Home Modifications vs Moving to a Facility

A reader asked about the considerations involved in making home modifications for people with disabilities and medical needs and allowing them to age in place vs placing them in an outside facility. *

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.

=============

* 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.

Read Full Post »

Financial Concerns and Help for Home Modifications

Do you need modifications to your home because of injury, illness, or just plain aging and a desire to stay in your home, eliminating obstacles that may exist to doing so, but don’t think you can afford them?

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.

Read Full Post »

Aging in Place, Universal Design, and Accessible Design

My friend Nicolette writes quite a bit about aging in place, disabilities, and interior design, and her posts usually get me thinking quite a lot, especially her one on strategies to deal with loss and aging.

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.

=========================

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.

Read Full Post »

Aging in Place and the Role of the Interior Designer

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.

Read Full Post »

Aging-in-Place Projects Scrub the Tub and Make Showers Accessible

 

A beautiful example of a stylish and fully accessible bathroom, complete with curbless shower/wet room, handheld showerhead, accessible sink, and well-placed grab bars. Notice how spacious this room feels without the tub or traditional shower one would normally have expected to find here, with the flooring continuous right into the shower. I'm pretty sure there's a seat just out of sight. This was designed by a professional who really fully understands accessible bathroom design.

“Despite the effect on resale value, replacing a tub with a shower is increasingly popular as aging-in-place remodeling gains interest. According to a National Association of Home Builders Remodelers survey, 70% of remodelers now report making universal-design home modifications, compared with 60% in 2006. Additionally, 60% of remodelers say these projects include adding a curbless shower, as well as grab bars, higher toilets, and wider doorways. Though most requests come from clients over age 55, more consumers are making the requests on behalf of aging or disabled family members.”

— Lauren Hunter, associate editor, REMODELING

==================================

This makes all the sense in the world for me, on several levels.

For starters, it reflects a greater focus on creating a home that is what people want for themselves, not viewing the place as an investment they are just parking in. Yes, it’s wonderful when you sell to make money, and to get the price you are hoping for or more, but what good is it, really, if you aren’t comfortable and don’t enjoy living in it yourself? Value is not necessarily measured in dollars, but in getting the biggest bang for your buck – and making sure you get what you need to support your own health and lifestyle before you try to worry about some hypothetical later buyer. Surround yourself with beautiful things and colors that you love, and the greatest (and longest lasting) reward you will reap will be your own delight and joy while you yourself live there.

Second, the reality is that our population is aging, and a far higher percentage of us are going to have to age in place whether we want to or not, just because the Baby Boomer generation is going to overwhelm our existing elder care options. Nobody really wants to leave the home that they love, but more savvy people are realizing that it makes sense to plan ahead for as many potential change scenarios as they can, while they are still able-bodied enough to do so, taking the time to do it right.

By middle age, too, the body starts breaking down, of course, and none of us can do all of what we could do when we were younger, or at least very few, and this process just accelerates as we get older. People are starting to face these realities, particularly as they see their parents and friends running into problems staying in their homes because of design that interferes with being able to do so safely and easily.  Particularly if people still love their homes and neighborhoods, remodeling to ease the transitions of getting older makes a lot of sense – and planning for it in advance of actually needing the modifications makes even more sense.

Curbless showers are particularly nice, because people in wheelchairs can just roll right in with no obstacles to overcome, there’s nothing for anyone else to trip over, either, and they make cleaning the floor a breeze, because there are fewer nooks and crannies for dirt to hide in, as with a traditional shower, and the entire floor has a tiny, imperceptible slope that prevents water from pooling anywhere.  They also make a smaller bathroom look a lot bigger because the continuous floor visually expands space, while anything that interrupts that span, like a shower curb, makes it look smaller.  It’s easier to get both kids and dogs in than to try to get them into a tub and keep them there, and controls placed low enough to be reachable by a seated user are also easier for children to reach.  The advantages go on and on.  And with today’s vast range of materials and finishes, your bathroom can still look every bit as stunning when accessible to everyone, regardless of whether you prefer a contemporary or a traditional look.

If you’ve got enough space for both a tub and a freestanding shower, you’ve got many more options, but if you can only fit one in, the shower offers more option for ease of use combined with beautiful aesthetics.

Many times these modifications are surprisingly easy and economical to do, especially if you are planning ahead and not under the gun of dealing with an emergency situation.  If you are already planning a remodel, make sure you include as many accessibility features as possible, particularly if you already have a medical condition that you know will eventually cause you to need to make changes to the house.  An interior designer who is a Certified Aging in Place Specialist to help you get the most bang for your buck (and time invested) in terms of both function and aesthetics, and integration with the rest of your home.

If you want to be sure you can stay in your home as you age, or as you move in elderly parents, or to enable disabled friends or other relatives to visit, contact Hoechstetter Interiors for anything from an evaluation of your current situation and recommendations to complete remodeling or new construction assistance to ensure accessibility, ease of use, and beauty for YOUR lifestyle.

Following are a few other images of beautiful bathrooms with roll-in (or near roll-in) showers and other accessibility features.  Future posts will look at accessibility issues and features in other rooms of the house.

This is a very tiny and narrow bathroom, but look how big it looks because of the open shower, continuous flooring, suspended vanity, and that marvelous huge mirror.  This stunning shower might be a little difficult for a wheelchair user to use in its present form because there’s no room to turn around, and hard to get assistance in if needed, but either a roll-in shower chair or the addition of a pull-down bench would allow for comfortable seating and easy transfer to the bench.  If this is all the space you’ve got, though, it’s definitely still workable even if a bit cramped – and without architectural changes.  Of course, grab bars would need to be added as well.  However, the handheld shower and controls are at a good height for a seated user (or children!), and you can see how well the shower integrates into the room without curbs, and how it visually expands the limited space.  The sink and vanity are already fully accessible because of the open space underneath, and placement at a height and with a depth that everyone in the family can use easily.

 

Even grab bars don’t have to be dull and institutional-looking.  Here is only one example of a growing number of beautifully designed styles of bathroom hardware that are designed to integrate beautifully with – or completely match – the rest of your fixtures and fittings, even in a more traditionally designed bathroom like this one.  The translucent fold-down shower seat nearly disappears visually.  I can’t tell if this is actually a roll-in shower or not, but it certainly could be.  The only thing noticeably missing here is a handheld showerhead and shower controls reachable from the seat.  It’s really a shame when a room is this attractively designed with such obvious intent to make it accessible, and such major elements are left out.  It’s on the right track, though, and shows how style and beauty simply need not be sacrificed even in a more traditional design.  If the necessary plumbing changes simply aren’t in the budget, there are add-on handheld showers that can be purchased separately and attached to the main showerhead that can bring additional functionality to a situation like this if need be.

 

This lovely “room within a room” shower still has a curb, but it’s low enough that most people would be able to navigate it with much less difficulty than with a standard curb (or tub edge!), and with help, a wheelchair could be gotten over it if necessary.  If designing this room from scratch, though, or remodeling it, it would be easy to eliminate it altogether with a little more attention paid to the way the floor slopes to the drain, with or without the contrasting flooring inside the shower and out.  The window ledge doubles as a seat (although perhaps a little low here) – totally functional, and totally unobtrusive as to purpose.  Add grab bars and a handheld showerhead, and this is another stunning example of how a shower can be accessible to all without sacrificing one iota of style.

 

This prefabricated showerpan is a lower cost way to achieve full accessibility in the shower.  That lip holds the water in, but is compressible, so that a wheelchair will just roll right over it, or you can step right on it if you can’t pick up your feet very far.  Add a drop down bench, and be sure there’s a handheld showerhead, and this is yet another well-designed accessible shower that integrates well into an attractive bathroom.  Horizontal grab bars are generally more useful and safer than slanted ones, but every little bit helps.  The sink, however, is not accessible as is, but could easily be made so by replacing the cabinet base with something that allows seated access as in some of the other images shown here, or by installing a cabinet base that can have doors while people are still all mobile, but which are designed to be easily removable later if wheelchair accessibility becomes necessary.

Many times, aging-in-place design allows for changes like this with flexible base cabinets when they become necessary, while retaining more “traditional” features until such time as they are needed.

Other options are installing backing in the shower in anticipation of adding grab bars later.  I’ve learned from hard personal experience, though, that you should buy the grab bars when you buy the rest of your fittings, and just store them away if you don’t want to install them right away.  It can take weeks or months to order something you’d really like to live with, and if you are injured (as I was last year, with a broken foot), even if you’ve already got the backing in place and every other accessibility feature set to go, you’ll get stuck with ugly hardware store special grab bars if you need them suddenly, or with finding a way to do without, which defeats the whole point.

(If anyone knows the photo credits for these images, please let me know and I will be happy to add the attributions.  My new software on my new Mac has eaten all the credits I had stored in the prior version on my PC <sigh>.)

Read Full Post »

Glass Tables – Stylish Accessories, or Death Traps?

(Please note:  This video may not run smoothly for some reason; you may have to restart it several times where it leaves off in order to view the whole thing, but make sure you watch it all, including the testing processes.)

Glass tables can be wonderful additions to many rooms in the house, and are particularly popular as coffee tables, end tables, and dining tables. They are stylish, help small rooms look larger, and can help reflect light that will help brighten any space.

But they do have one major downside, that people should be aware of, and that is that they can also provide a significant hazard for everyone in the house, but particularly for children and the elderly. Sharp edges can cause cuts and bruises when people bump into them, and particularly for the elderly, whose vision is not what it was when they are younger, they can just be more difficult to see, and thus harder to avoid bumping into. As we age, our skin gets thinner, so elderly skin is more likely to tear easily on a squared edge, too, than on one that is more rounded. Much is already made of these particular issues in aging-in-place and universal design circles.

However – and even more importantly – glass tables of all sizes and designs can also shatter, especially if someone falls on them, and severe injuries and even death may result, as the above video shows.

Even young, able-bodied adults are not immune from this risk, as both this video describes and the one blow shows graphically.

Although this second video starts out humorously, and looking like a commercial or a joke, the injuries the woman shown has likely sustained could well threaten her life, as well as disfigure her forever. The chances that the glass may penetrate her abdomen or chest, or sever a carotid artery or femoral artery (among other possibilities) are high, any of which injuries could cause her to bleed to death in a matter of minutes. She may well have also sustained a severe neck and/or back injury from this fall, fractures, and could need reconstructive plastic surgery to repair her face. This sort of trip and fall is not at all an unlikely occurrence in many homes, either, particularly as anyone who has ever had children or pets will attest.

Children are also particularly susceptible to such injuries, when they run around and jump on the furniture. Consumer Reports and the Providence Journal reported on one such tragic case of an 11 year old dying from a severe puncture wound to her leg that caused her to bleed to death.

According to Consumer Reports, “Each year an estimated 20,000 people, most of them children, are treated in emergency rooms for injuries sustained from glass furniture. In an average year, three children die”.

Pets can also cause the same kind of damage to glass furniture, and sustain the same kinds of injuries, especially if they are large and/or rowdy.

So, does this mean you should get rid of all glass tables, or never use them?

No, it just means you have to do a little homework when first buying them, and be sure that the glass is tempered/safety glass, not the more typical annealed glass used in most furniture.

Tempered glass (also known as safety glass), which is what your car windows, shower doors, and storm doors are made of, shatters into many small pebble-like pieces when it breaks, none of which are likely to cause life-threatening injuries, most of which have very few sharp edges. Annealed glass, however (which is what most home windows are made of, and almost all glass furniture parts), breaks into slabs and slices of glass of varying sizes, some quite large, with edges that are as sharp as knives, and which will quickly and easily penetrate all soft tissue, and even bone, if the force applied is sufficient. The first video above shows the difference graphically in a testing situation.

Because there are no safety standards or codes that apply to the type of glass used in tables yet (although they are now under development), it’s up to you the consumer (or your designer) to ensure that safety glass is used or specified, in order to ensure maximum safety, especially in areas of the home that have a lot of traffic, although it’s best to ensure the use of safety glass wherever glass is used in furniture in the home.

Some tables are made entirely of glass, and it may not be possible to get them in tempered glass, or they may be made in a way that makes replacing the glass portions impractical or impossible, so you will then have to decide what’s most important to you, taking into consideration where the piece will live, who will use it, the amount of traffic that will pass near it, etc.

Some manufacturers already use tempered glass as a matter of course, but far from all, so you will have to ask before you buy. If it’s just a glass top or insert, and you cannot custom order the piece with tempered glass (or you already have the piece), you can always have a replacement made of tempered glass yourself by a local glass shop. You could also have a replacement top fabricated from another material, including wood or stone, if that works with the piece and your space, and the look appeals to you, but then you will lose the visual appeal and other qualities of the glass, if that’s what you really want.

It’s also a good idea to ensure that everyone in your home and to whom you entrust the care of your children 0r elderly relatives, including babysitters and other caretakers, is trained in basic first aid, just on general principles. I don’t know enough about the case in Rhode Island, but depending upon the location of the puncture wound that bled uncontrollably as reported, it’s very possible that prompt first aid including direct pressure on the wound, arterial pressure, or even a tourniquet if necessary and possible based on the location of the wound, may have saved her life.

So, don’t let this post scare you out of using glass tables, because they are wonderful in the right settings, and totally appropriate. Just take reasonable precautions to ensure safety when selecting them – and enjoy your furniture for years to come.

Read Full Post »

Universal Design, Disability, and the “Sandwich” Generation

In his excellent Aging in Place Guide blog, which I have been following for some time because of my strong interest in universal and accessible design and aging in place, Louis Tenenbaum brought up the issue of the “sideways” pressure those of us in this position often feel coming from siblings who may be either more or less involved in the care of the parents. We’re all familiar with the concept of the upwards and downwards pressure of the three generations, but these sideways pressures don’t get much press, if any.

There’s still another aspect to this sideways pressure that Louis didn’t mention. Something that’s never talked about is what happens when the siblings themselves become in need of care, and become as much a part of the issues that we have to deal with as the aging parents, when neither of them are available to help with the care of the other. We expect to eventually have to take care of our parents, to have to worry about where they’ll live as they age, to possibly have to move them into assisted living or new, more accessible homes as they get older and sicker, but how often do we think about those potential needs for our siblings – or even ourselves?

I’ve been shoved headlong into this whole issue within the past two months in a way I never expected to have to face (or at least far younger than I ever dreamed we’d face it) – and of course, none of us do anticipate this sort of thing.

My father is undergoing radiation for cancer in Kansas, and his status is deteriorating, so we are absolutely going to have to do something about his present living arrangements. I’ve always done all the legwork to help him when he’s been sick over the past few years, and frankly resented that my brother didn’t do more – some of the sideways pressure Louis was talking about, only in reverse, but something that people face all the time. One sibling is usually the one doing most of the work while the other is less involved for any of a number of possible reasons, and this often results in tremendous family tensions, anger, guilt, and so on.

On Christmas day of 2008, however, I was suddenly thrust into the position of both having to take care of Dad – and my 50 year old brother, who has become critically ill in Pennsylvania as a result of ongoing complications of some surgery he had last year. He nearly died, and the extent and nature of his present illness and injuries mean that he’s not only facing a very long and difficult recovery, and is completely incapacitated now – but that he will very possibly not be able to return to his own home because it is completely and totally inaccessible.

And I’m here in California, suddenly trying to deal with both of them – with virtually no support from either – and certainly no assistance with the logistics.

Both of them are understandably deeply worried about the other, but neither of them are able to do a darned thing about it – and I’m pulled in three separate directions every day because of course I still have my own life and issues to deal with, as well as those of my partner.

The very fact of a still-young brother being as sick as he is highlights all the more the need for universal design at all stages of life, but particularly as we move into our middle years and on, because absolutely anything could happen – and very likely will at some point. Really, it’s critical to consider at all ages, because you simply never know when disaster may strike, but we do expect more debilitating illnesses and injuries as people age – and we have more people age 40 and up today than we’ve ever had at any time in the history of the world.

I’ve known the odds of something happening for decades, between my former career as a paramedic, and a stint selling life and disability insurance. S*** is going to happen in the majority of people’s lives at some point, end of story, or they are going to be touched by it one way or another. Not one of us is going to escape at least being touched by illness and disability at least in a family member or friend, if not our own selves.

When you come face to face with it actually happening in your own life in a catastrophic way like this, though, that brings it all home in a very different way than seeing the effects on patients or clients, or reading about it in actuarial charts or textbooks or blog posts. It moves from the conceptual into reality in a way that will make your head spin.

There is a chance that my brother will not be able to return home to his present house because of the nature and extent of his injuries, and the potential outcome he may be facing. I’m praying this won’t be the case, and with luck it won’t, but I’m bracing for it because it’s certainly not impossible. We would be able to do some modifications, but others simply won’t be possible without major reworking of the building and additions and/or extensive engineering as well as landscaping because of the size and layout of the house, so it will probably be a waste of time and money to do the little bit in this particular situation. In all likelihood, the best, easiest, and most economical course of action if things go in the direction they very well may in the course of his illness will be for him to move to a new home that would be more accessible to start with.

Can you even begin to imagine how traumatic it would be to be seriously ill, in the hospital and rehab for months, fighting for you life and even limbs – and then not even be able to return home to your own home? To have to go through the trauma of finding a new home, packing and moving, etc., especially when you are at your least physical and emotional ability to cope with the already substantial pressures of buying, selling, and moving that even fully healthy and mobile people go through? To know that you’re going to have to leave it to others to do all the legwork, packing, etc., because you won’t even be able to get to most of your own stuff? To realize that you may simply never be able to access the places you love in a home you are attached to ever again? That you literally can’t ever go home again?

Can you even imagine the pressure that you would face, even as just a family member who has a loved one go through this? Not just the emotional worry about your loved one’s health, but all the myriad of changes and decisions you’ll have to make to help them – learning how to navigate the health care system, as well as find resources to help once they come home, and likely have to figure out how to find a designer, architect, and contractor to help with housing modifications, as well as possibly a realtor, movers, etc.

I at least have the advantage of having both a strong medical background, as well as a strong design background with a particular interest in universal and accessible design, which I’ve been studying for years, and an ocean liner’s worth of resources to draw upon – but let me tell you, I still have a lot to deal with, because it’s a whole different ballgame with the personal involvement.

If you don’t already have this kind of broad background, trust me, you’ll be on a roller coaster ride to a crash course in a whole lot of things you never even thought about before, and never wanted to know about – at a pace you never imagined. And it will be all the harder because you’ll also be dealing with your own emotions and possibly even depression over your concern for your loved ones, exhaustion from their care and advocacy for them, travel, etc., and all the more so if you’ve got your own physical issues to contend with as well, which many of us do. You will absolutely have to have the help of social services people and designers and architects to even begin to be able to navigate the whole thing and filter through all of the endless details and things to consider and attend to in order to get your loved one healthy as possible again, and eventually settled back into a healthy and functional home of their own. No matter how much you know, you cannot navigate a complex situation like this by yourself.

You expect this to face these issues with parents, but not with otherwise strong and healthy younger siblings or other relatives – yet the reality is that the odds of being hit with some disabling condition at some point in life that lasts three months or longer before reaching the age of 65 are as high as 44% – and the chance that these same people will remain disabled for five years or more after the onset of the disability reach almost 60%. Here’s a great chart that shows the disability probabilities by age.

And if it’s not one of your siblings facing disability, in addition to your parents and/or children, it’s going to be you – and the others will be the ones having to deal with all of these issues for you instead. This is really inevitable in life, so we may as well all just plan for it. There’s just no point sticking our heads in the sand and hoping we’ll never have to face these kinds of issues.

A “disability” that may affect your use of your home and ability to care for your own self may be as “simple” as breaking your leg – how many of us go through things like that? Have you ever tried to take a shower with your leg in a cast in your present home? To get food prepared and onto a table while using crutches? To get up and down the stairs, do laundry, grocery shopping, put away the groceries, or clean? It’s hard enough for the couple of months you have to deal with it with a simple fracture – but what if you knew that was how things were going to remain for always? What do you do then?

Disability isn’t necessarily something catastrophic like a major stroke or paraplegia or even blindness, which is about all most people think of when they think of the term “disability”. Even the day-to-day injuries incurred by normally healthy and active people can result in their homes becoming serious barriers to their use, enjoyment, and even safety, even if they are expected to eventually recover from the problem.

And even if we ourselves are healthy and our homes provide no obstacles to us at present, how many of us have friends or relatives who would find barriers in our own homes, and thus be unable to even visit us? Or how many of us would have to move if we suddenly had to take in a disabled or elderly relative?

This is why I make the best efforts I can to incorporate as many universal design principals as possible into every project I design. We absolutely must all take these potential eventualities into consideration when buying a new home, renting a new apartment, and in designing any spaces we occupy. We must demand that builders build for these eventualities, especially since we are at a point in history where more people than ever are reaching the age where disability is more likely than ever.

Believe me, it is far easier to plan in advance, and be sure that your living space is usable for people across all age and ability ranges (or can at least be easily adapted) before a need arises than to have to worry about how to deal with it once a crisis is in your face.

And if you never do need these features? Terrific! They will still enhance your enjoyment of your home in myriad other ways, and can be easily designed by a competent designer so that they won’t even be remotely noticeable as anything unusual. Universal design is just plain good design – period. It makes navigating around the house easier for everyone, even the fully “temporarily able-bodied”. I hope we get to a point where we don’t even need the term any more, because the principles will just become so ingrained in design professionals as just the way things ought to be done, and in the public as just what they ought to have every right to expect everywhere in the built environment.

Read Full Post »