Every Spring Bill and I plant a vegetable garden.  It seems only natural to write a blog post about accessible gardening this time of year; I have previously written one myself (see “How does your modified garden grow “).  However, I find that most blog posts about accessible gardening (including mine) talk about accessible height planters, the vast array of modified and/or universally designed tools, but leave out one important factor:  access to the water supply.

I guess I have always known that access to and manipulation of the hose bib was a challenge for Bill, but being the independent soul that he is, and the mandate for me to not jump in and help him unless he asks (a gentle reminder that my role at home is spouse and not OT/Accessibility consultant-even though this can be difficult ) , conditioned me to not question it.  Not, at least, until this year.  Bill uses a power wheelchair for functional mobility while gardening.  Typically, he can get very close to the hose bibs to turn them on/off, but this process still requires that he bend very far forward to reach the hose bib while attempting to grasp and turn the handle with limited hand motion.

This year, many of our shrubs were overgrown limiting Bill from getting close enough for optimal access, requiring that I help him with this integral part of gardening.  As I bent down to access the hose bib, and felt the soreness in my back and knees from a long day of yard work, I could not help but question, why are they installed so low?  There has got to be an easier way for everyone to access a hose bib!

And there is…..

Hose bibs are typically installed without interference (avoiding joists/studs/masonry).   From a Universal Design perspective, it would make sense to install the hose bib higher to allow for less bending and overall easier access.  If they can be installed in a specialty box underground (that you will find in a cemetery or park) or on a roof top for cleaning roof top units, then why not install them higher for a homeowner?

Some possible modifications…..

If you are one of the many who already have hose bibs installed, there are some retrofit solutions to make them more accessible:

• Faucet extenders:  a free-standing hose stand (some with and without hose storage) that extends the hose bib for easier access.  There are many on the market with different features and run anywhere from ~$38.00 and up.

• Easy Grip Handles:  To allow for ease of manipulation of the faucet, there are a few products on the market that are ready to add-on to your existing faucet handle to provide increased ease with turning it on and off.  Cost varies from ~$9.00 and up.

• Remote-controlled watering:  The most convenient modification, but more costly, is to set up a remote-controlled sprinkler system.  This system can be started via the press of a button and/or setup with a timer to water at specific intervals.  There are many systems on the market than run the spectrum of lower to higher tech, with a multitude of features for user convenience.

Now if we can only figure out how to stop the phantom that keeps eating our strawberries……happy gardening!

Lewis hose bib extender

Gemplers Faucet extender

the foxtail by Life with Ease

Easy Gripper outdoor faucet handle

We parked in the van accessible designated space and started to deploy the lift.  It met Bill at the floor of the truck and he rolled onto the lift, no different from any other day.  As the lift gently places Bill onto the ground surface, it stops, leaving the “front gate” in the up position.  Bill is unable to roll off the lift.  We spend the next 30 minutes going through the motions to try to figure out why the “front gate” will not go down to let Bill roll out and off of the lift.  All of the features of the lift appear to be functioning except this last step in the process, and all of our efforts to remedy the situation prove to be unsuccessful.  The only thing left to do is to go back home.

In order to get Bill out of the truck, we have to bring his power wheelchair next to the lift, as it is deployed in the driveway.  He then transfers from the manual wheelchair to the power wheelchair to his freedom, while I lift his manual wheelchair over the “front gate” bump and back to accessible grounds.

Of course, it is a Sunday, and none of the adapted vehicle centers are open.  Bill waits until Monday to call and go over to the closest center (40 minutes from our house) to resolve the issue.  In order to get Bill back into the truck, we have to repeat the above process, with both his manual and power wheelchairs, to get him safely into the vehicle.  Luckily, Monday is Bill’s day off.  Unluckily, they are not able to see Bill and he has to go to the second service center which is another hour away, with no traffic.

Although this shop was busy, they were willing to accommodate Bill and service the lift.  They were able to help Bill get out of the truck, and put his service ticket in with the rest of the work they had to do for the day.  Three and a half hours later, the lift was fixed and Bill could drive the hour plus it takes to get back home.  Not the first choice of how to spend one’s day off, but a necessity to regain independence.

One small step for man, a giant leap for a wheelchair-user.

Yes, it’s true, this certainly is the direction our appliances our going, according to a recent article on CNN.com, from the Consumer Electronics Show (CES).  I am very excited about this continued technology expansion into our everyday items, as the design will benefit everyone, not just your gadget-lover.

One item on display at the show that has great benefits for everyone is the bathroom scale with a Wi-Fi connection, by Withings.  The scale will tweet your weight and/or it can connect to an iPhone to create a graph of the weight.  This concept can also be found in a lot of in-home monitoring systems currently on the market for seniors, such as GrandCare Systems.  This is convenient way for a caregiver to keep track of their loved one’s weight and monitor for changes.  This is an example of a concept that has been in the “senior market” for a while but has now found a mainstream marketing strategy.

The second item that I am excited about is smart fridge from LG.  The refrigerator “claims to know what food you’re storing and when it will go bad.”  In order for this to occur, however, the owner would need to input the food that they are storing on the specific shelves and enter expiration dates.  The fridge would then use a “tagging technology” that would send a text to the owner that a food item has gone bad.  This feature would be just as beneficial to the very busy family as it would be to seniors aging in place.  As we age, we all go through a slow progression of sensory losses including vision, taste and smell.  It is because this decline is gradual, an older person may not be aware that a decline in taste or smell acuity has occurred.  This refrigerator, although a high-end option, is a back-up system to monitor and maintain safe food consumption.

I am excited about the continued growth of smart home and appliance technology.  Although it certainly is not a new concept, perhaps continued mainstream marketing, and the hope that some of the prices will drop, will create more demand for these items as they truly have universal appeal.

Panasonic exhibited at the Third International Conference for Universal Design in HAMAMATSU 2010 and unveiled their theme and recent product developments.  In true universal design spirit, their efforts are to “provide universal design for a livelier, comfortable and richer lifestyle”, for all product users.

Panasonic displayed multiple products that allow for less maintenance, increased ease of use via reduced physical load, maximized visual access via the use of enlarged print, and provided for text to speech support via voice guidance.  As an Occupational Therapist, it is inspiring to see the multi-faceted approach and analysis of the product in order to determine how one’s physical, sensory and cognitive abilities may impact the overall use.

Unfortunately, I was unable to attend this conference, but am excited to see more companies continue to move in the direction of creating products that are universally designed.  Panasonic appears to be on that bubble of shifting from having just one or a few products in a line that integrate universal design, to the mindset of considering universal design principles from the beginning stages of product design, for every product created. If the end result produces a product that allows for the largest number of consumers to live with increased ease and comfort, why would products be designed any other way?

Penny for your thoughts……

I am talking about the issue of sprawl providing few or no options for a pedestrian or cyclist.  Limited public transportation creating a further disconnect from the community, unless you have a car or can be driven.  This national dilemma hit home for me this summer.  My parents, both in their 70s, live in a suburban neighborhood.  My father, being the primary transportation as my mother does not drive, had an unexpected six-week hospitalization.  My first reaction– drop everything and go help to set up my Mom with everything that she might need that requires a car– grocery shopping being at the top of the list.  Although I was being helpful, I could not help but continue to think how much she has to rely on someone else to be able to get around her community.  Sure, she could pay a taxi, but how many seniors on a fixed income would be able to afford such a service over a long period of time?  She could use the senior citizen bus (which she did) but this was only to go to and from medical appointments.  What if she wanted to go to the mall, go see a movie, visit a friend?  Another option might be for her to live in a 55+ community that offers a bus as an amenity, or, temporarily/permanently move in with me, but that would mean uprooting her from the community that she has lived in for almost 40 years.

Aging in Place has been talked about more and more, but the concept of “Aging in Community” is looking at the bigger picture.   The CDC Healthy Aging Research Network is focusing on just that—how the total environment is impacting a person’s ability to access community features and how this is subsequently impacting health and wellness.  It is a national issue that is gaining more press recently, with some areas of the country, such as Atlanta and Portland, moving further forward than others.

So how do we create livable communities?  One movement is Complete Streets. This is allowing for everyone (pedestrian of any age, motorist, bicyclist, wheelchair user, bus rider, etc) to safely utilize the streets.  “Instituting a complete streets policy ensures that transportation planners and engineers consistently design and operate the entire roadway with all users in mind.”  But, it is not just about the streets.  It is having a well-planned community where your housing is also near shops, green spaces, jobs and public transportation, to alleviate the need of having to jump in a car to access life outside your home.

More and more communities are talking with their state and local politicians advocating for the creation of a more livable environment.  Having access to grants and/or state and federal funding in combination with the support from your politicians to put policy change into effect is what is needed for the success of these initiatives.

How livable is your community?  What is happening on this front in your home-town?

With the Department of Justice adopting the revisions to ADA Title II and Title III, the amended regulations provide guidance on the sale of tickets for accessible seating, the sale of season tickets, the hold and release of accessible seating to persons other that those who need accessible seating, ticket pricing, prevention of the fraudulent purchase of accessible seating, and the ability to purchase multiple tickets when buying accessible seating. It also requires a venue operator to accommodate an individual with a disability who acquired inaccessible seating on the secondary ticket market only when there is unsold accessible seating for that event.

Part of the regulation that I am excited about, is the ability to “Permit individuals who use wheelchairs to sit with family members or other companions.”  This is opposed to ” a companion seat must be provided next to each wheelchair seating location.  The companion seat is a conventional seat that accommodates a friend or companion”.  This was a good start, but what happens to a family of four?  What about when we go to events with friends or other family?  Previously, we would always try to arrange to sit near our friends or other family.  Now, we will actually be able to sit together!

Although this is a positive change to some, it is being viewed as a negative to others.  One question that has been asked is, does this decrease the amount of accessible seating?  No.  There is still the same amount of accessible seating, but it now becomes a design issue.  How can the layout of the venue be setup to allow for the seating of multiple family members next to a person with a disability, but still provide a reasonable amount of accessible seating dispersed throughout the venue, while still maintaining lines of sight?

Perhaps all of the areas that are designated as accessible seating can allot for either a wheelchair and/or a conventional seat to be placed.  This scenario would increase the number of areas that would need to be available as possible accessible seating within the venue, but would meet the need for dispersion of seats.   This scenario will also allow for the change to have family sit next to the person with a disability while still allowing for the reasonable amount of accessible seats overall.

What are your thoughts on this change?  How do you anticipate this will be implemented?

Incorporating Universal Design principles into the design of a home not only allows for the most amount of users to have access, it also provides a layer of safety.  Pulling up throw rugs to allow for a smooth, firm and slip-resistant surface, not only eliminates an obstacle for persons using walkers and wheelchairs, it also removes a possible fall hazard for anyone else.  Removing clutter and rearranging furniture to create as much clear, open space for navigating throughout the home allows for users of mobility devices to have an unobstructed pathway, while decreasing trip hazards that may be in one’s frequently used pathway in the home.  Use of pull-out shelving eliminates the need for far reach and bending, decreasing one’s fall risk while attempting to get that one pot in the far back corner of the cabinet.

Utilizing both natural light as well as light within a room is integral to creating safe pathways in the home.  Exit/entryways, stairwells and bathrooms are of utmost importance.  Having a light switch, preferably a toggle, conveniently located just before one enters/exits the home will allow for an illuminated pathway and decrease chance of falling over unseen obstacles or bumping into furniture. Although important for universal design, it is not just about the height/location and type of light switch that meets the needs of the most amount of users.  It is the addition of extra lighting that also provides a convenience to all of the residents for safely traversing the frequently used pathways in the home.

The integration of grab bars and handrails will also provide a layer of support and safety.  At first, many will just think of the bathroom and the stairwells for need of this type of support.  However, while completing a home evaluation, an Occupational Therapist may determine that supportive bars and other assistive technology may be needed in other areas of the home to assist a homeowner with safely transitioning from sit to stand.  Occupational Therapists are uniquely prepared to contribute to fall prevention efforts because of our attention to diverse influences on occupational performance.  While Universal Design features can create an added layer of safety, each home and homeowners needs are very unique and need to be evaluated individually for falls prevention to determine appropriate recommendations.

On September 23, 2010 the Greater Philadelphia Aging in Place Chapter, local chapter of the National Aging in Place Council, will take part in an event with the Delaware Aging Network to educate consumers about falls prevention.  How will you spread the word?

1. Center for Disease Control and Prevention www.cdc.gov

I spoke with a Red Cross representative from my area to get some clarification.  There are three main critical objectives that need to be met for CPR certification 1-to get on the floor, 2-To be able to give an effective breath (making the chest rise) and 3-to be able to give effective chest compressions.  If a participant is able to complete these three main critical objectives, as well as pass the written exam, they will receive the CPR certification card.

The representative reviewed that modifications can be made, as long as the three main critical objectives are still met.  For example, a woman with a congenital birth defect that had left her without forearms or hands recently took the course and completed the  certification.  The Red Cross representative reported that she was able to get on the floor, she was able to give effective breaths, but instead of using her hands to complete the chest compressions, she was able to effectively complete the chest compressions with her foot.

If, however, a person is unable to complete any of the three main critical objectives, a certification card cannot be issued.  Although certification would not be obtained, auditing the class to learn the information is still a viable option.  Learning this information would allow you to instruct others to help with CPR, in case of an emergency.

I thoroughly understand the need for these critical objectives to be met to provide effective CPR, but am delighted to know that modifications can be made.  If you are interested in learning more about what accommodations can be made for completing CPR with a disability, please contact the American Red Cross and/or the American Heart Association for details.

Save a life, learn CPR!

Bill, who has C5-C6 incomplete quadriplegia, uses both a manual and/or a power wheelchair for mobility.  He started a tradition of going camping with his young nieces in his Mom’s very large and wooded backyard.  The setup is a large tent for the girls to share, and a tent-cot for Bill and the dog (I did not go on this particular adventure).  A tent-cot is the equivalent of a cot which sits about two feet off the ground enclosed in a tent.  This allows for ease of transfer to and from the wheelchair as the surface is almost level and the cot material is pulled very tight, creating more of a soft but solid surface.  Above the tent-cot was a canopy that was setup to help shield from the weather, just in case of any rain storms.

This setup, although seemingly fool-proof, was a catastrophe waiting to happen.  On the second night, a very severe thunderstorm came through the area.  The top of the girl’s tent ripped, soaking the girls with rain water, and they proceeded to run into the house screaming, leaving their Uncle Bill outside.  The canopy broke from the wind and rainwater build up.  This caused it to crash into the tent-cot below, sending all of the built up rainwater through the tent-cot window, flooding the space that Bill and the dog were sleeping.  Thankfully, the girls woke up Bill’s sister in the house and she was able to help him and the dog get out of the tent-cot and safely into the house.

When morning came, the damage was visible.  The girl’s tent was lost, the canopy was lost and the tent-cot was soaked.  In the clean-up process, Bill was helping to transport the canopy pieces on his lap in his power wheelchair.  In the process of removing the pieces from his lap to throw them in the garbage, one of the broken ends fell from his lap and landed on his bare foot, leaving a long gash down the top of his foot from his ankle to his small toe.  Although Bill took immediate precaution, rinsing with peroxide and bandaging with Neosporin, within two days, the foot was infected.  Decreased circulation due to the spinal cord injury always increases the healing time for any of Bill’s wounds.  To add insult to injury, Bill was also coughing, wheezing and generally not feeling well.  I could feel fluid in his lungs when he would take a deep breath.   The decreased strength of Bill’s diaphragm, due to the spinal cord injury, affects his ability to produce a strong cough and consequently will turn a cold into a respiratory infection a lot faster than someone who is able-bodied.  Off to the doctor you go!

Verdict:  respiratory infection and infected foot.   A tetanus shot and two weeks of solid antibiotics and he will be back to new.  Too bad he had already given me his cold, and I did not even go on the camping trip!  Oh, and need I mention that the dog also developed a bacterial infection on his belly.  It’s just another day in the life with Bill.  This saga is sure to continue…..

For info on the tent-cot go to: KampRite TentCot

Holly:
This idea of reinterpretation comes up often during caregiver coaching sessions. What other kinds of reinterpretation crop up in your work with clients?

Debra: Well, Holly, it can come up in the way a family member talks about their loved one’s condition. From a medical perspective, I may be working with a client in the kitchen to functionally walk with their mobility device to retrieve items from the cabinets and refrigerator for meal-prep.  The family will say, She’s not walking! I have to counter, No, she’s walking, but she’s doing it differently.  We need to help the family to see the picture differently, to reinterpret what is happening.

Or if someone has had a stroke, and one side has some paralysis, a family member will say, That’s the bad hand” or “bad side.” We have to help them to see that there’s no such thing as good or bad, it’s always a matter of degree of functionality.

Holly:
Oh yes, the words caregivers use directly impact their own peace of mind and that of their loved ones. In my book, “The Caregiver’s Compass,” a main focus is noticing the words one is using, and then switching them to words that are more empowering. The theory is called “action language,” the idea that language doesn’t just describe reality, it creates it. Speaking is an action that generates your experience of your world. Self-talk is an example. But in life, we don’t live in isolation, so we’re like fish swimming in a goldfish bowl—what we say also creates realities or meanings for those around us. A daughter saying to her dad, “You’re not walking!” as he’s inching forward on his walker, is not helpful. It’s disempowering. When I run into someone negative, I’ve been known to say, “Stop pooping in the fishbowl!”

—Holly Whiteside, caregiver’s coach & advocate, is author of “The Caregiver’s Compass: How to Navigate with Balance and Effectiveness Using Mindful Caregiving.” She invented Mindful Caregiving tools during her caregiving decade by applying to herself the life coaching principles that she had been teaching others. Find her book at Amazon.com, or learn more at www.CaregiversCompass.com. Holly can be reached at MindfulCaregiving@comcast.net.