Aging in Place & Visual Impairment

Aging in Place & Visual Impairment

When making home modifications for elderly people, we always have in mind current or future visual impairment.

Understanding Visual Impairment

Visual impairment is not at all the same thing as blindness. There is a range of visual impairment ranging from low vision to total blindness. In fact, of all the people with visual impairment, only about 15% of them are totally blind, that is with no visual perception at all.

This means that there is a great deal that can be done to improve the living environment of the 85 % who are in the category of low vision or partially sighted.

It is especially important to understand visual impairment in the context of aging in place, which is a major theme on this site. This is because ultimately all of us will become visually impaired.

Everything we talk about here is also related to aging in place. Most of the home modification recommendations for aging in place apply to the visually impaired.

• Related post: How to Remodel for Aging in Place

Visual impairment occurs naturally as we get older and independently of any disease of sight. An elderly person in good visual health needs almost three times the lighting as one in his late teens or early twenties. This is because as we age the amount of light that reaches the back of our eyes decreases, which makes objects look dull and less defined.

Remodeling for the Visually Impaired

A remodeling project for low or no vision people focuses on two areas:

1. Enhancing the visual experience to maximize the use of remaining sight, and
2. Enhancing the tactile experience of the home as an aid to getting around without sight.

This has the twin purpose of making the home safer and easier to navigate – with safety being paramount.

The Macro and Micro Home Environment of Visual Impairment 

Changing the home living environment to suit the visually impaired is a very big subject.  So it is important to distinguish between the macro and the micro parts of this effort.

An example of the micro part would be the various ways to mark clothing and tag kitchen utensils to make them easy for the visually impaired to work with them.

An example of the macro part would be making sure that the home’s infrastructure, such as the lighting system, is optimized for the visually impaired.

As remodelers, we are concerned with the macro part of this picture. It is the most important part because it provides the foundation upon which all the micro parts of the effort are built.

Nonetheless, our remodeling work must pay attention to and accommodate the micro parts of the project. And so that we don’t lose sight of them, we have provided a checklist of the major micro items further down in this post.

Enhancing the Visual

Proper lighting is important regardless of visual impairment. It reduces eye strain and fatigue; it reduces the chance of accidents and injury, and helps in the accomplishment of specific tasks. This is probably the most important contribution of remodeling for visual impairment.

• Related post: How to Design Lighting for a Remodel Project

For people with vision loss, adapting to changes in lighting becomes difficult. It affects balance and can lead to falls.

Ambient Lighting

Ambient light is a general light that brightens a large area. It helps with mobility because it aids in identifying obstacles to movement.

Pro tip: make sure the ambient light spreads evenly throughout the room. Place the light source in such a way as to reduce the creation of shadows. You want to avoid overly bright and dark spots in the room.

Task Lighting

A task light is one that focuses on a specific area allowing one to accomplish a given task, usually related to food preparation, reading, writing, crafting, etc. Task lights, except for kitchen and bathroom applications, are not permanently mounted. They will be table lamps or floor-based gooseneck lamps. However, depending on the planned location of portable task lights, the remodeler must make appropriate provision for wall or floor sockets.

Pro tip: the location of the task light matters. Do you want it for a recliner? For a table? When using a magnifier? Adjustable lighting will help you position the lamp better for your task. The worst possible place for a task light is directly behind the shoulder. This throws reflected glare directly back in your face.

Here is an example of good portable task lighting available on Amazon: Brightech LightView Pro LED Magnifying Floor Lamp

Accent Lighting

Accent lighting is used for such purposes as enhancing the appearance of artwork. It is not of paramount importance in creating a good environment for the visually impaired but it can be an important contributor to the overall ambient lighting in the home.

Lighting No-Nos

• Do not use ambient lighting as task lighting. If the distance from the light source to the task is too great, there will be insufficient light for the project.
• You should not be able to see the bulb when a task light is properly positioned.

The Language of Lighting

• Wattage: the amount of energy that produces the light
• Lumen: the brightness of the bulb
• Kelvin: the color temperature on the Kelvin absolute scale of temperature. A lower Kelvin (2700K – 3000K) is “soft white” and adds a warm, yellow/reddish color to the white. A “bright white” is at around 4000K.  A higher Kelvin (5000K+) is “Daylight/Full Spectrum” and gives off a cool, bluish-white tone.

Important note: One should avoid going over 5500K, as this is in the blue-violet range and produces glare. Individuals with vision loss may well have a preferred (more comfortable) color temperature depending on their condition and should consult their specialist on this.

Artificial Light Sources

We look for artificial lighting with high lumens and low wattage, that is, bright light with high energy efficiency. Here is a brief rundown of available types of light sources:

• Incandescent bulb (regular light bulb): this is inefficient, creates light by heating wire within the bulb and does not provide adequate lighting when compared to alternatives.
• Halogen: a type of incandescent bulb that uses a halogen gas atmosphere within the bulb. It is more efficient than the regular light bulb but puts off a lot of heat.
• Fluorescent: typically found in commercial buildings and characterized by long bulbs containing argon or mercury gas. Causes the most glare. Produces UV rays. It is known to bother many visually impaired people.
• CFL (compact fluorescent): more energy-efficient than incandescent bulbs. It also produces UV rays. Considered a mercury hazard.
• LED (Light Emitting Diode): long lifespan, durable and low maintenance. No heat or UV rays. Saves energy. Comes in a variety of Kelvin.

In our opinion, when remodeling for visual impairment, LED lighting is the only way to go. This is because the great variety of available Kelvin can be made to suit individual vision comfort preferences. There are other good reasons too.

Lighting Installation

Replace all lighting with high lumen, low wattage, dimmable LED lights (use dimmable lights to accommodate household members who are not low vision and do not need or want intense lighting).

Use Occupancy Lighting

Occupancy sensors turn lights on when someone enters a room and then turn them off when they leave. This is convenient and energy-efficient and saves the visually impaired from having to grope for a light switch.

• Replace old switches with rocker-style illuminated switches.
• Install lighting in stair risers or illuminate stair treads with, say, LED ribbon.
• In kitchens and bathrooms, install fixed task lighting in areas such as under cabinets, around mirrors, over food prep areas, over sinks, and over stovetops.

Maximizing Natural and Reflected Light

And let’s not forget the best light of all-natural light. Whenever we can, we should work on increasing the amount of natural light that enters different parts of the home and is then reflected around the home.

In ascending order of expense, this would include:

Using paint

• Starting with the outside, paint the underside of your eaves or roof soffit white. This has the effect of increasing the reflection of light through windows.
• Use light and bright paint colors on walls and ceilings. Paint has what is known as a Light Reflectance Value (LRV) which is scaled from 1% for pure white to 100% for black and with values for all other colors falling in between. Ceilings should for sure be painted white.
• Use gloss paint: the higher the gloss, the higher the LRV. And, on a practical note, it is also easier to clean.

Using reflective materials

Installing glass, glossy ceramic, or metallic tiles in kitchen and bathroom back splashes.

Replacing windows

1. Thick mullions or sashes restrict the passage of natural light, and so do very Low-E coatings. Discuss alternatives with an experienced window company.
2. Installing new windows or replacing sections of the exterior wall with glass block.
3. Installing skylights. Skylights are a very effective way to bring in natural light to targeted areas.

Using Colors

The use of colors in a remodeling project for the visually impaired goes hand in hand with considerations of lighting.

Solid bright colors (red, yellow, orange) reflect light well and help the visually impaired see things better.

Use contrasting colors: For example, a dark solid colored border around a white light switch will make it stand out. And a contrasting color nose tile on a step is a good safety measure. Floors and walls should be in contrasting colors. And in bathrooms, porcelain plumbing fixtures should not be the same color as the walls or floors.

In the kitchen and bathroom: Use contrasting colors to make cabinetry hardware, plumbing fixtures, and appliance fronts stand out. Also make sure the countertop not only contrasts with its surroundings but is also a light color with no confusing patterns, to make it easier to see the working surface.

If there are glass patio sliders, decorate them with contrasting color decals to help awareness of the presence of glass..

• Related post: How to Use Color in a Remodel Project

Enhancing the Tactile

Unlike vision, the sense of touch does not diminish as we get older. So as visual impairment increases so does the reliance on touch increase as we find our way around the home.

The remodeler is relatively limited in the tactile department when compared to the visual but nonetheless, can make an important contribution in these areas of home navigation and safety.

• Use contrasting floor surfaces. Tiled areas and carpeted areas provide useful landmarks for the visually impaired. Many homes already have this. For example, changes in the floor surface can indicate a transition from a hallway to a bedroom.
• Install non-slip tiles in showers.
• Install grab bars in bath and shower areas.
• Install handrails on both sides of the staircases.
• Use an induction cooktop to reduce the risk of accidental burns. Otherwise, avoid using a flat-topped range so that there is a change in texture to indicate the presence of burners.
• Install tactile overlay stickers or bump dots on appliance controls, for example for the microwave.
• Use tactile materials, such as textured wallpaper, in designated areas. An example would be a strip along a hallway at chair rail height.

The Details of Organizing for the Visually Impaired

As we go about our task of remodeling for visual impairment, we need to bear in mind and, to the extent we can, facilitate all the supportive things that should be done when we are finished. Here is a 21-point checklist of the main items:

Furniture Arrangement

1: When choosing new furniture select items with textured upholstery. This makes it easier to identify them when you can’t see them well.

2: Locate chairs near windows so you can read or work with the benefit of natural light.

3: Place dark chairs in front of light walls and vice versa.

4: Put colored lamps or vases on tables close to major furniture items to help you identify them from a distance.

5: Use dark-colored cushions with light-colored furniture and vice versa.

6: Position furniture close to the television; get a larger hi-def television

7: Eliminate low-profile furniture like coffee tables or end tables that can be tripped over,

Lighting

8: Introduce table and floor lamps for task lighting.

9: Use blinds or sheer curtains to reduce glare from windows

10: Place mirrors to eliminate glare.

Marking

11: Use fluorescent tape to mark door handles and other items.

12: Label everything. Labeling includes marking things like cans of food with rubber bands

13: Color-code household items

General Safety

14: Remove clutter from the floors

15: Tape rugs down or remove them altogether.

16: Make sure the fire extinguisher is easily identified and located. Same with the first aid kit.

17: Make sure there are no electrical cords to trip over.

Organization

18: Maximum use of closet and drawer organizers throughout the house.

19: Use special care in the separation and organization of medications.

20: Eliminating clutter from work areas

21: Organize kitchen items in ways that will help identify them.