1. Universal Design and Visit-ability in Housing: Promoting Public Health and Health Equity Katherine Hebert, MCRP Davidson Design for Life Coordinator Town of Davidson, NC

2. Agenda Davidson and Davidson Design for Life (DD4L) Health Impact Assessments (HIA) HIA and Housing Universal Design and Visit-ability HIA Findings and Recommendations Closing Thoughts

3. Town of Davidson, NC

4. Davidson Design for Life (DD4L) “Enhance the physical, mental, and emotional well- being of our residents.” (2010 Board Goal) Dimensions of Wellness- physical, intellectual, emotional, spiritual, occupational, environmental, social “To help Davidson be a community that is healthy today and even healthier tomorrow while serving as a model for other small towns by implementing healthy design.” (DD4L Mission)

5. 3 HIAs, 2 Trainings, Building HIA Capacity 3 Years: September 1, 2011- August 31, 2014 Roughly $110,000 Annually Other Grantees are Health Departments in: Oregon, Massachusetts, San Francisco, Baltimore, Douglas County Davidson Design for Life (DD4L)

6. Definition of HIA HIA is a systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and the distribution of those effects within the population. HIA provides recommendations on monitoring and managing those effects. National Research Council

7. Definition of HIA Systematic process (Six Steps) Data sources and analytic methods (Evidence Based) Input from stakeholders (Participatory) Potential health impacts (Positive & Negative) Distribution of those impacts (Health Equity) Four Ps (Policy, Program, Plan, Project) Provides recommendations (Prospective)

9. Social Determinants of Health

10. HIA and Housing Desire to do HIA on Variety of Topics Task Force on Aging/ Davidson Committee on Aging Planning Ordinance Re-Write Housing Rebound Expertise in Universal Design and Aging in Place AARP in Charlotte Mecklenburg County Ordinance Re-Write

11. What is Universal Design? Universal Design is the design of spaces to be more livable and more usable by as many people as possible regardless of their size, age or ability. In the home, there are three ways to implement Universal Design: – Build it into the initial design of the home for future adaptability – Retrofit it into an older home for aging in place – Provide “need specific” features to address a physical impairment

12. What is Visit-ability Visit-ability is an affordable, sustainable and inclusive design approach for integrating basic accessibility features into all newly built homes and housing. It is the most basic form of Universal Design boiled down to three key features: –one zero-step entrance into the home with an accessible path from the driveway & curb –an accessible path to one accessible bathroom on the main floor –a minimum of 32” wide door clearances for main floor doorways Added reinforced bathroom walls

13. What does Visit-ability Look Like?

19. Universal Design Room by Room

23. HIA Findings

24. Universal Design Room by Room

30. HIA Framework What’s the current situation… What’s the future looking like… Who will be impacted the most… –Age (youth, seniors) –Low-Income –Ability How will they be impacted if… What can the Town of Davidson do …. What can others do…

31. HIA Findings Corresponds with the Town’s Vision/ Planning Current and Future Housing Stock –3,671 households- 64% Single Family, 15% Townhomes –Additional 2,000-5,000 households (2010-2030) Population Changes –1,368 or 13% of population 65+ (2010) –65+ expected to increase to 2,377 (2030) ≈ 25% of pop.

32. HIA Findings Seniors –Aging-in-Place Survey (2008) 82% currently live in own home 94% want to remain in Davidson 70% want to live in current home as long as possible 10% will move to another dwelling in Davidson (downsize) 15% will move into assisted living within Davidson (The Pines ) –Health Implications Falls Social Isolation Stress Caused by Displacement Financial Constraints

33. HIA Findings Youth –Davidson, NC 1,344 children under age of 10 40% of children are under age of 5 –Unintentional Injury Leading Cause of Death Drowning, burns, and falls –44% of deaths ages 1-4 –31% of deaths ages 5-9 Falls in Mecklenburg County –169 hospitalization cases from 2007 to 2009 –11,697 visits from 2007 to 2009 –Health Implications Falls Burns Early Development/Independence Safety Social Health

34. HIA Findings Low-Income –Renovation vs. Initial Construction Zero-step entry- $3,300 versus $0-250 Wide doorways- $700/door versus $2/ door Reinforcing walls-$300-400/wall versus $160/wall –Cost of Assisted Living/ Healthcare $75,000/ Year in Mecklenburg Assisted Living Complex $61,000/ Year in Mecklenburg Private Nurse

35. HIA Findings People with Disabilities –36 Million People in U.S. have a disability (12%) –79 Adults in Davidson receive Adult Medicaid Services due to disability –1,715 Adults in Davidson (20% estimated) –450 Children in Davidson (18% estimated CSHCN) Health Implications –Social Isolation –Embarrassment –Kidney Disease –Falls, Burns, Scrapes, Bruises

36. HIA Recommendations Davidson Ordinance- Zero-Step Entry Mecklenburg County Ordinance- Hallways, Doorways, Bathroom, Reinforced Walls Public Education Campaign

38. HIA Recommendations Davidson Ordinance- Zero-Step Entry Mecklenburg County Ordinance- Hallways, Doorways, Bathroom, Reinforced Walls Public Education Campaign Track Availability of Housing and Market Voluntary Program for Homebuilders Assistance in Retrofitting Homes

39. Closing Thoughts Universal Design can be practical and beautiful Less expensive to incorporate into initial construction Health Implications of Visit-ability Minor Policy Change= Big Impact

40. Resources Universal Design for the Home by Wendy A. Jordan Jordana Maisel & Edward Steinfeld, Buffalo, NY, IDEA Center and Eleanor Smith, Concrete Change, Atlanta, GA, “Increasing Home Access: Designing for Visitability” Washington DC: AARP Public Policy Institute Related Links IDeA Center: www.ap.buffalo.edu/ideawww.ap.buffalo.edu/idea Concrete Change: www.concretechange.orgwww.concretechange.org

41. Katherine Hebert Davidson Design for Life Coordinator W:(704)940-9620 C: (828)781-8742 khebert@townofdavidson.org www.townofdavidson.org/DD4L