Designing for: Aging In Place (Season 2, Episode 1)

Designing for: Aging in Place
Guests: Deborah Pierce, Architect & Brian Harvey, Contractor

(Music / Intro)

Janet: In this series we will be discussing specific examples of design techniques that make a positive difference for people living with certain human conditions.

Carolyn: The more a designer understands the client and or the community the more effective and respectful the design will be.

(music up, then lower)

Janet: Welcome to Inclusive Designers Podcast, I’m your host Janet Roche.

Carolyn: And I’m your moderator, Carolyn Robbins. It’s a fact that today’s population is living longer, and most people want to stay in their own homes as long as possible. The definition of ‘Aging-in-Place’ is “the ability to live in one’s own home and community safely, independently, and comfortably”… but just what do you need to do to make that happen?

Janet:  In this episode, we’ll take a look at the process and the design decisions that can be implemented for Aging-in-Place, and to ensure that the home fits the specific needs of all the individuals living there…

Carolyn: Before we get to today’s discussion, let me tell you a little bit about our guests and their qualifications:

– Deborah Pierce is an award-winning architect and author of The Accessible Home, a guide to designing homes for people of all ages and abilities. She is AIA, (American institute of architects), and CAPS certified, which means she is an Aging-in-Place Specialist.Her architectural practice focuses on remodeling projects for people seeking to age in place – providing them with greater comfort, safety, and independence. Deb’s clients also include people living with a wide variety of disabling conditions… including sensory, cognitive, and physical impairments. She has written articles, spoken at conferences and leads accessibility workshops around the country on the many ways that architectural modifications can tailor the home to fit each clients’ unique needs and lifestyles.

– And today we also have Brian Harvey… Brian is NAHB, National Association of Home Builders, Certified Aging-In-Place Specialist, or CAPS, who owns ‘Harvey Home Modifications’, a building and remodeling business. His company focuses on modifying homes to cater to an individuals’ particular limitations. They do everything from grab bars to new construction, and are well versed in bathrooms, in-law-suites, and universally designed floorplans. Brian and his team of project managers and skilled laborers work closely with both families and non-profit organizations to help people live independently in their own homes.

Janet: This is also my area of expertise. Like Deb and Brian, I am a Certified Aging-in-Place Specialist. In today’s episode, we discuss how to design for Aging-in-Place and other comorbidities, which are the simultaneous presence of two or more chronic diseases or conditions in a patient. We examine the best designs and modifications for Aging-in-Place from the perspective of an architect, a designer and a contractor…

(Music – Transition to Interview)

Janet: Welcome to Inclusive Designer’s podcast. Today, our guests include architect Deborah Pierce and contractor Brian Harvey, and, of course myself Janet Roche as the designer. And we’ll be talking today about Aging-in-Place. Well, thank you both so much for, for joining me today. Deborah, why don’t we start with you, why don’t you tell us what your definition is of Aging-in-Place…

Deborah: Making a home that’s senior friendly, that has features that make it easier to get around if someone has difficulty with their legs or with breathing or with the shoulders, that makes it easy to see if there are any difficulties with vision or hearing. It’s really sensitively designed residence or environment for people with all the kinds of things that can happen with aging. And just briefly, I’d like to say that we don’t all know what will happen when we get older. We don’t know what we will have. And so really sensitive design that works for a variety of disabilities and conditions is what an Aging-in-Place environment is.

Janet: Right. And it really does depend on the person. And obviously, as we well know, everybody’s individual journey towards aging and Aging-in-Place is very different. And Brian, why don’t you tell us a little bit about what you think Aging-in-Place is from your perspective as a contractor.

Brian: Yeah, sure, so, my perspective is a bit unique. Mine is very much a family business. My father and mother have been caregivers for most of their lives. And my father, became a handyman, strictly for seniors. I joined him some time ago and was another set of hands. And as our capabilities grew, so did what we were able to accomplish. And the need for Aging-in- Place is enormous. And to me, really Aging-in-Place means, the want to stay at home or to stay at a particular residence. To ‘Age-in-Place’ is kind of a newer term that you’re hearing a lot today.

Janet: Right. And as the population has been aging and as we as we all know here in this particular room, 2030 will have the most seniors, most people over the age of 65 in the history of the world. So, this is a very important topic to talk about. Just as a little side note, I got a chance to meet your parents and what you guys do there with your particular type of brand of construction is really kind of terrific.

Brian: Thank you. Yeah, it’s definitely a labor of love for us.

Janet: Yeah. So, yeah…

Deborah: I think the quick answer to what is ‘Aging-in-Place’ is staying put.

Janet: I mean, that’s ultimately the bottom line and that’s the goal. And so, in this particular program today, we really want to talk about sort of the basics. So why don’t we start also talking just a little bit about what are some of the comorbidities. We’re all aging, right, but everybody has some sort of comorbidity, whether it’s some sort of a problem with their eyesight or maybe a stroke has left them slightly paralyzed. What kind of comorbidities are you guys seeing with Aging-in-Place, because as we well know, that aging is not in a vacuum… Deborah, do you want to start?

Deborah: It’s also not in a linear pattern. And so, aging, as well as life in general, is a time when different things can happen to a person’s body, right. We can have trouble walking around and have trouble hearing at the same time. People can have multiple conditions. And if it’s not one person having multiple conditions, it’s the people that share the home or it’s the people that visit. And so, good Aging-in-Place is designed with the needs of a variety of conditions that people may have because it needs to accommodate all of us. I think it’s important to mention that people go out less when they get older and they’re more socializing at home and more spending time at home. So, it’s really important to make sure that the home is really, really a haven. And that’s a, it’s accessible, it’s easy to use, it’s comfortable, it’s safe, it feels cozy. It’s just, it accommodates your hobbies. So, I think it’s important to be looking not just at the disabilities, but also the abilities and how can we live well.

Janet: Right. And that there’s other people in the house and that would be additional comorbidities besides just maybe what somebody who is getting older has.

Deborah: 17-percent of the population, I hear, has a hearing loss and only 25-percent of those people use hearing aids. So that’s a pretty common condition of aging. People also frequently have cardiovascular problems that can make it difficult to climb stairs, for example, or walk long distances without stopping to rest. Many people won’t be in wheelchairs, but people may be using walkers or canes or some kind of assistive device, for mobility. People will also often be using, having special medications and perhaps have some procedures regarding personal care, personal hygiene that will require maybe staying longer in the bathroom…

Janet: Right, we also talk about in this particular profession and also within the medical profession, we use the term ‘Activities of Daily Living’ right, so ADLs. And that’s a little bit about what you’re talking about. So, Brian … anything that you would like to add about the comorbidities that you’re seeing within Aging-in-Place?

Brian: Sure. I think every individual’s needs, every couple’s needs are completely unique. And as Deb can tell you better than I have, or I can, is that the ADA or AAB specs that you see on a piece of paper aren’t necessarily what’s going to work for someone to age in place, or when you’re talking about comorbidities, that particular need.

Deborah: There are several regulations that govern buildings to make them accessible for people who have disabilities. The ADA is a regulation that came out in the federal level in 1991 and it requires that public buildings be accessible. And that means wheelchair accessible generally. Then the state has a separate regulation called the Architectural Access Board regulations, and we call it AAB or MAAB, for Massachusetts. The ADA is enforced through the courts. So, if a building is not accessible— a library or a police station or a public building— then people bring a suit with the legal system against that building and the owners need to make upgrades. The AAB on the other hand, is enforced through the permitting process. And if a building needs to be conforming with the AAB, usually a public building, not a private residence, then in order to get a building permit, certain modifications need to be included in that project. Now people can be confused because ADA is used frequently to just describe something that’s accessible, that’s usable by people with disabilities. And so, you’ll see in a, in a sink catalog, for example, it’ll say ADA compliant, or an ADA sink or an ADA light switch or ADA appliances. And it’s a catch-all term now, I think, for something that’s user friendly when someone has some kind of limitations.

Janet: Right, yeah, that’s kind of a fascinating topic in itself. But when we talk about ‘Aging-in-Place’ for somebody’s residential home, though, we don’t need to apply those particular…

Deborah: We’re not required to conform to either of those codes for private residences, for single family residences. But I do find that they’re a useful guideline. (Janet: Agreed). So, it’s very helpful to just look at and then see what kind of dimensions, what kind of clearances. They’ve got ideas like keep some distance beside a door on the hinge side so that if a person needs to open the door and pull out of the way while the door is opening in their wheelchair, then these clearances will give them maneuvering space.

Janet: Brian, you want to add to that?

Brian: Yeah. I think that a lot of times what I see is that people are looking out for each other. Particularly couples. So, you know, the husband will say, well, you know, my wife needs this and, and that, and we definitely can’t have a tub. But then, he’s neglecting his own needs. And a lot of the times the caregivers actually has greater needs than the person that they’re describing. So that’s something to consider, too. And when you bring in a professional like any of us, they should pick up on those cues and always ask, “OK, well, what about what about you?” And get, it’s definitely important to get both people’s opinions and wants and needs. I find it helpful to create a list and then just reiterate it back to the family before I actually do any of the work.

Janet: Right.

Deborah: Interestingly, I was consulting with another architect on a multi-family housing renovation project and there was something like 80 apartment units in this building and it was assumed that we needed to meet the code, which is 5 percent of people with wheelchairs and 10 percent of units had to be adaptable, easily adaptable. And in speaking to the managers about the conditions that people had, just about everybody’s got something… so and so has got Meals on Wheels, they can’t cook. Somebody else has dialysis. Somebody else is using a walker now, and somebody else has got shoulder problems and knee problems and just had surgery on her hip. And, and so I think we really, this is so important because these are all facts of life.

Janet: It is, it’s so true. And, it’s actually, it brings up another episode, at some point we were going to go and look into doing, which is ‘universal design’ versus ‘individual design’… and what does that mean. Because universal, for those that don’t know, it’s a set of principles and it is the idea that it fits everybody. But to your point, how does one do that if somebody has a very specific types of, types of conditions that really need to be addressed. And so, you know, both worlds can live together. But it’s interesting how like separated they are, I think, in designers’ minds.

Deborah: Yeah, I’d like to say that in the last year I’ve had a couple of projects where we’ve added a second bathroom into a pantry and brought the laundry out of the basement and put it into a closet in one of the bedrooms or near the bathroom. And I think those are great ideas and they’ll really work in most houses. We’ve also frequently put an extra room on the first floor that can serve as a bedroom, but in the, but at the moment, it’s perhaps used as a living room or dining room or study. But if you have a full bathroom on the first floor and a sleeping space, then you’ve got an accessible home…

Janet: Right. Yeah. That’s all it takes sometimes. Right. And you can still have a beautiful home. Why don’t we then start talking about, Brian why don’t you start, when do we call a contractor and then Deborah, maybe you could talk about when we call an architect…

Brian: Sure. So unfortunately, the calls are never made or not often made when they should be…

Janet: They’re usually called under distress and we’re, we’re in a bit of a panic, right, and Dad’s coming home; Mom’s coming home; Grandma’s coming home and we’ve got three weeks to get our act together.

Brian: Yeah, that’s probably 75-percent of the calls I get. And it’s unfortunate because when you start to think about the level of modification that need to be made for a lot of instances, especially for those coming out of a long- or short-term rehabilitation, then you start to think about the building process, the design, the permitting and you’re talking months before commencing a project like that. And a lot of families have a need for it more immediately. So, I would say, well before things become or come to a head and become a real issue, someone like Deborah should be consulted and you should be considering these modifications before you need them…

Janet: …before you need them. It’s such an important point. Thank you, Brian, for bringing that up. I mean, it’s something that, you know, I think, Deborah, you can probably also agree as well, we get, like you said, we get called in, you know, sort of at the, like this panic stage.

Brian: Sure. And the unfortunate side of how it’s typically handled too late, or just very late, is that we see a lot of kind of one off projects, like if someone’s coming home from rehab, the first thing is, well, how do we get them into the house and into their room and how will we bathe them. So, bathrooms and entrances to the home become the primary projects, but the person then kind of feels trapped in the home because now they cannot use the kitchen, they can’t get to the second floor, they can’t get to a sunroom or place.

Janet: … a favorite sunroom, right. So, Deborah I saw you nodding, has that been your experience as well?

Deborah: Yeah, I think the bathroom and the entrance are the really critical projects that you have to, you can’t really manage in your home if you don’t have a usable bathroom and a usable entrance. And there are other peripheral projects that are usually done at the same time, widening doorways, sometimes I’ll relocate doors across a hall so that it’s easier to navigate instead of turning corners, particularly if someone has a mobility device. Kitchens. Yeah, it’s really important to be able to at least find a place where someone can get a snack, feel a little independence. Help out in the kitchen. There are children that have disabilities, or a person is coming home from the hospital and they expect that they’ll have assistance most of the time. We really want to promote independence and dignity and allow people to do as much as they can by themselves.

Janet: It’s so true and I think that you hit on a really good point with that, it’s cheaper to stay at the house. And so, you know, if we can give them some sort of independence and we can provide this type of environment, I think that seniors end up thriving better, too. And I think that that also makes you a healthier individual. And depression is probably something else that’s probably a lot less if you’re still living at home.

Brian: And here’s a scenario, too. I mean, my, my mother, having been a caregiver her whole life, you know, picture someone coming home from a rehab and their adult children have decided it’s time to get a caregiver for mom. And a caregiver comes to the house. But it hasn’t been, the home hasn’t been prepped to a point where they can access the kitchen or the dining room. And then as the caregiver is preparing food, mom is, you know, plopped down in the living room watching TV when maybe she could be reciting a recipe to her caregiver, socializing with them, interacting with the caregiver, but also the companion. So, there’s important pieces to it like that. Accessibility is important. But, you know, being able to use your home and being able to interact with the people in it is just as important.

Janet: It’s huge. And again, that goes back to the idea of, you know, having family and a support system and you know, and when designing these types of environments I think that that’s an important component to talk about, is that, you know, there’s other people in the house. And so, you got to make a house, in all those particular rooms that you talked about, comfortable, beautiful, but also functional for the individuals as well.

Deborah: In my practice, people frequently think about what to do for a couple of years before they call me in. And I think people have to go through some process of understanding that they really can’t do things by themselves, or that it, over the long run, they’d like to make it easier to do things. And so, I think it’s it does often mean that people are really ready to move and don’t understand that the design process can take four to six months. (Janet: Right). And if they need to do something immediately. Sometimes, I have been called from the hospital, somebody saying I’m coming home tomorrow, can you get me to some grab bars? And now I know I’ll call Brian, (Janet: you’ll call Brian). But I think people really have, they have to put their financial books in order. They need to talk to the bank. They need to talk to their estate planning people. They need to understand that there’s going to be some money involved. So, (Janet: So important.) you really can’t rush the process. And that’s one factor. Give yourself enough time.

And I think the other is when is a time, when do you know if it’s right for you to start thinking about a remodeling project? And I would say, one is, when things start to break in the house and you know that you’re going to have to be calling in a builder or an architect for a kitchen remodel or bathroom remodel, or maybe the porch needs to be rebuilt. And you’d like to have a cover over the porch or a screen porch so you can be outside. Many times, the renovations are started because something’s falling apart in the house, the cabinets are falling off the kitchen or the tiles popping in the bathroom or the plumbing is leaking. And so, people start a project and then they begin to think, “well, gee, while we’re doing this, why don’t we just make some other improvements here? The house is a little bit worn, and it’s time to make it our house and reclaim it after the kids have gone.” So, they call me in. And so, when you start contemplating another kind of project, it’s the time to ask yourself, ‘Maybe we could do some improvements that would make it easier to age in place’.

Janet: Right, it is such a smart way to look at your remodeling. And you know, and I think one of the things I’d like to emphasize, and you know, it really kind of shows up in your book, Deborah, and the work that you do, Brian, is that it doesn’t have to look like it’s an institution. It can be beautiful. It doesn’t have to be boring. It can be a lot of, you know, gorgeous stuff that anybody would be proud to have in their homes.

Deborah: I think that’s one of the reasons that people maybe put it off because they, they remember grandpa being in the living room in his hospital bed. (Janet: Bed, right) And they don’t want that in their house.

Janet: Right, we can talk a little bit later about how I feel about grab bars, because I think they can be, I use the hashtag ‘crazy, sexy, cool, grab bars’ when I find one because they’re out there and I’m always excited when I see a really great looking grab bar.

Brian: That’s all one hashtag?

Janet: That’s all one hashtag. I just, I really do appreciate a good, a good grab bar. And, but when they’re not, when they look institutional, people do call them the granny bars, right, and they think to themselves that if you put in the granny bar, it’s also going to lessen the value of their home. And I think what I would like to propose, and you guys can—and I see Brian shaking his head ‘yes’— if you put in something beautiful in the home and it doesn’t even matter if you have a grab bar, as long as it’s good looking, like it’s not going to devalue the value of their home. Did I say that correctly? (Brian: Yes.) Do you want to elaborate a little bit on that, Brian?

Brian: Yeah, I think that the furnishings and technology in home adaptive equipment is really improving. There’s a lot of companies out there that do just what you’re talking about, make shower niches and soap dishes and toilet paper holders to look like a statement piece but also act as a form of safety.

Janet: Right. It’s pretty, I think it where we’re living in sort of an amazing time right now. And these particular manufacturers, as you said, they’re understanding that. And one of the things that I do as a designer within Aging-in-Place for myself is that I look at evidence-based design and the types of theories that are out there. So, when we talk about comorbidities, maybe like the loss of the eyesight or hearing, how do we design for that, what are some of the standard best practices for stuff like that.

Deborah: We’re not all going to be in wheelchairs, (Janet: No, right.) very few of us will be. According to the census, 5 percent of the population uses wheelchairs. But as you said earlier, we have an unprecedented population growth where more people will be older than there have ever been before. And as those folks move into their 80s and 90s and hundreds, we’re going to have something that we’ve never had. No one knows what a large population of 100-year olds is like. I think we’re all more fit than past generations, and so, (Janet: We eat better). And that’s right. So, it’s a real unknown. That’s why I think it’s equally important to be looking at the other kinds of disabilities that people can have that are part of aging, but they’re also part of various conditions that can get occur in life as illnesses. And so poor vision, hard of hearing are both conditions that are improved by having good sightlines within the house. So, if you can open out a wall so that you can see somebody in the kitchen from when you’re standing in the dining room (Janet: Great point). And also, non-glare surfaces, floors that are matte finish instead of a high gloss polish; light fixtures where the bulbs aren’t shining in your face. It makes it much easier for people to see and communicate nonverbally because they know what’s going on and they’re not blinded by it. And so, whether they can not hear or whether they cannot see, making it easier to communicate visually and by body language, makes it easier for everybody to feel communicated and to feel connected.

Janet: And connection is such an important component to, you know, what we do. And again, that goes back to health and wellness for the occupants as well.

Deborah: Yeah. And I think in addition to sensory impairment, which can occur with age or with injuries and accidents, there’s also cognitive decline. (Janet: Yes). So how can we make it easier for people who might be a little disoriented or get a little forgetful? I think we can we can really use color coding, perhaps…

Janet: That’s a great, yeah. I’m sorry. I’m don’t mean to interrupt. But it’s it’s it’s a terrific way to help, and ‘way find’ for people, you know, because you want you want a certain sense, even with the cognitive, you know, some sort of dementia or something like that, you want people to be able to have the autonomy to be well enough to go and wander, but wander safely, so…

Deborah: Yes. And within the home you can change the flooring materials, so a person knows when they come to the wood floor, they’re in the bedroom area, for example (Janet: Exactly). You can also change the, you know, you want to have windows that let in a lot of light. So, you’ve got good lighting, whether it’s natural lighting in the day or artificial illumination at night. We also, open storage in the kitchen or somewhere in a utility room that makes it easy for people to find things if they’re getting forgetful. “Oh, my goodness. Where’s the, where’s the cereal now? I remember somebody moved it”. Just, you know, there’s a lot of things that you can do. And people don’t look at that as an example of someone’s frailty or somebody’s disability. We can have open shelving and open storage and in a very contemporary kitchen.

Janet: And it looks beautiful. And I mean, I have it my house.

Deborah: and I could go on and on in the kitchen. There’s so many hardware devices that can be brought in to make it easier. Pull down shelves, quiet, slide out in easy, close drawers, counters at different heights, a pull-out shelf in the counter so that you get extra workspace and then appliances. Oh my gosh, we can talk about appliances. Yeah, but how easy is it to use, if you press the buttons on the microwave, do they ping you? Do they signal that the message came through? Are they easy to read or they black on white or white on black versus silver on gray? Very hard to read that kind of thing.

Janet: That’s so true. Very, very true. I know.

Brian: This is why you don’t leave the designing till three weeks before.

Janet: Right. That’s a really good point, Brian.

Deborah: It takes time to shop around and hunt for these things.

Janet: And hunt for these things. And just to go back a little bit, the reason why you said this silver and the black, and white and the black lettering on a black background for people with visual acuity problems, this can be problematic. (Deborah: Absolutely).

Deborah: Right. And, you know, thermostats, for example (Janet: Great example), they can be very confusing to read and to program. And so, don’t just accept your mechanical contractors’ recommendation ‘oh, you need a thermostat? We’ll put this up’. Really ask yourself, ask the contractor. “How does this work?” You know, look at the manual. Go online. Find how easy it is to program yourself. Maybe you want something simpler. Maybe you want something with a bigger screen. Maybe the color contrast is needs to be important. Normally they put white on a white wall, and it tends to blend in. But sometimes you want something to be really easy to find.

Janet: Right. You know. Yes, easy to find. Or alternatively, not to be easy to be found because, you know, maybe somebody with the early signs of dementia might end up kind of fiddling with the thermostat unnecessarily.

Deborah: You know, people are always asking what can, isn’t technology going to solve all the problems of aging, isn’t going to solve all of our problems.

Janet: Well, you know, you’re bringing up a really good point. And I was going to jump into that. We might as well go right on into it. I had a professor that argued that any kind of technology is not a good thing. You can lose remote controls and that kind of thing. And I think there’s a good point to that. I also think that today’s seniors are more sophisticated. They have now been more exposed to things like computers and cell phones and, you know, and text messaging and all that stuff. So, they are a little more tech savvy, the group that at least is coming in at this point and then moving forward. What do you guys think about technology and the use of technology? Like sometimes I think it’s just terrific and I think it has really kind of helped and propelled our profession. But then sometimes I think, you know, should we, shouldn’t we be relying on our abilities to design without the need for technology? Brian, do you want to start?

Brian: Sure, I’ll start. Technology is a piece that I touch on a little bit. Not so much as maybe an architect or a designer like yourself would do, but I do notice certain intuitive technologies becoming important. One that’s wonderful for in-law suites, say mom and dad are home during the day and you’re at work. And maybe you are concerned that they’re jacking the heat up to 80-degrees. Well, you can check it on your phone now with the Nest. And you can reset it and you can lock it from the house, and you can do things like that. And you can make sure they’re safe, but also that they’re not burning all your oil and things like that. So, I think those technologies are great. But I think that some just aren’t worth the effort. And some just confuse things.

Janet: Do you want to give us an example?

Brian: Yeah, I think that a lot of people like Alexa is awesome to me, right. I look up recipes. while my hands have egg all over them or whatever, right, that’s cool. And it’s easy to add something to my shopping list. But, you know, you might be confusing someone with dementia in a house by constantly calling to Alexa and trying to tell her to do something, or trying to teach them how to use that. It may just cause more stress than it’s than it’s worth. And so, like, you know, different ADA or AAB style specs work well for some people, you can look at technology the same way.

Janet: Right. And Deborah, do you have any thoughts on technology and Aging-in-Place?

Deborah: Yeah, as you said, technology can break down and it changes, and you have to stay up to date and it can be costly to keep up to date. And it’s no excuse for good design and solid design (Janet: Exactly). It’s really something that can complement it. For example, elevators and platform lifts are things that I put in frequently when people have stairs in their house. The medical folks are having these same conversations as the building industry. And I think when we talk about technology, it’s important to know what’s coming down the road in terms of mobility devices. No one would have known a few years ago that they were working on a wheelchair that can go up and down stairs. Maybe that whole idea of elevators is obsolete. And that’s technology.

Janet: This is true.

Deborah: Technology comes into play with the appliances now that appliances are doing so many, so many things. A refrigerator can tell you when you’re running low on milk or make a shopping list for you. Or there is a refrigerator by LG that connects to your iPhone so that if grandma is in her house and she normally goes to the refrigerator every morning and she hasn’t and you’re seeing on your iPhone, she hasn’t used it. You can call her up and say, “Hey, you okay? Did you fall? You know. Why weren’t you in the refrigerator this morning?”

It’s really important to take a look at appliances to see how easy they are to use. For example, a stacking washer/dryer. Some of them have the controls so high up on the top unit that it’s hard to reach. Whether a person, you know, is shorter; has trouble with their shoulders, they may not be able to operate that. And then what’s the height at the eye level to look into the unit? (Janet: Right, that’s the other part). So, yeah, some of the time that information’s not available on the catalog or online. You really have to go out to a showroom and try them out for yourself. You know, I always tell people test drive your appliances to the extent that you can. Find an appliance shop that’s helpful, that a representative that can really kind of handhold you through making some of these choices.

You ask about technology. I’d like to say when we look at other countries and see what’s happening in these other countries. I think we’ll see some products that are coming across the ocean at some point. And a couple of exciting ones, I think are really cool, a floor that responds to a person’s footfall or a fall. And so, if a person falls (Janet: I think that, yeah), then the floor will call 9-1-1 and the ambulance will come, or it’ll call the doctor and say a phone call will be made “Are you OK?”

Janet: I think that that’s for me, that’s one of those, that’s a really great new product. And it goes back to the whole technology thing, but I think it’s, it’s well worth it.

Deborah: We’re balancing now, the ease of using technology with the lack of privacy that that can be associated with. So, I think there are some really great things coming up. Also, say emergency call buttons that might be placed in different parts of the house.…

Janet: Let’s talk a little bit about that. And Brian, you might want to jump in. I feel like that’s another granny bar type of situation. A lot of people won’t do Life Alert. I have a friend of mine whose mother is 92 and she’s like, I should probably get her that Life Alert alarm system. you know, what’s been your experience, do you find that people are pretty hesitant to do that as well?

Brian: Sure. So, I would say, yes, get those things. I would say anything that helps in an emergency is particularly important. If you don’t like matte tile on the walls or on the floors, well, maybe there are some things we can do to work around that, but don’t work around emergency response. That would be what I say.

Janet: Right.

Deborah: I think there’s some really cool things coming up with technologies that frequently connect to the iPhone. But I, but still, most of what we do is not technology. It’s just simple, good design.

Janet: Right, now you bring up in a really good point and it’s a great segue to go into trends. Any trends that either one of you are seeing that you’re totally digging. Is there something, you know, maybe just goes back to your point, you know, good design is good design, but is there anything else out there that you’re thinking, this is pretty nifty?

Deborah: Well, I think there are some really nice sinks that are accessible. The shallow sinks that the drain is at the back. They can be set into a vanity counter and keep the vanity space open underneath so a person can sit down, whether they’re in a wheelchair or whether they just choose to sit while they’re drying their hair. Is this a trend? Is this something that’s been happening for a long time? I think. I think some of these trends are being triggered by the Aging-in-Place movement and the accessibility movement. So, they are good ideas that work for everybody, where they started, I don’t think it really matters.

Janet: And Brian, why don’t you tell us a little bit about what you think… what kind of trends are you seeing?

Brian: Sure. So, in terms of the trends that I see, I think that, you know, I get kind of geeked out about the raw building material type of trends that help me. So, there’s a much greater need for a walk in and barrier free showers now, okay, and now a system that I love to use is called Wedi board and Wedi building panels.

Janet: Can you tell us a little bit about what that means?

Brian: Yeah, so we do a lot of a lot of bathrooms. And back in the day, what you had to do was to create a wet room or to create a barrier free shower, you had to, you know, outfit the entire room with a copper pan. and only the plumbers knew where to buy it and where to get it. And then, it was a very expensive material and installation process. And it makes the labor costs, it reduces the labor costs quite a bit. And it makes my job a lot easier, which, which is great. And it’s also just it’s, it’s cleaner. It’s, it’s better, you know, there’s a there’s fewer leaks, it has a lifetime warranty, so products like that, things like that that you’re not going to see necessarily.

Janet: Right, but that it makes things a lot, like you said for yourself, easier, it’s cheaper for the consumer. And then also it provides this beautiful look to the bathroom. I love a curbless bath shower, I mean, it’s just it’s so stunning to me. And, you know, and you can then wheel yourself in there if need be, or you can walk yourself in there with a walker, I mean, without having to go over of some sort of lip. I think that that’s just an amazing…

Brian: and I think it just looks better…

Janet: It looks sexy. I mean, doesn’t it? (Brian: Yeah), I’m a big, I’m a big fan of it. You know, I mean, I have a little lip in my, in my shower. And, and actually after it was finished, I had actually broken my leg. And I was actually kind of grateful it wasn’t a bathtub that I had to step in because I thought originally, I would want a bathtub. And having a handheld shower with also a bench was very helpful in my shower.

Brian: And that’s the thing, too. And Deb, you could probably speak to this more than I can, but I don’t think it’s like a “all right, I just had my 80th birthday, now it’s time to reconsider what we do for the construction”, I think anyone can benefit from that. Like you just said, you know, you you were glad you didn’t have a tub anymore. (Janet: Right). So, I would say anyone listening, I think we remodel our particular rooms every 10-, 15-years. Is that right? (Deborah: I think that’s fair). (Janet: That’s about right, yeah), I would say, well, if it’s time to do a remodel, maybe consider some of these things anyway. You might realize that you like barrier free showers better than tubs. (Janet: Right.) And then if something does happen, then you’re set.

Janet: Right. And it was funny. somebody had said to me not too long ago, a bathtub is a very slippery concave surface, which is kind of incredible that we think that this seems reasonable. I mean, I understand the need for a bathtub and enjoy a good soak, but for every day, you know, cleaning for yourself or for your family, I mean, a shower is sort of the way to to go.

Deborah: Yeah, I think maybe this is a trend as well, but many bathrooms now we’re putting showers and tubs. So, people like to soap, but they mostly would use a shower, too. And same thing in the in the kitchen, we put a cook top separate from the wall oven. That way the wall oven can be right at a comfortable height for using, you don’t bend down and reach inside. And also, that the cook top is open underneath either for a seated space or you can put storage cabinets (Janet: Which is great.) for pots and pans.

Janet: Right. But I do want to just kind of backtrack just to make sure that I’m understanding. So, I might be simplifying. So, whom do I call first? Theoretically, I should probably be calling the architect, right, I should be calling you Deb first?

Deborah: Yeah, I would say that if you can’t visualize what you’re doing and you need drawings, you’ll need an architect. If you are doing in addition, Architect. We draw. We look at alternatives. We help the owner understand all the variables involved in making choices and the ramifications of certain decisions. I think that’s the skill of the architect is that kind of big picture thinking. (Janet: Sure). If you know exactly what you want and you can describe it in writing, then shop around, collect the images of the things you like. You can go to a builder.

Janet: Absolutely. And Brian?

Brian: I think she hit the nail on the head. If you have the foresight, the means to call an architect, particularly to design a space that’s going to work for you and an oncoming health concern or mobility concern. Absolutely. And I’d add to that as well and say before you call either of us, you need to be working with your team of health care professionals and your family. (Janet: Great point) to speak with either of us or about a remodel or a designer like yourself. (Janet: like myself, right). who understands how different disabilities can impact you and different conditions, can impact you, so that you don’t do this remodel and mess it up (Janet: Right). but you’ve got to work with some professional.

Janet: Well, thank you very much Brian for that plug. That was very great of you. And Deborah…

Deborah: The question is where to start. If a person calls an architect and really needs a builder, I’ll send them to the builder. And I think most builders will understand when they feel that an architect should be brought in. So ideally, it’s a team effort and we’ll all be involved at some point.

And, I think it’s helpful, to, to start this process with a kind of masterplan and an overview and just take yourself away from we have to do something immediately and we have to know who to hire. If we can really think how much are we going to spend, what kinds of things do we think we need to do immediately? What do we, what can we put off a few years? That’s one of the ways to control costs, by the way, to think about phasing. I think if we also say, what can I do myself? What do I need help with? Many architects are trained in that kind of big picture thinking that we can help people identify what projects might benefit from what kinds of approach.

Janet: Right, right. And I work with both of you as a designer, you know, and, and especially in this particular field where I look at the types of, different types of conditions, and I would be able to say, hey, you know, this is going to be an addition. We need the architect. Hey, we’ve got some remodeling to do, let’s call Brian.

Deborah: Projects are team efforts… (Janet: Yeah) the homeowner knows their abilities. They know their house. They know what’s been done. They know its quirks. The architect knows what’s available out there for materials, knows what kinds of choices there are in terms of layout decisions and the different kinds of arrangements that can be made with contractors— lump sum versus time and materials contract, for example, or guaranteed maximum price. And a builder really knows the materials and the costs on a day to day basis and where to get things and what’s going to take a long time. So really, it’s complementary skills, we really all have to be communicating.

And I think there’s a role for the medical professionals in there, too. There’s a parallel conversation, I think, going on in orthopedic centers and in medical centers and even in medical technology as designers in that field are racing to find better ways, better wheelchairs, more, more mobile wheelchairs that can go up and down stairs. And I think that really adds a richness to the whole design process. So, I’m all for teamwork.

Janet: Right, and Brian?

Brian: Absolutely. Team, teamwork gets the job done for sure.

Janet: Just to piggy-back on, on what you’re saying, for this particular type of population we should be looking at people who are at least CAP certified. I think that’s such an important component that people understand the needs.

Deborah: Yes, I would put in a plug for contractors who are CAP certified because all of the subs on the job are not CAP certified, right? The, the electrician is going to put the switches 18 inches off the floor because that’s where he’s always done. You know, you may want to put those outlets on above the furniture so you don’t have to bend so much to get them.

Janet: Right, great point. Brian, you got anything else to add to that?

Brian: Yeah, I think a lot of subcontractors and a lot of general contractors who don’t have exposure to this are trying to do things cost effectively and make a profit. (Janet: True.) And this is you know, they’re fortunate for the work, but it’s, it’s another job to them. And they’re going to stay, they’re going to follow the building code and they’re going to get the job done hopefully on time and in budget. (Janet: Right) but there’s more to it.

Janet: There is, it’s very nuanced. And, and I think that that’s a great takeaway for our listeners to understand that, really gang— not just an architect, not just a builder, not just a designer— but ones that understand the nuances of Aging-in-Place.

Deborah: Many people will choose to hire an architect or a designer or they’ll choose to hire a builder, but it’s important to know not all builders understand the particular issues of Aging-in-Place, nor, nor do all architects and designers.

Janet: Absolutely. And that’s a, that’s a really good point.

Deborah: So, there’s a program by the AARP and the National Association of Home Builders called Certified Aging-in-Place Specialist. It’s, the acronym is CAPS, C-A-P-S. And these are people who have been trained in a few days, special workshop to develop the sensitivity and some skill sets at designing, understanding and communicating with people who are looking at aging issues.

Janet: I’m CAPS certified, as is Brian…

Deborah: As am I…

Janet: …As are you, right, exactly. And CAP certification is a good thing. And actually, my master’s degree was in human conditions and for design. But it’s a good point. So, is there anything that you guys want to add?

Deborah: I’d like to add a plug for my book.

Janet: Yes, please. I would love to plug your book, right?

Deborah: Yeah. I wrote a book, ‘The Accessible Home Designing for All Ages and Abilities’… It was published by the Taunton press a few years ago. And it tells the stories of 25 people around the country who have modified their homes to deal with particular disabilities that they’ve encountered. And the stories are just wonderful stories about how people go through the whole thought process. How do you know when to stay? When to leave? You know, remodel your present home versus find a new home. How do you make decisions about priorities? What kinds of things do you do depending on what the disability is? What about working with a ranch house versus a colonial house versus the house in the desert versus something in an apartment building versus a loft building? So, I think looking at all of these different stories, you kind of start to get a sense that, yeah, there’s a lot you can do, it really (J: a lot of different types of, right, environments). Yeah, different environments, different conditions result in different kinds of solutions. But there’s also something very similar to them, which is that they’re open, that the kinds of modifications have been seamlessly integrated and really, I think gives people a feeling of hope and a lot of tools in their tool chest to go about making changes in their homes.

Janet: And that’s awesome.

Brian: And I have read this book and I own this book and it sits right on my desk every day. If you’re a visual learner, (Janet: it’s beautiful) especially, take a look. I’ve gotten a lot of, I’ve brought it to customers’ homes. And said ‘hey, I think this would work really well right here’… So, it’s a great book.

Deborah: Thank you.

Janet: And looking at different types of situations, you know, much like what you talked about with your book, there is individuals who have stories to tell. So, is there any particular stories that the two of you have or any kind of anecdotes that you’d like to share?

Brian: Yeah, I have a really common kind of story. I work a lot in the Newton/Waltham, this whole area where people have these wonderful family homes, Victorians and things like that, that they’ve been in for a long time. And they come to me and say, hey, you know, we need to make these modifications. And after some conversation, I find, well, it’s not really that particular home that they’re attached to, it’s the community. So sometimes what we’ll do is say, “hey look, you know, you have, you have a wonderful home in a really desirable neighborhood. The resale value after a little bit of work is tremendous. And those, the proceeds from that, that are basically tax free, right, can be used to either create a new space in a more modest home within the same community, or to make more significant modifications, whether just aesthetically or for a particular disability”. That’s a, that’s a common story right there. People are really tied to their communities here in Massachusetts and I would assume everywhere, but that’s, I think some of the anxiety about leaving your home is to leave your community altogether.

Janet: In some cases, in that particular community you’ve been in for 30, 40, maybe even 50 years. So, yeah. So, elephant in the room. How much does this kind of thing cost people? What is, is there a ballpark? Is there some sort of magic number?

Brian: The amount you need to invest in your home changes so much. I live in a slab branch and it would be very simple to modify it. My doors and hallways are wide. Everything is completely level. That’s just not the case here. Homes are so old here, homes are big. Per room, if you were to say, hey, you know, what’s a barrier free shower or a wet room typically cost? I can tell you it’s usually in the 25- to 35-thousand-dollar range. Short wheelchair ramps into the house are, you know, around 5-thousand dollars. And you can get crazy with custom Azek decking and things like that. Or you could need a 50-foot long ramp and it could be a 15-, 20-thousand-dollar ramp. They are, you need to think about just the extent of the deconstruction of what you have to get to the point you need to be at. And I’m always very upfront about costs because, you know, depending on how much work you need to do, for myself and for the family, you might find out very quickly that someone’s cost assumptions are stuck in 1975 and you know, it’s 2020 now. So that’s the first conversation we have. Should be. You know, the elephant in the room, but it should be addressed at the first visit.

Janet Right. Yeah. Deborah?

Deborah: I’d say most of my significant renovations or a small edition projects range from about 100-thousand to 300-thousand. And that might seem like a lot, but when you think that the cost of assisted living can easily be 75-thousand a year. (Janet: Right). If you can prolong your ability to stay at home for three to five years, this expense is worth it (Janet: it’s so worth it). and very comparable. (Janet: Yeah.) And I think also renovations that are the kind of things we’ve been talking about do add to the value of the house.

Janet: And that’s the other thing. Again, it’s not, back to the whole looking like grandmas’ you know set up, it’s beautiful spaces. Your book proves it. Brian, your work proves it. So, I mean, it’s not something that, it’s just an improvement on the home. And it’s, I don’t want to say that it’s disguised, but it just blends into the aesthetics of the room, and it doesn’t have this kind of screaming like ‘somebody who, who’s old who lives here. Oh, no’. So, ‘somebody who is handicapped, who lives here. Oh, dear’. You know, It’s not like that at all. Right?

Deborah: No, I’d like to say that back to the question earlier about how do you know when it’s time to do a remodel? I think when you find your house cluttered with gadgets and storage. I was in a house not long ago where the bathroom had piles of depends and boxes of medicine and lots and lots of (J: Good point), lots of boxes of stuff. And so, I think it’s really important to make sure you get plenty of storage in your bathroom. That little old 15×17 medicine cabinet really doesn’t do it for most people. I mean, we’ve got hair stuff and first aid and, and dental care.

Janet: That’s a good point. Brian?

Brian: Yeah. I think typically the ones concerned with devaluing the home are the parents who say, “Oh, well, when I pass, I want my children to get the maximum value for the property”.

Janet: And that’s, I think that’s something that I’ve been kind of getting at, people tend to think that that’s going to be a problem, but I think, Deborah, to your excellent point is, is that nursing homes, not that they don’t have a place, or assisted living, is going to cost you about 75-thousand dollars or you know, and again, these home improvements are just that, they’re home improvements, they just happen to be better for people for accessibility or better for Aging-in-Place.

Brian: Yeah. Like, you know, the standard thinking in the past has been, “Well, if I make these modifications, that’s going to eliminate 25-percent of the market”, when really you just increased it to 100-percent of the market or 90-percent of the market.

Janet: It should be beautiful new design, and that will make any property, the property value to go up.

Deborah: I like to read the census, very interesting data about how the population’s changing, and 50-years ago, 26-percent of people over a certain age were in nursing homes. Now it’s 13-percent. People are not going to nursing homes… there is, a there’s a place for it, but I think people are really looking at what are the alternatives. One of things that I would love to see and maybe this is another, another podcast at some point, is what are the alternatives in living for aging. And for those who are moving out of their home, as Brian was saying, who find that the home is too big, what is out there, now is that apartment living? Is it assisted living? You know, we’ve talked about that very expensive. I’d like to see more alternatives for people to share a home with roommates, or to take a single-family home if zoning allows to make two family living spaces out of it, but they have some shared space. So, say, you know, with a friend, you might have your own independence but also have, say, a couple of gathering spaces that you could take turns with, or share if it’s my birthday…

Janet: It is a trend that is actually coming, I can see it coming. There’s been a few articles about that already that, you know, the baby boomers are changing up how we do age and Aging-in-Place though is something that’s high on their list. But to your point, also, to combat loneliness and depression is also to have roommates and, you know, to have people to kind of share your day with.

Brian: My parents have an adult daycare and they actually have just franchised it, (Deborah: ooh, good idea). That was, that was too good of a lead not to say, give them a plug. I won’t give myself a plug. But I mean, if you want to use it or not,

Janet: No, but I think it, it is interesting, you know, and…

Brian: I don’t want to get too far off topic of Aging-in-Place…

Deborah: Another program…

Brian: Another program…

Janet: Another program, right. We have, we have, well, what we’re hoping is, is that this topic of Aging-in-Place will be something that we will talk about for many years on Inclusive Designers, and I would love to have you guys back again at some point. And we can talk about other types of issues within Aging-in-Place and design and and to try to help our listeners make some educated choices.

Brian: This is nice. You guys don’t understand like on a jobsite talking to my framers, I don’t get to talk about this kind of stuff that much. I read about it and I’ve planned for it. And it’s like.

Janet: It’s one of the things I really enjoy about doing this podcast is I start talking to people and it’s like, these are my peeps, (Brian: Right). They understand me.

Brian: Yeah, that was fun. Thank you so much.

Janet: Oh, you’re welcome. Thank you both so much for joining me today.

Deborah: Thanks.

(Music- Transition to Outro)

Janet: I think a few important take-aways from our discussion today would be…

– First, you really want to be sure you call a qualified Certified-Aging-in-Place-Specialist, whether it’s an architect, designer or a contractor in order to get the best design for your residence. One of the three will fit your needs and your budget.

– And two, it’s really important to understand that there are comorbidities to consider when designing. It could be somebody else at the home, or the spouse of the person that you’re designing for… it doesn’t matter. Comorbidities, everybody has a comorbidity, everybody is aging, but everybody also has just that one more thing.

– Three, while ADA codes are not required for residential design, they provide a good guideline to follow.

– Furthermore, these modifications don’t have to be boring and can fit into a clients’ personal style. There are great design options for those types of products, even including grab bars.

Carolyn:  We hope you enjoy our Inclusive Designers Podcast and forum… and todays episode on Aging-in-Place. If you have any questions on today’s topic, or if you have suggestions for future topics you’d like us to cover, please shoot us an email at [email protected]

Janet: And of course, for more information on our guests or on the design and research covered in this episode, please check out our web page at: InclusiveDesigners.com

Carolyn: If you like this podcast, please sponsor us on Patreon…

Janet: Hit the Patreon button on our webpage.

Carolyn: And we look forward to your feedback too. Send us an email and let us know what you think…

Janet: Until our next podcast episode, Stay Well and Stay Well Informed… and thank you for listening.

Carolyn: Yes, thank you again.

(Music up and out)