SLINGERLANDS – There are about 48 million Americans over the age of 65, a number that is expected to double by 2060, according to the United States Census Bureau.

Where and how those people live has changed greatly over the years.

The number of nursing homes, once the only idea that many had when it came to long-term care, has declined even as the over-65 population has increased. The number of nursing homes declined by 15 percent between 1977 and 2014, while the number of Americans aged 65 and over increased from 10.6 percent of the population to about 15 percent, according to the United States Department of Health and Human Services’ Centers for Disease Control and Prevention. Nursing homes are being replaced by assisted-living or continuing-care communities, and in-home care.

“Aging in place” is one option that has given elderly people the ability to continue to live in their homes as long as they are able.

Lynda Shrager, in her new book, “Age in Place – A Guide to Modifying, Organizing and Decluttering Mom and Dad’s Home,” take readers room-by-room and step-by-step through modifications that can be made to an elderly person’s home that will allow him or her to remain in it.

Shrager, a Slingerlands resident who has her own home-assessment business, told The Enterprise that she starts at the home’s entryway; leveling thresholds eliminates a common tripping hazard as well as a barriers to entering the home or other room, especially people using wheelchairs.

Room by room

She will then move to the living room, where she will watch the home’s elderly resident get on and off the furniture, “because there are a lot of modifications that can be done if they are having trouble.”

As the resident moves to the kitchen, Shrager will observe how she gets things out of the cabinets or refrigerator; how she uses the oven; and, if she uses a walker, how she maneuvers.

To avoid bending or straining, she recommends side-by-side refrigerators, “it is the best option for the elderly or people in a wheelchair,” she said. Shrager, an occupational therapist, will then go through the contents of the refrigerator and ask the senior citizen which items are used most often and will then place them in order where they can be easily retrieved.

Moving to the bathroom, where, she said, most falls occur, Shrager will check the height of the toilet, which is a big deal. “It truly is,” she said.

Older homes usually have toilets with seats that are between 15 and 17 inches high, which can be a real inconvenience for someone with disability or injury, she said. To make it easier to sit, Shrager would recommend a “comfort height” toilet, which has a seat between 17 and 19 inches high. She also said that there are different attachments, like a toilet-seat riser, that she could recommend.

“Then, of course, the biggie, which is the shower,” Shrager said. Ideally, she said, a no-threshold, walk-in shower is the best option, but there are space and cost considerations. The national average for a walk-in tub installation, according to fixr.com, a site that provides cost guides and comparisons for remodeling projects, is between $5,000 and $7,000.

Shrager said that she is a huge proponent of grab bars. “It is much, much safer to have something to hold onto when you are in the shower,” she said. She also recommends installing the bars elsewhere, for instance, next to the bathroom sink or in a long hallway.

In the bedroom, the height of the bed is an issue. If it’s too low, an elderly person has no problem getting on the bed, but could have trouble getting off, or, if it’s too high, the senior won’t be able to swing his legs onto the bed.

If the home has a second floor, Shrager said, it’s important to have a railing or banister on the stairway; one on either side of the stairs is even better. Good lighting is very important, she said, noting “having having a light at the bottom and top of the stairs really helps.”

Universal design

Shrager is an advocate of “universal design,” a concept that means products and buildings are accessible and usable by everyone, including people with disabilities.

For example, she said, lever handles are easier to use than door knobs. “Anyone can open that, as opposed to more traditional door knob, which some people cannot grasp properly to open a door,” she said.

Another example, she said, is the zero-threshold entryway.

She said that a good local example of universal design is Stone Creek Estates of New Scotland on New Scotland Road in Slingerlands.

Charles Carrow, the developer of Stone Creek, told The Enterprise that the entryways of the homes in the development have no stairs, and that the doorways are 3 feet wide – every doorway in the house – to accomodate a wheelchair user. Typical doorways, Carrow said, are 2 feet, 8 inches wide.

There is hardwood flooring throughout the homes, carpet is not a good idea, he said. As people age, Carrow said, they want a home with no maintenance; with that in mind, he said, the homes were built with products, like Hardie siding, that don’t need upkeep.   

Carrow, who also built  the Omni Senior Living Community on Carman Road in Guilderland, said that there is demand for these types of homes. But he said that, in the Capital Region, this type of housing stock is far behind other areas of the country – like Florida and Arizona – where retirees tend to migrate, and, that this area lacks the quality housing seniors need.

Costs

The cost of aging in place can be prohibitive, as much as $20,000 when big-ticket items like a walk-in tub, stairlift, and ramp are included, according to fixr.com.

Shrager said that many towns have a Council on Aging, and that some of them have a loan closet, where seniors can get free items that will help them as they age in place. But, she said, “At some point, if they want to stay home, they are going to have to spend money.”

Shrager said that modifications alone will not do, and, that it is people – a family member, friend, or home aid – who make the difference.

Carrow said that there are added costs to the homes of Stone Creek. He pointed to the installation of hardwood floors rather than carpet, and said that building a bathroom that is compliant with the Americans with Disabilities Act increases costs as well. Homes in Stone Creek are listed online for sale in the low- to mid-$330s.

Having a conversation

Often, it’s an unfortunate event – a broken hip or bad fall – that precipitates the planning for an elderly person to age in place, but, there is also slow decline, which no one deals with, Shrager said.

In either instance, Shrager said, a conversation should have taken place long before.

“The best time to do so is when everything fine, when everyone is healthy, and there is no crisis. Mom and Dad are doing OK in their home and things are going pretty well – that is the time,” she said, “that they should get together with family and talk about what the elderly parent or loved one wants in their future.”

But she acknowledged that people don’t want to talk about being sick, until they are actually sick, “and we all do that,” she said.  

What makes the conversation so difficult is that, often, an adult child who has taken on the role caregiver has to avoid parenting their parent, Shrager said.

It can’t be a lecture or confrontational.

Shrager said that the key is for the child or caregiver to spend time in the home with the elderly resident. “They really have to spend a lot of time; it can’t be a one-time thing,” she said.

She said that the child or caregiver has to watch as the senior “mobilizes” his or her way through the home.

“Start outside in the driveway and see how they get in the house. Do they enter through a garage or the front door? How is the threshold to get them literally into the house and how do they walk around each room?” she asked.

“How do they function in the kitchen? And how do they get into the shower, which is often a big problem. Can they get on and off the toilet OK? Can they make the meals that they’ve always made?”

Shrager said that this time and observation needs to be done before “making any big proclamation that Mom and Dad have to leave.”

Now, the adult child or caregiver can say: “I love you very much and I am worried about you in the future, and I see that this house has issues. I want to have this talk, so we can be on the same page.”