A ‘bit’ of healthy office competition

wheelchairIt started one spring with just two employees, one a young new hire, the other an older associate. “Is that a Fitbit you’re wearing? Do you want to walk?” All summer the two walked three-mile circuits of the office park over lunch and did laps in the building corridors on rainy days. That fall they walked the entire coast of New Hampshire, 22 miles, just because they could. The data charts and pop-ups of encouragement from the smartphone app became oddly addicting. Other employees were intrigued.

Over the winter, the activity tracker phenomenon grew. The following spring, a dozen employees were sporting trackers. Colorful bracelets, discreet clip-ons, were seen on walkers everywhere.

One principal, a fifty-something man with a family history of weight issues triggering health problems, looked at the trackers and shrugged it off. “My phone has a built in activity tracker. I’m all set.”

An architect with a new Fitbit was noodling around the Fitbit phone app. “What’s this Workweek Hustle?" It was a special challenge, new from the folks at Fitbit, a competition that allows Fitbitters to compete Monday through Friday using a nifty smartphone app. The leader board displays everyone’s progress in real time, a winner is declared on Friday night, then the slate is wiped clean and a new competition begins the next week.

The architect signed on and invited other office walkers to sign on too. A bit of competition might be fun. Within weeks it escalated. Some went off the charts with mileage. A husband and wife duo competed behind the scenes: “I poured her extra wine at dinner, she fell asleep early, I took the dogs out for a late night walk and crushed her step count.”

Remember the principal who scoffed at the trackers? About this time, he had a medical checkup and left with sobering news, “You’re diabetic. I'm putting you on metformin, a diabetes medication that helps control blood sugar levels, and you need to lose weight.” His glucose reading was 220 mg/dl, the healthy goal is under 100 mg/dl. He was pissed, and committed to changing his prognosis.

The next week the Fitbit-scoffing principal was sporting the fanciest of all Fitbit trackers and signed on to the challenge. The tone of the competition changed. We were all walking for fun. This guy was walking to save his health, his life. He walked every lunch hour. He walked an hour, sometimes two, again in the evening. He raised the bar high, pushing the rest of the competitors to new levels. The weather was turning into perfect New Hampshire spring and step counts were climbing to never-seen-before levels. Forty-five miles in five days, 90,000+ steps? No problem.

The group joked that the competition needed a trophy. With a budget of zero, a trophy was crafted from office cast-offs. It was a beauty, and moved every Monday morning to the new winner, as coveted as the Stanley Cup.

Weeks went by, step counts continued to rise. Participants took recovery weeks when over-worked knees and shins became balky. New, better walking shoes appeared. Water bottles were added as accessories. Some walkers were hitting the streets at 5:30 in the morning, others added after dinner strolls. Some lost weight, some firmed up and everyone felt better. The trophy moved around the office every Monday. Each week, it seemed, someone different stepped up and walked and walked and walked. Step counts of over 100,000 in five days became the norm. The real-time leader board became a lie-detector of accountability.

Back to the newly-diabetic principal. Once he hit his stride, he won the trophy more weeks than anyone else. He became fiercely competitive, frustrated when someone trumped his step count at the last minute. But his real win was much more important than the trophy. Coupled with changes in his diet, the exercise was improving his health. His weight was steadily dropping. Four months into his walking frenzy he had lost over 50 pounds and his glucose dropped to a healthy 80 mg/dl. A three-month hemoglobin check showed no signs of diabetes. The metformin prescription was history.

Six months later the competition continues. The participants morph a bit from week to week. So far, the changes to our all too sedentary lifestyle seem to be sticking. It took the motivation of an entire office to help change one employee’s long-term health prognosis, but in the end, we’re all winners at this game.

Anne Weidman is JSA's marketing guru. Her latest initiative is Access Portsmouth, taking the mystery out of accessibility in historic Portsmouth.

Age-friendly cities and retirement communities

Different approaches, similar objectives. Mutually exclusive? Or is the whole greater than the sum of its parts? Jim Warner looks at the future of senior living in a thought-provoking white paper.


Aging Trends

According to the American Seniors Housing Association (ASHA), roughly three million seniors housing units will be needed by the year 2040. With only one million units in place today, it projects the need for another two million units over the next 24 years, roughly doubling the rate of the last 24. With the over-65 population continuing to grow, so should senior living and seniors housing, leading investors to believe, "If we build it, they will come." Or will they?

Aging at Home

Surveys from resources such as AARP show the vast majority of Americans over the age of 65 have no interest in moving to a retirement community. Reasons vary and include family, familiarity, connections to community, diversity, intergenerational living, memories, comfort and independence, whether perceived, real or imagined.

Staying in your own home is a naïve desire since many homes are simply not suited for aging in place. Homes with second floor bedrooms and bathrooms, narrow hallways and stairs, present challenges to aging adults with vision and hearing impairments, respiratory issues, mobility problems and other limited abilities.

Retirement Communities

Senior living and seniors housing offer many seniors the opportunity to avoid these pitfalls, opening doors to new experiences, growth and development that might otherwise never be experienced, enriching and extending lives. Due to high urban land costs, most communities exist on rural or suburban sites, self-contained and remote from familiar streets or neighborhoods, far from residents' home towns or cities. Is there a better way to serve an aging society?

Read the white paper.

A founding principal of JSA, James Warner, FAIA has helped lead the company's evolution into a national firm, and established the Studio structure it maintains today. Directly involved in Healthcare, Hospitality, Housing and Senior Living, he has most recently led the Senior Living Studio to national prominence.

Class is in session…

wheelchairThe first thing a good architect has to have is the ability to put themselves in other people’s shoes, to value both the physical and emotional needs of the people who’ll experience a building or space. That’s me, I thought. With a primary career specialty in healthcare design, I saw myself as an incredibly sensitive and empathetic individual and architect. Before engaging on a unique clinical assignment, I often spent nights in facilities, sometimes pretending to be a patient, badly in need of rest, other times shadowing staff to see what challenges they faced and what obstacles were in their way. When it came to folks with disabilities, I figured the ADA and the various accessibility codes told me what they needed, so that part was covered.

Beyond this overinflated self image as an uber-sensitive architect, I also saw myself someone who could defy the clock. I went about meticulously tallying my weekly running logs and planning epic mountainous hikes, oblivious to the fact that I was already half a century into my life. If aging happened to me, it would be graceful. Then eight years ago, during a long solo hike in the mountains, something didn’t feel quite right. Out of the blue, I was diagnosed with a rare degenerative neuromuscular disease. I found myself in a specialty waiting room at Mass General surrounded by people who struggled to walk and talk. I was about to learn real lessons in accommodating human needs that I couldn’t have begun to comprehend before. I felt like I was in a classroom on day one of a course that I was completely unequipped for, and it scared the hell out of me. 

Occasionally we do experience sudden epiphanies. That miraculous moment when something clicks in our brain and a previously blurry understanding suddenly comes into focus. Well, I can’t say that happened for me when it came to accessibility. There was no epiphany, no eureka moment where things became clear. It wouldn’t be a crash course in Disability 101. I’d learn these lessons little by little, kind of like learning a foreign language late in life. Simple things came much harder than I could have expected. Over a few years I went from athletic, to clumsy, then to swallowing my pride and getting a walker and finally to needing a wheelchair. Each phase brought new lessons along with the physical and emotional bruises. Early on I subtly looked for street signs or parking meters to hold before I stepped off a curb. When searching for handholds wasn’t enough, I reluctantly bought a rolling walker. I discovered things I never imaged, such as bracing yourself when reaching for a door, knowing that someone bursting through from the other side could be catastrophic. I fought doors like Don Quixote battled windmills. What appeared inconsequential to others became an epic struggle for me.

Wheelchair lessons

Next came my wheelchair lessons. The first thing I noticed from a wheelchair is that there are two basic types of people: the ones that give you a wide berth, avoiding the slightest eye contact, and the ones that go out of their way to help. Initially I welcomed the first type but once I got my self-consciousness in check, I greatly appreciated the later type. For example, it turns out that most of the things on my grocery list are located on the top shelf. I have a choice, wait for a Good Samaritan or revert to liking Fruit Loops. As much as we all crave total independence, I’ve come to accept that in some circumstances a helping hand is needed and that the interaction can be gratifying to both parties.

Navigating the world from a sitting position is still something I’m learning. It’s not as easy as I had imagined. Obstacles pop up everywhere and I have to admit the old me was blind to 90% of them. As an architect who relied on the ADA and the other accessibility guides, it’s been eye opening to learn what it means to actually use these features, assuming they weren’t overlooked. I stopped being surprised by the omissions, even at large chain hotels and restaurants. Compliant doesn’t mean easy to use. The tension on a door closer rarely is adjusted properly; chest high bathroom counters make it hard to wash hands but easy to soak shirt sleeves; out-swinging toilet doors without closers are almost impossible to close behind you. That 18” “clear space” requirement on the pull side of the bathroom usually seems like a fine place for someone to place a heavy waste paper receptacle. I’ve learned how a mouse feels in a have-a-heart trap.

Sadly most view accessibility as simply a legal minefield, so fearful a misstep could mean a lawsuit that it creates an “us versus them” mindset. That mindset is reinforced when people perceive the demands waste space, cost more, and are aesthetically compromised, that is to say, ugly. I’m guilty of feeling that way both before and after my disability, but I know we can do better with care, creativity and reasoning.

Learning is a lifelong experience and we don’t always get to choose what class we’ll have to take. But we can choose whether we’re going to embrace what we’ve learned and use it. Unlike college calculus, I can see a purpose in what I’m learning, especially as an architect. I’m catching on to what accessibility and inclusive environments are all about. The biggest lesson I’ve learned so far is that we can all do better.

Todd Hanson, AIA leads JSA's Healthcare Studio. He has been integral in establishing JSA's reputation for innovative programming, design sensitivity and client service.

My family discovers an alternative senior living option

Chuck with baby pamMany baby-boomers help long-distance parents navigate health issues, housing changes and daily care. In my case, my father’s rapid health decline served as a fast-track introduction into the world of skilled nursing and hospice care, Oregon-style. A week in the hospital, a week in a (dad-detested) skilled nursing facility, five additional days in the hospital — suddenly it was time for hospice care and a suggestion to explore residential adult foster care. Adult foster care? Our family was hesitant — it seemed unlikely that adult foster care could compare favorably to the high-level care facilities that are available in medically sophisticated Portland, Oregon. My father required Level 3 care, difficult to locate in recommended facilities.

Working with placement team professionals, my family toured skilled nursing facilities with hospice care. We considered full-time home care to keep dad at home with our mother. These two options were not a good fit for our family.

Next we visited adult foster care homes. I had never heard of adult foster care until my father was in need, but hospital nurses strongly suggested we explore this unique west coast option. Adult foster homes are classified according to approved care levels and by how many Activities of Daily Living (ADL, basic self-care skills) the resident can independently perform. Several home visits later we found an adult foster home that seemed to fit the bill. My mother was comfortable with the home and care givers, and a room was available. Only one Level 3 patient per household is allowed in adult foster care, homes are allowed to care for a maximum of five people. Additional care required by patients (hospice, physical therapy or other special care) is provided by outside nurses with regular visits to these homes, and are contracted separately (usually covered by Medicaid or private health insurance) along with frequent spot checks by the Oregon DHS — Department of Human Services.

The foster care home we chose was newly licensed, with four resident rooms. It is managed by three sisters who have been in the senior care business their entire careers. A close family, their mother was their silent business partner and ran her own adult foster home close by. My father’s room was small with a set of French doors leading to a deck, while another door to the corridor allowed my father to hear household activity. The care-giving sisters were proactive in their approach to care — they offered my father anything they could dream up from the kitchen: lamb stew, cookies and special shakes they concocted. He was no longer eating, but he surprised us by taking bites of things, from popcorn to clementines. I kept a careful watch for his reactions but he never indicated that he wanted to go home, remaining sharp as a tack during our conversations. An outpatient hospice care company provided much of his daily medical care, counseled staff on the administration of pain medications, provided baths, and offered family support.

A shift from traditional institutional care

The passage of the HR3590 Health Care Reform Act will trigger a shift from traditional institutional care to a person-centered model of care. Many nationally respected models, such the Eden Alternative and Wellspring Innovative Solutions, already support person-centered care. This culture change extends to nursing home environments, encouraging individualized care delivery systems for better clinical success.

The Centers for Medicare & Medicaid Services (CMS) has proposed revisions updating the federal requirements that nursing homes must meet in order to participate in Medicare and Medicaid programs. These revised requirements directly affect the design of facilities with Medicare and Medicaid patients, prompting the reform of individualized care requirements. Practical implementation of the 483.75 Quality assurance and performance improvement regulations into a person-focused environment within a skilled nursing or standard nursing facility will require some innovative design solutions. The CMS recently partnered with the Pioneer Network to present a national symposium on culture change, "Creating the home in the nursing home," beginning to bridge the gap between design changes and code issues.

It would be interesting if more states adopted this residential care option. While some families prefer more traditional care facilities, the personal relationship that develops between the caregiver, the patient and the family during this stressful time is very comforting. Although my mother feels lucky to have found this perfect fit for my father, she prefers a more private environment and has begun visiting assisted living communities for herself.

As an architect, my adult foster care experience was a fascinating eye opener in the quest to develop and provide attractive alternatives to traditional care facilities. For my family, adult foster care provided a warm and personal alternative to traditional end-of-life care. For my father, it meant a quiet and peaceful transition for his last few weeks, allowing him the dignity he deserved.

Pictured above with her father, Pamela Breyer, AIA is an architect with JSA Inc in Portsmouth, NH. She specializes in environments for senior living.

Read more about adult foster care and long-term care options:
Adult Foster Care Homes
A Guide to Oregon Adult Foster Homes
Culture Change and Resident Centered Care in Nursing Homes
Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities
Ten Senior Living Design Innovations

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