Best Practices for Aging in Place at Home and in Assisted Living

Posted on by Emily Kil

The concept of aging in place is something of an evolution in this day and age. As a consequence, best practices for aging in place are also in a bit of a state of flux as well. This article is presented to provide a basic discussion of the best practices for aging in place in an era when the concept of aging in place is in a period of some redefinition.

Historical Concepts Associated With and Evolution of Aging in Place

Historically, aging in place was defined as the ability of older individuals to grow old in their own homes. At times, aging in place at home necessitates the addition of caretaker assistance, typically to deal with some activities of daily living. This does remain the most applied definition of aging in place in this day. However, there is movement in another direction. 

In more recent times, aging in place sometimes has been broadened to include residing in an assisted care community. The reason this expansion has occurred in the minds of some individuals is because assisted living provides the same types of services an individual can receive by an in-home caretaker. The argument is that assisted living largely is a change of environment and not really level of care for those individuals obtaining assistance from an in-home caretaker. 

Philosophy of Aging in Place in an Assisted Living Community

The philosophy of aging in place in an assisted living community focuses on resident control over service delivery. This includes the types of services a resident in assisted living will receive and the manner in which those services will be delivered to the resident. This fairly can be called a consumer focused or oriented model in which services are organized around the resident as opposed to the assisted living facility and its administration and staff.

Four Elements of Successful Aging in Place in Assisted Living

Four elements of aging in place in assisted living have been identified through observation of operations as well as a comprehensive research study involving 141 assisted living communities with an aging in place component. These four elements of aging in place in assisted living are:

  • Choice
  • Flexibility
  • Mixed generation community
  • Calibrated support

Each of these elements of a successful aging in place endeavor in assisted living are examined in turn.

Choice

As has been alluded to previously in this article, aging in place requires a resident the ability to make choices in regard to services as well as delivery of services. When a resident so desires, family should also be permitted to be involved in the service and service delivery processes.

Flexibility

For the purposes of aging in place in assisted living, flexibility means that services will be delivered in a manner that they are available in a variety of different contexts. Flexibility underscores the fact that assisted living services, and those associated with aging in place in this type of community, meet the specific needs of an individual residence. 

Mixed Generation Community

The development of a mixed generation broader community associated with assisted living enhances the ability of a person aging in place in this type of facility to enjoy the fullest of benefits of this type of structure. Mixed generation community can mean residents in different age categories.

A mixed generation community can also come in the form of something like a daycare center for children being associated with an assisted living community with an aging in place component. Residents could elect to volunteer their time assisting themselves on behalf of the children in an associated daycare.

Calibrated Support

Calibrated support returns us to the point that one size for all does not fit in assisted living, particularly when aging in place is an element of such a facility. Calibrated care extends beyond the nature and extent of services and the manner of delivery. It also includes the manner in which an assisted living facility is designed and outfitted. 

For example, a small assisted living community located in what otherwise would appear to a private residence likely will have the design features necessary to enhance the benefits and ensure the satisfaction of the objectives of aging in place in assisted living.

Aging in Place at Home

In addition to providing this discussion of aging in place in assisted living and best practices, we turn to review best practices associated with aging in place in one’s own residence. There are a number of points in which we discuss in regard to this issue.

Remodeling the Residence

The National Association of Homebuilders has created an exhaustive list of what needs to be accomplished in the way of remodeling if a person wants to age in place at home. We include key points of the remodeling checklist for your reference should you or your parent elect to age in place at home.

Exterior

  • Low-maintenance exterior (vinyl, brick)
  • Low-maintenance shrubs and plants
  • Deck, patio, or balcony surfaces are no more than a half inch below interior floor level if made of wood

Overall Floor Plan

  • Main living on a single story, including full bath
  • No steps between rooms/areas on the same level
  • 5-foot by 5-foot clear/turn space in living area, kitchen, a bedroom, and a bathroom
  • Hallways
  • Minimum of 36-inches wide, wider preferred
  • Well lit

Entry

  • Accessible path of travel to the home
  • At least one no-step entry with a cover
  • Sensor light at exterior no-step entry focusing on the front-door lock
  • There needs to be 32-inches of clear width, which requires a 36-inch door
  • Non-slip flooring in foyer
  • Entry door sidelight or high/low peep hole viewer; sidelight should provide both privacy and safety
  • Doorbell in accessible location
  • Surface to place packages on when opening door

Thresholds

  • Flush preferable
  • Exterior maximum of a half inch beveled
  • Interior maximum of a quarter inch

Interior Doors

  • There needs to be 32-inches of clear width, which requires a 36-inch door
  • Levered door hardware

Windows

  • Plenty of windows for natural light
  • Lowered windows or taller windows with lower sill height
  • Low maintenance exterior and interior finishes
  • Easy to operate hardware

Garage or Carport

  • Covered carports and boarding spaces
  • Wider than average carports to accommodate lifts on vans
  • Door heights may need to be nine feet to accommodate some raised roof vans
  • Five-foot minimum access aisle between accessible van and car in garage
  • If code requires floor to be several inches below entrance to house for fume protection, can slope entire floor from front to back to eliminate need for ramp or step
  • Ramp to doorway, if needed
  • Handrail, if steps

Faucets

  • Lever handles or pedal-controlled
  • Thermostatic or anti-scald controls
  • Pressure balanced faucets

Kitchen and Laundry

  • Counters
  • Wall support and provision for adjustable and/or varied height counters and removable base cabinets
  • Upper wall cabinetry three inches lower than conventional height
  • Accented stripes on edge of countertops to provide visual orientation to the workspace
  • Counter space for dish landing adjacent to or opposite all appliances
  • Base cabinet with roll out trays and lazy susans
  • Pull-down shelving
  • Glass-front cabinet doors
  • Open shelving for easy access to frequently used items

Appliances

  • Easy to read controls
  • Washing machine and dryer raised 12-15 inches above floor
  • Front loading laundry machines
  • Microwave oven at counter height or in wall
  • Side-by-side refrigerator/freezer
  • Side-swing or wall oven
  • Raised dishwasher with push-button controls
  • Electric cook top with level burners for safety in transferring between the burners, front controls and downdraft feature to pull heat away from user; light to indicate when surface is hot

Bathroom

  • Wall support and provision for adjustable and/or varied height counters and removable base cabinets
  • Contrasting color edge border at countertops
  • At least one wheelchair maneuverable bath on main level with 60-inch turning radius or acceptable T-turn space and 36-inch by 36-inch or 30-inch by 48-inch clear space
  • Bracing in walls around tub, shower, shower seat, and toilet for installation of grab bars to support 250-300 pounds
  • If stand-up shower is used in main bath, it is curbless and minimum of 36-inches wide
  • Bathtub – lower for easier access
  • Fold down seat in the shower
  • Adjustable/handheld showerheads, 6-foot hose
  • Tub/shower controls offset from center
  • Shower stall with built-in antibacterial protection
  • Light in shower stall
  • Toilet two and half inches higher than standard toilet (17-19 inches) or height-adjustable
  • Design of the toilet paper holder allows rolls to be changed with one hand
  • Wall-hung sink with knee space and panel to protect user from pipes
  • Slip-resistant flooring in bathroom and shower

Aging in Place at Home Best Care Practices for Assistance

When aging in place at home, an older individual needs to be tuned in to what types of resources may need to be accessed. These include:

  • Caretaker assistance with activities of daily living
  • Reliable assistance with money management
  • Assistance with medicine management and other healthcare needs

The reality is that for most people aging in place, the day will come when these types of assistance are needed. It is best that a person aging in space understand this fact and proactively prepare for that eventuality.