As a caregiver, you are one of millions of Americans who spend all or part of the day assisting family members or friends who need help to remain at home. Many caregivers have multiple responsibilities. The great majority of caregivers are women caring for both older parents and children. Half of all caregivers also work outside the home. The demands and constraints of caregiving can become overwhelming.
There are many resources available to assist and support the caregiver and their family. Caregivers should not hesitate to ask other family members to share in the responsibility of looking after a loved one. It is important for all family members to become involved. Tasks and schedules should be delegated to other family members. Friends and neighbors may be willing to provide transportation, respite care, and help with shopping, household chores and repair tasks.
The help that caregivers, other family members and friends provide may still not be enough to enable an older person to remain independent. In this case, the caregiver will need to look for other avenues of support. The information provided here is by no means complete. There are many valuable resources available through your physician, the public library, the local Area Agency on Aging, the local Alzheimer's Association chapter, etc.
The Home Environment
People of all ages cherish their independence. However, normal changes that occur as we age mean that slight adjustments in our environment must take place. If these changes do not occur, our quality of life may suffer and living comfortably may become more difficult or even unsafe. Every caregiver wants to make sure that their relative is in a comfortable, safe home-like environment. Oftentimes, people find themselves in the caregiver role unexpectedly. Early planning, thinking and constructive action can make it easier for the entire family to cope.
Adapting the home (home modification) for a person who is partially or fully disabled can either be a demanding or relatively simple process. The more adaptations that can be made early on, the easier it will be for all involved. By providing simple, cost-effective home modifications, the caregiver has the opportunity to modify their home in order to prepare for the task ahead.
Zones: Danger, Respite, Safe
The first priority is to assess your home and make a plan as this is a step-by-step process. Take an objective look at the home and identify the following zones: Danger Zones, Respite Zones and Safe Zones.
Danger zones may be such areas as the garage, hobby room, workshop, computer room, kitchen and playroom. In addition, the office, laundry room, sewing room, storage closet, basement, cellar, pool area, attic and stairs are potentially dangerous.
Respite zones should be reserved for the caregiver and are typically off limits to the older adult. The respite zone needs to be a private place where the caregiver can relax and not be disturbed. Of course each individual is different and you can decide whether or not this is necessary.
Safe zones are the remaining areas of the home. All remaining areas should be safe and accessible. It is very important that the home be safety proofed.
Once these zones are identified, it is easier to establish a plan to modify these areas. When attempting to safety proof a home, it is important to remember that others may live in the home as well, so you should try to balance the needs of everyone. The caregiver should determine which suggestions are appropriate for their situation. The most important thing is to create a comfortable environment. Think therapeutically - a therapeutic home offers choices rather than avoids them and encourages independence. Simplify the home. The simpler things are the less environmental input there is to interpret.
Specific Home Modifications
Home modifications and repairs make homes easier and safer to carry out everyday activities such as bathing, cooking and moving throughout the home. There are many things that can be done to the home to accommodate lifestyle changes and increase comfort. The following suggestions can typically be made fairly easily and inexpensively.
The bathroom is typically the first room in the house that needs modifying in order to make everyday living easier. Most accidents occur in the bathroom. In a standard bathroom, there is constant bending, sitting, rising, leaning over, stepping into,out of, etc.
- Standard toilet heights are 14 inches high. This is not a problem for individuals that are able to rise from a sitting position. For others, there are portable commode seats that sit on top of the toilet. Most bathroom fixture manufacturers make 18 inch high toilets that can be installed in the same space that a lower toilet was removed from.
- To help a person from a toilet, you need four feet of clear floor space in front. To assist someone in a wheelchair, you need clear space beside the toilet.
- Provide a pager, remote doorbell, baby monitor or bell to jingle next to the toilet in case of emergencies.
- Remove medications and cleaning supplies from the bathroom. If this is not yet a risk factor, install lights in medicine cabinets so mistakes are not made when taking medicines.
- Remove the lock from the bathroom door.
Tubs and Showers:
- Install accessories like adjustable tub seats or bathboards. If your budget allows, replace the tub with a wheelchair accessible shower unit. Provide a tub seat or bench in the shower stall. Install grab bars, a nonskid tub mat and a hand-held showerhead. Remove glass shower doors and replace them with unbreakable plastic doors.
- Install anti-scalding devices and water temperature mixing values. Set the hot water thermostat below 120 degrees.
- Have an electrician replace existing outlets with Ground Fault Interrupted (GFI) electrical outlets.
- Insulate hot water pipes to prevent burns.
- Provide soap on a rope tied to the shower grab bar.
- If possible, the top edge of the sink should be no more than 33 inches from the floor. On the faucets, use levers instead of handles. Remove the base cabinet from the sink to provide wheelchair accessibility. Wall-hung models are best, to allow for ease of movement under the sink.
- Proper lighting can help reduce injuries from tripping and falls. Overhead lighting should be augmented with lighting above the shower or tub and accent lighting at the mirror.
- If a wheelchair is used, lower the heights of the light fixtures to reduce shadows. Pay special attention to avoid glare caused from poorly located light fixtures.
- Be sure the flooring is non-slip. Be careful that area rugs and bath mats do not become a potential tripping hazard.
The following suggestions are made to fit the needs of handicapped or elderly people who are able to function somewhat independently in the kitchen:
- Set the water temperature at 120 degrees. Use a single level faucet that can balance water temperature.
- Provide an area away from the knife drawer and the stove where the person in your care can help prepare food.
- Use a microwave oven whenever possible to prepare food to avoid burns from stovetops or ovens. NOTE: Do not use a microwave if a person with a pacemaker is present.
- Unplug appliances and add plastic plug guards.
- Put locks on cabinets if dementia is severe.
- Make stove modifications so the stove can not be turned on except by the caregiver, if dementia is a problem.
- Install wheels on dining chairs.
- Counters should be 2-3 inches below standard height (32'-34') because older people, especially women, tend to be shorter and stoop more.
- Cover the drain with a drain cover or sink mat to conceal the garbage disposal.
- Ask your local gas company to modify your stove to provide a gas odor strong enough to alert you if the pilot light goes out.
- Provide a step stool, never a chair, to reach high shelves.
- Install swivel plates in corner cabinets to allow easy access to food items.
- Replace drawer knobs with handles.
- Adapt one work counter for wheelchair access.
- Remove doors under the sink to accommodate a wheelchair. Insulate exposed water pipes.
- If possible, use a refrigerator with the freezer on the bottom.
- Install a fire extinguisher.
- Avoid floor mats.
Living Room, Family Room and Dining Room
The Living Room, Family Room and Dining Room are where the majority of family activity takes place. It is important to make modifications that allow the older adult to move freely about.
- Remove throw rugs, they can be a tripping hazard. Limit flooring changes to prevent tripping.
- Rearrange furniture to open up the room. Pathways may need to be widened or cleared. Remove any unnecessary furniture. Do not rearrange the remaining furniture once the older adult has grown accustomed to its placement.
- Eliminate furniture that blocks routes to windows, doors, displays, bookcases, or interesting table decorations.
- Remove any cords that may be a potential tripping hazard.
- Add additional lighting for night-time visibility.
- Furnish with stable, heavier furniture that can be used as a prop for the older adult.
- Provide a comfortable, stable chair with armrests that are long enough to help the person get up and down. Make sure cushion is firm enough to enable the individual to rise from a seated position.
- Place masking tape on glass doors and picture windows.
- Place non-skid tape on the edges of stairs or consider painting the edge of the first and last step a different color from the floor.
- Add a lockable cover for thermostat.
The older adult's room should be located close to family activity and the outside world. It should not be isolated from the rest of the household and from the caregiver. The bedroom should be cheerful and bright but not have glare from the sun.
- Rearrange furniture so pathways are clear and free of tripping hazards.
- Install bed rails if night wandering is a problem.
- Consider using a baby monitor or intercom system in case of emergencies.
- Install a telephone with emergency numbers listed plainly.
- Place the bed in a position where it can be accessed from all sides. Make sure it can not be easily moved if it were to be bumped.
- Ensure that a lamp or light switch is reachable from the bed.
- Maximize the view from the bedroom window. Use bird feeders and window boxes with potted plants to attract butterflies and birds. This provides good visual stimulation.
Stairs are a real problem when it comes to safety proofing a home. It is even more difficult if the bedrooms are on the second floor. If possible, relocate the older adult's bedroom to the first floor. If this is not possible, the following suggestions will help make the stairs less treacherous.
- Install gates or grab bars at top and bottom of stairs.
- See that stairs are well-lit and have light switches at the top and bottom.
- Make sure that all railings are securely mounted and easy to grip.
- Add gates at top and bottom if needed.
- Make sure that any floor covering on stairs is well fastened and not worn.
When making making a home modification plan for your home, be sure to consider your whole home, not just the interior. A lot of activities take place outside, so create a safe outdoor environment for all to enjoy.
- Ensure that paths and porches are even and free of obstructions.
- Repair any broken or unleveled steps.
- Install adequate lighting for night.
- Prune any tree branches below eye level.
- Make sure your house numbers contrast against their background to make them visible and readable.
- Consider installing raised planters to make it easier for an older person to garden.
- Add a swing or gazebo as a focal point to add visual interest.
- Furniture should be brightly colored and sturdy.
- Paths for wandering are good, but they must be level. Be aware of tree roots that may cause sidewalks and pathways to become unleveled.
- Both sunny and shady areas are nice to have for stimulation.
Author: Cindy Loshkreff.