2012 Complete Communities Delaware Summit

Last week Delaware held its first Complete Communities Summit as a means to create awareness and continue planning for meeting future infrastructure needs in Delaware.  As an occupational therapy practitioner that specializes in environmental modifications, this aligns with my position on Universal Design and Livable Communities.

Our keynote, Ed McMahon from the Urban Land Institute, spoke about sustainable communities being “a place of enduring value”.  He quoted Wendell Berry stating, “if you don’t know where you are, you don’t know who you are”.  This aligns with the occupational therapy perspective that home (and a sense of place), is connected with one’s identity.  It is not just physical; it is psychosocial and ties to a sense of familiarity and security.

During our lunch presentation, we had the opportunity to listen to Joe Molinaro, Managing Director, Community and Political Affairs, National Association of REALTORS®, speak about place-making.  He reviewed a Venn diagram which represented Physical Form, Social Activity and Economic Prosperity as three interrelated spheres.  The amount of overlap represents the amount of congruence in these areas, with the center (overlap area) being Place.  The more overlap of these three spheres, the better the sense of place.  This quickly reminded me of both the occupational therapy PEO (Person-Environment-Occupation) model of occupational performance as well as Powell Lawton’s environmental press theory.  This diagram, regarding place, was expressing that within the framework of form, activity occurs.  That may be social activity, economic activity or even socio-economic activity.  However, a sense of place flows from emotion, or human experience.  Therefore:  Form→Activity→Emotion.  The point in this discussion was that when planning for complete communities, you need to get into people’s thinking and emotions about what is a “good place”.

This also made sense to me, as an occupational therapy practitioner, as activities (what we call occupations) are the basis of what we do; we support people, across the lifespan, to promote active engagement in meaningful and purposeful community living as safely and independently as possible.  Participation in these meaningful community activities supports emotional health and well-being and creates a network of social-connectedness.  Here is the ‘emotion’ from the ‘activities’ that is within the ‘form’.  Community as identity.

It is this cohesiveness of thinking that makes occupational therapy practitioners that specializes in environmental modifications uniquely qualified and well suited to consult with architects, planners, community agencies, as well as local, state and federal policymakers with regard to universal design for livable and complete communities.  Occupational therapy practitioners bring a unique perspective; Designers, planners, policymakers and occupational therapy practitioners are necessary pieces of the puzzle, that when assembled, are most likely to best meet client needs with regard to aging in place in livable/complete communities.

For more  information on Livable Communities, check out the Livable Communities Daily at: http://paper.li/EmpowerAbility/1337434767

Livable Communities

A few weeks ago I had the pleasure to present on a panel at the 2012 MD/DE Chapter of the American Planning Association conference with Louis Tenenbaum and Alexander Chen.  Our presentation was a collaboration of viewpoints, from macro to micro, regarding Livable Communities.

A Livable Community provides residents with the ability to access goods, services, and transportation to support participation in meaningful activities that encourages civic and social connectedness.   My role, as an occupational therapist that specializes in environmental modifications, was to talk about the micro–the individual, and how the environment/community impacts an individual’s ability to participate in community activities.  Livable communities enable participation outside of the home.  There is plenty of research that espouses the benefits of social engagement on health and wellness, including but not limited to diminished cognitive decline, increased physical and mental health, and overall better quality of life.  Planning cities and communities with a Universal Design approach allows for participation by the majority of residents, regardless of age or ability, and provides for a sustainable city/community that will continue to benefit future generations.

How livable is your city/community?

Technology for Aging in Place

The other week I had the pleasure of presenting with Esther Greenhouse, an environmental gerontologist, on technology for Aging-in-Place at the 2012 Remodeling Show in Baltimore. Esther discussed the societal drivers and demographics that prompt the need for, as well as the obstacles to, aging-in-place. She also reviewed the rationale and solutions for enabling technology for seniors in relation to sensory changes, which occur with age.

This set the stage for the second part of the presentation, in which I provided an overview of the ‘players in the game’ (Occupational Therapists and Electronic Systems Contractors), as well as the technology options. According to the Center for Aging Services Technologies (CAST), there are three main categories of technology for aging-in-place. Here is a categorized list of some of the technology options reviewed during the presentation:

1-Safety technologies

• Philips with Autoalert
• CloseBy
• GrandCare
• Nest thermostat
• iControl
• Schlage Nexia
• Kwikset with Home Connect

2-Health and wellness technologies

• iHealth
• Philips Med dispenser
• Honeywell Hommed
• Guardian Medical Monitoring

3-Social connectedness technologies

• Discussed how many of the products are including the ability to stay socially connected, including a few listed above.

So what’s next? More mobile access with an app for that! Not only do we want to be able to control our homes and our health, we want to be able to control it wherever and whenever, and with our favorite mobile device. We are already seeing a boom in apps for mobile devices; this is just the beginning with the market projected to continue to grow exponentially. Are you currently using any mobile apps to control your home or your health? Are you using any of the above technology? If so, what do you think of the available technology for aging-in-place?

Check out these resources for more information:

A. American Occupational Therapy Association (AOTA)

B. Certified Aging in Place Specialists, Universal Design, Gerontology

C. Center for Aging Services Technologies (CAST)

D. Consumer Electronics Show (CES)

E. Custom Electronic Design and Installation Association (CEDIA)

F. Design for Lifetime PBS series

G. Home Technology Alliance (NAHB and CEDIA)

H. Independent for Life, Cisneros book

I. Lori Orlov’s Aging in Place Tech blog

J. Remodeling & Home Technologies Council (NARI and CEDIA)

A personal note on Aging in Place

It is what I talk about all of the time; the importance of thinking about your home and if your home will meet you and your family’s changing needs in the next 5, 10, and 20 years.  It may be a need for yourself, or it may be that you have a child that sustains a broken leg due to a skiing accident, or an aging family member that needs to move into your home.  We are all temporarily able-bodied; will your home be up to the challenge?  Will you have enough supports in place to manage having to be cared for, or caregive for someone else?

These are questions that most people do not ask themselves until there is a need.  Recently, my Mom underwent major surgery, requiring added time in recovery and subsequently becoming deconditioned.  This led to a month stay in subacute rehabilitation.  As a family, it was decided that my Mom would be discharged to stay with my brother, temporarily, prior to going back to her own home.  Although it would seem easier to have my Mom come to my house (a universally designed ranch style home that is 2.5 hours away from her home), it made more sense for my Mom to stay closer to her own home, closer to her own doctors and closer to her friends and familiar supports by staying with my brother who lives 10 minutes from her own home.   I immediately went into full home modifications mode.

My brother’s house is a typical three-story condominium with a 180* short radius stairway configuration from the first level to the second as well as from the second level to the third.  The second level of the home is the main living area with a half bath;  Full bathroom and bedrooms on the third level.  Prior to this major surgery, my Mom has had longstanding issues with her knees and would typically only go up and down her stairs one time a day, as she is not yet receptive to a stair lift  (wink wink smile)

So, it was time to put my money where my mouth is!  My Mom was very active, ambulating without assistance or an assistive device, and independent with all activities of daily living prior to the surgery.  She made great strides in subacute therapy and was discharged to my brother’s home utilizing both a rolling walker and a cane.  Our plan:  put up handrails on the stairway, as there were none currently in place.  We measured the length of the wall space based on installation of the handrails at 35” above the finished floor (as this falls within the 34”-38” range).  The handrail height could have been determined specific to my Mother, but being that this was my brother’s home, and to meet the needs of future residents, we decided to utilize a more universal height, opting for the lower end of the range as my Mom is only 5’3” tall.  We purchased a basic handrail of 1 ½” diameter, and handrail brackets with load weight capacity of 500# from one of those big box stores 🙂      Most importantly, we installed the brackets into the studs to ensure that the determined weight load capacity would be supported.  Voila! She is able to independently get up and down the stairs and the handrails look like they have always been there.  Ideally, and what I typically recommend, is installation of handrails on both sides of the stairs.  However, as professionals, we have all instances where our clients are not always receptive to our recommendations and in these instances, we continue to educate about the benefits and plant seeds for future change  (wink wink smile some more)

Will your home meet you and your family’s changing needs in the next 5, 10, and 20 years?

 

 

Imagine what it would be like to have your first mammogram…while seated in a wheelchair (2012 update)

Almost two years ago I wrote a blog regarding the Access Board planning to set standards for medical diagnostic equipment.  As of February 9, 2012, these proposed accessibility standards were published for comment in the Federal Register.

I am dedicating the re-posting of this blog in an effort to provoke thought about the importance of this issue.

From May 11, 2010:

For women around the world it is almost like a rite of passage: the baseline mammogram. It is advised to get it done prior to age 40 and I crossed that bridge this year. It is an interesting process that I felt more like a mannequin than a person, being positioned in such a way that the mammography machine can take the best picture. As I was standing there, being the compliant patient, I could not help but wonder, how would this process work if I were seated in a wheelchair? If I did not have control over my arms or my torso? Could the machine get a good picture???

In my case I actually needed to return as there was an inconclusive spot on one of my pictures. After a second round with the machine, it was determined that it was a positioning issue that folded the skin in such a way that obscured the picture. Now, if this can happen with an able-bodied person that can twist and contort in any way requested, how can one be sure an accurate picture can be taken for someone with a mobility impairment?

I frequently wonder how my husband manages, with a C5-C6 incomplete spinal cord injury, when he has a medical appointment.  I think about this as I sit in the dentist chair, as I am seated on the family doctor’s exam table, as I am getting up on the x-ray table sitting just so to get the best picture.  Currently, it may take him some extra time, but he is able to complete these functional transfers. What will happen five, ten or twenty years from now when he has less mobility? Less ability to complete functional transfers? How do others with mobility limitations manage this task when the equipment is built for use with able-bodied persons?

According to the Access Board, standards are to be set for medical diagnostic equipment under the new health care reform law. “The ‘Patient Protection and Affordable Care Act’ authorizes the Access Board to develop new access standards for medical diagnostic equipment including examination tables and chairs, weight scales, x-ray machines and other radiological equipment, and mammography equipment.” It is hard to believe that this is actually not addressed under the current ADA.

This is yet another area of accessibility that has been overlooked. I am thankful that there will be regulations for medical diagnostic equipment, but am realistic in knowing that seeing this actually take effect in the doctor offices may take a while.

What are your thoughts/experiences with this issue?

Where the sidewalk ends….

Yesterday was a beautiful Winter day to go outside and take a long family walk with the dog.  Our neighborhood was built with sidewalks, but for some reason a few of them abruptly end.  They remind of me of the infamous ‘bridge to nowhere’ and are the inspiration to this blog post, and Shel Silverstein reference.

I don’t quite understand why the sidewalk stops along the busiest part of our route around the neighborhood.  As you can see in the picture, it just ends….but it is met with a path that has been etched in the grass by Bill’s power wheelchair.  You can clearly see Bill’s trajectory from where the sidewalk ends to the other corner, where it just so happens to begin again.  Why not just connect the two forgotten ends?

In other spots, we have a connected sidewalk, but no curb cuts.  In order to cross the street, one must go off the sidewalk, through the portion of grass and navigate the swell, into the street and then repeat to get to the other side and sidewalk.

This is certainly not a complete streets approach.  Not only is this cumbersome for a person navigating the sidewalk with a mobility device, it is problematic for someone pushing a stroller, cyclists, joggers and even skateboarders.  Instead, we either have to traverse the change in terrain or go into the street, losing some of the safety that we gain with the sidewalk.  The completion of the sidewalk with curb cuts would be more universally designed, benefiting the majority of users, and provide for a more livable community overall.

Do you have unfinished sidewalks in your neighborhood?

How ‘livable’ is your community?

 

Water, water everywhere….but only if you can access the faucet!

It sure was a long winter, but out of the “newness” of Spring comes a new blog post to breathe life back into the EmpowerAbility blog!

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

A bump may as well be a mountain to a wheelchair-user

It never ceases to amaze me how a “bump” can change your immediate plans.  This scenario happened on one “Sunday fun-day”, during the Summer 2010, but is just as relevant to our lives today.  It started with Bill and I wanting to use a sale coupon at the mall and then go out to dinner.  We hopped into his wheelchair accessible truck and off to the mall we went.

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.

 

The future of appliances evokes memories of the Jetsens….

We have all become accustomed to our smart phones and having internet access whenever we want it.  So how would you feel if your washing machine sent you a text?

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.

Do your favorite brands universally design their products?

More and more I am finding products that have been created with universal design features integrated in their form and function.  Sure, you will find this mindset permeating kitchen and bath product manufacturers, but how often are you finding a line of products from other manufacturers that take universal design into consideration?  This is exactly why I was so excited to read an article on Panasonic’s current theme to create products “for the people and the earth of tomorrow towards a sustainable co-existence”.

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……