Physical Modifications

Physical Modifications to the Home

In the year 2000, seniors ages 65 and older experienced 1.8 million falls, resulting in emergency room visits costing $ 16.4 billion in medical and long-term care costs. Almost 55 percent of these falls occurred inside the house, while an additional 23 percent occurred outside but near the house (Kochera, 2002a). Falls are caused by dizziness, fainting, seizure, impairment of motion, lack of strength, lack of strength of arm or leg, gait impairment, arthritis, vitamin deficiencies, bad vision, poor balance, and the failure to use appropriate assistive devices such as walkers and canes. The side effects of medications are often culprits. Some, but not all, experts believe that falling could be reduced by environmental modifications - for example, reducing cluttered pathways, removing badly placed electrical cords, eliminating loose throw rugs, modifying slippery surfaces (such as in showers), reducing the height of out-of-reach cabinets and closets, and through the installation of grab bars, ramps, and handrails.

The 1995 American Housing survey from the United States Department of Housing and Urban Development (HUD) showed that over half of seniors with impairments (and thus greater risk of falling) had made no home modifications, and that another fourth had introduced but one. Just less than one in four reported they had made at least two modifications, including extra handrails or grab bars, widening of doors and hallways, adding ramps, and adding other accessibility features in the bathroom and kitchen, such as modifying the sink faucets and cabinets (Census Bureau, 2001).

Seniors are often hesitant to make home modifications because they are afraid of dealing with contractors or repair personnel who overcharge or do inadequate work. Lower income seniors would be especially likely to participate if there were more affordable government programs, less-confusing eligibility requirements, a simpler application process, home modification assessments coordinated with other social services such as home care, or if professionals working with seniors had more knowledge about the potential benefits of home modifications. Currently, city and county governments fund home modifications through subsidies received from the Community Development Block Grant programs and from Title III Older Americans Act programs. Private foundations and voluntary groups such as United Way and Rotary Clubs also financially support home modification programs (Pynoos, Liebig, Overton, & Calvert, 1997).

The information above is reprinted from Working with Seniors: Health, Financial and Social Issues with permission from Society of Certified Senior Advisors® . Copyright © 2009. All rights reserved. www.csa.us

 Aging-In Place Checklist

As the population ages, there is increased interest in building homes to allow owners to “age in place.”

The checklists below contain features you may want to consider for your new home or remodeling project. They also give you a quick reference for various aging-in-place issues. While these lists are not all-inclusive, they will get you thinking on the right track.

Exterior

  • Low-maintenance exterior (vinyl, brick)
  • Low-maintenance shrubs and plants
  • Deck, patio or balcony surfaces are no more than ½-inch below interior floor level if made of wood

Overall Floor Plan

  • Main living on a single story, including full bath
  • No steps between rooms/areas on the same level
  • 5-foot by 5-foot clear/turn space in living area, kitchen, a bedroom and a bathroom

Hallways

  • Minimum of 36 inches wide, wider preferred
  • Well lit

Entry

  • Accessible path of travel to the home
  • At least one no-step entry with a cover
  • Sensor light at exterior no-step entry focusing on the front-door lock
  • There needs to be 32 inches of clear width, which requires a 36-inch door
  • Non-slip flooring in foyer
  • Entry door sidelight or high/low peep hole viewer; sidelight should provide both privacy and safety
  • Doorbell in accessible location
  • Surface to place packages on when opening door

Thresholds

  • Flush preferable
  • Exterior maximum of ½-inch beveled
  • Levered door hardware
  • 

Interior Doors

  • There needs to be 32 inches of clear width, which requires a 36-inch door
  • Levered door hardware
  • 

Windows

  • Plenty of windows for natural light
  • Lowered windows or taller windows with lower sill height
  • Low maintenance exterior and interior finishes
  • Easy to operate hardware
  • 

Garage or Carport

  • Covered carports and boarding spaces
  • Wider than average carports to accommodate lifts on vans
  • Door heights may need to be nine feet to accommodate some raised roof vans
  • Five-foot minimum access aisle between accessible van and car in garage
  • Ramp to doorway if needed
  • Handrail if steps
  • 

Faucets

  • Lever handles or pedal-controlled
  • Thermostatic or anti-scald controls
  • Pressure balance faucets
  • 

Kitchen and Laundry Counters

  • Wall support and provision for adjustable and/or varied height counters and removable base cabinets
  • Upper wall cabinetry three inches lower than conventional height
  • Accented stripes on edge of countertops to provide visual orientation to the workspace
  • Counter space for dish landing adjacent to or opposite all appliances
  • Base cabinet with roll out trays and lazy susans
  • Pull-down shelving
  • Glass-front cabinet doors
  • Open shelving for easy access to frequently used items
  • 

Appliances

  • Easy to read controls
  • Washing machine and dryer raised to 12 to 15 inches above floor
  • Front loading laundry machines
  • Microwave oven at counter height or in wall
  • Side-by-side refrigerator/freezer
  • Side-swing or wall oven
  • Raised dishwasher with pushbutton controls
  • Electric cook top with level burners for safety in transferring between the burners, front controls and downdraft feature to pull heat away from user; light to indicate when surface is hot
  • 

Miscellaneous

  • Multi-level work areas to accommodate cooks of different heights
  • Open under-counter seated work areas
  • Placement of task lighting in appropriate work areas
  • Loop handles for easy grip and pull
  • Pull-out spray faucet; levered handles
  • In multi-story homes, laundry chute or laundry facilities in master bedroom
  • 

Bathroom

  • Wall support and provision for adjustable and/or varied height counters and removable base cabinets
  • Contrasting color edge border at countertops
  • At least one wheelchair maneuverable bath on main level with 60-inch turning radius or acceptable T-turn space and 36-inch-by-36-inch or 30-inch-by-48-inch clear space
  • Bracing in walls around tub, shower, shower seat, and toilet for installation of grab bars to support 250-300 pounds
  • If stand-up shower is used in main bath, it is curbless and minimum of 36 inches wide
  • Bathtub – lower for easier access
  • Fold down seat in the shower
  • Adjustable/handheld showerheads, 6-foot hose
  • Tub/shower controls offset from center
  • Shower stall with built-in antibacterial protection
  • Light in shower stall
  • Toilet 2 ½ inches higher than standard toilet (17 to 19 inches) or height-adjustable
  • Design of the toilet paper holder allows rolls to be changed with one hand
  • Wall-hung sink with knee space and panel to protect user from pipes
  • Slip-resistant flooring in bathroom and shower
  • 

Stairways, Lifts, and Elevators

  • Adequate hand rails on both sides of stairway, 1 ¼-inch diameter
  • Increased visibility of stairs through contrast strip on top and bottom stairs, color contrast between treads and risers on stairs and use of lighting
  • Multi-story homes may provide either pre-framed shaft (ie. Stacked closets) for future elevator, or stairway width must be minimum of 4 feet to allow space for lift
  • Residential elevator for lift
  • Ramps
  • Slope no greater than 1-inch rise for each 12 inches in length, adequate handrails
  • Five-foot landing provided at entrance
  • Two-inch curbs for safety
  • 

Storage

  • Adjustable closet rods and shelves
  • Lighting in closets
  • Easy open doors that do not obstruct access
  • 

Electrical, Lighting, Safety and Security

  • Light switches by each entrance to halls and rooms
  • Light receptacles with at least two bulbs in vital places (exits, bathroom)
  • Light switches, thermostats and other environmental controls placed in accessible locations no higher than 48 inches from floor
  • Electrical outlets 15 inches on center from floor; may need to be closer than 12 feet apart
  • Clear access space of 30 inches by 48 inches in front of switches and controls
  • Rocker or touch light switches
  • Audible and visual strobe light system to indicate when the doorbell, telephone, or smoke or CO2 detectors have been activated
  • High-tech security/intercom system that can be monitored, with the heating, air conditioning, and lighting from any TV in the house
  • Easy-to-see and read thermostats
  • Pre-programmed thermostats
  • Flashing porch light or 911 switch direct wired to police, fire and EMS (as option)
  • Home wired for security
  • Home wired for computers
  • 

Flooring

  • Smooth, non-glare, slip-resistant surfaces, interior and exterior
  • If carpeted, use low (less than ½ inch high pile) density, with firm pad
  • Color/texture contrast to indicate change in surface levels
  • 

Heating, Ventilation and Air Conditioning

  • HVAC should be designed so filters are easily accessible
  • Energy-efficient units
  • Windows that can be opened for cross ventilation, fresh air
  • 

Energy-Efficient Features

  • In-line framing with two by six studs spaced 24-inch on center
  • Air-barrier installation and sealing of duct work with mastic
  • Reduced-size air conditioning units with gas furnaces
  • Mechanical fresh air ventilation, installation of air returns in all bedrooms and use of carbon monoxide detectors
  • Installation of energy efficient windows with Low-E glass
  • 

Reduced Maintenance/Convenience Features

  • Easy to clean surfaces
  • Central vacuum
  • Built-in pet feeding system
  • Built-in recycling system
  • Video phones
  • Intercom system
  • 

Other Ideas

  • Separate apartment for rental income or future caregiver
  • Flex room that can be used as a nursery or playroom when the children are young and as a home office later; if combined with a full bath, room could also be used for an aging parent.

Source: Sean Flower, President of the Home Builders Association of Saint Louis & Eastern Missouri