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Showing posts sorted by date for query state health department. Sort by relevance Show all posts

Wednesday, February 7, 2018

Explore These Six Trails to Get Your Nature Fix

Read article : Explore These Six Trails to Get Your Nature Fix

Posted 08/16/17 by Suzanne Matyas in America's Trails, Trail Use, Health and Wellness

imageThe Banks-Vernonia State Trail is a verdant beauty running through its two namesake towns | Courtesy Oregon State Park

Can you imagine your perfect outdoor oasis? Take a moment to picture it. Is it quiet, or is it filled with the laughter of playing children or the melody of songbirds? Are there trees, fields, flowers, shorelines or lots of wildlife? Is it in a tiny city pocket park or a remote reserve?

Doesn’t it make you feel happy?

Being able to spend time outside to connect with nature is a uniquely special feeling and has many health benefits. It’s also something we believe that everyone should be able to experience. Thankfully, trails enable people of all ages and abilities to do just that. In urban, suburban and rural places all across the country, trails can take us to (and are!) incredible natural spaces.

No matter what your dream space looks like, we encourage you hit a trail and try to find it! To inspire you, here’s a list of some great paths for getting in touch nature:

imageBanks-Vernonia State Trail | Photo by Trailink.com/dabiker

1Banks-Vernonia State Trail, Oregon

Starting in the West, we’ve chosen one of our favorite city escapes: Oregon’s Banks-Vernonia State Trail. Sitting less than an hour's drive outside of the hustle, bustle and delightful “weirdness” of Portland, this trail stretches nearly 23 miles through the foothills of the Coast Mountains and the magnificent L.L. Stub Stewart State Park. The park is an 1,800-acre delight equipped with campgrounds (for people and for horses), RV hookups, an 18-hole disc golf course, wildlife viewing areas and a fun Discovery Depot.

The trail’s completion is in part due to the opening of the spectacular park in 2007; its history, however, extends back to the 1920s, when it was first used to haul timber. Currently, the route hosts hikers, cyclists and equestrians, and travels under 13 bridges and two 700-foot-long, 80-foot-high railroad trestles.

imageTahoe Trailways Bike Path is a favorite of hikers, cyclists and former Olympians alike | Photo courtesy Rails-to-Trails Conservancy

2Tahoe Trailways Bike Path, California

When asked about the Tahoe Trailways Bike Path, our team said it “could not get any prettier unless there were rainbow unicorns prancing on it.” And although you will not find any mythical beasts over its 19 miles, you will find this California rail-trail to be a magical place where peoples’ dreams come true—665 Olympic dreams, that is! One of the trail’s three branches travels to the base of the Squaw Valley Ski Resort in Olympic Valley, the home of the 1960 Winter Olympics.

In addition to its golden history, the trail leads its users by the Truckee River, Sugar Pine Point State Park and the shore of Lake Tahoe, the country’s second-deepest lake! The trail also has a bright future as it’s part of a developing network that will link communities across two states to trail.

imageThe Colorado Riverfront Trail is an developing system with nine unique sections | Photo by TrailLink/jmoreco

3Colorado Riverfront Trail, Colorado

Your moment of Zen on the Colorado Riverfront Trail is possible due to the dedication and hard work of the Colorado Riverfront Commission. This 22-mile paved beauty follows the Colorado River and goes through several parks. Starting off with a stunning view of the Colorado National Monument canyons, from the aptly named Monument View Section, the trail soon introduces you to the Walter Walker State Wildlife Area, reaches the Connected Lakes Section and then forks off into two other nature havens: the Blue Heron Section and Audubon Section. From either shady route, you’ll pass by glittering lakes and have the opportunity to spy some spectacular birds, including bald eagles, herons, osprey, owls and hawks.

The trail reunites again near the confluence of the Colorado and Gunnison rivers, and then passes by Western Colorado Botanical Gardens and Butterfly House, the Las Colonias, the James M. Robb Colorado River State and Clifton Nature parks before it ends.

imageThe Ti-Haul Trail lies just down the road from Shelburne Farms, which offers many educational programs | Photo by Brandi Horton

4Ti-Haul Trail, Vermont

In the Burlington, Vermont, suburb of Shelburne, near the mighty Lake Champlain, you’ll find the charming Ti-Haul Trail. This trail is short, sweet, scenic and shady, and was constructed for the sole purpose of moving the Ticonderoga steamboat from the lake to the Shelburne Museum.

Though the rail-trail itself only covers 1 mile, it links to Shelburne Bay Park and the park’s slightly longer Rec Path, and sits a mere half-mile away from the expansive Shelburne Farms. The entire length of the trail runs along this iconic property, which operates as a nonprofit dedicated to “educating for a sustainable future,” and encompasses 1,400 acres of working farm and forest as well as an estate that was designated a National Historic Landmark. The property has maintained the spirit of its roots, as it was originally created in 1886 to be a model agricultural estate by Dr. William Webb and Eliza Vanderbilt; the design was in part guided by Frank Law Olmstead, the famous landscape architect of New York City’s Central Park.

imageThe John Heinz Refuge Trail winds through pristine natural lands and connects to the Circuit Trails | Photo courtesy Heather Jerue/USFWS | CC 2.0

5John Heinz Refuge Trail, Pennsylvania

If you imagined your ideal space as an idyllic island surrounded by the thrum of industry, then you will absolutely love the John Heinz Refuge Trail. But even if you did picture something different, you will still fall for America’s first urban wildlife refuge and its residents: deer, opossums, foxes, turtles, frogs and more than 300 species of birds. Conveniently located within eyesight of the Philadelphia International Airport, this nearly 8-mile trail is as much a sanctuary for wildlife as it is a refuge for city dwellers.

While navigating its two wide loops along Darby Creek, woodlands, meadowland and the Tincum Marsh, trail users need only look northeast to feel welcomed by the City of Brotherly Love’s skyline. The trail also serves as a key piece of the developing 750-mile Circuit Trails Network and is part of the Maine-to-Florida route known as the East Coast Greenway.

imageOne of the New River Trail State Park’s highlights is the impressive 950-foot Hiawassee trestle | Photo by Lee Hogan

6New River Trail State Park, Virginia

Rounding out this list is one of our southern belle routes: Virginia’s New River Trail State Park. Truly the bell of the ball, this delightful rail-trail was declared an official National Recreation Trail by the U.S. Department of the Interior for good reason! Graced with the good looks and shade from the surrounding Blue Ridge Highlands—the professed Birthplace of Country Music—the majority of the verdant route is within view of the New River. Visitors can cool off and become fully “immersed” in nature by going for a swim or canoe ride in the refreshing water, or taking a forest bath underneath the tree canopy.

The 57-mile trail’s natural beauty is complemented by its manmade garnishes, including two cavernous tunnels, impressive dams, railroad trestles—such as the 950-foot Hiawassee trestle—the historical shot tower, train depots and even a red caboose.

Saturday, December 2, 2017

Vt. Health Department Recognizes Area Employers for Breastfeeding-Friendly Workplaces

Read article : Vt. Health Department Recognizes Area Employers for Breastfeeding-Friendly Workplaces

White River Junction — Aleigha Sykes was working in a preschool when she learned she was pregnant. At that point, the Brownsville resident sought work in a child care setting that had space for an infant.

She found just that at World of Discovery’s White River Junction location.

Sykes, now 24, worked in the infant room for a few months before her daughter Kinsleigh Cole was born in January 2016.

After a six-week maternity leave, Sykes returned to a breastfeeding-friendly workplace.

Mother and daughter can use a quiet space equipped with a comfy chair to nurse, but more often Kinsleigh, now 18 months old, chooses to nurse in her classroom or out on the playground.

When “she wants it, she wants it,” Sykes said of her daughter. “She’s not shy about it.”

Their comfort has been aided by support from the other members of the staff and the other children.

“It’s an awesome, awesome experience,” Sykes said.

Breastfeeding has helped the two of them bond and boosted Kinsleigh’s weak immune system, Sykes said.

“It helped us become a stronger unit,” she said.

World of Discovery, which also has locations in Perkinsville and Springfield, Vt., was one of 26 employers that the Vermont Department of Health honored in a newspaper ad last week as part of National Breastfeeding Month.

Though accommodating breastfeeding mothers is a legal requirement under the 2010 Affordable Care Act, several Upper Valley employers have been giving nursing moms space and time to nurse or pump for many years. They say it’s worth the effort to retain employees and to maintain a family-friendly work environment.

Breastfeeding provides “many important benefits to individual health as well as the health of our community,” said Laura Cody McNaughton, who directs the state health department’s White River Junction district office, which serves 22 towns in northern Windsor and southern Orange counties.

Health benefits for infants include reduced rates of infection, sudden infant death syndrome, allergies and certain chronic diseases such as obesity, according to the American Academy of Pediatrics 2012 policy statement on breastfeeding.

For moms, breastfeeding can reduce postpartum bleeding, reduce the risks of postpartum depression and ovarian and breast cancers, and helps prevent neglect, according to the AAP.

For communities, the benefits are in reduced medical costs, McNaughton said.

Employers may benefit from reduced absenteeism when babies and moms are healthier, and there can be health insurance cost savings for both employers and employees, she said. Families also can save money by avoiding purchasing formula, she said.

The AAP recommends breastfeeding exclusively for the first six months and continued breastfeeding for at least a year, while solids are introduced.

“We want moms to be able to continue to breastfeed for as long as possible,” McNaughton said.

Participants in the health department’s breastfeeding-friendly program have policies in place to address breastfeeding in the workplace and offer information about nursing to mothers before and after they return to work, perhaps in collaboration with the business’ health insurance provider, McNaughton said.

Participating businesses also offer private rooms other than bathrooms with a lock on the door so moms can express milk, flexibility in scheduling, or an alternate work schedule to allow them to work from home, she said.

Participants in the state’s program likely represent just a segment of Vermont (and some New Hampshire) employers with policies that are supportive of breastfeeding, McNaughton said.

Rates of breastfeeding in Vermont tend to be higher than average, McNaughton noted. Nearly 85 percent of Vermont babies were ever breastfed, compared to 81 percent nationally and almost 80 percent in New Hampshire, according to the U.S. Centers for Disease Control and Prevention’s 2016 Breastfeeding Report Card.

Several Upper Valley employers said family-friendly policies such as breastfeeding accommodations can help with worker retention.

“(We) do whatever we can to help nursing mothers come back to work,” said Beverly Widger, Mascoma Savings Bank’s senior vice president of human resources.

In addition to finding a private place such as a spare conference room with a comfortable chair for employees to use to pump breast milk and providing a refrigerator for storing it, Widger said the bank’s health insurer works with employees to assist them with prenatal and postnatal care.

“It’s never come up during an interview,” Widger said. “But I think it just is another way that Mascoma works with their employees to find solutions.”

Similarly, the Community College of Vermont makes quiet, private space available for breastfeeding employees and students and allows them the time to do so as a way of showing them support, said Bo Finnegan, CCV’s human resources director.

“We’re community-based and we’re family-friendly,” he said.

When a member of the staff is breastfeeding, the White River Junction-based Green Mountain Children’s Center converts an office for the purpose by adding a rocking chair, pillows, a radio and windows with curtains, according to the center’s director, Sally Avery. Employees whose children are enrolled in the center are given the time they need to feed their child in person, she said.

“We support each other and we want to be there for them,” Avery said.

Veterinarian Brad Burrington, the owner of Veremedy, an animal hospital with locations in Woodstock and White River Junction, said his 18-person workforce is primarily female.

It’s “all women and me,” he said.

Burrington, who said his wife nursed their children as babies, described the need for a clean, quiet place to pump as a practicality.

“Whatever,” he said. “Let’s support you, here we go.”

Finding the space and time to pump is really just the beginning, Burrington said. The next challenge is for employees to find affordable child care that works with the practice’s hours, which often go past 6 p.m.

But, he said, employees frequently step up to cover late afternoon hours when others have to pick up their children.

“We have each other’s backs,” he said.

In the 8½ years that Sara Kobylenski has been director of the Upper Valley Haven, the White River Junction-based social service organization that operates a homeless shelter, has had three nursing moms on staff.

“To create an environment (so that) the people that are helping others can be taking care of themselves at the same time is really important to us,” Kobylenski said.

Those with their own offices simply put notes on their doors while they were pumping saying “do not disturb,” Kobylenski said.

Nursing mothers in the shelter also are provided with private space to feed their babies, she said.

“(It’s) just good for everybody,” Kobylenski said.

In addition to accommodating breastfeeding, the Haven also invites new parents to bring their babies to work with them until the babies are 6 months old.

“We do have that kind of human-oriented environment,” Kobylenski said.

There are not any nursing moms currently employed at the Haven. The youngest to have spent his early months in the organization’s office is now 3.

But, “we do get our fill of little people,” Kobylenski said, as she looked at a picture of Thomas the Tank Engine drawn by a 5-year-old who was the first baby of a staff member to spend his early months at the Haven.

Though it’s counterintuitive, Kobylenski, who brought her own baby to work with her in the early 1980s, said babies are actually not disruptive.

“It actually works quite well,” she said. “The presence of a baby ... can really soften the environment where there can be a lot of stress otherwise.”

Find more information about the Breastfeeding Friendly Employer program and a list of participating businesses online at http://bit.ly/2vmXE1V.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.


Saturday, July 29, 2017

Man found hanged in bathroom cubicle at Huddersfield Royal Infirmary

Read article : Man found hanged in bathroom cubicle at Huddersfield Royal Infirmary

Mystery surrounds the death of a man who was found hanged in a bathroom cubicle at Huddersfield Royal Infirmary.

Stefan Rychter, a 33-year-old drug addict, of Leeds Road, Huddersfield, was found hanged by a shocked healthcare assistant on Ward 17 in the early hours of November 25, 2016.

But an inquest held at Bradford Coroner’s Court yesterday (Wed) found the reason for his action will never be known.

The court heard how although he suffered from depression he left no suicide note and gave no indication of his intentions before carrying out the act.

Assistant Coroner Kirsty Gomersal heard that Mr Rychter was admitted to the A&E department at 3.08am on November 22 after taking £40 of heroin the previous day at a friend’s house.

He was thought to be suffering from an abscess on his groin. He was given antibiotics intravenously and the plan was to discharge him on November 24.

In a statement read to the court, healthcare assistant Tracy Oakley, who found Mr Rychter, said she realised “he was nowhere to be seen” and wondered whether he was in the bathroom cubicle.

She said she tapped on the door but heard nothing. She said: “I was completely shocked to see him hanging. I panicked. I had never seen anything like this before. I shouted that there was an emergency.

“Sophia Madanhi, (a colleague), cut the body down. I was in a state of shock.”

In a statement Sophia said: “I rushed to the cubicle. We found him hanging. We were all shocked.” She said the Sister quickly got a pair of scissors and he was cut down and resuscitation started.

Sophia added: “Unfortunately he didn’t make it. A police and investigation team were called.”

Graham Martin of West Yorkshire’s Probation Service said in a statement that Mr Rychter had been in and out of jail for a variety of offences including shoplifting and assault.

He said: “He believed that if he could have found accommodation outside Huddersfield he could have turned his life around.”

Ms Gomersal gave a narrative conclusion. She said: “While he might have been depressed and a troubled young man his death was completely unexpected. We will sadly never know what Stefan intended.

“There is insufficient evidence to find that he committed suicide.”

She told members of his family who attended the inquest that his death “must have come as a terrible, awful shock.”

If you’re struggling to cope with mental health issues here are some of the ways you can access help.

Samaritans (116 123) operates a 24-hour service available every day of the year. If you prefer to write down how you’re feeling, or if you’re worried about being overheard on the phone, you can email Samaritans at jo@samaritans.org.

Childline (0800 1111) runs a helpline for children and young people in the UK. Calls are free and the number won’t show up on your phone bill.

PAPYRUS (0800 068 41 41) is a voluntary organisation supporting teenagers and young adults who are feeling suicidal.

Depression Alliance is a charity for people with depression. It doesn’t have a helpline, but offers a wide range of useful resources and links to other relevant information. The website is here

Students Against Depression is a website for students who are depressed, have a low mood or are having suicidal thoughts.

Bullying UK is a website for both children and adults affected by bullying. Click here for the website

Friday, June 2, 2017

Dispossessed in the Land of Dreams

Read article : Dispossessed in the Land of Dreams


Sometime in July 2012, Suzan Russaw and her husband, James, received a letter from their landlord asking them to vacate their $800-a-month one-bedroom apartment in Palo Alto, California. He gave them 60 days to leave. The “no-fault” eviction is a common way to clear out low-paying tenants without a legal hassle and bring in people willing to pay thousands more in rent. James was 83 at the time and suffering from the constellation of illnesses that affect the old: He had high blood pressure and was undergoing dialysis for kidney failure and experiencing the early stages of dementia.

Their rent was actually a couple of hundred dollars more than James’s monthly Social Security benefits, but he made up the rest by piecing together odd jobs. They looked for a new apartment for two months and didn’t find anything close to their price range. Their landlord gave them a six-week extension, but it yielded nothing. When mid-October came, Suzan and James had no choice but to leave. With hurried help from neighbors, they packed most of their belongings into two storage units and a ramshackle 1994 Ford Explorer which they called “the van.” They didn’t know where they were going.

A majority of the homeless population in Palo Alto—93 percent—ends up sleeping outside or in their cars. In part, that’s because Palo Alto, a technology boomtown that boasts a per capita income well over twice the average for California, has almost no shelter space: For the city’s homeless population, estimated to be at least 157, there are just 15 beds that rotate among city churches through a shelter program called Hotel de Zink; a charity organizes a loose network of 130 spare rooms, regular people motivated to offer up their homes only by neighborly goodwill. The lack of shelter space in Palo Alto—and more broadly in Santa Clara and San Mateo counties, which comprise the peninsula south of San Francisco and around San Jose—is unusual for an area of its size and population. A 2013 census showed Santa Clara County having more than 7,000 homeless people, the fifth-highest homeless population per capita in the country and among the highest populations sleeping outside or in unsuitable shelters like vehicles.

San Francisco and the rest of the Bay Area are gentrifying rapidly—especially with the most recent Silicon Valley surge in social media companies, though the trend stretches back decades—leading to a cascade of displacement of the region’s poor, working class, and ethnic and racial minorities. In San Francisco itself, currently the city with the most expensive housing market in the country, rents increased 13.5 percent in 2014 from the year before, leading more people to the middle-class suburbs. As real estate prices rise in places like Palo Alto, the middle class has begun to buy homes in the exurbs of the Central Valley, displacing farmworkers there.

Suzan, who is 70, is short and slight, with her bobbed hair dyed red. The first time I met her, she wore leggings, a T-shirt, a black cardigan wrapped around her shoulders, and fuzzy black boots I later learned were slippers she’d gotten from Goodwill and sewn up to look like outside shoes. (She wore basically the same outfit, with different T-shirts, nearly every time we met, and I realized she didn’t have many clothes.) Her voice is high and singsongy and she is always polite. You can tell she tries to smooth out tensions rather than confront them. She is a font of forced sunniness and likes to punctuate a sad sentence with phrases like “I’m so blessed!” or “I’m so lucky!” She wore a small necklace and said jewelry was important to her. “I feel, to dispel the image of homelessness, it’s important to have a little bling,” she said.

In the van, Suzan was in charge of taking care of everyone and everything, organizing a life that became filled with a unique brand of busy boredom. She and James spent most of their time figuring out where to go next, how to get there, and whether they could stay once they arrived. They found a short-term unit in a local family shelter in Menlo Park that lasted for five weeks. Afterward, they stayed in a few motels, but even fleabags in the area charge upwards of $100 a night. When they couldn’t afford a room they camped out in the van, reclining the backseats and making a pallet out of blankets piled on top of their clothes and other belongings. Slowly, there were fewer nights in hotels and more in the van, until the van was where they lived.

A life of homelessness is one of logistical challenges and exhaustion. Little things, like planning a wardrobe for the week, involved coordinated trips to storage units and laundromats, and could take hours. The biggest conundrum? Where to pull over and sleep. Suzan and James learned quickly not to pull over on a residential block, because the neighbors would call the police. They tried a church or two, 24-hour businesses where they thought they could hide amidst the other cars, and even an old naval field. The places with public toilets were best because, for reasons no one can quite explain, 3 a.m. is the witching hour for needing to pee. They kept their socks and shoes on, both for staying warm on chilly Bay Area nights and also for moving quickly if someone peered into their windows, or a cop flashed his light inside, ready to rouse. Wherever they were sleeping, they couldn’t sleep there. “Sometimes, I was so tired, I would be stopped at a red light and say, ‘Don’t go to sleep. Don’t go to sleep,’” Suzan said. “And then I would fall asleep.”

A few months in, a nice man in a 7-Eleven parking lot told them about a former high school turned community center on the eastern side of town called Cubberley. He’d walked up to their van after recognizing signs of life in the car, tired faces among the junk piling up in the back. Suzan and James were familiar with the community center because they’d taken their daughter to preschool there many years before, but they hadn’t thought about sleeping there. Cubberley had a quiet back parking lot, a flat grass amphitheater with a concrete paddock for a stage, and 24-hour public bathrooms with showers in an old gym. Rumor was that the cops wouldn’t bother anyone.

imageSuzan’s husband, James Russaw, pictured with two of their grandchildren.

Cubberley was a psychic relief because it solved so many basic needs: It had a place to bathe in the morning, a place to charge your phone. The parking lot had also formed its own etiquette and sense of community. People tended to park in the same places, a spot or two next to their neighbors, and they recognized one another and nodded at night. They weren’t exactly friends, but they were people who trusted each other, an impromptu neighborhood no one wanted to lose after losing so much. It was safe, a good place to spend the night. But it was next door to a segment of homeowners who were fighting hard to move the car dwellers out.

Normally, wealthy people who move into an area don’t see the results of their displacement because the people who lose their homes don’t stick around; they move to cheaper suburbs and work themselves into the fabric elsewhere. But the folks at Cubberley, 30 people on any given night, were the displacement made manifest. Most weren’t plagued with mental health or substance abuse problems; they simply could no longer afford rent and became homeless in the last place they lived. People will put up with a lot to stay in a place they know. “I’ve been analyzing why don’t I just get the heck on. Everybody says that, go to Wyoming, Montana, you can get a mansion,” Suzan said. “Move on, move on, always move on. And I say to myself, ‘Why should I have to move on?’”

It’s a new chapter in an old story. In his seminal 1893 lecture at the Chicago World’s Fair, Frederick Jackson Turner summarized the myth of the American frontier and the waves of settlers who created it as an early form of gentrification: First, farmers looking for land would find a remote spot of wilderness to tame; once they succeeded, more men and women would arrive to turn each new spot into a town; finally, outside investors would swoop in, pushing out the frontiersman and leaving him to pack up and start all over again. It has always been thus in America. Turner quoted from a guide published in 1837 for migrants headed for the Western frontiers of Ohio, Indiana, and Wisconsin: “Another wave rolls on. The men of capital and enterprise come. The ‘settler’ is ready to sell out and take the advantage of the rise of property, push farther into the interior, and become himself a man of capital and enterprise in turn.” This repeating cycle, Turner argued, of movement and resettlement was essential to the American character. But he foresaw a looming crisis. “The American energy will continually demand a wider field for its exercise,” he wrote. “But never again will such gifts of free land offer themselves.” In other words, we would run out of places for the displaced to go.


Suzan was born in 1945. Her father worked at what was then the Lockheed Corporation, and her mother had been raised by a wealthy family in Oak Park, Illinois. Her family called her Suzi. Though she grew up in nearby Saratoga—and spent some time in school in Switzerland—she distinctly remembers coming with her mother to visit Palo Alto, with its downtown theaters and streets named after poets. Palo Alto more than any other place formed the landscape of her childhood. “It was a little artsy-craftsy university town—you find charming towns are university towns.”

Like many women of her day, Suzan didn’t graduate from college. When she was 24, after her last stay in Switzerland, she moved to Mountain View, the town on Palo Alto’s eastern border that is now home to Google and LinkedIn. She was living off a small trust her family had set up for her when she met James at a barbecue their apartment manager threw to foster neighborliness among his tenants. James had grown up in a sharecropping family in Georgia, moved west during World War II, and was more than 17 years her senior, handsome and gentlemanly. Suzan thought: “I can learn something from him.” They were an interracial couple in the late 1960s, which was unusual, though she says her family didn’t mind. It was also an interclass marriage, and it moved Suzan down the income ladder.

For years, James and Suzan lived together, unmarried. They bought a house on University Avenue, just north of the county line and blocks from downtown Palo Alto, in 1979, and four years later had their only daughter, Nancy. It was the area’s ghetto, and the only source of affordable housing for many years. It was also the center of violence in the region, and, in 1992, was the murder capital of the country.

They never had much money. For most of their marriage, James ran a small recycling company and Suzan acted as his bookkeeper, secretary, and housewife. They refused to apply for most government assistance, even as homeless elders. “My husband and I had never been on welfare or food stamps,” she told me. “Even to this day.”

Suzan’s parents died in 2002 and 2003, and her older sister died in 2009. (“I thank God that they’re gone,” she told me. “They would die if they saw me now.”) It was a hard time for Suzan, who went to care for her dying parents and nearly left James. She felt he’d checked out of the difficulties. In retrospect, she thinks his dementia might already have been setting in; James was already in his seventies. He had taken out a second mortgage on their home, and they couldn’t pay it after he retired. They sold the house at a loss in 2005; it’s now a Century 21 office.

After they moved into the van, they settled into a routine. On the nights before James’s early-morning treatments, they slept in the dialysis center’s parking lot. Otherwise they generally stayed at Cubberley. They were still living off James’s retirement income, but most of it went to the $500 needed to rent the two storage units where their furniture remained, until they lost one for nonpayment. Finally, a few months in, Suzan was able to use a clause in a trust set up by her mother’s father to help her out in an emergency. It doubled their income—much of which was eaten up by the costs of gas, the remaining storage unit, parking tickets, and the other expenses of an unsettled life. It was a respectable income, one that technically kept them above poverty, but it still wasn’t enough for rent.

James was increasingly ill and van life was taking a toll. In addition to James’s other problems, both he and Suzan were starting to experience some of the health problems common among the homeless. The backseat of the van filled with bags of clothes, papers, fast-food detritus, pens, old parking tickets, and receipts. As the junk built up, the recline of their seats inched forever upward, until they were sitting up all the time, causing their legs to swell and nerves to become damaged, the medical consequences of not being able to raise your feet at night.


Gentrification used to be about poor neighborhoods, usually black and brown, underdeveloped and full of decrepit and neglected housing stock, run by the occasional slumlord—often described as “blighted,” though that designation has always been problematic—and how they become converted into wealthier ones, usually through the influx of richer white people and their demand for new services and new construction. It’s a negative process for the people who have to move, but there’s occasionally an element of good, because neglected neighborhoods revive. But what’s happening now in the Bay Area is that people who’ve done nothing wrong—not paid their rent late, violated their lease, or committed any other housing sin—are being forced out to make way. Displacement is reaching into unquestionably vibrant, historic, middle- and working-class neighborhoods, like The Mission in San Francisco, a former center of Chicano power. (The Mission alone has lost 8,000 Latino residents in the past ten years, according to a report from the local Council of Community Housing Organizations and the Mission Economic Development Agency.) And it’s happening to such an extent that the social workers who used to steer people to affordable apartments as far away as Santa Rosa or Sacramento, a two-hour drive, are now telling people to look even farther out. The vehicle dwellers I spoke with said they’d heard of friends living in places like Stockton, once a modest working-class city in the middle of the state, receiving notice-to-vacate letters like the one Suzan and James received.

For the most part, the traits that draw people to Palo Alto—good schools, a charming downtown, nice neighborhoods in which to raise a family, and a short commute to tech jobs—are the very same things that made the residents of Cubberley want to stay, even if it meant living in their car. The destabilizing pressure of a real estate market is also felt by the merely rich, the upper middle class, and the middle class, because the high-end demand of the global elite sets the market prices. “My block has the original owners, a retired schoolteacher and a retired postal worker,” said Hope Nakamura, a legal aid attorney who lives in Palo Alto. “They could never afford to buy anything there now.” Most people told me if they had to sell their homes today they wouldn’t be able to buy again anywhere in the area, which means many Palo Altans have all of their wealth tied up in expensive homes that they can’t access without upending their lives. It makes everyone anxious.

imageThe view inside a van parked outside a Palo Alto homeless organization.

The outcry from the neighbors over Cubberley was so fierce that it reshaped Palo Alto’s city government. The city council is nonpartisan, but a faction emerged that revived an old, slow-growth movement in town, known as the “residentialists.” Their concerns are varied (among them, the perennial suburban concerns of property values and traffic), but their influence has been to block any new development of affordable housing and shoo people like Suzan and James away from Palo Alto. An uproar scuttled an affordable-housing building for senior citizens near many public transit options that had been proposed by the city housing authority and unanimously approved by the city council. Opponents said they were worried about the effect the development would have on the surrounding community—they argued it wasn’t zoned for “density,” which is to say, small apartments—and that traffic congestion in the area would be made worse. Aparna Ananthasubramaniam, then a senior at Stanford, tried to start a women’s-only shelter in rotating churches, modeled after the Hotel de Zink. She said a woman came up to her after a community meeting where the same concerns had been raised by a real estate agent. “Her lips were quivering and she was physically shaking from how angry she was,” Ananthasubramaniam told me. “She was like, ‘You come back to me 20 years from now once you have sunk more than $1 million into an asset, like a house, and you tell me that you’re willing to take a risk like this.”

The trouble for Cubberley began when neighbors went to the police. There’d been at least one fight, and the neighbors complained about trash left around the center. At the time, Cubberley was home to a 64-year-old woman who’d found a $20-an-hour job after nine years of unemployment; a tall, lanky, panhandler from Louisiana who kept informal guard over her and other women at the center; a 63-year-old part-time school crossing guard who cared for his dying mother for 16 years, then lived off the proceeds from the sale of her house until the money ran out; two retired school teachers; a 23-year-old Palo Alto native who stayed with his mother in a rental car after his old car spontaneously combusted; and, for about six months, Suzan and James. “They didn’t fit this image that the powers that be are trying to create about homeless people. They did not fit that image at all,” Suzan told me. “We made sure the premises were respected, because it was an honor to be able to stay there.” She and others told me they cleaned up their areas at the center every morning.

“I said, ‘We have no place to go, and we’re staying right here.’ They were going to know about it.”

Pressured to find a way to move the residents out, the police department went to the city council claiming they needed a law banning vehicle habitation to address the neighbors’ concerns. Advocates for the homeless said that any problems could be solved if police would just enforce existing laws. Local attorneys warned the city council that such laws could soon be considered unconstitutional, because the Ninth Circuit Court of Appeals was hearing a challenge to a similar law in Los Angeles. Carrie LeRoy, an attorney who advocated on behalf of the unhoused, and other attorneys threatened to file a class-action lawsuit if the vehicle-habitation ban ever went into effect. The city council passed the ban anyway, in a 7-2 vote in August 2013, and the police department and other groups in the city started an outreach program to tell people about the law. “All of them had received these notices from the city,” LeRoy said, “And it was basically like, ‘Get out of our town.’”

A few weeks later, the city council also voted to close the showers at Cubberley and give it a 10:30 p.m. curfew, which made it illegal to sleep there. On their last night there, in October 2013, Suzan and James left around 8 p.m. so they wouldn’t get caught past the new curfew. They tried some old haunts and got kicked out. The stress of living in the van was hard on James. Around this time, James decided to end his dialysis. “Of course, we knew what that meant,” Suzan said.

One night, about a month after leaving Cubberley, the police pulled Suzan and James over. Their registration was expired. “This officer, he got a wild hair, and he said, ‘I’m going to impound your car,’ and called the tow truck.” Suzan told me. They got out of the car. Without pushing and demanding, she realized, she was never going to get out of the situation. She told me she said to the officer, “This is our home, and if you impound it we will not have a home.” He insisted. “I said ‘That’s fine. You do that. We will stay right here. I will put the beds out, I will put what we need here, right here on the sidewalk.” Other officers arrived and talked to them. They asked Suzan whether, surely, there was some other place they could go. “I said, ‘We have no place to go, and we’re staying right here.’ I was going to make a stink. They were going to know about it.” Suzan told me people were poking their heads out of their homes, and she realized the bigger fuss she made, the more likely officers might decide just to leave them alone.

Because James’s health had continued to worsen, he and Suzan finally qualified for motel vouchers during the cold weather. They got a room in a rundown hotel. “It had a microwave and a hot bath,” Suzan said. In his last few days, James was given a spot in a hospice in San Jose, and Suzan went with him. “It was so cut-and-dry. They said, ‘This is an end-of-life bed, period,’ ” Suzan said. “And I never said that to James.” He died on February 17, 2014, and a few weeks later a friend of theirs held a memorial service for James at her house. Suzan wore an old silk jacket of her mother’s, one that would later be ruined by moisture in the van, and a necklace Nancy had made. They ate James’s favorite foods—cornbread, shrimp, and pound cake. Suzan had a few motel vouchers left, and afterward stayed with friends and volunteers for a few weeks each, but she felt she was imposing.

That summer, she returned to her van. It was different without James; she realized she’d gotten to know him better during their van life than she ever had before. Maybe it was his dementia, but as they drove around or sat together, squished amidst their stuff, he’d started to tell her long stories, over and over, of his youth in Georgia. She’d never heard the tales before, but she’d started to be able to picture it all. On her own, without his imposing figure beside her, Suzan was scared, and more than a little lonely. Most nights, she stayed tucked away in a church parking lot, without permission from the pastor, hidden between bushes and vans. The law wasn’t being enforced, but sleeping in the lot made her a kind of a criminal. “The neighbors never gave me up,” she said.


Suzan told me she was in a fog of denial after James’s death, but it’s probably what protected her because homelessness is exhausting. “You start to lose it after a while,” she said. “You feel disenfranchised from your own society.” The Downtown Streets Team, a local homeless organization, had been helping her look for a long-term, stable housing solution. Indeed, Suzan told me that at various times, she and James had 27 applications in for affordable housing in Palo Alto. (When he died, she had to start over, submitting new applications for herself.) Her social worker at the local senior citizens center, Emily Farber, decided to also look for a temporary situation that would get Suzan under a roof for a few months, or even a few weeks. “We were dealing with very practical limitations: having a computer, having a stable phone number,” Farber said. Craigslist was only something Suzan had heard of. She’d finally gotten a cell phone through a federal program, but hadn’t quite mastered it.

For many months, Farber struck out. She didn’t think Suzan would want to live with three 25-year-old Google employees, or that they’d want her, either. She even tried Airbnb. Because Suzan didn’t have a profile, Farber used her own, and wrote to people who had rooms listed to say her 69-year-old friend needed a place to stay in the area for a couple of weeks. “We got three rejections in a row,” she said. Finally, in November, they found a room available for rent for $1,100—about 80 percent of her income from the trust and her widow’s benefits from Social Security. Suzan would have her own bedroom and bathroom in the two-bedroom apartment of a single mother. The mother crowded into the other bedroom with her 16-year-old son and seven-year-old daughter. The only downside for Suzan was that it was in Santa Clara, another charmingly bland suburban enclave in the South Bay, a half hour south of Palo Alto and a world away for Suzan. “It’s out of my comfort zone, but that’s OK!” she told me.

I met Suzan on the day she moved in, and the concept of being able to close a door was almost as unsettling to her as the concept of sleeping in the van had been. “I’m in this kind of survival mode,” she said, and had found a certain comfort in her van. “I’ve got this little cocoon I’m staying in, and everything is within arm’s reach.” She had a big blue mat in the back of the van, like a grown-up version of the kind kindergartners nap on, but soon she’d acquire a bed. She retrieved her old TV from her storage unit. She made a comfortable room, with chairs and a bed and a small table, and decided to eat her meals in there. She only signed a lease for three months, because it wasn’t really sustainable on her fixed income. She’d also applied for an affordable housing complex being built for seniors in Sunnyvale, one that would provide permanent housing for 60 senior citizens from among the 7,000 homeless people in the county at the time. She’d find out in April if she was selected in the lottery. All her hopes were pinned on it.

In the first few weeks after her move to Santa Clara, Suzan spent a healthy portion of her limited income on gas, driving the Explorer back and forth to Palo Alto. After all, her post office box was there, and so were her social workers. Her errands demanded a lot of face time, and in some ways, she still filled her days the way she had before she got her room, moving around trying to solve her problems. Her car was still packed, too, as if she hadn’t let go of the need to drive in it, to move forward, to keep her stuff around her within arm’s reach, as if she were still without a home base.

Two afternoons a week she went to a Palo Alto food closet. She usually made it right before it closed, in the early afternoons. When her number was called, she went up to the counter to watch the volunteer sort through what was left on the shelves, finding the most recently expired items—these were older goods grocery stores couldn’t keep past their sell-by dates. Suzan’s politeness was, as always, almost formal, from an earlier era, when being ladylike was a learned skill. The volunteer would ask her if she wanted milk, or peaches, or a serving-size Baggie of cereal, and she’d say, “Yes, very much so!” These days, she got to take raw eggs instead of the boiled ones, a treat reserved for those with kitchens. Her requests were glancing rather than direct. “Have you any lettuce?” and the answer was often no. I said it seemed like an efficient operation. Suzan said, “I really know the drill!”

Suzan needed to visit her social worker, Julia Lang, at the Downtown Streets Team office to get the form that allowed her to go to an even better food bank. She asked the receptionist whether her social worker was in. She wasn’t, and Suzan explained she was looking for the food bank vouchers. Then the receptionist asked for her address. That stopped Suzan. The receptionist explained that the pantry was for Palo Alto residents, and Suzan was considering, for the first time, whether that counted her. Suzan explained that she and her husband had gone to the pantry the year before, and said they should be in the system. We waited while the receptionist looked. Suzan waved at someone she’d seen around for years, from her car-dwelling days. Suzan told the receptionist, again, that they really should be in the system. But they weren’t. Suzan said that was OK, and she would come back. The receptionist said, “Are you sure? I just need your ID and your address.” Suzan demurred. She needed to talk to her social worker. This is what it meant to have to leave her hometown. She was leaving the city where she and James had known people, the city where James had died, the city where she’d grown up and near where she’d raised her own daughter. It was the city where she knew where to go, where she’d figured out how to be homeless. It was the city where she knew the drill.


That homelessness persists in Silicon Valley has puzzled me. It has an extremely wealthy population with liberal, altruistic values. Though it has a large homeless population relative to its size, in sheer numbers it’s not as large as New York City’s or L.A.’s. Some of the reasons could be found in the meeting on November 17, 2014, when the city finally overturned the car-camping ban. It had never been enforced because, as predicted, the Ninth Circuit had overturned L.A.’s ban. In the end, all but one person who’d voted for the ban the first time around voted to overturn it. The lone dissenter was councilman Larry Klein. “The social welfare agency in our area is the county, not the city,” he said. “To think we can solve the homeless problem just doesn’t make sense.”

This idea was repeated many times among city officials—that homelessness was too big an issue for the city to resolve. The city of Palo Alto itself has one full-time staff member devoted to homelessness, and it coordinates with county and nonprofit networks to counsel, house, and feed the homeless.

imageSuzan shows where she stored food in her car while homeless.

During the fight over the ban, the city tried to devise an alternative—a program that would allow car dwellers to park at churches—but then left the details up to the faith community to work out. Nick Selby, an attorney and member of the Palo Alto Friends Meeting House, said he and his fellow Quakers met with community resistance when they tried to accommodate three or four car dwellers on their tiny lot. Neighbors circulated a petition listing concerns like “the high prevalence of mental illness, drug abuse, and communicable diseases in the homeless population” and the risk of declining property values. But Selby said some of their concerns were fair. “People who objected were saying to the city, ‘What’s your program?’” Selby said. “And the city really had no answer to those questions.” Without a solid plan and logistical help from the city, other churches were reluctant to step forward. “The churches weren’t prepared to deal with this,” he said. After the church car-camping plan fell through, the city council said it had no choice but a ban.

Santa Clara County, too, struggles to address the problem. The county is participating in federal programs to build permanent supportive housing for the chronically homeless population, the population of long-term homeless who typically have interacting mental health and substance abuse problems. But land is expensive here, and the area is shortchanged by the federal formula that disperses funds. California, ever in budget-crisis mode, provides limited state funds. There isn’t a dedicated funding stream from the cities, which don’t necessarily pay a tax to the county for these projects, and local affordable housing developments are often rejected by residents as Palo Alto’s was. In September, the city of San Jose and the county announced a $13 million program to buy old hotels and renovate them as shelters, which will make 585 new beds available. While advocates credit the county’s efforts with cutting the estimated homeless population by 14 percent since 2013, the number of people like Suzan, who hide in their cars, is almost certainly underestimated. But most such efforts are centered in San Jose. Chris Richardson, a director of the Bay Area’s Downtown Streets Team, said what needs to happen is not a mystery: Other cities have to fund affordable housing, they have to fund more of it, and they have to do it in their own neighborhoods, without relying on San Francisco and San Jose to absorb all of the area’s poverty and problems. “You can’t just ship them down to the big, poor city,” he said.

When Palo Alto originally passed the car-camping ban, it also devoted $250,000 to the county’s homelessness program. When they voted to rescind the ban, council members asked for an update on what happened to the money. The city staff was not prepared to report on how it had been spent at that council meeting, more than a year into the funding. Members of the council again reiterated their desire to help the homeless. “Helping the homeless” was tabled, as a general idea, for another agenda at another meeting, as it always seems to be, or passed off to the county, or to someone else—and so helping the homeless is something nobody does.


Through the winter, Suzan remained ill; it was a bad flu season. She kept paying the rent on her room, on her storage units, on her P.O. box in Palo Alto, and she tried setting aside money she owed on parking tickets. Some months she’d run out of gas money to drive the 15 miles to Palo Alto and check her mail or visit her social workers. She was waiting to hear about the affordable apartment.

In May, she was denied. Suzan had bad credit, both because of the unpaid storage unit she and James had lost and because otherwise her credit history was so thin. Julia Lang, one of her social workers, told me she couldn’t even get a credit score for Suzan. Lang said people get denied on credit, or because they make too little for affordable housing that’s supposedly intended for extremely low-income people, all the time. “When you’re that destitute and have gone through so many complicated situations, what are the chances that your credit’s going to be good?” she said.

Suzan was livid and despondent, and she decided to appeal. “I wasn’t going to take that lying down,” Suzan told me. “I was proud of myself.” Catholic Charities helped her appeal. Suzan had to write a letter showing how she intended to repair her credit, and that she understood why it was bad in the first place. During the months of back and forth, Suzan bought a new Jeep, only one year newer than the Explorer, in case she needed to sleep in her car again. In July, she learned she’d won her appeal. She had two weeks to get her affairs in order, pay the first month’s rent and security deposit, and move in. Her social workers helped her with some of the move-in costs, and she signed a lease for a year.

I saw Suzan again in August, about three weeks after she’d moved in. Her hair was trimmed. She was wearing a brightly colored muumuu, blue and green with tropical flowers—“It’s a housedress but you can wear it out on the street!”—and a green sweater tied around her shoulders. She seemed relaxed and rested, and I told her so. Her bed was full of folded clothes, and her room was still in disarray. She was trying to cull her storage unit so that she could get a smaller one and cut down on rent. Most of the people in her complex had been in the same boat as Suzan, or had been worse off. She pays $810 a month, the amount determined to be affordable for her income. It had taken her more than three years, help from at least three social workers, and thousands of dollars, but she was finally stably housed. At least, for a year. 

Thursday, April 6, 2017

a continuing saga of inadequacy

Read article : a continuing saga of inadequacy

J R Soc Med. 2004 May; 97(5): 235–237.

PMCID:PMC1079464

Abstract

Previous surveys of UK hospitals have highlighted many deficiencies in the standards of hospital inpatient washing and bathing facilities—especially inadequate access for wheelchair users, insufficient bathing equipment, and unsatisfactory cleanliness and privacy. We conducted a qualitative survey in three hospitals in the North of England to see whether these facilities have improved.

There have been some improvements, particularly in the provision of bath hoists, adapted taps, alarm call systems, shower seats and wheelchair access to bathrooms. But many basic problems remain—absent locks and signs, inadequate heating, poor standards of privacy, insufficient bath aids, wet floors, and the inappropriate use of bathrooms as store rooms.

The overall condition of hospital bathrooms and showers remains unsatisfactory. Too many hospital bathrooms are austere, cold, smelly and poorly maintained.

INTRODUCTION

Bathing is an important activity of daily living and should be a pleasurable experience. Helping a patient to maintain personal hygiene is a fundamental aspect of nursing care but bathing of disabled and elderly people can be difficult and time consuming.1-3 If inadequate aids, equipment and facilities compound the difficulty, the process can become arduous for busy ward staff. Adequate and suitable washing and bathing facilities can help to ensure that patients are bathed in private and with dignity.

The last detailed survey of bathing facilities in a UK hospital was over 20 years ago.4 Conducted in the same region as the present study but at a different hospital, it revealed a generally poor standard of inpatient washing, bathing and toilet facilities, with insufficient equipment, especially bathing aids. It also highlighted poor access and inadequate adaptations for wheelchair users. The authors made recommendations for improvements.

Two large UK multicentre hospital surveys5,6 yielded comparable findings. The King's Fund questionnaire of patients in ten hospitals indicated that no patient was happy with the number of bathrooms or washbasins and that most were critical of standards of cleanliness. The Health Advisory Service survey of eight English hospitals commented on the poverty of the physical environment and shortcomings in bathroom cleanliness, access, equipment, upkeep, comfort, and privacy. We have looked at hospital bathing, washing and showering facilities to see if matters have improved.

METHOD

Two of us (AM and ST [see acknowledgment]) visited 46 hospital wards in three different hospitals in the North of England—a large teaching hospital, a smaller satellite hospital attached to the teaching hospital (mainly comprising specialist elderly rehabilitation wards), and a small district general hospital in a neighbouring city. All adult medical, surgical, and orthopaedic wards were assessed. Intensive care units, high dependency units, and psychiatric, and paediatric wards were not. We inspected all bathrooms and showers and recorded their physical characteristics on a checklist. We documented and compared details of door widths, height of light switches, accessibility for wheelchair occupants, alarm call systems, bathtub characteristics, bath aids, heating, floor surfaces, mirror height, sink accessibility, easy use of taps, privacy, and cleanliness.

RESULTS

The number of patients on each ward varied from 10 to 32, average 25. The total number of patients on all 46 wards was 1167. The proportion of physically disabled patients on wards varied from 12% to 100%, average 72%. For the purposes of this study, we defined physically disabled patients as those who needed any degree of assistance with washing or bathing while in hospital (this was determined by the ward nursing staff).

General features

All bathrooms and showers had a functioning alarm call system.

On 9 of the wards, there was no sign on the bathroom or shower door indicating the room's use. On 5 wards there was no lock on the bathroom or shower door. On 9 wards, the bathroom or shower room lacked privacy: for example, having only a small curtain or ‘concertina’ door separating the shower from the open ward; bathroom doors with large ‘peep holes’ or with large ‘see-through’ glass panels covered only by a small curtain. In one case, a paper towel was taped across the glass panel in place of a curtain. In another ward the bathroom was being used simultaneously as a toilet, with two patients using the room at one time (one in the bath, one on the toilet), separated only by a curtain.

The width of all bathroom doorways was above the minimum recommended (80 cm) to allow access for a wheelchair. However, on 13 (28%) wards, doorway width was less than 93 cm, the preferred width for wheelchair access. 8 wards had no heating in the bathroom. On 3 wards the light switch was too high to be accessible for someone seated or in a wheelchair.

In most bathrooms and shower rooms the decor was plain, uninspiring blue or green gloss paint (‘like a bad campsite washroom’ was one nurse's comment). At the time of inspection, bathrooms or shower rooms on 12 wards were considered unclean on subjective inspection. A recurrent finding was that the room smelled of urine. In some, the floor was wet and potentially hazardous. The standard arrangement was for one of the domestic staff to clean the bathroom and shower once daily. At all other times—and between baths and showers—this responsibility fell to the ward nurses.

Bathtubs and bath aids

The number of bathtubs per patient varied from 1 in 6 to 1 in 28. All wards had at least one bath, most had two. 12 wards had baths that were not free-standing, so carers were unable to get around both sides (though most of these wards also had another bath which was free-standing). Two free-standing baths had a shower obscuring one side, which blocked access for carers.

45 of 46 wards had a bath hoist (ambulift), 19 (41%) had bath rails, 10 (22%) had a bath seat, 20 (4%) had non-slip mats (now less favoured because of the theoretical risk of infection spread), 2 (4%) had a bath board. 19 (41%) had ‘easy to use’ or adapted taps (i.e. easier to turn on and off for patients with dexterity problems). 6 bathrooms also contained a bidet; few of these worked and all were unused. Most bathrooms were cluttered—sometimes almost full—with non-bathroom-essential ward objects such as mattresses, commodes, and weighing machines. In some cases, these impeded access to the bath.

Showers

Most wards had two separate showers, 16 had only one. 10% (7/73) of showers were either broken or not working. A recurring problem was water seeping under the door into the main ward, in one case dripping down through the ceiling to the floor below. Some of these had been awaiting repair for several months with no obvious indication that this would occur in the near future. This was a source of frustration to the nursing staff.

Only 33 (72%) wards had showers that were accessible to wheelchair users. Some had a large step up to the shower, others were too cramped, making manoeuvrability impossible. 82% (60/73) of showers had a shower seat, generally a simple plastic chair borrowed from the main ward.

Washbasins

Most washbasins were of a suitable height for those needing to sit and wash, and legroom was adequate. Taps were adapted or easy to use on 34 (72%) wards. 11% (10/90) of bathrooms had no mirror and 39% (31/80) of mirrors were > 130 cm off the ground (not easily accessible for someone seated or in a wheelchair).

DISCUSSION

72% of hospital inpatients in this study needed some assistance with washing and bathing. Since the previous study in 1982,4 improvement has occurred in wheelchair accessibility to bathrooms but not showers, and in access to washbasins (direct comparison is not possible, since the studies were done in different hospitals). The provision of alarms is now standard, and the use of bath hoists and showers is almost universal. Many taps are now easy to use. But little else has changed. We found identical themes to the previous surveys.5,6 The main deficiencies, as before, are limited accessibility of showers for wheelchair users, a paucity of bath aids and adaptations, concerns about cleanliness and lack of privacy. Other inadequacies include: poor signage, missing locks, lack of heating, unimaginative decor, unpleasant smells, wet floors, obstructive clutter, raised shower thresholds, mirrors and switches that are too high, and delayed repairs. This study was of 46 wards in three hospitals in one English region. Surveys of hospitals elsewhere are needed to show whether our findings are generalizeable: we suspect that the inadequate state of hospital bathing facilities is a widespread phenomenon.

It is of concern that many of our findings are similar to those of the King's Fund patient survey performed in 1966.5 The Department of Health survey in 19986 raised similar criticisms, and made many recommendations for action to be taken. However, in the hospitals that we studied we found little evidence of improvement. Overall, there were few changes from the situation encountered more than 35 years ago.

These findings should be placed in context. On most wards, facilities for washing and bathing were adequate and there were several other positive findings. For example, all rooms had functioning alarm call systems and light switches that worked. With one exception, all wards had a bath hoist, the most important bathroom aid for disabled patients. But many shortcomings persist. Few wards had a full set of simple bath aids. Mirrors should be lowered or enlarged to make washing, shaving and grooming easier for those who need to sit for this activity. All taps should be adapted for easier use. Wheelchair access to showers should be improved. Repairs to broken bath and showering equipment could be done much more quickly. More consideration might also be given to improving the decor, privacy, cleanliness, and general environment of these rooms, helping to make washing and bathing a more dignified, pleasurable and relaxing experience for all involved.

There is limited space on hospital wards, and bathrooms are commonly used inappropriately as store rooms. There should be alternative areas to store ward equipment, freeing the bathrooms for their proper use. Having to share the same bathroom with another person (fortunately, only one instance seen) is particularly unsatisfactory.

The recommended standards for disabled people using hospital say little about bathrooms and showers.7 Measures to improve overall quality of care, privacy, and facilities in hospital are in the National Service Framework for Older People8 but at present there are no comprehensive guidelines or national standards. Most of the improvements required would be inexpensive. Hospital managers, doctors, and modern matrons should focus on these important deficiencies in the bathing facilities of most hospital wards. Perhaps a designated member of staff (such as an occupational therapist) could ensure that washing and bathing facilities are adequate and act as patient advocate. It might be a good idea to make bathroom standards a key factor in government star ratings of hospitals. The aim should be to provide bathing facilities that we would be happy to use ourselves.

Acknowledgments

We thank Dr Sarah Twigg, Senior House Officer in Elderly Medicine, St James's University Hospital, Leeds, for her help with the data collection.

References

1. Whiting LS. Maintaining patients' personal hygiene. Prof Nurse 1999;14: 338-40 [PubMed]
2. Berwick L, Nisan C, Higgins M. Care of the body: maintaining dignity and respect. Perspectives 2002;26: 10-14 [PubMed]
3. Sloane PD, Rader J, Barrick AL, et al. Bathing persons with dementia. Gerontologist 1995;35: 672-8 [PubMed]

5. King Edward's Hospital Fund for London. Patients and their Hospitals. Maidstone: Alabaster, Passmore, 1969

6. Health Advisory Service. Not Because they are Old: an Independent Inquiry into the Care of Older People on Acute Wards in General Hospitals. London: HAS, 1998

7. Royal College of Physicians and Prince of Wales' Advisory Group on Disability. Charter for Disabled People Using Hospital. London: Royal College of Physicians, 1992 [PubMed]

8. Department of Health. National Service Framework for Older People. Standard 4: General Hospital Care. London: Department of Health, 2001

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press