By Carol Levine, AARP

An important first step in deciding whether staying in the same home can work is taking a hard look at the home. Looking past a cherished home’s attractive features and focusing on its flaws and hazards can be hard to do. Having someone with fresh eyes with you as you survey the premises can be helpful, preferably someone with experience in home modification for older people, such as a physical or occupational therapist, a geriatric care manager, or a contractor who has done similar jobs.

If you’re trying to improve the home for a relative, be aware that older people often downplay concerns about safety and resist change. Be tactful but firm. Safety is not the only issue, but it is a prerequisite for enjoying a good quality of life.

Falls and burns aren’t the only sources of injury at home, but if you address them, you’ll likely prevent other kinds of injury as well.

Preventing falls

Your first priority should be preventing falls. Falls are among the most common accidents in homes. Older people are at risk for falls because keeping your balance as you age is more difficult, and it’s harder to readjust your feet to regain your balance if you slip. Arthritis can limit your range of motion. Many older people suffer bone loss, or osteoporosis. Hips are the most likely joints to be injured because people tend to fall on their sides.

Falls are often the first step in a cascade of decline that ends up with a hospital stay and eventual placement in a nursing home or death. Fortunately, many fall-prevention measures are easy to take and are not expensive.

Here’s a checklist for falls prevention adapted from the National Center for Injury Prevention and Control, a division of the CDC. Another valuable CDC publication is available for family caregivers.

  • Floors:
    • When you walk through a room, do you have to walk around furniture? If so, make a clear path by moving the furniture.
    • Are there throw rugs on the floor? If so, remove them or use double-sided tape or a nonslip backing.
    • Are there papers, books, towels, shoes, magazines, boxes, or blankets on the floor? Pick them up and keep them off the floor.
    • Do you have to walk over or around wires or cords (like lamp, telephone, or extension cords)? Coil or tape cords and wires next to the wall. You may need an electrician to put in another outlet.
  • Stairs and steps:
    • Are shoes, papers, or other objects on the stairs? Remove them.
    • Are some steps broken or uneven? Have them repaired.
    • Does the stairway have a light? An electrician should install an overhead light and light switch at the top and bottom of the stairs. (Use an energy-saving type of light bulb so it doesn’t need to be changed as often.)
    • If there’s carpet on the stairs, make sure it’s firmly attached to every step.
    • Make sure that handrails are not loose or broken and that they’re on both sides of the stairs.
    • To make seeing the stairs easier, paint a contrasting color on the top edge of all the steps. For example, use a light color paint on dark wood.
  • Kitchen:
    • Are often-used items on high shelves? Move them to lower shelves (about waist level).
    • Is your step stool unsteady? If you must use a step stool, get one with a bar for support. Never use a chair as a step stool.
  • Bathroom:
    • Tubs and shower floors are often slippery. Put a nonslip rubber mat or self-stick strips on the floor.
    • Install grab bars inside the tub and next to the toilet. Make sure you have this done by someone who knows how to place them correctly and securely. The screws should be installed in the studs in the wall, not in the tiles, or the grab bar will pull loose.
  • Bedroom:
    • Is the light near the bed hard to reach? Make sure a sturdy lamp is close to the bed.
    • Is the path from the bed to the bathroom dark? Put in a night-light, preferably one that turns itself on after dark.

Handling clutter and hoarding

Your survey of the home may have uncovered an unpleasant secret. Perhaps unread newspapers and magazines have accumulated, the refrigerator is full of rotting food, or the cats have taken over the bathroom. This behavior is not just difficult to look at, but it also can be a fire and safety hazard. Some of this accumulation is clutter. Bending down to pick up papers may be difficult for a person with arthritis, or a person with vision problems may not be able to read the sell-by date on foods. But sometimes the accumulation of stuff rises to the level of hoarding, which is a more serious problem.

Hoarding interferes with ordinary life by making it impossible to use the space as intended and impedes access in an emergency. You may be tempted to overlook the problem because one good cleaning would get rid of the worst of the mess. But it’s not something that should be ignored, and if you get rid of the piles of what you call junk and your relative considers priceless, he or she will only refill the space as quickly as possible.

There are many theories about what causes this kind of behavior, which may be related to depression, anxiety, prior losses, or other mental-health issues. Hoarding is one manifestation of obsessive compulsive disorder (OCD). Dealing with hoarding requires consultation with experienced mental-health and home-organizing professionals who can negotiate the cleanup in nonjudgmental ways. A useful article prepared by the University of California-San Francisco is available. Another resource is the International OCD Foundation.

Preventing burns

Burns are a common problem in the home. Even a minor burn can lead to infection and serious consequences. Older people literally have thinner skin that’s more susceptible to scalding from hot water or burns from electrical appliances. To keep older people safe from burns at home, make sure that you:

  • Replace electrical cords that are broken or cracked.
  • Replace electronic devices, heaters, or appliances that overheat, spark, or smoke.
  • Use a power strip rather than an extension cord.
  • Keep electrical appliances away from water.
  • Unplug small appliances such as toaster ovens and coffeepots when not in use.
  • Keep a three-foot zone of safety around the stove, oven, and microwave.
  • Use microwave-safe cookware.
  • Set the water temperature to a maximum of 120 degrees Fahrenheit (this may be a job for a plumber or apartment building staff).
  • Use a humidifier that sprays cool mist rather than hot steam.
  • Have smoke alarms installed and change the batteries twice a year. You can use changes to and from daylight saving time as your reminder.

Smoking in bed is still a common cause of fires. Do everything you can to prevent this dangerous habit.

A comprehensive brochure with guidelines for preventing burns from the Hearst Burn Center at New York Presbyterian Hospital is available.