If you take care of your elderly parents, then you’ve probably talked with them at least once about their living situation. It’s one of those must-have conversations when your parents are aging, and it’s never easy.
Chances are, your parents want to stay in their home as long as possible, also known as “aging in place.” Of course they do; their home is comfortable, familiar, and full of good memories. The problem is that most homes aren’t designed around the specific needs of seniors. According to the Royal Society for the Prevention of Accidents in the U.K., accidents happen at home more than anywhere else, and this is especially true for seniors.
Many families also face financial challenges as their parents age. Nursing homes and assisted living facilities are expensive. According to Genworth Financial’s 2017 Cost of Care survey, the average national cost for assisted living is $3,628 per month.
The good news is that there’s a lot you can do to make your parents’ home safe to live in as they age. Helping your parents age in place requires planning and some honest conversations, but it can save everyone in the family a considerable amount of money compared to a nursing home or assisted living facility. It can also give your parents the freedom and independence they need to thrive in this next phase of life.
Let’s look at what aging in place entails, and how you can use this concept to help your parents stay in their home as long as possible.
Our Aging Population
The U.S. Census Bureau reports that over the next few decades, our population will go through a dramatic shift. It’s projected that by 2050, there will be over 83 million people aged 65 and older – double how many there are now.
This shift in our demographics looks startling by the numbers alone, but it’s even more concerning when you look the individuals and families that make up those numbers. As the Baby Boomer generation ages, they will need more support and care from their family, friends, health care providers, and community.
This increased level of care and support puts a strain on their children, who want to help but are often working full-time while raising children of their own. And most seniors want to stay as independent as possible for as long as possible; many don’t want, or can’t afford, to move into a quality nursing home. So, they choose to stay at home.
According to a 2012 study conducted by AARP, 90% of seniors plan to continue living in their homes for the next five to 10 years. However, only 65% of seniors aged 60 to 70 find it easy to live independently, and only 43% of seniors aged 70 and older find it easy.
The problem with staying at home is that it’s full of dangers that only become obvious as people age and lose some of their physical and cognitive functions. Ordinary features such as bathtubs, stairs, gas stoves, and ornamental rugs can be hazardous, or even fatal, to seniors living at home.
Can Your Parents Stay at Home?
Your parents might want to stay in their home as they age, but that doesn’t mean they should. Before you begin to make any changes to your parents’ home, it’s important to evaluate their health and emotional well-being, as well as their physical abilities, to make sure they’re a good fit for aging in place.
How do you know if your parents are well enough to age in place? Consider these factors.
- Nearness of Family and Friends. Do your parents live close to you or other family and friends? Are those friends and family members able and willing to help out with chores or errands when those needs arise? If your parents live in an isolated area, aging in place might not be a workable solution, at least in their current location.
- Temperament and Personality. Do your parents enjoy being independent and living alone? Would their happiness and self-esteem be affected if they had to move into a nursing home or assisted living facility? If your parents really resist the idea of being dependent on other caregivers, aging in place might be a better option.
- Social Networks. Do your parents live an active and social lifestyle that gets them out of the house at least occasionally? Do they have friends they see on a regular basis? According to a study in Proceedings of the National Academy of Sciences, social isolation and loneliness lead to higher mortality rates in older adults. If your parents don’t have a social network or other means to connect with others, they might be better off in an assisted living facility.
Next, look at your parents’ community to make sure their needs will be met as they age.
- Transportation. Your parents might be able to drive just fine right now. But what about in five or 10 years? Does their community provide access to public transportation? If not, how might your parents get around when they can no longer drive safely?
- Services. How far is your parents’ home from services they’re likely to need in the future, such as doctors and hospitals? Is there a senior center in the community?
- Safety. It’s impossible to predict how any neighborhood might change over the course of a decade or more. Still, look at the trends in your parents’ community to try to get an idea. Is crime relatively low, or are crime rates increasing? You can use NeighborhoodScout or CrimeReports to access crime reports for any address in the United States.
- Climate. What is the climate like in your parents’ community? Keep in mind that it gets harder to cope with temperature extremes as we age. Regions with very hot summers or very cold or harsh winters will make it harder for your parents to successfully age in place.
You also need to take a careful look at your parents’ home. Most homes can be retrofitted to make aging in place easier. However, some things can’t be fixed without incurring significant expenses. For example, does your parents’ home have a bedroom and bathroom on the main floor so they could avoid the stairs? If not, can you convert a downstairs room into a bedroom, or will you need to install a chair lift so they can get upstairs and downstairs safely?
Of course, some homes will require more work than others. As you go through the list below, consider the potential costs of these retrofits and renovations to make sure your parents can afford the changes. You might conclude that it’s a better idea to downsize and move them into a smaller home that will be easier to care for.
It’s also essential to weigh the cost of the most important renovations against what your parents would have to pay monthly at an assisted living facility. You can find the average cost for your state, including projected price increases, through Genworth Financial’s Cost of Care survey.
Available Financial Assistance
Keep in mind that some of the costs of aging in place, including hiring outside help, may be covered by Medicaid. Your parents might also qualify for help or financial assistance through their state. Check the following resources to see what help is available to your parents:
If one of your parents is a military veteran, they might qualify for additional help through the U.S. Department of Veterans Affairs (VA). Visit VA.gov to learn more.
Retrofitting a Home: Room by Room
It can feel overwhelming when you think about identifying and fixing all the potential hazards in your parents’ home. Where on earth do you start?
It’s best to focus on one room at a time. Retrofitting a home to accommodate aging in place is a process, and you certainly won’t get it all done in a day (or even a month). It’s best to go through your parents’ home room by room and, using a notepad, make a list of all of the hazards you can find. Rate each hazard in order of its severity so you know which areas you should address first.
According to the National Aging in Place Council, the bathroom is the most likely place in the home for an older person to slip and fall because of the excess moisture. The National Council on Aging reports that falls are the leading cause of fatal and non-fatal injuries for seniors, so the bathroom should be your first stop when going through your parents’ home.
The Tub or Shower
Look carefully at the tub or shower. Tubs or showers that require you to lift your leg up to enter are common dangers for seniors. However, there are several ways to make them safer.
If your family can afford it, consider investing in a walk-in tub. Walk-in tubs range in price from $1,800 to $6,000 or more, not including the cost of installation, but they eliminate the danger of tripping over the tub’s edge.
A less-expensive fix is to install handrails near the tub or shower, as well as a handrail inside, so your parents have solid handholds when they’re entering or exiting. Handrails should be able to support 200 to 300 pounds and have a texture that makes gripping easier. You can also put non-slip rubber mats outside and inside the tub or shower to reduce the risk of slipping.
Next, look at the showerhead. A stationary showerhead requires you to turn and move around to wash yourself thoroughly, which increases the risk of falls. Seniors often find it easier, and safer, to use a handheld showerhead.
Last, consider putting in a shower seat. These can be purchased at medical supply stores and help reduce the risk of falls by allowing you to sit safely while bathing. Install a low shelf in the shower to make it easy for your parents to reach the soap and shampoo when they’re sitting.
If your parents struggle with getting on and off the toilet, install a model that sits higher off the ground or purchase a toilet seat riser, which elevates the height of the existing toilet. Toilet seat risers range in price from $20 to $70 or more. The Vaunn Medical Elevated Toilet Seat riser is well-reviewed by consumers and requires no assembly.
Your parents will likely have to get up in the night to use the bathroom. Make sure their primary bathroom is well-lit and that there are plenty of night lights to illuminate the hallway and bathroom so they can see where they’re going. Also, remove any slippery rugs that might cause them to trip.
The kitchen is often full of hazards for seniors. It’s also where many people spend most of their time when they’re at home, so this should be your next stop.
Cabinets & Drawers
How easy is it to open the drawers in your parents’ kitchen? Drawers with knobs are harder to open, especially if arthritis is an issue. D-shaped pulls are much easier to grasp, even for people with a reduced range of motion in their fingers.
Next, look at how easy it is to access items in the upper cabinets. Pull-down shelving, such as the Rev-A-Shelf system, reduces the amount of reaching you have to do to access items. However, pull-down shelving ranges in price from $250 to $400 or more, so it can get expensive.
The lower cabinets also need to be examined. Do your parents have to bend down to retrieve frequently used items? Consider moving these items up to the counter if there’s room, or installing pull-out drawers to eliminate having to bend all the way down.
You also want to reduce or eliminate the need for a step stool in the kitchen, which can easily lead to a fall. That might mean decluttering and reorganizing the entire kitchen so that the most commonly used items are easy to reach. Don’t be afraid to think outside the box. If your parents have extra space in another closet or bedroom, consider installing wall shelving in those areas to store items that are still needed but not used frequently.
Have your parents wash a dish in their sink. As they do so, look at their posture. Do they have to bend significantly to reach a dish when it’s in the sink? If so, the sink might be too deep. There are few options to fix this.
Depending on the sink and countertop, you might be able to adjust the height of the sink. You could also consider installing a shallow sink, which is typically five or six inches deep. A shallow sink ranges in price from $250 to $400 or more.
Next, look at the faucet. How easy is it for your parents to turn the water on and off? Faucets with levers or touch-sensitive controls are easier for older adults to use. The faucet should also have a temperature regulator to prevent the risk of scalding.
Start with the stove. Is it gas or electric? While each has its own hazards, gas stoves can be more dangerous because of the open flame. Electric stoves often come with a color indicator that alerts you when the range is still hot, even after the range has been turned off.
How easy is it for your parents to turn the knobs to operate the stove? Are the knobs or controls at the front of the unit, or do they have to bend over the stove to reach them at the back, thus possibly exposing their midsection to a hot burner? Now, look at the display. Is it easy to read and easy to use?
If your parents have an antiquated stove that’s ready for an upgrade, resist the urge to purchase a high-tech model unless they’re excited about it too. You want a model that will be easy for them to use over the next decade or more, so go with your parents to choose a model they feel comfortable with.
The same goes for the refrigerator. Hi-tech, WiFi-enabled models might be exciting for you but could be overwhelming for your parents. Discuss options with your parents to determine how high-tech they want to go.
Choose a refrigerator model with long handles that allow for multiple gripping points and plenty of door storage to make it easier to lift gallon jugs. If it does have an exterior display, make sure it’s easy for your parents to read. Some models have slide-out shelving to make it easier to reach items in the back.
Lighting in the kitchen is another important consideration. How much natural light comes into the kitchen? If your parents frequently keep the curtains or blinds closed, talk to them about how important it is to keep the kitchen well-lit. Good lighting will help prevent falls, accidents when preparing food, and bumping into the counter or an open cabinet. Replace any burned-out bulbs and install additional lighting if the room is still too dark.
If the light switches are the traditional toggle style found in most homes, replace them with rocker-style switches, which are easier for older adults to use, especially if they have arthritis. You can make these switch replacements throughout the house to make it easier to turn on the lights.
Finally, look at the overall layout of the kitchen. How easy is it to move around the space? If your parents have to use a walker or wheelchair, will they still be able to function in here?
It’s recommended that kitchen pathways have 42 to 45 inches of clearance and doorways have at least 36 inches of clearance to accommodate walkers and wheelchairs.
Ideally, your parents will have a bedroom (and bathroom) on the main floor so they won’t have to use the stairs. As your parents age, going up and down a long set of stairs will become dangerous, so do whatever it takes to get them a bedroom on the main floor, even if you have to convert a spare room, like the library or dining room, into a bedroom.
If this isn’t possible, you’ll have to install a chair lift to reduce the risk of falls. Chair lifts are expensive, costing around $3,000 to $5,000 to install. However, Medicaid might reimburse you for a portion of this expense. Talk to a Medicaid representative in your state, using the number on the back of your parent’s Medicaid card, to find out if they would be covered for a chair lift.
Getting in and out of bed can be challenging for older adults, so install safety handles on the bed to make this easier. Bed safety rails such as the Vaunn Medical Home Bed Assist Handle/Rail are widely used and cost $30 to $50.
Your parents should also have a phone next to the bed in case they need to call for help. Cell phones can be misplaced or left in another room when they’re needed, so consider a landline phone for emergencies.
Next, look carefully at the floor. Pick up any small rugs that might cause your parents to trip. Secure large rugs in place with rug tape or mats. Make sure there are wide, clear pathways around the bed, to the closet, and to the bathroom. Remove any furniture or items that might be tripped over in the dark.
Finally, look at the closets. Is it easy to access clothing and other items? Are the closets spacious and well-lit? Are there any heavy or dangerous items on higher shelves that could injure someone if they fell? Make sure there’s a chair or bench right by the closet so your parents can sit down when changing clothes.
Which entrance do your parents use most often? It could be the front door, a side door, or a door from the garage to the house. Head over there first to analyze their primary entrance.
Start with the approach. Do your parents have to climb any stairs to enter the house? If so, make sure they’re in good condition and have non-slip, textured surface tape on each step. Examine the railing to make sure it’s sturdy and doesn’t wobble when you use it. If possible, install another railing on the other side of the steps so your parents can hold on with both hands when going up or down.
A safer option is to avoid the steps entirely and install a ramp. Custom-built ramps can be expensive, costing several thousand dollars. However, depending on the layout and number of steps involved, you might be able to purchase a pre-made metal ramp from a medical supply company; these usually cost several hundred dollars.
Next, look at the door frame of the primary entrance. Frames must be at least 32 inches wide to accommodate a wheelchair, and 36 inches is recommended for ease of use. If you can’t widen the door frame, consider using offset door hinges, which can increase the clearance in a narrow doorway.
Now, look at the threshold; this is the tiny lip that you have to walk over when you enter through the door. It should be less than half an inch high. You can purchase a threshold ramp, which typically costs $30 to $50, to eliminate this lip entirely and reduce the risk of falls.
Examine the doorknobs. Round doorknobs can be challenging for older adults to grip, so install lever doorknobs instead. Consider putting a chair or bench next to the primary entrance to allow your parents to sit down while they look for their keys or put down a package while they open the door.
Next, look at lighting. Is the entrance to the home well-lit? Consider installing a motion-sensor light that will turn on automatically when your parents exit or enter the home.
Examine the sidewalk and pathways around the home closely. Are there any cracks, loose gravel, or uneven surfaces that might cause a fall? Do any shrubs or branches protrude into paths and pose a tripping risk?
Go around the home and look at every door and window from a security perspective. There are lots of things you can do to reduce home burglary, such as making sure every entrance (door or window) is kept locked at all times. Keep in mind that seniors are often at higher risk for burglary, so double-key deadbolts and secured patio doors are important.
One of the best alarm systems you can have is an indoor dog. Dogs have become treasured companions for many people as they age, and research shows that dogs can be very beneficial to a senior’s physical, emotional, and mental health. However, dogs can be expensive, so make sure your parents can afford to have a pet before you head over to the animal shelter.
5. Other Considerations
You also need to examine how much stuff your parents have. Homes with a lot of clutter will be harder to clean – which, in turn, could attract bugs or rodents or contribute to allergies and other health problems. Excess stuff also creates more tripping hazards, as well as the danger of items falling out of a cluttered closet or off an overladen shelf.
If your parents’ home is overflowing with a lifetime of things, talk to them gently but candidly about letting some of it go. Help them start decluttering their home and encourage them to pass items on to family and friends so they know their things are going to a good home. The best-selling book “The Joy of Less” outlines concrete strategies you can use to help your parents declutter.
Next, talk to your parents about signing up for Life Alert or a similar service. Life Alert gives seniors the ability to call for help, even when they’ve “fallen and can’t get up.” A study conducted by AC Neilson found that Life Alert members were able to stay in their home six years longer than those who did not have Life Alert.
Senior Living Safety
In addition to analyzing your parents’ home, you also need to talk to them about strategies they can use to reduce the risk of injury and make themselves less vulnerable to thieves and scammers.
For example, encourage your parents to put together a 72-hour emergency kit. If a disaster occurs, you might not be able to reach them for several days, so it’s important that they have enough supplies on hand to get through a short-term emergency. You can also work with them to prepare for a long-term power outage that might occur with a winter storm or hurricane.
Next, talk to your parents about elder financial abuse and scams that target the elderly. You can’t be there for every phone call or visitor, so it’s important they know how to tell if someone is legitimate or not.
Make a list of the chores they have to do daily, weekly, and monthly around the house, and talk to them candidly about how challenging or easy these chores are. For example, are your parents able to take the garbage out to the curb safely each week? If it’s snowy or icy, is there a neighbor or friend who could help with this chore when it’s not safe to go outside? What about cutting the grass, raking leaves, or tending the flower beds?
Your parents might be able to handle these chores right now, but it’s important to start talking about how these chores will be handled as their physical abilities start to wane. With a plan in place, you’ll all feel better that their needs will be met effectively over time.
My grandmother lived in her own home until she passed away last year at 93. She was fiercely independent and loathed the idea of relying on anyone for help.
It was a fall that led to her passing. She was putting on a pair of jeans while standing, her legs got shaky and tangled, and she fell and fractured her hip. Her injury wasn’t as serious as it might have been, but I suspect that what really caused her passing a month later was her loss of freedom and independence after being placed in a nursing home. I can’t help but think that if she’d known about some of these senior living strategies, such as sitting down while getting dressed, she’d still be alive today.
The conversations you have with your parents about aging in place might be difficult. After all, no one likes to think about losing their freedom and independence; my grandmother sure didn’t. But the steps you take today to make your parents’ home safer could save their lives and help give them many more years of health and happiness living where they want to live. So, don’t give up.
Have you talked to your parents about where they’ll spend the next phase of their lives? If they choose to stay at home, what challenges will you face to help make their living space safer for aging in place?