Rise Above the Fear of Falling

By: Michael Leavy
Home Healthcare Adaptations


Falling is not a nice experience for anybody, but it is particularly frightening for older people, who are more likely not only to encounter a fall but also suffer serious injury or death from falling. In turn, they may feel fearful and apprehensive about simply being in their own home, and this fear can lead to a loss of self-confidence.

Therefore, those of us living with an elderly person have a responsibility to make the home as safe as possible in terms of reducing fall risk and to promote a sense of ‘I can’ over ‘I can’t’ in our elders. Older people shouldn’t be so afraid of falling that they are restrained from moving around their own home. It is up to younger family members to eliminate fall hazards insofar as possible and also to convince older people that they can move freely around the home. By pushing this positive mindset and encouraging our elders to partake in balance-improving exercises such as the chair rise, their fear of falling should subside and they will instead move around the home with confidence.

This infographic from Home Healthcare Adaptations (http://www.home-healthcare-adaptations.ie/stairlifts-dublin/) in Ireland shows how you can minimize the risk of falling in elderly people. 

content and infographic provided by: Michael Leavy
http://www.home-healthcare-adaptations.ie/stairlifts-dublin

Aging in Place Tax Credits Get a Step Closer

We have write-offs for energy efficiency, why not for aging efficiency?

July 20, 2016
by Richard Eisenberg

About a year ago, Next Avenue described a clever idea from Louis Tenenbaum, of HomesRenewed.org, to create federal tax credits that would help people age in place safely and independently by subsidizing the cost of retrofitting their homes. The idea just got a baby step closer.

Recently, a (barely) bipartisan group of Congressional members introduced The Senior Accessible Housing Act (HR 5254, for the C-SPAN crowd), which would provide a tax credit of up to $30,000 to people over 60 for aging-in-place modifications to their homes, such as widening doorways for wheelchairs and installing ramps, nonslip flooring, handrails and grab bars. (The credit would be nonrefundable, which means it wouldn’t be of use to those who don’t owe federal income taxes.)

Many of these modifications don’t come cheaply. Ramps can run as much as $4,000, installing grab bars and level handles throughout a home can go for $1,500 and you can spend $1,000 or so to widen a doorway.

If you can stay in your home safely, that cuts down on falls, which cost patients and insurance companies $34 billion a year.

— Louis Tenenbaum

First Federal Bill for Homeowners to Age in Place

Tenenbaum, founder of the Aging in Place Institute, believes The Senior Accessible Housing Act is the first federal bill to incentivize older Americans to prepare their homes for aging in place.

He’s over the moon.

“I love it because it exposes the issue of individual housing that needs to be updated,” Tenenbaum told me. “This jumpstarts it to a national stage.”

The bill, supported by the Alliance for Retired Americans, was introduced by Rep. Patrick Murphy (D-Fla. and a Senate candidate) and Rep. Bruce Poliquin (R-Maine). Additional co-sponsors include Rep. John Conyers (D-Mich.), Rep. G.K. Butterfield (D-N.C.), Rep. Raul Grijalva (D-Ariz.) and Rep. Kyrsten Sinema (D-Ariz.)

Said Murphy: “With many older Americans living on limited incomes, home improvements to make their residences more accessible are often unaffordable. Making it easier for seniors to make these modifications means that they can stay in their homes longer without being forced to turn to assisted living facilities or nursing homes, which can often cost more.”

Of course, introducing legislation and actually passing it are very different things. And the odds of this (or nearly any) bill becoming law in this highly-charged election year are extremely slim.

But legislation has to start somewhere. And this is one bill that just might appeal to legislators on both sides of the aisle, since 88 percent of people 65 and older say they want to stay in their current residences as long as possible, according to AARP.

The Candidates and Aging in Place

I haven’t seen either Donald Trump or Hillary Clinton talk about ways to help people age in place — “It’s not on the national radar” says Tenenbaum. (Republican House Speaker Paul Ryan’s tax plan would eliminate nearly all tax credits and deductions, not add new ones.)

Bernie Sanders, however, called aging in place a “civil rights issue” at the Leadership Council of Aging Seniors Decide 2016 forum last February. “Clearly we should be doing everything that we can to provide resources to keep people in their own homes,” Sanders said. “Staying in their own homes is what most people would prefer and we should respect that.”

Problem is, although most older Americans want to age in place, their homes won’t let them.

As architect Duo Dickinson said at the HomeAdvisor Insights Forum on aging in place I attended last fall, “The undeniable reality is that the largest demographic bulge in America is processing through to a place where their homes will become a threat.”

Why America’s Homes Are Unfit for Older Americans

As I noted in an earlier Next Avenue post, the Bipartisan Policy Center says five universal design features can help make homes safer for older residents: no-step entries; single-floor living; switches and outlets accessible at any height; extra-wide hallways and doors to accommodate walkers and wheelchairs and lever-style door and faucet handles. But only 57 percent of existing homes have more than one of those features, according toHarvard’s Joint Center for Housing Studies.

For those who ask: “Why should the government help cover the cost of aging-in-place modifications?” my answer — and Tenenbaum’s too — is that these fixes ultimately save money.

“If you can stay in your home safely, that cuts down on falls, which cost patients and insurance companies $34 billion a year,” says Tenenbaum. (The figure is on the Centers for Disease Control and Prevention website.)

Also, Tenenbaum adds, when an older person is “rehabbing from an injury or illness or surgery, that’s often in an expensive rehab facility, because you can’t get back into your house.”

Lacking Savings to Live at Home Safely

Backing him up, and demonstrating the need for assistance such as aging-in-place tax credits: The Bipartisan Policy Center’s May 2016 report, Healthy Aging Begins at Home.

The report says: “Over the next 20 years, nearly 40 percent of individuals over the age of 62 are projected to have financial assets of $25,000 or less; 20 percent of those over 62 will have $5,000 or less. For many, this level of savings will be woefully inadequate to cover the expenses of daily living, never mind finance long-term services and supports or the modifications necessary to make living independently at home safe and secure.”

The Bipartisan Policy Center called for states and municipalities to “establish and expand programs to assist low-income seniors with home modifications through property tax credits, grants, or forgivable loans,” such as ones in Allegheny County, Pa.; Georgia; Virginia and Washington, D.C.

Don’t hold your breath, though. Tenenbaum concedes “it’s hard for us to grasp that some kind of spending now equals savings later.”

But that’s why we already have federal tax credits for making our homes more energy efficient. This year, you can claim 10 percent of the cost of certain expenses, up to $500, and 30 percent of the cost for things like solar energy systems and geothermal heat pumps.

If you want to show your support for HR 5254, check out Tenenbaum’s support letter template and write your Congressperson.

After all: if we can help people make their homes more energy efficient, why not help them make their homes more aging efficient?

 

This article can be found on Next Avenue's website here.

Respite Care: Why It Suits Both Caregiver And Patient

by Helen O’Keeffe
(all content and infographic in this post provided by
http://www.homecareplus.ie/palliative-care)

Caregivers are often so involved in caring for their patients that they neglect their own health, and the longer that continues, the more likely it is that the relationship between both parties can be harmed. Even though it may go against their innate, unselfish tendencies, there comes a point where a caregiver needs to say ‘stop’ and take a brief rest period for themselves.

If you provide regular care for someone and you find yourself becoming increasingly agitated, making poor judgements, feeling unusually exhausted or even losing your desire for caregiving, the time has come to take some respite. This can be for a few days or it can mean cutting back your caregiving time so that you have a few hours to yourself in the evening.

You’ll quite likely have forged such a strong sense of commitment to your patient that you could feel guilty about taking respite care. In the long run, it’s the best thing you can do. You want the patient to receive the best care possible, and if you feel so worn out that you can’t provide that for the time being, find someone else to take over for a short period. The patient can also benefit from temporary access to a fresh voice and, when you’re ready to resume caregiving duties, they’ll be delighted to see you back, not to mention the reinvigoration that you’ll experience.

It’s not a crime to know your limits and take a breather. As this infographic from Home Care Plus (http://www.homecareplus.ie/palliative-care) in Ireland shows, respite care is highly beneficial for both the caregiver and the patient. If you feel in need of a timeout, go for it. You’ve earned it from your enormous commitment to caregiving. 

Best cell phone and plans for seniors

Technology can be overwhelming, especially to seniors who are just learning how to use it. Just in the world of cell phones, there are so many different options (phones, plans, apps, etc.) that it can be sometimes difficult to sort through to find the best solutions. Certain phones make it easier for seniors to adapt to the idea of a cell phone and the safety benefits it can provide for the elderly. Verizon has composed a list of the best cell phones and plans for seniors:

For more details regarding plans please see Verizon's article here

Winter Weather Preparation

Have you ever been stuck on the road in a storm and had to pull over? Or do you remember the 2011 snowstorm in Chicago, which caused people to abandon their cars on the road? Winter storms seem to get more intense every year and with winter weather already here for parts of the country, it’s always good to remember that there are certain precautions you must take to stay safe. Blizzards can virtually stop cities; stranding drivers, delaying emergency responders, and even causing power outages. Usually, it is the elderly or very young who are most affected by the cold temperatures associated with winter storms. Many casualties are not directly related to the storm itself, but rather from the aftermath— elderly people stuck in their homes, heart attacks or strokes from shoveling snow, or car accidents due to unsafe roads. While it is difficult to estimate how much damage a winter storm can cause, it is possible to know when they will occur, and that vital piece of information will hopefully give you enough time to prepare.

Many people live in small towns and while this doesn’t mean total isolation during a storm, it could mean longer recovery time, so it is best to be prepared on your own. If you are at home during an extreme winter storm, make sure you have supplies that will allow you to stay comfortable and warm. If you have a fireplace, keep a pile of firewood available in case the heat goes out. Canned or non-perishable food will come in handy in case you lose power and the roads are snowed in. Emergency equipment such as flashlights and electric generators should be prepared for use and in working order.  Keep bottles of clean water for drinking and cooking because your pipes can freeze.

When you are at home, weathering the storm, you will want to receive the latest weather updates. Luckily, many smart phones automatically update users on any weather warnings, but if your phone does not do this, then you should manually sign up for weather alerts on your mobile phone or email. The Weather Channel offers free weather alerts for any area on their website. However, if the internet goes out, have a radio readily available as well. All of your mobile devices should be charged in case of a power outage.

Mobile devices and landlines are extremely important for older people who live alone. Your family, wherever they may be living, will want to know that you are safe. If they live in another state, designate a friend or neighbor as an emergency point of contact. If you are an older person that lives near loved ones, it could be a good idea to group together at one location.  Locate a place for everyone to meet when a winter storm warning is issued, depending on where you and your family are.

You should also make sure your home is ready for the winter. For example, be sure that your home’s walls and attic are properly insulated to avoid losing heat. To prevent your pipes from bursting, keep your faucets dripping. It is also important to know how to shut off your home’s water valves in case a pipe does burst. Set up emergency heating equipment, such as a fireplace with wood or a portable stove with plenty of fuel. Space heaters are helpful when used correctly. Keep your space heater at least three feet away from all furniture, flammable objects, or drapes. If no one is present in the room, turn off the heater. Never place any objects directly on a heater.

If you do need to travel in extreme conditions, or if you are stuck in the middle of a storm in your car, make sure that it is properly fitted to drive. Have your car’s radiator system serviced, use antifreeze in your car, and check your windshield wipers. If your tires have worn-down tread, replace them. It is also recommended that you keep jumper cables and chains in your car. These steps should help you stay safe during the cold winter months, and prevent an emergency from occurring.

Written by guest blogger: Jacob Edward 

Jacob Edward is the founder of Senior Planning and Prime Medical in Phoenix, Arizona. Prime Medical Alert not only operates in Arizona, but across all fifty states, including Maryland. In his spare time, Jacob enjoys dining out and supporting his alma mater Arizona State's sports teams. Jacob lives in Tempe, Arizona.

IAHSA China - JSR Associates' Experiences in China

For those watching the development of China’s senior housing industry, a handful of pilot projects have garnered a lot of attention. Those of Cascade (Emeritus), China Senior Care, and Merrill in particular each come to mind. Being a pioneer isn’t easy, and each of the companies has shown the grit and determination to push through a lot of unknowns in order to build projects designed to validate that their business model can be successfully deployed in China. These operators many times garner the most attention, but their efforts are supported by, and made possible through, similar efforts to understand the China market’s unique needs on the part of a variety of service firms. One such example is JSR Associates, who has been working with China Senior Care (CSC) for the past three years as CSC develops its business plan and care model. JSR’s Principal and Founder, Jane Rohde, recently agreed to share her experiences in advance of the presentation she will be providing at the upcoming IAHSA annual conference in China (register here!).

JSR Associates has provided senior living design and consulting services for over 17 years for new, renovated, and repositioned senior living projects. These include continuing care retirement communities (CCRC), adult living communities, independent living settings, assisted living projects, adult day care, and skilled nursing projects in the US and, most relevant to the upcoming IAHSA conference, in China. JSR’s goal during the strategic planning and programming process is to overlay the plan and concepts with current trends in senior living, reimbursements, staff needs and operational function, culture change, and care models to meet the future needs of current residents, as well as the next generation of residents. These challenges are particularly acute in a market such as China where much of the operational variables are either not known, or are being built on assumptions that may prove to be in need of additional localization.

Building on their roughly three years of work with CSC, Jane added, “I have found that the basic questions to ask in regard to design, is how is the facility going to be programmed, what is the care model, and what is the design regulatory process for development of design and construction documents? Their needs to be an integrated design process that assists with developing an operational plan, as there is no Chinese benchmark for senior living projects. What I’ve seen is that all newly constructed facilities are built as tenant fit-out projects; so in order to provide a physical space environment, there needs to be a programming development phase with expertise from both the US and China that work together to establish the function of the environments. Prior to the finalization of the construction documents for the infrastructure, a programmatic layout has to be developed based upon the care model and all operational functions planned for the facility.” I would also submit that among the reasons the CSC project in Hangzhou is important is that, as Jane references, it will not be a rehabbed site; rather, it will reflect conscious design and programmatic choices made from – quite literally – the ground up, capturing what CSC and JSR believes will best serve the Chinese consumer.

Given what Jane has seen in China, she believes there “is also a demand for need-driven extended care; which includes skilled nursing and memory care. Independent living is starting to be developed, but this is choice and lifestyle driven. A Chinese elder would need to decide with their child if and when they would be making a change; versus skilled nursing and care for those with dementia, which is need driven.” She added, “There are also opportunities for evaluating higher end, as well as a middle income solutions, for Chinese families, as elders age.” That was music to my ears given my own fears that too many foreign operators are looking past the middle-income market, leaving it for the domestic Chinese players (specifically insurance companies) to focus on.

Much of what will shape Jane’s presentation at IAHSA is advice she has for foreign operators and investors who want to pair off with Chinese developers. With this in mind, I asked her what she felt both sides needed to keep in mind. Jane pointed out that in the US, “[what we have] learned has resulted in the recognition of needing flexibility in care models and adaptability to acuities as people age, regulatory barriers when providing resident-centered care environments, and provision of multiple types of care within one setting. These lessons can be applied to China, as the industry is in its infancy; therefore allowing the needs and care models to drive the licensing process.” Jane echoed concerns most of us in the sector have had about accessing trained staff: “China has a need to evaluate the need for educational programs in geriatrics and dementia, as there are few potential staff trained in any type of long term care, activities, and person-centered care provision.” In addition, Jane ended her comments on what I think is a particularly important insight: “There is a concern that Chinese developers are looking to architectural firms to provide designs that are similar to the US; however prior to engagement of the design of the building, most Chinese developers need operational and care model guidance. Without this coming first, buildings are being built and operators sought, without having facility design input. This is providing inefficiency and could also prevent a resident-centered care model to maximize resident positive outcomes; which is needed to fulfill filial piety.”

Given Jane’s experience in both the US and China, I wondered what she is most interested to see transferred from the US to China. She pointed out six factors: “Furthering the utilization of the Senior Living Sustainability Guide® (www.withseniorsinmind.org) as a means to develop resident centered-care; resident-centered care as a standard of care (versus institutionalization); household and small house models that can serve a variety of acuity levels; provision of adult day care models coupled with extended care; provision of home healthcare services that support residents living with family or in the community at-large; bring back to the US best practices based upon bench-marked research and data from China residential aged care communities to be able to improve US models.” If that last point surprises you, it shouldn’t. After all, China may have some things to teach America about community care in particular that have been overlooked given America’s historical affluence, an economic reality being tested as our Baby Boomers begin to retire themselves.

Posted on October 7, 2013 - Written by Benjamin Shobert

Article can be found: www.healthintelasia.com/iahsa-china-jsr-associates-experiences-china/

Senior Dating Blog

From dating websites to dinner and a movie, there's now a great guide and resource for single and dating seniors. 

Senior Dating Blog: www.bestseniordatingsites.org/blog/

Joseph Atkins, the webmaster and editor of Senior Dating Blog, created a site to share insight into the senior dating lifestyle. He offers tips on finding the right match, safety, as well as date ideas. 

The most recent article called, "50 Google+ Pages For Senior Citizens Worth Following" is a great resource for Atkin's audience. 

"Now that the baby boomers are becoming seniors, there is extra demand for goods and services that cater to them. Popularly known as the healthiest, most active, and most physically fit generation of seniors, they demand and deserve the best amenities, entertainment and care. Below is a list of the top 50 Google Plus pages worth following for senior citizens, ranging from limo and car services, homes and communities to meals on wheels and technology training. We all work very hard for retirement so check out the below for the best ways to enhance it!" -Senior Dating Blog

Check out this blog entry and many more! www.bestseniordatingsites.org/blog/

"Conversations with Nora: A Family's Journey with Alzheimer's"

Converstations with Nora: A Family's Journey with Alzheimer's, a Pulitzer Prize nominee, follows the journey of two sisters, Allison and Louisa, as they each struggle to understand the grip of Alzheimer's on their family. The novel, inspired by a true story, takes the reader from the sisters' first realization that something is wrong with Mother; through her agonizing denial and efforts to thwart the daughters' attempts to care for her; and then plunges the reader along with the entire family into the dark and confusing maze of dementia. The path to finding a place where Mother will be secure and can feel at home is filled with many obstacles, not the least of which are her own fight for independence and a medical system that seems unwilling to help them. Told through the conversations between the eldest daughter Allison and her friend Nora, the healing power of love and caring takes on a fresh meaning. Nora's supportive, patient, and nonjudmental presence provides a safe place for Allison to move through a raw and painful reality toward healing.

Visit the Author's Blog at: www.abandaidforthecaregiver.blogspot.com

In paperback and Kindle at Amazon.com & in paperback and Nook at Barnesandnoble.com

New FGI Guidelines for Residential Care Facilities Opens for Comment

The Facility Guidelines Institute (FGI) has released the draft of a new standard on residential care facilities for public comment. Titled Guidelines for Design and Construction of Residential Health, Care, and Support Facilities, the document provides minimum recommendations for new construction and renovation of nursing homes, hospice facilities, assisted living facilities, independent living settings, adult day care facilities, wellness centers, and outpatient rehabilitation centers.

Developed in response to the widespread adoption of person-centered care and deinstitutionalization in the residential care industry, the new guidelines are based on the requirements for residential care facilities in the 2010 edition of the FGI Guidelines for Design and Construction of Health Care Facilities and public proposals submitted on that text in fall 2011. “The new FGI Guidelines, created with an interdisciplinary volunteer team, is a milestone document created to support the evolution of long-term care environments, while providing consistent guidance for providers, design professionals, and authorities have jurisdiction. The ultimate goal is to provide the framework for environments that support positive resident outcomes,” says Jane Rohde, tri-chair of the FGI Specialty Subgroup on Residential Facilities, which developed the draft of the new document.

The proposed content for the Guidelines for Design and Construction of Residential Health, Care, and Support Facilities addresses the programming process in detail as the basis for well-designed and well-constructed long-term care environments. Specific overlay information has been added to help designers address the needs of residents with dementia, mental health diagnoses, and cognitive and developmental disabilities along with information on how facilities support bariatric needs and sustainable design for residential care facilities. The new standard will generally follow the format of the original, with text written as code language so states can easily adopt it to regulate design and construction of included facility types.

Residential care providers, gerontology experts, architects, consulting engineers, administrators, facility managers, interior designers, residents of facility types included in the book, regulators, and other interested parties are invited to review the content of the new standard and submit their suggestions for revision. All comments must be submitted through an electronic proposal system hosted by the Facility Guidelines Institute, a nonprofit organization founded to support the Guidelines revision process and ensure the Guidelines books are updated regularly using a public, multidisciplinary process. The comment system, which can be accessed from the FGI website at www.fgiguidelines.org, will be open until March 20, 2013.

It is imperative that care providers, designers, and regulatory authorities responsible for residential health, care, and support facilities take advantage of the public comment period to make their expectations known. “These consensus Guidelines are not a product of a regulatory organization but the product of a multidisciplinary committee of experts, and we are seeking public input,” says Douglas Erickson, chair of FGI’s 2014 Health Guidelines Revision Committee. This is an opportunity for regulators to evaluate existing codes and provide comments that reflect needed updates for residential health, care, and support facilities that meet person-centered goals for care environments.

Checklist for ‘Mom’!

In the past few months, I’ve had different friends ask me about how to evaluate selecting accommodations for a loved one with memory impairment. As I was re-assembling a list of questions, I thought others may benefit from this type of checklist as well. Please find the following questions that I would start asking, if I was searching for the right place for my Mom.

1. Ask to speak to other resident families

2. When meeting with a group, the marketing folks are fine, but I would recommend interviewing the executive director, the social worker, a dining services person, a housekeeper, and a CNA/GNA (Certified Nursing Assistant/Geriatric Nursing Assistant) within a memory care setting.

3. I would ask the following questions:
    a. Are you embracing resident-centered care initiatives? If they look at you funny, you know that they haven’t the slightest idea of what you are speaking about, and you can go to the next place on the listing.
    b. How much time per day is spent with the CNA/GNA (? What is the ratio of CNA to residents on all shifts)? You would like the hands-on care staff to consistently care for the same residents over a period of time. So limiting the number of residents that they are responsible for is the best way to do this. So the small house or household model is very appealing, because staff works with specific residents that are the same. Basically the more a care staff member knows about your loved one, the better it is for her (meeting needs, etc.).
    c. Can my loved one choose when she wakes up in the morning? What are your policies about sleeping and waking?
    d. Can my loved one choose to eat when she wants to during each meal time? Does she have choices?
    e. When an intake is completed, in additional to a physical assessment for medical conditions, what other types of assessments are completed? Such as, do you make note of my mother in-laws current/past hobbies, what are her favorite things to do, what are her favorite foods and what foods does she dislike, what is her favorite color, and how does she like to have her clothing cared for? Basically, I call it a “Life Plan”, so that the staff knows as much as possible, “celebrating” her uniqueness, instead of treating her like a medical diagnosis.
    f. What types of restorative care and therapy is available to provide interventions for incontinence issues? 
    g. What types of activities are designed to assist your loved one with participation, despite their memory impairment and encourage participation?

4. Note the physical environment, as it can often tell you a lot about the consistency of care:
    a. Is everything clean?
    b. Did you notice any distinctive odor (urine or musty smell)? Or even too much Clorox can be overpowering as well.
    c. Is the seating arranged for conversational groups, instead of lined up against the wall?
    d. Does the interior look like 1980’s with shiny floors and glaring lights or is it diffused lighting and feels warm and comfortable?
    e. Are the staff smiling and happy? Or do they seem ill-tempered and not happy? This is a true sign that management and staff don’t work well together, immediately impacting the care level.
    f. Does your loved one have access to the outside?

Are Your Buildings Contributing to Poor Residential Health?

How to Develop a Successful Indoor Environmental Quality Plan for your Community

With the current economic climate, existing Senior Living Communities will be under increasing pressure to reposition their existing buildings including ongoing upgrades and maintenance to ensure that they are healthy and comfortable places to live and work. Applying green building principles with a concentration on Indoor Environmental Quality (IEQ) will have a long term positive effect on the residents and staff. To define the concept- Indoor Environmental Quality is the overall comfort of a building's interior space with regard to the comfort and health of its occupants and consists of multiple elements including: lighting, acoustics, thermal comfort, indoor air quality, ventilation, occupant control and ergonomics.

This concept is important as we spend an average of 90% of our time indoors with seniors spending an even greater amount of time indoors. In addition, indoor air typically contains a much higher concentration of pollutants than outdoor air, as much as 2 to 5 times more on average. Considering seniors often have a compromised immune system and have a much greater risk of developing cardiovascular and respiratory diseases these pollutants need to be addressed. When you look at IEQ from a business perspective, communities are facing potential insurance issues with regard to coverage of facility born injuries and aquired infections. As well, a community's payroll is the majority of operating costs. This is critical considerable amount, therefore maintaining and attracting qualified staff will become an issue as demand for senior living rises.

Inadequate or improper light levels can cause eye strain and headaches as well as disorientation, accentuating the affects of the againg eye within the resident population. Staff can also experience an increase in errors and a decrease in alertness which can both lead to low productivity. Exposure to natural daylight is also an important issue when discussing overall lighting, not enough can cause disruption of the circadian rythm and a lack of production of vitamin D. Controlling the amount of daylight is also important as too much can cause glare and too much heat. Acoustics are a very important aspect of the overall comfort of the residents and effectiveness of the staff. Poor acoustics can limit speech recognition by residents which between residents and staff can lead to errors, strain and irritability. Interruption of sleep quality can also be attributed to poor acoustic control; this can lead to psychological and physiological health risks. The ventilation can also affect comfort by not having enough fresh air introduced into a space therefore odors and pollutants can linger. Particulates which are suspended organic and inorganic particles in the air may cause short term eye, nose and throat irritation as well as increase risk of respiratory infections. Long term affects can lead to asthma, bronchitis, pneumonia, emphysema and even heart or lung disease.These are a few examples of how inadequate indoor environmental elements have an impact on the comfort and health of its occupants and staff.

Fortunately, Senior Living Communities can adopt an Indoor Environmental Quality Plan to address any current or future issues and provide a healthy environment to live and work. An IEQ Plan begins with the assembly of the Community’s Green Team and most importantly the identification of the Green Champion. This Green Champion can be appointed or be a volunteer who will then assemble all of the community’s stakeholders. The stakeholders are representatives from across the community who would collaborate to create the IEQ Plan, the stakeholders can be maintenance staff, cleaning staff, physical plant engineer, food service, nursing staff and even a resident representative or two. It is important to have representation from all facets of the community. The committee will create a Mission Statement and set guidelines for community operations. An integrated design process should be used to get all issues on the table and addressed from the beginning; this will afford a more comprehensive approach and end result.

The next step in creating an IEQ Plan is to conduct a Community Assessment to establish goals both short range and long term. It is critical to identify where the most exposure lies as well as what the low hanging fruit is – those issues that can be addressed quickly and with little to no cost and show immediate results to build momentum. The actual assessment will consist of a thorough review of all building systems to make sure they are working properly and efficiently and at minimum meet performance values as set by the building code having jurisdiction. The building envelope should be investigated for air and water leaks in addition to its overall thermal value. All building materials and daily use products should be examined to determine if any have known carcinogens or other toxins. Assess the overall lighting and acoustics of all spaces and identify problem areas. Identify all other sources of potential pollution and contamination such as adjacencies of fresh air intakes and the trash dumpsters or path of delivery trucks. Along with the assessment a decision making process should be established to take all the information gained and work it into the long range capital plan to suit the needs of the community.

Once the community assessment is complete, Control Measures need to be established as they will be the benchmark by which the success of the IEQ Plan will be measured. The control measures are to conform with the local building code and other accepted criteria for building performance. This may require that the community contact a professional such as a sustainable building expert with the knowledge and experience to aid in the development of these control measures. Control measures would consist of such regulations like the amount of air exchanges required by the building code and the recommended or required lighting levels for different use spaces within each community. Other measures would address issues such as the amount of volatile organic compounds (VOC’s) found in various materials such as paints, adhesives and flooring materials – they can even be found in daily use products. It is important to establish a purchasing program that eliminates toxins from products like make up, cleaning products and even food packaging. Gathering all this information can be tedious but necessary to enable the community to know where they are at. It is also important to note that each measure established must be coordinated with all the other measures as they will need to be employed in concert with each other otherwise you may have conflicts with the desired results.

The final act is to establish a system to monitor and document all findings, analyze and track information related to all the areas of the IEQ Plan; lighting, acoustics, thermal comfort, indoor air quality, ventilation, occupant control and ergonomics. Conduct post occupancy evaluations and share the trend information with the staff, residents and families. Create provisions for corrective action and address any issues immediately to show that the community is committed to the application of the IEQ Plan. Transparent accountability will help create a sense of ownership within the process and generate a positive outcome.

Content provided by: Donald K. Green, NCARB, AIA, LEED AP

Senior Living Facilities are a Unique Type Entity

Senior Living facilities are unique entities, with various types of building uses, in one place. Is a senior living facility a residence or health care facility? Does it fit into the hospitality or educational category?

   Do we have an opportunity to employ green construction practices when considering new construction, interior space, special needs and 24/7 operation?

   In the United States the US Green Building Council established benchmark criteria for sustainable construction and building operations. The USGBC LEED® process focuses on new construction for commercial buildings, residential, health care and hospitality accommodations. The process also addresses existing buildings and how they operate. There is a LEED process which concentrates on educational buildings and campus development.

  Though the LEED® tools predominantly evaluate the built environment, the Senior Living Sustainability Guide® moves beyond this by addressing: the organization, the residents, and functional sides of developing sustainable environments from the beginning of the development process.

   A sustainably-minded developer must merge the concepts presented in each category and select the best practices available. A developer must always be mindful of the primary function of a building, regardless of the desire to construct and operate a sustainable facility. A green building that does not function well, and delight it's residents and staff, is not truly sustainable. Sustainability is defined by a concept known as “Triple Bottom Line.” The proper balance of environmental, social and financial criteria is optimized to serve and satisfy building users.

   Various special needs must be considered in the case of senior living, including:
• HealthCare
• Dining
• Residential
• Educational
• Recreational
• Entertainment
• Safety
• Lighting
• Indoor Air Quality
• Accessibility
•  Climate-controlled environment, tailored to special circumstances.

   The senior living building environment is a special one designed for maximum safety, comfort and environmental exposure. The Senior Living Sustainability Guide® provides guidance for development of environments for seniors.

Content provided by: Steve Baer

Role of Governance in Organizational Sustainability

We are familiar with the application of the concept of sustainability to an organization’s physical setting by minimizing the use of non-renewable resources, increasing the life-expectancy of the facilities, reducing the life-time cost, and maximizing the adaptability of the setting design for evolving uses.

However, even more important is the sustainability of the organization itself which exists to make a difference in the world. The physical setting is a means of making that difference.

How does an organization increase its effectiveness in making a difference and its potential for sustainability? The key is the governing body, the only enduring element of the organization. Corporate law requires corporations to have a governing body, which because it is made up of individuals who are serially replaced can continue forever. Among the responsibilities a governing body should fulfill are to identify 1) the values that guide the governance and operational decisions and actions of the organization, and 2) the vision of the difference the organization is striving to make. These foundational statements need to persist from one CEO to the next in order for the organization to build and maintain momentum.

Without sound governance, an organization may do well in moving toward its vision for several years under a competent CEO who has integrity and is values-driven and innovative. However, the probability of continuing the progress with integrity through a change in CEO is not good. For sustainability, the board must be the definers and guardians of the values and vision, and must monitor progress toward their vision and compliance with their standards of operation.

Good governance, which is essential for organizational sustainability, can only be achieved when the governing body is built on sound foundational statements, is disciplined to adhere to those statements, utilizes proven governance processes, and continuously monitors itself as well as the work of the CEO for effectiveness and integrity.

Content provided by David Green, creator and facilitator of Values-Driven Governance.