful addition to the home.
Remove clutter by donating or disposing of items that are no longer needed.
Make sure trash receptacles are easily accessible from inside the home and can be brought to the curb without difficulty. In-home caregivers can also take out the trash for seniors, which is especially helpful in icy conditions or during winter months.
Consider repurposing a closet or other area on the ground floor into a laundry room if laundry machines are located on an upper floor or basement of a multi-level home. Replace top-loading machines with front-loading appliances that are easier to use. If necessary, laundry can be outsourced to a laundry service or added to the tasks completed by a home care aide.
Ensure smoke alarms and carbon monoxide detectors are placed in all key areas of the home. Test them and change the batteries regularly.
Each room and space in your loved one’s home serves a unique purpose and may have specific challenges to address. The following suggestions are room-by-room modifications that family caregivers can make that will help enhance home safety for seniors.
Entryway safety tips
Make sure foyers and home entryways are easily accessible by reviewing these suggestions.
Clear a convenient path from the driveway to the entry of the home.
Inspect all walkways for cracks, loose bricks or stones, and uneven surfaces. Repair any flaws to provide a level walking surface free of trip hazards.
Consider installing a doorbell with a camera or a mailbox alert so seniors know when someone is at their home.
Remove or trim landscaping so that walking paths are wide enough for someone using a wheelchair or walker.
Install handrails on both sides of any entry stairs. Ensure stair treads are nonslip and deep enough to accommodate the whole foot.
Evaluate if there is room to install a ramp. Stepless entries make it easier and safer to gain access, whether the person is in a wheelchair or using a mobility aid like a walker or cane. Install threshold ramps wherever possible.
Evaluate the security of the front door. Are the locks sturdy and easy to operate? Is there a window panel or peephole in the proper location?
Add swing-clear hinges to doors or hire a contractor to widen existing doorways to accommodate mobility aids.
Kitchen safety tips
The following tips can help ensure kitchens are safe spaces for seniors.
Replace knobs on cabinets and drawers with levers or pulls.
Keep a long-handled grabber in the kitchen to reach objects that may be out of reach. This can reduce a senior’s temptation to use a step stool or another unstable device.
Move frequently used items from high shelves and under-the-counter cabinets to more accessible locations that do not require reaching up or leaning down.
Consider the functionality of older appliances. Ideally, oven controls should be placed at the front of the range rather than toward the rear to prevent reaching over the stove burners. Knobs should be clearly labeled and easy to use. A thin layer of paraffin wax or petroleum jelly can be rubbed around the gasket of a refrigerator door that is difficult to open.
Replace small appliances, such as coffee makers and toaster ovens, with models that have an automatic shut-off feature.
Use colorful dishes, utensils, and cookware that contrast with the color of countertops, tabletops, and storage areas to help an elder with poor eyesight navigate the kitchen.
Use thermometers and timers with flashing lights to alert someone who is hard of hearing that dinner’s ready.
Use a “Lazy Susan” to increase access to out-of-reach items on the dining table, on shelves, and in cabinets.
Bedroom safety tips
A senior’s bedroom should be a welcoming space where they feel comfortable. These recommendations can help keep their room cozy and secure.
Adjust the height of the bed for easy transfers. A senior should be able to sit on the edge of the bed with their knees bent and their feet flat on the floor. Add height with risers or a taller bedframe if it’s too low. If it’s too high, consider removing or replacing the box spring with a low-profile box spring or purchasing a lower bedframe.
Add pull-up devices under the mattress to assist with sitting up when in bed.
Keep a working flashlight in the nightstand for emergencies.
Consider setting up a bedside commode if nighttime trips to the bathroom are common.
Bathroom safety tips
Bathrooms can be challenging spaces for seniors. They often feature slippery flooring materials that become even more dangerous when wet from sink or shower spray. Consider the following safety modifications.
Install grab bars for additional support while toileting and while getting into and out of the shower/bath.
Consider installing motion-activated night lights along the path to the bathroom to make nighttime trips safer and more convenient. Abundant lighting for the overall space as well as tasks is essential. Special waterproof incandescent lights should be placed in the ceiling of the shower and over the tub for extra visibility.
Set the water heater to 120 degrees Fahrenheit or lower, and clearly label hot and cold faucets. Consider installing anti-scald devices on faucets to prevent burns.
Ensure showers have a step-free entry. Step-in tub models feature a door for easy entrance and exit. The shower/tub should be fitted with a seat, a hand-held showerhead, and a niche or shelf at a convenient height so bath products can be reached easily. A large, zero-entry shower with a bench will allow one to roll a wheelchair in and bathe.
Add non-skid decals to any slippery areas in the bathroom. If possible, floors should be slip-resistant wood, vinyl, or tile with a lot of grout for traction.
Fit all cabinets and drawers with levers or pulls rather than knobs.
Consider installing a comfort-height toilet, which is a few inches taller than standard models, or adding a toilet seat riser to an existing toilet. This is especially important following joint replacements and may help during arthritis flare-ups. The extra height allows for easier toileting, especially if one must transfer to and from a wheelchair.
Making simple home modifications is an easy way that family caregivers can support loved ones aging in place. Applying the tips above can make any senior’s home safer and more accessible. However, you may begin to notice that your parent could benefit from additional help around the house.
Expert guidance to keep your loved one safe: Home care services and senior resources
Adding supportive care is another good option to help keep your parent secure in their space. Safe home care services range from assistance with activities of daily living (ADLs) to transportation. In-home care can help seniors age safely in place and delay or avoid the transition to a senior living community.
Home care aides can help with the following:
Browse Our Free Senior Care Guides
Assessing hazards around the house and making suggestions for reducing fall risks throughout the home
Keeping the home clean and tidy
Monitoring your loved one’s medical status to make sure they’re healthy enough to continue safely living on their own
Reminding seniors to take medications as prescribed and watching for potential side effects
Offering much-needed socialization and camaraderie for older adults
Another resource for helping improve home safety for seniors is the local Area Agency on Aging (AAA). AAA offices coordinate local services that support elderly adults aging in place. Their services differ depending on the location of the agency, but many help facilitate safety inspections, meal deliveries, social and recreational activities, home repairs, and more. Explore their services and identify an Area Agency on Aging near your loved one.
AgingCare can help connect you with local home care services to help your parent age in place gracefully. Being proactive about meeting a senior’s current and emerging needs will extend their independence, boost their confidence, and give family caregivers invaluable peace of mind.
Reviewed by caregiving expert Carol Bradley Bursack.
Sources:
Where We Live, Where We Age: Trends in Home and Community Preferences (https://www.aarp.org/research/topics/community/info-2021/2021-home-community-preferences.html)
Eldercare Locator: Area Agencies on Aging (https://eldercare.acl.gov/Public/About/Aging_Network/AAA.aspx)
4 Caregiving Essentials
It all begins with an idea.
Renata Gelman, Partners in Care
Working in the home care profession enables you to see certain elements of an elder's life that may fly under the radars of their doctor, their friends and even their closest family members.
The people caring for your loved one, home health aides, registered nurses, social workers, etc., witness some of the individual's most vulnerable moments as they handle real-time critical issues related to a senior's health and well-being. Here are some important lessons from home care nurses that can help you in care giving and beyond.
Routines matter
A daily routine will put your loved one in a better mood and keep their spirits high. For folks combating multiple chronic diseases—such as hypertension, Parkinson's disease or dementia—a morning ritual can help kick-start their motor skills, triggering their mind that it's a new day and it's time to get going. If you are having trouble getting into the groove of a routine, start with small steps. One home health aide started getting her patient up just ten minutes earlier each day to provide more time at breakfast. This type of thoughtful caregiving enabled the elder to avoid rushing through the meal, causing unnecessary stress and anxiety. Learn more about the benefits of setting and sticking to a daily routine for dementia patients.
Browse Our Free Senior Care Guides
Subtle clues can be a lifesaver
When your loved one asks for a foot rub again and again, don't assume he or she just wants pleasure. There might be an underlying medical issue that is causing significant discomfort in their feet. Sometimes when patients ask to be massaged or rubbed, it is because they are experiencing pain, but do not want to feel as if they are complaining or being an inconvenience to their family members. Additionally, some people may not be cognitively equipped to express what they are truly feeling. So, be on the lookout for subtle messages!
Listen and take action
Home Health Aide Bonita Scott is no stranger to moderating family situations. She routinely sees family members not clearly communicating over difficult subjects, such as changes in their loved one's health condition or care. She shares an experience about a patient whose children would insist that their mother participate in their routine family nights that were held in the basement. The mother had difficulty making it up and down the stairs, and the children just thought she didn't want to participate. After witnessing the miscommunication and stress it was causing, Scott intervened and encouraged the family to put in a chair lift to make it easier for their mother to join them in their festivities. Discover how caregivers can listen with intention.
Stay connected, virtually or in person
Aging at home can be one of the best options in terms of comfort, convenience and privacy. It can also be lonely for those who live alone or do not have loved ones who visit frequently. All too often, nurses see lonesome older adults who wish they had more people around. Part of care giving is showing people how to stay connected, or get connected, via social channels, like Facebook, Twitter and online games. Additionally, caregivers help people find social groups in their community, whether it is a weekly bingo night, book club or game at a local senior center. Discover how online interactions can be a simple way to prevent senior depression.
R
EXPERTRenata GelmanPartners in Care
About Renata Gelman
Renata Gelman, RN, B.S.N., is assistant director of clinical services at Partners in Care, an affiliate of the Visiting Nurse Service of New York (VNSNY). In this role, she coordinates patient care and manages a multi-disciplinary team of field nursing and home health care professionals in the clinical area of a VNSNY’s private care division.