By Peggy Reisser Winburne
When Veronica Engle and her husband, Lawrence Schmitt, were planning a new home for their retirement years, they considered the present and the future.
Engle is a professor emeritus in the College of Nursing at the University of Tennessee Health Science Center (UTHSC). With expertise in geriatrics, it was only natural that she would want the home to fit their needs now and as they grow older.
Engle consulted Lawrence Faulkner, an associate professor in the UTHSC Department of Occupational Therapy and a certified aging-in-place specialist, for advice on making the home they built last year livable for life.
“My husband and I are in good shape and don’t need housing modifications now,” Engle says. “However, we may need modifications in the future as we age in place.”
Both aged 65, they represent a growing trend in home design and construction that is fueled by the fact that the number of older Americans is on the rise. According to the U.S. Census Bureau, there will be approximately 71.5 million Americans older than 65 by 2030, a number that is more than double what it was in 2000. And, as care for the elderly increasingly moves away from institutional settings, more of those older Americans will be living at home, often out of necessity but increasingly by choice.
“The majority of older people want to stay in their homes,” Faulkner says. “In the 2000s, the trend has gone from assisted living to a recognition that, ‘I would really like to stay in my own home where I’m comfortable, where I know my neighbors.’” Aging at home offers not only familiarity of place but the comfort of community, he says.
“We want to stay in our retirement home as long as possible,” Engle says. “That is why we built an accessible house with an option to finish a studio apartment over the garage for a caregiver or relative.”
All of the main living space in the home is on one floor, with only a den and attic on the second floor. “We won’t have to use those rooms when we need to live solely on the first floor,” Engle says.
Bathrooms were constructed with blocking behind the walls, so grab bars can be installed when they are needed. The shower has no threshold to step over. Hallways range from 36 inches to 42 inches wide so a wheelchair can move easily throughout the house.
Doorways allow ample room for wheelchair access. Lever door and faucet handles, as well as paddle-operated light switches, can be used if dexterity is limited. Thresholds from room to room and from outdoors to indoors are flat for ease of movement.
“I think all new houses should be accessible in addition to being energy efficient,” Engle says. “Think of all the horror stories of middle-aged children trying to care for their aging parents in a home that was not built for a person using a walker or wheelchair or trying to modify a house.”
Stephanie Lancaster, clinical coordinator in the Department of Occupational Therapy at UTHSC, lived that horror story when her father was diagnosed with brain cancer. “It left me with a new level of understanding about the need for clients and caregivers to be provided with access to resources to assist with equipping the home for accessibility,” she says. Lancaster worked with colleagues from Occupational Therapy and Physical Therapy to make her parents’ home more accessible and comfortable. “I learned that, despite a person’s efforts to stay healthy and active as he or she ages, things can change dramatically in the blink of an eye and that making even small changes within the home can make a difference,” she says.
Some Tips for Making New or Existing Homes More Accessible
Lawrence Faulkner, a certified aging-in-place specialist, said the best homes for lifelong living have open floor plans, 36- to 42-inch-wide hallways, no thresholds from room to room and from outdoors to indoors, ramps instead of stairs, excellent task and room lighting, and are designed with attention to preventing falls. But certain rooms require special attention as we age.
The bathroom (This is where most falls occur.)
- Use bath mats with non-skid bottoms.
- Replace towel racks with grab bars tied into studs behind the walls. They should support up to 250 pounds. Supports can be blocked in during new construction or added in a remodel.
- Install or replace door, tub, shower and sink knobs with lever handles.
- Install a zero-threshold walk-in shower, at least in a first-floor bathroom. If that is not possible, step-through inserts are available to retrofit bathtubs for better accessibility. Use a hand-held spray shower fixture.
- In new construction or a remodel, allow for at least a 42-inch path and a 5-foot-by-5-foot turning radius to accommodate a wheelchair. If that is not an option, clear as much floor space as possible.
- Provide a place to sit while doing prep work, and set up the workspace so pots and pans can be moved without lifting.
- Remove cabinet doors under the sink for wheelchair access.
- Raise or lower cabinets in new construction or retrofit with pull-out options to reduce bending and stretching.
- Have enough light for the task you want to do but not so much that glare or shadows interfere with vision.
- Remove area rugs or thick carpets that can contribute to falls.
- Install electrical outlets about 12 inches off the floor instead of the standard 6 inches.
- Use less furniture and choose heavier pieces. This allows for ease of navigation and support for those with balance issues.
“Find a good contractor, but don’t allow them to only go by ADA (Americans with Disabilities Act) Accessibility Guidelines,” Faulkner says. “Find someone who is aware of you and what you want, your clinical history and your prognosis.”