Addressing the Relationship of Healthcare and Housing
By Chris Vandiviere, Vice President
Universal Design Group
Kentucky Doc Magazine, Oct 2009, Lexington, KY
In the early 20th century the average lifespan was less than 50 years. Those with serious disabling accidents or disease had a poor chance of survival. But today expected lifespan continues to increase with advances in medicine, nutrition, sanitation, and disease prevention. Today over 80 % of the population lives past the age of 65. In fact, the 65 and over population is expected to increase from 35 million in 2000 to over 55 million by 2020. In addition to those living longer lives, other demographic changes are rapidly placing further demands upon the healthcare industry. More people are living with disabilities than ever before. According to the U.S. Census Bureau 2005 data, over 20% of the population lives with some form of disability, 54.5 million Americans reported a disability, an increase from the 51.2 million reported in the 2002 Census. Among those age 15 and older, 10.2 million use canes, crutches or walkers, and 3.3 million use wheelchairs. Those who posses hearing difficulties number 7.8 million, 1.8 million are blind, and over 16 million have a cognitive mental or emotional disability.
The number of elderly and those with disabilities will increase dramatically in the future. In the past, the family provided much of the care and support for the elderly and disabled. Retiring parents now tend to live great distances form their children and more of these children are living in two-income households where husband and wife both work full-time jobs. In addition, those living on fixed incomes are finding it more difficult to cope with increased living costs which are not being compensated by increases in the retirement funds they depend upon.
The landscape in long-term care is changing as well. The assisted living model which was the norm during earlier decades has faced serious challenges as residency and construction rates have declined. The Senior Housing Association estimates the vacancy rate at approximately 10 %. In a few markets the percentage of empty beds is as high as 50%. The national average for nursing home care costs in a private room is now $74, 460; a semi-private room is $66,579. Assisted living costs average $35,544. In Kentucky, the average monthly rate for assisted living is $2,700 and a semi-private room in a nursing home facility averages $5,370 per month. (John Hancock 2008 Cost of Care Survey).
Acknowledgement of those with disabilities and the needs of the elderly have in recent years fueled many changes in legislation such as the Americans with Disabilities Act. As population dynamics and the nature of housing have changed, Americans are becoming more attuned to the necessity for new approaches to the needs of the disabled and the elderly. A few states and some communities have instituted long-term care plans to prepare for the growth of their aging populations with an emphasis on more cost-effective means to deliver care and barrier-free housing. Many developments have occurred in the design of housing as a result of legislation and the demands of the shifting population.
Aging-in-Place
A primary desire of all health care professionals is to help each patient maintain their independence as much as possible. Whether due to aging or disability, everyone desires to remain in their own home and familiar surroundings. Over the past few years there has been a greater recognition that it is not always necessary or desirable to relocate as abilities change, but environments can be modified by renovations and assistive technologies. Not only is the concept of aging-in-place the most desirable goal for the patient and the health professional, but in most cases is the most cost-effective. Rather than a rigid care delivery system designed to meet the needs of the majority of individuals, appropriate healthcare and housing can be individualized resulting in cost savings, increased independence, and the physician can be more involved in the general wellness of the patient.
Disability, whether from injury, aging, or other reasons is by definition limiting, but many things affect how limiting it is. Access to excellent medical care, adequate social and physical support, and attitude all contribute to the degree of functioning an individual experiences. Depending upon each patient’s requirements, a holistic approach to patient care encompassing the primary care physician and other professionals is desired. These professionals may include such disciplines as an occupational therapist, physical therapist, home health care provider, durable medical equipment supplier, social worker, and others as required. In addition, a certified specialist in remodeling and aging-in-place may be included in the team.
In the 1990’s the term “Universal Design” was coined by Ron Mace, a paraplegic North Carolina architect. Universal design is a framework that strives to integrate people and their environments to serve the needs of those of all ages and abilities. In universally designed homes, considerations are given to convenience, comfort and safety. Features are evaluated on design aspects to remain convenient, safe, and easy to use as time passes and physical abilities change. Universal design is not only for those in wheelchairs and senior citizens, but seeks to accommodate those of all ages and abilities.
While legislative remedies to address the problems of those with physical impairments and the elderly have brought much needed change and recognition, universal design encompasses solutions far exceeding those of the ADA guidelines and similar laws and regulations. The requirements of the ADA can be thoroughly adhered to and yet fail to meet the actual needs of the disabled and be a hindrance to those not disabled. Universal design is about a new way of viewing design, eliminates isolation, and is inclusive of all users regardless of circumstance.
The seven principles of Universal Design (Compiled by the Center for Universal Design in 1997):
1. Equitable use-the design does not disadvantage or stigmatize any group of users.
2. Flexibility in use-the design accommodates a wide range of individual preferences and abilities.
3. Simple, Intuitive Use-use of the design is easy to understand, regardless of the user’s experience,
knowledge, language skills, or current concentration level.
4. Perceptible Information-the design communicates necessary information effectively to the user,
regardless of ambient conditions or the user’s sensory abilities.
5. Tolerance for Error-the design minimizes hazards and the adverse consequences of accidental or
unintended actions.
6. Low Physical Effort-the design can be used efficiently and comfortably, and with a minimum of
fatigue.
7. Size and Space for Approach & Use-appropriate size and space is provided for approach, reach,
manipulation, and use, regardless of the user’s body size, posture, or mobility.
Universal design elements, assistive technologies and aging-in-place work synergistically. Implementation of universal design can make an existing home meet the individual needs of the homeowner while improving the home’s value. Remodeling the home to incorporate such things as wider doors, lever handles for doors and faucets, improved lighting, shelving, sinks, appliances, and counters installed at convenient heights, installing grab bars and other safety items, roll-in showers or step-in tubs, an elevator or lift, a ramp, or a security system are all modifications that make life easier and safer. Remodeling a home to meet the challenges of aging or disability typically focus on kitchens, bathrooms, or barrier-free modifications, but may involve a complete master suite added to the first floor or more extensive modifications.
Issues of senior or disabled housing and senior or disabled health should not be viewed in isolation. They cannot be separated as a housing problem can create a health problem and a health problem can create a housing problem. An evaluation of the home by a professional trained to identify individual needs and existing or potential hazards should be part of preventative care whenever possible. Early identification and correction of problems, as with preventative medicine, may save a patient from future accidents that will greatly affect their health and well being. Falls are common among the elderly, leading to injury, loss of independence, or even death. A home evaluation will identify many safety concerns. In some cases an individual homeowner may be so accustomed to an existing dangerous condition in the home it is accepted as a nuisance to live with. The homeowner may not be aware that a solution exists. Some risks are easily corrected, while some may require extensive modifications. Of course, although not the ideal recommendation, there may be cases in which the patient would be safer in a different environment.
As with all those involved in patient issues, it is important to consult a professional when seeking someone to evaluate a living environment, make recommendations, and perform modifications. To be assured of using a competent and knowledgeable professional, the physician can recommend the expertise of a Certified Aging-In-Place Specialist (CAPS). The CAPS program was designed by the National Association of Home Builders (NAHB), the Remodelors Council, and the NAHB Seniors Housing Council to meet the needs of an aging population and to assure professional standards in this specialized segment of the construction industry. The program was developed for general contractors, architects, home remodelors, designers, and health care consultants. Certified Aging-In-Place Specialists are trained in the unique requirements of the aging population and those with disabilities, home modifications, and solutions for barrier-free living.
About the author
Chris Vandiviere is Vice President of Universal Design Group, a Certified Aging-In-Place Specialist, and has over 20 years experience in the construction industry. He is a member of the Kentucky Association of Gerontology, Kentucky Guardianship Association, and the Kentucky Association of Senior Services. Universal Design Group has three Certified Aging-In-Place Specialists on staff and is a member of the America Association of General Contractors. He can be reached at (859) 983-1856 for consultations.
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