Aging in Place Universally – Bob Johnson

“Nobody wants to move to a nursing home”, said psychiatrist Anya Parura during her opening remarks at the Successful Aging: You Can Get There From Here symposium at Washington DC’s Hill Center on October 4, 2013. The Hill Center is a conference center that now occupies the renovated 1864 Navy Hospital at 901 Pennsylvania Avenue, mid way between the Navy Yard and the Capitol. The event was sponsored by Capitol Hill Village to get older residents to rethink their housing and aging needs with the prospect of not going to the nursing home but, instead, aging in place where they currently live. The audience, which filled the 100-person capacity of the Lincoln Meeting room and spilled into an overflow room was clearly of Social Security retirement age. The girls outnumbered the guys in clear accordance with actuary tables.

The daylong agenda covered expected topics like navigating the healthcare system while introducing new concepts like the World Health Organization and AARP sponsored Age-Friendly Cities Initiatives. Lunch included either brown bag or signups for 8th Street eateries and a Qigong demonstration that mashed up breathing, movement, and exercise into another twist of the yoga industry. Vendors from agencies that helped people stay in their homes through on-site nursing, rehabilitation and referrals to medical equipment suppliers and home remodelers showcased their goods in the Sousa Room from 12 to 4.

Like at any conference, there were some surprises including discussion of a leader in the geriatric field, Dr. Bill Thomas, who advocates abolishing nursing homes altogether and slowing down the burgeoning industry of knee and hip replacement and cosmetic surgery in favor of a good fiber diet and acceptance of aging while embracing the vast opportunity of an extended lifespan. Donna Barbisch, a presenter, quoted George Eliot, “It’s never too late to be what we wanted to be” while advocating that the key to living longer is social engagement and exercise, both mental and physical. Dr. Parpura noted earlier that current members of the aging population are paving the way for the baby bomber generation, myself included, who are coming on hard into retirement age of 65 at the rate of 10,000 a month

The Age-Friendly City concept was interesting in that it is a worldwide movement with DC being one of the few cities in the US to officially embrace it. Within this is the recognition that infrastructure and social services, both governmental and volunteer, have a direct effect on the quality of life of older people. While handicap accessibility is widely recognized, it is still not universally applied and much more can be done through better building codes, planning and product innovation.

A vendor at the Hill Center symposium was Tori Beddington, a petite Cornell graduate from New York who now lives on Capitol Hill and has her own occupational therapy business that focuses on the needs of the elderly who still live at home. A primary service she provides is a survey to assess the needs of the elderly for which Medicare reimburses her $90.00 for the 4-7-page report. Tori introduced me to the concept of older being trapped in their homes, eventually reducing themselves to living in only one room. While she has aligned herself with local remodelers who can expand people’s range within their homes and to outside, many just cannot afford any modifications or relief. Medicare’s solution to difficulty in getting to one’s bathroom is providing a portable toilet rather than paying to widen a bathroom door or installing grab bars.

The biggest problem Tori saw on home visits was the isolation that older people have that leads to severe depression. She mentioned a 90-year-old client that had beautiful artwork throughout her house but, reduced to only one room, could no longer enjoy it. Tori mentioned that she also did assessments for people getting out of the hospital after a serious illness or injury. If Tori saw that they could not get around or out of their house, they could not return there, forcing them into a nursing home. “It was just sad.”

I also talked to Ann Marie Moriarty at the NAHB about trends in the market for those that want to age in place. The mantra is Universal Design (UD) where the home is designed or remodeled for better access including easy access through steps into the house, wider hallways and doors and the reduction of barriers like poor lighting and knobs that were hard to turn. The best advance she’d seen recently was the trench drain at the shower where there is no lip to prevent entry yet no water escapes onto the floor. Ann Marie mentioned that an important factor of UD is that homes don’t look like an old person lives there, an important factor in promoting its value to boomers who already are in greater denial of aging than their parents. Ann Marie also talked about how almost everyone will have a period of incapacitation at some point in their life, typically an orthopedic injury where UD will really pay off.

Both Ann Marie and Tori recommended I speak to John Salmen, an architect and renowned expert in the field of Universal Design. Meeting him at his Takoma Park, Maryland office, John had the enthusiasm of a freshly graduated evangelistic and promptly showed me his PowerPoint on the all things UD. John cleared up the distinction between building code requirements of the American Disability Act (ADA) and UD by pointing out that ADA was a minimum code that applied only to public space, not homes. UD, on the other hand, should be seen “as a horizon” that is constantly evolving with recommended standards and features that are custom fit to the needs of the client.

John then took me to his remodeled 1920 home to show me what he meant. Obviously all entrances were zero step with minimal thresholds. A simple feature were benches inside and out to put packages down while looking for keys. Although his baths had the expected grab bars, he also had two sinks, each at different levels with one with space below for a wheelchair. He carried this multiple levels of countertops in the kitchen and had rollaway carts for storage that could easily be moved to accommodate wheelchairs when needed. The few upper cabinets had no doors and contained everyday dishes and glasses because people with memory loss otherwise wouldn’t remember where they are. Cabinet hardware and doorknobs were easy to operate using what John called the “closed fist” rule in deference to arthritis.

John related that older people often become weaker on side or the other and won’t know which side it will be until it happens. To prepare for this, he had handrails (or blocking for future installation) on both sides of halls and stairs and in bathrooms where people had to “transfer” from wheelchairs to toilets and showers. John also noted that people, and hence wheelchairs, are getting bigger and the ADA code that people follow might be too restrictive in the future. John saw studies that suggested another seven inches of clearance might be needed, which would be disastrous in remodels and costly in new construction.

Still, it was encouraging to see that the world is preparing for the baby boomers coming into retirement and providing options other than assisted living homes. As Rolling Stone’s Keith Richards once stated, “The older I get, the older I want to get.” I too want to get older, just not in a nursing home.

December 2013