Designing Your Forever Home: How Enabling Design Can Help You Age in Place
According to a national survey by AARP 76% of adults over age 50 want to age in place, but did you know that your home can determine your ability to do so?
We talked to environmental gerontologist and built environment strategist Esther Greenhouse, a nationally recognized expert in Universal Design and Aging in Place, about what to look for in a forever home and simple enabling design changes that can allow anyone to age independently.
Q: WHAT IS ENABLING DESIGN?
I developed the Enabling Design Approach to address the aging of the population, remedy the fact that the status quo of our housing unnecessarily makes people frail as they age, and apply the powerful theory of environmental fit and press to improve people’s lives. This theory states that when there is a good fit between a person and their environment they can function independently. When there is poor fit, the person’s abilities will be reduced by the “press” of the environment, resulting in artificially created dependency. Recognizing and understanding the above leads to the solution of using design to enable people to thrive. We can enable people to maintain as much independence as possible, rather than forcing them into frailty.
“…our standards and conventions for designing and building create places that are ideal for the average height male (5’9”) with the highest physical, cognitive, and sensory abilities.”
The Enabling Design Approach shifts from a deficits-based view of the person, to a strengths-based view of the relationship between the person and the place, rejecting the status quo that people must adapt to their environments, even though they are improperly designed.
I often say that if my students had designed our society, especially our housing, the way that professionals do, I would have either failed them or had them redo the project. It’s not well known but our standards and conventions for designing and building create places that are ideal for the average height male (5’9”) with the highest physical, cognitive, and sensory abilities. How does it make sense to design housing that works for a limited subset of the population? It’s impractical, and really at the heart, it’s discriminatory, not only by age but by size. I have two visual processing disorders, but I struggle more on a daily basis because I’m 5’1’’. Reaching the gas pedal in the car, finding an office chair that fits comfortably, reaching things in stores, it’s a challenge, and it has nothing to do with age or being disabled. This is another important component of Enabling Design — designing for the real variations of abilities, size, and behaviors present in our society.
Q: HOW HAS AGEISM HINDERED ENABLING DESIGN?
Aging is unacceptable in our society. Ageism is one of the last socially acceptable biases. It’s amazing the negative comments I hear from people about being old. People who would never say anything remotely racist give no thought to saying something ageist. This translates to how people view themselves and the decisions they make. You see people over 50 who are building or buying their dream home, or they’re making extensive renovations to their home, and they reject the idea of incorporating features that work for the lifespan because they’re afraid of the concept of growing old and becoming frail. Which is ironic, because these features can actually prevent or reduce frailty.
Home suitable for aging in place: exterior ramp for wheelchair and wide entries (Image from ageinplacehome.com)
Q: WHY SHOULD WE THINK ABOUT DESIGNING FOR OUR LIFESPAN NOW?
People sometimes say “I’ll put in grab bars later if I need it.” But they need to understand that if they wait until they have the need, they have already been unnecessarily disabled by the design of their home. You can’t wait to incorporate these features, because as the gap grows between your abilities and what your environment requires of you, the environment is going to push you to a lower level of functioning — this is an example of environmental press that I refer to as “forced frailty”. It will increase your risk of accidents, and more importantly, lower your ability to function. It doesn’t have to be this way, but most people, including experienced builders and architects, don’t even know this exists. If they did, they would design and build differently.
“…if they wait until they have the need, they have already been unnecessarily disabled by the design of their home.”
Q: HOW DOES ENABLING DESIGN SUPPORT YOUR ABILITY TO AGE IN PLACE?
My mom’s house is one of my best case studies because we designed it to be as enabling as possible. We built it for her 10 years ago when she already had health and mobility issues, and she’s still able to live there independently with minimal support.
She has help from us, we do the things she can’t do, she has an aide that comes in a couple of times a week, but daily, because of how we designed the house, she’s able to go from the bedroom to the bathroom independently. She’s able to fix meals for herself. In most houses, she wouldn’t be able to do that.
Q: CAN YOU TALK ABOUT WHAT ENABLING DESIGN FEATURES YOU USED IN YOUR MOTHER'S HOME?
The home has a zero-step entry to the deck so that she can go out and enjoy the weather when she wants to. There’s another zero-step entry with a ramp into the garage. If we didn’t have this I don’t know how she’d be able to get in and out without a special service to come and help. Wider doorways make a huge difference in terms of her comfortably using her walker. Having a consistent floor level throughout the first floor and using the same type of flooring as much as possible helps her walk with a rolling walker and reduces falls. If you use carpeting, it has to be a low pile with no padding underneath to allow for wheeled mobility devices, canes, and shuffling of feet. What’s really popular in residential construction that we used a lot in my mom’s house is luxury vinyl flooring. It’s sold in squares or planks, it’s softer than tile or hardwood and less slippery and easy to maintain. It’s a really nice option.
Examples of enabling design features in homes. (Image from bobvila.com)
Q: IS THERE ANYTHING YOU WOULD HAVE DONE DIFFERENTLY WITH YOUR MOTHER’S HOME?
One thing she didn’t do that she’s regretting is having a no-step shower. The standard shower units all have curbs to keep the water in, and she insisted that she could step over it. In her case, her balance issues worsened and her reaction time decreased, as expected, and now it’s too challenging and unsafe for her to get in and out of the shower by herself. A zero-step shower is terrific for anyone at any age, because you are stepping in and out and up and down in a slippery environment. But because she has a standard shower with a curb, she is dependent on me or an aide to help her bathe.
Q: WHAT ARE THE EXPENSES OF MAKING THESE CHANGES?
If you’re building new or making renovations, there’s often little cost to switch to these features. A common example is wider doors. A standard door in new construction is typically between 28 and 32 inches wide. Prior to the current pandemic-induced pricing, a basic door cost about $100-150. Upgrading to a 36-inch door would typically cost $10-$30 more. If you have 10 doors in the house, that adds up. But if your goal is to successfully age in place, what is the cost of home health care services? Typically about $100/shift. If those wider doors enable maintaining your independence, and they pay for themselves right away.
“If you’re building new or making renovations, there’s often little cost to switch to these features.”
Overall, people should consider the cost of assisted living, which is currently $3500 to over $10,000 per month. If you spend a few hundred or a few thousand dollars more to make the house work for you as you age, and this enables you to delay or avoid having to move out, these changes pay for themselves within the first month.
Q: IS ENABLING DESIGN ONLY FOR AGING?
Definitely not. While it’s really important to talk about these features in terms of enabling people to successfully live in their home across their lifespan as they age, we have to keep coming back to the reality that it’s not only about age — it’s about behaviors and abilities. If you have wider doorways and you’re carrying a sleeping child, you are less likely to hit their head on the doorway; it’s easier to carry a laundry basket or bags of groceries. Moving furniture and equipment through the house is easier. A tiny bit more space is a lot more comfortable. It's practical design that respects the way people function across their lives.
Kitchen interior with wide under sink and table space for wheelchair users (Image from NKBA).
Q: HOW IS ENABLING DESIGN A GOOD ECONOMIC INVESTMENT?
All of this started for me because I saw in my family and research that people were being forced to move out of their homes because the home wasn’t properly designed for them. Learning more about it, I saw they were not only forced out of their homes but forced into frailty, and there’s a whole economic angle to this.
One of the big things I’m focusing on is the Enabling Design Approach as an economic investment. Many people work with a financial planner to make sure they have enough money in their retirement years, but there’s a whole hidden aspect. The design of your home should be a key component to good financial planning because it can enable you to maintain your physical and financial independence. Because my mom’s home is so enabling, she’s avoided moving into a facility and has retained her assets, and her independence. As her primary caregiver, I benefit from her enabling home. If I had to do more, that would take away from my work which would cause me to lose income and negatively impact my retirement savings. People need to be informed and leverage the design of their homes and their parents' homes as an untapped long-term investment strategy. If you’re renovating and finally putting in that dream kitchen, make sure the changes you make don’t force you out of your house but enable you to stay there as long as wish.
Q: ANY FINAL THINGS YOU WANT PEOPLE TO TAKE AWAY?
None of the features that I talk about are radical. We’re not talking about a dome-shaped house, or round windows, or anything really different. The Enabling Design Approach is radical because it emphatically shows that the status quo is completely unacceptable. Small changes of standard features have a very significant impact. It’s like if you’re charting a course for a boat with just a one degree shift — it’s going to get you to a very different destination on the other shore. My purpose is to help get people to that destination, so they can thrive.
Esther Greenhouse
ABOUT ESTHER
Esther Greenhouse is a built environment strategist and environmental gerontologist, consulting for municipalities, senior housing providers, builders and developers, and major organizations to leverage the design of the built environment to enable people to thrive. She is the Strategic Director for one of the United States' first Age-Friendly Centers for Excellence. Esther creates and develops innovative initiatives, such as Equity by Design, a collaboration with AARP International to create a quantum leap for Age-Friendly Housing and Multigenerational Communities. She serves as an Industry Scholar in the Cornell Institute for Healthy Futures. Esther contributed to the design of the nation's first elder-focused ER and to the American Planning Association's first Aging In Community Policy Guide. Contact her for more information on how she can help you thrive by design at https://www.esthergreenhouse.com/.