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    What would a truly disabled-accessible city look ? DETAIL
    What would a truly ...

    Most cities are utterly unfriendly to people with disabilities – but with almost one billion estimated to be urban-dwellers by 2050, a few cities are undergoing a remarkable shift To David Meere, a visually impaired man from Melbourne, among the various obstacles to life in cities is another that is less frequently discussed: fear. “The fear of not being able to navigate busy, cluttered and visually oriented environments is a major barrier to participation in normal life,” says Meere, 52, “be that going to the shops, going for a walk in the park, going to work, looking for work, or simply socialising.” That’s what makes an innovative project at the city’s Southern Cross train station so important to him. A new “beacon navigation system” sends audio cues to users via their smartphones, providing directions, flagging escalator outages and otherwise transforming what previously a “no-go” area for Meere. “I no longer have to hope there’s a willing bystander or a capable staff member to provide direct assistance,” he says. “And on a very personal and powerful level it allows me to use this major transport hub in one of Australia’s largest cities with certainty and independence as a parent with small children. It’s a real game-changer.” Meere is just one of the hundreds of millions of people with disabilities who live in cities around the world. By 2050, they will number an estimated 940 million people, or 15% of what will be roughly 6.25 billion total urban dwellers, lending an urgency to the UN’s declaration that poor accessibility “presents a major challenge”. For the physically disabled, barriers can range from blocked wheelchair ramps, to buildings without lifts, to inaccessible toilets, to shops without step-free access. Meanwhile, for learning disabled people or those on the autistic spectrum, the cluttered and hectic metropolitan environment can be a sensory minefield. Stairs, revolving doors, cobbles and steps on to trains are a few of the features that make it difficult for people in wheelchairs to access their cities Although the Convention on the Rights of Persons with Disabilities and laws such as the Americans with Disabilities Act, Britain’s Equality Act and Australia’s Disability Discrimination Act aim to boost rights and access, the reality on the ground can be very different, as Guardian Cities readers recently reported. And yet, cities benefit from accessibility. One World Health Organisation studydescribed how, like Meere, disabled people are less likely to socialise or work without accessible transport. Cities also miss out on economic gains: in the UK the “purple pound” is worth £212bn, and the accessible-tourism market an estimated £12bn. Some cities, however, are leading the way. Mapping apps make navigating cities a doddle for most people – but their lack of detail on ramps and ped kerbs mean they don’t always work well for people with a physical disability. Take the hilly city of Seattle, where several neighbourhoods have no pavements at all, and many streets have a slope grade (or tilt) of 10% or even 20%. The University of Washington’s Taskar Center for Accessible Technology has a solution: a map-based app allowing pedestrians with limited mobility to plan accessible routes. AccessMap enables users to enter a destination, and receive suggested routes depending on customised settings, such as limiting uphill or downhill inclines. The image above shows Seattle streets coloured by incline: green means flat; red means a slope of 10% or above. For example, while Google Maps sends pedestrians from University Street station to City Hall via Seneca Street, with its steep 10% grade, AccessMap sends them via Pike Street instead – a slope of less than 2%. OpenSidewalks is crowdsourcing information such as pavement width and kerb -downs It also supplements data from Seattle’s Department of Transportation and the US Geological Survey with information from mapathon events. Now the Taskar Centre’s related OpenSidewalks project is taking it further by crowdsourcing extra information, such as pavement width and the location of handrails. By 2030, one in five Singaporeans will be over 60, with this “silver tsunami” driving awareness of ageing and disability. The city may not historically be known for inclusive practices, but has recently won praise from the UN for its accessible “user-friendly built environment”. The Universal Design principles drawn up by Singapore’s Building Construction Authority have encouraged accessibility in new developments since its launch in 2007. CapitaGreen, in the central business district, is a 40-storey office block that has won a host of UD awards. Completed in 2014 at a cost of S$1.3bn (£700m), the Toyo Ito-designed structure features column-free spaces and a low concierge counter to help disabled people move around the building more easily. Braille directions on handrails in the award-winning CapitaGreen office block Lift doors stay open longer, handrails flank both sides of staircases, and the chairs have grab handles. A hearing induction loop enables clearer communication for those using hearing aids, while Braille directions, tactile guidance and easy-to-read pictographs help the visually impaired. Routes into the office from underground pedestrian walkways and two Mass Rapid Transit (MRT) stations are barrier-free. Singapore’s MRT has also been working to improve accessibility over the past decade. The 30-year-old nework has been getting more lifts, wider gates and tactile guidance, and more than 80% of the 138 stations have at least two barrier-free routes. The title of world’s most accessible metro system, however, probably goes to Washington, DC. All 91 subway stations are fully accessible, along with its rail carriages and the entire bus fleet. People with autism can be hypersensitive to sound, light and movement, and become overwhelmed by noisy, cluttered or crowded spaces. Sweetwater Spectrum, a $6.8m supported-housing project in Sonoma, California, aims to address this. The site, which opened in 2013, includes four 4-bed homes for 16 young adults, a community centre, therapy pools and an urban farm – all designed by Leddy Maytum Stacy Architects according to autism-specific principles recommended by Arizona State University to promote a sense of calm. Inside the Sweetwater Spectrum housing project Along with simple, clear lines, the homes are designed so residents can clearly see spaces across thresholds. Noise is kept to a minimum thanks to quiet heating and ventilation systems and thoughtful design, such as locating the laundry room away from the bedrooms. Fittings and decor reduce sensory stimulation and clutter, with muted colours, neutral tones and recessed or natural light. The Musholm sports, holiday and conference complex in Korsør has won numerous awards, most recently from the International Olympic Committee and the International Paralympic Committee, for its 2015 redesign of the basic 1998 site. At the centre of the venue, owned by the Danish Muscular Dystrophy Foundation, is a vast, circular sports hall, with an aerial ropeway and climbing wall for wheelchair users and an integrated pulley system. Outside, a 100m ramp spirals up from the base of the hall to a sky lounge. (The ramp can also be used as a wheelchair racing track.) The 24 hotel rooms each have ceiling hoists, electronic curtains, beds that can be automatically raised or reclined, adjustable height sinks and accessible toilets. By the waterside, a private bathing jetty is wide enough for wheelchairs and accessible via a ramp. The multi-purpose sports hall in the Musholm complex “Accessibility must be felt but not seen,” says foundation director Henrik Ib Jørgensen. Musholm, which cost €14.5m (£12.9m) to build, is run as a social enterprise. “Lack of accessibility, other people’s assumptions, body ideals and a lack self confidence among people with disabilities are often the biggest barriers for diversity,” he adds. “We wanted to a place where there is space for differences.” Denmark is also home to what is widely regarded as the world’s most accessible office building. The House of Disabled People’s Organisations in the Copenhagen suburb of Taastrup is the shared headquarters of some 30 different disability groups. Built in 2012 for 178m krone (£21m), the Universal Design includes drive-through lifts so wheelchair users don’t have to turn around, and small, tactile knobs on railings so blind people can easily tell which floor they are on. Chester in north-west England is renowned for its two-mile circuit of Roman, Saxon and Medieval walls and its elevated walkways, called Rows. But the city’s historic status belies its role as an accessibility champion: last year it became the first British city to win the European commission’s Access City award. The Rows are accessible with ramps, a lift and an escalator, while the council’s 15-year regeneration strategy prioritises accessibility in new developments. Take the £300m Northgate shopping and leisure development, to be completed by 2021. The site will include accessible stores, restaurants, housing and a 157-room hotel including eight accessible rooms with ceiling hoists. The hotel will include a changing places facility for people with complex or multiple and profound disabilities. (Unlike standard accessible toilets, these include a height-adjustable changing bench, adjustable sink, a toilet designed for assisted use and hoist.) Chester already has six such changing places facilities, including one at the recently opened bus interchange, and more are planned around the city. The Storyhouse cultural centre has flexible seating, audio loops and accessible backstage changing rooms The accessible design of Chester’s year-old cultural centre, Storyhouse, was d after feedback from disability groups and the council’s access team. The £37m theatre, cinema and library complex has seven accessible toilets, a changing places facility, flexible seating for groups of disabled theatre-goers, audio description and hearing loops. Backstage, there is an accessible toilet, accessible changing rooms and lift. As David Meere discovered, in Melbourne, Australia, an eight-month pilot scheme is currently transforming how visually impaired people navigate public space. The project at Southern Cross station rail terminal uses Bluetooth and free GPS smartphone app BlindSquare to a beacon navigation system. Users receive audio cues via their smartphones, providing directions or real time information about issues such as escalator outages. Outside, the app provides real time directional information; inside, where GPS is unreliable, 20 wireless Bluetooth beacons means users still receive information. Audio cues include advice such as: “Approaching three escalators on left, followed by a set of doors – the doors on the left are automated.” The trial is led by the charity Guide Dogs Victoria, which plans to install similar systems at Melbourne Zoo, Albert Park (home to the Australian Grand Prix) and the Docklands area. “In many situations, the person with low vision and blindness will have greater knowledge than the sighted person,” says Alastair Stott of Guide Dogs Victoria. “It’s a complete role reversal.”   by Saba Salman

    Kitchen furniture for elderly people DETAIL
    Kitchen furniture ...

    Abstract:The percentage of elderly people grows enormously from one year to another. The share of people who have poor eyesight, hearing, memory; impaired motor abilities and who perceive information with difficulty due to their old age is increasing. The question is how to facilitate the use of living spaces for the elderly. It is intriguing that nowadays the majority of products are designed for healthy, young, active and agile people. According to research, such products form up to 90% of the market. Many elderly and disabled people no longer have the ability to fully use them; therefore, domestic chores cause more stress and consequently malaise. The goal of our research was to determine whether people are generally with the functionality of their kitchens and whether the degree of dissatisfaction increases with the age of the users. The study aims to pinpoint any major problems facing elderly people whilst working in their kitchens and to establish criteria for kitchen furniture design that could be tailored for senior users, particularly wih safety in mind. This research was carried out via individual surveys at the respondents' homes. The results show that elderly people will perform daily tasks, with more appropriate kitchen equipment, faster, safer, and with less effort. Therefore, we designed several items of equipment that are adapted to the specific requirements of the elderly. Key words: kitchen; elderly; senior; furniture; design; ergonomics 1 Introduction Higher standard, nutrition and well regulated health care enables a high increase of the share of the elderly each year. According to statistical prognoses, 36% of world population will be older than 60 years by the year 2030 (Hilderbrand H. 2002). During 2004 and 2050 the expected life span of men will increase by 6 years, the life span of women by 5 years. The share of people older than 80 years will increase to 11.4% by 2050. The highest increase is expected for the period from 2015 and 2035, when the age group of people older than 60 years will increse by 2 million (Demographic challenge and solidarity between generations, 2010). The decrease of the birth rate and the mortality rate are also changing the age structure of Slovenians. The share of people who suffer weaker sight, hearing, memory, weaker motor skills and who comprehend information with more difficultly due to old age, is increasing. This sets completely new demands for residential and public facilities. The question remains, how the use of residential buildings can be simplified for the elderly, or people on Wheel chairs or visually impaired people, and how the culture of living could be improved. It is interesting that 90% products today are designed for healthy, young, active people with normal physical abilities. Many elderly and disabled people do not have the skills to use such products to their full extent, therefore, house chores present greater strain and discomfort for them. Due to inappropriately designed living space, this causes additional health problems like back pain and injuries that emerge at accidents. M. Colombo and associates analysed apartments, where people over 55 years of age live. Considering the analysis results, they identified the most frequent problems that these people face. He established that in 33% of apartments the elderly have problems with safety at working in the kitchen, 25% of them have inappropriate lighting to ensure comfortable living and safe work. The research has shown that by adjusting living space to the needs of the elderly, the disabled and visually impaired, we can reduce the possibility for injuries or accidents in apartments by 30 to 50%. A few studies focused on the connection between ergonomics and the design of kitchen furniture. (Trajkovič et al, 2002; Pissareva et al 2009) and on the analysis of the needs of older people (Hrovatin 2002; Klos. et al. 2012). Kirvesoja et al. (2000) and Pheasant (2006) found that the elderly over 65 years of age have problems in adjusting to work and storage area that is set higher up to 1350 mm. Pennathur et al (2003) in their article on functional limitations of the elderly found that 26.67% of all tested women reach objects in hanging cabinets in their own kitchen, 56.67% of them need some help, 16.67% of the tested women do not reach objects in hanging cabinets. 12.9% of women have no problems accessing lower cabinets, 51.61% of them require some assistance, 35.48% of them cannot in any way reach objects in such cabinets. The EU strategic implementation plan, adopted by the steering group in November 2011 refers to measures within three pillars, one of which is the pillar that focuses on active ageing and independent life. Priority measures within the “Active Ageing and Independent Living” pillar anticipate: the prolongation of active and independent life with customised solutions. These encourage innovations in the field of elderly friendly buildings, cities and residential environment, as well as the “Design for All” (Mandate 473). The Article 77 of EU Official Journal with regards to Demographic Challenges and Intergenerational Solidarity states that opening new economic markets for the elderly presents a great opportunity for improving competitiveness and innovation as well as increasing growth and employment. According to our analaysis Slovenia does not have manufacturers of standard furniture for the elderly people. Orders for individual clients carry a small carpenters workshops. Slovenian company Gorenje is still developing products for the elderly and visually impaired, namely, within the scope of its competence centre, it develops home appliance elements. On the other hand, the University Rehabilitation Institute of the Republic of Slovenia exhibits a kitchen appropriate for the disabled, however, it only assures the minimum standards. In this paper we present some results of our analaysis. Based of the analaysis results we will show same proposals how to improve the kitchen furniture for the elderly people. 2 Material and methods The research was carried out via individual surveys. The survey only includes people over the age of 55. More than 210 questionnaires were filled in, of which 204 were valid. The respondents were aged between 55 and 91. Most respondents, 76%, were aged between 55 and 74. The survey pool consisted of 75% women and 25% men. The questionnaire included open and semi-open questions. Collected data have been coded and subjected to comprehensive statistical analysis. 3 Results and discussion 3.1 Functionality Figure 1 shows the analysis results considering the functionalty of the Standard furniture of the kitchen. Most answers poined out the folowing dissatisfactions: inadequate lighting over the kitchen work surfaces and inside the cupboards, inappropriate height of shelves, oven, refrigerator, troublesome cleaning set-up (e.g. contact between wall and work surface, contact between work surface and kitchen appliances), damaged furniture fittings (particularly in older kitchens), inadequate handle design (e.g. too small, slippery, fall off, in the way), hard-to-reach places in the corners or shelves under the cupboards. Figure 1. Dissatisfaction with functionality in kitchens We were interested to learn how many people have light sources installed high up so that they have to climb up on something to change bulbs. The results show that all but one respondent have such inappropriate light sources. One of the main problems of the elderly people is how to keep the kitchen clean. Almost all have impared sight and physical abilities. On our question what problems they encounter while cleaning the kitchen we recorded the folowing answers, Figure 2. Figure 2. What causes them the most problems when cleaning 3.1.2 The impact of bad memory on work in the kitchen Many senior citizens suffer from bad memory. We asked the respondents whether or not they face problems connected with bad memory whilst performing kitchen tasks, and if yes, in what specific ways (Fig.3). Figure 3. Problems connected with bad memory whilst performing kitchen tasks 3.1.3 The use of modern technology In the analysis we wonder how many senior users are prepared to use modern technology and computers. Of the 15 who stated they use a computer, 14 were younger than 65. A somewhat higher percentage (21%) would be comfortable with using kitchen robots (Tab.1). Table 1. Percentage of respondents who use a computer and those who would be willing to use a kitchen robot 3.2. Same proposals for improving design Considering the results of analaysis we have designed same kitchen furniture elements for people which are older than 65 years. In the interdisciplinary design group designers, architects, mechanical engineers, electric engineers, wood engineers and ergonomics experts have taken active part. As a result of the work different kitchen elemets for the elderly were designed with personal security and the ability to perform kitchen tasks faster and more easily in mind. Figure 4 shows the solutions how to solve the problem with the kitchen dishes which are located higher than 150 cm or lower than 65 cm. Figure 4. New proposal for kitchen elements design The possibility of maintaining hygiene in a kitchen is of great importance for senior users, who are more susceptible to infection. The analaysis results shows that the elderly people have trouble cleaning handles, profiled surfaces and unsuitable transitions between work-surfaces, walls and appliances. Therefore, we recommend that for doors of the elements and all flat surfaces in the kitchen the materials which are easy to clean have to be used. A good solution for senior users are handle-free doors of cupboards which we can open simply by pressing on the cupboard door. The surface of the kichen elements should be made in one piece and have a seamless passage between work-surface and wall. The sink and stove have to be mounted in to avoid gaps or thresholds that make cleaning harder, Figure 5. Cupboards which are placed under work-surfaces and have a base reaching to the floor facilitate cleaning, since senior users find it difficult to bend and sweep underneath cupboards. Similar problems occur on the top sides of tall and wall-mounted cupboards. Figure 5. Sink mounted to avoid gaps or thresholds that make cleaning harder a - bad solution, b - good solutions 4 Conclusions Most elderly who would like to renovate their kitchen in order for it being used for the rest of their lives, do not have enough information and experience to consider ergonomic adaptations for specific needs of old age. Manufacturers should design kitchen furniture systems that would allow for implementation adapted for special needs and should inform 40 buyers more about the significance of an adequately furnished kitchen, heeding the needs of advanced age. Before we start to design the kichen for the elderly people should take into consideration the following rules: ‒ appropriate materials considering the configuration, security, cleaning and manipulation of the funiture, ‒ incoporate the inteligent technology a much as possible, ‒ the organisation of kitchen elements in space has to be adapted with the requirements of the senior users in mind. ‒ future kichen disign has to include robots, computer regulation, advanced mechanisms and modern nano films on surfaces to simplify everyday chores and ensure better hygiene standards. Proceedings of the XXVIth International Conference Research for Furniture Industry Jasna Hrovatin, Jože Vižintin 1 Aassociated member of University of Primorska, Academy of design Ljubljana, Slovenija. 2 Faculty of Mechanical Eingineering, University of Ljubljana, Slovenija.

    Nondiscrimination on the Basis of Disability by State and Local Governments and Places of Public Accommodation; Equipment and Furniture DETAIL
    Nondiscrimination ...

    Comments on the 2010 Advance Notice of Proposed Rulemaking on Equipment and Furniture — Question 21. Nondiscrimination on the Basis of Disability by State and Local Governments and Places of Public Accommodation; Equipment and Furniture Document ID DOJ-CRT-2010-0008-0001 28 C.F.R. Parts 35 and 36 CRT Docket No. 113 AG Order No. RIN 1190-AA64 This comment addresses question 21 in the Advance Notice of Proposed Rulemaking (“ANPRM”), 75 Fed. Reg. 43452 (July 26, 2010), concerning the standards governing equipment and furniture in the Department of Justice regulations governing Nondiscrimination on the Basis of Disability in Public Accommodations and in Commercial Facilities: Department of Justice Question 21 (75 Fed. Reg. at 43459). Are there other types of equipment or furniture that impede accessibility that should be specifically addressed in the Department ́s regulation? What types of accessible equipment or furniture would effectively address any such concerns? What scoping would adequately address the impediments to accessibility and what triggering event would be appropriate for each type of other equipment or furniture? Are there particularly helpful types of equipment or furniture that are not generally available to the public that may assist individuals with disabilities, such as pool or shower chairs? A. MERCHANDISE IN PUBLIC ACCOMMODATIONS We propose that the Department adopt the following regulatory language in subpart D of title 28, part 36, “New Construction and Alterations”: Free-standing fixtures or elements used to display merchandise for self-service by the customers of a place of public accommodation and located in an area governed by this subpart shall be located on an accessible route as that term is defined in the 2010 Standards. While we believe clear, objective standards are required for all free-standing equipment, this Comment focuses primarily on access barriers in retail stores and proposed regulatory language to address them. The current approach — in which, even in new construction, people with disabilities must prove that rearranging displays is “readily achievable” — is unworkable, and has resulted in a situation in which very few newly constructed retail stores are fully accessible to customers who use wheelchairs. Overview Of Proposed Standard People who use wheelchairs need clear accessibility standards for merchandise displays and other non-fixed elements in retail stores. These standards should ensure that individuals with disabilities have “full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations,” 42 U.S.C. § 12182(a) (emphasis added), of retail stores, and that the regulations effectuate the will of Congress that “over time, access … be the rule, rather than the exception,” H.R. Rep. 101-485, pt. 3, at 63 (1990). The ANPRM recognizes that “[a]ccessible equipment and furniture is often critical to an entity’s ability to provide a person with a disability equal access to its services.” 75 Fed. Reg. at 43455. In order to ensure that the standards are enforceable by people with disabilities, the standards should be clear and objective; that is, in new construction and ations, they should not rely on the subjective standards such as “readily achievable” and “undue burden.” The amount of expert analysis required to make a showing under these standards can often be prohibitive for a plaintiff with a disability, and it is our strong belief that retail companies conduct themselves and organize their stores on the assumption that there is simply no governing standard. Our proposed objective standard is also consistent with the Department’s statement that, “[t]o the extent that ADA standards apply requirement for fixed equipment and furniture, the Department will look to those standards for guidance on accessibility standards for equipment and furniture that are not fixed.” Id. at 43454-55. We thus urge the Department to adopt a regulation requiring that, in newly constructed or ed facilities, free-standing fixtures or elements on which merchandise displayed for sale and allowing self-service by customers be on an accessible route as that term is defined in the 2010 Standards. We specifically propose that the following language be included in subpart D of title 28, part 36, “New Construction and Alterations”: Free-standing fixtures or elements used to display merchandise for self-service by the customers of a place of public accommodation and located in an area governed by this subpart shall be located on an accessible route as that term is defined in the 2010 Standards. We propose that the Department clarify in commentary that this standard would not necessarily require 36 inches around each such element, as an “accessible route” can narrow to 32 inches for lengths of 24 inches or less, see 2010 Standards 403.5.1, and note such access to two opposite sides of typical clothing display units may be sufficient to enable customers with disabilities to reach most of the merchandise on display. In the native, we urge the Department to adopt language that ensures that section 225.2.2 of the 2010 Standards covers all retail shelving and display units, including those that are not physically attached to the building. For example: All self-service shelving and display units in places of public accommodation, whether fixed or free-standing, shall be subject to section 225.2.2 of the 2010 Standards. The remainder of this comment explains the need for this regulation in light of the ongoing severe problem that many people who use wheelchairs have in retail stores. Regulation Is Necessary In Order To Ensure Nondiscriminatory Shopping Even now, 20 years after the ADA was passed, an ordinary shopping trip can be an ordeal of exclusion, frustration and dependence for people who use wheelchairs. Most modern retail stores are designed for self-service by customers. Nondisabled shoppers are able to browse throughout available merchandise, either to search for a desired item, model, color, size or style, or simply at random, open to the inspiration retailers crave: the impulse purchase. The comprehensive access enjoyed by nondisabled shoppers permits them to examine the material and workmanship of potential purchases, to compare or coordinate different items, and — in clothing stores — to items to try on. Retailers encourage full use of their stores, designing them to attract customers to browse as much merchandise as possible. In stores that do not provide an accessible route to merchandise, shopping is a very different experience for people who use wheelchairs. When such customers enter a clothing store, shelves and display units are often arranged so as to block access to much of the merchandise. Tables jut out in front of T-shaped racks, and round racks are backed up against each other or the store wall. Clothing racks are often spaced so that none of the merchandise displayed on them is accessible, or even visible. Whole sections of the store and large quantities of merchandise are inaccessible because display units are crowded so close that only those able to walk can pass between them. Under these conditions people with disabilities often have no access to specific items for which they are searching. Even when they can see items at a distance, they are unable to inspect the material or workmanship or to compare and coordinate items before purchase. Leisurely browsing — enjoyed by so many nondisabled shoppers — is out of the question for people who use wheelchairs. In addition, customers with disabilities may incur injuries or damage to their wheelchairs or may find themselves unable to avoid damaging merchandise when attempting to access display units that are inaccessible. Many stores argue that, in lieu of independent access to merchandise, customers who use wheelchairs should rely on sales help to retrieve merchandise from inaccessible fixtures. This is, of course, a far cry from equal access. There is simply no way an employee can retrieve all of the merchandise necessary to provide the equivalent ability to browse, compare and that nondisabled shoppers have. In addition, the need for assistance in shopping eliminates the independence that nondisabled shoppers take for granted.”No, thank you, I’m just looking” is a common response when store employees ask if a customer would like any assistance. Shoppers who use wheelchairs, like all shoppers, want to be able to browse and shop at their own pace, without the oversight of store employees. Ultimately, a system in which people who use wheelchairs can only shop with assistance is in fundamental conflict with the independence the ADA was passed to ensure. See 42 U.S.C. § 12101(a)(8) (“the Nation’s proper goals regarding individuals with disabilities are to assure equality of opportunity, full participation, independent living and economic self-sufficiency for such individuals”). The real-world impact of the congestion that occurs daily in the display practices of most retailers is that many people who use wheelchairs are simply unable to patronize these businesses. If a newly-constructed store had steps at the entrance rather than a ramp, no one would contest that the store discriminated against people with disabilities. The deterrent effect of congested display areas is as real as steps at an entrance. Legislative History The ADA requires that new construction and ations be “readily accessible to and usable by individuals with disabilities.” 42 U.S.C. § 12183(a). In the legislative history of the ADA, Congress made clear that that standard meant “access to the goods, services, and programs of the facility. For example, a new building should be designed so that a potential patron can get to a store, get into the store, and get to the areas where goods are being provided.” H.R. Rep. 101-485, pt. 3, at 63 (1990) (emphasis added). It stated further that, the New Construction Standard “is intended to enable people with disabilities … to get to, enter, and use a facility. While the term does not necessarily require the accessibility of every part of every area of a facility, the term contemplates a high degree of convenient accessibility, entailing … access to the goods, services, programs, facilities, and accommodations offered at the facility.” H.R. Rep. 101-485, pt. 2, at 117-18 (1990) . Ultimately, Congress required a higher standard in new construction and ations than in existing facilities because [t]he ADA is geared to the future — its goal being that, over time, access will be the rule, rather than the exception. Thus, the bill only requires modest expenditures to provide access in existing facilities, while requiring all new construction to be accessible.   H.R. Rep. 101-485, pt. 3, at 63. Although the legislative history also contains language suggesting that not all merchandise needs to be accessible, H.R. Rep. 101-485, pt. 2 at 110, this language appears in a section discussing the “readily achievable” standard applicable only to existing facilities, and should not be read to undermine Congress’s goal of requiring new facilities to be fully accessible to ensure that access increases over time. The State Of The Law Under The 1991 Standards Section 4.1.3(12)(b) of the 1991 Standards addressed storage, shelving and display units. Several courts have taken the position that this provision applies only to fixed elements, and that moveable racks are subject to the “readily achievable” standard of 42 U.S.C. § 12182(b)(2)(A)(iv). See Colorado Cross-Disability Coalition v. Too (Delaware), Inc., 344 F. Supp. 2d 707 (D. Colo. 2004); Lieber v. Macy’s West, Inc., 80 F. Supp. 2d 1065 (N.D. Cal. 1999). Retail stores have taken the position that this standard thus applies to any shelf or display rack that is not structurally integrated into the building. And because the “readily achievable” standard is very difficult for a plaintiff to meet in this context, the effect is that many retail stores built long after January 26, 1993, remain almost completely inaccessible. The “readily achievable” standard is very difficult to litigate in the retail display context because — unlike the analysis of, say, the cost to install a ramp — defendants insist that it involves examination of the impact of rearranging display racks on a company’s finances. This puts the company in a unique position to control — and potentially exaggerate — the analysis of the effect of minor rearrangements on inventory, sales, profits, cash flow, supply chain and other retail factors. Proving — to a retailer pre-litigation or to a court in litigation — that access is readily achievable thus requires a person with a disability to have access to confidential company financial, marking, design and supply chain information and to retain multiple experts to analyze that information. While there may be a few public interest and private law firms with the resources to engage in this analysis, as a practical matter, it will be far beyond the reach of the average shopper who merely wants independent access to merchandise. It also makes pre-suit settlement almost impossible. In addition, because the “readily achievable” analysis generally examines the impact of the removal of the number of displays or merchandise items necessary to access, it s a perverse incentive: the more displays — that is, the more crowded and inaccessible the store — to start with, the more severe the ultimate financial impact, and the more likely the store will prevail. Because of this, shopping remains highly inaccessible and challenges to this lack of access are now very rare. Currently, a retail store built after January 26, 1993 can place all of its display racks so close together that they are completely inaccessible to customers who use wheelchairs, and there is virtually nothing — as a practical matter — that disabled shoppers can do. The 2010 Standards And The ANPRM The 2010 Standards do not contain the language in section 4.1.3(12). In fact, they make no reference at all to “displays,” and contain the following regulation governing shelving: 225.2.2 Self-Service Shelving. Self-service shelves shall be located on an accessible route complying with 402. Self-service shelving shall not be required to comply with 308. The 2010 Standards include this “advisory”: Self-service shelves include, but are not limited to, library, store, or post office shelves. From new language to be added to the Department’s Title III regulations, it’s clear that this applies only to fixed self-service shelving. See 36.406(b) (“The … 2010 Standards apply to fixed or built-in elements …”). However, as noted above, the Department stated, in the present ANPRM, that “[t]o the extent that ADA standards apply requirement for fixed equipment and furniture, the Department will look to those standards for guidance on accessibility standards for equipment and furniture that are not fixed.” Id. at 43454-55. As an initial matter, then, we urge the Department to make clear that 225.2.2 applies to both fixed and moveable self-service shelving. Simply relying on Section 225.2.2 will not, however, address displays other than shelving, for example, clothing racks. Yet one of the biggest problems for people who use wheelchairs who want to shop independently is free-standing clothing racks that are placed so close together they are excluded from most or all of the store. In light of this, we urge the Department to adopt regulations explicitly ensuring that people with disabilities will be able to shop independently: Free-standing fixtures or elements used to display merchandise for self-service by the customers of a place of public accommodation and located in an area governed by this subpart shall be located on an accessible route as that term is defined in the 2010 Standards. Conclusion We strongly urge the Department to effectuate the will of Congress that people with disabilities have “full and equal enjoyment of the goods … of any place of public accommodation,” and that “over time, access will be the rule, rather than the exception,” by requiring that all retail displays in new construction and ed areas be accessible. Any other approach will perpetuate the status quo in which — 20 years after passage of the ADA — many newly constructed retail stores remain essentially inaccessible to people with disabilities. B. VOTING EQUIPMENT At least one recent Circuit Court decision has held that electronic voting machines are not covered by the accessibility requirements of the ADA. American Assn. of People with Disabilities v. Holland, 605 F.3d 1124 (2010). The court believed that, because such machines were not fixed, they were not required to be accessible. It is important that the Department make clear that voting machines are subject to the communication and physical accessibility requirements applicable to other forms of electronic and information technology, including accessible input and output methods, reach ranges, clear space, and viewing angles. C. OTHER TYPES OF EQUIPMENT AND FURNITURE In Medical Settings The following non-exhaustie list of furniture and equipment is either commonly found in medical facilities and intended for the use of eeryone in the facility, or is more specialized equipment and furniture that would particularly benefit users with disabilities in medical facilities. At times patients may use the following items, but generally not for the purpose of diagnosis or treatment. People with disabilities in medical facilities are not only patients, but also comprise isitors, family members, and staff. The Department has already explicitly recognized that coered entities hae an obligation to ensure, for example, effectie communication with a “companion,” defined as “a family member, friend, or associate of an indiidual seeking access to a serice, program, or actiity of a public entity, who, along with such indiidual, is an appropriate person with whom the public entity should communicate.” We recommend that the Department clearly incorporate a similar definition of a companion in its medical furniture and equipment regulation for Title II and Title III medical facilities; the comments below use “companion” in this sense. Many inpatient medical facilities offer such features as food serice areas and housing for family members, especially parents of minor patients. Such features must be accessibly designed and maintained to proide an equal benefit to companions with disabilities. Accessibility and scoping standards for the following items will benefit all people with disabilities, no matter if their presence is motiated by personal illness, a simple check-up, familial or social relationships, legal guardianship, or patient adocacy. Waiting Room Seating All outpatients and inpatients, barring the most urgent emergency admissions, generally must spend some period of time in a waiting area. At least 25 percent of waiting room chairs and benches in general practice facilities should consist of loe-seat type sofas and larger bariatric chairs, dispersed across all primary and medical specialty waiting areas in a manner that is proportionate by size of the waiting area. The benefits of such seats accrue not only to larger indiiduals, but also allow patients and parents to sit with their children or loed ones without the restrictions of arm rails. Inpatient practices, rehabilitation facilities, and hospitals or units within them that specialize in and see large numbers of patients with arthritis, orthopedic, and back conditions should also include at least one Hip/Post-Operatie Orthopedic Chair for eery main waiting area. These chairs proide added stability, and a retractable footrest can also help with the transition from sitting to standing. Both of the above requirements should: Be triggered upon the earlier of either the replacement or acquisition of waiting room furniture, or the passage of two years after the effectie date of medical equipment regulations; Be addressed within the coered entity’s medical equipment transition plan. Many medical facility waiting rooms fail to proide clear floor space for wheelchair users to wait outside of paths of trael because fixed or moable seating occupies all the aailable space. Though, like other accessibility proisions discussed here, clear floor space for wheelchair users is currently required by the ADA, the Department should make it explicit that such space must be proided, whether the seating in the waiting room is fixed or moable. Televisions Commonly mounted in patient rooms, but also at times mounted in public waiting areas, the control buttons on some of these televisions or teleision remotes are smooth membrane switches that are difficult or impossible to operate by patients or companions who hae ision impairments, who do not hae use of their hands, or who hae limited dexterity and/or strength. Controls should hae tactile indications and their operable parts should comply with the ADA Standards for Accessible Design. Accessible EIT is already required by the Department’s 2010 Title II and Title III regulations which are effectie in 2011. DREDF recommends that: all accessible inpatient rooms also be equipped with teleision controls with operable parts that comply with the ADA Standards for Accessible Design; 25 percent of all televisions in non-accessible patient rooms hae teleision controls with operable parts that comply with the ADA Standards for Accessible Design, dispersed across all primary and medical specialty units in a manner that is proportionate by type of medical specialty; and all outpatient and inpatient waiting areas that proide a teleision also hae such controls within 24 months of the date on which the equipment and furniture regulations take effect. Public Computers / Kiosks Please see the comments and recommendations made in #20 with regard to electronic isitor and patient kiosks. Hand Sanitizer Dispensers All isitors and staff to medical facilities are encouraged to make use of hand sanitizer dispensers located throughout a facility as both a personal and public health measure. Clearly these dispensers should be mounted or placed on stands that are within reach range and the Department should clarify the importance of this simple but necessary requirement. Gien the longstanding obligation and the ease of compliance, all medical facilities must hae their hand sanitizer dispensers placed within reach range by the effectie date of the medical equipment regulations. Public Signage We recommend that the Department further regulate signage in medical facilities by requiring: Posted text, as well as handouts in nate formats, to inform indiiduals with disabilities of the aailability of accessible equipment, and their right to request policy modification and effectie communication as well as barrier remoal. Medical facilities to proide this notice The aboe to be proided within 12 months of the effectie date of the medical equipment regulations. In-patient Sleeper Chairs/Beds These items are proided in patient rooms for the use of companions. DREDF recommends that 10 percent of all in-patient sleeper chairs/beds should incorporate accessibility features such as height adjustability, retractable or remoable arms to facilitate independent transfers, and powered or power assisted reclining mechanisms that will not require core and/or limb strength to extend the chair into an extended flat sleeping position. These accessible in-patient sleepers should be distributed among all those departments and units that already hae in-patient sleeper chairs. Self-serice Food Preparation and Storage Areas Some inpatient hospital units such as maternity wards or children’s wards proide an area where appliances such as refrigerators, microwaes, and electric kettles are aailable for the self-serice nutritional needs of patients or companions. The Department should require these appliances to be placed within a reach range that would allow for their independent use by wheelchair users, and the appliances themseles should hae controls that include tactile indications for their operation by someone with ision impairments. Medical facilities should proide at least one accessible item of each appliance type aailable within each self-sere area, within 12 months of the date on which the medical equipment regulations take effect. Lodging Proided for Companions Nearby housing that is proided for minimal or no cost to companions of indiiduals undergoing treatment in a medical facility should be equally aailable and fully accessible to companions with disabilities. Such housing should proide at a minimum one fully accessible room, up to the same proportion of accessible rooms that is required in places of lodging, with sufficient accompanying accessible restrooms and the ready aailability of a lift where required. Accessible rooms should be in place within 24 months of the effectie date of the medical equipment regulations. Emergency Eacuation Equipment When an emergency occurs in an in- or out-patient setting, emergency eacuation equipment on site makes it easier and safer to moe indiiduals who are injured or who hae mobility limitations. These deices help quickly moe people in locations in which wheelchair and scooter users cannot go, such as up or down stairs and across rough terrain. Some deices permit a relatiely small person to transport a larger person. Other deices work best if the two people are about the same weight. The Rehabilitation Engineering and Assistie Technology Society of North America (RESNA) has d a committee to establish standards for emergency stair trael deices for people with disabilities. The committee is chaired by Glen Hedman,, a rehabilitation engineer and clinical associate professor at Uniersity of Illinois at Chicago’s Institute on Disability and Human Deelopment. The standards are intended to coer “ocabulary, methods of measurement, test methods and requirements for: dimensions and weight; seating and positioning; performance measures; strength and durability testing; operating limitations; and disclosure requirements” for emergency stair trael deices. Affected stakeholders are expected to include people with mobility disabilities, caregiers, building owners and managers, code deelopment and enforcement professionals, and manufacturers, researchers, designers and test laboratories of emergency stair trael deices. Additional information can be found at The Committee’s work and analysis of how to ealuate and compare emergency stair trael deices will be a aluable resource for the Departments regulation of these deices. In the interim, the Department should nonetheless require all inpatient medical facilities and larger outpatient facilities to inestigate and acquire a certain minimum number of deices in proportion to the aerage size of the patient population at any gien point in time, and train staff on their operation.

    Suitable for 0-3 years Safe baby furniture checklist DETAIL
    Suitable for 0-3 ...

    Suitable for 0-3 years Safe baby furniture checklist Key points When choosing baby furniture, look for Australian/New Zealand Standards (AS/NZS) labels. Carefully check the condition of second-hand baby furniture. Supervising your child and teaching your child safe habits are also key to keeping your child safe. Choosing safe baby furniture There are several things you can do to find out about choosing safe baby furniture: Check with the Department of Consumer Affairs or the Department of Fair Trading in your state or territory for the latest information about child and baby safety. You can also check with Product Safety Australia. Look at the Product Safety Australia – Keeping baby safe booklet. Buy, rent or accept equipment with an Australian/New Zealand Standards (AS/NZS) label. This label shows the product has been manufactured according to sound quality standards and, where necessary, that it complies with compulsory Australian safety standards. Note that not all baby equipment meets the Standards. Go to Red Nose for advice on beds and cots. *After choosing safe baby furniture or equipment, it’s important to follow the manufacturer’s instructions to set up and use the furniture safely. And you’ll still need to watch your child and teach her safe habits to make sure she doesn’t come up with creative and perhaps unsafe ways to use your baby furniture!   Safe second-hand baby furniture Friends and relatives might offer you their old baby furniture. It’s important for your baby’s safety to check the furniture before you use it. In general, the furniture needs to be solid and stable. It should have brakes or locking devices in good working order. There should be no rough surfaces, sharp edges, paint chips or parts that stick out, like screws. The furniture should also come with full instructions so you can set it up and use it properly. Baby cots and mattresses These tips can help you choose a safe baby cot and baby mattress: Look for the Australian/NZ Standards label, especially if you’re buying a new cot. The standard for cots is AS/NZS 2172:2003. Make sure the cot has no horizontal bars or footholds your baby can use to climb out. Check the locking devices and stability of the cot before you use it, especially if it’s second hand. Check that the mattress is firm. Use a tape measure to check that the: space between bars is 50-95 mm – gaps wider than 95 mm could trap your child’s head or let your child fall out of the cot distance between the base and the top of the cot is at least 600 mm – this is important for preventing falls once your baby can stand up gap between the mattress and the sides and ends of the cot is no more than 20 mm, so your child’s head, arms or legs can’t be trapped. Once you’ve bought and are using the cot, don’t: make any ations to the cot use pillows, doonas, cot bumpers and cot restraints. These can be suffocation risks. Portable cots Portable cots – or portacots – are meant only for short-term use. These tips can help you choose a safe portable cot: Look for the Australian Standards labels AS/NZS 2195:1999 or AS/NZS 2195:2010. Check that the portable cot has a firm mattress that touches the cot on every side and fits snugly. Check that the cot is deep enough and has no footholds so your child can’t climb out. Make sure the cot has locking devices on the frame with clear locked positions. The locking devices should be designed so your child can’t unlock them. The inside of all folding or portable cots must have permanent and clear labels with: instructions for assembly and locking procedures a warning to check that the cot is correctly assembled and fully locked into place before each use either a warning to use only a mattress of specified dimensions or a warning to use only the mattress supplied with the product a warning not to add an extra mattress. Before you put your child into a portable cot, check that it’s properly locked together and stable. This is especially important if you’re using a second-hand portable cot. Never make any ations to portable cots. Highchairs These tips can help you choose a safe highchair: Look for the Australian Standards label, especially if you’re buying a new highchair. The standard for highchairs is AS 4684:2009. Look for a highchair that is sturdy and stable with a five-point body harness – that is, a harness with straps that go over the shoulders and hips and between the legs. If the highchair has wheels, make sure the wheels can be locked. If the highchair folds, make sure it can be locked firmly into position. If you’re using a chair that hooks onto the back of an adult chair, make sure it’s slip-resistant and that the seat is level. Look for a simple design – it’ll be easier to clean and there’s also less chance of small fingers getting caught. Using a highchair safely Always strap your child into the five-point harness in highchairs so he can’t fall out. Keep the chair away from walls and cupboards so your child can’t push away and tip the chair over. Keep the chair away from other hazards like curtain and blind cords, windows and electrical appliances. Always help your child climb into and out of the chair. Hang portable chairs from sturdy low tables that won’t tip. Supervise your child when in a high chair. That’s because your child has access to everything within reach on the table. Change tables There’s no Australian Standard for change tables, so it’s important to look carefully at the safety features of any change tables you’re interested in. If you choose to use a change table, these tips can help you choose one that’s safe: Make sure that the table has a child safety harness and raised sides that are at least 100 mm higher than the changing surface. Make sure there are no gaps or spaces at the top of the table. Check that the table is stable and has secure locks. Look for a table that’s a good height for you, so you’re not bending uncomfortably. Using a change table safely At home, it’s safest to change your baby on a mat on the floor, so she can’t fall. If you do use a table, these tips can help keep your baby safe: Make sure all the clothes, wipes, nappies and other gear you need are within arm’s reach before you lay your baby on the change table. Stay with your baby while he’s on the table. Keep a hand on him at all times to stop him from wriggling off. Teach older children to keep off the change table. Make sure you don’t overload the side pouches. Safety gates and barriers There’s no Australian Standard for safety gates, so it’s important to look carefully at the safety features of any safety gates you’re interested in. Choosing safe and practical safety gates Read the manufacturer’s instructions and warning labels to ensure you have the right gate for your needs. Note that gates that open are more practical than barriers you have to step over. They’re also safer. Look for a model that you can open with a foot pedal. You should need to use reasonable force to open the gate, or the gate should need at least two separate actions to open it. Check that the spaces between bars in the gate are 50-95 mm wide. If they’re any wider, your child’s head could get trapped. Check that the gate has no crossbars or mesh that your child could use to climb over. It should also have no sharp edges and no detachable small parts that could pose a choking risk. Check that the size of the opening to be gated is within the recommended dimensions for your preferred model. Many gates have extensions you can use for larger openings. Note that models you can adjust without needing a spanner are more convenient. They’re safe as long as the nuts are done up tightly. Using safety gates on stairs Use a safety gate on stairs with more than three steps. Check that the gate you’re interested in is intended for stair use and can be securely attached to the wall or banisters. Use approved and securely attached safety gates at the top and bottom of stairs. Note that not all safety gates are safe for use at the top of the stairs. Other baby furniture If you have a bouncinette or baby chair, use it only on the floor, not on a table or raised surface. If your baby can roll over, don’t use a bouncinette. Baby walkers aren’t recommended. A baby in a baby walker is incredibly mobile – she could be down the stairs or out the door before you realise it. And walkers give extra height, which means your baby can reach all sorts of things you thought were out of reach. If you do choose to use a baby walker, Australian Standards require that baby walkers have an automatic braking system and safety warning labels. And it’s best to use the walker for only short periods, like 15 minutes, because overuse might mean your baby is slower in learning to walk. Like baby walkers, jolly jumpers aren’t recommended. If you do decide to use a jolly jumper, check that the clamps and straps are secure before each bouncing session. If you use a jolly jumper that hangs in a doorway, make sure the doorframe can support your child’s weight, and that you hang the jolly jumper securely. Don’t leave your child unattended in a jolly jumper, and tell older children not to push or pull the baby in the jolly jumper. * A safer and cheaper native to a baby walker or jolly jumper is to put your baby on a play mat or blanket on the floor. This is stimulating for your baby’s development and is a good chance for baby to have tummy time .

    Seating in aged care: Physical fit, independence and comfort DETAIL
    Seating in aged ...

    Seating in aged care: Physical fit, independence and comfort Objectives: This research was intended to provide a greater understanding of the context and needs of aged care seating, specifically: To conduct an audit of typical chairs used in aged care facilities; To collect data about resident and staff experiences and behaviour around chairs in order to gain a deeper understanding of the exact issues that residents and staff have with the chairs they use at aged care facilities; To identify positive and negative issues influencing use of chairs in aged care facilities; To deliver evidence-based recommendations for the design of chairs for aged care facilities. Methods: Methods included a chair dimension audit, interviews with residents, experts and carers and observations of aged care residents getting into chairs, sitting in them and getting out. Results: Results showed that residents, experts and carers all prefer chairs which are above the recommended height for older people so that they will be able to get out of them more easily. Armrests were essential for ease of entry and egress. However, many residents struggled with chairs which were also too deep in the seat pan so that they could not easily touch the floor or sit comfortably and were forced to slump. Most residents used cushions and pillows to relieve discomfort where possible. Conclusion: The implications of these issues for chair design and ion are discussed. Variable height chairs, a range of chairs of different heights in each space and footrests could all address the height problem. Chair designers need to address the seat depth problem by reducing depth in most aged care specific chairs, even when they are higher. Armrests must be provided but could be made easier to grip. Addressing these issues would increase access to comfortable yet easy-to-use chairs for a wider range of the aged care population. Keywords: Aged care, seating design, ergonomics, anthropometrics, sit-to-stand transfer, occupational therapy   Objectives: This research was intended to provide a greater understanding of the context and needs of aged care seating, specifically: To conduct an audit of typical chairs used in aged care facilities; To collect data about resident and staff experiences and behaviour around chairs in order to gain a deeper understanding of the exact issues that residents and staff have with the chairs they use at aged care facilities; To identify positive and negative issues influencing use of chairs in aged care facilities; To deliver evidence-based recommendations for the design of chairs for aged care facilities. Methods: Methods included a chair dimension audit, interviews with residents, experts and carers and observations of aged care residents getting into chairs, sitting in them and getting out. Results: Results showed that residents, experts and carers all prefer chairs which are above the recommended height for older people so that they will be able to get out of them more easily. Armrests were essential for ease of entry and egress. However, many residents struggled with chairs which were also too deep in the seat pan so that they could not easily touch the floor or sit comfortably and were forced to slump. Most residents used cushions and pillows to relieve discomfort where possible. Conclusion: The implications of these issues for chair design and ion are discussed. Variable height chairs, a range of chairs of different heights in each space and footrests could all address the height problem. Chair designers need to address the seat depth problem by reducing depth in most aged care specific chairs, even when they are higher. Armrests must be provided but could be made easier to grip. Addressing these issues would increase access to comfortable yet easy-to-use chairs for a wider range of the aged care population. Keywords: Aged care, seating design, ergonomics, anthropometrics, sit-to-stand transfer, occupational therapy This article reports on a research study intended to provide a greater understanding of the needs of aged care seating users in context. First, we provide the background to the anthropometric issues of seating in aged care and then present the results of an audit, observations and interviews which were carried out across four aged care facilities in Queensland, Australia, to investigate whether or not the available seating met both anthropometric and user requirements for the aged care context. The chair audit (including measurements) was conducted across two facilities and four websites. Interviews were conducted with staff from four facilities and one outside organisation, and observations and interviews with residents were conducted at two facilities. Discussion of the findings and their potential implications follows. Seating research in relation to older people An enormous amount of research has been conducted in relation to seating, and particularly the ergonomics of seating and chair design. Much of it has been translated into design guidelines now contained in national and international standards for chair design.1 There are many benefits for older people in using appropriate chairs. As residents of care facilities tend to have reduced functional capacity, with mobility limitations particularly common,2 suitable seating design is imperative. Mobility and independence are maintained if a person is able to get in and out of a chair with relative ease, without having to wait or ask for assistance. Additionally, appropriate seating encourages good postural stability and support while reducing pain, fatigue, venous thrombosis (VT) risk and pressure sores. Good seating may also encourage social interaction, improve respiratory function and intake of food and drink.3,4 Inappropriate seating, however, reduces independence by increasing reliance on others. Poor seating can also simply be uncomfortable, and particularly in older adults with cognitive impairments, discomfort can lead to frustration and behavioural issues.4 However, providing recommendations for older adults in residential aged care environments is complex. Those still independent and mobile require a chair that is easy to get into and out of independently, while encouraging healthy posture but not restricting movement. Those with less mobility and postural control require greater contoured support and safe-assisted transfer.5 So while the ergonomic specifications for seating furniture in office environments are quite explicit, recommendations for aged care seating furniture tend to be more ambiguous. Publicly available information on choosing a chair for older people tends to be directed towards individuals.6,7 In care facilities, physiotherapists and senior staff have made decisions about the most appropriate seating furniture for residents.4 More recently, facilities’ interior designers, rather than carers, physiotherapists or occupational therapists, are liaising with manufacturers in relation to chair design specifications (Tatum, 2015, personal communication). Sit-to-stand transfer The act of standing from a seated position is a physical task performed regularly throughout a day and is one of the most important measures of physical function.8 Often referred to as chair-rise, or sit-to-stand (STS) transfer, this ability is key to maintaining mobility and independence and has been identified as the most important factor for older people when choosing a chair.9,10 Biomechanically, rising from a chair is perhaps one of the toughest tasks and involves moving from a static, seated position through an unstable transition phase, to a ‘quasi-static’ (standing) position.11Successful transition requires significant motor control, momentum and coordination.12 A number of strategies have been observed and classified: momentum transfer (MT), stabilisation (or exaggerated trunk flexion, ETF) and dominant vertical rise (DVR). Strategies differ in the amount of work required by the trunk, the knee and the hip. Some strategies require more strength, some more time, some are used in conjunction with others.10–13 Scarborough et al.12 observed chair-rise strategies in older adults with functional limitations and concluded MT to be the most common, efficient and preferred chair-rise strategy. In another study of older adults, the most common strategy used was leaning forward (MT), the least used strategy was sliding forward (ETF).10 However, older adults employ many strategies and when faced with difficult situations, they will their strategies, employ several strategies or avoid certain types of seating altogether.10,14 The results of these studies into STS have been worked into chair design guidelines that can reduce STS difficulties and improve function for older people. Several characteristics of chairs have been found to impact STS performance; the seat height and size, the space underneath the seat,15 the angle of the seat and backrest and whether the chair has armrests are among the most important. Unfortunately, however, some of the factors that make it more difficult to rise from a chair: lowered seat height, increased posterior seat tilt and increased back recline, for example, tend to be the same features that make the chair more comfortable to sit in for extended periods.9 Anthropometrics and chair design guidelines for older people The information in this section summarises specifications found in the literature on chair design guidelines for chairs used by older people. Where available the recommended values are presented alongside relevant anthropometric and ergonomic data for older members of the population;1,16,17 the crucial elements being seat height, seat size and armrests. Seat height Seat height is the most important factor for easy STS6 and is measured as the height of the compressed cushion to the floor.3,5 Higher seat height reduces the motion and strength required by the hips and knees to rise from the chair, and less exertion is required to rise from higher chairs as the distance travelled by the body is smaller.5 Furthermore, those with limited ability to flex the hips, such as after hip replacement or due to the effects of arthritis, will not be able to use lower set chairs. Lower seating also increases pressure on the pelvis rather than distributing it along the thighs.6 Thus, providing seating with a variety of heights is recommended where possible.5,9 However, older adults are not necessarily more comfortable using higher seats. Seats that are too high can compromise stability while seated because a person’s feet will be unable to reach the floor;9 this increases discomfort under thighs and pressure behind the knee,5 which s a VT risk. Permanently higher seats with footrests are an option for some older people,5,6 and indeed use of footrests is a recommendation for office seating that may need to cater for older employees.16 However, this solution may not be feasible in aged care environments where the footrest could become a trip hazard.5 Motorised chairs that rise up with the person reduce joint stress on rising, but can leave the person unbalanced at the end of rising. Furthermore, as well as being expensive, motorised chairs are generally not viewed favourably as they encourage dependency on the chair rather than on the use of the person’s remaining abilities.5 Thus, although they have their place, they are not discussed further in this article. A fifth percentile Australian female over the age of 65 (we’ll refer to her as ‘Jean’) has a popliteal height of 330 mm, while the mean dimension for the same population is 379 mm. Studies of seating for older people have recommend an optimal height of 430 mm,9 or 470 mm with a footrest.18 According to Christenson,15chair height for older women in care facilities should not exceed 431 mm. However, Christenson also recommended that to best cater for the majority of residents, facilities should provide a variety of lounge chairs with seat heights ranging from 380 to 457 mm. All these recommended seat heights are higher than the mean popliteal height for the age group of 379 mm,16 and suitable only for those elderly females above the 50th percentile, not including ‘Jean’. Seat size (depth and width) Seat depth has been identified as an important factor in seating comfort for older people.5 Seats should be able to support the full length of the thighs without the sitter having to slouch or lean to support the back,1,6 and there should be space behind the knees for circulation.4 ‘Jean’ has a buttock to popliteal length of 376 mm and a hip breadth of 277 mm. The mean dimensions for the same population are 440 and 338 mm, respectively.9,18 Kothiyal and Tettey16 recommend 376 mm for both office and bus seating, exactly right for ‘Jean’. The current Australian Standard for fixed height chairs suggests an effective seat depth range of 380–480 mm.1 However, the Standard also notes that to allow for a majority of users to benefit from the backrest, a depth of 440 mm is preferred, which is way too deep for ‘Jean’, or anyone below the mean dimension. Width of the hips ‘plus a clenched fist on either side’ is recommended to allow for changes in sitting position while in the chair.3,6 Kothiyal and Tettey16 use hip breadth for the 95th percentile female for seat width and recommend a value of 409 mm. Armrests Armrests that are high and extend to the edge of the seat have been found to support chair-rise performance by maintaining stability while rising.9 Designs that are lower at the back than the front are preferred,15 and researchers have found that armrests around 250 mm from the seat best facilitate STS performance.19 Holden and Fernie18 recommended that armrests should have a height of 730 mm from the floor at the front and 250 mm from the seat at the back, with a width of 120 mm and a protrusion of 120 mm from the front edge of the seat. The existing literature shows that guidelines do exist for some aspects of chairs in aged care, but not all of them cater for ‘Jean’ particularly well. The next sections describe our research with residents, and therapists and chairs in aged care facilities. Go to: Aged care seating study Between December 2015 and March 2016, we conducted an audit of the various types of seating available across two residential aged care facilities. Eight main types of seating were recorded and measured. We also conducted observations and semi-structured interviews with aged care residents, carers (staff) and therapists (experts) in order to understand how the residents and staff related to the chairs available and to video-record the STS processes used by the residents. Participants were from four aged care facilities, and one therapist was from a specialist service for independent living. We also conducted a website audit of published aged care specific chair dimensions in 2017. This research was funded by a commercial client (Lifecare Furniture Pty Ltd) who commissioned this research from the university in order to improve the design of their own offerings in seating for aged care and have given full permission for publication of this material. There is no perceived conflict of interest as their chairs were not assessed as part of this project since none of the facilities visited were clients of theirs. Participants Participants were 19 aged care residents (6 male, 13 female), five staff members (3 Facility Managers, 1 Assistant in Nursing (AIN), 1 Clinical Manager) and two experts (1 Occupational Therapist, 1 Physiotherapist). The resident participants were representative of the gender balance of aged care residents in Australia, which is 69% female.20 The staff and experts were representatives from four aged care facilities and one specialist service for independent living and assistive technology. For residents, inclusion criteria were that participants should be living full time in the facility, and participants had to be capable of giving informed consent and were ed by the staff at the facilities. The researchers were not permitted by the facilities to approach potential resident participants resident directly. All data collection was approved by the university Human Research Ethics committee (approval number 1500000968) and by each facility involved. All participants signed a consent form and image release form and received a AUD$25 gift card in return for their participation. Data collection methods An audit was conducted on all available communal chairs in two different aged care residences to record context and dimensions. Aged care facilities representing low-end, high-end and mid-range facilities (in terms of cost of care and market position) were invited to participate in order to capture differences across facilities due to level of investment in the facilities’ furniture. The website audit was based on a Google search for Australian-based aged care seating furniture providers in order to provide direct comparisons to chairs encountered in facilities. A total of four websites (overall 54 seats) were audited as they were the ones selling aged care furniture in Australia which included appropriate dimensions on their sites. The primary research method used with participants was a semi-structured interview accompanied by video-recorded observation. This allowed us to collect opinions and behavioural data simultaneously. During the semi-structured interview, participants (some alone, some in groups or couples) were asked to answer 10–15 questions about their experiences of chairs in aged care (Appendices 1–3). During the observation, aged care residents were also asked to show the researcher how they would normally sit down in a chair. Then, after the interview questions, the residents were asked to show how they would stand up from the chair. Since the whole session was video recorded, we also captured data about how they sat in the chairs, if they moved around, pulled themselves up, slumped and so on, and what other props they used (e.g. walking aids, footrests, cushions and pillows). The types of chairs varied depending on the location of the observation. Some chairs were high-back lounge chairs and dining chairs available in the communal areas of residential facilities. However, when observations were held in residents’ private rooms, chairs ranged from occasional chairs provided by the facilities to office chairs, lounge chairs and recliners that belonged to the residents and had been brought to the facility when they moved in. The interview questions and structure changed slightly for residents, experts and carers but covered the same information based on their expertise (see Appendices 1–3). Data analysis The audio-visual data were imported into Noldus Observer XT software for coding.21 The coding scheme used (Appendix 4) was based on the literature and the initial viewing of the video data, combined with expert input from the research team. It was designed to help us to understand which issues were most important to the residents, experts and carers. The coding scheme included top-level codes from answers to interview questions, such as which is your favourite chair or what do you think of the height and comfort of the chairs. For each code, there were ‘modifiers’ which allowed us to code which chair features were relevant to the particular comment. This allowed us to understand, for example, whether armrests were important for STS or whether seat height and depth were related to comfort. When coding of video data was complete, the resulting codes were exported to MS Excel to provide quantitative results. These methods were strongly grounded in the approaches we have developed over the past 10–15 years,22 which are focussed on finding out what people actually do in their day-to-day lives rather than simply collecting opinions and beliefs or measuring objects. Go to: Findings First, the findings of the seating audit are presented, supported by quotes from resident and staff interviews and relevant images of seating, followed by findings from the website audit. Finally, results from the interviews and observations are presented, supported by quotes, images of seating in use and STS transfer in progress. Seating audit The seating audit indicated that aged care facilities provide a variety of seating, particularly in communal and public spaces. Table 1 provides the dimensions for the high-back lounge chair used for observations in one mid-range facility. Table 2 provides dimensions of all communal chairs available in a high-end ‘club’ facility. All of the chairs included in Tables 1 and ​and22 were provided by a facility-approved aged care seating manufacturer.   Table 1. High-back lounge chair – mid-range facility. Type, location and example Seat height Seat width Seat depth Armrest height – from floor Armrest width Back height – from floor High-back lounge Recreation hall/lounge room   460  485  480      630   100    970                 All measurements are in mm.     Table 2. Chair audit results from high-end facility. Type, location and example Seat height (sloped backa) Seat height compressed Seat width Seat depth Armrest height from floor Armrest width Back height from floor Wicker chair Waiting areas   460   600 500 610 115 760–840     High-back lounge TV area       480     455–460     510/1025     515–530     660     70     1040   Dining casual Communal meals area     475–505a     490–580   485   665   45   915   Dining Private dining room     440–480a     460   425       970 Day chair Bedrooms and cinema   480 470 490 520 650 70 910   Woven Outdoors     440     400–590   460   640   40   910   Café Coffee shop reception     410–445a     420   390   645   35   815 Open in a separate window All measurements are in mm. asignifies that the seat pan is sloped backwards so that it is lower at the back than at the front. While there was a variety of chair types on offer, and slight changes in size across the range of seating, the chairs used most frequently by residents in the communal areas – the high-back lounge and the dining chair – were quite similar, particularly in terms of seat height and depth. There was no change in size within a particular chair type – all high-back lounges were identical, for example. Space and financial constraints play a role in the provision of seating in aged care contexts. The images below (Figures 1​1–3) provide a context comparison across three facilities: a four-year old, high-end club facility; a slightly older, mid-range facility; and an older secure dementia facility. All facilities highlighted the need for a home-like environment, however, the style and the need varied depending on the level of care. Some seating, particularly in the dementia secure facility, was simply standard seating available at any major retailer. Facilities relied on advice from in-house physiotherapists or occupational therapists; they used approved suppliers and were guided by recommendations from those suppliers: ‘Who chooses the furniture?’ ‘Our property division. But it’s from a company that are specific to aged care’. (Staff 3) Figure 1. Chairs lined up together in a high-end ‘Club’ facility.   Figure 2. Uniform seating in mid-range facility.   Figure 3. Seating options in a (low-end) secure dementia facility.   In addition, a review of websites of Australian aged care furniture manufacturers was conducted and seat depth and height for lounge chairs (NOT recliners, automated chairs, two or three seaters or bed chairs) were assessed. None of the experts or carers was aware of any specific dimensions for appropriate seating for aged care. The occupational therapist and physiotherapist had guidelines they would refer to, but these were general recommendations on fitting a chair to an individual. Facilities were reliant upon manufacturers for appropriate specifications: As a company we have approved suppliers…whatever specifications they’re making their stuff to we’re pretty much trusting the fact that it’s going to be suitable for the residents. (Staff 1) In the high-end and mid-range facilities, the seating was relatively fixed and served a dedicated purpose (e.g. for the lounge room, cinema, café or activities areas). In the older secure dementia (low-end) facility, only the dining chair was specifically designed for aged care. Here, the priority was a home-like appearance and cleanliness. By comparison, the high-and mid-range facilities had several communal spaces where maintaining a uniform appearance was a priority. Seating was carefully lined up side by side with a lot of space in front, leaving sufficient room for residents to place wheelie walkers in front of their seats or to manoeuvre through in their wheelchairs. Websites were identified using a Google search on the term ‘aged care’ and then searched through for those containing relevant interior dimensions for their seating. Most websites state only the external dimensions but some list seat height and/or depth for some of their chairs. These dimensions (Table 3) suggest that the chairs we audited in situ (Tables 1 and ​and2)2) were not out of the ordinary for their context. In fact, we were told by an aged care furniture manufacturer that these are the standard kinds of dimensions in use in the industry and perceived to be in demand by the clients. Table 3. Chair audit results from Australian websites. Provider Lounge chairs with dimensions listed Seat height Seat depth Direct Online23 3 Mean 423 480 (only one listed) Regency Health Care24 2 Mean 455 Mean 485 Aidacare25 2 Mean 520 Mean 485 Healthcraft Furniture26 47 Mean 473Range 420–510 No dimensions available All measurements are in mm.   Interview and observation results In this section, first resident and then expert and carer perspectives and examples are presented, with quotes from interviews and images from observations used to illustrate the findings. Residents’ perspectives Figure 4 outlines the key features of chairs that were discussed by resident participants in this research. It is an illustration of frequency. For example, the most common feature coded in the analysis was Armrests, followed by Seat height and so on. A list of every incidence of each code was generated. From here, the list was filtered for the most frequently coded modifiers. These key modifiers were then filtered again in a separate analysis that included the other modifiers they were coded with. For example, Armrests featured most frequently with the modifiers STS transitions and positive, meaning that when participants spoke about armrests, it was generally in a positive context and in relation to STS transitions. Quotes and images are provided on the following pages to illustrate the findings relating to armrests and STS, seat height and seat depth.   Figure 4. Residents’ perspectives on chair features.   Armrests and STS When armrests were available they were used 100% of the time regardless of the resident’s level of mobility (Figures 5 and ​and6).6). They were viewed as a tool to aid STS transitions, used to pull forward and push up when standing up, and as guidance and support when sitting down: …if I have armrests I’ll use them…I hold one arm on the armrest and another on the table…so I can balance myself as I’m standing. (Resident 17) …if you’ve got the armrests, you’re half-way there [to standing]. (Resident 3) …unless they’ve got a good arm to push yourself up from, some of them are difficult to get out from because you slip…you’ve just gotta watch if you’re standing up if there’s no arm. (Resident 4)       Figure 5. Using armrests to pull forward and sit up, then stand up.   Figure 6. Leaning forward and pushing up on armrests during STS transition.   While armrests provided stability during STS transitions, they also provided security while sitting and a sense of independence as the residents knew they could get up when they wanted to without needing assistance: It is nice at a restaurant if they have armchairs, it makes all the difference to how you feel… if you’re independent and you’ve got an armchair you feel like anybody else. (Resident 3) However, there was mention of some armrests being too broad and therefore difficult to grip securely (Figure 5): … [armrests with] the wooden ends… I find that far better than the padded ones so you can actually get a grip. (Resident 3) When trying to stand from a chair without armrests, residents would push on other features such as the table, seat back or the seat itself (Figure 7). One resident said having no armrest made her feel very insecure: I hate this, it’s a real problem for me, I don’t know what I’d do, I’d just panic, I don’t like it. I’m looking for somewhere to push. (Resident 5)   Figure 7. Standing up using table and chair seat (walker placed behind resident).   Of STS transitions observed, 90% involved careful, considered techniques. All STS transitions involved leaning forward and pushing up on something – armrests when they were available, the seat, the table, a walker or stick. Figures 5​5​–8 illustrate STS transitions using various techniques and aids. Figure 8. Multiple attempts at standing from a chair that is too low for the resident, using armrests and walker.   Sometimes residents would make an attempt to get up on their own, before using some assistance, and 90% of those observed during STS needed more than one attempt to stand (Figure 8): …so I’ll just get up…[several attempts]…eventually [laughs]. (Resident 2) As the quotes and figures demonstrate, for some residents, a mobility aid played a key role in the success of their STS transitions. For others, it provided security and balance once standing. Walkers or walking sticks are essential for most people in aged care. Figure 9 illustrates the aids used by the residents in this research. Open in a separate window Figure 9. Mobility aids used by residents in the study. Mobility aids are particularly relevant in STS transitions. Figure 10 illustrates a resident sitting down with the walker to the side, and Figure 11 shows a resident reversing into a chair using her walker. When sitting down, many residents reversed into the chair, and there was a preference for the walker or walking stick to be close-at-hand: I use my stick or the walker…always have something here. (Resident 14) I usually take the wheelie walker to the chair, until I feel it on the back of my legs and then I sit right back into it. (Resident 1) …with the lounge chair in my room I’ve really go to push myself up off it to get out of it. And I need to have the wheelie walker poised so that I can get on the wheelie walker to go where you want to go. (Resident 1) Figure 10. Sitting down using walker and armrests. Figure 11. Reversing into chair using walker. However, storing the walking aid close to them while sitting so they can easily get up again could be an issue: …well hopefully it’s at a chair behind you [the walker], but you can’t always do that so beside you or right in front of you. (Resident 4) …sometimes the walker is over there, B* goes mad if I leave the walker away. (Resident 8) …there’s not much room in the room, so I’d move it round [wheelie walker] so that it was easily accessible. (Resident 1) Seat height Residents approached seat height mostly from the perspective of STS transitions. There was a consistent view that many chairs were too low for easy STS, although we observed many seats that were too high for comfortable sitting. Figure 12 shows examples of chairs which were too high and too low. Figure 12. Examples of sitting and chair height.   …it’s too low… I’ve really got to heave to get out… if it’s just that bit higher you can get straight out. (Resident 3) I find the lounge chair in my room too low. It’s alright to sit down and watch television in, but then it’s hard to get out of. (Resident 1) …terrible [of high back lounge chairs]… too low to get yourself up and out of them. (Resident 17) There was also repeated mention of the variety of sizes of residents and that a chair that suited one would not suit another: The thing the manufacturer should do is make the same chair in four to six sizes. (Resident 3) I think that they should be adjustable for height, because I’m not the only tall person in this place…. (Resident 11) It’s quite alright with me, but I don’t know about someone that’s six foot two in height, I’m only five foot two…. (Resident 10) Seat depth For residents, seat depth was very much linked to comfort as well as recognition that space behind the knee was important for their circulation. The general perspective was that most of the seating residents had experienced in the aged care setting was too deep. Slumping (posterior pelvic tilt) was consistently observed due to seats being too deep (Figure 13). This meant that residents would shift their feet closer to the floor by tilting their pelvis, creating an unsupported space behind the back, often filled with a cushion or pillow. Pillows and cushions were observed on seats in every private room we accessed. The cushions were used for additional back support to help maintain an upright position while sitting (Figure 14), effectively reducing seat depth: [takes cushion away from back]… see that takes me back further… I think I prefer the cushion… or I have to push my bottom back into the chair. (Resident 10) … they stop sometimes the blood circulation [at back of the knee]…You sit far back on them and, it hurts. (Resident 17) So many arm chairs have deep seats so you’re right in the back. Where I’m personally more comfortable sitting upright in a chair with a shorter seat so that my knees are actually beyond the edge. (Resident 3) The average chair is too small for me… I like… having a deep seat. (Resident 2) Yes, well, you’ve got longer legs. Our knees get to the end [front of seat] before our bums get to the back. (Resident 3) Figure 13. Excess seat depth leading to slumping. Figure 14. Using a cushion to sit forward and upright.   Expert and staff perspectives Figure 15 outlines the key features of chairs that were discussed by experts and staff members. It is again an illustration of frequency. A list of every incidence of each code was generated and the list was filtered for the most frequently coded modifiers. Quotes and images are provided on the following pages to illustrate the findings. Open in a separate window Figure 15. Expert and staff perspectives on chair features. Armrests and STS Armrests were generally seen as positive by the experts and staff, particularly in relation to the stability of the chair and the ability to complete successful STS transitions. Armrests were considered essential for STS transitions, and STS transitions were identified as vital for maintaining independence. The preferred method was for older adults to be able to achieve STS on their own without being given prompts or assistance: Sit-to-stand transfer is often rated higher by organisations getting that chair, and for the person, because it allows them to independently transfer – get out of the chair when they want… so that autonomy, which is often lost in aged care. (OT) Some residents with a more limited mobility may have difficulty getting out of a chair which is why the ones we’ve got with the arms seem to be a lot easier… for them to push down and push themselves up out of the chair. (Staff 5) ‘You would prefer residents to use the arms?’ ‘Most definitely… because it’s easier for them to get a standing transfer and be in a more supported position’. (OT) …there’s a lot of support with them. Especially with the arms and with the height, allowing residents to maintain that independence. So if they have a wheelie walker in front of them, they have that advantage of being able to get up themselves. (Staff 3) The experts and staff were able to offer detailed descriptions on both positive and negative aspects of armrests, particularly related to height and width: …it’s no good having an armrest that’s this wide [gesturing to suggest armrests that are wider than the hands], that the residents can’t [get their hands around], you want something that they can actually grip quite easily. (Staff 1) …armrests are not great for the shoulder joints sometimes, they bring your shoulders up if they’re too high…. (OT) Cushion density, although vital for comfort, also had an impact on effective STS transitions, and stability was also a factor for STS: If you have it too soft then they sink into it and they find it hard to get out of it. If it’s too hard they end up with a sore bottom. (Staff 4) …the squishability of the chair… if it’s a very squishy chair then it might provide some added comfort for some individuals but then its extra hard to get out of…. (OT) So how stable is that chair when they go to sit down on it? Does the chair balance? Is it safe for them to be rough with their sitting? (OT) …they’ve got to be sturdy because people don’t gently sit down. (Staff 2) Seat height Seat height was discussed by experts and carers both in terms of independence and STS transitions, but also in relation to reducing risk for staff during manual handling: The benefit with a higher chair is that it is easier to transfer, it’s easier to do that sit-to-stand… It’s also good for the carers. They like high chairs because it’s not hurting their backs, and back care is one of those big issues with aged care. (OT) We’ve got to make sure the chair is not too low for the staff to get them up to standing…. (Staff 2) Chairs that were too low were considered to have a negative impact on STS transitions and also were not suitable for those with hip fractures or replacements: If you can vary the seat height that would be optimal… any chair that had variable height ability by changing the leg length would be great. (Physio) too low… especially lounge chairs…When you sit in a lounge chair, because the cushion is comfortable and collapses you go down below that position and so your hips get below your knees. That s a change in mechanical advantage… needed to get you up. (Physio) …this chair is too low… especially in the case of fractured hips… then you need over 90 degrees angle at the hip. (OT) Seat height was also referenced in terms of maintaining the aesthetic of the Club facility. As detailed in the chair audit (Table 2), there was very little variability in seat height overall, and no variation in size within each particular chair type. This consistency seems linked to the ‘club facility’ image, where uniformity in aesthetics was a priority: We’re a club site so, having uniform chairs, this sort of height… so as you can see, same height same structure the whole way round. (Staff 3) Seat depth Although seat depth was not mentioned as frequently by managers and nursing staff as it was by residents, it did feature in interviews with the physiotherapist and occupational therapist, particularly in relation to poor and painful seating positions (Figure 16): So the depth of the seat is too long for my legs [feet do not touch the floor]… so what’s going to naturally happen if I’m an older person who doesn’t have good postural support, has weakened limbs. They’re just going to gradually tuck under and slide out, looking for a base of support on their feet… the issue with this is not only a falls safety concern, but also of pressure, sheer forces, on their bottom. (OT)      Figure 16. Occupational therapist demonstrating the impact of a seat that is both too high and too deep.   Discussion In summary, none of the chairs audited (Tables 1​1-​-3)3) would fit ‘Jean’ – all were too high and too deep. Residents, experts and staff all preferred higher seats to allow for effective STS transfers. Seat height has been identified as the most important factor for easy STS,6 and the literature suggests that older people find it easier to rise from higher seats because the body has to travel a shorter distance, with less effort, to stand.5 A variety of seat heights was observed from 410 to 505 mm in facilities and 423–510 mm in the website audit. Almost all chairs were well over the mean popliteal height for older people (416 mm in males and 379 mm in females); most were above recommended heights for older people and far above ‘Jean’s’ popliteal height of 330 mm. Even so, many residents and staff stated that they would prefer even higher seats, revealing their preoccupation with STS over comfort. These higher chairs may be ideal for STS transfers but not necessarily for comfort, and observations showed that many residents could not touch the floor easily once they were seated. The problem of high seats can also be alleviated with footrests, which are recommended for older people5,6 but in the real world, they are used very little due to perceived risks. Additionally, none of the experts or carers was aware of any specific dimensions regarding appropriate seating for aged care and relied on manufacturers to use appropriate guidelines. The mean buttock popliteal length for an older Australian female is 440 mm; the Australian Standard recommendation for seat depth for fixed height chairs is 440 mm, but observed seat depths for lounge chairs in our study ranged from 480 to 530 mm in facilities and 470–500 mm in the website audit. This may be because a chair which is over-high but not proportionately deep could look unbalanced and unwelcoming, even though it would probably be more ideal for the residents, so may be less likely to be chosen by facilities and offered by manufacturers. Thus, the combination of the justified and desired excess seat height and unnecessarily generous seat depth can be problematic during sitting if residents are unable to touch the floor. Reducing seat depth on some of the chairs offered would reduce problems of residents having to slump in order to touch the floor, reduce reliance on pillows and increase comfort, while still allowing for easier STS transfers. It should also assist with easier egress from the chair as shuffling forward would not be necessary. This could involve making chairs adjustable or providing a range of seat heights and depths in all spaces. In the high- and mid-end facilities, the need to maintain a uniform appearance was prioritised over the fit of the chairs to a variety of individuals. Where possible, providing seating with a variety of heights is recommended.5,9However, the need for a uniform appearance in high- and even mid-range facilities meant that all chairs of the same style had the same finish, fabrics and size, suiting the ‘look’ but not all residents. The disparity between seat height required for STS and seat height required for comfort while seated, coupled with unnecessary seat depth, becomes an equity issue, whereby shorter residents are being disadvantaged compared with taller ones, suffering discomfort and possible musculoskeletal damage while sitting and being put at risk of deep venous thrombosis (DVT) due to the seating design. In Australia, women comprise 69% of people in permanent aged care20 and of course they are most likely to be the shorter residents. This means that a substantial percentage of the residents in aged care are using chairs which are likely to be uncomfortable and potentially even dangerous for them and are missing out on the benefits that could be gained from good seating discussed earlier (e.g. reduced pain, fatigue, VT risk and pressure sores, increased social interaction, improved respiratory function and intake of food and drink3,4). Armrests were identified as vital by all participants, were always used for STS when available and were also essential for the feeling of confidence and autonomy from knowing that a transfer could potentially be achieved. Ideally, armrests should be lower at the back than the front; however, only the casual dining chairs were observed to have an angled armrest. Furthermore, with an average of 645 mm across all of the chairs, all of the armrest heights measured were lower than the 730 mm from the floor recommended by Holden and Fernie.18 Holden and Fernie18 also recommended an ideal armrest width of 120 mm. However, participants (residents and experts/carers) mentioned that a slimmer armrest was easier for residents to grip during STS transitions, so chairs which flout Holden and Fernie’s recommendation on armrest width may actually be better suited to this age group. There was a focus by all experts and carers on fostering and encouraging residents’ remaining abilities and independence. Chairs can help to do this if residents are able to manage STS transitions without assistance; if they are able to reach their walking aid so they can get out of a chair and move away from it as and when they wish; and if they are comfortable enough in the chair that they can sit in it as long as they desire for the activity they are undertaking. The right balance needs to be achieved between assistance from the chair, other aids or other people and the residents’ various abilities, as well as between STS transfer and comfort. Some measures that could be taken by furniture manufacturers in order to find this balance include developing chairs which easily and simply increase in height for STS transition but lower for prolonged sitting (not fully automated recliners as these already exist but are very costly and bulky and do not encourage users to make the most of their remaining abilities) and reducing seat depth on almost all chairs for aged care contexts. Meanwhile, aged care facilities could help by allowing footrests to be used in facilities, allowing residents to bring cushions and pillows from their rooms into communal areas in order to customise the seating and providing a better variety of seat heights in each of the various contexts within facilities. Go to: Limitations This study used a convenience sample to investigate a variety of aged care seating with residents, staff and experts based around Brisbane, Australia. Australia is a multi-cultural society but even so this does not make this sample representative of all aged care residents and staff in terms of anthropometrics, abilities or attitudes. In addition, the seating audited was limited to that available in Australia and is not necessarily representative of aged care seating available elsewhere in the world. The study was qualitative and collected subjective opinions of participants. It did not include objective measures of strain, pressure or movement but aimed more at discovering subjective perceptions about what was working and not working for aged care residents on a day-to-day basis. Studies employing more objective measures may be required to evaluate particular seating solutions developed based on our recommendations. However, by focusing on subjective perceptions of comfort and observing actual STS and sitting activity within the aged care environment, this study has begun an important conversation about the specific seating needs of older people within the residential aged care context. Go to: Conclusion In this article, we have discussed the extant literature about seating in aged care and the recommended anthropometric and design guidelines relevant for aged care seating. Furthermore, we have described an investigation of current seating furniture available online and in use in aged care facilities in Queensland (Australia). Taking the importance of STS transfers into account, suitability of most chair dimensions (including excess height) was justifiable apart from seat depth in many cases. As a result of increased seat height for STS purposes and unnecessary excess depth of seat pans, chairs were too high and/or deep for many residents to sit comfortably. There was almost no use of footrests to offset these issues and very little variety in seat heights throughout facilities. This research suggests that a balance needs to be found between ease of egress, independence and comfort for all residents regardless of their size. This disconnection between comfort, STS and function is an area in need of further attention in seating design for the aged care context. Go to: Appendix 1 Interview questions residents What would be your ideal lounge chair? Are you happy with the height of the chairs you use? a. When you are sitting; b. When you are getting up and down. 3. Do you use footrests? a. If so, what do you think of them? b. Which type do you prefer and why? 4. Which parts of the lounge chair do you find most/least comfortable? 5. Are you happy with the comfort of the chairs, when you are sitting for a long time? a. If not, why? 6. Do you have a favourite and least favourite chair? a. Please show us and explain why. 7. Do you prefer a firm or soft lounge chair? 8. If you fall asleep in the chair, does that cause pain or discomfort? 9. What would be the most number of hours you spend sitting in the same chair? 10. What makes you feel stable when sitting down into a chair? 11. What makes you feel unstable when sitting down into a chair? 12. What are the key grab points or hand supports you look for when sitting in a chair? 13. If your chair could recline how far back would you prefer it to go? 14. If you could adjust the pressure in any part of the chair – seat, lumber, neck support – which would you think most critical? 15. What kinds of things do you do while sitting in lounge chairs, that is, activities such as reading, knitting, watching telly, playing games? 16. Do you have any comments about other types of chairs? Go to: Appendix 2 Interview questions experts From your experience, could you describe or show us some of the chairs most frequently used by older people at your workplace? In your opinion, are there any clear positive or negative aspects about these most frequently used chairs? What issues do you face in moving residents in and out of these frequently used chairs? How does the design of the frequently used chairs impact your work? What would be your ideal lounge chair for aged care? Are you happy with the height of the chairs? a. When residents are sitting; b. When they are getting up and down (STS transfer). 7. Do you use footrests? a. If so, what do you think of them? b. Which type do you prefer and why? 8. Which parts of the chair do you think residents find most/least comfortable? 9. Are you happy with the comfort of the chairs, when residents are sitting for a long time? a. If not, why not? 10. If residents fall asleep in the chair, does that cause pain or discomfort? 11. Do you use or see any need for additional neck support? 12. What would be the most number of hours residents spend sitting in the same chair? 13. Is there a specific chair per resident? a. Is it then adapted for them? b. If so how? 14. Do you have any comments about lounge chairs or other types of chairs? Go to: Appendix 3 Interview questions carers From your experience, could you describe or show us some of the chairs most frequently used by older people? In your opinion, are there any clear positive or negative aspects about these frequently used chairs? What issues do you face while using these frequently used chairs to care for residents? What issues do the people you care for experience while using these frequently used chairs? How does the design of the frequently used chairs impact your work? What would be your ideal lounge chair for aged care? Are you happy with the height of the chairs: a. When residents are sitting; b. When they are getting up and down (STS transfer)? 8. Do you use footrests? a. If so, what do you think of them? b. Which type do you prefer and why? 9. Which parts of the chair do you think residents find most/least comfortable? 10. Are you happy with the comfort of the chairs, when residents are sitting for a long time? a. If not, why not? 11. If residents fall asleep in the chair, does that cause pain or discomfort? 12. Do you use or see any need for additional neck support? 13. What would be the most number of hours residents spend sitting in the same chair? 14. Is there a specific chair per resident? a. Is it then adapted for them? If so how? 15. What types of activities do you perform for residents while they are in the chairs – for example, serving ments, applying or checking dressings and moving around? 16. What kinds of things do residents do while sitting in lounge chairs – that is, activities such as reading, knitting, watching telly, playing games? 17. Do you have any comments about lounge chairs or other types of chairs – for example, dining chairs? Go to: Appendix 4   Full coding scheme. Behaviour Behaviour OBSERVED DISCUSSED     Bed - Lying Down Activity Bed - Sitting Care Leaning Chair Pushing Up Environment Reaching Feature Reposition Time Sit Down   Sitting   Stand Up   Standing   Open in a separate window     Modifier Modifier Modifier Type of Chair ……………………...…………… Body positions ……………………………………... USING ………………….. 2/3 seater couches Back footrest 2/3 seater couches bench seat back feet not flat on floor footrest handle cafe chair knee(s) hoist dining chair legs nothing facility chair/ supplied/ communal looking for something to push on/hold/grip person/staff help high back lounge multiple attempts pillow/ cushion lift-chair neck pressure cushion occasional/ day not holding/ pushing anything railing office chair one arm table own chair/ personal/ private one hand at a time towel recliner perched walker toilet posterior tilt- pelvic tuck - walking stick wheel chair pushing   wing chair put feet up _ in recliner     reclined                 Open in a separate window   Modifier Modifier Features - Chair or Room Impact and Considerations convenient position activities of daily living controls/ button for recliner assessed by physio comfort cognition - cognitive decline cluttered home- like cushion density independence dirty - easy to clean - stain resistant - infection control maintaining/ improving chair against wall mental health adjustable mobility back support/back rest model of care armrests negative easily moved not used fabric/ material physical health familiarity - used to it positive grip - armrest pressure head rest quality of life lifespan – longevity- durability risk - to individual or staff modified - customised - personalised skin conditions/ abrasions multi-functional sliding forward/ sliding out of chair no armrests technique removable used regularly/ frequently safety   seat   seat depth   seat height   seat width   softness   space behind knee   stable/ strong   too big   too low   too small   uncomfortable   variety   water resistant   Open in a separate window Footnotes Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article. Ethical approval: Ethical approval for this study was obtained from QUT University Ethics Committee Approval number 1500000968. Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by a commercial client (Lifecare Furniture Pty Ltd) who commissioned this research from the university and has given full permission for publication of this material. Informed consent: Written informed consent was obtained from all subjects before the study.   References 1. AS/NZS 4688.1:2000. Furniture-fixed height chairs – part 1: ergonomic and general requirements (Standards Australia/Standards New Zealand). [Google Scholar] 2. O’Reilly M, Courtney M, Edwards H, et al. Clinical outcomes in residential care: setting benchmarks for quality. Australas J Ageing 2011; 30: 63–69. 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    How do you prepare a home for the disabled or elderly? DETAIL
    How do you prepare ...

    How do you prepare a home for the disabled or elderly? What Changes Should be Made First? Focus on Safety before convenience, Easy before difficult, Temporary before permanent, and Affordable before extravagant. Making homes safe and friendly for seniors can include major considerations like eliminating stairs, expanding doorways, building a first-floor bedroom/bathroom suite, and making sinks, counters and appliances wheelchair-accessible. But there are also smaller projects that can go a long way toward improving mobility and the ability to safely live independently. Just remember that as we get older, or suffer an injury or other disability, our sore joints, weakened muscles, and a lack of balance, dexterity and vision make simple tasks difficult, including reaching, bending, lifting, and moving about. This can contribute to accidents and affect our personal hygiene, nutrition, and well-being. So remember what Benjamin Franklin said, “An ounce of prevention is worth a pound of cure.” With planning and preparation, you can help prevent falls and injuries rather than react to them. FIRST, AVOID FALLS – This may be the single most important objective, because here are the statistics: Each year in the United States, one of every three persons over the age of 65 will experience a fall. Half of them are repeat fallers. Falls account for 87% of all fractures among people over the age of 65 and are the second leading cause of spinal cord and brain injury. For people aged 65-84 years, falls are the second leading cause of injury-related death; for those aged 85 years or older, falls are the leading cause of injury-related death. Half of all elderly adults (over the age of 65) hospitalized for hip fractures cannot return home or live independently after the fracture. So, remove loose rugs since they’re a primary cause of falls and broken bones. That’s free. Then, add cheap bath mats to the tub or shower floor, or apply slip resistant coatings that leave an invisible anti-slip finish. SolidStepCote is one of the slip resistant coatings that can be applied to any flooring for a clear, safe and easy to maintain surface. GET A GRIP – Replace rocking chairs and unstable furniture, because seniors may try to use them to steady themselves. Also install levered faucets and door handles, as well as grab bars in showers and near toilets with raised seats. Even a portable shower seat at the right height, along with the right hand-shower and grab bars, can make getting clean an easier and more enjoyable experience. DE-CLUTTER & REORGANIZE – Clean house and discard everything that’s not needed, remembering to reuse (donate) and recycle where possible. Organize the things that remain so objects used daily are within easy reach, add knobs to cabinet doors, and include cabinet accessories such as pull-out draws and lazy Suzans. LIGHTEN UP – Replace heavy pots, pans, vacuums, and trash cans with lightweight models. What Problems Might Homeowners FORGET to Consider? SEE THE LIGHT – Bright lighting is important to people with poor eyesight, so replace existing light bulbs with the new compact fluorescent or LED variety. They not only save energy, but they last much longer. Take advantage of natural light as much as possible, since it improves visibility, saves energy, and requires less artificial lighting. When artificial lighting is necessary, make sure it’s bright and within easy reach, with no cords running across pathways. Remote controls, like those used for the TV and cable box, make it easy to control lights, window blinds, and fans too – all while seated or from the bedside. Use night lights between the bed and the bathroom and front door to avoid falls when getting up from bed at night. In winter, leave curtains open during the day to let the sun in, then close them at night to hold in the heat. In summer, close curtains during the day to block the sun, then open at night to let any heat escape. STAY WARM – Seniors can get cold when not moving around, so cut the chills with attic insulation and weather stripping to eliminate drafts, and add ceiling fans for use during summer months. PHONE HOME – Cordless phones can be put in any room, or every room, but look for models that are easy to use. Mobile phone access away from home is a safety issue in my book, but rather than look for the simple models with big buttons for seniors, consider smart phones and the benefit of apps designed for seniors. FRIENDLY FURNITURE – Consider adjustable beds and chairs that recline easily, but avoid cushiony furniture that’s hard to get in and out of. APPLIANCES – Front-loaded appliances are easy for someone in a wheelchair to use. Top-loaded models are not. But get the extensions that raise the washer/dryer to make them easier to load. PERS – Personal emergency response systems ($50 install, $15-35/month monitoring) provide a wearable pushbutton for summoning help. They are often available as accessories to existing monitored home security systems. DOORWAYS – Remove doors that serve no useful purpose, and make doorways wider (at least 36”) so people can get around with canes, walkers or wheelchairs. STAIR RAMPS – Make sure all stairs and outside steps have sturdy handrails, and for wheelchair entry, replace or cover steps with ramps. They can be made permanent or temporary. STAIR LIFTS – If your two-story home lacks a bedroom and full bath downstairs and you can’t remodel, then consider a stair lift ($3,000-$12,000). They can be purchased or rented, and you can often find good refurbished models. They can even traverse a spiral staircase. DO YOUR CHORES – In addition to any professional medical help that’s needed, consider the relatively inexpensive cost of weekly maid service, lawn care, and Meals on Wheels. SAVE MONEY AND THE ENVIRONMENT – Purchase wisely, buy second hand, recycle, and donate. OTHER OPTIONS – Add up the total costs of adding a room downstairs, remodeling a bathroom, or reconfiguring cabinets and counters to add knee space and pull-out shelves. You may find that remodeling is more expensive than moving. How can People Building Homes FROM SCRATCH Plan for the Possibility of Adapting their Home Later? UNIVERSAL DESIGN – The concept is to design homes and products for use by anyone regardless of age or ability. Doing that broadens the market appeal and increases your home’s value. Wide doorways and zero-step entryways, for example, are just as useful for a young couple with a baby stroller as a road warrior with wheeled luggage or a disabled person with a walker or wheelchair. It’s a lot easier to make the right design decisions up front, because the cost of doing a complete kitchen or bathroom remodel, replacing a tub with a walk-in shower, for example, can be quite expensive and cost over $30,000. CAPS – The National Association of Home Builders has a Certified Aging-in-Place program to teach contractors about building and remodeling for aging-in-place. This training gives them an appreciation of the problems faced by the elderly and disabled, as well as the various solutions available. But be sure to check out your contractor, since some states have laws that shield builders and contractors from lawsuits and accountability. INDEPENDENT FOR LIFE – There are many good references for designing homes and neighborhoods, and one is this book coauthored by Henry Cisneros, the former HUD Secretary under Clinton. LOW MAINTENANCE – An important part of aging in place is making caring for a home more manageable. Cut down on grass that needs mowing by making your yard more natural, with low-maintenance native plants and trees that also provide shade and can cut cooling costs. Driveways and walkways made of gravel, pavers or other permeable systems not only allow rain water to reach the ground, but they can offer seniors a safer, less-slippery walking surface if well maintained. When building from scratch or remodeling, ask your contractor to use materials that are low-maintenance and support our environment for future generations. Examples are wood species that rapidly renew such as bamboo, finishes that are low in volatile organic compounds, and recycled- materials in carpeting, siding, concrete, decks and fences. BLOCKING – Even if you decide not to install grab bars, it’s a good idea to include wood blocking behind the sheetrock in showers and by toilets, similar to what builders already do for the future installation of ceiling fans. CHANNELING – When your lot or zoning dictates a two-story design, consider having the architect include a channel between floors that can be used initially as closet space but converted later to a shaft for a home elevator if needed. Are There Any Changes that AREN’T WORTH the Cost? Even a $50,000 remodel for wheelchair accessibility can be financially better than the nursing home native, which can cost over $100,000 per year for a private room and shorten one’s lifespan. Because of the much lower cost of home healthcare, if that’s an native, and the fact that most remodeling projects can be entirely funded with home equity, remodeling can help save the family estate. On the other hand, you might want to question the value of permanent and expensive improvements that don’t add value to the home, especially improvements that scream, “I’m old and frail.” But if you get good advice and plan carefully, you should be able to avoid that problem.  Wayne Caswell