Living in Place

Helping aging parents to find the most comfortable living arrangements.

Helping an aging parent find the most comfortable living arrangements is something most of us will experience at some time.

BY BILL HENSLEY

MOM, CAN I HAVE THE CAR KEYS? Most of us can remember the first time we got a positive response to this question. Perhaps around age 16? And hopefully with a recently earned driver’s license. It was a rite of passage to be celebrated. The car represented freedom, adventure, excitement and a healthy dose of worry for our parents. And not unwarranted worry. As sixteen-year-olds, we knew we were perfect drivers who made no mistakes and were always safe enough. As adults decades later we know better.

My mom was a vigorous woman, fiercely independent and usually got her way. She played tennis with a mean backhand till age 80, and then got a couple of hip replacements over the next few years. As might often be the case, she probably should have stopped driving well before I finally asked for the keys back sometime around age 90. Still, it wasn’t an easy request. Neither my brother nor I lived close to the home we grew up in, and when I suggested it was time for one of us to make a special visit to “ask for the car keys” he replied, “you’re right, let me know how it goes.”

It actually went quite well. Fortunately, she had a friend/ helper who was already handling some of the driving. Being sharp as a tack, mom probably realized it was for the best. This was just one of the many episodes in the several decades long aging in place trajectory. Mom was always adamant about staying in the house she called home since 1958 and we were happy to help. She finally passed a few weeks shy of 100 years old right where she wanted to be.

Helping an aging parent find the most comfortable living arrangements is something most of us will experience at some time. Looking back, my brother and I had it rather easy. Mom knew what she wanted, and we made it work. There were bumps, scares and hospitalizations along the way, and towards the end the care was 24 hours a day. But the house was a single story with only one step up to the front porch, so the modifications we needed to make were minimal. One thing we certainly didn’t have to consider several years ago was the novel coronavirus and COVID-19.

the new normal?

In mid-June the Kaiser Family Foundation reported that as of June 4th over 43,000 COVID-19 related resident and staff deaths had been reported in long-term care facilities and nursing homes by the 41 states that reported COVID-19 long term care data. In 27 of those states long-term care and nursing facility residents accounted for 50 percent or more of all COVID-19 deaths. And in early July as the country tried to get back to business, new infections are spiking in the general population at 50,000+ per day and hotspots were on the rise in many states.

In this COVID-19 era seniors and their family members are rethinking what it means to be safe in long-term living arrangements. Many are concluding that the best option includes making some modifications to the place called home, either on their own or with family members. Aging is of course a continuum, one that varies from individual to individual. We won’t attempt to be all inclusive in this story but intend to get us all thinking about options.

don’t call it aging in place

We begin by asking what makes for successful aging in place during our later decades? First, it’s important not to think of it as “aging in place” at all. Yes, aging is happening but the thing we all are doing first and foremost is living—getting on with our everyday activities in a comfortable and safe home environment

Working with our aging living-in-place clients, we start where design and technology professionals always start—by asking questions. Questions that uncover not just the surface wants, but the needs that underly them. Questions that help us create that one-plus-one-equals-three scenario where the home not only removes dangers and obstacles but is intuitive to the occupants’ needs. As designers, builders, and home technology pros, we are the ones who can make a difference as our clients embark on a home reset that helps them get on with living. Perhaps they are looking at modifications to an existing home to make it more friendly and responsive to their approaching years of reduced vigor. Perhaps they are planning a new home that meets these same needs, while downsizing out of the larger home in which they raised a family. Perhaps it is the adult children of that family planning a remodel that creates a separate-but-connected apartment for mom or dad to move into. In each case, the question is “how do we enable independence?”

Co-Founder of the Living In Place Institute, Louie Delaware, advises professionals in the building, design, and medical fields on the importance of identifying and mitigating the household danger spots when designing the “forever in place” home. “Home is where the memories were made,” says Delaware, and the Institute is dedicated to educating professionals on the important factors in designing and building new and remodeled homes to make them safe, comfortable, and accessible for everyone. The Institute offers the Certified Living In Place Professional™ (CLIPP™) program, endorsed by the National Kitchen & Bath Association.

Toni Sabatino is a CLIPP certified member of several industry design councils, an award-winning member of the Interior Design Society and a member of the Sustainable Furnishings Council. “A well-designed home for someone living in place is one that makes everyone feel comfortable and secure,” she says. “It becomes everyone’s favorite place because it’s accessible and easy. It has to function well so the people who own it get to age naturally and gracefully in it.”

“Let’s start with flooring,” continues Delaware. “Choose materials that have a reasonably high coefficient of friction. And where possible, widen doorways and remove thresholds.” Thresholds are trip hazards, and at some future point, the doorway may need to be widened to accommodate caregivers assisting clients with walking or in a wheelchair. Bedroom and bathroom doors that open away from the room have an added safety benefit; if someone falls against the door they don’t risk being trapped in the room. Overall, open floorplans work well for mobility. Delaware emphasizes, “We can assist our aging clients and family members’ cognitive stamina by making it easier and less stressful to navigate the home.”

Floor temperature can also reduce stress and in colder climates in-floor heating is a beneficial option. For most of us it will be added comfort and one less point of possible stress. But cold tile floors can also “set nerves on overdrive,” particularly in adults affected by peripheral neuropathy—damage or dysfunction of nerves that can result in numbness, tingling, muscle weakness and pain in the extremities. Risk factors for neuropathy include advancing age, high blood pressure, high cholesterol, obesity, and diabetes (more on diabetes later).