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Do you or do your parents or even grandparents want to remain at home for the rest of your lives?

 For 75% of people, age 50 and above the answer is absolutely yes! But sadly less than 1% of people actually live in an environment that makes this possible. Right now, we are at a unique point in history where there's legislation that can actually help counties, cities, and municipalities create a new reality for their residents.

A reality that will allow many of them to remain at home as they wish. Join me with my special guest Esther Greenhouse, to learn more about the longevity economy, how our homes are forcing us into frailty and how our state and local governments can rise to this challenge, right now.

This is the smart planning 101 podcast .

From Honolulu, Hawaii, Aloha everyone. I'm Nicole Wipp, and I'm your host.

As an elder law and estate planning attorney, one thing I know is that almost every single person I've ever talked to either personally or professionally, wants to age in place. They want to stay home for the remainder of their lives. But as I say to people all the time, almost every single long-term care, also known as nursing home facility, as well as every assisted living facility is full of people that never wanted or expected to be there.

Some of this is because of unexpected illness, that's absolutely true. But what if a large percentage of people in these places, our grandparents, our parents, maybe even ourselves eventually are there because our actual living environment, our home forces frailty that our loved ones are being evicted from their homes by design. This is about our built environment and the severe shortcomings we have in them today.

The good news, there are things that can be done about it. And I have just the person to talk about it today with me.

Welcome Esther greenhouse to the smart planning 101 podcast.

Thanks Nicole. I'm so glad to be here.

I'm so glad to help you. And I want to properly introduce you to the audience.

Everybody Esther Greenhouse is a really unique professional. She's a built environment strategists. Consulting with organizations to create innovative initiatives at the intersection of today's challenges and the built environment. Her mission is to change the way we design and build our nations places to eliminate the discrimination, dependency and force frailty created by the status quo.

Applying to her unique enabling design approach. She leverages the power of informed design to enable all people to thrive. To that end, Esther is collaborating with AARP international on a multi-year initiative for the creation of enabling an equitable housing multi-generational communities.

At Cornell university, she is an adjunct lecturer and an industry scholar in the Institute for healthy futures. She's been invited to contribute her expertise, presenting for the Clinton global initiative, coauthor of the American Planning Association’s Aging in Community Policy Guide and has consulted on the design of the U.S's first elder focused emergency department. Ms. Greenhouse is the strategic director for one of the nation's first age friendly centers for excellence.

Welcome again, Esther. So let's start super broad. Okay? First, what is the built environment and what are the current shortcomings of our built-enviroments?

The built environment in several different professions, such as municipal work, community planning, architecture, engineering, refers to man-made structures.

So our infrastructure, our housing stock, public buildings. Private buildings it's anything that has been designed and built by society versus the natural environment. Some of the shortcomings of the built environment are actually many. So really the primary issue with the built environment is that we have created a society that is full of places and spaces that are ideally designed for the needs of the average height, male, about five foot nine between the ages of 20 and 40. So things work really well, if you are between those ages, male five foot nine, and have the highest abilities in terms of physical, cognitive and psychological and everyone else who doesn't fit within those parameters needs to adapt.

Number one, very few people know this about our built environments. They don't know that the status quo is discriminatory, that it's built for a subset of the population. And it's really crucial because, if it's designed for the subset, then what happens to everyone else who's not in that category?

Everyone else is forced to adapt. So the other key issue to understand is the more that a person is required to adapt by his or her environment, the more a person is forced to adapt to their environment. The more they are pushed to an artificially lower ability level.

And that's really crucial, especially as we age, because what happens then is we are forced into frailty. We're forced into frailty, and then we become more dependent on our family caregivers on home health aids and on community services. And my mission in my work is to help communities understand what the status quo is that it's disabling and discriminatory.

And secondly, to understand what we can do about it, which is really just setting up things for a one degree shift in how we design our built environments. We're not talking about radically changing what our spaces and places look like. It's really a one degree shift in lots of details, like with the drawer weighs zero step entries, making things work for the true ability span and lifespan in our society.

I love this so much because you pointed out a couple of things that I really want to highlight. And I want to just expand upon from my perspective as an elder law attorney, because when people go to see an elder law attorney they're most of the time, because they're really, and this is something that's been really an aha for me, by the way, Esther, in talking to you is that they're coming to me because their built environment is no longer working for them and or their caregivers. And now we're in a crisis mode. Where we have to change the environment.

Like I said, at the top, like people go into assisted living and nursing home type facilities because their built environment no longer works for them and they need care. And I think that I have always, like you pointed out, been under the impression that there was, I didn't even think about it. It never even occurred to me.

My, my view was not wide enough to see. That there are things that could have happened early in the home environment that could have avoided that, but by the cumulative effect of years, cause that's what we're talking about here and that now this person is into force frailty, eviction by design they're in this position.

And I think that also I want to stick a pin in the fact that this is part of the reason why it's important to say this is why counties, municipalities, cities, our communities need to be involved because there's policy issues that need to be resolved to change this dynamic, right? Individually, we can do things, but there's also some policy, right?

A hundred percent. Yes, so let me explain. You used a term that I coined called eviction by design actually came out of personal experiences. So my grandmother, as she began to need to use a Walker in our home, found that she was effectively barred from the bathroom because the doorways were too narrow.

And she had to leave our home and move to a nursing home where she could be cared for, but she was evicted by the design of the house. Didn't work for the lifespan. And there are a couple of crucial things to understand about this one is this is preventable. So in my case, quite happily in my family, I rectified this with my very own mother.

We designed and built a house for her 10 years ago. That is enabling, it has wider doorways, zero step entry, everything she needs on the first floor, though, it is a two story home and she has been enabled by these thoughtful features, that are respectful of the lifespan and the ability span to live in that home with minimal support into her nineties, with chronic diseases.

So she will never be evicted from the home by design and she may need to move for medical conditions, but it will never be because the house is pushing her to an artificially lower level of functioning. The house is not. Forcing her into frailty.

Yes, And I just, want the audience to hear this because I'm telling you right now as an elder law attorney, that these two things feel interconnected.

Everybody can see their interconnectivity, but I don't think that people really understand how important this is and that the level of this. So then. Part of it is, there's there's, this is a huge conversation. I honestly like you and I could literally talk about this for 10 days straight and still not get it all out, but because there's a lot of policy issues, a lot of thought that needs to go into this.

But bottom line is right now, we're in a moment, right this moment, where there's legislation that has passed, the American rescue plan. And then there's also some pending legislation related to infrastructure is everybody's probably aware if you watch the news at all, that does and would give money to counties, cities, and municipalities for the scope of these things is enormous.

But. You think, and I agree with you that they should be implementing some very specific things with this money to jump on this opportunity to fix built environments for communities. So what is it that you think they should be doing?

Absolutely, Nicole, there are a lot of key opportunities. So in terms of state and local governments, first and foremost, they need to understand the force frailty and dependency that is created by the status quo of their housing and infrastructure. That's number one, they also need to understand what it's costing them because the more their citizenry is disabled by design.

The more, those people are going to be accessing community services or they're going to be accessing Medicaid funds. So if we can enable people to maintain their physical and financial independence and stay at home, it's a win-win for everyone. Then, in addition, in terms of this moment in history where we have these incredible opportunities created by these coming federal funds communities have to look and say, we should not be throwing good money after bad.

We need to bring this crucial paradigm, widen our lens, make sure we are inclusive of all people in terms of abilities, in terms of age and behaviors and design accordingly. So in order for communities to really leverage these funds effectively and get the most from them and be the most efficient, I have developed an approach.

My firms, new focus is called silver to gold strategic consulting, and that's helping communities turn their silver older population into gold are financial savings and benefits for the municipalities and for the older adults.

That's interesting because first of all, irrespective of the fact that these are our parents, our grandparents, our aunts and uncles, like our actual family members. They only look at it as a drain. And so they don't put any importance on it. So how do they turn their silver into gold?

That's a great question. So one way that communities can turn their silver into gold is by incentivizing or mandating new housing and new projects to be as enabling as possible.

So minimize any kind of forced frailty or eviction by design in terms of the new projects. So again, shifting the design from the status quo, which is biased and doesn't work for people of all ages and sizes and abilities and widening that lens. I just want to interject something really important in my work with every sector that I deal with, there's a lot of confusion about the Americans with disabilities act. And while this has been groundbreaking and life-changing legislation, the Americans with disabilities act accessibility guidelines, don't apply to every single space in our communities.

For example, they don't apply to single family housing. There are limitations in terms of multifamily, how many units, there's a minimum number of units that, that then kicks in complying with ADA accessibility guidelines. A lot of places are grandfathered out. The other issue is that the ADA accessibility guidelines while they're so powerful, the purpose of them is to remove minimal barriers to access, not to enable.

So it's a very different focus.

Like minimal barriers versus an enablement, which enablement in this context means. To be able to survive and thrive.

Exactly. Exactly. Our goal here is to thrive by design. Absolutely. So state and local governments can incentivize or mandate that builders and developers shift the design of new projects. So they minimize forced frailty.

And the question I always ask communities when they're exploring this is why should your community pay for buildings that are going to create more dependent seniors, or have the need for home modifications later down the road that depending on the program, like if these are people who qualify for a government program, you're paying for that.

And one county in particular is an example that they wisely mandated these lifespan features into their housing stock and over 10 years built over 20,000 new homes that otherwise would have contributed to frailty and dependency.

So in my career, I've worked with building planning and aging services sectors to create special initiatives that pertain to this. And I can help communities bring these seemingly disparate groups together to move forward for everyone's benefit.

The second key aspect is for communities to embrace what is known as the longevity economy. This is the portion of economic activity that's generated by people 50 and older. This represents 51 cents of every dollar, and if we pulled the longevity economy out and looked at it independently, it would be the third largest economy in the world behind the U S and China.

So wait a minute. Are you saying that there is data that shows that for that the longevity economy, 50 plus people spend 51 cents out of every dollar in the entire economy?

Yes, it's a combination of them spending it and then paying into state and local taxes, which they contribute over $600 billion in state and local taxes. So the other thing that's crucial for us to recognize is that the longevity economy is projected to triple by 2050.

So it's really crucial for state and local governments to view their 50 and older population, rather than a drain as silver to gold.

I see this as two issues though. First individuals need to demand that the money that these places, these cities, these counties, these municipalities are receiving is spent responsibly. And not just in a reactionary way. And when I say reactionary, because these funds can be earmarked for all kinds of projects that may not really benefit our loved ones in this way.

So we all know how it is to be an elected official, right? There's a lot of reactionary-ness to it, and if you're the type of person that cares about your community, your family's place in that community, then you need to be a person that demands that this money is spent responsibility. That's the first issue that I see, even when I think about my clients or even my own family and my own friends and their parents and things like that, so that people can stay home.

But then the second is that these governmental units need to think about how to properly spend it. And that's where you come in, right?

Yes. Yes, absolutely. Nicole. So this is very important and meaningful work. My expertise with communities and the building and planning, sectors, creating local regional national and international initiatives has really informed my understanding of the hidden struggles that both individuals and families and communities unnecessarily face.

So first of all, you and I, our families, our loved ones and citizens in general must understand that the status quo their housing and their communities is unnecessarily making them frail and really exacerbating aging. Because in our society, we tend to view aging as a negative, and we also tend to view it as like a moral failing of the person, like you haven't done a good enough job. And so your abilities are changing when real lifestyle does play a role, genetics do play a role, but this whole hidden aspects of how your built environment is influencing you is rarely discussed. So on the individual and family level, people can be proactive by incorporating features that enable independence.

For example, if you are renovating your kitchen, why not think about certain things that are going to work across the lifespan or in a bathroom it's, there's tons of resources available. And in fact, for several years, I taught a program through the national association of home builders that, was created at the request of AARP called certified aging in place specialist. So there are people who have expertise to help people stay in their own homes.

Lastly, an important thing about that, that really relates to communities as well is the fact that home modifications can be really beneficial and powerful when somebody's needs have changed. But the big issue is they typically come too late. They come after somebody has been disabled by design, after they are increasingly frail. And what we want to do and we really need to do is look at the power to prevent by these enabling design features.

Well, we're sitting here, like those people that might be listening to this are a little bit younger. And when I say younger, I'm talking forties, fifties, sixties might be thinking of course, don't, we all want to prevent unnecessary aging? And we think about it in terms of eating and exercising and what we put on our skin and all those things. But you're bringing in this amazingly new dimension that people really need to think about, which is our environment around us and how that very insidiously creates this. That's the issue is it's insidious. Like you don't see it. It's just a little bit at a time, every single day. And then next thing it's too late. And so you're saying let's get ahead of it and I love that.

Absolutely let's get ahead of it. And the other thing is there's a lot of discussion about, what age is really relevant. And for me, I tend to talk about people 50 and older for a variety of reasons. And this also relates nicely to the longevity economy, that's it, it helps reinforce why 50 and older is a really good age range because by the time all of us are 50, the majority of us have already experienced some natural age related changes to our abilities, it's normal.

So the ability to see fine details, the ability to read without reading glasses drive without bifocals, and be able to read the GPS and drive, and so on. Our hearing there are significant changes to vision and hearing by the time we're 50. That's a given. So it really makes sense to be thinking at all ages and earlier ages about this prevention, but what is actually terrific about this is that even though we're the impetus is to meet the needs of the aging population and really remove a significant negative variable in terms of aging, the exciting thing is that everyone benefits.

Yes.

Everyone benefits people of all ages. So if we say it's really important to have a zero step entry into someone's home, it's not just about a person who may use a cane or a walker or wheelchair. It's also about bringing in heavy furniture. It's about the boomerang child who's moving in and out. It's about bringing in a sleeping child in a stroller, carrying heavy packages. So again, these are not radical design changes. These are small shifts in how we design that have very significant impacts.

And ultimately I think that the reason that cities and municipalities and all like the governmental units need to be listening to your message and they should be talking to you is because they can do things our governmental units can do things that individually we may not be able to accomplish for a variety of reasons.

 And this is like by far one of the prime examples it's that we don't know how much our built environment hurts us. We don't understand as a governmental actor, how much the lack of planning for the built environment is affecting the tax space and the revenue in our communities.

 Absolutely. Yes, you're right. You're right, and so in my own situation, the design features that we put in my mother's home, enabled her to avoid moving to a facility and have saved her, I'm estimating over $500,000, by being able to stay home with minimal support from us and from a home health aid.

So that's really powerful and communities need to look at that example and see how it's multiplied over by the people in their communities who currently or may in the future need assistance and who may become dependent. So this ties in really nicely with an important trend that's been going on in our community, an important trend that's been going on in our nation, the shift to increased Medicaid dollars for home and community-based services.

That is going to change and increase because there is significant funding in the American rescue plan act for home and community-based services. And in addition, the plan current plan in the infrastructure bill is that there's going to be an injection of $400 billion. Into the home and community-based services, which is phenomenal because the federal government is recognizing and responding to the fact that it costs less to take care of people in their own homes.

And a lot of people don't need a significant medical model for care, but they do need support in the home.

Hold on one second. I actually really want to talk about that for one second, because what you just said is a hundred percent accurate from the government's perspective, it's cheaper for the government to keep people home.

But I want people to understand that in the current world that we live in, it is not cheaper to stay home

Yes

and get care, and that's why attorneys like myself exist because it's not cheaper. People cannot afford to stay home, but it's cheaper for the government to keep you home.

But what we need to have is those two things coming together, where you can afford to stay home and be able to be home in a responsible and safe fashion. And then it's a, win-win our tax dollars are being spent better, we're not having to access and our own funds are not being spent on all these things.

And so that's the issue is because it's cheaper for the government right now. It's not cheaper for individuals to stay home and receive care that they absolutely have because their built environment does not work for them.

100%, 100%.

So Esther, how can you help cities, counties, municipalities, whoever that's receiving these funds to think through the best way to deploy these funds and use them to create and keep vibrant communities be more attractive as a community, and then turn that silver into gold, how can you help?

 Nicole, there are a variety of ways that I can help communities. So first of all, I work with communities through forums and workshops and by developing initiatives to help them understand first and foremost how disabling the status quo is and why that is creating an unnecessary demand and drain on their services and how that can be addressed.

We also use my community assessment tool to help them see where are some of the barriers in the community, and then also what existing assets they have that they can call upon. So there are a couple of things that communities really need to think about. For example, talking about the issue of home and community based services, how can they efficiently and effectively leverage those funds when much of their population can't even get through the bathroom door, using a Walker with the assistance of a home health aid or because they are one of over 40% of Americans who are obese? So simple things like looking at their housing stock, how are they going to efficiently increase home and community-based services and use their share of that 400 billion when they're fighting against these really basic, essential, but powerful problems within their housing and infrastructure.

Yeah. It's almost like fixing the things that are broken before you start layering on all kinds of additional things that you maybe don't need to spend so much money on that, if you could fix it at the back end, the front end, I feel like there's a lot of, and this is common because we're human, everybody chases their tail and the government there's no worse than the government, but that's partly because.

We don't have, if we, but we have expert help, like you, we have expert help to think through these problems, then we're going to be able to get there so much faster. And so I think for any community that really wants to address these problems, they need that expert help. They need somebody like you.

Absolutely, and that's why I'm doing this because there's a significant need. A lot of the things I talk about there are like the whole idea that theory of environmental fit and press, which is the greater the gap between a person's abilities and what the built environment demands, the more they officially lower ability level that is really only talked about in academia, in a few specific professions and occupational therapists are aware of that.

They're aware that we're trying to work towards an optimal fit or good fit between a person and his, or her environment, but the majority of practitioners, builders, designers, architects, they haven't been trained in this. And one of the things that I feel is my responsibility with municipalities is to bring that awareness to them so that they are essentially informed consumers and customers and clients to any builders or developers who are creating spaces in their communities.

Yeah. That's amazing. So Esther, I just love your work so much. I am a huge fan. And I want to thank you for bringing this to my attention. I'm going to say it. I'm a little bit embarrassed, to be honest with you that with the work that I do, that this was not in my vision, but I want, I guess that's part of the reason why it was so important to me to bring you on here today. Because, somebody like me, that literally lives major. Part of my work is exactly involved with this population. This was a major blind spot for me. And if it's a major blind spot for me that I can only imagine what kind of blind spot it is for everyone else. Just you bringing attention to this matter is so great.

And I really hope that we have more and more conversation about this as a country and in our communities, as things goes on. And so Esther Greenhouse, thank you so much for coming on the smart planning 101 podcast today. How can people find you?

So they can visit my website, esthergreenhouse.com. That's E S T H E R greenhouse.com. And there I'm also on LinkedIn. And I think you're going to be posting the links?

Absolutely all the links to her website, LinkedIn Twitter, and her Facebook page will be posted in the show notes for today. So certainly make sure that if you want to contact Esther or, follow her for her great insights and wisdom, those are the places, whatever your preferred platform is, the place to do it.

We just can't talk about this enough, this is something that we're going to have to be revisiting over the time, but I really want to thank you for coming on today.

Nicole. Thank you so much for having me and giving me the opportunity to talk about how together we can enable citizens and communities to thrive.