How to Keep Your Loved One at Home—Part I: Support Services and Home Adaptations

One of the most challenging issues that families face when planning care for aging loved ones is how to keep your elder independent, at home, for as long as possible.

Developing a workable solution begins with understanding your loved one’s unique circumstances. Among the many factors to be considered:

  • Extent of disability and care need
  • Structure of the home
  • Available funds and other types of support

As you work through these questions and develop a care plan, it’s most helpful to build a care team—attorney, financial advisor, care provider, care manager and others who can provide expert guidance.

Get a Professional Functional Assessment
To determine what services are necessary, you’ll need a functional assessment that identifies your loved one’s  strengths and deficits and how to support her needs. Assessments can be performed by nurses, therapists, social workers, private care managers and case managers.  The depth and focus of the assessment depends on the assessor.

This step includes an assessment of Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). ADLs are bathing, dressing, transferring/mobility within the home, toileting and feeding oneself.  IADLs include meal preparation, grocery shopping, housework, laundry, medication management, using the telephone, financial management and transportation.

Identify Home Adaptations
The assessor should also determine what home adaptations can be made and what equipment can improve safety. Some simple adaptations can make a significant difference:

  • Remove any clutter from the home
  • Rearrange furniture to maximize mobility
  • Set up living space on one floor and minimize the need to use any stairs.

The next step is finding the right equipment.

Get a Personal Emergency Response System
The most popular type of aid is the PERS (personal emergency response system).  This is the “I’ve fallen and I can’t get up” button. Many people resist getting one, telling me that they’ll know when they need one.  Sadly, this is when they are on the floor. Accidents happen. I recommend the PERS to virtually every elder living alone (no matter how healthy) and also to couples where one person is relatively healthy but the other may not be able to make an emergency phone call if needed.  Because the PERS can work for a good range, even outside of the house, it is a handy item to wear when taking out the trash.

There are several companies that offer these types of systems and even some systems that will automatically dial the emergency number if there is a fall. In addition to the PERS, there are other systems that assist with managing medications and even track movement in the home.

Make Necessary Structural Modifications
Homes can also be adapted with permanent or temporary ramps, hand- and grab-rails, stair lifts, walk-in tubs, major additions or renovations.  There are architects and contractors who specialize in home adaptation and companies that specialize in specific changes (such as stair lifts or tubs).  As you work through these options, it’ s important to have a professional such as an occupational therapist conduct a thorough assessment to determine the most appropriate adaptations. I also recommend that you work with a licensed contractor to enact them.

Several companies offer temporary home modules, fully handicapped accessible, that can be linked to an existing home.  Be sure to research zoning requirements before embarking on any major renovation or addition.

In Part II, we’ll  explore the range of home care services, including visiting nurses and private home health aide, and some of the issues to consider when hiring.

A version of this article originally appeared on

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified geriatric care manager. Drawing on more than 30 years of professional experience in geriatric care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting.

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