Louis Tenenbaum has written a very nice article about the basic strategy for aging in place remodeling, discussing the important considerations. I wrote a short response on his blog, then decided to take a more comprehensive look here on my own.
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.