Remodelers Can Help Seniors Remain in Their Homes Longer

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By Elizabeth Seay
From The Wall Street Journal Online

Mary Zelle, an active traveler, recently found there was one place she was having trouble getting around: her own bathroom.

At age 70, she was in good health, but after foot surgery, she found her balance was off. “I was always afraid of falling in the bathtub.” That got Ms. Zelle and her husband, John, thinking about their future in their house just outside Chattanooga, Tenn. “We don’t want to move unless we absolutely have to,” she says.

The Zelles are one of a growing number of families across the country who find themselves at a crossroads: They wish to remain in their homes as they age, but they recognize that their kitchens, bathrooms, hallways and bedrooms need to be safer and easier to navigate.
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That need is giving rise to an army of experts who are eager to help people age in place. Many are home builders and remodelers, with titles like certified aging-in-place specialist. Others are interior designers, architects and occupational therapists. Even appliance and gadget makers, health-care providers and lenders are jumping in.

But who is the best person to help you with the task of continuing to live in your home — and do you really need a specialist?

The one issue that most experts agree on is that the sooner you plan for changes in your home, the better.

” ‘I’ll get to that when I fall and break my hip’ is not a great approach,” says Nancy Thompson, a spokeswoman for AARP, a membership group for older Americans.

Hiring a Contractor

A contractor is the person many homeowners automatically turn to when it comes to home improvement. But there are some contractors out there who are trained to deal with the specific needs of older homeowners.

The National Association of Home Builders says its certified aging-in-place specialists, or CAPS, help ensure that older adults get help from people familiar with their needs. Since the NAHB program started in 2002, more than 1,000 building contractors, as well as architects, occupational therapists and other professionals who seek to work with older adults, have been certified.

The certification involves three days of instruction. One day is devoted to design solutions for aging people. A second day is devoted to working with and marketing to older adults — including things like communicating clearly, using readable print in a contract, avoiding jargon, and responding to reasons why potential clients may be reluctant to make aging-in-place modifications. A third day — which is optional for those who have received some other NAHB certifications — covers how to run a remodeling business.

Though the instruction is brief, teachers and NAHB executives say the classes expose their students to critical knowledge. For one, CAPS contractors are familiar with common alterations, building codes, specifications — including how high to mount a bar for grabbing in the shower and how to figure out wheelchair clearance for a roll-under sink — and sources for specialized products, according to Jim Lapides, communications manager for the NAHB’s Remodelors Council.

Moreover, Mr. Lapides says, CAPS contractors think about appearances. “No concrete stairs with the edge painted bright yellow,” he says. Instead of putting a wheelchair ramp on a house, a contractor may add an attractive sidewalk that gradually rises to the level of the house.

Vince Butler, a CAPS instructor and owner of Butler Brothers Corp., a design-build remodeling company in Clifton, Va., says CAPS contractors also can make suggestions that homeowners may not have thought of. For instance, if clients are already renovating a bathroom, a contractor who’s thinking ahead can reinforce the spaces behind the walls so they can later put in “grab bars” to hold onto in the shower, or put electrical outlets in places where they won’t prevent a doorway from being widened later for wheelchair access. Or if designing an addition, they may want to create space for a future elevator shaft by stacking closets on top of each other.

“A lot of solutions are design solutions,” Mr. Butler says. “It’s not just stuff that is listed in a book…. It’s just as challenging as any other type of good design, and maybe even a little more difficult, because no client wants to make this look institutional.”

Most experts advise getting recommendations on contractors from friends; getting several bids on a job; asking for written agreements, with small down payments; and checking out contractors with the local Better Business Bureau.

Thinking Ahead

Larry Sanders, a CAPS client in Houston, says it can help to hire a contractor who knows how to design for the aging.

Mr. Sanders, 56, says he realized he needed help when the nurse attending his wheelchair-bound mother, 85-year-old Deloris Sanders, told him flat out: “You need to fix your momma’s bathroom.” The home-nurse service helped him find a CAPS contractor, Dan Bawden of Houston.

“We intended to do something, but it wasn’t like we knew what that something was going to be,” Mr. Sanders says. “These guys did. You could think all day and some of this stuff wouldn’t occur to you.”

His mother’s new bathroom has a giant shower that her aides can roll her wheelchair into and move around in, a big shower bench, hand grips, and a special showerhead on a hose. She can run her wheelchair under the sink and easily use a one-handled faucet. Mr. Sanders also appreciated touches such as bathroom-door hinges that allowed the doors to open wider without requiring a bigger doorway, as well as a front-door threshold that flattens when a wheelchair runs over it.

The cost: just over $20,000. He says the project came in at budget, with no surprises.

Plus, Mr. Sanders says, with input from his wife, Fran, the contractors put in new tiles that make the bathroom “the brightest, sunniest little room you’ve ever seen in your life,” he says. “It doesn’t look like a handicapped bathroom.” Down the road, he says, when they have to sell the house, “someone is going to walk in and say, ‘That’s a great shower.’ You could just frolic in it.”

For Ms. Zelle’s bathroom, the Zelles chose a local general contractor they had worked with before. This spring, they widened the doorway and put in a taller toilet. They also took out the bathtub so she didn’t have to step over its side, and replaced it with a shower stall that featured a built-in seat. The job cost around $4,000, Ms. Zelle says.

Next, she’s considering easier access to the front porch. There is just one step, she says, but “if I have to have any more surgery, I would like a ramp put on so I could walk up. One step can be quite a barrier.”

Other Resources

While experts on aging and accessibility agree that many homes will require alterations in coming years, some say remodeling that requires a contractor isn’t always needed. Their advice: First, check other sources of information.

“Aging in place is not just architectural design,” says Doug Usiak, executive director of the Western New York Independent Living Project family of agencies, which help people with disabilities. “And very few independent contractors look at the overall picture of the person’s functional abilities.”

One resource is an independent living center, a nonprofit organization that provides services to people with disabilities. About 600 of these centers can be found across the country, and many offer free assessments of a home’s architectural barriers, such as steps and narrow doorways. After people have a sense of what they want, they can find product resources, design consultants — or contractors — through the centers.

Occupational therapists, state agencies on aging and local offices for senior services also can help.

Occupational therapists are trained to look at many aspects of aging — physical, cognitive, sensory and social — and they tend to have a broad “knowledge of human capacity,” says Carolyn Baum, president of the American Occupational Therapy Association, or AOTA. And that allows them to tailor their recommendations to a client’s needs and offer hands-on training to help people make the most of changes in their home.

For instance, to help someone with weak vision to cook, therapists not only may suggest new lighting and touch or high-contrast controls for ovens but also can help train clients to prepare a meal differently, relying on nonvisual cues, according to the AOTA. Or for someone with less mobility, therapists might start by moving a washer/dryer to the kitchen from the basement, suggest using a reaching device and a wheeled laundry basket, and help the client come up with a new laundry routine.

A growing number of occupational therapists either work with remodelers or have undergone training through programs like CAPS itself, a new AOTA certification in environmental modifications, or courses at Washington University in St. Louis and other schools that help them to translate their knowledge into suggestions for modifying spaces.

“You should consult with a person who understands the aging process, the access issues, and can give you a written report, so you can sit down and make a decision,” Mr. Usiak says.

Modifications don’t have to be expensive to make a difference. In 1999, the Rehabilitation Engineering Research Center on Aging at the University at Buffalo in New York published a study in which a group of people age 60 and older received some basic assistive technology, such as magnifiers and reachers, and simple home modifications, such as getting rid of loose throw rugs and adding hand rails on stairs.

Within 18 months, this group racked up just one-third of the health-care costs of a group who didn’t receive these modifications. “If people used the assistive technology, they could maintain their functional status,” says Machiko Tomita, the data analyst for the study. “If they didn’t, they declined.”

The total cost of the modifications: $2,620 per person.
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