By Judd Matsunaga, Esq.
This article is for the Sansei generation, who are getting up in years themselves. Even if you’re healthy today, you might not stay that way as you age to 100 and beyond. If your mobility declines in the future, this article describes some of the home modifications you might want to make ahead of time, so you won’t have to scramble at the last minute after a hospital stay.
“What do you mean ‘scramble’?” you ask. If you end up in a nursing home or “rehab” center after a hospital stay of three or more nights, Medicare will pay up to the first 100 days. Actually, it’s more the first 20 days — full coverage, the next 80 days — partial coverage. Your supplemental health insurance, e.g., Blue Cross, United Health Care, Kaiser, etc., should pick up the balance through the 100th day (unless deemed “custodial”).
Unfortunately, many families are told after the first two weeks that their parent (or spouse) is being discharged home because they’re out of their 20 days of Medicare coverage.
lthough not legally required to do so (topic of a future Rafu article — it’s all about money), most families will take their loved one home and do their best to make sure they are cared for. That’s what I mean by “scramble.”
According to the AARP, almost 90% of people over age 65 want to “age in place.” But the feasibility of aging in place begins with your physical health. If you plan to age in place, you’ll have to consider whether your home can safely accommodate you in the years to come. If your health and mobility are good, you’ll have far fewer obstacles to remaining in place than if you need frequent medical attention and assistance in the home.
However, conditions like arthritis, dementia, or a stroke can throw off your balance and judgment to the point that self-care tasks like cooking or getting dressed become difficult, and even a simple trip to the bathroom is fraught with danger. If your home becomes hard for you to navigate safely, you need to ensure that your home is free of hazards and has special accommodations that can help you in the coming years.
The following are helpful tips I found in a Special Health Report from Harvard Medical School, “Aging in Place.” Let’s start with the importance of good lighting. No matter how clear your vision was years ago, time inevitably takes its toll on visual clarity and focusing power. The book you once held comfortably now must be held at arm’s length. You need one set of glasses to read a menu or theater program, and another to watch a movie.
In your 60s and beyond, vision problems like cataracts, dry eye, diabetic retinopathy, glaucoma, and age-related macular degeneration can start to blur and obscure your vision. Seeing your ophthalmologist for regular vision check-ups and keeping your eyeglass or contact lens prescription up to date is one way to combat vision issues.
Another important approach is to address the lighting in your home. By age 60, you’ll need about three to four times lighter to see than you did in your 30s. Turning up the dimmer switch or installing brighter bulbs is one solution. Boosting illumination where you need it, such as by keeping a reading light by your bedside and adding task lighting under kitchen cabinets, is also a good idea. Make sure you have adequate lighting in every part of your home — especially in areas where dim lighting might trip you up, such as at the front entrance, in hallways, on stairs, and in the bathroom.
Because your eyes take longer now to adjust to changing light conditions, keep the light strength uniform from room to room. Install a dimmer switch by your front door, so you can turn on the light gradually as you enter the house at night. Older eyes have more difficulty discerning objects with little contrast. Design your house with brightly contrasting colors, if possible. A white table set against a white painted wall is much harder to see than a red or blue table against the same wall. Paint your baseboards and doors in a color that contrasts with walls and floors.
Because aging can also throw off your depth perception, make sure all stairways are well lit. Mark each stair with a white or brightly colored tape stripe to help you see it. Also put colored tape on the edges of cabinet and room doors so you’ll know when they’re open.
At the Front Entrance
The front of your home should be easy for you to access — no matter what your mobility limitations are. If you have steps leading up to your front door, think about how reasonable — and affordable — it would be for you to replace them with a ramp. Check to see that your front entrance meets all of the following criteria:
● There are few to no steps leading up to the entrance of your home. If you have several steps, you might need to replace them with a wheelchair-accessible ramp if your mobility is compromised. If you do have steps at your home’s entrance, they should be in good shape, with no crumbling bricks or sagging wood. There should be a sturdy handrail on one or (preferably) both sides of the stairs, and no potted plants or other obstacles in the way of the front door.
● Your front doorway is at least 36 inches wide to accommodate a wheelchair or walker. Adding offset hinges is a low-cost way to widen a narrow doorway.
● The threshold to your house is less than ½ inch high.
On the Stairs
Climbing up and down the stairs can be difficult enough, especially if you have arthritis or other mobility issues. When stairs are dimly lit and poorly maintained, they become a serious fall hazard. Check to see that your stairs meet all these criteria:
● The stairs are well lit from top to bottom. For nighttime trips up or down the stairs, consider installing lights that illuminate each time you take a step — or at least put a light switch at both the top and bottom of the stairs.
● Sturdy handrails are on both sides of the stairway, and they extend all the way to the top and bottom steps. There is enough room between the handrails and the wall that you can easily get your hand around them.
● Carpet is tacked down completely. If the stairs aren’t carpeted, there are non-skid strips on the edges. If you can no longer negotiate the stairs, consider installing a stair lift.
In the Hallway
A now hallway might not be a problem for walking, but it can become inaccessible to a wheelchair or walker. Doorways also need to be wide enough to accommodate any mobility device you might need in the future. Check to see that your hallways meet all of these criteria:
● Doorways are at least 36 inches wide to fit a wheelchair or walker.
● The doorway thresholds are less than ½ inch high.
● Rugs are tacked down, have a non-skid backing, and aren’t frayed or worn.
● Doorknobs are easy to turn. If not, replace them with lever handles.
In the Bathroom
Bathrooms can quickly become inaccessible when mobility is limited or a wheelchair comes into play. Step-in showers and high tubs are trip-and-fall hazards. And low toilets can become too painful to use when arthritis grips hip and ankle joints. Check to see that your bathroom meets all of the following criteria:
● There is a clear space around your bathtub, shower, and sink, in case you need to get around with a wheelchair or walker.
● You have a night light.
● Your sink is low enough that you can sit to get washed up, and has enough knee clearance to accommodate a wheelchair.
● Your toilet is high enough that you can sit down easily and reach the toilet paper. If not, add a seat extender.
● There are grab bars next to your toilet, shower, and/or bathtub.
● Your shower has a low entrance, or you have a curbless shower and/or bathtub.
● Your shower has a permanent or fold-down shower seat and a handheld showerhead so you can bathe sitting down.
In the Kitchen
The kitchen may be the hub of your entire home. It’s where your family, and sometimes your friends, come together to eat and socialize. If you cook, you may spend a significant time here preparing meals. Check to see that your kitchen meets all of the following criteria:
● The lighting is bright enough so that you can read labels and recipes, and see what you’re cutting.
● Stove and oven controls are clearly marked and easy to turn.
● Cabinets are easy to reach or feature pull-down shelves.
● The sink and counter are low enough to accommodate a stool or
wheelchair.
● The oven is high enough that you don’t need to bend over to move food in and out.
● Faucets have levers, rather than harder-to-turn knobs.
● Doors and drawers have easy-to-open D-shaped handles.
● Any islands are on wheels, so you can push them out of the way to have a wider path through the kitchen.
In the Bedroom
The location of your bedroom is important. Right now, a second-floor bedroom might not be a problem, but if your ability to climb stairs is ever compromised, can you easily relocate your bedroom to the first floor? In your bedroom, you need plenty of space to navigate and easy access to your clothing. Check to see that your bedroom meets all the following criteria:
● You can set your feet flat on the floor when you sit on the edge of your bed. There shouldn’t be more than 18 inches from the floor to the top of the mattress.
● Your mattress is firm enough that you don’t sink back into it when you try to stand up.
● You have a clear pathway through your bedroom and to your bathroom.
● You can easily reach your clothing in the closet. If not, consider installing lower rods and shelves. Or use grasping tools to reach items on high shelves.
In conclusion, if aging in place is your goal, you need to consider how you’ll pay for these services. Home modification costs can be expensive, particularly if you’re adding a walk-in bathtub, new lighting, or handrails. The costs of home modifications can quickly mount and wipe out any funds you’ve put away for your retirement. That’s where you need to “tap” into the equity in your home with a reverse mortgage.
Lastly, make sure your power of attorneys and living trust are updated.
Judd Matsunaga, Esq., is the founding partner of the Law Offices of Matsunaga & Associates, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena and Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.