When Ellen Connor needed a hip replacement in October, her doctor recommended that rather than being discharged to a rehab facility, because of COVID-19 it would be better to go home after surgery.
The only problem for the 83-year-old was the flight of 14 stairs to her second-floor apartment in Baldwin. Her adult children recommended a stair lift at a cost of $3,000.
"When my daughter suggested it, I said I’m not doing that. I just didn’t think I needed it," Connor said. "But then I thought about it. Even before my surgery it was already hard to get my packages up the stairs and I had to take the steps one at a time. I really do like it. It certainly makes it more comfortable and easier to deal with everyday things like shopping."
Another change she made to her apartment four years ago also turned out to be good planning: She had the tub she hardly used replaced with a walk-in shower, built-in corner bench and grab bars for safety, as well as a comfort-height toilet. "All these changes are very helpful now," she said.
Many seniors — and their adult children — would rather they remain at home, particularly as nursing homes have been hit hard by the pandemic, said Heather Brin, the principal architect of Aging in Place Architecture in Port Jefferson. Even before COVID, according to a 2017 AARP study, 90% of people age 65 and over would prefer to stay in their own homes as they get older — and not go to a nursing home or assisted living facility.
The alternative is aging in place, a term the Centers for Disease Control and Prevention defines as "the ability to live in one's own home and community safely, independently and comfortably, regardless of age, income or ability level."
Often that means using a universal design, a concept for building, designing or remodeling your home to consider fixes that can prevent injuries, sickness, discomfort and avoidable fatalities. The problem on Long Island, said Brin, is that many homes were built in the 1960s with lots of levels, intended for young families. That can mean to age in place will require home renovations.
This was the consideration two years ago for Lynn Spinnato when it became clear that her widowed mother and mother-in-law, both in their eighties, needed to move in. She and her husband decided on a one-story extension to the rear of their existing two-story historic house in East Setauket. The addition, which was designed by Brin of Aging in Place Architecture and required getting village permits, included two new bedrooms with en suite bathrooms and a common living space. It’s separated from the existing house with a barn door with a moon-shaped window.
"They liked having that space as a private area. Even though they're older and you want to be able to watch them, they liked that independence; it was very important to them," said Spinnato, whose mother has since passed away.
Don’t wait to assess those future needs. "Preparing for the future is always better if you can do it during the calm. Smarter decisions are made when it’s not an urgent situation," said Kim Kuester, owner of 101 Mobility in Farmingdale, which sells and rents mobility equipment such as stair lifts, elevators and ramps.
"There are so many falls and complications that can be avoided by taking some very simple and inexpensive steps," said Lisa Stern, assistant vice president for senior and adult services at the Mineola-based nonprofit FCA, formerly known as Family & Children’s Association, which offers case management, financial counseling and other services for seniors.
In some cases, federal, state and local agencies can help low-income seniors modify their longtime homes. "You can also consider a reverse mortgage and Medicare will pay for medical equipment," Stern said. "People don't want to spend money on renovating their house, but the cost of putting some small things in place might be less expensive than if you were to go to an institutional facility."
Universal designs don’t have to be extensive. Stern said it’s about assessing your situation and making modifications that work for your space. When evaluating your home for future needs consider these five factors.
Ideally your home has an existing first-floor bedroom and bath, but if not, this may be a renovation to look into. Jolanda Schreurs in Port Jefferson is in the process of reviewing plans with Brin to renovate a ground floor bedroom and adjacent bathroom for her 90-year-old mother who will be moving in this year. The plans include wider doorways for walker/wheelchair access and a first-floor laundry room. "We are creating a space for both the immediate needs of my mother as well as for my husband and myself as we consider our future," said Schreurs, 63.
Review your entryways
Assess the entrances to the house. How many steps do you have and could you ramp it if needed? Are there handrails? Can you enter through the garage and if so, is there a threshold to get over? Brin said these are considerations to be aware of while you’re still mobile.
Furthermore, if you’re doing any renovations, consider widening the doorways to the ADA recommendation of a clear opening of 32 to 36 inches for wheelchair passage. "Doors to bathrooms and bedrooms are the priority," Brin said.
She also recommends replacing doorknobs with ADA lever door handles, which are easier to use if someone has grip issues. The cost to replace the doors can start at about $185 for materials and labor; lever handles start at about $30 for materials and labor.
When getting in and out of your home becomes a problem — or getting to another floor — there are several solutions.
When Renee Romero’s 86-year-old mother broke her leg in two places, she had to figure out how her mother was going to navigate the two sets of steps to the main floor of her West Babylon home. "The house has four steps, a landing and then 10 steps, so we had to connect them with two stair lifts," she said. She got two pre-owned stair lifts, which are about $2,350 each.
Other solutions for dealing with steps indoors and outdoors include threshold ramps, a wedge that gets you over the door jamb for as little as $60, and modular ramps that cover the steps to your front door.
Kuester said, "We have to watch the pitch and the slope so that it's not too steep for people. Sometimes we have to add a platform. Every house is different." The average cost to install a new ramp is $3,000 to $4,000. Pre-owned and rentals are available for less.
Stair lifts can be used inside and outdoors and a base model is $2,895 and can be rented or bought. Kuester said that when a stairway isn’t straight, or you need to connect it to another one like in a split-level house, there are curved stair lifts, which are customized. They start at around $12,000.
There are also motorized vertical platforms that start around $6,000 and usually are the height of four to six steps. Flex steps convert four to seven steps into a platform for a wheelchair that lifts. The cost starts around $20,000.
Or consider a home lift, or elevator, that can be installed, usually behind stairs or through closets. The cost starts in the mid-$20,000 range.
Michael Shapiro, 78, had an electric elevator installed in his Massapequa home in October for a cost of $30,000. "We have four stories and my wife has a bad leg so doesn’t do stairs well and I have bad knees and we figured why wait until it gets so bad we can’t do anything? The elevator was fitted into a coat closet with half in and half extending out, so no real room was lost. It goes from the second floor to the fourth floor where the bedroom is."
Brin said there are simple steps you can take during your next update to prepare for ease of use and safety in the future.
"When you do general maintenance or updating, that's the opportunity to think about future-proofing," Brin said. "That means, for instance, if you're opening up bathroom walls, you put a nailing block at a height of approximately 36 inches above the finished floor behind the Sheetrock. You can do that in the shower area and near the toilet. If sometime in the future you need to put in some grab bars, you can screw them right through the tiles or Sheetrock into the nailing block. Before you tile it over, take pictures to see exactly where it is." The nailing block must be able to bear a weight of at least 250 pounds, Brin said.
You can do the same behind the bathroom vanity in case you need a wall-mounted sink in the future to slide a wheelchair under. Brin suggests tiling under a floor-mounted vanity so that if you do need to remove it, the floor won’t need to be repaired.
If you’re putting in a new toilet, rather than a standard height, which is 15 inches, Brin recommends installing a comfort-height toilet, which is 17 to 19 inches and starts at about $220 for labor and materials.
You can also replace a tub with a low threshold or no threshold shower as Connor did.
Brin said when renovating your kitchen, consider areas that can easily be changed in the future. For instance, many kitchens have desks. "That desk works well for a wheelchair so it has a dual function," she said.
Rather than putting the microwave above the stove, consider putting it at counter height. The counter area near the sink could have removable cabinets underneath.
"The biggest issue with future-proofing is to have the components there and you don't necessarily have to go all the way to install them, but you have the option to pull something out and put something else in," Brin said.
Resources for aging in place
For resources for seniors who are considering modifying their homes, contact:
- FCA: 516-746-0350
- Nassau County Office for the Aging: 516-227-8900
- Suffolk County Office for the Aging: 631-853-8200
- Community Development Corp. of Long Island: 631-471-1215 ext. 227, or email@example.com
These three organizations can do safety assessments as well as construction: