I recently had lunch with a terrific architect who is creating new senior living and care options. We are exploring ways that my expertise and services can further benefit his clients. While we share similar goals, I was stunned when he told me that in his non-licensed residential communities, “We don’t include grab bars and accessories like that. They can be added later when needed.” No. No. No. Absolutely not.
Waiting to install grab bars until they are deemed necessary, is putting them in too late and has significant negative impacts on individuals, families, and society.
While this professional includes wider doorways, zero step entries and showers, he’s not alone in not including grab bars. Often clients, whether developers or individuals, reject them. The former often for the extra cost, the latter for the frailty they think grab bars represent. Actually, grab bars are the opposite: they can go a long way to preventing frailty and enabling people to maintain independence. Let’s look at why waiting until there is an obvious need for grab bars and these features reinforces misconceptions about both need and the impacts of design.
1) Why would we let the built environment dis-able people unnecessarily? For further explanation of this, see my Enabling Design Approach for more information. Anyone can need something to hold onto when balancing on a wet, slippery floor. Additionally, grab bars can be used in non-bathroom locations, such as at a doorway, especially if there is a step. Complaints about grab bars being institutional are not relevant because a) the more they are used in residential environments the less they become institutional, and b) there are so many great style and design options that are not institutional.
2) The renovation process can be costly, stressful, and time-consuming. How does it make sense to put people who suddenly require these features– often due to a health event– through the stress and uncertainty of renovations? Can the renovations be made while waiting to come home from the hospital or rehab? How often is a contractor able to modify your home to support your new needs in a matter of weeks? Adding grab bars may not be straightforward: blocking is needed in the wall to support the grab bars, and sometimes a design that hasn’t accounted for grab bars limits which ones and where they can be used–decreasing their benefits. Consider that building a wider doorway in new construction may cost nothing or as little as an additional $10 per door, but retrofitting an existing doorway will usually cost over $1000 per doorway. (1)
3) Who pays for these features in a retrofit? Why would we create places that don’t meet the needs of the true range of people and then expect them to pay to revise them? Especially when they are on a fixed income? Housing and community design that enables people to maintain their physical, cognitive, and financial independence must be viewed as crucial strategies to funding retirement and as crucial to the economic development of communities and states. (2)
4) How can you predict when they will be needed and by whom? When I was 25 years old, I slipped on the 2nd floor landing at the top of the stairs of my relatives’ home. There was not a handrail in sight until I was already rapidly falling down the stairs on my tailbone, and flew by a short bannister on one side that only went 2/3 up from the bottom of the stairs. This event required years of physical therapy to resolve and negatively impacted my daily life.
It can be difficult to have a conversation about accidents and safety because of the fears they provoke, and my professional belief is that we should primarily focus on the positive perspective of using design to enable people to thrive. But we do need to look at the safety issues. Consider the costs: $754 million is spent yearly on medical costs due to falls. (3) Who pays for this? We all do because if a person is on Medicare or Medicaid, society covers part or all of those costs. In addition, older people (especially those age 65 and older) pay for inappropriately designed places with a diminished quality of life, sometimes even with their very lives. Fall-related injuries also increase the demand for long-term care both in private homes for people attempting to age in place, and in facilities. With demand for care outstripping the supply of caregivers and projected to be exacerbated by demographic trends, we must look at all the variables to reduce demand. One obvious way: leverage design to enable people to maintain as much of their physical capacity as possible. This is why my firm, Silver to Gold Strategic Consulting, is developing an initiative “Tackling the Caregiving Crisis by Demand.” To learn more about how this can benefit your community or organization, please reach out to us via https://silvertogoldstrategies.com/contact/
When we design spaces that lack features that respect the needs of all ages and abilities, we are behaving as if everyone has high physical, sensory, and cognitive abilities, is of average height, and is financially and cognitively capable of making retrofits. Essentially, we are putting the responsibility of good design on homeowners. This unnecessarily contributes to our nation’s long term care crisis and increases costs for all, while hurting people’s quality of life. By utilizing the Enabling Design Approach to normalize features such as grab bars and zero-step entries, designers can help their clients save money, avoid the hassle of renovations while they’re dealing with impairments, and have more dignified, fulfilling lives in their homes and communities of choice.
References
1) “Quick Guide: Low Costs of Visitability” from Visitability.org https://visitability.org/quick-guide-to-low-costs-of-visitability-vs-costs-of-no-change/
2) “Enabling by Design: Leveraging Home Features for Physical and Financial Independence in Retirement” https://www.linkedin.com/in/esthergreenhouse/overlay/1635501467694/single-media-viewer/?profileId=ACoAAAGdCe4BIokel0xcdVF1WcX6gKs6tVNCgrA
3) “Get the Facts on Falls Prevention” National Council on Aging https://ncoa.org/article/get-the-facts-on-falls-prevention