I am not too knowledgeable about these things but I will say, if you can't get a wheelchair through the doors and hallways (our house can't either) then this is probably not the house for you to age in place. I've seen this with my mother, who is 92. She wanted to age in place in her own home, as so many do today. But as she lost her ability to walk, the hallways and doorways were too small for a wheelchair. Yet still she insisted she would not move. This created a lot of headaches. Seriously, we hear so much about how seniors should remain in their own homes until they pass away. In theory it sounds great, but in reality there are some difficulties. The maintenence of the house usually falls to the children, which in my mothers case, was considerable work. None of us has a crystal ball to tell us how well we will age, can we get around with a walker, or is a wheelchair required? Having seen this first hand, I plan to sell my home when I cannot manage to take care of it, and move into a senior citizens apartment complex. That way, the apartments are made to accommodate wheelchairs, the bathrooms set up for the elderly too. And, you just call the super when you need something fixed. I think my mother would have been much happier in a seniors complex, she would have had peers her own age to socialize with, public transportation, lots of activities to join in, etc. and it would have made our lives a bit easier too.

I can see that it does create headaches when a house doesn't accommodate your needs as you age, but I think the reality is, that with the Baby Boomer generation all becoming seniors at the same time, the 'system' to accommodate them is not really there. I believe the emphasis on renovating homes to allow you to age in place, is due to the fact that there probably won't be enough places to accommodate aging seniors. And the cost of doing so is well beyond the reach of many.

Of course, you are speculating about what your mom's experience would have been if she went to a senior's apartment complex. And actually, you run into the same problem once you get there, sooner or later the senior's health deteriorates to the point they can't remain in the senior citizen's complex either and then a new facility that can care for them has to be found. We've had both situations in our family. One parent who did need to move to a facility and another parent who moved in with one of their kids. I would say the parent who moved in with one of their kids had the best experience and the children of that parent felt the best about it in the long run.

And I believe the only asset you can keep and still be eligible for the state to help pay for in facility care, is your home. If you sell your home, you have to spend down all your assets to pay for a long term care facility before the state can help cover the costs.

Everyone's circumstances are different. Some parents have kids who are financially in a position to fend for themselves, some want to leave something for their kids, because their kids need the help.

I guess there are a lot of ways you have to look at it and a lot of difficult decisions to make.

I think you've already discovered that it a walk-in shower won't meet your projected needs. If you can walk, you can probably lift your feet over a low shower curb, but not necessarily get in (and out!) of a tub. I doubt you have enough incline in an 8 X 5 bathroom to have a walk-in shower. The whole floor must slant to the shower drain.

You speak of this situation on your 'first floor'; presumably there is a second floor. This doesn't sound like an 'aging in place' kind of house, shower issue aside. You may need to "think outside the box", the 'box' being your current home.

In 2001 my DH and I built our present house to be our last house. We didn't build ADA-compliant, but it's single floor with 36" wide doorways throughout. There are no thresholds; all floors are wood and tile. Doors have lever handles. Light switches are back-lighted rocker style. There is a single step up to the house from the garage/outside doors. I hope we have many more years here, adding help as needed. When the maintenance/costs outweigh our pleasure in the home, we'll sell and move on to housing that better suits our needs.

Just as it is often a costly RE mistake to enlarge/remodel as your family grows rather than move, it may not be logical to try to adapt a house suited to a family to meet senior needs. I think of these things when I see ads for reverse mortgages 'so we can stay in our home'. Too many people take this expensive step, then are out of that house in a few years anyway.

If you have nice neighbors where you live now, chances are you are the kind of people who will find nice ones wherever you are. If you need to move, move. If you don't need these 'improvements' yet, don't make them.

I don't know if this fits your time line, but someone at Apartment Therapy posed a question about flooring for "aging in place" titled "What floors are elderly-friendly" and one of the responders sent a link to a course to a free four week online course through Future Learn, called "Ageing
Well: Falls" offered by Newcastle University in Great Britain that they highly recommended - I'm going to take it myself - it starts September 7, and is 4 weeks at 2 hours per week future learn- Aging Well: Falls

Thanks, it's helpful to hear how others are trying to make these choices.

Chisue, I'll have to give some of your ideas more thought and thanks for that link Alexa - looks worthwhile.

I think the problem is that you're looking at aging-in-place as a series of small projects: Let's make the shower curbless, pop in a seat, and -- yippee! -- the house is now age-friendly! (Okay, that's an exaggeration.)

The reality is that you need to consider the whole house. Imagine yourself moving through the house -- where are the problems?

I lost my beloved grandmother a little over a year ago, and the things that really gave her trouble aren't the things that are typically discussed on these boards.

My college daughter is working in home health this summer, and -- likewise -- the things that give her patients the most trouble aren't the things that're discussed here.

Read, read, read, and consider what will really help you in the long run.

We decided to go with a curbless shower. Ultimately it added $2,100 to the cost of the remodel. If one of us is ever permanently in a wheelchair, we will likely have to move as the kitchen isn't accessible and the door into that bathroom is just 30 inches with a tight turn.

But this place would work well for a walker--one step up to get in the front door and all one floor. And it could likely work for temporary wheelchair use with some assistance. We decided the extra $2,100 now was worth the possibility that it would allow us to stay in the house for some extra years In the future.

We are also putting in grab bars and also extra blocking (documented by photos) for future additional grab bars.

When we thought the curbless shower would be more expensive, I looked at some low curb options, figuring that would also work for a walker. So that might be an option to consider.

There are wheelchairs that are much narrower than the standard wheelchair. Many of them are rehab types. Not meant for rolling around town, but for inside the house. Bedroom to bathroom, etc. They can also fit into a smaller-than ADA spec shower if that shower was curbless.

That said? Transfer seats work fine for getting over a tub edge. Properly placed grab bars can help someone navigate a shower curb with confidence.

So how much you want to embrace accessible design is really up to you. From your description it sounds like it's not practical to fully embrace unless you make some serious changes to the floor plan.

Mrspete, I would love to hear what your grandmother had the most trouble with. Especially if it isn’t what is usually what you read on the forums. And what your daughter is finding with her patients.

CRL - Blocking is a good idea, we’re thinking of adding it in a few places. We actually have a good first floor set up except for that hall. Our kitchen and LR are very open. Although the kitchen is not set up for wheelchair use. The stove controls are not at the front and you can’t access the sink with a wheelchair under. But really those kind of changes don’t make sense to do unless you actually have the disability. We do have four steps up to get in the house. I’m wondering if a ramp could be added in the just the back, since we have a long lead up to the back steps.

Moving is something we’ve considered, but, finding something is another story.

Mongo - that is a great idea - about finding a more narrow wheelchair. I’ll have to look for a transfer seat.

I’m coming to that conclusion, that it’s a waste of money to put in some changes, without going all the way and making the floor plan different. We are about to renovate the house and the first floor bath is on the list. My only problem is that the hall wall is shared by the dining room. But I haven’t tried to figure a way to do it yet.

Well its true that the baby boomers are going to create a lot of issues, as far as services available to them. The nursing home my mother is a senior complex really. It has senior citizen apartments, for those who can live independently but want an apartment with activities and such for healthy seniors. Then, there is an assisted living unit, for those who cannot live completely independently, need some help but not nursing home care. And of course, the nursing home for those that need that level of care. So, you could move from one living situation to the next as your needs change. I think we will see more places like this as the baby boomers age. Assisted living and nursing homes are very expensive though.

Aging in place sounds good, but the renovations can be costly too, depending on what needs to be done. And usually it requires family to help, which isn't always an option especially for those who have no children or whose children live far away. This is something parents should discuss with their children well in advance of when they might need these things. And as for the medicaid spend down, you can only keep your house if you have a spouse still living, the idea being that he/she may still be living there while you go into a nursing home. In my mothers case, she is divorced so her home was sold and all assets spent down so she has nothing more to pay with, therefore medicaid eligible. You can however, prepay your funeral, and I believe keep about $3,000. At least that is how it works in NY.

I am not a big believer in relying on your kids for help unless absolutely neccessary. Making the decison to move Mom or Dad in with a child is a kind thing to do. But, often there is a spouse to consider, how does he/she feel about it? Because often, you don't fully realize what is involved. There is taking Mom to the doctor, cooking, cleaning for her, help paying her bills, helping her bathe and get to the toilet, giving her medications, etc. My sister moved Mom in with her until Mom needed 24 hr care. Much as she loves Mom, she had no idea how difficult it can be at times. Lifting Mom in and out of the tub, she strained her back and knees. And it put stress on her marriage, her husband loved Mom too but found the daily responsibilities made it difficult for them to enjoy a normal life and my sister was often very stressed and it tears because of it. Getting aides to help out was difficult due to the rural area we live in, and of course, Mom didn't want anyone but her daughters helping her with her personal care. If you work at a job, it requires taking a lot of time off for the many doctors appointments that seniors have. I found I neglected my own doctors appointments so I could use my personal time to take Mom to hers.

This is not to discourage people from doing it, we were happy to help Mom where we could but you should know what you are getting into. It can be rewarding but also very draining emotionally, mentally and physically. Having seen it firsthand, I never want my kids to do the same for us. Of course we never know what the future holds but all we can do is try to stay healthy, mentally and physically, try to stay financially independent and have plans in place in the event that you do need more care.

Lam702 - The Baby Boomers on average are already 65 years old already, so not sure how many more facilities will be able to be built in time for them to be useful. I wonder if you have seen the recent documentary on PBS on the subject of Baby Boomers as they age? Here is a link to a description of it.

PBS documentary on Baby Boomers

You have your own circumstances that guided the choices your family made as everyone does. And I can’t disagree that it’s not an easy task for family to help aging parents. I’m sure it always has been for each generation.

There is little doubt though, that most seniors would prefer to stay home in their own home and get services at home in order to do that. And most families can identify with a parent who doesn’t wish to spend their final years in a nursing home with strangers caring for them. And I suspect being in their own home would keep them mentally and physically healthier longer. If your basic home, in general, accommodates that, it is something that can be accomplished in most cases. Lifts to transfer a patient can be provided. Aides can be brought into the home in most cases. Nurse practitioners can make home visits. Families in most areas can be given the support they need to make caring for their parents less of a burden. At the present, I’m not sure if the medicaid rules make that more difficult to do.

If you can find that PBS special, it might still be on, I'm sure you would find it interesting.

Some very good suggestions. I agree, no one wants to go into a nursing home, but it depends on the level of care a person needs. And medicaid rules will determine what you can do, if you exhaust all your funds. Medicaid doesn't pay for at home care, but they do pay for nursing home care, which seems a bit backwards, since at home care costs less than a nursing home. It's never an easy decision, so much depends on the physical and mental health of the elderly person.

Every so often, my 93 yr old father, who appears to be mentally very sharp, will tell me he has won some kind of lottery, all he has to do is send a check in for "processing fees" He's been scammed a few times like this, each time I explain to him these are scams and he seems to understand but then,a few months later it happens again. I finally convinced him that whenever he gets these letters and emails, to call the state attorney's office and ask if it's legit. He takes the attorney generals office word for it, not mine but thats ok, as long as he doesn't get scammed. He still insists upon managing his finances and is very secretive about it though. I suspect he's been scammed on other things but is too ashamed to admit it. He cannot resist those "too good to be true" deals. Its a fine line we walk, trying to protect them while at the same time not making them feel like we think they are helpless. Its the loss of independence that bothers them most of all, I think.

Wow- really great points from everyone. I've been in health care over 25 years in urban and rural areas and have seen most of what everyone describes in some way or another. And have faced it even more personally when my 80+ year old mom fell and broke her hip last year. The differences in the services we have access to in the town with population 1500 where she lives now and the city where I live (funding not even part of the equation) was like night and day. Mix in a mother not willing to move from her home, not willing to make any changes to the layout of her home, not willing to wear any kind of an alert device- it's kept my siblings and I up more than one night.

Mrs Pete- your daughter is spot on with the points she's made. And thank you for raising a nurse. The profession is aging just like the rest of the population. Who will take over for us is a big concern in the field.

Lisa

Iam702, you're right about the scamming thing. I watched my grandmother, who was very intelligent and had a college degree in days when women just didn't have college degrees, become more and more confused by "offers" she'd receive in the mail. And one day she'd tell me something I flat-out knew to be false, and then the next day she'd be herself again. Sometimes she'd insist upon teaching me things; for example, near the end of her life she spent 30 minutes one day explaining to me how to turn the lights on and off.

My daughter told me a concerning story: She said while she was working with her main client, a salesperson came to the door, and the client's husband actually pulled out his social security card and shared his number with a door-to-door salesperson!

South, I can't claim I made this kid a nurse. She already was one when she was three years old. I couldn't keep bandaids in the house, and she'd line up her dolls and tell them what was wrong with each one (you have the chicken pox, you need an operation, you need a shot), and then she'd take care of each one. The one big push I gave her: When it was time for her to choose an elective as a high school freshman, she was leaning towards just following her friends, and I said, "No, you need to take Health Occupations 1". When she balked, I took her in after school to meet the teacher. When she saw the room, complete with hospital bed, skeleton in the corner, and all sorts of medical equipment, she was sold ... she took all four levels of the class, spent 1/2 her day as a senior at the hospital/nursing home, and earned a CNA along with her high school diploma. She says today that those Health Occupations classes were the most influential classes she took in high school.

On the other hand, I was already a teacher at that age. When my siblings couldn't be corralled, I lined up stuffed animals on the fireplace hearth and talked to them about sentences or math. None of my children or nieces, who are all now young adults, played in this same way.

We teachers are also concerned about who will take our jobs in future years. The legislature of my state is determined to rid itself of teachers like me; that is, those of us who've been around 20+ years and are near the top of the salary scale. They're doing a great job: MANY of my colleagues are opting to leave at 25 years instead of staying the full 30 for a full pension. Trouble is, the colleges aren't turning out new teachers; my daughter attends a large state school that was originally a teachers' college -- last year they graduated FOUR students qualified to teach high school. Young people are paying attention to how teachers are being treated in this state, women have a wide variety of opportunities today (when I graduated, girls were pushed towards teaching or nursing), and we are headed towards a shortage. Yes, I do wonder who will teach my younger nieces and nephew.

MrsPete - Good suggestion to check for services available. I remembered that our community has a very active Seniors Center, so I checked it out. What they offer looks pretty good. They have a program called SHINE which is a service available to assist and inform elders of their rights under Medicare and to help sort it all out. They have Caregiver’s Support Groups and Legal Aid. There is also ‘in town’ transportation that accommodates wheelchairs and can take you to medical appointments, shopping and general activities. They do have a senior center that offers lunch every day and meals on wheels. And this quote….

“ ….. we provide a wide range of supportive services to residents designed to maintain individuals in their own home and community. Services include case management, in home services, money management, nursing home pre-screening, companionship and Alzheimer’s services.”

Putting the money into the shower and bathroom - I guess it's a case of biting the bullet now. That is the decision we will be going over with our designer next week and the hallway will come up too.

Great accommodation for getting from the house to the garage by having two walkers and grab bars. And I’d forgotten a place to keep a wheelchair. Garage or mudroom sounds right.

I wonder if your Grandmother had any Physical Therapy?

Not easy to find space near the bedrooms for a laundry. Although in our proposed renovation, we’re trying to see if we might incorporate laundry into a small mudroom, that would actually be fairly close to the first floor bedroom.

Grocery shopping and meal prep, major house cleaning. I’m already good at eating very low effort foods. Grazing with fruits and vegetables and yogurt. And I believe there is still a Peapod service that delivers groceries somewhere around here. Major house cleaning would be a hire out job and home maintenance as well.

Space in a small house. I’ve been thinking of that lately as we’ve been clearing out a lot of junk in the basement and I’m amazed at how much space it was taking up. Sometimes we have too many ‘things’ and clutter too.

Had not thought of a ‘fire exit’ near the bedroom. Door handles are on our list.

Really helpful input and I appreciate your time in sharing that. Thank you. :-)

lam702 - Wonderful to have a 93 year old father. I think you have it right, to try to find that sweet spot between trying to protect them and helping them remain as independent as possible. Quite a worry though to wonder what they are doing with their finances.

Lisa - I sympathize with all that worry you have. Has your Mom’s hip healed and has she regained any mobility?

MrsPete - that is such a cute story about your daughter. :-) And you did a good job of persuading her to take those high school classes.

It is disturbing that so few people are pursuing a career as a teacher, but, with all the violence in schools as well, it is not very surprising. You wonder how that is all going to play itself out.

prairiemoon, I am also planning an age-in-place bath. i was thinking of doing a wet room with curbless steam shower and soaking tub after i saw one in a Candace Olsen design book. i thought this would give us more room to move around and having a steam shower would be good for colds, and the soaking tub for easing joints. a curbless shower would be great as well as a tub with a door/seat

.

We considered a Fiber-Fab ADA compliant barrier free shower unit (link.) They require that just a 8" x 8" area around the drain be blocked out; you don't have to have a totally sloped floor. Of course, if you want tile that's a completely different project. However, I think if you're serious about aging in place, you're not going to use materials that require sealing and grout cleaning.

I think a safe toilet is more important than a curbless shower. We made sure our toilets are parallel to a wall so they can have sufficient grab bars. Toilets that are sandwiched between a vanity and a tub are the worst! My cousin is an EMT and he's had more than one elderly person fall between a toilet and a tub.

If anyone is interested in the ADA guidelines, I highly recommend the NKBA Kitchen and Bathroom Planning Guidelines with Access Standards [Kindle Edition]. It was the best $10.49 I spent while planning our remodel.

It has figures like this:

Prairie, You're right that so many services are available to the elderly -- yet a lot of people don't investigate their availability /won't use them. My grandmother, for example, welcomed Meals on Wheels but balked at calling the county's handicapped /elderly transportation van. Public transportation? That's for poor people! One of the reasons I'm pretty much sold on a certain building lot is that the neighborhood is connected to the town's "city center", which includes the town's senior center, the library and a pharmacy. We'd be able to walk (or golf cart) to these places without getting out on the main road.

Physical therapy? After a serious illness my grandmother had physical therapy while she was an inpatient at a rehab facility, then she went twice a week to the hospital for some months. It did her a great deal of good. More recently my mother had physical therapy after surgery. Her therapist started her with "in bed exercises". He brought a board to her house, which he slid under her, and she did her exercises lying down. Then they moved on to the kitchen, where he had her exercise while holding onto the counter as a stabilizer. When she was doing her exercises alone, she "cheated" and held onto the sofa back instead so she could watch TV while she exercised. I think my mom was fortunate to get an A++ therapist, and he did her a world of good.

Are you asking because you're trying to make sure you plan space enough for exercise in your house?

BenjesBride, I don't know that I'd say the toilet is more important than the shower. I think you're more likely to be injured in the shower because of the water /possible slipping .... but you use the toilet more frequently, so you have more opportunities for accidents. Of course, the right answer is to make both as safe as possible!

I think my girls' bathroom has a good set-up for an elderly person's toilet, and we're actually copying it for our future house. This is a random internet picture, not my actual house, but it's the layout I'm discussing -- I do like the color scheme and traditional look in this bathroom:

The person using the toilet is a bit hidden from view, but the wall and the shorty wall provide plenty of space to anchor grab bars. An assistant could help an elderly person reach this toilet, then retreat a step to allow for some dignity ... without leaving the person completely alone. I'm thinking I want to make the pony wall thicker so it can also hold spare toilet paper.

Using the same thought process, we're using solid pony-walls in our shower /glass only on the upper portion. Yes, full glass would look nicer, would make the room look larger, and would allow light to pour into the shower ... but a piece of glass can't support grab bars on both sides of the shower, and I like the idea of having bars all around.

mrspete I wrote "I think a safe toilet is more important than a curbless shower." Shower safety is obviously very important, but the OP was focusing on a curb-less shower for aging-in-place. I don't think curbless is necessarily a high priority when it comes to accessibility.

We don't currently need grab bars and there wasn't a great and attractive way to put them near our toilet. Our GC suggested putting blocking in on each side of the toilet so we can install some that swing down if we need them in the future.

http://www.acessinc.com/assistive_handrail_fixed_mount.htm

Our vanity can come out and be replaced by a wall mount sink if we need more space next to the toilet and/or a more accessible sink. This way we have the storage now, but a relatively simple solution down the road

(We are in our forties and this is currently our children's bathroom--ours is too small for accessibility to work very well.)

PLEASE rework the halls so at least a regular size wheelchair can pass through, or as in the case of our dad, a gurney! They had to literally drag our weak, sick dad out of his bedroom and through a narrow hall on the seat of his walker. It was very difficult for two strong EMTs and hard on dad. They were finally able to get him on the gurney outside the back door. (And yes his u-step walker fit but wheelchairs do not fit in this 1950's era ranch home.)

Dad was able to stay in his home three years after Mom died, with our help, my almost daily visits from 25 miles away and wonderful aides helping a few hours a week and he wore a medical alert pendant. It literally saved his life several times as his Parkinson's caused him to fall several times. But the last fall three weeks ago was due to blood loss from teeth extraction and landed him in the hospital. Five days there found him still weak but ready to be moved to a rehab/ skilled nursing facility. Two weeks there has done him a world of good! Taking his meds on time, with healthy food and mandatory OT and PT. He will likely be ready to move to the assisted living apartment he had reserved the DAY before he collapsed.

Yes most of our parents want to stay home, and it is cheaper but do everything you possibly can to make the house more accessible. And definitely leave extra room by one side of the toilet for a helper to help with cleaning the backside of the love one. Cubbies and knee walls are not helpful!

Do a curbless shower if at all possible! Find one somewhere, use a walker or wheelchair and try it out.

Thank you all for all the wonderful, thoughtful comments on this thread. All are SO very true!

prairiemom61, I'm sorry to hear about your father's fall, but glad he is doing well m