Setting Up Your Home Environment to Live Well with Parkinson’s — Part 3

Setting Up Your Home for Parkinson's 3 Feature - Davis Phinney Foundation

As an architect and person living with Parkinson’s, Duff Balmer has a wealth of ideas on how to create spaces where people can thrive. In part three of this four-part series, we’ve asked Duff to share what he knows about designing a Parkinson’s-friendly space that takes symptoms, lifestyle, and budget into account. You can read part one here and part two here.

If someone is in the position where they are going to move to a more Parkinson’s-friendly home, what are some key things to look for?

With the growing uncertainty associated with Parkinson’s come many questions about the long-term viability of our homes. Deciding whether to stay or leave one’s home is always a difficult and emotional decision but often a necessary step in maintaining a level of independence, particularly when this environment presents increasing mobility and maintenance challenges. These are three key things to think about:

#1 – Stay Well Connected.

The location of your home is especially critical as symptoms become more advanced with Parkinson’s and your ability to drive diminishes. In particular, access to community-based services and transportation should be considered. This naturally favors a more centralized location where these services and amenities are closer at hand and generally within walking distance.

#2 – Make it Easy to manage.

As you consider the need for a more accessible location or layout, this can often prompt a desire to downsize. In these instances, an easier-to-manage condominium, apartment, or retirement complex may offer more viable alternatives. These housing options offer many implicit benefits in that they are typically planned on a single level and in many cases, especially in newer builds, offer the ability to be equipped with accessibility features. This type of housing also often comes with many built-in amenities such as fitness rooms, concierge services, elevator access, and underground parking, which offer another level of convenience and peace of mind for those with Parkinson’s. In many cities across North America, growing demand for affordable housing units is also starting to happen, which will hopefully offer greater equity within the marketplace when finding the right place to live.

#3 – Look for a built-in community.

In many parts of Europe and North America, there is now a growing shift toward co-housing, where multiple generations live in self-contained apartment units while also sharing communal dining and garden/patio spaces. This model of housing offers another level of community integration, where residents informally check in on one another and support each other. As our needs change with Parkinson’s, this model of housing could offer another viable option in creating a better balance between independence and support and hopefully delay the need for institutionalized care.

Does the list of requirements change if I live alone?

The requirements don’t necessarily change. However, if you do live alone, the need to simplify may come sooner as the burden of a larger home or more remote location will likely become increasingly unmanageable. The need for a broad support network outside the home is also that much more critical in these instances. This might include friends, neighbors, family members, a formal care partner, or even a handyman to help change a light bulb or tend to maintenance issues. Location is obviously a key part of this.

The need for adequate communication devices is also especially important when living alone. This could be a phone, alarm button, or medical alert necklace or bracelet. Where these elements are integrated into the space, be sure to place them where the risk of falling is highest, such as in a washroom or at a staircase. Also, have a list of trusted individuals who can be contacted in these moments and make sure they have access to your home. This can provide you, and those who love you, peace of mind.

What should I consider when designing or accessing the kitchen?

The kitchen, often closely coupled with a family room or dining area, is the central hub of most homes. For many, the preparation of food is an important source of satisfaction and expression which contributes positively to overall health and wellness. Adapting the kitchen to your evolving needs with Parkinson’s can greatly extend your use and enjoyment of this space, while also ensuring adequate safety.  Here are five elements to consider when assessing and looking for an ideal kitchen space:

#1 – Create Ease of Access and Movement.

A good flow of space and adequate dimension between counters should be prioritized.  This becomes even more important and reassuring as symptoms progress and you need more assistance. One option is to put the kitchen island on lockable castors so that it can be easily shifted or even removed down the road for better access.

#2 – Make it ergonomically friendly.

It is important to think about ease of reach from both a sitting and standing position to counter space and associated storage areas.  In general, keep commonly used items at lower heights and provide easy glide drawers rather than deep and high shelving. Given the diminished dexterity that comes with Parkinson’s, provide easily graspable handles at cupboards and drawers rather than knobs and, where possible, try to select appliances, such as ovens, refrigerators, and dishwashers, which often have heavier doors, based on ease of operation.

#3 – Design for each task.

When laying out the counter space, sub-divide major tasks, such as chopping, cooking, and washing up areas around distinct zones so that each can be treated as a focused activity. At each zone, locate commonly used utensils and food disposal close at hand to minimize unnecessary turning and distractions that could lead to falls.

#4 – Test it out.

A useful exercise is to try using the kitchen from a seated position at various locations within the space – this is often a good way to identify issues early on, such as oven controls that may be difficult to safely access or under counter lighting that may cause unwanted glare.

#5 – Plan ahead.

As symptoms progress, a greater focus on accessibility should inform the design of your kitchen. Given that these are typically the most expensive spaces within our homes, considering these ‘down the road’ features earlier in the process is often more practical and can avoid costly retrofits and downtime. This might include reducing the height of an island countertop and providing added knee space to accommodate a wheelchair, for example. In the short term, this feature can be used as a dining table with regular chairs as well as a more comfortable sitting height prep area.

Setting Up Your Home for Parkinson's 3 Kitchen - Davis Phinney Foundation
An open-planned kitchen by Haeccity Studio Architecture includes an innovative motorized height adjustable kitchen island for both sitting and standing.

What should I consider when designing or assessing the bedroom?

The bedroom is an important space within the overall home design for those living with Parkinson’s. This space needs to address a series of significant challenges associated with Parkinson’s, including the loss of mobility during OFF times, the growing need to use the washroom at night, and the inherent disruption to sleep patterns. Here are four considerations to keep in mind:

# 1- Plan for Ease of Access.

Plan a direct and convenient path of access between your bed and the bathroom. This addresses the higher incidence of falls that often occur at night during OFF times and in dimmed lighting conditions. Provide night lighting along this pathway, with easy access to light switches and replace hinged doors with sliding pocket doors where possible.

#2 – Design for a Bigger Bed.

Consider transitioning to a wider king-sized bed or push two single beds close together with separate sheets, as this allows you a greater range of movement if you suffer from restless leg, tremors, or REM sleep disorder. This way you can be close to your partner without disrupting their sleep.

#3 – Create a Quiet and Clam Retreat.

Outfit your bedroom with dimmable warm temperature lighting, black-out curtains and blinds, and subdued colors to reinforce your natural circadian rhythms. Where possible, zoning the bedroom to minimize exposure to street noise and direct natural light can also make a big difference.

#4 – Take a Graduated Approach.

As symptoms progress, the configuration of your bedroom space may need to be adjusted, including the type of bed and supportive devices you have. And in the most advanced stages, you may even need to relocate to another part of the house that offers greater ease of accessibility. By thinking of the design in a phased or graduated way, these adjustments can be made more manageable.

Setting Up Your Home for Parkinson's 3 Bedroom - Davis Phinney Foundation
An open-planned bedroom with carefully placed lighting controls by Superkul architects offers increased ease of access.

What are surface transitions and textures and what should I look for when assessing a home?

Providing a smooth, consistent floor surface can help reduce the effort required to walk or wheel within your home. Generally, hardwood, laminate, vinyl, porcelain, cork, or linoleum are all good choices, given their overall consistency of surface and resilience. …and the fewer surfaces the better.

Slip resistance is another important consideration and installing finishes that have some level of texture or cleft in the case of a stone or porcelain tile, or even various hardwoods, can offer significant benefits. This is especially important in zones close to the main entry points of your home where there is greater susceptibility to water penetration.

Where surface transitions do occur within the floorspace, changes in surface level should be minimized and kept to no more than a ½”. In this case, beveled transition strips can be used with a maximum 1:2 slope, so as to not present a tripping hazard or a noticeable obstruction to a wheelchair or walker. These transition strips are widely available and often provided with specific flooring systems.

Seeking advice from a flooring manufacturer or designer, particularly around slip resistance and overall durability with respect to various locations of the home can be incredibly helpful, given the immense range of choices within the marketplace. So too can seeking advice from an occupational therapist to identify specific risk areas of your home.

Are there different types of homes that I should look at when I am looking to rent/buy? What are they and how can I find them?

As mentioned previously, a one-story home is the preferred model, but is often in short supply in more traditional single-family neighborhoods, depending on where you live. At the same time, the choice of moving to a condominium or apartment may force you to move further away from family and friends and come with its own challenges.

Alternatively, there are several new housing types on the market today, which offer new ways to live longer in closer contact with family and community, without necessarily the financial burden of home ownership.

For example, in many municipalities across North America, multi-generational housing is growing in popularity. Through new legislation and relaxed zoning, this is allowing smaller independent accessory units or secondary suites to be built adjacent to or above a principal residence within a shared property. In Toronto, where I live, laneway housing and garden suites are quickly gaining traction, which in many cases offer a more affordable alternative to condominium living and are helping inject new life into many parts of the city.

When it comes to those with health issues such as Parkinson’s, the ability to remain connected with family and community within a familiar setting, while at the same time maintaining a level of autonomy is an attractive option. Given the close proximity or in some cases direct interconnection of units that come with this housing type, this can provide increased peace of mind for family members in looking after those with health issues, especially as more supervision and care are required.

Given that many of these types of units are now being designed specifically around aging-in-place, with built-in accessibility features such as ‘curbless’ showers, these units are proving especially attractive for this segment of the population. Given the growing preference to stay at home over other forms of alternative care, especially in light of the many shortcomings of long-term care facilities that we have seen during the pandemic, I hope these new housing types will continue to increase in demand in the future.

Setting Up Your Home for Parkinson's 3 Sketch - Davis Phinney Foundation
City of Toronto laneway housing requirements.

What are SMART homes and what are some SMART features that have the biggest impact on people living with Parkinson’s?

SMART systems within the home have become increasingly popular and cost-effective in recent years and offer many ways to automate the systems and devices of the home for increased safety and security. These SMART systems can be pre-programmed to control such things as lighting, security, and thermostats, and they can be connected to a smartphone for remote operation and monitoring.

Use of SMART lighting for example can allow you to put lighting on schedules, have lights triggered by movement or other devices, or simply turn them on or off as needed. This is often integrated through SMART in-wall light switches, replacing conventional switches, which enable this enhanced capability, while at the same time allowing lights to be manually operated. Smart lighting is especially useful when mobility and or dexterity become a problem over time.

Additional home safety features include SMART plugs which allow electrical devices such as heaters to be automatically turned off or to turn on low-level hallway lights at specific times. These devices can be controlled by means of a smartphone and can be paired with voice control for added flexibility. Similar technology can also be applied to appliance monitoring such as stove sensors which can provide an alert if gas has been left on. These systems are generally more expensive than other monitoring devices such as SMART smoke detectors or CO2 sensors, and they often require professional assistance to install.

Beyond the safety and security benefits, SMART systems can also play a key role in your ability to communicate. Here, home features hard-wired with SMART communication technology can be used. These more permanent systems are particularly important where hand-held devices are impractical such as during an online fitness class or where tasks are more complex and require more focus such as in the kitchen. These systems can also be more easily customized to address potential impairments such as loss of voice audibility, which may require a more sensitive microphone as an example.

In general, automated systems can help bolster your confidence with Parkinson’s and allow greater flexibility in the lives of your care partners. When considering these systems, given the wide array of options and features, it is often helpful to consult with a home automation specialist to ensure they are integrated in the simplest most user-friendly way.

There’s more to come

This is the third post in our series, “Setting Up Your Home Environment to Live Well with Parkinson’s.” You can read the first post in the series here and the second one here. In our final post in the series, we will share information for people interested in the broader social and environmental implications of living well with Parkinson’s.

Duff Balmer is an architect, designer of living spaces, and person living with Parkinson’s. In dealing with his own diagnosis, symptoms, and future, Duff has begun imagining the many ways that living spaces can be re-imagined, re-designed, or re-configured to accommodate the needs of those with Parkinson’s. “Setting Up Your Home Environment to Live Well with Parkinson’s” is a four-part series presenting philosophies, strategies, and design recommendations to make homes safer, more efficient, more comfortable, and more conducive to supporting the needs of those living with Parkinson’s.

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