How to elder-proof a home for safety and better mobility

Most older people prefer to stay in their own home, but it’s not always safe for them to do so. As we age, there are some things in our homes that can create a safety risk.

Thankfully, accommodations can be made, explained Bethany Graham, PT, DPT, rehabilitation practice manager at the Visiting Nurse Association of Cape Cod (VNA). The VNA rehab clinicians complete home safety evaluations when a physician refers a patient to them due to a change in health status from an injury or an illness.

However, many changes to improve safety and independence can be done without a home evaluation. Most of the things that Graham recommends can easily be done by family members or a local contractor.

Here are some suggestions.

Exterior Safety

Graham begins the safety evaluation before she even enters the home. First, she checks the terrain of the driveway to make sure it’s not uneven. Holes or bumps need to be filled in or corrected. Next, she checks the pathways to make sure they are wide enough to accommodate a walker or a cane. Even ground and terrain can help when balance is an issue for someone.

Most houses on the Cape have at least a few steps to climb to enter. So, there are a few tips to make navigating them easier.

“Sometimes people put the nonskid sandpaper on the stairs, and you can make it a bright color,” she said. “The sandpaper creates friction so you don’t lose your balance, and the color creates visual assistance so you can see where the step starts and ends for people that have poor vision or macular degeneration.”

Next, she checks handrails to make sure they are intact and not too wide for frail hands to grasp, to create stability for the person’s upper body. Adjustments can be made if they aren’t safe.

“Then, when you get to the top of the landing of the stairs, is the landing wide enough to open the door and accommodate an assistive device or can it potentially knock the patient and the walker off the stairs?” Graham said.

If the door swings out and the landing is too small, accommodations can be made to have the door hinge in the other direction.

Living Room

One of the biggest dangers in a living room is a loose throw rug, Graham said. She recommends that patients remove any loose rugs. But this, and all of her recommendations, come with the caveat that she likes to make sure that the person retains their autonomy.

“We tell them what the risk is, and we give them choices,” she said. “We want to keep them safe in their home, but they do have choices.”

For example, if a person has a large Oriental rug they simply cannot part with for sentimental reasons, she recommends cleaning under the rug really well and then putting double-sided tape to adhere the ends of the rug to the floor, so a walker foot doesn’t catch on it. 

The living room should be set up to ensure there is enough space for a patient with a walker to move around and to safely seat themselves in a chair or couch. A firm chair is best and, if it’s too low to the ground, you can add a stable pillow or cushion.

“Make sure there is adequate room for the walker or cane when you back up, so you can back all the way up with your legs hitting the chair, with the walker in front of you, and safely reach the armrest to sit down,” Graham said. “All space in the living room needs to accommodate a walker transitioning from sitting to standing.”

Once the person is seated, you want to make sure they can safely reach a nearby coffee table and have a reachable light source, because many falls occur due to inadequate window light in the daytime and when people don’t turn on artificial lights.

Loose cords and pet toys on the floor can also cause a fall. In general, the less clutter the better.

Hallways

Ranch houses are attractive for elderly people because they offer one-floor living, but often they have long dark hallways. Adding a nightlight that automatically turns on is a good idea. There are also battery-operated flashlights.

“If there are narrow pathways, we can move the walker wheels from the outside to the inside, so it takes a couple of inches off the width of the walker,” Graham said. “The wheels are on the walker, and you just switch the left to right and then they become on the inside.”

Kitchen

Once again, remove any throw rugs. Graham recommends making sure things are reachable at counter height. Some people wear aprons with pockets to carry things from the fridge to the counter or cutting board.

Bedroom

If the bedroom is small, you can move the bed off center to accommodate a walker so the person can safely get to their bed. Grab-bar style bedrails also help because patients can use them to safely pull themselves up to a sitting position from lying down.

One patient told Graham the grab bars were the "cheapest thing she bought that allows her to remain independent."

Getting dressed can also be hard for people with mobility issues. Graham recommends three devices that can help:

• A grabber/reacher tool to get things deep in the closet or on the floor/overhead
• A shoehorn to help put on shoes, and
• A sock aide for people who can’t reach their feet.

Bathroom

The bathroom can be the most dangerous room in the house simply because water makes surfaces slippery. A commode chair or elevated seat can help people who struggle to successfully get on and off a lower toilet. There are also comfort-height toilets that are a few inches higher than a standard toilet.

Another good idea is a diagonal grab bar on the wall next to the toilet to help someone get on and off the toilet, using upper body assistance.

Graham highly recommends getting rid of the little rugs that go around the base of the toilet. People love them because they keep their feet warm, but Graham recommends non-skid socks instead.

For the bathtub or shower, a wall-mounted grab bar to help you get in and out is important. A secondary choice is a suction grab bar, but people should proceed with caution with them because they can detach easily.

“I always tell patients, before you are going to weight-bear on it, give it a test when you are on your walker to make sure it’s adequately adhered to the wall,” she said. “Test it prior to every use it, if it’s a suction grab bar.”

A rubber-backed bathroom mat is the safest type, and a non-skid floor mat inside the tub is essential for preventing falls on the slippery shower floor.

“We want to use a handheld shower head for ease of bathing, so they can have a shower chair and then they can adjust the water temperature and use the handheld shower head while seated,” Graham said.

“There are two types of shower chairs. There’s the standard shower chair and then there is one called over-the-tub bench that will go over the tub wall, so there’s two legs on the outside and two legs on the inside.” This type of chair allows someone to sit on the edge and scoot into the tub seated on the chair.

A long-handled sponge helps clean hard to reach spots like the back.

Swag for Your Walker

A walker basket or walker tray helps people carry things.

“A tray table goes over the handles of the walker,” Graham said. “You can still hold on, but you can put a plate on the table to move it from the kitchen to the dining room table. With a basket, you can carry your phone or your remote — or your Stanley cup — in your walker basket.”