The 66-year-old former bank employee lives alone in an 1,800-square foot, two-bedroom mobile home in Santa Clarita. Worsening rheumatoid arthritis has made her dependent on a wheelchair. But a mobile home, no matter how generously sized its rooms, isn't wheelchair friendly.
"I could be quite comfortable in a smaller place, but I've lived here a long time," Troupe says. "It's a nice park and I'd like to stay as long as I can."
The Santa Clarita Senior Center's handy-worker program has furnished her with a variety of low-cost alterations. The program supervisor is Frank Pascoe, her daughter Pam's boyfriend of 25 years.
The program has a $2,000 annual limit for people who meet the qualifications. "That's not a large amount of money," Pascoe says, "but we can generally get a wheelchair ramp built for that."
Troupe got such a ramp, but the 1994 Northridge earthquake "kind of took care of that," leaving her stranded until neighbors arrived. The handy-worker program replaced the ramp with a used electric lift, widened her bathroom door, took out bedroom doors and put in bathroom grab bars.
Many Put Off Asking for Help
Unlike Troupe, many aging Americans are reluctant to acknowledge their vulnerability or ask for help until their need becomes acute.
"My experience with seniors is that, much more often than not, a decline in physical ability . . . is a sign of kind of throwing in the towel. They'd almost rather put a sharp stick in their eye than install a grab bar," says Allan J. Browne, president of Extended Home Living Services in Wheeling, Ill. Browne says his clients have spent as little as $100 or as much as $750,000--but generally don't come calling until an emergency strikes.
Seniors clinging to their independence change their behavior before altering their environment. They'll stop taking baths because they can no longer climb into the tub. They'll stop visiting friends because they can no longer manage front stairs. They'll move into their first-floor dining room because reaching a second-floor bedrooms feels like climbing Mt. Everest.
Approaching them is "very tricky," says Laura Gitlin, a research sociologist at Thomas Jefferson University in Philadelphia. But once they come to grips with the idea of installing some modifications to make their daily routines easier, the devices get "used a lot," Gitlin says.
Early research shows such changes do make a difference.
A study in the May-June issue of Archives of Family Medicine found that after 18 months, frail seniors who received intensive services and home adaptations were more independent and experienced less pain than similarly frail seniors who received typical services like home nursing, Meals on Wheels and help with personal care.
Study author William Mann, who runs the Rehabilitation Engineering Research Center on Aging at the State University of New York at Buffalo, says he was particularly struck by the reported reduction in pain. The reasons aren't clear, but he surmises that the adaptations and devices encouraged independence and activity, which may have distracted the seniors from their discomforts.
The study looked at 104 frail elderly people. Although all declined in health during the study period, those who got intensive services declined less than those who got the common services.
While more money was spent upfront for seniors receiving more intensive services, medical savings were dramatic: an average of $5,630 for their nursing home or hospital care during the study period contrasted with $31,610 in such care for those who got the typical services.
Some of the obstacles to making changes at home stem from the newness of the "aging in place" movement.
A Warning Against Do-It-Yourself Work
Many homeowners looking to make changes aren't confident they can locate skilled and honest contractors familiar with their special needs--there aren't many in the business. Gitlin warns against do-it-yourself work because "even something as simple as a grab bar in the bathroom, or a tub bench . . . becomes potentially an unsafe modification if it is not done by a professional."
Although a few countries--Sweden and Denmark, for example--are advanced in helping their seniors through government-funded programs, federal help in this country is scattershot. Medicaid generally will only pay for "durable medical equipment," such as walkers. A few states, however, have received special waivers making Medicaid recipients eligible for up to $500 toward home modifications to keep them out of nursing homes.
If you're poor and elderly, the federal Department of Housing and Urban Development offers subsidized housing, but specially equipped units aren't always available. HUD's Home Investment Partnerships Program provides some communities with funds for rehabilitating homes or apartments, but HUD figures show the program's funds renovated just 5,547 elders' homes in 1997 and 4,883 last year.
