Ground-Floor or Upper-Floor Living in Later Life

What changes with age

Stairs do not suddenly become impossible. They become slower, more tiring, more painful and more dangerous, in stages:

• Needing the rail and taking one step at a time.
• Resting on the landing or avoiding going up more than once a day.
• Fear of falling and avoiding the stairs.
• A fall on the stairs, or a near miss.
• Needing help from another person.
• Not being able to use the stairs at all, after an illness, a fracture or deterioration.

A parent who is housebound upstairs, or who cannot leave the flat without help, loses independence, company and exercise; see loneliness and isolation in older adults. Planning before the crisis is better than reacting after.

Ground-floor living: advantages

• No stairs to climb inside the home, so daily life is simpler and safer.
• Easier access for visitors, deliveries, doctors, ambulances and care staff.
• Easier use of walkers and wheelchairs, if the entrance can be ramped.
• Quick exit in a fire or emergency.
• Closer to the garden, the street and community life.
• Less dependence on a lift, which may break or lose power.
• Lower cost of adapting, since stair lifts and lifts are not needed.

Ground-floor living: drawbacks and fixes

• Security. Ground floors are more exposed to intruders. Fit secure locks, grilles, a door chain, a viewer and an alert system; see lock and door safety for seniors.
• Noise, dust and pollution from the street. Use double glazing, curtains, air purifiers and ventilation at suitable times; see indoor air quality for older lungs.
• Damp and mould, especially in monsoon and coastal areas; see damp, mould and pests.
• Pests and insects, such as mosquitoes and rodents; use screens and good hygiene.
• Flooding, in low-lying areas, which needs a plan.
• Privacy: passers-by looking in. Use curtains and blinds.
• Less light and views in some homes.
• Entrance steps. Many ground floors have a few steps at the door; add a ramp and rails; see stairs, steps and thresholds.
• Bathroom location. Check that there is a toilet and bathroom on the ground floor.

Upper-floor living: advantages

• Light, air and views, and a sense of space and safety from the street.
• Better security and privacy.
• Less damp, noise and pollution at street level (though not always).
• A lift can make upper floors as accessible as the ground, in well-run buildings.
• Cooler or warmer, depending on the building.

Upper-floor living: drawbacks and fixes

• Stairs. If there is no lift, stairs can be impossible; see handrails and stair lifts.
• Lift reliability. Lifts break, are serviced, or stop in power cuts. A parent stuck on the fourth floor with no lift is trapped. Check the building's maintenance, backup power and a plan for emergencies; see lifts and apartment living for seniors.
• Difficulty for emergency services to reach and carry a person down stairs. Ask about stretchers and lift sizes.
• Isolation, with fewer chance encounters with neighbours.
• Deliveries and appointments need a lift and help.
• Heat on the top floor in summer.
• Balcony risks: falls; see garden, balcony and terrace safety.
• Fire escape routes: know them.

How to decide: questions to ask

1. How well does your parent manage stairs now, and what is the outlook? Ask a physiotherapist. 2. Is there a lift, and how reliable is it? Does it fit a wheelchair or a stretcher? Is there backup power? 3. Are all essentials on one floor: bedroom, toilet and bathroom, kitchen, living area? 4. Can the entrance be made accessible, with a ramp or level approach? 5. What are the risks of the location: noise, pollution, flooding, security, heat? 6. What does your parent want? Their home, neighbours and routines matter greatly. 7. What support is available? Family nearby, neighbours, services. 8. What is the likely future? Will needs increase? 9. What can be adapted, and at what cost?

Rearranging a house

If your parent lives in a two-storey house, consider moving daily life downstairs.

• Bedroom: use a downstairs room, perhaps a study or dining room, with a hospital bed if needed; see setting up a hospital bed at home and a hospital room at home: the complete setup.
• Toilet and bathroom: ensure a ground-floor toilet; if none, consider adding one, or a bedside commode; see commode chairs.
• Kitchen and living: keep them accessible.
• Privacy: screens or curtains.
• Equipment: duplicate items for each floor.
• Keep upstairs access for others.
• Make it feel like home: bring familiar furniture and photographs.

This can feel like a loss of the family bedroom, so discuss it with sensitivity.

Choosing or moving to a flat

If a move is being considered:

• Prefer ground-floor flats or buildings with a reliable, spacious lift.
• Check: step-free entrance, wide doors, lift size, backup power, security, proximity to healthcare, shops, parks and family.
• Look at the layout: the bathroom, kitchen and bedroom close together, with space for walkers.
• Consider building management: maintenance, rules, a caretaker, community.
• Think about the neighbourhood: a familiar area, friends, temple, clinic.
• Consider senior-friendly housing, assisted living or retirement communities, as options; see choosing an assisted living facility or care home.
• Involve your parent; moving can be distressing, particularly with memory loss; see moving a parent to your city.

Making any home safer

Whichever floor, the same principles apply: good lighting, non-slip floors, rails and grab bars, clear paths, an alert system and regular safety checks; see ageing in place, room by room, monthly home safety check and home safety for seniors living alone.

Emergency planning

• Know how help will reach you: stairs, lift, key safe, access for ambulance and fire services.
• Have a plan for lift failure: an alternative route, a neighbour, a carry chair.
• Fire escape: know the route and keep it clear; for upper floors, consider an evacuation plan.
• Keep medical information and a bag ready; see emergency plan for seniors.
• Tell neighbours, the building manager and family.
• A key safe for entry; see key safes.

A worked example

Consider a seventy-eight-year-old widower who lives in a two-storey house with his bedroom and bathroom upstairs. Last year he fell on the stairs but was not hurt. Now he climbs once in the morning, comes down once at night and avoids the stairs between, which means he rarely uses the upstairs toilet in the day and sometimes holds on too long. His son asks a physiotherapist, who finds his knees are weak and his balance is borderline. The family looks at the options: a rail on both sides and better lighting, a stair lift, or moving the bedroom to the dining room downstairs with a commode and later a ground-floor shower. After talking with him, they choose the third, with rails and lighting as well, because it is cheapest, safest and keeps him close to the kitchen and the front door. The dining table moves to the living room, the bed is set up with a firm mattress and a night light, and a small wardrobe is added. He keeps the upstairs room for guests and for his books. Six months later he is walking more, going out more and feels less afraid. The same family might make a different choice if his health changed, which is why they plan to review the arrangement every year.

When to ask a professional

A physiotherapist or occupational therapist can assess mobility, predict needs and advise on adaptations and the best floor; see occupational therapy home assessment. A builder or architect can advise on structural changes, ramps and extra toilets. A doctor can discuss health prospects. Our care advisors can help weigh options and arrange adaptations or support.