Home modifications are alterations made to a home to facilitate long term care at home. Many homes are not conducive to someone with mobility issues, whether they stem from an injury, illness, or the natural aging process. By performing home modifications such as adding a wheelchair ramp, widening doorways, or remodeling a bathroom, the home can be made safe and comfortable for many people’s entire lifetime. Sometimes a few minor and inexpensive changes can make the difference between being able to live in the home and having to move. When choosing a contractor, be sure to select someone who understands the special requirements of someone who is aging in place. Be aware that long term care insurance, veteran’s benefits, and tax credits may help to defray some of the costs of home modifications.
Are home modifications expensive?
This question is hard to answer because there is such a wide range of modifications that people can do to make their home safer and more accessible. Some modifications, such as removing trailing extension cords and moving loose throw rugs to prevent tripping hazards don’t cost anything. Other modifications such as adding an accessible master suite on the ground floor can cost tens of thousands of dollars. I suggest assessing your current and future needs and planning your course of action accordingly.
I can’t climb the stairs leading to my home anymore. Should I move?
There are a number of ways to get around your inability to use stairs whether it is getting into the house or between floors. A ramp is probably the most common solution, but there are other solutions that work in many circumstances. Consider whether the easiest access is in the front, the back, or maybe the garage. A lot depends on the topography of your lot. A contractor familiar with home modifications may be able to suggest a solution you haven’t thought of.
It is hard for me to get in and out of the bathtub and I am afraid of falling. What should I do?
I would strongly recommend that you have some grab bars installed. Having a strong handhold is especially important in the bathroom where surfaces are slippery and falls are common. In addition, you might want to consider a tub cut that converts your existing bathtub into a step in shower or removing the tub and installing a curbless shower. Also, if the floor of the bathroom or the shower is slippery, consider applying a non slip coating or stick on treads for a better grip.
My brother (or sister) and I can’t agree on whether mom (or dad) should continue living at home or whether she (or he) should be put into some kind of senior housing. How do we decide?
The decision to relocate your aging parent or other loved one can be excruciating. I suggest you get as much input as possible from the health care professionals involved with their care. The input of family members and the patient themselves is vital as well. The decision to receive long term care at home can be very rewarding as many people feel much more comfortable in their familiar surroundings. It is important to note, however, that many of the services that are included in a CCRC or other senior living facility have to be individually arranged for when receiving long term care at home. These include such services as nursing care, therapy, non medical home care, transportation, meals, and housekeeping to name a few. Many of these services are offered by members of the National Aging in Place Council. By having necessary services provided at home rather than in a facility, many people are more comfortable and relaxed and the cost is usually less as well.
How do I know if home modifications are necessary?
Many times, particularly if an aging parent lives alone, the other family members may not be aware of the struggles their loved one is having. Make a point when visiting to observe how they get around the house. Input from their doctor and other health care professionals may give you insight on their abilities and areas of difficulty. If you have concerns, it is probably time to consider an assessment. Find a contractor who specializes in home modification and who will coordinate with their health care team.
What are the most important home modifications to have done?
I break home modifications down into three categories, safety, accessibility, and convenience. While there is certainly some overlap and most projects will have elements of each, we need to consider the priority of projects in this order. Anything that presents a fall or other safety hazard should be taken care of immediately. Those modifications which enhance accessibility should be done as soon as possible, and those which are primarily for convenience can be delayed if budgetary concerns warrant.
Are there any funding sources to help me pay for needed home modifications?
There are a number of sources of funding for people who need home modifications but lack the financial resources to pay for them. Virginia has the Livable Homes Tax Credit that provides a credit against state income tax up to $5,000 for qualifying home modifications. Some home modifications may qualify as a medical expense, particularly if you have a prescription from your doctor, and thus qualify as a deductible expense on tour federal income taxes. Consult your tax advisor for more information. Medicare currently does not pay for home modifications, but Medicaid waivers will pay for some home modifications if the recipient is on Medicaid and is transferring out of a facility and back into their home. The Veterans Administration has several programs to pay for home modifications for veterans, especially for those veterans who need modifications because of a service related disability. The VHDA has programs to pay for home modifications for renters and service connected veterans. Some long term care insurance policies pay for certain home modifications. If the home modifications are needed as the result of injury, workers compensation or liability insurance may pay for the modifications. I expect to see more funding sources open up as demographic changes and cost saving measures create a demand for more long term care at home.
My elderly parent or other loved one lives alone. I am concerned about his or her safety but I don’t know what to do?
One of the best ways to ensure the safety and independence of a loved one living alone is with a remote activity monitoring system. These systems will monitor the activity in the home and send out a customized alert to a family member or a caregiver if certain criteria are met. For example, if medication is not taken in a timely manner, a stove is left on, an exterior door is opened during certain hours, or any number of other situations arise. By having help readily available, independent living and peace of mind can be maintained for many people who otherwise couldn’t live alone. It is also a good idea to have family and friends check in on them regularly.
We are struggling with declining vision. Are there any products to help with this?
Almost all of us experience declining vision to one degree or another as we age. Simply adding brighter light bulbs, as well as additional task lighting in all areas where we spend time reading, preparing foods, and other tasks will help tremendously. Also using contrasting colors on the edges of surfaces such as stairs and countertops will make it easier to differentiate the top from the side and help prevent accidents. Be especially aware of lighting in the kitchen and bathroom since many accidents occur in these areas.
My loved is very unsteady and I am worried about falls. What can I do to help prevent falls?
You are correct to be concerned about falls. About one third of adults over the age of 65 fall each year, and of those who fall, two thirds will fall again within six months. The first thing you should do is make sure that there are no trailing extension cords, loose throw rugs, or clutter that could present a tripping hazard. Then make sure you have railings or grab bars installed wherever practical as something to hold onto. Having hand holds in place before they are needed will get you in the habit of reaching for them, so that when you need them the habit is already ingrained. Please don’t wait until after a fall to take action! Consider replacing slippery flooring with a non slip alternative. Remember that an ounce of prevention is worth a pound of cure.
After you take all available actions to reduce falls, is there anything that can be done to prevent injury if you do fall?
No matter how careful you are you cannot avoid every fall. By the use of fall protection flooring, up to 90% of the impact of the fall can be absorbed by the flooring. By the use of fall protection flooring, many injuries can be prevented. Fall protection flooring can be installed throughout the house or only in high risk areas.
I have trouble grasping doorknobs, faucets, and other controls. Are there any solutions to help with this?
As much as possible use lever handles instead of knobs for all controls. A lever doorknob can be opened without the ability to grasp or turn a handle. It can even be opened with an elbow if your hands are full. After market products are available to attach to an existing doorknob to convert it to a lever. Handles on kitchen and bathroom faucets should also be levers whenever possible. In many cases you can change the handles without changing the entire faucet.
How do I find a reputable contractor to perform home modifications?
As with finding any service provider, ask friends and neighbors for recommendations of contractors they have gotten good service from. To find contractors who specialize in home modifications you can find a directory of Certified Aging in Place Specialists at the National Association of Home Builders website at www.nahb.org. You also might want to check their Better Business Bureau rating at www.bbb.org and check out information websites like www.caring.com. Be sure to get clear, detailed proposals in writing, ask for references, and make sure the contractor is properly licensed and insured.
What is a zero step entry and why is it important?
A zero step entry is an entry into your home that does not have a step, curb, or threshold and can therefore be easily crossed in a wheelchair, walker, stroller, etc. At least one entry into your home should be a zero step entry. This can be an exterior door or a door between the house and garage. It is a good idea to have this entry protected from the weather and well lit, preferably with a light controlled by a motion sensor. A package shelf is also convenient for putting down whatever you are carrying to get the keys out and open the door.
I have seen various checklists of suggested home modifications. Which of these are the best to use?
There are indeed many checklists available to begin to evaluate the need for home modifications. Some are quite basic and others are extremely extensive. While I recognize the value of a checklist in the decision making process, the shortcoming inherent in any checklist is that it applies the same criteria to every situation. I prefer an individualized approach that takes into account the health and vitality of the person we are performing home modifications for as well as input from family, caregivers, and members of the medical team. By using this approach we are able to craft a solution with the greatest probability of a successful outcome.
Is there anything that can be done to keep someone safe at home who is experiencing forgetfulness or dementia?
Once again, it is extremely important to get input from family members and the health care team. Often no one is aware of how far along dementia has progressed. That being said, remote activity monitoring can alert a family member or caregiver in the event of potential harmful activities such as leaving a stove on, not taking medications, or wandering. Often, these systems can help someone to live independently for much longer than would otherwise be possible.