There don't seem to be many books focused on aging in place, which is part of [[Our strategy for my mom's aging]]. For the most part, we learned many lessons from my dad's experience, extrapolated those lessons to other situations my mom might face, and paid careful attention to each and every one of the items in the house. And then, we came across this book, which spells out much of what we focused on. If you have a family member who will be aging at home, especially independently, then you should read this book. ## The book **[Age in Place: A Guide to Modifying, Organizing and Decluttering Mom and Dad's Home](https://amzn.to/439cDws)[^1]** by Lynda Shrager OTR, MSW ## About these notes Eventually, I'll add my own additional thoughts and lessons about things to consider when aging in one's home, which can run a bit deeper than Shrager goes in the book. But in the meanwhile, here are various snippets I highlighted from the book, along with some raw notes and comments intended for myself and my wife. Keep in mind that your situation will be different, and that this is not an adequate summary of the book's contents. Instead, these snippets are simply random items that I wanted to highlight for myself personally for some reason or another. I post it here so you get a sense of what the book is like and how it reads. ## Highlights from Kindle These activities are called “activities of daily living” (ADLs) or “instrumental activities of daily living” (IADLs). ADLs and IADLs are anything people do from the minute they wake up in the morning until they go to bed at night. LOCATION: 157 Couch canes are handy products that aid users when they transition from standing to sitting and back up again from a chair, couch, or recliner. LOCATION: 591 If you are considering one of these for your parents, I highly recommend contacting a reputable home medical supply company that knows how to determine the correct size, type, and options in your price range. The one feature I insist my patients look for is a chair with no space between the seat and footrest when the chair is in the reclining position. Such a space does not provide continuous support, which can cause pressure areas on the back of the legs, and it could create a hazard if their legs get caught in the gap. NOTE: Lift chairs LOCATION: 597 Lift chairs are especially good for people who have chronic obstructive pulmonary disease (COPD) and other breathing difficulties. The chair enables them to rest while keeping their head elevated, which in turn eases breathing. I find that many of my patients end up sleeping in their lift chairs rather than their bed. At first the kids worry about this, but they come to understand it better once they see that it is often the best way for mom and dad to rest comfortably and easily get in and out of “bed.” LOCATION: 601 Another option when considering a lift chair is a Risedale chair. Only the seat cushion elevates, and the style of chair is a classic open-legged wing back so it often fits in easily with the décor. It takes up less room then a classic lift chair, and if the user only needs a boost up it is a great option. Search “Risedale chair” for more information. LOCATION: 605 If they desire to sleep in the chair because it eases their breathing and the mechanical benefits offer added comfort and less strain on their joints, then what they have chosen may be a good solution. The caveat: be sure they don’t develop any pressure areas on their back or buttocks from sitting and lying in only one position. You can’t turn on your side when sleeping in a lift chair. I tell my patients to get up and walk every two to three hours, and lay on their sides on their “real” beds for a rest each day if possible. LOCATION: 610 With many seniors, the location of their furniture has remained static since it was first delivered, and they rarely consider making what are often simple tweaks to enhance the livability of the space. LOCATION: 614 What does work for older people is to reduce glare and use task lighting in areas that are in high use, such as near the chair where mom sits to read the paper or at the desk where dad pays his bills. LOCATION: 651 Try the “Shrager twist test” to determine if the rug is safe. Simply step on the rug with your feet about 12 inches apart, wiggle your hips, and try to do the twist. Music is optional. If the rug moves under your feet, it is not safe. LOCATION: 665 Clutter in itself causes a buildup of excess dust, which may exacerbate breathing disorders such as asthma, and makes it harder to get around safely. LOCATION: 698 An interesting exercise is for both you and them to do a walk-though and role-play that you are guests for the very first time in the house. Take note of everything that seems cluttered, dirty, or dingy or is hindering mobility around the house. You may find that what once was a neat and uncluttered house has transformed into various sections of overflowing stuff, with things that your parents need most “buried under the rubble.” NOTE: Good opportunity to photograph and journal about memories for each possession too. Then you’re not losing the memory when you get rid of it. LOCATION: 700 most falls in the kitchen are a result of someone trying to reach up into a cabinet or shelf. LOCATION: 768 safer as we age involves making logical and often simple adaptations to existing conditions. LOCATION: 769 Suggest to mom that she consider applying anti-slip products to the floor (research “anti-slip floor treatments”), avoid floor wax, and be careful when using cleaners. LOCATION: 783 The most comfortable and controllable working height for the hands is that which places the wrists slightly below the elbows. Since the elbow of the average-height person is slightly higher than 36 inches above the floor, a kitchen counter height of 34 to 36 inches is appropriate for someone standing. LOCATION: 788 It is best to have at least 18 to 24 inches of cleared countertop space on at least one side of the oven, cooktop, microwave, and sink on which hot or heavy items can be placed to “rest” for a moment. This allows mom or dad to get their balance and get a good grip on the item with both hands before moving it to its destination. The countertops near the oven and cooktop should be heat resistant for easy and safe transfer of hot dishes. LOCATION: 790 If the hardware on the top cabinets is too high to reach, attach loops of rope or leather to the fixtures for mom or dad to grab on to and pull. LOCATION: 803 Cabinets can be retrofitted with pullout drawers. Some pull out and drop down to almost counter height. Lower cabinets can also be modified with pullout drawers so mom or dad doesn’t have to bend down and reach in for what they need. LOCATION: 805 One of the best types of faucet has a single lever with a built-in anti-scald feature. LOCATION: 814 Chairs that are on wheels can alleviate some of the maneuvering issues, but they need to be careful to guard against the chair slipping out from under them before they sit. The way to prevent this is to turn the chair so the back is against the table, sit down, and then turn to face the table while sitting on the chair. I also recommend this technique for sitting at a desk. NOTE: Good technique here LOCATION: 819 If vision is a problem, consider outlining the knobs and marking the most-used settings with Hi-Mark pens. They create a raised, easy-to-see mark to delineate objects. They also work well on microwave dials. LOCATION: 835 If possible, consider installing a pot-filler faucet near the stove that folds out of the way when not in use. This reduces the need for transporting heavy pots of water from the sink to the cooktop and allows for easily adding in some water if it evaporates during cooking. To empty a heavy pot of water, slide it onto the counter and over to the sink. If you can’t let the water cool, such as when making pasta, use tongs or a spaghetti scooper to lift the pasta out of the hot water and place in the colander. Another option is a rolling cart to transport it to the sink. LOCATION: 837 Toaster ovens take up little space and are relatively inexpensive. Besides toasting, they can be used for grilling, baking, and broiling. NOTE: When she’s done using the oven regularly, maybe you put a toaster oven next to it and the glass stovetop becomes a large hot plate area for dealing with items from a large toaster oven or microwave. LOCATION: 844 The goal is to create a safe condition where it requires the least amount of steps to transport plates and bowls of food. LOCATION: 850 The dishwasher should ideally be located on the side of the sink corresponding to the user’s dominant hand. LOCATION: 852 Bright light is essential, especially in areas where food is prepared. Task lighting should be placed in appropriate areas such as over the sink, stove, and food preparation counters. NOTE: Should we figure out an easier way to turn on the main kitchen lights? Right now the switch is on the far side near the fridge.At some point, I could see re-doing the entire kitchen to make it more aging friendly. Fewer high cabinets, heat resistant countertop everywhere, maybe other improvements to make it easier for her to cook/live there. LOCATION: 855 To make items more reachable in closets and pantries, add a lazy Susan and sliding baskets or sliding shelves for things used most often. LOCATION: 875 When organizing items in the refrigerator, place things most often used in the front, on waist-level shelves, or in the doors. Some models come with convenient pullout shelving. Alternatively, various sized bins are available at home goods stores to help keep like items together and tighter on the shelf. The coldest part of the fridge is the bottom shelf in the back, so that is where to store raw meat that has been placed in a bin to catch any leakage. The middle shelf, which is generally at eye level, is the most accessible, so I recommend that location for the food that needs to be eaten soon, such as leftovers, plus things they use the most. LOCATION: 877 I have become a fan of slow cookers (with auto shut off) for use by my senior patients. The ingredients can be thrown into the pot in the morning and taken out as dinner in the evening, with minimal monitoring, stirring, or maintenance. LOCATION: 886 Prepared foods and convenience items are helpful in decreasing repetitious movements that could lead to muscle strain in the arms and hands. Prewashed and shredded salad is a great example of this. Fresh vegetables are now being packaged in “stir-fry” packs, “roasting” packs, and “soup” packs, all precut and ready to go. LOCATION: 888 If mom or dad has any vision issues, suggest they use plastic, colored cutting boards for different foods to avoid cross-contamination. Use dark color boards for light foods and vice versa to create contrast. LOCATION: 893 An item called a rocker knife provides a sharp edge and cuts through thick vegetables or meat but does not require a lot of strength. NOTE: Look into these LOCATION: 895 Speaking of cutting with one hand, there are one-handed cutting boards that are designed with a couple of spikes coming up from the bottom to spear and thereby stabilize the food being cut. They also have a rim on the corners to stabilize the food for meal preparation. LOCATION: 899 Bump dots provide a tactile clue for the visually impaired. They come in all shapes, sizes, and colors and stick on easily to almost anything, including the microwave, coffee maker, and other appliances. Research “bump dots” online for more information. LOCATION: 928 After opening a jar of food, immediately mark the date on the label with a permanent marker before refrigerating it. This will save the angst of trying to determine how long it’s been since it was opened and whether the contents are actually supposed to be green. NOTE: GREAT TIP. Need to get some permanent markers and holders for the fridge so she can do this. We should do this too. LOCATION: 934 Use scissors to open packages rather than tearing with hands or teeth or attempting to cut open with a sharp knife. LOCATION: 939 Cut a small piece of rubber shelf liner and use it to open jars. Rubber gloves also work well. LOCATION: 940 Mount a fire extinguisher that is approved for grease fires in an easy-to-reach location. Review how to use it. LOCATION: 941 Place a pant hanger over a cabinet knob and use the hooks to hold a recipe. LOCATION: 942 Out of counter space? Open a kitchen drawer and lay a cutting board over it. LOCATION: 944 Use electric appliances to chop and blend rather than trying to do it by hand. LOCATION: 945 When preparing meals, double the recipe and freeze the extra portions for days when they don’t feel like cooking. Label these freezer packets with their contents and date for no-guess reheating. NOTE: She probably needs some better containers to freeze stuff in. LOCATION: 950 Jazz up your color scheme if vision is an issue or you just want to brighten things up. Yellow, oranges and reds are easiest to see. Use contrasting colors for dishes and tablecloths rather than, say, a white plate on a white cloth. LOCATION: 956 I had her daughter purchase from the local sporting goods store a step created especially for aerobics step exercises. It has sturdy rubber feet and a nonslip surface that is wide and easy to step up on. NOTE: Alternative for a small step stool for pantry? LOCATION: 976 I always recommend to my patients that they do not let the bedspread drape across their walking path. Instead, fold extra bedding back toward the bed or tuck it, if possible, under the mattress. LOCATION: 997 The rule of thumb is the lower the height of the bed, the easier it is to get into. But here’s the catch: the higher it is, the easier it is to get out of. Ideally, when your parent is sitting on the edge of the bed with knees bent at 90 degrees, their feet should rest flat on the floor. For the easiest transfers getting in and out of the bed, the height from the floor to the top of the mattress should be around 22 inches. NOTE: Bending more than 90 degrees can make getting up much harder. I think a higher bed makes far more sense. LOCATION: 1001 many falls occur when an elderly person stands up and starts to walk away from the bed. LOCATION: 1016 One explanation is postural or orthostatic hypotension, medical names for low blood pressure caused by blood vessels that don’t constrict when the body becomes upright.1 This can result in dizziness or light-headedness. LOCATION: 1016 Transfer-handle bed rails are an effective modification to help the user move around in bed and to assist with sitting, standing, and balance before taking those first steps away from the bed. LOCATION: 1024 A leg lifter is a gadget that looks like a stiff dog leash with a loop at the end. Dad sits on the edge of the bed, shimmies his buttocks back as far as possible, catches his foot in the loop, and lifts his leg onto the bed. LOCATION: 1036 The most important path is from the bed to the bathroom. LOCATION: 1040 The best way to illuminate the bedroom during the day is by keeping curtains and shades open to let in natural light. Use the maximum wattage light bulb that is approved for their particular lamps. The bedside lamp should be easily accessible, and it should be easy to turn on and off. Install an illuminated rocker or touch light switch within easy reach from the bed. Rocker switches are easier to manipulate than standard switches and can be triggered with little manual dexterity using any part of their hand or even the elbow. A touch-sensitive or clapper-type lamp is a great modification for someone with diminished reach. A night-light should illuminate the path from the bed to the bathroom. LOCATION: 1046 A light switch right outside the closet that turns on an overhead light inside the closet will improve mom’s ability to find what she is looking for, even if the closet is small. NOTE: What about battery operated motion lights inside the closet enclosure, so they’d only turn on when she’s looking for something? We'd have to occasionally charge them, but presumably not often. LOCATION: 1054 I discourage my patients from standing in the middle of the room to put on their clothes, but old habits are very hard to break. If the bed is an easy height to manage, that’s the best place for mom and dad to put on their clothes. Dad can gather his clothing, lay it out on the bed, and then sit in a relaxed position to get dressed. When he stands to pull up his pants, in case he loses his balance, the worst-case scenario is that he falls back onto the bed. If the bed is too high, place a sturdy chair with arms against a wall in the bedroom to create another safe place to get dressed. NOTE: Have her start getting dressed between dresser and bed, where she can either hold onto the dresser for support, or flop on the bed if she falls. LOCATION: 1060 The Mattress Genie is a really cool device that fits under the mattress and lifts it to various positions via remote control. It helps to prop up the person who has trouble breathing while lying flat or who may have back or hip issues. LOCATION: 1079 Over-the-bed tables are not just for hospital rooms. These provide a handy adjustable-height surface that can hold needed items next to the bed or in any room for that matter. NOTE: Would this be useful on the far side of the bed? Could be slid up or down the end and be an easy spot to put something. Something like what I have for dad would work fine. LOCATION: 1086 As far as toileting, if the actual toilet is difficult to access, the best alternative is to place a commode within a short distance of where the person spends most of their time. NOTE: Not a fan of this, as it then requires emptying which also seems problematic LOCATION: 1113 With most wheeled walkers, the two wheels protrude out from each side of the frame. If you remove the posts holding the wheels, switch them to the opposite legs, and reattach them, the wheels will then be on the inside of the frame. It should not hinder stability, and you will have gained 2 inches of room on each side of the walker. NOTE: This is a good hack LOCATION: 1125 To widen a door entrance without undertaking expensive renovations, one option is to try swing-away or swing-clear door hinges. These enlarge the doorway opening by 1½ to 1¾ inches, providing sufficient clearance for wheelchair entry. Another easy fix is to remove doorstops, those little “boingy” things behind some doors to keep the doorknob from hitting the wall. This will allow the door to open an additional three-quarters of an inch. As a worst-case scenario, consider removing the entire door. This could add 2¼ to 2¾ inches of clearance. LOCATION: 1130 If remodeling, have the door open out rather than into the bathroom to provide more interior bathroom space. An outward-opening door is also a good safeguard because if a person falls in the bathroom in front of a door that opens in, it may be difficult to open the door to get to them. Pocket doors that slide into the wall and completely out of the way are a great option when remodeling or building a new home. LOCATION: 1137 My first inclination is to look for the best place to install a couple of grab bars. Grab bars come in all sizes, are available angled and straight, and are made of various metals and plastics. If using them inside the shower or tub, I highly recommend getting the textured ones that do not become slippery when wet. Generally speaking, a 24-inch vertical grab bar on either end to grab on to when entering the tub and a 36-inch horizontal grab bar across the back wall will suffice. LOCATION: 1150 Suction grab bars are also ideal for figuring out the best placement for “real ones” that will eventually be installed. NOTE: Good tip in grab bars! LOCATION: 1165 The best scenario is a walk-in shower with little to no threshold and grab bars installed at a height that works best for the patient. I like to see one hung vertically at the entrance and another horizontally across the back. I also recommend installing one outside the shower for support coming and going. (Not a bad idea for a tub, either.) LOCATION: 1188 There is also a product called a collapsible water barrier that can be placed along the edge of the shower to accomplish the same goal. LOCATION: 1193 Sliding-bar showerheads move up and down on a bar mounted on the wall and are beneficial because the height of the spray is easily adjustable. A handheld showerhead comes off the mounting and is most useful when washing hair or nooks and crannies, as I like to call the hard-to-reach parts. It is also a good choice when a caregiver will be helping with the shower. LOCATION: 1198 There are also various roll-on coatings that can be applied to the bottom of a tub or shower. I like the peel-and-stick treads (fish-shaped are my personal faves), which are easy to apply and quite effective. Another easy product to install is the Gator Grip. It is a traction mat that is easily installed on the entire bottom of the tub. It does not have to be cleaned underneath because adhesive seals out mold and mildew. Check it out at noslipgatorgrip.com. LOCATION: 1205 Although raised toilet seats can be very helpful, some of my patients complain that the opening is too small, which may lead to difficulties completing personal hygiene after a bowel movement, and often there is no lid because the actual lid of the toilet stays up to accommodate the riser. An alternative to adding a riser is a product called the Toilevator, which raises the entire toilet on a plastic base installed into the floor. It was researched and developed at the Centre for Studies in Aging, which is a division of Sunnybrook Health Sciences Centre in Canada. It adds 3½ inches of height to either a round or oblong toilet, and the biggest perk is mom continues to be able to sit on the actual seat of the toilet. NOTE: This looks like a better solution. They cost between $100-200 and I think it'd be worth installing in both bathrooms. LOCATION: 1236 If you do not need added height, you can just add handles on either side of the toilet. An example of this setup is a product called a Versa frame. This is an armrest that surrounds the toilet to provide a gripping surface to help push up off of and lower down onto the toilet without adding height to the seat. Pull-down bars, also called flip-up bars, attach to the wall with tension adjustments so they can be set to various heights depending on the needs of the user. They need strong support in the wall in order to remain sturdy, so have them installed by someone familiar with this type of work. When not in use, they fold up against the wall and out of the way. They’re like the Murphy bed of grab bars! LOCATION: 1241 One of my favorite new products is a combination grab bar/toilet paper holder. It is attractive, does not look like a grab bar, and has a weight capacity of 250 pounds. LOCATION: 1256 Single-lever faucets are best because they provide a visual indication of water temperature from a single tap and don’t require fine hand dexterity to operate. LOCATION: 1268 If your parents are completing a bathroom renovation or buying a new home, install nonskid or slip-resistant flooring in the bathroom. Most of the time we have to work with the existing flooring. People are often reluctant to use bath mats because they “heard” you should remove all throw rugs to prevent falls, but in this case I advise otherwise. In the bathroom, I recommend a good-sized rubber-backed rug in front of the tub or shower to step onto after bathing. This helps to dry the feet, and any water dripping off you is absorbed rather than making the floor slippery. NOTE: Sounds like we should use a mat in spite of our concerns. LOCATION: 1270 Folding, however, is a great exercise for my patients, as it requires them to move all the joints of their arms but with little resistance. LOCATION: 1287 Use long handles for mops, brooms, and dustpans to avoid bending. LOCATION: 1300 Great present idea: a thick, thirsty terry cloth robe to put on after bathing. It will absorb most of the moisture, making drying off easier. LOCATION: 1313 Always have a night-light on in the bathroom to safely illuminate the way for those nighttime visits. LOCATION: 1322 Body washes that come in pump bottles are easier to handle than a bar of soap. Use a loofah-type sponge that comes with a strap that goes around the wrist to ensure an easy grip. LOCATION: 1325 Put a rubber band around the slippery shampoo bottle to improve grip. You can also put multiple rubber bands on the cream rinse to help tell it apart from the shampoo. Better yet, transfer these products to pump bottles so they can be operated with only one hand. LOCATION: 1327 If they have trouble reaching all parts of their body, purchase long-handled brushes for washing legs, back, and feet. LOCATION: 1329 Foot scrubbers are great gadgets that adhere to the floor of the tub with suction cups. They have upward-facing bristles that remove rough and dry skin like a loofah and clean the feet just with a wiggle of the toes. All mom has to do is rub her feet along the brush’s surface. LOCATION: 1330 When placing full-sized appliances side by side, make sure the one on the left opens to the left and the one on the right opens to the right, making it easier to switch the clothes from the washer to the dryer. LOCATION: 1456 Place a colored strip of tape or paint the edges of steps to more easily see where each step begins and ends. LOCATION: 1459 Creating a team to assist with your parents is the first and one of the most essential tasks. Trying to do everything yourself may lead to burnout and problems with your own physical and mental health. Reach out and form a larger network of friends, family, and community resources that can assume various responsibilities. LOCATION: 1726 If you are truly alone and you cannot find anyone to join the team, look into hiring a geriatric care manager. Geriatric care managers provide advice and coordination of care for seniors and their families and are particularly helpful when families are geographically separated. Check out the Aging Life Care Association website to find a professional near your parent and for more information. LOCATION: 1753 The Mother List: Vital Documents You Should Be Able to Locate Legal: Last will and testament Power of attorney Health care proxy and alternate Health care directives Health Care: Personal medical history (surgeries, immunizations, allergies, blood type, medication list) Family medical history Current medical conditions Doctors/dentist with contact information Authorizations to release health information Medicare/Medicaid card MOLST (medical treatment orders for life-sustaining treatment) Insurance: Health insurance policies and cards Life insurance policies with contact information for beneficiaries Long-term care policies Supplemental polices (e.g., Aflac) Homeowners/renters policies Auto policies Identifying Information: Driver’s license or non-driver ID Social Security number/card Passport/green card Vital Records: Birth certificate Marriage license Divorce decree Military records Adoption papers Financial Information: Name/location of banks with account numbers Online bank info with user names and passwords Investment accounts—stocks, bonds, mutual funds US savings bonds Name/location of safe deposit box with key and number Credit/debit card statements/access to actual cards Retirement accounts—pension, 401(k), IRA, thrift savings plan Checkbooks/passbooks Existing loans and balances owed Tax returns covering the last seven years Hidden cash, treasures, safes/vaults Deeds: House Car title Cemetery plot Any other properties Household: Mortgage Home equity loans Apartment lease Property/school tax records Utility bills—electric, water, gas or oil Service Providers: Lawyer Accountant Insurance agent Banker(s) Stockbroker Electrician Plumber Handyman Trash removal Lawn care/snow removal Deliveries: Newspapers and magazines Mail Post office box location, number, and key Pet Information: Veterinarian Health history Food type Career/Personal Highlights (for Obituary): Employment history and dates Awards Honors Death: Instructions for funeral Burial arrangements LOCATION: 2155 What May Be Included in the Health Care Notebook I. Health History Chronic illnesses, surgical history with dates, acute episodes (broken bones, non-chronic skin issues, etc.) Feminine history (if applicable) Family history (all generations of blood relatives—children, parents, siblings, grandparents, aunts, uncles, and cousins) II. Insurance Information Photocopy of all relevant cards Policy numbers, ID numbers Contact people, case managers at health insurance agency III. Diagnostic Tests/Lab Results Written reports of test results and labs with date and doctor who ordered clearly delineated Name, location, contact information for test sites—where tests, films, slides, and other data is stored IV. Medications Current drugs with dose, frequency, why they were ordered, and when Contact information for doctors who ordered these drugs Pharmacy contact information V. Treatment Information Names of doctors who are currently treating the patient, with all contact information Names of therapists, nurses, social workers, and any other ancillary medical personnel, with contact information Information/plans regarding current treatments (chemotherapy, home exercise programs, drug regimens, etc.) VI. Daily Log Diary of medical events as they happen—brief entries to help keep a chronological record VII. Support Information regarding various support groups Advocates—family members, friends, paid advocates—all with contact information VIII. Home Care Information regarding agencies and personnel Medical supplies (walkers, wheelchairs, oxygen, diabetic supplies, adaptive equipment, etc.) with receipts, serial numbers, and other pertinent information IX. Important Papers Advance directives—living will, medical power of attorney, health care proxies Copies of authorizations for release of medical information (HIPAA) Legal power of attorney LOCATION: 2202 Aging Life Care Association, http://www.aginglifecare.org. LOCATION: 2346 [^1]: This is an Amazon affiliate link, which means if you buy the book via this link, I'll get a very small kickback (probably measured in single digit cents). It's an easy way to support the costs of this site, which I post as a public service and not as a business venture. --- Updated: June 27, 2023