Perhaps your parents have lived in the same house since you were born and never had a problem. Why look for trouble now? As was noted in Chapter 1, accidents are the sixth-leading cause of death for seniors, and falls are the leading cause of death from injury in people over age sixty-five. Most of the falls happen in the place of residence, whether it is their own home, senior housing facility, or skilled nursing facility.

Many seniors use a cane or walker to assist them when they ambulate in the community; however, at home they choose not to use the device. This is often a contributing factor in falls. They feel safe in their familiar environment and “know” where things are, even in the dark. They hang on to walls and furniture and feel secure. One missed step is all it takes. A throw rug, an electrical cord, or oxygen tubing can be some of the most dangerous obstacles in the home.

Throw rugs are a primary problem, but getting rid of them is not always so easy. They can conceal a multitude of sins such as worn carpet, which could be even more dangerous, or help to cover up a slippery floor, which left uncovered can be just as dangerous. If they are simply for decoration or to cover up spills and stains, get rid of them. If they are necessary, try to rearrange furniture or tack them down with carpet tape and be sure to use nonslip backings on slippery floors. If possible, replace throw rugs with new carpeting or larger room-size rugs and use carpet tape to secure the edges and nonslip backings as needed to keep rugs from moving.

Clean Out the Clutter

Clutter is another factor. Piles of newspapers and magazines cannot only be fire hazards, they can also block the flow of traffic throughout the home. Hoarding can be a real problem with some seniors. They won't throw them out because of the recipes or articles they haven't retrieved. Yet they will fight to the death not to have them discarded. It can become an issue of trust and betrayal if you try to remove them or have it done while a parent is in the hospital, for example. You need to tackle this issue and make some compromises. Perhaps you can persuade your parents to discard papers and magazines older than one year. You can also suggest they go through a set pile by a deadline. Anything they didn't get through by that time, they agree to discard. Most likely, you're going to have to set aside some time to assist them with this project and be firm about how much they can keep.

Too much furniture can be another issue. While they may have it grouped close together so they can hang on to tables and chairs to maneuver through the house, obstacles can be problems in the event of an accident and getting access to the residents. Even though they know exactly where something is, they can still misjudge and trip over the leg of a table or chair. Try to clear out some of the clutter and move furniture to rooms that aren't being used, or rearrange a few pieces to better suit a flow of traffic. Be sure that your parents know where you have made changes so they can make mental notes of the changes and so don't rely on where things used to be. Again, don't make too many changes at one time.

Bathroom Safety

Grab bars in the bathroom can be life savers. Most major home improvement stores and even large chain drug stores carry varieties of grab bars. There are some varieties that can be attached to the edge of the bathtub; others have to be placed on the walls and secured with toggle bolts. If you need assistance in figuring out proper placement, contact your parents' physician to arrange for a home-health safety evaluation from a physical therapist. She can help evaluate the home setting for other safety issues as well as for grab-bar placement and offer instruction on safe use of the bars once installed. The therapist will not install the bars for you.

A variety of bathtub chairs are available to make showering easier and safer. There are sophisticated devices to lower one into the bathtub, and there are now walk-in bathtubs that can replace standard tubs and provide safer tub bathing for the less agile. In a pinch, a resin garden chair can work well to sit on in the shower. Tennis balls cut to fit on the tips of the legs can offer more stability. A rubber tub mat to prevent slipping is a must.

Elevated toilet seats can be easily attached to a toilet to make it easier to get on and off. Some come with handrail attachments for further assistance.

Walking Assistance

Walkers come in a variety of configurations and some offer a handy seat. They can be fitted with trays or baskets or even a plastic grocery bag tied on to help carry things from one place to another. Canes come in single-point and quad-point bases for assistance with ambulation. These devices should be adjusted to the height of the person using them — most have adjustable settings or come in various lengths. Tennis balls can be cut and placed on the tips for easier sliding and better stability.

Oxygen Tanks and Tubing

Many seniors need oxygen in the home and may have miles of tubing so they can move all over the house and not have to haul the tank with them. One issue is the tripping hazard created by the tubing. It isn't always the person using the oxygen for whom this is the greatest hazard but for other household members, especially an elderly spouse. Some of the lengths of tubing could be tacked down with colorful masking tape or have colorful tags tied on to make it more visible to others.

The other issue with the oxygen is cooking and smoking. The oxygen should be removed while cooking. There should be no smoking anywhere in the home while oxygen is in use. In many cases, the oxygen is required because of lung damage from years of smoking. All too often, the patient continues to smoke and, yes, smokes with the oxygen on! This is a tremendous fire and explosion hazard; one the senior is willing to take, but he needs to be reminded that the danger is extended to others as well. Not only could his home burn, neighbors could be harmed or have their houses burn as well.