More focus on well done but affordable solutions. please.

This article at Silver Planet is from awhile back (a post I never got around to finishing) but seems as pertinent now as last year. It does a good job of conveying one of my common themes--that our approach to aging is about one's lifestyle, not just about adapting to decline. The subject, Cynthia Leibrock, is a noted author and had large feature article in the New York Times that I also intended to blog on but did not get around to, so this is a second chance. The NYT piece is the better article in my view for its message about remodeling for aging. Cynthia and I have only communicated via email a few times, so I really don't have a sense of her personality as portrayed in the Times' article. What i know is that she HAS contributed some great viewpoints about appropriate home environments. BUT, what irritates me about the Times article in particular it this: it is easy to create an aging-in-place showcase when you have a $600,000 budget. That's great, lovely, I'm sure it fits her lifestyle well and the future buyer of a home like that can afford to rip out whatever they don't like and install what they do like.



The bigger challenge, in my mind, is one that our company deals with every day. How to make a good aging-in-place environment when your budget is 5% if that amount, much less the 1% that is a typical number for many of our customers.



Aging wisely (aging beautifully, as Cynthia puts it) needs its cheerleaders, for sure. But it also needs its guys who are good with a hammer and able to knock out nice, functional, value-oriented solutions. I see the same thing when the local paper profiles an AIP remodel--it's always higher end, seldom (never?) about lower cost, practical solutions.

Cynthia makes a related point on her website when she discusses volunteering as a way to provide solutions for the less well off. But volunteerism will not solve the problem. I got a similar response from Senator Ron Wyden when I asked why Medicaid/Medicare will provide a wheelchair but do nothing to ensure the person can get past the 5 step entrance to their home. He gave a dodging, "it takes a community" type answer. Not that I necessarily want the government to take on yet another role, but as a country we need to treat these issues more rationally and creatively. Providing one solution without the other is an example of waste.

We need more attention on mainstream solutions, please--and I don't mean recycling those same old CDC checklists with a few new items. We are seeing the business community come to the plate with more and better solutions for things like barrier free shower systems. But we need to move to affordable, holistic solutions that cover both public and private resources.

Here are links to the articles mentioned above.



http://www.silverplanet.com/health/healthy-living/redesigning-homes-eye-future/54770



http://www.nytimes.com/2009/02/19/garden/19colorado.html



http://agingbeautifully.org/1024x768.html

Google Nexus and Apple iPhone—assistive tech?

I was following the hoopla about the new Google Nexus phone and happened to notice the image on the Google site—this phone’s user appears to be “helping Grandpa get his tech on.” (It's down next to the weather icon.) It got me thinking, are these new generations of phones particular well suited to the aging among us? Could Google even be targeting the new phone for such users?



ElderGadget (http://www.eldergadget.com/) has posted several related articles on Elder Friendly iPhone and iTouch apps. I like what I see in that most of the applications are not things designed just for “old people” but rather are apps intended to be mainstream but with particular application or pertinence for seniors. Brain Games, for example, are stimulation exercises that can benefit anyone, but brain stimulation does have particular merit for seniors. While the original post fell into the trap of focusing primarily on health and emergency related apps, later posts have branched out to include apps for relaxation and mood lifting.

But, don’t I really have to be an iPhone user before I would experience these apps and find them useful? I’m not sure that many seniors would adopt the iPhone form factor in order to get the apps. The would adopt the iPhone for the same reasons people of any age will—because it is fun, interesting, engaging, well marketed and “cool.” But if there is anything about the iPhone, Nexus or their emerging ilk that does anything inherently to be more age appropriate and “help grandpa get his tech on” is that they have larger screens and single touch, icon driven operation rather than the small keypads and screens of more traditional cell phone offerings. It’s the basic design that provides the real benefit.

The Wii has generated widespread adoption in senior communities because the interface and opened up a whole world of virtual activities that seniors can easily adopt. I’m not sure that the touch screen interface of the newest phones has married to the software to the same degree.

Differences, and similarities, between aging and gardening;

It is late-summer, almost the end of August. There is much in my garden that is vibrant—those rose bushes that have decided to put on a dramatic show this year, the bee balm in full flower and drawing hummers from every corner. The Kentucky Runners dangling their tender bean pods. But as I walk around my garden I see everything that has already bloomed. While there is so much good weather left to experience—here in Portland we can expect the pleasant weather to last well into October-- so much has passed, not to come again this year.

As with almost everything, I see an allegory to our clientele at In Your Home. So many people we work for have much good time left despite the fact that so much of bloom of their life has faded. The difference is that when I look at the spent blooms of my garden, I naturally think about next year. What do I want to move or propagate to extend the blooming season? What do I want to give something better conditions so it can really flower. Where are there holes to fill in the border or overcrowded beds to thin. There always another chance that another spring and summer provides.

But we humans aren’t a garden. We talk about the seasons of our life, but as I see it we are not a plant, but ourselves a garden that has one long “growing season.” Just like the garden in spring is different than the garden in late summer, if we live well, we can flower repeatedly with different blooms fitting each of our stages in life. Yet in the end, if we are honest, we know we have but one season that slips away toward that cold winter soil.

So, how do we provide the conditions that will make these lifelong season one that is as nurturing and fertile as possible? As always, I find, the garden has some inspirations:

• Don’t be afraid to transplant. Uprooting and moving can be the right decision for many plants. We humans tend to be unique, enjoying changes in our environment at different times. We can fix up a house and sell it and move on to a new experience—aging in place need not mean being trapped in the same ol’ structure, it is aging independently and in community. As with a garden, certain times are better than others to transplant—leaving it too late or under the wrong conditions can mean your success is compromised.

• Tend and till. A home, like a garden, only prospers if tended. A light hand at tending, perhaps, but tending none-the-less. If we don’t take care of our home, it will be eaten by mold, nibbled at by destructive creatures, and generally lose its vibrancy due to lack of care.

• Acknowledge what does not work. Trying to get in and out of a tub shower has about as much likelihood of success as growing lavender in a bog. It may work for a few seasons if we work hard and catch good luck from the weather, but eventually the rot occurs. Better to plant (or build) what will work for the long term with minimum care.
  

If I think now about how I want my garden to be next year, I have a chance to make those changes and enjoy something better next year. Even if it does not work, the vibrancy of spring will mask my mistakes. But there is no spring vibrancy for us poor aging humans—so if I think now about how I want my own life to be, I can make the changes and start to appreciate them tomorrow. There is little point in waiting.

Survey targeting businesses serving the AIP market

Mark Hager at ageinplace.com is fielding a survey targeting business people who are focused on the AIP movement. Sponsored by SRES (Senior Real Estate Specialists). A number of us in the community provided input.

It you are such a business, please take a moment to complete the survey.

http://www.ageinplacepros.com/about/aging-in-place-projects/2009-aging-in-place-business-survey/

Ageism at The Open

Reading the press coverage of The (British) Open this morning after, the sports writers and pundits are showing the ugly head of ageism right and left. Their reports are rife with phase like “his tired old bones,” “his age finally showed,” and even “old geezer.” Never mind that other players of much younger ages have blown final round leads of greater margins with poorer play. Never mind that leading The Open, or any other major tournament, on all four days is a seldom achieved event. Never mind that a certain great player of the day never even made the cut. And never mind that there is a whole cadre of golfers Watson’s age who play professionally week in and week out. I’m sorry, but playing 22 holes of golf is not beyond a fit 59 year old’s ability, and especially not a great athlete like we saw this weekend.

Sure, there are not many times when a professional athlete past their thirties plays at the top of their sport. Certainly age catches up with us. But to say that the only reason that Tom Watson lost was because he is “old” just shows how far we have yet to go before we treat age fairly, practically and without bias. Nothing was a more insidious reflection of this than the two announcers saying that it was nice Cink had won because he is young, and that if Tom had won, it would not have changed his life. Meaning: he’s just a washed up old man with not much life left. Wasn't it nice he got out for a good walk.

Of course it would have changed his life. He would have been remembered for doing what no one else had done, to seal that image he thirsts for still—to be remember as a truly great golfer. Achievements change our lives every day until we die. To say they don’t knocks the legs out from anyone who tries to live the latter years of their life with dignity, grace and purpose.

Of course, the apologists trot out the adage “age is just a number” which is just as idiotic as saying that Watson lost because of his age. Age is much more than a number. It's a reality, baby. It is a reality that each of us chooses to handle in our own way. Some of us retire to an easy chair, adding to our girth and our medical problems. Some of us become demoralized and withdraw. And some of us choose to adapt and keep doing what we love to do, as best we can. Racings cars, gardening, climbing mountains, cooking, running companies, writing, travelling, etc. We retrofit our bodies and our homes and keep living as we want to.

Tom Watson has adapted. He has had joint replacement. He has stayed fit. He has adapted his game and the courses he plays—links style golf suits him well, whereas by his own admission he hates the Masters because the course does not suit his game and he feels like an honorary golfer rather than a contender.

Adaptation is the key to aging well and Tom Watson has given us a rare glimpse into how it can work. He played extremely well for someone of any age. I won’t say that what Watson did was a great thing and he should feel good about it even though he lost. Sure, it was a great thing, no doubt. But losing is going to, in his words, tear at his gut. To say that he should be proud anyway is patronizing and ageist. I like Jack Nicklaus’s explanation that it wasn't age or being tired,but that missing the putt on 18, missing the chance to seize the Claret Jug then and there, very likely took the wind out of his sales and he didn’t recover from that. It’s the same thing that happens to many people in all sorts of situations and all walks of life. But it is part of choosing to live a rich life. Age does not defeat us as much as not caring, not engaging, and also not being realistic does.

And to say that he lost because of his age is not only a great disservice to Tom, it is a disservice to Stewart Cink, who won not because Tom is “old”, but because Cink fought back, gave himself a chance, and had the drive to treat Tom as an equal and a bona fide contender and do what he needed to slam the door on Watson’s chances to take another title. While I’m sure some thoughts about Tom’s stature and age crossed his mind, Cink was one person on the course who was not looking through the lens of ageism—he just competed. Any class of people who are not treated as equal suffers, and that applies to those who have a few years on the rest of us as well as anyone.

Cink’s competitiveness underscores the point that Watson has done a better job than most of adapting and staying fit and keeping motivated by what he loves. The more we all deal with our age in a manner that reflects Watson’s drive and spirit, the better off we all will be. Our company helps people every day who are doing the same in much smaller and less public ways, and it is a joy to see.

Ageism endeavors to make us less than we are. The sooner we see the back side of it, the better. How widespread it was this weekend was a sad state of affairs.

What lesson will they learn?

As we boomers age and take first hand seats watching how our older friends and our parents handle the journey, I wonder what lessons we will really learn. Many times, we have customers who call us out to discuss a plan for an aging or disabled relative, only to have the person’s condition worsen before anything can be done. Often, the loved one passes away. In some cases they have spent years dealing with frailty and diminished ability, with an environment that creates stress or unhappiness, but when they finally decide to take action, it is too late. In the current economy, this is happening more and more.

In just the past month, we numerous examples—a family that made some urgent modifications and bought a portable ramp that never got out of the box because their loved one died. A family who wanted to make home better for their father who was in their 80’s—he passed away just before we were to visit the home. He was surrounded by his grandchildren and passed quietly in his sleep—isn’t that how we would all like to go.

One lesson, the one I would like to see, is that we need to be proactive in order for adaptations to our homes to provide value. But I’m sure many others will see a lesson of “why bother.” Perhaps this will be resignation that the latter stages of our life will be short and not worth taking precautions for. And that will be true for some. But for many more, life could be safer and more gratifying if we plan ahead. Not just for things like walk in showers or masters on the main, but for basic requirements for sound roof, durable flooring and efficient HVAC.

As a generation, which will be the lesson we most often learn—act, wait or not bother at all?

Aging in place is green.

I came across an article yesterday that does a good job of covering a topic we've touched on here before--that aging in place is by definition a green approach to housing. There is so much stored energy in a home that you can never be greener by building something smaller, even if you downsize and use new technologies, so we shold be planning, designing and retrofitting our current homes to accomodate long life spans and a range of life situations. This article profiles Palo Alto architect Jon Stoumen. What I like most is many of the simple, lo tech, low cost design elements--like grape vines as heat reducing sun shades. And his philosophy about going green perfectly reflects our philosophy about aging in place--do what makes sense now, but plan for the future.

"We're going for universal access, so we've laid the groundwork for the elevator, but the clients won't need it for a long time. When they do need help getting up to the second floor, they'll be able to put the elevator in because we've planned for it with the infrastructure. It's one of the things about this house that will allow the owners to age in place. And I can't think of anything greener than aging in place. When you move, you throw a bunch of stuff away, new people move in and they remodel everything and throw a bunch more stuff away," Stoumen said. For that reason, the ground floor of the home is at grade. In the future, wheelchair access will not be a problem.

The model of planning for the elevator also follows Stoumen's idea that taking small steps toward greener living is a healthy way to think about environmental improvements. "People see all that you can do to make a home greener, and they think, 'I want it all now.' But not everyone can afford to do it all now. I think it's better to do what you can now and plan for the future," Stoumen said."

Read the complete article at :

http://www.paloaltoonline.com/news/show_story.php?id=8459

Lifespan of modifications--its not kid stuff

Because of In Your Home's consistently high ratings on Angie's List, we are getting a lot of calls from folks from outside our specialty--growing families who are looking to modify their home to accommodate the kids. Adding extra space, adding or updating a bathroom, removing hazardous conditions. Lots of similarity to what we do for our target population and we do often take these projects on. After all, business is business. But while we have long questioned why families are willing to modify for children and not for adults, a new thought struck. Comparatively, how long can we expect these modifications to be useful?

If we modify a room for a nursery, it's appropriate for five to 10 years, depending on how many children we have and at what intervals. By the time we get around to adding a separate bedroom or bathroom, maybe we get 15 years of active use. Same for a playroom.

But what if we are in our late 50's, our 60's or 70's and looking to modify the home for the long term? That playroom converted to an adult entertainment area, hobby or exercise space could easily serve us for over 20 years. A bathroom modified to be safer and supportive for adults will easily get 10 to 20 years of useful life. And, not only will these mods add value to the home (if done attractively and well,) but they have a higher payback since they can help us stay more independent and healthy so we can avoid the expense of assisted living and long or short term nursing care. And we can enjoy them so much--most people do tend to spend more time in their homes as they age, so its all the more important that the home environment be attractive and supportive for maintaining the activities we love--hobbies, cooking, gardening, etc. The earlier we do it, but more we will benefit from it.

You could easily say that you will get as many or more useful years from aging-in-place modifications, which indicates a better financial justification. Of course, we don't remodel for our young families just because of financial payback--we do it because we want things to be the best they can be during that phase of our lives. But many of us have this dismal thought that we are getting old and aren't worth investing in. Or it's that old refusal to acknowledge that while we feel 40 we are past 60 and need to think ahead. If we get past those thoughts, then the value of adding a shop, changing a floor plan or modifying a bathroom can make things the best the can be at these new phases of life. That makes a lot of sense--financially and otherwise.

Dates set for 2008 Aging In Place week

WASHINGTON, D.C. (February 25, 2008) – The National Aging Aging in Place Council announced the Fifth Annual Aging in Place Week, from October 13 to October 19, 2008. Building on the success of last year, where over 100 educational activities were organized throughout the country, this year is expected to garner even greater local support and attention.

http://guidetoretirementliving.com/wordpress/?p=1163

We've watched these events get more and more popular, it will be interesting to see the scope of this year's event--hopefully the trend of public and private sector participation will continue.

Aging-in-Place is about designing for dreams not just disability

I bumped into a former work colleague the other day and we got to talking about career choices in later life. This sparked one of my pet issues—that when we think about aging-in-place modifications, too often we only think about infirmity and disability rather than creating spaces that support us in broader, more fulfilling ways. Michael and his wife Eve recently decided that her long standing passion for painting and sketching should be a business as well. But to accommodate this, they needed to make a few changes around the home.

When they first moved across the country to Oregon, they downsized from a 4000 square foot converted barn to a 1500 square foot efficiency home, a common pattern for empty nesters. But the size reduction was a little too severe and when they decided to launch the new business, they had to look for some additional space. They found a new home that met their needs fairly well:

• There is a large loft that serves as the studio and instruction area. Being above the level of the rest of the home gives them a sense of privacy. The business and the home feel distinct.

• While the home is not large, it does have three bathrooms, one of which is easily accessed by students from the loft area and further supports the sense that the business is a separate entity.

• They did make some modifications to the home—adding skylights to the loft area, which not only provide natural lighting for the studio but can be opened to let warm air out at night during the summers. They replaced the flooring with a high grade of linoleum for ease of cleaning in the studio environment, and they added storage to make access to art supplies easy. This sort of customized storage is something we do for many customers, providing easier access to everything from hobby materials to medical supplies to kitchen pots and pans.

• Storage was also added to the garage for more efficient use of space—while the new home is larger than their last, it’s still smaller than their old converted barn and they had materials that they did not need to have quick access to that could be stored in the garage.

Throughout this process they’ve made conscious choices about their environment. They are working very hard to stay fit and don’t expect that the stairs will present a major obstacle in the future. But if they do it’s a single straight flight, unlike the three flights of stairs in the old home. They’ve considered low maintenance and flexibility in the design of the space. They had to make some trade-offs—they’d like one more large room for living space away from the loft and the master bath has a "useless two person tub.” But overall the new home environment is well suited to this new phase in their life. This is what good aging-in-place design is really all about in my opinion.

And if you happen to be interested in Eve’s business, check it out at http://www.evekenyonsartdept.com/

Helping Boomers plan and adapt

The Boomer Advisor just published the first in a series of articles we've written on how to adapt the home. The targeted readers here arethe boomers who are more typically going to be concerned about these issues for a parent or grandparent. But, as the article notes some of us boomers have started experiencing the need already or will soon.

In the article we take the design of a typical modern bathroom and point out a variety of issues and tips for better design.

Read the full article at the Boomer Advisor and let us know what you think.

http://www.advisor.com/boomer/story/remodeling-safety-bathroom?page=0%2C0

When it comes to assistive technology, expect convenenience and benefit to win out.

At the National Aging In Place Council (NAIPC) regional meeting in Denver this week I heard Nathan Colburn of Accessible Solutions in Denver give a good discussion of assistive technology. Like us, Nathan feels that increasingly many needs can be met by technology rather than remodeling. But until the worst happens, and sometimes after, there are few people who will proactive seek out assistive technology.

The catch is that if you think about it, we all use “assistive technology” everyday. What about the television remote control? While it may not always be the easiest thing to master, there are not many people these days who get up and change the channels manually. (When I was a kid, kids were the assistive technology—I can still hear mom directing me to get up and change the channel for her. Young knees and all that.)

Another great example, the garage door opener—everyone in the audience who had a garage also had an automatic opener. Even simple things like eyeglasses and cell phones can be categorized as assistive technology. How about artificial joints? And all of them met with resistance and had their share of new technology issues, but we eventually embraced them because of the obvious benefits they offer. Convenience, safety, status--you name it. As we begin to embrace assistive technology for aging, the “mature market” will increasing experience the benefits. And that will lead to more widespread acceptance which will yield benefits for all.

Another reason to like Hawaii

I'll admit, Hawaii is one of my favorite vacation spots and we are planning to get back there this winter. But in addition to great views, warm water and tropical breezes, I came across this bit of news from the Aloha state that makes me like it all the better. Govenor Linda Lingle has proposed several tax relief meassures, one of which definitely relates to what I talk about all the time:

Aging in Place Tax Credit

To make it easier and more practical for seniors to stay in their own homes or with their family, the Administration is proposing a refundable tax credit of up to 50 percent of the costs to modify a personal residence to accommodate an aging or disabled family member. Examples of qualifying expenditures include grab bars in a shower or bathtub, ramps or inclines, and larger doorways for wheelchairs. The maximum credit would be $2,500 for a single taxpayer or $5,000 for a married couple. The tax credits would save residents $8 million per year.


Can we look to other states to be forward looking in this area? Or at least play catch-up?

Link to Governor Lingle's proposal

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

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.

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.