Aging in Place The Sequel: Showers, Grab Bars, and Drains Oh My

@kampeck_ink

OK now that you know a little more about the grey wave coming and how to help aging eyes through it. Let’s talk about the other aspects of the home that can be altered to make aging in place an easier transition. (Did you hear there is going to be a remake of The Golden Girls with Tracee Ellis Ross, Regina King, Alfre Woodard, and Sanaa Lathan? Aging is trending.) 

According to the National Council on Aging, one in four Americans over the age of 65 falls each year and 80 percent of these falls happen in the bathroom. No joke. 

Ergo, it makes sense that if you can only alter one room in your home for aging in place and fall prevention, it should be the bathroom. So from least amount of surgery to most amount of surgery here are some choices to make.

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Paint

A nice interior mold free paint from Benjamin Moore or Dunhill Edwards will run you about $50-$75/gallon which also allows you to cover about 400-500 of square footage...this will cover the entire space of most bathrooms. So two things you can do to make life easier is to paint the ceiling a lighter color than the walls and also keep the sheen muted to a flat or matte finish. This will help avoid the glare issue discussed in the last post and allow what light you have to work effectively as it bounces around the room from artificial or daylight sources. This is probably why you see a lot of browns and taupes in senior facilities. But this doesn’t mean that you have to stick to neutrals...mauves, lavenders and rose colors can be just as effective without seeming like the grey wave is literally crashing over your entire room. 

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Tile

Moving up in cost you have tile. 

When retiling a bathing area, the big thing to think about is choosing a tile that has the right slip-resistance factor. This will commonly come with the tech spec sheet but there is no mandated standard for residential showers. Most manufacturers will simply let you know if the tile is impervious to water and leave it at that.  

What this means is that you should not pick a tile by picture alone. You should feel it and hopefully it will have some tooth to it. Don’t be deceived by labels like “good for bathrooms” because this can also reflect its water resistance vs. its slip resistance. Take a look at the technical specs for the tile you are interested in on vendor websites and then look at the DCOF Rating when WET which is the coefficient of friction test of the tile when it is wet. You are looking for a number larger than .42 but for a bathroom it should really be at least .55 Again, feel it. I was surprised to see the coefficient of friction number for the Emser Perspective Tile to be >.60 while the Emser Barn tile was >.5 because both are “porcelain” tile and the feel of the barn tile is actually less slick. So after you do your first round of looking at the numbers, try to get a sample of the tile and walk on it barefoot if you can. Chances are you aren’t bringing this back, right?

Both are Considered “Porcelain Tile” but one actually feels less slick.

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Grab Bars

When people think of altering a space for aging in place, grab bars are the first thing people visualize. You would think something as simple as mounting a three foot metal rod wouldn’t be super challenging but even this can get complicated because you are talking about several trades working in a space as small as five by two and half feet.

I am assuming already that you are bright enough not to just mount a grab bar to an existing wall because not only could you potentially interfere with the existing plumbing but you might find negative space with nothing for the grab bar to attach to. Don’t rely on mounting to your existing studs either. Studs are commonly placed 16” apart and grab bars are not 32” across. To attach a grab bar you need to be working with an open wall.

In a public setting for ADA, you will be mounting a grab bar 33” to 36” from the top of the grab bar above a finished floor. What a contractor will commonly do is mount a piece of wood blocking like a 2 x 6 across the length of the wall mounted at the intended height somewhere between 33”-36” from the floor. 

But let’s do some math and look at the unknowns. First of all that nominal 2 x 6  lumber is actually 1 ½” x 5 ½” so you are working with a diminished dimension already. Then we don’t know if the contractors are mounting with the finished tile depth in mind which can vary up to 3/4 inch or more. They could be making their calculations from the unfinished floor. They could be measuring from the low side of the shower near the drain vs, the high side of the shower where it starts to slope. The plumber could come in and adjust the blocking based on the diverter, hot and cold piping, and the supply and just walk away without telling anyone they moved the blocking around.  

This adds up to a lot of unknowns and potential for error. You have tradespeople who are often not talking to each other and sharing information on site. So what are some things to demand?

• Make sure your contractor talks to the other trades and gives them detailed calculations at the end of each phase of their work.

• Have your contractor use a bigger piece of blocking such as a 2 x 8 or 2 x 10 to cover possible inches lost in translation and have that blocking run the length of the wall intended for the grab bar, not just the middle of the wall. 

• Although contractors may claim they “do everything” and don't need other trades, make sure if they are doing plumbing that they are licensed for plumbing and if they claim to  “do tile” ask for photos and follow up with the referrals. Each of these trades is specialized work and although it will seem more complicated to do all this due diligence,  often times it is better to go with the multi-person approach and have each trade concentrate their energy to the trade at which they are most adept. Tile setters actually have to be licensed in their trade and take out permits to tile showers.

• Make your expectations with your contractor explicit. Directly ask for an ADA compliant grab bar height mounted at a finished height of 33-36” measured from the top of the grab bar. In this case you can actually choose as a shorter person or a taller person what that three inch increment should be but for the aforementioned reasons if you say 34” or 35”

And remember that a grab bar doesn’t have to look like it belongs in a hospital. There are many finishes to a grab bar and as long as it has a 1 ½” diameter and a smooth return to the wall with 1 ½” of space left behind the grab bar you can even get one customized. I emphasize the smooth return. Nothing sounds more unpleasant than getting jabbed in the hip when you’re naked. 

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Barrier Free Showers & Mental Barriers 

I was talking to my stepmother recently about potentially renovating her bathroom for herself at age 72 and my father who is 84.  She mentioned that their bathroom from the 1990s was cramped and contained things like a Roman Tub that they never used. She would like to remodel it to be more efficient for them. During the conversation she talked about grab bars and opening up the space more but I realized that she never mentioned including a barrier free shower in her thoughts.

 If you are going through all that trouble to demo a space for someone who is getting older, doesn’t it make sense to take the extra step so to speak and create a barrier free environment for someone who might have to use a wheelchair later in life? And even if it does not come to that loss of ambulatory life, an older person would still benefit from not having to step over a dam.  This same reasoning applies to someone who uses a walker.

A contractor may have to do some extra demo to lower the subfloor but if this is the home you plan to own for the rest of your years, make it work for you. The contractor gets to leave after the job. You are stuck with your own decisions. 

Again, if you manage to convince your loved one or yourself to go the extra mile and install a linear drain, make sure that you not only hire a licensed trade to do the job but someone with experience installing this type of drain. A  plumber who claims to “do them all the time” still needs to be asked for photos and referrals. After the drain is installed communication is required between the contractor and the plumber and the tiler. I’ve also been in situations where I realized that English was not the tiler’s first language and I managed to hire a plumber who spoke Spanish. These small observations can pay off enormously in the long run.

Before the physical barriers can come down, the mental barriers have to be shedded first. Unfortunately when people plan a project and begin the hiring process, therapists are often not the first trade one thinks about as part of the team. But overcoming mental hurdles and roadblocks can be helpful, especially when one emphasizes how a barrier free environment could help all future caretakers, family and potential employed help alike. 

And you thought the actual remodeling process would be the hard part….

Aging in Place | Eat Dessert First | Plan Your Lighting Scheme Before the Grab Bars

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@kampeck_ink

Aging In Place in the 21st Century

We’ve all heard the statistics about the grey wave, and how by 2034 we will have more people over the age of 65 in the US than under the age of 18. These people will need some place to live. These people may be your parents. These people may be you.

As we consider how we might alter our spaces for an aging in place environment, the first thought often goes to grab bars, walk in tubs, slip resistant tile, etc. Important things to consider, and things we will consider in my posts here as well. But I would challenge you to think about what people usually think of last in design which is lighting for aging in place.

Perhaps I am thinking of this because my father is a retired ophthalmologist who often left magazines on the coffee table with their covers of human eyeballs staring at you when you were looking for a coaster. Regardless, lighting design is really important.

As we age, our eyes will also age, and we should use any aging in place design to accommodate this fact. So let’s take a look at some of the most common eye problems out there and how we can make some smart decisions to adjust: these common eye problems include cataracts, glaucoma, and macular degeneration. 

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Eye Disease 101 

Cataracts are a gradual opacification of your lens due to aging and UV light (yet another reason to wear your sunglasses when out and about). What ends up happening is a gradual loss of central vision...Dad said patients would often just say that the world looked… dimmer. There are different kinds of cataracts including a nuclear cataract where the lens gets browner and actually filters out blue rays so the eye only registers greens, yellows and tans.  The other type of cataract, the cortical cataract, scatters light and creates glare. You don’t really want to sign up for either.  

The good news is that cataracts can be removed by surgery. The bad news is that cataracts usually develop in the mid 50s but people don’t usually get them out until their late 60s and women get them younger than men. What this means is that people, more often of them women, will be living in a compromised vision space for 10 to 15 years or more without even realizing it. 

Glaucoma affects over three million Americans, and again about 50 percent of the population don’t know they have it. Statistics at UCSF reveal that it is the number one leading cause of vision loss in African Americans. 

What is glaucoma? It is progressive damage to the optic nerve that creates eye pressure and leads to side vision loss or vignetting, the opposite experience from a cataract. The bad news is that glaucoma is not curable, it can only be controlled via drops, and at times, surgery. 

Macular Degeneration occurs mostly after the age of 50 but 25% of adults over the age of 70 have signs of this and 50% have signs of this by the age of 90. Macular degeneration results in the loss of central vision. 

(BTW, this photo was taken in Israel near the Dead Sea of a man riding a camel at a gas station. But if your vision is impaired you don’t register everything which is unfortunate.)

While I don’t suggest making huge renovation modifications based on eye disease, practially anyone who is aging will experience some vision loss….even if you are given corrective lenses as you age maybe you want to be able to walk around your kitchen or bathroom without wearing your glasses. So now let’s take a look at the way some design decisions can make dealing with the simple act of eye aging easier.

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Think Miami Vice. 

I may be outing myself age-wise with this reference to Crockett and Tubbs but then I have scrolled through enough of my Millennial friends’ Instagram accounts to know that attending a throwback Miami Vice party in your pastel blazers is kind of trendy. But what I’m talking about here is not the fashion so much as the look that director Michael Mann would employ often for his shots which was blue light. Whether he thought it was sexier to set his characters more in motion for a drug deal before sunrise I don’t know but the blue hue to his shots became a Miami Vice signature. So let’s employ it here in our aging in place design.

So say you are shopping for lightbulbs (or lamps as we say in the biz) and you have a choice of purchasing something that is advertised as “warm” or “cool.” Most people would pick the “warm” because it sounds cozier. In actuality, you may be making a better decision for an eye that is potentially yellowing to buy  a bulb that is bluer or a daylight bulb to offset the yellowing degeneration of the eye. Look for something that advertises a chromacity above 4000K to achieve this. Even a “daylight” bulb usually rated at 5600K would be a good bet. 

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Avoiding The Godfather Effect by Layering Light

I know what you’re thinking. But I like The Godfather. Why wouldn’t I want to look like I’m part of this movie? The answer is that this deliberate cinematographic choice to light from above created the effect of hollowing out Brando’s eyes. This is what you look like to most people talking to you in the room with standard boilerplate recessed can configurations in the ceiling. So unless you are part of the mafia let’s improve on this.

One of the things that lighting designers often find woeful is how there seems to be a cookie cutter way of lighting spaces with recessed cans four feet apart that has the habit of lighting furniture vs. people (see Kampeck_Ink’s image at the beginning of this post). Let’s not give our relatives or ourselves a plan where we are lighting the armchair perfectly and yet we can’t find our glasses on our own laps. For this part of the job we are going to have to look at changing up the standard recessed can design and also looking at the other elements in our space that could be contributing to problems.

So whether you are working with a design professional or just the contractor yourself you should advocate for lighting that is layered, lighting that will ambiently light the space as well as lighting that might wash the art etc. on your wall plus task lighting. Let’s say you are working on a living room space. Perhaps you will have one large surface mount fixture for ambient lighting, some wall washing cans for the art, and then simple armchair lamps or end table lamps for tasks like reading. By layering the light you won’t simply be walking in between dark spaces that the recessed cans above don’t reach and everything will be evenly lit. Our goal here is not to make the eye work harder in an aging in place environment but to help it out.

For most contractors this will be hardest adjustment to make. The reason why the four foot apart recessed can mantra is so prevalent is because it is simple for THEM. But guess what, they aren’t the ones living there! So ask them to do what will serve your needs!

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Avoiding Glare Bombs

Notice the bulbs have no modification which can cause intense glare. Sorry fan, ditch your light and we’ll talk.

So if you look at the “eye disease” section again the most common response on how the eye ages is the feeling of gradual dimming of a space. We need quality light but less glare or excessive brightness. Simple things can cause glare. Contrast between rooms causes glare. So if the living room is dark and the kitchen is not, that can cause glare. 

There are different kinds of glare. Direct glare is high illumination not covered or shielded (any unshielded lamp more than 25 watts can cause glare.) Indirect glare is reflected glare like sunlight bouncing off a white surface. Discomfort glare is uncomfortable but you can still perform tasks. Disability glare is glare so bad you can’t see. Let’s not get to the point where we are living in any of these states.

Upshot? When we are designing a space for aging in place we are also looking at the ways we can control glare. This comes from controlling the fixture and controlling the environment. 

So when you are selecting the light fixtures themselves make sure they have an option for modifying then such as a louver, shade or baffle. If this gets too heady, ask a designer or the vendor for help. In many cases you may be able to return the modifier if it doesn’t work out.

You should also look at your environment. What are your windows treatments doing to scatter the light effectively? Could you add a simple sheer to your curtains to diffuse the light?

If you are making new appliance selections, that stainless steel appliance may look slamming but maybe not the best choice for aging in place where the reflectance quality is 50-60 percent. So start looking at all those products you are considering with your newfound glare radar.  

If you are making a cabinet selection for your kitchen or bathroom remember that they don’t have to look like a Porsche dealership. You won’t be able to reach those cabinets if you are blinded and fall.

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