Author: Jane Bringolf

Ageing in place, ageing and place

A fireside, a hot drink in a mug and slippered feet up on the recliner.Ageing in place and ageing and place are intertwined but distinct. Both place and home need to support people as they age – one is insufficient without the other. Generally, ageing in place means ‘staying put’. That can mean the staying in the same home or staying in the same community or neighbourhood. 

Research with older people suggests that ageing in place is more nuanced than just a home or neighbourhood. It’s also about personal and cultural values, priorities and connections to people and places. It is layered with social, material and symbolic meaning. And it’s about having choices about where and how to age. 

Janine Wiles and Tara Coleman found that older people valued highly the ability to have choices about their living arrangements and access to services. Familiarity and connections brought a sense of belonging and security. 

Meaning of home

Housing is basically an infrastructure concept whereas home is where personal routines and interactions take place. This is what brings meaning. This is why we become attached to places. Wiles and Coleman found that this sense of attachment has positive functional, physical and mental health outcomes all contributing to wellbeing. 

Home maintenance

The ability to carry out maintenance tasks contributes to attachment. However, when these tasks become difficult, either through ability or financial constraints, the sense of home is disrupted. Homes in disrepair are not only hazardous but lessen the attachment to the home. 

‘Home and aging’ by Wiles and Coleman is a chapter in Handbook on Aging and Place. Editors are Malcolm Cutchin and Graham D Rowles. It is available for purchase from ElgarOnline. 

Chapter Introduction

Home is a concept both underpinning and animated by ideas about ‘aging in place’ and experiences of place and aging. Home is an important resource during older age. At a time when people typically face changes and challenges, having a secure sense of home and strong attachment to place can give a sense of agency, autonomy, and resilience. A sense of home is intricately entwined with our preferred sense of who we are, and with how we build and sustain relationships with others and with places. Conversely, disruption to the sense of home can create instability and accentuate the feeling of being ‘at the end of life’ or of vulnerability and fragility.

Legal documents favour visible disabilities

A man's hand is writing the word regulations in large script style writing.Norway has been following the underlying concepts of universal design for 25 years. This means they have a history of policy and activities to reflect upon. Previous papers have highlighted successes and where there is room for improvement. A new Norwegian study looks at universal design through a legislative lens and finds legal documents favour visible disabilities. 

In more recent years, people with invisible disabilities have raised their voices in the disability rights movement. However, their voices are yet to be incorporated into legislative documents. Historically, people with mobility and vision impairments led the way in disability rights. This means their needs were front of mind when legislation was formed. 

The Norwegian researchers wanted to find out if there is a “disability prestige” at play. This is where some disabilities count more than others. Or is it something as basic as just having your disability visible to others? The researchers concluded that visibility was more important to explain discrimination between groups. 

The Norwegian study can be generalised to many other countries. In Australia the Access to Premises Standard also favours people with mobility and vision impairments. 

The Norwegian researchers carried out their study in the context of transport. They discuss the wording of documents and how terms such as “reduced mobility” are interpreted. It can mean a person with a physical and/or a cognitive impairment. However, it is most often linked to movement of the body. 

Prestige versus visibility

In the Norwegian documents mobility impairments are mentioned more frequently than other disabilities. Vision impairments, also frequently mentioned, come in second. The researchers conclude that discrimination between disability types is mostly explained by the visibility of a disability.  

Why does this matter? Because when provision for other disabilities and long term health conditions are not mentioned in legal documents, businesses and services don’t provide them. 

The title is, How laws of universal design discriminate between different types of disabilities – Lessons learned from Norway.

Air travel with a wheelchair

Air travel is an anxious affair for many, but for people with disability the worries are multiplied. The Australian Government has produced an Aviation White Paper which highlights the difficulties people with disability experience travelling by air. For wheelchair users, the US Transport Board’s report found there is no engineering reason why power chairs can’t be secured in the aircraft.

Melbourne Airport trials disability access hubs

Beginning from September 2024, Melbourne Airport will trial a four-month Airport Assist program. The program will help passengers navigate the airport precinct, check-in and pick-up and drop-off zones.

The hub is open from 10am to 6pm and offers buggy transfers between T4 ground transport areas and departure areas. It will also have lanyard for the Hidden Disability Sunflower Program.

A man sitting in a wheelchair is talking to a woman standing at a kiosk. The sign says Melbourne Airport Assist.

Air travel with a wheelchair

Wheelchair users can stay in their powered wheelchair in taxis, trains and buses, but not in aircraft. Every wheelchair user takes a deep breath and hopes their wheelchair will come through the flight without damage. The risk of personal injury in wheelchair to seat transfers is also a worry. The other inconveniences and indignities just add to air travel with a wheelchair.

Currently, people are potentially put on a flight in a seat that is not appropriate for them. Travellers and airlines risk injury in transfer and in flight. It also risks serious damage to their wheelchair which is set up for their individual requirements.

Close up of a row of aircraft seats which are bright blue with grey backs.

Preliminary research from the US Transport Research Board (TRB) found no major design or engineering challenges stand in the way of securing personal power wheelchairs in commercial aircraft. The TRB concluded that installing wheelchair securements is a win-win for wheelchair users, airlines, and everyone else involved in transporting wheelchair users. Consequently, that means it is up to the willingness of airlines to make the necessary changes.

No major design or engineering challenges stand in the way of securing power wheelchairs in commercial aircraft.

Transport Research Board.
Photo credit Heike Fabig (in Daily Mail)
A 12 year old girl is distressed in an aircraft aisle chair after her power wheelchair was taken away.

Airport experience begins arrival kerbside

While there are mandates for minimum standards for the built environment, airport layout design make life difficult for people with disability and older people. Many airports were designed decades ago when traveller comforts were not considered. Arriving kerbside or at the drop-off is where the problems begin.

Assistance is not available outside the terminal entrance which becomes the first hurdle to overcome. In many instances, help is not available until check-in processes are complete. A kerbside or drop-off check-in would solve that. Or at least provide a means for travellers to contact service staff to help them from the kerbside point.

The US Airport Cooperative Research Program has a detailed report that identifies the issues and provides solutions. The title of the report is, Assessing Airport Programs for Travelers with Disabilities and Older Adults. The aim is to assist airport designers and airline operators to make their places and services accessible and inclusive. There are 8 chapters to the report.

Airport facilities

Chapter 7 of the report is about Facility Accessibility. It begins with access on arrival at the airport and the provision of accessible ground transportation. The advice for the design of terminals is to adopt a universal, inclusive approach. That includes addressing long distances between the key points for travellers who don’t use a mobility device.

Self-service kiosks, elevators, power outlets, seating and lighting, along with catering for people with a diversity of cognitive conditions are covered in detail. Case studies provide information about restrooms, adult sanitary change facilities, provisions for assistance animals, and quiet rooms.

August 2024 Update

The Commonwealth Government is proposing to update the transport disability standards to include aviation standards. The standards will require airlines to set up assistance profiles for passengers which lists what they need. The list could include things like wheelchair battery specifications and assistance animals. The two wheelchair policies will also be under review. A new Aviation Ombudsman will replace the industry-funded Airline Consumer Advocate. This information was taken from a Crikey article.

Financial inclusion for all

Looking upwards to the gable of a federation building with the name Bank on it.Financial inclusion should be a top priority for policymakers keen to alleviate poverty. Five of the Sustainable Development Goals feature financial inclusion, including reducing gender based inequalities. Access to financial services is a human right but overlooked for people with disability. 

Financial services include banking, credit, insurance and financial advisors. Each of these should be readily available to everyone. A literature review identified five key barriers:

  1. People with disability have a lower demand for formal financial services than those without disability
  2. Banks do not expect or welcome customers with disability
  3. More appropriate technologies are needed to overcome communication barriers because communication technology (ICT) fails to meet the web content accessibility requirements 
  4. Financial services are not tailored to meet the needs of people with disability 
  5. The formal financial system requires accessible public infrastructure to include people with disability.

What are the solutions?

Multi-stakeholder collaboration to counter stigma and attitudinal barriers is the starting point. Financial education and accessible assistive technology and ICT is essential as well as the physical environment of financial institutions. 

The title of the research article is, Financial inclusion for people with disability: a scoping review. 

From the conclusion

Access to financial services is a human right that seems to have been overlooked for people with disability. The push for financial inclusion of people with disability is a matter of economic strategy as well as a moral imperative rooted in justice and equity.

The financial sector’s landscape, shaped by innovations in ICT, provides an unparalleled opportunity to bridge the financial divide faced by people with disability. However, it will take more than technological advancements to solve the problems.

True financial inclusion necessitates a paradigm shift in attitudes, policies, and strategies. Our findings underscore the urgency to redesign financial systems that are accessible to all and cognisant of the preferences and needs of people with disability.

Addressing the multiple dimensions of financial exclusion of people with disability requires a comprehensive, multifaceted approach, integrating attitudinal change, ICT accessibility, and a commitment to disability justice. There is an emphatic call for banks, policymakers, and society to converge their efforts.

From the abstract

Financial exclusion is a human rights issue affecting health equity. Evidence demonstrates that financial exclusion is exacerbated for people with disability and those in low- to middle-income countries. Barriers to financial access include limited demand for services, banking inadequacies in catering to people with disability, and insufficiently accessible information technologies (ICT) and infrastructure.

Recommendations include using ICT, digital innovation and multi-stakeholder collaboration to address the financial barriers experienced by people with disability. These efforts, rooted in social justice, aim to include people with disability as valued financial sector participants, promoting health and equity.

 

Inclusive urban environments: but when?

An urban street scene showing tall buildings, some traffic and people walking on a pedestrian crossing.The design of the public built environment has long been problematic for a diverse range of people with disability. And while attempts are made with new or upgraded precincts, barriers are still created. While this is often unintentional, once the concrete is down, it is difficult and/or costly to remedy. And so the barriers remain and inclusive urban environments remain a dream for the future.

A team of researchers from the UK, USA, and Pakistan carried out a qualitative research project with people with disability. The results are not new but confirm existing research and the experience of users. One area not often mentioned in previous research is the role of legislation and accountability.

The research paper discusses the state of play and the methods they used. The text contains quotes from participants which personalises the information. The research was carried out in two urban areas in the UK.

Footpaths, seating and toilets

Top of the list of physical barriers was footpaths and the opportunity to rest on a seat. Road crossings was the top hazard for most participants even when signalised. Unexpected maintenance work was also considered dangerous for wheelchair users and people who are blind.

Despite having a legislative framework and access standards, local authorities seem unable to provide accessible environments. Some issues such as footpaths linking with road crossings mean that two authorities are responsible.

Transport barriers included physical access to public transport, lack of information, including cost, and bus driver attitudes. Access to public toilets was also raised. The paper has more detail on the attitudinal barriers and service barriers.

From the conclusions

Barriers are interrelated in many cases, but most are related to poor physical designs, inadequate policy considerations and negative attitudes. The findings reinforce previous research but with a user’s perspective. People who are deaf or hard of hearing are mostly absent in the literature. This is because it is assumed they are safe from physical obstructions. However, they experience their own barriers to inclusion.

The title of the paper is Designing out Barriers for Disabled: Towards an Inclusive Urban Environments.  Note that the preferred language in the UK is disabled people rather than people with disability. 

From the abstract

People with disability often struggle with the complexities of the built environment, hindering their full participation in everyday urban life. Accessibility and social inclusiveness are major challenges for active participation for people with disability.

The lack of legal obligation for authorities to implement inclusive solutions, and lack of training in disability awareness has led to environments full of barriers for the disabled community.

The research explored the nature of barriers faced by persons with diverse disabilities by highlighting a user perspective. The barriers fell into four categories: poor physical design, inadequate policies, negative attitudes, and absence of technical solutions.

Recommendations to overcome the barriers are presented in the research.

Older people, mobility and cars

An older man in a blue and white t shirt sits at the wheel of a car and is driving down the road.The policy push to encourage people to walk and use public transport is one way to reduce emissions and improve health. However, whether to choose the car or public transport, or not to go out at all, depends on many factors. So, do people choose the car because they are constrained from using other forms of transport? Or do they use the car because it just suits them better? 

A review of the literature found that people with poor health, older age, low income and lack of access to a car are less likely to get out and about. Difficulties with public transport are linked with walking difficulties. So the design of the public transport system itself is not the total problem. 

Some retirees might engage in several activities in one day making public transport a time consuming business. On the other hand, some retirees may only leave the house for medical appointments and grocery shopping. The paper based on the literature review goes into these issues in depth. 

Some conclusions

Policies aimed at reducing car usage by older people with physical and mental impairments, must be approached with caution. Car mobility represents a crucial means of maintaining independence for older people. 

The advantages of allowing older people to drive, despite minor disabilities, often outweigh the risks they may pose to themselves and others. It is noteworthy that France, togethr with the Netherlands and the UK, are nations with the most lenient procedures and minimal medical examination requirements for driving license renewal. However, these countries also report the lowest fatality rates for car drivers within this age group.

The links between mobility, safety, and older people shows that people aged over 65 are considerably more vulnerable to fatal incidents as pedestrians than as drivers. So there is an intricate balance between considering the mobility needs and safety of the older drivers and pedestrians.

Universal design helps

Researchers found that physical difficulties are contextual, and decrease when universal design measures are taken. Universal design is not a luxury for a few individuals. Physical accessibility helps a lot a people to move around more smoothly and comfortably. 

The title of the article is, Older adults’ immobility: disentangling choice and constraint. It looks at people who are not in the workforce and spend most of their daily lives in their homes.

In a nutshell: the motor car becomes a mobility device as people age and walking becomes more difficult. 

From the abstract

Our research challenges the prevailing notion that immobility only occurs in exceptional circumstances. Our work shows instead a close link with individuals’ activity levels and constraints on their schedules.

Retirees and non-working population groups exhibit higher immobility levels than workers. This is influenced by factors such as poor health, old age, low income, lack of access to a car, or rural residency.

Driving and walking difficulties are significant contributors to immobility, with age being a primary explanatory factor. However, living in dense urban areas tends to reduce immobility levels across household categories. Difficulties with public transport, as such, do not trigger immobility, but they are entangled with walking difficulties.

Implications for public action include targeting age-specific interventions for reducing car dependency, and approaching policies aimed at curbing car use by older people cautiously.

Implementing universal design measures to enhance physical accessibility also helps to make mobility smoother and decrease perceived walking difficulties. Finally, this paper underlines the interconnectedness of mobility, social isolation, and sedentary lifestyles.

University for all toolkit

Front cover of Unlocking Inclusion: Toolkit for Universal Design in Higher Education. The concept of Universal Design for Learning (UDL) has been around for a long time. UDL is not a special type of teaching method for certain groups. The principles are applicable to teaching and learning across schools, universities and workplace training. A group in Ireland has devised a university-for-all toolkit to show how to do it. 

The Toolkit is designed for university leaders, faculty members, and professional and administrative staff. By moving the focus away from deficits, universal design shifts the focus to proactive inclusive design.

The aim of the guide is to show how Universal Design for Learning can transform institutions into inclusive learning places. Using examples of good practice from both national and international institutions, it brings together universal design expertise from around the world.

The Toolkit includes self assessment activities and case studies. It covers institutional foundations such as leadership, approaches to access and inclusion and strategic planning. The four pillars of universal design for learning in higher education are explained in detail. Briefly they are: 

Adults seated at tables in a classroom setting looking forward to the instructor at the front of the room. university for all.

  1. Learning, teaching and assessment, curriculum review.
  2. Student supports, services and social engagement, library services
  3. Physical campus and built environment, challenges and solutions
  4. Digital environment, websites, social media platforms

The title of the publication is, Unlocking Inclusion: Toolkit for Universal Design in Higher Education. 

Additional information about the online training program and how to make the training and the toolkit suited for other nations.

The 2 minute video below provides an overview of the purpose of the Toolkit. 

 

Go-along techniques inform design

There’s nothing like getting instant feedback as people negotiate the built environment. Go-along techniques inform design because they really get to the key points. Some of the exclusions are only obvious when pointed out and that’s valuable information.

The go-along technique is where researchers walk with the participant and observe the barriers they experience as they encounter them. The dialogue that ensues provides rich information about design – how to do it and how not to do it.  

Image taken from the research paper 

Researchers in Sweden used this method and found there is an ongoing multifaceted exclusion of citizens in the built environment. This is despite current building regulations. Also, it doesn’t meet the aim of inclusion and international conventions. 

However, there are opportunities to change this with knowledge about enablers in the built environment. The researchers point universal design as an important planning variable to bring about change.  

The research paper has a lot of excellent information, much of which planners and disability advocates hear anecdotally. This paper documents the issues well and in detail. 

The necessary enablers

Benches, or seating were the most mentioned during the go-along activities. These are a decisive factor for spending a day in the city centre. People would walk more if they could also sit. 

Access to public toilets was also critical. Finding them, having access, and in some cases, navigating payment systems all pose problems. Again, another factor in visiting the city. 

People who live outside the city centre need flexible mobility systems – public transport, plus being able to use a car and then parking the car. 

Lighting in public places, clear signage and orientation board were also important along with handrails in challenging environments. 

Planning process needs a re-think

The researchers argue that there is an urgent need to rethink the planning processes to account for human diversity. It’s essential to move away from notions of an ‘average’ person or the idea of normal.

There is a gap between what building regulations state as accessible and the the lived experience of accessibility (or inaccessibility).  As the researchers say,

 “The pointing out of the necessary enablers is important knowledge to achieve accessibility also in an overall, entire-city-perspective. The concept and practice of Universal Design is a key to pursuing such a development.”

The title of the research paper is, Is the City Planned and Built for me? Photos highlight some of the key issues experienced by participants. There is a lot of really good information in this paper. 

Design skills in healthcare

Does the design of medical products impact on the safety of patients and health practitioners? The answer in many cases will be, yes. For patients it affects everyday medical items like respiratory equipment. But the real issues are for health practitioners. That’s why we need design skills in healthcare. Authors of a recent paper discuss some of the issues. They note that when design unwittingly excludes whole groups of users it becomes bad design. Medical products and services designed to best fit a Caucasian male body type means a poor fit for others.  The authors provide an excellent example of where a design is potentially dangerous. “In one example, the only green button on a defibrillator switched the device off, whereas the only red button was for shocking. In simulated A wall mounted defibrillator in bright orange.emergency situations, it was no surprise that some participants pushed the green button and inadvertently switched the device off when intending to shock.”  Co-design is considered the appropriate approach in healthcare services, products and building design. It enables stakeholders in healthcare sciences and delivery to provide input at the early stages of design. Although co-design is accepted as a good idea, design skills are yet to be emphasised and captured in co-design processes.  The title of the paper is, Design as a quality improvement strategy: The case for design expertise

From the abstract

Bad design in safety-critical environments like healthcare can lead to users being frustrated, excluded or injured. In contrast, good design makes it easier to use a service correctly. Design impacts on both the safety and efficiency of healthcare delivery, as well as the experience of patients and staff. Co-design as an improvement strategy has gained traction in the healthcare quality improvement literature. However, the role of design expertise and professional design is much less explored. Good design does not happen by accident: it takes specific design expertise.  We define design, show why poor design can be disastrous and illustrate the benefits of good design. We argue for the recognition of distinctive design expertise and describe some of its characteristics. Finally, we discuss how design could be better promoted in healthcare improvement.

Residential spaces for healthcare

An Introduction to Inclusive Healthcare Design By Kiwana T. McClungAn Introduction to Inclusive Healthcare Design is a book with more articles on healthcare design. It includes the built environment, allied health, social care, and urban studies.  One chapter, The Design of Residential Spaces for Healthcare, looks at homes and residential spaces for delivering healthcare. 

Stroke Toolkit co-designed

The Canadian Stroke Toolkit for Aquatic Rehabilitation and Recreation Therapy (STARRT) was devised using a co-design method. The STARRT website has a section on the process as well as using the toolkit. Briefly, the method has four parts:

    1. Scoping review focused on the implementation of the therapy
    2. Qualitative interviews with participants post-stroke and professionals
    3. Participatory design with design team and consumers for the toolkit
    4. Prototyping and dissemination of the toolkit.

Playgrounds: universal design not enough

A girl sits on the ground in a playspace. She is smiling at the camera. Universal design is not enough for inclusion.
Image from “Everyone Can Play” guide.

Children with disability are often excluded from playing at playgrounds due to design limitations. Of course, one solution includes building playgrounds using a universal design approach. However, playgrounds with universal design features are not enough to make an inclusive space. 

Universally designed playspaces bring play into the lives of families with disabilities. They also provide opportunities to champion disability advocacy, and support disabled children in developing critical social skills. However, additional work and resources are needed to achieve full social inclusivity.

Distance shot of children on a carousel or spinner
Image: Livvi’s Place Carousel

Findings from a Canadian study can help guide designs of future playgrounds and other community spaces to improve inclusivity for everyone. 

This paper begins with the playground experience and universal design and then applies this to other public spaces. 

The title of the article is, Understanding the experiences of parents of disabled and non-disabled children at playgrounds designed for disability inclusion. There is no free access to this publication in Disability and Society. However, you can request full access from ResearchGate. 

From the abstract

Disabled children and their families are often excluded from community play opportunities, including playgrounds. One potential solution is, of course, to design inclusive playgrounds.

This study explores the experiences of parents of disabled and non-disabled children at playgrounds inspired by Principles of Universal Design. Participants were 29 parents (16 with disabled children). They were located across four Canadian cities with newly built inclusively designed playgrounds.

Three themes were identified which provide deeper understandings of ableism in community playspaces and the impact on children and their families. 1. Inclusive playgrounds also act as a platform for disability advocacy. 2. They provide opportunities for social and emotional development. 3. Inclusive play may influence family dynamics.

Findings highlight the value of universal design, but indicate that physical environments alone do not ensure social inclusion, as social barriers can continue to exist even in spaces purposefully designed for disability inclusion.