In an article by DAASE Founding Professional Member Shelly Siegel, FASID, CAPS for Today's Wound Clinic Magazine, she makes the case for staying at home.

At the beginning of the 20th century—the average human lifespan was only 47 years—and people with chronic conditions lived in institutions. Obviously, people are living longer today. The average lifespan has increased to 76, largely due to healthier living, better medicine, and vaccines and sanitation that have virtually eliminated many deadly infectious diseases. Nearly 80% of the population now lives past the age of 65. By 2020, the Census Bureau estimates that 7 to 8 million people will be over age 85 and 214,000 will be over age 100.

These demographic changes result in a population that is older and with more disabling conditions than many realize and these trends continue. The limitations imposed by products and environments designed and built without regard to the needs and rights of all people are significant but often unrecognized.

It is a long known fact that the physical environment has an effect on the healing process, both positive and negative. Knowing this, it is important when releasing a patient to heal at home to consider the home as a component of the continuum of care.

Contrary to what was believed to be true by Winston Churchill, we must adapt our homes to our needs rather than us adapting to them. Promoting independence not only has psychological effects on a person’s self esteem, but allows them to safely move around their environment. Unfortunately, in the past, homes were not designed to accommodate illness, the normal processes of aging and changing abilities. 

Home Assessments

Home assessments can provide an abundance of information and when properly prepared can turn an unsafe, disabling environment into a healing home. Understanding the varied needs of individuals is the first step in completing a home assessment. A normally healthy patient healing from a wound interacts with their environment differently than an older, disabled client with several factors affecting them. To effectively evaluate needs, it is important to understand that a disability is a condition or function judged to be significantly impaired relative to the usual standard of an individual or group. The term is used to refer to individual functioning, and including physical impairment, sensory impairment, cognitive impairment, intellectual impairment, mental illness, and various types of chronic disease. “Disability” can be broken down into a number of broad sub-categories, which include the following:

• Mobility and physical impairments can be either in-born or an acquired with age problem. It could also be the effect of a disease. People who have a broken bone also fall into this category of disability.

• Vision disability affects hundreds of thousands of people suffering from minor to various serious visual impairments. These injuries can also result into some serious problems or diseases like blindness and ocular trauma, to name a few. Some of the common vision impairments include scratched cornea, scratches on the sclera, diabetes related eye conditions, dry eyes, and corneal graft.

• Hearing disabilities include people that are completely or partially deaf. Deafness can be evident at birth or occur later in life from several bio- logic causes: for example, Meningitis can damage the auditory nerve or the cochlea.

• Cognitive disabilities are the kind of impairments present in people who are suffering from dyslexia and various other learning difficulties and include speech disorders.

• Invisible disabilities are disabilities that are not immediately apparent to others. It is estimated that 10% of people in the U.S. have a medical condition considered a type of invisible disability.

Coupled with the special needs of the healing process, being able to fully function at home is as important as the medication prescribed. Familiar surroundings, family interaction, and the fostering of independence are believed to accelerate the healing process.    

Home Modification Solutions

•  1) Safety and accessibility are paramount in the home of a patient with chronic wounds. A clean, textured gently sloping pathway, which leads to and from the curb, makes maneuvering effortless for the patient, their caregivers, and all who visit. A well-lit, covered entrance will also welcome every- one, including the patient with the chronic wound, into the home.

•  2) All living spaces should be clear of clutter with adequate maneuvering space. Since falls are a concern, all furniture with sharp edges should be removed or protected to prevent injuries. A simple, easily installed corner protector, like those used to childproof a home, is a low cost solution to this challenge. Flooring should be stable, firmly attached and nonslip. All throw rugs should be removed. Because many patients with chronic wounds are unstable on their feet, they have a tendency to hold on to furniture or to use the wall as a balancing instrument.

Therefore, care should be given to assess the hazards. Artwork must be firmly attached or removed if the possibility exists that it might crash to the ground and cause a dangerous situation. Eliminate extension cords extended across empty spaces and never run cords under carpeting. Seating should be firm and not easily tipped over. Armchairs are preferred since they allow the individual to easily rise and get their balance. Lighting should be adequate and without glare. Window treatments should be easy to reach and adjust.

•  3) Kitchens present other dangers and should be carefully evaluated to minimize injury and to encourage good nutrition and socialization. As with all living spaces, flooring should be stable and throw rugs should be removed. Whenever possible, ranges should have controls on the front to prevent reaching over hot burners. Items used everyday should be in a convenient location to prevent any extra effort in reaching or stretching. A sturdy chair should be available to pre- vent fatigue. Chairs on rolling casters and lightweight pedestal tables should be avoided. 

Quality lighting over work surfaces is essential to prevent injuries or the use of an inappropriate product. One patient used a well-known pine scented cleaner instead of cooking oil because the bottles and color of the products were similar. For the sight- impaired individual, a contrasting band of color or a textured strip on the edge of counter tops will give a visual cue between surfaces.

• 4) Bathroom modifications can be more extensive and possibly the most expensive, but are the most  important in the home. The ability to function independently is so important to the healing process. The ideal bathroom would be large enough to accommodate a wheelchair, have a wheel-in shower stall, a comfort height toilet, and an opening under the vanity for grooming from a seated position.

When this is not financially or physically feasible, a few simple features can make the room more functional for short term healing. Improved bathroom safety and convenience can be achieved with the installation of a raised toilet seat designed to increase seat height and assist those with bending or sitting difficulties. These seats fit on top of the toilet bowl so care should be taken to assure that they are properly installed and maintained. A sturdy shower seat that allows easy transferring can turn the most in-accessible bathtub into a seated shower. 

Grab bars are a must and, again, should be properly installed to prevent them from being pulled out of the wall. Many a bathroom accident was caused by using a towel bar or toilet paper holder as a grab bar. Whether using these simple modifications or completely renovating the bathroom, it is important to periodically evaluate the work to be sure it is properly maintained and functioning as planned for the patient. 

• 5) Outdoor spaces should also be considered when sending your patient home to heal. There are numerous benefits for being out- doors among carefully planned landscaping. As with the entrance into the home, a clean, textured gently sloping pathway leading around the area should be well lit and provide study seating. Raised garden boxes can also provide a therapeutic activity that helps give a feeling of accomplishment.

• 6) A home interior can aid in promoting well-being and health. There are so many elements that individually or combined can have a positive effect on the healing process. The healthiest of homes are furnished with natural materials and have the proper mix of natural and artificial lighting. The colors chosen also have an impact on the occupants. Nerves can be calmed, appetite stimulated, or activity encouraged, all with the use of proper colors.

• 7) The first step in modifying the home of a patient with one or more chronic wounds is to con- duct the Home Assessment. Evaluating current conditions and removing hazards will begin the healing process of the home. Just as patients with chronic wounds should seek care from wound care professionals, families that need to modify their homes for family members with chronic wounds and/or other disabilities, should partner with a design professional who can do a more extensive needs evaluation and present a plan that will accommodate individuals today and beyond. 
    _________________________________________________________________________

Shelley Siegel, FASID, is founder and president of Universal Design & Education Network, the Healthcare and Continuing Education division of Siegel Design Group, Inc. Shelley holds a degree in Interior Design, is licensed by the State of Florida, and is NCIDQ qualified. Shelley also completed a Masters Degree in Gerontology at Nova South- eastern University.

For more information, you may contact the author at Shelley@UniversalDesignandEducation.net.

 

As boomers contemplate their future, many are making plans for their independence… staying in place of their own choosing.  In this article and interview with Consumer Reports, Michael Thomas shares his thoughts on the best ways to "age in place."  

CLICK HERE to read the interview. 

From a short video on PBS, this show showcases a fresh way of thinking about staying at home for as long as you like.

A new community model lets seniors enjoy all of the security and social amenities of a retirement community without leaving their homes. The alternative is called "aging in place." Ray Suarez reports on how this village concept may help seniors retain their independence into their golden years.

Here is the transcript from the PBS show...

RAY SUAREZ: Once a week, 82- year-old John Sears gets picked up at his Beacon Hill townhouse, and driven to a nearby grocery store. Sears looks forward to that weekly outing, and not just to replenish his pantry. His driver, Bob Spicer, works for Beacon Hill Village, a nonprofit membership organization which provides low-cost services to seniors who want to continue to live in their own homes.

JOHN SEARS:  They call all the time. A couple times a week, someone will call up and say, are you still there? And if so, why? And what can we do to help you?

RAY SUAREZ: The village offers transportation to doctors and grocery stores, and provides free exercise classes and lectures on current events. It organizes social clubs like the weekly Second Cup gathering at the Beacon Hill Bistro, where members discuss books, movies and, perhaps most importantly, politics. And there's a biweekly Terrific Tuesdays happy hour where women gather at a local restaurant to plan trips to concerts and art galleries.

In short, Beacon Hill Village offers all of the amenities of a retirement community, distributed, you might say, in the dense streets of an urban neighborhood. So getting old doesn't mean leaving a cherished life behind. Instead, a senior can age in place.

When people hear about the Beacon Hill Village concept, when they learn they don't have to leave their homes, they don't have to leave everything that's familiar to them, they want to know more. And they want it for themselves. There are now 110 such villages around the United States and nearly twice that many in development.

RAY SUAREZ: Twelve years ago, Susan McWhinney-Morse and her neighbors got together to devise a way to stay in their Boston neighborhood even as their needs changed, and increased with age.

SUSAN MCWHINNEY-MORSE, Beacon Hill Village: When we initially started Beacon Hill Village, there were 11 of us who got together one cold November day with this abstract determination that, we're not going anywhere.

But we wanted to be responsible by not going anywhere. We didn't want to have to depend upon our children, who might live across the country. So, after two years, we formed this organization that seemed to fit our needs. And it was at that point we understood, began to understand that maybe we had tapped into a whole movement.

RAY SUAREZ: Beacon Hill Village now has 400 members who pay an annual fee of about $100 to $1,000, depending on their financial circumstances.

The organization has just four full-time employees and a small office space. The Village depends on donations and the work of volunteers to survive. Many of the activities take place in borrowed community spaces. Members are charged additional fees for driving and social outings. And the Village negotiates reduced prices for members to receive medical care and home repair services when needed.

When we visited John Sears, he was getting a window screen replaced.

JOHN SEARS:  I have a bar for the shower and a bar for the tub that they put there and tiles fixed and bulbs inserted. Come downstairs, I have a computer. And they sent a teenager over to help get me back online. It's kind of wonderful that there are a bunch people who simply give a hoot about us old-timers around here, and that matters so much.

JOANNE COOPER: This little hut actually...

RAY SUAREZ: Is where you...

JOANNE COOPER: That's where we went down.

RAY SUAREZ: For years, Joanne Cooper, an active 78-year-old, didn't think she needed the Village because she was busy traveling. She showed me photos of her and her partner, Bill, on an archaeological dig in Israel three years ago. But Bill had a massive heart attack, and everything changed.

JOANNE COOPER: I knew that when he came home from the hospital, which was after a very brief stay, that we would need help. And so we said, it's about time. I think it's time we have to join the Village. And the Village was great.

We had a fabulous woman who would come practically every day and, when he was stronger, take him for walks, do all kinds of things. 

RAY SUAREZ: Bill never recovered and died six months later. That's when Cooper discovered she needed the Village even more.

JOANNE COOPER: We had a great life, and you want to maintain that. And then you're by yourself and you have to sort of renegotiate how you're going to do things. And I started going to things at the Village.

And I began to do all the things that I did before Bill got sick, and then more.

RAY SUAREZ: The Beacon Hill Village has spawned a national organization to advise other communities.

But McWhinney-Morse says it's important for every Village to be different, tailored to the specific needs of each community. What works in an urban setting like Boston may not work in a rural town in Iowa.

SUSAN MCWHINNEY-MORSE: That's perhaps one of the geniuses in the way the village movement has been set up, because it takes into account the fact that we are all aging in different ways with different needs at different times.

People said, you cannot retire on Beacon Hill. It just won't work. You have bricks to fall on, stairs to climb, and that's not appropriate for older people. And my answer to that is that, if I stop climbing stairs, I won't be able to climb stairs.

RAY SUAREZ: And she's convinced the village concept works in neighborhoods with people of all different socioeconomic levels.

SUSAN MCWHINNEY-MORSE: We are probably a terrific answer to particularly people who are low and moderate income and middle class, who simply have no other options, who can't move to retirement communities, who don't have the resources to go to Sun City or.

RAY SUAREZ: Still, it's not easy to create a village. It takes strong leadership and commitment from residents, and a lot of money. It took an initial investment of $80,000 to start Beacon Hill Village. And, every year, the organization must raise nearly $200,000 in grants and donations to keep the operation running.

But John Sears says it's worth it. He is convinced staying in his own home is what keeps him feeling young and active.

JOHN SEARS:  I love the fact that we have some kids on this little old street that, when the snow comes, they will toboggan down those cobbles that you just walked across. And they keep us a little younger and feeling that we're still part of the world.

RAY SUAREZ: Sears acknowledges not everyone will be able to stay in their own homes. Not everyone can. Mobility issues could make such a lifestyle difficult. Only 10 percent of Beacon Hill members use wheelchairs, scooters or walkers.

But he other and the other members think America should be looking at the village concept, as tens of millions of baby boomers enter their 70s and 80s in the coming years. 

Recently, members of the media have reached out to DAASE and asked a lot of questions… such as how did the idea for DAASE come about and who will the organization serve? The answers were easy. After one recent inquiry, an invitation to write an article was made that would help showcase our new organization.  The response we received was amazing.  One design professional summed up our efforts like this… "This is such a huge thoughtful concept, one whose time is now.  I'd say your group is pretty impressive." 

Here is a reprint of the article from Designer's Circle

A Time For Change and A Time for Conversation On Change 
By Michael A. Thomas, FASID, CAPS, National President of DAASE

For the past few years, much of the conversation within the design community has been how to survive the economic downturn. Designers, architects, contractors, showrooms, design centers, vendors and suppliers have all experienced this downturn in one way or another.

In recent months however, as we approach 2014, conversations have been more positive. The reason? The economy appears to be growing, new housing starts are up and buyers are gobbling up properties. As business and manufacturing sectors expand, so will the need for design professionals. And according to Remodeling Magazine, consumers who have long delayed even the most essential of projects are contemplating what needs to be done.

As we look forward to better times, and with 10,000 Baby Boomers turning 65 every day, the conversation is most timely about how to adapt, design and plan our home and workplace environments, and even cities and towns, to accommodate the impact 76 million Boomers will have over time. And while those aging-in-place concepts are still valid, it is time to expand the conversation.

---To the point, many who embraced age-in-place concepts, including myself, thought too small. It isn’t about the design of spaces to accommodate an aging population. What it is about is the thoughtful design of spaces and communities that support the quality of life - no matter the years or mobility.

But the conversations need not stop with aging in place.

It is also time for a fresh conversation about sustainability. When we think “green,” we refer to the design of environments that are both sensitive to the use of the planets resources and energy efficient. However, lately green design has been much more about “brand marketing”, a trend in building design that is more than just an effort to reduce the impact on the environment. 

What about sustaining the quality of life?

With those themes in mind, a small group of designers, contractors, business associates, Realtors, healthcare professionals and industry partners began conversations that merged the elements of universal design and aging in place with sustainable design concepts.

Those meetings led to the creation of a new national association as an advocate for change in the design of the built environment, a new organization envisioned to be a conduit to:

- inform and engage consumers about these ideas,
- be a resource of information and education, and
- support advances in the design of both homes and communities.

This new group is called the Design Alliance for Accessible Sustainable Environments (DAASE.) We call it “Daisy” for short. It is now a registered 501(c)3 non-profit organization with a rapidly growing number of members from Florida to California. Membership categories include interior designers, architects, contractors, real estate, financial and healthcare professionals as well as consumers and other nonprofit groups.

The mission of DAASE is to inform, educate and advocate that which supports the quality of life and to be an acknowledged resource for consumers while providing thoughtful leadership thru, by and for members.

In a few short months, DAASE has developed a robust website, a Facebook page, Linked-In special interest page, created member marketing tools, published an exclusive home assessment guide and provided lectures and educational workshops.

It is about an opportunity to change the course of conversation within our communities to inspire action by our civic leaders that encourages regulations that address both environmental design and the design of environments.

With “design” as a common denominator and developing partnerships with others, the conversation in our community can and will evolve to sustaining the quality of life for all people, no matter their location, economic status, age, agility or ability.

As one of the leaders of this new group, I am excited about the potential it has to deliver such an important message to consumers and to be able to create a platform to bring together diverse groups of business and design associates. 

For more information about DAASE, go to the website: www.stayinplace.org or visit on Facebook at www.facebook.com/StayInPlace


 

    •   From the Vancouver Sun, this article shows that change is on the horizon at least in Vancouver, B.C.… making spaces more user friendly.  But it is not only just the door knobs… it is about applying the principles of universal design.  •  And it is sure about time. 
____________________________________________________________________________

It is a ubiquitous piece of equipment found in virtually every building, a requirement for entry, a necessity for exit.

For some, the humble round doorknob is unremarkable and utilitarian, a simple tool, a means to an end. For others, it is a piece of art, an object of beauty, an architecturally significant adornment on the welcoming portal to a building. For others, it is so synonymous with ordinariness that a “knob” is a pejorative word for being dull or stupid.

In Vancouver, the doorknob is heading into a setting sun. Its future has been date-marked, legislated out of existence in all future construction, a tip to society’s quest for universal design and the easier-to-use lever handle.

And as it goes in Vancouver, so will it go in B.C., Canada, and perhaps even the world.

Vancouver is the only city in Canada with its own building code, so the changes made here are often chased into the B.C. Building Code and Canada’s National Building Code, and then put into practice in cities and towns across Canada. Vancouver’s influence is wide. And as go the codes, so too goes the construction industry.

Remember the regular toilet? Try to find one. Low-flush is all there is to be had. The incandescent light bulb? Sorry, just energy-saving fluorescent or LED now in most stores.

The change has crept up on us silently and without fanfare. Look at any new condo building. Any new office door. Any door to a public washroom that doesn’t have pneumatic hinges and a push-pad. There they are, these silver, black or brass-coloured levers that can spring a door open with even a forearm when hands are filled.

And, as doorknobs go, so too will go those other ubiquitous knobs, the ones that turn on and off water faucets. For they too are being legislatively upgraded to levers more conducive to the arthritic, gnarled or weakened hands we earn with age.

In September, Vancouver council adopted new amendments to its building code, effective next March, that, among other things, will require lever handles on all doors and lever faucets in all new housing construction.

It is not like the doorknob will disappear entirely. Like many inventions, it will hold its own for a long, long time. There are, after all, a few people who still use typewriters instead of computers. Vancouver’s rule is not retroactive to existing homes. But over time, the effect will become magnified as housing is replaced.

Vancouver has already signalled how serious it was about this change. Last year, before the amendments were proposed, city maintenance workers quietly removed most of the Art Deco doorknobs from the public doors in the heritage-listed City Hall, which was built in 1936. Where once the public, politicians and bureaucrats alike grasped ornate brass knobs with a stylized face embossed with “VCH” — for Vancouver City Hall — they now find utilitarian gold-coloured levers.

Finnish architect Juhani Pallasmaa has described the door handle as “the handshake of a building.” If that is so, the doorknob has made a lot of introductions.

The origin of the doorknob is lost in history. Long before its emergence, people opened, closed and latched doors with wood handles, iron bars, leather thongs, strings, cables, rudimentary latches, anything at hand.

According to Allen Joslyn, the president of the Antique Door Knob Collectors of America, the first true knobs were likely simple pulls on church and palace doors.

“People always ask me what the first doorknob was. I tell them you tell me when the first door was made and I’ll be able to figure out when the first doorknob was made,” he said, in a telephone interview.

In the U.S., the first patent for pressing glass knobs by mechanical means was granted in 1824 to Pittsburgh’s John P. Bakewell for use as furniture pulls. Two years later, Henry Whitney and Enoch Robinson of the New England Glass Company in Cambridge, Mass., patented a variation of the glass pressing machine for making doorknobs.

If imitation is a sincere form of flattery, Whitney and Robinson didn’t take it well; in 1831, in what was the first patent infringement suit involving knobs in America, they sued another glass knob maker named Emmett and won $500. That same year another glass maker, Spencer Richards of Cambridge, Mass., patented one of the earliest versions of a single knob design.

Robinson broke away from New England Glass, and in the next half-century built an empire as a knob and lock manufacturer and obtained many patents. He had a passion for round things; in 1856, he built a striking round three-storey wood frame house in Sommerville, Mass. that still stands. From the air, it even resembles a knob.

Joslyn says the heyday of highly decorative and collectible knobs ran from the 1840s to about 1915, but adds that lots of decorative knobs were made in later years, such as the ones at Vancouver City Hall.

He doesn’t think Vancouver’s building code amendments will kill the doorknob-making industry. There is, after all, a vibrant industry in the manufacture of reproduction knobs for decorative purposes. But he wonders if Vancouver has gone too far.

“I can understand if you have a public building where everybody wants to have free access and that is a problem,” he said. “But to say that when I build my private home and nobody is disabled that I have to put levers on, strikes me as overreach.”

Vancouver’s interest in door handles instead of knobs stems from a little-known but important and developing concept called universal design.

Tim Stainton, a professor and director of the School of Social Work at the University of B.C., says the concept is based around building a society as open as possible to everyone, rather than creating exceptions to fit a few.

“Basically, the idea is that you try to make environments that are as universally usable by any part of the population,” he said. “The old model was adaptation, or adapted design. You took a space and you adapted for use of the person with a disability. What universal design says is let’s turn it around and let’s just build everything so it is as usable by the largest segments of the population as possible.”

Stainton says there are examples of universal design all around us that we may not even recognize as such.

“A really simple version is the cut curbs on every corner. That helps elderly people, people with visual impairments, moms with strollers. It makes a sidewalk that could otherwise be difficult for parts of the population universally accessible,” he said.

A more oblique example is patterned china and thicker cutlery in some restaurants.

“If you are visually impaired, a white plate on a white tablecloth is difficult to see. You may not be able to distinguish where the plate ends and the table starts. In a lot of places you won’t see plain white china any more. They will design a ring around it, or change the edges,” Stainton says.

Fire alarms with flashing lights are another example. “A sonic fire alarm doesn’t do anything for a person who is deaf. So now, all the alarms you see will have a light on them,” he said. “You don’t want to be the only person sitting in a building on fire thinking ‘where did everybody go’.”

And the door lever? Until this story, you probably didn’t pay attention to what you use to open a door, Stainton suggests.

“Most people don’t think twice now about a doorknob in their office. They don’t think ‘Oh, I don’t have a doorknob but I have a lever.’ They don’t think of that lever as anything other than a way to open the door, and that is the logic here.”

Will Johnston, the former Vancouver chief building inspector who wrote the changes in consultation with the building industry, doesn’t see this as the inevitable death of the doorknob because the rules aren’t retroactive. People can also still buy doorknobs and put them back on lever handle-equipped houses.

But he won’t bemoan the loss of the knob.

“We keep talking about the doorknob. Go into Home Depot and look at how many lever door handles there are. There are lots because that is the trend,” he said, adding that with handles you don’t require a tight grasp.

“Technology changes. Things change. We live with that. … When I look at what we are proposing, it is simply good design. It allows for homes to be built that can be used more easily for everybody.”

vancouversun.com/jefflee