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Stay at Home Solutions blogs on topics such as aging in place, universal design, adaptive equipment, home modifications, accessibility, durable medical equipment, legislation, and caregiving.

Posts in zero step entry
Do I Really Need a Ramp as I Age?

This answer is: not really. It depends on how well you plan changes to your home!

Ramps are mostly a utilitarian tool for houses with steps to enter. I’ve never known anyone to say that they would LOVE to have a ramp attached to their house. More people would rather have a zero step entry.

But if life sneaks up on you and you have little time to plan, a ramp is a good option to keep in mind to keep that ability to get in and out of your house. Let’s go over what types of ramps exist!

Photo of modular ramp by Upside Innovations

Photo of modular ramp by Upside Innovations

Modular ramp:

Modular ramps are cost effective in that they can be prepped in one location and assembled in another. They are reusable, which is great for low income families or people who need to move to a different home. Modular ramps are considered a temporary structure and require no permit to build.

Here’s a link for more information on how to build a modular ramp from a local non profit in Minnesota. You can even add stairs to this model!

Permanent ramp:

Photo of wooden permanent ramp by Upside Innovations

Photo of wooden permanent ramp by Upside Innovations

You do need a permit from your city to build a permanent ramp. These ramps are typically made of aluminum, wood, or concrete. Consider building this type of ramp if you are planning to live in your home for a lifetime.

Permanent ramps are the most expensive ones on the list. Make sure that you are satisfied with the design of the ramp before you build! Any last minute changes could be VERY expensive!

I would also double check and make sure the surface of the ramp will resist feeling slick from rain or ice. Have you ever pushed or pulled something with wheels up a hill or ramp when it’s slippery? If you haven’t, it’s NOT easy! I don’t want my ramp to turn into a slide if I can help it!

Transportable ramps:

I grouped the following ramps together because they are all designed to be set up and taken down frequently over a few steps: telescopic, folding, and suitcase. They are typically made of aluminum and some sort of anti-slip tape or treads.

Photo of telescopic ramp by Upside Innovations

Photo of telescopic ramp by Upside Innovations

Telescopic ramps have two separate troughs for the right and left wheels of a wheelchair. This is a bad choice for scooters due to the third wheel in the middle!

Photo of foldable ramp by Upside Innovations

Photo of foldable ramp by Upside Innovations

Folding ramps come in a variety of different sizes and are either bi-fold or tri-fold. They are foldable in order to conserve space when stored. People typically use these ramps to get in and out of a wheelchair accessible van.

Photo of suitcase ramp by Upside Innovations

Photo of suitcase ramp by Upside Innovations

Suitcase ramps are bi-folds with handles to make it less awkward to carry. They vary in length from two to six feet, which makes it convenient to throw in the trunk of a car if you’re travelling or visiting family or friends.

Always check the weight limitations that transportable ramps can support. For instance, power wheelchairs can weigh up to 250 pounds alone! You definitely want to have a ramp that can support the power wheelchair plus a person.

Threshold ramps:

Photo of threshold ramp by Upside Innovations

Photo of threshold ramp by Upside Innovations

This type of ramp is used to maneuver over a small barrier, like a door threshold or a curb. They’re made of rubber or metal and are very lightweight. Threshold ramps work on heights from ½ to six inches, so please don’t try and stack them if you need a height exceeding that (speaking from experience!).

Rampscape:

Lastly, let’s talk about my favorite type of ramp, the rampscape. They incorporate landscaping and grading to create a gradual incline to the threshold.

Photo of rampscape by Innovate Building Solutions. It doesn’t look like a ramp!

Photo of rampscape by Innovate Building Solutions. It doesn’t look like a ramp!

In my case, I would love to make a rampscape to my back door, which is the main entry in and out of my house. I’m planning on grading the dirt and pouring a concrete sidewalk that will make a gradual slope to my back door. This will eliminate the steps and make my door a zero step entry!

Rampscapes are beautiful, have great curb appeal, and stand the test of time. If you put in a rampscape, then anyone with any ability can visit your home! I have relatives who have a hard time walking and climbing steps. A rampscape would allow my relatives and wheelchair users to effortlessly go in and out of my house.

How cool is it to be the house everyone can visit?

Let me give you two tips for consideration when using ramps. First, try to place an overhead cover above your ramp. This helps with weather protection, especially if your ramp becomes slick from rain, ice, or snow. Overhead covers keep you dry and comfortable while self propelling wheelchairs, fumbling for keys, opening the door, etc.

The second thing to remember is that ramps with a rise of one inch to one foot (1:1) is the most ideal.

Why is that?

Well, have you ever pushed anyone in a wheelchair up or down a ramp? If the slope is more than 1:1, you are working VERY hard. This leads to increased physical labor for caregivers and a higher chance of injury.

Heck, I feel my body working harder when I’m walking up a steep hill by myself! I don’t want to work too hard when I’m helping somebody else!

Make sure you have the space for the length of the ramp you need. The rise at my back door is 14 inches, which means I need 14 feet of length for my ramp to be 1:1. Personally, I have the space to do that in my yard.

Now, if you don’t have the space for that, you may need to install something else besides a ramp, like a vertical lift.

Your takeaway from this tip should be: steep ramps are pains in the BUTT! Make sure you’ve got the room to make a ramp with a gradual slope. Steep ramps make it hard to get in and out of the house, which makes it so people never want to leave the house. Not leaving the house is very bad for your health!

I hope this article helps you plan for a ramp (or NO ramp) in your future. Personally, I don’t want to have to deal with ramps to get in and out of my home EVER. With my experience as a caregiver and occupational therapist, I’ve found that ramps can be treacherous.

That’s why I’m planning my rampscape while I can easily climb stairs, not when I struggle getting in and out of the house.

Do you use ramps at home? What type of ramp do you have? Tell us what you think about it in the comments below!

Remember, you better do it before you need it!

(Thank you to Upside Innovations for their great article on types of ramps!)

What Do You Need? A Zero Step Entry!
Front entry with zero step entry. Photo by the Journal of Light Construction

Front entry with zero step entry. Photo by the Journal of Light Construction

A zero step entry is a doorway to get in and out of your house with ZERO steps.

You know what’s a shame though? Less than 3.5% of homes in the U.S. have one zero step entry according to Joint Center for Housing Studies (2011).

Now, of course, I hope that figure has gone up since 2011. But I highly doubt it!

When I drive around and see new construction for houses and apartments, you better believe I’m rubbernecking to see if they’re putting in one entryway with zero steps!

But here’s the unfortunate truth: I see steps to go inside the front door, back door, and garage door.

Why do builders do this?

Because they do what they know. Builders don’t obsess about accessibility the way occupational therapists like me do!

I understand people think that a couple, two, three stairs won’t hurt anybody from going in and out of their house. But it actually does in the long run.

Let’s try an experiment:

I want you to carry something that requires two hands, like a laundry basket, across level flooring for ten feet.

I’ll wait here. . .

Okay! You’re finished! Great! How much effort did you put into that? How hard are you breathing? Can you still hold a conversation? Are your muscles tired?

Now, I want you to carry that same object up and down at least two stairs. If you have more stairs, try carrying your object up and down all of your stairs.

After all of your stair climbing, how much effort did your body put in to carrying an object up and down the stairs compared to no stairs at all?

As we age, this “simple” task of carrying objects up and down stairs becomes more difficult. Even though I’m in my 30’s, I notice I exert more energy to carry things up and down stairs compared to carrying things across the floor.

I hate to burst your bubble, but there will be a day when it’s harder for you to carry things up and down the stairs. It may be due to a back injury, arthritis, heart condition, etc., etc. You just never know!

So if you DON’T have a zero step entry, what can you do NOW to make sure you’re set for the future?

Start planning your zero step entry for your home!

Front zero step entry with portico and rampscape. Photo by Sutton Group Preferred Realty

Front zero step entry with portico and rampscape. Photo by Sutton Group Preferred Realty

It can be any entry you desire! The front door, the side door, the back door, the garage door, etc. You pick what works best for you and your house.

You can convert an existing window into a zero step entry door! If you’re creating a door out of a non-existing door, make sure to have the doorway width measure 36 inches for plenty of room to maneuver in and out of the house.

An issue that may come up is the fact that the main level of your house is not the same as the ground outside.

I have that EXACT same issue! So let’s dive into the problem solving process for my humble abode.

This is my back stoop with uneven pavers and rubber mats! This is a work in process, my darlings!

This is my back stoop with uneven pavers and rubber mats! This is a work in process, my darlings!

The problem for my house is the front and back entryway both have stairs to go inside. I would choose to make my back door zero entry because it’s closest to our driveway. There are several options I can think of off the top of my dome:

Wooden ramp from driveway to front door. Photo by Wheelchair Special Needs Project.

Wooden ramp from driveway to front door. Photo by Wheelchair Special Needs Project.

1) Install a ramp at the back door and create a minimum 6’x6’ landing for space to open the door and walk inside and outside. The ramp incline would need to gradually rise one foot per inch from the ground level to the height of the door threshold.

In my case, I would need 14 feet of ramp to accommodate the 14 inches from the ground to the top of my threshold. I would also make the ramp width at least 60 inches to allow plenty of room for a wheelchair user.

2) Install a rampscape at the back door. Rampscapes are ramps made by grading dirt to make that gradual incline to the door threshold. They look very pretty when landscaped with whatever materials you choose. I would lay a 6’x6’ concrete patio by the door, a 60 inch wide concrete sidewalk on the rampscape, and add lots of plants around it!

Rampscape from the driveway to the front door using pavers with a gradual incline. Photo by Schafer Construction

Rampscape from the driveway to the front door using pavers with a gradual incline. Photo by Schafer Construction

3) Install a vertical lift. A vertical lift is a platform that takes you from ground level and elevates you to the main threshold, like an outdoor elevator! I would still create a 6’x6’ landing to allow enough room to open and close the back door. This option would definitely require an overhead above the vertical lift to protect it from rain and snow.

Vertical platform lift next to small porch with four steps to enter door. Photo by Mobility Express

Vertical platform lift next to small porch with four steps to enter door. Photo by Mobility Express

All of the options above would cost thousands of dollars. The most inexpensive option would be installing a ramp. Personally, I would install an overhang or portico to cover the landing above the back doorway to avoid all forms of precipitation, especially after witnessing Missouri imitating Siberia this year!

Although I don’t have the funds at the moment, I can discuss this with my family, look for ways to fund a zero step entry, and ask for bids to help me select the best option and plan. Creating a zero step entry is a three year goal for me.

If you’re looking into building a new home, then you will spend the least amount of money to create a zero step entry!

Let’s say you wanted your zero step entry to be your garage door. Tell your builder! They can grade the site to ensure you drive into your garage and effortlessly step in and out of your home.

Sometimes, people are concerned that the only style of house they can build to include a zero step entry is a patio home.

NOT TRUE.

If your builder is not willing to make at least one zero step entry and keep whatever style of house you choose, then they do not have the creativity or desire to move outside of their comfort zone.

You can build ANY style of house and have at least one zero step entry.

Whichever doorway you choose, remember: it’s best to have the doorway covered above and to make sure water will drain away from the door. Water is bad inside of the house.

Contact me to help you create a zero step entry! You better do it before you need it!

Do you have a zero step entry? Show us pics. If not, what are your plans? Share in the comments below!

Can You Relate?
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Breaking a bone in your body is one of the worst experiences you can have in your lifetime. Trust me. I know this experience firsthand!

When I was eight-years-old, I climbed the wobbly, rickety chain link fence in the backyard at home and toppled over to fall to the ground breaking my left elbow. I remember passing out from the pain after seeing my mother’s scared facial expression.

At the hospital, I was given pain medication that completely knocked me out. The radiology tech had to keep prodding me to stay awake while taking x-rays of my arm. Eventually, I had surgery to realign my bones with two pins.

I remember the whole experience vividly! I was small and nimble enough to not need any home modifications. BUT I needed help with getting dressed, going to the bathroom, taking a shower, and brushing my hair. The pain from my arm would wake me up sometimes at night. I had to sleep lying on my back with my arm propped up on pillows.

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I HATE sleeping on my back!

Luckily, I am right handed and had all the benefits of youth while waiting for my arm to heal! I was able to easily manipulate brushing my teeth, drawing, feeding, playing card games, and anything else you can think of with my right hand. Recovery took no time at all for me as a child. As soon as I was able to use my left arm, I quickly returned to dance lessons and playing piano.

I could never forget how my injury impacted my life in such a profound way. My mother was wary and extra protective while my arm healed. She made sure my sisters and cousins were careful when they played around me. Mom did not want me to be hurt again!

Looking back, I not only see the physical impacts a broken arm had on my life. I also see how I changed the way I took care of myself and how my family members and friends treated me.

As an eight-year-old, I was very independent in taking care of myself prior to the injury, especially as the oldest of four children. When I broke my arm, it felt like going in reverse needing even more help from my mother. She even tied my shoes again. I saw myself as an independent person changing into an interdependent person.

That’s hard even for an eight-year-old child.

I can’t tell you how happy and relieved I was to resume my independence again after my arm fully recovered. But not everyone can experience this type of relief.

As an adult, injuries like broken bones can be more damaging and long lasting than what children experience. This is where it gets deep, people!

Adults have decades of being independent in taking care of themselves and others. A broken bone drastically changes how they view themselves. Accepting help can sometimes be seen in the same vein as becoming older or aging.

Of course, as occupational therapists, it’s easy for us to reassure adults with injuries that they are not old people (there’s nothing wrong with that anyway!). We educate them on all of the ways they can still do what they need and want to do. However, we do need to remind ourselves that when people break a bone, they are grieving the loss (temporary or permanent) of their independence and the way they used to do daily activities. Even little eight-year-old me grieved over not being able to play tag and ride my bike for a couple of months.

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Whoa. Grief? Yes. Here’s an example!

Dave broke his tibia stepping off a sidewalk into the street while heading to a coffee shop. He had surgery and needed to use a walker to help balance while hopping on one leg to get around. He quickly realized he needed a lot of help with getting in and out of his house, bed, shower, and going up and down the stairs. Dave was frustrated he could not move easily around his house anymore.

Pistola squat by Workoutlabs.com

Pistola squat by Workoutlabs.com

He thought, “Dang, I never thought I would need to do a pistola squat to get on and off the toilet! I don’t want my wife to help me with this every day!”

Dave even needed help picking up his dog’s bowls to put water and food in them! He felt like he had to rely on his wife to do everything. Dave started to feel depressed while his leg was healing because he wanted to do more by himself. Dave loved his wife, but he didn’t want to be soooo intimate with her while toileting and bathing.

He missed his ability to move around and take care of himself on his own time. Dave wondered if he will be able to continue living in his current house as it was. “What if I could never walk again? What will I do?”

In this situation, it’s easy to see why Dave would grieve the loss of his privacy, caring for himself, and moving around. He feels frustrated on how much effort he has to put in to simply move around the house. These emotions are very normal for any person. Have you every had this type of experience? Can you relate to Dave?

There are some things we cannot control whatsoever, like accidents. But we certainly can control our environment! Since we know breaking bones is such a challenging physical and emotional time, I am happy to say there are ways we can prevent lessen some of the pain and maintain our dignity by making changes in the home.

Yes, as a kid, I easily navigated my environment with a broken arm. However, poor adult Dave struggled to move around in and outside of his house with a broken leg. Let me tell you three things he could do to his house to make recovery better:

Stanton Homes

Stanton Homes

1) Create one entrance at home with ZERO steps. This will make it easier to use a walker to hop on one leg in and out of the house. Dave will be able to escape the home in case of emergency, see the doctor, go to outpatient therapy, spend time with friends at the ball game, etc. Dave can just enjoy not struggling to get in and out of his own house! He will not feel like a trapped prisoner!

Barrier free shower by Accessible Solutions

Barrier free shower by Accessible Solutions

2) Build a bathroom on the main floor of the house. Preferably this will be a full bathroom, but a half bathroom will certainly suffice! Put blocking in the walls in order to install grab bars later if needed. The blocking will allow you to install grab bars at any height! How neat! Grab bars could help Dave get on and off the toilet by himself, but there are a lot more options I can talk about with Dave and his wife.

3) Install a barrier free shower. Dave can easily use this shower with or without a broken leg! A barrier free shower lets you walk in and out without stepping over anything! This type of shower is perfect for all ages and abilities from wheelchair users to people who walk on two legs. Learn more by clicking here or here!

If you can relate to Dave, you may want to consider planning on making changes to your current home. Life is unpredictable, but if you do it before you need it then you are setting yourself up to maintain your independence and dignity in your own home. Please comment below if you or someone you know has had Dave’s experience of grieving the loss of taking care of yourself.

Hey, Missouri! Show Me the Money: 6 Ways to Finance Home Projects!

Last week we discussed three ways to pay for home projects that help us and our families live at home safely and independently. Apparently, that article left you hungry for more information! So this week, I wanted to follow up with EVEN MORE financial resources for your consideration!

Let's do a quick recap on the who, what, and why it's important to invest in home projects, such as home modification or remodeling. We all want to live in our homes as long as we possibly can. (I have never EVER met anyone who said they wanted to live in a nursing home!) Despite us wanting to live in our homes forever, over 90% of housing in the U.S. is NOT set up for us to safely age in in place! That means every person in the U.S. needs to start investing in home modifications that will allow us to remain independent caring for ourselves, OR we will ALL end up spending more money on things we hate, like medical bills and rehab.

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So you may ask, "Maria, how can I afford to pay for home modifications?" Great question! Here are six solutions for you:

1) If you are a home owner, renter, or landlord with a low to moderate income, listen up! You can request home repairs or simple modifications through your area agency on aging, which is financed by the Housing and Urban Development HOME Program and Community Development Block Grants. In Kansas City, MO, you can click here to request help to fix repairs and install accessible features, like grab bars in the bathroom. 

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2) Don't worry Missouri farmers and ranchers! I'm thinking about you too! The United States Department of Agriculture and Rural Development offer loan programs for low to moderate income home owners and landlords to buy, build, rehab, or improve a house! It is worthwhile to consider these low interest loans for home improvements that allow you to age in place. Before your family talks you into moving to the city for retirement, look into this type of loan for home modifications to stay safe and independent on your land! 

3) Go to your local bank or credit union and ask about the loans they provide that are insured by the Federal Housing Administration (FHA). Let's say you take out a loan that is FHA insured and something terrible happens where you are unable to repay the loan. Not to worry! FHA will reimburse your bank the amount of the loan balance. Since the bank is guaranteed a loan payoff, they are often willing to lower loan requirements for the income and credit score. These types of fixed or variable rate loans are great for low to moderate income homeowners and landlords to make homes accessible for people to live for a lifetime!

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4) Do you care for children 18 years and younger with developmental disabilities? Do they feel heavier and heavier every time you pick them up to feed/dress/bathe/toilet them? It's time for some home modifications to protect your back and the health of your child! Check out the Missouri Medicaid waiver that pays for home environmental modifications to make it safer and easier for you to help your kiddo! This waiver is available to both homeowners or renters across the state!

5) If you have trouble getting in and out of your home, take a look at the Missouri Residential Dwelling Accessibility Tax Credit. This tax credit is for people with disabilities who have an income of $30,000 or less a year. You can be credited up to $2,500 for modifying your entryway (i.e. garage, front door, back door, side door) to make it easier to enter and exit your home. Personally, I love being reimbursed by the government for doing something good for my home and my physical health! No more worrying about accidental injuries when getting in and out of the house!

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6) Veterans! You have sacrificed your time and lives for our country's independence! Now, it's time for you homeowners or renters to maintain your independence in the community! Go to this link to apply for housing grants to adapt your home! You deserve to live in a home that is set up for you to complete your daily activities. Also, click here to learn more about the Home Improvement and Structural Alterations Grant for veterans that focuses on home modifications specifically for bathrooms, entryways, and kitchens. In my humble opinion, those are the top three places in your home that you should address first!

The time for home modifications is now! I don't care how old you are! I'm looking at you all in your twenties, thirties, forties, fifties, or above! I don't care if you can still walk or drive at night! I don't even care if you think you can rely on your kids in your golden years! People of all ages need to make changes in the home now to live at home for a lifetime. All it takes is one project at a time, folks.

After you find out which financial resources above will work for you, call an occupational therapist, like me, to guide you in creating home modifications custom made for you. Occupational therapists understand that people have different wants and needs in their home. We love working with people to tailor their home environment just for them! In fact, check out the research showing that occupational therapists are the most effective at home modification recommendations!

Lastly, I know that you know people who could benefit from this information. Share this article with every veteran, grandparent, parent, farmer, neighbor you know! Click on the links above and learn more about these grants, waivers, and loans for Missouri residents! Consider this: if you clicked on one link a day, you would be finished in one week. Take notes on which financial resources will and won't work for you to stay organized. If anything, celebrate this Independence Day with looking at ways to pay for your independence in the future!

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What Do Older Adults Face? (And How to Help!)

In college, I took a class called, "Biology of Aging" with great curiosity. The class revealed detailed facts on the decline of every body system throughout the aging process. The recently deceased Philip Roth gave a quote to adequately sum up my overall feelings of the course, "Old age isn't a battle; old age is a massacre." Although it gave me a somber perspective, the class allowed me to be more empathetic and understanding of an older adult's experience while working as an occupational therapist in skilled nursing facilities.

stay_at_home_solutions_aging_process

The aging process can be a barrier to a person's ability to be as independent as they used to be. Here are a few examples of barriers to every day living:

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  • As we age, our sensations (i.e. eyesight, touch, smell, taste, hearing, balance) diminish making it more difficult to be aware of potential harm in our homes and community.

  • There is an increased risk of falling with potential to damage paper-thin skin or break bones plagued with osteoporosis.

  • The medications prescribed for heart problems, diabetes, sleep problems, or allergies can make older adults feel dizzy when standing up and moving around the home.

  • Seniors feel insecure about urinary incontinence while going out into the community with the fear of having an accident in public.

Fear not! Aging is not a doom and gloom story. 

This article is not meant to make you feel depressed or sorry for older adults! I am writing this to show you why life is different as we grow older. The good thing is there are A LOT of things we can do to help ourselves stay safe and independent in our homes.

Here are the top three things to look at for yourself or someone you know at home:

Zero step entry: Innovate Building Solutions

Zero step entry: Innovate Building Solutions

1) Look for one entryway into the home with NO stairs. This is called a zero step or zero level entry. Why is it important? Because no stairs equals less chance of falling! It's so handy when you're carrying groceries or laundry in and out of the house!

2) Examine the toilet. Are you struggling to get on and off of it? A history of back, knee, shoulder, and hip problems may make toileting more difficult in the future. If so, call an occupational therapist to help you find the right solution for your specific needs and bathroom set up. In my experience, everyone has different needs to keep toileting independently.

3) Consider having an occupational therapist give safety recommendations for the shower! We look at factors like the type of shower, shower faucet, water controls, flooring, color contrast in the bathroom, secure seating, and a person's ability to shower on their own (and how to keep it that way!).

Barrier free shower: Access Solutions

Barrier free shower: Access Solutions

If you make changes to the entryway, toilet, and shower, I guarantee improved safety and independence for older adults at home. I am very passionate in helping people remain in their homes for a lifetime. Won't you consider taking a look for yourself or family member today?