It’s not about getting old.

When I was in school I studied the related concepts of “Universal Design” and “Visitability”.

Universal Design is about designing spaces for accessibility from the beginning, so that what we consider “accommodations” are simply a part of reality.

Visitability is about making all living spaces “visitable” by people with mobility challenges.

Visitability was pioneered by Eleanor Smith of the organization Concrete Change in Atlanta. She posited that a few simple changes in how we design and build houses would make a world of difference. If all homes had a zero-step entrance (this could mean a ground-level entrance or a ramp), 32 inch clear openings in first floor doorways, and a wheelchair-accessible bathroom on the main level, wheelchair users could visit their friends and family. If all of these are incorporated into design, the costs are minimal. She began with a local ordinance requiring visitability in all housing built with government funds.

Visitability is not the same as accessibility. To make a home fully wheelchair-accessible includes (among other things) raising outlets and lowering light switches to make them reachable from a wheelchair.

Opponents argue about interference with private property rights, but all housing requires permits and all permits require compliance with building codes. Codes change. Incorporating visitability into building codes means we don’t single out government-funded housing. If we add these to the UBC (the model Uniform Building Code), we don’t have islands of compliance in a sea of non-compliance.

Universal Design means (from the Disability Act of 2005):

  1. The design and composition of an environment so that it may be accessed, understood and used
    1. To the greatest possible extent
    2. In the most independent and natural manner possible
    3. In the widest possible range of situations
    4. Without the need for adaptation, modification, assistive devices or specialised solutions, by any persons of any age or size or having any particular physical, sensory, mental health or intellectual ability or disability, and
  2. Means, in relation to electronic systems, any electronics-based process of creating products, services or systems so that they may be used by any person.

It is based on seven principles (from

In my work I see a lot of people who fall. Many of them are averse to making changes in their homes because they see them as for “old people” and getting old is something they don’t want to do or admit to. I often reply that it beats the hell out of the alternative. This leads to the third related principle, that of “Aging in place“.

Aging in place refers to staying in your own home as you age. If we incorporated universal design into all homes built, that would be a pretty straightforward task. If you live in a 100+ year old home, as I do, that takes a little more thought.

Installing grab bars during new construction is simple and cheap. Installing blocking in the walls to prepare for the future installation of grab bars is cheaper yet. It can usually be done with scrap lumber that would otherwise end up in a dumpster.

Image from Paradigm Interiors – blocking for grab bars, allowing lots of choices

Retrofitting with grab bars takes a bit more thought but is still pretty simple. Wall studs are generally built on 16 inch centers. Grab bars generally come in increments of 6 inches. Do you see a problem here? 6 and 16 only line up at 48 inches (and multiples thereof). Do you need a 48 inch bar? Probably not. But this brings an opportunity. (All of these numbers may change in countries that use the metric system.)

Studs on 16 inch centers with 36 inch (or 18 inch, stopping halfway) grab bar in blue.

We are not all the same height. Standards that you read may show the “correct” height for a grab bar. Actually, the correct height is the one that works for the user. The same height won’t work for one person who is 6’2″ and another who is 4’11”. Our wrist works best when our hand is in line with our forearm, like (e), not (f) below.

Image from ResearchGate

If a horizontal bar is too high, your wrist will look like (f). If the bar is too low, you will either bend awkwardly to reach it or not use it at all. If you mount the bar at an angle as shown, you have a range of available heights to reach with the appropriate wrist position. The other alternative, of course, is to mount the bar vertically, along a stud. Generally, to get into a shower or built-in bathtub, I recommend one bar mounted vertically to hold as you step in, then a second bar mounted at an angle along the side wall to hold once you’re in. Due to the standard dimension of bathtubs, there should be a stud in an appropriate spot. Shower stalls have more variation, but you should still be able to find a stud in an acceptable spot, either inside or outside of the door.

Image from

Before you screw it in place, try it! Either have someone hold the bar while you try it (grasping it but not bearing weight on the hand as you step), or mark the proposed location with blue painter’s tape and fake it, checking the height and angle. If more than one person is in the home, have them all try it.

If you don’t know how to install it, find someone who does. Your life may depend on proper installation. If you’re drilling through tile, tape the spot where you will drill, and drill through the tape. This will help prevent the tile from chipping. Use a sharp masonry drill. If you are drilling through a plastic tub surround, tape it and apply pressure with your free hand to prevent the plastic from chattering in and out from the wall with the drill action. Don’t trust screw anchors to hold the bar. Drill into studs or blocking. Some bars have multiple choices for mounting holes so you can maximize the number of screws into studs.

Think before you place screws. In the pictures above, the solid blue are studs, the large blue circles are the grab bar mounting plates, and the small blue circles are the screw holes. This is a common design. (The ones I mounted today have five holes in each plate, with three screws, so you can pick the best combination.) On the left you note that two screws are solidly in the stud and the third misses. On the right, no screw is solidly in the stud. If your choice is two screws (on each end) solidly into framing and one anchor (or unused hole) or three screws, none of which are actually going to hold, I’d opt for two solid screws over zero. With a three hole plate and nominal 2 x 4 framing (which is actually 1½ x 3½), this is what you get.

When mounting in a wet area, caulk the side of the mounting plate that will be against the wall to keep water from getting behind it and running into the screw holes, ruining your wall over time. Leave an opening at the bottom so that, if any water gets in, it can drain out.

The caulk will not be visible from the outside but, if I drew it that way, you couldn’t see it.

There are lots of choices for bars. Feel the bar in your hand. Is it slippery? Probably not a good choice. How is the diameter? Can you get a good grip? You can get them in stainless steel, chrome, or enameled finishes. You can get finishes that match your other hardware. You can get brushed or knurled finishes to make it grippier when wet.

If you use a suction-mounted bar, don’t have the suction cups cross a tile grout line. The suction will not hold. Don’t place it on a plastic tub surround that is not firmly adherent to the wall. Remount it every time you use it, to be sure it is firmly adherent. They work best on solid surface (e.g. Corian) tub surrounds.

A towel rack is not a grab bar, nor is a curtain rod nor the handle on a shower door!

The hand-held shower shown above is a nice addition, simple to install, and inexpensive – or you can spend a ton of money for the aesthetic you want.

If you tire or tend to lose balance in the shower, a shower chair comes in handy. If you can’t step over the tub edge, a tub transfer bench fills the bill for a lot less money than removing the tub to install a shower or modifying the tub to a step-in model. Note that you can buy them a lot cheaper from a hardware store or drug store than from a medical supply store or a home health agency. I do not recommend falling in the bathroom, as there are no soft places to land.

Why should you listen to anything I just said? As a plumber (and before that, as maintenance director of a housing cooperative), I installed grab bars for a living. As an occupational therapist, I work with people who have been injured from falls and I work with them to make their homes safer. As an old person, this is not merely academic to me. As a bicyclist, I plan to stay healthy and keep riding for a long time.

Bare Necessities

Growing up, I was taught that the necessities of life were food, clothing, and shelter. Going to work, I found those definitions changing. This is another story alluded to in an old post – “a story for another time”. Here we are, in another time.

So what are the bare necessities in my book, and how did I find them? My first full time job was in a restaurant – preparing food for people. My first “career” was in a grocery co-operative – providing basic food via the Willy Street Co-op. I was pretty sure food counted as a basic need.

After 10 years I left the co-op and moved to Northern California, where I was Maintenance Director (then Financial Manager and General Manager) of the Twin Pines Co-operative Community, a community of 79 families that jointly owned an 80-unit low-income housing co-operative (the 80th unit was a rental reserved for an employee and I was the sole renter for part of my time there). I learned that the Silicon Valley was not filled with Yuppies. Before it became the Silicon Valley, the Santa Clara Valley was The Valley of Heart’s Delight, a vast area of fruit orchards. Now I knew why the supply of apricots had dried up back when I was in the grocery biz – the orchards were being ripped out for factories, office buildings, and housing. (The apricot supply has since recovered somewhat.) There were people who worked in those factories and were the secretaries in those offices and who fixed the fancy cars of those over-priced engineers. They were the people I worked for, and they needed a place to live. Yup, housing made my list.

I’d always had a side job or two. While at Willy Street I was a volunteer programmer at WORT-FM, a listener-sponsored community radio station. I was a patient advocate at the Near East Side Community Health Center, and I was the local representative of FLOC (the Farm Labor Organizing Committee, a farmworkers union started in the tomato fields of Ohio – they later merged with the UFW). In California my side job involved co-operative housing in Nicaragua.

In Nicaragua I found that the Matagalpa River (where we cleaned up after a work day) was also where everyone did their laundry and drew their drinking water, as well as where towns discharged their raw sewage. We found a mountain spring, had the water tested, built a dam and a pipeline, and supplied pure water to the houses we were building. (Fred Colgan deserves the lion’s share of the credit for that.) While we weren’t big enough to set up a sewage treatment program, we dug outhouses so sewage from our little community would not go straight to the river.

When my second visa expired I moved to San Francisco and became a plumber (after a side trip for the Mole Poblano tour, o quiere decir La Vuelta de Mole Poblano). It was pretty clear that clean water and sewage treatment made the list of bare necessities, so I made my living doing that. I mostly did residential service work, but also some remodeling and work in bars and restaurants. I used to tell people that my job involved hanging out in gay bars at 9 o’clock in the morning.

Life being what it is (and a story that I probably won’t bother telling here unless shelter in place lasts a really long time), my plumbing career came to an end. I became a college student and then an occupational therapist. Before I became a patient, I had never heard of occupational therapy. My sister (a Speech and Language Pathologist) defined occupational therapists as the people who come up with a simple commonsense solution to a problem; a solution that seems obvious in retrospect. Then she’d realize that she hadn’t though of it. When people ask me what the difference between a physical and an occupational therapist is, I sometimes say the PT’s job is to make sure you can move around, and my job is to make sure you can do all the things you want to move around for. It is a job that varies widely depending on the setting you are working in; and the lines between what I do and what my PT partner does are sometimes pretty blurry. (If you really want to know the gritty details, I have a 13 hour online course for you. Someday I may be able to do it live again.)

I saw firsthand how much access to healthcare depends on money, and how the US, unlike most industrialized countries, lacks a healthcare system. (I work in a hospital that provides care to all regardless of ability to pay – but that doesn’t mean they don’t get billed later, and it clearly affects the care they get after discharge.) Other countries have a healthcare system. We have an insurance system. Healthcare was now clearly on my list of bare necessities.

A common thread running through these, and made clear by our shelter at home situation, is community. I realized I had found my personal definition of the bare necessities: food, housing, water and sewer, healthcare, and community. I hope my list is complete because I’m closer to 70 than to 60 and I probably don’t want to start another career now. I’d like to pretend I had the forethought 50 years ago to build a life based on the necessities and pretend that my life and career trajectory was planned. Never mind, I don’t even want to pretend that. This was a case of going where life led me, then looking back and seeing what the path looks like. Or, as Robert Hunter said:

There is a road, no simple highway, between the dawn and the dark of night…

Le Tour de France/La Vuelta a España/Il Giro d’Italia

The French tour has been postponed and is now scheduled from 29 August to 20 September. The Spanish tour is still scheduled from 14 August to 6 September, but there is talk of moving it to the fall. The Italian tour is being run in a virtual format and the real version may be moved to late fall. The World Championship is also scheduled in the same timeframe as the rescheduled tours.

I think the only answer to scheduling anything right now is “Who knows?” I know of one cycling event scheduled for June that is still scheduled and another in July that has already been canceled.

Stay safe out there…ride alone and enjoy the scenery.

And now for something completely different

Riding a bike isn’t the only thing we do. People who ride (and write about) bikes have jobs and families and friends who don’t ride bikes. (Duh.)

After a 14 mile ride for an appointment this morning, it seemed prudent to get out on the water and not spend the day inside working. A couple of hours in a kayak does wonders for changing one’s outlook, and the view from the middle of the lake is a nice change from the shoreline. Staring at a computer screen can wait.

Even the time at the keyboard required a break, as a sudden downpour hit before I put the kayak away – can’t let the boat get wet;) The sun remained shining as torrential rain fell for about ten minutes. It’s 80 degrees (27 degrees Celsius) and the sun is blindingly bright. If it weren’t for the fact that I just changed clothes and my hair is still dripping, I’d think I imagined it. Now to go bail out what got in before I closed the hatches and covered the cockpit.

So what else do we do? One of us trains Occupational and Physical Therapists (and Assistants) for the acute care of patients with multiple traumatic injuries. While the odds that one of you reading this fits that description are slim (unless a search engine brought you here), maybe you know someone that fits. Nurses and Speech and Language Pathologists may also find value. This is a two day course, offered in the Detroit area September 17-20 (two presentations in different locations), downtown Milwaukee September 27-28, Kansas City area October 28-31, and NYC area December 10-13.

This is a trial run. If these seminars are successful, the program will be offered nationally next year. There will be a live webcast of the Kansas City presentation (which will be available on DVD) but, in our humble opinion, a webcast of a hands-on seminar sorta defeats the purpose, or at least limits the opportunity.

If you have questions that aren’t answered here or in the links (one to UW-Milwaukee, the other to PESI Rehab; both with copies of course brochure available), the instructor can be reached at Please help spread the word. Stay safe out there! We’d rather see you on the road than in the hospital.

We’re official! We just received a photo of our sign:

And one last word from the road via Charlie, who finished his eighth crossing of the continent by bike:

Nothin’ half-fast about Charlie. He didn’t even mention his partial crossing of the continent with us last year, ended early because he had a date to go climb a mountain.

More kids growing up

I went on a long ride Sunday – long mostly because of the 20+ mph headwind for the first 35 miles. I got home in time to see Joel Paterson and the Modern Sounds at the Pursuit of Joel PHappiness Festival. Joel is a phenomenal guitarist who can play anything. He has a number of bands to give him a chance to play multiple styles. The Modern Sounds play old jazz and swing with a little rockabilly, R&B, and blues in the mix. He started playing in these parts as a kid, then grew up and moved to Chicago. He also figures into my life in an indirect sort of way.

Those who know me in another part of my life know I work in health care. It was Joel’s mom who started me on that path. When I was 20 I injured my ankle. I was treated in an emergency room (after fashioning a crutch to get back down from the mountains, but that’s another story) while traveling but it didn’t get better. Walking was an interesting adventure. Running was out of the question. I went to my local free clinic (The Near East Side Community Health Center, which has merged into Access Community Health Centers, run by my friend Ken Loving – another story for another time).

In the free clinic, there was a volunteer position called “Patient Advocate”. The Advocate’s job was to act as a medical assistant (gathering health history and chief complaint) and more. It was the advocate’s job to be sure the patient’s needs were met. The advocate helped the patient formulate questions for the doctor, guided them with follow up questions as needed, and ensured that their needs were met before the doctor left the room.

Joel’s mom was my advocate. (She had also been my sister’s high school classmate.) Before I left the clinic that night, she extracted a promise that I would return as a patient advocate after I saw the orthopedic surgeon they referred me to.

I went back and volunteered as an advocate for a few years. Something must have stuck with me, as I became an Occupational Therapist about 25 years later. Patient advocacy is still an important part of my job.

Joel has a YouTube channel that can give you an idea of his range. Or you can look at what others have uploaded here. I’m not sure what to pick to just link to one or two things. Here’s a Scotty Moore tribute:

Here’s a bit of swing:

How about blues?

Now go listen to him live and buy his albums. A musician can’t make a living if all we do is watch his/her YouTube videos.

Back to bikes for a minute. A while back I posted a series on bike safety. I thought I was done but I left something out – and it’s something I’ve used the past few days.

It’s a baseball metaphor. For those of you who have played, you know what it means to “look the runner back”. You can skip the next paragraph. For those who don’t, read on.

If you’re playing shortstop and there’s a runner on second and a ground ball is hit to you, your natural play is to throw the batter out at first; but you don’t want the runner on second to go to third. You “look him/her back”. You make eye contact in a way that says, “If you break for third, you’re out. Better stay where you are.” When the runner turns back to second, you make your play at first.

It works with drivers. You’re at a four way stop. The car to your left was there first and has the right of way. You let her/him go. The car behind her/him decides to go at the same time. You look her/him back; making eye contact in a way that says, “wait your turn.” That driver know it’s your turn to go and was hoping you’d be cowed because their car is bigger than your bike. Most of the time, the driver will acquiesce, knowing they were trying to pull a fast one. If they go anyway, you let them. You both know what’s what.

In this way you can be an assertive, not aggressive, bicyclist.