Decade of healthy aging

We’re all getting older. It is one of life’s certainties.
However, how we live when we age is something we can control.
But often, aging Canadians and their families wait until difficult decisions have to be made, rather than making them in advance.
In this episode of SARA MAKES SENSE, Sara speaks with an expert of why planning now could save you thousands of dollars and many sleepless nights later.

Guest Margot McWhirter

Got a question for Sara? Send her an email at ask@saramakessense.ca and she might respond to it in an upcoming episode

Sara's website is https://www.wddevelopment.ca/ 

Transcript

Sara:

Yeah, I'm completely not ready. So let's do this thing.

Sara:

Is sixty the new fifty? Is seventy the new sixty? So if eighty is the new seventy, then the time to start planning that you can stay in your home when you're eighty, because eighty might feel like eighty? Then, I think, you know what I mean. We’ve all seen parents, grandparents loved ones who have been there or are headed there. And time just has a way of making everyday activities more difficult and those basement stairs and the backyard shed that used to be so easy are now a challenge. But news flash, people don't like change. Even when we know it's coming, we ignore it and then we wait until the issues seem like a surprise. One of my favorite quotes is; things happen gradually then suddenly and this is one of those things. I'm Sara McCullough and in this episode of Sara Sakes Sense we're talking about your home and sometimes your home is where your heart is. One of my clients, when he talks about his home, he said to me, Sara, this home touches my soul. I don't want to sell it ever. And so in this episode, we're talking about what does it take to stay in your home until you're ready to leave?

My guest today is an expert in the field. Officially Margo's credentials read; registered occupational therapist. Unofficially, Margo helps people like our parents and grandparents. And you know, I'm turning 50 later this year and I'm a planner so Margo's stories and her experience,  I'm kind of using those as my preview section. Margot's been doing this for almost three decades and in that time there's been a ton of change in her industry, but there's one consistent theme. One thought that's familiar to each and every one of us and that is people hate change. And there may not be a bigger change than leaving your home after you've been there for 30, 40, or 50 years. Margo welcome.

Margo:

Hi, Sara, great to be here.

Sara:

So explain to me a little bit about what is aging in place.

Margo:

So aging in place is generally described as remaining in one's home, um, while bringing the services that you might need to help you live safely and independently so that you actually don't have to leave the home that you love.

Sara:

And so I think in some ways, this idea of aging in place is, is getting more familiar to us. And I think most of us just say; I don't wanna leave my home, I don't want to go into care. When I'm meeting with clients and I'm talking to them about their longer term plans usually what I hear is; they're gonna have to take me out in a box. But what exactly does it take to do that? I mean, if you have built an entire career on helping people do this, that makes me think it's not as easy as it sounds.

Margo:

That's a very fair point. And I think, uh, you raised a really good point or in terms of how you phrased it. People often think about the aging process and their future as things they want to avoid, so they talk about what they don't wanna have happen. But when we think about it, people who are actively aging; they may be living with a chronic illness or disability, they may be aging into disability. It's not so much about keeping your fingers crossed and being defiant in what you want to avoid but in fact, being very clear and strategic and plan for your goals and hopes and aspirations in terms of what you want your older years in your, you know, sixties, seventies, eighties, nineties to look like. So it really is having a conversation, understanding what the individual, the couple and/or the family might want to work towards rather than simply saying, I'm not going to do X, Y, or Z.

Sara:

Okay, so I think, again, that's the big, broad thing is, we say, you know, I'd like to age in place or I don't wanna leave and then I think there's another layer that often we fall into and I admit, I probably had a little bit of this that I didn't realize I had until we had our first conversation. You know, in my case I can default to, I already live in a bungalow; I don't have stairs. Right, I think we kind of, and I, again, I hear that a lot from clients; well we renovated our house and put our bedroom on the main floor, so we don't have to sell, but I get the sense from you that there's more nuances to that, that we might not understand. Can you talk to me a little bit about the details that you can help people with once they've recognized that they need care and can you just clarify; are you providing care directly? You're not, talk to me just about the specifics of what you do for a client when they're working with you.

Margo:

Happy to. So really there's kind of two prongs to the services that I offer and the work that I do with clients and couples and families. So one is around assessing and evaluating their home and the need for modifications. So you did talk about, say for example, the value of one level living, or at least having the flexibility and option to create a bedroom and a bathroom on the main floor. The other piece of what I do is around patient navigation, which really is again, working with individuals and families, where they are at and based on their goals to coordinate and provide awareness education and in some cases, advocacy for the services that are available to them. So I come from a perspective as an occupational therapist with, as you say, almost three decades of experience across the healthcare system. So I know where the gaps are, I know how to access a lot of the services, whether they're publicly or privately funded, and then really provide not only that education and in some cases, the advocacy to my clients, but also provide them with that reassurance that they've got a co-pilot, somebody who understands how the system works, where some of the pitfalls might be, who's there to work with them to help them achieve their goals so that they aren't feeling like they are caught in a system that may be quite depersonalized in terms of the types of services, supports, care and home modification or equipment that they want and need. And every client situation that I work with is really very unique. So to give you a couple of concrete examples, this week I was contacted by a lady who is in her eighties. She is now a widow; she's downsizing from a large family home into a condo and while she doesn't actually have any significant health issues at this point in time, because she, along with caregivers, help to provide care for her husband who was very ill, she understands the importance of having a well designed home environment. (Okay.) So she's actually planning to make a significant renovation to the condo before she moves in focusing primarily in areas around the bathroom, the kitchen, as well as key storage areas, like say her bedroom closet. (Okay.) So that's one very specific example where I'm going to be meeting with her, taking a health history, taking some critical measurements so that I can then come up with a customized set of recommendations based on universal design principles that I can share with her and her designer and that they can then implement that.

Sara:

That's really fascinating and there's a whole bunch of things that you just said in there, so I think I'll try to work backwards. So in that example that you just gave, that client was really aware of specifically what might happen, because in some ways she saw her, you know, she went through it with her husband. (Exactly.) Right and so she had a sense of, you know, what does the physical environment need to be like that it isn't like now to accommodate, you know, restrictions or obstacles or, or things like that right? And so I think there's that piece about just as I say, I think most of us default to, well, I'll just have fewer stairs and then everything should work fine, you know, and you just talked about measurements for storage areas and doorways and things like that and it does seem to me that we don't have really great publicly available standards for accessible physical spaces.

Margo:

So yes and no, there are some quite good standards oftentimes it's less about building to code, whether we wanna talk about building code or whether we wanna talk about certain design guidelines and it's more about understanding how we can customize recommendations to the individual and really go beyond the code or beyond guidelines to make sure that you know, physical environment, that space and the objects that people interact with on a daily basis are going to work for them and it's, I think a well known fact or reality in my world, at least where architects and designers they do start to, or the education and the continuing education programs that they have access to get into a little bit of barrier free design, and certainly within the building code and, and design standards. But, part of what I do is help those designers, and then with the construction and on the contracting side, really paint a picture and marry the needs and abilities and limitations of the individual, whether that is a physical limitation or a cognitive limitation. (Okay.) And also help the designers and the contractors to understand, it's not only about zero step entries or one level living and wider doors. We also need to think about how do we design for people with sensory loss; so that could be low vision but not visually impaired or legally blind. It could be hearing loss. It could be somebody with limited activity endurance because of a condition such as cardiac or a lung disease. It could be somebody living with a progressive illness such as Parkinson's disease, where they, their condition is gonna progress over time, or it may fluctuate throughout the day or from one day to the next. And so they really need an environment that is not only going to be physically accessible, but also help to manage fluctuations in energy endurance, as well as some of those practical things like, can I, you know, reach an item that I might need to get in, in a closet or a cupboard.

Sara:

Okay, I really love that idea. As you were talking, you know, I was thinking through just how important it is to me when I'm working; my office, my desk in my office is often very clean, I don't like clutter on there because I work better when it's not cluttered. And so it's so interesting to me that we have these, you know, best practices for success in your career that make sense to us, but I hadn't ever carried it through to aging and my physical environment and that I may need to do some of those same things in that situation and who can do that. (Yes, right.) Yes and so I love that piece of your experience that you just made aging in my house sound really relaxing Margo.

Margo:

That's great and yeah, one of the things that I like to remind people is, that while we are aging; our houses, our living situation is also aging. So the other thing to consider is not only having a space that's accessible, functional, usable and, basically, age friendly, but is it also low maintenance. Or if you are no longer able to maintain certain areas of your home, what are you doing to set up and to plan for bringing some of those services and supports in? So for sure you might need to have some services and care come into the home from a personal care perspective, or maybe it is around managing finances and powers of attorney, but then there is the whole aspect of home management and recognizing that for some people, what might feel like a luxury might actually be a necessity because without that kind of circle of care and that that team of support, (right) the environment in which you are living and aging may really create excessive demands relative to what you are able to do. So it's about matching the demands of the environment, and we all come into contact with objects and products and spaces every day that either meet our physical and cognitive abilities; it might be too low in terms of the challenge or stimulation and that's where we see people, you know, potentially getting bored. (Okay.) Or the opposite, where the demand of the environment so far exceeds what we're able to do, that then creates a disability that wouldn't necessarily exist if we modify the home, if we brought some supports into place. So that, again, it's about matching the person with the environment so that they can do the day to day activities that they want and need to do more easily, more safely, more independently, which then all ties in, in my opinion, to a quality of life and a sense of self, (absolutely) cause we don't want people giving up who they are as individuals, because of the aging process or as a result of an illness or a disability. We can change the environment and keep people either independent or interdependent where they're doing things with others, (right) rather than becoming prematurely or excessively dependent on others for day to day activities.

Sara:

And I think again, when I think back over all of the client conversations I've had over the years, that is one of our deepest fears about aging is that we will really lose who we are or lose the ability to really express ourselves the way we want to as we lose these physical capacities, or, you know, in the case of dementia, mental capacities. And so I think it's just so fascinating that as much as a lot of your work is very, you know, physical and measurements and things like that. It's really not that's not why you do it, right?

 Margo:

I believe in the power of the person and empowering people so that they can continue, as you say, to be the person that they have always been albeit with that dreaded word, as we talked about off the top; change. (Yes.) So I like to use the phrase, I'm a bit of a word nerd, so I like to use the term flexibility or adaptability rather than change, cuz people kind of run in the opposite direction when they hear change.

Sara:

Those are hot button words aren't they? And I think you're right. We all either avoid using the word ourselves or we have a reaction to move away when we hear the word sometimes. And I think you're right that the words we use are important and again, you're talking about kind of small shifts in there that really, again, open up all of these possibilities that your clients may have thought that they had lost. (Yes.) Right, so that ability to be, you know, either fully independent or as you are needing more care again, I think over, over the last 14, 15 months, you know, we've on the other side, talked more and more about the value of community and how much we miss community, especially as we've been more separate in COVID. And yet there is a beauty in that idea of interdependence and having other people be with us and be part of our lives in that stage of our lives.

Margo:

I agree and, you know, I think it can be challenging when we define our health, our value, based solely on the idea of being completely independent and not needing help and not relying on, or being a burden to our family. When in fact, as humans, we are social beings and each of us, regardless of age and stage of life can contribute to the quality of life, can practically be of assistance and support and show to others, whether it's family, friends, or neighbors, how we can lean on each other. And as you say, throughout COVID that's become even more important and obvious for people not to become isolated or more isolated, but while still following all the public health measures, but yeah, really making sure that we don't have peoples’ worlds shrink, and this can be a huge issue for seniors, whether they have family or not, but certainly as their mobility declines, possibly as they lose a driver's license and all the freedom and independence that comes with that; their world can start to shrink. And so then we have to look for ways and opportunities, whether that is bringing in outside care, whether that's setting people up and getting them comfortable using technology, you know, even just looking at something as basic and essential as a telephone with a good volume control so that somebody with a hearing impairment can comfortably use the phone. I have a client right now who has a significant hearing impairment, but refuses to wear her hearing aids. And we all know, yeah, right? 

Sara:

That must be the only one on the planet, Margo, and they're your client because I've never heard that before. 

Margo:

Yeah. You know, she's in her eighties and she's an amazing texter and if we call her on her house phone, there's a good volume control and we can have an excellent conversation. But if I try calling her on her cell phone, it just doesn't work. So it's

Sara:

So interesting, right, as you say it's those small things and it's how to work with the client in a way that doesn't make them feel like, just like I'm old and I can't hear anymore. So, right, so really again making that change just more normal. (Exactly.) I mean, we do all get older, right? There's only one option to that and that's early death and most of us don't choose that. So the reality is, this is gonna happen. All right, I'd like to switch tracks a little bit. And so we've talked about the importance of your role in helping your clients kind of maintain as much of their world as possible and making sure that they don't feel too narrow. But there's another piece of this that I think sometimes can feel very narrow and very intense, and that's the relationship change that can happen between, either, you know, the parent and an adult child, if your parent needs care or I know you and I have had a bit of a conversation about what happens between spouses when one of them has a health event or, you know, kind of declines rapidly. And can you just talk a little bit about how you help families through that period?

Margo:

Mm-hmm sure, yeah, I think understanding that when I say that I'm client centered in my approach to working with aging individuals, really what I'm saying is that I am family centered because I'm not only working with the senior themselves or the individual, it's working with couples and working with families and part of the assessment and the getting to know each other phase of my professional relationship is also understanding the roles that, as you say, exist between spouses or between adult children or an adult child and the parent and, particularly when we're talking about a spousal relationship. You know, my parents, you know, I'm very fortunate, have good health, they're celebrating their 61st (wow) wedding anniversary this year. And, you know, the wonderful thing is, they're a team, right? (Right). They are in this quite literally for life and whether it is implicit or explicit, they've got this pact that they are there for each other for better or for worse, richer, poorer, you know, in, in good times and in bad. What that can mean is that if one party, if one person in the relationship experiences a significant health challenge and they are continuing to live at home, then the spouse who is able to assist and provide care either gradually or potentially very suddenly if somebody had a catastrophic medical event and the person's in hospital and then comes home. (Yeah.) They can assume and take on that caregiving responsibility to the point where they get burned out. (Yes.) And so, in some cases what I'm doing is, I'm again working with couples or with families and holding up a bit of a mirror to the whole family or to the couple to say, this is what I'm seeing, this is what I'm hearing and doing kind of a values check in to say, is this what you want? It may be a short term thing and so that's fine, but particularly where we're talking about, you know a permanent and potentially quite significant physical or mental impairment. What does that look like long term and what are the potential negative consequences for the “well” spouse or adult child in terms of burnout. And so one of the things that you and I had talked about is the idea of opening up the conversation, talking about the possibility of bringing in care and it might start off, you know, very gradually, or somebody may say, no, I really can't do all of this, we need all the help we can get. But the idea that you and I had talked about and that I speak with my clients and families about, is the idea of preserving that family relationship so that, for example, as a spouse you don't lose that identity, that role, and that bond, because you are busy being potentially a full-time caregiver.

Sara:

So what I love about that whole piece that you just said Margo was I think, on some level, we feel irresponsible if we ask for help in caring for our spouse or our parent and it's interesting that I've had similar conversations about, you know, just that responsibility and that it's somehow disrespectful to have somebody outside the family provide care and I had conversations on that topic and kind of on those values when my kids were younger and I, because of my work schedule and I have three kids, there was a time that I had a live in nanny because that just provided the care that we needed to kind of keep everything else going. And I had an acquaintance at the time who also has three kids, same ages as mine and when I would see her, both she and her husband worked full time and she was just kind of falling apart because she had, you know, family was providing care on these days and then the kids went over here on other days and I said, have you considered a live-in? And she said, I can't, my mother-in-law would be so angry, she said, I just can't. Because I said, you know, if you have somebody live in, they can help with the cleaning, they can help with the laundry and just that idea of but if somebody else did the laundry I would be an irresponsible parent and I think we all carry pieces of that because I've heard that come up often in different areas of planning with my clients, and I love the fact that you are so deliberate in saying, wait a minute, because at the same time we celebrate these long marriages, well then we need to preserve part of that, right? And I love the fact that you're so deliberate about, this is important and yes, you've had changes, but we can still keep this, because it's important. And so preserving that spousal relationship, because I think people do feel lost at that time, right, when you're seeing a spouse decline and you know that you're going to, you know, maybe they're likely to go before you. Right, so you're going to be the surviving spouse.

Margo:

Yeah and you've expressed it really well, too, that sense of grief and loss, and also potentially like the idea of we're breaking some unwritten contract or written contract, (yes) either that we tell ourselves or that as a couple, or even in families, right, when we think about relationships, it's like, oh no, I promised my mom that I would never. (Right). Or I always said I would do this. And it is important to kind of be, as an outsider but one who works to build the trust and be a trusted advisor to the client and the family, it is that idea of holding up a mirror, asking good questions, sometimes asking them to trust me to ask uncomfortable questions (yes) and giving people permission that I'm not going to respond the way their spouse or their adult child would. So that's one of the pieces of feedback that I often get when I'm working with clients, potentially with multiple children, say is, yeah, you know, I say, let me shoulder some of the challenges or the burden if you will, put responsibility on me, I'm happy to take that on because you know, it might be something as simple as, I don't know, putting groceries away that can become a hot button topic. (No.) Yeah, right, it's like (ridiculous fights over meaningless things?) Exactly.

(What do you mean Margo?) Yeah, I'm like, those aren't my buttons, so we can negotiate this and I can introduce possibly a different way of doing it. And that doesn't mean that the individual is going to agree with me. But again, part of what I do is help people understand and safely explore alternatives and options with no vested interest in terms of, well; this is how it has to be. You know, I can take the time, I can, you know, make a suggestion. We can practice, try it out, see how it feels, talk about it. Say absolutely no way and then three months or six months later, I can come back to it. I can bring it up again and say, this didn't really, you know, fly with you before, what's changed or have things changed that you're now thinking about, maybe that is a good idea. You know, often I talk about it as planting seeds. And so it's bringing up an idea, creating a vision of what's possible for individuals and families, testing out by, you know, trying something, or at least talking about it, having them feel comfortable enough with me to share their feelings; like the number of times that a senior says to me, now don't tell my kids or don't tell my, you know, spouse that I'm telling you this. And so, you know, I'm not a bartender, I'm not a hairdresser. You know, I always say, you know, this isn't a confession booth, right? But if you need to share, this is a judgment free zone. (Right.) And maybe we can, in talking through and talking about things, that's also a way that I learn about my clients and learn about what's important to them and then that really opens up, I think, a much more effective conversation about options and problem solving in a way that allows me to suggest, and then either research or coordinate strategies that are going to work for them because it's actually for them and not for their family member and certainly not for me.

Sara:

Right, right and that just, as I say, sounds like it solves, you know, a lot of the biggest fears for most of us; that I just don't know, I have all these, you know, impressions floating around in my head, all of these; you must do this, you must not do this. And you're really saying that you can come in with your background in occupational therapy, in understanding how the healthcare system works, the systems that we do have, and kind of making all of those visible, accessible, working for the client, so it really is that totally though based on the client, not based on how well the client fits into a preexisting system that most of us don't really understand.

Margo:

You got it, yeah. It's not about pushing people through a system and saying, this is how it's going to be and it's gonna happen on this day. It is really, it is all about the client. And, you know, it's not that I have a magic wand or that I can work miracles. So there may be times where I say, I hear that this is really important to you and this is what you would like to have happen; that may not be possible, either because of somebody's financial situation (yep) or from a safety perspective. You know, especially when I'm working with somebody, you know, with a cognitive impairment. (Yes.) They may have unrealistic expectations about what they can and should be doing. And so again, it's with dignity, with respect, with compassion and with empathy that I try to navigate those difficult and challenging conversations. (Yes.) So that people understand that yeah, I'm not there to force them into doing anything or to convince them; I'm really there as a co-pilot to walk the journey with them, to focus on their goals, their needs, their preferences. (Right.) And then also inject my objective and professional opinion and experience and ideas and then take things from there.

Sara:

Right, all right, I think that about wraps up our time. Is there anything that we didn't talk about Margo that feels really important for you that it be included?

Margo:

So I think one of the things to really have your listeners appreciate is that we have both a publicly funded and a privately funded system. So whether we're talking about healthcare in terms of medical care or community care services and supports. And it's not an all or nothing situation, it is an all or something. (Okay.) And where, you know, families are maybe starting out, or individuals are starting out because of a change in medical or mobility status and they really just don't even know where to begin, to start to establish what it is they need and how to go about finding things. Recognizing that there are trusted advisors such as myself, who will inform people and can help to coordinate both publicly and privately funded services and supports cuz I, I do think it's important to recognize it's not one or the other, there's often a hybrid of supports and that can be reassuring to people as well that, you know, I'm not there to try and sell them a whole bunch of services that they are going to only have to pay out of pocket.

Sara: 

Right and you know, as we've been talking you and I have had that conversation just one on one and as we've been talking, I know we haven't dealt with, you know, the healthcare system specifically and what's available and what's not available and what's private and what's public. And so what I'm going to do Margo is put your contact information in the show notes. And I will also have a blog post related to this podcast because there really just is so much information. And again, as you've said, it really comes down to that individual. So I think that's a really good point that that is a whole other area that we have not covered today. And it is so important, but your contact information will be available. There will be more information on my blog because we just can't possibly fit it all in, in a fair way. I didn't wanna, I thought a couple of times, okay, I think I'm gonna ask her about that here and then I thought, no, I just don't think it'll fit because it's so big. It's just so big. And I think again, that speaks to not only your experience, but your ability to use that experience in the best interest of the client, right? I don't care how much experience somebody has if they're not listening to me first and not really advising in my best interest, I don't want what's best for somebody else, I want what's best for me and I think because this is such a close issue for people, I love that you've used your experience, not just to be really super smart and rattle off answers really fast. It's about listening to the client first and then saying, all right, here are the options that I think suit what you want and what you can do.

Margo:

That's right, yeah, so thinking about what is possible from a big picture thinking perspective, but then bringing it right down to the practical, in terms of, okay, so what's doable, what's that gonna look like and how can we work at accomplishing that together?

Sara:

Right, right, well, thank you so much for your time today, Margo, I really appreciate you dropping in for this podcast.

Margo:

You're so welcome. It's been my pleasure. And it was a really great conversation. Thanks for having me.

Sara:

In life we all have pieces scattered here and there. And from time to time, we need someone who can cut through the noise. And in this episode, I hope it's been clear that sometimes you need more than one someone, that there are different areas of expertise. And that is so, so valuable, not only to us, but to those who love us and to those around us and this, someone should get to know you as a person, and then they can really show you and make sense of, not only your financial plan, but also your life plan. This relationship, this plan belongs to you, not your planner. I'm Sara McCullough, thank you for listening to Sara Makes Sense.

Disclaimer:

The information in this podcast is intended for general information and illustrative purposes. For advice relevant to your specific situation, meet with a qualified financial planner, lawyer or accountant before making any changes to your situation. Sara's designations and licensing include:  Certified Financial Planner, Registered Financial Planner, Certified Divorce Financial Analyst, and holding an insurance license.