Age In Place – Book Summary

https://www.amazon.com/How-Age-Place-Independent-Financially/dp/1607744163/ref=pd_lpo_sbs_14_img_0/147-4408082-8327644?_encoding=UTF8&psc=1&refRID=5ZRTXAGTXYE37SWXXKDR

Having just retired, but wanting to spend many, many years in my current home … I came across this book with lots of good ideas. It’s really targeted at looking out for mom and dad but certainly can easily apply to those earlier in their aging process wanting to get a jump on addressing items around their own homes for years down the road.

  • Intro
    • We often picture ourselves as the same as when we were young
    • An orderly, well-maintained house is a safe house
    • Start with decluttering … disorganization contributes to stress
    • Activities are categorized
      • “activities of daily living” (ADLs) – self care activities
      • “instrumental activities of daily living” (IADLs) – anything done from minute they wake till going to bed … include making meals, shopping, managing meds, transportation, managing home
  • Declutter/Modify
    • Walkways
      • Evaluate driveway and sidewalk condition
      • Bannisters and handrails not just for staircase in front/back of house
      • Lighting along pathways
      • Motion sensor activated floodlights
      • Keep walkways clear and de-iced
    • Driveways
      • Careful of driveway seal coats as they can be slippery
    • Lawns
      • Look for problem areas (holes or other safety issues)
    • Gardening
      • Used raised boxes
      • Kneepads / garden kneeler
      • Consider as an exercise so warm up and cool down before/after (stretch)
      • Gather all tools needed before starting
      • Consider how to best access water supply
      • Ensure equipment kept up to “spec” (sharpening, changing oil, etc)
      • If supplies come in heavy bags, separate into smaller loads with carts
      • When pulling deep weeds, keep back straight and knees bent
      • Lift with legs
      • Do not twist
      • When lifting things like dirt, move feet to turn body rather than twist
      • Vary tasks rather than doing same thing over and over
      • Avoid tightly gripping tools
      • 30-minute gardening sessions rather than one super session
      • Use gloves and long pants (and sometimes long sleeve shirts)
      • Sunscreen, bug repellant, hat, sunglasses
    • Snow
      • Is a huge strain
      • Ware layers of clothing
      • Protect hands/face
      • Warm up and cool down before/after (stretch)
      • Push rather than lift
      • Walk to where snow needs to be dumped rather than throwing
      • Rest frequently
      • Stay hydrated
    • Raking
      • Dress in layers
      • Use sturdy shoes (goes for gardening and snow too)
      • Warm up/cool down before/after (stretch)
      • Use the “scissor stance” (one foot forward, one foot back) and reverse at intervals
      • Vary direction pulling rake
      • Stay hydrated
    • Miscellaneous
      • Big house numbers easily visible … contrast color with house
      • Put obvious stakes in dips/holes in yard
      • Hang tennis ball on rope from garage ceiling to identify optimal parking place
      • Solar lights along sidewalks, etc
      • Keep easily accessed salt and kitty litter for traction in winter for driveway/walkway
    • “Visitability”
      • Concept of universal design where anyone regardless of mobility impairment can use
    • Front Door
      • Ideal is to have a no-step entrance (zero-threshold)
      • If not available and ramp necessary, then ending should be at least a 5×5′ landing space
      • For stairs, risers should be minimum of 4″ and max of 7.5″ and tread should be 11″
      • Railings are a requirement, not an option
      • Railings on both sides of stairs
      • If railings very far apart, install a central railing too
      • Railings should extend beyond top and bottom steps
      • Install a “half rise” step in places where necessary (existing steps too tall)
    • Ramps
      • Those wearing bifocals may have difficulty judging slope/distance of ramp
      • Ensure it has a non-slip surface
      • No more than 1″ rise per 12″ run but a better ratio is 1:20
      • Landings are a requirement at top/bottom of ramp and need to be 5’x5′ with handrails
    • Other items to consider at home entrances
      • Entry mat should be heavy and non-slip
      • Light fixtures for good illumination (LED lights enable higher lumens per watt than previously capable without drawing excessive power)
      • Lighted doorbell
      • Put a shelf next to door to store items while trying to enter building
      • Ideal width of front door is 36″ along with a window on one side or other (for safety)
      • Ideal threshold is no more than 0.5″ high…if more than that a portable threshold ramp could be considered
      • Mix paint applied to ramps with silica to create traction (1lb per gallon)
      • Large reflective house numbers in easy to spot location
    • Door Handles
      • Lever door handles easiest to use
    • Attached Garages
      • Install railing and extend railing beyond stairs.
      • Put railing 1.5″ away from wall to avoid getting arm caught between wall/rail
      • Install a safety handle/grab bar on either side of doorway
      • Put garbage/recycling bins near door for easy access
    • Declutter Garage
      • Don’t tackle alone
      • Can be used as catalyst for discussing future issues
      • Look for a warm/dry stretch of at least 2 days
      • Formulate plan
      • Sweep garage floor
      • Trash any items whose purpose forgotten
      • Separate rest of items into 4 piles
        • Keep
        • Give away/donate
        • Sell
        • Trash
      • Store related items together
      • Use pegboards/wiregrids/shelving to organize
    • Living, Dining, General Living areas
      • Furniture
        • Rule of thumb is higher chair/couch easier to get on/off
        • Can use “furniture risers”
        • Build up height by placing firm cushion on top of existing one (will admit what I did on my favorite chair whose cushion got soggy was to force several 1×4″ boards)
        • Fold up blanket and putting under existing cushion can help
        • Firm seats helpful in transfers on/off furniture
        • Higher the back on a chair the better back support.
        • “Couch canes” to aid transitions from seating to standing
        • Make sure placement of furniture is done such that clear pathways and good accessibility occur
        • “Furniture Walking” … where a person uses furniture as support to navigate
      • Lighting/electrical
        • Ensure chords secured
        • Switches mounted 42-48″ from floor
        • Reduce glare and leverage task lighting
      • Floor surfaces
        • Ideal floor is flat with no changes in surface
      • Throw rugs
        • To see if rug “ok” step onto it with feet about 12″ apart and then wiggle hips to see if rug moves. If so, then rug needs to be moved or done away with
        • Large area rugs/hall runners not usually an issue
      • Windows
        • The more windows for natural light, the better
        • Clear clutter to create access to windows
        • Ensure they easily open/close
      • Declutter living areas
        • Being surrounded by things gathered over the years makes us happy
        • Belongings accumulated over a lifetime morph into clutter … do a walk-thru
          • Pretend you are a guest for first time in house and identify things that look cluttered, dirty, dingy or hindering mobility around house
        • Initial “blitz”
          • Trash things with no real value (sentimental/monetary) … throw as much stuff away as possible
          • More than one pass may be needed
        • Then do the same exercise as before: keep, give away, sell, donate, trash piles
    • Kitchen
      • Flooring
        • Anti-slip treatments
      • Countertops
        • Most comfortable height is where wrists are slightly below elbows … 34-36″ for standing people typically
        • Keep 18-24″ of cleared counterspace on one side of oven
        • Countertops near over should be heat resistant (if not, there are cheap products that can be purchased to do the trick)
        • A kitchen/bar stool is handy if you want to sit while working
      • Cabinets
        • Put loops of rope/leather on door hardware that are hard to reach
        • Use “organizers” (e.g., lazy Suzan’s)
      • Dining Table
        • Getting in/out of seat … turn chair so back against table … sit down … turn to face table
        • Consider furniture glides … if rug under table then consider plastic runners/mats
      • Refrig
        • Should be located on a wall facing most open/unobstructed area of room
        • Useful to have counter space on each side of frig
        • Long handles on doors
        • See-thru bins
      • Stoves
        • Ovens 18″ of floor ideal for those who need to sit
        • Need to have heat-resistant counter space next to stove (again, check for products if you, like me, have Formica..I got a 17×14″ item from amazon for $10 and no worries putting a 500 degree item on it with no damage to counter below)
        • Stove knobs need to be in front or side (not back)
        • Outlining knobs with most used settings with a Hi-Mark pen can be handy
        • Use tongs or wire scoop to lift items out of boiling water if transferring pot not ideal
      • Dishwasher
        • Located on side of sink that corresponds to dominant hand
        • Ideally, install with base 6-9″ off floor
      • Lighting/power
        • Bright light a requirement … along with task lighting. LED lighting perfect for this
        • Use power strip on counter but don’t overload
      • Step stools
        • Wide based step with treads and rubber bottom
        • Safety bar handrail
        • Single step
        • Avoid folding stools
      • Frig organization
        • Most often used items in front
        • Coldest part is on back of bottom shelf … put things like raw meat there
      • Food prep
        • Slow cookers are good tools
        • Use plastic, color coded cutting boards for different foods (helps avoid cross contamination)
        • Anything can be converted to non-skid by putting rubber shelf liner under it
      • Decluttering kitchen
        • This is something I go after on at least a yearly basis…and has nothing to do with age
        • Throw out obvious junk
        • Evaluate what are on countertops and kitchen table …do they need to be there?
        • Categorize again into the 5 categories: keep, give away, sell, donate, trash
        • Throw away old/expired food
      • Miscellaneous
        • Use bump dots to provide tactile clues
        • After opening container of food, immediately mark the date before refrigerating it (or freezing or canning)
        • Use a mop rather than getting on hands/knees to clean floors
        • Use scissors to open packages
        • Put a fire extinguisher in easy to reach location
        • Any power outlet close to water needs to be GFCI
        • Get rid of cabinet doors if impeding access to contents
        • Double recipes and freeze extra for later use (and avoid cooking/cleaning)
        • Use paper plates/plastic utensils to avoid having to wash
        • A tool belt/apron to transport items handy
    • Bedrooms
      • Create a path between dresser/bed at least 36″
      • Linens
        • Getting stuck in bed in wintertime a hazard (I’m not old and with a couple heavy wool blankets to keep warm I’ve had that happen)
        • Flannel PJ’s on flannel sheets not good … lots of friction
        • Cotton, silk PJ’s and flannel sheets much better
      • Height of bed
        • Lower the bed easier to get into
        • Higher the bed easer to get out of
        • Sit on edge of bed with knees bent at 90 degrees with feet flat on floor should give good indicate of optimal height…~22″
      • Getting on/off bed
        • Sit as close to pillow as possible before putting legs on bed
        • Transfer-handle bed rails and pivot bars available
        • Use a “step” to reduce gap between floor and bed … use a step used in aerobic exercise … wide and one step
      • Miscellaneous
        • Ensure drawers lubricated … paraffin, candle wax. WD-40 perhaps
        • Let in natural light in daytime
        • Bedside light should be easily accessible
        • Flooring should be low pile and any area rugs should not slip when standing on them and wiggling hips
        • Closets should have overhead lights easy to turn on/off
        • Closets should have rods hung at various heights
        • When getting dressed, don’t stand in middle of room
      • Declutter
        • Get rid of any items of clothing not used in the last year (some exceptions for things like super dress up, funerals, etc)
        • Donating clothes gets tax deduction potentially
    • Bathrooms
      • Sometimes getting to bathroom is a big hurdle
      • 36″ wide door ideal, usually impracticle
      • Have door open out rather than in
      • Use pocket doors
      • Showers/tubs
        • Need easily reachable faucets
        • Grab bars around entire perimeter … vertical and horizontal
      • Grab bars
        • Textured ones good for inside tub/shower to avoid slippage
        • 24″ vertical bar on either side of tub good and 36″ bar across back
        • Must be installed into studs
        • Suction cup bars have their uses … to steady … but not support weight
        • Bathtub safety handles are helpful devices
        • Install grab bars low enough to reach when sitting on bottom of tub
        • Stall shower grab bars should be installed vertically at entrance and horizontally at back as well as one outside shower for support
      • Tub/shower surfaces
        • Peel and stick treads
        • Have also found wooden platforms over good non slip surfaces
      • Toilets
        • Height should be 17-19″ per ADA
        • If too low, multiple products to increase height
        • Add handles on either side for support
      • Flooring
        • Nonskid, slip-resistant
      • Declutter/organize
        • Trash expired drugs, seldom used items
        • Trash sheets/towels that are end of life
        • Grab bars not just for tubs/showers
      • Miscellaneous
        • Portable bidet attachments (I used one of these while in Japan and Israel … why aren’t these more prevalent in the US?)
        • Always have a night light in bathroom
        • Use shower caddies
        • Body washes versus bars of soap
        • Put rubber band around slippery bottles
        • Use long handled brushes for washing
        • Foot scrubbers
    • Stairs, Hallways, Basement, Laundry
      • Stairs
        • Risers are a max of 7″
        • Tread is optimally 11″ deep
        • Straight staircases 36″ wide are best
        • Install railings on both sides and extend beyond top/bottom
        • Railings need to be 1.5″ from wall
        • Railings should be 1.25″ to 1.5″ in diameter
        • Shoes/slippers/socks with rubber bottoms (bare feet better than regular socks)
        • Good lighting is a requirement
        • Stairlifts can make difference between staying at home and having to move
      • Hallways
        • 36″ wide and better at 42-48″
        • Install light at either end
        • Add a railing along one wall
      • Thresholds
        • Should not exceed 0.25″ height
      • Basements
        • Install carpet on steps
        • Install banisters on both sides of steps
        • Light switches at bottom and top
      • Laundry
        • When placing full-sizes appliances side by side, ensure one on left opens to left and one on right opens to right
      • Miscellaneous
        • Put colored tape strip on edge of steps
        • Keep consistent light levels in bedrooms and hallways
    • General Items
      • Monitoring from afar
        • Personal emergency response systems to wear so with push of button, an alert can be issues 24/7
        • Sensor monitoring systems to detect change in activity patterns and alert
      • Safety
        • Set hot water heater to 120 degrees
        • Make sure to regularly clean lint trap
        • Install fresh batteries in smoke/Co2 detectors
      • Clothing
        • Ensure footwear compatible with activity
        • Consider length of clothing
        • Avoid flannel on flannel
    • Organizing
      • Common issue is coffee tables too close to couch making access difficult
      • Is refrig/oven/microwave clean
      • Re-arrange items in cabinets to have most used items in front and easiest height to reach
      • Put items on nightstand that may be needed during night
      • Are there opportunities for interacting with other people
      • Have plan in place before crisis
      • US Postal Service has a service called the Carrier Alert Program
    • Document Categories to be Easily Located
      • Legal
      • Health Care
      • Insurance
      • ID Info
      • Vital Records
      • Financial Info
      • Deeds
      • Household
      • Service Providers
      • Deliveries
      • Career/Personal Highlights
      • Death
    • Items to be considered for a “Health Care Notebook” categories
      • Health History
      • Insurance Info
      • Diagnostic Tests/Results
      • Medications
      • Treatment Info
      • Daily Log
      • Support
      • Home Care
      • Important Papers
    • Miscellaneous

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