Universal design: for aging in place. (Cover Feature).

INTERVIEW WITH MARY JO PETERSON

"THE OLD IS NEW." That paradox has been often stated by devotees of the field of aging. The recent demographic surge in people approaching or exceeding age 65 has created a new field of endeavor in which original ideas and fresh concepts are valued. One of the newest and freshest ideas in the field is "universal design"--an approach to making older people's dwellings habit able for them for as long as possible, regardless of the decrements of aging. "Aging in place" is fast becoming a selling concept not only for active adult housing, but for assisted living, and even for skilled nursing facilities wanting to become more homelike for all hut the most frail of residents. But "aging in place" and "homelike" both risk becoming cliches unless there is something real to back them up--some adaptation of the elderly residents' living environment to make it happen. That is where "universal design" comes in. One of its most well-known practitioners, authors and presenters, Mary Jo Peterson, discussed how some of these concepts might filter into the design planning of renovated and newly constructed facilities for long-term care in a recent interview with Nursing Homes/Long Term Care Management Editor Richard L. Peck.

Peck: Why is universal design worth thinking about for a long-term care facility, and what might some initial considerations be?

Peterson: Universal design is a way of designing a dwelling so that it can accommodate aging and yet still look like home. What is interesting is that some facility developers are starting to move in that direction, but not far enough. Recently, for example, I visited an independent living facility that had a very charming dining room--small, very private feeling--and then I saw the bathroom, which was very hospital appearing, ADA compliant, all grab bars in place and looking like a place for sick people. If we think these things through, it doesn't have to be that way.

Peck: How do you "hide" that sort of necessary functionality?

Peterson: You don't have to hide it. You try to meld appearance and function. Take grab bars, for example. Standard-size, ADA-compliant, 1 1/2" bars now come in every color of the rainbow and in finishes other than metallic. They can serve as decorative towel racks, and if you need to make them as visible as possible for aging eyes, you can build in contrast with the tile pattern behind them. In fact, if your budget can accommodate the price point of tile, you have every opportunity to make an impact with color selection and pattern. It's all about adding personality to the room.

Peck: Do you have other suggestions regarding bathroom design?

Peterson: One interesting point is that although the traditional bathroom is quite small, there is really no need to expand the space to make it more accessible and attractive. A good way to open it up is to make the entire floor a "wet" floor, so that you no longer need barriers for the shower area. Again, there is a lot you can do with tile here to make the bathroom attractive and inviting.

In addition, I'm starting to see wall-hung toilets making a comeback. They are so much easier to set at the correct height and maintain around the floor area. They disappeared from the market when the low-gallon flush tank came into use because the flushing mechanism just didn't work well, but the problem appears to have been addressed because one of the more active manufacturers, Geberit, recently reintroduced it.

Finally, there are some beautiful vanity models available that offer knee space beneath the sink so that the resident can sit at the sink.

The important thing to remember is that areas such as the bathroom can be upgraded in appearance, but with no compromise in safety and support.

Peck: What about another area that you've concentrated on in your work in universal design--the kitchen?

Peterson: One area to focus on is the countertop. It wouldn't be impractical for developers of independent living units to provide lower countertops to begin with, because people shrink and begin to stoop as they age. But even with standard-height countertops, you can install pull-out countertops in spaces that normally would have drawers, so that people can sit at these lower-height counters as they work.

Also, you can have sinks with completely open space with finished flooring underneath--the plumbing is at the back--so someone could use that space to sit at the sink. The sinks themselves should be shallower (a maximum depth of 6 1/2"), and the backsplash area can be designed for handy storage of accessories, such as salt and pepper shakers, spices and so forth. Optionally, the space could be enclosed by a fold-out door and used for storage or perhaps a rollout waste container.

In an Alzheimer's unit I helped design, I tried to provide several areas where residents could tack up personal photos or other mementos, using, for example, magnetic strips along the bottom of cabinets or cork inserts in doors. This gave the resident plenty of opportunity to personalize the space. Another feature in this unit that was tried experimentally but caused some controversy was an on/off switch controlling the cooktop and located outside the unit. Staff could simply turn off the cooktop at night to enhance safety. Though the purpose made sense, there was concern that residents would experience serious confusion if they attempted to heat up a cup of tea at night and nothing happened. I learned why managing Alzheimer's disease is such a complex challenge.

I learned a good deal more, too--for example, the importance of avoiding too much contrast between design elements because contrast is so easily misinterpreted by residents.

Lighting was another area of concern. It was brought home to me how important it is to allow for natural lighting wherever possible, but to provide non-glare windows and, when the sun goes down, to have plenty of task lighting available in its place. With the elderly, though, more lighting is not always sufficient. Light bulbs should be screened with diffusers. Indirect lighting bounced off the ceiling is always preferable for its warm, comfortable feeling. Sometimes, to enhance visibility for the aging eye, task lighting and ambient lighting have to be balanced--for example, enhancing contrast by turning on the task lighting and dimming the ambient lighting.

In general, you could write a book on the topic of lighting in senior design.

Peck: What do you think about some of the newer technologies that are emerging, such as smart appliances, voice activation and wireless, and how they might apply to aging in place?

Peterson: I would recommend that all new buildings be wired to eventually accommodate this technology. There are some important considerations, though. One is that the technology, whatever it might be, has to be acceptable to the consumer. With voice activation, for example, I've been told by my contacts at General Electric that people have not reacted well to voice-activated appliances. This explains why there aren't very many on the market right now.

The good news is that all the "electronic servants" that used to operate using separate and distinct "widgets" and were, therefore, too complicated to keep track of are starting to integrate, so that consumers only have to master a few controls on one keypad to be able to check the front door, order a movie or groceries, or shut off their stove from a remote location. More relevant to long-term care, the technology is integrating to expedite medication monitoring, routine safety checks, calls for assistance, and operating lighting and door controls automatically. The "smart house" is coming, but right now it's all about making the technology more palatable and pleasant for the consumer to use. As acceptance grows, facilities will have to be prepared to accommodate it.

RELATED ARTICLE: RESOURCES ON UNIVERSAL DESIGN

ABLEDATA

[phone]

www.abledata.com

Access One, Inc.

[phone]

www.beyondbarriers.com

Adaptive Environments Center, Inc.

[phone]

www.adaptiveenvironments.org

American National Standards Institute 

[phone]

www.ansi.org

American Occupational Therapy Association

[phone]

www.aota.org

Center for Inclusive Design & Environmental Access (IDEA Center)

[phone], ext. 329

www.ap.buffalo.edu/idea

Click on "Special Interests" for instructions on joining the e-mail-based Home Modifications Discussion List or Visitability Discussion List.

Center for UniversaL Design, The

[phone]

http://www.design.ncsu.edu:8120/cud

Independent Living Research Utilization Program

[phone]

www.itru.org

Lifease, Inc.

[phone]

www.lifease.com

National Center for Seniors Housing Research

[phone]

www.nahbrc.org

National Kitchen & Bath Association

[phone]

www.nkba.org

National Resource Center on Supportive Housing and Home Modification-Ethel Percy Andrus Gerontology Center

[phone]

www.homemods.org

ProMatura Group, LLC 

[phone]

www.promatura.com

Universal Designers and Consultants, Inc.

[phone]

www.universaldesign.com

U.S. Access Board

[phone]

www.access-board.gov

Mary Jo Peterson is president of Mary Jo Peterson Design Consultants, Brookfield, Conn. She can be reached at [e-mail], phone [phone] or fax [phone].