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Answering the Call for People-Centered Housing All Life Long

Bring on the candles and cake: The first baby boomers turn 60 in 2006. This milestone birthday also serves as a sobering reminder that America is aging — and brings up the question of how ready the nation is to help this "forever young" generation, as well as current seniors and people with disabilities, stay in their homes.

The Dec. 2005 White House Conference on Aging specifically addressed the need to help seniors age in place by adopting resolutions that called for the country to "Expand opportunities for developing innovative housing designs for seniors' needs," among others. Additional resolutions addressed the need for safe and accessible senior transportation, both public and private. (See the sidebar in this story.)

A successful aging-in-place strategy, of course, must include education, so seniors know what kinds of product solutions — both high and low tech — are available. Rehab suppliers also can reach out to current clients who, in addition to their custom wheelchairs and seating systems, could benefit from lift and transfer equipment, bath safety products and accessibility solutions.

Use this special home accessibility feature section to catch up on new legislative developments, and to help customers take full advantage of mobility solutions for the home.

A Home Accessibility Checklist White House Conference on Aging

A Home Accessibility Checklist

Mobility Solutions to Common Home Challenges
Home is where the heart is, as the saying goes, but for people with mobility issues, home can also be a place full of challenges. Fortunately, the mobility industry is full of solutions, whether your customer is a senior with strength or balance issues, or a rehab client in a custom wheelchair and seating system. The first challenge is recognizing potential danger areas. The second is finding products that can help. Some barriers — such as narrow doorways — may only be fixed by reconstruction and renovation. But the good news is that mobility products can solve a lot of other problems. We start you off by describing the kinds of mobility equipment that can improve home accessibility. To find product brand names and manufacturers, check Mobility Management's 2006 buyer's guide.

To help seniors find a certified aging-in-place specialist (CAPS) who can recommend and/or perform home renovations, visit www.nahb.org — the Web site for the National Association of Home Builders.

Challenge 1: The Front Door
AARP, the Center for Universal Design at the College of Design, North Carolina, and Easter Seals all offer checklists to assess a home's accessibility. Of course, accessibility starts before a client even enters the home. So let's begin with the front door.

Accessibility Alerts: Entrances may include steps or thresholds that impede wheelchairs and POVS, and require ambulatory users to lift their walkers, canes and rollators and step up and over. Entry areas may be so narrow that wheelchair and POV users must approach head-first so doorknobs are too far away to reach. Doorknobs may be difficult to grasp and turn. Doors may be too heavy to push open. Inside, entryways may be too narrow or small for wheelchair users to pull the door open while also moving their chairs out of the way.

Accessibility Answers:

  • Wheelchair lifts and custom and modular ramp systems can replace stairs leading to an entrance.
  • Modular and portable ramps can temporarily or permanently bridge smaller numbers of steps.
  • Doormat-like ramps can enable wheelchair and POV users to traverse single steps or thresholds.
  • Door-opening systems can lock, unlock, open and close doors from a distance — and thanks to battery backup, the systems will even work during power outages.
  • In addition, at last fall's Medtrade, several power chair and driving control manufacturers showed off new systems that can be programmed to open doors and windows, control thermostats and enable users to carry out other functions from the comfort of their wheelchairs.

Accessibility Extras: AARP suggests keeping plants well trimmed along walkways and entryways, and choosing plants that will not drop berries or leaves along those paths.

Challenge 2: The Bedroom
Checklists from the Center for Universal Design and Easter Seals suggest an optimally accessible home would include a bedroom with an open floor plan (to maximize sight lines and minimize hallways, doorways and "blind spots") and an accessible bathroom.

Accessibility Alerts: Tight quarters make transfers and maneuvering difficult for people with disabilities and caregivers. Transfers from bed to wheelchairs or stationary chairs and back are time-consuming, laborious and potentially dangerous.

Accessibility Answers:

  • A bed that can be lowered close to the floor can facilitate transfers.
  • A bed rail can help prevent falling and can increase maneuverability in and out of bed. If using a bed rail, assess the mattress to make sure there is no gap between it and the side rail to reduce bed rail-related injuries. Smaller, portable bed rails can be attached to different locations along a bed frame, then moved or removed as necessary.
  • A mattress with raised foam edges provides a sense of boundaries and may eliminate the need for bed rails.
  • Side rail protective covers, bed alarms, assist bars or mats next to the bed can improve safety.
  • Ample floor space for mobility equipment ensures easier transferring.
  • A reinforced ceiling can accommodate ceiling-mounted patient lifts. If users and caregivers prefer portable patient lifts, they'll need enough room to maneuver the lift next to the bed for safe transfers.
  • A larger closet in an accessible area may be able to accommodate an elevator. Architect Laurence Weinstein suggests two-story homes include closets on each floor, one directly above the other: "(The closets) could easily be converted into a shaftway for easy installation of a residential elevator."
  • Transfer aids can help people with disabilities transfer more safely and easily.

Accessibility Extras: Easter Seals suggests that sliding closet doors or pocket doors may be easier to use (and take less space) than doors that swing out or in.

Challenge 3: The Bathroom
According to the National Safety Council, injuries from falls were the third leading cause of accidental deaths in the United States in 2002 (behind transportation accidents and drug/toxins poisoning). And the mortality rate from falls rises as seniors age, according to George F. Fuller, of the White House Medical Clinic in Washington, D.C. Says Fuller in an American Academy of Family Physicians report: "The mortality rate for falls increases dramatically with age in both sexes and in all racial and ethnic groups, with falls accounting for 70 percent of accidental deaths in persons 75 years of age and older." Because of the number of vital activities that take place in the bathroom every day — from toileting and grooming to bathing and dressing, it's easy to understand why so many household accidents occur here.

Accessibility Alarms: Because bathrooms are generally small and include tiled floors, sinks, counters and toilets, people who fall here are very likely to strike one or more hard surfaces. Wet surfaces create slippery conditions on floors and in showers or bathtubs. Scalding-hot water or water pipes can cause burns, particularly dangerous to those who can't feel that they've been injured due to loss of sensation.

Accessibility Answers:

  • Curbless, walk-in showers or bathtubs with doors help users to step in or wheel in without navigating over high barriers.
  • Non-slip surfaces in showers and bathtubs can help prevent falls.
  • Grab bars in showers, on walls above bathtubs and on the walls near toilets provide secure handgrips. Contemporary grab bars are designed to look like towel bars and match other bathroom accessories.
  • A handheld showerhead, newly available with handstraps to minimize dropping, provide greater independence.
  • Easy-to-reach and easy-to-use water controls with anti-scald devices prevent serious burns.
  • A place to sit can foster independence while minimizing the risk of falling. In the bathtub, a flat ledge wide enough for sitting can be added. For a walk-in shower, a fold-down seat can be attached securely to the wall. Shower chairs and benches are portable alternatives.
  • Raised toilets reduce the distance a user must travel to sit. Adjustable toilets also aid in transfers from wheelchairs.
  • Bidet systems and automatic-flush toilets can make hygiene easier and safer.

Accessibility Extras: Bathroom doors should swing out for safety. Because most bathrooms are small, people who fall often block the doors, making them difficult to open for caregivers or rescuers. Bathrooms should also be fitted with telephones, so users can call for help. A clear interior bathroom area at least 5' by 5' will provide most wheelchair users with enough space to maneuver. Providing clear space in front and to one side of the toilet and knee space under sinks can enable wheelchair users to perform bathroom functions more independently. Pipes under sinks should be securely covered in insulation so wheelchair users don't bump their knees or suffer hot water pipe burns.

For real-life home accessibility case studies, check out the July 2006 issue of Mobility Management.

White House Conference on Aging: A National Conversation for Universal Design and Accessibility

Imagine a world where people get older and stay in their dream homes. Imagine a place where the products, services and technologies not only help people to stay at home, but also to retain their independence and abilities. Several resolutions drafted at The White House Conference on Aging (WHCoA), which convened for four days in mid-December and only occurs once every 10 years, are likely to create a better world for seniors.

The theme for this year's conference, "The Booming Dynamics of Aging: From Awareness to Action," focused on the challenges and opportunities that face the 78 million baby boomers born between 1946 and 1964 and how to develop effective aging policies and initiatives for the future.

The 17-member WHCoA Policy Committee, appointed by the president and Congress, held 13 Listening Sessions in 2005 to gather information from the public, 20 Solution Forums that helped the committee define its agenda, as well as several mini-conferences. Delegates (1,200 total), including governors, the National Congress of American Indians, members of the 109th Congress as well as representatives of aging organizations, selected the top 50 resolutions they believe to be the most important policy initiatives for current and future generations of seniors. Delegates will use this list to make recommendations to the president and Congress. (To view the list in its entirety, visit www.whcoa.gov.)

Some of the resolutions that spell good news for the HME industry include:

  • Reauthorize the Older Americans Act within the first six months following the White House Conference on Aging (see sidebar)
  • Expand opportunities for developing innovative housing designs for seniors' needs
  • Encourage community designs to promote livable communities that enable aging in place
  • Support older drivers to retain mobility and independence through strategies to continue safe driving
  • Ensure that older Americans have transportation options to retain mobility and independence
  • Ensure appropriate care for seniors with disabilities
  • Ensure appropriate recognition and care for veterans across all health care settings
  • Strengthen and improve the Medicaid program for seniors
  • Strengthen and improve the Medicare program

Many of the resolutions reflect awareness that people with disabilities are living longer and healthier lives and as a result, have specific concerns and needs that have to be addressed. In addition to people aging into a disability, more attention is now cast on the needs of seniors aging with disabilities because they are often living as long as their non-disabled counterparts.

Through this recognition, considerable focus was placed on the goal of creating an accessible nation by "expanding the availability and utilization of assistive and universally designed technologies and environmental interventions," says delegate Margaret Campbell, Ph.D. and research director for the Rehabilitation Research and Training Center on Aging with Disability, located at Rancho Los Amigos Medical Center (RLAMC) in Downey, Calif.

Campbell presented the following list of specific strategies to the WHCoA policy committee to carry out the goals for developing livable communities that support aging in place and innovative designs:

  • Establish a national accessibility and visitability tax credit for Americans to adapt their home environments to promote living and aging in place.
  • Direct increased federal research and development investments toward accessible, assistive and universally designed technologies and environmental interventions that will support independence, productivity and community living for people aging with disabilities and older adults.
  • Expand market-driven federal procurement strategies beyond electronic and information technology to promote increased availability and utilization of accessible, universally designed technologies that are effective in reducing other barriers to full participation in work and community life.
  • Amend the Older Americans Act to mandate the development and delivery of trans-generational accessible, assistive and universally designed technologies and environmental interventions that support healthy and productive living in a safe and least restrictive environment.
  • Support the establishment of a national consumer report of users' experiences with accessible products.

The strategies are designed to remove barriers to universal design, such as lack of research and development, inadequate training of researchers and engineers, lack of coordination of public and private programs and lack of awareness of consumers on the benefits of assistive technology and universal design.

Experts say that considerable progress toward universal design is evident simply by the fact that resolutions for aging in place and promotion of livable communities were selected at the WHCoA as part of its final 50 list.

This article originally appeared in the February 2006 issue of Mobility Management.

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