Transcript:
[00:00:33] Sarah: Hello, good fit, poor Fit listeners Today, Rebecca and I are back at the mic with occupational therapy student Caroline Hart, and she is jumping into a topic that I would say is probably one of the most frequently asked questions that we get from consumers, therapists, and designers alike when they are trying to decide how to proceed with making homes more accessible. All right, listeners, what were you thinking? The answer might be as I was introducing this topic, if you guessed finances or money, you are correct! Caroline give us a little bit more info on the categories we are going to chat about today.
[00:01:11] Caroline: Hey everyone. I’m so excited to discuss this important topic today. What’s the most cost effective way to age in place, and how can we make homes more functional for everyone? you’re planning for the future recovering from an injury, or raising a child with disabilities, this episode is for you. Is it worth building universal design into your home from the start? What happens if you wait or have to remodel later? Or what if you decide to move into an existing home and make it accessible from there? And how does all of that compare to the cost of moving into an assisted living facility? We’re going to break this down from both a practical and financial angle, and I’ll walk you through how occupational therapists can guide your decisions at every stage.
[00:01:56] Rebecca: Caroline, I’m so glad we’re touching on this topic. I think it can be an overwhelming and often stressful one to think about. Certainly the financial piece is important and something that we haven’t really dug into a ton on Good Fit Poor Fit, and so I’m really glad that today’s the day. But I also wanna make sure we acknowledge that there’s quite a mental strain in making such a decision that goes beyond the money, including care, the design of the home or facility, as well as many other community factors like socialization or transportation.
[00:02:26] Rebecca: And I also wanna acknowledge that it’s so hard to put our current selves in our future selves brains. We don’t necessarily know what we’ll want or need in the future in terms of a home, and that’s tough, but also steers us towards universal design because, and I sound like a broken record, universal design encompasses flexibility and ease of use and perception, which are things that can be helpful for a lot of people at a lot of different stages of their lives.
[00:02:50] Rebecca: So Caroline, let’s dive into the universal design of it. What about people who are thinking they may want to go straight in and build with universal design in mind from the start?
[00:03:02] Caroline So what if you implement universal design features from the start, when building or doing major home renovations? design means creating a space that works for all people regardless of age or ability. Instead of retrofitting an existing home with grab bars or ramps later, the home is already designed to accommodate people who use mobility aids or might have vision changes and limited dexterity just to name a few. Now, here’s the cost breakdown. A 2024 study by Lelegems & Vanrie found that universal design adds only one to 5% of the overall cost of new construction in most residential projects. That means if you’re building a $300,000 and home, you might spend an extra $3,000 to $15,000 to make it age ready from day one. What’s great about this approach is that you avoid future remodeling and everything is more integrated, stylish, and seamless.
[00:04:01] Sarah: And to dig deeper into this topic a bit more while building with UD in mind from the start, it of course benefits people who are, looking to do this for themselves, but it also has the potential to benefit many more. Alright, listen up, builders, architects, and designers. If you are working on single family homes or even better new developments. Building with UD from the start significantly helps put more homes out on the market for people to choose from that need functional features or might need it in the future. There aren’t a lot of single family homes out there that already have UD baked into the design. I’m definitely seeing more and more multi-story town homes, and cookie cutter houses with lots of steps and that severely limits the options available for people looking to age in place or find something that’s easy to use. We just went through this process of trying to find somewhere to live, and we were moving out of a apartment complex and it’s very difficult for people that need access now to find something that works well without having to renovate. Even just having one level living, no steps to get in, plus an easy to use bathroom, And those features only scratch the surface. By thinking through the design aspect from the start of the design process, you save a lot of money than doing it as an afterthought.
[00:05:25] Caroline: And that’s why we need occupational therapists. We’re a huge asset in the design and building process, not just after the fact. A lot of OTs work directly with builders, architects, and designers to make sure accessibility is built in from the ground up without sacrificing beauty, function, or comfort. One of the cool things about OT is that our knowledge covers a wide range of needs, mobility, sensory processing, aging, neurodiversity, caregiving, you name it, we cover it. If a project doesn’t have a specific person in mind, we can still make recommendations that work for a broad group of people, but if for a specific person, we can help tailor the layout, features, and equipment to support that individual’s routines and goals, even in a brand new home. We’re all about making spaces more usable and more supportive, no matter who’s living there.
[00:06:18] Caroline: And when you bring us in early, those smart design decisions can save you time, money, and major renovations down the road.
[00:06:28] Rebecca: I couldn’t agree more with all of that. I know that we love to hype up interprofessional collaboration here at the Universal Design Project, so I am shamelessly going to do it again. Now, building a universal design home is a perfect situation in which you need a lot of brains at the table. You need people with construction based knowledge, someone who knows about plumbing, electrical, sewage, the aesthetics, and if you’re trying to make something that will enable a wide variety of people to participate in the household’s activities, you also need an occupational therapist. Not that I’m biased or anything, but Okay. So Caroline, let’s be real. Not a lot of people have the ability to build a home from scratch.
[00:07:07] Rebecca: So what are some other ways that universal design can be introduced into homes, and what data do we have about those options?
[00:07:14] Caroline: So OT lead assessments prioritize what’s most urgent and what’s most effective. Now let’s say you didn’t build universal design into your home. Maybe you bought an older home or aging in place wasn’t on your radar at the time, so now you’re looking at remodeling to adapt. This is where things get a little bit more expensive. The cost of remodeling for accessibility varies widely. Especially where you’re at in the United States or world, according to credible sources like HomeAdvisor and Angi, widening, a doorway might run between $300 to $2,500. A curbless shower could cost anywhere from $3,000 to $10,000. Adding a wheelchair ramp, that can be $1,000 to $8,000, and if you need a vertical lift, you could be looking at $5,000 to $15,000. In total, a full home remodel for aging in place can cost anywhere from $10,000 to $50,000, depending on how much needs to be changed and how urgent the needs are. And here’s the kicker. When you remodel later, you’re often reacting to a crisis. Maybe someone fell, had surgery, or suddenly using a walker. reactive approach is not only more stressful, it’s usually more expensive. Occupational therapists are key players here too. They help assess how you use your space, identify risks, and prioritize what to change now versus what can wait. A 2006 randomized trial by Gitlin at all found that older adults who received OT led home modifications, experience significantly fewer functional difficulties and falls, and the improvements lasted up to a year. So while remodeling can be costly, it’s still far more affordable than the alternative we’re going to talk about next.
[00:09:03] Sarah: My mouth just like dropped when you were reading all of those stats, like all of that money. That is a lot of money and it’s very stressful, especially if it’s something that just happened quickly and you have to make all these changes. And I think the stats have such a large range here because you really have to consider all the factors from cost of materials, the style of the home you’re working with. Is this home older or newer? What’s the current design? Is there a lot to change? I think that’s why they’re difficult to pinpoint an exact range. And like you said, it probably varies from region to region of the US. I also know of many OTs who have creatively helped people problem solve ways to figure out what is the most important thing to focus on first. And that’s a really fantastic way to save all people in the project some money. Now Caroline, I know that many modifications help people stay at home longer than having no modifications at all. But in certain situations, based on the care needed and who is available to be a caregiver, the only option is to look into assisted living.
[00:10:11] Sarah: These are really tough conversations. So what did you find in the data for that?
[00:10:16] Caroline: So if your home doesn’t support aging in place and you’re unable to find the necessary modifications, assisted living often becomes the default, According to the 2024 Genworth cost of care survey, the national median cost of assisted living is about $4,500 per month. That’s $54,000 per year. That’s a lot of people’s salary, and that’s for standard care. Basic care. If you need additional services like memory care, physical assistance, or skilled nursing, the costs jump significantly, sometimes up to $8,000 per month or more on where you live. Remember, those are reoccurring costs.
[00:10:58] Caroline: If you spend three to five years in assisted living, you could easily spend 150,000 to $250,000. Money that you might have been able to put into modifying your home instead. Medicare typically does not cover assisted living only medical services, these costs often fall on you, your family, or long-term care insurance If you have it. Compare that to a one time $15,000 to $25,000 home renovation guided by an OT or architect slash universal design specialist. It becomes clear that staying home when possible is not only more comfortable, it’s much smarter investment in the long run.
[00:11:38] Rebecca: Yeah, this is certainly a compelling case for making home renovations to allow for aging in place, but I also feel like we need to pause and acknowledge that all of these numbers we’re throwing around are no joke when we’re comparing these prices of long-term care to renovations, $15,000 to $250,000, are all very steep prices and way more than any individual or family should have to spend to ensure that someone can live a full, safe and healthy life as they age. In an ideal world, everyone would have the means to age in place in a safe home, a nurturing community. In a place where they’d have access to all the care needs that they may incur.
[00:12:14] Rebecca: And unfortunately, we don’t live in that world. And that’s why we have conversations like these about what options we may have if we do wanna age in place in a way that’s safe. Anyway, I think that was a minor tangent, but I think it’s an important part of this rather nuanced conversation. Caroline, what final thoughts do you have to start wrapping things up here?
[00:12:32] Caroline: Whether you’re building from scratch, remodeling later or somewhere in between, an OT can help you get the most value out of your home modifications. Here’s how. conduct home safety assessments to identify hidden risks. They create phased upgraded plans, prioritizing fall prevention and mobility. They help you apply for funding like VA housing grants, Medicaid waivers, or capable programs, and they make sure modifications match your daily routines, not just generic checklists. Research backs this up. The ABLE program, which combines home modifications with OT and nursing support, has been shown to be cost effective, improving outcomes while reducing healthcare costs by thousands. So wherever you are in your journey, planning ahead or making changes right now, don’t underestimate how much support and savings a good OT can bring to the table.
[00:13:26] Sarah: I love all the programs that have come about for OTs to be more involved in this process. And we have a lot of links in the show notes for you to look at too if you’re interested in learning more. But I also wanna mention here that there’s also some funding from HUD that pays occupational therapists to work on some of these projects up to a certain amount.
[00:13:45] Sarah: So that’s definitely something to check out too. Businesses and communities are really going to need to start figuring out creative ways to help people in their homes because our population isn’t getting any younger and our housing options aren’t keeping up. My husband, Scott, made a good point the other day. It’s not that people with disabilities are out there just homeless. They don’t have anywhere to live because they aren’t living in accessible homes… they are living in inaccessible homes with designs that compromise their independence, and in turn, their caregivers are maxing out and they’re finding it too difficult to financially and mentally figure out which direction to go next. So the easiest thing is to stay put and try to figure out what small changes can be made, and that’s exhausting. All right, Caroline, I’ll step off my soapbox here, um, and I’ll have you close us out. But what is the bottom line of what we discussed today?
[00:14:41] Caroline: Well, today we looked at three options implementing universal design from the start, which comes with a small upfront cost, maybe 1% to 5% of your home’s price, but offers lifelong savings. Remodeling later, which is more expensive, especially if it’s reactive, which can be very stressful, but still far cheaper than institutional care, and assisted living, which costs around $54,000 a year, isn’t typically covered by Medicare and is far less flexible. The bottom line, investing in your home and working with an occupational therapist to do so is almost always the most cost effective way to age in place. Thanks so much for listening to our episode on Funding and Universal Design. If you found this episode helpful, share it with someone you love or someone who’s planning ahead.
[00:15:28] Rebecca: Yes. Thank you Caroline and thank you listeners. We will be back talking more universal design soon.
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