By Ann Cameron Siegal
Special to The Washington Post
Saturday, February 21, 2009
Steven Mintz, a Department of Energy economist, had multiple sclerosis diagnosed more than 30 years ago, so he and his wife, Suzanne, have had plenty of time to think about adapting their Kensington home in preparation for the disease's progression.
John Salmen is not facing mobility issues yet, but he and his wife, Ann Scher, have converted their Takoma Park bungalow to "a house for the next 50 years."
What the couples have in common is a desire to stay in their own homes as long as possible, instead of moving to housing designed for seniors. It's an option called aging in place. Increasingly, it appears that the turmoil in the housing market may also tie others to homes they are unable to sell.
"One of the unwritten tragedies of the current housing price collapse is that for a host of reasons [e.g., money, job security, depreciated properties], a higher share of older Americans will be 'forced' to age in place, who might otherwise have considered alternative housing arrangements," said Stephen Golant, a gerontologist and geographer who teaches at the University of Florida.
As we age, the day-to-day challenges of getting around will most likely increase, whether for simple things such as turning a doorknob or more complex tasks such as taking a shower or navigating a stairway. Often, people wait until a stroke, heart attack, hip replacement or other crisis before thinking about housing adjustments. Such hasty decisions can end up being unattractive and costly.
Awareness of these issues is rising, said Peter Bell, executive director of the National Aging in Place Council. "Boomers may be more cognizant of the need to plan ahead because they have had to deal with their parents in a reaction mode."Terminology
The aging baby boomer population has a multitude of strategies that fall under the age-in-place umbrella.
Universal design is the most common term. It covers items that aim to serve all members of a household without the need for further adaptations. "Universal design simply enlarges the population of people who can use something," said Louis Tenenbaum, a Potomac-based consultant for independent-living strategies. As an example, he noted that curb cuts were designed for wheelchair access, but are popular with people pushing strollers or wheeling luggage.
Around the house, "A walk-in shower works if you're dependent on a wheelchair or walker, but also makes it easier to wash the dog," said Nancy Thompson, with the Livable Communities department of AARP, the seniors association.
By the same token, while bi-level or adjustable countertops and sinks can make tasks easier for those who cannot stand up, they also make routine tasks easier for others by accommodating height differences.
Other common terms:
· Accessible, which refers to features that comply with the Americans With Disabilities Act.
· Adaptable, for features that accommodate changing needs with some tweaking. For example, closets built above each other would be adaptable to an elevator shaft later.
· Visitable, which means that while the homeowners may not need specific accommodations, they have a floor of their house that is navigable for visitors who have limitations.So, Where to Start?
Begin with a family discussion. "Make a very clear list of your accessibility needs and make your wish list," said Suzanne Mintz, president of the National Family Caregivers Association.
Set priorities. Vince Butler, president of Butler Brothers Construction in Fairfax County, said life safety should be paramount. That includes sufficient safe exits from each level of the house. Sometimes, in cases of limited mobility, the adaptation could be as simple as switching bedrooms so that the person needing the most assistance has easiest access to the outside and thus to rescue, such as through French doors opening onto a balcony.
The next priority, Butler said, should be fall prevention. What are potential dangers in and around your house? Key areas to think about include entryways, bathrooms, kitchens and stairs. Brainstorm solutions. What are the advantages and disadvantages to each?
Next come the convenience features. What is going to add the most to your quality of life? Adapting one level of your house for one-floor living is usually the primary goal.
Preparing your house for potential mobility limitations is akin to preparing for a new baby, Bell said. "Not in a demeaning way, but in a change of life way." You need to look at what is within reach and what needs to be close to hand.
Is your house even a good candidate for age-in-place modifications? Budget considerations, particularly in older houses, may make major changes impractical. Moving may be more economical.
Following are some of the plan-ahead measures that homeowners can take to ease movement into and through the house.Getting In and Out
Think about independence, dignity and control. "Plan for getting out of the house on the day you feel the very worst, and not overburdening your family or caregiver," Tenenbaum said.
Ramps from the front door are usually the first thing people think about as aging takes hold. With careful design, they don't have to look atrocious. However, some people have concerns about privacy and security, because they see ramps as advertising that someone with limited mobility lives within.
Butler said gentle slopes may be good for wheelchairs, but shallow, wide steps are better for those who use walkers. Consider your needs and think "adaptability."
Access does not always have to be via the front door, said Salmen, president of Universal Designers and Consultants. Look for other places for a no-step entrance, maybe at the side or rear of the house, or through the garage.
Tenenbaum has installed lifts next to front porches or wide stoops. Effective landscaping can conceal them from street view.
Salmen's 1920s bungalow is historically protected, so he couldn't change the appearance from the street. Instead, he had the driveway sloped to allow wheelchair access on the ground level. "With a 5 percent slope, you don't need handrails," he said.Simple Fixes
Statistics show that most accidents happen in the home. For seniors, there's often a predictable downward spiral after a major fall -- a broken hip leads to increased dependence, which leads to depression and so on.
One of the most dangerous areas in the home is at the bottom of stairs where lighting is often poor. So add light where needed.
Do away with throw rugs and tack down doormats that may become tripping hazards.
Install handrails on both sides of stairways. Just having that extra assistance going up and down stairs helps conserve a lot of energy, said Greg Sieb, director of Granting-You-Access.org.
Install railings in hallways, too. Sieb said he looks for where adults have left fingerprints on the wall or door frames because that suggests the places where people seek balance help.
How is the traffic flow? The ideal is a three-foot-wide route from the entryway to each room on the main level, without sharp turns or changes in levels. Often simply rearranging furniture opens up paths.
Doorways can be widened a few inches without structural changes by installing "swing clear" hinges that enlarge the opening by the thickness of the door. For Mintz, "this was such a minor change but a very big change in my life," when he started to rely on a wheelchair. It extended the usefulness of the bathroom.
Removing doorstops might gain you another three-quarters of an inch or so.
Change doorknobs -- both interior and exterior -- to lever handles. "If you doubt what a big difference that small change can make, put a full bag of groceries in each of your arms, then try opening the door" using a conventional door knob, said Ann Scher, who works with people who have sports injuries. Or, try it with wet hands. Now, try both exercises with a levered handle.
Replacing raised thresholds with slightly beveled ones can make navigating in a wheelchair or walker easier.
In the bathroom, grab bars placed strategically around the room and in the shower are a must. They need to be fastened securely to walls designed to take the force placed upon them. New styles fit most decors and don't look so industrial.
Having a chair by the washer and dryer, or a rolling seat in the bathroom can help, too. "Sometimes a piece of equipment is the solution," Salmen said.Other Remedies
Consider putting vision panels in solid interior doors. Those are the see-through panels that prevent you from opening the door and knocking someone over.
Increase accessibility by placing controls such as thermostats, light switches or intercoms at about 48 inches from the floor, a bit lower than usual; put electric outlets at about 27 inches, higher than usual, to minimize bending and stooping. Use rocker switch plates rather than conventional ones. "If you can operate a piece of equipment with a closed fist, then anyone can use it," Salmen said.
Consider bringing controls for disposals, stoves and other appliances forward so the reaching distance is less than 20 inches. (These suggestions, like others, must be balanced with concerns for safety if there are young children around. That can be tricky, but there are devices, especially for front-of-stove controls, that deter little hands while letting adults have use.)
Angle the corners on cabinets or counters to make navigating around them easier.Extensive Work
More extensive renovations can increase usability in older houses, but they involve some expense. For example, installing pocket doors will free up the space needed for conventional doors to swing open and shut.
The Mintz and Salmen families have both incorporated elevators into their home renovations.
Mintz converted a first-floor bedroom to an open office with an elevator, then added a second floor to his rambler. Equipment can run in the neighborhood of $25,000, not including labor.
Where elevators aren't practical, stair lifts -- seats that ride up and down on a rail -- can help. They run $3,000 to $5,000 and can even be purchased with coordinating fabric to match the decor.
Stair lifts aren't for everyone, Tenenbaum cautioned. "They're a good value for bad knees or hearts, but a mediocre value for bad hips or more severe mobility issues."Finding a Contractor
A home assessment by a knowledgeable professional can help you save money and make changes in an orderly way. Just be sure the assessment is geared to meet your needs rather than to sell you something.
Check for Certified Aging in Place Specialist (CAPS) designation. This is a National Association of Home Builders program geared to training contractors and others to serve aging-in-place remodeling clients.
Seek referrals from occupational therapists, and groups such as the National Aging in Place Council, which has a list of helpful books on its Web site, http://www.naipc.org.