By Kara Gavin
University of Michigan Medicine

There’s no place like home. There’s no place like home. There’s no place like home. 

If you’re old enough to remember watching the Wizard of Oz when it was only on television once a year, you remember that line.

But have you thought about how to adapt your own home to be a great place to grow older?

If you’re like 88% of people over age 50 who answered a recent University of Michigan poll, you probably want to “age in place” where you live now. 

But the report, from U-M’s National Poll on Healthy Aging, also finds that many people over 50 haven’t given much thought to what it might take to make their house, apartment or condo a safer, more comfortable and more age-friendly place that they can keep living in for years to come.

Fortunately, it doesn’t take a wizard, a pair of ruby slippers or Glinda the Good Witch to make those changes happen. But it does take a bit of planning – whether you’re doing it for yourself or helping an older relative or friend. 

Aging in place can also take money, and the ability to ask or pay for help from family, friends, community organizations and businesses.

That’s why you should start early, work it into your budget, and make changes gradually over time, says Beth Spencer, M.A., M.S.W., a retired geriatric social worker at the University of Michigan Geriatrics Center, and Sheria Robinson-Lane, Ph.D., who studies aging in place topics at the U-M School of Nursing.

Spencer recently gave a talk, available on YouTube, that is packed with useful tips.  Robinson-Lane worked on the team that conducted the recent poll.

Both advise older adults not to wait for a crisis to arrive before taking action. Rather, think of aging in place as a journey on a road – perhaps a yellow brick road. 

4 key tips on how to successfully “age in place”

1. Start planning now if you haven’t already

It’s not easy to think about getting older, and about changes in your ability to move, see, hear, think or drive like you do now. 

“In our society, people don’t want to think about aging,” says Spencer, who is in her 70s. “You may be in great shape now, but stuff happens. Like it or not, most of us will have some disability at some point, and it really requires thinking about this.”

By planning ahead, you can maintain your independence a lot longer, no matter what health-related changes come up.

Spencer advises doing a walk through of your home with an eye on what it might be like for an older version of you to live there. What might it take to help you get in the door, to go up and down the stairs, to take a shower or bath, to avoid having to dash to answer the door, to do laundry, or to get groceries in and cook? 

The new poll showed that only a third of older adults think their home definitely has the features needed to help them stay in it over the long term. It also showed that 1 in 10 older adults had moved in the past five years to a home that’s easier to get around. After all, not all homes can be made age-friendly, or at least not with the financial resources of the people who live there. 

Part of planning ahead is talking with your family about what you want over the long term. 

“It is important to include family and close friends in conversations about growing older,” says Robinson-Lane. “Talk with them about your preferences and wishes in the event of a major medical crises and spend some time thinking about who you can rely on.” “You may be in great shape now, but stuff happens. Like it or not, most of us will have some disability at some point.”Beth Spencer, M.A., M.S.W.Retired geriatric social worker, University of Michigan

And if you realize that your current home isn’t going to be easy to age in, you can take your time to look at, and plan your budget around, options like condos, apartments for older adults, and assisted living facilities or other group settings. 

“So many people don’t want to look forward, don’t want to think about leaving the home they’re living in, don’t want to think about accepting help,” says Spencer. “But the more you can think and talk about it, the more smoothly it will go.”

2. Take specific small steps to make aging in place easier

No matter what your age, here are some small but powerful changes you can make, either by doing it yourself or hiring someone. They can prevent trips and falls, which can cause injuries that can lead to temporary or lasting effects on health and your ability to get around.

• Railings: Install one, or two, on every staircase, including along the steps to every entry door, between levels or floors, and down to the basement.
• Grab bars: In the tub or shower, and in the rest of the bathroom, securely mounted bars can help someone avoid a fall if they slip or lose balance. They don’t have to look ugly – Spencer found decorative towel bars that get mounted to wall studs and include a grab bar. 
• Good lighting: Add ceiling fixtures and upgrade to LED bulbs that give off more light while being more energy efficient, so you can see while cutting things in the kitchen, walking down a hall, or hunting for items in a closet.
• Nightlights: Put them in bathrooms, halls and staircases; many falls happen when someone is trying to get to the bathroom in the middle of the night.
• Rugs and mats: Put non-skid material under them, including in the corners. Or get rid of them entirely. If you have old carpeting that has become slick, consider planning to replace it with something that has more ‘grip.’ If your tub or shower doesn’t have a mat, get one that stays in place with suction cups.
• Stairs and steps: Use tape or bright-colored paint on a bottom step to make it stand out, so people know they’ve reached the end of a staircase or that there’s a small step down between rooms. Add non-skid patches to stairs made of hard surfaces to keep them from becoming slick – especially if they are near an outside door. 
• Furniture: Clear paths through rooms by moving or removing furniture. Replace armless dining room and kitchen chairs with ones that have arms to make it easier to get up.
• Cords: If you have them snaking across your floor, figure out a way to tuck them away or reconfigure them away from main paths – they’re a serious trip hazard.
• Clutter: Do you tend to let things pile up on the floor? Take time to reduce piles or at least store them higher up. 
• Technology: If you’re not already using them, talk with a tech-savvy friend or relative about “smart home” technologies that might make remaining at home easier or provide some reassurance to loved ones. A doorbell camera and remote-controlled door locks, a wearable device that can be used to communicate in case of a fall or other emergency, motion-activated lights, automated medication reminders and in-home cameras are just some of the options.  

3. Think about bigger projects to adapt your home to fit your needs

• Bathroom remodels: Taking out a tub and putting in a shower stall can cost a lot. But it can greatly increase the amount of time a person can stay in a home. A handheld shower head, and a built-in bench or a bench-style wooden seat, can make it easier for someone who can’t stand easily in a shower. If removing the tub isn’t an option, a tub chair with a platform that sits outside the tub can help.
• One-level living: Plan ahead for how you could create a bedroom out of a main-level room temporarily or permanently if you needed to. Think about whether you could move a washer and dryer to the main living level, and whether you could add a shower stall to a bathroom on that level.
• Ramps: People who have trouble getting around can often navigate a ramp more easily, even if they don’t use a wheelchair or walker. But permanent ramps can be expensive and depending on local rules may not fit on the property. Temporary ramps that attach to entrance steps, or short flights of stairs or single steps indoors, can help. 
• Stair lifts: These movable ‘stair chairs’ can extend someone’s ability to stay in a multi-level home, not just to move themselves but their laundry or supplies too. Used ones may be available for a lower cost than new ones.

4. Overcome your reluctance to ask for, or pay for, help

The U-M poll shows that most older adults have someone living with them or nearby who can help with routine shopping and household chores. But if they needed help with personal care like bathing and dressing, only 48% of those who live with someone, and 27% of those who live alone, said they could get help easily. 

Meanwhile, two in five older adults aren’t confident they could afford to hire someone to help them with these tasks. The percentage was even higher among those who say they’re in fair or poor physical or mental health.

Even if they have someone they could turn to, or financial resources, it’s often hard for older people to accept that it’s time to seek help with tasks they’ve done for themselves for decades, or to spend money on a contractor to do aging-in-place projects, says Spencer.

“One of the ways to age gracefully is to learn to accept help and to be realistic about the help that you may need,” she said. If you don’t need help yet, you should “think hard about how well you’ll be able to accept help when you need it,” including from people who you don’t know. 

Finding in-home personal care and medical help can be difficult, especially in the time of COVID-19, but Spencer encourages asking around with friends and neighbors.

Think of spending money on aging-in-place projects as an investment – and also as a cheaper option than medical bills or lost mobility after a fall. 

If you’re worried about spending on help for yourself because it would reduce how much money you can leave to loved ones, remember that you may do more for them now by hiring someone instead of relying on their help, or making them worry about your ability to stay safe in your own home. 

Free or low-cost resources may be available through your community’s senior center, the federal Area Agency on Aging that serves your region, the national Eldercare service. Hiring a geriatric care manager to do a big-picture look at your situation can also help. 

“It’s not uncommon, to either not have close family, or to have no desire to necessarily live with them as you grow older,” says Robinson-Lane. “In these instances it is most important to really think about what other types of supports are available that will allow for independent living for as long as possible.  Organizations like the Area Agencies on Aging can help connect older adults with housing, programs, and services that support independent living. A little bit of planning now can truly go a long way later.”

Robinson-Lane notes that another key thing you can get help on is filling out advance directives for yourself. “Make it easy on your family and make the hard choices for yourself about how you would like to be cared for in the event of a major medical event,” she says. “These are difficult conversations, but they are ones all of us have to have.”

If you have an older loved one, or a spouse or partner, who just doesn’t want to talk about planning for the future or seeking help, Spencer advises starting the conversation by talking about someone else.

An acquaintance’s bad fall, or a neighbor’s sudden move after a health crisis, could provide the opening to talk about what your partner or your loved one would want for themselves.

Said Spencer, “It’s less threatening when you make the conversation about someone else, and can overcome denial instincts.”