Enhancing quality of care through design

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Dr. Eleanor Barbera
Dr. Eleanor Barbera

Last week, I attended an accessible design symposium at the Cooper Hewitt Museum in New York City to see what ideas I could use with elders in long-term care. Through listening to the symposium speakers, reading descriptions of works featured in the student design contest and viewing the Access+Ability exhibit, I found more than I had expected.

Crash course in accessible design

I suspect I'm not the only McKnight's reader with a lack of knowledge about accessible design — even though we work with elders with abilities that are typically different than those of younger adults.

Patricia Moore, introduced as “the mother of universal design,” told the audience that her elderly grandparents inspired her work. They struggled to maintain their independence in a world that made it difficult for them. “Grandma wasn't broken,” she said. “The tools we gave her were inadequate.”

In my crash course in accessibility, I learned that objects can be designed in ways that increase the mismatch between our bodies and the environment or, in accessible design, to intentionally decrease that mismatch. For example, the standard design of a walking cane allows it to fall to the floor, making it difficult to retrieve for someone with mobility problems. In the Cooper Hewitt exhibit, I saw canes that stayed upright when not in use.

Another speaker discussed how “designing for disability” very often results in products that are good for everyone, such as books on tape, height adjustable desks or ramps for building access that are used by parents pushing strollers and travelers with rolling suitcases, in addition to those with walkers or wheelchairs.

Nothing about us without us

There was a small, vocal group of disability activists present. When I entered the symposium I was handed a card from their organization that read, “Nothing about us … without us.” They echoed the sentiment of the speakers that increasing the diversity of people designing products and systems results in products and systems that work better for a larger number of people.

Including elders and direct care staff in more of the decisions that affect them within our organizations is likely to result in better decisions.

To illustrate this point, another item in the Access+Ability exhibit was a hospital wheelchair simultaneously designed for the comfort of the patient and the transporter, for the maintenance people and infection control purposes and for storage needs. Feedback from the end users was incorporated into its creation.

As I viewed the thoughtful wheelchair, I reflected on the aides I observed at a facility entering resident care information into a computer mounted on the wall in the hallway. Some stood, bracing themselves on the wall. Others sat in a chair beneath the mounted screen and worked with their arms above their heads. Clearly, feedback from the end users could improve this charting experience.

Products of note

The design contest for university students resulted in some great products, from adaptable drinking cups for bedridden patients to armrests added to a chair for easier sitting and rising to window coverings that can adjust the amount of light let into a room via remote control.

In addition to the thoughtful wheelchair and standing canes, the Access+Ability exhibit had a body suit called “wearable strength” that adds power to the user when standing up, a collapsible cane that alerts blind users to obstacles through vibrations, and devices to make it easier to button shirts, pull zippers and use keys.

I know many women who would love the bling-encrusted hearing aids and people with dementia who'd appreciate the ability to listen to pre-loaded music or a book on tape by simply lifting the lid on the streamlined music box and closing it to make the sounds stop.

Several items for people with dementia were the result of collaboration between Cooper Hewitt, Pratt Institute and CaringKind. My favorites were the “dirty dog,” complete with dark-colored soap, which shifts the attention of residents with dementia from unwanted or frightening showers to cleaning the microfiber dog, and the Velcro wallpaper that allows items such as television remote controls to be attached to its surface for easy retrieval. Velcro wallpaper is also a good way to allow for personalization of resident rooms (think Velcro-mounted photo frames).

Functional and aesthetically appealing

One of the main tenets when designing for accessibility is that the items not only work well but also look good. A speaker from Norway revealed that wheelchair ramps in her country are more likely to be attractive features integrated into the steps to a building than metal ramps that detract from the architecture. Facilities undergoing renovations or new construction might make use of that option.

Similarly, eyeglasses — once considered medical equipment — are now fashion statements. Residents might feel better about needing canes, walkers or wheelchairs if there were style choices, such as the canes exhibited with interchangeable colored tops.

Incorporating the principles of accessible design into LTC leads to communities where inclusion and independence are emphasized. Now that's a mission worth promoting.

Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with over 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.

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