Some 70% of seniors spend the rest of their life in the place where they celebrated their 65th birthday.

Age in Place

To "Age in Place" - what is it?

We are using the term "age in place" in reference to living where you have lived for many years, or to living in a non-healthcare environment, and using products, services, and conveniences to enable you not to have to move as circumstances change. More recently, to "age in place" is a term used in marketing by those in the rapidly evolving senior housing industry. CCRCs, (Continuing Care Retirement Communities), by definition, offer the chance to age in place, but first you must move to their community to "start aging." Multi-level campuses market "Independent Living," "Assisted Living," and perhaps Alzheimer's care and Skilled Nursing in one location, and claim to offer the opportunity to "age in place." But again, you must move there first. In many cases, you must also move from one wing of the campus to another to receive the increased services.

Here we address issues and needs related to "aging in place," without first relocating.

What is a "NORC"

A Naturally Occurring Retirement Community, or "NORC" for short, is a community or neighborhood that develops naturally as a result of residents that simply remain in their homes for years and age as neighbors. A NORC may refer to a specific apartment building or a street of old single family homes.

It is possible to band together and develop or seek help to develop, access to services to aid those needing assistance, thereby retaining the highest quality of life for all residents as they age.

Some 27% of seniors live in a NORC.

Fair housing laws provide for a complex with 80% of its residents over 55, to become officially age restricted. Another classification for restricted age is for 100% of residents to be above the age of 62, but this is rare in an evolving NORC.

For many years the law required an age-restricted community to offer significant amenities and services if it was age restricted. That is no longer the case, but to compete, and attract residents, we still see most age-restricted communities offering amenities and services to serve their residents.

Significant amenities and services may include:

  • Social and recreational programs
  • Continuing education programs
  • Information and counseling
  • Outside maintenance and referral services
  • Emergency and preventive health care programs
  • Meal Programs
  • Transportation on a schedule

Why Aging in Place

A significant concern as people grow older is that they may have to leave their home. This would mean leaving behind a comfortable setting familiar community and many memories. In addition, a certain amount of control is lost when one leaves home. This "control" provides the underpinning to our feelings of dignity, quality of life, and independence. One's home is a strong element in that sense of security.

Most American seniors desire to stay in their homes for the rest of their lives. An AARP survey found this number to be greater than 80% of seniors. This "stay at home" approach is also known as "Aging in Place." Several reasons are cited for this strong Age in Place preference. These include:

  • Comfortable Environs
  • Feelings of Independence
  • Aging Comfortable Environs
  • Aging Independently
  • Convenience to Services
  • Familiarity
  • Aging Convenient Services
  • Aging with Familiarity
  • Safety and Security
  • Proximity to Family
  • Aging Security
  • Aging with Family

To successfully "age in place" requires planning. To accommodate physical, mental, and psychological changes that may accompany aging, physical changes should be made in your home.

Changes Related to Aging

Contrary to popular belief, most American seniors live independently while maintaining strong relationships with family and friends. Their personalities remain relatively stable throughout their lives. Depression occurs less in non-institutionalized seniors than among young adults. Normal age-related changes do occur. These may include:

  • Hearing impairment
  • Failing vision
  • Osteoporosis
  • Increased likelihood of arthritis, diabetes, heart disease, and hypertension

Mental process changes:

  • speed at which information is processed
  • speed of responding to changes in the environment
  • long term memory decline
  • word finding ability declines
  • Visual decline
  • decreased reading speed
  • seeing acuity in dim light
  • reading fine print
  • sensing peripheral changes

These changes may lead to difficulties in interacting with one's living environment. These include:

  • Decreased mobility and dexterity
  • Decreased strength and stamina
  • Reduced sensory acuity: vision, hearing, thermal sensitivity, touch, smell

However, some functions tend to remain the same with advancing age, and changes differ between people. While seniors tend to process new information slower, daily social and occupational functioning ability remains stable. Most language-related skills also tend to remain stable with age. Most notably, creativity and wisdom continue at strong levels.

In addition to physical changes, seniors experience social changes that may be disruptive. These include isolation from family and friends, loss of peers children living far away and a changing neighborhood.

The majority of seniors learn to adapt to their changing situations and lead happy and productive lives. Read more about changes related to aging.

Aging and Your Home

The aging process is blamed for many problems seniors may encounter with daily activities. However, quite often it is the home that creates the difficulties. Most residential housing is geared to young, healthy adults. Most Builders do not take into account age-related conditions such as reduced mobility or limited range of reach. Hence, dwellings do not support the physical and sensory changes that older adults encounter as they age. What appears to be insignificant home features can have a significant effect: for a person with even minor aging issues. For example, the pleasure of that "home cooked meal" may be unavailable with the senior's propensity to forget something is cooking and tend to it.

Many seniors avoid home modifications and helpful technology items designed for people with disabilities because these products have an industrial appearance. No one wants to have their home look like a hospital. Consumer demand and computer technology have pushed institutional products to be redesigned to be more acceptable in the home. Some of these include:

  • Cooking range monitoring to avoid fires
  • Chairs designed for easier in and out
  • Enhanced high and low-frequency tones for doorbells and telephones
  • Grab bars and handrails with decorator colors
  • Hospital type beds with wooden headboards and footboards
  • Items that are easier for arthritic hands to handle
  • Larger print for declining eyesight
  • On/off buttons with color contrasts
  • Walkers in bright hues

The National Center for Injury Prevention and Control (NCIPC) states that falls are the number one cause of home injury, and studies suggest that a significant proportion of all falls are due to environmental factors The three leading causes of home injuries, according to the NCIPC, are falls, burns, and poisoning. Seniors are especially susceptible to these types of injuries. Most falls are caused by environmental factors such as a home not truly suited for a person with elderly issues. Burns are caused primarily from fires. Older adults are killed in home fires at twice the rate of society as a whole (National Association of Home Builders [NAHB], 1990) Poisoning is mostly caused by medicine non-compliance: older adults are six times more likely than other age groups to suffer adverse medical reactions (Alliance for Aging Research, 1998).

One of the more significant challenges is to identify safety issues that may be unique to an individual based on their particular aging status and conditions. While research via books and the internet can help focus on such issues, the use of a good checklist in assessing the home environment is helpful.

Home Assessment

It is important to do a thorough assessment of the home to assure that it can properly handle an elderly or infirm individual. The following list provides a summary of items to review and consider.

Difficulty: Balance and Coordination
Possible Remedies:

  • Bath seat in the tub or shower.
  • Bathtub with transfer bench
  • Counters edges are rounded
  • Grab bars near the bath and toilet.
  • Handrails extend beyond the top and bottom of the stairs.
  • No stairs to the bedroom or bathroom.
  • Phone in the bathroom.
  • Stairway handrails on both sides.
  • Walk-in shower with pull-down seat.

Difficulty: Hearing Impairment
Possible Remedies:

  • Dishwasher is ultra-quiet to reduce background noise.
  • Increased volume on phones.
  • Smoke detectors have strobe lights.

Difficulty: Limited Reach
Possible Remedies:

  • Cabinet shelves are no more than 10 inches deep.
  • Closet organizer to reach belongings.
  • Closet rods pull down to a comfortable level.
  • Clothes washer and dryer are front-loading
  • The cooktop has easy-to-reach controls at the front.
  • Electrical outlets are 27 inches above the floor.
  • Handheld shower in the bathroom.
  • Kitchen and closets have pull-down shelving.
  • Lazy Susan to reach things stored on deep shelves.
  • The microwave oven is no higher than 48 inches above the floor.
  • Oven doors swing to the side.
  • Pull-out shelves in the kitchen.
  • Side-by-side refrigerator.
  • Sink controls are on the side
  • Upper kitchen cabinets are 48 inches from the floor.

Difficulty: Limited Vision
Possible Remedies:

  • Edge of counters a different color than the top.
  • Edge of each step is a color that stands out.
  • Increased wattage of light bulbs.
  • Lights are in all closets.
  • Outside walkways and entrances are all well-lit.
  • Stairs are well lit.
  • Steps are a different color than the surrounding area.
  • Stove controls are clearly marked and easy to see.
  • Stove has big numbers that can seen from across the room.
  • Stove uses different colors to tell which parts are hot.
  • Under-the-cabinet lights are over the kitchen counter.

Difficulty: Weak Hand and Arm Strength
Possible Remedies:

  • Automatic garage door opener.
  • Cabinets and drawers have D-shape handles.
  • Countertops smooth so heavy pans can slide across them.
  • Doors have lever handles.
  • Garbage disposal to reduce trash
  • Heat-resistant counter near the microwave oven.
  • Push-button controls are on appliances.
  • Rocker light switches
  • Sinks with lever faucet handles.
  • Special hardware to make drawers slide easily.
  • Spray hose to fill pots on the stove
  • Trash compactor to minimize trash bags.
  • The dishwasher is eight inches from the floor.

Difficulty: Trouble Bending
Possible Remedies:

  • Elevated toilet or toilet seat.
  • Lower kitchen cabinets six inches above the floor.
  • Sink no more than 6 inches deep.
  • Carpet is low pile and a firm pad.
  • Clutter and electric cords are out of pathways
  • Countertop that can be used while sitting
  • Doors are wide enough for a walker to get through.

Difficulty: Trouble Walking and Climbing Stairs
Possible Remedies:

  • Driveway is smooth, but not slippery.
  • Floors are smooth and slip-resistant.
  • Knee space under sinks, can sit while washing.
  • Knee space under the stove, can sit while cooking.
  • No area rugs.
  • Ramp to the front door with handrails on both sides.
  • Stairs have a slip-resistant surface.
  • The threshold on the door is no higher than 1/4 inch.

Difficulty: Using a Wheelchair
Possible Remedies:

  • Walk-in closet that is wide enough for a wheelchair.
  • Appliances have controls at the front
  • Cabinet shelves no more than 10 inches deep.
  • Can use my counter while sitting in a wheelchair.
  • Can wheel from car to the front door and then inside.
  • Can wheel to bedroom, bathroom, and kitchen.
  • Closet organizer to help reach all belongings.
  • Closet rods pull down to a comfortable level.
  • Clutter and electric cords are out of pathways.
  • Doors and hallways are wide enough for a wheelchair.
  • Electrical outlets are 27 inches above the floor.
  • Enough floor space near doors to move the wheelchair.
  • Floors are smooth; carpet has a low pile and a firm pad.
  • Handheld shower.
  • Heat-resistant counter near my microwave oven.
  • Kitchen ad closets have pull-down shelving.
  • Knee space under all sinks.
  • Knee space under the stove.
  • Lazy Susan to reach things stored on deep shelves.
  • Microwave oven is no higher than 48 inches above the floor.
  • Oven doors swing to the side.
  • Pull-out shelves in the kitchen.
  • The ramp has an edging.
  • Ramp to my front door with landings at bottom and top.
  • Roll-in shower.
  • Side-by-side refrigerator.
  • Space to transfer from wheelchair to toilet.
  • Threshold on the door is 1/4 inch or less.
  • Walkway and driveway are smooth but not slippery.
  • Way to transfer into the tub.

Walk-In Bathtubs can aid people with limited mobility, seniors, and the disabled. Some include the therapeutic benefits and luxury of a whirlpool tub, with the safety, accessibility, and simplicity of access. Perfect for those with limited mobility who wish to enjoy the freedom of living comfortably at home.

Additional Items to Review

Safety Checklist

Safety Related Items

To successfully "age in place" requires identifying and correcting any safety pitfalls. These may include many things, some of which were noted in the table above. However, preventing falls and other accidents must be a major focus to assure a safe environment. Further discussion of safety-related items can be found here.

Low Vision

Senior Low Vision

Over one million Americans aged 40 and over are currently blind, and an additional 2.4 million are visually impaired. The leading causes of vision impairment (low vision) and blindness in the U.S. are diabetic retinopathy, age-related macular degeneration, cataract, and glaucoma.

DIABETIC RETINOPATHY is a common complication of diabetes. Retinal blood vessels can break down, leak, or become blocked, affecting and impairing vision over time. Nearly half of all people with diabetes will develop some degree of diabetic retinopathy during their lifetime, and the risk increases with age and duration of diabetes. People with diabetes are encouraged to seek annual dilated eye exams. Currently, laser surgery and a procedure called a vitrectomy are highly effective in treating diabetic retinopathy. Research into pharmaceutical treatment options is continuing.

AGE-RELATED MACULAR DEGENERATION is a condition that primarily affects the part of the retina responsible for sharp central vision. There are two forms of AMD -- dry AMD and wet AMD. Because AMD often damages central vision, it is the most common cause of legal blindness and vision impairment in older Americans (AMD rarely affects those under the age of 60). While there is no generally accepted treatment for dry AMD, laser therapies to destroy leaking blood vessels can help reduce the risk of advancing vision loss in many cases of wet AMD. Research sponsored by the National Eye Institute has recently shown that a combination of zinc, vitamins C and E, and beta-carotene may also reduce the risk of advanced AMD by 25 percent.

CATARACT is a clouding of the eye's naturally clear lens. Most cataracts appear with advancing age. Scientists are unsure what causes cataract. The most important factor is increasing age, but there are additional factors, including smoking, diabetes, and excessive exposure to sunlight. Cataracts are the leading cause of blindness in the world and affect nearly 20.5 million Americans age 40 and older. By age 80, more than half of all Americans develop a cataract. A cataract is sometimes considered a conquered disease because surgical treatment that can eliminate vision loss due to the disease is widely available. However, cataract still accounts for a significant amount of vision impairment in the U.S., particularly among people age 65 and over who may have difficulty accessing appropriate eye care.

GLAUCOMA is a disease that causes gradual damage to the optic nerve that carries visual information from the eye to the brain. The loss of vision is not experienced until a significant amount of nerve damage has occurred. For this reason, as many as half of all people with glaucoma are unaware of their disease. About 2.2 million Americans age 40 and older have been diagnosed with glaucoma, and another two million do not know they have it. Most cases of glaucoma can be controlled, and vision loss slowed or halted by timely diagnosis and treatment. However, any vision lost to glaucoma cannot be restored.

Those affected by low vision often become depressed, are prone to falls and resultant injuries, and many are socially isolated. Several things can be done to assist those with low vision. Tips for handling low vision situations can be found here.

Low Vision

Senior Fire Safety

The physical and mental impairments that tend to accompany aging tend to reduce older adults' reaction times and place them at a higher risk for causing fires, and thus at a higher risk of fire injury.

Disabilities present additional fire risks and concerns for the elderly. Many Medicare enrollees are unable to complete at least some of the normal activities of daily living (ADL) necessary for a degree of self-sufficiency. Economic and social concerns also contribute to the fire risk for older adults. Most live on fixed incomes, and many live in poverty. Hence, they may be unable to afford to make necessary home improvements that could substantially reduce their risk of fire.

Unattended cooking ranges are the #1 cause of home fires in the US.

Several other tips for addressing senior fire safety can be found here.

Pest Control

Pest Control

Pest control is a big headache and a big business. Over $5 billion in damage annually is caused by termites alone. Seniors may face unique problems and considerations when they have a pest infestation. The response to pests is a function of the importance of the damage done, and ranges from tolerance, to deterrence and management, to attempts to completely eradicate the pest. Many homeowners, renters, and landlords can control household pests through a combination of preventive measures, including proper sanitation and good home maintenance practices. However, some infestations may be extensive, or a particular pest may be difficult to eliminate. These may need pest control company services.

In residential settings, the pests include termites, cockroaches, bed bugs, mosquitoes, rodents, and other organisms. These share our environment and feed on and spoil possessions. A significant concern is that pests may transmit diseases. Standard control methods for these pests are exclusion, repulsion, physical removal, or chemical means.

Learn more about pest control for seniors.

Remodeling Your Home for your Age

There are many items to consider when remodeling your home. You may wish to consult a professional Aging in Place Specialist early in your evaluation process. No one is going to make all of the modifications, but be wise regarding those you focus on, i.e. if you already know your eyesight is failing, focus on modifications that benefit poor, or poorer eyesight the most. If you have arthritis that impairs mobility, focus on modifications that cater to your anticipated increasing mobility limitations.

Adapt lower floor of home for possible one level living Increased incandescent general and specific task lighting Easy garage or parking access At least one entry is without steps Doorways 36" wide with off-set hinges on doors Levered door handles instead of knobs Electrical outlets at 18 inches instead of 12 Easy to open or lock patio doors and screens Light switches at 42" instead of 48 Adjustable controls on light switches Luminous switches in bedrooms, baths and hallways Strobe light or vibrator-assisted smoke and burglar alarms Lower window sills especially for windows on the street Programmable thermostats for heating and cooling Contrast colors between floor and walls Color borders around floor and counter-top edges Non-skid flooring Matte finish paint, flooring and counter-tops Non-glare glass on artwork Peephole at a low height Incorporation of an emergency response system installed or wearable

Lever faucets and faucet mixers with anti-scald valves Temperature controlled shower and tub fixtures Stall shower with a low threshold and shower seat Grab bars at the back and sides of shower, tub, and toilet or wall reinforcement for later installation Bathrooms with turn-around and transfer space for walker or wheelchair (36" by 36") Higher bathroom counters Telephone jack Installation of a medical response device

Kitchen cabinets with pullout shelves and lazy susans Easy to grasp cabinet knobs or pulls Task lighting under counters Cooktop with front controls Side by side refrigerator Adjustable upper shelves and pull out lower shelves Variety in kitchen counter height - some as low as table height (30 inches) Gas sensor near gas cooking, water heater and gas furnace Color or pattern borders at counter edges

Living Room
Seating at least 18 inches off the floor Chairs with sturdy arms

Make Your Home Aging-in-Place Friendly

As we age we don’t hear so well, we sometimes forget or get confused and we can even outlive doctor’s predictions about our longevity. So as long as we persist in growing older, why not arrange our homes to accommodate our reality. Incorporate memory triggers into the way we arrange cabinets and counters, Add soft fabrics to muffle background noises, change appliances to better accommodate our short-comings and make our homes senior-friendly.

We highly-recommend contacting an Aging in Place Specialist near you - they are trained to assess your situation and make recommendations that will allow you to age in place in a way that meets your goals.

Also visit: The Universal Design Living Laboratory: A National Demonstration Home by Rosemarie Rossetti, PhD

Possible Assistance Needs

To "age in place," one should be aware of community help and services available to deal with increasing frailty or age-related problems. They may also be needed in the event of illness.

Services can provide:

  • Outdoor home maintenance and gardening
  • Indoor home maintenance
  • Heavy or light cleaning and housework
  • Driving
    • Trips to the grocery store
    • Other shopping trips
    • Home delivery of groceries
    • Transportation to doctors appointments
  • Homecare
    • Meal preparation
    • Bathing and dressing
    • Personal care assistance
    • Home nursing
  • Emergency call/response systems
    • In your home
    • To wear on your person

Hiring Personal Care Help

Non-medical in-home support services provide an opportunity for frail or ailing people to stay in their home and perhaps maintain a more independent lifestyle than a group home might offer.

Agencies can provide experienced caregivers who can assist these seniors in several ways. Reputable agencies are bonded and insured, and their employees are covered by workers compensation and are regularly supervised. Caregivers may work for a client a few hours per day or 24 hours, seven days a week. They prepare meals, do housekeeping, medication reminders, run errands, manage incontinence, give baths, and help clients transfer. They also provide valuable companionship and encourage clients to exercise and participate in activities. They are a help when a caregiver lives at a distance, or with the frail senior, and cannot do all the services necessary.

Non-medical homemaker services are often confused with licensed home healthcare agencies. Some of these agencies also offer non-medical care, but generally, they provide nursing types of services on an intermittent short-term basis. The client usually has a medical need that requires the expertise of an RN, physical therapist, or some other medical specialty. In-home supportive companies often work hand in hand with home healthcare companies to help their clients.

In-home support services range from $15-$20 dollars per hour and $140- $300 for 24-hour care. Long term care insurance policies can help meet some of this cost. People who cannot afford this cost may hire people privately for less money. However, they are taking a risk and will have to manage these caregivers with no professional assistance. However, reality sometimes dictates that this is the only viable choice.

Whether you hire an agency to send you a helper or hire one directly, consider the following points:

  • Inquire if there is a charge for the interview.
  • Interview the candidate/agency.
  • Get three work references for the candidate.
  • Get client references for the agency.
  • Is the care provider or agency bonded?
  • Obtain the Department of Motor Vehicle print out from their driver's license.
  • Do a Felony Background Check or know that the agency has conducted one. An Investigating Service will do this for a small fee.
  • Ask for proof of provider (or agency) worker's compensation insurance.
  • Ask for proof of care provider (or agency) full professional liability insurance.
  • If the care provider is unable to work one day, will the care provider (or agency) provide a substitute care provider?
  • How many years have you been in home care?
  • What were your duties for your last two patients?
  • What is your favorite duty while taking care of a patient?
  • What is your least favorite duty?
  • On a scale of 1-10, 10 being best, how do you rate your:
    • Cooking skills?
    • Housekeeping skills?
    • Personal care?
    • Ability to following directions?
    • Flexibility?
    • Ability to work with other family members visiting or living in the home

Particularlly if you are helping your parents or other older adults through the process of evaluating in-home care, read the article Helping Elderly Parents Transition To In-Home Care.

Resources, Products, and Other Considerations

Long Term Care Insurance

Because of old age, mental or physical illness, or injury, some people find themselves in need of help with eating, bathing, dressing, and other physical activities. Long-term care insurance can help pay for such care in the future. To help protect your financial independence, as you grow older, many Long Term Care Insurance providers have plans that offer comprehensive benefits as well as a proven track record of claims payments and financial stability. You should review all your options carefully.

For additional financial information, see our insurance page.

Reverse Mortgage Information

A Reverse Mortgage program enables older homeowners to free up a portion of the equity in their home and convert it into cash to put toward medical or other needs. Thus, remaining in their home for as long as they want. We have a couple of informative articles detailing the program benefits and commonly asked questions about reverse mortgage finance and general reverse mortgage information.

There are also reverse mortgage programs that can be very beneficial to homeowners who have higher home values. To read more about it, do some research on "jumbo reverse mortgage" programs.

For additional financial information, see our senior finance page.

Wheelchair Options and Accessories

Individuals with a long time disability tend to give careful consideration to the best way to acquire mobility. It is a critical element of their independence. For some, the answers have included multiple devices - different environments, different devices - a manual wheelchair in the home, a scooter for work, another device for exercise. A wheelchair is much more than "looks." There are as many differences in wheelchairs just as there are differences in cars or microwave ovens or any consumer product. With wheelchairs, it can be even more critical. Wheelchairs have significant differences in how they feel, how they fit, how they respond, and what they enable us to do. There are many differences in wheelchair users. Users vary in Age, Gender, Body Type, Medical Condition, Desired Activities, Environment, and Personal Preferences. Thus many combinations of people and mobility equipment make it important to carefully consider any equipment purchase. For many decisions, there is even a caregiver who figures into these decisions. The United Spinal Association offers a guide to lead you through such decisions.

Options and Accessories
Wheelchair options and accessories make a wheelchair more suitable for a person’s specific illness, injury, or condition. Medicare covers options and accessories for wheelchairs when a patient has a wheelchair that meets Medicare coverage guidelines, and the options or accessories are necessary for the patient to perform normal daily activities.

For an option or accessory for a manual wheelchair to be covered, a written signed and dated order must be received by the supplier before a claim is submitted to the Durable Medical Equipment Regional Carrier (DMERC). If the supplier bills for an item without first obtaining the completed order, the item will be denied as not medically necessary. Also, supporting documentation for the medical need of this item must be on file.

Patient Lifts
Patients Lifts offer caregivers the ability to utilize mechanically assisted transfer. Using patient lifts help prevent occupational injuries associated with repeated manual lifting. Transfers are difficult on both the caregiver and the patient's body. Patient lifts allow for transfers from beds, wheelchairs, showers, and bathtubs.

While you might first encounter a patient lift in a hospital, there are affordable options made for your home. Check out the affordable selection on Amazon here.

Aging in Place Specialists and Resources in your State