Don’t fight your *problem. Know that there is a solution.

-Joseph Murphy

 I came across another content rich article written by a Physical Therapist and ergonomics expert, Shane Haas that is exceptional. Mr. Haas is in the business of solving problems for aging in place; enjoy his insights and remember there is a solution.

Therapists help patients see that home ergonomics modifications can work.

by Shane Haas, PT, MSIE, CPE
The benefits of applying ergonomics to the home are happier, safer and more independent patients. Ergonomics is the science of creating the best fit possible between people and their surroundings. Developed in production-based work as a way to reduce injuries, improve job productivity and increase employee satisfaction, ergonomics has since grown into other industries, including home care. Despite being long removed from the factory floor, the goal of home ergonomics remains true to its roots: adapt the environment to fit the individual.

Given the challenges of aging or living with a disability, the vast majority of patients still wish to remain living at home. The problem is that many homes, once places of comfortable living, become source of obstacles. Few homes are built with consideration of the changing needs associated with aging or living with a disability. To meet these challenges, adaptations to the home are often needed. A basic understanding of home ergonomics will help ensure such adaptations are a success. It should be noted that fall prevention efforts are more effective when adaptations are combined with other strategies (e.g., exercise, medication management, dietary supplements, footwear management).

Home Ergonomics

It is the focus of this article to highlight ergonomic modifications to the home environment. Home ergonomics deals with a population that is often old and physically limited. In industrial ergonomics, a young and physically fit population is more common. In industry, common hand tools of interest include hammers, wrenches and drills. In home ergonomics these are replaced by canes, reachers and walkers. In home ergonomics, the focal point is a single user, the patient, with particular attention being paid to his unique capabilities and limitations. In contrast, in industrial ergonomics the focus is on multiple users with attention to trends and population-based data. In industry, solutions are based on information from organizations like NIOSH and OSHA; in home ergonomics, it is the Americans with Disabilities Act (ADA).

To better fit the surroundings to the individual, the typical ergonomics approach is to reduce or eliminate risk factors in the environment. The most common ergonomic risk factors in the home are excessive force and awkward posture. Excessive force is exemplified in tasks that require significant strain or call for more strength than the patient is able to generate. Patients are often too limited physically to safely lift or control their own bodyweight which leads to struggles with basic tasks like getting up from a chair or climbing stairs. Limitations in hand strength creates other unique problems such as the inability to remove lids and tops, manipulate kitchen utensils and controls, and handle items in the bathroom.

Awkward posture is a significant deviation of the body from a neutral position. Whether sitting or standing, the further the deviation from neutral the more awkward the posture. Examples of awkward posture include low chairs or commodes that position the knees higher than the hips. The lack of adequate space under a sink forces awkward posture, as wheelchair users must twist to the side to access the sink. Narrow doorways create awkward postures as patients turn walkers sideways and use small, choppy steps to get through the door.

We will review five common activities of daily living and discuss possible ergonomic improvements for each. These improvements target reducing or eliminating excessive force and awkward postures, in order to create the best fit possible between the patient and the home. Solutions listed focus on inexpensive adaptive aids and not larger, more expensive home renovations.

1. Transfers into and out of the shower. Does the patient need to hold onto anything (e.g., wall, faucet, towel rack) while getting into and out of the shower? Is the patient able to safely lift the legs over the edge of the shower or tub (up to 18 inches)? If a lack of secure hand holds is noted, consider adding grab bars. Follow ADA standards for grab bar selection and placement. If grab bars are not able to be installed due to lack of landlord approval, poor wall durability, etc., consider alternatives such as a suction-cup grab bar, tub cane or security pole. If an inability to safely lift legs over the edge of the shower or tub is seen, adding a transfer bench can increase safety as the patient is able to remain seated during the transfer. Other showering aids to consider include anti-slip mats or strips, hand-held showers and long-handled sponges.

2. Transfers on and off the commode. When seated, are the knees positioned at a height noticeably higher than the hips? Does the patient need to push off of or hold on to anything (e.g., toilet paper holder, corner of the sink) during the transfer? To help correct low seat heights (typical height is 15 inches), consider adding an elevated toilet seat, placing a frame over the toilet, or changing out the commode with a taller bowl (17 inches). If pushing off is noted, think about adding toilet safety rails or grab bars. A flip-up grab bar may be needed if there aren’t walls near the commode. For steadiness upon initial standing, consider an angled grab bar which allows the patient to both push off and hold onto once standing.

3. Transfers into and out of home. Are there steps or stairs to get into and out of the home? If so, are there adequate handrails? Is the patient able to lift and place the assistive devices (e.g., cane, walker, crutch) on the steps safely? Can they open, close and lock the door? A ramp may be needed if the patient is unable to safely ambulate up and down stairs. If already in place, does the ramp comply with ADA standards? Common ramp-related mistakes could be the slope is too steep, a lack of sufficient landing space, inadequate hand rail(s) and poor structural integrity.

If wheels aren’t needed, but balance is still limited, consider adding handrails or secure hand-holds at the steps or stairs to help increase steadiness at these transition points. For rolling walkers and wheelchairs, doorway thresholds higher than ½ inch can impede rolling. Think about adding a threshold ramp. Threshold ramps come in various materials and sizes, ranging in height from 1- 4 inches. If opening or closing doors is a problem, consider removing a storm door (or the door closers on the storm door) or adding an automatic door opener. If manipulating door handles and locks is a problem, consider using lever handles and remote deadbolts.

4. Transfers into and out of bed. When preparing to get into bed, is the patient able to sit on the edge of the bed with hips far enough back to prevent sliding off? Can he lift his legs up and into the bed? Does the patient grab and pull onto anything (e.g., head board, side of mattress, night stand) when trying to get out of bed? If the bed is notably high, e.g., the patient is unable to sit far enough back on the bed to get in, consider adding a footstool with a handle. A leg lift can be used to help lift legs into the bed. If the patient grabs and pulls on anything to get out of bed, think about adding bed cane or rail to provide a secure hand hold for transferring out of bed and give support upon initial standing.

5. Transfers on and off a seat. Similar to transfers on and off the commode, when the patient is seated in their recliner, couch, or chair of choice, are the knees positioned at a height noticeably higher than the hips? Does the patient need to grab or hold on to anything during the transfer? If the seat is too low, consider adding furniture risers. Stackable risers are available for graded adjustments in seat height. Specially designed risers are also available for the uniquely shaped bases on recliners. Adding a couch cane will provide a secure hand hold to aid in standing. While not recommended as the best first option for seating problems, if patients need assistance beyond furniture risers and couch canes, consider replacing recliner with a lift chair.

In home ergonomics, small changes can result in big improvements in the fit between patients and their surroundings. Removing sources of excessive force and awkward postures eliminates obstacles in the home. Fewer obstacles helps return the home to a place of comfort and security, fulfilling the benefit of home ergonomics: happier, safer and more independent patients. 

 Shane Haas, PT, MSIE, CPE is Senior Fall Prevention Specialist, Adapt It Ergonomics. He graciously granted permission to reproduce this article.

See

Lighting for the Aging Eye by Shanna Casey

 (photo epicturs.com)  

*note the image shows a lovely tub that is not an aging in place solution and could be a problem for older adults.

To be idle is a short road to death and to be diligent is a way of life; foolish people are idle, wise people are diligent.

-Buddha

 It was another lovely weekend in the Pacific Northwest and I was having coffee and planning my daily activities with the local talk station as back-drop. Living in a home built in 1930 (and not the least bit handy) I tune into Around the House with Handyman Bob to pick up relevant/practical ideas on home improvement.

Today’s topic: Radon

Radon is not something I think about; in fact when we moved into our lovely money pit, we had it tested for Radon—and thought nothing of it again when the tests results showed it wasn’t an issue. Today’s program brought radon back on my radar screen. Handyman Bob began with statistics like those offered by The EPA: 

Radon is the number one cause of lung cancer among non-smokers, according to EPA estimates.  Overall, radon is the second leading cause of lung cancer.  Radon is responsible for about 21,000 lung cancer deaths every year.  About 2,900 of these deaths occur among people who have never smoked.

Bob’s delivery is kindly yet authoritative, he’s local, cares about the community and it’s palpable in every show. This edition took on a tone of warning and the statistics grabbed my attention and got me thinking about how this relates to aging in place. 

Aging in Place with Radon

Aging-in-place professionals talk of home safety in terms of the built environment and support services, seldom do I hear any one mention radon. January is National Radon Action Month and this is as important as any universal design kitchen or 24/hr alert button worn around the neck. Get your home checked—period.

Proactive Steps

1. The EPA provides maps of Radon Zones around the country—check it to see if your aging in place home is in a hot zone by clicking the link here: Radon Zone Map

 2. Find a Radon Professional in your area by clicking the link here: Radon Professionals

We lock our homes at night, use smoke detectors, remodel for bathroom safety, leave on nightlights, eat right, don’t smoke, visit the doctor and countless other measures to ensure successful aging in place in the homes we love—yet a silent killer could end it all…

Be wise, be diligent–get your home checked; I’m in favor of your aging in place for many years to come and I know The ol’ Handyman is too.

See

Radon Expert Gary Hodgden

Rutgers University/Bill Broadhead 

Listen to Around the House with Handyman Bob: On Radon The Silent Killer

Radon Show 1/12/12

Radon Show 1/14/12

Radon Show cont’ 1/14/12  

EPA: Get Your House Tested

(photo uglyhousephotos.com)

He that will not apply new remedies must expect new evils; for time is the greatest innovator.
-Francis Bacon

Jean is 91, I know she won’t mind my telling you her age—she’s proud of it. She is a walking endorsement of “Successful Aging.” And just what is SUCCESSFUL AGING? The most accessible definition comes from the book by John Rowe, MD and Robert Kahn, PhD based on the Longitudinal MacArthur Foundation Study.

The components of successful aging include:

• Good health, low risk of disease and disability.
• High mental and physical functioning.
• Active engagement with life, an active life.

Jean has all 3 in abundance. She does a light workout at the gym daily; along with regular check ups. She is the front-desk-go-to-person at my gym, and not only drives across town to get to work, but keeps the books, signs up new members, answers the phone, trouble shoots/problem solves an aging infrastructure, and interacts with a vast generational continuum. I’ve seen Jean baby sit for active mothers in yoga class, watch pets for iron-pumping baby boomers, and consult moody teens—all in the course of my work out. She also has her nose in a book or paper when not busy with her duties.

Without knowing, or pursuing it directly, she’s aging successfully by her lifestyle; it’s complex, engaging, purposeful, and active. I know, I’ve made an informal study of her over the years. So when she speaks, I listen… 

Aging in Place Remodeling

One day she mentioned to me in passing that she was having her bathroom remodeled. I asked if she was adding any Universal Design features (we’ve talked before about aging-in-place design) and of course she did. “I added a grab bar and a tiled-floor non-barrier shower. The bathroom remodel is so beautiful I want to have a party to show it off!” 

I inquired if she had done any other remodeling to her home—turns out she has done extensive work and plans on staying put! Just how much surprised me; not only did she invest in a new lovely bathroom remodel, but also added a new roof, new front door, a full kitchen remodel and painting, as well as having her 47 year old home’s foundation lifted after many years of settling. “I fixed it so the doors would close correctly.” She also had the decaying and unsafe deck rebuilt and covered—adding a new living space that had been neglected for years.

Reverse Mortgage to the Rescue

Jean had been putting off much needed home improvements due to the prohibitive costs involved—but then she reported: “I got a reverse mortgage and it made it all possible.”

A well-known financial institution in the area supplied the reverse mortgage, walked her through all the steps and made it happen for her. She was also lucky to find a wonderful contractor who is orchestrating all the sub-contracting jobs and overseeing the project. Jean could not be happier. She loves her “new home,” feels safer in it, and it has added to the quality of her life experience.

Effect of Aging in Place with a Reverse Mortgage on the Economy

As I listened to Jean proudly report the progress of her aging-in-place remodeling it occurred to me how much economic stimulus was being generated by her acquiring a reverse mortgage. Jean was a stimulus package unto herself! Thinking in terms of systems, imagine all the economic transactions involved in the following list: 

1. New Front Door

2. New Roof

3. Newly remolded Kitchen and floor

4. Newly remodeled bathroom

5. Painting

6. Redoing the foundation

7. New deck

All the economic activity generated by just one reverse mortgage—work that would not have been done otherwise. Not to mention the added security, safety, and pure joy of living in a remolded home…what a win-win! 

Saving the Economy one Home at a Time

In the United States (not to mention the rest of the world) we have an aging building stock that requires remodeling to accommodate the demographic transition. By the end of 2011, 28% of America’s housing inventory will be 56 years old or older; 52% will be 35 years old and getting older. There are over 41 million houses in this age bracket, and many are homes of rapidly aging occupants. Even if limited percentages are reverse mortgage candidates imagine the potential boost to a sagging economy.

Couched purely in economic terms, putting workers back on the job, purchasing needed products, keeping people in the community verses early institutionalization (huge cost savings) and employing companies that provide reverse mortgages, all makes sense. Add the value in safety, preserving aging housing stocks/neighborhoods, social equity of an employed public, and quality of life enhancement for older adults—it’s a “slam-dunk.”   

The Bathroom Remodel Party

Jean will have her party in the new bathroom; I’ve been invited and look forward to seeing the end product. May her ranks grow one-by-one, neighborhood-by-neighborhood, city-by-city, coast-to-coast. It’s been said: If you want a BIG opportunity…find a BIG problem. This is both, and something to consider carefully.

See 

Reverse Mortgage Information.org

8 Elements of a Home in High Demand for an Aging Population

(photo newburghrestoration.com)

Thousands of candles can be lighted from a single candle, and the life of the candle will not be shortened. Happiness never decreases by being shared.

 -Buddha

One of my favorite songs is James Taylor’s The Secret O’ Life is Enjoying the Passage of Time; and the holidays remind me that another year will soon be past. As I hung the paper-star lanterns in the front window, it seemed like I had just put them away…and now it was time to ponder gift-giving once again. 

Something You Want

I read a post about an older adult named “Bob” whose step-son asked him what he wanted for a gift this year. His response…”I really don’t need anything.”  The step-son replied “Bob, I am going to get you something, it might as well be something you want.”  What I read next simply delighted me with its practicality and possibilities.

Bob:

I thought for a while and finally said: “Give me three light bulbs and the promise that you will install them as needed.” The beauty of the gift is that I have not been on a ladder in over a year and thus have avoided the risk of falling. 

The Gift of Aging in Place

Each year getting older adults gifts (or yourself for that matter) can actually be counter-productive; see hoarding and clutter. How many times have we heard the “I don’t need anything” line, and a desire to give gets even more clouded by feelings of obligation or tradition. And in today’s climate resources are tight for many, so here are some thoughts on capitalizing on two trends affecting all of us; the aging population and the economic downturn. Give the gift of aging in place, because according to AARP this is what 89 percent of boomers/seniors want.

Get creative and make a coupon book, or single coupons for the following aging in place gift ideas:

10 Aging in Place Gifts that cost only your time

1. One home safety inspection: Then on the coupon date, go over the CDC/MetLife foundation Check List for Fall Prevention and Home Safety with the home owner and identify possible needed home modifications.

2. To put up/take down Christmas lights

3. Be their chauffeur for a day (you will drive them in their car anywhere they desire)

4. Walk the dog each week for a year

5. Cut the grass every two weeks/or shovel snow

6. Give a caregiver the weekend off and you do the caring

7. Cook dinner in-home one night for the senior

8. A deep-cleaning of the home

9. Tech-session (computer tutoring) help them set up a Facebook page or email

10. Wash/wax/change oil/vacuum the car  

10 Aging in Place Gifts under $30

1. Home Smoke Alarm battery changes every 6 months

2. Change out lower watt bulbs with 3 higher/brighter energy-saving ones

3. Replace 3 toggle light switches with 3 rocker-style ones

4. Put in a Lever handle door opener to replace an old round doorknob    

5. Install a toilet seat raiser

6. Put non-skid strips in the tub/shower

7. Paint the steps a brighter color (or paint the ends of the steps a bright contrasting color)

8. Place 2 Sensor LED Lights; one at the top and bottom of the stairs

9. Install a Duro-Med Expandable Door Hinge

10. Add a Wide Angle Peephole Viewer in the front door

10 Aging in Place Gifts $100

1. Rubber Threshold Ramp with Beveled Edges

2. The MemoryPlus amplified BIG button phone

3. Replace old worn bedroom slippers with new with nonSlip sole ones

4. Clamp-on tub rail

5. DRILL-FREE Slide Bar with Handheld Shower and Showerhead

6. Snapfon “ez ONE” Cell phone for seniors w/ big buttons

7. Switch Sticks Walking Cane

8. Outdoor Motion Sensor Solar Security Light

9. Toro Electric Power Shovel

10. JitterBug (GreatCall) Phone

Marjorie Holmes said; “At Christmas, all roads lead home.”  This year make aging in place the gift; because home is the most important place on earth to enjoy the passage of time…

See

Tip: The Goodwill often has aging-in-place items like walkers, shower chairs, canes and wheelchairs (look there first to save)

Aging in Place Gifts

Laurie Orlov’s: Tech Gifts for Seniors

The Secret O’ Life by James Taylor

My Safe Home

NAHB Aging in Place Checklist

Hire an AIP CAPS Professional  

(photo angel-lifestyle.com)

*Note these items and actions do not guarantee successful aging in place-but they can increase the odds

“Discovery consists of seeing what everybody has seen and thinking what nobody has thought.”

 — Albert von Szent-Gyorgy

Louis Tenenbaum is the father of the aging in place movement in this country; when he speaks/writes, I for one, pay attention. Here is a guest post by Louis on being inspired in Beantown. Within these words is some gem lying in waiting; enjoy.   

I am an innovation immigrant. 

I don’t often feel inspired. But I am inspired by the incredible third annual Aging Means Business Conference held Friday in Boston associated with the Gerontological Society of America annual meeting.  This was my second time at this conference organized by Greg O’Neill and his team of Sarah Wilson and Dani Kaiserman from the National Academy on an Aging Society working with Mary Furlong and this time with the always provocative and fun (and of course, natty!) Joe Coughlin from MIT AgeLab.

I have been involved with Mary’s events for a few years…having been a semifinalist in the first year of her Boomer Venture $10,000 Business Plan Competition and on the winning team a few years ago. This time the results Mary has been working toward really came together. There was a healthy mix of long dedicated and newly interested business thinkers. The energy was palpable. Just being in this crowd was fun.

The air of excitement started at a Friday night reception hosted by First Republic….a bank that is doing things differently. As we learned in one of the next day’s presentations, they are paying attention to their customers! What a novel idea! The innovation I heard that sounds great?…NO music! (Turns out I am not alone unable to hear and concentrate with music playing in the air around me. I avoid retail and restaurant experiences for this problem. This bank listened.)

Curiously (or NOT- maybe expectably) that issue rose again later in the day. Gretchen Addie and Jose´ Colucci  from IDEO, the quintessential design and innovation consulting firm, engaged us in a process throughout the day rather than just giving a presentation. Innovation worksheets were on the tables when we came in. We were encouraged to state ideas, note the participants, explain the idea, make a sketch and then hang them on a board. Gretchen and Jose´ reviewed them, then shared their take on a few, putting our new ideas in a context of some of their previous projects. We saw how they help ideas grow.

One of these ideas related to the bank practice- Cones of Silence for restaurant tables – allowing diners to dial the background ambiance/noise up or down to balance their desire and threshold for atmosphere and conversation. BOY would I love that!

Matthias Hollwich, the keynoter was a real hit. Matthias is a co-founder of HWKN and the design leader of the BOOM senior communities. Those of us in the senior community design field for many years might say there is really nothing new here, other than wild looking/futuristic house forms. That misses the point. The point is a young, excited and out of the box designer came to this field cold, with no prior knowledge or assumptions and came to the same conceptual conclusions about lifestyle and community we have been promoting for years. That is totally validating! Second, his work is evidence of fresh and growing interest in these opportunities. Third, he brings fresh ideas for reaching the solutions. This young and really pleasant architect and…. just  plain….leader,  pulled together an extraordinary team, bringing real excitement to housing older folks in community.

True to form, Matthias would not be satisfied with the same old survey data. He engaged Hunter Tura of Bruce Mau Design, also new to this field, to develop a tool (looks like an app, folks) to gain customer insight. They hit the nail on the head.

I was excited, but not inspired, when I went to bed. I woke up ready to work, and, reviewing some materials, the inspiration hit.  What turned up the volume? Two more stories.  Do you have the patience?

1. I was so happy to see Jan Hively when I walked into the room Friday morning. Jan Hively, human extraordinaire, is lively, engaged, committed and she gets things done! Jan showed me a brochure from the European Union AAL program (Ambient Assisted Living- the EU term for aging in place or community). The EU has declared 2012 as the European Year on Active Ageing and Solidarity between Generations.  Saturday morning I downloaded the ‘brochure’, a catalogue really, of projects- and started looking for individual project pdf’s to download for reading on the plane home. I was bowled over by the sheer number of ideas they are pursuing in the EU effort.
2. That reminded me of a conversation I had at the conference with Marcus Wilhelm, Research Director from Redstar. Marcus, like Matthias, is an innovation native.  He explained the way his company building company works. They generate eight ideas a month, winnow them down through research with the goal of supporting a few startups per quarter. I had heard this sort of thing before but never got much of a handle on it.

I have been trying to get a handle on innovation for a few weeks. I thought I had it recently- thinking it was about leaving assumptions behind. That is part of it. Now I think it is about the process of rapid idea generation. That fits the pace of the digital/internet world, where I am also an immigrant.

This is exactly what Gretchen and Jose´ did with us.  It clicked for me as I paged through the plethora of ideas being pursued in the EU.  The process of innovation is to generate lots of ideas and consider them. For we immigrants it is a new way to think.

I feel inspired to generate lots of new ideas for the problems I am trying to solve, many of which are identified in Aging in Place 2.0: Rethinking Solutions to the Home Care Challenge

Trust me there was much more to think about and many other exciting, even inspiring, people at this conference. I may get another post or two out of it.

Congratulations and THANKS to those who worked so hard to pull this together. Inspiration is a gift. I appreciate it. I hope I see all of you at next year’s conference November 14-18, 2012 in San Diego.    Why miss a chance for inspiration?

See

Aging in Place Ideas

(photo cupboardsonline.com)

Life’s most rewarding challenge lies in defeating the temptation to merely exist.

- Laurie Harper,  A Taste for Life (1983)

I called my friend Frances the other day; she’s in her 90’s and residing in a traditional nursing home. Our conversation always gets around to her anguish over being “stuck in this “godforsaken place.” Her home defined her in a very real sense; it was her life’s purpose.

She now depends on a wheelchair for mobility and her mind has atrophied from the lack of stimulation. I miss our challenging conversations in her home office and watching the squirrels together, under the tree in her yard.

When Aging in Place Doesn’t Work

Howard Gleckman wrote a thought provoking piece on the challenges with aging in place. His premise was thatfactors having to do with social issues, more so than medical concerns, are often the barriers to aging in place:

-Lack of qualified caregivers

-Lack of services such as basic transportation

-Lack of housing or funds for repairs

-Lack of social networks and isolation

His solutions include more flexible Medicaid programs (they pay for NH, but limited benefits for home care) and anemphasis on long term care insurance which will provide financial resources to care for loved ones.

Gleckman concludes that we can’t keep everyone home (i.e. those with severe dementia), but postponing institutionalization of the elderly, by even months or years, is a goal worthy of our best efforts.

I agree keeping the dream of aging in place alive is not easy, and neither is telling a loved one they must leave their home…

Listen to: Convincing an Aging Mother to Take a Hard Step

See

Aging in Place is not so Easy

The Death of Nursing Homes

Can Aging in Place Reduce the Cost, Increase Quality of Healthcare?

Swedish “Night Patrols” Help Elderly Stay out of Nursing Homes

(photo photonet.com)

The home should be the treasure chest of living.

-Le Corbusier

Once in a while I’m delighted by someone else’s thoughts; so much so, I’d wish I had written them. This is such a case…A guest post by Ronny Wiskin: 

Home, a place with familiar surroundings having provided years of memorable events. Staying in your home might still be your best option.

Why are so many mature adults moving after investing a considerable amount of time and resources into their properties? Before making that decision, why not investigate options that are available to remain in the home you love. The thought of relocation begins when routines like personal hygiene, cleaning, preparing meals and social activities becomes too difficult to manage. It can feel like moving is the only option to retain dignity and independence. But does moving from a 2000 sq/ft home into a 500 sq/ft nice facility or dorm room make sense? Many people will store, sell or give away belongings and downsize to a smaller home that seems easier to maintain when home becomes an obstacle course filled with challenges at every turn. The plan is referred to as retirement or independent community living.

When moving into retirement living, people want a more manageable lifestyle. A common belief is that moving into a retirement community means that help will be available whenever it’s needed. It’s also believed that moving into an independent living building means that the environment will meet long term accessibility needs for varying levels of ability. Unfortunately, this is not possible in either scenario because barrier free design features are not a current requirement under local municipal building codes and assistance with homemaking or personal care is too costly to include in monthly maintenance or rental fees for most of these facilities. Yes there is a social appeal (people like to make new friends.) Certainly, many amenities and services are offered outside your designated living space. But community centers and other social environments and programs for senior adults are available in most neighborhoods.

Retirement living communities offer another option. However they can also present many of the same challenges as staying in the existing home. If an injury or illness occurs, performing activities of daily living can be difficult to manage independently no matter where you live. Help should be brought into the home when individual attention is needed. Moving into a nursing home is a common solution for people that require full time assistance, although this personal help will cost over and above the standard living expenses. This is why many of today’s senior adults are choosing to adapt their current homes in order to meet their long term accessibility and care needs. Bringing a mix of independent and government provided care services into the family home is a consideration that avoids having to move while natural changes in lifestyle occur.

In Ontario, housing built before and during the 1900’s was not designed with barrier free living or wheel friendly access in mind. This is largely because local municipal building codes do not specify accessibility as a mandatory requirement for residential construction. Today there is a greater demand for accessibility being recognized. The standards are beginning to improve. What can be done in order to remain in the home you love? Modifications can be made to houses, condominiums, retirement homes and long term care facilities. These adaptations are made so that residents are able to live, work and play to the best of their abilities with reduced need for assistance. Examples of how these changes can be made are listed as a resource for some of the most practical home modifications made for independent living and fall prevention to ensure long term accessibility.

Entrances and Pathways
• Upgrading lighting that surround pathways and entrances for increased visibility.
• Leveling pathways and entrances eliminates trip hazards.
• Security upgrades can keep unwanted visitors away.
• Handrails, ramps and porch lifts increase safety and accessibility for mobility devices such as walkers, canes, wheelchairs and scooters.
• Widening of doorways allows for clear passage of mobility aides and devices throughout the home.

Stairwells and Living areas
• Lighting upgrades inside the home increases visibility of trip hazards such as belongings left on the floor or even a small pet.
• Removal or securing throw rugs will minimize risks associated with falls.
• Handrails on both sides of the staircase and adding a “No-Skidding” floor surface to stair treads makes climbing stairs safer.
• Installation of stair glides makes getting up and down levels safer for those having difficulties with mobility or balance.
• Elevators or vertical platform lifts are installed between two levels or multiple levels to achieve complete wheel friendly access for multi level dwellings.

Kitchens and Bathrooms
• Installation of full extension glides in existing lower cabinets including under sinks and pantries will allow for easy access to pots, pans, dishes, glasses etc. without the need of bending and crouching or the dangerous use of step stools.
• Installation of shower rails, increases bathroom safety and ease of use.
• “No-skidding” floor treatments reduce slip and fall hazards on wet floors.
• “Safety Bath” tubs make bathing safer and easier for people with mobility challenges.
• Barrier free showers provide independent access to showering for people of all abilities.
Contacting a trained professional to perform a safety and comfort assessment can help identify risks and prevent major injuries at home. You will begin to realize that by making the appropriate changes it will allow you to live more comfortably and remain independent in your own home for as long as you want!

See
Ronny Wiskin, Aging at Home Consultant Founder of Reliable Independent Living Services® www.reliableliving.com

Email or phone for a free special report 416-502-9200 info@reliableliving.com

© 2011 the above can not be copied or published without the written consent of the author. Reliable Independent Living Services® design and install barrier-free living spaces. They have the experience and resources needed in order to transform any work or living place into a comfortable, barrier-free environment.

(photo daytoninteriordesingers.com)

 (Photo Reuters)

The lover is a monotheist who knows that other people worship different gods but cannot himself imagine that there could be other gods.

-Theodor Reik, Of Love and Lust, 1957

When I was working as a nurse’s aide during my under-graduate days in a nursing home we had a resident with a girlfriend who made conjugal visits. We all were aware of the scheduled times and pulled the curtain on his semi-private room during these encounters. Even his roommate “Sam” who’s stroke left him in a wheelchair with left-sided paralysis, knew it was time to leave the confines of room #12 for the designated period. I’m ashamed to admit the staff (me included) joked about it—because he too was wheel chair-bound and had complicating medical issues. Like clock-work “she” would show up and the resident, let’s call him “Mr. Mark,” Old-Spiced up, showered and shaved, would make love as scheduled on Wednesday afternoons at 1800 (6pm).

Old people have Plenty of Sex when Not in Institutional Settings 

A nationally representative survey of more than 3,000 U.S. adults ages 57 to 85 found that more than half to three-quarters of those questioned remain sexually active, with a significant proportion engaging in frequent and varied sexual behaviors. So this tells me older people are having plenty of sex, but those in institutional settings face many intimacy gauntlets; 

1. Too narrow of Mattress to accommodate two adults

2. Culture and Place-bound lack of cultural sensitivity to customs

3. Nurses and aides entering the room unannounced

4. Can’t lock doors

5. Institutional Time Nursing homes are run for efficiency, not for individual schedules

6. A Room of My Own Privacy sacrificed due to shared space

7. Loss of Identity status stripped away

8 Loss of Meaningful Objects Personal items locked up and limited room decor

9. Aged Not Entirely Human Talked about in the third person

10. Exposure to Constant Death Turn Over Residents disappear without explanation

11. Nursing home administrators afraid of Law suites due to dementia in residents being overcautious with policies on intimate contact 

Sex: An Argument for Aging in Place 

Over the years I’ve made arguments for the case of aging in place; suggesting taking care of yourself physically/mentally, getting a home assessment, making universal design changes in the home, considering New Urbanism, or looking into aging-in-community options, or CoHouisng. Aging-in-place professionals often get frustrated with trying to get clients to consider making home modifications now, not later when it’s a crisis—a few are listening and preparing…but the majority aren’t. Maybe SEX is a compelling enough reason to plan for aging in place?

“Why is it so hard to remain sexually active in a nursing home?” asks a psychologist. His answer: because nursing homes may be denying residents the individual rights of privacy and the pursuit of happiness. Although many nursing homes are making strides, sex and the nursing home are still strange bed-fellows. Perhaps it’s because they are institutions designed for supervision and surveillance (paternalistic); having professionals decide what’s best for residents. But do people in nursing homes retain the same rights as the rest of us to mess up or enhance their lives with sex?  

Like any complicated issue there are multiple sides to consider, but in the end, I too, hope we continue to insist on our cherished rights of self-expression. In the meantime, does it make sense that it’s easier to get a conjugal visit in a jail than in a nursing home? Boomers if this doesn’t convince you—nothing will. You may want to consider planning that aging-in-place strategy now—your future love-life may depend on it.

Love in a Life    

by Robert Browning

Room after room, I hunt the house through We inhabit together. Heart, fear nothing, for, heart, thou shalt find her, Next time, herself!—not the trouble behind her Left in the curtain, the couch’s perfume! As she brushed it, the cornice-wreath blossomed anew,—Yon looking-glass gleamed at the wave of her feather. Yet the day wears, and door succeeds door; I try the fresh fortune—Range the wide house from the wing to the centre. Still the same chance! She goes out as I enter. Spend my whole day in the quest,—who cares? But ’tis twilight, you see,—with such suites to explore, such closets to search, such alcoves to importune! 

See

 AARP Sex Study

Naughty Nursing Homes: Is it time to let the elderly have more sex?

An Affair to Remember

 Un-Married Seniors Having Sex in Nursig Homes

Eric Clapton Old Love  

Then it don’t matter. I’ll be all around in the dark – I’ll be everywhere. Wherever you can look – wherever there’s a fight, so hungry people can eat, I’ll be there. Wherever there’s a cop beatin’ up a guy, I’ll be there. I’ll be in the way guys yell when they’re mad. I’ll be in the way kids laugh when they’re hungry and they know supper’s ready, and when the people are eatin’ the stuff they raise and livin’ in the houses they build – I’ll be there, too.
–Tom Joad
Character in The Grapes of Wrath (1939) by John Steinbeck

I remember as a senior in high school being exposed to the black and white movie classic The Grapes of Wrath in a sociology class. I don’t recall being all that impressed at the time…But, as the Buddhist saying goes: When the student is ready, the teacher will appear…
Many years later I was reading a fair amount of John Steinbeck (you never know when the seeds of influence will sprout). So taken by his prose I was compelled to make a pilgrimage to the land of his birth Salinas, California. The road trip consisted of coffee and Steinbeck audio tapes–I was in heaven.

After several days of long-haul driving, I found myself on the steps of his boyhood home in Salinas. I stood on the porch and tried to imagine the world from his vantage point. Later in the day I visited The National Steinbeck Center and the immersion into literary bliss continued.

The Nobel and Pulitzer Prize winning Author’s observations of the human condition took me places I could never have dreamed existed. The insights and pictures he painted with common words sparked my imagination and taunted my comfort zones.

The Salinas valley is known as “the salad bowl of the world” because of titanic quantities of leafy greens that blanket the lowlands. The fields have been traditionally the domain of the working class and migrants, which greatly influenced the young Steinbeck.

Aging in a place other than home
I mention Steinbeck because of an image I saw recently of 77 year old Lyla Cocburn sleeping in a camper after a foreclosure eviction. The photo is hauntingly Steinbeckish and harkens back to a time of national suffering depicted in The Grapes of Wrath:
“The houses were vacant, and a vacant house falls quickly apart.” Chapter 11, pg. 149

“Grampa didn’t die tonight. He died the minute you took ‘m off the place.” Chapter 13, pg. 186

“I ain’t no good no more. Spen’ all my time thinkin’ of home, an’ I ain’t never gonna see it no more.” Chapter 28, pg. 538

The conditions aren’t as extreme as during the dust bowl or the great depression, but in the spotlight of national politics there is finger pointing, scapegoating; and the gamut runs from unscrupulous opportunists to those genuinely seeking solutions. In the meantime real people are losing their homes. This hits seniors especially hard and threatens the dream of aging in place.

Isn’t it Pretty to Think so
Nia Apartments is a King County Housing Authority (KCHA) project in Seattle dealing with the issue of affordable housing for seniors and people with disabilities. Here, dedicated individuals are keeping the dream of aging in place alive for those who were short on hope.

There is also sobering news from a KCHA report:
• By 2025, the number of seniors in King County will double, representing 23 percent of King County’s total population. The numbers of seniors living in poverty will more than double.
• Currently, the need for affordable housing greatly surpasses the supply. An additional 936 subsidized units will need to be created each year until 2025 just to maintain the current ratio of affordable housing to poor seniors.
• The future needs of seniors will differ in some respects from today’s seniors. The baby boom generation is less likely than prior generations to derive its retirement income from lifetime sources such as pensions or annuities. Instead, more seniors will have to rely on lump-sum sources such as 401(k) and savings plans, which require more attention and are less secure. Seniors are expected to live longer and spend more years with limited mobility and supportive services needs.

What is true for King County, Seattle, is reflective of the rest of the country facing the age wave.

If Steinbeck were alive today he’d witness history repeating itself and observe that human suffering in the land of plenty unfortunately lives on.
For things did get better after the great depression and they will again…In the words of another writer of muscular prose: “Isn’t it pretty to think so.”

See

Modern Day Grapes of Wrath

The Grapes of Wrath (1939): John Steinbeck, The Village Press-James Lloyd.
Quote:The Sun Also Rises (Ernest Hemingway): “‘Yes,” I said. “Isn’t it pretty to think so.”
For more on Seattle and King County see: Senior Digest

(photo twentyfourframes.wordpress.com)

To a father growing old nothing is dearer than a daughter.

-Euripides

I recently posted a “best-of” (retread) blog titled: The Meaning of Things to make a point that meaningful objects from home lose meaning in institutions like nursing homes. When bloggers share ideas/concepts/stories on the net, we can only hope—like sending children off to school, they will do good in the world or have some positive influence. This post evoked a response I will always remember—and made my point more eloquently and personally than any of my efforts may have engendered. Sometimes replies trump the blog-post; and this was one of those times.

Please read “Roberta’s” contribution, and imagine what she must have felt—I know you’ll be moved:

August 12th, 2011 on 12:18 pm

What a beautiful and powerful article. I have had experience with cherished things belonging to cherished people (my parents) in nursing homes. The loss of my Dad’s glasses still haunts me. How could someone have taken his glasses, how could we have prevented their loss?

In his final days he could not clearly see faces of the people he loved. His mind was totally sharp it was his body that was sick. After the morning that we discovered that they had disappeared over night he never mentioned them again. We could not get a new prescription fast enough. He never again saw us or the smile of his beloved grandchildren.

Cherished objects become cherished because they connect us to the world and to ourselves. We cannot dismiss them as unimportant – they are part of what helps us to live and eventually to let go at peace.

 See

(photo rreyes.corbitecso.com)

The Meaning of Things