August 29th, 2011 by admin

Hello, I hope that everyone is doing well after such stormy weekend here in NYC. As promised, today, we will be talking about tax benefits, reverse mortgages, and other sources of financing for home modifications.

Personal Income Tax

Home modifications can be claimed as a medical expense by anyone if the criteria put forth by the IRS are fulfilled. Under IRS publication 502 (2010), “Medical and Dental Expenses” an individual can claim any expenses incurred in the acquisition of special equipment of home improvements made to a residence; as long as, these have been deemed medically necessary by a physician. A medical expense claim can be filed if the special equipment is for yourself, your spouse, or a qualifying dependent. The IRS has a broad definition of what is considered a dependent. In order to deduct 100% of the expenses as a medical expense, the IRS requires that the property value not be increased by the installation of special equipment or improvements.  If the property value is found to have been increased due to the improvements, you will only be able to claim some of the expenses.

This is a list of some home improvements that may qualify as a medical expense:

  • Constructing entrance or exit ramps for your home
  • Widening doorways at entrances or exits to your home
  • Widening or otherwise modifying hallways and interior doorways
  • Installing railings, support bars, or other modifications to bathrooms
  • Lowering or modifying kitchen cabinets and equipment
  • Moving or modifying electrical outlets and fixtures
  • Installing porch lifts and other forms of lifts (but elevators generally add value to the house)
  • Modifying fire alarms, smoke detectors, and other warning systems
  • Modifying stairways
  • Adding handrails or grab bars anywhere (whether or not in bathrooms)
  • Modifying hardware on doors
  • Modifying areas in front of entrance and exit doorways
  • Leveling the ground to provide access to the residence

If you would like to obtain more detailed information, please click on the link below:

Tax credit for the elderly or the disabled

Individuals aged 65 or older and retired with a permanent total or partial disability can claim this tax credit; as long as, they fulfill all other requirements put forth by the IRS on publication 524 (2010). Although, the tax credit is only $1,125.00, I think that every little bit counts. For more information about this tax credit, click on the link below

New York State Property Taxes

The New York State School Tax Relief Program (STAR) Enhanced is a tax credit that benefits seniors 65 years or older who own and live in their primary residence. To qualify, the household income cannot exceed $79,050. The maximum tax benefit varies depending upon location, time, and the level of assessment performed by municipality.  It is also based upon the annual adjustment rate based upon inflation. Generally speaking, senior home owners can save hundreds of dollars in taxes. For more information, click on the link below:


Reverse Equity Mortgage

Reverse mortgage is a financial vehicle that allows seniors to use home equity; in order to, cover living expenses or necessary projects such as home modifications. In order for a senior to be eligible for a reverse mortgage, he or she must have enough equity built into the house value.  They must also never have defaulted on a federal debt.  Reverse mortgages as opposed to regular mortgages, do not require a credit history check since the equity on the house is used as collateral.  Another important aspect of reverse mortgages is that they do not need to be repaid right away.  The amount of equity taken out on the house depends upon the client’s age, current interest rates, and the equity built on the house.  Last but not least, the only thing asked of the borrower is that they pay their taxes, insurance, and maintain their homes.  For more information, please click on link


Miller Calberto, MS, OTR/L, CAPS
Senior partner
Adapting Spaces, LLC

3 ways to protect the arthritic hand while at home

July 8th, 2013 by admin

When was the last time you heard of a senior complaining about pain in their shoulders, elbows and/ or hands. I hear it on a regular basis with clients in the nursing home.  At least in the nursing home, residents have access to rehabilitation services readily available to take care of these ailments.  What about elders in the community that do not have easy access to these services. That is why I thought about sharing some ideas that would help elders in the community who are suffering from arthritis live better and more productive lives.

Modify the environment

Nowadays, there is no excuse for not having lever type door handles around the house and/ or apartment. Lever door handles are just an example of a growing number of items that can make navigating home much easier. It is also a good idea to start changing door knobs on all cabinetry for stylish door handles. You can also change faucets with knobs to faucets with handles or motion activated faucets. Another good alternative to decrease stress on the joints is to switch items with regular sized keypads such as remote controls and telephones with enlarged keypads. These are just a few of the many ways the environment can be modified to reduce joint stress and promote joint stability.

Modify the way you do things

Wringing a towel or mop towards your pinky finger, carrying heavy shopping bags with your hands, carrying a heavy cooking pot by the handles. These are all examples of everyday activities performed by seniors in the community that can exacerbate joint degeneration. Therefore, seniors need to look for ways to modify these activities without limiting their independence. As a general rule every time a manual activity is going to be performed, it is recommended that the person use larger muscle groups such as those in your shoulders and arms rather than your smaller and weaker muscles like those in your forearms and hands. For instance, when going grocery shopping seniors should push a shopping cart that way there is minimum joint stress. If the senior does not own a shopping cart an alternative could be to carry large brown bags which can be carried between the arm and the hip.

Respect pain

Oh, the good old saying “no pain, no gain” definitely does not apply in this case. If there is one thing people suffering with arthritis should learn is to try to keep pain as far away as possible. Therefore, it is important to respect pain and avoid any activity or action that would start it. Seniors who understand their limitations and manage their level of activity will usually protect their joints better and limit the amount of pain they feel. Whereas, those that generally decide to work through the pain end up causing more joint degeneration which in term increases their pain levels.

Consult with an Aging in Place Specialist (CAPS) or occupational therapist if you would like to make your loved one or family member safer and more comfortable in their home during their golden years.


Miller Calberto, MS, OTR/L, CAPS

Senior Partner

Adapting Spaces, LLC


Aging in place ideas for renovating a Brooklyn apartment, Part 2

June 6th, 2013 by admin

The kitchen and bathroom are two of the most important areas in an apartment, even more so when trying to keep the landlord or tenant living in it safely and independently. Throughout this blog, I will talk about my experience making repairs to these two areas and will give specific ideas as to how to make them more user-friendly. I will also provide solutions to improve the use of lighting and electric fixtures around the apartment.


  • If you are getting new appliances, pick ones that have easy-to-read, simple controls near the front of the cabinet edge.
  • Faucets:  Choose faucets with one control in the middle or choose paddle-style controls. Avoid small knobs that twist to operate the faucet.
  • Consider a hands-free faucet if you have hand/arm issues like arthritis.  If arthritis runs in your family this may affect you in the coming years.
  • There are some technologies available that can control the temperature of the water at the spigot (faucet). This is a good way to prevent scalding if the building has water that is way too hot.
  • Make sure to plan for a countertop near the cooking surface, so that pots can be set down easily if needed. Consider a work area or two that has a lower countertop height – that way people of all ages and abilities can help prepare the meal (and clean up!)
  • Flooring: Choose flooring in the kitchen that is different than the color of the cabinets. Kitchens can be a dangerous place and often people are carrying things. Anything you can do to make walking paths safer is a good investment and contrasting colors are a simple way to do this.


  • Very important! Have the contractors install 3/4” plywood backing behind the sheetrock of all walls, especially near the shower and toilet!  You’ll want to have this in place if it is ever needed for grab bar support.
  • Create a walk-in shower that does NOT have a built-up tile barrier between the shower area and the room. (“zero step entry”). There are beautiful, well-designed drains that will keep the floor dry. No need to create a short wall that someone might not be able to get over.
  • Bathroom falls are common and dangerous. Choose a floor tile that is less “slippery when wet.”
  • Place the toilet in an area where there is room to maneuver around it.
  • Consider a sink that is bolted to the wall and DOES NOT HAVE a vanity under it. I know storage space is very important in Brooklyn apartments, but work with your designer to create other storage. You can even have your plumber align the pipes parallel to the wall, so that there is more “roll under” space for those that may need wheelchair access. Be aware to insulate the pipes if they are close to where bodies will be.  And again — paddle controls for the water, not knobs.


  • Install rocker-style lighting controls, not the traditional switch kind. Dimmers are also helpful. Motion-detecting lights can help someone get around safely at night. There are even touch-free switches available.
  • Choose fixtures that light the way and the task, but that do not shine directly into the person’s eyes.  Task lighting and lighting design in general, make spaces more inviting and safer.
  • Be creative! Lighting is a place where you can really let your personality and priorities shine.
  • Consider installing a few outlets near “social areas” that are higher up the wall then the usual 14” from the ground.  (Outlets at that height are most useful to children who like to stick things into them.)

There are so many more things to think about – and if you are working with a good architect, they probably will present these kinds of ideas to you. But if you are working with a contractor on just a part of your apartment, you might need to guide them to the solutions you want.

The important thing to keep in mind is that you do not need to compromise AT ALL on good style to make your home welcoming to everyone.  In fact, thoughtful design choices will open worlds of creativity and accessibility that may also give you a return on your investment immediately and years to come!

Consult with an Aging in Place Specialist if you would like to make your loved one or family member safer and more comfortable in their home throughout their golden years.

Kristine M Samms
856 345 9208
Safe, functional, dignified living in your home.

Aging in place ideas for renovating a Brooklyn apartment

May 17th, 2013 by admin

Our homes should be places of safety and promote good health, but often our homes work against these quality-of-life factors. I am an Aging-In-Place Specialist in Brooklyn. I see apartments being renovated all the time.  I see some really good design, but often I see apartment design that will make it difficult to live there if the tenant/owner’s physical ability changes.  So here are some ideas to think about as you make renovation decisions about your apartment.

In general:

  • Homes should be safe for people of all ages and abilities.  It should make guests feel independent and comfortable when visiting their loved ones.
  • Create spaces that are open and passageways that are wide.  Everyone will be very thankful for ease of motion throughout the apartment, whether someone has a stroller or a wheelchair/ mobility device.
  • If there are elevation changes between spaces (I see these mini-steps in the older apartments often), find creative ways to CLEARLY mark them – even with automatic lights at night if possible.  Try to avoid using door thresholds between rooms, if possible.
  • Natural light:  If, at some point, someone needs to be in the apartment for long periods of time, a big part of health for them will be lots of fresh air and natural light.
  • When replacing windows, choose casement windows that open with a crank or a horizontal sliding window.  Fresh air is so important, and some people can’t raise the sash of a conventional window (or lock it).
  • Choose lever-style door handles, not door knobs.  Not only are lever-style handles more stylish, they will be useful to all residents and visitors for years to come.  Something we might be seeing more of is keyless locks with touchpads to operate the lock. If you are having new locks installed, why not choose one that will be useful and safer; regardless, of your dexterity (and also helpful when your arms are full of organic groceries).

Consult with an Aging in Place Specialist if you would like to make your loved one or family member safer and more comfortable at homes during the golden years.

Kristine M Samms
856 345 9208
Safe, functional, dignified living in your home.

Carpal Tunnel Syndrome: Are you suffering from it?

April 23rd, 2013 by admin

Today’s advances in technology have proven to be a wonderful thing for many of us. However, with the boom of this computer age many people have been developing different types of injuries to their wrists and hands.  One of the most common repetitive stress injuries affecting our society is Carpal Tunnel Syndrome (CTS). 

CTS may start with some tingling and/ or pain at the wrist which can eventually radiate to the hand and forearm.  Usually those with this condition also experience decreased sensitivity of the thumb, index finger (pointer), middle finger, and half of the ring finger of the palm side of the hand.  This condition is caused by compression of the median nerve which is located in the carpal tunnel of the wrist.  It can even lead to muscle damage to the affected hand.  The prevalence of this condition has increased considerably, currently affecting 50 cases in 1000 subjects (5%) in the general population.

Many of the people suffering from this condition:

  • usually work on the computer all day (due to poor wrist posture and shape while working, table height, the angle of the elbows, and repetitive motion)
  • are woman that are pregnant (due to swelling and inflammation)
  • are individuals with rheumatoid arthritis and other medical conditions that cause swelling and inflammation
  • are those that had a wrist fracture
  • are people that are constantly working with vibrating tools
  • and those that perform repetitive bending/ twisting movements of the hand/ wrist

Treatment approaches may vary from conservative modalities to surgical interventions.  Treatment can focus on decreasing pain and paresthesias (tingling/ numbness/ pain); increasing or maintaining muscle strength; maintaining function of the hand; use of a splint; anti-inflammatory medications; and patient education (preventative measures).  If this condition is not treated, it can lead to permanent nerve damage and severe loss of hand function.  If these signs and symptoms are affecting or interfering with how you are performing your day to day activities, you should seek medical attention and/ or treatment from an occupational therapist.


Esther Gonzalez M.S. OTR/L, Bil TSHH

Senior Partner

Adapting Spaces, LLC


Stay at home safely – strategies for success

April 9th, 2013 by admin

Almost everyone would prefer living at home, though thinking of the best ways to accomplish safe and independent living at home can be a challenge.  Fortunately today more than ever there are a variety of options and products that can help you stay in your home.  The greatest challenges can be finding the right products and solutions that truly help you stay independent and safe, while maintaining your home’s aesthetics.

Making a plan

Finding the right solutions and sorting through the numerousproducts available requires making a plan for success.  There are many individuals (builders, remodelers, and medical equipment providers) who claim to be “aging in place specialists” who hold marketing information but lack a true understanding of creating individualized solutions.  Finding the right solution for your independence and safety depends on your own individualized needs and comes best from the perspective of a physical or occupational therapist.

Why is the physical/occupational therapist perspective important?

For any remodeling industry professional who has taken the NAHB – CAPS certification (a brief introduction to the field of home accessibility), the importance of collaborating with an occupational therapist for accessible modifications is of familiar importance.  Creating a plan with an accessibility provider or specialist with background as a physical or occupational therapist makes sense as therapists have an in depth knowledge of the aging process, disabilities, function, and most importantly an understanding of task analysis.  The process of task analysis entails breakdown of functional tasks or activities of daily living into their smaller components.  By gaining a more detailed knowledge of what is required to complete an activity, we gain a better understanding and ability to provide effective solutions.

Considering your home’s limitations

In addition to requirements of the individual we need to look at thelimitations of the home as well.  From this aspect it is important to work with an experienced and qualified remodeler who has an understanding of the structural limitations and requirements of your home or environment.  As with most things in life, a well thought out plan can provide savings in time, money, and in the case of homemods – preserve or enhance the beauty of your home.

Finding the right solutions

It requires the right team to look at the whole picture and find the best solutions for your home.  Common areas that require assistance for accessible modifications include:

  • bathroom accessibility (barrier free showers, grab bars, tub lifts, tub cut outs, and walk in tubs)
  • accessible entry to the home (ramps, porch lifts, automatic dooropeners)
  • managing stairs inside the home (stair lifts, home elevators, dumbwaiters, inclined platform lifts, vertical platform lifts, and mechanical lift devices)
  • independent function in the home (function within the kitchen, independence with transfers, ceiling lifts, door widening, railings and supports).

Planning ahead is well worth it, and incorporating the functional and medical perspective of occupational or physical therapists trained in accessible designs can provide a valuable perspective in finding the best solutions.

This article was written by Rob Horkheimer, MPT, CEAC, CAPS, ECHM, accessibility specialist and owner of BILD (serving Wisconsin and Illinois).  Rob’s Milwaukee based company provides the collaboration of physical and occupational therapists trained in the field of home modifications along with experienced contractors, designers, and elevator/lift specialists who find intelligent solutions for independence and safety in the home.  Visit to learn more about accessible options and opportunities available for home and community.

United States Senior Housing Problem

March 27th, 2013 by admin

The first baby boomers turned 65 years old in 2012, that is roughly 2.8 million seniors nationwide. By the time we are done with this wave of baby boomers turning of age, there will be approximately 70 million seniors according to the AARP. While working on a series of blogs about New York City and its crippling housing stock, I came across an interesting video. In the video, Henry Cisneros, the former U.S. Secretary of Housing and Urban Development, talked about the current state of senior housing in the United States. He spoke about the current challenges faced by seniors with the shortage of suitable living environments that can accommodate to their needs; what is being done about it; and what the plans are for the future.

I want to share this video because this is not only a challenge for seniors , but a challenge for the American society as a whole. As a healthcare professional and Aging in Place Specialist, I see a huge opportunity for society to move forward by advocating for more user-friendly spaces and fully accessible communities that will not only benefit seniors but anyone regardless of their level of function. Mr. Cisneros mentioned a series of long term solutions that could help in dealing with this challenge. One of the solutions was the creation of a program similar to the Weatherization Assistance Program, WAP. For those not familiar with WAP, it is a public assistance program that helps income-eligible families reduce their energy consumption and finance repairs to make the home more energy efficient.  Mr. Cisneros proposes a similar program that would provide financial assistance for seniors and homeowners to retrofit their homes in order to make them more user-friendly. Any comments or feedback about this video is welcomed.

Watch video.


Miller Calberto, MS, OTR/L, CAPS

Senior Partner

Adapting Spaces, LLC


Visual-Perceptual Difficulties In Children

February 23rd, 2013 by admin

“I can’t do my homework! It’s too hard!!”  Many of you have heard this complaint countless times.  Some children use this as an excuse not to do their work; however, others actually mean it.  Often, children have trouble with reading, writing, or math because they have difficulty understanding what they see.  Visual perceptual or visual processing difficulties affect how the brain perceives and processes visual information.  If we can’t make sense of what we are reading or writing, how are we expected to learn and acquire new information being taught to us?  Unfortunately, many of the children that experience these difficulties go undiagnosed for years. As a result, they may become frustrated or bored while in class and act out because they can’t see (understand) what’s on the board or read with relative ease.  It is usually the case that children with problems seeing are often considered the “behavioral child”.

Living with visual perceptual difficulties can be very confusing and disconcerting.  Therefore, if you believe that your child is experiencing difficulty in school because of a visual perceptual difficulty, seek the help of an occupational therapist or vision specialist.  Through the implementation of adaptations and/ or strategies your child can have greater success while in the school environment.  Just because he or she may have visual perceptual difficulties, doesn’t mean that they can not learn and overcome this challenge.  Occupational therapists and vision specialists have the training needed to help your child succeed.  Below are a list of possible warning signs that your child may be suffering from a visual perceptual deficit:

  • Letter reversals
  • Difficulty learning the alphabet
  • Difficulty recognizing words
  • Understanding basic math concepts
  • Maintaining letters on lines and within page margins
  • Organizing written information on paper
  • Holds paper close to face
  • Excessive rubbing of the eyes
  • Constant squinting/ blinking
  • Watery eyes or swollen eyelids

After meeting with a professional to discuss your child’s concerns, it is important to develop a plan that you can incorporate while at home.  Here is a free website that can be useful which contains exercises to help your child improve his/ her visual perceptual skills in a fun and interactive way.

By: Esther Gonzalez M.S. OTR/L Bil TSHH

Senior Partner

Adapting Spaces, LLC


“Dangerous” Activities of Daily Living

February 12th, 2013 by admin

Extra, extra!! Read all about it!! One common potential danger we face on a daily basis, is a routine and mindless act that we perform at least 365 times a year. That’s right!! There are times where something as simple as taking a shower can be hazardous to your health. I will explain… The chances of suffering a fatal accident while in the shower are greater than those of being hit in a terrorist attack. We have become more aware of the dangers we face relating to gun violence, terrorist attacks, and nuclear weapons. However, we have become less vigilant when it comes to the dangers we can encounter in our own homes. I recently read an article published in the New York Times that discussed this issue and how seniors 65 years and older are at greater risk. It is important to understand that some activities of daily living, such as taking a shower, can become more challenging as our functional capabilities diminish. An active lifestyle and exercise can help you maintain an adequate level of function. However, there are instances where this is not enough and accommodations need to be made to the environment. These modifications can make the living space more user-friendly so that the senior can perform their everyday activities more comfortably and safely. Follow the link below to read the entire article, “That Daily Shower Can Be a Killer”.

Miller Calberto, MS, OTR/L, CAPS

Senior Partner

Adapting Spaces, LLC


Helping Children with Handwriting Difficulties

January 22nd, 2013 by admin

As the state standards increase, so do the demands placed on our children.  Many children have trouble completing classroom assignments due to handwriting difficulties. Handwriting concerns have become more prominent since handwriting is no longer taught as part of the school curriculum.  Nowadays, children are expected to know how to identify and write upper case letters, lower case letters, and numbers while in Kindergarten.  This poses a serious problem for many children especially those facing difficulties with fine motor skills, sensory processing/ modulation, low/ high muscle tone, decreased hand/ body strength, visual- perceptual skills, amongst other conditions.

As an Occupational Therapist, I work with children facing this struggle on a daily basis. Many of you may be wondering, how can an Occupational Therapist help my child learn how to write?  After all, they are not teachers! Don’t they work in hospitals or clinics? Yes, it is true that we are not teachers and we usually work at other sites.  However, many occupational therapists specialize in the area of handwriting since it affects how children function within their school environment.  Our job as occupational therapists is to help individuals become more independent in their day to day activities.  In this case, since a child’s main occupation is to go to school and learn we help them access their education.  One way to help them access their education is by working on their handwriting skills.  Giving them the opportunity to improve upon their handwriting skills will in turn allow them to produce written work so that they can demonstrate understanding of what they have learned within the classroom.

Many teachers and parents are recognizing the growing need for children to receive help with their handwriting skills.  A recent New York Times article also made reference to this major concern. Children may have trouble holding their pencils properly as well as identifying letters and numbers (visual memory) or producing them correctly.  Other components of handwriting addressed in occupational therapy are: sequencing (formulating numbers or letters with the correct sequence/steps); line regard (keeping them on the line); orientation (no number or letter reversals); and letter and word spacing (proper distance between letters and words).  For older children, we tend to work more on observing the page margins, punctuation marks and writing speed (so that they can keep up with the rest of the class).

Since the demands of classroom work continues to increase with each year that passes, we see more and more that children can benefit from our services.  If your child is having difficulty performing written tasks and keeping up with the classroom demands due to handwriting concerns, seek the help of an occupational therapist.  We are specialized in this area and want to help your child access their education so that they can be successful in their learning environment.

By: Esther Gonzalez  Bil T.S.H.H. M.S. OTR/L

Senior Partner

Adapting Spaces, LLC


Improving The Well-Being of Dialysis Patients, an OT Approach

December 10th, 2012 by admin

It is possible that you may know someone that was diagnosed with Chronic Kidney Disease (CKD). It is also very likely that you or someone you know is suffering from Diabetes, High Blood pressure, or both. These two chronic conditions are among the leading causes of kidney disease.  Another cause is frequent urinary tract infections. According to the U.S Department of Health and Human Services, 1 in 10 American adults (more than 20 million people) have some form of Chronic Kidney Disease.  End Stage Renal Disease, (ESRD) is when there is total damage to the kidney and the patient needs to undergo dialysis treatment. According to the U.S Department of Health and Human Services, the prevalence of ESRD between 1980 and 2009 has increased by almost 600 percent from 290 to 1,738 clients for every million cases.

George Washington University conducted a study examining the quality of life and psychosocial issues affecting dialysis patients. They found that depression is the most prevalent psychological symptom affecting dialysis patients. Researchers believe that dialysis patients may feel depressed due to their heightened awareness of the possibility of death.  Other reasons were linked to the feeling of loss of independence, increased family burden, and decreased physical level of function.

Occupational therapy can help individuals undergoing dialysis treatment live a more fulfilling and healthy life by helping them modify or adapt the activities they perform. Occupational therapists have been uniquely trained to break down tasks into individual components to better understand the performance demands it has on the individual. The occupational therapist uses a client- centered approach to find out what are the most important daily activities to the client. Then they establish a parallel between the demands of each specific task and how much effort is required by the patient to perform it.  Once this parallel has been drawn, the occupational therapist formulates a work plan which may include ways to improve the patient’s ability to maintain an adequate level of function that would allow the patient to continue performing the task. If the patient is no longer able to perform the task the way he or she is accustomed to do so, the occupational therapist will develop a list of alternate ways to perform the task successfully.

For instance, I had a patient not too long ago that has been receiving dialysis for over 10 years.  In the recent years, she has been experiencing increased pain in her legs due to peripheral neuropathy which makes it difficult for her to enjoy one of her favorite past-times- window shopping. I understood that 10 years of dialysis and the effects of Diabetes had taken a toll on this patient’s body, but not on her mind.  Although she was not feeling optimistic about her future prognosis because of her medical condition, she still wanted to feel alive and do the things she enjoyed. So I worked with her and her case manager to develop a plan that included: an exercise regimen; proper footwear selection; implementation of energy conservation techniques; training on fall and safety precautions; appropriate and convenient means of transportation; amongst other things. We were also able to modify the way the patient performed the activity of window shopping, so that she could continue to do so successfully. Through the implementation of strategies and adapting the task, she is currently able to window shop and is happy to do so.


Miller Calberto, MS, OTR/L , CAPS

Senior Partner

Adapting Spaces, LLC