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.