by Stephen Jon Romero, Registered Architect
For many of us, our home is our sanctuary. It’s where we raise our children, create memories, and feel safe, secure, and comfortable. It’s the place we return to at the end of the day and where we live our lives. However, for a person with dementia, navigating their home can be challenging and even dangerous. Ensuring that individuals with dementia can remain in their homes is a critical concern. According to an AARP survey, 90% of seniors prefer to age in their own homes rather than move to an assisted living facility.
Dementia can take many forms, including Alzheimer’s disease, which accounts for about 70% of all dementia cases. Many of these conditions lead to mobility issues, such as balance problems, difficulty with posture control, and an overall decline in mobility. For someone experiencing these challenges, their once-safe and comfortable home can become a difficult and sometimes hazardous environment. Fortunately, there are various ways to help mitigate these issues.
Most of us take for granted how we move about our homes. We rarely think about how we approach, open, and close doors, use the toilet, or get in and out of the bathtub or shower. We often overlook how we communicate with others inside and outside our homes. For individuals with mobility issues due to dementia, these everyday tasks can become frustrating and detrimental to their quality of life. However, there are strategies to alleviate the impact of these mobility challenges, creating a safer and more accommodating environment that allows individuals with dementia to remain in their homes longer, with greater safety and comfort.
Home modification is one practical approach to creating a safer, more mobility-friendly environment. But what does this entail? Home modification involves addressing specific mobility challenges that make everyday activities difficult. Depending on the severity of the mobility impairments, these modifications can range from minimal adjustments to extensive renovations. There is no one-size-fits-all solution; modifications should be tailored to the individual’s needs, factoring in the current and potentially advancing nature of their mobility issues and the cost-benefit of the modifications.
Some potential modifications include replacing round doorknobs with lever-type handles, installing grab bars in the bathroom and shower, adding ramps instead of stairs, and ensuring clear floor space at doorways, kitchen appliances, and bathrooms.
For most people, opening a door is a simple and instinctive action that doesn’t require much thought. However, individuals with dementia often have significantly reduced hand strength and dexterity, making even basic tasks difficult. To improve their independence and quality of life, we can make thoughtful modifications to their living spaces. One practical and cost-effective solution is to replace round doorknobs with lever-style handles.
Lever-style door handles require minimal grip strength and often no finger dexterity. The design allows users to apply a small force on top of the handle and push it down, which can be done with a closed hand, fist, or even the back of the hand or wrist. This provides easy access from both the push and pull sides of the door. For locking mechanisms, push-button locks are preferable over turn-style locks, as the latter require greater finger dexterity, twisting, and pinching to operate.
For many people who are not mobility impaired, moving around the home is often taken for granted. However, these everyday actions can be significantly more complicated for those with mobility challenges. Simple tasks such as opening or closing a door, using the toilet, or getting in and out of a bathtub or shower require additional space for maneuvering. The Americans with Disabilities Act (ADA) of 1990 is a federal law that provides civil rights protections for individuals with disabilities, including standards for barrier-free access. While the ADA primarily applies to public spaces and does not enforce requirements in private homes, its guidelines can be useful for ensuring accessibility in residential environments.
When approaching a door, fully ambulatory individuals instinctively know how to navigate the movement: They approach the door directly from the front, reach for the doorknob, turn it, pull it open, and step back. This sequence is a well-coordinated action that many people have memorized. However, this coordination can be challenging for those with cognitive, spatial, or mobility impairments.
One of the federal standards concerns clear floor spaces. These are minimum areas required at doors, appliances, plumbing fixtures (including tubs, showers, and toilets), and other locations in the home to provide additional room for maneuverability.
For example, on the approach side of a door that swings towards us, an 18-inch clear area should be provided next to the door handle, also known as the strike side. This space should extend from the floor up to at least the top of the door. This clear space allows a person to approach the door handle at an angle or from a position out of the way of the door’s outward swing, enabling them to open the door without needing to back up.
While this federal standard is primarily designed for individuals in wheelchairs, it is also beneficial for anyone who requires extra maneuvering space on the pull side of a door. This serves as an example of how the concept of clear floor spaces can be valuable; there are many applications for clear floor space in various elements throughout the home.
It would be challenging to address every type of modification available within the context of this article, as individual needs vary. Factors such as the home’s existing conditions, the permanency of the changes, and budget constraints all play a role in determining which home modifications will provide the greatest practical and cost-effective benefit.
Each situation is unique, and modifications should be based on an assessment of the individual’s current, developing and future mobility impairments. This approach ensures that the changes are tailored to create a safe and comfortable environment, allowing mobility-impaired individuals to remain in their homes for as long as possible.
Next month’s topic: Stairs
