When caring for a loved one at home, there are many ways we can help adapt their environment to enable them to age in place for as long as possible. These modifications can benefit people with physical, cognitive, or sensory impairments by allowing them to safely perform necessary activities of daily living, such as self-care, home management, and leisure.
In this article, I will give examples of some helpful home improvements and tips of the trade to assist you in making your loved one’s home safer and more accessible.
As an occupational therapy practitioner, I have spent countless hours with family and caregivers in the home, helping to identify possible barriers to safety and performance during daily tasks. With a few minor adjustments, you can help adapt your loved one’s living space to promote a safer, more self-sufficient lifestyle.
Pro Tip: To learn more practical tips in your home, check out my range of caregiving guides.
Fall Prevention for Seniors
One of the most important goals of home modification is to reduce fall risk. According to the CDC, each year, 3 million older adults are treated in emergency departments for fall injuries. Falls can be costly, leading to hospitalization, and in some cases, will be a determinant factor in whether or not a person may return home. Luckily, many risk factors can be changed or modified to help prevent falls.
When speaking to my patients, most report falling inside the home due to similar reasons: attempting to reach an unreachable item, tripping, bending too low, or reaching too high overhead without support. While there’s no way to completely eliminate these risks, there are some ways to decrease the overall chances of falls.
The Importance of Footwear
To start, it is important to make sure your loved one has a good pair of rubber-soled shoes to wear while inside the home, especially on tile or laminate surfaces. These can be tennis shoes, slippers (avoid “mule” style without full foot support), or deck shoes. If the person in your care dislikes wearing shoes indoors, a slipper sock with anti-slip soles will be just fine. Make sure pants and long skirts are not overly long, preferably stopping at ankle length.
Each year, 30 percent of adults over the age of 65 will have a fall. A person struggling with vision impairment will have more than double that risk. Lack of proper lighting, non-use of prescription eyewear, or even wearing glasses with dirty lenses or crooked frames can contribute to vision impairments. Ensuring that your loved one always dons their appropriate eyewear at the start of the day is essential to avoid falls due to low vision.
Eyeglass chains can be a good idea if you notice they have a habit of setting their glasses down and walking away. Opening blinds and turning on lights in high traffic areas of the home at the start of the day is an easy way to immediately increase visual acuity.
If your family member uses a walker or cane for mobility, always insist they use the device when they’re up and about and that it’s within reach while at rest. Proper training of mobility devices can increase a person’s confidence with the device, and also provide a rationale for use.
If using a standard, front-wheeled walker or a four-wheeled walker/rollator with a seat, make sure to adjust the height so that your loved one’s elbows are bent at approximately 45 degrees, and encourage them to stay close and within the frame. When using a rollator, ensure the brakes are locked when the walker is stationary, especially when rising from a seated position or sitting on the seat.
Cane height can be measured as follows: have your loved one stand with their arm hanging down at their side. The top of the cane should come up to the crease of their wrist. When walking with a cane for balance, make sure the cane is planted firmly before taking a step forward. In my practice, I have seen many trips and falls as a result of improper cane use. The most common mistake is stepping while simultaneously lifting and swinging the cane forward. When used properly, assistive devices can make the difference between a near-fall, and a fall resulting in a broken bone.
Moving furniture to provide a clear and wide path throughout the home is step number one. If a walker is in use, make sure there is ample room for your loved one to walk and turn without getting caught on the edge of a table or chair. In smaller spaces, removing some furniture is sometimes necessary.
Area rugs with unsecured edges must be removed or taped down to prevent tripping. Rugs can bunch up under a walker or cane, resulting in the person needing to lift the device over the hazard, creating a very high risk for loss of balance and falling. Large area rug edges often curl up at the corners, and many older adults no longer pick up their feet as high as they once did.
As you can see, this is also a recipe for disaster. Rugs can be taped down or removed altogether for the safest option. On hardwood or tile flooring, the danger increases if a non-slip pad is not used to secure a cloth rug to the floor.
Proper lighting is needed to avoid disorientation while navigating the home, especially in darker areas or at night. Pathway lighting or motion sensor lights can be helpful in avoiding falls while providing a clear, well-lit passage from room to room without the need to remember to turn on the light or find a light switch.
Providing high contrast color strips on steps or door frames can aid in-depth perception, and can be as easy as applying brightly colored tape to prominent edges. This method can also be used on stovetop knobs, cabinet pulls, and drawer handles for family members who struggle with vision impairments.
Doors can also be a physical barrier for those who are wheelchair-bound or loved ones with balance and coordination deficits. It can be difficult to manage a heavier door, or one that tends to swing shut, while focusing on a walker or simply attempting to maintain balance while passing through.
One solution is to remove the door completely if it is inside the home. Installing magnetic door stops to prevent sudden closing and allow easy release once safely through is another great option. For energy conservation and safety when donning and doffing shoes, a small entryway bench can be placed near the front door.
Pet care is an often overlooked aspect of home modification. I once worked with a patient who was referred to my rehab facility after spending months in the hospital for a fractured hip sustained after a fall in the kitchen. She had a small dog and kept the food and water bowls at floor level. While trying to change the water one day, she bent too low and lost her balance. After this, her family wanted to re-home the dog. My patient was devastated!
Instead, I had a small railing installed in the space and helped her purchase an elevated pet bowl stand. With a simple home modification, we were able to adapt to her needs and she was able to keep her beloved pet.
Room-Specific Fall Prevention
Shoulder joint impairments, arthritis, and general muscle weakness can cause loss of access to many areas in the home. If you notice your loved one struggling to reach items at eye level and overhead, there are changes that can be made to accommodate a limited range of motion in the main areas of use. Similarly, poor balance and low bending concerns can also be helped with some minor home adjustments.
To increase accessibility, closet rods can be lowered to allow access to hanging items, while lesser-used items can be moved from the floor to an overhead shelf to eliminate low bending and remove clutter in the closet. A clear pathway to the chosen side of the bed, especially if a walker is used, is essential in fall prevention.
There should also be a table lamp within reach. I always train my patients on the importance of using light at night when walking to the bathroom, and sitting at the edge of the bed for a few minutes before standing to increase alertness. Bed height is an often overlooked topic. A bed that is too low can be near impossible to stand from, but a bed that is too high can cause falls when your loved one attempts to slide out. Adjust the bed frame so that the person can back up and sit with minimal effort, with no standing on tiptoes or extreme squatting. Avoid silk sheets to minimize sliding off the edge when entering or exiting the bed.
In the kitchen, cabinet shelves can also be lowered, or daily use items simply moved to a lower shelf or at counter level for easy access. Low friction sliding pads can be placed under heavy kitchen appliances to easily slide from the back of the counter to access during use. Things like holiday glassware or seldom-used serving bowls can be moved to a higher position and removed by you as needed.
Bathrooms are a common site for falls in older adults. A removable shower head that can be placed at a lower height can eliminate overhead reaching while bathing, and proper grab bar installation and use of a shower chair or tub transfer bench will allow for safer bathing. All rugs in the bathroom should have rubber bottoms, and non-slip mats placed in the shower/bathtub. In my OT experience, falls from slipping on unsecured rugs in the bathroom are the number one cause of fractured hips in seniors.
Long-Term Home Modifications
When minimal home modifications aren’t enough, you can always turn to more permanent options. Throughout my career, I have assessed homes and made recommendations for alterations or additions to the home environment through the use of specialized features, tech equipment, and products that affect the safety and accessibility of the home.
Walk-in tubs are a wonderful option for older adults, as they allow for safer entry and security due to low thresholds and stable seating with permanent grab bars. Sometimes, after training and practicing shower transfers with a patient, it will become clear that they will never be safe enough to bathe independently. Walk-in tubs are the perfect solution to maintain independence and dignity in this self-care task.
FYI: To learn more about this type of modification, check out my pick for this year’s best walk-in tub.
For those living in a multilevel home, stairs can be a barrier to accessing upper levels. Stair lifts can be installed, even when several landings are present. One patient I worked with had advanced Parkinson’s disease and had not been able to navigate stairs in her home for over four years. Our entire plan of care centered around her learning how to safely utilize her new stair lift.
By the end of our time together, she was able to transfer safely from her walker to the first seat, dismount on the landing, and move onto the second-tier lift before reaching the second story in her home. Because of this addition, my patient was able to move from sleeping on the couch in the living room back to her own bedroom upstairs. Some additions may be costly but can make all the difference in a person’s quality of life.
Medical alert systems can be a great addition to your caregiver tool kit. They provide another layer of assistance by allowing a person to notify an emergency dispatcher or family member in the case of a fall or other incident requiring assistance. In most cases, the alert device is a button attached to a necklace or bracelet, worn 24/7, and pressed when needed.
Unlike tubs and stair lifts, medical alert systems can also be purchased for a pretty low price, starting as low as $19.99 per month.
As the population of older adults continues to grow, home modifications are a key factor in enabling individuals to “age in place.” In my line of work, making modifications to a person’s environment is of the utmost importance to ensure a person’s safety and independence.
To get started with making your home more senior-friendly, consider the following:
Walk through your home and take note of any problem areas.
Ex: loose carpeting, hard-to-reach places, and other locales that pose risks
Ask your loved one about the activities that give them trouble or stress. If they’re embarrassed to admit these things, watch how they navigate their home, and see which necessary activities they’re avoiding.
Ex: walking up stairs or lowering themselves on the toilet
Start with the quick fixes.
Ex: installing grab bars, decluttering walkways, reorganizing cabinets, purchasing a medical alert system
While Medicare won’t pay for home modifications, Medicaid can often be used to pay for them through home and community-based services. Commonly referred to as Medicaid waivers, this service can pay for some or all of the costs associated with environmental modifications like wheelchair ramps, stair lifts, and accessible tubs or showers.
Through the implementation of easy fixes like decluttering and anti-slip surfaces, combined with larger modifications like stair lifts and accessible bathroom hardware, most homes can be modified to become senior-friendly.
The most common aging in place remodeling project, in my experience, is the implementation of grab bars and railing in both hallways and the bathroom. This simple and affordable solution is a great way to help people maintain balance and security.
A former member of the Navy, Jenny Atwell has spent six years as an occupational therapy assistant, working in rehab hospitals, skilled nursing facilities, and, most recently, as a home health care specialist. Her primary focus is on geriatric care in a variety of settings.