How to Age in Place? Plan Ahead

Reprinted from the NYTimes by Paula Span. From 2017 – but POST COVID,with many more therapists now offering aging in place, it is very timely so I wanted to share.

“All the carpets are coming up, so they won’t be a trip hazard,” said Ernie MacNeill, walking through the split-level house in Fair Lawn, N.J., that he is remodeling for a client who struggles to walk. Mr. MacNeill also plans to widen a bathroom door to provide better access for a wheelchair or walker. “We’ll knock this closet back,” he added. The home’s owner, Elliot Goldberg, 71, currently has to transfer from one stair lift to another to reach his third-level bedroom and bath. Moving the second-floor closet will make space for a new lift that can turn the corner and proceed upstairs, a far safer configuration.

Mr. Goldberg, a Vietnam veteran with multiple health problems, has lived on this quiet suburban street for 30 years. His wife died four years ago, but he shares the house with their daughter and grandson. He could move to a single-floor apartment or an assisted living facility, but like most older people, he wants to stay put. “I have a lot of good memories here,” he said.

So he turned to Mr. MacNeill, a longtime contractor in nearby Pine Brook. In 2014, Mr. MacNeill took a three-day course through the National Association of Home Builders to become a Certified Aging in Place Specialist, or CAPS.

Older people have the highest rate of homeownership in the country — about 80 percent, according to a 2016 report by the Joint Center for Housing Studies at Harvard. The great majority live in single-family homes, most of them poorly suited for the disabilities common in later life.

The center has looked at three of the most important accessibility features that allow people to move safely around their living spaces: entrances without steps, single-floor living, and wide hallways and doorways that can accommodate wheelchairs.

“Less than 4 percent of the U.S. housing stock has all three of those,” said Jennifer Molinsky, a senior research associate at the center.

Add two more important elements for aging in place — doors with lever handles, and light switches and electrical outlets that can be reached from a wheelchair — and the proportion drops to 1 percent.

You’ll often hear older people vow that they won’t leave their homes except “feet first.” Without modifications, however, the design of most older Americans’ homes could eventually thwart their owners’ desire to stay in them.

Solving that problem, individually or collectively, means confronting certain obstacles.

About 3,500 CAPS graduates across the country — builders and remodelers, occupational therapists, interior designers — retrofit homes to help people remain in them safely, said Dan Bawden, a Houston contractor who helped develop the program in 2001. I asked how many it would take to serve all the older and disabled Americans who want to age in place. “Ten times the number we have now,” he said. Moreover, participants in the program remain unevenly distributed, clustered in cities. Many of the nation’s more than 200,000 occupational therapists also assess homes and recommend safety modifications, said Scott Trudeau, who manages productive aging programs for the American Occupational Therapy Association. The process works best, he said, when CAPS-trained remodelers and occupational therapists team up, as a growing number have. Mr. Bawden’s Legal Eagle Contractors (he’s also a lawyer) works with a therapist, Kate Akers, for example.

“She’s better at spotting problems than I am,” he said. “Then I come in and make the changes based on what she suggests.”

odifications were bathroom grab bars and higher toilets, followed by curbless showers, widened doorways and added lighting.

Architects have long argued for such features, known collectively as “universal design” — elements that promote independence for disabled and older people and prove useful for everyone else, too.

“If your aging mother is going to come live with you, you can pour a gently sloping sidewalk to your front door” that allows her to enter without climbing steps, Mr. Bawden pointed out. “But a zero-step entrance is also good for a mom with twins in a stroller.”

Other groups are also tackling home accessibility, including nurses, academic researchers, and another certification program called the Certified Living in Place Professional program. Local agencies on aging or senior centers may provide referrals, too.

Yet even as more professionals enter the field, costs present a major barrier.

Though prices vary by location, most CAPS remodelers can install two grab bars for a modest $200 to $300. Figure $60 to $90 to replace a doorknob with an easier-to-maneuver lever, Mr. Bawden said, and $175 to $250 for every relocated light switch or outlet. But replacing a tub with a roll-in shower will run $8,000 to $10,000, he said. A new bathroom incorporating universal design elements could top $25,000. Homeowners will find scant government help with that expense. Some states reimburse homeowners through tax credits or Medicaid, and the Department of Veterans Affairs offers some grants. (It is paying the bill for Mr. Goldberg’s $7,900 renovation, for instance, and buying the new stair lift.)

But home modification remains essentially a privately financed undertaking, even though it could help prevent far more expensive hospitalizations and nursing home admissions. A bill to offer seniors $30,000 in federal tax credits for modifications was introduced in Congress last year with bipartisan support, but it has made little headway.

“How do we structure these programs so they’re available not just to the few, but to the many?” Mr. Trudeau asked. “C.M.S.” — the federal Medicare and Medicaid agency — “needs to start thinking about this.”

Another obstacle is homeowners’ own discomfort with aging and the changes it brings. Some start adapting their homes before they need to, but others resist.

“That’s the biggest hurdle to overcome, is someone admitting they need these modifications,” Mr. MacNeill said. “The adult children see the writing on the wall, but the parent is saying: ‘I don’t need that. I’ll be all right.’” Yet older adults are fervent remodelers: Those over age 55 account for more than half of all home improvement spending, the Harvard study reported.One way to incorporate universal design in more seniors’ homes, then, is to make it part of every renovation. Widening an existing doorway can cost $2,000, but a 34-inch doorway adds little to the cost of a new kitchen or bath project that already involves moving walls.

Lynn Masiello, an interior designer and CAPS participant in Verona, N.J., took that approach with a recent condo renovation.

Her 66-year-old client wasn’t particularly interested in making her home more accessible. But Ms. Masiello tactfully pointed out the attractiveness of contemporary grab bars (she used polished nickel) and made sure the new refrigerator had a freezer on the bottom. She suggested textured kitchen floors that wouldn’t be slippery. And because aging eyes can lose depth perception, the color of the kitchen counters contrasts with the floor.

Her client was delighted. “I imagine I could live here forever,” she said.