While I have professional expertise in aging, personal experiences can be a different matter. For over 10 years I served as the primary caregiver for my mom. In those 10 years, her life was dramatically better than it would have been without my professional expertise.
My mother was widowed when she was 53 and I was 13, and I was the one she leaned on. Nearly 10 years later when I graduated from college and she retired, I was just starting out as an environmental gerontologist and knew that my mom still felt terrible about “putting” her own mother into a nursing home. I said “let’s plan for your future. Let’s map out the different scenarios and prepare for them.” At age 65, a woman can expect to pay $45,000 more than a man for long term care and services. My mom needed to protect her money and her future. Even though my mom was a planner and a saver, her response to me was a reactive “I don’t have one foot in the grave yet.”
What my mom’s emotions blocked was the valuable and little known fact that the design of our housing and communities actually contributes unnecessarily to age-related decline–but this is preventable. Because we don’t design for the true range of needs, abilities, and behaviors across the lifespan (which is “ageism by design”), as we age places can create forced frailty and lead to eviction by design. The latter is when one is forced to move out of their home because the home is not designed for their needs. This leads to greater dependency, more caregiving needs, higher long term care costs, and a greater demand on government services. But it doesn’t have to be this way. If we slightly shift the way we design, we can enable people to thrive across the lifespan by design.
When my mom was 80 and dealing with multiple chronic health issues and changes to her abilities, she asked my husband, a custom homebuilder, and I to design and build a home for her, next door to ours. We applied my Enabling Design Approach: considering the likely needs and scenarios for my mom’s future, as well as any future resident. Some of the simple but impactful features we included were wider doorways, no-step entries, non-skid flooring, and put everything she needed on one floor. Because my mom is uncommonly short, we made a custom solution and lowered the kitchen counters. Other than that, every design feature worked well for virtually any one of any age and could work well for any person living in the house at any time.
One other custom feature had a big impact on her quality of life, on long term care expenses, and caregiving: a bidet toilet seat. This less than $1,000 investment gave her independence and dignity. It also was practical: she could easily clean herself safely and independently any time, day or night. She never developed a UTI. Because she cleaned herself so frequently, she could do with one less shower per week. At a cost of approximately $100 for an aide shift, she was saving $100 each week. Over the course of the seven years when she could not shower independently, this one feature saved her approximately $35,000 in reduced caregiving costs. An over 3000% return on investment!
Due to these choices, my mom was enabled to live as independently as possible in the home of her choice. The design of the home did not contribute to decline, and likely slowed it. Not only did my mom benefit directly, but the realistic design of the home made it easier to provide care, by both family and professional caregivers. All of these helped delay my mom’s move to an assisted living facility. The enabling design of the home saved over $500,000 in long term care expenses for my mom, the family, and the government. Her financial planner benefitted too, as it delayed the shrinking of her investment funds which would have been caused by withdrawals for more significant long term care expenses. Her municipality and state spent less on services, as did the federal government, and she placed fewer demands on her regional health care system. She also placed less demands on the limited pool of direct care workers in the community, freeing them up for those who truly needed them.
Care is hard to come by. Many of the nation’s 53 million family caregivers work outside the home in addition to providing care for a family member–and that includes paid caregivers who may be providing care professionally at work, and personally at home. If one can afford to pay a home health aide–the national average for the typical three hour shift is $90–there is the challenge of our nation’s shortage of direct care workers. This shortage is negatively affecting people who need care in their homes. For older adults, this threatens their ability to successfully age in place (desired by over 70% of adults 45 and older), rather than simply aging in place by default, which most people do. The impacts of the staffing shortage are also felt in senior care facilities–by residents, management, and especially the direct care workers who are doing this hard and important work with fewer colleagues. But everyone in these environments can also benefit from the Enabling Design Approach. By incorporating thoughtful and practical features which help residents maintain as much independence as possible and which make the provision of care easier and more efficient for direct care workers, facilities have the opportunity to address the staffing shortage and enable residents and staff to THRIVE.