Another note about attitude and planning ahead

I came across a couple of blog entries that spurred some thoughts related to the last post. The first opened as follows: "The accident that alters your life happens to you at the most unexpected moment in your life”. The author was primarily discussing issues for the disabled in public places, but notes that the aging population is also a large issue for design. What struck me about this statement was that it is true whether we are 40 or 80--few of us truly think that a disabling fall or other event is going to happen. And hopefully, it won't, but there is a difference between optimism and denial, between expecting the worst and actively looking for ways to avoid or mitigate the worst.

This ties into a statement by Elinor Ginzler, 55, AARP's director of livable communities: "We minimize risk in our financial investments. Why shouldn't we do it in our homes?" Elinor is quoted is a very good article that appeared in the Washington Post written by Annie Groer and available online at this blog (click here). She makes an excellent point--much of this is about risk management, just not risk management in a way we are used to thinking about it. AIP is about more of course--all the emotional benefits of staying independent--but perhaps it behooves us all to think of it more as risk management. That certainly puts a virtuous, non-indulgent tone on it. It helps convey that you have a range of options, all of which can help and deliver different benefits according to your needs and goals, just as you have different options for your financial portfolio. Most seniors would not invest in penny stocks, but not thinking about their aging-in-place needs is just as risky. and mitigating that risk can be as simple as just moving the coffee machine up to the bedroom, as one couple in the article did.

The first entry, author, by the way, is writing about Sri Lanka--another example of the global relevance of this issue. That blog is available here.

A Positive Attitude

One of the things we often think about is that real success for Aging in Place will come when more of today's elders (and the boomers who will follow) develope a more positive attitude toward AIP modifications. I came across an article that put it well: "The key to aging in place, experts say, is to embrace rather than deny the need to adapt living spaces to meet physical changes as mobility, eyesight and hearing decline." This came from an article from the Washington Post, but I found it reprinted in the on-line version of the Hong Kong paper The Standard. Link to The Standard Article.

This article profiles the efforts of 90 year old Charlotte Goldstein to adapt her home to improve safety. The picture shows some basic handrails put up to complement the existing banister on her stairs. A very practical solution and a fairly common project for our company. But I am still more likely to encounter people who say they can make do without the second rail. I recently met with a woman who had already fallen and fractured a collarbone who refused either a second hand rail or any form of slip protection on her stairs because "it just wouldn't look right." However, I think that seldom are these reactions about cost or aesthetics--simple rails are not that expensive and I am as likely to get resistance from the well off as those who struggle on a fixed income. Plus they can be made made to fit in with decor and are easy to remove.

No, unfortunately it is the perceived weakness that such modifications are seen to represent that prevent "embracing" making changes to our homes. That and persistent denial even in the face of real need. Mindsets like these create the most resistance. Only when an increasing number of people see that the virtue is in preparing and that part of being able to keep your home is keeping it appropriate to your abilities and phase of life will a major barrier to successful aging in place fall to the wayside.

Aging in Place runner up for word of the year

I came across this snippet yesterday--Oxford University Press gave a nod to Aging in Place as a runner up for the 2007 word of the year.

"Locavore" got the top honor (that means someone who tries to eat foods grown/produced locally.) In the justification is was noted that the past year as seen a strong trend in that direction (which I can confirm, it's certainly at evidence in our home.)

So, can we assume that the nomination of Aging in Place for the honor is also supported by a strong trend? Certainly the phrase is not a new one, it was becoming well used six years ago when we began work on In Your Home. Is it now rising to the awareness of dictionary publishers everywhere because of the trend's momentum? Let's hope so.

OUP defines Aging in Place as "the process of growing older while living in one’s own residence, instead of having to move to a new home or community."

I'll leave it to them as to why it is considered a single word.

http://blog.oup.com/2007/11/locavore

Making people whole again

Last summer a client threw one of the those "This Old House" parties to celebrate the end of a large project. This happened to be for a couple moving to town to be closer to family. One half of the couple needs to use a power chair to get around and we created a number of features and design elements with her needs in mind--smooth flooring throughout the home, a bathroom designed around her needs, some basic modification to make the kitchen more useful, modifications to exterior paths, etc. She expressed her gratitude to our team with the following words. "In my last house I increasingly felt like an invalid. In this home, I feel like a person again."


We are doing more projects these days that are not for seniors or related to aging or disability. There are two primary reasons for this. One is that we have a top notch rating on Angie's List and get a lot of calls from people outside of our target demographic (Angie List is a great resource, we even use it to find subs.) The other is word of mouth referrals--once you do a good job and show that you are a reliable resource, friends and family members come knocking.


We're business people so we're practical. And we have a great crew that we are committed to keeping employed and busy. So we happily take on projects matching our skill sets regardless of the age or ability of the customer. A kitchen remodel for a growing family, rebuilding a dilapidated garage for the daughter of a client, a bath remodel for an executive woman. Creating a space that someone enjoys, or helping to remove worry by fixing a maintenance problem, is always enjoyable.

And as we so often say, aging in place isn't about grab bars and ramps, its a much broader vision of home environments that support our stage in life, and at its core that is a vision that fits with people of all ages and abilities--young families, fit and vigorous seniors and folks with impairments. So we try to leverage our experience and common sense into all the projects we do.

But we have to admit, the greatest joys come from our projects where we can impact a life like we did for this woman. Our personal spaces should be refuges and havens, not daily struggles to accomplish simple tasks. That's a very attainable goal for homeowners and one that will pay back the homeowner in a variety of ways. And it pays us in spades when we get this sort of appreciation,well beyond the financial earnings.

Care in choosing contractors

We're not the sort of people who like to try to sell by creating fear, but I came across this video clip and thought I would pass it on. It underscores the risks people face when dealing with contractors. While it does not make the point, seniors can be at an even greater risk for this sort of scam artist. It's part of the reason why we started our business--to provide a recognizable, trustworthy resource for a wide variety of home maintenance and remodeling needs. Because we are insured, licensed and take extra steps like conducting employee background checks and training on customer service, we are seldom the cheapest option in town. While sometimes cheapest is a deal, often it becomes an expensive lesson or even turns into a risk for your family. For seniors on tight budgets and a sense of what things used to cost, the temptation can be strong to save money. But seniors can often be at greater risk due to decreased mental capacity, medical conditions, grief from a lost spouse and so on. And, as one of our customers said last week when scheduling a grab bar installation--"I don't want something that is going to pull out of the wall." Even a handyman who isn't a crook can unintentionally create problems by improper methods.

As this story mentions, not all states regulate contractors, so verifying the contractor can be a problem. They give some good tips in the video clip. They did not mention Angie's List--a great way to see what customers say about the company and how the company responds, which is often just as important.

The video is located at the link below, and you'll have to watch a commercial of some sort before it starts--the one I saw was for a video game.

http://video.msn.com/video.aspx?mkt=en-US&brand=msnbc&vid=b83da96a-d107-4f6c-ba7d-8d7c7bd3ba03

Personal Design vs Universal Design

One of the things I've observed is that with all the attention on Universal Design there is becoming a certain dogmatic stance in some areas or by some people. Sometimes we seem to forget that UD is a set of seven principles to help guide decision making, not an enforceable code. When you are dealing with residential housing and a person's living space, universality can take a back seat to something tailored to the individual. We aren't talking about public buildings here, rather individual living spaces. Here are a few examples from work we did this summer.

• The aging-in-place bias in redoing a bathroom for a senior would be to expand the shower and make it zero threshold in the event that a wheelchair is in their future. But we had two customers (both smaller women) who really wanted smaller showers--they felt more secure and stable in the small shower, the walls providing an envelope that makes it easier for them to maintain their balance. The new showers will accommodate a small shower chair if needed in the future, so there is that provision for flexibility. But never will a wheelchair be practical in the bathroom (in one of the homes, a wheelchair will never be practical anywhere.) So, while this might not live up to UD principles of equitable use or size and space for approach and use, for these particular homeowners it was the right design for now.

• We like wall ovens over ranges--less bending and lifting, easier to see into. Separate cook tops allow for storing pots and pans where they are needed or even the ability to sit and cook. But for one customer, the wall often was wasted space that was better put to storage. So, the wall oven came out and the oven cavity was fitted with pull-outs. Separate cabinets were modified for a freestanding range. This resulted in an overall more functional design for the customer, even though we had to go with a less UD appliance. Sometimes the practical issue is how and where to apply the UD principles. In remodeling, there are typically trade-offs.

• Split level counters are seen as a good idea to accommodate people of different heights or who need to sit. They find their way into a lot of kitchen designs these days. But for someone with a severe visual impairment, misjudging where one height ends and the other begins can result in spills and broken dishes. A common height counter, or one where the height differences are in distinctly different areas of the workspace, is the better solution for the individual.

Don't get me wrong, the attention on UD is great. Even in these designs, we employed UD principles where we could--lever handles, hand showers on glide bars in the shower, grab bars instead of towel bars that offer no support if grabbed, materials and designs that provide visual cuing, task lighting, storage that minimizes reaching, etc. But let's remember that it is a set of principles to help shape a design, not a set of routine solutions. Often in residential remodeling the design dictates are very personal.

A funny thing happened at Aging in Place week

Last week was national Aging In Place week. If memory serves (a risky assumption at times) this is the fourth such event, fostered by the efforts of the National Aging In Place Council. As one of the first members of the NAIPC, we've participated in the events. Typically, they have been a forum to network with others involved in providing services to older adults and have been poorly attended by people actually interested in their own aging-in-place efforts.

This year was different. It was odd. It was surprising. There were actually seniors or their families in the seats! We spoke or exhibited at three events durng the week and two of these were very well attended with approximately 30 attendees at one and around 60 at the other. The events are getting better organized and that accounts for some of the draw I'm sure, but I also think more and more people are interested in the topic and, from their comments, are happy to find knowledgeable resources to advise them.

Our topic (modifying/adapting the home) also plays well because it tends to be a more positive or upbeat message than some of the other aging related topics. But the third talk was at a home and garden show (which was just a coincidence and not related to AIP week.) It was poorly attended--as I have seen other AIP talks at such venues be. I suspect that it's a topic that plays well to the right audience but does not yet draw well against all the booths and trade displays--its not why the attendees are there. But it is great to see the momentum building and more and more people acting practively to set a plan and maintain their independence.

Here comes the bandwagon

It's been a very busy summer for us at In Your Home and I haven't posted for awhile. Lots of new customers, we've grown our crew, business is about double last year. While we like to believe this has a lot to do with how we run our business, it is partly a reflection of the growing demand for services to support folks choosing to "age in place."

This growing demand for services has been noted in a variety of recent industry reports and news stories. Combined with the slump in new home construction, lots of people are targeting residential remodeling and especially "aging in place" as a more robust segment of the housing market. All the attention is good because it will hopefully lead not only to better solutions but greater awareness and willingness throughout the population of how modifications can improve our lives as we age. But there is also a big risk in this goldrush mentality. Here are a few examples:

• Untested products. Over the summer we discovered a new walk-in tub that had some nice features making it a great solution for a particular client. It was offered by a reputable company so we decided to give it a try. A week after the order was scheduled to ship, we were informed that something had gone wrong with the manufacturer relationship and the product could not be delivered as promised. We had to go to plan B, delaying the project for nearly a month, an inconvenience for our customer. But at least it was discovered before we had a situation with a faulty product. As more and more people target these sorts of solutions, we are likely to have many products that do not work or can't be delivered as advertised--experience and the remodeler's willingness to stand behind the work will be very important.
• Supportive business practices. It's one thing to know how to replace a tub with a shower, it is another to have the work practices that protect the customer in other ways. For example, we currently have two customers experiencing the onset of Alzheimers. They have tried to hide our supplies and give away their belongings to our crew--things that we are accustomed to and have strict policies regarding. This is just one example where a true aging-in-place specialist will have the experience and work practices that meet the needs of this customer base, beyond basic remodeling skills.
• Real Focus. It is increasingly easy for remodelers to say they do aging-in-place projects, but how many do they really do? I've spoken with CAPS designees who admit that aging-in-place work is only a small percentage of the work they do. Admittedly, we are doing more and more projects that are outside the aging-in-place marketspace--family members who want us to do work on their home, referrals from Angies List just looking for someone they can trust, etc. But our focus and the core of our business is on the senior population and it creates a very different reality for our team than for someone who doesn't focus there.
• Informed solutions. Not focusing on this market space can also impact the quality of the solution--we sell as many or more aluminum ramps as we build wood ones because in many cases they are the better solution. One of our customers couldn't find a contractor who knew anything about accessible shower pans--they had designed a ground floor bathroom and living space with the idea that it would be accessible for visiting relatives, but everyone they dealt with kept trying to install a traditional shower pan because that is all they knew. A true specialist can address the full range of solutions and won't force fit inadequate ones.

These are a few examples that underscore the need to people to be aware of what it really takes to be a viable resource for senior homeowners.

Beware the easy fix for increased lighting

One of the common issues we experience as we age is that we need more light to see clearly--especially the print of important things like medicine bottles, food packages, and, in my case, the daily crossword puzzle. The best way to get this additional lighting varies by what we need it for and by the condition of our eyes. But one solution that is never a good one is to shove higher wattage bulbs into fixtures that are not rated for them. Doing this can cause burns and fires.

I say this and many people scoff--what can be the harm of a brighter light bulb? Mountain out of a mole hill, they say. Well, witness this customer we helped out last week who called to have some water damage around a light fixture repaired. When our handyman got there, he found not water damage but heat damage. The owner had installed 100 watt bulbs in a closed fixture rated for 60 watt bulbs. Not only was the ceiling scorched and discolored, but the plastic junction box and wires were "crispy." The potential for a fire was very real.

Just a reminder that if more light is in your future, upgrade your fixtures to handle it. Also, consider putting them on dimmers so that you don't waste the wattage when you don't need it.

Study reinforces the value of home modifications

I came across this data at Cynthia Lebrock's website. Cynthia does us all the favor of reviewing a lot of academic articles and providing a synopsis of the findings. The data came from a longitudinal (meaning data collected and tracked over a period of time) study by the university of Michigan. Researcher Kyung Sook June showed that while disabilities increased the likelihood that the person will relocate into an institutional setting, the presence of basic home modifications like shower bars, ramps, lifts, etc. decreased that likelihood. Interestingly, the presence of a caregiver did not decrease the likelihood of relocation to an institutional setting. Since this data set was collected a decade ago, a reasonable hypothesis would be that improved product and design solutions and increased acceptance of home modifications would make these findings all the more true today.

Temporary solutions can help caregivers

When I did my bathroom options post awhile back, I didn't include a practical option for shorter term needs. We frequently get calls from families providing care for a loved one who, realistically, is in the final stages of being in the family residence or nearing the end of their life. A full bathroom remodel may not be needed or would create too much disruption. There are portable and temporary shower units available that can make life easier for a family in this situation or for someone who is recuperating from an injury or illness and needs a shorter term solution.

I've used portable showers out camping, but those aren't a solution in the home. But there are new solutions being designed that can make it practical.

FAWSsit is folding shower with an electric pump that can be set up in a room where there is sufficient space and an available source of heated water and a drain (sink, toilet, floor drain, etc) Laundry rooms and kitchens are obvious options. Since it can easily be folded and stored away, you don't need a dedicated space, making it possible to provide a shower to someone with greater ease and less stress on everyone. www.fawssit.com

Another resource is Shower Anywhere. These are more what I would call temporary rather than permanent shower solutions, so they require some dedicated space, but are an option when remodeling is not practical or in the long term interests of the homeowner.

Neither of these would be a great long term solution--having a home designed to have an accessible bath and bedroom on the ground floor is still the best precaution, but when that is not the case, a solution like these can certainly make life easier.

As we age one thing we can look forward to is more technology and non-traditional solutions like these to help us navigate this journey.

I've seen some interesting data lately about strength and safety in later life. One was this article about strength training--actually making muscles "younger."

http://news.yahoo.com/s/nm/20070523/hl_nm/strength_training_dc_1

And there is this bit out of London saying that older adults are net contributors to society, not the drain they are commonly portrayed as:

The future ... is not penury or dependence," said Clive Bannister, managing director of HSBC Insurance, which asked the institute to conduct the study on the elderly so it could learn about consumer behavior. "They have become turbos rather than the brakes of our community."

Researchers interviewed more than 21,000 people between the ages of 40 and 79 in more than 20 countries for the largest study of its kind. The aim was to explore attitudes about retirement and the sunset years.

Contrary to the commonly held belief that older people are draining state resources, the study indicates they are more independent and active in social and economic life than previously thought. (http://www.denverpost.com/ci_5971357?source=rss)

These are just a few of the items that paint a much more positive picture of aging. But then today I see this from an AP story showing that falls and safety concerns for older adults are are the increase. And this story only deals the the injury and death rate--just as concerning is how expensive and life changing a non-fatal fall related injury is
(http://www.chicagotribune.com/news/nationworld/sns-ap-accidental-deaths,1,3008203.story?coll=chi-news-hed):

The rate of deaths from falls for people 65 and older rose 31 percent from 1999 to 2003, the council reported, which means that deaths from falls are increasing faster than the older population is increasing. A death within one year after a fall can be attributed to the fall. "We tend to see our home as our safe haven. The data tell us it's not," McMillan said, adding that families can take steps to protect the elderly from falls by removing hazards and installing stair rails and grab bars.

Deaths from falls climbed from 16,257 in 2002 to 17,229 in 2003, the most recent year for which data are available. The rate also went up, from 5.6 deaths to 5.9 deaths per 100,000 people.

My thought. We always say staying fit is your best fall prevention strategy. No amount of adaptation will prevent a fall for someone who is frail. But since we have this potential to stay stronger, more active and vital, shouldn't we consider proactive modifications to our home that will improve safety, or allow easier rehabilitation at home should we be unlucky? Research has shown that those who benefit the most from supportive adaptations are those who are still relatively fit. And my designing our environment to support us more completely, we can ensure that the changes are pleasing, not ugly stop gaps, and keep home a place we love being. Proactively designing a home environment for our later years is one of the things we can do ensure we stay active, stimulated, safe and comfortable and make the most of a positive future. When you envision your future, re-envision your environment!

Better home environments save private and public money

You would expect me to advocate spending money on home environments that will suit us better as we age--after all, I co-own a company that creates better living spaces and am fostering it through a franchise strategy. But in this case, the company and strategy are an outgrowth of the need. I saw some very compelling data today in this article--from Tennessee but which happens to cover a lot of data about my home state of Oregon.

http://www.dicksonherald.com/apps/pbcs.dll/article?AID=/20070520/NEWS07/705200397

Joe Easton, manager of Oregon's in-home-care support unit, said the average cost of in-home care there is $800 a month versus $200 a day — or about $6,000 a month — for nursing home care. "People would rather stay in their own home, and the cost is much less," Easton said. By adopting policies to get people out of nursing homes and into other types of care, McGuire says, Oregon spends about $400 million less in state and federal money than Tennessee each year. "You can serve a lot more people for a lot less money outside of a nursing home," McGuire said. "It just makes sense financially."

Imagine being able to cut your monthly living costs by over 85%--which is what the numbers above suggest. Wouldn't it be worth investing a bit in your home to facilitate that?

Options for more accessible showering and bathing.

We find the bathroom is the area of the home that creates the greatest challenge for people--and not just because it seems we wait forever for someone to get out only to find they've used all the hot water. As we get older, the old design and using the bathtub may just stop being an option. What to do?

There are five basic solutions--here they are in order of cost.

1. Tub transfer seat and lifts. There are lots of products on the market now that can be used to help people get into and out of the existing bath. A tub transfer bench allows you to sit down outside the walls of the tub and then swing your legs up and over. With a set of grab bars and a hand shower, this can be an effective solution. However, many people find that they cannot easily lift their legs over the tub wall even when sitting, and controlling the water from a sitting position can be difficult for some. Another option in this vein is the tub lift, a motorized seat that is placed in the tub to raise and lower the person for tub bathing. You still have the issue of getting legs over the tub wall, and you use a few inches of depth in the bath, but it is an option. With any of these solutions, they are visually unappealing and make the tub less usable for others.

2. Tub Cuts. In this solution, the front wall of the tub is cut away and refinished to make an opening, allowing someone to step into the tub with only about a 4-6 inch step. Even that can be tough, and this approach most likely detracts from the home's value, but it is a popular low budget option. Be sure to disable the drain plug and ensure your drain is running clear so that you don't get a flood in the bathroom.

3. Tub replacement. Here we remove the old tub and put a shower unit in its place. You can even install a shower that is barrier free and wheelchair accessible. This is the time to upgrade shower valves to those that provide better tempurature control/automated settings. You can keep it this simple or make other modifications to the room to give yourself a cleaner, fresher bath--and remodeling the bath has one of the highest paybacks of any type of remodel. Be awre that one drawback is that unless the drain and vent lines are replaced, the new shower may not meet local building codes. We are finding that having one accessible shower in the house, preferably on the main floor, is a desirable feature when you go to sell.

4. Walk-in tubs. This is a specially designed tub with a door in it. You can open the door, walk in, and water tight seals keep water from leaking out. While the tubs are deeper than normal tubs, most people will still have problems getting their shoulders under the water. But if you like to bath, or if you could benefit from hydrotherapy, these can be great solutions. Drawbacks are that you may need to upgrade your hot water heater, and you need to be away of one important issue with the swing of the doors. Most of these tubs are built with door that swings into the tub--in part so that the pressure of the water holds the seal tight. However, if your should faint or pass out in the tub, someone coming to your aide would be unable to open the door, at least until the water drains out and maybe not at all because your body would block it. Out-swing doors, while less common, avoid this problem.

5. Integral shower floor. Maybe you have seen this in a hotel room, high end residence or magazine picture. In this solution, the shower drain is built right into the floor, so there is no barrier at all to entering the shower. In a remodel situation, this requires modification to the floor joists and is overall the most expensive solution since you typically will be replacing the entire bathroom interior. If you can afford it, it is the way to create an elegant, accessible bathing space that will truly add value to the home. The picture shows such a shower--this one happens to be shared between two separate bathrooms. It's hard to say which will actually cost more, this or the walk in tub. It will depend on the choice of tub, fixtures, finishes and the amount of structural changes required.

Remember that when trying to create an accessible bath, it is best not to try to squeeze it into too small a space.

So, which do you choose? Factors to consider are:

1. Your ability to pay. Let's be honest that many people cannot afford a major remodel and will need to make do with the lowest cost solution possible. If you are in this category, you should explore getting public funds--however they are limited and in our experience the approval process can take months, even a year or more.

2. How much longer you plan to be in the home. If you are not "fixing to stay" then temporary solutions are the best option. If you are planning to stay for 5 years or longer, a permanent solution with resale value makes more sense.

3. Your abilities today and your expectations for tomorrow. If you already cannot lift your legs over the tub wall, the temporary solutions are not much help. By planning ahead and creating an environment that meets your personal vision with an eye toward what you might need in the future, you will be better off.

4. The value of your home. There may not be much financial benefit to putting in a high end accessible shower in a home that just doesn't have the street value. On the other hand, if it is an amenity that helps you preserve your independence and feel good about your surroundings, then there are other measures of value. Think through how much you need or want this to pay off in increased home value vs. treating it as an expense you are willing to incur to feel good.

Age, health and preparing for caregiving

Over the past couple of weeks there has been a lot written about the Health and Retirement study (discussed in this Washington Post article that indicated the maturing Americans may be less healthy than their predecessors as they approach retirement. This study of early Boomers reported more complaints of mobility issues such as trouble climbing stairs and failing joints as well as increase obesity and often related conditions like diabetes and heart problems. There are a lot of reasons why this may be occurring--living longer, more sedentary lifestyles, more stress and so on. I also think it supports one of the common views about boomers that they are less stoic and more focused on "me" than other generations, so the awareness and willingness to address physical concerns may simply be increasing.

But I find this information a greater cause for concern when coupled with another study showing a lack of preparation for and by caregivers. The opening paragraph of the news release says it pretty succinctly:

"Women expect to care for their aging parents and are willing to take on the responsibility, but few take steps to plan for it. A survey for Securian Financial Group, Inc. by Gestalt Inc., shows 84 percent of the women surveyed with a parent who had received care indicated no plans were made until care was needed."

The article goes on to cite limited financial resources as a compounding problem that will prevent care homes from being a viable resource for many and require that families and primarily women provide care in their own home (the study was funded by a financial services company, but the concern is valid.) Taken together, the two studies shine a light on just how important it is for people to start envisioning the type of home environment that will work for them in the future, whether providing care for a loved on or receiving care themselves.

Even though In Your Home assists seniors every day, we still find it rare to get the call from someone who is truly planning ahead. A review of our new customer inquiries from the past week or two show people calling with urgent needs because of an injury to themselves, a spouse or a parent. Off hand, I can think of one new client in the past month who has has obviously been modifying her home with the intent of making her caregiving for her mom easier and because, as she says, "this is where I'll spend my last years too." We've had more calls about new kitchen counters than we have about making smart modifications. Not that I'm complaining, the beauty, comfort and resale value of a space is always part of the equation with ability appropriate design. But it shows how far we are from being smarter about this whole aging journey, and if we are going to be the caregivers, if our wives and daughters are going to take on this role, then the sooner we think about how to make the home a better environment, the better off we all will be.

Aging in place—good for the earth?

I opened up the Sunday paper today to a Home Depot ad listing 20 some things you could buy to be more environmentally responsible. Now, put aside for a moment the irony of encouraging consumerism in order to be environmentally responsible and turning Earth Day into just another shopping holiday. Many of the items, such as compact fluorescent light bulbs, are the sort of things that you are going to be buying anyway—going without lights is hardly a viable environmental strategy. So that ad got me thinking about how aging in place may or may not be sound, ecologically speaking.

One could argue that by keeping people in their homes, we are heating and lighting larger spaces than might be necessary and that we’ll have to create senior-focused transit options that will require more fuel, and so on with similar arguments to suggest that aging in place might be the best thing for mom but not for Mother Earth.

However, I think of that old maxim “reduce, reuse recycle.” To me, it fits well with aging in place. Rather than building new housing, we reuse the existing housing, reducing the consumption of natural resources and recycling our existing housing stock. Since many older homes tend to be smaller than the current 2400 square foot standard that older housing stock can be wisely modified and reused to the benefit of our older citizens and our communities.

And, keeping our seniors in mixed communities means we can share (recycle?) their experience and talents with younger generations more easily.

I believe that many of the best solutions for aging-in-place are also good for the earth. That compact fluorescent light bulb uses less energy and last 10 times as long, meaning seniors not only reduce their electrical expenses but also avoid getting up on stools and ladders to change bulbs as often. Similarly, when installing new appliances or heating systems for safety and comfort the homeowner will likely find that the new versions are much more energy efficient as well. Showers are not only more accessible, they use less water, another double benefit. The same can be said of lower maintenance landscaping.

I suspect that as we go further down this path, we will find more and more synergies between environmental stewardship and creating healthy, safe and comfortable homes and communities for our aging population. Especially if we remodelers strive to be as green as we can.

A good post about sensitivity to universal design

I read this post on another blog today and thought I'd link and comment here. The posting can be found at http://house.seniorwomen.com/?p=25

Some key things I noted:

• The author's post underscores that the issues of accessibility are important not only for people with permanent disabilities but also for temporary impairments--an accessible house is flexible and wise for a wide variety of people at different stages in their life.
• I like the comment that automatic "touchless" faucets are smart not only for seniors but good to keep the grand kids from leaving the faucet running. Underscores that many of the things we think of as "handicap" are much more universally helpful.
• The author's acknowledgement of Iraq war veterans is another (sobering) reminder that the needs for accessibility and universal design are widespread and varied.
• I particularly like the experiential design element where she toured the framed-out home in a borrowed wheelchair, uncovering issues that would prevent or complicate future use of a wheelchair. No one likes to change the framing, but better to change it then than after the home is finished. Seniors who are purchasing a new home for retirement could benefit from doing the same and then making the necessary modifications before moving in.

Trouble in Snowbird country.

So, I’m down in Palm Desert with my family for Spring Break. We’re renting a very nice condo in a very nice community where the typical income and age of the homeowners are well above average. It’s snowbird country for sure. Driving around the neighborhoods you see some of the advantages of desert living—minimal yardwork, lots of homes with accessible front entrances and no stairs, the ability to drive your golf cart to the store. Why then, are the bathrooms so atrocious?

This condo has two beds/two baths. Ideal for empty nesters who might want their kids or friends to come visit. But both bathrooms have:

• Fixed shower nozzles that are mounted about 5 1/2 feet high—requiring an over 6 foot person like myself to do back bends or contortions to get my head under the shower. (Okay, I’ll admit that this is a pet peeve of mine and puts me in a dark mood about the bathroom altogether.)
  
• Tubs that have to be stepped into for a shower but are hardly big enough for a bath.
  
• Push/pull knob style shower valves that require tons of finger strength to turn them on and a great deal of dexterity and persistence to get them to a comfortable setting.
  
• No grab bars—though I can see from the caulked holes in the shower tile there once were some. Looks like they were installed with plastic anchors.
  
• Sliding glass shower doors that further make it difficult to climb into or out of the tub.
  

There are other things I'm not fond of, like having to walk through the master bedroom closet area to get to the bath or having toilets tucked into alcoves. Even without the fact the doors conflict and bang in to each other, these designs just complicate accessibility. But that's not the big issue--a bathroom serves two primarily purpose and design like this makes one of them difficult for many people.

The bathroom actually has some good features—like a place to sit at the counter and natural lighting over the tub. Someone was thinking about livability when they put in those touches. All the more amazing then to see such poor design in homes that are ostensibly built with senior residents in mind—and which are used as rentals where a wide variety of people with differing abilities will visit.

There is little that universal about this design, other than universally bad. Lots and lots of progress to be made in this regard, even down here in Snowbird country.

And I’d like to have a choice word or two with the contractor who saved 50 cents worth of pipe on the supply to the shower nozzle.

The emotional benefits of home modifications

Something people often wonder is “are home modifications effective.” This is usually asked in the context of do they help stop people from falling. But I sat in on a presentation at the recent ASA/NCOA joint conference in Chicago and it reminded me of the wider benefits that home mods can have. The presentation was based on a study focused on the value of home mods in helping people who are aging with a disability to stay in community. But a lot of the findings addressed the emotional benefits of home modifications. In a nutshell, their research showed that modifications helped the homeowners feel more freedom and empowerment—they got out and did more on their own time schedules than those people who had not had needed modifications.

Particularly memorable was the power of bathing independence, which we see regularly in our business. Study participants who could sit in an accessible shower and “let the water wash over me” noted its restorative powers—they not only felt better about their hygiene, but since showering was easier, they actually had more energy to get out and do things. Our clients tell us the same thing all the time—rather than a struggle or an event fraught with worry, an accessible shower or walk-in tub makes bathing comfortable and enjoyable again. It just makes you feel good all over. The researchers noted that other modifications can have a similar effect.

The research was conducted by Andrea Gossett and Joy Hammel from the University of Illinois at Chicago.

Practical mods—what makes them practical?

Last time we rambled on about some types of modifications that can be practical. But when in the course of one’s life does it make the most sense to worry about such things? In some research we did, nearly half of a 55+ sample didn’t disagree that retirement housing is something we don’t have to think about until much later. That’s why we commonly see the need appearing at specific, individual life events.

Life events are easier seen in others than in ourselves. We see the need to make things easier for children—our, or our grandkids. We see the need when someone else struggles to make do. But we tend to miss the need when it is ourselves—maybe we are too focused on our own emotional response to our changes. But life events—positive and negative—should be the natural triggers. Here are a few life events that should cause us to pause and think about our “built environment”:

• Buying your retirement home. So many times, we’ve hear of someone who bought, built or remodeled the home they plan to live in for their retirement and they gave not a thought to accessibility, caregiving. No planning to put a grab in the shower or even considering if they could easily get out of that deep jetted tub or off the lowboy toilet they liked. Buying a home for your empty nester years and beyond is the time to ensure you have the basic provisions for the future. And, if the home does not have the basics, get them before you move in. Later, it will be a heck of a disruption to your life to retrofit them.

• Early warning signs. Unfortunately, some of the most enlightened people we deal with are those who have assisted a loved one through a disability or degenerative condition. Being a caregiver can be a wake-up call that helps them to see that one’s home does not need to be such an unforgiving environment (the fifth principle of universal design is Tolerance for Error, which should be expanded to cover the “I wish I had thought this through before” type of error.) When you first get word that you have some issues, that is the time to modify so that your world is as forgiving as possible for as long as you have the ability to enjoy it.

• Time for you. What is wrong with having what you want? A home you enjoy and can be proud of rather than curse and be frustrated with? As you look to spend more and more time in your home—or maybe a second home—you should look at what you want to do to make it yours. And while you consider the aesthetics, think of your future and what will make this home a haven for as long as you want it to be one. If you are smart, beauty and future function will merge wonderfully.

Often, it also just makes more financial—as well as emotional—sense to maintain and modify your home. Sounds like a good topic for next time.

Proactive or practical?

So, in the last entry we broached the topic of “what is practical” when it comes to home modifications for aging in place. Is “practical” creating an aging-in-place showplace that covers every contingency you might experience? We’d say that’s a demonstration home for ideas and technology, not a real life home for everyday people. Even when we created our two project homes here in Portland, we did not try to cover every possibility and contingency. Instead, we tried to ensure that the basics were covered, which we see including:

• Good provisions for accessibility. We like the “visitable” rule that says someone in a power or wheel chair can get in to the front door, in to a bath, and through the kitchen. This will cover anyone who has friends who become dependent on a set of personal wheels, or themselves if they temporarily are in a wheelchair. That’s something that will happen to most of us if we live long enough.

• Well thought out lighting. Most homes were built a) with mostly just switched plugs, which is economical b) with a single domed light fixture in the middle of each room or c) before electricity. Modern lighting designs apply to only a fraction of the available housing stock and mostly at the high end. Scene lighting is an excellent concept that we advocate if you can afford it, but most people benefit from some simple retrofits that include lighted switches, pathway lighting, task lighting and more indirect/reflective light. Oh, and don’t forget making the most of natural light where you can.

• Reduction of effort. Eventually, even Jack LaLanne has lost some of his vigor (but what an inspiration he still is, eh?) For most of us, it happens long before—few of us will tow 70 people in 70 rowboats to celebrate our 70th birthday even without the shackles. Making it easier to reach, to get things stored down low, to go up and down stairs, even to open the windows can make life at home a bit more enjoyable and safer. Admire Jack, but be realistic about yourself.

• Smarter bathrooms. We still say that the shower grab bar will be like the seat belt. In the early 60’s, they were an option. Now, try buying a car without them, much less ignoring those “click it or ticket” rules. Every shower should have well designed grabs for getting into and out of the shower—or for hanging on as we wash the bottoms of our feet. Think grabs are a sign of being an invalid? Just watch some 6 or 9 year olds—they’ll grab ‘em without care. As time goes by, more people will accept them as natural--even if they are just the plan jane stainless, public restroom type. But you should see the beautiful ones you can get these days. Of course, grabs are just the start--walk-in tubs, barrier free showers, doors wider than 28 inches, etc all contribute to having a bathroom that serves you well for a long time.

Oh, there’s more. Lot’s of simple things that can be done around the home to just make life a bit easier and to help preserve your independence. But how to decide what’s really needed? What’s practical?

Next time, we’ll talk about when (which situations) make it practical to be proactive.

Will boomers be more proactive about home mods?

I was chatting with an old friend yesterday and we got on to the topic of a long planned addition to his home. Among the several reasons he was questioning the wisdom of the expense was that part of his goal was to build an accessible bathroom. Being hale and hearty today, they may not need such a bath for many years, if ever. This got me thinking about the whole “Boomer revolution” as it applies to home modifications.

One of the conventional bits of wisdom about the home modifications is that the Baby Boomers will get more proactive and be more willing to make (demand?) changes to their environment. But how do we know this will occur? Will we really take a different path than our parents or will we struggle to retain youthful ways and delay addressing practical realities? It's hard to say what the effect of growing older will be on boomers, but we can be sure there will be conflicting forces. Sure, Boomers has a group are seen to have been less stoic and more focused on "self actualization." But prior generations have been just as concerned about maintaining their independence and being in control of their destiny. The problem is, as we age, too many of us lose some of the motivation and give up at the realization that our destiny is never fully in our control. Even if we avoid a crippling condition like ALS or Alzheimer's, we are going to age and it will affect our abilities. But are any of us going to be more receptive to kids harping "Dad, you shouldn't be climbing that ladder”? I suspect this is less an issue between generational classifications and more a reflection of individual personality and family dynamics.

Its probably a good bet that many boomers will fall victim to the same patterns--postponing making hard choices for too long, just like their parents did. Oh sure, modifications will be a lot more commonplace, just because a lot more of us aging into our 70's, 80's and 90's will create the demand. This demographic swell will create one big difference from today--more and more homes will have had the necessary modifications. Once that happens, the idea of adapting the home environment to our needs will be more commonplace and will swell demand further. And since more of us will have helped our parents make these decisions, it should be more natural to consider getting support to keep the home maintained and to make modifications--when we get to “that point.” But these changes are not because of an inherent difference in the Boomer mindset. It will be interesting to watch will be if boomers are really any more proactive in this regard than their parents.