Home Modification and Universal Design for Elder-Friendly Living

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No matter when the older person's home was built and regardless of whether it is modern or traditional in style, it likely was designed for young adults and their young families. As adults age their homes also grow older, but most are not updated to accommodate the resident's changing needs. Home adaptation or modification can provide friendlier elder living so older occupants may continue to live in the comfort of home.

The focus in making a home elder-friendly should always be on increasing and improving the following five elements:

  • Self-sufficiency/self-reliance
  • Mobility
  • Safety
  • Security
  • Comfort/convenience

It is probably not possible to make any home accident-proof and so that should not be the main goal of home modification. Where possible, emphasis should be placed on preserving and strengthening the capabilities of the older person rather than on coping with limitations or disabilities. This is particularly important if a family member introduces the concept of home modification. The elderly relative must recognize and accept the need for change and should be involved as much as possible in the process. It would be contrary to the goal of enhancing independence to force unwelcome changes on a reluctant older person. The exception, of course, would be someone suffering from dementia who is unable to meaningfully participate in such decision making.

One way to begin explaining the need for and process of home modification to an older person is to illustrate the use and practicality of some small items. Purchasing several independence-enhancing products as holiday gifts and demonstrating their use might help overcome future resistance.

Decide How and When to Undertake Home Modification

The best time to start thinking about home modification is long before the need actually arises. Ideally, people in their fifties and sixties should prepare their homes for later installations while they are doing routine home improvements and repairs. Extra wide doorways that can accommodate a wheelchair can be an attractive feature in any home. Strong supports can be installed behind tile walls when updating bathrooms to later accommodate grab bars.

It is always best to undertake home modification before a crisis occurs so that the work can be carefully planned and budgeted. Before any changes in the home environment are considered, a thorough room-by-room assessment of the surroundings should be made. This should include consideration of the resident's current and future needs, the way in which he/she uses the home and its contents and any barriers that might limit movement or access. A good general safety checklist that can be used for this purpose is available without cost from the U.S. Consumer Product Safety Commission (CPSC) in Washington D.C.

Many design publications written by or for professional home designers, architects and construction contractors are available by mail, in bookstores or on the Internet. These provide extensive information including instructions for building ramps and installing grab bars. These publications range in cost from under $10 to more than $80.

Conduct a Home Assessment

A functional plan for modification can be easily developed if time is taken to observe how the older person uses his/her surroundings. Consider, for example, the individualized ways in which spaces and objects in the home are used. Is the older person's bedroom, in addition to sleeping quarters, a place in which guests are welcomed, meals are taken and leisure activities performed such as watching TV, sewing and reading? Are naps and meals taken on the living room sofa? An assessment will highlight needed changes for increased functionality and comfort and a well-planned renovation will make living safer and more pleasant while increasing independence and self-sufficiency.

One way in which to conduct a home assessment is to spend a typical day with the older person observing how daily activities are managed. An occupational therapist can also make a home visit to assess the safety and accessibility of the environment and suggest modifications. If a walker or wheelchair is used, pay close attention to difficulties that may arise when performing personal hygiene routines, preparing meals, washing dishes, feeding a pet or taking out the trash. Do room thresholds or small rugs hamper use of the walker? Would the addition to the walker of a tray or carry-all bag make it easier to transport food to the table or knitting supplies to a favorite chair?

When conducting a home assessment, don't neglect the outside. Brighter outdoor lighting, widening of pathways and clearance of shrubs and clutter may be needed for improved safety, accessibility and security. The addition of an entry ramp may avoid the need to climb steps and provide wheelchair access should that be (or become) necessary.

After completing a home assessment, compile a list of changes that are essential to the well being and self-sufficiency of the older person. This list will be useful when getting work estimates, if you hire workers to make the modifications for you. You will be able to use it to compare their cost estimates.

Determine the Needed Modifications or Adaptations

Home design for aging adults is a new concept currently focused most often on broad home adaptations such as single level living and installation of ramps and handrails. Some designers and contractors who specialize in home modification for the disabled or the elderly can remodel a home or build a retirement home with every conceivable convenience from adjustable height kitchen counters and bathroom sinks to bathtubs with doors for wheelchair entry. While these features do contribute to the elements of elder living stated above, they don't go far enough in assuring independence. Attention also must be paid to the smaller features - the details that increase comfort and functionality and allow for greater self-reliance.

Many beautiful and aesthetically pleasing designs are not functional for persons with limited mobility, failing eyesight or impaired hearing. Therefore, if you are planning an extensive home modification, it's advisable to work with a licensed architect or design professional with substantial experience in accommodating the needs of older people, someone who can draw detailed plans for your renovation. The architect's or designer's fee will add to the cost, but may save you from making even more expensive mistakes. If you do not know a licensed architect, call the American Institute of Architects (AIA) for a referral to a member of this national organization in your area.

Whether working with an architect or a construction contractor, be sure to obtain and check references. Ask for the names of several clients in your area and question them about whether the person you plan to hire starts and finishes jobs in a timely manner, sticks as closely as possible to the budget, keeps the client informed about potential cost overruns, keeps the site of construction as clean and clear of debris as possible, responds to calls promptly and is generally pleasant.

When doing a renovation that does not require extensive remodeling, an interior design professional may be the appropriate person to hire. You can ask friends and relatives for referrals or call the American Society of Interior Design (ASID) for the names of professionals in your area. Be sure to check references, ask about experience with home modification for older adults and determine whether your personalities are compatible. Always get a written agreement stating the terms of the work arrangement and the fees involved.

Make Low-Cost or "Do-It-Yourself" Modifications

Some of the basic modifications to make a home elder-friendly involve adjustments to compensate for sensory loss that can be made without a major investment in remodeling. For those with low vision, walls should be painted a light but glare-free color while ceilings should be white to better reflect the room's lighting. Floors should be dull rather than waxed both for safety and to eliminate glare. Since older people need more light to perform the same tasks that they did in their younger years, more lighting fixtures should be used, especially direct task lighting and higher wattage bulbs. Light bulbs should not be visible so that glare is reduced. Stairways should be well lighted with switches at both the top and bottom.

The use of contrasting colors (red and yellow are best) helps to indicate a change in height from one room to another as at a rear doorway, garage entry or sunken living room. Inexpensive measures can be taken such as using colored tape to indicate the top and bottom steps on a stairway. Grab bars in baths shouldn't blend with the tile walls; rather they should contrast with them to make them more easily visible. Furniture might need to be rearranged for ease of passage and to create appropriate walkways, but there should not be so extensive a redecoration as to make the room feel unfamiliar to the older person. All stairways should have handrails on both sides that extend beyond the last step. This enables a person with weakness on one side to always have a railing available on the stronger side. Handrails should be strong enough to support the full body weight of a falling person.

  • Have you interviewed and obtained written estimates and/or comparable bids when considering the hiring of an architect, designer or contractor? Are costs clearly spelled out in writing and a detailed plan provided?
  • Is the professional with whom you chose to work licensed by the appropriate state agency and experienced in modifications for the elderly?
  • Have you checked references, the Better Business Bureau, local Consumer Advocate's office and professional associations?
  • Is the professional adequately insured for property damage and personal liability?
  • Does your written contract contain start and completion dates, a payment schedule, penalties for lateness, responsibility for obtaining permits and complying with applicable building and housing codes, a contingency for failure to obtain required inspections?

Connolly is President and CEO of Castle Connolly Medical Ltd., America's trusted source for finding top doctors. He has an extensive background in management and healthcare. He was President of New York Medical College and a Fellow of the New York Academy of Medicine.

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3 Comments

Some great suggestions mentioned here. For more on elder home safety tips, a free Home Safety Checklist is available for download here:
If the elder cannot do these modifications without obtaining some type of loan, it might be time to consider downsizing to a more affordable home, such as independent living designed just for seniors.