I’m pleased to introduce Casey Little as our guest blogger today. She will be commenting on her experiences working in a dining room in a facility for older adults. Casey Little is a second-year occupational therapy student at Thomas Jefferson University working on her combined Bachelor’s to Master’s degree. She is a certified Primary Caregiver for older adults and has four years of experience working in long-term care and memory care Geriatric facilities working in the dining room and activities departments. While working in these facilities, Casey experiences how the environment impacts the person’s functioning in their daily activities and believes the environment is an important factor that contributes to a person’s independence and ability to age in place.

 

The dining room is an important part of the daily running of any facility. Throughout my time working in a dining room in a nursing home, I have observed various aspects of the layout of the room that make meal time challenging for the residents and the staff.

The dining room at my facility is a large room that is longer than it is wide. There are two single doors to enter- one towards the front of the room and one towards the back of the room. Four circle tables are pushed to the outer perimeter of the room as far as possible so that there is just enough space for a resident to fit in between the table and the wall. Additionally, there is one rectangular table that is set up so that the residents sitting at that table can look at the courtyard garden outside through a floor to ceiling window.

However, because the room is longer than it is wide, when all the residents are at the tables in their wheelchairs and there are walkers throughout the room, it leaves a small aisle between the tables that only allows for one resident using a wheelchair or walker to walk through at a time. It becomes difficult to maneuver through the room safely when it is in use for both the residents and the staff. Also, the base of the tables are very wide which makes it difficult for the residents who use wheelchairs to get close enough to the table to eat comfortably without the foot pedals and wheels of the chairs hitting the base. Similarly, the diameter of the tables is too short to accommodate multiple residents using wheelchairs at once; there is not enough room under the tables for them to fit. When the majority of residents use wheelchairs, removing the foot pedals to get closer to the table becomes a storage issue. Placing items on the floor invites falls for all in the space.

To improve the space, it would be beneficial to have tables with a longer diameter and a smaller base to accommodate the amount of space that wheelchairs take up underneath the table so the residents can sit closer to the table and eat independently. This is an important aspect to consider as there are many residents that need to eat and not enough nurses to be able to feed all of them in a timely manner. Additionally, finding a balance between the dimensions of the room and the intended furniture would increase the space for navigation between tables and make sure it is enough space to accommodate multiple individuals with wheelchairs and walkers. Achieving this balance would also make the job of the staff easier as they assist in serving food and feeding residents in need of that kind of assistance.

The Baltimore Sun recently published an article about Aging in Place and the growing market for homes designed according to this idea. It highlights the shortage of housing supportive of people to age in place and also features the story of a couple as they attempted to buy a new home. The article has good statistics on the state of the housing stock in the United States and the costs of renovations or custom building a home in order to demonstrate the importance of incorporating aging in place features into new construction from the start as a long term solution. It is definitely worth the read.

http://www.baltimoresun.com/business/real-estate/bs-re-aging-housing-20161213-story.html

Sherman, N. (2016, December 16). With aging population, a gap in home design. The Baltimore Sun.

This post, we will take a small break from the topic of flooring. I would like to share an incredible experience from a few weekends ago. I was fortunate to visit Rosemarie Rosetti, PhD, and Mark Leder’s home in Columbus, OH, where they graciously hosted a CLIPP training.

Their home is the Universal Design Living Laboratory. After a spinal cord injury, Dr. Rosetti found her home to be not truly accessible, despite modifications. After acquiring sponsorships and establishing a team, she and her husband designed and built a home that would suit not only her needs, but the needs of anyone walking through the door. The home has been awarded several Universal Design and Green building certifications.

The house is, simply put, phenomenal. It is a fantastic example of how accessibility does not have to mean unattractive. Many features are subtle, yet powerful.

A few key points/features that stuck out to me:

• The kitchen counters are higher that what is recommended for people in wheelchairs in order to meet the needs of Mr. Leder while also allowing Dr. Rosetti comfortable access. The kitchen island is actually comprised of counters of 3 heights; one for Mr. Leder, one for Dr. Rosetti at wheelchair level, and another at the counter height of the rest of the kitchen.
• The design of the front door with the3 sets of clear glass circles is not only attractive but highly functional for safety. The glass circles are peepholes for each person… and a set for the bird watching cat!
• There is a steamer build into the stove top with its own drainage system. Dr. Rosetti can fill it with water from the nearby pot filler, boil water, etc., and drain the water right from the stovetop. No need to drag heavy and/or hot pots of water across a counter and risk getting hurt!

Their home is open for tours if you contact them to schedule. The website also has a virtual tour (pro tip: the resident cat, Keiko, is present in at least 2 frames), and lists of all the features and items in their home for each room.

http://www.udll.com/

Today we will continue with the flooring theme. I have seen many different styles of carpeting in facilities meant for older adults. People do not truly appreciate the difference a good carpet choice can make. We will focus on the pattern of the carpet today.

Patterns are important to people since it is the first attribute they notice when walking into the space. When colors are used properly, it can be useful. Contrast can be used to differentiate thresholds, the rise from the tread on stairs, and even highlight a clear pathway.

When older adults have vision problems, contrast makes a huge difference. However, when there are many colors and patterns running throughout the carpet, the contrast of colors has been negated. Also, when light and dark spaces are not used strategically, people with dementia might think it is a hole in the ground. They will refuse to walk over it. People with Parkinson’s have trouble processing information from the environment (be it visual, auditory,  etc) while doing other things, like walking. If a flooring is too busy and distracting, they are too occupied with processing the floor that they are unable to also move. Then you see the stereotypical freezing patterns associated with the disorder.

This carpet is a new installation in an assisted living building. The vines are attractive to the eye. The use of the green against the gray walls and gray carpet entering another room (Seen at the bottom of the picture) make for good contrast and visual cues that there is a room change. The picture does not show it well, but the bright green diamonds and vines are very bright. It actually hurt my eyes when I entered the facility after installation. The juxtaposition of the bright green against the dark green can be a problem for people who cannot see well or process what they see accurately. This is a good example of a kind of carpet someone with dementia might think are holes in the floor or would cause freezing in someone with Parkinson’s Disease. Luckily, the pile on the carpet is low, and it is durable, so people in wheelchairs and walkers do not have a difficult time getting down to the dining room.

This picture with a more detailed explanation can be found here: Bright Green Diamond Carpet

 

While sorting through various pictures I have taken, I came across a picture of new flooring in an assisted living building I used to work in. Flooring is an interesting topic to discuss. It has to be durable yet attractive. It can make or break a space. It needs to be easy to clean and maintain; in heavily trafficked areas, it also needs to hide stains. It should not be too slippery, especially in areas that can get wet. Good quality floors are not cheap either.

Floors make a difference when it comes to the ability of older adults to navigate spaces. Slippery floors= falls. Glares on the floors= falls. Contrasts on the floors used improperly= falls. Pretty much, poor flooring means a fall, a potentially broken hip, and the start of the slippery slope of decline. If you did not know, a broken hip, more than any other fracture, plays a large role in the functional decline of an older adult.

We will embark on a flooring discussion with different characteristics discussed with each post and the recommendations and perspectives of other professionals interspersed. As always, comments and recommendations are more than welcome!

To start, check out the Wall and Floor Coverings tab for some pictures. (Click Below)

Wall and Floor Coverings

While I have posting about the wildly successful real life train station redesign project, other students in my class were working with interior design students on the creation and design of a hypothetical transgenerational mentorship community center. This was another example of the benefits of two professions working together.

My students were required to come up with the programming within the center, a list of items that would be needed to run this programming, and then to consult on design and materials two times after for accessibility purposes. The interior designers took the information and designed the interior space, chose color schemes, and picked out flooring, seating options, lighting, etc. When we came together, my students were treated as both the customer and the consultant. The teams worked together to make sure the design not only suited the needs of the OT programming, but would be accessible to all people. We analyzed materials for ability to create contrast in needed areas, lighting to reduce glare on older eyes, how far people needed to walk from certain areas to reach the bathroom they needed, child behavior control through design, inclusion of people of all abilities in each section, the sensory stimulation of colors/ carpeting/ wall treatment, etc., and the flow and ability to pathfind in the entire building.

It was a fruitful partnership. I personally saw many designs change from simply beautiful to beautiful and functional over time. The OT students commented on their amazement at the creativity of the interior designers. In fact, their creativity inspired the OT students to add more to their programs, since they learned so much more is possible with the right design and materials. The final products from my students suddenly included indoor herb gardens for their kitchen groups, study nooks in the quiet spaces, and even sensory swings… all features added in due to the creativity of the interior designer who first suggested it. OT students loved realizing when I said the sky is the limit, it was really true, and someone can create it.

I was fortunate to serve as a juror for the interior design students’ final products. Every group implemented every suggestion of the OT student. They also took the initial program ideas and expanded them every further, making the space much more dynamic than initially imagined. In their creativity, they designed spaces that were visually appealing, and when incorporating the accessibility related suggestions, suddenly had an area that was more useful and functional than they had originally imagined. My favorite example of this was the group who added swings in the gym area. They made sure to add a wheelchair platform swing as well. The OT students recommended the use of platform throughout, in line with what is used in sensory integration therapy. The interior design students had originally thought these swings would just be fun for kids; they did not know that it could be used to help a child regulate themselves due to sensory processing issues. But most importantly, every group genuinely thanked OT for their contributions.

As professionals, we do not need these experiences to teach us how to consult or design. But at the educational level, the students are already learning to value each other, a sentiment I hope follows both sides into their future practices. We could learn a few things from them and their experiences!

The train station project is coming to an end. The architecture students will be presenting their final projects this week, as the semester finishes. It has been a real treat to experience collaboration in this sense, and to be sincerely appreciated for the OT mindset of how all people would be able to function in the environment being designed.

The architecture professor in charge was interviewed for a local paper and spoke kindly of the collaborative process, calling occupational therapy “the conscience of the project.” Check out the article for the full story on the project, which truly was a collaboration between the community and transit authority as well as the departments within the university. It just shows how working on these kinds of projects together can foster an appreciation for others’ expertise. The architecture students were amazed by the thought process of us OTs, where we could consider the needs of many different people at once and make design recommendations to improve upon the function of their plans. For us OTs, we continued to marvel at the creativity of the architect’s mind.

http://www.montgomerynews.com/articles/2016/04/18/roxborough_review/news/doc571574d6a9a07026642841.txt?viewmode=fullstory

 

 

 

A few days ago, I came across a Buzzfeed article about a home design app developed by Alzheimer’s Australia. It makes small and cheap suggestions on how to change the living environment to be more friendly to people with dementia. Imagine if we could implement some of these design factors immediately!

Dementia Home Safety App

It ties into another topic of discussion. The train station projects continues at PhilaU. As part of the collaborative process, we invited the interior design and architecture students to a Disability Awareness Day. They were able to experience simulations of common conditions they should keep in mind when designing environments. The OT students had the opportunity to explain the role of OT in home design and modifications, and relate the symptoms of their chosen condition to the ability to function within a space. It was a huge success from all accounts. Many design students expressed surprise at the difficulties faced on a daily basis by people with disabilities and how the environment can be an inhibitor as much as a facilitator. Understandably, the simulations using walkers and wheelchairs were most surprising for them. However, many were also surprised at the difficulties surrounded low vision, stroke related vision impairments, and the amount of pain that comes with arthritis.

My students who were running the walker simulation and the low vision simulations also discussed the principles present on the home safety app. Specifically, the use of patterns and colors and how people with dementia process changes in flooring, be it colors, patterns, or transitioning between types, were of great interest and surprise to the design students.

The best line I saw on the feedback forms from design said [she] didn’t know how they ever designed without this knowledge. My students also expressed surprise at how easily our disciplines align.

 

Earlier last month, I was given the opportunity to join the faculty at Philadelphia University. What makes this appointment special and relevant to this blog is the emphasis Philadelphia University places on interprofessional collaboration among both faculty and students. As part of my program development course, I have a  group of OT students who will be collaborating with the architecture students, the local transit authority (SEPTA), and the community in the redesign of a local train station.

While this is not home design nor aging in place, it is a unique collaborative experience and warrants mention on this forum. The goal is to create an iconic, community oriented train station that is accessible to all. Already we have had two meetings, and the amount of  collaboration has been impressive. What I feel will make this project so successful follows some theories surrounding group dynamics.

First, we have a concrete project in which everyone has some level of investment. SEPTA wishes to increase their ridership and make it possible for everyone to access and utilize the local rail station. The community members also want to make their train station easier to use while also hoping for it to be the gateway to the community. This is the local train station for both groups of students, and all students are interested in improving the station. My students, in particular, chose to do this project versus other options out of interest in the process. This mutual investment provides a solid foundation for team formation.

Second, as I saw during our first community meeting  with all the team players last night, there is a respect for the viewpoints of others. Everyone’s opinions were heard and considered. Several people approached others of the various groups after the meeting for continued discussions. I often feel a lack of  openness and respect for others causes the most rife in a team.

I will continue to post about our progress and the experiences of developing an interprofessional team as the project continues this semester. I would also be interested to hear about your own experiences.

It seems that tiny homes are becoming a movement, all with the aim of living simply and cheaply. Arguably, one of the best features is the focus on sustainability with many of these tiny houses. I like the idea of them being small and manageable from the standpoint of maintaining a home, and feel, if designed properly with aging in mind, they could be an interesting solution to people wanting to move into smaller dwellings as they age. Of course, I worry about the space that would be needed for wheelchairs and walkers in key spaces, such as the kitchen and bathroom. Does anyone have a solution or idea in regards to this?

I came across this story about four couples who have been best friends for a long time. They have created their own tiny town where they can live together in these tiny houses. The idea of community appeals to me, since social isolation can be a very large problem for older adults aging in the community, and is considered a serious health hazard. What is your opinion on the tiny house movement and especially for older adults?

http://www.earthporm.com/tiny-town/