Little Free Libraries

Have you heard about the Little Free Library? I am borrowing with a abandon from a recently published blog describing their presence in on lucky neighborhood in Seattle, Washington. In this case, a loving husband gave his writer/reader/blogger wife the sturdy little structure as a gift.

According to “The Little Free Library Book” (Coffee House Press, $25), there are 25,000 of these pedestal libraries worldwide, spread across 50 states and 80 countries. “The basic definition: a box of books, posted in an accessible spot, often in a residential yard near a sidewalk. The key to having a Little Free Library is to release control. Take a book, leave a book. A lot of people feel an obligation to reciprocate.”

As the happy, but a little hesitant-at-first Seattle blogger (Mary Ann Gwinn) phrases it, “Do I want my neighbors to think that I actually bought and read “How to Hook a Hottie,” which sat in my Little Free Library for a week before someone took it away?” She adds,”I think of … reader-service librarians, and how their mission is to find each person their book. Who am I to judge? Why worry if people are judging me? My motto is, Every Book Its Reader. And someone did finally take that Bob Hope biography.”

We have a little free library built by a creative, woodcraftsman friend sitting on a table on our patio ready to be installed. I am starting with children’s’ books. Maybe we could place a bench nearby and we would get to observe—parents and grandparents reading to their little ones—or vice versa. I have numerous copies of “Good Night Moon.” I bet they disappear quickly.

What is your Little Free Library story? Send them — bizarre, inspiring, off-the-wall, to mgwinn@seattletimes.com, or leave a comment online. Want to start your own? Go to littlefreelibrary.org.

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Don’t Fall for This Part 2

Sharon and I have both blog about fall prevention in general but I want to get very specific….floor coverings such as mats and throw rugs are dangerous.  Two questions.  1. Are these floor coverings in good condition or noticeably worn or torn?  2. Do the floor coverings bunch up or slide when you walk on them?

If you answered “yes” to either question the best advice we can give you is to get rid of those rugs or mats.  If you can stand the thought of getting rid of grandma’s old throw rug or that cute fuzzy mat in the bathroom here are some suggestions from the National Association of Geriatric Care Managers and the International Rug Safety Insitute:

  • Recognize surface changes from one room to another (i.e. carpet in living room to linoleum in the kitchen) can present balance issues.
  • Purchase carpets, rugs, runners and mats with “slip resistant” backing or padding, remembering that such materials become less effective with repeated washings.
  • Consider thick, cut-to-fit rubber shelf liner under a carpet.
  • Carpets should be high density, low pile.  If replaced, use the same color as previous carpeting to reduce likely visual disorientation.  Recognize that color changes can visually cue the resident to the boundaries between surfaces.  Note:  bold patterns, and black on blue backgrounds can lead to misjudgments of spatial distances.
  • If a new mobility devices is required (such as a cane or walker), assure the introduction to walking on various surfaces is well monitored.  Older adults with delays in light/dark adaption, decreased contract sensitivity, poor depth perception or limited peripheral vision will also need more careful monitoring.
  • If mats, scatter rugs or runner replacements are not possible due to financial constraints, etc., apply double-faced adhesive carpet tape or heavy duty masking tape (rolled around spread fingers five times) and secured around the edges of the rug or mat.
  • Consider Press and Stick Rug Grippers (available at Lowes, Home Depot, local flooring and carpet outlets or Amazon).  Press into each corner of the carpet.  Recheck adhesive periodically and replace if you see a powdery substance that indicates deterioration.
  • Choosing aesthetically pleasing carpets, rugs and runners that meet personal preference is always balanced against functional floor coverings that promote safe navigation.

Falling can be a lifetime game changer.  Get a grip.

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You and Me at 83…

Let’s say I’m eighty-three years old. I’m not that old—but let’s assume I am, just for the purposes of this blog. Let’s assume you’re in your eighties too.

Where would we like to live? It’s a relatively easy question for both of us, I suspect. We’d like to be comfortably situated in our own homes. I know I’d like to be independently observing my personal morning rituals and managing my own activities of daily living.

If either of us were in chronically ill or physically frail and had a need for constant medical attention, living independently might not be possible.

That’s what I used to think. An article in the “Atlantic” (www.theatlantic.com) and a new report in Kiplinger (April 2015) titled “6 Simple Things You Must Know About Aging in Place” altered my view.

Here’s the story. It’s about Ellen, who is an 82 year old widow living in Anaheim California. “One Wednesday morning last year she got on the scale, as she does every morning, and It read one hundred and forty-six pounds—wasn’t that a little high? Ellen felt vaguely troubled as she poured herself a bowl of oat bran.” As Ellen ate her cereal, the phone rang, and a friendly voice from the health clinic where Ellen was a patient expressed concern about Ellen’s weight—which “had jumped three pounds from the previous day.”

The friendly voice knew that because Ellen’s scale had transmitted the information through a wireless connection. Because Ellen had a history of congestive heart failure, a three-pound weight gain in a 24-hour period was a potentially dangerous situation. There was likely to be fluid build-up that would complicate her already-existing medical issues. She needed treatment immediately.

So now you may be thinking—that friendly voice (not a mechanized one by the way—a real person) probably told her to come into the clinic. Or maybe, the voice said “Call 911 and get to an emergency room.” Nope. The friendly voice said, ‘We’re sending a car to pick you up,” which they did. Ellen’s health provider gave her no-fee transportation from her home to the health clinic over the next few weeks, as well as appropriate medical treatment, until her health situation stabilized.

Had this not occurred, Ellen might have languished. Perhaps she would have eaten less because she was afraid she was gaining too much weight. She may have experienced a life-threatening cardiac event. She could have ended up in the hospital for days or weeks undergoing painful—and expensive—treatment.

The California-based clinic system that supported Ellen in this way is appropriately named CareMore (www.caremore.org) and it specializes in patient-centered approaches that also seem to avert huge medical costs. As their website says—“That’s what we do.”

This is impressive health care. According to the Atlantic article, CareMore has a hospitalization rate 24% below average and hospitals stays are 38% shorter. Overall costs are 18% lower than average. And the surveyed satisfaction rate is well above 90%. (And remember 80 year olds can be hard to please…)

When I’m in my eighties—that’s the kind of health care I want—coordinated, integrated, tuned into my personal needs and preferences. You too?

Whatever you may think about the Affordable Care Act President Obama signed into law in 2010, these are the kind of innovative approaches included in it. These ideas effectively combine common sense with technology— or as some system-watchers put it, “It’s about improving the quality of our country’s health care, but at a reduced cost.
It’s really about–you and me at eighty-three.

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What about Lucy?

Last month Sharon and I presented at the American Society on Aging (ASA) “Aging in America” conference in Chicago.  The program was packed with presentations on a wide variety of subjects relating to aging, but one in particular caught our attention.

In recent years we have tried to plan for aging and end-of-life decisions and issues.  We drafted wills; we executed durable powers of attorney and updated our advanced directives.  We purchased plots in the Jacksonville Cemetery.  We even built a lovely, age-friendly, Lifelong Housing Certified single story home that features all manner of innovations to help us “age-in-place.”  All set right?  Well, what about Lucy?

If you have followed this blog for long you know that we added a new member to our family last September; a cute little Cavalier King Charles Spaniel puppy we name Lucy.

At the Chicago ASA Conference we attended a workshop titled “Aging in Community with Pets:  Insights, Innovations and Advance Planning.”  There it was….advance planning for Lucy.  How could we forget Lucy?

We heard from Amy Shever, Executive Director, 2nd Chance 4 Pets, an all-volunteer animal welfare organization that strives to reduce the number of companion animals that are unnecessarily euthanized each year due to the death or incapacity of their human companions.  The facts are stunning, after the tragedy of September 11 over 800 pets were orphaned.  At present over 500,000 pets are orphaned each year due to the death or disability of their human companion.

Here is what 2nd Chance 4 Pets (www.2ndchance4pets.org) recommends:

  1. Identify Caregivers – Identify individuals who would be willing to care for your pets in the hours, days, or weeks after an emergency as well as individuals who would be willing to adopt your pets should you die or become incapacitated.
  2. Prepare Written instructions – Describe, in writing, how your pets should be cared for.  To make sure your wishes are carried out, document your instructions and let others know where your instructions are located.
  3. Set Up a Fund – You currently pay for food, supplies, and medical care for your pets.  Should anything happen to you, these expenses will still need to be taken care of.  Consider setting aside funds to cover temporary or permanent care of your pets.  Pet trusts are legal in Oregon.

Ok Lucy.. We’ve got you covered.

 

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Better Living By Design: A Symposium You Must Not Miss

Even if I were not one of the people organizing and planning it, I would absolutely want to be present for this event!  Saturday May 16, 2015, thinking homeowners and forward-looking building professionals will come together to rock the house (literally and figuratively)!

The all-day (9-3 pm) Symposium is titled “Better Living By Design: Making Our Homes More Adaptable for All Ages.” The location in downtown Medford, Oregon is the Rogue Community College/Southern Oregon University Higher Education Center (RCC/HEC). The fee is $20 and includes lunch and morning snacks. CEUs available too.  Does it get any better than this?

Here is the line-up of speakers:
Alan Delatorre PhD Portland State University, Institute on Aging, Age-Friendly Cities Project; Title: “Baby Boomers Evolving Housing Preferences Will Shape New, Innovative Options: Stand Ready!” Overview of demographics and the opportunities on the horizon across the state and in southern Oregon.

Susan M. Duncan R.N., National Accessibility and Home Modifications Specialist. Designer and founder of The ABCs of Accessibility® Topic: Home Modifications Title: “Peeling Back the Layers of Home Access Modifications” You have questions about renovating an older home to be sure you can still easily live in it at age 80-plus…. even if you or your spouse needs a wheelchair or walker … ?  Susan has the answers. She is a pistol of a presentor!

Leigh Anne Jasheway MPH, Faculty, University of Oregon, well-regarded area Humorist. Her presentation is titled: “Watch Your Step: Oh, I Forgot, There Aren’t Any.” Leigh Anne uses all-to-true stories and anecdotes plus hilarious “Improv” routines to prompt us to laugh out loud at the decisions we make and  at our aging selves. (Laughing is aerobic exercise so this event even has some calorie-burning opportunities.)

The day ends with the tour of two local homes certified to the Lifelong Housing Standard. There are only five of these in the state and you will see the exterior of all five and the interior of two of them.  It will change the way you think about aging.

Register on the Age-Friendly Innovators website www.agefriendlyinnovators.org or by calling 541-261-2037.  Space limited so make the reservation now!

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Fire Safety

It takes a bit to shock me these days but when I saw a statistic recently regarding fire safety I was stunned.  According to a report by the U.S. Fire Administration, older adults (age 65 and older) are more than twice as likely to die in fires than the Nation’s population as a whole.  Individuals aged 85 and over are more than four times likely to die in a fire than the general population.  Clearly older adult mobility is a major contributing factor.

As frequent readers of this blog know, Sharon and I are the Executive Director and Deputy Director of Age-Friendly Innovators, Inc., a 501(c)(3) non-profit, dedicated to helping older adults remain in their homes as long as possible.  But certainly not if those homes are fire traps.  One of our foundation-funded projects is the development of a tool to evaluate the homes of older adults with respect to fall-risk, in-home safety and accessibility.  While we have conducted over 20 in-home assessments to date, we had not specifically targeted fire risk.  That will now change.

The U.S. Fire Administration has a short fire safety check list of yes or no questions the identify fire risk:

  • Do you have working smoke alarms on every level of your home?
  • Do you stay in the kitchen while you are frying, grilling, or broiling food?
  • Are space heaters placed at least 3 feet or more away from things that can burn?
  • Are all electrical cords in good condition (not damaged or cracked)?
  • Do you know two ways out of every room in your home?
  • Do you know what to do if your smoke alarm sounds?

If you checked NO to any of these questions, you are at greater risk for being injured in a home fire.  You can download the entire Fire Safety Checklist for Older Adults as:  https://www.usfa.fema.gov/downloads/pdf/publications/fa-221pdf

A few final excerpts from the Checklist brochure:

  • Smoking is the leading cause of home fire deaths for adults 65 and over.
  • Cooking fires are the number one cause of home fires in America.
  • Install CO (carbon monoxide) alarms, especially if the home is heated by any source other than electricity.
  • Candles look pretty but represent an open flame that can easily ignite anything that burns around it.

If you have parents living in their own home, get the checklist and take it with you when you next visit.  If you have an elderly neighbor living alone, take note of the items on this checklist next time you visit.

Sharon and I will be at the Southern Oregon Home Show (booth #1) on April 24-26.  Stop by and we can continue the conversation.  We knows, the life you save may be your own.

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Denial is Not a River in Egypt

Here’s a scenario most of us have experienced in some form. It’s the middle of the night and the phone rings. It’s your son in Seattle calling to tell you his 70- year old father-in-law took a fall and he’s with him in a hospital emergency room. He has a fracture—or did he say “fractures”—plural. Or maybe it’s an early morning call; your 80-something sister in Florida is calling; she just received a diagnosis that will keep her homebound–maybe even bedbound–for months.
Those calls are “911 look-alikes.” You’re not the one in crisis, but the family member at the other end of the line is dealing with an emergency and wants/needs your assistance. Even if you have been fortunate enough to avoid any kind of personal health crisis or life-changing accident, someone else’s 911 situation is about to impact you. Be ready—use that moment well.
You are a good and caring person, of course, and you will provide gentle counsel and offer information and resources appropriate to their emergent situation. Maybe you’ll do follow-up calls or make a cross-country visit to the individuals(s) in distress. You’ll probably send a get-well card or flowers. Maybe you’ll use the internet to assemble ideas that address “their” issues. And then, quite probably, time will pass and you will move on to the other things in your life. Opportunity lost.
“Opportunity,” you say? “Yes,” I reply.
Here’s how I see it. As older adults, we are in active denial–about “being old” of course, but also about the likelihood we’ll have a debilitating fall or be diagnosed with a medical condition that displaces us from our circle of comfort. According to aging expert, Dr. Mary Doheny, we are unwilling to talk about aging “until something really traumatic happens to us like the death of a spouse, the illness of a partner or the need for hip or knee replacement.” And at that point, “denial often turns to despair” and any ability to make informed choices is reduced—dramatically.
Denial does not work. Aging keeps happening. And many people do not have a strategy for dealing with that reality. When a “911 look-alike” occurs—maybe we should use that moment as a reminder to develop that strategy. Here’s why. The Federal Commission on Long-Term Care indicates “70% of us who live beyond the age of 75 will need some sort of caregiving, on average for three years.” Do you have a plan for that?
Perhaps, as are many, you’re “counting on family members to provide any needed caregiving” But are you talking to them about your care preferences?” This is not a conversation about death and dying—this is a conversation about “defining how you want to ‘live,’ despite changing health needs and the daily physical struggles that emerge as you age.“
Maybe you won’t need a middle of the night call to ignite your interest in developing a personal long-term care strategy. Maybe this information will do it. I like to think it will, at minimum, prompt more conversation. Prove me right?
Excerpted from 2014 Mail Tribune column.

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The Future is Now

The front page feature in today’s Mail Tribune was an article on Medford’s plans to expand their urban growth boundary to accommodate anticipated population growth over the next 20 years.  Having spent five years on the Jacksonville Planning Commission I am familiar with the process (and have the scars to prove it).  This expansion is expected to result in the construction of 15,000 new homes.

What is unsettling to me after reading the article was that there is no mention of accessibility in the article and indeed the city planners apparently do not take that under consideration.  The criteria used to score properties under consideration to expand Medford’s boundaries are:  transportation, affordability, environmental, infrastructure, required density, neighborhood integration and housing diversity.  The final criterion, housing diversity, potentially offers an opportunity to plead my case for accessibility.

Last year Harvard University’s Joint Center for Housing Studies published a report titled “Housing America’s Older Adults, Meeting the Needs of an Aging Population.”  The report stated very clearly “affordable, accessible, and well-located housing is central to the quality of life for people of all ages, but especially older adults.  Accessibility is essential to older adults’ health and safety as physical and cognitive limitations increase.  But the existing U.S. housing stock is unprepared to meet the escalating need for affordability, accessibility, social connectivity and supportive services.”

Will Medford allow 15,000 new homes to be built without attention to accessibility?  Who will purchase these new homes?  By 2020, according to census projections, 23.2% of Jackson County residents will be over age 65.  Medford has long been a retirement Mecca of sorts, drawing Californians to our Valley.  Will these retirees find accessible homes they can “age-in-place?”

The Harvard study states that the five most important “universal design” features in a home are:  no-step entries, extra-wide hallways, accessible living spaces on the ground floor and accessible light switches and door levers.  According to the study only one percent of the housing units in America have all five of these features.  Today with a few notable exceptions, most developers are still building homes without these necessary universal design features.  Are we going to allow development of homes for the future or the past?

One additional item from the Harvard report should give us all pause.  They cite the disconnect between housing programs and health care systems which put older adults with disabilities or long-term car needs at risk of “premature institutionalization.”  Put simply this means that if a homeowner develops a health issue or suffers a major injury, say from a fall, it is possible that person will not be able to stay in their own home because it lacks accessibility.

There is a solution to this issue.  The planners in all major Southern Oregon cities (indeed throughout the country) should adopt as part of their criteria for scoring properties the first level of the Rogue Valley Council of Governments” Lifelong Housing Certification Standard.  This first of three levels of certification requires that homes be “visitable” for all guests.  This means a person in a wheel chair can easily access the main entertainment area of the home including a hallway with sufficient width leading to an accessible bathroom.

If you want to see what these homes look like drive out to the Twin Creeks Development in Central Point and follow N. Haskell St. to the Age-Friendly Homes sign.  The future is now.

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The Guest List: Check!

Later today we’re having a dinner party for twenty people. You may wonder what I’m doing blogging at this moment in light of the various preparations needed for an event of that kind. The answer would be “guilt”—because I have not blogged recently. Another good answer to that question is, “Having guests in your home involves more than turning on the BBQ, making a delicious pasta salad and getting the silverware and napkins readied.” It involves ‘thinking around the corner’ regarding your home environment.

For example– this occasion is the birthday party for a ninety-two year old gem of a man and many of his/our guests will have mobility issues. So the pathway to our home really needs to be “older-generation friendly.” No obstacles or objects in the way. No wobbly railings. No slippery sidewalks. Check.

The guests arrive in daylight but will leave after dark, so we have assured that walkways are well lit. Very well lit. Inside our home, we do not have scatter rugs of any kind because we know the fall-risk attached to them, but if we did– we would be vigilant in removing them or securing them tightly with double-scaled carpet tape. Seating for these guests is particularly important. It should be “appropriately firm, high in the seat and, preferably have arms,” according to a recent article from the National Association of Home Builders. More ”Tips for Elderly Visitor Safety” are available at www.nahb.org    Check…it out.

You might also look at the Age Friendly Innovators (www.agefriendlyinnovators.org)  website and its companion Facebook page for more of this kind of information. “Like”" on Facebook if you will. My husband hosts that site and he just passed 100 “likes” on  all his various postings over the past six months. When we get to 200 “likes” we plan to have have another dinner party. The guest list is already being developed. Let us know if you are available. Check!

 

 

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And if I Die Before I Wake

I woke up this morning thinking about dying.  No, I didn’t “think” I was dying,  just thinking about the subject in general.  I’m not hung up on the subject and am in great health (thanks in no small measure to my dear and caring wife) but recently I came across three articles about dying.  Before I share these articles let me say at the outset that I don’t know when I will die and I don’t know how I will die….but I do know where I intend to die.  More about that later.

The first piece was an essay in the New York Times titled “My Own Life” written by famed 81 year old neurologist Oliver Sacks.  Dr. Sacks announced in his essay that his cancer from some years back had returned and metastasized into his liver leaving him with just months to live.  I cannot hope to condense his words into a paragraph and do him justice so I will pick a few sentences.  Sacks wrote “over the last few days, I have been able to see my life as from a great altitude, as a sort of landscape, and with a deepening sense of the connection of all its parts.  This does not mean I am finished with life, on the contrary, I feel intensely alive, and I want and hope in the time that remains to deepen friendships, to say farewell to those I love, to write more, to travel if I have the strength, to achieve new levels of understanding and insight.”

The second item on dying was a review of a new book titled “The Age of Dignity” by Al-Jen Poo.  the book is subtitled “Preparing for the Elder Boom in a Changing America.”  She writes about her experience with her grandfather and his death in a multi-bed nursing home room shared “with six other people, half of whom were completely silent, while the other half expressed their misery in loud, painful, cries.  The room lights were kept off, while a sickly fluorescent light in the hallway flickered.  The place smelled like mold and death.  It was my heart-wrenching introduction to dehumanizing institutional care”  she writes.  Al-Jen Poo’s book is a wake-up call to America where 10,000 people are turning 65 each day and will continue to do so for the next 19 years.  Where will the caregivers come from and how and where will these tens of millions live out their lives.  I’ve ordered the book and will share more in a later blog.

The final items was an article in the Mail Tribune this morning regarding a series of presentations on death and dying titled “Facing Mortality:  The Elephant in the Room.”  The presentations are sponsored by Choosing Options, Honoring Options (COHO) and the next presentation on February 26 is a play based on the story of a brilliant scholar battling ovarian cancer. This will be followed on March 12 with a discussion on “choosing levels of late-in-life treatment.”  On March 19 there will be a theatrical presentation called “Mom, Not at Thanksgiving!” about trying to have a conversation about dying.  The final session in the series will be on April 16 on creating advanced directives.  Pre-registration is required at http://cohoroguevalley.org or by calling 541-292-6466.  All presentations are free and will be held at the Asante Smullin Center.  A $10 donation is suggested.

As I said at the beginning, I don’t know when I will die.  I don’t know how I will die.  What I do know is that, if I become incapacitated, I can die in my own home, perhaps in what is now my office, looking out the window at the glorious foothills to the West of the Valley and my wife by my side.  Through careful planning we have created a home environment that is, well, to die for.  It’s never too early to begin thinking about end of life planning.

 

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