The importance of mindset

I'd like to thank Tim, a PT in Northern CA for catching my colleague Brian on a very valid issue of proper mindset.  A while back Brian was interviewed for a video segment on aging-in-place. You can see the video at the link. As Tim said, some good information.
 

http://www.seniorhometours.com/Portland-Oregon-Your-Retirement-Connection-Video-of-Aging-In-Place-Interview-and-Living-with-Family-Discussion.html

But Tim makes a great point, to wit "I could not help but to cringe on the 3 occasions when the term "wheelchair bound" was used.  As you know, a wheelchair allows for independence and therefore does the exact opposite of 'bind'."  Tim's exactly right.  While I'm sure there are some people who, once fully ambulatory, now feel "bound" to their chair, in reality it is their chair that enables them to get out and about in the world, it is only binding from the perspective of what was, not what will or can be. Mobility is key to our wellbeing. 

His comment made me think of some wheelchair racers who passed me by while I was running a 10K some years ago. While they were moving too fast for me to ask, if I should have had the inclination to do so, I doubt that they were feeling tethered.

It also made me think of what can truly bind the wheelchair user--ineffective access.  While instances of barriers and poor design are rampant in our cities, many chair users can more effectively navigate in much of the public world than in their own home.  And our public policies don't help much there. A few years ago we were called to urgently build a ramp for a couple.  The husband needed twice a week kidney dialysis and had recently lost his ability to walk. Medicaid provided the wheelchair and the transportation, but would make no accommodation for getting him in and out of the home.  And this was not a couple of small steps that could be bumped down. Like providing a car but no key and no way to open the garage door.  Their frustration (and fear of what would happen if they could not get a solution) was palpable.

Assistive devices and modifications go hand in hand as things that cut the ties that bind us and make our lives easier.  But we need to have the proper mindset of what they bring to our lives when built or used well, rather than thinking of them as symbols of loss.

Rethink suburban AIP

This article raises a topic that has been under consideration for some time--that the suburban environments our country has developed over the past 60 years are often poorly suited to aging-in-place largely do to their lack of services and resources within walking distance, something that forces continued reliance on the automobile and the potential for isolation.

I did some research awhile back for the engineering firm EDAW where we looked at urban areas as an environment for aging and the inherent advantages were clear--not only for walkability but for the vibrancy of the arts and entertainment scenes and access to continuing education. And it need not be a big city--modest college towns can be great locations for the same reason.  But some of these lessons could be applied to age-restricted communities--why do so few of them have a central village design that can house shops and services? 

I live in a close-in neighborhood but even then walking can be difficult because of lack of sidewalks and people driving way too fast on residential streets--the same concerns that keep families from letting their kids walk a few blocks to school. The more reasons we have to walk, and the safer it is, the healthier we all would be.  Hopefully a greater emphasis on creating those sorts of neighborhoods will go hand-in-hand with the aging population--another positive force our getting older might have on the country.

http://www.placemakers.com/2012/10/08/ready-for-the-geezer-glut-think-beyond-aging-in-place/

Universal design gaining ground but not yet accepted for everyone.

While I might challenge the assertion in this article that "Everyone realizes they are going to need an accessible home someday" I agree with the larger premise that universal design is becoming more commonplace.  I'm regularly seeing TV ads about getting rid of unused bathtubs in favor of more functional showers, using gutter covers to keep off ladders, the joy of getting a Hoverround, and so on.  You'd almost think these companies were running for office by the frequency of the ads. However, I also keep hearing plenty of denial.  A friend of our family recently bought a new home and is having the bathroom redone with a stylish barrier free shower--while my much older in-laws have a tough time understanding why she feels she needs it.

As the article states, more and more companies are offering UD products.  However, we still can detect the undercurrent in the article that UD is for folks with disabilities or the infirm.  The reality is, when well done, it is simply easier for everyone.  I think the real market movement will come from two fronts:

1. We will be led by those in need. Really well done UD implementations that are constructed for people with needs will prove how much more enjoyable a UD environment can be--and will show lasting value for all.

2. Nice bathrooms.  Modern, no threshold, "Euro-style" bathrooms are cleaner, more functional and great to look at.  It is in the bathroom that we are seeing a lot of innovation related to UD and acceptance of it.  As more people opt for these designs, I expect that will start to look for similar UD elements elsewhere in the home.

http://www.housingzone.com/universal-design-goes-mainstream-home-building

How could you carpet a home for $37?

Contractors have a reputation for questionable business practices and ethics, most of the result of a few disreputable small time operators. But for some time now, some of the big players in the remodeling industry have been using sales tactics that are as misleading as any fly-by-night roofer or siding salesman.

Home Depot is running ads saying that, on certain brands of carpet, you can get your entire home carpeted for $37. Now think about it that. The fine print says that it does not include the time it takes to move the furniture, pull up and dispose of old carpet, or install on stairs--so right there that $37 goes out the window. The installer is going to charge plenty for those items--but at least its relatively easy to see that these are not included.

But think about installing that carpet. In my state, the minimum wage is $8.40. When you figure employer costs on top of that, you would be lucky to get 4 hours of labor out of that $37. And do you want minimum wage labor installing your carpet?

Obviously the cost of installation is covered in the cost of the carpet--and possibly the charges for all those non-covered items. How else could it get paid for? Which means that you are paying more for the carpet than if the labor were priced separately.

At the end of the day, the total cost for carpet and installation may work out to be the same price as another carpet installer--but this type of advertising is misleading if not deceptive. It leads people to have unrealistic expectations as to what reputable, competent labor from a reliable company costs. And that does not do anyone in this industry a favor. Especially in the aging-in-place market where limited resources and fixed incomes require homeowners to do careful planning, creating unrealistic expectations is a bad idea.

The where's and whys of falls

We’ve been providing our free online home assessment for nearly 7 years now and about 500 people have taken it. I’m starting to look at some of the data for patterns—while it is not a scientific survey, we can still see some interesting things by looking at what people are experiencing.
One thing that we do is ask if they have fallen recently and if so, how often. We also ask them where they have fallen. I plugged these “where” responses into a word cloud—if you are not familiar with these, a word cloud simply counts the words and shows words that occur more commonly in a larger font size. The results are interesting and confirm much of what we know about falls:

• First, 43% of people completing the assessment reported falling, and that 43% reported an average of 5 falls in the past year—underscoring that once falls begin they can become relatively common due to chronic issues like poor balance, dizziness, vision problems or strength issues like “weak knees" or medical issues like a drop in blood pressure or "low blood sugar”

• Tripping over any variety of objects is another common issue—rugs, stools, garden hoses, even the family dog are all mentioned.

• Stairs or steps stand out as a key item related to falls—interestingly, when looking at the actual comments it is clear that this is much more commonly related to a single or short set of steps than a long stairway. We spend a lot of time worrying about staircases between floors but it is those hidden steps like sunken living rooms or entrance steps that appear to be the bigger culprit in falls--many who don't feel safe navigate long stairs probably simple avoid them--we've had a number of clients who have only lived on the ground floor of their house and avoided the upstairs or basement.

• It's no surprise that the bathroom comes out as the most common location for a fall followed by the bedroom—where people report falling getting out of or around the bed. Ensuring that we have adequate support around the bed and taking our time here is and important but often overlooked area for home mods--my own mother fell getting our of bed and broke her pelvis, starting her long spiral of decline.

• The kitchen is also a common place to fall—often because we are leaning or bending over and lose balance. Better cabinet design and retrofit pull-out shelving can help.

• Living rooms/Dens are also common mentions. Some of this may simply be becuase these are rooms where we spend time--reading, watching TV, visiting. Steps, tripping hazards, loss of balance are all mentioned--the only pattern appears to be that these are rooms where we spend time, and so are going to get their share of falls.

• Falls are hardly limited to the interior of the home. Sidewalks and outdoor garden areas come up regularly (look for the words individually). Tripping over objects or uneven surfaces appears to be quite common—reinforcing the need to ensure that pathways are smooth and continuous.

I’ll be sharing more insights from our assessment tool over the coming months.