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Summary
In this episode of CareLab: Mythbusters—Aging in Place Edition, hosts Emilia Bourland and Brandy Archie debunk common misconceptions about aging at home. They discuss essential home modifications, safety strategies, and how caregivers can better support older adults who want to remain independent. Through real-life experiences and expert insights, they provide practical solutions to help seniors live comfortably and safely in their own homes.
Key Takeaway
- Aging in place is achievable with proper planning and modifications. Many people assume they must either live independently without issue or move into a nursing home, but there are many in-between options, like home modifications, community support, and part-time assistance.
- Small but strategic home changes can make a big difference. Installing grab bars, improving lighting, widening doorways, and switching to a walk-in shower can significantly enhance safety and mobility, allowing older adults to stay in their homes longer.
- Occupational therapists play a key role in aging at home. They can assess living spaces, recommend necessary modifications, and suggest assistive devices or strategies to help seniors maintain independence while staying safe.
- Caregiving is a balance between support and independence. Family members and caregivers should focus on helping seniors maintain autonomy while ensuring they have the necessary resources, whether through home care services, community programs, or modifications.
- Early planning prevents stress and costly last-minute decisions. Thinking ahead about housing options, accessibility upgrades, and potential caregiving needs allows seniors and their families to make informed, proactive choices rather than reacting to emergencies.
Transcript
Brandy Archie, OTD, OTR/L
Welcome to CareLab everybody.
Emilia Bourland
Welcome to Care Lab. It's Friday, fun day at Care Lab, as always.
how you doing this morning?
Brandy Archie, OTD, OTR/L
great. There's a lot going on and that's a blessing. So I'm doing great. How about you?
Emilia Bourland
good. You know, I just wrote my chairs like squeaking. Can you hear my chair squeak? Oh, I'm a mess. I'm my my sound. My sound is a mess. What's wrong with me, Brandy? I got coffee cups. got squeaky chairs. I'll get better every time I promise. Can I tell you? Can I tell you a funny story from this morning?
Brandy Archie, OTD, OTR/L
a little bit, but not as much as I could hear that coffee cup last time.
Brandy Archie, OTD, OTR/L
We're working on it.
Brandy Archie, OTD, OTR/L
It's always a learning game.
Absolutely, yes.
Emilia Bourland
or something I think is funny. So a lot of times when my kids wake up in the morning, like they get themselves up, they get dressed. They like to watch a little TV in the morning. I'm fine with that. But my ask is that before you turn on the TV, you make sure your book bags are packed. You get yourself some breakfast. Like you've got all your stuff together. So that when I come, so that when I'm coming down the stairs, coming in hot saying, okay, it's time to go. We can all just go.
Brandy Archie, OTD, OTR/L
Yes. Yes.
Brandy Archie, OTD, OTR/L
then you can walk out and get in the car.
Emilia Bourland
Right? So earlier in the week, I came down, their TV's on. It comes to pass that all of the other things are not done. You know, we're trying to get, anyway, it was a mess. We made it. But I was like, okay, guys, no TV the rest of the week. You know, boys are disappointed, but honestly, they're good kids. They're gonna live and they're good kids. actually, for the most part, if I say like, you know, know this or know that, they...
Brandy Archie, OTD, OTR/L
Of course not.
Brandy Archie, OTD, OTR/L
They're gonna live.
Emilia Bourland
They generally like follow instructions and they won't like it, but they'll do it. So I come down this morning and we've got like a little room off of our kitchen that's got the TV in it and couch and stuff. And so, and I see that door is closed. I'm like, are they watching TV in there? I open the door and I look at them and they're both sitting on the couch and they're staring at the TV. And I go, guys, I said no TV. And then I look at the TV and it is not on.
Brandy Archie, OTD, OTR/L
Yes.
Brandy Archie, OTD, OTR/L
You
Emilia Bourland
I don't, I'm like, guys, what is, what has happened? They're like, I don't know, we just like to be here. I'm like, your habit is so much coming and always watching TV in the morning that, that like that was their, I guess so. I don't know.
Brandy Archie, OTD, OTR/L
You just gonna watch a blank screen? Do you think they were really watching a blank screen and that they didn't just turn it off right when you open the door?
Emilia Bourland
You know what, think, I mean, realistically, it feels like you're right. But here's the thing. My kids aren't that fast when the TV is on because they're like super, and I'm the same way. Like if the TV is on, I'm like zoned in on it and I can't hear anything else that's going on. So they're not usually alert enough to not get caught. I could be wrong. I could be wrong because it does seem weird.
Brandy Archie, OTD, OTR/L
yeah, they're like zoned in.
Brandy Archie, OTD, OTR/L
Uh-huh.
Emilia Bourland
that they were sitting there staring at the screen. Maybe, I don't know, maybe it could, maybe they had a book in there or something and I didn't, didn't notice, but I thought that was hilarious. Crazy kids. Yeah.
Brandy Archie, OTD, OTR/L
I'm interested in watching a blank screen.
Brandy Archie, OTD, OTR/L
That's funny.
Woo. So today.
Emilia Bourland
Mm-hmm.
Brandy Archie, OTD, OTR/L
Okay, today.
Brandy Archie, OTD, OTR/L
Okay, can you hear me and see me okay?
Emilia Bourland
Yeah, can you hear me and see me okay?
Brandy Archie, OTD, OTR/L
Now I can. was... Anyways, I marked it. Make sure we let him know to chop this part out.
Emilia Bourland
Okay.
Emilia Bourland
Yeah, yeah.
Brandy Archie, OTD, OTR/L
Okay, so today I think we have a myth to talk about, right?
Emilia Bourland
I think so. Do you want to tee it up or do want me to tee it up?
Brandy Archie, OTD, OTR/L
I'll talk about it. So, okay. We had a little discussion about this and I often, I work with a lot of people in senior care in which we have maybe competing interests because we're providing two different kinds of solutions for what happens when we get more than two, multiple kinds of solutions. And so I get this question a lot. so the myth that we want to talk about today is either,
Emilia Bourland
Okay.
Emilia Bourland
Mm-hmm.
Emilia Bourland
Mm-hmm.
Brandy Archie, OTD, OTR/L
you're going to live independently until the end of your days and continue your life. Or you're going to struggle and end up in a nursing home or assisted living and that there is no in between. And so pretty much everybody, thanks on option A, it says, I'll be fine. And then, but that's, but that's also not true. You know, like everybody, the stats show that everybody needs some level of help, right? Just depends on where you get it from.
Emilia Bourland
Hmm.
Emilia Bourland
Mm-hmm.
Emilia Bourland
Sure. Sure.
Brandy Archie, OTD, OTR/L
So what I wanted us to talk about today is how is, why is that not true? And also what's the gray space that we're avoiding? Sound good?
Emilia Bourland
Yeah, think that sounds great. I think that's a really interesting question, too, because I do think, you know, just as humans, I think we like two choices, and we like to see things in black and white, and for there to be a really clear distinction between choice A and choice B. And we don't love gray area. And of course, that's where most of life actually happens. But yeah, this kind of black and white distinction that we have when we think of aging.
Brandy Archie, OTD, OTR/L
Black and white. Yeah.
Brandy Archie, OTD, OTR/L
Mm-hmm.
Emilia Bourland
for our loved ones or for ourselves is either, yeah, I'm gonna live independently till the end of my days, dancing on tabletops until I die in my sleep, or I'm gonna end up in a nursing home. And no one wants the latter. We all just hope for the best for the former. But you're completely right. The fact is that for most people, we will end up in that gray area. And there are actually good ways to do that and plan for that.
Brandy Archie, OTD, OTR/L
Mm-hmm.
Brandy Archie, OTD, OTR/L
for the first one. Yeah.
Emilia Bourland
in a way that helps you to live your life closer to what you're thinking of in choice A than what you want in choice B, right? So what's the kind of the first way that you start thinking about some of these different choices if you're in conversation with someone about it?
Brandy Archie, OTD, OTR/L
Yeah, exactly.
Brandy Archie, OTD, OTR/L
I think it all depends. I think the way I like to think about it is in stages. And so the thing that everybody's trying to avoid is go into a nursing home, right? But there are levels to all this, right? And so I think maybe if we start at the highest level of care, work our way down to the ways that we can make it more actionable, that would make most sense. nursing home level of care, let's just make a definition. Yeah.
Emilia Bourland
Mm-hmm.
Emilia Bourland
As Maria says, as Maria, the former nun from Sound of Music says, let's start at the very beginning. A very good place to start.
Brandy Archie, OTD, OTR/L
Okay, let's start at the very beginning. Exactly. Sound of Music is one of my favorite movies. Nobody would know that, but I do love it. I love musicals. I love musicals. Yeah. Yeah. I don't know. I don't know, but I do love them.
Emilia Bourland
Okay, is it really me? Me too. my gosh, me too. How did I not know that about you before?
Okay, all right, sorry, continue. Listen, that's my job. That's my job here.
Brandy Archie, OTD, OTR/L
Okay, was on my whole high horse about giving a good explanation about this. Okay, so let's first say what is nursing home level of care? Because let's have our right definitions. You need a nursing home if you need 24-7 care, medical care. Okay, so that's technically what's supposed to happen in a nursing home. You are fragile enough that you need a nurse on staff and need caregivers around, you need the doctor to come to you.
Emilia Bourland
Ooh, that's a great idea.
Brandy Archie, OTD, OTR/L
because of your medical condition. Oftentimes that seems like somebody who can't get out of the bed and has a lot of wounds or is on an IV or some kind of medical device that keeps them needing medical level of care. Now, that's the definition. What ends up happening in practice sometimes though, is that people who don't have enough support in their homes or in their places where they live end up in nursing homes because there is support all the time.
They have enough medical conditions, because we all do by the time we get a certain age, that it gets qualified in nursing home care. But it's mostly about having somebody around all the time. Not so much about they're so medically fragile that they need a nurse and a doctor on staff. So that's nursing home level care. Our goal is, nobody's goal really is to go there. But we do need to have as a society, because some people do need that. So then the step down from that is assisted living, right? Because then that's like having an independent apartment.
Emilia Bourland
Mm-hmm.
Brandy Archie, OTD, OTR/L
where you have help around you as soon as you push a button in theory. And so that's a great idea. And a lot of assisted livings feel like a cruise ship on land. There's activities, there's stuff to do, there's community. Yes, they gots. They're usually nice and new and your meals are made for you and stuff. depending, there's levels to all that, but that's the general philosophy there. Challenge though is.
Emilia Bourland
Ooh, they're so good. I wanna move in, now.
Brandy Archie, OTD, OTR/L
while you might be willing to move there, it costs a lot of money. Like the average in Missouri is $5,000 and that's Missouri. That's the average. What I hear from the coast and other places that it's eight, 10 easy a month I'm talking about. this is go ahead.
Emilia Bourland
lot of money.
Emilia Bourland
And keep in mind that that cost does not, again, when we say assisted living, that means usually a pretty minimal level of assistance. And that can vary depending on the community that you're living in. So assisted living might mean that they're helping you with your cleaning, your laundry, and they provide meals. But it doesn't necessarily include assistance with toileting, bathing, dressing. A lot of times those are add on fees.
Brandy Archie, OTD, OTR/L
Yes.
Brandy Archie, OTD, OTR/L
Yeah, that's-
Emilia Bourland
that you have to be able to pay. Again, it depends on the community, but these are good things to know and ask about.
Brandy Archie, OTD, OTR/L
Exactly. When you get sold a bill that says like, you have assistants around you all the time. That is true, but you're also going to pay extra for that.
So the reality is most people in America can't afford that. Even if you are the most fiscally responsible adult and you have a retirement savings, that doesn't mean that's going to last you the rest of your life at those rates which go up. One, as your level of ability decreases and you more help, you got to pay more. And two, just like everything else in America, it goes up over time because the costs for money go up over time. So it's really hard to bank on that.
And some people just can't afford it on any level, right? So then you got to go down another level. What would you say is before an assisted living?
Emilia Bourland
for an assisted living life, but you need assistance.
Brandy Archie, OTD, OTR/L
You need some assistance, you need to make life easier, but you can't afford assisted living.
Emilia Bourland
Mm-hmm.
Well, I would say trying to have some assistance come into your home. Is that where you were going?
Brandy Archie, OTD, OTR/L
I definitely think that's one of ways for sure. I also think too that like you might consider downsizing. So.
Yeah, because like, I might be able to take my shower and do the things for me, but I'm having a hard time managing my house, buying groceries, getting them in the house, shuttling my driveway, you know, all the things that come with the space that you live in. I s-
Emilia Bourland
I thought, so you're talking about like IADL kind of level of assistance, not necessarily ADL level of assistance, which dear listener is like ADLs are what we talk about when we talk about like the basic things we do to take care of our bodies. And IADLs are like the other things that we have to do day to day around the house, cooking, cleaning, medication management, that kind of stuff. Okay, sorry, continue.
Brandy Archie, OTD, OTR/L
Yes, yes and yes. Also, changing where you live at could be a good way to make your ADLs easier too, your regular basic stuff. Because if at your house you have a tub, shower, and you can move into a senior apartment, you're not getting any services from this apartment. It's just an apartment, but it's smaller. It has a walk-in shower. You have less space to walk, you know, so maybe that's helpful to you. You have a smaller kitchen, so maybe that's helpful to getting around it a little easier. That might make your everyday stuff
Emilia Bourland
Mm-hmm.
Brandy Archie, OTD, OTR/L
easier to do without adding a person to come help you. So I would say that that's another solution, another way to maintain your level of independence without necessarily going to a nursing home or assisted.
Emilia Bourland
Mm-hmm. Mm-hmm.
Emilia Bourland
That's such a good point. And I think that that can be one of the really hard decisions for people to make actually, because we get really attached to our homes. We get attached to our neighbors and our communities, and we don't necessarily, we're afraid to move and give those things up. And of course, absolutely, that's always part of the consideration. But going to a smaller space, moving into a condo or an apartment or something like that, that's just more manageable, that might be set up better for you is a
Brandy Archie, OTD, OTR/L
Totally.
Emilia Bourland
really strategic way to allow yourself to continue to be independent for longer. Now on the flip side of that though, which I think is where we're getting to now is let's say you don't want to leave this home. You don't want to leave your community. You don't want to leave your neighbors. Then we're really thinking about how can we make changes or small modifications, a small or big maybe, to the home that you're in in order to allow you to stay there for as long as possible.
Brandy Archie, OTD, OTR/L
Mm-hmm.
Emilia Bourland
And make your life as easy as possible so that you're more likely to stay healthy Have fewer risks that kind of thing, right? Is that where we were going next?
Brandy Archie, OTD, OTR/L
Yeah, that is where we're going next. before we go there, I just want to put one more. I think that moving to a senior apartment is overlooked as a strategy. But in real life, even though you could give up a lot, it could help you in the long run. maybe you consider the financial cost of like, my home is paid for, and now we'll go to an apartment I got to pay monthly for. Well, if you consider buying a condo, it's probably cheaper than the house that you have.
Emilia Bourland
Mm.
Emilia Bourland
Mm.
Brandy Archie, OTD, OTR/L
and you can sell your house and still have the money that you need to live into retirement and have a place that you're not paying rent on. And also if the rent that you're paying at the senior apartment ends up being like less than what the paying a caregiver to come to your house is and to pay somebody to your grass and pay somebody to shovel the snow, like you got to put all those costs in. And so just want to make sure that people think through that in its entirety to see that like.
it really could be a viable option. And we have a lot more housing stock in the apartment range, even if it's not a senior apartment, then we do an assisted living or caregivers to come to your house. That's just like the exclamation point I wanted to put on that for thinking for the future. If you're listening to this, about yourself in the next 10, 20 years.
Emilia Bourland
I think that's a really, really good point. I'm glad you talked about that because you're right. I think that is like an overlooked option for folks. And I kind of want to zero in on a little on kind of a niche of that a little bit more, which is like, as you said, senior living apartments may, you know, there are lots of apartments, there's condos, there's other ways to downsize. But there are like specific senior living apartments and communities that are not the same as like
being an independent living community or assisted living or something like that. It literally could just be like a 55 plus, you know, condo community or apartment community or whatever it is. And that can be great for things like socialization, because you're around other folks of your own age who might share the same interests as you. And socialization, know, is really important for mental health, for our physical health, for fall prevention, for all kinds of things. Like socialization is crazy important.
Brandy Archie, OTD, OTR/L
Totally.
Brandy Archie, OTD, OTR/L
Mm-hmm.
Emilia Bourland
What I would always want people to know though, if they're looking into something that is called, know, 55 and up, senior living, whatever it is, slapping that name on something does not necessarily mean that they built those apartments or those condos or whatever it is in a way that is accessible. so, and sometimes there can be a premium,
Brandy Archie, OTD, OTR/L
Facts.
Emilia Bourland
that is placed on having that name be on that community or that complex or whatever it is. there are some things, what are some things, I realize I'm getting us a little bit off track here, but what are some things that we think people should look for if they're like, okay, I'm gonna move into this 55 plus apartment community or condo community, and it says 55 plus, says for seniors, so it must be built.
Brandy Archie, OTD, OTR/L
Mmm.
Emilia Bourland
for me to age in place there, it's gotta be designed that way, right? What are some things that people should look for to actually make sure that it was more intentionally designed for safe aging?
Brandy Archie, OTD, OTR/L
Yeah, so what you're saying is what are the things you need in order to stay living in that place for a long time, right? Because if you do the effort of moving from your house to this apartment, you want to stay there a long time, right? You don't want to be forced to move somewhere else unless you really do need more care, not just because your environment. So I would one, make sure... So I'm going to start from the beginning. Make sure that there's no steps to enter this building. That seems basic, but there's lots of places that have steps into the building. So, yep, lots. So make sure that...
Emilia Bourland
Mm-hmm.
Emilia Bourland
Lots. Even if it's one or two, it still counts. Zero steps.
Brandy Archie, OTD, OTR/L
Zero, there need to be zero steps down to that building. And they need, or they need to have a ramp available if there are steps and that is accessible to you. And then there needs to be an elevator. Not all buildings have elevators. And so, cause not everybody can get on the first floor. I've been to many senior apartments that don't have elevators. So it needs an elevator. Then when you get into your own apartment, you want to have a walk-in shower in there instead of a tub.
You also want to make sure that the doorways are wide enough, meaning at least 30 inches. 30 is the minimum. So don't go no lower than that. But it need to be at least 30 inches wide so you can get a device through there if you should need to use one in the future. Not just the front door, but the doors to the bathroom, the doors to the bedroom, the hallway inside your apartment. Those would be the things that I would be like a must. There's all kinds of nice to have, but those would be like my must. need to, this apartment needs to have these things.
Emilia Bourland
Mm-hmm.
Emilia Bourland
Okay, here's a couple of things that I would add to that. And I'll preface this by saying, I think that when I say that some people are gonna be like wah, wah, but I have really good reason for making these recommendations. So it is actually better, and I know it feels less high end, but you would rather not have a glass enclosure around that walk-in shower. And the reason is because glass...
Brandy Archie, OTD, OTR/L
Okay
Brandy Archie, OTD, OTR/L
Fair? Yes.
Emilia Bourland
Enclosures around those walk-in showers make it much more difficult to, if you ever need some kind of equipment in there to keep you safe, it makes it much less likely that you're going to be able to put that in there. If you ever need a grab bar installed in order to get into that shower, it is very, very difficult in most shower layouts to properly get a grab bar installed somewhere where you can use it.
with a glass shower enclosure. It's not impossible. I'm not saying it's impossible. It can depend on like door swing and where the door is and all these different factors. So I'm not saying it's impossible, but it's much easier. If you have a shower curtain, that shower curtain is not gonna stop you from putting a grab bar wherever it needs to be. And so...
Brandy Archie, OTD, OTR/L
Yeah, totally. You open it all the way up, you have the full width of the shower to act to get in and out and put stuff in and have help.
Emilia Bourland
Yep. So I realized that that is wildly unpopular, but it is a really important consideration for long-term use and access. And the other thing that I would say is, you know, a lot of places very well, they're very well intentioned and they will build in like built in benches or seats into the shower. Right. And I'm not talking about ones that flip down and out from the wall. I think those are, those are pretty great a lot of the time, but they'll have like a built in shelf there essentially that's supposedly for you to sit on.
Brandy Archie, OTD, OTR/L
Mm-hmm, mm-hmm.
Emilia Bourland
I've met very few people's bottoms and very few benches that actually work together well. They're so tiny.
Brandy Archie, OTD, OTR/L
these little things. Think of those as shower as bottle holders. They're not booty holders. They are...
Emilia Bourland
And listen, that's what people use them for anyway. They put their stuff on those things, right? But they're not usually designed in a way to actually make it easy for you to access the water faucets. A lot of times your bottom won't fit on there. Sometimes they might be too low for the person who actually has to use it. And the other problem is then they take up that space a lot of the time. So it can make it really difficult for you to actually put the correct shower.
Brandy Archie, OTD, OTR/L
Yes.
Emilia Bourland
Seating system, you know, whether it's a simple chair or something like that, then you can't get it in there where you need it to be So that's another big consideration, too I won't go down all of the rabbit holes I could go on right now because you know, I realize that's not the point of this show But these are really important things to think about just because we call it senior living doesn't mean that has been intentionally designed for senior living and we should be Holding ourselves to a better standard
Brandy Archie, OTD, OTR/L
Totally.
Emilia Bourland
for making sure that if we're calling something senior living, we're really intentionally designing it that way for people to thrive there in the long term.
Brandy Archie, OTD, OTR/L
Yeah, from a professional standpoint, we should totally be doing that instead of using a 55 plus as a marketing term. But for you looking for a place, you should say to, hey, you tour it, you realize they have a built-in shower that's not gonna work, doesn't shower seat, not gonna work for you and not gonna make it available for a shower chair. And the doorways are too narrow and you leave the place and say, are you gonna rent it? You're like, no. And then you can tell them why and say, hey, it's not accessible. And they're like, oh, you're walking right now. Like, yeah, but I might not be walking every day forever. So I'm planning for the future and this is supposed to be a senior.
Emilia Bourland
Mm-hmm
Brandy Archie, OTD, OTR/L
plus building and you ain't even thought about that. So, bye. So anyways, I think people need that feedback. They only hear it when people are struggling and I think they need it in the forefront as a business strategy, but that's another rabbit hole. And if these considerations for like they came too fast and you're not trying to rewind this podcast, a really good resource is, I could just see myself doing that. I could be like, oh yeah, those are all good things. And then when it's time to actually go to a tour, they're like, what did they say I need to look for?
Emilia Bourland
Mm-hmm.
Totally.
Emilia Bourland
Hahaha!
Emilia Bourland
It's the same.
Brandy Archie, OTD, OTR/L
So a really good resource is the AARP Home Fit Guide. If you just Google that, and we can put a link in the show notes too actually. It goes through all the rooms in the home, but you could think about it specifically for entrances and exits for apartments and look at the bathroom section for the apartment and it will tell you all the things that we just said.
Emilia Bourland
That is awesome. That's great tip. And yes, we will go ahead and link that in the show notes so that you don't have to hit rewind over and over again. Over and over again. And you can just go straight there if that's something that you're looking for. Okay, what's the next step that we're getting to here?
Brandy Archie, OTD, OTR/L
over and over again. Yes.
Brandy Archie, OTD, OTR/L
Okay, now we're going back to, okay, moving into an apartment is not a thing I'm trying to do for any number of reasons. I want to stay home. How can I do that?
Emilia Bourland
Mm-hmm.
Emilia Bourland
Mm-hmm.
So we want to take a look at our current existing home the same way that we sort of walked through that apartment with a not meanly critical, but a objectively critical eye saying, OK, what are some things here that if I had to use a walker or if maybe I wasn't getting around as well as I normally was or normally am right now?
where might there be some barriers? we can, you know, and really thinking about those rooms, cause we have to prioritize here. You know, some folks, if you have all the funds in the world to make the whole house, you know, completely accessible, then that's awesome. Go do that. Most people are not in that bucket, right? So really thinking about, okay, what are the areas of my home that no matter what, I am going to have to be able to access?
Brandy Archie, OTD, OTR/L
Mm-hmm.
Emilia Bourland
It's going to be the kitchen, the bathroom, your bedroom at a minimum, right? And then really starting to take a look at how wide are these doorways? How wide are the entrances into places besides doorways, right? Like sometimes you might be walking into your kitchen. There's not necessarily a doorway there, but is it wide enough for you to get through if you had to use something? Is there space to maneuver in turn if you had a walker or a cane or something like that?
Brandy Archie, OTD, OTR/L
and a minimum.
Emilia Bourland
taking those same considerations into place for your bathroom. Now here's where sometimes this gets a little bit trickier in someone's individual home and with you as an individual. Because homes are already built and you as an individual have particular desires or concerns or things that are going on with you, sometimes we can't always apply the exact same concept in every single house to get the outcome that you want. And that's when it's really
Brandy Archie, OTD, OTR/L
Fair.
Emilia Bourland
That's when it's really valuable to work preemptively with an occupational therapist first to have them really go through all of those areas with you, sit and listen and put together a plan that's gonna work for you now and then in the long term. And then work with them again, that any construction work that you might need continues. On the other side of that,
occupational therapist might also be able to help you avoid doing any construction work because sometimes we assume that home modification or accessibility just always has to do with construction and of course it doesn't. It doesn't a lot of the time. Sometimes it's just it right it can be about having the right equipment changing maybe the way a certain task is done but having a plan in place for that before you need it saves a
Brandy Archie, OTD, OTR/L
Yes.
Brandy Archie, OTD, OTR/L
a lot of the time.
Emilia Bourland
whole lot of stress and will help you to actually stay there where you are, hopefully for as long as you want.
Brandy Archie, OTD, OTR/L
Exactly. And that's the point of using resources like occupational therapists or finding equipment at AFSAMI or any of those things. Because the further ahead you plan it, the better options you have, right? Whether that's applying for a grant or getting on a wait list for a program in your area that helps with those modifications. Like you have those options when you start in advance, right? As long as you meet their whatever those
requirements are or maybe you're gonna do the remodel. You can buy some of these things in individual over time and then they're like, I got all the kind of grab bars I like. They match my decor. They're functional. Now I'm gonna pay the contractor. We're gonna do this change like make a plan and let's like execute a plan. So I think at this stage we should talk about, okay, yes, maybe my house is accessible and I'm gonna stay living there or in the place wherever I live, but it's just unavoidable. need physical help. I need some
Emilia Bourland
Mm-hmm.
Emilia Bourland
Mm-hmm.
Brandy Archie, OTD, OTR/L
body to help me. What are, I think we should talk about like a couple of ways that you can get a person to help you. What's first thing you think?
Emilia Bourland
So there are more options for this than we think. And I'm going to kind of like bundle into different buckets or groups here. So obviously there's paid assistance that you can get to come in. In some ways, that's like the easiest phone call to make, right? Because if you're willing to pay for something, you can usually find someone to come and do that for you. That's called in-home care. This is usually going to be non-medical care, so insurance is not going to cover it.
Brandy Archie, OTD, OTR/L
That's called in-home care.
Emilia Bourland
What I would say is that for there are some programs, for example, like PACE programs are really amazing programs that are funded by both Medicaid and Medicare that can allow people to stay in their homes and get all of their care in home, including both medical and non-medical. And so those are really great. But so there's this paid bucket and professional bucket. And then there's our community services bucket. So how are we?
Brandy Archie, OTD, OTR/L
Mm-hmm.
Emilia Bourland
building our community in terms of our relationships of people who might be able to step in and provide some assistance, even with things as simple as do you have a neighbor who's willing to help you get your garbage to the curb? Do you have a friend who's willing to come and take your dog for a walk or can help drop off your groceries? And then also thinking about what are the community centers in our communities?
Are there senior resource centers that maybe are able to tie in things like respite care or daily companion care that someone might need? And a lot of times those services can be provided at low cost or they can be provided free because sometimes they're volunteer services. So there are kind of options like that as well. What else would you add to that Brandy?
Brandy Archie, OTD, OTR/L
Mm-hmm.
Brandy Archie, OTD, OTR/L
Let me tell you a small story. My neighbor, well, my former neighbor, Mr. J, I can say that because he passed away not too long ago, but over like two or three years ago, he was already thinking about moving to assisted living. And one of his primary things was, you know, he lives in a big house by himself and we're in an oldish neighborhood with old trees and we get a lot of wind and the tree lens break. And he already has services for grass and shoveling and all that stuff. And he was like, well, I'm worried that I'm not gonna be able to
Emilia Bourland
Okay.
Brandy Archie, OTD, OTR/L
take these to the back, we have a creek in the back and like drop them off the back and move them. And I was like, that's not a reason for you to move out Mr. J. Do you see how many kids I got in this house? Do you know how many? What we could do? We could just, we come out and walk our yard after storm and we drag limbs. We can just drag your limbs to the back. It's really literally no problem. You know, and so like, that's just an example of like, it bothers me zero, less than zero to do that. But that was bothersome enough to him that he was thinking about moving out. And so
Emilia Bourland
Ha ha!
Emilia Bourland
Mm-hmm.
Emilia Bourland
Yeah.
Brandy Archie, OTD, OTR/L
you should really think about your community as a whole and don't feel ashamed to at least talk about the things you're concerned about because you never know what people might volunteer to do.
Emilia Bourland
think that's a really good sort of way to segue into this idea that we really have to rely on each other as neighbors and as communities, whether we like it or not, because there just aren't enough people to go around to do all of these jobs professionally. And frankly, there's not enough money to go around to do all of these jobs professionally.
Brandy Archie, OTD, OTR/L
Yes.
Emilia Bourland
that would allow all of that to get done. So when we talk about like, you know, the like the baby boom population growing older and this like mushroom of older adults that we're gonna have demographically in our society, one of the ways that we are going to have to solve this is through community. And that doesn't mean that we're,
Brandy Archie, OTD, OTR/L
Andrew.
Emilia Bourland
that younger people are helping older people and those older people are not able to help the younger people. No, no, no, that's not what that means at all. Like, do you have an older adult who's a neighbor who maybe they need help, you know, picking up some tree limbs from time to time, but they're totally capable of, could they watch your kids after school if you're running late? You know, like we have to think about how we work together as communities and build relationships with each other.
And ultimately that makes everyone's lives better and stronger and richer, right? But we have to be intentional about that.
Brandy Archie, OTD, OTR/L
Yeah, exactly. You make a plan for that or like be, you know, build community. I think the myth that we started out with was that you're either gonna live your whole life perfectly fine, die in your sleep, which is everybody's goal, or you're gonna struggle completely and go to a nursing home and die a horrible death, right? And the reality is it's in the middle. And so most people are gonna end up in the middle. There's a few people on either end, but most people are gonna end up in the middle. And because of that,
What we're also saying is everybody's gonna need some level of help. So you should just expect that. And so if you expect that instead of just wishing for option A, then you're gonna be able to build community. Cause you know what? You're see somebody who's 10, 15 years older than you and you'd like, know what? It's really no big deal for me to pick up a few extra groceries when I go every week. And it's a big deal for them to go. So you know what? Let me just offer. You know, I'm just saying you put those things out, you get those things back in return and you think about it as a communal effort, which is antithetical.
to American society because we're all about independence at all costs, right? And I don't think that anybody's life actually functions that way, even though we create this high ideal that it should be that way. Which leads me to the next idea about having more help. And that's thinking about living together with somebody, whether that's with your kids or your parents live with you or you live with another single individual or I don't know.
They don't have to be single. Somebody else who's also older, because there's more power in numbers, right? And what you might be capable of doing, they might not be capable and vice versa. And together, you're making this thing work. And so I think that we even further underutilize this as an option because we have such a strong focus in our culture on doing everything independently, having your own space. cannot tell you how many times a client has said to me, well, I just don't want to burden my kids.
They got their own life. They got their kids to raise. I don't want to burden my kids. And while that might feel like a noble thing to say, your kids are worried about you in the house by yourself. And nobody wants to admit the two things and talk about it. And you probably could come up with a way to operate within community to do this. So intergenerational living is like a way that helps everybody. And you'll have to think of it as charity to yourself if you're the older adult. And if you have made a plan to do this,
Brandy Archie, OTD, OTR/L
or thought through it, then it doesn't have to feel like a burden if you're the person bringing somebody else into your house because you've already kind of thought about that. You know what saying?
Emilia Bourland
Yeah, I'm so glad that you brought that up. Because one of the things that you and I had talked about before we started recording this episode was the fact that that's something that you've already been thinking about for years in terms of when or if my parents need to come and live with us, how can we make that easy for them? Would you talk a little bit about your decision making and what you and your husband were thinking about?
Brandy Archie, OTD, OTR/L
Yeah, so, wow, five years ago now, we were moving from our condo and looking for a house because I was pregnant and we already had a kid, we a one bedroom condo. And so we needed a bigger space. And so when we were looking at houses, me and my husband independently, we're thinking this, but then as we talk to each other, we're like, yeah, we're both on the same page. We're thinking about houses based on like, their function for us now, but also their function for us in the future, in the case that either of our parents or somebody else would need to come live with us.
And so the house we ended up settling on was perfect for us for many reasons. But one of the reasons, two of the reasons had to do with accessibility. First thing I saw when we walked in there, has a little porch that has one step and a very little step to get into the house. And both of those could be mastered with two little threshold ramps that would cost under $100. I'm like, this is accessible. We can come in and out of here if we need to. There's also a bedroom already on the first floor with a bathroom on the first floor. And so we're like, hey, while we're
Emilia Bourland
Mm-hmm.
Brandy Archie, OTD, OTR/L
That wasn't the room we chose to sleep in first. And it was my office at first. It was also a place that either of our parents could stay in and go in and out through their own door on our two little steps or on a ramp if they needed it. And you know, that, we was like, this is perfect. They can be in this space right here. They wouldn't have to go upstairs at all. Everything they needed is here. The kitchen is down here. All the family living space would be down here. And so, you know, that was part of the reason why we loved that house and made sense to us because it has all those levels of function for us, even though
You know, at the time, we were in our 30s, you know, and our parents are all, we're all doing fine.
Emilia Bourland
Yeah, I think it's so important to have that aspect of planning ahead and thinking, you know, a lot of this episode, I think we've been talking more about things like if you are the person who is at this point in your life where you're an older adult and you're thinking about where you're going to be like, here's some different ways to think about it. But if you are the child of that of that person, this is stuff that you have to be thinking about about, too, because guess what? You're going to be involved. And how
Brandy Archie, OTD, OTR/L
You're gonna be involved.
Emilia Bourland
how do we be involved in a way that is gonna be the most, both the most convenient, the easiest, but also maybe the most beneficial to everyone in the long run, right? There are a lot of benefits to intergenerational living. We try to juggle so much on our own as tiny little nuclear units of families getting kids to and from and
Brandy Archie, OTD, OTR/L
Yes.
Emilia Bourland
managing all the activities and making sure, can you take off work to be here? Because the dishwasher needs to be repaired and they're coming during the six hour window. know, like, so how do you handle that? This is why humans started in groups and why we are meant to be in groups, right? Is because we do better when we can depend on each other. And then no one has to feel like they're a burden because everyone is working at it together. And you know what? Sometimes
Brandy Archie, OTD, OTR/L
How do you handle that? You have to have more people than just you. It's too hard. It's too hard.
Brandy Archie, OTD, OTR/L
Contributing! Yes!
Emilia Bourland
Sometimes we all need help. We might need help with different things, but sometimes we all need a hand and everyone can contribute to that.
Brandy Archie, OTD, OTR/L
And whether they live in your house or do you live, you decide that you're going to live nearby. I've families where they have, they're all on the same block. And so yeah, you get to have your own space, but then it's easy to walk over here and the kids come to grandma's house after school instead of our house and they help do these things. And then she's not by herself. And you know, there's just like so many benefits to that. And I think people just should consider it instead of not considering it. And also the other thing I think is in the same way, the myth is
Emilia Bourland
Mm-hmm.
Emilia Bourland
Mm-hmm.
Brandy Archie, OTD, OTR/L
either everything's perfect or everything's terrible. Somebody living with you is not always for forever, right? Like after we moved into this house, this thing did happen where one of my parents had a surgery and needed to be supervising to have the help around. And they were able to come stay with us in that room that I talked about. And it was not a big deal because we already had the space and the availability to do it. And it was already fairly accessible, you know, and that didn't last for forever, but it also meant.
Their whole life wasn't turned upside down. Trying to run back and forth to their house and do all the things, get them to the doctor's point. You know what mean? It was just like, okay, this is a little bit of a change, but it's not like, unmanageable.
Emilia Bourland
Mm-hmm. right. think we tackled the heck out of that myth.
Brandy Archie, OTD, OTR/L
I think we did too. Hopefully you feel like we've had, we've given you plenty of things to think about and ways that you can incorporate into your life because there are so many ways. And just the first thing you be is not in denial. Everybody needs help now and in the future. So deal with it people, it's okay.
Emilia Bourland
Okay.
Emilia Bourland
Mm-hmm.
Emilia Bourland
It's okay. And there's not one perfect solution. Like one of these solutions is not better than the other. It depends on you and your lifestyle, your goals and your particular needs. Exactly. Exactly. So, you know, this is all just about having information to help you make the right decisions for you where you are right now. Okay.
Brandy Archie, OTD, OTR/L
and the time in your life.
Emilia Bourland
Well, if you made it to the end of this episode, thank you so much. Make sure that you check out some of our other episodes, download them, leave some comments, ask some questions. We would be happy to address listener comments and questions. So we make sure that we're giving you stuff that you wanna hear. Make sure you like and subscribe and we'll see you next time right back here on Care Lab. Bye.
Brandy Archie, OTD, OTR/L
Bye everybody.
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