Best Cities for Aging? – Not Medford

Carrying out the mission of our nonprofit organization, Age-Friendly Innovators, includes a great deal of market research.  This means looking at the demographics of aging, future housing needs of older adults and wading through a number of research papers and reports.

Recently, I came across a 61-page 2014 report titled “Best Cities for Successful Aging.”  The report was produced by the Milken Institute, an independent economic think tank, whose mission is to improve the lives and economic conditions of people in the U.S. and around the world.  The report can be found at   The report is a subset of a larger report titled “Best Cities.”

The report introduction states “two important, unassailable facts underpin our 2014 “Best Cities for Successful Aging™” report.  Our nation is aging at an unprecedented rate, in a titanic shift that is creating the largest older population in history; and these mature adults live predominantly in urban settings.  A product of lower birth rates and increasing longevity, this phenomenon is changing the landscape of the United States and the world.”

The report ranks the 100 largest metropolitan areas in the U.S. and 252 smaller metro areas in the following categories:  general (which includes 7 indicators such as cost of living, crime rate, weather, over 65 employment), health care, wellness, financial, living arrangements, employment/education, transportation and community engagement.

I was surprised and disappointed to see that Medford ranked 194th out of 252 small metropolitan areas surveyed.  Medford had an overall score of 76.42 compared to the top small metro, Iowa City, IA, which scored 100.  Individual metro scores for the 252 areas ranged from 100 (Iowa City, IA) to Vineland-Bridgeton, NJ (68.22).  Interestingly the categories where Medford scored well below the national average were health care (-25.61% below average), living arrangements (-10.71%) and employment/education (-15.57%).  Medford ranked 211th our of 252 cities in the healthcare category.

For health care, Medford had only 3 our of 16 indicators above the national average and these were:  number of hospitals with Alzheimer’s units, number of hospitals with hospice services and number of physical therapists.  Oddly, Medford ranked 61st among the 252 metro areas in “wellness,” so we must be doing something right.

There are 11 indicators within the living arrangements category and Medford ranked 5th for continuing care facilities and 20th for the percentage of houses with residents 65 or older.  However, the number of nursing beds (249th) and number of home health-care providers (190th) resulted in an overall ranking of 202 in this category.

For the average person, wading through all this data is not easy and I must admit I found it tough going at times.  What I do believe is that this report should be read and understood by our city and county administrators and perhaps there needs to be a more cohesive strategy developed for how we deal with the burgeoning older adult population.  Oh, by the way, Medford did beat out Eugene, which was ranked 196th.  No something to brag about however.  The larger Best Cities report had Medford ranked 91st out of 179 small metro areas.

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We decided to call it a “demonstration” home and this is what that idea looks like in practice. So far this week we have given seven tours of our “certified Lifelong Housing” home to over a dozen people. And we are only at mid-week! One of the tours was to Janet Eastman, well-regarded Oregonian journalist who then wrote an article, with accompanying photos. It’s up on the ‘Oregon Live’ link and will be featured in the Oregonian in February.

Our kids who live at a distance have not seen this new home of ours yet, so they were ecstatic to roll through the slides and commentary. Elisabeth, our oldest daughter, posted her own comment on Facebook. “My parents never slow down…and now they don’t have to.”

We love our convenient, easy living home with its lessened likelihood of having a fall and fracture. The no-step entries and bathroom grab-bars reduce our fall-risk. And if we did fall and break something, we could easily return to  a home that had a comfort toilet and a bathroom that accommodated  walker or wheelchair.

We are eager to share our home’s “universal design” with people who recognize that as we age we need conveniences like levered handled doors and no-scald showers. But wait!! We probably need those kind of conveniences at any age.Homes that meet the universal design criteria stand the test of time. They assure little things like windows that open with the touch of a finger or a closed fist or big things like the availability of a bathroom that your friend who is in a wheel chair can get into when she comes to visit. The most frequent comment we get from visitors is “Wow, this is beautiful, I thought it would look like a nursing home.”

Check us out! Think about the little and big possibilities in your own life.

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Tale of the Tape

At some point as people get older they begin to plan for the future.  Most often it is a look at their finances and retirement plans.  We also begin to think about health and legal issues and may draft an Advanced Directive to indicate our health care preferences and perhaps a Will.  There is one other tool that is vital to planning your future…..a tape measure.

Surveys tell us quite clearly that most people plan to stay in their current home as they grow older.  Thus a 65 year old might be living in a home built ten, twenty or more years ago that may have undergone some remodeling in the intervening years.  However, surveys also indicate most people do not have a plan for staying in their home; what the Centers for Disease Control and Prevent terms “aging-in-place.”

This is where the tape measure comes in.  The process of looking at your home through a “ten years in the future” lens will help you understand what modifications might be necessary to remain in your home.

Grab your tape measure and step out your front door.  How many steps do you have from the sidewalk, the street or from your driveway?  Let’s say you have four steps each five inches high to your front porch.  This equals an elevation of 20 inches.  Should wheelchair access be needed now or later, at the recommended 12:1 slope (12 inches to one foot) you would need a 20 foot ramp or raised walkway.  Is this possible?  In our new home we had the advantage of being able to design a meandering concrete walkway from the sidewalk to the porch.  Visitors don’t even realize it was intended as a wheelchair ramp.  An alternative entry might be through a garage or rear entrance if a suitable scope could be achieved.

Now that you are at the front door, take your tape measure and check the width of your front entrance.  If you have less than 32 inch clearance, a wheelchair will likely not fit.  Optimum size would be a 36 inch door with a maximum 1/2 inch threshold.

Once you are back in the house, scan the living area.  Do you have an open concept floor plan or are the rooms (dining, living and kitchen) confined by walls and halls.  If so, you need to get the tape measure out and see if you have 36 inch wide access to these rooms. 

Finally, check out your guest bathroom.  Again, you want at least a 32 inch entrance door and greater room to navigate either a 60 inch turnaround space or a 30 inch by 48 inch clear space with an entrance door that opens out and not in.

There are numerous other home features you may need as you “age-in-place,” such as grab bars in the bathroom or hard survace floors instead of carpet, but understanding the dimensions discussed are fundamental to planning future modifications to your home.

If you make the tough decision, as we did, to sell our home of 14 years because future access would have been cost-prohibitive, or just because you want to downsize, make certain your next, and perhaps final, home measures up.

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I Get It. Took a While.

Here are the facts. Over the past year, my husband and I have immersed ourselves in educating others about “age-friendly” living and “life-long” housing. We launched a non-profit organization whose name (Age-Friendly Innovators Inc.) shouts our intentions. We built a home using universal design principles and tour people through to demonstrate the easier living that comes with no-step entries and comfort height toilets. We are using multiple forms of media to spread the word.

We have tried to do everything we can to assure people understand and absorb what is needed for aging adults to “age-in-place” in a home of their own. After all–who wants to spend the final years of life in the corner bed of a nursing care facility.

Here is the reality. People are not aging. Differently put, most folks do not see themselves as getting older. Nope. Nada. “Not me…” That makes them resist attempts to talk about the living situation that might be required at age 75 and plan for it. Active denial is epidemic.

I finally “get it.” But how do you deal with an epidemic of denial about getting older? An anti-aging vaccine would have huge receptivity. But there is none. The possibility of developing a substance of any kind that will slow or reverse the biological process of aging is highly unlikely yet retailer’s shelves are packed with expensive, unproven products that try to make the case. You probably have some in your medicine cabinet.

If this is an epidemic of denial and the “cure” is preparation and planning for late in life realities. How do we better make the case?

We are open to ideas. A presidential proclamation about the joys of aging? Huge discounts on purchases to anyone who self-identifies as over age 70? Appointment of an “aging czar” who is 80 years of age but looks and acts decades younger? Ad campaigns that feature actively aging movie stars in their accessible homes?

My husband and I are self-described “social innovators” so we will keep the ideas coming. Now that we “get it” maybe we can make new inroads. May the force be with us. And also with you.

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Removing Barriers Is Good Insurance

If you have read our previous blogs you know that Sharon and I have been very involved in issues related to universal design and aging-in-place.  Our journey began in the summer of 2012 when we took the three-day National Association of Home Builders Certified Aging-in-Place Specialist course in Denver, Colorado.  While the training was mainly for builders and remodelers, it offered us an opportunity to learn more about the issues and opportunities relating to removing barriers in the home and thus allowing people to remain where they are as they age.

I recently reviewed a 2014 cost of care survey for the State of Oregon and the figures are sobering.  According to the Genworth Financial survey the monthly rate for an assisted living facility in Medford ranges from $2,898 to $5,050 (compared to the state average of $2,196 to $5,463).  Nursing home daily rates in Medford ranged from $254 to $270 for a private room and $154 to $260 for a semi-private room.  Finally, home health aide services in Medford range from $20 to $25 per hour.  It adds up fast.

If you fall and break a hip you will likely be hospitalized and perhaps sent to a rehabilitation facility after that.  If your home is not accessible (narrow doors being the biggest culprit) you may be sent to a nursing home for an extended period of time.

The point I am trying to make is that remodeling a home to remove barriers can be very cost effective versus the cost of care outside the home.  Take the front door for example; to remove the frame and increase the width (ideally for a 36″ wide door) can cost $1,000 to $1,500 depending upon the structure.  Interior doorways may also need to be widened.  At least one entrance to the home should be “no step” and likely will require a ramp.  The cost of a ramp varies widely depending upon the degree of elevation.  The recommendation is you need one foot of ramp length for each inch of elevation.  Thus two six inch steps would require a ramp 12 feet long.

If the cost of removing barriers is too great perhaps you should consider new construction.  The cost of wider doors, no step entry, wheelchair accessible bathrooms is just about the same as standard construction costs and doesn’t have to look like a nursing home environment.  certainly if you are planning to sell your home and “downsize” you should consider building a totally accessible, age-friend, home.  We did and we love it.

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Saving Lives

What I am about to tell you could save your life or the life of a loved one.  We all know about seat belts and how they save lives.  Seat belts are standard equipment in cars these days and “buckling up” is the law.  No, this blog is not about seat belts, it’s about grab bars.  My last blog (A Little Toilet Talk) mentioned grab bars and the fact that we had installed them in our new home but I did not elaborate.

We need to dispel the notion that grab bars are just for “old, feeble,” people in nursing homes.  grab bars are as important to home safety and fall prevention as a seat belt is to drivers of every age.  A 2011 study by the Centers for Disease Control and Prevention (CDC) found that every year over 235,000 people over age 15 visited emergency rooms because of injures suffered in the bathroom and almost 14 percent were hospitalized.  According to the CDC the most hazardous activities for all ages are bathing, showering (accounting for one-third of the injuries) and getting out of the tub/shower.  Only 2.2 percent of injuries occur while getting into the tub/shower, but 9.8 percent occur while getting out.  Another 14 percent of injuries occurred near the toilet.

So this is why Sharon and I, both healthy retirees, installed a grab bar in our shower and grab bars around the toilet and tub in our guest bathroom.  Anyone, at any age, can slip and fall in the bathroom and a grab bar might be the difference between life or death.  Anyone considering a remodel should install grab bars and the best method is to install what builders call “blocking” to the studs around the tub and toilet.  Thus the reinforced walls can have grab bars installed at any angle rather than just relying on stud location.

Grab bars need not be that obvious.  In our guest bathroom the grab bars are white and blend in with the tub surround and bathroom color scheme.  Some grab bars may even double as towel holders.  The complement the tub/shower grab bars you might also insure that you have a non-slip surface for added protection.  Remember, you don’t need a seat belt until you need a seat belt.  The same is true of grab bars.  They both save lives.

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I’ve have been at it for almost an hour. Dad Gum It. I am increasingly exasperated as I try to unsubscribe to websites sending me unsolicited email messages.

I woke up this morning determined to do something dramatic to end the relentless onslaught of incoming messages that I have no interest in receiving.My computer is sending me warnings about “mailbox overload” and advertisements for things like hair restoration and free-standing metal buildings had taken over my life.

Clearly, my early-in-the-year vow to delete unwanted items on a daily basis has not worked. Setting up an automatic archiving function was also not keeping up– and I’d recently realized I might be putting messages in an archive that I absolutely had no interest in ever retrieving. I am on a mission to clean up my act.

A few websites are easy to detach from. I just scroll down the page to the very bottom, search out the word “unsubscribe” which always seems to be written in the smallest possible font, and tap the word. I love it when I just have to do that once and the site says “You have unsubscribed.” Mission accomplished. Although I have noticed that sometimes those same sites mysteriously start reappearing weeks or months later. I envision I am in their archives under the heading… “Re-instate her when the moon is full and we have a sale on pet toys.”

Then there is this. Many sites make it extremely difficult to find the word “unsubscribe,” or if you do find it and tap it– several more screens appear querying you about exactly why you are unsubscribing. Some even give you options like ” too many emails.” You think?

I wish there was a category that allowed me to say ‘I am unsubscribing because I have been beleaguered by your incessant emails for months and finally figured out how to stop them from coming.”

Or better yet, “I am unsubscribing because I’m on stimulus overload.” You think?

Or what if there was a website called Oh my!  I just checked–and there is.

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A Little Toilet Talk

As you may have figured out from our blogs, Sharon and I are now living in the “Age-Friendly” single story home we had built in the Twin Creeks Development in Central Point.  While neither of us have mobility issues at this time, we did want to plan for the future and what that may hold in terms of health.  Thus are new home is fully accessible and has been certified to the Lifelong Housing standard developed by AARP Oregon and the Rogue Valley Council of Governments.

Which brings me to the bathroom toilet.  In every room of the house we tried to incorporate not only the recommended fixtures that were considered “age-friendly” but also adoption of the newest technology.  In our guest bathroom we installed grab bars in the tub/shower, a pedestal sink to conserve space and grab bars adjacent to the toilet for those that might need a little help getting on and off.  In addition, we installed what is often referred to as a “comfort height” toilet with a seat that is at least 18 inches high (16 1/2 inches to the rim) instead of the standard height toilet.   This height is much more comfortable for adults of all ages and abilities and I would recommend it for anyone remodeling a bathroom.

In our master bathroom we installed another unique feature; a bidet toilet seat (called BioBidet) that does, well, what a bidet is supposed to do.  For older adults a bidet toilet may be the difference between independence and assistance.  The BioBidet is essentially a toilet seat with special features and requires a nearby electrical outlet.  It is as easy to install as a standard toilet seat and also functions as a nightlight.

I thought we had covered all the bases (so to speak) when we put in our toilets but technology is always pursuing better solutions to everyday problems.  Today I saw a headline that gave me pause….”Odor-eating toilet seat offers a breath of fresh air.”  Turns out Kohler has developed a deodorizing toilet seat that promises to eliminate bathroom odors and the need for candles, matches or sprays.  The device has a fan hidden in the battery-operated seat which moves air through a carbon filter.

I’m not sure if we will buy this new odor eating toilet seat but you never know.  I will keep my eye out for other innovations that will make life easier and age-friendly.  Any ideas?



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Lazy Able-Bodied People Could Live Here

Life is good. We have been in our certified Lifelong Housing, age-friendly home for over six weeks and our often-stated comment to one another is how “easy” it is to live in a home like this. One of us says that almost every day—smiling as we do.

The no-step entrances assure convenient access from the outdoors or from the large patio in the back of the house. There are 36-inch windowed-doors (with in-built privacy blinds) that lead from the patio to an office or to the great room with its remote-controlled fireplace –or our large master bedroom with its no-door, roll-in shower.

The curving, slightly-elevated and beveled-concrete sidewalk to the front door of this house is actually a ramp– but no one ever realizes that—they instead comment on what a gracious entry we have designed for our home. Anyone could ring the well-positioned doorbell and independently maneuver their wheelchair or walker inside our home without assistance. That was important to us–we have friends who are wheelchair-users and the idea that someone has to carry their chairs with them in the chair (or physically lift them out of the chair —because the chair itself does not fit through a too-narrow door) was definitely not how we wanted to welcome dinner guests.  The living area is spacious and well-lit. We have a drop-down counter that allows a person in a wheelchair (or a small child ) to help the host cook a meal if they choose. (Those helpers are my personally-favorite kind of guests.)

Yes–this is a home that acknowledges and respects that some of us have, or will have, mobility issues. But it is also a home a young family with a baby in a stroller could roll in and out of —with no difficulties. It is the kind of home where a teenager could put his soiled football jersey right through a chute in the closet wall to a basket in the laundry room where an easy-access raised washer and dryer might even prompt him to actually wash those dirty clothes. (Well, that’s probably asking too much…).

People who visit us usually know we went through a process to get our newly-built home certified to a specific standard and say upon entering for the first time–”Oh my gosh, I thought it would look institutional! The more typical comment is “This is really quite beautiful.” Thank you very much.

I often say it’s a home for “lazy able-bodied people.” Our guests laugh at that. It might be funny– but it is also true.

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Don’t Fall For This

I have probably written about this before but it bears repeating.  Falling is a killer for older adults.  I would guess that if you were to ask 10 people over age 65 “Have you or a loved one experienced a debilitating fall?” the answer over 80 percent of the time would be “yes.”   According the Centers for Disease Control and Prevention (CDC) the rate of severe falls has been increasing for Americans over the age of 65.  Researchers note that one reason for the increase in falls may be the link to diseases such as diabetes, heart disease, stroke, arthritis and Parkinson’s disease.  The CDC adds that in some cases, the medication to treat the disease can increase the risk of falling.

While Americans became frantic recently over one death from Ebola in this country you don’t hear much concern about the number of people over 65 who died after a fall.  Would you believe 24,000 in 2012?   That, according to the CDC is almost double the number reported 10 years earlier.  In addition, more than 2.4 million people over 65 were treated in emergency departments for injuries from falls in 2012 alone.  Falls, according to the CDC, are the leading cause of injury-related death for those over 65.

Now, one more scary statistic to make you take notice.  Currently 10,000 people turn 65 every day in this country and that trend will continue for the next 19 years!  Baby Boomers are not immune.  There is no vaccine for falls.

As most people who read the blogs Sharon and I have been posting know we designed and built an “age-friendly” home in Central Point that has been certified to the Rogue Valley Council of Governments “Lifelong Housing” standard.  This home has no step entry, wider doors and a host of other features…including some to help us avoid falls.

Lighting is critically important for older adults, not just for reading, but for navigating.  We have a a lot of light in our house and even in the dead of night it is possible to see our way to the bathroom without turning on a light.  Also, in the bathroom the light in the toilet has a motion sensor so it comes on automatically.  In our guest bathroom we have grab bars in the bathtub and around the toilet.  In our shower we also have a grab bar.  Some would say since we are healthy adults why do we need grab bars?  To me grab bars are like seat belts… don’t need them until you need them and then they are lifesavers.  Think about installing grab bars in your bathroom before it is too late.

Another simple step to preventing falls is to get ride of scatter rugs.  They may look attractive but can be lethal to slow moving folks that shuffle their feet when they walk.  Exercise can also improve one’s balance and I have been told (but haven’t verified) that Tai Chi can improve one’s stability.

While Sharon and I have been vigilant in trying to prevent falls in our home we have one hazard that remains.  Out new little puppy Lucy is often underfoot and Sharon has bought a lot of little toys for her that often get under foot.  If you come to visit watch your step.


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