No one wants to think about becoming disabled or too old to safely stay in their own home. Images of sterile nursing homes abound, with wide linoleum hallways, wheelchair ramps and stainless-steel grab bars.

But an increasing number of people are rejecting this gloomy stereotype. They're choosing instead to make their homes accommodate their changing bodies -- without forgoing the stylish creature comforts to which they're accustomed.

The construction, home-furnishings and appliances industries are taking note. "It's a huge market," says Jim Lapides, of the National Association of Home Builders' Remodelors Council. "The baby boomers are seeing what is happening with their parents. They are saying, 'This is my last house.'"

According to the AARP, 83% of people over 45 own their own homes. A 2003 AARP survey, "These Four Walls," sampled this group and found that 75% expect to stay there for the rest of their lives; 51% envision making changes so that can happen.

The status quo: Peter Pan homes
Changes are sorely needed, says Leon Harper, a founding member of the National Home Modification Action Coalition, a group of gerontology and design activists, because the typical American home is a "Peter Pan house" -- made for able-bodied young adults and sold "as if this is all they'll need for the rest of their lives."

"It's not that older people or middle-aged people become disabled and become a burden on society," Harper says. But "by the time the first kid breaks their leg and can't use the bathroom, or they have the first illness and can't get up and down the stairs, they begin to think, 'I'm stupid. I'm useless.'" But he tells everyone, "It's not you, it's the house."

Jon Pynoos knew this in theory when he remodeled a backyard playhouse into a separate apartment for his father-in-law. Pynoos, a professor of gerontology, policy, planning and development at the University of Southern California, directs the National Resource Center on Supportive Housing and Home Modification. Still, the remodeling project taught him that the aesthetics of such a remodel are just as important as the utility.

His wife's dad, who has since passed away, was in his 70s and had Paget's disease, which made walking difficult. The goal was a great-looking remodel with accommodations as invisible as possible. Pynoos lavished attention on the bathroom. He used a walk-in shower with no obstructing lip or ledge at the entrance. He chose good-looking, two-inch-square commercial nonskid tile (available in a wide range of colors) to make the bathroom floor safer when wet. Lever handles replaced doorknobs throughout, even in the shower. An anti-scald device kept water temperature even. (Aged skin is less sensitive to heat, so you can get burned before you know it's happening.)

The entire living space was well-lit, with dimmers -- on every light -- controlled by arthritis-friendly rocker switches. Control panels for all the lights were placed at the bed and the front door.

"The nice thing about all these kinds of features is that they are unobtrusive," Pynoos says. "You wouldn't notice them." Even the bathroom grab bars and higher toilet did not look "institutional."

What's 'universal design'?
Such high-design improvements originate in the "universal design" movement, also called "design for all" or "inclusive design." The idea, says Wolfgang Preiser, a professor of architecture and interior design at the University of Cincinnati, is to make homes and furnishings that work for nearly everyone, of all sizes, shapes, ages and abilities. Preiser is co-editor of  "The Universal Design Handbook," a bible for designers, students, clients and builders.

The movement is making inroads in the U.S. One measure is the marketing of accessible products by manufacturers like American Standard and Toto. The companies target, in addition to the graying market, younger families with children who find the appliances and fixtures useful during pregnancy and recovery from sports injuries.

Builders are gearing up. Polling remodelers, the National Association of Home Builders learned that:

  • 75% reported getting more requests for "aging in place" projects;
  • 60% had done such jobs. Of those:
    • 43% were for customers aged 45 to 54;
    • 76% were for customers aged 55 to 64; and
    • 67% were for customers 65 and older.

The remodelers reported that clients wanted aging-in-place remodeling because:

  • 75% were planning for future needs;
  • 53% were living with older parents;
  • 46% had acute, age-related disabilities; and
  • 23% had acute disabilities unrelated to aging.

The industry group predicts aging will be the second-biggest influence on the remodeling industry in the next five years, just behind finding enough skilled labor.

The builders and the AARP created a popular course focusing on this new market, says Lapides, of the Remodelors Council. Since 2002, the NAHB Remodelors Council has been turning out "Certified Aging in Place" specialists (find one near you here). About 1,115 students have graduated from the course, which is more focused on sensitivity training than carpentry techniques, says Lapides. Students -- remodelers, architects, designers, occupational therapists and others -- maneuver through buildings in wheelchairs and simulate the experience of arthritis, for example, by holding a tennis ball in each hand while writing a check or opening a door.

Manufacturers hop on board
Still, the marketplace is responding to the demands of graying remodelers with caution, taking careful note that it is the combination of luxury and accessibility that sells.

Contractormag.com, an industry trade sheet, cautions builders that when upscale, graying clients are remodeling for accessibility, "stylish is replacing sterile." People with disabilities have been lobbying for design changes for decades, but the word "disability" still is a turnoff, Gary Uhl told the magazine. Uhl is design director for bathroom-fixtures maker American Standard. "The vast majority" of American Standard's new products meet ADA (Americans with Disabilities Act) requirements, said Uhl, but the company markets them by emphasizing their stylishness.

GE's universal design kitchen includes:

  • A sink that can be raised or lowered;
  • A raised dishwasher;
  • Roll-out shelves;
  • Cabinet doors that retract to leave knee space for people in wheelchairs;
  • A counter that slides out from under the oven; and
  • Kitchen-floor edging in a contrasting color to help orient people with limited eyesight.

More appliance makers tout universal design, even if they don't use that name. High-end Japanese toilet maker Toto markets its "washlet" -- a toilet-seat bidet that can be inserted into a standard toilet -- to older Americans. ("While (it) is perfect for everyone, it's also ideal for expectant mothers, the physically challenged or the elderly," says Toto.) The washlet features a heated seat, air purification and a stream of warm water aimed at the front or rear of the user's anatomy, followed by a rush of warm air -- for paperless drying.

Americans, unaccustomed to bidets, may poke fun at the product, but it's easy to see how it could solve hygiene problems and extend independence for those who have difficulty moving.

At Kohler's "Bath Design: Aging Gracefully" site, the stress is also on design: "The last thing health-conscious baby boomers want, however, are bathrooms that suggest old age or anything remotely institutional," the site says. For easy bathing, Kohler suggests a "shower tower," starting at $4,541, with seven adjustable water outlets -- two showerheads, four body sprays and a hand-held shower, plus a safety valve that heads off sudden spurts of dangerously hot water due to drops in water pressure. Faucets have lever handles, a standard feature of universal design. Kohler offers electronically controlled shower heads, concealed in tile work, that remember how you like your shower, just as up-market cars remember drivers' seat positions. There are vanities with adjustable or removable cabinets. One cabinet has a removable base or pocket doors so a wheelchair can glide right up to the wall-mounted Kohler sink.

Handsome, taller toilets are made now to eliminate the difficulty of stooping and standing without the need for institutional-looking toilet-seat extenders. American Standard makes the Cadet Right-Height Pressure-Assisted Elongated Toilet -- in 10 colors. One Kohler solution, the high-fashion "hatbox" toilet, perfectly illustrates the demand for both design and function in accessible appliances.

Even the bathroom grab bar, the appliance that most shouts "old age!" and "infirmity!," has been given a design upgrade by companies like Moen, with a variety of styles and finishes that often match the faucets and your other bathroom hardware.

11 tips for a successful, accessible remodel
If you're ready to remodel with an eye to the future, take advantage of all the existing research out there. Search the Internet and bookstores using terms like "universal design" and "aging in place." The National Resource Center on Supportive Housing and Home Modification Web site is a good starting point. It has basic guidelines on design for safety and accessibility.

One of the biggest ways to ensure success is to choose the right contractor, one who is interested and wants your ideas. But remember, accessibility design is still new to many building professionals, so respectfully communicate the specifics of your plan and expectations to your contractor and each subcontractor. Document a concise explanation with detailed drawings of what you require and why. You'll also want to watchdog every step of the remodel process, politely ensuring that your plans are carried out. If you can't do that, hire someone who can.

As for the actual changes to consider making to your home, Sam Clark has the following suggestions. He's a builder and author of "The Real Goods Independent Builder: Designing & Building a House Your Own Way" and "Remodeling a Kitchen":

  • Remodel your home so that you can live on the ground level if necessary.
  • Widen doorways to accommodate wheelchairs. Leave enough interior space for a wheelchair to maneuver and turn (a turning circle is 5 feet in diameter; backing and turning requires a 3-foot-wide T-shape path).
  • Plan the front entry to be as level with the ground as local building codes allow. Eliminate stairs with gently sloping sidewalks that roll right up to a no-barrier front-door threshold. By planning for this now you can avoid later "building a 25-foot-long wheelchair ramp that is a) costly and b) kind of unsightly," says Clark.
  • Try to think way ahead. Example: In a bathroom remodel, install reinforcement for grab bars while the walls are torn up, even if you don't need the bars now. You can install the bars later without ripping up walls.
  • Use drawers instead of cupboards where possible.
  • Install lever handles throughout the house. They're decorative and, for people with arthritis (the most common chronic condition of old age, particularly among women), pressing down is much easier than turning a knob.
  • Use hard flooring or choose an attractive, low-pile commercial carpet. Omit the pad and glue the carpet directly to the floor so there is nothing to trip over.
  • When installing grab bars, tailor the exact location to the height of the people using them. Get your installer to measure your reach from sitting atop the toilet and sitting in the shower.
  • Place electric outlets higher than usual and switches lower.
  • Install a shelf outside the front door so you can put down packages while searching for keys.

Following these guidelines requires a lot of thought and effort. But for your trouble, you may stave off a nursing home. "My father-in-law lived with us for five years," Pynoos says. "He said to me once, this was the best thing I ever could have done for him."

By Marilyn Lewis