are located at the front of the stove. The location of the knobs ensures safety, and the size will be easy to manipulate in the future. Lighting concerns in the kitchen are the same for any room in the house. Placing lights above workstations and in cabinets and dark pantries will help illuminate the area. Kitchens typically have a natural light, which should be taken advantage of through skylights and the use of blinds and shades to reduce light angles. Before changing light sources, analyze the shadows from current light fixtures and see if a change in light bulb does not solve the problem. It is ideal to spread the light as evenly as possible across the kitchen. Adhesive puck and rope lights can be used to increase lighting and create task lighting; other light sources, such as light bars, can be installed and may require the use of an outlet or electrical work. Entryways Difficulty exiting and entering the home is one reason older adults become housebound. Ideally at least one entrance to the home should have no step to enter and enough space for the door to open and not block the person or hallways. During the home assessment, the clinician should check that sidewalks, porches, and handrails are in good condition so as not to pose an extra safety hazard. Ideally, the entryway should be covered as weather protection. Homeowners can speak with the local post office to move mailboxes from the curb to the front door. The post office should review the request with provision of appropriate documentation from a physician that indicates the homeowner’s inability to access the mailbox safely. The new location of the box should be accessible to the homeowner; at times, people move it without considering its use, making the relocation moot. Installation of a package shelf at the entrance also helps older adults. They can place purses, bags, etc. on the shelf by the door, allowing them to safely retrieve their keys and manage the door. For those who have permanent steps, vertical platform lifts can be installed.
Figure 8: Stove Controls
Note. From Western Schools, © 2018.
These are especially common on inner-city row homes in certain parts of the country. With the doors themselves, no thresholds are best to reduce tripping hazards. However, thresholds do keep drafts and debris out while delineating different rooms. If thresholds are needed, they should be less than ¼” high, or ½” high with an angled edge and a 45° slope. If they are too big or steep, people will trip on them, or not be able to ambulate over them with mobility devices or wheelchairs. People have many options when it comes to doors. Each has its own unique properties to be considered given the space in the area, the person’s preferences, and current and potential needs. A common issue with doors is the width of the doorway. ADA requires 36” in public buildings; this is too wide for resident homes. In residences, 32” often suffices. If more space is needed and it is not possible to widen the doorway, installation of an offset door hinge will widen the door an extra two inches. Door hinges can also be replaced with double hinge door hinges to allow them to swing in either direction. Table 3 compares door types in more detail.
Table 3: Door Comparisons Door Description
Considerations
Standard Swinging door, will swing into or out of a room depending on hinge.
May be narrow or swing into spaces. The swing of the door may block other entrances or cabinets. Easy to maneuver when moving in the direction of the door swing.
French
Two doors that swing in one direction. A door that swings in both directions.
Provides a wide opening for access. They tend to have one direction of swing and require manipulation of both doors for full access. These are common in kitchens. People will always be moving in the direction of the door swing. Multiple door swings increase the risk of being hit by the door. Magnetic door holders are available in hardware stores. Space is needed in the wall to install; however, it eliminates door swings. The pull inside the door can be hard to access; some models now have a push button that releases a larger pull that is easier to use. The lateral weight shift required to manipulate the door may cause a fall. Same concerns as a pocket door. Added concern of space needed on a wall for when the door is open. Typically in pairs and found in utility areas of the home. The knob on the door may need to be replaced with a D handle. They require several inches of space on each side of the doorway and at the fold when opened, but this is less than a standard door.
Double hinged
A door that slides out from a slot in the wall.
Barn
A pocket door located on the outside of the wall. Door that folds in half longitudinally when opened.
Bifold
Floors and walls With floors and walls, busy patterns should be avoided and contrast with furniture and possible handrails considered when choosing patterns and colors. Satin, eggshell, and flat paint finishes create less glare and are therefore easier on the eyes than a semigloss or gloss paint. A hallway can seem bigger with the use of light colors, and the use of a darker color on one side reduces the tunnel effect in longer corridors. The darker color also can provide direction for someone who may have vision or cognitive deficits.
As mentioned earlier, avoiding glossy tiles and utilizing matte finishes reduces glare and discomfort on people’s eyes. Wear and tear with extended use should also be considered depending on the location and use frequency of the area. High pile and textured carpets can be very difficult for people to navigate once they require a wheelchair or walker, and are therefore best avoided. A clinician should also pay attention to dark colors in carpets and tiles, because these may look like holes to people with dementia or vision deficits. People
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