Appliance makers show Senior Sensitive products in Orlando

Catering to the Baby Boomer market, appliance-makers are focusing more on ease of use. Last week the had the equivalent of the ultimate home center with 1,900 exhibitors at the International Builders' Show here in orlando displaying cutting-edge products for the home.

Take, for example, the Lift Oven by Gaggenau. With the push of a button, the glass-ceramic base drops down to counter height so cookie sheets and roasting pans can slide from the counter to be easily loaded and then raised back up to the oven. "You do not have to bend or lift. When you reach into the oven, that's when you get burned. This time the oven comes to your worktop," said spokeswoman Vanessa Trost. Already for sale in Europe, the oven will be available in the U.S. in July and will cost about $3,300.

Fumbling with house keys may soon be a thing of the past as both Schlage and Kwikset showed locks that work with the touch of a finger. Kwikset's biometric fingerprint SmartScan deadbolt is activated by the swipe of a fingerprint across an indicator behind the teardrop-shaped lock. The battery-operated lock requires no hardwiring and can be programmed for up to 50 fingerprints. It also can be programmed to allow entry for limited time periods if, say, the housekeeper comes from 8 a.m. to noon on Fridays. And, of course, it could solve the problem if you always lose your keys, like me. The lock will cost about $200 and be available in June.

Interesting Post On Gilbert Guide Blog

Here's an interesting post on Baby Boomer Women sandwiched between children and senior family members. This relates to the topic of Caregiver burnout as a major cause of having to move to assisted living which was discussed earlier here.

Monitoring and Response for Seniors

We have all seen the classic “I’ve fallen and I can’t get up!” commercials. This caricature, although humorous, is representative of an important class of technology that provides monitoring of health and well-being status, communication to interested parties, and in some cases provides automated responses to perform some corrective action. Few people would choose to have a caregiver following their movements twenty-four hours a day, seven days a week to ensure their well being. Studies show that providing this level of monitoring through technology is more acceptable and provides a high level of support for independent seniors. With a professionally developed program the caregiver can better the ongoing day to day maintenance required and also life’s little emergencies.

These monitor and response systems can operate in the short term to sense a crisis situation, such as a fall, and provide a way to make a call for help. Medical alert systems like American Medical Alarms, Inc. all allow a greater degree of freedom for an older person, and peace of mind for adult children, by allowing independence while providing a safety net in case of medical crisis. Some devices might automatically detect a crisis (such as a fall). Others depend on activation by the individual (or someone nearby) to initiate a call for help.

Monitoring systems can be classified along a number of dimensions:

• What information is being recorded or transmitted? It could be medical information (e.g., heart rate, respiration, blood pressure, medication compliance, incontinence), movement data (e.g., restlessness in bed, gait patterns), or simply awareness information (e.g., a video transmission to a relative).
• Over what period of time are data analyzed? The capture of information can be for instantaneous purposes only (e.g., a “GrannyCam” usually transmits images over the Internet to be viewed in real time only) or over a period of time for trend analysis, as you would expect for vital signs in a telemedicine application or in medication monitoring for compliance in a home or assisted living environment.
• How is information reported to relevant individuals? Medical alert systems provide a phone call to a response agency. Telemedicine applications report over a secure channel to an electronic patient record that can be consulted by trusted medical professionals or even by the individual being monitored. Cameras are sued to provide easy monitoring for family (usually over the Internet, serving an important social communication function discussed below) or remote caregivers (at a nursing station, for example).
• What is the role of the older person in using the technology? Does the monitoring require any instrumentation or active cooperation on the part of the individual being monitored? For example, do they have to wear an infrared badge for a positioning system, or is it passive, with the environment instrumented to measure a naturally occurring phenomenon using devices such as a motion detector or face recognition system?

There are many examples of these monitoring systems for an aging population. Some address the safety and security of individuals who may wander. Devices can either prevent undesired wandering (e.g., automatically closing doors or gates to a house or community grounds to protect Alzheimer’s patients) or remind other to take corrective action (e.g., at nighttime when someone inappropriately leaves the bed). Simple load sensors in the beds of residents at Elite Care’s Oatfield Estates Cluster in Milwaukie, Oregon (http://www.elite-care.com), feed a visualization to allow caretakers to detect periods of restlessness in the night.

Some research is focused on monitoring ADL tasks in the home using a variety of sensing technologies and this is the part we’re interested in. Sensors and switches attached to various objects, or optical and audio sensors embedded in the environment, are used to detect which task a person is performing. Research trials with several subjects indicate that this method of tracking a person’s actions is a good way to monitor the state of a person’s health and independence and several commercial products are available for this purpose. Two companies, Quietcare (http://www.quietcare.com/) in partnership with ADT, and Xanboo in partnership with AT&T (http://www.attrm.com/) deliver home monitoring capability. The Quietcare product is best described in the attached first comment and is a significant and thoughtful step in home based senior monitoring. It is critical to have the infrastructure to support installations for effective home monitoring of seniors. People and homes are complex and individual and the configuration requirements for each installation cannot be managed with a canned security approach. The Quietcare product is focused on homebound elderly and other at-risk clients with chronic medical conditions, on monitoring in assisted care facilities and the AT&T product on home monitoring while the senior is in their summer or winter residence.

Friedman (1993) developed a wearable microcomputer with a location-sensing system and additional sensors to determine task-related information. Recently a commercial product is available from Bodymedia which shows some benefit of a wearable unit but primarily to support an exercise regime. Still, this is worth considering if you need to lose weight although I hate the idea of wearing an armband continually personally.

Age at Home - Dallas Morning News Example

Tuesday, February 6, 2007 By BOB MOOS / The Dallas Morning News

Bill and Judy Slease have built a house for the ages. All ages. The sixtysomething couple have constructed for themselves a "universally designed" house that can accommodate every stage of life and every physical ability.

As the nation's older population doubles over the next 25 years, experts predict, the demand for homes such as the Sleases' will grow substantially.

MIKE STONE/Special Contributor

Judy Slease, with husband Bill Slease, pulls out a mixer using a mount in her kitchen, which also includes a retractable bread board.

Empty-nesters looking to buy the home of their dreams will want a
place where they can spend the rest of their lives.

The Sleases say their new house gives them peace of mind. Both now enjoy good health. But if either becomes disabled or frail in old age, they know they'll be able to remain in their home as long as they like.

"We intend for this to be our last house," Mr. Slease said as he relaxed in his living room, which would be an easy wheelchair ride to the rest of the house and even the outdoors, through wide hallways and doorways and no steps.

Universal design has been around since the 1970s, but it has only recently attracted attention as more Americans approach retirement.

The Sleases first heard about the concept at a homebuilders convention. Intrigued by it, they decided to try the idea on themselves.

Their two-story, 3,500-square-foot home looks like any other in their upscale McKinney neighborhood, but it includes 80 elements of universal design.

"The beauty of universal design is that it doesn't call attention to itself; it just makes life more convenient," Mr. Slease said.

The first hints that there's something different about the Sleases' house are the step-free entrance and wide front door.

Inside, there are wider hallways, hard-surface floors, lower light switches, higher electrical outlets and an elevator that resembles an entryway closet.

The master bedroom and a full bath are on the first floor, to the side of the spacious living room.

All make it easier for anyone to move around and use the home.

Kitchens and bathrooms

In building their house, the couple paid particular attention to the kitchen and bathrooms, since those often present barriers to people with disabilities.

In the kitchen, cabinets and appliances such as the oven and microwave are mounted lower on the walls. On the other hand, the dishwasher is elevated, so that someone in a wheelchair doesn't have to bend down to load or unload it.

In the master bath, the shower floor has been sloped for drainage, so it doesn't need the little lip that most shower entrances have. The toilet is higher. And decorative grab bars have been installed throughout the room.

The Sleases have led dozens of tours through their home in recent months.

Prospective clients, other homebuilders, curious real estate agents and advocates for the disabled have visited the house to learn more about universal design.

"It's difficult to describe universal design, but when you see it, it instantly makes sense," Mr. Slease said.

The Sleases hope their house will persuade others in their industry to rethink how they build homes.

"Homebuilders may have heard about universal design, but very few have actually incorporated it into their construction," said Richard Duncan, senior project manager at North Carolina State University's Center for Universal Design.

Though builders are jumping into the remodeling business to make existing residences more accessible for older people who want to "age in place," they've been slower to construct universally designed houses, Mr. Duncan said.

The Sleases' company, Tapestry Custom Homes, is one of only seven builders that belong to EasyLiving Home Texas, a recently formed public-private coalition that promotes the concept of accessibility in home construction.

Tajauna Arnold, the group's project director, said she visits homebuilder shows to introduce the coalition and recruit members.

"We're where energy-efficient homes once were," she said. "Builders don't understand us yet. Once they do, they'll climb aboard."

Universal design still labors under several misconceptions, Mr. Duncan said.

One is that homes built to accommodate all ages and abilities are ugly.

Charles Schwab, an Illinois architect who designed 10 age-friendly houses last year, including one in Texarkana, said many builders are under the mistaken impression that universal design gives a home an institutional look and feel.

"When done well, a universally designed home resembles any another house," he said.

The Slease's kitchen includes a retractable bread board.

Dallas-based Centex Corp. recently built a univerally designed house in one of its Virginia subdivisions to acquaint homebuyers with the concept.

An architect took one of Centex's existing designs – a two-story, 4,000-square-foot house – and adapted it.

"The public's response has been overwhelming. A couple of thousand people have walked through it since December and have raved about it," said Char Kurihara, vice president of sales for Centex Homes in the Virginia area.

Ms. Kurihara said the demonstration house will help Centex develop a corporate strategy on universal design.

Cost myth

A second misconception about universally designed homes is that they're much more expensive, Mr. Duncan said.

"In many cases, universal design is no more expensive," Mr. Slease said. "It doesn't cost any more, for instance, to use door levers instead of knobs."

When all features are included, a universally designed house may cost up to 5 percent more, Mr. Schwab said.

That's because kitchens and baths must be roomier to accommodate wheelchairs, he said. Likewise, wider hallways add square footage.

On the other hand, incorporating universal design in a home under construction is far less expensive than modifying it later, Mr. Schwab said.

"Why not spend a few thousand more to build an age-friendly bath now and save yourself the $20,000 to retrofit it later?" he said.

Experts say the main reason most builders haven't yet adopted universal design is that they think there's only a limited market for it.

"Builders aren't risk-takers. They respond to the market," said Leon Harper, a senior housing specialist who worked with Centex on its Virginia home.

"So far, homebuyers haven't banged on builders' doors asking for universal design," he said.

Most consumers still don't know about it, Mr. Harper said, or don't understand it.

Boomer market

But he and other advocates of universal design are convinced that's about to change.

Mr. Schwab said many of his clients are boomers who have seen elderly parents reluctantly move out of their homes of 30 or 40 years because they can't climb the stairs or step into the shower anymore.

"The average home doesn't work for an older adult, and boomers are beginning to demand something better for themselves when they grow old," he said.

A universally designed house may turn out to be the smartest investment someone makes, Mr. Duncan said.

"An assisted-living community costs $40,000 a year and a nursing home, even more," he said. "If you can avoid or delay moving out of your home, just think of the savings, not to mention the satisfaction of staying put."

This is a great example of the kind of things one can do to their home to set themselves up for the future. Here are some common features of a universally designed home:

•No steps at the entrance

•All doorways at least 36 inches wide

•Lever door handles

•Pull-down shelves in upper cabinets and rollout shelves in lower cabinets (below)

•Elevator or shaft for future installation

•Stepless shower stall (right)

•Low-pile carpet or hard-surface floors

•One bedroom and full bath on main floor

•Front-loading washer and dryer

SOURCE: Center for Universal Design

Shortage of Home Care Aides

In the United States, there is a severe shortage of home care aides, who are essential lifelines for many elderly and disabled Americans struggling to maintain independent lives in their homes. Aides provide personal care such as bathing, feeding, and dressing, as well as, home making activities, such as doing light housework, preparing meals, and shopping. Recipients of these services are more impaired and frail than most of the over 60 population (Ref: Highlights from the Pilot Study: Second National Survey of Older Americans Act Title III Service Recipients). Without these aides’ vital assistance, many elderly and disabled Americans would be unable to remain in their homes. They would be forced into institutional living situations at great expense to the public care system and at the loss of their personal choice and dignity.

Personal care aides are critical components in the home care industry performing physically, mentally, and emotionally demanding jobs with the most vulnerable members of our population. They often are poorly screened, minimally trained or supervised and rarely provided fringe benefits. These critical workers receive some of the lowest wages in the workforce often making less than hotel maids and fast- food workers. Turnover due to difficult working conditions and low wages drives up the cost of elder care while disrupting continuity and eroding the overall quality of care received by older citizens.

What Do They Do and Who Are They?

Direct care workers, usually referred to as personal and home care aides provide the bulk of paid home care. Personal care aides are unlicensed individuals who provide direct care services in the home as an employee of the client or an agency. They assist with personal care activities such as, bathing, dressing, toileting, transferring, and eating, and home-making activities such as preparing meals, doing light housecleaning, and shopping. These aides are truly essential to the ability of many older and disabled individuals to live as independently and productively as possible.

The need for personal care aides will grow faster than the average of all occupations through 2014. The number of personal care aides will grow 47 percent between 2000 and 2010 (Ref: Health Care Employment Projections: An Analysis of Bureau of Labor Statistics Occupational Projections, 2000-2010). But this is as would be expected based simply on the demographic trends previously discussed. Personal and home care aide is expected to be one of the fastest growing occupations, as a result of both growing demand for home services from an aging population and efforts to contain costs by moving patients out of hospitals and nursing care facilities as quickly as possible.

Agencies report vacancy rates as high as 35 percent and difficulties finding qualified personal care providers. Few agencies are accepting new clients for personal care services. This means that thousands of elders and people with disabilities are languishing in costly government funded institutions. In Texas, for example, the average cost of community care is $15,529 per year compared to an average cost for nursing home care of $30,882 per year. This is a shocking waste of both human capital and public dollars.

Who is taking these jobs?

Nine out of ten personal care aides are women approximately 40 years old. These women often are the sole providers for their own households. Many personal care aides earn incomes below the federal poverty level with many workers or their children qualifying for public assistance programs. Individuals work as aides for a variety of reasons but characteristically because they care and know they are making a difference for the clients they serve.

Why Is There a Shortage of Direct Care Workers?

Despite the current need and growing demand for personal care aides, high turnover rates plague the industry, ranging from 25 to 50 percent in home health care. The majority of that turnover occurs in the first three months of employment. High turnover rates lead to poor quality of care, disruption of continuity of care and reduced access to service for these services. High turnover rates also increase the costs for providers. High turnover and vacancies mean that providers must spend relatively large amounts on recruitment and training costs, an estimate of at least $2,500 per lost employee. This reduces funds available for aide compensation, thereby creating a cycle of further high turnover and vacancies.

What Needs to Be Done?

Efforts must be concentrated in areas that will enhance screening, promote retention and reverse high turnover rates for direct care workers. First, enhanced screening methods that provide comprehensive criminal record and applicable registries checks must be employed. Adequate and ongoing training of personal care aides must be provided by care institutions. The content needs to provide practical up-front training with peers and orientation for new hires to prepare individuals to work with increasingly frail, possibly cognitively altered elders. Finally, and most importantly, wages must be raised to a competitive level for these positions. A Wisconsin study found that facilities that paid direct care workers higher wages had lower turnover rates (Ref. Hattan, E. & Dresser, L. (2003).

What’s the big deal? It all comes down to paying a reasonable wage, providing adequate training, treating people with respect and expecting them to be respectful.

Recent Research on Falls and the Value of Exercise

We've seem in a previous blog that seniors can reduce the risk of falls by increasing body strength and improving balance through regular physical activity (Judge 1993; Lord 1993; Campbell 1999). Recent research by Dr. Phillippe Perrin of the Universite Henri Poincare-Nancy, at Villers-les-Nancy investigated 130 men and women who averaged 70 years of age and showed that seniors who are active in their older years, no matter when they start benefit about the same as seniors who exercise all of their life. Also, individuals who are active their whole life but sedentary in their old age are nor better off than individuals who are sedentary for most of their life. Once again we see the value of any form of exercise.

Renovation and Home Maintenance for Seniors and others

One thing about having a business idea is to test it in the marketplace but this will take us a little while as we raise capital for marketing and our final push of product development . . . so it's worth seeing what other people are doing out there to see if our proposal has any traction.

This article from the Catholic Sentinel discusses Senior Home Renovation and Maintenance programs in Oregon is remarkably similar to my own experience. The origins of Age@Home come from a late night discussion with my mother, Betty, 3000 miles away in Ireland. Now, Betty is 74 years of age, in reasonable health and of very sound mind. After way too many whiskies we started discussing the topic of what she wanted as her age and inevitably declining health progressed. I was surprised by the strength of her answer - 'I want my own doorstep' and the emotion in her voice. So I started studying (like any good Irish Boy/Man who has an engineering degree) to see how we could help . . . and hence we are where we are today and sometime later this year or early next year I'm shipping the crew to Ireland for a week to set them up. Anyway, back to the article, the story is about Brian Bartholomew in Oregon who had a similar awakening with his mother as she moved into a care facility. He too was interested in moving away from corporate life, and started a local Renovation and Maintenance company to assist seniors who want to continue living at home.

In late 2003, they launched their business, which they called In Your Home.Now they have eight employees and a growing list of faithful customers. Last year, In Your Home brought in $700,000 in revenue.

Customers are the 50-plus crowd and people who are disabled. Both groups have a fierce desire to remain independent as long as possible. Most get in touch with Bartholomew with a crisis like this — “My husband broke his hip and can’t come home until the bathtub gets revised.” Others are slowly becoming unable to rise from the toilet seat, reach high shelves or read the newspaper with current lighting schemes. For example, lever doorknobs are kinder on arthritic hands. Steps from outside can become gradual cement ramps. The oven door can swing to the side, rather than down. Grab bars can make it easier to use the toilet or get out of the shower. Sliding shelves can make cabinets more usable. Wider doors are better for wheelchairs and walkers. In Your Home can install technology such as automatic door openers, bathtub lifts and devices that allow people to answer a call without going to the phone.

In Your Home can do one job and then be gone, but more often the company becomes an abiding presence. Bartholomew takes photos in houses and keeps meticulous records so that when a customer calls needing a door widened or a ramp added, he knows just what they’re talking about. Some clients keep a list of small fixes needed and get a visit every three months from a worker.

In Your Home is often a comfort for children of seniors, who face the struggle of what to do as parents age. Also, it often turns out to be cheaper to make a senior’s home livable than to move.

Bartholomew says that some Baby Boomers are thinking ahead for themselves, getting their homes ready for the days when they are 80-somethings. He admires those people who have overcome society’s general denial of aging. Everyone, he adds, should consider whether visitors can use their house safely.

So, this is small, but is a good example of the kind of one-time and ongoing support services which can be offered and which clearly have benefit. There are many such organizations springing up around the country, such as one similar to Age@Home in Minnesota and ones where the community is built for boomers to move in and is ready made for Aging in Place in California. On the charitable side there's Rebuilding Together which worked on 8900 homes in 2006 (although it isn't just for seniors) and many government initiatives at federal, state, and local levels.

If you have any other good examples, I'd be interested in hearing - send me a note at steve@age-at-home.com.