One thing my wife, Rose, and I have noticed in our trips to the nursing home is that nobody wants to be there. They would all rather be home. Most could not function on their own, because of dementia or some other infirmity, but maybe one-quarter or a third of the people we met were mentally and psychologically fine, but physically not so good.
Many of these people could have avoided the nursing home experience, and the horrendous expenses involved, if they had been able to remodel their homes to fit their needs and had the time to do it. The trouble is, by the time they realized their needs, it was too late and too expensive.
Wendy Lamirand, of Medina, has been an occupational therapist for 16 years and has earned a Certified Aging in Place Specialist (CAPS) designation from the National Association of Home Builders. She has noticed a growing collaboration recently between builders and occupational and physical therapists to allow people to live in their homes longer.
"What we do is go into the home and perform a home assessment," Wendy says. "We ask the person to go through her regular day, perform her daily tasks, and we just watch. Is the lighting OK? Is the laundry down in the basement? Is she hauling heavy laundry baskets up and down steep, dark stairs? Are the kitchen cupboards too high? Then we get together with the homeowner and the builder and say here is the problem, this is what has to be done, this is how we can solve it."
Remodeling is very expensive if you have to do it all at once. But if you plan now, before you need it, and stretch the projects, and the payments, out over five or seven years, you can save skazillions by evading, or at least delaying, nursing home costs.
Here are some things to consider:
1. Remodel so you can live on the ground level. That means wider doorways (many Internet sites say a 32-inch minimum width, but I'd go for 36 inches) to accommodate wheelchairs, main entries as level as local building codes allow, ramps instead of, or in addition to, steps. Ramps are tricky things. Most seem to be at a 1-to-12 pitch, i.e., they rise one inch for every foot in length. A 1-to-20 pitch would be better, if you have the room, and if you wind up with a long ramp, make sure you include a flat landing halfway up, to offer a place to rest. Speaking of rest, one Web site suggested putting a small shelf or bench right outside the main entry, so you can put the groceries down while fishing through your pockets for the keys.
2. The bathroom is the big-ticket item inside. It is also the room that requires the most planning and care. You'll need wide doors, lower sink (not a vanity), easily accessible storage, a walk-in (or roll-in) shower and a commode that's got room for you and the wheelchair and an aide (or two) to get around. Do not put the commode in the corner. While you're ripping out walls for the new doors and plumbing, you might as well install some backer boards between the studs to support grab bars and rails. You'll need to install those eventually. (Be patient, Lamirand says manufacturers are working on better universally designed, less institutional-looking products.)
3. Once the main entry and bathrooms are done, the rest is pretty simple. You'll need wider doorways throughout the house, lever handles instead of knobs, perhaps a flashing light to supplement doorbells and telephone rings, hard tile or wood floors or low-pile commercial carpet instead of thick carpeting and throw rugs, higher electrical outlets, lower electrical switches. (The switch-less touch lamp is a great invention.)
4. Homeremodelersgroup.com suggests that drawers are easier to find things in than cupboards. Remodelingforeldercare.com emphasizes the need for wide-open spaces, especially around the dining and kitchen area. The site also recommends telephones and TV remotes that have big buttons and lighted pads.
The National Association of Home Builders Web site (nahb.com) lists seven people, including Lamirand in Western New York, as CAPS graduates. AARP.org has a lot of information on Aging in Place and Universal Design, which is the latest buzzword for all this.
Bottom line is, if you plan now, and do a little every year, you could avoid the nursing home altogether. That would add thousands to your pocket and provide your family with some peace of mind.