Sunday, August 24, 2014
We've reported several times, including here and here, on recent academic and professional publications that address the sensitive topic of "consent" to sexual relations for individuals residing in nursing homes.
The Huffington Post and other media reports now bring the topic into the general public realm with coverage of a complicated case emerging in Iowa, where a husband has been arrested on charges connected to sexual relations with his wife, a resident with Alzheimer's, in her nursing home room.
Two items that may be critical to the outcome of the case: Alleged "notice" to the husband by the facility that his wife was no longer legally able to give consent to sexual relations, and the identity of the husband as a public figure. The fact that the husband is a state legislator is a reason why the case may get wide news coverage. But that wider coverage could also generate important discussion and debate about the deeper legal, personal and public issues. From one article:
"An Iowa legislator who allegedly had sex with his mentally incapacitated late wife has been charged with sexual abuse. Henry Rayhons, 78, a Republican state representative from Iowa House District 8, was told by medical staff on May 15 that his wife, 78-year-old Donna Rayhons, no longer had the mental ability to consent to sexual activity, according to a criminal complaint obtained by WHO-TV. Donna Rayhons, who suffered from Alzheimer's disease, had been living in Concord Care Center in Garner, Iowa, since March, according to the Des Moines Register....
In an interview with law enforcement in June,Rayhons allegedly confessed to 'having sexual contact' with his wife, according to KCCI. He also allegedly admitted that he had a copy of the document that stated his wife did not have the cognitive ability to give consent. Rayhons was charged with third-degree sexual abuse on Friday.
Elizabeth Barnhill, executive director of the Iowa Coalition Against Sexual Assault, told the Des Moines Register that even though spousal rape has been illegal in Iowa for about 25 years, arrests for the crime are rare and 'convictions are even rarer.' Barnhill also noted that sexual assault between spouses is not considered a 'forcible felony' in Iowa."
According to new sources, the family has also made a statement.
August 24, 2014 in Cognitive Impairment, Crimes, Dementia/Alzheimer’s, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, State Cases, State Statutes/Regulations | Permalink | Comments (0) | TrackBack (0)
The Pennsyvania Joint State Government Commission issued a final report of its Advisory Committee on Long Term Care Services and Support for Older Pennsylvanians on August 21, 2014, following a year-long assessment of existing concerns of independent and care-dependent elders in Pennsylvania.
In a one-page summary of the 200 page report, the Commision makes the following Recommendations:
"Opportunities exist to improve system structure and organization, reduce barriers, and break down silos that characterize service delivery and payment. Better care transitions and improved coordination of service providers are also crucial, along with increased support for family caregivers. Focused information and awareness for consumers and families helps ensure they know where to turn when a crisis hits, which is often their first exposure to long term care. Expanding access to services and supports, through a tiered system that shares costs, will help improve quality and increase accountability. Enhancements to local resources, including Area Agency on Aging networks, will focus services and advance more equal community, facility, and home care options. These reforms will help ensure access to long term care for all Pennsylvania seniors, and prevent those who need assistance but don’t qualify for supports, from falling between the cracks."
Now comes the hard work . . . getting to an implementation stage.
Saturday, August 23, 2014
The New York Times uses the history of one family's struggle to demonstrate growing concern on the part of banks and other financial institutions about potential misuse of popular documents such as powers of attorney or trusts to access accounts. In "Power of Attorney Is Not Always the Solution," writer Paul Sullivan tells the story of "Carol" and her brother, now suffering from dementia, who years before had named his sister as his agent:
"[W]hen she looked at the power of attorney, she noticed that he had used her legal first name, Carol, which she had all but abandoned in childhood, not the middle name she had used instead.
She didn’t think much of it until she went to the first of the many banks he used. She presented the power of attorney, explained the situation and waited. Instead of getting access to his accounts to pay for his care, she was told the bank would not honor her power of attorney because the name was wrong....
She said she has lost countless hours from work and her own family sorting out payment for his care. After supplying a pile of documents, the two that seemed to have helped were an affidavit from her brother’s lawyer saying that Christine is the person he wanted to have control over this affairs and a document from the Social Security Administration that was the missing link for the various iterations of her name.
She has been able to move some of his assets into a trust for his care, yet she remains baffled by a process that is far from over. 'It’s insane,' she said. 'He was all buttoned up with all the documents you needed. But he could outlive me, which is going to be interesting. Then what happens?'"
Hat tip to to Prof. Laurel Terry, and her early morning practice of reading the New York Times, for alerting us to this piece!
Friday, August 22, 2014
Canada's hospitals are "overflowing at the seams" with patients who don't need to be there - frail and aging seniors, many of them with dementia, who have nowhere else to go, says the incoming leader of the Canadian Medical Association. The "warehousing of seniors" is costing the system $2.3 billion a year and highlights urgent need for a national rethink of seniors' care, Dr. Chris Simpson said in his inaugural speech Wednesday as CMA president.
Simpson, who also chairs the national Wait Times Alliance, said Canadians are facing long waits for virtually every non-urgent test, surgery or procedure "because the beds needed are filled with patients who don't need to be in hospitals."
Seniors awaiting placement in other facilities are occupying about 15 per cent of hospital beds. But "instead of focusing on getting them back to their independence we put them in beds, because that's what we do in hospitals. We put people to bed instead of putting them in a care environment that lifts them up and restores them and helps them live a dignified life."
One of the goals of the 3rd World Congress on Adult Guardianship was to form an online International Resource Library on Adult Guardianship. All submissions, including papers, brochures, manuals, handbooks and more, are welcome if they would be of help to others.
Submissions may be made by emailing email@example.com with the subject line “resource library.” Please provide, in English, a description regarding the document(s) you send, so that we can name and categorize them. Resources may be in English or in the language in which they were written. Please respect U.S. Copyright laws.
Access the International Resource Library.
From our good friends at the National Senior Citizens Law Center (NSCLC), which has offices in California and Washington D.C., details of a major fellowship opportunity for law school graduates for 2015 -- but interested individuals will need to work quickly:
The Position: NSCLC seeks to sponsor law student applicants for 2015 Fellowships, including school-based fellowships, the Borchard Foundation Center on Law and Aging Fellowship, the Equal Justice Works Fellowship, the Skadden Fellowship, and others. Work could commence in summer or fall 2015. The joint application process between NSCLC and the applicant for a 2015 fellowship would begin in summer 2014. The location for the Fellow is Los Angeles, Oakland or Washington, D.C., depending on the fellow’s preference, the subject matter, and NSCLC’s needs.
The Project: NSCLC staff will work with the applicant to prepare a fellowship application for a project of the applicant’s choosing, in any area of NSCLC’s expertise, including income security advocacy, issues affecting dual eligibles (those on both Medicare and Medicaid), and Medicaid issues around community-based options for long-term care, including assisted living. NSCLC attorneys will work very closely with prospective fellowship applicants to develop a fellowship project that meshes NSCLC priorities with the applicant’s interests and talents. We have hosted Borchard and Skadden fellows in the past, and hope to continue and expand our fellowship program.
Qualifications: The ideal candidate has a genuine and documented commitment to working for poor and underserved populations, high-caliber legal research and writing skills, and the ability to take initiative and work independently. A commitment to a public interest career is extremely desirable. Individuals with ties to low-income, racial/ethnic minority communities, and other underserved populations are encouraged to apply.
Interested candidates are instructed to send a cover letter, resume, law school transcript, writing sample, and a list of three references to Katrina Cohens, firstname.lastname@example.org.
Further, substantive questions about the fellowship program can be directed to NSCLC's current Skadden Fellow, Hannah Weinberger-Divack, at email@example.com.
Deadline for applications for 2015 positions: Aug. 25, 2014.
Articles recently posted by U.S. law school academics on the Social Science Research Network's (SSRN's) Elder Law Studies network:
- "Rethinking ERISA's Promise of Income Security in a World of 401(k) Plans," by Prof. Larry Frolik (Pitt Law), to be published in the Connecticut Insurance Law Journal (2014)
- "Making Mediation Work in Guardianship Proceedings: Protecting and Enhancing the Voices, Rights and Well-being of Elders," by Prof. Jennifer L. Wright (St. Thomas Law), for the Journal of International Aging, Law and Policy (2014)
- "Storm Surges, Disaster Planning and Vulnerable Populations at the Urban Periphery: Imagining a Resilient New York after Superstorm Sandy," by Prof. Andrea McCardle (CUNY Law) to be published in the Idaho Law Review (2014)
- "Letters Non-Testamentary," by Deborah Gordon (Drexel Law), to be published in Kansas Law Review (2014)
- "Complex Decision-Making and Cognitive Aging Call for Enhanced Protection of Seniors Contemplating Reverse Mortgages," by Profs. Debra Stark (John Marshall Law), Jessica Choplin (Depaul), Joseph Mikels (Depaul), and Amber McDonnell (John Marshall Law), for the Arizona State Law Journal (2014)
Thursday, August 21, 2014
We have blogged several times on articles about whether Americans are "retirement ready". A recent article published by Rand offers good news (or at least better news) about retirement readiness. The recent research brief, More Americans May Be Adequately Prepared for Retirement Than Previously Thought, concludes "that, overall, about 71 percent of individuals ages 66–69 are adequately economically prepared to retire, given expected consumption... [there are] large disparities across subsets of the population and the significant contribution of Social Security to seniors’ financial preparation for retirement [continues]. The key findings from the research explains a bit more:
•Overall, 71 percent of Americans are adequately prepared for retirement: 80 percent of married persons and 55 percent of single persons.
• Those with low education are much less adequately prepared than those with higher levels of education, especially single women.
• Social Security benefits contribute significantly to financial security at older ages.
Wow! Medicaid transfer rules argued in prime time! (Well, almost...)
On August 20, the Ohio Supreme Court heard oral argument on Estate of Atkinson v. Ohio Dept. of Job & Family Services, Case No. 2013-1773. Video of the presentations (including the very interesting questions from the bench) can now be viewed here on the Ohio Channel.
This strikes me as a great opportunity for Elder Law course students to read briefs and observe lawyers in oral argument tackle technical, challenging legal issues (listen to the Court ask one attorney to slow down and explain his use of pronouns). Can you predict the outcome? Note: The Supreme Court's arguments on Ohio Channel appear as high quality productions, well edited, with subtitles indicating the names of the speakers and the identity of the issues on appeal, and the website is searchable for other appellate cases for faculty members looking for examples to use in other classes.
As framed in the appeal, the issue is whether the community husband's actions triggered a period of ineligibility for Medicaid benefits for his wife in the nursing home. The record showed the husband transfered the couple's home "out" of the couple's long-standing revocable trust to the name of the institutionalized spouse, and then in turn, the same day, to the community spouse. As described in one news account:
"The county department of job and family services found that the transfer of the home, valued at $53,750, was improper because it violated federal and state Medicaid rules. While Mrs. Atkinson’s Medicaid benefits were approved, the agency temporarily excluded nursing-home care from her coverage because of the transfer."
The state has been successful with its arguments before state agencies up to this point. The Ohio Supreme Court, however, asked the attorneys about the applicability and relevance of the 6th Circuit's 2013 decision in Hughes v. McCarthy regarding permitted use of spousal annuities in Medicaid planning in Ohio. During the oral argument, one Justice also asks whether the state should be bound by the position taken by the federal agency, Health and Human Services (apparently in an amicus brief), in support of the family's argument.
There are also opportunities here to think about whether -- and how -- this particular transfer issue might have been avoided with different planning.
Pennsylvania has had its share of tragic recent stories connected to the death of older persons under circumstances that raise a question of suicide or murder.
Sadly, New Mexico now provides another example, where an 89-year old woman was found dead in the basement of her rural ranch home in early January. Her 69- year old daughter was charged with murder -- and at first the facts seemed to fit, given the very unusual manner of death. But this week the District Attorney dropped the charges, citing the lack of DNA or fingerprints to tie the daughter to the death, as well as expert analysis concluding the mother had written both "suicide notes" explaining her choice.
The notes suggested the older woman "did not want to be a burden to others." That history has led the family, now that the charges have been dropped, to encourage wider "exploration" of options that could prevent future tragedies, especially for older adults. Albuquerque Journal writer Leslie Linthicum, who first encountered both women 24 years before while working on a story about women ranchers in New Mexico, provides a balanced, thoughtful account of this latest tragedy.
As one saying goes, "there has to be a better way," but in most states the law does not currently recognize "better" choices. We're tackling important societal issues on many fronts right now, including same-gender marriage and legalized use of marijuana. Certainly we can also do a better job with laws affecting end-of-life decisions.
Recent Duke Law graduate Whitney Bosworth Blazek is the author of a timely, interesting note, "Combating Privatization: Modifying Veterans Administration Fiduciary Program to Protect Incompetent Veterans" in a recent issue of the Duke Law Journal. The abstract explains:
"Created to supervise the distribution of Veterans Administration benefits, the Veterans Benefit Administration Fiduciary Program was designed to help thousands of incompetent veterans handle their finances. Rather than directly managing each veteran's funds, the Fiduciary Program employs a privatization model whereby a private individual or institution is appointed to manage a veteran's assets. The Fiduciary Program then monitors these fiduciaries to ensure the veteran's funds are properly expended.
This Note argues that in practice this privatization model is seriously flawed and that it exposes some of the most vulnerable portions of the veteran population's funds to misuse. In support of this conclusion, this Note compares the federal statutes, regulations, and internal directives that govern the Fiduciary Program--paying special attention to the Fiduciary Program Manual-- with audits performed by the Veterans Affairs Office of Audits and Evaluations and the U.S. Government Accountability Office. Relying on these audits, this inquiry rejects total reliance on substantive statutory reform in light of legislative and judicial barriers. Instead, this Note advocates for critical internal reforms designed to improve the Program's efficiency and functionality, the adoption of a state enforcement mechanism, and reliance on principles of cooperative federalism and interagency cooperation."
Wednesday, August 20, 2014
The Yomiuri Shimbun Between fiscal 2009 and 2013, 65 social welfare corporations nationwide were given guidance by 41 local governments on the basis of the Social Welfare Law to improve their operations over budget misuse by executive directors or receiving large amounts of pay without consulting with boards of directors, according to a Yomiuri Shimbun survey. The Health, Labor and Welfare Ministry plans to discuss reviewing the inspection system, saying, “It is possible that the boards of directors are not functioning appropriately.”
Social welfare corporations are nonprofit private-sector organizations established to run such institutions as special nursing homes for the elderly, as well as facilities for children and the disabled. There were about 20,000 such corporations nationwide as of the end of 2012, according to the health ministry. The survey asked 109 municipalities, including Tokyo and other prefectures with ordinance-designated major cities, about their inspections of social welfare corporations as of the end of fiscal 2013. The Yomiuri Shimbun asked each municipality surveyed to disclose related internal information. The results showed that at 65 corporations, board members used company funds for private purposes by misusing administrative budgets and receiving large amounts of money without consulting with the board of directors between fiscal 2009 and 2013. Of them, 29 corporations were ordered to reform operations based on the law by the end of fiscal 2013.
Source/more: Japan News
A veteran women’s rights activist, Patricia Brownell was taken aback by the prevalence of abuse against older women she discovered during dozens of conversations she and her colleagues had with victims. They found that for every one official report of abuse made by agencies in New York State, there are 23 self-reports, with the abusers ranging from husbands, sons, daughters and other relatives to complete strangers. “It’s underreported,” Brownell, vice president of the National Committee for the Prevention of Elder Abuse, told IPS. “In many cases, the victims did not want to talk about it. They felt guilty. They felt it was their fault.” Most research on the abuse of older women has focused on North America and Europe. A study conducted in five European countries in 2011 found that around 28 percent of older women had experienced abuse. The situation in developing countries, where the socio-economic conditions are worse and the welfare system weaker, mostly remains unknown.
Violence directed against younger women has long overshadowed that against the elderly, who in some cases are more vulnerable. There has been so little research into the issue that activists said they do not know its full scope yet, hampering efforts to prevent and fight the violence. Abuse of older women can take various forms, from physical, psychological and emotional (verbal aggression or threats), to sexual, financial (swindling, theft), and intentional or unintentional neglect, according to the World Health Organisation (WHO). Addressing the Fifth Working Group on Aging at the United Nations in New York, Silvia Perel-Levin, chair of the NGO Committee on Ageing in Geneva, showed how fragmented the picture is: the prevalence of abuse ranges from six percent to 44 percent of those surveyed, depending on the geographic location and socio-economic conditions.
Read more: Inter-Press News Agency
Jared Bernstein, former chief economist to Vice President Biden and a senior fellow at the Center on Budget and Policy Priorities, reminds us that is easy -- perhaps a bit too easy -- to blame the federal government for problems. In a piece for the Washington Post, Bernstein points to several successes wrought by Social Security, a program that celebrated its 79th "birthday" on August 14, 2014, including:
• Social Security lifts the incomes of 58 million Americans, and for most of its elderly beneficiaries it’s the single most important income source, accounting for two-thirds of their income on average.
• For more than one-third of retirees on the program, Social Security accounts for at least 90 percent of their income.
• [Figures show] that were it not for Social Security benefits, over 44 percent of the elderly would be poor. With it, that share falls to 9 percent. What’s that again about government programs failing to reduce poverty?
The impact of monthly Social Security benefits on impoverished older persons is demonstrated by this chart from Kathy Ruffing, Center on Budget and Policy Priorities:
Tuesday, August 19, 2014
We have blogged previously on hospice, and a new article adds to the body of literature on the subject. The Journal of Palliative Medicine published an article by Dr. Joan Teno, Dr. Michael Plotzke, Dr. Pedro Gozalo, and Dr. Vincent Mor, A National Study of Live Discharges from Hospice. The study recognizes that there are various reasons that a person may leave hospice care, such as "patients decide to resume curative care, their condition improves, or hospices may inappropriately use live discharge to avoid costly hospitalizations." The abstract offers the following conclusion-about 20% of "hospice patients are discharged alive with variation by geographic regions and hospice programs. Not-for-profit hospices and older hospices have lower rates of live discharge." Why is it important to study this? As the introduction to article points out, there are instances when a provider may improperly discharge a patient and the timing can be telling: improper admission to hospice at the beginning or an effort to avoid costs. Building on existing research, this study finds similar results in some areas, but makes some important conclusions that deserve additional study
Provide and state variation raises concern that live discharges are not driven by patient preference but by provider and market behavior. Hospice programs that exceed their aggregate reimbursement caps (a marker for hospices with an excessive average hospice length of stay) had nearly double the rate of live discharges compared to hospice programs that did not exceed their aggregate cap.
The authors suggest there are certain red flags that should alert regulators that more careful scrutiny is needed for a specific hospice.
A hospice program with a high rate of live discharges deserves regulatory scrutiny especially when they have a pattern of hospitalization and hospice readmission. With increased hospice competition or potential future changes in hospice payment policies, hospices may change their enrollment and pattern of live discharges to maximize their profitability. Potentially, live hospice discharges represent a vulnerability of the Medicare Hospice Benefit. Hospices with high rate of these patterns of live discharges should trigger further regulatory review that examine whether their hospice enrollees were eligible, adequately informed about the Medicare hospice benefit before electing hospice, and whether the hospice program did a good enough job of advance care planning to avoid hospitalizations.
The Centers for Disease Control says more than 1 million people in the U.S. are living with HIV, and almost 1 in 6 don't know they are infected. This could affect Suncoast seniors who may be unaware of the dangers. There are certain things we are hesitant to discuss with children, and frequently those same topics are avoided with seniors. But whether we address it or not, older people are not only sexually active; according to the American Academy of HIV Medicine, by 2015, half the U.S. HIV population will be age fifty or older. “But they think they're not at risk. In their day, condoms were only for birth control. And so today, they don't have to worry about birth control and they don't know about HIV and all the other STD's that they could have to worry about.” Seniors with HIV that don't realize it are in a very dangerous position. “HIV accelerates and predisposes you to a number of diseases which causes death.
This summer I had the pleasure of visiting friends on the West Coast, including a stop in Carlsbad, California to learn more about actuarial and accounting standards for continuing care communities (CCRCs). As I walked into "Carlsbad by the Sea" on the corner of Grand Avenue and the old Pacific Coast Highway, I thought things looked a bit familiar. The mission style, the healing waters from a "well" across the street, a Victorian style building a few steps away that I seemed to recall as the "chicken place" (and honestly, that's a compliment!) -- they all seemed familiar. I telephoned my mother in Phoenix and asked, "by any chance, when I was a kid, did we ever stay at a hotel at this location?"
My mother laughed and said that the family didn't -- but she and my father visited the historic Carlsbad Hotel on this spot in 1952 on their honeymoon! She told me they had the "best" roast beef in the dining room. I had seen pictures of my parents in photo albums, arm in arm in the hotel gardens and sitting on the steep steps to the beach. (Later, as a family, we also toured Carlsbad on a family summer vacation -- hence my memories of the "chicken place," a restaurant popular with families because of a huge plaster chicken on the corner and live hens and roosters roaming the grounds. At that age I didn't make the connection to what we were probably eating....).
I learned that the Carlsbad Hotel was first opened in the late 1880s. In 1929, it was rebuilt in a classic California mission style (shown above)and the resort was known for its proximity to the beach -- and its hot and cold mineral baths. In the 1930s, the resort was popular with the Barrymores and Greta Garbo. In the 1990s it closed -- and was eventually rebuilt and reopened as Carlsbad by the Sea Retirement Community. My mother enjoyed my latest photos, showing how the garden and building traditions continue in the new setting.
So, from luxury hotel to a remarkably nice retirement community by the sea, with independent living, assisted living and skilled nursing available on the site. And, I'm happy to report there is still very fine dining available. The "hospitality" industry has given way to the "long-term care" industry. All of this is another sign of our aging times, right?
P.S. For more on the "chicken place," once called the Twin Inns, here's a link, including a surprising Pennsylvania-to-California connection.
Monday, August 18, 2014
Ever try to cross a busy street within the time of the walk light at a normal pace? Ever cross with someone using a walker or a manual wheelchair? Is the light long enough? If the light seems too short, perhaps it's not timed for the users. I ran into an article recently that studied this. Published in 2012 in Age & Ageing, Most older pedestrians are unable to cross the road in time: a cross-sectional study concludes that
most older adults either cannot walk 8 feet safely or cannot walk fast enough to use a pedestrian crossing in the UK. The health impacts on older adults include limited independence and reduced opportunities for physical activity and social interaction. An assumed normal walking speed for pedestrian crossings of 1.2 m/s is inappropriate for older adults and revision of these timings should be considered.
Although this is a UK study, it's instructive if we are to move more toward walkable communities and away from communities designed around cars.
The ministry of social justice and welfare has proposed the formation of a national commission for senior citizens to better protect the rights of the elderly. India's elderly population, 60 years and above, was close to 10.4 crore, according to the 2011 census. It is expected to touch 32 crore by 2050. The need for a senior citizens' commission is tremendous, say activists, who have been demanding the formation of such a commission since 2010. On February 7, a Parliamentary standing committee report had recommended the formation of the commission for senior citizens.The draft bill for the National Commission for Senior Citizens lists the proposed commission's responsibilities. These involve looking into matters of deprivation of senior citizens' rights, taking suo moto cognisance of their human rights violations and making recommendations to relevant authorities to take action. The proposed commission will inspect old-age homes, prisons and remand homes to see if their rights are being violated.
Experts said that the commission should have teeth and all stake holders should be consulted before it's formation. "While the number for elder abuse cases are rising especially in the rural areas, the Maintenance and Welfare Act for Senior Citizens, 2007 is yet to percolate to the last person. A commission will define the roles to be played by NGOs, police and the ministry and act as a nodal agency for redress of complaints," said Sailesh Mishra, founder, Silver Innings Foundation.
A number of years ago I audited a very interesting course in a gerontology program with the title "Housing the Elderly." It occurred to me at the time, however, that the title was a bit unfortunate, as it implied "warehousing" old folks rather than truly accomodating potential needs. Fortunately, over time I have sensed a growing appreciation of the significance of the distinction.
I was reminded of this while reading "For an Aging Parent, an 'In-Law Suite' Can Provide a Home within a Home" in the Washington Post. The article describes the experience of one family's decision to add a bedroom suite on the first level of their home to meet the needs of a aging parent. According to housing experts quoted in the article "demand for in-law suites is growing."
The article contrasts "true in-law suites" -- defined as a "living space integrated into a house to accomodate an older or disabled reative" -- with "accessory dwelling units" or ADUs. ADUs "function as separate dwelling units and often are intenteded for rental." As I recall, a few years ago, prefabricated versions of ADUs were popular in the media and dubbed "granny pods." Does anyone know whether granny pods ever caught on? The article suggests that building codes and zoning codes may present barriers to certain types of supplemental construction. I suspect that it would also be easy to trigger homeowner association restrictions.
The article suggests practical considerations:
- The suite should be comfortable and private to foster a feeling of independence....
At the same time, it should be close and connected to the family living area.
Place the suite on the main floor so that it has access to shared living spaces without the barrier of stairs.
Incorporate wide hallways and doorways (at least 36 inches) in the suite and adjoining living spaces to accommodate wheelchairs, walkers and people walking side by side.
- Integrate features that are attractive but safe and accessible, such as smooth flooring, lever handles for doors and faucets, non-skid bathroom flooring, a large curbless shower, a shower bench, a hand-held shower head, a chair-height toilet and sturdy, good-looking grab bars.
Many of these are core principles for "Universal Design," a housing construction movement that can be traced back to the early 1960s.
Building or selecting a new house? Consideration of universal design features may make it possible to stay at home much longer as you age. AARP offers additional suggestions in a recent interview with Universal Design Specialist Richard Duncan. And more info is available at UniversalDesign.com including citations to local, state or federal laws that may mandate certain elements of universal design for new construction.