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Home For Life

If you ask anyone over the age of 45 where they want to grow old, they will invariably say that they want to remain in their homes. Despite this, very few retirees have prepared their homes to meet their aging needs. Aging in Place is a philosophy that promotes independency and livability of all types of living environments no matter the age of the occupant or their level of abilities. There is a growing movement to educate the public on how to build or modify homes to enable people to continue to enjoy life in their living space as their physical needs and abilities change.

As we face the “Silver Tsunami” wave of aging baby boomers, we are also facing a reality of where and how all of these seniors are going to be cared for as they grow old. It is estimated that the population over 65 will increase by 36% by 2020. That means that there will be 72.1 million people over the age of 65 by 2030. Of that number, 6.6 million people will be over the age of 85. The number that is NOT growing is that only 4.4% of the population over 65 live in institutional settings such as nursing homes. This number has not really changed over the past decade which means that the growing number of seniors are choosing alternative means to providing for their aging needs.

Paradigm Shift

Physical therapists can play a vital role in this paradigm shift. We have always been involved in assisting with home safety evaluations to provide function to people with physical impairments. We just aren’t accustomed to being proactive in our thinking. How many times have you sent a 3 in 1 commode or elevated toilet seat home with a hip fracture patient only to find it in the closet or yard sale 2 months later?

The problem may be that we are a vain society. Nobody wants to be reminded of their limitations or physical frailty. These “appliances” that we prescribe are an embarrassment to the patient. They don’t want their friends to see such things when they come to visit. The patient readily acknowledges how useful the device is, but still hauls it out to the garage at the first opportunity. To combat this situation an alternative is that the way to provide functional safety in the home is to build it into the structure itself. A taller toilet with decorative bars strategically placed is more likely to remain in place and get used daily providing the safety that it is designed for without making obvious statements about the home occupants. This can be extrapolated to the entire house for maximum function.

The reality is that this new wave of seniors is going to be very different. This is a savvy, educated group coming forward. Boomers are very much into doing their own research and demanding what they want. The days of “spec” home building could well be over. My elderly parents would never have dreamed of asking a builder to do anything different from what they saw in the model they toured. They would have obediently picked from the color chart given, and patiently waited until the home was finished and ready to move into. The thought of moving walls, demanding more flooring options, planning for optimal natural lighting and pushing for creative financing was simply unheard of. You could only do that with custom built homes – and then only if you had a lot of money.

The building industry has not traditionally built homes that were designed to “fit” the occupants. Building contractors are very money driven. They are willing to do whatever the buyers want to make them happy, but generally don’t get vested in the decision making. Most developers and contractors are seeking to find the most efficient and cost effective way to build as many homes as possible. They don’t really care “why” you might want it a certain way, they just want to get the job done and move to the next job. This leaves the home buyer trying to design the home on their own. Architects and engineers can certainly help, but even these professionals lack the knowledge of what the aging body might require in the future. However when you consider who has the expertise and should therefore have an expanded role, it is the medical community. Physical and Occupational Therapists, as team players with builders, are the perfect choice for helping to tie these entities together. It is almost embarrassing that the National Association of Home Builders came up with the concept without us.

Certified Aging in Place Specialist

The Certified Aging in Place Specialist is a certification process that was developed by the National Association of Home Builders (NAHB) Remodelers in conjunction with AARP, NAHB Research Center, and NAHB Senior Housing Council. This program was developed to provide professionals training that would enable them to accommodate the needs of people over the age of 50, as well as the knowledge they would need to modify their homes for aging in place. The training is a 3 day course followed by exams to become certified. To maintain the certification, the specialist has to have 12 hours of continuing education in building industry education per year. The training is relatively simple. It involves a section on design techniques, marketing, customer service and business training, and universal / accessible design training. Contractors and Remodelers tend to be the biggest attendee population, although there are a handful of PT’s and OT’s starting to take interest. There is an assumption that the attendees have a basic knowledge of building and construction technique prior to the training. It is also not a cheap process. Expect to spend about $1000 or so before it is all over.

I found the training to be fascinating. The courses really focused on the particulars of installing grab bars, and designing kitchens and bathrooms. The attendees in my training were all builders and interior designers who had no clue as to “why” these appliances were needed or used, but more interested in the “how to” of installation. That was not to say that they weren’t appreciative of the perspective that my OT colleague and I had to offer. We were welcomed with open arms and bombarded with questions. The whole experience really opened my eyes to a whole new niche practice where my expertise and skills are badly needed.

Team Housing Building

Since the housing market crashed a couple of years ago, builders are suddenly more open to new lines of business. Many are opening up to the concept of “team building” as a way to meet the demands of the savvy, senior wave coming. This is a huge paradigm shift for them, but because many of the contractors are dealing with aging parents or starting to age themselves, they are really starting to “get it”. Finding willing and qualified medical professionals isn’t easy. To be able to work in the trenches with builders, I have had to learn to speak a completely foreign language. I have had to learn a lot about products I never knew existed, what they cost, and where to get them. I have had to learn about creative financing, and lots about compromise to get to the goal. It is no longer useful or practical to simply hand over a list of recommendations. We need to be prepared to do feasibility and cost reports that go with that. We need to stay with the client until the project is completed to ensure that the desired functional outcome is achieved. I think that we are talking about a whole new specialty of physical therapy practice here.

This is the first in a series of articles in GeriNotes on the skills and the process for becoming a valued member of the home building team for the senior population. The first article will speak to the different types of design and their uses. Subsequent articles will speak to implementation and decision making for the design, product availability and uses, and marketing of services. This is an exciting area of opportunity for therapists so stay tuned!

To get more information on the Certified Aging In Place Specialist process, go to

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