Yes, actually, it may be you one day

I could fill a book with transcripts of frustrating conversations I’ve had with executives, project managers, and developers who – to put it politely – exhibited an amazing mastery of stopping a constructive conversation in its tracks by offering up excuse after excuse about why they couldn’t buy or develop an accessible ICT product or system. It didn’t matter what I said or how much evidence I had to support my position because they had entered the conversation with their minds made up already. I know I’m not alone here and in fact it was hearing others’ troubles that made me begin the series “Selling Accessibility“.

Web Accessibility advocates have developed a series of Business Case arguments about why accessibility matters, among them is the argument that an accessible website performs better for older people. I have provided my own commentary on the business case arguments. Of the multiple arguments for accessibility, the one I pointed to as being best tied to real ROI is Web Accessibility Support for Aging Populations. The basic premise for supporting aging populations is this:

28% of the WCAG Success Criterion are mapped to benefits for Senior users. Baby Boomers account for 47% of US families and have over $2,000,000,000 in buying power.

Because of this, you may be able to reach a market population with extensive buying power. Provided, of course, you market to them successfully. But wait, there’s something else. Not only is the population of older people growing, but as people get older their rate of disabilities increase as well.

Bar chart showing that as people get older their rates of disabilities increase.

The data doesn’t lie. If you’re lucky enough to live to an advanced age, your chances of having some kind of disability rises significantly – to 50% and beyond. So when you’re considering whether or not accessibility is important, keep in mind that it could actually be you you’re ensuring accessibility for. If it isn’t you, it will definitely be someone you know, and possibly someone you love.

A real story to illustrate my point

A little over a year ago my mom, now 65, began having some health problems. She had been feeling a little weak and lethargic at times. Doctors determined that she wasn’t getting enough potassium and other electrolytes and set upon a course of treating it. Thus began a saga of regular doctor visits. Due to her age and this annoying electrolyte issue, my mom began seeing doctors rather frequently to try to get these issues sorted. Typically these visits came out like this: “We don’t know what’s going on. Let’s go ahead and run a few more tests.” During one of these visits the doctor recommended she get checked out for cancer. My mother was diagnosed with colon cancer about 18 months ago and soon after had surgery for it. The good news, if there is any when talking of cancer, was that the location and amount of cancer they removed was small enough that she had a full recovery and did not need any follow-up treatments with chemotherapy. When it comes to cancers, apparently her type of colon cancer has a very high survival rate compared to other types. Follow-up visits to the doctor indicated they had gotten it all and she was good to go.

Perhaps my use of “full recovery” in the previous paragraph was a bit hasty, as was the assumption we made at the time. I don’t think anyone can really say because although all indications show that the cancer was clearly gone, she really didn’t get back to being her old self again. That’s because she began holding water. Her legs swelled a lot and it became difficult to get up from a seated position. To those around her, including doctors, this seemed a continuance of the electrolyte issue. Afterall, electrolytes are vital during muscle contraction and the posterior chain muscles are the largest in the body. So, ostensibly, if there’s some sort of electrolyte issue it seems sensible that those muscles would be impacted by it the most. And thus continues our saga of doctor visits.

After several months of back-and-forth trips to different doctors doing different tests, it was time to go to Johns Hopkins. There, we hoped, she could get seen by some of the best doctors there are. Unfortunately, the wait to see one of their doctors was several weeks long. A few weeks later, the swelling, weakness, and lethargy took a significant turn for the worse. My dad drove my mother to the Emergency Room at Hopkins and, after a 24-hour wait in the ER, she was admitted. Her total time at Hopkins was about a week during which they also did test after test to determine what was happening. As it turns out, she not only had the electrolyte issue, but also cirrhosis.

The cirrhosis diagnosis was somewhat of a surprise considering she was not a heavy drinker and was free from all of the other typical causes of cirrhosis like Hepatitis. However, it turns out that the most likely cause of this was a surgical procedure she had in the late 70s called a Jejunoileal bypass – an early type of gastric bypass surgery for weightloss that became renown for the many resulting complications including hepatic cirrhosis in 30% of patients who got the procedure. The odd part, in her case, was that it took so long to manifest.

During the stay at Hopkins, they treated her for the water retention and got her on a path to better recovery than she had been getting as an outpatient with her regular doctors. Unfortunately, there’s no cure for cirrhosis short of a liver transplant, so she was also scheduled to see a transplant specialist. As things tend to go with Hopkins, scheduling for this was several weeks out.

As the saying goes, hindsight is 20/20. Shortly after she came home her behavior and speech became “odd”, for lack of a better word. My wife would get off the phone with her and say to me, “Has your mom been drinking?”. She sounded lazy in her speech and more whimsical and even giggly at times. My dad also would comment later that she was impulsive and bought things online that she normally wouldn’t and certainly didn’t need. After a few weeks of this, she began to get very lethargic, very forgetful, and very clumsy. One day she fell and, in light of other odd (or, more odd than normal at this point) things that had happened that day, my dad decided to call 911. She was taken to the ER and then admitted to the hospital.

It turns out she was experiencing a bad bout of Hepatic encephalopathy (hereafter referred to as HE). Blood tests showed that the level of ammonia in her blood was 3-4 times as much as would be considered normal and her liver’s inability to clean toxic substances from the blood had caused the HE. At her worst, she was in a near comatose state, however doctors got the ammonia levels under control and after a few days she was released to a rehabilitation center.

My mother was released to a rehab center to get rehabilitative care to recover from some of the more lasting effects of the HE which are, from outward appearances, much like a stroke: trouble walking, trouble speaking, loss of memory or confusion, etc.. Like a stroke, depending upon how bad the episode is, the level of recovery from HE can vary.

Here’s the tie-in to accessibility

Like many baby boomers, my mom is very internet savvy. She is like a lot of internet users. She uses the internet for email and search, she shops and purchases products online, books her travel online, and uses Facebook, Twitter, and Skype to keep in touch with friends and family. She’s also like a lot of people in that she’s glued to her smartphone and uses email and apps on her phone and likes to text. Her phone of choice was an HTC Thunderbolt. Or, I should say it was an HTC Thunderbolt.

One of the lasting effects of the HE is poor vision. Her vision is bad enough that I would consider her to be low-vision. When my wife and I went to visit my mother in the rehabilitation center, one of the first things my mother said to me was “How do I make the stuff bigger on my phone?”.  My answer: You don’t. Android, all the way up to the latest versions don’t do ‘zoom’ and historically Android lags behind iOS significantly in accessibility in general.

iOS? Well basically the short answer is that Apple “Gets it”.  From the beginning iPhone has kicked Android’s ass in accessibility, even despite the improvements in Jelly Bean.  Want to enable Zoom in your iPhone? Simple: Settings -> General -> Accessibility -> Zoom.  Bang, done.  Want to enable Zoom in your Android?  Go to your mobile provider and trade it in for an iPhone, which is exactly what we’re going to do for my mother.  I’m not an Apple Fanboy.  I buy & use what I like and have had Android devices since they came out.  I had a Windows mobile phone before iOS or Android existed. I have 8 Windows machines in my home. But the fact remains that from an accessibility perspective iPhone does it the best.

This story of my mother isn’t the only one out there and as baby boomers get older these sorts of stories will become more commonplace. Smart businesses adapt and react to market demand.  If you market or develop ICT products and services and you’re still ignoring accessibility, you’re ignoring the coming reality.  One day it will be you, or someone you know and love.

If you are interested in learning about the next generation in Web Accessibility Testing, give Tenon.io a try.
If you or your organization need help with accessibility consulting, strategy, or accessible web development, email me directly at karl@karlgroves.com or call me at +1 443-875-7343. Download Resume [MS Word]

One Comment

  • Joanne
    Posted November 23, 2012 at 2:31 pm   Permalink

    It could happen anyday to perfectly healthy people. Suppose you broke your right arm. It happens. But how can you use your computer without your mouse? Guess what, you have a mobility disability, albeit only temporarily. Thank goodness you can use your software with just the keyboard.

    This is one of the ways accessibility helps everyone no matter where you are in life.

    Joanne (ok, stepping off her soapbox…)

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