How can chronic care management be integrated into home design?

By: Jessika Toothman

Getting the house ready for your golden years can be a good investment -- and it's cheapest to make integrations while the house is being built.
Getting the house ready for your golden years can be a good investment -- and it's cheapest to make integrations while the house is being built.
Ken Chernus/Digital Vision/Getty Images

In the developed world, an average person's lifespan is significantly longer these days than those of a hundred years ago -- but with longevity comes an increased chance for one or more chronic conditions. Chronic conditions, which are persistent and hard to get rid of, can limit what a person is able to do, and they include a wide-array of diseases and disorders. Common ones include hypertension, chronic mental conditions (like anxiety, schizophrenia or personality disorders), asthma and other respiratory diseases, Alzheimer's, arthritis, heart disease, eye disorders (such as cataracts or glaucoma) and diabetes.

­In America, everyone's eyes are locked on baby boomers as they ease ever closer to their 60s and middle-aged aches and pains begin to become more serious chronic conditions. It's also common among the elderly to have multiple chronic conditions -- apparently, Father Time really likes to heap it on.


Many baby boomers shudder at the thought of nursing homes, for both themselves and their aging parents. Some are embracing the universal design concept, which basically means utilizing architectural and building techniques that can be used by anyone, of any age or ability-level. More and more builders are receiving requests from people who want their homes prepared in advance for the likelihood they or loved ones could have chronic conditions down the line. It can be a real cost saver to have aging in place features installed during the process of building a new home. To learn more about universal design, read How is an aging baby boomer generation changing the design of homes?

On the next page, let's take a look at some of the highly recommended chronic care management tips for home design, and see why they might be pretty solid home improvement tips regardless of your health status.


Implementing Chronic Care Home Design

So-called cozy kitchens can be a real hassle for someone in a wheelchair.
So-called cozy kitchens can be a real hassle for someone in a wheelchair.
Steve Mason/Photodisc/Getty Images

Whether mom is moving in, the parents want to live out their golden years in their own home or you're looking ahead to when your mild case of arthritis becomes something more serious, there are some pretty basic steps you might want to take to make everyone's lives a little easier -- and in many cases, a lot safer.



There are lots and lots of ways to prepare a house for chronic care management, so here's a list of some of the most common options. And don't forget, what applies to bathroom counters holds true for ones in the kitchen, too. These are good ideas for anywhere in the house.

In the Kitchen, with the Candlestick:

  • It's a good thing to plan for the kitchen to be located near the front door -- those groceries can be heavy.
  • Keep it nice and bright. Dim or uneven lights are a danger to people with vision and movement problems. Nightlights are recommended, as well as lights in closets and stairwells. Make sure all lights are easy to maintain.
  • One of the key things in the kitchen, and throughout the house, is to design everything to be accessible to people in wheelchairs. For example, the microwave shouldn't be mounted up under the cabinets, and appliances like sinks and dishwashers should be easy to maneuver around. Side-by-side refrigerators are a smart choice. Racks and closets can be built with adjustable brackets in case things need to be lowered in the future.
  • Heat can be a big problem for people with chronic conditions, so a lot of thought needs to be given to preventing burns and fires. Heat-resistant countertops, lights to indicate when burners are hot and devices to automatically shut off heating elements left on too long are some of the available options.
  • Lots of counter space in general is a plus. Heaving a turkey out of the stove and then having to carry it halfway across the kitchen isn't fun for anyone, but it can be dangerous for someone frail or disorientated.
  • Keep dangerous objects and substances stored away safely, especially in the case of dementia or Alzheimer's.

In the Bathroom, with the Lead Pipe:

  • We can't say it enough: Large spaces for easy wheelchair maneuvering coupled with nonslip-textured surfaces are critical. Properly installed handrails and grab bars are a must as well (Luckily, designers are making these much more stylish nowadays). Easy-to-reach seats, ledges and toiletries are a plus.
  • Bathroom telephones and rounded counter edges can be a good idea, and it's also smart to enable someone to unlock the bathroom door from the outside.
  • This is another place heat can be a danger. As in the kitchen, install anti-scald devices on all faucets to prevent burns. The water controls (ones with one-lever handles are best) should be accessible from outside the shower.
  • Bidets can make things easier. So can handheld showerheads.

It's also important to keep in mind that different precautions are geared more toward some types of chronic conditions than others, but since aging is frequently linked to the onset of multiple chronic conditions, it can be a good idea to focus on planning for the worst-case scenario before it's at your doorstep.

And speaking of doors, on the next page, we'll learn more about those and other parts of the house that can warrant a closer look if you're planning for in-home chronic care management.


Chronic Care Home Design Tips

I could've tripped on that horrible little throw rug and broke my hip!
I could've tripped on that horrible little throw rug and broke my hip!
Ralf Nau/Digital Vision/Getty Images

We've still got some more ground to cover if we're going to enable a home to be supportive of a chronic care patient. We hit some of the major rooms, but what about the spaces in between?

In the Hall, with the Wrench:


  • Some of the main pitfalls to avoid in this section are things that could cause someone to trip and fall. Items to keep a close eye out for are thresholds in doorways (especially if they are higher than half an inch or uneven), loose rugs and carpeting, as well as any clutter lying around. All flooring and steps throughout the house should be selected to decrease the chances of someone slipping. Hardwood floors are a good bet.
  • Hallways should also be wide enough to allow comfortable ease of motion for someone who is wheelchair-bound -- a minimum of 36 inches (91 centimeters) wide.
  • This is a good place to talk about height, too. Thermostats, light switches, door handles, outlets, you name it -- they need to be low enough for someone in a wheelchair to reach them.

The Secret Passages:

  • Stepless entry is definitely a good choice to make for chronic care management integration and for universal design in general. If your steps are there to stay, you may want to consider installing a ramp, in which case calling a professional to do the job is recommended.
  • Doors should be at least 32 (81 centimeters) inches wide and have door handles that are levers, not knobs. That goes for cabinets and closets too -- pick ones that are easy to grab.
  • The path leading up to the front door in particular is another good area to focus. Ideally, the front door should be visible from the street and have plenty of space for maneuvering around it. There should be a shelf or bench to set down possessions while locking and unlocking the door, and keyless entry can be a good idea. An overhang is also recommended, along with good lighting along the path and at the doorway. The path should be smoothly leveled and cleared of shrubs and debris. Texturing it can be a good idea, as well as installing motion-sensor lights and a way to see visitors before opening the door.
  • Double sets of handrails are good to have on all of your house's stairs, along with deep tread depth, frequent light switches and carefully planned landings. Reflective tape is smart to have on non-carpeted stairs, while carpeted stairs in different shades can be helpful. If you do have carpeting, shorter is better.

In general, when planning for the aging of an elderly person in a home, ease and simplicity are the way to go. There's a lot to be said for gutters that don't need cleaning, low-maintenance landscaping and a master bedroom on the first floor. In fact, even if the person is not experiencing any movement impairment, the best idea is to prepare the home so he or she can live comfortably using only the first floor, in case any chronic conditions worsen. Building a space that can be converted into an elevator shaft is also an option.

There's a lot more out there for people who're taking on the role of caregiver or looking to prepare a home for aging in place, so continue to the next page for lots of links to more great information.


Lots More Information

Related HowStuffWorks Articles

More Great Links


  • "Aging-In-Place Checklists." National Association of Home Builders. (7/28/2008)
  • Baldauf, Sarah. "Taking Care of Your Parents: Preparing the Home." U.S. News & World Report. 11/2/2007. (7/31/2008)
  • Canada, Carol. "Adapting the Home for Alzheimer's and Dementia Sufferers." CareGuide@Home. (7/28/2008)
  • "Chronic Conditions: Making the Case for Ongoing Care." Partnership for Solutions -- A Project of Johns Hopkins University and The Robert Wood Johnson Foundation. 12/2002. (7/30/2008)
  • "Chronic Disease Notes & Reports." CDC. 6/2/2007. (7/30/2008)
  • "Chronic Disease Overview." CDC's National Center for Chronic Disease Prevention and Health Promotion. 3/20/2008. (7/30/2008)
  • "Current Projects in the Lab." Human Factors & Aging Lab at the Georgia Institute of Technology. (7/28/2008)
  • "Definition of Chronic Disease." 6/22/2004. (7/30/2008)
  • Edmonds, Molly. "How is an aging baby boomer generation changing the design of homes." (7/29/2008)
  • Edmonds, Molly. "How Smart Homes Work." (7/29/2008)
  • Jones, Brian et al. "Aware Home Research Initiative at the Georgia Institute of Technology." Georgia Institute of Technology. 7/17/2008. (7/28/2008)
  • "Survey Reveals Americans' Concerns About Living with Chronic Conditions and Desire for Elected Officials to Take Action to Improve Care." Partnership for Solutions -- A Project of Johns Hopkins University and The Robert Wood Johnson Foundation. (7/30/2008)
  • "Safety in the Home." Alzheimer's Society. 1/2002. (7/29/2009)
  • The Aware Home Research Initiative Web site. A Residential Laboratory at Georgia Institute of Technology. (7/28/2008)
  • Trevey, John. "Design Techniques for the Homes of Alzheimers Patients." Disabled World. 8/23/2007. (7/29/2008)
  • "What is Universal Design." AARP. (7/30/2008)