By MARGARET M. GILBERT, AIA
Where we live and how we live can have a profound effect on our health and happiness as we age.
There are a multitude of questions to ask when making the decision of Aging in Place. What does aging in place mean? Aging: “to become old” and place: “the particular portion of space occupied by or allocated to a person…” (The American Heritage Dictionary, 3rd addition)
Yet Aging in Place is more than just the definition. Do you want to stay in your current home, move to a new home, or move in with family? It is best to think about how to spend those “Golden Years” earlier rather than later. This article focuses on the physical elements of place common to building an accessible new home that allows aging to be safe and happy. Friends living in their current home have said “I wish I had added features to grow old in this home.” Neighbors who have just moved into a new home have said “I wish I had thought of elements helpful to growing older.” In my thirty-five years of experience practicing architecture in the housing and the healthcare fields, I’ve seen how individuals interact with their environment as they grow older and their needs change and have designed solutions to meet those specific needs.
Where is place for you? The home that you moved into to raise your children? The downsized new home where there is less house and yard to take care of? The neighborhood where you know everyone on the block? The new neighborhood where there are activities, amenities and people who want to be active like you? An article from the US Department of Housing and Urban Development reported “A 2010 AARP survey found that 88% of respondents over age 65 wanted to remain in their homes for as long as possible and 92% said they wanted to remain in their communities.” (HUD.gov, Aging in Place: Facilitating Choice and Independence, Fall 2013)
Some common design improvements for older adults relate to balance and strength, reaching and bending, stiff joints, and using a cane, crutches or walker. A design professional’s assistance helps with safety and access concerns that are important. The designer will ask questions of the homeowner about their needs and suggest elements that provide the most comprehensive approach to growing old gracefully in a new home. A 2008 study found that “Since half of falls happen at home, keeping paths free of clutter and well lit goes a long way toward reducing the potential for devastating falls…” (“The Hidden Dangers of Falling” by gerencherk, June 23, 2008)
The two areas of concentration are discussed: 1. the bathroom and 2. storage. The bathroom presents a multitude of safety issues related to balance (falls) and strength (moving from a seated to standing position). The various storage areas of a home provide focus to access, reaching and bending.
Truisms and statistics
- Every bar is a grab bar.
- Floors get wet.
- Rugs move.
- Tripping can occur with as little as 1 inch of height change.
- “About 35% of people over age 65 fall in their homes at least once a year. That figure increases to 50% for those ages 75 and over.” (Harvard Women’s Health Watch, Feb 2009)
- Every bar in the bathroom; towel bar, toilet roll dispenser, slider for hand-held shower wand or even a hook should be firmly anchored to reinforcement in the wall. Horizontal and vertical grab bars should be firmly anchored to reinforcement in the wall and placed in the following locations: the wall at the side and back of the toilet, the control end and side wall of a tub, and the three walls of a shower. A tubular grab bar should have an outside diameter between one and one-quarter to two inches and a length depending on location. (Adapted from Chapter 6, ICC/ANSI A117.1-2003)
- A vanity cabinet with a sink, the faucets and storage in the cabinet present reaching, bending, strength and safety issues. Place the sink off-center from the cabinet allows for workspace and a place to set-down toiletries. Faucet handles are difficult to use when hand strength lessens or arthritis affects joints. Faucets with a lever style control are easier to use when gripping is a challenge. A hands-free faucet that turns the water on and off at a pre-set temperature is another possibility. A hands-free faucet requires a power outlet. A power outlet inside the cabinet allows grooming appliances to be out of sight and not take space on the countertop when not in use.
- When a shower is chosen in lieu of a tub, a trench drain between the shower pan and the bathroom floor is recommended. This type of drain provides a smooth transition into the shower to avoid tripping and allows a walker to roll in. To maintain safety and aid with balance the shower needs a sturdy seat. The design of a built in seat should allow water to run off. A decline of one-eighth inch per foot will suffice. There are also many sturdy portable seats available. Shower dimensions of thirty inches deep by sixty inches wide match the space needed for a standard bathtub or the new walk-in tubs. If shower or walk-in tub modifications are planned for later the shower pan should be located to accommodate the location of the future tub drain. A shower with a low threshold and an offset drain can also replace a standard bathtub.
- Toilet clearances should be sixty inches wide and fifty-six inches front to back. From an adjacent wall, the centerline of a toilet should be no more than nineteen inches nor closer than seventeen inches. The height to the top of the toilet seat should be between seventeen inches and nineteen inches. This height has been found to make sitting and getting up from the toilet easier. (Adapted from portions of Chapter 6, ICC/ANSI A117.1-2003) These clearances allow another person to aid an aging adult in sitting down and getting up from the toilet and provide adequate room for a walking aid to be placed at their side.
The potential for accidents or injury in the bathroom are many. Slipping and falling, grabbing something that is handy but not securely fastened to the wall, burning your hands or body on water that is too hot or difficulty maneuvering in a bathroom even if you are young and on crutches are just a few of the accidents that frequently occur in a bathroom. There are varied design solutions for a bathroom that are aesthetically pleasing, not age specific and function well.
Truisms and statistics
- There is never enough storage.
- “I can reach that with my stool.” (from a seventy-plus-year-old, five-foot, four-inch tall woman)
- “Among older people, men are more likely to die from a fall but women are more than twice as likely to suffer a fracture-especially a hip fracture which often results in long-term impairment and nursing home admission.” (Harvard Healthbeat, Oct 28, 2008)
- Not all stools are created equal.
- The best design of storage, cabinets, closets, and shelves eliminates bending and reaching and does not require a stool to access every day needs. A person’s vertical reach is proportional to their height. A five-foot, four-inch tall woman can normally reach the top edge of a refrigerator (approximately six feet tall) but not the items in the cabinet above without the aid of a stool. A safe stool or ladder will not require the user to stand on the top step and has a vertical extension beyond the top step to hold onto.
- Storage should be designed to include an easy reach into a shelf, drawer or cabinet. The target range for every day storage (dishes, food stuffs, cooking pots and pans) in cabinets or a pantry is between twenty-four inches and seventy-two inches above the floor. Reaching for these items does not require bending down or climbing on a stool. When this storage is limited to this forty-eight inch range the storage depth should be increased so as not to lose storage space. Pull-out shelves and drawers inside a cabinet that are twenty-four inches deep and eye level fixed shelves that are sixteen inch deep allow visibility to the back of the shelves and drawers.
- The key to storage, whether it is a closet, pantry, kitchen or bath cabinet, or in the garage is the flexibility to customize to the individual needs of the homeowner and easily reconfigure. Ideally the design reflects a mix of full height storage with countertops in the kitchen and bath, folding space in the laundry and shelving that is unobstructed by a counter, washer/dryer or appliances.
Focusing on the bathroom and storage makes a real difference a safe place to live and maintain mobility. How to solve these concerns will depend on the physical elements or constraints of the design of the home.
In any setting; moving to a new home, staying in your existing home, or moving in with family, the goal for Aging in Place is the ability to remain in the home of your choice. Having control over the choices in housing is important to the health and well-being of any adult growing older.
The goal of Aging in Place is to take away the danger of living in the home of your choice not take away the home.
(Editor’s Note: Margaret Gilbert has practiced architecture for more than 35 years in the specialties of healthcare facility design and housing. She resides in Colorado Springs, Colorado.)