How a New Generation Approaches Aging in Place

James Harbin has a propensity to find potential in anything.

Maybe he gets it from his granddad. Born and raised on an Alabama goat farm, Harbin’s grandfather taught him everything from mowing grass to believing in himself.

Now in his twenties and the founder of an outfitting company that is less than a year old, Harbin wants to change the way ramps are installed.

Despite being told by a high school counselor that he wasn’t likely to make it in college, Harbin went on to receive a bachelor’s in social work from the University of North Alabama and a master’s in social work from the University of Alabama. He was working with the Community Action Partnership of North Alabama when COVID-19 broke out in 2020 and convinced him he wanted to create a bigger impact. So he applied for an accelerated Master of Science in Nursing program at the University of Alabama at Birmingham.

“It was tremendously difficult … and I just worked as hard as I could nonstop,” Harbin said. “I was living in an apartment with a mattress on the floor and no furniture but a desk. I put up a 6-foot by 8-foot whiteboard in my living room.”

His dedication paid off when he graduated and went on to work in cardiovascular intensive care at a medical center in Birmingham, Alabama.

Then, about two years later, Harbin’s grandfather began to develop dementia and fell repeatedly. The whole family stepped up to help outfit his home with grab bars, smart home devices, fall alert kits—and anything else they could think of to keep him safe and in the comfort of his own home for the rest of his days.

“Ultimately, he passed away,” Harbin said. “And this is the truth, but a week before he did, he told me that he always believed in me, that he loves me and that he knows I can do anything I want to do in my life.”

Building a Business

That encouragement—plus the knowledge he gained from outfitting his grandfather’s home and the skills he had picked up from working in software sales at a health tech startup—gave Harbin the vision and ability to start his own home modification company.

He launched Harbin Home Outfitters, or H2O for short, in mid-2023 in his hometown of Auburn, Alabama. The young company focuses on multiple things. The first and largest is what they call “smart safety outfitting,” in which the team, currently serving homes in Alabama, Georgia and Florida, uses technology, adaptive equipment and preventative safety measures to assess a client’s living area, mark immediate,and long-term environmental risk factors, and design and implement projects to make a home safe for someone aging in place.

This process, which might take some home accessibility companies multiple days and several visits to complete, often only takes H2O a single day, thanks to online mapping technology that uses maps and math to determine the necessary dimensions for ramps, guard rails and other safety features they might outfit a home with.

“We can get it shipped to their home in usually less than 24 hours, sometimes 48, and install it on-site,” Harbin said.

Harbin’s innovation doesn’t stop there, however. He also has goals for self-manufacturing ramps instead of relying on outsourcing.

“The best part is no part at all, right? It’s not about trying to make the screw easier to fit in the hole, it’s about taking it away entirely,” he said. “So, if we can find a way to build a wheelchair ramp with zero hardware, where my grandmother … can put it together in her front yard, that’s what we hope to move toward. I know it sounds preposterous, to think of that as a destination. But that’s what we want to do. Because a lot of the populations we serve don’t have anybody to put (ramps) together for them. So, if we accomplish that for them, we’re solving a huge problem.”

H2O’s website also notes other methods the team uses to increase independence for those aging in home, including nutrition plans, exercise goals and medication compliance.

Lastly, H2O also intends to venture into the smart home world to make homes as safe as possible for aging in place.

A Novel Approach

Harbin’s education and background in clinical settings has proven to be an edge, not just from a business perspective, but from a home assessment and care perspective as well. Some industry professionals have noted a trend in home access contractors building more connections between the teams that do the work and the clinical teams that set up a plan for it. Harbin is both in one.

He leans on his clinical expertise in assessing a client’s needs. Everything influences everything, Harbin said. Each variable—whether that be family, pets, mobility or medication—impacts the others.

“For instance, if (a client is) on a medication that causes vertigo, then that’s going to decrease their balance,” Harbin said. “But someone who may not know the side effects of a specific psychotropic medication, like a benzodiazepine, (isn’t) going to understand that it causes dizziness … so that could influence balance, which influences falling. And then, if you add up all of the different factors of medication, age, mobility, past falls, circulation, neurological function, pretty much everything, it all adds up to the real risk of taking a fall.”

Harbin said true risk is always greater than perceived risk, and that true risk is what he is training his team to look for when they are outfitting homes. Harkening back on his days in an empty apartment with his study group, Harbin is pulling knowledge from (diagnostic manuals), nursing textbooks, pharmacology and more.

“It’s not every day that a founder makes his ramp company employees watch nursing videos, but it really helps increase their understanding,” he said.

Harbin believes this blended approach is how industry advancements happen.

“When you are able to combine so many forms of knowledge and understanding and different fields and different industries and combine it into a unique perspective that nobody else has, that’s how you can make real change,” Harbin said.

A New Generation

At age 29, Harbin is a younger leader in the home medical equipment (HME) space, and he believes it’s important for more people in his generation to get involved in the industry.

“It is so important to return the love and the protection and the respect that (our grandparents) gave (us),” he said. “It is so important to me to go back home to my grandmother and my grandfather when he was alive, and not just pay him back, but give him what he is due. We have to look at the generation who raised our parents and who raised us and ask ourselves what can we do to help them.”

Harbin also said there is innovation that can come about when you are new to a field and not fully aware of certain preconceived limitations other long-term veterans of the industry might be steeped in. While he believes in the idea that it takes 10,000 hours to master something, and that there is power in being an expert, having fresh eyes in an aging industry can be a superpower in its own right.

“It would be unreasonable for me to believe that I am better at doing something because of my experience in an industry that I don’t have a ton in, right? But at the same time, I do believe that my team and my company are better at doing things because of the lack of experience we have in this industry,” he said. “And I don’t think that’s across the board-—I think it’s in specific cases where we aren’t afraid to question things that are just presumed to be facts and presumed to be truth.”

Through everything, including innovation, Harbin gives credit to his team. Going above a “treat people how you want to be treated” motto, Harbin believes in treating his team the way he would want them to treat his grandmother. From paying them what they’re worth to investing in their knowledge, Harbin aims to put his employees first.

“You train them well enough to work anywhere they want, but you treat them well enough that they’ll want to work with you,” he said. “(Running a company) is more than what I ever thought. It is more hours, it is more time, it is more emotion, it is more brainpower, it is more exhausting, it is more tiring, it is more everything. And if I didn’t have a team that understood that, we wouldn’t be here.”

It’s easy to expect people to look down on younger entrepreneurs trying to enter a market already dominated by big players, Harbin said—but expectations are not always reality. Don’t let worst-case scenarios dictate how you interact with those who might have valuable advice, he said.

“People who are ahead of you in entrepreneurship are normally pretty nice people,” Harbin said. “They are super people who want to help you get where you want to be, because they had somebody who helped them, and they are always willing to return the favor.”

Harbin says that if he can do it, anyone can.

“That’s not in a self-deprecating way,” he said. “If I can inspire somebody else to take the jump and do it, too, I promise you, it’s worth it. Even if you fail, keep going. Because the only true failure is quitting. Everything else is a win eventually.”