Accessibility - Equipment and Environment

Design and Accessibility Best Practices for a Senior-Friendly ED

By Haley Rae Dinnall-Atkinson, on January 17, 2017 No Comments / 4873 views

This letter from Haley Rae Dinnall-Atkinson to the Geriatric-ED.com team provides commentary relating to accessibility best practices, not including requirements outlined in the Ontario Building Code, within the physical environment as outlined in the Geriatric Emergency Department Guidelines.

Accessibility Recommendations

The following recommendations are based on accessibility requirements taken from the following sources:

Belinda Parke and Kathleen Friesen, Code Plus: Physical Design Components for an Elder Friendly Hospital, 2^nd Edition. Fraser Health; Dr. B Parke; K. Friesen, 2015
General known best practices in the field of accessibility
Expertise gathered from conducting accessibility audits

The outline contains both the best practice as well as a brief statement on the rationale of the suggestion.

The following summary does not address design for multi-stall washrooms, universal washrooms, parking and outdoor space requirements. For further detail please refer to the applicable Building Code and your city’s accessibility guideline standard.

Lighting

Best Practice	Rationale
Skylight inside each entrance Awnings and other covers over each entrance Night lights in washrooms and near doorways Illuminated light switches in washrooms	Using multiple light sources (natural & artificial, direct & indirect) will help maintain gradual changes in lighting, avoiding the disorientation of older adults.
Type T5, T8 or soft lights (i.e.,170-watt incandescent with ultra-high diffusion coating)	Lighting that is even, soft and well diffused (i.e., full spectrum light bulbs) minimizes glare on walls and the floor.
Dimmer switches	Allow persons to control lighting levels. Low levels of light decrease visibility, which in turn can add agitation or frustration in some people.
Exterior shading devices or window glazing	Systems that control direct sunlight reduce glare.

Colour

Best Practice	Rationale
Decorate with warm colours (red, orange and yellow)	Warm colours are easier for older adults to see than cooler tones (blue, green, purple, or pastels).
Avoid the use of bold patterns on walls and the floor	Visual over-stimulation can exacerbate confusion in older adults.
Highlight doors in patient areas	Contrasting colour combinations help to highlight elements in the environment.
Camouflage exit doors and out of bounds areas	Using the same colour on the doors as used on nearby walls can reduce unwanted use or out of bounds areas.
Use art or wayfinding elements on a unit/ward for memory cueing	Colour cueing/coding techniques in conjunction with assistive devices help people remember and feel safer.

Flooring & Walls

Best Practice	Rationale
Non-abrasive surfaces	Keep the walls behind handrails smooth to prevent abrasion injuries to knuckles.
Matte (non-shiny) finish on surfaces	Matte finishes reduce glare.
Non-slip surfaces (i.e., cork floors, rubberized tiles)	Helps older adults maintain stability and mobility.
Differentiate baseboard, floor, and wall using contrasting colours or material finishes	Contrasting colours provides independence and safety for people with visual limitations when navigating.

Hallways, Doors and Windows

Best Practice	Rationale
2500 mm diameter clear floor space for turning circles	Provide the space for larger mobility devices to complete a 360 degree turn.
900 x 1500 mm clear floor space	Provides space for 95% of mobility devices used in North America.
Remove clutter from trafficked areas	Maintain a clear path of travel to ensure the passage of wheelchair users. Ensure equipment and supplies are stored in convenient locations outside of the path of travel.
Recessed rest areas	Rest areas help promote walking, independence and mobility (i.e., in long hallways).
Thresholds must be a maximum of 13 mm	Maintain barrier free threshold for people who use mobility devices.
Lever-style door handles	Ensure use by people with limited dexterity by choosing handles that do not require twisting or pinching and can be used with one hand or a closed fist.
Automatic or sliding doors with adjustable opening/closing delay system	Opening/closing system programmed to keep doors open for a longer duration than required by code is beneficial to older adults especially in high traffic areas.
Operable windows (i.e., side hinged with window screens and limited width opening)	Allow persons to control windows, drapes, blinds, or an energy efficient transparent sun screen system. Ensure controls are operable by people with limited dexterity and within reach from a wheelchair.

Handrails

Best Practices	Rationale
Provide in out-patient clinics, hallways as well as at walkways, ramps, stairways	Supports patients who undergo medical diagnostic testing while promoting walking and mobility. Walkways with a gradient of 5% or less do not require handrails, but it is recommended that they are provided.
Do not store items in front and/or under hand rails	Ensure that handrail is continuous and uninterrupted.
Colour that contrasts the walls and the floor	Provides independence and safety for persons who have visual limitations.
Non-slip texture	Smooth, easy to grip design.
Braille and/or tactile signal (i.e., a notch cut into the rail or hazard strips)	Communicates the end of the handrail to persons who have visual limitations.

Wayfinding and Signage

Best Practices	Rationale
Locate in high trafficked areas adjacent to main path of travel	More effective when used in conjunction with landmarks in key places (i.e., elevators). Allow people time to self-pace their examination of the information.
Hang between 910 mm to 1320 mm (3 ft to 4 ft 5 in) high or as low as 50 mm (2 in) if above handrails.	Helpful for persons with visual limitations as well as people between wheelchair and standing heights.
Use high contrast colour coding combinations	Light letters on dark, matte finish backgrounds are easier for older adults to see. Avoid combining yellow lettering on black, yellow on green, green on blue, or red on green.
Place maps (i.e., “You Are Here” maps) and large font informational handouts at reception areas	Helps people orient themselves within the unit/ward and plan their route.
Consistent language, simple and explanatory graphics/pictures on signs using universal symbols (i.e., International Symbol of Access)	Avoids confusion and ensures consistency and instruction to help people problem solve.
Font – 16 mm (5/8 in) high on small signs and at least 40 mm (1-1/ 2in) high on larger signs; Helvetica-style (sans serif) is recommended, Tactile letters should be raised 1 mm (1/2 0in); combination of capital and lower case lettering.	Helpful for persons who have visual limitations. Makes signs more readable to all hospital visitors.

Walkways, Ramps, Stairways

Best Practices	Rationale
Firm and slip-resistant ground surface (i.e., rough concrete or treated cement)	Supports mobility and prevents falling
Ground grate opening width of 13 mm maximum	Supports mobility especially for persons using a wheelchair, walker or cane
Clearly identify edges of ramps and stair risers (steps) with contrastive colour (i.e., yellow strip)	Colour contrast and Tactile Attention Indicators help persons with visual limitations
Rest areas with appropriate seating i.e., provide every 9000 mm (30 ft)	Rest areas help break up long walkways or ramps

Acoustic Considerations

Best Practices	Rationale
Materials and features that are designed to muffle noise (i.e., walls and the floor separating patient rooms and medical areas, solid-core doors with sound stripping, double-glazed windows)	Reduces acoustic reverberation to avoid over and under stimulation.
Combination of single and double occupancy patient rooms	Single rooms should be isolating; noise levels should be monitored to avoid over and under stimulation.
Assistive devices (i.e., earphones, earplugs, hearing amplifiers [Pocket Talker], personal paging)	Volume control options (i.e., television noise, overhead paging) especially in units and patient rooms support acute patient care as well as persons with hearing impairment.
Fluorescent light bulb ballasts	Lighting that does not interfere with hearing aids.
Quiet systems and controls (i.e., switches for HVAC)	Supports noise reduction and acoustic reverberation.

Furniture

Best Practices	Rationale
Maintain clear path of travel Provide adequate room between beds (2500 mm diameter)	The layout should avoid furniture with jutting or recessed bases. Furniture placed adjacent to the accessible path of travel.
Seating with pressure reduction, lumbar support, and slight forward angle chair cushions 450-460 mm seat height, 450-500 mm seat depth Matte-finish and non-slip upholstery	Supports persons with limited range of motion as they raise themselves to a standing position.
A variety of seating (i.e., chairs or benches), including adjustable seating (i.e., armrests and backrests)	Seating to facilitate transfer to/from a wheelchair; arms should cover the full length of the seat base. Avoid back tilting options or those that are on castors.
Upholstered and non-upholstered furniture provided in warm colours that contrast the walls and the floor, and avoiding the use of patterns	Contrasting colour combinations help to define the furniture edges from the surrounding environment. Supports persons with visual limitations
Stable tables with rounded corners	Supports persons with limited range of motion especial people who use wheelchairs/walkers and canes.
Counters especially in reception areas no higher than 840mm	Supports patients and visitors who use wheelchairs/walkers

Elevator

Best Practices	Rationale
Large call buttons and contrasting colours	Supports independent wayfinding and mobility

Equipment and Technology [Supplies]

Best Practices	Rationale
Telephone (i.e., black, with large white push buttons, contrasting numbers and letters, volume control features suitable for use with hearing aids and/or equipped for T-switch, accessible from a wheelchair, direct taxi services, a directory, have TDD/TTY apparatus etc.)	Provide at patient’s bedside and at entrances near waiting areas to support communication and travel outside of unit/ward
A variety of assistive mobility devices (i.e., wheelchairs, walkers, and canes)	Provided near building entrance, common areas, in special function areas, and in patient rooms to support patients and visitors with limited range of motion
Manual temperature control in rooms and supplies (i.e., blanket warmers)	Allow persons to independently regulate heating and cooling
Memory aids (i.e., dry-erase board to provide written cues as needed, large faced clocks, oversized calendars) in view from personal hospital beds	Supports older adults, patients, visitors and is dementia friendly
Wandering alert system (i.e., audible or visual indicators)	Monitors confused mobile older adults
Mechanically adjustable beds, stretchers, treatment tables that lower to 460mm	Supports older adults with mobility limitations and those of low stature; eases the transfer of patients from wheelchairs/walkers. If not adjustable provide options at the lowest recommended height
Pressure reading mattresses on beds/stretchers	Supports acute care patients
Physical conditioning equipment (i.e., step, resistance bands)	Equipment accessible to patients when monitored by physiotherapists, where appropriate
Provide 2 chairs in patient rooms	Supports the “rooming in opportunity” for visitor to stay overnight
Beds with 4 adjustable, split side rails; avoid side rails which fold down to the floor	Supports older adult’s mobility in and out of bed
Full lifts, transfer lifts and ceiling lifts with adequate room to use lifts and/or stretchers; ensure clear floor space	Supports acute patient care
Space for emergency equipment and physiotherapy aids without disturbing patients, beds, or moving furniture	Supports older adults with limited range of motion as well as hospital staff and medical personnel
Soft touch controls operable by patient placed no more than 1050mm from the floor, or 600 mm reach (i.e., lighting, nurse call system, television controls, audio equipment)	Supports persons with limited reach and dexterity
Commode – height should permit feet to be flat on the floor; soft seat; padded and tilted slightly backwards to prevent falls; padded arms can be locked in place for support and arms move toward the patient as they are set in place; equipped with foot-operated brakes; bedpan is sited low on the commode frame to ease waste disposal	Supports acute care patient

References and Resources

Belinda Parke and Kathleen Friesen, Code Plus: Physical Design Components for an Elder Friendly Hospital, 2^nd Edition. Fraser Health; Dr. B Parke; K. Friesen, 2015
Wilber ST, Burger B, Gerson LW, et al. Reclining Chairs Reduce Pain from Gurneys in Older Emergency Department Patients: A Randomized Controlled Trial. Acad Emerg Med. 2005;12: 119-123
Bradley SM, Hernandez CR. Geriatric assistive devices. Am Fam Physician. 2011;84: 405-411.

Haley Rae Dinnall-Atkinson

Haley Rae a multidisciplinary designer who believes in integrity and taking initiative in her design practice, education as well as throughout her community. She is passionate about accessibility and the design of public and private spaces as they relate to our sense of place in urban landscapes. She is a Junior Built Accessibility Auditor with AccessAbility Advantage – a joint venture between March of Dimes Canada and Quadrangle Architects Limited, and a recognized leader in accessibility and universal design.

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