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Tips for aging in place
Nov 10, 2021

Aging in Place: What to Do Now to Stay in Your Home Later

There’s no way around it: If you want to age in place, you need a plan. Here’s what to put on that to-do list.

Nearly two-thirds of Americans say aging in place is a goal, but only one-third think they’ll succeed, according to a recent survey by Fresenius Medical Care, a company that supports those with chronic kidney disease. What makes people so pessimistic? Some worry about the financial barriers, while others are concerned about practical or emotional ones—about one in four said their homes weren’t suitable for it, and 19% were worried about feeling alone.

But the biggest reason people fall short of their goal is that they haven’t come up with a plan, say experts. “People tend to not act until some kind of a crisis occurs. So my best advice is to be proactive,” says Lynda Shrager, an occupational therapist and author of Age in Place: A Guide to Modifying, Organizing, and Decluttering Mom and Dad’s Home. “I know you think nothing will ever happen, but a health crisis can often happen with no warning.”

One such crisis: losing your balance and falling. Every year, about 36 million Americans ages 65 and older take a tumble—and one in 10 ends up in the emergency room with an injury, according to the Centers for Disease Control and Prevention. Your health can take a turn for the worse in other ways too, from losing your memory to having a heart attack, making it hard to stay independent at home.

Your primary doctor is a great person to talk to about your plan to age at home. Then you can start prepping for any curveball that may come your way with these tips:

Start looking around your house.

Yes, you can move into a ranch-style house that’s all on one level, say experts. But if that’s not an option, think about potential obstacles where you live now, Shrager recommends.

“If you are in a home that is two levels, think about how you would get upstairs if something should happen physically to you. Would you be able to take one of the rooms downstairs and make it a flex room and turn it into a bedroom? What’s the bathroom situation on the first floor?” Often the full bath with the shower or tub is on the second floor, which could be problematic. Take stock of the stairs and how high your tub is (more on the fixes below).

Have a sit-down with your partner (if you have one). If your spouse doesn’t share your concerns or wants to put things off, bring out the heavy artillery. Use examples from friends or family, says Shrager: “Say, ‘Mary had a heart attack out of the blue and now look at the situation—she’s so weak, she can’t manage the house.’” Or enlist the kids to help call a family meeting, she suggests. Chances are they’re keen on having this conversation sooner rather than later.

Hire a pro.

An occupational therapist (OT) and/or a certified aging-in-place specialist (CAPS) will go room by room and show you how to modify your home to stay safe, says Shrager, who is also a certified aging-in-place specialist. The cost varies depending upon your state and the size of your home.

Go to the National Association of Home Builders, which is the organization that certifies CAPS professionals, to find one near you. Or if an OT is going to do a consult for a family member (either because of a fall or surgery), see if you can be there, too. This is a great time to pick up pointers, suggests Jennifer L. FitzPatrick, MSW, a gerontology instructor at Johns Hopkins University in Baltimore and author of Cruising Through Caregiving: Reducing the Stress of Caring for Your Loved One.

Stay active.

“Not moving is the kiss of death for being independent,” says FitzPatrick. Walking and cardio workouts, as well as balance exercises like tai chi or yoga, are great for your body and mind. “We don’t have a true prevention for Alzheimer’s. All we know is try to avoid a head injury and try to avoid heart disease and diabetes, because anything bad for your heart and your endocrine system is bad for your brain,” says FitzPatrick.

Read more about how walking 30 minutes a day can change your body.

Clear the clutter.

Too much furniture and other household objects can increase your risk of accidents, but you don’t have to tidy the whole home to be safer (though that would be great). Instead, look at the most important pathways, says Shrager.

Start with the pathways leading to the bathrooms, since frequent trips are more common as we age, she says. Move anything that blocks the way to any bathroom in the house, especially the path from your bed. Then turn your attention to the garage: “That is often a pathway to get out of the house, so clear that out as well,” she advises.

If you get overwhelmed at the thought of decluttering, “take a deep breath and break it up into little bites that you can handle,” Shrager advises. “Take two hours and work on a closet or a set of shelves, and don’t stop until you accomplish this task.” If you choose a room that you are in a lot, the visual image of it being less cluttered will give you motivation to keep going. Continue room by room, and you may be surprised by how quickly you get through the whole house, she adds.

Join a village.

Village to Village Network (vtvnetwork.org) is a nonprofit that helps people create co-op-like communities of friends and neighbors who band together to help one another with transportation, chores, and other daily essentials. There are villages across the country, which all function a little bit differently, says FitzPatrick.

“Some are very organized—it’s all about membership and banking hours. You contribute the skills that you’re good at, and other people contribute the skills they’re good at,” she explains. If there isn’t one near you, start talking to your neighbors and friends about starting one, FitzPatrick suggests. She recommends looking at the business model for one in Maryland called HomePorts, in Chestertown. Not only is it a way to engage with people, but it can also be a budget-friendly way to find an extra pair of hands (or lend them).

Beef up your contacts.

“It’s great to be active, and if you want to rake your own leaves and shovel your own snow, awesome,” says FitzPatrick. “But if you’re high risk for falls, can you get a neighbor to do some of this? Especially wet leaves—they’re an awful contributor to falls.”

It’s also never too early to figure out where to find home health aides, just in case, says Shrager. Yes, you can look online, but ask around too. Networking in your community is a great way to find trustworthy aides. Someone usually knows someone they loved who cared for their aunt, grandmother, etc., and will share the name. “It’s like when we were younger and we had the babysitter list,” she says. “It’s kind of the same thing but even better.”

Fix fall hazards.

Six out of every 10 falls happen in the home, according to the National Institute on Aging, with the bedroom and living room being the most likely rooms for accidents to happen. The kitchen, bathroom, and stairs can also be hazardous to your health, thanks to slippery floors and the chance of tumbling from a higher location. To minimize the risks:

In the kitchen

Rearrange. The items you use most (plates and glasses, pots and pans, etc.) should be either on the counter or at the front of the easiest-to-reach cabinets. “If you have joint issues or arthritis, any kind of reaching is hard. If you’re weak in your upper extremities, lifting that heavy plate down is hard to do without dropping it,” Shrager explains. “And any time you get on your tiptoes and start really reaching, your balance is off.” And forget about getting on a stool or chair.

In the bathroom

Splurge on multiple grab bars. Climbing in and out of a tub can get harder as the years go by, but not everyone has the money to install a walk-in shower. Instead, place grab bars along the tub wall that will help you keep your balance and give you something to, well, grab onto in case you slip.

But don’t stop there, says Shrager: “Depending on the need, grab bars can be placed next to the toilet, next to the sink, along the wall leading into the bathroom from the doorway, and behind the toilet for men who stand to urinate.” There are some grab bars that are combination grab bar–towel racks or grab bar–toilet paper holders, which don’t look like classic grab bars, for those who want to avoid an “institutional” look.

Consider a transfer bench. If you are having difficulty stepping over the wall of the tub, a transfer bench can help. It has two legs that sit outside the wall of the tub and two that are inside the tub. You start by standing outside the tub, then sit down on the bench and simply lift your legs over the edge of the tub. When you’re done showering, pull the curtain in front of the bench and no one will even know it’s there, says Shrager.

Swap in a raised toilet seat. If you are having difficulty getting on and off the toilet, try a raised seat that’s at least 17 to 19 inches high so getting up is less of a pain.

On stairways

Install a banister on both sides of the stairs. “If you have a weakness on one side, arm, or leg, you’ve got the other side to hold on to,” Shrager explains. Make sure the banisters extend beyond the top and bottom stairs.

Keep the top and bottom well lit (invest in good lighting if you have to). “You don’t want a dark staircase. I’ve had many people who missed the bottom step,” says Shrager.

Install a skidproof runner on the stairs. If you have trouble with your vision, you may even want to install contrasting tape on the edge of each step to help you see them more clearly.

Think about putting in a stair-lift or glide. “If physical ability declines so you can no longer navigate the stairs, they can be a game changer because you can rent or buy them. Then you can go up and down the stairs for the rest of your life,” says Shrager. They’re expensive, but less pricey than buying a new home.

The bottom line: “If this is your goal—to stay in your own house as long as possible—then you have to work at it a little bit,” says Shrager. “You’re going to be more successful if you’re prepared.”

Additional Sources
Survey: Fresenius Medical Care North America. (2020). “Aging in Place in America.”

Fall statistics:
Centers for Disease Control and Prevention
National Institute on Aging

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