Rethinking Aging in Place
Aging in place represents a broad array of new service opportunities for the senior market.
- By David Kopf
- Dec 10, 2019
You might not realize it, but there’s a good
chance you’re an aging in place provider.
That might seem a bit “off,” but it’s true. Many
providers in the post-acute care space have very
specific ideas on what aging in place means, and those ideas
typically fixate on home access. When they think “aging in place,”
they think about ramps, lifts and other, more access-oriented items.
But given the market opportunity, that’s not the way providers should
be thinking about aging in place. America’s getting older. There were
37.3 million Americans aged 65 years or older in 2006, according to the
Department of Health and Human Services Administration on Aging (AOA).
The AOA projected that by 2030, the AOA says there will be about 71.5
million Americans aged 65 years or older. At 78 million people, the Baby
Boom is retiring at the rate of 8,000 people a day.
As providers already know, the majority of this large population wants to
keep living in their homes as they age, and they will need the products and
services to help them do that.
And those products go far beyond stair lifts and threshold ramps. If
anything, providers need to look at aging in place as a continuum of
products. It’s not just access. It’s not just safety. Aging in place means all
the products that can help seniors continue living independently.
Ultimately, what aging in place needs is a rethink. Moreover, providers
must start believing that they are part of this overall trend.
“We need to get educated on what it takes to help someone live safe at
home,” says Jim Greatorex, president of The VGM Group Inc.’s Accessible
Home Improvement of America (AHIA) division. “Everybody is an individual.
You need to look at their specific needs and build a plan around
their home that they can afford, and not only help them now, but five
years from now.”
Providers need to be able to look at their clients’ entire aging in place
situation, and create the solutions that will make that possible, Greatorex
explains. He adds that he does not think that the industry, as whole, is ready
to do that in a uniform way, and is working to create some kind of certification
that can create a consistent approach industry-wide.
“The industry, as a whole, has to work to certify people, and to create
the education that can do that,” he says. “That’s where we think we need
to start the process. We’ll do it with a non-profit involved that is non-biased
and doesn’t have an agenda, and that can bring all these people that do
have agendas, even myself, into the fold so that we can work together with
manufacturers, providers, clinical people, and consumers to make standards
that we can live by.
“It’s for the good of the industry,” he adds. “There are going to be more
government dollars thrown at this, because it’s going to be the least expensive
alternative in many situations.”
In the meantime, providers that work with seniors work to redefine and
reimagine what aging in place actually means, and ponder the variety of
HME offerings that help clients live independently. Here are some key
categories that will make up that spectrum of offerings:
Let’s start with an obvious aging in place category: ramps. For any senior
that has mobility issues that require assistance entering the home, ramps are
a key product consideration. Simply put, ramps make home access possible.
But the key “hump” for a provider that serves seniors to get over when
considering adding ramps to their product mix isn’t a
learning curve, but rather a comfort curve, according to
Bob Heffernan, president of ramp manufacturer Access4U.
“I’ve met a number of people who have a store or a local
business providing wheelchairs, walkers, mobility devices of
one sort or another, but are ‘intimidated,’ I think is the right word,
by bigger ramps,” Heffernan says.
His advice is that if investing in all the tools and equipment and
construction knowledge is not a provider’s cup of tea, that’s fine. But that
provider still can get in the ramp game, and should.
“What does seem to work is partnering with a local handyman or
construction company that might already be doing some accessibility
work,” Heffernan advises.
Specifically, he suggests a provider go with a smaller construction firm
that has the tools, truck, license and knowledge, and then the provider can
play to its strengths in terms of understanding the senior’s access needs.
“I’ve paired a couple of people with, two people that work together,”
Heffernan explains. “One [the provider] finds the need and the other goes
out and does the assessment and installation. ... He has the background on
accessibility from his other work.”
Providers should understand the typical installations costs. A starting
ballpark estimate for a typical “front of the house” ramp to the door is
about $120 a foot or so, according to Heffernan. Twists and turns that
additional platforms will increase the cost of a job.
In terms of the space a ramp consumes, ADA guidelines require one inch
of rise per 12 inches of ramp, which puts a ramp’s incline at 4.9 degrees.
That said, local codes can be more accommodating, though it might be
best to stick with the original ADA rules.
“The ADA law has been widely adopted, but it is also true that frequently
local codes,” Heffernan notes. “So one will allow one inch of rise per eight
inches of ramp. Typically, you don’t want to go any steeper than that. I think
the people that did the original ADA guideline work did an excellent job.
You typically don’t want to go more than one to eight, even on a residence
where someone has a power chair.
“Just for a visual, think of a guy who might be a double amputee,” he
continues. “He has most of his weight up in his chest and so on. He heads
down and his body’s going to want to tip forward and so on. A sudden
stop or anything like that, and you don’t want him falling out forward. …
You want to err on the side of caution and safety.”
And Heffernan says he suspects most providers probably understand the
safety factors that will vary based on patient assessment, and likely to watch
for in patients and they know the ADA guidelines intuitively.
“They’ve been taught that and they know what to look for,” he says.
“What they don’t know sometimes is construction kinds of things, which leads me back to my original thought of partnering with some small local
accessibility company that you can work with.”
Getting back to that partnership element, Heffernan advises a
team approach out of the gate to really develop an approach
to the jobs and to ensure the partnership is smooth and
You’ve got to do a couple of projects together to be
successful, but the first three or four times, they should both
go on the evaluation visit,” he says. “Ahen after that, maybe
only one of them can go, once they’re both on the same page.
What I’ve done with people is say, ‘You both have costs on that.
Split it down the middle in the beginning.’ Just find a working partnership
... it takes a little time to learn to work together.”
Still, many seniors have no trouble entering their homes; they simply
need a little help safely negotiating around them. And that little bit of
help can prevent big problems. Among older adults, falls are the leading
cause of injury deaths, and are also the most common cause of non-fatal
injuries and hospital admissions for trauma, according to the Centers for
Disease Control. Most fractures among older adults are caused by falls.
For instance, in 2005, 15,800 people 65 and older died from injuries related
to unintentional falls; approximately 1.8 million people 65 and older were
treated in emergency departments for non-fatal injuries from falls. Startling
Standing aids are a critical element in a provider’s aging in place product
lineup because they help prevent injuries from falls.
“Most people don’t really start educating themselves about aging in
place until after there’s an accident,” says Wade Olsen, chief strategy
officer for Stander Inc., which manufactures various standing aids.
Olsen says a typical aging in place scenario might see the family of
a senior that is struggling to stay in her home try to ensure she has the
resources she needs in order to be remain home and live independently.
They will typically start doing some Googling and quickly encounter a
good bit of sticker shock in the process.
“I don’t know if you’ve done this, but most of the searches online about
aging in place will take you to contractors’ websites talking about the need
to widen doors and hallways and revamp that kitchen and bathroom,” Olsen
explains. “And you’re suddenly looking at a $70,000 to $100,000 price tag.”
The alternative scenario to that is an assisted living center that can cost
thousands of dollars every month. Essentially, the family is looking at “the
nuclear option” no matter how they look at it, as Olsen points out. And
that’s particularly frustrating if the senior currently only needs a little bit of
help to live independently.
“There are a few stability and mobility products that can help add years of independence onto seniors’ lives with just a couple of hundred dollars,”
Olsen explains. “Really, the types of products that we sell are pretty critical
because a lot of times when they first start having issues with independence,
they may not need to do the full home remodel. The products that
we develop are ones that blend into the home and add this level of
stability and mobility that will often, with many people, get them
through year, years’ worth of independence without having to
make drastic changes.”
So what are the key considerations when providing standing
aids? It starts with offering a rich lineup. Olsen advises it starts
with differentiation. Providers must offer the kinds of unique,
non-commodity items client’s won’t find in a big box retailer.
Also, providers want to offer plenty of options in that regard.
Olsen notes that studies have shown that HME customers are more
likely to buy when they have between three and six items from which
to choose. That makese sense given that no two HME clients’ circumstances
are going to be the same. Think about it: not every person
trying to get out of a chair is going to have the same problems. They’ll
be different heights, suffer from differing physical limitations — heck,
they’re all going to have different chairs. So choice is key.
Also, providers should provide products that differ enough in terms
of features and cost that the provider can serve up a range of “good,
better, best” selection to its customers. According to Olsen, customers
are more likely to trust a standing aid’s price if they can compare its
function and price to other product options. Moreover, those clients
that prioritize product quality will gravitate toward the “best”-option
product thanks to the provider’s price range. Also, because the provider
is offering unique items and in a range that highlights both features and
price, it will further differentiate itself from the general retailers offering
Above everything, providers must keep in mind is that these retail
sales items are real life-savers not just in terms of living independence,
independence. They have an opportunity to really make an
difference in their clients’ lives, so they should not be afraid to
sell the customer everything he or she needs or wants.
“We’ve done an analysis on it and the average home remodel is 70,000
for aging in place at home,” Olsen says. “That’s the average remodel. If
you go through and get a cocktail of product, not just ours but all of them
— like toilet seat risers and lift chairs, things that we don’t sell — a regular
DME store might be able to write up a ticket around $4,000 to $5,000 and
pretty much solve that person’s needs for a long time.
“What they forget is that they’re a hero. In that moment, $4,000 is a
lifesaving number to these people,” he continues. “One of the pitfalls is
just hesitancy or feeling like what they’re offering, with their expertise, what
they’re offering isn’t worth the price tag. It’s not only worth the price tag,
they’re a hero in the eyes of that customer walking in the door.”
In the same vein as standing aids, lift chairs help seniors safely get in and
out of chairs by raising and lowering. To get in the chair, the senior uses
a control wand or similar input to have the chair raise up. As it raises,
the chair tilts forward. The senior then leans against the chair cushion,
and then commands the chair to lower to a seated position. To get up,
the senior raises the chair up to the point where he or she is standing.
Essentially the chair provides not only safety, but convenient safety to a
senior that might have trouble getting in and out of a chair even with a
The key thing for providers to understand from an aging in place context
is that lift chairs are changing in dramatic ways. Because seniors are living
much more actively and independently these days, lift chairs are quickly
going from a need to a want, says Micah Swick, director of sales for Pride
Mobility Products Corp.
“We’re taking a fresh look at lift chairs and a fresh approach to this category
and one of the things that I think is important we talk about because
people are healthier today than they were,” he says. “I mean, 70 today is not
what 70 was 10 years ago or 20 years ago.
“Lift chairs used to be a need,” he continues. “It was ‘Oh, jeez, Mom can’t
get up any more and I can’t lift her. I can’t get her out of the chair, so we
have to go get a lift chair.’ Those days are not gone, but we’re not in that
era anymore. … Eventually, everybody gets to that place. But let’s make it
exciting. Let’s make it comfortable.”
So, Swick companies such as Pride are starting to focus on how to make
lift chairs the type of product that seniors simply want to buy, regardless of
whether or not they officially require one.
“We’re doing things like offering pocketed coils seating that provides
this unprecedented comfort in the seat,” Swick explains. “We’re making the
chairs bigger because Americans are not just living longer and living better
but they’re larger.
“We’re providing a fashionable piece of furniture that is using the latest
style in fabrics, in colors, in comfort that hasn’t existed in the category
before,” he says. “Forget the fact it’s a lift chair, we all have furniture in our
home. We all need some place to sit, so let’s provide some place that’s
really comfortable and really enjoyable; some place you really want to be,
with features that you really appreciate.”
That approach also means trying to think outside the box about the sorts
of things the chair can do. For instance, how many times have you been
sitting in a chair and your smart phone or tablet is just about to run out of
juice. Walking upstairs or across the house to fetch a charger can be a pain
in the neck. For a senior who has difficulty getting up and down and walking
through the home, that pain in the neck is far worse.
“We also offer a USB charging port in our hand control on all of our
chairs,” says Renae Storie, director of strategic accounts for Pride. “While
someone is resting in their chair, they don’t need to find a plug for their
smartphone or their iPad or Kindle or whatever device that they’re using.
They can charge it directly through the hand control of the lift chair.”
And the features will keep coming in this category. The dynamics of a
retail marketplace for lift chairs demand it. Swick notes that features
Pride will be launching include power headrests, power lumbar support,
new heat technology, and other enhancements to make them more comfortable and desirable.
“We’re trying to look at this in a very retail-minded approach,” he says.
“Who is our customer and how can we best serve them? How can we make
products that they both enjoy and want and meet their needs whether
they’re today’s needs or tomorrow’s needs?”
That is the same approach providers should be taking to the categories
of lift chairs. Hearkening back to Olsen’s points about offering feature
and price ranges, providers must ensure they are able to provide their
customers with the kind of options that will enhancing their aging in place.
Seniors and the bathroom don’t make for a good combination. We already
know that the bathroom is the most dangerous room in the house. More
than 80 percent of home accidents occur in the bathroom, according to the
National Safety Council. A 2008 study from the Centers for Disease Control
and Prevention said that every year about 235,000 people over the age of 15
visit emergency rooms because of injuries suffered in the bathroom. Of the
injured more than 33 percent were caused while bathing or showering; and
more than 14 percent occurred while using the toilet.
Moreover, injury rates increased with age, especially those that occurred
on or near the toilet. The proportion of injuries in or around the tub or
shower was highest among persons aged 15 years to 24 years (84.5 percent)
and lowest among persons aged 85 or older (38.9 percent), whereas the
proportion of injuries that happened on or near the toilet was lowest among
persons aged 15 years to 24 years (7 percent) and highest among persons
aged 85 and older (51.7 percent).
Injuries associated with getting into and out of the tub or shower
occurred among persons of all ages, suggesting that adding grab bars both
inside and outside the tub or shower might help prevent bathroom injuries
to all household residents. Overall, approximately 14 percent of injuries
were associated with standing up from, sitting down on, or using the toilet,
but among persons aged 65 years and older, the proportion ranged from 19
percent to 37 percent. The CDC said that preventing falls and subsequent
injuries in this vulnerable older population is critical. Persons with postural
hypotension can reduce symptoms by standing up slowly; installing grab
bars near the toilet would provide an additional measure of safety.
So, if providers want to enter the aging in place category, bath safety is an
almost mandatory category to stock. Bearing that in mind the DME industry
has an extensive inventory of bath safety products.
And, like standing aids, bath safety products don’t have to cost a lot to
make big differences for aging in place customers. Bath safety items represent
a key retail sales category for HME providers, given that many bath
safety items fall below the $200 price mark. Moreover, those devices that
are more expensive are typical going to be DME that the patient specifically
needs and will buy. So where to begin?
For starters, grab bars are critical. They should be strategically located
in and around the bathing area, as well as around the toilet. This has two
benefits: it ensures that the patient is supported and kept safe from a fall,
but it also helps the patient gently lower and raise himself or herself while
bathing or using the toilet. In terms of the toilet, ideally the patient would
use a raised toilet so that he or she does not have far to travel when rising or
lowering. Commode lifts are another option in this case.
For the bathing area, the ideal situation would be to have a bathing stool
or bench that the senior can use in conjunction with a handheld shower to
protect against falls. Along with the aforementioned grab bars, the shower
floor should be lined with non-slip material or strips. In general it also is a
good idea to avoid having bathmats or other items on the floor that could
cause a fall. Also, another bathing option could be a bath lift, which raises
and lowers the client into the tub.
Also, ensure that the bathroom is brightly lit and that there is a bright
enough night light to help the patient negotiate the bathroom at night,
when poor vision could otherwise contribute to a fall. If possible, situate a
chair or stool in the bathroom that the senior can use while grooming themselves
or applying makeup, and ensure there are nearby grab bars, as well.
Lights and stools are simple, non-DME products providers can stock that
pay major bath safety dividends.
But providing bath safety can go much deeper. If the senior has mobility
limitations, other products can come into play. Typical modifications include
replacing the bathtub or existing shower stall with a roll-in shower stall. That
can mean knocking out just the tub, or possibly expanding the bathroom
itself. Another option might be to remove the lip of a shower stall and
replace the shower stall frame.
If the bathroom requires deeper renovation to ensure safety and access
for the aging in place client, the scenario can get trickier. A complete bathroom
remodel can range between $15,000 and $30,000, but there are less
expensive options, such as removing cupboards or installing pedestal or
hanging sinks. Other modifications include moving the toilet and removing
the tub and installing a roll-in shower, which requires a change in drainage
system and other plumbing modifications.
Naturally, most HME providers do not staff certified and licensed
plumbers or electricians, and tearing out a bathroom, expanding it and
putting in all new fixtures sounds like a challenging task better suited
for a building contractor. Extrapolating from Heffernan’s point about
partnering for ramp installs, there are professionals with whom providers
can align to provide turnkey services to patients in need of heavy-duty
bath safety help.
Fortunately, the National Association of Home Builders offers a Certified
Aging in Place Specialist (CAPS) designation for builders who specialize in
these types of modifications. Moreover that designation is geared toward
ensuring that the contractor works to understand and match the solution to
the patient need and organize the work in such a way as to minimize disruption.
Also, the VGM Group’s Accessible Home Improvement of America
offers its Certified Environmental Access Consultant (CEAC) certification.
The Level 5 CEAC certification is for certified/licensed healthcare professionals
and licensed contractors and remodelers, and ensures those professionals
understand major remodels and will comply with any applicable
local building codes and license requirements.
Scooters and Group 2 power chairs play an important role in aging in place
scenarios because they help clients get around their homes, as well as
outside. Whether due to medical necessity or because they tire easily, many
seniors need assistance getting around. Given that there is a wide variety of
both funded and retail product, providers are in a place to offer their senior
clients many solutions, notes Pride’s Swick.
“Regardless of where they’re at today, or where providers are focusing
their attention, there’s an opportunity and the need to expand the breadth
of the product,” he says. “Every business has to go out, should be going out there trying to find new areas of opportunities. New categories.”
Given the profit margin on mobility solutions, as well as the
large number of clients that could benefit from them, standard
power mobility is an upsell providers can’t afford to ignore.
“If I have a customer coming into my building and I’m selling
them product X, and I could also sell them product Y, then
I have the opportunity to get twice the business, or maybe
five times the business, depending on the price point of that
product, that I’m currently enjoying,” Swick explains.
However, the key with scooters is to put the priority on quality
and features. Quality has been an issue for scooters in the recent
past, as funding pressures created a “race to the bottom” when it comes
to product quality. Given the Baby Boom’s purchase power, Swick says that
was the wrong course to take. Many seniors can afford devices that offer
both high quality and lots of features.
“Retail is a fashion business,” he explains. “Consumers spend money on
what they want, not what they need. Let’s give them something they can
be excited about having, so it can make them feel young again and more
fashionable, more stylish.”
Certain features are obviously important in aging in place scenarios.
Mobility devices need to work both in and out of the home. Tires shouldn’t
leave scuff marks. The scooter should be able to maneuver through doorways
and safely negotiate household obstacles.
“We try to make sure that all of our products are very maneuverable in
the home,” Prides Storie notes. “Keeping in mind we want to have good
foot room, and good overall size of the scooter. But it also needs to keep
a very tight turning radius so that you can move around your home very
easily, and get from the bathroom to the bedroom in those cases without
“The other thing is, a majority of our scooters break down very easily,”
she continues, highlighting that many users travel with their mobility
devices. “If it’s something that you’re transporting from a home to a facility,
or a facility to your children’s home, it can easily be taken apart and transported
in vehicles, or on one of our vehicle lifts. You can simply bring the
battery pack in and just charge directly off that, so you don’t even have to
bring in the whole unit if you’re storing it somewhere.”
This need to provide lots of options and high-quality product creates a
conundrum for providers: inventory. Mobility devices are expensive and
providers cannot tie up huge amounts of overhead in stock that is waiting
for a client to buy it. Fortunately, vendors are responding to this.
“Companies like ours, we stock all of this product for them,” Swick
says. “Really, all they have to do is have one in their showroom.
They don’t need warehouses. They don’t need stock and inventory.
…You’ve got to get one product on your floor, and then
use that product to sell off our inventory. We’re going to ship it
either to you, or directly to your consumer, in the matter of just
a few hours.”
Let’s switch gears and look at a category that at first glance might
seem far afield from aging in place, but is more closely aligned with
the care segment than one might initially think: oxygen. Oxygen services can
help senior patients live in their homes, and portable oxygen in specific can
help them live independently in their homes for a lot longer than they might
otherwise be able to do.
“The problem is the disease our products help manage is incurable and
it’s progressive, and it just continues to get worse,” says George Coppola,
director of marketing for oxygen equipment maker CAIRE Inc., a Chart
Industries Company. “We have a full range of products that progress with
that patient through the disease state. As they age and as they get worse
we can move them from one product to another.
Conditions such as Chronic Obstructive Pulmonary Disorder (COPD)
can hit anywhere from age 45 on up, and given that COPD and related
conditions are seeing increased diagnosis. These patients — even at retirement
age — are not ready to sit in their homes. They want to get out and
live their lives and portable oxygen can help make that possible.
“Let’s say you have this tightness of breath and you’re up there in age
but you’re in walking club,” Coppola says. “Your tightness of breath is
preventing you from going out and spending time with those people
and doing the walking and getting the exercise that you really need and
want. What a POC does, is a POC will allow you to do that by giving you
the oxygen you need as you do those activities. It helps you maintain your
quality of life.
It’s important to be cognizant that oxygen can represent a major learning
curve. A generalist HME provider or a mobility provider recognizing
oxygen’s relevance in the aging in place continuum probably already
understands that respiratory services represent a much larger degree of
onboard expertise needed in comparison to offering, say, standing aids or
bath safety items. For a provider that is interested in branching out into this
sector they could try entering a referral relationship with another provider,
or perhaps adding the services through acquisition, or organically gaining
For providers looking to organically adding oxygen services, Coppola
says it starts with gaining Respiratory Therapist on staff, not only to have
the relevant care competency, but to ensure the provider is working in
accordance with state-level licensure or certification requirements. It’s like
building a whole new business.
“They [providers] need to have the right capabilities and they need to
understand the needs of that segment,” Coppola says. “And they have to
make sure that their business has the infrastructure to support those needs.”
And of course the provider will need to work with its Accrediting
Organization to have the right accreditation. Also, the provider will want to
work with its vendor to ensure its technicians are properly trained.
“We offer service schools,” Coppola says. “For our service school, [the
provider] would bring its technicians into our facility and we would show
them how to fix a product should it break. We also offer product training,
Bottom line is that oxygen does help patients remain independent, so it
should sit on the aging in place continuum, but it is a complex offering that
should not be undertaken lightly. Care, forethought and proper planning
are mandatory — even when growing by acquisition — in approaching and
serving this category.