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Simple changes can make a home more accessible to aging or disabled people

Multiple sclerosis keeps Debbie Russell-Hoeber at home most of the time. Her journey with the disease started 16 years ago with foot drop and hip pain. She’s since moved, slowly, into a walker and, a couple of years ago, onto a motorized wheelchair.

“I’ve learned to adapt,” she said. “I don’t want to live in some rehab center.”

Russell-Hoeber, 59, of Hamburg, is among the three of four Americans over 50 who long to live out their days at home, regardless of their health. Nearly nine of 10 people ages 65 and older feel the same way, according to AARP.

It isn’t always easy – a home health aide is a regular companion to Russell-Hoeber – and it can become costly. But families willing to make changes, both big and small, can make a good go of it.

“People don’t want to think proactively but having things in place eliminates so much stress and strain on people,” said Jill Eppolito, a physical therapist, certified aging in place specialist and owner of Accessible Home Solutions in East Amherst. “The other part about being proactive is you have more choices available to you and you can do it over time.”

You can roll with the changes that aging brings by making a home more accessible, regardless of age.

“All of the things we’re talking about that are safer and better for seniors are safer and better for all of us,” Eppolito said.

ADAPT

Russell-Hoeber and her husband, Mark Hoeber, live in one of a few dozen tidy houses on a side street in their village. The front yards on the block are modest in size, the driveways fairly narrow. She aims to stay here for as long as humanly possible. She hates to admit it, but she spends too much time watching reality TV shows about spoiled housewives in top American cities. She likes ABC sitcoms, too, and football. But hanging out with her two most constant companions, a Golden doodle named Brooks and a Cavachon named Raven, often brings the greatest joy to her days.

She and her husband bought their house in 1994, when she was pregnant with their son Jordan, now 21. The couple remodeled soon thereafter, putting in new laminate floors, widening entryways and building a walk-in closet in what needed to become a first-floor bedroom – all steps that have proven a godsend these past few years. “A lot was already here before I got MS, so we kind of lucked out,” she said.

Russell-Hoeber worked in medical billing for about 30 years. She was diagnosed with MS in late 1999. Five years later, as her gait weakened, she fell and broke her left wrist. In the later part of her career, she handled her duties at Sedona Holistic Medical Centre in Hamburg using a walker. She went on disability in 2009. The family since has added an electric vertical platform lift off the back porch so she can get out into the driveway and a new wheelchair-accessible van. She and her husband have looked over the years at a series of steps they could take to make their home more accessible. Eppolito has helped.

Many choices that make daily life more manageable for those with limitations cost less than $100, Eppolito said. Others can costs hundreds of dollars, while ramps and some home remodeling jobs can run into the thousands.

For about $300, Eppolito can do a home assessment and design a plan that allows for more ease of movement throughout a house. Residents then can find contractors on their own or choose from a list Eppolito recommends.

Too expensive? Consider the alternative: One in three people age 65 or older will fall this year, most of them in their homes. One in five will need medical care. That will run an average of $35,000 – $7,700 of which will come out of pocket, according to the Centers for Disease Control and Prevention.

Life can get much harder for those resistant to change after a fall or serious illness, Eppolito said. That’s why she recommends a closer look at the following.

Stairs

Those who need just a little help with the stairs should consider railings on both sides, properly pitched and installed. Each step should be uniform in height at least 11 inches in length to step down upon. The back of each step should be closed so a foot can’t slip through a set of stairs.

Lighting

Entrances, hallways, stairways and places where tasks are performed – to cook, read or pursue a hobby – should be generously lighted.

Doors

“I prefer a minimum 36-inch-wide door, inside and out,” Eppolito said. “We prefer lever-style handles and hardware versus the knobs that you have to grip and twist.” Interior doors should require less than 5 pounds of force to open; exterior doors, a maximum of 8 pounds. You can get an extra inch or two in a doorway by adding hinge extenders.

Flooring

“A smooth, durable, hard floor is great throughout,” Eppolito said. Tile, hardwood, laminate or vinyl are best. “There are no tripping hazards and if a person uses a walker or a wheelchair. They can move from room to room very easily without having to navigate over thick, plush carpet.” Area rugs can be a tripping hazard, especially for those with an inconsistent or unsteady gait.

Living room

Russell-Hoeber has a powerlift chair in the living room and a small TV tray that holds her remote control, reading material and her medications, the latter of which are in dated pill boxes.

Bathroom

“Many bathrooms are tiny but you can be creative and make more space,” Eppolito said. The first-floor Hoeber bathroom once had a free-standing bathtub and a separate shower stall with sliding doors and a 4-inch curb on the bottom, both of which became impossible for Russell-Hoeber to navigate. “I can’t imagine her trying to get around in that bathroom,” said Julie Stebbins, one of her home health aides, with Health Force Home Health Care Services.

The family called Eppolito about a year ago and she recommended several modifications. Today, Russell-Hoeber can be wheeled into a shower that is flush to the floor and slopes gently in every direction toward the drain. She showers in a shower chair, with a hand-held shower head. An adjustable commode with handrails can be moved above the toilet. She can slide her wheelchair underneath the top of her new vanity. Mirrors tilt downward so she can brush her teeth and hair, and apply makeup. A “rolling” or “zero entry” shower can be built in roughly the same space where a bathtub is removed, Eppolito said, and can provide caregivers more room to help get a loved one on or off the toilet. Adjustable bars and railings also can help with bathroom use.

Bedroom

Russell-Hoeber’s bedroom includes a hospital bed stashed alongside a regular bed. She also has a bed cart with a table that raises and lowers. That’s where she often keeps her cellphone.

Kitchen

Russell-Hoeber depends on her husband and home health aides to handle cooking duties. For others with limitations, countertops often need to be lowered, and knee space provided under a stove and elsewhere. Eppolito finds that those with limitations often decide to forgo the expense to remodel a kitchen, but said one quick, inexpensive change involves buying a small, countertop microwave that costs less than $100. Tables, she noted, generally are lower than countertops so should be OK for those in wheelchairs. Food prep can be handled at a kitchen table.

Hallways

Where possible, these should be a minimum of 36 inches wide; 42 is preferable because a wheelchair and person can pass each other in that space, Eppolito said. If you need to buy a walker or whee
lchair, you need to know how wide your hallways are – as well as your doorways, because you’ll need to turn from one into the other. Hallways also are rarely good spots for tables and hope chests once a walker or wheelchair is introduced to home life.

Clutter

Don’t pile up newspapers, books or boxes, particularly behind doors. “You can gain access just by removing clutter,” Eppolito said.

Maintenance

Make sure steps are in good repair, that concrete isn’t chipping, wooden steps sagging or peeling. If you don’t know a trusted handyman, ask friends, contact your senior services office or check Angie’s List at angieslist.com. And make a list of little jobs that might pop up, whether they’ve become a safety issue or just a daily inconvenience.

Eppolito stressed that families – but especially individuals – also should try to understand and accept their health conditions, especially if they’re chronic and progressive.

“I don’t know if it’s a defense mechanism that prevents people from looking that far ahead,” she said. “It’s amazing how many people are unprepared. Some people decline very rapidly. Others, it’s over many, many years. You can’t predict with aging, but having things in place from the start, you never have to worry as much.”

RESOURCES TO MAKE HOME SAFER

Erie County Caregiver Coalition

eriecountycaregiver.com; 858-8526

Provides links on its website to help caregivers in a variety of ways, including with health care questions, home safety assessments, advanced care planning, transportation and proper nutrition.

NY Connects

aging.ny.gov; (800) 342-9871

A starting point for those looking for caregiving services, including the Erie County Department of Senior Services or outlying county Offices for the Aging, as well as a variety of support for families dealing with loved ones of any age who have a range of physical and mental health conditions.

Network in Aging of WNY

networkinaging.com; 829-3712

University at Buffalo-based agency of professionals devoted to promoting safe, healthy aging. Includes links to a variety of agencies including home health care information.

Accessible Home Solutions

accessiblehomesolutions.org; 628-5479

Private East Amherst company serves the region with aging-in-place planning.

COST OF FALLS

• Each year, 2.5 million Americans age 65 and older are treated in emergency departments for injuries from falls.

• More than 95 percent of hip fractures are caused by falling.

• At least 250,000 older people are hospitalized annually for hip fractures.

• Falls are the most common cause of traumatic brain injuries.

• The average hospital cost for a fall injury is $35,000 – $7,700 of which are out-of-pocket expenses.

Source: Centers for Disease Control and Prevention

Aging in Place resources at Buffalo & Erie County public libraries

Because devices that can help those with limitations change at a rapid rate, many books can become obsolete within a few years, said Renée Masters, a registered nurse and outreach librarian based at the Central Library. Here are some books and websites she recommends that can provide valuable information.

BOOKS

“The Illustrated Guide to Assistive Technology and Devices: Tools and gadgets for living independently,” Suzanne Robitaille

“Dressing Tips and Clothing Resources for Making Life Easier,” Shelley Peterman Schwarz

“Making Life More Livable: Simple adaptations for living at home after vision loss,” Maureen A Duffy

SUBJECT GUIDES

These provide access and direction to a variety of useful resources. Visit the library website at buffalolib.org then click on Subject Guides. Choose the Disability Resources and Caregiving guides.

WEBSITES

AbleData (abledata.com): Provides comprehensive information on products, solutions and resources to improve productivity and ease life’s tasks. AbleData is funded by the National Institute on Disability, Independent Living, and Rehabilitation Research. It is part of the U.S. Department of Health and Human Services’ Administration for Community Living. It does not sell products nor endorse any nongovernment websites, companies or applications.

Family Caregiver Alliance (caregiver.org/choosing-assistive-technology): California-based organization devoted to helping caregivers of seniors and the chronically ill.

AgingCare (agingcare.com/products): A commercial site that offers links to resources for a wide range of needs designed to help people live independently.

mail: refresh@buffnews.com

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