Should I Stay or Should I Go?

Simple lyrics and a serious consideration for seniors. Should they remain in their homes as they get older?

If given the choice, the majority of older Americans would like to age in place rather than move to an assisted living facility. After all, living at home is not only more familiar, but it's also more economical. The one thing it might not be, however, is safer.

"Part of keeping people at home is making sure they have a safe environment," says Frank Belfsky, owner of Living at Home Senior Care in Amherst, who runs a seminar on fall prevention for senior groups. "And one of the biggest causes of losing that independence is falls." According to the Centers for Disease Control and Prevention, one in every three adults age 65 and older falls each year. And in this same group, falls are the leading cause of death from injury. Slippery walkways, loose rugs and clutter can all be factors, but so can improper footwear (think fuzzy backless slippers) and side effects from medications. Should a senior slip and fall, they might be singing a different tune about staying put. Thankfully there are plenty of ways to reduce the chances of having an accident at home.

By far the most dangerous areas of the house are the bathrooms and the stairways, says Robert Presti, owner of Boston Walk-In Bath Company in Boxborough, Mass., whose company actually focuses on both of these areas, despite the focus on one room in the company name. "Imagine telling your mother to climb three steps at once. She'd probably turn around and whack you over the head," laughs Presti. "Well, that's essentially what you're asking her to do when she steps into a tub: the side of the tub is about the same as three steps – the average step is 7 1/4 inches, and a tub side is 20 inches." He adds that not only are seniors stepping over this tall barrier off-balance on one foot, but they're also getting into a surface that is slippery, unforgivingly hard and curved. By replacing a regular tub or shower with a walk-in bathtub, you replace those hazards with a 6-inch step, a seat that is the height of a kitchen chair where the water comes up to you and a surface made from Coremat, the same stuff they make sailboat and motor boat decks out of so that it's not slippery, says Presti.

Falls aren't the only factor to consider in the bathroom either, adds Presti. "Seniors who have lost feeling in their legs from neuropathy can very easily burn themselves and not even know it with very hot water. It's important to have an anti-scald valve in your tub." Grab bars for the toilet and bathtub are another important component when tackling safety issues in the bathroom.

Stairs present another problem for seniors because as people age their sense of balance may be affected. Loose carpeting or poor lighting might contribute to spills so it's important that handrails are on both sides, the area is well lit and free of clutter and flooring is even and level. In the kitchen the lighting should be bright over the sink, stove and countertops. For seniors with arthritis, replace hard-to-open knobs and cabinet pulls with C- or D-type handles. Have a sturdy step stool with handrails (or a "grabber tool" for securing items out of reach, says Belfsky). Keep a fire extinguisher nearby and an anti-scald device on the sink faucet.

While anyone can look over a safety checklist to see how their house may – or may not – stack up, often it helps to have a fresh eye look over surroundings. "When you grow up with it, you don't think of it as a risk," says Belfsky. "One of the things our nurses do is a patient assessment of the environment to make sure it's safe at home or make modifications that might be necessary. It could just be a basic thing like making sure throw rugs are secure to the floor and there aren't any loose rugs anywhere." Studies back up Belfsky's logic: older people who are visited by service providers are more likely to have low-hazard levels than those who were never visited, possibly because the providers make suggestions about how to make their homes safer and seniors would be more likely to take them up on their advice.

Some companies specialize in making safety modifications, such as Community House Calls in Chester. Ray Mailloux, the owner, says sometimes it's just very simple things that make a difference. "Everybody's homes are different and everybody's needs are different but there's nothing better than walking out of a house and knowing that the person can now do something they couldn't do before you went in." And, he adds, "what's nice is that a lot of equipment does not look institutional anymore. It doesn't have to look like a hospital."

As for the expense of making these modifications, Presti says that seniors and their families should keep it all in perspective. He points out the example of one 98-year-old client who wanted to stay in the second-story of her two-family home but needed a stairlift to maneuver the curved stairwell to get her mail and take a walk each day. While the cost was somewhere between $15,000-$16,000, one of her daughters pointed out that although it was a lot of money it was only a fraction of what an assisted living facility would cost.

And there are some changes seniors can make that don't have anything to do with their house at all but may make all the difference in being safe at home: a medical alert emergency pendant -"I've fallen and I can't get up" should be playing in your head right about now- or even a whistle on a lanyard, as one senior suggested to Belfsky at one of his seminars; getting regular physicals and eye exams; and gathering up all of your medications so that a doctor or pharmacist can look them over and make sure there aren't any harmful drug interactions.

Exercise is also important to keep strength and balance. Tai Chi programs can be especially good for both these things, but even walking on a regular basis is helpful.

"Unless you are physically sick, you are giving up an awful lot if you leave your house," says Presti. "Unless you have something seriously wrong with you, do everything you can to stay at home and be safe."

Here are AARP’s Top 10 Favorite Fixes to Potential Hazards in Your Home

1. Install handrails on both sides of all steps (indoors and out).
2. Secure all carpets and area rugs with double-sided tape or carpet mesh.
3. Install easy-to-grasp C- or D-shaped handles for all drawers and cabinet doors.
4. Use brighter lightbulbs that don’t produce excessive glare.
5. Install night-lights in all areas of night activity.
6. Add reflective, non-slip tape on all non-carpeted stairs.
7. Install lever handles on all doors.
8. Place a bench near entrances for resting or setting down purchases.
9. Install closet lights, as well as adjustable, pull-down rods and shelves.
10. Install rocker-style light switches and consider illuminated ones in select areas.