That’s an excellent question, and one for which there is no set answer – and it’s usually not an easy or obvious answer in any given situation, either.  The very first considerations are also definitely not about the physical modifications themselves, but about what the client needs in order to remain safe and to manage whatever care they need, although if the needed changes cannot be made for one reason or another, that certainly needs to be known early on in the decision making process.

Assuming the medical condition allows a choice, it’s really got to be an individual decision in every case, taking many issues into account, starting with the client’s medical needs, what they are able to do for themselves, how that would be impacted with home modifications if they are needed and made, what services they need and can afford, whether or not they have help from family and/or friends that they can rely on, what insurance, Medicare, medical assistance, VA benefits, etc. will pay for, what future needs are anticipated, etc. – and then comparing all of that with the costs and services available in an outside facility, including looking at long term ramifications of each option.

This evaluation has to include these analyses with each of the different facilities they are considering, as they vary extensively in every possible way.
One of the biggest issues, of course, is the psychological and emotional impact of one choice vs another.  Most people want to stay at home if they can, and that almost always outweighs any other consideration initially.  If money is tight, though, as it is for most people, compromises may have to be made, or decisions that would otherwise not be desired.

The needs and comfort of other residents of the home may also need to be considered, if there are any, and those of caregivers.  For some people, this will not be an issue, but for others it might.

What, for example, will a healthy spouse who is still able to get around just fine do for a living room if the only space in their small house where his wife’s hospital bed will fit is the current living room, and the bed and her medical supplies take up the whole room?   Or what will the children or grandchildren that live there or visit frequently do?  How will she get to the bathroom if the only one is upstairs, if indeed she is able to walk and toilet on her own at all, but can’t manage stairs?   How will she bathe?   How will her privacy be protected if she’s in a public space like the living room – especially if it faces the street and front door?  Will other residents be able to navigate the single bathroom once it’s full of the disabled/elderly person’s access paraphernalia?

These answers could be very different depending on the particular home, its location, size, what the family can afford, the specific needs, etc. – and the solutions that would be viable for one client might not be for another with similar needs, both in terms of what home modifications can be made, or the choice of doing them vs moving the client to a facility.

Of course, from a design and construction point of view, it’s critical to evaluate early on whether or not a given residence can, in fact, be modified sufficiently for the client’s particular needs and preferences – and at a price they can afford. Many homes simply cannot be modified in a viable way at all for one reason or another, or maybe not without really extraordinary expense and/or total aesthetic destruction or other issues.

Even when it’s possible to do the modifications, and the client can afford it, if major changes are to be made, they can take a tremendous amount of time, just like any other remodeling project.

At times, people may also have to settle for changes that are far less aesthetically desirable or less than ideally functional than they would prefer just because of time constraints and product availability.

Some people will absolutely have to move somewhere else no matter what if they have a sudden need for an accessible home, and the job can’t be done in the time available before insurance quits paying for a hospital stay, for example – and that somewhere else may well need to be an extended care facility of some sort, possibly at their own expense.  And if the modifications can’t be made for one reason or another, and moving to a new house is not an option, the patient will end up in a facility of some sort if they have nowhere else to go.  Or they will end up totally housebound, perhaps even confined to a single room or even bedridden, depending on their condition and the house, none of which are very attractive options.

This is a big part of why it makes much more sense to plan ahead and to make universal design changes including moving to a new home if necessary while one is still healthy, to prepare in advance, so as to not get caught in a time squeeze when and if an actual need comes up.  Major remodeling is stressful enough at the best of times without adding illness and urgency on top of it.

If a person facing such possibilities is elderly, or on disability, Medicare or medical assistance might pay for a long term care facility, but if they have been released to go home, that is highly unlikely.  If they are younger and/or previously healthy, even those safety nets won’t exist.  If the care needed is not medical but personal only, then no insurance or assistance program other than a really good independent long term care insurance policy will pay for it anywhere.

On the flip side, insurance, Medicare, etc. will often pay for inpatient care but not care at home, if ongoing medical care of any sort is needed, so the decision may well be made for the client just by that alone.

Again, this is all a very individual thing, and without a professional evaluation of a particular residence and client’s needs, it may not be at all obvious what can – or cannot – be done with the home, and at what price, if in fact remaining at home is even an option in light of these and a number of other possible considerations.

Once a person sits down to do these evaluations and comparisons, from a financial and logistical point of view, the results can actually be quite surprising.  For some people, doing whatever it takes to remain at home is the best choice, for any or all of a number of reasons.  For others, it will be to move to a new home and to make whatever changes there might be necessary – or move into a facility.

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* A “facility” could include anything from an independent living house or apartment within a continuing care retirement community (CCRC), assisted living, personal care home, or skilled nursing, depending on the individual’s needs, what they can afford, and availability.

Independent living is actually still living in one’s own home or apartment, except that it’s physically located in and part of the CCRC (or similar facility). They make it easier for people to remain more independent for longer than they might be able to in their own separate homes, though.

There are a great number of other benefits included in the price of such a residency option, including meals available onsite, various activities onsite such as lectures and classes, transportation to doctors, grocery stores, banks, etc. (which can be critical if one can no longer drive), oftentimes minor medical care, physical therapy if needed, and many other possible ones including laundry and basic housecleaning service, dry cleaning pick up and delivery, onsite maintenance and assistance with even things like changing lightbulbs, and some even have swimming pools and other recreational facilities and assistance designing a fitness plan. They can be quite luxurious at prices that may actually be well below local market rates for a comparable separate home or apartment – and are already designed and built to be fully accessible. Some modifications may still be necessary; for example, we still needed to add grab bars in my father’s bathroom, but sometimes those will be paid for by the facility as they were in our particular situation where Dad lived.

First of all, many modifications may cost far less than you might expect, because they often don’t need to be as extensive or labor-intensive as you might imagine, and can actually be quite simple.

For example, sometimes all that is needed to ensure wheelchair accessibility may be to remove the moldings from around your doors and finish off the opening without them, and maybe either add new doors that fit the enlarged opening better, or in some cases, dispense with them altogether.  This alone can add a couple of inches of width to the doorway that can make all the difference, without getting into major remodeling.

And in places like the bathroom, as long as you can get the chair in there (which the door width may be the only obstacle to), depending on your particular situation, all you might need to be able to shower or bathe on your own might be a transfer bench and grab bars – although of course, you could certainly also opt do a full remodel with a wheel-in shower, step-in tub, and many other helpful aids that can be created in a way that no one else needs to know their purpose if you prefer.

Your best bet to determine what will serve your needs the best in a way that will fit your budget will be to consult a professional with the CAPS (Certified Aging in Place Specialist) designation to find out what’s necessary and possible, and to get a realistic idea of what it will cost.  You can search for an appropriate professional in your area via the National Association of Home Builders CAPS Directory.  CAPS specialists are specifically trained to manage the changes needed in the residential built environment in order for people to age comfortably and safely in their own homes – and that same training applies to both accessible and universal design as well.

If you have an occupational or physical therapist, you might want to involve them in the process as well, even if they have not already done a home visit, so that your needs and the specific obstacles in your home are most appropriately identified from a medical/functional perspective, leaving the design professionals to create a solution that best implements those requirements in the most aesthetically-pleasing way possible within your budget constraints.

Accessible design is created for people with specific, known needs, and universal design is a more general concept that allows people of a range of ages and abilities to function well together in the same space, anticipating potential needs along with addressing actual existing ones.   They overlap with each other, and both overlap with aging-in-place.

If aesthetics is important to you (and it should be, because that greatly impacts your enjoyment of your home), start with an interior designer or architect who is CAPS-certified, and hire a contractor who also holds the designation for the optimal combination of design and construction knowledge.  No one wants to – or needs to – live in a home that looks institutional in order for it to function well for physical needs.

Some contractors, although far from all, may have some training in interior and/or architectural design, so unless you know you only need or want the most basic of changes like functional grab bars and/or stair glides, the best outcomes in any renovation or new construction project will usually come from hiring a team that works together to address not just the technical issues but also the aesthetic ones, and not just the physical house issues, but also furnishings, color, lighting, etc., all of which can also be modified as necessary to address various types of disabilities, including normal age-related vision loss.

Most designers and architects will meet with you initially at no charge to explain their services, find out generally what your needs, budget, and preferences are, and to make a proposal, so don’t be afraid to call one even if you think you can’t afford our services.  If it does turn out to be more than you want to spend to hire one to do the whole project, many, myself included, will also work on an hourly consultation basis to give you advice, review contractors’ plans before the proposed modifications are built, etc.

Finally, when it does come time to do whatever work needs to be done, if you find that you really can’t afford them on your own, you may be able to locate some surprising sources of help in funding the modifications.

While it is beyond the scope of this blog – and indeed the scope of any design or construction trade professional – to offer specific advice about financial assistance, or its appropriateness for any specific situation or type of situation, I would like to share some resources that you can investigate on your own.  Please do consult with your own financial, tax, and legal advisors to determine the impacts and pros and cons of any financial options you may be considering.  In some situations, there might even be tax breaks associated with such modifications that might increase their affordability, but again, please do consult your own advisors for details.

One place to start, certainly, is asking your bank about a loan, and another is to ask your accountant and/or attorney about any sources they may know of.  Likewise, your church, synagogue, or other house of worship might be able to suggest or offer assistance through either that particular facility or through the religion’s local or national agencies and charities.  Fraternal organizations might have options as well, if you belong to one.

The Our Parents blog (which is a wonderful general resource for information about aging in general, and caring for older adults) also has a nice article on where to turn to seek financial aid with an assortment of links that will help you research options in your area, or that apply to your particular circumstances.

Don’t be put off by the name of the blog or references to aging and seniors if you are not of that “certain age”, as many of these agencies might also have programs that could benefit younger people as well if they have significant disabilities, and the blog certainly has information that would be beneficial to people with other disabling conditions.  They also have a nice article with other links about the possible pitfalls of reverse mortgages, which many people think of, and which may or may not be appropriate for a given situation.

While I do also dislike Kelly Wearstler’s work, and quite agree that there’s a lot of bad design out in the world in general, much of which is getting a lot of press due to better marketing than many of the truly best designers do, I can’t agree that there’s anything inherently wrong with promoting one’s own self, products, and business, no matter how dreadful some of us may think it is. It would be nice on one level if we could live In a society where everything was tastefully designed, but a) we live in a free country and everyone has the right to their own preferences – and professions, b) who would get to decide what is good and what isn’t?, and c) how boring life would be if everything were always perfect, and there was no room for differences in taste!

Frankly, I’m surprised that magazine of I&S’s caliber is putting up a feature with this nasty an edge. Yes, we all snark about others at times, but whatever happened to common courtesy? And how is an attack of this nature useful to anyone?

The reason there is bad design is because not everyone trying to do it is equally talented. And not everyone hiring bad designers knows the difference. It really is all about marketing, in the end – and the fact that many people just don’t have good taste, and/or have never been exposed to anything better, or learned the differences. There’s no great mystery or sociological higher reason why we “allow” bad design to exist – and allow bad designers to stay in business. The reality is that neither of these is anyone else’s call, other than the parties directly involved in the transactions and projects.

If you want to talk about bad design, I’d suggest that it would be far more productive, useful, mature, and *professional* to do it as a proper critique of exactly what does and does not work about a particular object, space, or body of work. It would not only provide more useful content to designers, particularly those at the start of their careers, but it would frankly look better to the public who stumble in there as well. Their perception of designers as nasty, stuck up, and unreasonably demanding is bad enough, and is already fed by many sources. Let’s not make it worse in professional publications like this.

There’s plenty of room for snark in that kind of presentation as well, but I’d like to see things kept basically respectful – and educational, at least the post put up by the magazine. Please see James Swan’s hilarious “100 Things I Hate About Your House” on Facebook for some superb examples in which both humor, snark, and real education and professional discussion merge beautifully. When he snarks, it actually is funny. This post was not.

It’s also one thing for commenters to snark in their responses, but quite another for someone representing a major professional magazine to do so in his or her original posts.

I also find it quite disturbing that this new feature is written by someone who isn’t putting her own name on the line, who is unwilling to own her own words publicly. It’s obvious why – and in my opinion, it’s extremely cowardly and unprofessional. For shame, I&S. You’ve just gone way downhill in my estimation.

I’ve recently been thinking that I need to really get started on cleaning out the clutter in my house – and I don’t just need to, but I actually want to.  I’ve got a beautiful home, but far too much stuff filling it up, and it’s really started to weigh on me for a lot of reasons.  For one thing, the clutter keeps me from enjoying my home as much as I’d like to.  For another, I’d like to do some travelling and possibly rent the place out for an extended period of time so I can wander a bit, and it’s just not possible without a real clean out.  But most importantly, an excess of stuff is literally weighing me down in many ways.  My life has changed dramatically in the past couple of years, and I’m feeling in need of something resembling a fresh start to clean out the cobwebs of the many negative things that have happened, and to make room for something new to come into my life in this next phase of it.  If you want to know the condition of your mind, look in your closets and around your house.

I wonder what I can live without of all of this.  When I look at it, there are reasons for keeping all of it, and I start thinking it’s going to be a herculean task, and that I’ll feel deprived if I give up all this stuff.  But when I had a fire in the house several years ago and was left unable to access or use the majority of my belongings (thankfully they just needed deep cleaning), and had to live without 99% of this for nearly a year, I can honestly say I didn’t miss the vast majority of it – and didn’t even remember I had a lot of it.

These thoughts were literally keeping me up last night, so I got up early, only to find the following article in my email, sent by the wonderful kitchen and bath showroom DJ Mehler.  It seems this is a common theme these days.

What do you think you could never live without, and what are you sure you want to jettison?

Take a look at the following article reprinted from Family Circle.com for a list of 18 things you can get rid of today, and some great ideas on how to let the things you don’t need go.

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Just Say No to Too Much Stuff

Stuff. For many of us it’s worse than any four-letter word. That’s because “stuff” can weigh you down and hold you back, says Gail Blanke, author of Throw Out Fifty Things. And, in the end, much of what we accumulate in life isn’t all that important. As Marilyn Bohn, author of Go Organize!, points out, “No one ever says, ‘I wish I’d kept more stuff.’”

Still, getting rid of our discards can be a challenge. Carla Eskelsen, a mom in Farmington, Utah, admits she had trouble letting go of stuff until she figured out how to manage her “pioneer DNA.” Once she figured out that donating and recycling “honored” her pioneer ancestors, she found it much easier. “It’s about sharing and blessing others instead of keeping it all for yourself,” she says. Here’s how you can share and bless others with all of your stuff-and end up with a cleaner, more peaceful home while you’re at it.
1. Kitchen Utensils

Is your utensil drawer so full you can barely open and close it? You’re not alone. When Robin Austin started cleaning her kitchen in preparation for a move, she found she had plenty of duplicate utensils, the result of a new marriage that combined households and six kids. Many of us also buy new utensils but forget to get rid of the old.

Here’s a smart way to figure out what you’re really using, from Motherboard Mom Jeanne Smith, Overland Park, Kansas: Toss everything-all the spatulas, rubber scrapers, pie servers, and so on-into a box. As you use a utensil from the box, put it back in the drawer. After a month, check what’s left in the box. Keep those once-a-year items that remain in the box, like a turkey baster or candy thermometer. But donate the rest.

2. Coffee Mugs

Another item many moms find hogging valuable cupboard space: coffee mugs. “We had over 20 coffee mugs,” says Kansas mom Dawn Schnake. She and her husband each chose four mugs to keep and donated the rest to a church rummage sale.

“Even if you received something as a gift, it’s okay to let it go,” says organizer Marilyn Bohn. “You only need to keep what works for you.”

3. Plastic Containers

Mary Pankiewicz, owner of Clutter-Free and Organized in east Tennessee, suspects that plastic containers have a secret life (probably hanging out with those AWOL socks and hangers). How else can you explain why so many lids and bottoms don’t match up? She suggests holding a “lid party” to match up those errant tops and bottoms. Pankiewicz recently took her own advice. “I had 25 lids with no bottoms and six bottoms with no lids,” she says. After swapping with friends, she recycled the rest of the mismatched items.

4. Little-Used Kitchen Stuff

When was the last time you used that Bundt pan? If it was months ago, maybe you should give it to a friend. That’s what Suzy Ayres and a pal did when they performed a joint kitchen cleanup. They took everything out of their cabinets and only put back what they used regularly. “The things that we left out that didn’t get used much, we had to choose. If we put one thing back in the cabinet, we had to pick one thing to donate,” Ayres says. The two also traded items: “She had lots of muffin pans and I didn’t.”

An added bonus to the plan: They now know what’s in each other’s kitchens, and don’t need to buy some of those rarely used items, like a Bundt pan. “We’ve been trading the same ice bucket back and forth for years,” Ayres says. “I can’t even remember who it belongs to!”

6. Food

Cupboards full of food you’re not sure you’re going to use? Some solutions:

·Check the expiration dates on everything in your pantry, fridge, or freezer. If it’s about to expire, put it on the menu for that week, says professional organizer Bohn.

·Motherboard Mom Dawn Schnake gives her sons what they call “muffin pan snacks” to get rid of those almost-empty bags of cereal, crackers, and chips. She fills each of the 12 muffin cups with a different snack and throws in some veggies, cut-up fruit, and cheese cubes. “The boys think they’ve sat down to a feast,” she says-and she gets her pantry cleaned out.

·If you know you’re never going to use an item-and it’s still good-give it to your local food pantry.

·Have an “Eat Out of the Pantry or Freezer” week, says Marla Cilley, flylady.net. You’ll be surprised at how creative you can get with your menu planning when you’re only using the ingredients on hand. She also suggests this as a way to inspire creativity and frugality: “When you throw away food, imagine you’re throwing dollar bills in the trash can!”

Organize Your Pantry

5. Vases

Got vases from the last three Valentine’s Day bouquets? Take them back to the florist, says Marla Cilley, who lives in Transylvania County, North Carolina, and runs the flylady.net, an Internet site devoted to housecleaning and organization.

“It takes away your creativity and takes over your mind,” Cilley says.

7. Spices

They don’t mold and don’t appear to go bad, but spices don’t last forever, not even cayenne pepper. (Cinnamon’s an exception to the rule.) “Dried is one thing, tasteless is another,” says organizer Blanke. Give your spices the smell and taste test and if they’ve gone bland and boring, dump them. To find out how old your McCormick or Schilling brand spices are, go to http://mccormick.com/Spices101/HowOldSpices.aspx. And when you buy new spices, mark down the date on the package with a Sharpie.

8. Receipts

Computers were supposed to usher in a paperless society, but it hasn’t happened quite yet. “Most of us are still drowning in paper,” says organizer Pankiewicz. She suggests an annual cleanup. Check with your accountant about how long to keep important papers like tax returns but, in general, materials that support tax returns (receipts and so on) can be tossed after seven years.

9. Magazines

Do you have a stack of magazines by your bed that you haven’t read? If two months have passed and they’re still sitting there, consider donating them to a retirement home, hospital, doctor’s office, or school. Many take magazines for art projects (if not for reading material). If, like former magazine editor Cherie Spino, a mom of four in Toledo, Ohio, you “can’t throw a magazine away without reading it,” do the flip-and-rip. Spino rips out recipes or articles she wants to keep and throws the rest into the recycling bin. She’s putting the recipes in a binder.

Organizer Bohn suggests tearing out articles and putting them in a folder you can grab when you know you’ll be sitting and waiting (think doctor’s office). Or, if you’re a tech-lover, you can get many popular magazines as an app for your phone or electronic reader.

10. Mail

It’s a common bad habit: Grab the mail, flip through it for anything interesting, and then set it on “the pile” that accumulates until the day you start searching for overdue bills. “Scan and stand” is the system recommended by organizer Pankiewicz. “Standing is the trick,” she says. Don’t be tempted to sit down: Bring in the mail. Leave your coat on. Find a place by the wastebasket, recycling bin, or shredder, and stand and handle each piece of mail. Put bills in a basket or pretty gift bag, take magazines to where you read them, scan any newsletters and bulletins for important information, and discard the rest. “Your goal is to make the mail disappear,” she says.

Clearing Paper Clutter

11. Unread Books

“Books are our friends,” says organizer Blanke. “I know my husband won’t ever get rid of his dog-chewed copy of Rudyard Kipling’s Kim that he’s read 50 times.” So, keep your favorites-the ones you’ll read again or you use for reference-neatly in a bookcase. In fact, if you’re a book-lover with a big collection, a whole wall of books can make a dramatic statement and keep them organized. But, if you have lots of volumes that you have no intention of reading any time soon, donate them. Blanke suggests giving them to www.booksforsoldiers.com. “You really are paying it forward when you donate things,” she emphasizes.

Make Over Your Home Office

12. Clothes

Here’s a sad truth: You’re probably not going to lose the weight to fit into those 10-year-old clothes you have in the closet. Just give it up and give them away, says Pankiewicz. This doesn’t mean you’re giving up on ever being healthier or thinner, it just means you aren’t going to be held hostage by some old clothes that don’t fit, need repair, or were on sale (but you never liked). Donate them all and we guarantee you’ll feel “lighter.”

Need closet culling tips? Here’s what some Motherboard Moms do:

·”I can’t stand to have a closet full of clothes that I don’t wear,” says Michelle Speak, mom of three in Parker, Colorado. She sorts through her clothes each season, weeding out what she hasn’t worn, although she’ll make a few exceptions for items like skirts that she wears infrequently.

·Mom Suzy Ayres has an easy way to tell what she’s worn. At the beginning of a new season, she turns all of her hangers around backward. After she wears something, she puts it on the hanger and turns it around the right way. Anything still turned backward is donated at the end of the season. “Right before cooler weather hit this year, anything I knew I couldn’t part with, I wore it so I could put it in the ‘save’ pile,” she says.

Organize Your Clothing Closet

13. Kids’ Clothes

Michaela Freeman, a mom in Oklahoma City, Oklahoma, keeps clothes for her children a year after the end of each season in case things still fit. What doesn’t is passed to friends with young children. “How can you put a price on helping another person?” she asks. She’s benefited as well. Friends with older kids pass clothes on to her youngsters.

14. Kids’ Artwork

Of course every piece of artwork your child ever did is a masterpiece. But that doesn’t mean you need to keep it. If it’s not something you want to put on the wall or in a portfolio to save, take a photo and toss it. You can develop a digital “art gallery” or put photos in a photo album and you’ll take up a lot less space. After all, think about it: If you keep four pieces of paper per week per child, by the time they’ve graduated from high school, you’ll have one huge collection, points out Bohn. “Take a picture and let it go!” she says.

15. Electronics

Power cords, USB cords, and other paraphernalia for electronics clog up our desks and cabinets, says Chris McKenry, owner of Get It Together LA!, a professional organizing company in Los Angeles. “It’s a jungle,” he says. “And there’s not room for the things you need.”

Sort through that “jungle” and match cords to gadgets. Old cell phones can be donated to women’s shelters. Other old electronic items, like some printers and computers, should be properly recycled. “It’s against the law in some cities to put electronic waste in the trash,” warns McKenry. Check with your city for E-waste collection sites. Ditto for old VHS and cassette tapes. McKenry suggests transferring them to your computer for digital storage and then putting the tapes in E-waste collections.

16. Linens

“Most of us have way too many towels and sheets,” says The Fly Lady. “Some people no longer even have beds that the sheets fit!” She recommends two sets of sheets per bed and keeping the extra set under the foot of the mattress or in a drawer in the bedroom to free up room in the linen closet.

Organize Your Linen Closet

17. Medicine

Check your medicine cabinet for expired prescription and over-the-counter drugs, but don’t flush them or throw them in the trash. Instead, take them to your local pharmacist for proper disposal.

Organize Your Bathroom

18. Toys

Start teaching your children early to donate the toys they’re no longer using, says organizer Blanke. “I know one mom who tells her kids Santa won’t come until they give away the toys they’re finished with.” Here, other Motherboard Mom solutions to too many toys:

·Carol Showers Brown, mom to three in Manassas, Virginia, also taught her kids to donate toys. “We lived in Bangkok and the orphanages there were so grateful for toys, even used ones.” Her kids would fill a basket with toys to give away several times a year. “It worked really well because the kids picked out what toys they were ready to part with,” she says.

·Remember that preschool song of “Clean up, clean up”? At Diana Dawson’s Austin house the song was more likely “Wade through it,” she says. That’s why she set “dump-it deadlines”-if the kids’ stuff wasn’t picked up by a certain time on a certain date, she would gather their things and donate them. Sure enough, the first time she had to follow through with her daughter. “The most difficult were the books on the floor, and I donated those to her elementary school,” Dawson says. “The school librarian told her she appreciated the donations and other kids enjoyed her books.” Her children and a group of neighborhood kids also put on their own garage sale of their toys to raise money to adopt a family at the holidays.

·Mom Michelle Speak has donated many of her children’s toys as they’ve outgrown them, but not all. “I’ve kept the toys I can imagine my grandchildren would play with.” Put the special, keepsake toys away in a well-labeled box.

Tell Us What You Think: What Could You NEVER Part With

It’s a topic that’s near and dear to my own heart as well, along with the related issues of universal and accessible design, all of which are really tied together and inseparable. There’s a lot of overlap among the concepts of aging-in-place and universal design in particular, but also with accessible design. These are issues that we all eventually face one way or another; it just happens to be the turn of my generation to learn how to age well.

Disability, of course, can and does strike at any age. In my own family, my brother has been dealing with an illness and injuries that will leave him disabled and mobility-impaired for life, and he’s only 50. At the same time, both my father and his partner are ill, as is my aunt. My now-former partner is facing serious medical problems in his own family as well, so we were both stressed out by these issues. I myself cope with several disabilities, and have found my mobility impaired by injuries, and even my ability to dress myself and take care of my own hair is greatly diminished at times. Age is taking its toll on us all in various ways – and these kinds of stressors impact all relationships.

Having the tragedy of my brother’s situation occur so suddenly, on top of trying to look after my father at a particularly difficult period in his own life, really brought these issues home for me in ways that even a decade as a paramedic, a stint selling life and disability insurance, and even my own travails never did, and is the reason why I finally completed the coursework I needed to obtain my credentials as a Certified Aging in Place Specialist (CAPS designation) a couple of years ago. I will discuss what CAPS is more extensively in another post.

There are many, many things that can be done in a home or office to assist people in dealing with the physical challenges of disabilities and aging. Hundreds of websites and resources exist; there’s no shortage of information out there. I’ll be writing more about these topics as time goes by, but for the moment, let’s just take this as a given.

In reality, the physical changes required for designing a home that supports aging in place or dealing with a wide range of disabilities well are the easy part. The technology exists, and with enough ingenuity (and sometimes cash, admittedly), anything is possible.

Even if a major remodel is not possible, there are usually at least small modifications that can help improve the functionality of the physical space immensely, especially for people who do not require major changes for wheelchair access. Not long ago, for example, I consulted with a lovely, vibrant woman in her 70s who is feeling the losses associated with arthritis on how she can modify her draperies so that they are easier to draw, and don’t hurt her shoulders. She’s on an extremely tight budget, so a lot of the products I normally work with are out of the question, but even in a brief discussion, I identified at least four different ways she could modify things with cheap, readily available materials just from the hardware store that would still preserve the open, airy, minimalist kind of look she prefers, and we are looking now at more specific products. She’s got cafe curtains hung with a rod pocket, which take some pushing even for able-bodied people to move, so just changing to a style with rings or grommets will allow them to glide effortlessly on the rod. She won’t have to reach up any more, either.

This small change alone will allow her to deal with something she has to handle daily with much less wear and tear on her shoulders, and bring a measure of ease to her life that she never even thought she could have, especially without spending a fortune. When you are in pain, and your joints are deteriorating like this, even eliminating one or two aggravating movements a day can make a very big difference in your comfort level – and your ability to enjoy your home. An accumulation of several or many such minor modifications can really add up over time.

Willingness and ability to think outside the box to adapt common materials to the task at hand are critical skills for designers, especially those of us who work with people with physical limitations or tight budgets. A good interior designer is invaluable to this process – and to making changes that integrate well, still look beautiful, employ the same kind of quality materials of any other good design – and which don’t scream “disability” or “old people”.

People often don’t even know there’s anything that can be done to help some of the difficulties they have, so a sensitive, perceptive, and creative designer who knows how to ask the right questions and to observe well can open a lot of doors, and create solutions for problems that a client never even knew were possible and thus may have never even thought to ask about or request.

I was very gratified to see the face of the lady I consulted with just open up with amazement and hope upon hearing the range of possibilities I was able to come up with; that’s the kind of response that drives me to do what I do. And I didn’t even realize just how automatic it is for me to think this way until she herself commented on how natural it is to me. She’s been incredibly frustrated because she hasn’t been able to find a new kind of wand that would be more functional – but that isn’t where the best solution actually lies.

But what most stops people, especially from doing anything about modifying their environments before they absolutely have to, and which causes them the most difficulty, is undoubtedly the emotional component – the need to acknowledge the fact of these changes, whether existing or pending. And often, we put off making the changes we know we may need while it’s still easy, and end up in a crisis that forces decision-making at the worst possible times.

We don’t like to face the thought of our own mortality, even when the evidence continues to mount. It’s a natural human reaction. We don’t want to let go of who we once were, the things we could do before, the hopes and dreams for the future. We don’t want to acknowledge that there is indeed a sunset period to life, and that we must all face it someday. We don’t like the idea of letting go of cherished possessions, or moving to a place that doesn’t hold the same memories of our present homes. We are afraid of what life will look like as we lose abilities, and as our friends also decline – and inevitably die. We hang onto our stuff for dear life, as if it’s the only anchor that will remind us of who we are and where we have been, as if we can keep time from advancing if we just don’t change a thing in our environments. We hold onto our old ways of doing things, and outdated, nonfunctional homes, often because of fear that somehow admitting to what’s inevitable will somehow make it come to pass more quickly and take something away from us now.

Some people are lucky enough that they will be able to stay in their own homes for the rest of their lives, and without modifications. For many of the rest of us, though, changes are inevitable, even if only because of declining incomes, or desire to just not have so much house to take care of any more. But the first – and most ongoing – hurdle we have to face is the one in our own heads.

Also, as we Baby Boomers age, the stresses our sheer numbers will put on the health care and elder care systems will overwhelm both, and more and more long term care will have to occur in our own homes. We must plan in advance for these changes, if we are able to. Most people want to remain at home as long as it’s humanly possible anyways, but we are going to face the situation where there is likely not going to be any other choice for many of us who might actually prefer or need to utilize services such as assisted living at some point, just because of overload on the system.

Fortunately, there is a lot of help out there even for mental adjustments we may need to make. Good therapists and support groups can be invaluable, and there is no shortage of reading material. A good interior designer will also be exquisitely sensitive to needs, and can open doors that you haven’t even thought about. There are many strategies for combing through your possessions in an orderly way and deciding what to keep and what needs to find a new home, so that we can “right-size” our lives.

Identifying the things you own that have the most meaning to you and taking them with you if you move even if you have to jettison the rest can go a long, long ways towards helping ease the pain of change, for example. Do you really need that entire collection of decorative boxes you’ve amassed over the years? Or are there a few choice pieces that hold the most meaning for you, and which would help remind you of all of the rest? Can you photograph them and save them that way instead of taking them with you physically? Do you ever even look at all of those old photo albums that are piled up in the den, or would just keeping a few photos, framing them beautifully and using them in your new home still give you as much joy?

Start editing your possessions by asking yourself what single item you would take with you if you were told you had to evacuate your home immediately, and were only allowed to take one thing (ignoring whether it’s actually portable or not). Then repeat this exercise with the thought that you could only take one more item, and so on.

Looking at the move or remodel as an exciting opportunity to start afresh can help immensely as well. Even if the reason for remodeling your bathroom and kitchen is because you are now in a wheelchair, or expect you will be in a couple of years, if you can look at this as a positive thing that will help you continue to live as normally as possible, and increase convenience for you and everyone else living in or entering your home, you will be far, far ahead of the game. There’s no reason a fully accessible home has to look like a hospital, and it can easily be a showcase, just as any other home.

Consider, for example, that you get to have a brand new bathroom – focus on the wonderful new things you will have, and how simple things like taking a shower will now be much easier than they have been – or possible in the first place. Order beautiful cabinetry, tile, lighting, and fixtures. There are even beautiful grab bars made now that will coordinate perfectly with the rest of your bathroom fittings. The additional space you will need will make the room more functional for everyone. Make the space a sanctuary, not something institutional in character, and it will become a destination for the whole family – a source of joy, peace, and comfort, instead of a reminder of loss or impending loss.

Because loss and change are inevitable parts of life. They affect us in so many ways. The outlook we bring to the process, and to any home or office changes we must make, can make all the difference in the world – and that much, at least, need not cost a cent.

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If you would like an evaluation of your existing space to see if it is suitable for aging in place or accommodating a known or expected disability, or for assistance in designing a new home that will fully support your living your life to the fullest regardless of your own current or future physical needs (or those of your family members), and you want to ensure a beautiful as well as highly functional result, please contact me.

More than 100 designers who are members of the National Kitchen & Bath Association (NKBA), and have designed kitchens or bathrooms during the last three months of 2010, participated in an NKBA survey to reveal design trends in the marketplace for 2011. The results of this survey suggest there will be some changes in the direction that kitchen and bath styles will take this year. Below are 7 kitchen trends and 4 bathroom trends that are poised to take hold in 2011. These are overall trends across the United States and Canada; they won’t necessarily appear in all geographic areas.

Kitchens

1) Shake It Up

The Shaker style began a rise in popularity in 2009 and gained momentum in 2010. By the end of the year, Shaker has supplanted Contemporary as the second most popular style used by NKBA member designers. While Traditional remains the most popular style, having been used by 76% of designers surveyed over that last three months of 2010, that’s a slight drop from the previous year. Meanwhile, the percent of respondents who designed contemporary kitchens fell to 48%, while Shaker rose to 55%. Cottage was the only other style to garner at least 20% of the market, as it registered at 21%.

2) Dark Finishes

Dark natural finishes overtook medium natural, glazed, and white painted finishes to become the most specified type of finish toward the end of 2010. While medium natural fell from being used by 53% to 48% of designers, glazed from 53% to 42%, and white painted from 49% to 47%, dark natural finishes rose from 42 to 51%. Light natural and colored painted finishes remained fairly common, as each rose slightly from the previous year: 24% to 25% for light natural and 24% to 29% for colored paints. Distressed finishes dropped significantly from a year ago, when they were used by 16% of designers, to just 5%.

3) A Place for Wine

While the incorporation of wine refrigerators seems to be on the decline (see Bonjour Réfrigérateur below), unchilled wine storage is growing in popularity. While only 39% of surveyed designers incorporated wine storage areas into their kitchens at the end of 2009, just over half—51%—did so as 2010 came to a close. While other types of cabinetry options remain more common, most are on the decline, including tall pantries (89% to 84%), lazy Susans (90% to 78%), and pull-out racks (81% to 71%). Appliance garages also seem to be falling out of favor, as their use declined from 36% at the end of 2009 to 29% a year later.

4) Bonjour Réfrigérateur

The French door refrigerator has strengthened its position as the type specified most often by NKBA member designers. While freezer-top refrigerators were only specified by 8% of designers as 2010 drew to a close—down from 10% a year earlier, freezer-bottom models fell very slightly from 60% to 59% and side-by-side units actually rose slightly from 46% to 49%. Meanwhile, French door refrigerators jumped from 67% to 78%. Among smaller units, refrigerator or freezer drawers remained flat at 31%, while undercounter wine refrigerators fell sharply from 50% to 36%, an interesting change given the increasing use of unchilled wine storage.

5) Inducting a New Cooktop

Induction cooktops haven’t overtaken gas and electric models, but they’re closing the gap. As we entered 2010, gas cooktops had been recently specified by 76% of NKBA designers, compared to 38% for electric and 26% for induction. However, while the incorporation of gas cooktops has fallen to 70%, electric cooktops has risen slightly to 41%, while induction cooktops are up to 34%. Meanwhile, single wall ovens are down from 46% to 42%, although double wall ovens are up from 68% to 74%. In addition, warming drawers are down from 49% to 42%, and ranges are down sharply from 81% to 68%.

6) LED Lighting

Incandescent lighting continues its journey to obsolescence. While 50% of NKBA member designers incorporated incandescent bulbs into their designs at the end of 2009, only 35% have done so a year later. Instead, designers are clearly opting for more energy-efficient lighting options. While the use of halogen lighting is down from 46% to 40% over the past year, LED (light-emitting diode) lighting has increased from 47% to 54%. Designers aren’t turning to CFLs (compact fluorescent lights) as a solution, though, most likely due to the poor quality of light they produce; their use by designers remained flat at 35%.

7) Trashy Designs

A greater emphasis is being made to address trash considerations in the kitchen. Some 89% of kitchens designed by NKBA members in the final quarter of 2010 include a trash or recycling pull-outs. In addition, garbage disposals were incorporated by 86% of designers, up from 75% the previous year. Trash compactors have also become more common. Entering 2010, they were recently used in designs by 11% of designers, but a year later, that figure had climbed to 18%. These changes may be due to an increase in sustainability awareness, but they certainly indicate an increase in concern toward trash generated in the kitchen.

Bathrooms

1) Quartz Countertops

Quartz continues to take away market share from granite in the market for bathroom vanity tops. A year ago, 85% of NKBA bathroom designers incorporated granite into a recent design, compared to just 48% for quartz, but now, that gap has narrowed to 83% for granite and 54% for quartz. Unlike in the kitchen, solid surfaces haven’t gained much popularity in the bathroom, increasing only from 23% to 25% over the past year. Meanwhile, solid marble has declined from 46% to 37%, while cultured marble and onyx have increased from 12% to 19%. No other material has even 10% of the market.

2) Green Bathrooms

No, we’re not referring to eco-friendly spaces—we literally mean green bathrooms. A year ago, green color palettes were used by only 14% of NKBA designers, but at the end of 2010, that figure had risen to 24%. Still, whites and off-whites, beiges, and browns are the three most commonly used color tones in bathrooms. However, while white and off-white palettes are up slightly from 57% to 60%, beiges are down sharply from 66% to 57%, while browns have dropped from 48% to 38%. Other common color tones include blues at 22%, grays at 21%, and bronzes and terracottas at 17%.

3) A Worthy Vessel

Under-mount sinks continue to dominate newly remodeled bathrooms, with 97% of NKBA bathroom designers having specified them over the last three months of 2010, up from 95% a year earlier. However, vessel sinks have become the clear second choice among designers, as 51% of NKBA member designers have specified them in the final quarter of 2010, up from 39% a year ago. Integrated sink tops were also up from 34% to 38%, pedestal sinks were up from 21% to 29%, and drop-in sinks were up from 23% to 27%. This shows that bathroom designers have been specifying more lavoratory sinks across the board.

4) Satin Nickel Faucets

This trend relates to both bathrooms and kitchens. From the end of 2009 to the end of 2010, the percent of NKBA designers who specified a satin nickel faucet rose from 41% to 63% in the kitchen and from 45% to 57% in the bathroom, while the percent who specified a brushed nickel faucet fell from 61% to 48% in the kitchen and from 66% to 38% in the bathroom. Other popular faucet finishes in both the kitchen and bathroom are bronze and oil-rubbed bronze, polished chrome, and polished nickel. However, while stainless steel is popular in the kitchen, specified recently by 44% of designers, that figure drops to just 16% in the bathroom.

ABOUT NKBA

The National Kitchen & Bath Association (NKBA) is a non-profit trade association that has educated and led the kitchen and bath industry for more than 45 years. NKBA.org provides consumers with an inspiration gallery of award-winning kitchen and bath designs, as well as articles, tips, and an extensive glossary of remodeling terms. At NKBA.org, consumers can also find certified kitchen and bath professionals in their areas, submit questions to NKBA experts, and order the free NKBA Kitchen Planner and NKBA Bath Planner.

via Custom Builder

For beautiful kitchens, baths and entire homes that you will delight in and which will support and enhance your lifestyle regardless of your age or ability level, please contact Wendy at Hoechstetter Interiors for an evaluation of your present home or new construction project, and for assistance in creating the forever home of your dreams, no matter what your color, style, or materials preferences.

In addition to the main points inherent specifically with aging in place, Louis has hit on a couple of things I rarely see spoken about, namely the challenges inherent in figuring out what a client wants and needs, as well as their aesthetic preferences, and translating it all into something workable – and the design team’s role in helping the client envision what is coming from a medical point of view.

One thing that really surprises me is how seldom anyone involved in universal design and aging in place ever thinks to include an interior designer on the team.  Most interior designers really have no idea what they are doing with respect to aging in place, etc., but all really good ones certainly know how to figure out a client’s aesthetics at minimum and translate them – and how to work with a team of architect, contractor, and other consultants to create a comprehensive whole.

A few undertake additional training to learn about this specialized area of design, but exceedingly few go the extra mile to obtain the Certified Aging in Place Specialist credential that verifies the designer really understands the needs of this population.

What good interior designers in general do, however (even those without such specialized training), perhaps more than any other party to the design team, is translate all of the needs and desires to a workable daily interface that also meets all of the client’s aesthetic requirements, both interfacing with the structure itself, and in selecting the most appropriate finishes and furnishings, and all other interior elements.  The best designers know how to get past what is not said or is poorly articulated to ferret out the real needs and desires and to translate it all into what is actually wanted and needed, both functionally and aesthetically.

A good interior designer adds far more value to this whole undertaking than most people have a clue about, both in this arena and in working with any other kind of client as well.

In addition to having a usually much broader knowledge of possible interior finishes and design styles than anyone else on the design team, interior designers almost invariably know more about a far broader range of furnishings and fittings.  We hear a lot of talk about temperature and pressure balancing valves in the bathroom, for example – but the world of possibilities extends far, far beyond what is available at Home Depot or other typical builder supply houses.  There is no reason that a home for an aging person, or one with specific accessibility needs, cannot be as cutting edge and high style as any other, except for the limitations of the design team’s resources and vision, including not just the structural elements, but every other consideration in the physical space and how people interface with it.

It is really this human interface where interior designers are by far the best choice of professional.  That is really what we ultimately do – create interfaces that are beautiful and support the lives of the people who occupy the space.

One thing that particularly makes me crazy is seeing furniture layouts that are not well suited for aging in place or wheelchair access – and specific furnishings so often chosen that are actually dangerous and/or outright difficult for people who are differently abled to use, and not providing other options for them.  It really pains me to see spaces created by people who claim to know what they are doing that includes things like sharp-edged square or rectangular glass tables, and soft, cushy couches and oversized easy chairs with poorly-placed arms from which it is difficult for weaker people to rise once seated, or deep seating without arms from which only the Jolly Green Giant could easily stand, or 12”+ tile or stone slabs on floors, particularly in wet areas such as bathrooms and kitchens.  The latter are dangerous enough to fully able-bodied people; for those with mobility, vision, or other limitations, they are even more hazardous.  Every element in the home from the structure down to the fabrics chosen for the furniture and the type and details of flooring chosen may be affected by the client’s current or projected medical or other needs.

Most of the residential projects in particular that I’ve seen that do show an understanding of these furnishing parameters tend to look fairly institutional, or pretty low end.   A really good designer who thoroughly understands the needs has a far more vast bank of resources to draw on that will seamlessly meld both the functional requirements with beauty and high quality without sacrificing either beauty or individuality than most architects do.  It is not necessary to have everything fully custom made to achieve these goals, but one must have a broad range of resources in order to ensure that one project doesn’t end up looking like every other one – or like a nursing home or office waiting room.

Another thing that interior designers generally do better than anyone else is space planning, which includes not just placement of furnishings and other elements in an existing space, but designing the space itself so that it is most functional.  The reason for this is that we are specifically trained in considering both traffic patterns through the space as well as designing furniture groupings that allow the best circulation and encouraging optimal interaction among the space’s occupants.  Sometimes the only change necessary is the placement of a door – but other times, only a gut remodel can fix the issues.  When designing for people with functional limitations either current or anticipated, ensuring a clear path of travel through a space while still allowing for comfortable and functional user spaces within it is even more important.

Even most interior designers don’t fully understand these requirements, and even fewer architects or contractors do.  Think about how many spec houses or tract houses you’ve seen that may be gorgeous architecturally, but there’s nowhere in all that vast space to put the furniture without obstructing doorways, or no way to actually have a conversation grouping vs just a lone sofa against the wall – or conversely, there are vast tracts of space that go completely unused.  They are all the result of designing and building without consideration to what the actual human interface is going to be – or should be.

Space planning details when you are planning for universal design or aging in place may also vary from the norm, though, and that’s where a specialist comes in who understands these differences.

What works for universal design or aging in place will work for everyone, because universal design is just plain good design – but the reverse is absolutely not true at all.

Another really valuable element to add to the team, I think, is someone who has a professional understanding of the medical elements – not just the physical aspects, but the kinds of functional limitations that can be expected to result both in the process of aging in general and throughout the course of any already known medical problem.  No, you cannot predict with certainty what will happen with any particular client, even those who have known progressive illnesses, but you can certainly increase your accuracy if *someone* on the team really understands the medical realities of a broad range of conditions.  People in the medical professions are also very good at eliciting information from people about what their limitations and needs are.

The most valuable skill set that I personally bring to the table is my medical background coupled with professional design training (and a lifetime around the industry and the arts), and my CAPS (Certified Aging in Place) training and designation.  After a career as a paramedic, my skills in drawing out people about their health issues are very finely honed, and my training and daily work experience centered very much around dealing with how the environment impacts the medical situation and vice versa.

Certain kinds of situations can be predicted to cause particular kinds of injuries or difficulties, and problems navigating the built environment can also be easily predicted with a solid understanding of the medical issues and the same skill set of evaluating what we call the “mechanism of injury”.   A paramedic’s own life and safety often depends on accurate assessment of these kinds of factors, so it became second nature to me to do so.

I’ve found that this medical background and skill set has has been invaluable and has also translated very well to interviewing design clients and figuring out what they want and need even when they themselves really have no clue.  Interviewing a patient (taking a history and doing a physical exam) is very similar in many ways to interviewing a design client, and figuring out what the problems and their best solutions are is likewise a remarkably similar undertaking.  Because I have a lot of experience doing so, I am able to bring these issues up in a sensitive way, and to sort through the likely potential medical scenarios and best design solutions.  (Needless to say, absolute confidentiality is assured!)

I am also multiply disabled myself, so I bring personal understanding of many of these issues from the inside to the table as well.  That is a nice feature to have in your designer, but certainly not necessary, and by itself does not in any way ensure the designer is competent at design, let alone design for special needs.

Louis also poses the question of whether or not the design team should be helping the client see down the road to what may be coming medically and in terms of what their own changing abilities may be, and a few of the issues inherent in doing so.

I feel very strongly that the design team should indeed be helping clients envision what might be (or will be) coming down the pike.  No, people don’t like to think about this – but if they have already called us in and tasked us with coming up with a solution that is looking that direction, they are already going to be open to a discussion that goes into more depth than most people in the building professions themselves may be comfortable doing – or qualified to do – and I think we owe them as comprehensive and as thorough an evaluation as we can bring to the table.  The success of our interventions, as in medicine, depends on having as broad and comprehensive an understanding of the issues as possible – and to do that requires asking questions and raising issues that aren’t always easy to deal with.

From there, with an understanding of design solutions that are appropriate for each kind of situation, and the ability to pull together a team of professionals who can each contribute their expertise to the endeavor, it becomes a much easier endeavor to come up with a solution that not only fits the individual’s requirements but is also not just aesthetically pleasing but actually beautiful and indistinguishable from any other well-designed home.

But even without a client’s specific input, if someone on the team thoroughly understands the issues inherent in aging, or with particular medical conditions a given client may be struggling with, the design can be done to accomodate many of those needs without the client even knowing it.  We can then just point out the advantages to this choice or that – and there are often many that go well beyond the needs of the aging, including making many things easier for children and just day to day life for everyone.  The very best results will ensue, however, with more complete input from the client and/or his medical team, so it’s important to find a way to obtain as much of that information as possible.

If you would like an evaluation of your existing space to see if it is suitable for aging in place or accommodating a known or expected disability, or assistance in designing a new home that will fully support your living your life to the fullest regardless of your own current or future physical needs (or those of your family members), and you want to ensure a beautiful as well as highly functional result, please contact me.

HIGH POINT — The American Home Furnishings Alliance is launching a program called Eco3Home that will allow consumers to research information on AHFA members and their products regarding safety, health and environmental stewardship.

It will be anchored by a consumer website, www.eco3home.com, where shoppers will be able to find out about AHFA manufacturer or importer members participating in the program, and also can research a particular piece of furniture in detail.

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So far, very few manufacturers have signed on to this program, but perhaps more will with time, as it becomes known.  The idea is certainly an excellent one, and I hope this program really takes off.

I sure hope that the high end companies like Dessin Fournir, Holly Hunt, and others that I am accustomed to using most frequently will get onto this sort of bandwagon.  There is progress happening in the industry, with more and more attractive furniture being made in green ways, so that environmental responsibility need not mean sacrificing style, but it still hasn’t hit the really top quality goods.