10 Questions for . . . Michael Thomas, Aging in Place Expert

In this installment of 10 Questions for . . . , Senior Editor Daniel DiClerico speaks with Michael Thomas, FASID, CAPS, an interior designer and a coauthor of Residential Design for Aging In Place. Here, Thomas (shown below) talks about the past and future of the aging-in-place movement and offers tips for making your home more accessible in only a weekend.

How do you define aging-in-place design?
Aging in place is about creating homes that are safe and secure but, more important, it's about creating homes that will allow someone to remain as independent as they possibly can regardless of their abilities.

What's the history behind the aging-in-place movement?
It goes all the way back to Franklin Roosevelt, who most people today know had polio. But at the time very few people realized he had the crippling disease. Around 1938, Roosevelt desired a retreat he could escape to from the spotlight of the White House, a smaller home where he could, in his own words, become the independent person he longed to be. As the recorded architect on the building, which he would call Top Cottage, FDR was able to specify things like zero thresholds between the doorways and lower windows, which allowed him to gaze outdoors from his wheelchair. FDR might not have invented aging in place, but he was among the first to apply its principles.

Seventy years later, why is aging in place just reaching the mainstream?
From FDR, fast-forward to the end of World War II, when returning soldiers started having families. Baby boomers were the largest group of Americans born in a particular time, 76 million between 1946 and 1964. Younger boomers are now starting to turn 50, and older ones are into theirs sixties. This generation is living healthier lives and is beginning to contemplate where they're going to be for the rest of their years and decades. On top of that many of them are taking care of an aging parent themselves and don't necessarily want to think about alternatives such as assisted-living centers and nursing homes. So between the baby boomers and their elders, we have somewhere in the order of 100 million people in need of aging-in-place-environments. The tipping point is still four or five years out, but it's coming on fast.

Is it a challenge getting clients to think about getting old?
Yes, but the way we get them to accept it is by making aging in place as transparent as possible. It's often just a matter of perspective. For example, level thresholds (or a "curbless shower," like the one shown) facilitate access and they also just plain look good. So emphasizing the aesthetic value is very persuasive. Or take wider doorways: They enhance accessibility, also make a space look larger, and make it easier to get in and out with a suitcase, a baby carriage, or a wheelchair.

What other key principles can be applied throughout a home?
It starts with nonslip floors. Whether the surface is tile or stone, it needs a nonslip finish, because as we age, the potential to do real damage when we fall goes way up. In the kitchen, having multiple counter heights creates the ability to stand or sit. Raising the dishwasher up off the floor about 12 or 18 inches means someone with back problems or arthritis doesn't have to bend over to load the dishes. In the bathroom, lowering the counter and cabinets will allow someone to shave or apply make-up while in a seated position.

Taller toilets are another key. Low-rise toilets, whose seats are 15 to 16 inches above the floor, became popular in the mid-90s, especially at the higher end. But using them puts more stress on the body, because your rear actually ends up lower than your knees. So-called comfort-height toilets, which are 17 to 19 inches off the ground, are much more preferable. If you're stuck with low-rise toilets, there are aftermarket products—basically little blocks that raise the toilet seat—but they compromise the transparency I spoke of earlier because they're so conspicuous.

What are some quick projects that can be done in a weekend?
It's a good long list—anything that creates the sense that we're still in control of our lives.
* Change doorknobs to lever-style handles and swap out knobs for handles on kitchen and bathroom cabinets.
* Add more light in a space, not only the general room illumination but also task lighting.
* Remove nonessential doors, such as those in hallways. If you have doors that have to stay but you want to create a wider accessibility, you can buy offset hinges that will allow the door to move into room and create better accessibility.
* Take up area rugs from the floors, like the welcome mat at the entryway. Unless they're perfectly flat, these rugs create a stumbling hazard.
* Eliminate one or two pieces of furniture. If someone in the home is getting to point where they need a walker, having more open space will permit them to move more comfortably.
* Choose chairs with arms that extend to the edge of the seat are easier to lift yourself up out of.
* Use remote controls for more than TVs. They can also operate blinds and window coverings and turn on and off lights.

How does aging in place affect the exterior of a home?
There's a designer in Atlanta named Eleanor Smith who came up with the term "visitability." What it means is that anybody who comes to a home should have the easiest possible access. In addition to curb cuts in the walkways, that means no stairs at all to at least one entryway, and a door that's at least 36 inches. As for outdoor-living spaces, many of the same principles of interior design apply, including zero thresholds.

How much does building an accessible home add to construction costs?
When the National Association of Home Builders looked at building costs, its surveys found a 1 to 2 percent increase to create a very accessible home during new construction. Remodeling depends on the home and the client needs, but we've seen an average increase of 3 to 5 percent. That's because you need to do things like reinforce walls in the shower for grab bars and gut a space that has multiple elevations to make it one level. But so much of aging in place is elementary good design decisions that don't increase the cost.

Are manufacturers embracing the movement?
Manufacturers are beginning to realize the market but are not yet focusing on it. About five years ago, I had a conversation with an executive at a major plumbing manufacturer. He said to me, "It's just not worth it to create a line of products for old people." My reply was, "You have a large group of people who are holding the bulk of the wealth in this country. You can create very fashionable products that will appeal to these people and turn a nice profit for you." Five years later, plumbing-fixture companies like Kohler, Moen, and American Standard are beginning to realize that there is this unique marketplace where they can gain a foothold.

Where can people go to learn more about aging in place?
The American Society of Interior Designers is a great resource, as is the American Institute of Architects. The NAHB has a wonderful program called Certified Aging-In-Place Specialist (CAPS), and AARP is always a great resource where aging in place is concerned. On my Web site, I provide a list of "aging" resources, and through my blog I regularly publish new information to help everyone understand the benefits.

Essential information: Join the discussion about smart moves for older homeowners on our Money Blog.

Comments

[Carol Troutner]

I like all of your ideas.

Steps in hallways should come with railings on both sides of walls to encourage the use of railings with free hands.

Hallways should be well light, electrical receptacles should be installed in hallways so night lights could be used to light the way down steps.

Bathrooms should automatically come with bars in tub/shower and at toilet. You never know when you might need a little help.

[Patrick J. Roden]

Wayne Gretzky is credited with saying:
"A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be."

Aging-in-place is "where the puck is going to be." Michael is spot-on in his prediction.

I had never read about FDR and his early contribution to what is now the aging-in-place movement...I appreciated this insight.
The concept is really about making the future a part of your current philosophy. Many will only consider aging-in-place/universal design changes when it is a crisis--best to be savvy and plan ahead for a life-time of being home by choice.

[Konrad Kaletschj]

from Konrad Kaletsch, November 19, 2008
http://www.universaldesignresource.com/

Imagine you’re a construction worker, single and moving into a new rental apartment. Unknown to you it has been updated applying universal design. Not a bad place. Bigger bathroom, wider doors and hallways, everything is easier to reach. Different … but good. Then one day, oops, hernia. Back home after the hospital, whew, now this apartment is really great! It’s making life easy as you recover, especially when coughing by itself is a chore, never mind having to manage the rest of day-to-day living. You later discover the apartment owner had renovated the apartment for his father and learn about universal design; forever you will include it in your life – it made that much of a difference.

Without having a hernia, how can you appreciate universal design? Here are a few games to try that take away some degree of mobility and foster an appreciation for designs that accommodate your changing condition (these make it easier to appreciate the benefits of universal design for one who is presently able-bodied):

1. Tired legs: Add about 5-10 pounds to each leg – ideally use an ankle cuff weight and wear as much as possible. Discover the extra effort needed just to walk. Looking for elevators and benches now?
2. Car-less: Leave the car at home for one week. Who’s driving you around? How convenient is public transportation?
3. Arthritis: Invent ways to mimic the loss of grip with your hand or loss of mobility. Use medical tape to restrict your thumb or finger’s movement. Wear an undersized jacket from the thrift store and move without ripping the shoulder seams.
4. Vision Impairments: Be responsible and safe with this one - have a friend spot you! Wear an eye patch and notice diminished depth of field. Wear sunglasses throughout the day and into the evening. How much more light is enough? To a pair of eyeglasses, (use non-prescription if you don’t have eyeglasses), smear a thin film of soap. Can you dial a phone number?

As you visit places, think about your mobility as if some aspect of your body was less than able. Remember that time when you had crutches. Or, observe how others are getting about. I see moms with strollers navigating the NYC subway – it’s a two-person operation and they struggle mostly on their own. Have fun; explore.

I am a consumer advocate for universal design, committed to every one knowing those two keywords. Much like having a baby, when the time comes, you need the info. Even today, 30 years after Ron Mace first conceived universal design, few know about it - not doctors, not even builders. Most are left to struggle and stumble to help spouses and parents find new livable situations. For great resources, please visit:

http://www.universaldesignresource.com/
http://universaldesignresource.blogspot.com/

[David L. Hensley Sr.]

What type of bathroom tile will last a long time and looks nice in that order?