In June, the Neuro Challenge Foundation hosted a webinar with gerontologist Arlene Grosso on home modifications. As Parkinson’s Disease (PD) progresses and more people are choosing to age in place (at home rather than an assisted living facility), home modifications may be needed to reduce fall risk and remove safety hazards. Arlene described modifications for the kitchen, entryway, stairway, bathroom, laundry and electrical outlets. 

Some modifications that Arlene suggested in these six areas are:

• Kitchen:  A table in the kitchen where you can sit down and rest
• Entryway:  Exterior lighting by the doorway, and clear large house numbers visible from the street
• Entryway:  Level thresholds when walking through the door into the house
• Stairway:  Handrails on both sides of the stairs
• Bathroom:  Utilizing tub benches and shower seats
• Laundry:  Having laundry machines on a platform to avoid bending forward too much
• Electrical Outlets:  Rocker style light switches

For more information on staying independent and fall prevention, please see these Stanford Parkinson’s Community Outreach webpages: 

Staying Independent

Fall Prevention

Also, Stanford Parkinson’s Community Outreach and Brain Support Network (BSN) recently co-hosted a “gadget meeting” for caregivers.  Many of the gadgets were in the domain of safety.  See a BSN blog post about that virtual meeting here.

See below for notes on the June 11th webinar.

Regards, 

– Joëlle Kuehn

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“Modifications to Help Make Your Home Safer” – Webinar notes

Speaker: Arlene Grosso, gerontologist, M&D Enterprise, St. Petersburg, Florida

Webinar Host: Neuro Challenge Foundation  

Webinar Date:  June 11, 2021

Summary by Joëlle Kuehn, Stanford Parkinson’s Community Outreach

At age 50+:

• Should start planning about aging in place
• No one plans until they fall, until something happens
• We have a hard time getting people out of rehab because their houses don’t have ramps, lifts or access to their bathrooms 

Kitchen: 

• Have an area that you can do food prep, recipe hunting, bookkeeping sitting down
  • Seating area, even a card table where you can sit and rest
  • When you start feeling fatigue, you need to sit down
  • Want to conserve energy
• Larger handles are also helpful, rather than drawer knobs
• Stove control should be in front, not the back, don’t want to be reaching over.  Don’t need to buy a new stove, but if you are making changes, this is something you can look for
• Rev-A-shelves – hydraulic shelves to get things from the top shelves easier
• Rearrange kitchen so that everything you need is on the bottom shelf
• Microwaves should stand on the counter, as reaching up while having shoulder difficulties and holding something hot is dangerous 
• Seated are where you can rest
• French door refrigerators – freezer on the bottom
• Microwave on counter
• Pull out tray below the oven
• Oven doors that may pull down and push into the wall
• Pull up a char to the countertop to help with fatigue
• Stove control knobs on the front

Universal Design and Visitability:

• Whatever you love to do, there are ways to make sure you can do that
• Example:  if you want to keep gardening but are in a wheelchair, raised garden boxes can help
• There is always a solution to keep doing what you love doing, as for your mindset is is important to preserve and keep doing what you love
• Universal Design: concept that this design is good for anyone with any ability
  • People with walkers and wheelchairs have similar constrictions to pushing strollers with young children
  • Ramps and large doorways
• Zero step / no step – entries and showers so that you don’t have to lose your balance to get in, so those with a wheelchair can easily get in and out
• Livability:  Design for a lifetime – can age in place in your own home

Entryway modifications:

• Ideally would be no steps, and easy to get in and out
• Exterior lighting by the doorway – motion sensor lights can be helpful 
• Chair or table next to door for packages or bags
• Clear, large house number – so the fire department can find your house immediately, as seconds matter.  Numbers should be 4-6 inches high.
• You can make concrete ramps that aren’t obvious to people driving by
• Entry door should be 36”wide for ADA compliance, although 34 is sometimes needed if the doorway structure can’t be changed too much 
  • Swing away hinges can widen door
  • When door is open, it takes up 1-2 inches of entry way, so swing away hinges get it completely out of the way
• Try to not have anything on the floor that could be a tripping hazard
• Ramps – can be in the garage, so people can keep the entrance as it was built
• Handrails should be on both sides of any steps 
• Sometimes we can’t put a ramp in if it’s too steep, mechanical lifts are an option
  • For every inch up, it should be a foot out, that way it isn’t too steep – ADA coded.  ~8% incline is an easy incline to go up and down
  • The biggest issue with putting the ramp in at the right incline is the space
• Lifts like vertical platform lifts are helpful 
  • Stilt homes, homes near the water etc.
  • Look at prognosis, if you will need a more advanced lift in the future, get the more advanced version put in now rather than having to put in 2 lifts
• Door threshold – walking through a doorway
  • Try to have level thresholds, which smoothen the doorway
  • Threshold ramps can help 1-3 inches of threshold
  • Note that they don’t have handrails
• Lever handles rather than door knobs because they have more grip

Stairways:

• Have handrails on both sides
• Well lit
• Non-slip surfaces
  • Make sure carpet is tacked, not torn, and really tight
  • Even better if you can not have carpet
  • “Slip doctors”  – non-slip flooring product
• Stairlifts – help with making the transfer

Bathroom:

• Remove all clutter
• Make sure nothing is in the way, clear pathways throughout the home
• Tub/shower combinations – harder to get into
• Make sure you have grab bars.  Do not have suction cup grab bars
• Utilize tub benches or shower seats
• Comfort height toilets are higher and easier to get on and off.  Grab bars attached to the toilet are an inexpensive option   
• Try to have enough space to maneuver a wheelchair
• Motion sensor faucets are great to avoid having to reach forward

Laundry:

• Washer / dryer can be put on a platform so they are the correct height

Electrical outlets/switches:

• Maximum height of switches should be 48” from floor
• Use rocker style switches
• Have at both bottom and top of indoor stylish
• Traditional outlet height is ok, but try to have it raised in areas of most use

Question & Answer:

Question: How would you get connected to a person you can trust who can implement these changes?

Answer:  There are several certifications (CAPS certification – certified aging in place specialists, or CEAC – certified environmental accessibility consultant) for home modifications, so everyone you are relying on to make these changes should be certified. Find a licenced building contractor, not just a handyman. You may need permits, and the licenced contractors will have liability insurance and designations. If you call the national association of builders and ask what CAPS certified builders there are in your area, they would be able to tell you. Go to a licenced contractor rather than an interior designer because they can do the work and can tell you more accurately what it will cost.

Question: What do you do if the fixes are out of your budget?

Answer: We work with occupational therapists who do assessments, and they are professionals, they study this. If the CAPS certified person can talk with your health professional about your prognosis, we can put a plan together about what it’s going to cost. You don’t have to do all things all at once, you can do things as they progress.

Question: Recommendations for an ease of transition from carpet to tile from room to room?   

Answer: You need at least a 2 inch threshold strip. Carpeting can sometimes be loose, so make sure it’s glued down. They are also wheelchair thresholds to help. 

Question: In an apartment, do you know to what extent you can do modifications on your own, and when you need to bring in your apartment manager?

Answer: There’s no obligation for the landlord or management company to pay for any improvements for disability. They have a hard time saying no to it, but it is at the tenants cost. If they say no to it, they can contact us or other CAPS certified professionals, and they will contact the county that will tell the landlord it’s justifiable cause and they can’t refuse. They can make you take all improvements out when you move out. Every county is different, but there is also the national ADA requirement. No landlord can refuse the improvement for someone with a disability. Your doctor would give you the RX (prescription) for the disability.