Reducing Preventable Extended Care & Caregiving Demands & Costs with Esther Greenhouse

🎙️ Welcome back to Steadfast Care Planning, where we plan for care to live well. Today, we have a compelling episode with a very special guest, Esther Greenhouse, a longevity strategist and the founder of Silver to Gold Strategic Consulting. Esther brings her extensive expertise in gerontology, environmental psychology, and design to tackle the challenges of aging in place.

🛠️ In this episode, we'll dive into the critical myths and misconceptions surrounding financial security and quality of life in the later years. Esther will shed light on how the design of our homes can significantly impact our frailty, dependence, and financial stability as we age.

🏡 We'll explore practical strategies to improve the physical and financial well-being of older adults through intentional home modifications and enabling design. Plus, Esther shares a personal and professional case study that highlights the profound benefits of planning and proactive design.

💡 Whether you're an individual planning for your future, a caregiver, or a professional in financial services or long-term care, this episode is packed with invaluable insights that can help you plan for care to live well.

In this episode they covered:

🔹 Myths and misconceptions about financial security and quality of life in later years.

🔹 Aging in place—what it means today and its significant societal changes.

🔹 The crucial role of home modifications and the impact of home design on aging.

🔹 Enabling design approach and how it can enhance independence.

🔹 Real-life examples of reducing long-term care needs through design.

🔹 Tackling the long-term care and the caregiving crisis by design.

🔹 How Silver to Gold Strategies aligns with financial planning and long-term care insurance businesses.

For more information about Esther Greenhouse and Silver to Gold Strategic Consulting, please visit:

https://silvertogoldstrategies.com

Or, LinkedIn:

https://www.linkedin.com/in/esthergreenhouse/

https://www.linkedin.com/company/silver-to-gold-strategies/

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📽️ To watch this podcast: https://youtu.be/iokLviitDRI 

#SteadfastInsurance #EstherGreenhouse #SteadfastCarePlanning #SilverToGoldStrategicConsulting #longtermcareinsurance 

For additional information about Kelly, check her out on Linkedin or www.SteadfastAgents.com.

To explore your options for long-term care insurance, click here.

Steadfast Care Planning podcast is made possible by Steadfast Insurance LLC,
Certification in Long Term Care, and AMADA Senior Care Columbus.

Come back next time for more helpful guidance!

Chapters

• 0:00 Introduction to Esther Greenhouse and Silver to Gold Strategic Consulting
• 0:20 Planning for longevity and how to reduce preventable extended care and caregiving demands and costs.
• 0:54 Myths and misconceptions that threaten financial security and quality of life in later years
• 1:16 The design of our housing actually contributes to our frailty, our dependency, and our impoverishment as we age
• 1:40 People have always aged in place. That's been the norm since the beginning of humanity. So why is it such an issue now?
• 2:30 One of the key trends that has shaped aging in place is that wages have not kept pace with inflation over the past 50 years. So more and more, we need two incomes for a family.
• 2:50 Another significant trend is migration of adult children across the country and even of older adults as they age.
• 3:41 Another key myth and misconception is the notion of home modifications and the idea that, "Oh, I can make some modifications to my home if I have the need, and then I'll be fine."
• 4:18 A lot of people don't even have the funds for home modifications.
• 5:09 The enabling design approach has three pillars. The first is the concept of person environment fit. It's really simple and really powerful, and that is that there is an ideal fit between a person and their environment.
• 5:57 We don't design housing communities or products to really work well across the lifespan, or across the ability span. So to get more specific on this, our data, our conventions, our codes result in places, particularly housing.
• 6:53 The third pillar is taking those two lenses and looking at everything that's crucial to our well being as we age.
• 8:12 What's also critical to understand is that we can't predict if we will need care. We cannot predict our physical decline.
• 9:47 The CLTC Commercial
• 10:14 Preventable long-term care and caregiving needs and costs in order to minimize frailty, dependence, and impoverishment with age.
• 10:58 Case study of Esther's mom's aging process and how they used enabling design and other methods to improve her well-being.
• 12:08 Her home had features like a zero step entry, it had wider doorways, it had non glare lighting, non slippery floors, and that everything that she needed to do to function independently was on one level.
• 13:09 Estimated that enabling design and methodologies saved the family and the government anywhere from $500,000 to $1.5 million.
• 15:04 Bidet seat that cost $1,000 was an investment that yielded a 3,000% return on investment.
• 17:53 AMADA Senior Care Commercial
• 18:23 Overview of tackling the long-term care and caregiving crisis by design.
• 18:51 We have an increasing older adult population in this society and in most industrialized societies.
• 19:24 Another variable is the increased cost of health care.
• 19:45 The last variable is financial resources. Too many things are pulling on people's money.
• 22:10 The design of the built environment. We leverage the design of our homes. Using enabling design to prevent health care costs and caregiving.
• 23:41 Financial planning and long-term care insurance are vehicles to help people feel safe and secure in their later years. How does Silver to Gold Strategies fit in with these?
• 24:40 Silver to Gold Strategies provide varied and tailored services and can be adapted to a variety of audiences.
• 26:44 Help inform and educate clients about what are the issues that they are unknowingly facing and what are the resources that they can be taking advantage of to make changes.
• 28:22 There is this hidden threat of the design of housing that is limiting and jeopardizing success in long-term care, success in your later years. It's jeopardizing financial security, and it doesn't have to.
• 29:31 How to contact Silver to Gold Strategic Consulting.

Transcript

Kelly Augspurger [00:00:02]:
Hey everyone, welcome to Steadfast Care Planning, where we plan for care to live well. I'm Kelly Augspurger, long-term care insurance specialist, and your guide. With me today is Esther Greenhouse. Esther is a longevity strategist. Her firm, Silver to Gold Strategic Consulting, helps organizations enable their clients and employees to reduce preventable long-term care and caregiving demands and costs in order to minimize frailty, dependence, and impoverishment with age, improving their lives while improving the company's bottom line. Welcome, Esther. Thanks so much for being here.

Esther Greenhouse [00:00:36]:
Thanks for having me, Kelly. I appreciate it.

Kelly Augspurger [00:00:38]:
Today we're going to be talking about planning for longevity and how to reduce preventable extended care and caregiving demands and costs. So, Esther, can we jump right in?

Esther Greenhouse [00:00:48]:
Yes, please.

Kelly Augspurger [00:00:49]:
Okay. Well, I'd love for you to kick us off with what are some myths and misconceptions that threaten financial security and quality of life in later years?

Esther Greenhouse [00:00:59]:
The number one thing that people need to understand, whether you're an Individual, a family, or a professional, is, sadly, that the design of our housing actually contributes to our frailty, our dependency, and our impoverishment as we age. This is a crucial variable of longevity planning, retirement planning that very few people are aware of, and it's something that can be addressed. So some specific additional myths and misconceptions are one, the notion of aging in place. It's very interesting to observe that over the past 10 to 15 years, there's been a lot more discussion and focus on aging in place. And if you step back and question that, you realize, well, people have always aged in place. That's been the norm since the beginning of humanity. So why is it such an issue now?

Kelly Augspurger [00:01:58]:
It's a buzz term, Esther.

Esther Greenhouse [00:02:00]:
It is a buzz term.

Kelly Augspurger [00:02:01]:
Yes.

Esther Greenhouse [00:02:01]:
Yes. And it's a relevant buzz term because we've had some really major changes in our society, as well as in other industrialized societies over the past 50 to 60 years. So one of the key trends that has shaped aging in place is that wages have not kept pace with inflation over the past 50 years. So more and more, we need two incomes for a family. It's not a choice that both parents will work. When that happens, we're typically taking the woman out of the home who often was providing care, especially to older adults. Another significant trend is migration of adult children across the country and even of older adults as they age. So the result is that typically, as we're aging and we may need some occasional assistance, or more significant informal caregiving, is we typically are not living near our adult children.

Esther Greenhouse [00:03:11]:
So how do we address that? Another issue is that aging in place is actually the norm. So there's all this emphasis on aging in place, and how can you age in place? We have to shift the discussion to successful aging in place because currently over 90% of older adults age in place, but they're doing so by default and without a plan. Okay, so another key myth and misconception is the notion of home modifications and the idea that, "Oh, I can make some modifications to my home if I have the need, and then I'll be fine." The issues with this are, one, home modifications can be costly. Home modifications are typically done after somebody has had a significant change to their needs and abilities, and who wants to be modifying their home when they're recovering from a surgery, or a health event.

Kelly Augspurger [00:04:12]:
Right.

Esther Greenhouse [00:04:12]:
And lastly, a lot of people don't even have the funds for home modifications. Now, if they're fortunate enough to have funds for home modifications, the other thing to recognize is that home modifications typically come too late. Not only have you had a health event, but actually the design of your home has exacerbated preventable, age related and disease related decline. And that brings me to the third myth and misconception. And that's really the lack of understanding among everyone, even design professionals and builders, about the true impact of the design of our home as we age. And because of that, we've created something called the enabling design approach. The enabling design approach has three pillars. The first is the concept of person environment fit.

Esther Greenhouse [00:05:07]:
It's really simple and really powerful, and that is that there is an ideal fit between a person and their environment. When you have good fit, you can function at your highest level of independence.

Kelly Augspurger [00:05:22]:
Makes sense.

Esther Greenhouse [00:05:23]:
However, the greater the gap between my abilities and what an environment asks of me, the more I'm subjected to a form of stress. It's called environmental press, and it actually pushes me to a lower level of functioning by design. So the second pillar is also not well understood, or well known, and that's the status quo of how we design and build. We don't design housing communities or products to really work well across the lifespan, or across the ability span. So to get more specific on this, our data, our conventions, our codes result in places, particularly housing, that are ideal for the average height male, that's approximately 5' 9'', and for someone with high physical, sensory and cognitive abilities. So that results in environments that are pretty exclusive, meaning they're well designed for the average height male between the ages of 20 and 40. Because all of us, by the time we're in our early 40's are experiencing normal age related changes, particularly to vision and to hearing. And so the third pillar is taking those two lenses and looking at everything that's crucial to our well being as we age.

Esther Greenhouse [00:06:59]:
So it includes what our finances, what are policies and programs, what are needs and behaviors that we want to support? Looking at them as a whole and really strategizing, how can we remove the negative impact of design and actually leverage those features to enable people to maintain their physical and financial independence with age?

Kelly Augspurger [00:07:24]:
These are great points, Esther. I think, let's just back up a minute about those home modifications, because I see this often where older adults, something will happen. Maybe there's a crisis, or maybe it is just a gradual progression of aging. You need these modifications, these changes in design to your home to make it so that you can successfully age in your home and you can stay in your home longer. But they're doing it after the fact, right? Correct. They're not doing it in advance. Maybe at a younger age where you still are physically capable and able to do all those things on your own. But I would imagine there's much more success for the person that needs the care in the future and their family if these things are addressed before.

Esther Greenhouse [00:08:06]:
Absolutely, Kelly, and what's also critical to understand is that we can't predict if we will need care. We cannot predict our physical decline. Now, you can in certain situations say, "Okay, there is a family history of x, or, I already have this chronic health condition." But the big thing to understand is, and really ask is why are we failing to design our houses for the full lifespan? Why do we design housing that is limiting and actually works against us as we age?

Kelly Augspurger [00:08:45]:
We were offline joking yesterday about we're both petite and 5' 1'' and a half, to be exact.

Esther Greenhouse [00:08:53]:
We have the same height.

Kelly Augspurger [00:08:54]:
That's right. And so Esther told me we're designing homes for a 5' 9" male. And so it's like, we are definitely at a disadvantage in some instances, especially when we talk about the kitchen and counters and cabinets and those types of things. So imagine us who are able bodied people, right? We are physically capable of doing all of our activities of daily living, instrumental activities of daily living. We don't need any assistance. Imagine people at our size who do have limitations. I'm glad that you brought that up because that's something that I haven't thought about before. You know, I always have a step stool in the kitchen.

Kelly Augspurger [00:09:29]:
But if people are able to better design, or modify their homes, I think they're going to be set up, again, for success and better aging, safer aging as well.

Esther Greenhouse [00:09:42]:
Yes.

Kelly Augspurger [00:09:42]:
Esther, can you tell us what you mean when you talk about preventable long-term care and caregiving needs and costs in order to minimize frailty, dependence, and impoverishment with age?

Esther Greenhouse [00:09:52]:
Yes. So I'll give you one of my most important case studies. It's actually not only professional, but it's personal. So many years ago, I made a commitment to my mother that I would do whatever I could to prevent or delay her moving to a care facility and also do what I could to prevent her from outliving her money. And my mom, while she had been extremely fiscally responsible and invested her money, she really didn't work with a financial planner that had the expertise or the approach that your audience does. And so she didn't take advantage of a lot of special financial vehicles for ensuring financial independence and retirement security. She also didn't have long-term care insurance. But what she did have was a daughter with a unique constellation of expertise.

Esther Greenhouse [00:10:56]:
I have expertise in gerontology, environmental psychology, design, city and regional planning, caregiving and aging services. And I brought my enabling design approach to her later years. So one of the things that we did was we decided in advance that she would move near us and that I would be her primary caregiver, and we would supplement that with home health care. And we also applied the enabling design approach, not only in terms of this plan, but specifically to the design of her home. So we made sure that her home had features like a zero step entry, it had wider doorways, it had non glare lighting, non slippery floors, and that everything that she needed to do to function independently was on one level. We also thought about the delivery of care within the home, whether it was from an informal caregiver like myself, or my son and husband, or it was from home health aides. And none of the features we included were radical, but really, the facts that we planned and prepared. And we had these goals of helping her to retain her physical and financial independence.

Esther Greenhouse [00:12:26]:
That's what was radical. That was what is unusual. And I'm really happy to report that that approach and those simple but impactful design features delivered. So my mom was able to delay moving to a care facility by at least seven years. We estimate that that saved the family and the government anywhere from $500,000 to $1.5 million.

Kelly Augspurger [00:12:54]:
Wow. That's impressive.

Esther Greenhouse [00:12:56]:
Yes, it is really substantial. Now, we also have the benefits that my mom was able to successfully age in place in her home of choice she was also able to be much more involved in her care and her life. She was able, even though she had a few years of home health care expenses, they were pretty minor. She had an aide come in one to three times a week at 3 hours per visit. And then she spent the last nine months of her life in a care facility because her dementia was progressing to the point where we couldn't really predict when she would need assistance. So she needed access to round the clock assistance.

Kelly Augspurger [00:13:48]:
Okay.

Esther Greenhouse [00:13:49]:
And in addition to the fact that she had so much agency and dignity and choice and quality of life in the last ten years of her life, what also happened was she didn't outlive her money, and she was able to leave a nice inheritance to two daughters and three grandchildren.

Kelly Augspurger [00:14:09]:
Wow. So you're really able to help her maintain that independence, that dignity, really age with grace and confidence, probably too, right? Yes. Certainly your expertise played very largely in the successful plan for your mom. So, yeah, thanks for sharing that example. And actually, when we talked offline, Esther, you even gave me an example of one of the things that you made an adjustment in the bathroom for her, which was a game changer for your mom. So there can be changes, whether it's in the kitchen, the restroom, the bedroom, like, so many different changes that can be made in the home. Again, to be able to minimize that frailty and minimize falls. I think that is a thing that we often see with older adults, is the risk of falls. And really, one fall can change at all.

Kelly Augspurger [00:14:57]:
As cliche as it sounds like, it really can change the trajectory of a person's later years if they do fall. And so I would imagine those are the types of things that you also address with your mom and that you do with your clients.

Esther Greenhouse [00:15:09]:
Right. And exactly the examples that I gave earlier of a zero step entry, no grade changes on the first floor, being able to live successfully on one floor, glare free lighting, wider doorways, in addition to grab bars in select locations. And the grab bars don't have to look like they're from a hospital. These things reduce the risk of falls. And I would like to share briefly the example in the bathroom that we talked about. So, bidet seats and bidet toilets are becoming increasingly popular in the US. And my mother had requested one, and it was maybe a $1,000 investment between the cost of the bidet seat, which was probably about $500, and the cost of having a licensed electrician come in and install a dedicated outlet for that bidet seat.

Kelly Augspurger [00:16:06]:
Okay.

Esther Greenhouse [00:16:06]:
And that $1,000 investment yielded a 3,000% return on investment.

Kelly Augspurger [00:16:13]:
Incredible.

Esther Greenhouse [00:16:14]:
Incredible.

Kelly Augspurger [00:16:15]:
And explain why, Esther, why is that? Yeah.

Esther Greenhouse [00:16:18]:
Yeah. And so it's funny, because every time I give a keynote, or a formal presentation, I double check the math because it's so astounding.

Kelly Augspurger [00:16:27]:
Yeah.

Esther Greenhouse [00:16:28]:
So the way it worked was my mom regularly used that bidet seat. She kept herself clean. She never had a UTI. She had agency and dignity. And because she kept herself clean regularly, she was able to have one less aid visit per week, which translated to a savings of about $100 a week. Multiply that over 50 - 52 weeks a year. Over seven years, and we saw a savings of over $30,000.

Kelly Augspurger [00:17:01]:
Astounding.

Esther Greenhouse [00:17:02]:
Astounding.

Kelly Augspurger [00:17:03]:
A $1000 investment, saving $30,000. By one simple change.

Esther Greenhouse [00:17:09]:
Yes.

Kelly Augspurger [00:17:10]:
Pretty incredible. So this is just the power of thoughtful design, intentional design, preparing in advance of how that can really change the outcome of a situation for you, or a family member. Esther, I know your firm offers an initiative called tackling the long-term care and caregiving crisis by design. Can you give us an overview of how you view the long-term care and caregiving crisis at Silver to Gold Strategic Consulting?

Esther Greenhouse [00:17:36]:
The way we view the long term care and caregiving crisis in this country is as an equation. So the variables in that equation are as follows. We have an increasing older adult population in this society and in most industrialized societies. We at the same time have a decreasing potential caregiver population. So in 2010, we had about seven potential caregivers for one older adult. Now we have five caregivers for every one older adult. And in about ten years, we will have three potential caregivers to every one older adult who may need care. Another variable is the increased cost of health care, which is due to complexity, but it's also due to people living longer with chronic health conditions and also experiencing those health conditions at increasingly younger ages.

Esther Greenhouse [00:18:42]:
And then the last variable is financial resources. So whether it's individuals and families, state, local, federal government, private organizations, there are so many more issues that are vying for our financial resources. So the bottom line is that when you add all of these things up, you do not have a balanced equation. We have a crisis in terms of long-term care needs and lack of caregiving. So how do you balance the equation? Well, we cannot change the number of older adults in our country. Not only do we have the aging baby boomers, which is a huge cohort, but the generations that came before them are increasingly still here, and they're living into their 90's and even to over 100 right now. The Stanford Center on Longevity says that we need to be planning and preparing for the hundred year life. So that is not changing in terms of how many older adults we have in terms of the number of caregivers.

Esther Greenhouse [00:19:50]:
Well, how do we address this? We can do like some other countries, like Canada has done, and shift immigration policies to allow for more people who have expertise in health care and are willing to provide long-term care services and caregiving. That's not likely to happen in the next few years, so that's not an option. Other options include tax breaks for family caregivers, and there are some programs in existence. But really to make an impact on the 53 million family caregivers, we would need to expand that significantly. Another issue is that we could shift the pool of caregivers and the whole approach to paid care. If I'm a paid caregiver, I really need a living wage and I need benefits. Again, there is a shift in this country and some programs that are working towards that, but this is a multifaceted problem that's going to take a few years to address. How do we address the last two variables of increasing long-term care and health care costs and the fact that we have constraints on our financial resources, and we do so in a few ways.

Esther Greenhouse [00:21:09]:
Number one, we use existing and new financial products that can enable us to get more out of our money. We use long-term care insurance policies. But we also look at this missing variable, what I believe is an insidious threat to our well being as we age, both our physical and financial well being. And that's the design of the built environment. We leverage the design of our home so that we actually decrease our need for health care and long-term care as we age, and thus we put fewer demands on our limited financial resources.

Kelly Augspurger [00:21:56]:
This is such a key idea here, Esther, which I would imagine a lot of people really haven't put a lot of thought into how much the design of a home can really, again, change the trajectory of a person's later years. And so preparing in advance, thinking of these things being intentional, gathering together a care team, coming up with a plan of care. All of these things really need to work together in advance in order to have this successful aging in place. And so I hope you all are paying attention to this, because this is just so important. I don't think there's enough emphasis currently on how do we design our homes better for those older adults in our communities and in our families. Esther, we know that financial planning and long-term care insurance are vehicles to help people feel safe and secure in their later years. How do Silver to Gold Strategies fit in with these?

Esther Greenhouse [00:22:49]:
So Silver to Gold Strategic Consulting is a partner in longevity planning, planning for financial services firms, long-term care insurance carriers and agents, as well as employee benefits programs and employee assistance programs. And the goal is really to complement and amplify the work that all of those professionals are doing by addressing this under recognized, underappreciated, misunderstood variable of the impact of home.

Kelly Augspurger [00:23:27]:
Okay. And so by offering, I would imagine you do consulting, you do trainings, educational things. What does that look like, Esther?

Esther Greenhouse [00:23:36]:
Yes, so the services we provide are varied and they are tailored and can be adapted to a variety of audiences. So one thing that we do is, for example, we have a 90 day signature intensive for financial planning firms and long-term care insurance carriers and agents. And what we do with this is through key stakeholder interviews and some focused assessments of products and information. We offer information and experiential trainings that really raise awareness and provide key understanding of what's normal aging, what's not normal aging, and how that intersects with the design of a home and how that can exacerbate age related decline, exacerbate disease related decline, and how we can prevent that. Other ways that we work with organizations, for example, is an employer or an organization like long-term care insurance carriers, or agents that work with worksite clients will bring us in for strategy sessions with key employees that are really struggling under the burden of caregiving. We have 53 million family caregivers in the US. Many of them are women between the ages of 40 and 60, and they are attempting to work full-time. And this not only has a big impact on their personal lives, but it impacts their working lives, and it can impact employers through absenteeism, presenteeism, and reduced productivity.

Esther Greenhouse [00:25:27]:
So one of the things that we've seen in our strategy sessions is that people who need care or providing care really are overwhelmed. They are typically not aware of a lot of basic services. If they're aware of them, they just don't know what to prioritize and what things to focus on. So providing them with guidance and structure, we enable them to focus on what's really critical and to actually make a plan and implement the plan. And another way that we really love to work with clients. And this is really nice, again, for large organizations like financial services firms, or long-term care insurance. And that's to create regional summits for their clients, whether it's for individual clients, private clients, or for worksite clients. What we do is we bring together relevant, often under tapped subject matter experts in key areas, key sectors, to help inform and educate their clients about what are the issues that they are unknowingly facing and what are the resources that they can be taking advantage of to make changes.

Esther Greenhouse [00:26:50]:
And what's really beautiful about these summits is not only do the clients benefit, but the people that work for your organization also learn a lot from these presentations and the application of the information.

Kelly Augspurger [00:27:05]:
I would imagine, it's so important to have the plan, but to actually apply it and emphasize it, that's where rubber meets the road. Right? And that's really where we want to see the difference being made. Well, Esther, any final advice on how people can plan for care to live well?

Esther Greenhouse [00:27:19]:
Absolutely. So in terms of your goals, whether you're an individual, or a family or you're a professional in financial services, or long-term care, or an employer, the big thing to recognize is that there is this hidden threat of the design of housing that is limiting and jeopardizing success in long-term care, success in your later years. It's jeopardizing financial security, and it doesn't have to. It's preventable by design that enables people to thrive. So whether you're looking at avoiding outliving your money, whether you're looking at avoiding being, and I hate to use this term, but a burden to your loved ones in terms of need and care, whether you're an insurance firm looking to reduce preventable long-term insurance claims, there are things you can do. Decline by design is preventable. You just have to ask. So you can easily visit our website, www.SilverToGoldStrategies.com, and set up an introductory call.

Esther Greenhouse [00:28:41]:
And we'd be happy to walk you through the possibilities.

Kelly Augspurger [00:28:44]:
Fantastic. Well, Esther, thank you so much for your time and expertise today. We really appreciate it. Have a great day.

Esther Greenhouse [00:28:51]:
Thanks for having me. Kelly.