Home Comforts

Small actions at the right time can make a huge difference, not least when it comes to the care of vulnerable people.

Sadly, the UK is still wedded to the out-dated ideas of ‘home help’ and ‘home adaptations’. Whether it’s old age, becoming partially sighted or losing the use of limbs, most work to keep people in their own homes is based on a social services assessment and funding pots.

But the number of older people is growing and, thanks to medical advances, people with previously life-limiting conditions are living longer.

One of the country’s top occupational therapists is challenging the country’s approach to home design, arguing that really great solutions and installation can add quality to people’s lives – and save the NHS millions.

What are the problems?

Kate Sheehan is director of The OT Service consultancy and a leading occupational therapy expert on bathrooms and kitchens.

Occupational therapy is about not only clinical health, but also psychology and mental health. It’s about adapting the tasks and environment taking into account people’s physical health. And Sheehan wants our industry’s decision-makers to catch up with a customer base that has changed radically. Her approach is based on analysis and problem-solving. She is concerned why the UK is so stuck in its ways. She says: “Things are changing; we’re getting there slowly. The problem we have is that there are lots of silos in industry and especially in government. There’s the Department of Health, the Ministry for Housing Communities and Local Government and Department for Education and Skills. You’d think they talk to each other; in practice, they don’t.“Then you have the housebuilders who are influenced by shareholders and don’t want to do anything because it will impact on their profit. But all this is inefficient for everybody. We need housing that’s going to help us to help them.”

And what about the point of sale?

“The problem we’ve got is the disparity between industry and mainstream buyers, and that’s fundamental,” Sheehan says.“They make everything as though everybody is one person. I’m one of five in my family and I’m 5ft 5in. My brother is 6ft 1in. When you’re designing for both people it’s as if they’re in different places – but most people have one accommodation. Why aren’t we designing in a new way for mainstream? We should be designing for different.”The decision-makers, installers and buyers aren’t focused on every day activities. She explains: “Most people over 40 wear glasses for many forms of work or for reading or driving. It’s part of the deterioration of the body. But it’s forgotten in design. Who showers with their glasses on?” There is a fix, Sheehan believes, and it involves creating best products rather than for the ‘average’ consumer.

Sheehan says: “We need to design better to meet the multi-generational needs, so we don’t have to adapt repeatedly in properties. We are moving into a society where we increasingly have multi-generations living in one home because of things like young people not being able to afford to move out. It’s called inclusive design and it’s been around for decades.”

So how can the industry stop older people and the less able getting such a raw deal?

Sheehan says they should think about the environment and the person’s connection with it: “Heating is just one example; there’s lots of people in later life who all have the same functions but how they use the space is different. If someone has a physical impairment, they tend to stay in one place for longer.

“As every plumbing and heating engineer knows, maintaining a higher home temperature is the ideal. It’s how you say to the client why that’s the case, but it’s also about a better conversation when you know the complexity of how they live so you can coordinate how they go from even temperature to even temperature.”

She explains: “Ideally, 18ºC is the temperature we want. Let’s look at the rooms and how we achieve it. Where is the person most active? In the kitchen, because of the oven, you don’t need an additional heat source. But if they are sitting in the lounge watching TV or not feeling very well, having some form of additional heating is very useful. It could just be installing thermostatic radiators or a smart thermostat.”

A familiar problem – but it has a serious health impact.

Sheehan says: “There’s a risk on the body; moving regularly from high to low temperatures can cause heart problems.

Scalding – a major campaign issue for the CIPHE – is also an area of concern for her.“The bathroom is one of the key places where we have these accidents. We’re more vulnerable and the most delicate parts of the skin are usually involved,” she says.

She offers a forensic analysis of how it can go badly wrong: “If you wear glasses, you tend to take them off in the bathroom, leaving you with limited vision. If you’ve got children, there are distractions – and they are not always aware of the risks.”

What can installers do to make a difference?

“Thermostatic showers and taps make a huge difference. It’s not about getting rid of choice: if you’re using a programmable shower you can set it for different people,” she says.

“Talking about this at the start is the key. Ask the householder ‘do you have any vulnerable people in your house?’”

Falls and trips in the home are traditionally associated with poor-fitting slippers. It’s a misnomer because there are other significant risks.

Sheehan says: “With the older generation, their balance isn’t as good. Slips and falls in the bathroom are common. Why don’t we design out the risks early? A real bug-bear of mine is the positioning of radiators in a bathroom,” she says. “They tend to be next to the toilet. A lot of falls happen getting on or off it. What happens if you are sitting on a toilet is that you can fall down and grab or land next to it. If you don’t move quickly, you will get a significant burn. Is there anywhere else you can put the radiator?”

It doesn’t end there: “Think not only about the position of products but how they can be used. Another bug bear is where people put toilet lever pushes. When it’s put on the corner, you have to reach and that can take an older person off-centre, unbalancing them. Put it on the outside end, not on the corner.”

Quality also counts towards safety: “Push buttons on toilets don’t work for a lot of people. If you have long fingernail extensions or arthritis, it’s a problem. Those £50 nail extensions ping off. It’s better to have a lever with a normal movement. Showers are slippery places. Why don’t you have a riser or a grab rail as well?”

Why make changes?

Those changes are inexpensive but can save lives – and save the NHS money.

She says: “Showers and washing facilities are where falls happen that cause hip fractures. A hip replacement costs £25,000. Why risk it for £100? It’s just good practice.”

Sheehan also reveals a quirk among installers that could render even the best-chosen product useless.

“Installers often fit to their working height not the height needed for the customer, so I have detailed plans that go down to the millimetre,” she says. “And I still have installers that don’t seem to read them beforehand, so I have a build sheet that I stick on the wall where the work is being done.”

But ultimately, it’s about more than just health and safety or neat design. For Sheehan, all those small details protect the mental health and dignity of the client.

She says: “Personal acceptance in decision-making is part of control and empowerment. You want to do things like have a shower because they are good for you mentally and physically. When somebody suggests that an older person can just strip wash, I go ballistic. If this was 100 years ago, that would be the norm. Today that’s not acceptable.”

And how should we think to best achieve inclusive design? Sheehan sums it up in one thought: “If this was you, how would you feel?”


Secrets of design success

Kate Sheehan’s step by step guide to getting home design right

• I look at the person and their needs. Ask what they need and want to do.

• Think: What do they use the space for, when and how?

• Use a checklist of questions and have a copy of the plan where the work is being done

• Educate: people must need and want to do something. Show the research to back up your advice. After that, very few say ‘I’m not having that’.

• Personal care is important. They need things explained. It’s not only about cognitive ability; it’s politeness.


Kate Sheehan, DipCOT MRCOT, is director of The OT Service. She qualified in 1987. She has presented her work on Inclusive Design and housing standards at The Royal College of Occupational Therapists and internationally. The former chairperson and treasurer of the RCOTSS, she developed and teaches the first Housing pathway MSc at York St John University. She is co-author of the new Wheelchair Housing Design Guide.


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