Although Baby Boomers may be loath to admit it, their bodies are aging with many of the same aches, pains, and weaknesses that have afflicted prior generations. In Boomer parlance, this realization may be "a major bummer," but that does not mean that Boomers need to prepare for a future life at an assisted living center. At the University of Southern California's Andrus Gerontology Center, Jon Pynoos, PhD, and Anna Quyen Do Nguyen, OTD, of The Fall Prevention Center of Excellence, Los Angeles, are studying methods to modify and prepare homes so that retired individuals of any generation can age comfortably and safely in one place for years to come. HME providers who wish to explore this highly specialized niche can learn a lot from Pynoos and Nguyen.

When normal function is impeded by aging, simple tasks may become more difficult, such as climbing stairs, carrying packages in and out of the house, getting in and out of a bathtub safely, or just overreaching to take a vase down from a cabinet shelf. These challenges may happen slowly due to arthritis and other degenerative conditions, or sometimes they can happen very suddenly, such as when a person has a bad fall, a stroke, or a knee replacement. It is only after coming home from the hospital or getting injured in a bathtub fall that people begin to look at how their home can be modified to help prevent future falls or environmental challenges.

Pynoos believes that Baby Boomers are at an ideal time in their lives to be thinking about home modification for the future. He says, "People who are Baby Boomers are often in the process of remodeling their homes. The first thing that they tend to do is remodel their kitchens or bathrooms, especially people who have lived in their house for a long time. This is a wonderful opportunity to make changes that will help them age in place and make life easier."

CONSIDERING THE HOMEOWNER

When considering improving a home or designing a new home from the ground up, occupational therapists, architects, and interior designers must think about the space, but must also respect the individual. "Most people see their homes as the place that they hold near and dear to their hearts," says Nguyen, an occupational therapist and research scientist at The Fall Prevention Center of Excellence who specializes in home modification and fall assessments. The job requires a high level of awareness and sensitivity. She says, "As a therapist in general—physical, occupational, or any kind of therapist or health care professional—you make recommendations that, in your experience, can best help somebody. But for some individuals, asking them to install a grab bar may be a violation or a blow to their identity."

THINKING AHEAD WITH UNIVERSAL DESIGN

To lessen the risk of costly retirement home remodifications after an accident or degenerative condition, Pynoos says that clients can work with architects and other specialists about using Universal Design concepts.

Universal Design is a term created by Ronald L. Mace, an architect and educator who died in 1998. In the Universal Design philosophy, it is the conventional home environment that creates the disability, not the person. Pynoos says, "Universal Design is a concept that basically says that housing should work for people of all ages, all sizes, and all abilities. The way this translates into housing in the most elemental manner is to think about places in the house that could present problems. So, the front steps could be difficult for anybody in a wheelchair, for anybody who uses a walker, and in fact, for younger people who have children with strollers, or anybody trying to get a little roller-suitcase in and out of a house or carry packages."

Aging individuals may also consider remodeling a two-story house so that—should the need occur—it would be possible to live entirely on the ground floor. For example, one can expand a den and then add or remodel an adjoining bathroom to include a universally designed walk-in shower with grab bars, an elevated toilet, and faucets with single-lever handles.

ASSESSING THE HOME

Nguyen keeps five design goals in mind when assessing a home. She considers:

Minimizing trip hazards. Remove items from walking surfaces to create clear areas by minimizing clutter; relocating phone wires, extension cords, and cables; or rearranging awkwardly placed furniture.

Maximizing slip resistance. Areas with slick surfaces (eg, tiles or a glossy floor) combined with water or other liquids (eg, bathroom, kitchen, or pool patio) can increase an individual's risk of falling. Providing additional traction, such as by adding inexpensive adhesive nonslip strips or removing the item or liquid, can help reduce falls.

Minimizing overreaching. Relocate commonly used items to easily accessible areas. For example, in the kitchen, pullout drawers can be installed in lower cabinets to decrease bending and reaching. If items need to be retrieved from high places on occasion, using a wide-based step stool that has a hand rail that you can hold on to is an inexpensive solution.

Maximizing visual support. Proper lighting is especially important as we grow older and need more light. Aside from key lighting in task areas such as the kitchen, easy access to light switches and standing lamps is a plus for all ages and abilities. Backlit switches and night-lights can be an inexpensive but significant aid when waking up in the middle of the night to go to the bathroom.

Maximizing physical support. Physical support can come in many forms, depending on the room, from grab bars in the bathroom to hand rails on interior or exterior stairs, to specialized chair lifts that elevate patients from a seated to a standing position.

Other than the above parameters, Nguyen does not follow any one assessment scoring method, believing that every individual and home is unique. She further warns that only seeing the room can be misleading without observing the client engaged in the room's routine activities, because falls are multifactorial in nature. Nguyen performed an assessment where she asked a client to step into the bathtub and the client used the doorknob to balance herself. Her reliance on an unstable door was a potential hazard. Similarly, a living room may actually become a bedroom for those who cannot reach a higher floor.

HOME MODIFICATIONS: ELEVATORS TO THE "TOILEVATORS"

Home-modification solutions for fall hazards and preparing for the future will vary according to the environment and the client's physical condition, budget, and taste. For Baby Boomers who are building or remodeling their retirement homes, it can be a big cost-saver to think ahead about certain common features.

For example, Pynoos tells of friends who are not only making their first floors potentially livable with universally designed dens and bathrooms, but who are also putting in elevators. Others who do not have the budget for an elevator have designed stacking closets, where the closets on the first floor are directly below the closets on the second floor. Then, if Pynoos' friends ever require an elevator for second-floor access, the remodeling and cost would be minimized.

Many Universal Design solutions are comparable in price to conventional designs, and they can be just as attractive, unobtrusive, and functional for all.

While Pynoos and Nguyen say that therapists must always consider a client's individual wishes as well as the therapist's recommendations, they do offer some general modifications and devices for each room or section of the house.

One of the most important is the bathroom. Therapists generally assess how clients get in and out of the tub or shower, use the toilet facilities, and perform personal care tasks at the sink. No-step, curbless, tiled showers can now be nicely designed, allowing for a wheelchair or an assistive device to accompany the client.

Grab bars can now be decorative and attractively installed into tubs and showers, and by the toilet. In addition, pull-down grab bars, which can flip out of the way when not in use, are available. These can be installed on one or both sides of the toilet. There are removable grab bars for the tub that can be hidden when company is present. To decrease the risk of falls, you may recommend antislip strips be installed on the shower or tub. Bathroom rugs should have low piling with rubber backing. Floor tiles should be not be glazed or glossy.

For more on home modification and universal design, see the May 2006 article Building Freedom by consultant Louis Tenenbaum, CAPS in the online archives.

Sink and tub fixtures can have a single-lever handle that mixes hot and cold water. Showers should also have adjustable handheld shower wands and antiscald devices. Aside from removable shower chairs, contractors can design built-in attractive tiled seats.

Toilets should be 17 to 19 inches in height. As an alternative to removable raised toilet chairs or replacing a standard toilet, you can suggest "Toilevators," which are modules that discreetly increase a standard toilet's height by adding a matching raised base under the toilet's original base.

Tor Valenza is a staff writer for HME Today.