Episode 15
Experts Opine: Esther Greenhouse, Environmental Gerontologist
Welcome!
In this episode we have an expert guest, Esther Greenhouse, talking all things environmental gerontology (how cool is that?). We talk about design challenges, caregiver labor shortages and tips/tricks for aging in place.
Find out more about Esther...
Esther Greenhouse, CEO of Silver to Gold Strategic Consulting, is a strategist and environmental gerontologist bringing a unique constellation of experience and expertise in design, gerontology, environmental psychology, and planning to help organizations and communities excel at meeting the needs of the 50+ population to enable them to THRIVE! Her unique Enabling Design Approach is a pillar for AARP International’s Equity by Design initiative, and informed the design of the nation’s first elder-focused ER at the request of Dr. Bill Thomas. She co-authored the American Planning Association's Aging in Community Policy Guide, is an industry scholar for the Cornell Institute for Healthy Futures, and served as the Strategic Director for one of the nation’s first Age-Friendly Centers for Excellence. The International Well Building Institute has appointed Esther to their newly formed Investing for Health Advisory. For 10 years she was the primary caregiver for her mother, and Esther’s Enabling Design Approach enabled her mother to maintain her physical and financial independence for longer, reduced demands on family and professional caregivers, and resulted in savings of over $500,000. This is the basis of Silver to Gold's Caregiving by Design Initiative, to help municipalities and senior care providers address the caregiving crisis and enable greater independence and well-being among the seniors they serve.
Also Referenced: http://www.louistenenbaum.com/
Caveats:
- This is a judgement free zone
- There are no "shoulds" allowed, we live in curiosity
- Take what works well for you, leave the rest!
My course "unSandwiched: 5 steps to managing mental drama about aging parents" goes live on July 20th. Please see the interest list here.
If you are finding value in this podcast, please share and leave a review so others can find it too!
Rebecca
Disclaimer: The information presented on this podcast is solely for information purposes. We do not provide medical, legal, financial, or other professional advice through this podcast and we are not responsible for any errors or omissions. It is your responsibility to seek advice from a licensed professional. Any actions you take are done at your own risk.
Transcript
Thank you everyone for joining us for another episode of Real
Speaker:Conversations About Aging Parents.
Speaker:I am with us today, a special guest, Esther Greenhouse.
Speaker:We met a couple months ago at a conference called Environments for Aging.
Speaker:And when she told me about her passions and her background and
Speaker:What she gets to do every day.
Speaker:I was absolutely developing a design crush.
Speaker:Esther doesn't know this yet on what she does and how she does it.
Speaker:And one of the things I took away from that conference is that there are true
Speaker:blue academics out there that just really love this topic that really want to
Speaker:push the topic of how we take care of aging persons and their environments.
Speaker:all the way, not just from the design, but just how it impacts
Speaker:their lives and their function.
Speaker:And I'm just so excited to have you here today, Esther.
Speaker:Thank you for being here.
Speaker:Rebecca, it's my pleasure.
Speaker:Thank you for having me on your important podcast.
Speaker:I really enjoyed meeting you as well at the Environments for Aging conference.
Speaker:Um, I felt a connection to you right away, even before we met based on your comments.
Speaker:And I thought, Who is this woman?
Speaker:What does she do?
Speaker:I'd like to get to know her.
Speaker:So I'm so glad that you reached out to me and that we've connected.
Speaker:Well, yeah, and I'm glad we're here.
Speaker:And I remember one of the first things we talked about was
Speaker:having you come on the podcast.
Speaker:I think you have so much to share.
Speaker:Uh, so just for, for context today, we're going to focus on, um, Esther's
Speaker:professional experience and a lot of the things that she's learned and she's
Speaker:going to share them with you here today.
Speaker:But before we dive into that.
Speaker:Esther, can you just give everybody an idea of what kind of work you do?
Speaker:What's the term for it?
Speaker:How did you arrive at that?
Speaker:Yes, so I am an environmental gerontologist and a built
Speaker:environment strategist.
Speaker:Um, I'm now shortening that to refer to myself as a gerostrategist.
Speaker:Being an environmental gerontologist means that I am dedicated to improving the lives
Speaker:of older adults via the built environment.
Speaker:And that doesn't mean that I'm solely working in Um, design for older adults.
Speaker:Um, part of my work is collaborating with designers and architects, collaborating
Speaker:with senior living providers to inform the design of spaces that will be used
Speaker:by older adults to enable them to thrive.
Speaker:But in addition, there's so much more that goes into shaping the lives of
Speaker:older adults through built environments.
Speaker:There's policy.
Speaker:There are zoning ordinances, building codes.
Speaker:I've been involved in creating initiatives like AARP's Equity by
Speaker:Design, which is an initiative for The built environment sector to help them
Speaker:create enabling and equitable multi generational housing and communities.
Speaker:. Okay.
Speaker:So go back to what kind of communities.
Speaker:These are equitable.
Speaker:Equitable and enabling so enabling.
Speaker:Okay.
Speaker:Can you talk more about what that means?
Speaker:Yes.
Speaker:Yes.
Speaker:So we all know the term equity.
Speaker:Um, the enabling comes from my enabling design approach, which I created as
Speaker:a response and a Guide to changing the discriminatory status quo of our
Speaker:housing and our built environments.
Speaker:So there are three parts to the enabling design approach.
Speaker:The first is the concept of environmental fit and press.
Speaker:And environmental fit and press comes from the field of environmental psychology.
Speaker:And when you distill it to its essence, it's very simple and it's very powerful.
Speaker:Essentially, when there's good fit between a person and their environment,
Speaker:They can be independent, and that doesn't mean that they may not need
Speaker:any assistance from other people, they may not, they may need to use some
Speaker:assistive devices, but with the design of the environment with the protocol of
Speaker:care, whether it's formal or informal, they can be as independent as possible.
Speaker:Unfortunately, when you have poor fit between a person and their environment.
Speaker:That person is subjected to a form of stress.
Speaker:called environmental press.
Speaker:So actually, the greater the gap between what my abilities are and
Speaker:what the built environment asks of me, the more my abilities are pushed
Speaker:to an artificially lower level.
Speaker:So it makes me unnecessarily frail and dependent.
Speaker:And where we see that most is with older adults.
Speaker:Now some people say, okay, with older adults, you can
Speaker:move to specialized housing.
Speaker:Um, but as you well know, Rebecca, um, that doesn't work for everybody.
Speaker:In fact, over 90% of older adults do not live in senior housing.
Speaker:So we really need to then look at the second pillar, which is the
Speaker:fact that Our building codes and conventions create housing and other
Speaker:environments that are ideal for the average height male with high physical
Speaker:sensory and cognitive abilities.
Speaker:And so what that really means is that we've built a society that is
Speaker:great for the average height male between the ages of 20 and 40, and
Speaker:then everyone else has to adapt.
Speaker:Now I'm five foot one.
Speaker:I have two visual processing disorders.
Speaker:I have sensory processing disorder.
Speaker:I am always experiencing some degree of environmental press.
Speaker:So not all of this is age related.
Speaker:So the third pillar of the enabling design approach is After looking at the world
Speaker:through the lens of environmental fit and press and the disabling and narrowly
Speaker:designed status quo, what is the response?
Speaker:We need to look at our policies, our programs, and our protocols.
Speaker:We need to look at returns on investments and cost benefit analyses to make
Speaker:sure that we're creating environments that enable people to thrive.
Speaker:Across the lifespan and across the ability span.
Speaker:Thank you so much.
Speaker:That's a very thorough explanation.
Speaker:That's going to set us up very well for a lot more questions I have for you.
Speaker:Um, so the first question I have is just in general, this is a very, you know,
Speaker:specific topic, but how does somebody get into, uh, Environmental gerontology.
Speaker:Like how is that an academic?
Speaker:What's the the after after high school?
Speaker:What does that look like getting in to do something like what you get to do?
Speaker:Well, I'm glad you ask how you become an environmental gerontologist
Speaker:because there are very few of us.
Speaker:And clearly, um, with the exponential growth of the
Speaker:aging population, we need more.
Speaker:So, um, there are a variety of ways that one can pursue this
Speaker:one can, um, study design, uh, as an undergraduate, they can study
Speaker:psychology, and then, and then pursue a master's degree in a related field.
Speaker:So for example, in my case.
Speaker:I studied interior design.
Speaker:Um, it was, uh, it is part of a program at Cornell University called
Speaker:Design and Environmental Analysis.
Speaker:And, um, I think now they've changed the name to the, of the department
Speaker:to, um, Human Centered Design.
Speaker:But all the majors within that program were rooted in
Speaker:environmental psychology research.
Speaker:So while I was Um, and while I was studying design and learning to actually
Speaker:be a designer in design studios in the afternoon, in the mornings, I was taking
Speaker:environmental psychology classes to be informed, um, to understand how the
Speaker:built environment affects people, and why we don't design randomly, but we
Speaker:seek information, both from research, As well as from, um, the people who
Speaker:will be using the places we design.
Speaker:In my case, while I was studying design and environmental psychology as an
Speaker:undergraduate, The college developed a certificate program in gerontology,
Speaker:and I was like, this is terrific.
Speaker:I was very interested in how the built environment
Speaker:specifically impacts older adults.
Speaker:And here was this minor that I could pursue.
Speaker:Which I did, and, um, after graduation, I went and worked in an architecture
Speaker:and engineering firm for a couple of years, and I was very unhappy
Speaker:because we were not doing any projects related to older adults.
Speaker:And, um, I remember approaching one of the principals of the firm and
Speaker:saying, I know I'm in my early 20s and I don't know a lot about going out and
Speaker:getting a client and running a project.
Speaker:But I know that, , environments for older adults is the next big trend.
Speaker:The next big unmet need, and I'm one of few people in the country who has
Speaker:expertise and design for older adults.
Speaker:So if you're interested, we can pursue that, you know, I'd love to be part of,
Speaker:of growing the firm in that direction.
Speaker:And, um, it, I was, uh, ignored.
Speaker:And it was really fascinating.
Speaker:I then, um, left that firm after a couple of years and went back to design and
Speaker:environmental analysis at Cornell and specifically pursued a master's in applied
Speaker:research in environmental psychology.
Speaker:And, um, with that, I looked at, um, reducing the visual deficits that occur
Speaker:with Alzheimer's disease and other dementias and the intersection between.
Speaker:lighting and those visual deficits, creating a form of environmental
Speaker:press and how you can thoughtfully use lighting to reduce those issues.
Speaker:So that was my path for becoming an environmental gerontologist.
Speaker:Wow.
Speaker:I, I honestly didn't know that even existed until I met you.
Speaker:And thank you so much for talking about that.
Speaker:It seems like we need, you know, hundreds more of those knowing the demographic
Speaker:shift that we're about to, or we're seeing right about to see, but we're
Speaker:seeing, um, since you've been involved in this for, it sounds like, you know,
Speaker:since your early twenties, what are the three most encouraging trends that you
Speaker:see sitting at your perch right now?
Speaker:Okay.
Speaker:So first I'll say that.
Speaker:I actually haven't been involved with this since my early 20s.
Speaker:This actually has been a lifelong interest of mine, because I mentioned
Speaker:that I have sensory processing disorder and two visual processing disorders.
Speaker:I'm very sensitive to light.
Speaker:So you can see photos of me as a child reading, um, by a lamp in my room and
Speaker:wearing a brim tat because I'm trying to shield myself from too much light.
Speaker:So I've always been very aware about the built environment.
Speaker:Um, there's also a Really nice video on the homepage of my website,
Speaker:which talks about my mission and what led me to this work.
Speaker:And that really began when I was about five years old, and my maternal
Speaker:grandmother who lived with us.
Speaker:Was, um, suffering from rheumatoid arthritis and as it progressed
Speaker:and she needed to use a walker.
Speaker:Um, she found she couldn't get into the bathroom with the walker
Speaker:because the doorway was too narrow.
Speaker:Um, and before long, she needed to move to a skilled nursing facility
Speaker:because this was the early 70s and most people didn't do home modifications
Speaker:to enable someone to age in place.
Speaker:Um, and so that experience and then visiting her regularly until she
Speaker:passed away, um, at the skilled nursing facility, it was, um,
Speaker:it was really eye opening to me.
Speaker:So the, some of the trends that I'm seeing, um, so I'm very excited
Speaker:about, um, trends related to aging in place I'll give you some context.
Speaker:Not only is it really meaningful to me because of my grandmother's experience,
Speaker:um, it's also really meaningful to me because I, um, collaborated with
Speaker:my husband, who was a custom home builder, to design and build a house
Speaker:for my mother that would enable her to as much of her physical and
Speaker:financial independence as possible.
Speaker:And We succeeded.
Speaker:We were able to delay her moving to a facility by five to seven
Speaker:years and through simple features, um, like installing a bidet
Speaker:seat, which she used regularly.
Speaker:We estimate that that saved her probably about 30, 000 over seven years.
Speaker:Because she was able to have one less aid visit per week for showering,
Speaker:not to mention the probably half a million dollars or more that the
Speaker:family saved and the government saved by keeping her at home.
Speaker:So, the, the trends that I'm seeing related to aging in place.
Speaker:Um, and I think the um, one, um, that senior living providers are looking at
Speaker:shifting from the model of a continuum of care that requires a person to move to
Speaker:different units and have different homes, different room, a different apartment,
Speaker:as their needs for care increase.
Speaker:That's the.
Speaker:the typical model.
Speaker:So whether a person lives in, um, a continuing care retirement
Speaker:community, where there are various levels of care on one campus, um,
Speaker:Esther, if I can interject, um, to my loyal tribe of listeners for this
Speaker:podcast, what Esther's talking about, if you refer back to episode two,
Speaker:when we interviewed Renee about her mother's living situation in Florida.
Speaker:That's those continuing care communities, and that is where you enter, usually
Speaker:in an independent living situation, and then as your needs increase, then
Speaker:they move you into an assisted living or a skilled nursing type, uh, setting.
Speaker:And, uh, that's the trend that Esther is talking about, that That
Speaker:either it could be in one room, like the room itself could just change
Speaker:to meet the needs of the person.
Speaker:Um, and the idea would be that they're not having to relocate at a time when
Speaker:they're also experiencing some decline.
Speaker:Is it, do I have that right, Esther?
Speaker:Right, so actually what I was going to say, in addition to the Continuing
Speaker:Care the CCRC, you also have people moving to different levels of
Speaker:care and different environments.
Speaker:from facility to facility.
Speaker:So for example, my mother lived the last few months of her life in an assisted
Speaker:living facility and had her needs progressed enough, she would have had to
Speaker:leave there entirely and move to a new facility, a skilled nursing facility.
Speaker:So that's the old model, but exactly what I was getting at was I'm so excited
Speaker:by this new trend of looking at how can we have A person move into a room, an
Speaker:apartment that will be their home until they pass away and any level of care
Speaker:they need can be provided in that room.
Speaker:So that's really meaningful to me because First of all, common sense dictates that
Speaker:if you have to make a change that you're not happy with, in terms of your home, Um,
Speaker:it's going to be challenging, but we also have research to support that that can
Speaker:be really devastating for older adults.
Speaker:And in fact, it can, um, it can hasten their deaths.
Speaker:So we really want to respect people and make sure that they feel at
Speaker:home and provide the levels of care.
Speaker:Um, another trend that I'm seeing, um, is serving older adults kind
Speaker:of in the opposite direction.
Speaker:It's It's the trend for senior living providers to provide what they call
Speaker:senior living services or senior living without walls out into the community, as
Speaker:you and I have talked about over 90% of older adults are not aging in specialized
Speaker:housing in a dedicated senior facility.
Speaker:And.
Speaker:Um, their needs are not being successfully met.
Speaker:So they're there and that's happening for a variety of reasons.
Speaker:Um, one reason is that we have not prepared for the exponential
Speaker:growth in older adults.
Speaker:And, um, the fact that.
Speaker:Fewer family caregivers really are in a great position to deliver care, um,
Speaker:but many of them are doing it anyway.
Speaker:Um, we also have issues that The design of our housing and our communities
Speaker:makes the provision of care harder.
Speaker:So it makes it harder for, uh, an assistant, um, such as a home
Speaker:health aide or a family member to help somebody use the bathroom.
Speaker:Even Even if I'm there to help my grandmother when she's using a walker,
Speaker:though, that door is still too narrow.
Speaker:And so it's going to be challenging for two of us to get through together.
Speaker:But the other thing to think about is the plight of home health aides, um, and
Speaker:the plight of certified nurse, nurses, aides who are working in facilities.
Speaker:This population is primarily made up of women.
Speaker:Um, they tend to be the primary breadwinner for their families.
Speaker:Um, they're often what we call sandwich generation where they're providing
Speaker:care for their own children, um, as well as for an elder in their family.
Speaker:Um, they might even be providing care for a grandchild.
Speaker:Um, and they're trying to get to senior living facilities, which by the typical
Speaker:way that are zoning ordinances set up and our land is used in this country
Speaker:Um, it.
Speaker:It's often very difficult to access those locations unless you have a car.
Speaker:Um, they are not in, um, downtown centers or nodes, um, of community design.
Speaker:The other issue is how we have typically set up our towns.
Speaker:Um, and cities where the focus has been to get people into the city center
Speaker:into the downtown center, uh, to to do work and be there from 8 to 5 or 9
Speaker:to 5 and then commute back out well.
Speaker:If I'm an aide and I'm living in an urban environment and I need to get
Speaker:out to a more rural environment or a suburban environment to take care of
Speaker:an older adult who's attempting to age in place, how am I going to do so?
Speaker:Because often the trains and buses are designed for me people to be
Speaker:commuting in the other direction.
Speaker:Often, this population, these women, are trying to commute against the tide.
Speaker:And, um, we just don't have appropriate Uh, in many cases, we
Speaker:don't have appropriate transportation systems that make that a reality.
Speaker:That's working against us.
Speaker:So the other thing that I think we're starting to see, well, the other trend
Speaker:that I see is much more discussion about aging in place, but I always
Speaker:encourage people to not focus on aging in place, but successful aging in place.
Speaker:Because so many people are just aging in place by default, and they
Speaker:don't realize how the design of their home is working against them.
Speaker:It's exacerbating their decline and creates what I call forced frailty.
Speaker:And that is preventable by good design.
Speaker:That respects people's needs across the lifespan, and I went, I think one of the
Speaker:things, one of the challenges about that is the age of the homes themselves so
Speaker:even if we were able to turn the tide and all the new track housing going up here.
Speaker:Kind of was was had a wider doorway or things like that.
Speaker:I'm wondering the implications of the current or pending crisis
Speaker:with the demographic shift is for people staying in their home.
Speaker:Those homes may be 5060 70 years old and the affordability.
Speaker:Of going back and doing and you're married to a builder.
Speaker:Right.
Speaker:And so, and that's even changed the last several years.
Speaker:Um, and we don't really incentivize people or a system and
Speaker:renovating, although it would be.
Speaker:Cost beneficial to the greater population if we were able to
Speaker:keep people in their homes.
Speaker:An example of that would be the Canadians coming out and allowing
Speaker:tax rebates or tax deductions for aging in place type renovations.
Speaker:Have you heard of any?
Speaker:I've heard there might be some similar legislation here in the United States.
Speaker:It's not live yet.
Speaker:I don't, I don't know where it's stuck right now, but do
Speaker:you have any updates on that?
Speaker:Yes, so I encourage everyone to visit lewis tenenbaum.
Speaker:com and I can give you some links to post on your website.
Speaker:Um, Lewis tenenbaum, um, has been a.
Speaker:incredible advocate for successful aging in place for via
Speaker:appropriately designed housing.
Speaker:Um, he is a former builder and, um, like me, Lewis, uh, taught the certified aging
Speaker:in place specialist program run by the National Association of Home Builders.
Speaker:And, um, he has put forth Um, I, a bill to provide, um, a tax break.
Speaker:For people to when they make they invest in their housing and
Speaker:they make home modifications.
Speaker:So I'm not going to speak to that, but I will share the information and
Speaker:your listeners can look into that.
Speaker:I'd like to chat a little bit.
Speaker:I'm always interested in big picture economics as well.
Speaker:And from my point of view, maybe more on the healthcare side, is the way that
Speaker:we deal with the aging in place problem.
Speaker:So for people that have resources, it's not a problem.
Speaker:Um, like all the, you know, the settings we were just mentioning, you're not
Speaker:going into an independent living or a private assisted living facility without
Speaker:somewhere around six to 8, 000 a month.
Speaker:Um, and if you're not working, then you're assuming that that's either a pension or
Speaker:that's a retirement that's doing really well, or you have some other pot of money,
Speaker:um, and, and not knowing for most people exactly how long they're going to live.
Speaker:And you're looking at, say, you're 75 entering an assisted living
Speaker:and you think I could live five more years or 25 more years.
Speaker:That can be a hard decision, right?
Speaker:Because it might not be, um, you know, or your needs might change
Speaker:or your finances might change.
Speaker:But if we'll just take that population.
Speaker:Uh, and put them on the shelf and look at the other people that, um, maybe
Speaker:don't have the resources to, to go there or personally don't want to go there.
Speaker:The way that this is handled by the government is a couple of different ways.
Speaker:So if you, if you stay in your home, there are home health services
Speaker:that are designed to help extend some health care to, into the home
Speaker:setting for like wound, uh, dressing changes, sometimes IV antibiotics.
Speaker:So to help keep you in your home versus being in a nursing facility, but if push
Speaker:comes a shove and somebody is unsafe to live in their home and has to go into a
Speaker:nursing facility for the, for the vast majority of people that's going to be paid
Speaker:for by Medicaid, which is a state funded.
Speaker:And kind of hybrid federally funded program that you can only only be
Speaker:eligible for once you have less than 2, 000 to your name, period.
Speaker:And so there's usually a spend down period say you had 15, 000 and you
Speaker:spend that down get below 2, 000 and then you're eligible for Medicaid,
Speaker:which will then fund, um, not necessarily a selective place some some.
Speaker:Places offer Medicaid beds, some don't, and then you end up living, um, off of
Speaker:a state funded, um, retire, I don't know how to say that, a state funded, um,
Speaker:resource that's going to give you housing, um, and, but because that comes out of
Speaker:what looks like a health care budget, so Medicaid's considered, Healthcare
Speaker:colored money and not residential colored money, we're almost doing this
Speaker:weird shuffling on like if we had all the money and laid out on the table.
Speaker:We're calling it healthcare spending because they have to be qualified to
Speaker:need some sort of nursing oversight in order to be in these in these settings.
Speaker:So it's coming out of a healthcare budget, but it's really indirectly solving
Speaker:what was initially a housing problem.
Speaker:Does that sound right?
Speaker:Thank It's an excellent explanation.
Speaker:Yes.
Speaker:Um, I, like many people find, um, uh, the specifics of Medicaid, um,
Speaker:and Medicare, um, overwhelming.
Speaker:Um, but yes, it's true.
Speaker:And the other thing that's really important is, if we're looking at
Speaker:it in terms of healthcare spending, which is, uh, not unreasonable, well,
Speaker:There's a very easy shift we can make.
Speaker:Um, I remember, I think it was when I was a teenager in the 80s and we started
Speaker:to move, um, with insurance to, um, to preventative care insurance programs.
Speaker:And that's exactly what we can do with Medicaid spending.
Speaker:We just need to recognize.
Speaker:That because we are designing our housing or transportation systems are public
Speaker:places are workplaces for a small subset of the population that average height
Speaker:male between the ages of 20 and 40.
Speaker:And the impact that that has over time.
Speaker:As we age.
Speaker:and how it can make people more frail and make people need more long term
Speaker:care, we can easily just shift the view and say, how do we prevent that?
Speaker:What, what are the variables?
Speaker:And really the built environment is of the social determinants of health.
Speaker:Um, which are areas, uh, or rather variables that are considered in public
Speaker:health in also in, in healthcare fields like, um, um, city and regional planning.
Speaker:So we know this makes a difference.
Speaker:That's the reason that I do the work I do in my, my number one goal.
Speaker:is to enable people to maintain their physical and secondarily
Speaker:financial independence as they age.
Speaker:I want people to be able to thrive.
Speaker:If, if we were talking to somebody who is asking for three or four lower budget
Speaker:modifications that you see have the greatest, like, pound per dollar, I don't
Speaker:know how to say, the greatest punch for the amount of money you're spending.
Speaker:And you've seen this, people be able to make these modifications.
Speaker:What would those be?
Speaker:That's, that's a great question.
Speaker:I love that.
Speaker:Um, so it's important to recognize that not everyone can build a
Speaker:custom home like my mom did.
Speaker:Or, um, completely renovate a house before I get into some low
Speaker:hanging fruit of easy renovations.
Speaker:I also want to remind people that the best time to change the design of your
Speaker:home to be enabling across the lifespan is before you're already impacted.
Speaker:And so often, I meet people, when my husband was a builder, he had clients
Speaker:who did this, I, I know people who are in the aging space, they are
Speaker:undertaking a renovation, they're updating their kitchen, they're, um,
Speaker:finally, uh, creating a master suite with a beautiful bathroom en suite,
Speaker:and they are not putting in features, you know, ренovation features.
Speaker:That will enable them to successfully age in place.
Speaker:That's one thing to keep in mind.
Speaker:That it doesn't typically cost more.
Speaker:You just have to be aware and think about it but then when we look at specific
Speaker:features, I'm a big fan of a bidet seat.
Speaker:So my mother had requested when we built her house, she wanted a bidet seat.
Speaker:I think the bidet seat we bought for her was maybe about 500, and
Speaker:then what was needed was a dedicated outlet, which in this case, my
Speaker:husband installed, but let's say you hire an electrician to install that.
Speaker:You're looking at approximately a 1, 000 investment.
Speaker:Because my mother used the bidet seat every time she toileted, she was
Speaker:able to have one less shower a week.
Speaker:Either I showered her or an aide showered her.
Speaker:And with the cost of an aide visit being approximately 100 a visit, because
Speaker:it's Typically about 25 to 30 per hour.
Speaker:Usually there's a minimum of a three hour shift.
Speaker:So every last shower she could have saved her 100.
Speaker:And when you add that up over weeks and months and years.
Speaker:over a seven year period when she needed assistance with bathing, we
Speaker:calculate that she saved over 30, 000.
Speaker:Did that, so to have a 3, 000 return on investment.
Speaker:And for people that don't know, so a bidet seat is, there's a lot of different
Speaker:versions of them, but it's usually an attachment to an existing toilet that
Speaker:will help clean your bottom without having to be able to reach your bottom.
Speaker:Or even without toilet paper.
Speaker:So it's a combination of water and followed by air to dry.
Speaker:Uh, so that people that are either weak or maybe because of their body,
Speaker:um, the way their body is, they just can't get, um, to do that hygiene,
Speaker:what that saves them, if, uh, what that saves them in terms of caregiving is
Speaker:somebody would not have to come and do perform personal hygiene for them.
Speaker:Um, and so there's a good privacy gain from that.
Speaker:There's obviously a great independence of that.
Speaker:There's a good health outcome, because having a clean, bottom
Speaker:you're talking about a population very prone to urinary tract
Speaker:infections, to GI infections as well.
Speaker:Maybe they have poor visual, , issues and maybe they can't confirm that
Speaker:they, they've cleaned really well.
Speaker:So that's another option.
Speaker:I will say that there are some versions of bidets that don't require an outlet.
Speaker:They just have less features.
Speaker:They're available on Amazon.
Speaker:I would only know this because I have a son who's very clean and requested a bidet
Speaker:for his birthday, which is hilarious.
Speaker:Um, and, uh, we had that installed in the, in, in his bathroom recently.
Speaker:And, um, so his future spouse, you are welcome.
Speaker:I have a very clean eight year old.
Speaker:boy, um, that I think will grow into a person that loves to be clean.
Speaker:So, um, so that is the, if you're wondering yourself, you
Speaker:know, what, what is a bidet?
Speaker:In some cultures, they're standard.
Speaker:They're across, uh, especially if you go places like Japan, um, you won't use
Speaker:a restroom that doesn't have a bidet.
Speaker:Um, here in the United States, it's still kind of a funny word.
Speaker:It's still a funny concept, but.
Speaker:As far as what Esther is describing, something easy that
Speaker:can be done, um, and added without existing, uh, massive renovation.
Speaker:So what are a few other things that kind of hit your brain as, as easy?
Speaker:So, uh, another issue is wider doorways.
Speaker:So to undertake, um, a renovation of actually widening a doorway and installing
Speaker:a new door, um, you know, the, the all, all data pre 800 to about 1, 500
Speaker:per doorway.
Speaker:To widen, um, the door.
Speaker:And when you think about it, um, why would it be so costly?
Speaker:Well, the first thing is you need to buy an entirely new door.
Speaker:Um, so that will run you a couple of hundred dollars, give or
Speaker:take, depending on the style.
Speaker:Um, the other issues are you'll often have to patch the flooring.
Speaker:Um, you may have to move the electrical, um, outlet and light
Speaker:switch that are close to the door.
Speaker:Aside to make for a wider opening.
Speaker:So there's there's quite a bit of work involved in that.
Speaker:Now, first thing I'll say is to spend 1500 to have a wider doorway that enables
Speaker:you to get into the bathroom and remain in your home or live, for example, with
Speaker:your adult children in their home is a one time investment versus 3500 8500 a month.
Speaker:To live in assisted living.
Speaker:So it's very important to do a cost benefit analysis.
Speaker:The other thing is, I really encourage people, if they're building a new
Speaker:home or doing any renovations on their home, um, to think about doing,
Speaker:making wider doorways from the get go.
Speaker:Um, on new construction, sometimes the cost of a wider doorway is zero, um,
Speaker:and often it's as little as 20 per door.
Speaker:But other things that can be done are, um, you can remove the existing
Speaker:hinges and put on hinges that are, um, referred to as swing away hinges.
Speaker:So they allow the door to swing out of the way and you can often pick up,
Speaker:um, an inch or sometimes maybe up to two inches with replacing the hinges.
Speaker:Other things that are important.
Speaker:Modifications that you can make are thinking about the lighting in your home.
Speaker:It's really important to have lighting that is respectful of age related changes.
Speaker:And, um, again, this is something for me that I can really relate to because
Speaker:I've always been very sensitive to light and very sensitive to glare.
Speaker:So, um, and specifically, I, um, had to have an operation on one of my eyes two
Speaker:years ago, and because of that surgery, cutting into the lens of my eye, I was
Speaker:told, you're going to develop a cataract.
Speaker:And I have.
Speaker:So now, um, at age 53, um, I have a cataract in one eye and it's
Speaker:helping me understand, um, older adult vision that much more.
Speaker:So what does that translate into in reality?
Speaker:One is, um, a terrible, terrible, terrible trend in lighting is
Speaker:clear bulbs with exposed filaments.
Speaker:Okay.
Speaker:I have had a very hard time with that.
Speaker:Um, and, and I know, um, a lot of older people do other people
Speaker:who are very sensitive to light.
Speaker:Um, for example, people who are on the autistic spectrum, um,
Speaker:this, this just doesn't work.
Speaker:So do not have any light fixtures in your home that have.
Speaker:clear glass, um, and an exposed filament.
Speaker:Going further, I really recommend that all lighting have, um, either
Speaker:a milky white diffuser, which is the, the shell, so to speak, around
Speaker:a light bulb, um, or a lampshade.
Speaker:You don't want to see the light source, uh, because glare can be disabling.
Speaker:Another thing you want to do is to have different options
Speaker:for lighting within a space.
Speaker:So you want to be able to have, um, a lot of light or very low levels
Speaker:of light, maybe at night, but that still help you find your way.
Speaker:Um, and there are different ways to do that.
Speaker:You can install, um, uh, nightlights that plug into outlets that just come
Speaker:on, uh, when the light levels are low and they illuminate your path.
Speaker:Other things to think about with lighting is also the amount of light
Speaker:you're getting from the exterior, um, a really bright window can have, um,
Speaker:be over 300 foot candles of light, um, which can create, uh, intense glare.
Speaker:And related to this, you want to think about the other surfaces in the room.
Speaker:So if you have flooring that's shiny.
Speaker:When that sunlight comes in, or the light, the artificial light in the
Speaker:room bounces off of it, it's going to create hot spots of glare, and that
Speaker:can be disabling by causing strain on the visual system, and sometimes
Speaker:even pain, but it also causes problems because it impacts how you perceive it.
Speaker:That floor.
Speaker:Um, it can make the floor appear uneven, for example, and then you
Speaker:change your gate unnecessarily and you're more likely to slip and fall.
Speaker:Thank you for sharing those.
Speaker:Yeah, I think lighting is something that, um, You know, fairly easy to
Speaker:change out or rearrange buying a floor lamp right that's not out too far
Speaker:out of most people's budget if that's what's going to be best for that room.
Speaker:And I want to reassure people I, as, as many of you know design is my, my side.
Speaker:Passion as well.
Speaker:So I'll do future podcasts.
Speaker:Hopefully Esther will come back and speak with us again about
Speaker:specifically about some more aging in place design type recommendations.
Speaker:So, um, Esther from from where you sit in the industry that you're in right now.
Speaker:Um, can you give anybody just an idea.
Speaker:Of if they are an adult child wanting to help support an aging parent,
Speaker:you've mentioned, um, trying to do some renovations, maybe not go
Speaker:crazy, but some things you can do ahead of time, um, trying to think
Speaker:about the financial aspects of it.
Speaker:And I know you yourself have been somebody that supported a mother and
Speaker:then, as you mentioned, a grandmother.
Speaker:Can you think of any advice you would give to them or lessons learned if
Speaker:I'm sitting in that situation and wondering how I could pick the brain
Speaker:of an environmental gerontologist, like what they would tell me?
Speaker:Yes, so a couple of things.
Speaker:One is I'll share some links.
Speaker:to um, uh, some articles.
Speaker:There's an article that, um, I wrote for, um, the Certified Senior Advisors
Speaker:Association specifically on leveraging home design features to, um, enable
Speaker:physical and financial independence as part of a retirement strategy.
Speaker:So that would be one of the key things is.
Speaker:Look at your home and where you're going to live as part
Speaker:of your retirement strategy.
Speaker:A lot of people are really uncomfortable with having conversations about
Speaker:how, what design features they might need to support them as they age.
Speaker:I remember, um, when I had, um, finished my master's, my mom was in her, um,
Speaker:mid to late 60s, and she had recently suffered a minor heart attack, and
Speaker:I said, okay, let's Make a plan, you know, your, your mother had to move to a
Speaker:nursing home, which you don't want to do.
Speaker:Let's plan out different scenarios and prepare.
Speaker:And her response was.
Speaker:I don't have one foot in the grave yet.
Speaker:And that was the end of the, that was the end of the discussion until she
Speaker:was 80 and um, she had a slight fall and that was a wake up call to her.
Speaker:So I'm gonna, I am totally in love with this idea of aging in place design as part
Speaker:of a truly comprehensive retirement plan.
Speaker:Um, and that's cost avoidance, right?
Speaker:And then it's also, um, preservation of function and quality of life.
Speaker:Like, I don't know that a lot of people go into retirement saying, oh,
Speaker:I hope I would have to move someday.
Speaker:And I think that the best for most families, right, is to, to really
Speaker:find environments that promote healthy aging in place as much as possible,
Speaker:fall prevention, kind of the big, the big ones that are up there.
Speaker:And I'm not, I think we do a lot of hand wringing about Avoiding the topic and
Speaker:then also when the topic comes up it being like a like a huge tsunami wave
Speaker:that hits us all at one time and then we're not making our best decisions.
Speaker:Maybe we're now really financially stressed because
Speaker:somebody's been in the hospital.
Speaker:And so I love this idea of the maybe a cultural shift that you've
Speaker:worked so hard for your retirement.
Speaker:And again, I'll tie this back to the podcast I did right before Father's Day
Speaker:with my dad talking about how he's kind of modified his home, being proactive,
Speaker:trying to stay there, but also because that's part of his retirement plan.
Speaker:Um, and, and maybe using that wedge of retirement planning as a way to have a
Speaker:difficult conversation about preserving their retirement, preserving everything
Speaker:they've worked for, um, and not making it like, Hey, you're, you're up next, right?
Speaker:You're about to.
Speaker:To, to jump to the other world.
Speaker:Right.
Speaker:Um, it's more about, you know, that's your, you know, what if this was a routine
Speaker:part of that financial conversation with the financial planner or banker or,
Speaker:or whomever, because we get so siloed.
Speaker:Right.
Speaker:And I'll share a story and I haven't shared on the podcast yet.
Speaker:But when I first started getting interested in design several years ago.
Speaker:Not knowing any better, I just started randomly calling designers
Speaker:and architects like a eureka, like, oh, this is such an important thing.
Speaker:I think people should, um, you know, care about this and worry about it.
Speaker:And, and I was very, very naive.
Speaker:And I remember An architect actually went far enough to invite me to their facility.
Speaker:I'm sorry, an architect went far enough to invite me to sit down with his team.
Speaker:And I did this PowerPoint presentation very boldly talking
Speaker:about a lot of these topics.
Speaker:And at the end of the day, I had really not understood
Speaker:the architect business model.
Speaker:And sitting down with a potential client and talking to them about aging
Speaker:and all of their health needs was not necessarily something they wanted.
Speaker:And, um, it was a young architect that pulled me aside as I was about
Speaker:to leave and she said, I, I, I don't want to ask them because I
Speaker:feel like I'll lose the business.
Speaker:And she had described, um, just a week before a client having a difficult
Speaker:time ascending the five stairs it took to get into her office and that
Speaker:they looked like they might have some mobility issues and then sitting
Speaker:down and planning their dream home.
Speaker:And she said, I knew the entire time that they should be
Speaker:thinking about aging in place.
Speaker:We should be talking about doorways, but I was so terrified in this competitive
Speaker:market to try to get people's, you know.
Speaker:Business that if I had just brought it up that maybe they'd walk right out
Speaker:the door and it was, you know, it was hard to hear for me in that moment and
Speaker:I totally understood it and I was so glad somebody pulled me aside and said
Speaker:that because I had not quite understood.
Speaker:Some of the challenges like you and I talk as if it's common sense and
Speaker:everybody would do this, um, but there's aesthetic challenges to it.
Speaker:There is a worry about the home feeling institutionalized, um, for designers,
Speaker:which if you don't know that industry is an extremely crowded and competitive.
Speaker:industry itself.
Speaker:And so that's when I started thinking more broadly about what I was going to do.
Speaker:Which was really focused on educating the consumer and supporting the consumer
Speaker:to make these decisions because that was much more balanced in the way that the
Speaker:the finances flow in that industry is a consumer would come to an architect or
Speaker:designer and say, I want to age in place.
Speaker:I need you to do this.
Speaker:And they can totally do it right.
Speaker:They can get certifications in it.
Speaker:They can.
Speaker:There's lots and lots of resources out there.
Speaker:But I don't think people understand that it's it's still a taboo topic.
Speaker:And as comfortably as we're talking about it here today, that is not normal.
Speaker:Thank you.
Speaker:In those design settings.
Speaker:Can you talk to us a little bit more about that?
Speaker:Yes.
Speaker:Yes.
Speaker:Um, I'm glad that you had that experience and, um, that, that architect was kind
Speaker:enough to share her experiences with you.
Speaker:Um, it's amazing because That architect also could have not talked about aging
Speaker:and ability at all and could have framed this in the advantages of having
Speaker:wider doorways that when you're walking through carrying a laundry basket,
Speaker:um, when you're moving furniture, just moving throughout the space, those
Speaker:few inches make a world of difference.
Speaker:My husband and I will never forget when my mom's new house was done and
Speaker:the movers Uh, arrived and they had lots of issues moving her stuff up
Speaker:unrelated to my mother, but she lived in a condo, um, where, or maybe it was
Speaker:a co op where there were restrictions on what hours of the day they could be
Speaker:at the building, taking her things out.
Speaker:Um, then they had difficulties with their trucks and it was a very long trip.
Speaker:It was a five hour drive.
Speaker:They finally arrived at her house at nine o'clock at night.
Speaker:We insisted they ate the dinner that we had got for them.
Speaker:And then they walked into the house.
Speaker:It's 10 o'clock at night.
Speaker:They're utterly exhausted.
Speaker:And they're like, Oh my gosh, thank goodness for these wider doorways.
Speaker:And no steps and no transitions.
Speaker:So, you know, and that's another key feature.
Speaker:Having at least one zero step entry to the house and putting in
Speaker:a shower that's a no step shower.
Speaker:And in a lot of circles, no step showers are not called no
Speaker:step showers for aging in place.
Speaker:They're called spa showers.
Speaker:And the ease and luxury of having the tile floor and no, no
Speaker:transition, no grade change is viewed as something that's luxurious.
Speaker:So a lot of this is the framing.
Speaker:We do talk in terms of beauty and appearances about.
Speaker:anti aging and, um, retaining your youthful look and That
Speaker:really doesn't translate.
Speaker:It's not working to translate that well into the home environment.
Speaker:Um, and that really ties into a huge issue, uh, which is the shame of aging.
Speaker:And one of the components of my mission is to help people understand
Speaker:that aging is a normal process.
Speaker:It can be exacerbated by disease.
Speaker:It can be exacerbated by lifestyle, but overall, it's a normal process.
Speaker:And, um, part of the decline that we experienced.
Speaker:Is because of the environments that were forced to live in, and I
Speaker:don't blame designers and builders because many of them don't know.
Speaker:Also, they're busy trying to build to code, and they're trying to build
Speaker:to address a whole host of variables.
Speaker:What we really need to do like you said is we need to educate
Speaker:consumers, but we need to educate everybody involved in the process.
Speaker:Because for example, I often will work with municipalities and one important
Speaker:role I have is getting the municipalities to understand that every new housing
Speaker:unit that's built in their community that's built to the disabling status
Speaker:quo is going to cost them money.
Speaker:It's going to make one more unnecessarily frail person.
Speaker:That they have to try to figure out how to accommodate.
Speaker:So we have to address the shame of aging.
Speaker:And while the anti ageism movement rightly so says that we shouldn't be
Speaker:trying to, um, hold onto our youth.
Speaker:I think to some extent it could be helpful for consumers.
Speaker:Um, and other decision makers to view these environmental features to view
Speaker:the design components in their home and in their communities as a path
Speaker:to the fountain of youth in a way, um, and not that they're going to,
Speaker:um, you know, not that it's going to make them be 30 something forever.
Speaker:Um, but that they actually have some agency, they have some choice.
Speaker:And the decline that they may have experienced is not their fault.
Speaker:You know, there are these, these very significant variables
Speaker:that are working against them.
Speaker:Um, and it doesn't have to be that way.
Speaker:That's one of the most important things.
Speaker:This is not rocket science.
Speaker:We know how to do these things.
Speaker:Most of these things don't cost extra money.
Speaker:You just have to know and do.
Speaker:And one of the things that you spoke passionately about when we
Speaker:first met at that conference was the pending, or maybe it's already here,
Speaker:shortage of actual caregiving labor.
Speaker:And this idea that, you know, we kind of take for granted that
Speaker:people will work for 8 an hour to help lift people in and out of bed.
Speaker:And the days where that's either a sustainable job or even ethical
Speaker:to pay that much, um, that that labor pool is also shrinking.
Speaker:Yes, there's injuries in that labor pool, and that's not a livable wage being paid
Speaker:for that type of labor, and we're sort of making these assumptions that people
Speaker:will come out of the woodwork and the next couple of decades and and take care
Speaker:of people, including ourselves as we age.
Speaker:And perhaps that's not the case.
Speaker:So can you touch on that briefly.
Speaker:This is.
Speaker:A monumental trend in our society and demographic trend that we're
Speaker:already, um, being hurt by and it's only going to get worse.
Speaker:So what's happening is that the older adult population is growing
Speaker:exponentially and at the same time, younger populations contain potential
Speaker:caregivers, whether their family members or they would be paid caregivers.
Speaker:are shrinking.
Speaker:So we're going to have increased demand for long term care and
Speaker:at the same time that the supply of that care is contracting.
Speaker:So in my, from my perspective, from my 30 plus years of experience and expertise,
Speaker:the way you balance the equation is to look at the built environment.
Speaker:So all of the things I talk about not only apply to the supply of
Speaker:housing, the housing stock in our country to make sure that we're
Speaker:over 90% of older adults are aging.
Speaker:is designed to minimize the demand for long term care and also make the
Speaker:provision of care in the home much easier.
Speaker:But it's also, um, to make environments That are, um, senior living, housing
Speaker:and facilities more enabling enable the independence of the residents
Speaker:to make the demand for care, the limited staffing that's already
Speaker:there, limit the demands on them.
Speaker:At the same time that you're thinking about how can we make.
Speaker:The job easier for staff.
Speaker:I remember when I was an undergraduate and I was pursuing the gerontology minor
Speaker:in one of my classes, we were studying the workforce and all the issues.
Speaker:that we talked about then hold true today, underpaying this population,
Speaker:not supporting their needs.
Speaker:And I really call on, um, all of those in positions to employ, um, The home health
Speaker:aides, certified nursing assistants, um, direct care workers, anyone who
Speaker:can make a decision about their salary.
Speaker:We need to pay these people a living wage.
Speaker:It's not just the minimum wage.
Speaker:It's not just more than the minimum wage.
Speaker:It's not just more than your competitors.
Speaker:There's data on what is the living wage in your region, and we need
Speaker:to pay these people that wage.
Speaker:We also need to go a few steps further.
Speaker:We need to recognize, okay, a lot of these providers, these care, the
Speaker:direct care providers, have Children or grandchildren, they're responsible for.
Speaker:I can't tell you how many times I've heard discussions.
Speaker:I've even written issue briefs about this, but having child care on site and
Speaker:like what an amazing thing that would be, it would make it easier for the AIDS.
Speaker:It would.
Speaker:Um, bring the life of children into the facility, allow for
Speaker:intergenerational programming, um, why is that not more frequently done?
Speaker:Other issues too are things like affordable housing.
Speaker:Our nation is in a crisis.
Speaker:We significantly lack affordable housing.
Speaker:Why don't we look at returning to older models of workforce housing?
Speaker:Um, you could provide housing on site.
Speaker:You could provide housing within a community and lastly to tie this
Speaker:all together, um, I've developed an initiative for my firm called tackling
Speaker:the caregiving crisis by design and one of the components is helping communities,
Speaker:helping regions address this issue because both municipalities and regional health
Speaker:care systems are impacted by the number of frail people within their communities.
Speaker:In addition, they are at the mercy at the number and availability of
Speaker:direct care workers to provide care.
Speaker:And they need to really come together.
Speaker:Um, sometimes it's public private partnerships, sometimes it's public
Speaker:public partnerships to address this.
Speaker:Um, because we're in a period now where we are moving from, um, I think in 2010,
Speaker:it was, there was approximate, there were approximately seven potential caregivers
Speaker:for every one, um, person who needed care.
Speaker:Um, we're at about one in five now, and within 10 years or so, it'll be
Speaker:less than three potential caregivers for every one person who needs care.
Speaker:So we need to make these changes.
Speaker:We need to also incentivize, um, or provide, uh, funding programs for
Speaker:home modifications, which supports the crucial work that you do.
Speaker:And we also need to change our building and zoning codes to stop
Speaker:replicating the production of disabling and discriminatory housing.
Speaker:And, um, before, uh, we wrap up here, can you tell people how to
Speaker:get a hold of you if they wanted to reach out to you or learn more?
Speaker:Sure.
Speaker:Um, they, people can visit my website.
Speaker:My firm is called Silver to Gold Strategic Consulting, and my website is www.
Speaker:silver.
Speaker:gold.
Speaker:com.
Speaker:to gold strategies dot com and that two in the web address is spelled
Speaker:to silver to gold because our mission is to turn the silver of
Speaker:aging to gold for everyone involved.
Speaker:Well, I don't think we could have had a better note to end this awesome interview.
Speaker:Thank you so much for bringing all of your knowledge and
Speaker:expertise to our audience here.
Speaker:I think that was a very fascinating topic.
Speaker:I still have a massive design crush on you.
Speaker:Um, so I'd like to keep following what you're doing.
Speaker:And I just appreciate you being open.
Speaker:For anybody who's wondering, yes, I am going to have Esther back.
Speaker:Completely different conversation about her experience with, as
Speaker:being a caregiver for her mom.
Speaker:Um, so we'll take it from a totally different perspective.
Speaker:I think that'll actually add some depth to some of the
Speaker:things you've talked about here.
Speaker:So Esther, thank you so much for joining me today.
Speaker:Thank you, Rebecca, and I would love to support your important work.
Speaker:Thank you for having me.
