Two of our favorite community partners have teamed up in the effort to increase access to Universal Changing Places across our great state of Texas. Changing SA is a grassroots community initiative working to raise awareness and increase access to appropriate changing tables for aging adults and those in the disability community. disABILITYsa is working to amplify this message and coordinate policy development both locally and statewide.
To summarize, there is a large population of Texans who are limited from fully interacting in their communities due to the lack of a safe and sanitary changing space. Older children and adults with disabilities who require assistance for toileting often resort to being changed on the restroom floor or in the back of a vehicle, or are forced to stay home because of this lack of appropriate facilities. If you would like to join in voicing your support for this initiative, please complete this survey:
The Texas Governor’s Committee on People with Disabilities (GCPD) is holding their quarterly business meeting on July 30th-31st via Zoom, where discussion will be held and possible action taken to recommend inclusion of Universal Changing Places in the Texas Accessibility Standards. The team at La Fe Consulting is proud to provide critical comments on this topic. Here is the letter we have sent to the GCPD.
“July 27, 2020
Committee on People with Disabilities
Office of the Texas Governor
1100 San Jacinto
Austin, TX 78701
Dear Committee Members,
It is with strong conviction that I write to you to voice my support of the proposed inclusion of Universal Changing Places in the Texas Accessibility Standards. This year, we celebrate the 30th anniversary of the Americans with Disabilities Act. While this legislation has been monumental in improving access for those in the disability community, there is still much work to be done in creating environments and structural processes that are equitable and barrier-free.
As a physical therapist and accessible design consultant, I am faced with the reality each day that unfortunately, this world is not designed for those with disabilities. My professional work centers around the creation of beautiful, functional spaces that can be easily utilized and enjoyed by those of all ages and ability levels. While this sometimes feels like I am fighting an uphill battle, I firmly believe that when we bring our collective voices together, we have the power to enact meaningful change.
The performance of self-care tasks (also termed activities of daily living or ADLs) is an instrumental component of everyday life. Toileting is among the most vital of these functions. For many individuals, this includes the process of locating and safely navigating to the restroom (including any physical barriers encountered along the way), negotiating the available space once within the restroom, transferring to and from the commode, and then completing hygiene tasks. For those with incontinence, those who utilize catheters or colostomies, and those who require physical assistance during the toileting process, additional steps are often necessary.
A 2014 CDC report (1) found that 50.9% of community-dwelling adults 65 years and older report bowel or bladder incontinence. Data from the 2011 National Health and Aging Trends Study (2) shows that 25.8% of adults in this same demographic require physical assistance for self-care, mobility, or household activity performance. These numbers significantly increase as we take into account the population of older adults who live in care centers or nursing homes. However, these needs are not isolated to the adult population. The CDC estimates (3) that approximately 17% of children aged 3-17 years have one or more developmental disabilities. This equates to millions of children who rely on caregiver assistance for ADL performance. Furthermore, an estimated 6.2% of US parents of dependent children have a disability (4). These statistics highlight the fact that a significant portion of the population has unique needs related to self-care tasks.
The installation of Universal Changing Places, defined as powered height-adjustable adult changing tables, into public areas would have far-reaching implications for numerous people. For many in the aging and disability communities, the lack of access to a suitable area to perform toileting tasks limits the ability of individuals and their loved ones to interact with the community. Many have to resort to dehumanizing, unsanitary, and unsafe conditions (for example, changing their loved one on the floor or in the car). Others simply stay home, contributing to the elevated levels of isolation (5) experienced by the disability community and their families. This is an issue of human rights and human dignity.
Universal Changing Places have the potential to drastically improve the quality of life of a wide variety of individuals. Think about the family unit of a seven-year-old with cerebral palsy. Or the new mother caring for her infant daughter while also using a wheelchair for mobility. Think about the single father raising his teenage son with autism, or a multigenerational home where everyone works together to look after their great-grandma. Think about the college professor with multiple sclerosis who needs a sanitary place to self-catheterize. Think about the grandparents who might be slowing down a little more than they used to, but still want to help take care of their grandbabies. These are real people who have a real problem, and we are proposing a real solution. Every infant could be changed on a height-adjustable adult changing table. No adults or children can safely be changed on standard infant changing tables, which support on average only up to 30lbs.
We propose the strategic installation of Universal Changing Places in key locations to improve accessibility to safe and sanitary toileting for all. In an ideal world, every venue would be accessible. Until that dream is realized, we must work to enact legislation that supports full and equal access for all. Hospitals, professional offices and clinics of healthcare providers, and rehabilitation centers are a natural starting point. Senior centers, homeless shelters, state and local government buildings, and places of education (from primary schools to postgraduate universities) all provide services to those who would benefit from Universal Changing Places. Expanding to museums, libraries, theatres, sports arenas, music venues, amusement parks, zoos, airports and large shopping malls would further open doors to people with disabilities and their caregivers and loved ones. This list is by no means exhaustive, but it is a necessary starting point.
If you have any questions, or would like additional information, please do not hesitate to reach out. Thank you for the important work you do, and for your time and consideration on this matter.
Take care,
Katherine A. Franklin, PT, DPT
Certified Aging-in-Place Specialist
Citations:
1. Gorina Y, Schappert S, Bercovitz A, et al. Prevalence of incontinence among older Americans. National Center for Health Statistics. Vital Health Stat 3(36). 2014.
2. Freedman VA, Spillman BC. Disability and care needs among older Americans. Milbank Q. 2014;92(3):509-541. doi:10.1111/1468-0009.12076
3. Zablotsky B, Black LI, Maenner MJ, Schieve LA, Danielson ML, Bitsko RH, Blumberg SJ, Kogan MD, Boyle CA. Prevalence and Trends of Developmental Disabilities among Children in the US: 2009–2017. Pediatrics. 2019; 144(4):e20190811.
4. National Council on Disability. (2012). Rocking the cradle: Ensuring the rights of parents with disabilities and their children. Washington, DC: National Council on Disability.
5. Hernon, J., Brandon, M., Cossar, J., & Shakespeare, T. (2015). Recognising and responding to the maltreatment of disabled children: A children’s rights approach. Social Work and Social Sciences Review, 17(2), 22-56.”
For more information about the GCPD’s quarterly meeting, including additional ways to get involved, please see their meeting notice. We’d love to hear your thoughts in the comments!
