Coming: design to minimize resident moves; Interview with Susan Mack, OTR/L, CAPS, president, homes for easy living—universal design consultants

Nursing Homes, Dec, 2004

People just want to stay home. That simple statement underlies what many are calling the future of long-term care: the surge by many states toward Medicaid-financed home- and community-based services; the Bush administration's encouragement of same (see "Gazing Into a Crystal Ball" by Alan E. Schabes, Esq., October 2004, p. 92); and the ongoing census troubles of nursing homes and even assisted living facilities. And yet an essential component of this trend--the use of universal design to accommodate aging in place--has implications for assisted living and nursing homes for a couple of reasons: (1) Most residents, once having moved in, would rather not leave those facilities either, and (2) it's always good to know what your independent living colleagues are up to. Recently a leading proponent of universal design for senior living, consultant Susan Mack, OTR/L, CAPS, surveyed the long-term care horizon with Nursing Homes/Long Term Care Management Editor-in-Chief Richard L. Peck.

Peck: I understand that you come at this from an occupational therapy back-ground.

Mack: That's true. Occupational therapy, as you know, involves modifying the environment to facilitate a person's ability to function. As an OT, though, I was frustrated. You prepare clients for home and then find out that the home is fraught with architectural barriers they had never thought of as potential obstacles to their returning home. Everything we had accomplished in our facility's supportive environment was lost. And people themselves didn't want to spend the money on making the necessary modifications to their homes. Today's elderly, in particular, came out of the Depression era and are fiscally conservative. They just say, "Don't worry, honey," and go home and substitute sponge baths for bathing, resulting in skin breakdown, and stop cooking, resulting in nutritional status deterioration. They become socially isolated because of their inability to navigate stairs.

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We did what we could. From when I was a student in the 1960s, I used to make adaptive equipment by hand, like the built-up spoon handles that the OXO company has made mainstream today. It took about 20 years for the light to come on for me that this sort of environmental and product design could be beneficial to everyone, that these modifications have universal benefits--hence the name universal design.

Peck: Universal design has taken the knock in some quarters that building in accommodations for later-life disability makes a residence look like an old person's home before its time. Your thoughts?

Mack: Universal design, when it is done well, is beautiful. In my work on universally designed homes, I'd say 80% of my buyers are able-bodied adults who are not at all frail. As long as the design is not obtrusive and institutional-looking, clients love the open, spacious, and user-friendly floor plans and see the ergonomic benefits, as well as the future aging-in-place benefits, and are appreciative. Universal design is something, by the way, that can benefit institutions. Assisted living is designed for caregiving, not necessarily for enhancing independence, but universal design can do both. And when you step into a nursing facility, as I have, and see bathrooms too small for the caregiver to provide assistance, you know that there is still a lot of need for better education in universal design.

Peck: Just what is universal design, in your view?

Mack: Universal design is not just an accessible bathroom. It is a supportive community designed to accommodate diversity and ongoing changes in human function. Universal design has five basic components:

1. It has enhanced safety built-in with, for example, convenient and sturdy grab bars, enhanced lighting for aging eyes, and reduced trip hazards, such as no-step entries and walkways, and close attention to transitions from carpet to hard surface flooring.

2. It is ergonomic: For example, providing raised, front-loading washers and dryers will benefit not only the elderly but everyone with a bad back.

3. It is work-simplifying; universally designed kitchens, for example, make meal preparation safer and easier, with minimal distances to traverse.

4. It is inclusive, offering options for everyone from granny to the XXL football player down the street; that means it is adaptable and flexible to meet the needs of diverse ages, sizes, and abilities.

5. It affords the ability to age in place in family neighborhoods, as well as retirement communities.

Peck: What interesting innovations are you seeing in this field?

Mack: You see some vendors now trying to mainstream universal design into private housing. Kohler is an example: It now offers a selection of "comfort-height" toilets. We're seeing better shower products: better designed grab bars, and molded seats, and thresholds that are low, flexible, or even removable; Comfort Design, Best Bath, and LASCO are putting out nice products here. Moen is marketing grab bars that match the designs of its high-end faucets in overall finish. In kitchen design, Frigidaire is marketing side-opening ovens for ease of use. Whirlpool came out with its front-loading, front-controls, raised-pedestal Duet washers and dryers to reduce stress on the back. So vendors are most definitely responding.