Universal Design in Clothing

I am very impressed with SOFT Clothing for All Children. It exemplifies the process and result of Universal Design. A need is recognized in a smaller part of the population and the solution is a benefit to all. No extra cost, just great ideas that advance the way things can be.

My hat is off to Jessica Ralli, a teacher, who recognized the need from her work with children. "More than 1 in 150 children have sensory needs that are largely unmet by the children's apparel market today". And "Soft provides comfort and style for all children."

SOFT is one of those special confluences that are meant to be. A gifted and visionary teacher with a background and love for fashion hooks up with a mom, advocate and entrepenuer who shares her passion for the issues and.... viola- an important fix emerges.

I have no doubt similar issues impact adults - especially some with dementia and who have difficulty moving. Will Jessica and Suzy launch an Aging in Place line to relieve those who have trouble articulating their discomfort OR who cannot move around enough to dislodge discomfort from seams? When I first learned about SOFT from new friend and Jessica's proud mom, Barbara Elsas, I automatically started to fidget against the discomfort of the jeans I was wearing. I need SOFT, too! I am now dreaming of corollary benefit Universal Design soft clothing for ME!

Do I hear a subsidiary calling?

Where do I get...What I need to Age in Place?

Frank Zappa poked fun at valley girls in 1972's Just Another Band from LA with lyrics like
"Where do I go to get my speaker's fixed?,....."

Where to get the things we want and need is always a question. Even with google.

Currently, homeowners, designers, contractors and others who are preparing for Aging in Place want to know where they can get some of the hardware common to these projects. Here is a short list of some manufacturers and suppliers:

Great Grabz

Barrier Free Architecturals

Enable Me

Adapt My

AKW

Ponte Guilio

Ginger

Dynamic Living

The Alzeimer's Store

Wing-its

I am sure you have more resources, favorites and experience. Let me know.

Aging in Place, Entitlement, The Trigger

Heading into the Post Office yesterday I saw a woman taking the time to steady herself after climbing from the car. I offered to take her letters into the box. She gathered strength and concentration for a smile and declined. "I have to check the postage at the desk."

On my way out I traded smiles with another woman climbing into her car.
She was using a 'handicapped" space (I hate the handle, but that is another blog). She seemed not to have too much trouble walking. She had the placard. She earned it with her years and arthritis and maybe much more I cannot see. She feels entitled to that space.

Folks with disabilities who need the middle space for unloading or transferring, have difficulty walking or very little stamina are sometimes miffed about ambulatory placard holders filling those spaces. This is not today's topic.

The topic is the trigger. The trigger is one of my consistent noodles. How do we get people to act, in their own best interest, in advance of needs, to plan for Aging in Place? How do we move the trigger forward?

It is tough to sell home modifications for Aging in Place when they are really needed. The timing and mindset aren't right for design and remodeling decisions. The prognosis and so the value is not clear.

Home modification value is more clear when you do them earlier. Universal Design is the approach. The results are beautiful, helpful, preventative, not problem focused, corollary benefits. The time for design is available. Inclusion and lifestyle as well as planning for Aging in Place are rationale for Universal Design in remodeling. Not desperation. It makes good sense.

But Universal Design is a real tough sell! Promoting Universal Design suffers an inherent contradiction. Because so few know what it is many promotional efforts end up referring to disability and frailty, the antithesis of Universal Design. This association results in a stigma, and avoidance by, the general population Universal Design is conceived to reach.

Why are people who feel entitled to a 'handicap space' reluctant to plan in their own homes? The stigma, at it's worst, is right there in the space's name- Handicapped! Yet people sign up proudly. AARP, and other research show that people want to Age in Place. Yet, very few plan for it. How is the planning for Aging in Place different than applying for a handicapped space placard?

I don't have any answers, but I sure am interested. I invite you to share your thoughts.

DYNAMIC systems make Aging in Place work

DYNAMIC 2 a : marked by usually continuous and productive activity or change
(www.merriam-webster.com)

I always stress dynamic in describing the systems and services needed for Aging in Place.

Dynamic is important because our lives are always changing. This becomes more important as we are older and require assistance to get through our days and our lives. The services must match the needs as they rise and fall.

Assisted Living, the primary alternative to staying in your own home as your need for assistance grows is predicated on a comprehensive model. Everything that may be needed to match your stage is available at all times. If you don't need it you don't need to use it, BUT you do pay for it. Ah! Paying for things you don't need? That's called waste. In addition if your needs change beyond the stage serviced by a particular assisted living operation, you must move! Doesn't sound like home to me.

Contrast to Aging in Place at home with DYNAMIC services. As your needs change- both growing and cycling with your health services are provided and withdrawn as needed. Dynamic! The services must match the needs as they rise and fall. You only get/pay for what you need! As your 'stage' changes the services grow more robust and regular. That is a model of efficiency. That is Aging in Place! That sounds like HOME!

Aging in Place - Government Systems and Resources

Sara Mansfield Taber's piece, "Caring for Mom, Mum, and Maman", in the Outlook section of the Sunday, January 8 Washington Post, hits the nail right on the head. Sara compares her personal experience as a caregiver to the experience of friends in England and France. This is our cohort, folks! We are caregivers. Her comparisons make the point very clearly. We need a very thorough overhaul of our approach to caring for older Americans.

Sara lets us know it can be done because she cites examples of systems that make sense and work. She doesn't use the words, but the working systems are Aging in Place. Services and infrastructure helping people be happier in surroundings they love with the care they need. Sure there is cost, but there is also value. Her really personal examples are familiar to us.

Where Michael Moore hits us on the head, Sara takes us gently but clearly and succinctly. We need a radical departure from what we have. The current health care debate teaches how hard it is to depart from our current morass of inefficiency and expense. How hard it is to upset the financial paths and players from lobbied entitlement.

This piece points us in the right, plausible direction. Whether we have the political will to get there is another question. How we organize to demand and how we make such sweeping change needs to be explored.

Consumer Barriers to Aging in Place #1

We all see headlines like:
Senior Citizen Population on Brink of Explosion in World and in United States: Census Bureau
U. S. Seniors may increase by 40% in five years, world senior age group to triple by 2050

You would think this steady media barrage would provoke people to do some preparation. I don't think much is happening. I started selling Aging in Place remodeling in the early 90's. I thought it would be easy. Heck, there was no competition. Almost everyone gets the idea once you explain it. The problem is no one buys it.

Why is Aging in Place (remodeling) so hard to sell? Four client categories.

1. Younger folks. Most younger folks just don't want to think about the issues. They are busy with other things...raising children, dealing with their careers and often caring for their parents. Most of us do not project ourselves into a future with problems. Try to bring it up. the standard answer is, "I'll deal with it then." They aren't buying.

2. "Mature" consumers starting to plan their future. The most enlightened of these folks may have visited all types of 'senior housing' from active adult through continuing care communities. As any wise consumer who doesn't find what they want, they stay out of the market. Many aren't buying.

What about Aging in Place remodeling? These same enlightened shoppers know how complex needs and services for aging can be. They have seen the list of services and amenities at a continuing care community. Or they learned from assisted living or nursing home experiences with family or friends. They know remodeling services are just a piece of the puzzle. I can't assure them how to budget or how care resources will be managed. Frankly, without any idea how things may work out, they just aren't buying.

3. Okay. I have a lot of respect for older folks but there are some who seem to be in denial. Many have grown so slowly to their current condition that they are hardly aware how much they have slowed down and become sedentary. They can't see or won't act in their own self interest.
They are not buying.

4. When there are needs, results of a health change- stroke, amputation, severe heart attack, results of a fall, etc. it is most often too late. It is difficult to make significant decisions about remodeling when you are in a health crisis. It is difficult to make remodeling decisions when you are unsure of the prognosis - both the long and short term future needs as well as finances.

When someone is in rehab, unsure of when, how well or if they will recover, it is difficult for them or their family to consider and invest in remodeling. Too often when outcomes are clear the time is too short to get the work done. Remodeling- design, blueprints, permits, and construction take too much time. These folks are not buying.

So these are some of the consumer barriers to Aging in Place preparations as far as remodeling goes. The same factors are barriers to other preparations.

What can we do to change things? Incentives such as tax benefits for home mods like the current benefits for renewable energy installations are a good idea. A jobs program for home modifications is another good idea. Can stimulus funds be found for this good idea? How about insurance premium breaks for grab bars and other safety features? There is precedent in alarm systems.

How do we move this ball forward? Lets do it in 2010!

The Case for Telehealth

Telehealth is remote health care visits. The obvious use and value of telehealth is when the patient and health care professional cannot be in the same place. The clearest examples include a sailor on the high seas or the famous case of the physician in the arctic who diagnosed and treated her cancer for months before she could be evacuated.

The application most people think of is rural older folks. The distance and difficulty of rural travel make the value clear and obvious. The distance between patient homes makes house calls very expensive and the distance and difficulty for the patient and caregiver is avoided as well. The patient attaches a blood pressure cuff to their arm and their phone line or home health monitoring device ( such as Grand Care Systems) while 'visiting' with a health care professional over two way video conference hook up. This is pretty easy to envision now that skype is a household word. There is obvious benefit for rural Aging in Place.

Though the distance is smaller, the trip is still difficult in non-rural areas. Try getting out of your apartment, down the elevator, ride the bus, find a cab or a ride and get across town for an appointment. How about the parking and traffic medical professionals face in scheduling home visits?

The case for non-rural telehealth may not be as obvious but it is just as strong.

Aging in Place-Two Keys

The New York Times Blog, The New Old Age is a really good and wide ranging approach to the issues of coping and caring. The current entry on small scale assisted living by Paula Span, is right on the button, as I would expect.

Clicking around as things work with on line media I hit a less current article that makes still relevant points. This 2006 article, written by Jane Gross who founded the blog, is about senior care benefits major employers provide to employees. The article is clear that benefits are for employers as much as employees. Nothing like enlightened self interest. That is how things work.

I want to highlight two points from the article:

1. Managing Resources is more critical than information about resources.

2. Prognosis, how long one will be well, when the tide turns and how long they will be sick is a huge unknown. It makes planning very difficult. It also explains why child care benefits are less a model for eldercare benefits than we might expect. In most cases kids bring less surprises as time goes on. Not so for older folks.

These points need to be resolved for Aging in Place to be the reality we expect it to be.

How do we get there?

Happy New Year to All! Here is hoping for health, happiness and some answers, please.

Universal Design - Do You Believe in Magic?

...from the Lovin' Spoonful to:

And you know something is happening
But you don't know what it is.. Bob Dylan

The wonderful magic of Universal Design is unanticipated corollary benefits. Closed captioning is a really clear example. Including those with hearing difficulties to mainstream media was the intended outcome. Reading TV in bars and airport waiting areas is unanticipated benefit for ALL. I am not sure, but doubt that the planners expected such widespread and common use of this innovation. That is Universal Design.

In building design we typically cite the use of ramps for strollers and wheeled suitcases. Same thing. Widespread use of unanticipated benefit.

We may not be so aware of corollary benefits at the community level. AARP's livable communities definition is not too specific about benefits:
"A livable community is one that has affordable and appropriate housing, supportive community features and services, and adequate mobility options, which together facilitate personal independence and the engagement of residents in civic and social life."

Community planning that works for older residents - essentially neighborhoods where walking and rolling are useful parts of the transportation mix - are Universal Design. The benefits - connections to shopping, activities and additional transportation accrue to many. If it works for those who can no longer or don't care to drive, it works for younger folks too. If older folks can get to the store so can kids, giving them opportunities for usefulness, activities and exploration that seem like they are from a wistful, bygone era.

Neighborliness is facilitated, too. Walking always encourage friendliness. That works for all regardless of age and physical situation.

Walk and Roll communities are sustainable communities. The more people who can get someplace without their personal car the fewer auto miles, carbon and traffic we endure.

An incredible wealth of thinking on this topic is available at the Lifelong Communities Charrette pages of the Atlanta Regional Commission. I welcome you to study there. Put in some time with the written reports, vidoes and graphics. Then we can share our thoughts and excitement and bring Universal Design unanticipated corollary benefits to communities and lives all over the world.

This is the Magic of Universal Design.

Peace and Happiness to all,

Aging in Place Technology Status

Someone asked me to summarize the situation with Technology and Aging in Place.
I share my Rambling reply:

1. There is a lot of interest and promise. PERS (lifeline) is the only thing making significant inroads to people's homes. A few pill minders are also working.

2. The VA, using Health Buddy, is reaping benefits, especially based on their excellent care manager training program. They are a single payer system.

3. The next level, more substantial monitoring and two way interface (like health buddy) have trouble getting into homes. There is some use by assisted living, recognizing increasing staffing efficiencies. The 'final mile' delivery, setup, training, troubleshooting- (ie geek squad) is really missing and the tech folks don't want to do it.

4. People want to grab the monitoring space, seems like a good place to invest without some of the headaches of product developing and marketing, but it is premature.

5. It will come, will be closely related to eligibility and funding, but no one knows when or exactly how. It is advanced in Europe because of the payer system. Once communities (at whatever scale) take responsibility for health/payment, they see the value and invest. The UK has regulated monitoring centers.

I wrote a series of blogs about it a while ago. I reviewed them, they are still a pretty food synopsis.

Laurie Orlov is a leader in this space. Our point of view is pretty closely aligned.

CAST, division of AAHSA, pushed by Intel, is about tech standards for interface. They have slowed down, although their tech house design was a recent hit. There is a lot of research going on at universities.

There is the barest start at the new design oriented marketing research organizations.

NORCs / Villages - What's the DIF?: Intentionality

NORCs and Villages are both hot topics. What is the difference? How do they relate?

NORC, Naturally Occurring Retirement Community, just happens. People move to an area, grow older and the result is a NORC. A Washington, D.C. example is upper Connecticut Avenue. The apartment rich area and surrounding neighborhoods became popular as the area population expanded. Many residents are of similar age. Years go by, people do not move out. It's a NORC. Some planned communities and even suburban areas will become NORCs as well. The homes are occupied in fairly tight time frames by fairly tight age cohorts. Time goes by and a NORC results. You might say it happens by default.

From different points of view a NORC is either a homogeneous community where support can be offered efficiently or a super concentration of need that is hell to service. This reflects either a 'take the bull by the horns', progressive policy or 'head in the sand' avoidance. Similarly, smart business leaders can find a concentration of clients through good service and word of mouth marketing.

Starting in the mid 80's pro-active efforts to provide community services to NORC concentrated populations have demonstrated real success in making people more comfortable, more engaged socially, getting healthcare and others services to residents more efficiently and generally improving the lifestyle of older Americans living in NORCS. Starting as limited demonstrations a host of successful community assessment techniques, service ideas, methods and organizing systems have emerged. One example is The Advantage Initiative. NORC programs are positive support for successful Aging in Place. (Unfortunately some confusion has developed: People refer to both the naturally occurring community and the service program as "a NORC").

Along comes Villages. Based on the incredibly successful and exciting Beacon Hill Village in Boston the concept is sweeping the nation. No fewer than five are open in DC alone. People trying to find an easy way to describe the Village concept compare it to concierge services for older residents. But Villages are growing and elderly concierge services struggle, so that is not right. What is the difference? The difference between NORCs and Villages is the seed.

Intentionality. Beacon Hill Village is a grass roots organization. The residents started it themselves. NORCs occur by default. The impetus was not helpful, paternalistic or opportunistic on the part of local government agencies or well meaning social workers. It was self responsibilityPlanning and direction is democratic. Beacon Hill has not shied away from using the best consultants, service providers and management. That is smart. That contributes to success. It does not change the foundation. They do it themselves.

The 'village concept' has also been adopted by service organizations but they feel different. It is a 'program' not a movement. The goals may be similar but the difference is palpable.

When we speak of independence we talk about choice, dignity, respect, control, self-empowerment. Those values are at the base of the successful village concept. These may be intangibles but they matter deeply to individuals and communities alike.

'Optional' = 'Never'

The word 'optional' is kind of funny in Universal Design. In fact, it really doesn't work.

Almost no one chooses the accessibility items we advocate. Especially if there is an associated cost. Universal Design must be required, standard or strongly incentivized. NOT optional.

Two points.

One is that over time we find that Universal Design features, while conceived for those with problems, provide benefit for all. (see earlier post on Magic) It is best for everyone to understand that they benefit themselves.

The second is clear when we consider Aging in Place. Many of us come to need UD features in the process of our lives, in particular through increasing longevity. Their absence causes dislocations and hardship. Adding the features costs too much.

Example: Accessible plugs and controls for lighting and fan in the kitchen. If these are cost options to homebuyers no one will buy them because they are not needed. If they are not included when the homes are built their cost (while not incidental now) will be prohibitive later. Making them optional means leaving them out forever. If we are making the kitchen useful to a future user, someone who has trouble walking, reaching and leaning, etc. we have to do it now.

These items are less recognized but of equal import to manuevering spaces and no step entries. Many are starting to see that those cannot be optional. It is too hard to change the landscape and grade or hallways and door width later. We need to widen our scope because the faulty 'optional' mechanism is the same.

'Optional' = 'Never'