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Plan on ‘aging in place’? Start early and be patient

Since the global COVID-19 pandemic, the vast majority of Canadians have expressed a desire to continue living in their homes and communities (i.e., “age in place”) for as long as possible. For those who are proactive and with financial means, redesigning and modifying may extend their ability to do so.

When we consider what makes a home age-friendly or accessible, we often think about reducing the number of stairs or steps. Bungalows are better than multi-storey homes. Apartments or condominiums with elevators must then be better, right? Perhaps. The reality is that there are several “accessibility specs” that are not commonly accounted for and, even when they are, there may be invisible barriers or limitations in the process of retrofitting one’s home that creep up along the way.

Alcina Sung has worked as an interior designer for 20 years. Like many in the “sandwich generation,” she has recognized the challenge of helping older relatives age in place, a topic that seeped into many of her social conversations. As co-founder and design lead of Togethering, she is now serving families looking to retrofit and redesign their existing homes for changing health and accessibility needs, actual or anticipated.

“Especially with the pandemic, more and more of my social circle is facing how to keep their parents at home for as long as possible,” says Sung. “Everyone is scared of having to live in a care home, so how do we solve for that with some foresight and advance planning? It’s been a new challenge for me – one that turns out to be a lot more complicated than I’d ever expected! Also, those of us with first-generation ‘self-made’ immigrant parents know that there’s pride and independence with having conquered so much. To get them to accept that they’re inevitably aging, accept help and spend money on a future unknown can be daunting.”

Sung’s most recent design/construction project poignantly illustrates this web of complexity. Over the past year, she has been helping her childhood friend, Janice, redesign and renovate her parents’ condominium bathroom in Toronto. Despite living in Boston, Janice has taken on  several caregiving responsibilities, especially since her mother’s (Claire) diagnosis of a rare form of cancer in 2016. Around that time, her parents downsized to a condo to reduce maintenance and concern about stairs. To their credit, a condo was a far better alternative than the house. But, as many others have experienced, the foresight for what other space accommodations may be needed remained a big unknown.

Since moving to the condo, Claire’s day-to-day functioning and mobility continued on a slow decline. She and her husband, David, managed as best they could but, once Claire became confined to a wheelchair, they realized that condo living was not enough to help her remain independent. From Boston, Janice helped her parents purchase various products to make everyday life easier: bedside grab bars to help Claire get in and out of bed, a plastic shower seat and a removable seat with grab bars placed over the toilet.

In 2021, during one of Janice’s many visits back home, she convinced her parents to retrofit their condo bathroom – their biggest pain point. Incidentally, there was a leak in the bathroom that needed to be repaired so Claire and David had an “excuse to might as well renovate.” Sung notes the irony – that simply making their lives easier did not seem enough of a reason in itself.

Gathering the requirements

Beyond repairing the leak, the goal of the design project was to improve Claire’s autonomy and ease of use in the bathroom.

The design

Aesthetically, the space needed to be functionally barrier-free but pleasing without a “sterile and clinical look” found in hospitals and care homes. Her design would enlarge the shower space to create more room for two or more people, removing the corner jacuzzi tub and replacing it with a freestanding tub (for David’s use). The shower would also include a handheld shower head (for ease of use for the personal support worker and for Claire in the seated position), plus an overhead shower head for flexibility. A strong flip seat (with blocking in the walls) would be installed in the shower to replace the portable shower seat. Structurally stable grab bars at the right heights would be installed throughout the toilet and shower. Flip-up grab bars would also suit the needs of both Claire and David. Floor tiles would be a matte and slightly textured material to avoid slipping. Side-by-side matching sinks would both be at barrier-free height and one sink would have wheelchair access below. LED potlights would replace old potlights to reduce maintenance and improve visibility. The bathroom door would be replaced by a sliding door to allow for hallway access unobstructed by a swinging door.

Finding a construction crew

Given the GTA’s hot reno market since the pandemic, finding a general contractor proved nearly impossible. “With everyone renovating, it’s hard for (general contractors) to prioritize small projects when there’s more money to be made elsewhere.” After two months, Sung finally found a licensed contractor “who was touched by the situation” and agreed to take on the project. Even then, he was only available four later.

What could have been done differently? Should the design and renovation process have started earlier?

Construction challenges within a condo building

Then came a slew of construction complications related to the condo building. First, there were major limitations and delays due to the condo building’s lengthy approval process. For example, the step into the shower (an accessibility “barrier”) could not be fully removed because a main plumbing piece was higher than floor level, meaning the contractor had to fashion a portable ramp.

Then, there were “typical” on-site complications that added time, effort and cost. Old, rusted pipes and plumbing fasteners, for example, had to be replaced.

As Claire’s health condition did not allow them to move out during the renovation, they lived through the construction. This meant scheduling entry and construction around their day-to-day routines, which were inevitably complicated by Claire’s declining health. With the condo unit doubling as a home and construction site, the crew had limited space to cut tiles, stage their work tools/equipment and store/prepare materials. At the same time, the crew tried its best to reduce the dust and debris during the renovation, and thoughtfully placed and moved equipment and materials to avoid obstructing Claire’s wheelchair access or creating safety hazards.

Altogether, the project has gone on for almost 10 months from the initial meeting with the client. The renovation bill is $35,000-$40,000.

The outcome and lessons learned

Having declined significantly over this time, Claire is now scheduled for a major surgery. Her family has been told that this is the last operation, and she may not survive it, let alone get to use the bathroom designed for her, leaving Sung and Janice deflated and heartbroken.

But what could have been done differently? Should the design and renovation process have started earlier? Even though Janice had reached out almost a year ago, would that have helped? “When and how do you plan for the unknown?” Sung asks. “On one hand, we might advocate that seniors with the means and intention of staying at home start these kinds of projects before something happens. But then, how do you convince them to spend the money when they think they’re ‘still OK’?”

Age-proofing a home may mean spending money earmarked for retirement plans, bucket lists or children’s and grandchildren’s inheritances. At the same time, not age-proofing one’s home may mean settling for the limited range of seniors housing options currently available. If a health crisis or disability creates day-to-day care needs, a senior with no desire or option to live with family, but with financial means, may choose to move to a private retirement home, which can vary anywhere from $2,000 to $10,000 per month depending on shared/private, suite size, amenities and level of care needs (e.g., bathroom support, portering, feeding, night checks, memory support, etc.). Those without such deep pockets may have to sit on a long-term care waitlist, which itself can take several years, especially for ethnic long-term care homes. Of course, both retirement and long-term care homes entail adapting to congregate living among other residents and employed staff, and adhering to the changing protocols and restrictions due to the COVID-19 pandemic.

The more proactive seniors and families may “downsize early” by purchasing or life-leasing an “independent living” apartment in a seniors’ building. As a team, however, we have noticed that most of these dwellings are not truly barrier-free. It’s quite common to find standing height sinks and countertops, step-in/over bathtubs and showers, low-set toilets and stairs. And if these dwellings are not truly barrier-free, would a subsequent move or hiring caregivers be necessary despite their proactive efforts?

Another major issue we have often encountered, but is rarely discussed is that many seniors have trouble envisioning their future care needs, much less organizing an action plan around it. Most we have spoken don’t want to be burdens in the future but also have trouble discussing such topics with family members. These conversations can breed family disagreements and conflicts that further hamper meaningful action. Figuring out how to have constructive, empathetic and collaborative family conversations is a feat in itself.

While there is no easy answer to any of these problems, Sung and the Togethering team are compiling resources that may better educate families, designers and developers on accessibility considerations and other resources that may support these discussions. For families, this may inform whether they “invest” in a reno/retrofit project or consider other options. At a minimum, it gets families thinking about future needs and options they may wish to explore.

“I see myself collaborating more with practitioners, like occupational therapists, who can consult on the health and accessibility requirements and look to me as a designer to harmonize those specs with aesthetics, function and personal taste,” says Sung. “I want families to be able to enjoy functional, supportive spaces that still feel like home. Maybe seeing nicer examples of what’s possible will plant seeds for families to invest in making changes earlier.”

No doubt, it’s definitely a start.

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Authors

Amy Hwang

Contributor

Amy Hwang is a second-generation Chinese Canadian mother, care partner, social entrepreneur, and aging + design researcher. Her mission is to help individuals, families, and communities co-create more meaningful relationships as they age together.

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