A Paradigm Shift in our Built Environment with Esther Greenhouse

[Originally posted on March 19, 2012 at Longevity.Stanford.Edu]


Last week I had the pleasure of speaking with Esther Greenhouse, an expert on how the built environment (our houses, doors, sidewalks, roads, buildings, etc.) fits with different lifestyles, especially the elderly. Or as her bio from her website reads:

Esther Greenhouse is an environmental gerontologist, specializing in the impact of the built environment on the level of functioning and well-being of seniors, and is also involved in the broader movement of Universal Design–design for everyone, every day. Esther is an advocate for Aging in Place, and furthers this by teaching CAPS (Certified Aging in Place Specialist) courses on behalf of NAHB.

(photos from http://www.esthergreenhouse.com/ credit: Lindsay France)

I was excited to talk with Esther because a lot of my work so far has focused on the “soft” features of communities: planning, politics, group work and engagement. I was ready to learn more about the physical features of a locale or house that really help the elderly thrive and “age in place” as apparently 80% of people plan and desire to do.

The big idea

The big take-home point is that planning ahead and incorporating universal design principles into all new communities, complexes, houses, etc. just makes sense. It’s a paradigm shift whose time has come. It may require some regulations and policy mandates to make it happen now, but down the line it will save individuals and societies a tremendous amount of money worth of renovations and retrofits. Staying in your own home even just one year longer than in a care facility can save you tens of thousands of dollars! Furthermore, it makes for more livable, desirable communities and homes in the meantime for even broader segments of the population.

We jumped into the basic design principles she espouses for the built environment on all levels.

First is the concept of environmental fit, or how well-matched are the environmental demands and the users of that environment?

  • On the one hand we can have environmental press where we have a poor fit because the daily activities of an individual are very challenging to accomplish in a particular environment. This would be like an elderly lady who can’t cook food or take care of her own body and own home. Sometimes a wake-up call comes in the form of a fall or other event where the environmental press becomes too strong, or sometimes it’s just a background issue that brings chronic stress.
  • On the other hand we might have a prosthetic environment like a skilled nursing facility. This is also usually not an ideal fit because there’s not enough autonomyand challenge in daily life. The environment leads people to adopt the “sick role” where others take care of everything. We also don’t want that.

So we want something in-between, and ideally this means letting builders and designers do whatever they want to do, but just with universal design principles in mind. This means designing a community or a house with the goal of creating something that can be used effectively by as many different segments of the population as possible.

Specific Recommendations

We spoke briefly about the community level and she echoed some important recommendations from Rick Holt:

  1. We don’t want age-segregated communities. We want mixed-use neighborhoods that are multi-generational.
  2. We need affordable, safe public transportation. Oftentimes 25% of the income of elderly people goes towards a personal car that they eventually can’t use. It’s too much!

And then on the level of an individual building, here are some features to think about:

  1. Having one zero-step entry into the house (for wheeled devices to cross)
  2. Having at least a half bathroom on the ground floor
  3. Having 32″ of clear space when a door is opened
  4. Having passageways of at least 36″ in width
  5. Having a shower that doesn’t require stepping over a barrier (a Roman Shower)
  6. Having outlets 18″ above the floor instead of 15″
  7. Have kitchen surfaces that can be used while seated

How to make it happen

That all sounds fine to me, but I was curious about how you get people to go along with recommendations like these. Esther had a few strategies:

  • First is the way it’s presented to the consumer or builder. A principle of visitability has gained a lot of traction: the idea that you want to make your building visitable to friends at all levels of ability, including those in wheelchairs or who use walkers.
  • Second is framing. Selling a zero-step entryway as “for wheelchairs and walkers” gets people a lot less excited about it than as an entryway for strollers, furniture on dollies, or for ease of carrying groceries. The point with universal design principles is that they actually make life easier for everybody along the way in daily life.
  • And finally, on a regulatory level it seems like policy mandates make the most sense because she’s seen a 10-fold increase in participation when these regulations are mandated over when they are voluntary or incentivized.

Where these ideas are going

Esther’s been working on these ideas in this field for twenty years and she reports that interest and awareness have jumped steeply in the last five years, and that the next five years are a big time for growth in the realm of universal design and proper environmental fit. It indeed is a time of paradigm shift as we move towards a society that designs not just for the present, but also for the future.

She also emphasized that there are home modification programs for those with limited resources. One can also take part in the Certified Aging in Place Specialist Program (CAPS) that she teaches.

And just as Raines Cohen said, this is all about opening up options later in life instead of being stuck between a rock (a home that’s exerting too much environmental press) and a hard place (a nursing facility that has too much of a prosthetic environment).

Yet another post about what appear to be tremendously common-sense ideas about how to plan for the future. An ounce of preparation seems to save a whole ton of renovation down the line!