Alternative Geriactics

[PokyNursing]

Can anyone tell my anything or link me to information about alternative geriactrics? Is there such a thing?

The baby boomer post hippies are going to want some kind of alternative to the traditional nursing home setting.

[Hellllllo Nurse, BSN, RN]

There is The Eden Alternative.

Some love it, others say it is a failure.

[PokyNursing]

I will do a search on Google, thanks for the tip.

[NancyRN]

I find it very sad when people have to move out of their homes simply because they cannot get around anymore. Wouldn't it be nice if all new homes being built today were handicapped accessible? Its not expensive to make wider doorways etc when building new, but the cost of remodeling is prohibitive. With all the aging boomers I don't know why more thought isnt given to this.

[gwenith, BSN, RN]

This is Australian but you might find some answers there.

http://www.health.gov.au/ageing.htm

[grouchy]

Very good thought! I've seen one article that bears directly on this . I believe it was in U.S. News and World Report or Newsweek, and it was about a gay nursing home and a gay retirement community, both of which are firsts. Neither would be conceivable without the social changes associated with the boomer generation.

Newsweek also had an article several years ago about how boomers are changing funeral rituals. Web site memorials and less formal, nontraditional/nonreligious funerals are also becoming more common.

I have also read that there is something of a movement amongst architects to promote what they now call universal access, rather than handicapped access. I don't think it's made much impact on retail homebuilding yet. I would like to see more of a public health campaign aimed at 50 and 60 year olds to encourage them to make their homes more accessible as part of their retirement planning.

[grouchy]

Universal design is the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design.

-Ron Mace

It would be nice if there was a tax credit for elderly people to retrofit their house.

The following characteristics are elements, features, ideas or concepts that contribute to or can be components of a universal house. This list is intended as a guide. The features described are those we might look for in a universal house but not all are expected to be included in a given home.

Some are finite recommendations, some are lists of options, and some are scope statements in regard to how many particular features must or should be included. Obviously, the more universal design characteristics or features included, the more usable the house.

Entrances: Site Design Methods for Integrated Stepless Entrances

*Level bridges from entry to uphill point.

*Drive and garage elevated to floor level, so vehicles do the climbing.

*Earth berm and bridge and sloping walk.

*Site grading and earth work (with foundation waterproofing) and sloping walks at 1 in 20 maximum slope.

*Avoid ramps. If ramps are used, integrate into the design.

Stepless Entrances

*Making all home entrances stepless is best.

*More than one stepless entrance is preferred.

*At least one stepless entrance is essential; if only one, consider passage through a garage, patio or raised deck.

Other Entrance Features

*One-half inch maximum rise at entrance thresholds.

*View of callers for all people, including children and seated users through side lights, wide angle door viewers, TV monitors, windows in doors, and/or windows nearby.

*A place to put packages while opening doors: built-in shelf, bench or table with knee space below located on the outside next to the door.

*Covered entrys such as porches, stoop with roof, awnings, long roof overhangs, and/or

carports provide shelter while unlocking and opening doors.

*A way for visitors to communicate with residents, such as lighted doorbell at a reachable height, intercom with cordless telephone link, and/or hardwired intercom.

*Space at entry doors should be a minimum 5' x 5' level clear space inside and outside of entry door for maneuvering while opening or closing door. (Can be smaller if automatic power door is provided.)

*Good lighting at entry doors: focused light on lockset, general illumination for

seeing visitors at night, and/or motion detector controls that turn on lights when

someone approaches the door to eliminate the problem of dark approaches to home

adding a sense of security.

*Address/house number should be large, high contrast, well lit located in a promi-nent place, easy for friends and emergency personnel to locate.

Interior Circulation

*At least one bedroom and accessible bathroom should be located on an accessible ground floor entry level (same level as kitchen, living room, etc.).

*Clear door opening width (32" minimum, 34" - 36" wide doors), for all doorways.

*Clear floor space (18" minimum) beside door on pull side at latch jamb provides space to move out of the way of the door swing when pulling it open.

*Passage route (42" minimum width) to provide maneuvering room in the hallways and archways.

*Turning space in all rooms (at least 60" diameter).

* An open plan design, minimizing hallways and doorways and maximizing sight lines.

Vertical Circulation

*All stairs should have appropriate width and space at the bottom for later installation of a platform lift, if needed.

If a two-story dwelling:

*at least one set of stacked closets, pantries, or storage spaces with knock-out floor for later use as an elevator shaft or

*a residential elevator with minimum 3' x 4' clear floor installed at the time of initial construction.

*Stair handrails to extend horizontally beyond top and bottom risers.

Bathrooms

When more than one bathroom is provided, all should meet the following criteria, including bathrooms on the second floor.

At least one bathroom must have one of the following accessible bathing fixtures:

*minimum 5' x 3' (4' preferred), deep curbless shower (see wet area shower details) or

*tub with integral seat, waterproof floor, and a floor drain.

Other bathrooms in the same house may have a tub with an integral seat or a 3' x 3' transfer shower with "L" shaped folding seat and 1/2" maximum lip (curb) in lieu of fixtures described above. When more than one bathroom has the same type of bathing fixture (a tub, shower, wet area shower), at least one shower should be arranged for left hand use and one for right.

*Adequate maneuvering space: 60" diameter turning space in the room and 30" x 48" clear floor spaces at each fixture. Spaces may overlap.

*Clear space (36") in front and to one side of toilet allows for easy maneuvering at toilet.

*Toilet centered 18" from any side wall, cabinet or tub.

*Broad blocking in walls around toilet, tub, and shower allows for future placement and relocation of grab bars while assuring adequate load-bearing and eliminates the need to open up wall to add blocking later.

*Lavatory counter height (32" minimum).

*Knee space under lavatory (29" high) allows someone to use lavatory from a seated position. May be open knee space or achieved by means of removable vanity or fold-back or self-storing doors. Pipe protection must be provided to prevent contact with hot or sharp surfaces.

*Countertop lavatories preferred with bowl mounted as close to front edge as possible.

*Wall hung lavatories acceptable with appropriate pipe protection.

*Pedestal lavatories are not acceptable.

*Long mirrors should be placed with bottom no more than 36" above finished floor and top at least 72" high. Full-length mirrors are good choices.

*Offset controls in tub/shower with adjacent clear floor space allows for easy access from outside the tub with no inconvenience when inside.

*Integral transfer seat in tub and in 3' x 3' shower stall allows people to sit in tub/shower without needing additional equipment.

*Grab bars, if installed, need not be stainless steel or chrome. Colors are available to

match decor.

Fixture Controls

*Single-lever water controls at all plumbing fixtures and faucets.

*Pressure balanced anti-scald valves at tubs and showers.

*Hand-held showers in all tubs and showers, in addition to fixed heads, if provided. Single lever diverter valves if needed.

*Adjustable height, movable hand-held shower head or 60" flexible hose allows easy use by people of all heights.

*Mixer valve with pressure balancing and hot water limiter prevents scalding people who cannot move out of the way if water temperature and/or pressure changes suddenly.

Kitchens

*Space between face of cabinets and opposite walls should be 48" minimum.

*Clear knee space under sink (29" high minimum) allows someone to use the sink from a seated position. May be open knee space or achieved by means of removable base cabinets or fold-back, bi-fold, or self-storing doors. Pipe protection panels must be provided to prevent contact with hot or sharp surfaces.

*Adjustable height work surfaces (28" - 42"), electrically powered, continuously adjustable counter segments, some with cook tops and/or sinks and disposal units

or

*Mechanically adjustable counter segments, some with sinks and disposal units, some with cook tops, adjustable in 2" increments (28" - 42") allows in-kitchen work for people of all heights, those with back trouble, people who are seated, and/or children.

*Contrasting color edge treatment on countertops. Color or contrast difference allows easy recognition of the edges of counters helping prevent accidental spills.

*Stretches of continuous counter tops for easy sliding of heavy items, particularly between refrigerator, sink, and stove top, for easy one-level food flow.

*Full-extension, pull-out drawers, shelves and racks in base cabinets for easy access to all storage space.

*Adjustable height shelves in wall cabinets.

*Pantry storage with easy access pull-out and/or adjustable height shelves for easy reaching of otherwise hard-to-get items.

*Front mounted controls on appliances to facilitate easy reach.

*Cook top with knee space below allows someone to use the appliance from a seated position. May be open knee space or achieved by means of removable base cabinets or fold-back or self-storing doors. Pipe protection panels must be provided to prevent contact with hot or abrasive surfaces.

*Cook top or range with staggered burners and front or side mounted controls to eliminate dangerous reaching over hot burners.

*Glare-free task lighting to illuminate work areas without too much reflectivity.

*Side-by-side refrigerator allows easy reach of otherwise hard-to-get items, particularly if pull-out shelving is provided.

or

*Use under counter or drawer type refrigerators and install them on raised platforms for optimum access to storage space of 18" - 48" above finished floor.

*Built-in oven with knee space beside, set for one pull-out oven rack at the same height as adjacent counter top.

*Drop in range with knee space beside, top set at 34" above finished floor.

*Dishwasher raised on a platform or drawer unit, so top rack is level with adjacent counter top, puts bottom racks within easy reach requiring less bending.

*Single-lever water controls at all plumbing fixtures and faucets.

Laundry Areas

*Front loading washers and dryers, with front controls, raised on platforms, utilize platform for storage area.

*Laundry sink and counter top surface no more than 34" above finished floor with knee space below.

*Clear floor space 36" wide across in front of washer and dryer and extending at least 18" beyond right and left sides. (Extended space can be part of knee space under counter tops, sink, etc.)

Storage

*50% of storage to be no more than 54" high.

*Adjustable height closet rods and shelves allows for flexibility of storage options.

*Motorized cabinets that raise and lower.

*Power operated clothing carousels.

Garages And Carports

*Power operated overhead doors.

*Door height and headroom clearances (8' minimum) for tall vehicles or provide alternative on site outdoor parking space.

*Extra length and width inside for easy movement around parked cars.

*No ramp in garages.

*Sloping garage floor (with through-the-wall/door vents at bottom of slope to release fumes) in lieu of stepped entrance with ramp from garage/patio to house interior.

Decks

*Build deck at same level as house floor.

*Keep deck clear of the house and use slatted decking for positive drainage (i.e., a wood trench drain).

Hardware

*Easy to use, requiring little or no strength or flexibility:

* lever door handles

* push plates

* loop handle pulls on drawers and cabinet doors-no knobs

* touch latches

* magnetic latches in lieu of mechanical, keyless locks

Home Automation

*Motion detector light switches in garages, utility spaces, entrances, bathrooms, hallways and basements.

*Remote controls for selected lights.

*Remote controls for heating and cooling.

*Doorbell intercoms that connect to cordless telephones.

*Audible and visual alarms for doorbell, baby monitor, smoke detectors, etc.

Light and Color

*Color contrast between floor surfaces and trim allows easy recognition of the junction of floor surfaces and walls. Avoid glossy surfaces.

*Color contrast difference between treads and risers on stairs.

*Ambient and focused lighting allows lots of light. Lighting that is thoughtful and variable, emphasizing lighting at stairs, entrances and task lighting

*Contrast between counter tops and front edges or cabinet faces.

Switches and Controls

*Light switches above floor, 36" - 44" maximum, and thermostats at 48" maximum height.

*Easy-touch rocker or motion activated switches. (See Home Automation)

*Additional electrical outlets at bed locations and desk for equipment, four-plex boxes each side for computer and electronic equipment as well as personal use equipment.

*Electrical outlets, 18" minimum height, allows easy reach from a sitting position as well as for those who have trouble bending over.

*Electrical panel with top no more than 54" above floor located with a minimum 30" x 40" clear floor space in front.

Windows

*Windows for viewing, 36" maximum sill height.

*Casements, awnings, hoppers, and jalousies are good choices but not essential.

*Crank operated windows.

*Power operators whenever possible.

Sliding Doors

* Exterior sliding doors: - drop frame and threshold into sub floor to reduce upstanding threshold track, or ramp the finished flooring to top of track on both sides.

* Interior pocket doors: When fully open door should extend 2" minimum outside door jamb and be equipped with open-loop handles for easy gripping..

* By- passing closet doors - each panel should create an opening at least 32" clear

Special Optional Features

* Power door operators when ever possible on exterior doors.

* Overhead track lifts with storage "garages."

[grouchy]

Couldn't find a link for the U.S. gay nsg home yet, but found this

15 October 1999

"It's not separatism. It's coming together!" exclaims Wolf Huis, chairman of the L.A. Ries Foundation. Wolf was shocked when a research project amongst 30 nursing homes in Amsterdam revealed that all the participating directors and nurses claimed that homosexuality didn't exist in their homes.

Thus was the LA Ries Foundation born: a housing project for 8 elderly gays in Amsterdam's Jordaan district. The inevitable publicity resulted in a waiting list for the apartments. Seven gay men and one lesbian with the most pressing cases were chosen.

http://www.rnw.nl/culture/html/our_own_kind.html

[grouchy]

I found a link for the gay U.S. retirement community.

[grouchy]

I wonder if anyone will try a cooperative or commune-style nsg home or retirement community, where residents share chores with help from paid staff? Maybe as better drugs for dementia become available it might be doable.

Maybe it sounds crazy, but there is something of a precedent. Years ago, I read about Project Projimo in Mexico. It fascinated me, and I hope to visit it someday. It's a rehabilitation facility serving an impuverished clientele. Because of the lack of funds, as pt's progress, they are trained to help other pts with their physical therapy exercises or help build and repair wheelchairs. I saw a picture of a wheelchair bound teenage boy helping guide another pt with range of motion exercises. Apparently, this really helps them with the psychological aspect of rehabilitation, too. I think it sounds awesome!

[NancyRN]

grouchy, I love the Universal Design concept. I believe if there were a neighborhood of new homes being built to these specs there would be a 10 year waiting list!

I am just in my early 50's and I am in good health, but since I want to stay in my home, I will be looking for Universal access in any new home I build.

[grouchy]

Originally posted by NancyRN

grouchy, I love the Universal Design concept. I believe if there were a neighborhood of new homes being built to these specs there would be a 10 year waiting list!

I am just in my early 50's and I am in good health, but since I want to stay in my home, I will be looking for Universal access in any new home I build.

I really began to appreciate the wisdom of it when I broke my ankle. Even young people can benefit from it.

One of my home care pts had the best ramp entrance I ever saw. He had an attached garage. The ramp was in the garage, going up to the door in the side of the kitchen. No snow or ice, no shovelling, and the house looked the same from the outside.

One of my elderly neighbors fell and broke her leg while shovelling last winter. Since then, she moved her washer and dryer from the basement to her bedroom. It doesn't look good, but it works great for her.

While a full retrofit would be really expensive, I think if you just made sure you had a ground floor bathroom, a sleeper sofa on the ground floor, extra lighting, removed area rugs, installed a grab bar in the shower, and minimized clutter, you'd be in pretty good shape on a reasonable budget.