Sadly, family members and other caregivers often sabotage well-intended efforts to help their loved ones simply because they haven't thought about answers to basic questions. And when it comes to recommending changes in someone's home, the balancing act can be particularly acute. This is a place where someone has lived all his life, where she feels comfortable, where he feels safe. The fact is, however, that while most people say they want to live in their homes as long as possible, most are not designed to allow them to age successfully in place.

It's not just the ill, but the "well elderly" who experience the effects of aging. Aging affects vision, mobility, dexterity and endurance. Arthritis or other degenerative diseases may make it difficult to do the things one used to do. This usually translates into some very real and practical problems at home. The three most common problems are: getting in and out of the house; using the bathroom; and going up and down the stairs. Because most people are unaware that simple home modifications can alleviate these problems, many develop coping strategies to stay in their homes, but put them at risk for accidents or injury.

While approaching the possibility of home modifications can be sensitive, the right preparation and understanding can make all the difference. It's a fact of life. As people age, their bodies change and they may have difficulty performing certain daily activities because of physical and cognitive limitations. So the house that was once perfect for them may not be anymore. Consider this, when couples have their first child they make changes around the home. But very few realize that as they get older they also need to make changes to make the home more appropriate for this stage as well.

As an occupational therapist who works in a county office in aging, I see attempts at this balancing act on a daily basis. Some successful. Some not. But all well intended. While an occupational therapist has specialized skills and expertise to match an environment to a person's abilities, there are simple steps family caregivers can use.

1. Investigate and Raise Awareness
The best first step, even before you raise the home modification issue with your loved one, is to build a list of helpful resources for yourself. If you've ever tried to find particular products or home contractors for general work, you know how difficult this process can be. Who do you trust? What is the right price? Who have others used before?

Because investigating resources can be the biggest obstacle a person faces when considering home modifications, becoming aware of different products and services can really help to facilitate this process. Subscribing to a catalogue that carries home modification products is a good idea and can easily be found by conducting a quick "Google" search on the subject.
If you find something you think might be immediately useful, try introducing the idea of change in the form of a gift, like a new bathmat with non-skid backing. Or, if some regular home maintenance is already being performed, include handrails, if necessary, as part of that project.

Community resources, like area agencies on aging, can be enormously helpful and are good places to start. These agencies may be knowledgeable about products and local services that can help with home modifications and offer referrals on aging resources - both subsidized and private.
Sometimes, resources may be in your own back yard. Neighbors and friends who have successfully adopted changes can be great role models.

2. Assessing
While a professional who specializes in aging is the best person to provide a complete assessment, there certainly are things caregivers can begin to do that will be enormously helpful when a professional is brought in.

Carefully observe and look out for any changes in the home and with the person. As you look around the home, ask yourself if the environment has changed in any way. Is it clean? Is anything broken? Is there food in the kitchen? Has the laundry been done? As for the person, have you noticed whether they are forgetting things? Are medications being taken? Are bills being paid? It's good to keep an eye out for any kind of change in typical, everyday behavior.

These are things you can learn from observing. There are also things you can learn by asking. You might not always get a complete response, but you will have started the dialogue and reinforced your efforts in raising awareness.

Consider asking
What kinds of things are you having difficulty doing at home?
What are you not doing now that you used to be able to do, or that you still want to do?
What are the reasons you don't do those things?
Which feel unsafe and which are you unable to do?

It's important to problem-solve together. If you strongly impose your own ideas, they run the risk of being ignored. Approach the subject by letting your family members know that you are concerned about their health and safety and assure them that you don't assume that getting older means self-awareness and understanding are diminished.

3. Consult a Professional
The truth is no matter how prepared you might be, no matter what kind of approach you take, you should count on a certain amount of resistance to your offer of help. A soft, patient approach is key, but in the end, it may not be all that is required.

An occupational therapist can match an environment to a person's abilities so they can do what they want and need to do at home. The occupational therapist's unique, three-pronged approach - looking at the person, the task and the environment - results in an individualized assessment that matches a person's physical and cognitive abilities to the features of the physical environment allowing them to do what they want and need to do. It enables people to live what they consider to be full and meaningful lives.

To be honest, while utilizing the resources of an occupational therapist may provide enormous benefit to your loved one, it also relieves an enormous amount of pressure from the caregiver. The external professional can come in and ask questions in a way that produces the kind of responses that help lead to the development of an action plan.

An OT can walk into the home and immediately begin to identify what a person is doing well and can emphasize the person's success. For example, she might say, "I notice you have cleared everything out which really helps in preventing falls. Are there other areas that you would like to focus on?"

An occupational therapist can take the blame off of the person and put it on the environment - it's not you - it's the home. Explaining that most houses were built when people's life expectancies were not nearly as long really rings true for some.

The process of change
It's essential to recognize and think about changes before they are needed rather than waiting for a crisis situation that may force a person to be removed from a home. Advanced planning empowers the person to make changes for themselves rather than have someone else step in. Often, it you wait until a crisis, individuals will resist even more.

Expect change and the adoption of new behaviors to occur slowly. The process usually takes several steps including: 1) pre-contemplation; 2) awareness; 3) information gathering; 4) planning; 5) action; and 6) maintenance.

In the planning stage, consider the Home Modification Strategies recently released from the American Occupational Therapy Association (see sidebar). This resource offers a room-by-room guide of things to look for and changes to consider in the home.

In his famous graduation speech turned book, Dr. Seuss reminds us in Oh the Places You'll Go, to:

Step with care and great tact / And remember that Life's a Great Balancing Act / Just never forget to be dexterous and deft / And never mix up your right foot with your left.

Life is a great balancing act, but not an impossible one. Through awareness, education, planning and action, you can help your loved ones fulfill their desire to remain in their homes for as long as possible.

Mary Becker-Omvig is the American Occupational Therapy Association's national Aging in Place spokesperson. Professionally, she is the Home Modification/Fall Prevention Coordinator for the nationally recognized Aging in Place program of the Howard County Office on Aging in Columbia, MD.