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Creating Inclusive Homes: Aging in Place with Accessible Design
121 Plays1 month ago
We’re thrilled to announce the latest episode of Growing OT! This time, we’re talking about aging in place and accessibility with Margot McWhirter, an inspiring OT with over 30 years of experience in gerontology and home modifications. 🌿🏠
Margot shares her insights on creating accessible environments, fighting ageism, and the importance of designing homes that support older adults in thriving where they live. Whether you’re an OT, caregiver, or interested in inclusive design, this episode is packed with valuable knowledge and heartwarming stories.
Recommended
Transcript
Introduction to the Growing OT Podcast
00:00:04
Speaker
to Growing OT, the podcast that's developed and produced by the Society of Alberta Occupational Therapists. SAOT wants to get listeners excited about the wonderful world of OT. Whether you're an OT yourself or a member of the general public, we hope that you find this podcast inspiring and informative. You can subscribe to Growing OT on Spotify, Apple Podcasts, or wherever you're listening to us right now.
Interview with Margo McWherther
00:00:32
Speaker
I'm your host, Vilmarie Myberg, and on today's episode, we will be speaking with Margo McWherther. She's a dynamic and a passionate registered occupational therapist with a master's degree in gerontology, as well as certifications in universal design, patient navigation, and the executive certificate in home modifications from University of Southern California.
00:00:58
Speaker
She operates her Ontario-based private practice, Inclusive Aging, which specializes in accessibility and aging in place services. Margo also collaborates with businesses to develop more inclusive products, spaces, and services. She's co-chair of the CAOT's Home Modifications and Inclusive Design Practice Network. She's a member of an interprofessional design and dementia community of best practice.
00:01:26
Speaker
and a retired member of the Canadian Standards Association's Technical Committee on Accessible Design for the Built Environment. She's frequently invited as a public speaker and lecturer and Margo is dedicated to ending one of the last socially acceptable prejudices, ageism.
Margo's Experience and Background
00:01:45
Speaker
She's committed to creating a world where everyone feels included and we're so looking forward to diving into this conversation with her today.
00:01:55
Speaker
Welcome Margo, it's so great to have you here with us. I'm really looking forward to this discussion today and I'm wondering if to get us started with things you can let us know a bit about the practice settings that you've worked in as an OT and how you got into this specific area of practice.
00:02:16
Speaker
Yeah, wonderful. I'm really pleased to be here. So thank you for having me. I have been an occupational therapist for 30 years now and have really practiced in a very broad spectrum of settings, both clinical and nonclinical. So I started off in medical legal auto insurance and then transitioned into inpatient rehab.
00:02:43
Speaker
um inpatient acute care, but I've really spent the majority of my clinical OT practice and career in home and community care in one aspect or another. um And in terms of non-clinical roles, which I say has um done a great service to me in terms of preparing me for having my own private practice,
00:03:08
Speaker
I actually worked in home health equipment sales, but then in clinical education and training. And that, as I say, that gave me a lot of exposure to the business side of healthcare care and home health in particular.
00:03:25
Speaker
I will say that both my undergrad and my master's degrees, which are in gerontology, I have always had a long-standing interest, passion and commitment for older adult adults.
00:03:41
Speaker
And so even when I first graduated from OT school, I knew that I wanted to specialize in gerontology and geriatrics and working with older adults. But I and also recognized the value and importance of gaining as much diversity of experience so that I could understand, you know, as many of the developmental milestones and skill sets and quite frankly, the journey
00:04:13
Speaker
that people who are blessed to reach older age have experienced in order to inform my practice with them, but also really for me to continue to respect my elders and to appreciate the valuable lessons that I learn from my clients.
Collaborative Approach in OT
00:04:38
Speaker
Thank you for sharing all that with us. you know It sounds like you have such a a diverse skill set and also a lot of first-hand knowledge in terms of not only the equipment that you're recommending, but also the value in learning from this population and their unique needs.
00:04:55
Speaker
And I think I like the way that you put it, respecting your elders for the knowledge and experiences that they bring to the table. I think it's important to recognize that because I talk about being on a journey, almost being a co-pilot or sometimes a quarterback, a life manager, if you will, with many of the clients and the families that I work with.
00:05:20
Speaker
It's really about collaboration and understanding that each individual has a lifetime of knowledge, skill, and experience that only they can know and make them experts of themselves. And I contribute my occupational therapy and my gerontological knowledge among other areas of specialty in order to augment their life experiences.
Aging in Place: Concepts and Importance
00:05:51
Speaker
And so hopefully together we are are combining forces and ultimately achieving the most ah desirable and the most successful and positive outcome um with the clients that I work with. And, you know, you've already sort of touched on this, but I'm hoping you can tell us a bit more um about
00:06:14
Speaker
aging in place as an important area of practice and what has been your drive and your motivation to advance this area of practice.
00:06:25
Speaker
and hello As some of your audience may be familiar and for those who have not necessarily heard a definition of aging in place before, so it's generally defined as people continuing to live in the home of their preference as they grow older while bringing supports and services to them.
00:06:51
Speaker
Over the years, the terminology has even changed slightly in some in some circles where people actually now to take away potentially from some of the stigma that is associated with ageism in our society to talk about living in place or even thriving in place.
00:07:12
Speaker
And with the background knowledge and ah education that I have in gerontology, there's such a focus on psychological theories and models of aging. And so when we think of the person environment and occupation,
00:07:31
Speaker
or environmental press theories, that's where I first got exposed to this idea that environments, both physical, so the built environment, but also the social environment in which we all exist and hopefully live and thrive and age,
00:07:51
Speaker
that those environments can be enabling or disabling.
Challenging Ageism and Creating Inclusive Environments
00:07:55
Speaker
And I just love the idea that we can, as I can, as an occupational therapist, focusing on aging in place, can support older adults to live where they choose. And we do know that the vast majority majority majority of older Canadians right up until their 80s, 90s, and even over 100, they actually do live in the community.
00:08:20
Speaker
Yes, they might downsize to a condo or an apartment, and certainly some will move into a retirement residence or assisted living, sometimes memory care, but really very, very few older adults, which are really just yours and my you know neighbors and fellow citizens, they, blessedly and and thankfully, I say, they live amongst us. And so why wouldn't we and I certainly advocate as strongly as I can, why wouldn't we have a designed world that allows them to flourish rather than basically creating a premature and even an avoidable disability or injury when we can do better and hopefully will continue to do better by the older adults in society?
00:09:12
Speaker
really profound. Thank you for speaking to that point as well. And kind of our duty not only as occupational therapists, perhaps, but also as fellow citizens in society to help create spaces where older adults feel comfortable and feel able to live meaningful lives to the best of of their abilities. Absolutely. And in some cases, it is busting the myths of aging.
00:09:40
Speaker
and the ageist attitude that in fact many of my own clients possess themselves, which is not too surprising because we live in a world that is incredibly ageist. Oftentimes I've heard the expression that the last socially acceptable form of prejudice is ageism. And we internalize that, not only me know myself as as an older you know or an aging woman,
00:10:05
Speaker
um But, you know, older men and women oftentimes, depending on the experiences they've had in their own life, but then also with previous generations, they may have a very negative or distorted view of what aging is and can be.
00:10:24
Speaker
And if we don't create an environment, create a ah world that is much more inclusive of all ages and abilities, then all we're doing is feeding that prejudice and that false identity, which I just, I don't know, I can't say for sure where that fierce passion that I have comes from, but I fundamentally believe that we can create a better world and that it is worth it. And maybe it's that I recognize we're all aging at the same rate.
00:11:01
Speaker
Sometimes when I'm working with clients and families or speaking at ah at a public event and people say, oh, that's interesting what you do, maybe later in my life when I'm older. And I just politely say, I'm getting old at the same rate as you one day at a time. So why wouldn't we want
Personalized Planning for Successful Aging
00:11:20
Speaker
to create a more inclusive and welcoming world together?
00:11:24
Speaker
I wonder, having mentioned those myths that you've come up against in practice, can you tell us ah some of the most typical myths about aging that you're often needing to debunk?
00:11:37
Speaker
whoo um I think that certainly when people think about things like physical changes and physiological changes, that maybe being tired or run down, experiencing some aches and pains, and certainly when we're talking about things like mild or mo moderate cognitive impairment and memory loss,
00:12:02
Speaker
It's not unusual for people that I interact with to assume that is typical or a normal part of aging and as well for people that may be experiencing cognitive impairment, which then may influence or affect their personality. Or there may be individuals who have had lifelong struggles with mental health, but they've managed it relatively well But then, due to a sudden loss or change in personal circumstances, they may become very depressed or something that might be an indication of, say, an anxiety disorder.
00:12:48
Speaker
which might typically have been portrayed or seen by family and friends as high energy and life of the party. But now that sort of tips over into, oh, I don't think mom or dad is coping as well. And so even having conversations, again, with concerned friends and family members about what normal or typical aging is,
00:13:17
Speaker
And then with the whole family and circle of care, including this client themselves, basically to say, depending on personality, because some people are either a bit more passive or accepting of life in general, but also of some of the age-related changes that happen. And they may, for whatever reason, be less inclined to try to change the circumstances. They just go with the flow and don't rock the boat, and other people are kicking and screaming. But whatever is important, and you know as an occupational therapist, certainly when we're talking about goal setting and prioritizing what's most important to
00:14:04
Speaker
the clients that I work with, that's where I delve into sort of that combination, if you will, or the overlap between what is lifelong personality and kind of habits and routines. What's their outlook on life and how do they typically make decisions? Are they, you know, read every yeah you know web website or book available and make an informed decision or you know study forever, all of their options, so that actually is a way of procrastinating and avoiding making decisions. Or is somebody more of a leap before you look, and then we're having to um ah consider and and maybe deal with some of the consequences, both good and bad, of that. It's looking at, as I was saying before, lifelong habits and personality.
00:14:57
Speaker
and then layering on top of that people's personal or familial belief systems around aging? And then what is the person's own aging journey look like and experience? And are there some myths that we have to maybe point out and then invite people if they want to explore that further or even modify
Early Planning and Adaptable Home Designs
00:15:22
Speaker
their thinking. So it's that mindset around healthy aging or successful aging. What does that even mean and look like? And it can't just be what I think it means because then that wouldn't be client-centered of me.
00:15:38
Speaker
It sounds like you have to really, first of all, assess what this client's baseline was prior to their interaction with you potentially, as well as what's meaningful and important to them, and then collaborating with them to perhaps challenge any internalized beliefs, if appropriate, if they're open to that, and then working together to see what aging in place or thriving in place means to them.
00:16:05
Speaker
Yeah, and in some cases it's um inviting the elder to actually consider the possibility of what a successful or healthy aging could be because they may have experienced a significant health setback or social setback and they don't necessarily feel that they have the reserves or the resilience to bounce back from that.
00:16:33
Speaker
Or they may be making assumptions or have ideas about what's possible or what's next for me, for them, based on what they've seen happen in their own family or with friends. And so I like to talk about empowering seniors through education.
00:16:54
Speaker
and this idea that people don't know what they don't know. And so often, especially in the world we live in now, where we've got all kinds of access to online information, people can do a lot of research, but it's not enough just to have information at your fingertips. You also, I think, need to know what is useful for you as the individual.
00:17:20
Speaker
and then have a trusted advisor, somebody like myself who is you know unbiased in the sense that I can walk clients and families through their choices around a whole host of things.
00:17:35
Speaker
whether it's housing, whether it's healthcare, care whether it's the decision to discontinue driving, could be ah any host of things, but walking people through that and then exploring the options. And as you said, really tuning in to what's meaningful and important to the client so that hopefully at the end of the day, because there's no truly right or wrong solution in many cases, it's what's right and best and most aligned with an individual's values and preferences and goals.
00:18:13
Speaker
I'm wondering along those lines, when is the best time to start having these conversations as it relates to planning for aging in place?
Vital Resources and Social Supports for Aging Individuals
00:18:25
Speaker
Other elements of this might be a long question is how can families plan ahead and anticipate some challenges that their loved one or they as a family might face? um And what kinds of resources can they turn to?
00:18:40
Speaker
Yeah. So I to say that it's never too early or too late to start conversations. And it's not just about planning, but actually taking action to age in place, thrive in place.
00:18:58
Speaker
Or if the choice is to move and downsize and move maybe to a different living situation, make those changes. In an ideal world, I would love to see that people who are empty nesters, who have some money in the bank, so to speak, or access to monies, maybe the kids have gone off to university or they've started their own families.
00:19:25
Speaker
And so now they're going to renovate the kitchen like they always wanted or build a personal craft room or something. And I think that if you're in your sixties, maybe seventies, when that period of time might come for you, that's when you should think about, are, am I going to stay in the house I currently live in and what are some of the things that I need to include?
00:19:49
Speaker
Not that I necessarily need them now, but I need to leave myself the option by including that adaptable, flexible design features so that it may simply be that somebody has a temporary illness or a disability. They may have a joint replacement surgery, or they might experience something more catastrophic.
00:20:11
Speaker
And because we know that most of the current housing stock in Canada, let alone North America, is not designed with aging in place in mind, and even basic visibility or accessibility,
00:20:27
Speaker
Again, the built environment in which we operate requires us as the homeowners or the renters and the occupants to be so flexible and adaptable to the space around us. Wouldn't it be wonderful if the our home or the places that we visited, even the businesses that we frequented, wouldn't it be wonderful if they were far more adaptable and accessible as our needs changed?
00:20:56
Speaker
And as I say, that's a bit of an ideal because in reality, it's often once somebody either has one or more significant falls, once they develop either a progressive and often neurological condition, it could be something like Parkinson's or another significant change in their personal circumstance or in their physical or cognitive health,
00:21:24
Speaker
where the family do everything they can within their ability and within their knowledge of the system, health care, primary care, acute care, et cetera, to manage. And then when it's, ugh, this is really becoming either a danger, a hazard, or it's just becoming too much.
00:21:44
Speaker
And people start to question, families question, and maybe it's that the adult child or children have conversations amongst themselves. And then they're trying to figure out, okay, who's going to talk to mum and or dad about this? And so having those difficult conversations, as the name implies, they're not easy, but I think if they can be conversations, again, this idea of having values based conversations as a family throughout one's lifetime or certainly as our elders enter older age, then it's just a continuation of that conversation as opposed to we're in the midst of a crisis.
00:22:31
Speaker
And that certainly does happen, right? Somebody may have a significant stroke, a heart attack. They may be living with a limiting illness such as a cardiac issue or COPD. And the things that used to they used to be able to do five years ago or five months ago, they can't do any more in this space. And so what are some of the changes that we need to be making?
Importance of Home Modifications
00:22:55
Speaker
And where, as you had asked, in terms of the resources, where do people turn?
00:23:00
Speaker
I think it's not unusual for people certainly to check with family doctors and that can be a great resource. As an experienced occupational therapist working throughout the healthcare system, we assume everybody knows about home care and about the variety, even home health ah retail stores, but it's amazing the number of clients and families I meet who simply don't know these solutions exist.
00:23:27
Speaker
where they do a little bit of research online, and so then they start ordering things um from any of the online retailers. And when those things don't work, they assume there isn't a solution. And again, one of the things that I like to say in terms of the benefits that I can offer to the clients and families I work with is I can, um following an assessment and evaluation and recommendations, I can say this product category or a specific device, this will help you because of X, Y, and Z reasons, whereas either the product that you ordered or looked at or a different product, which to an untrained non-OTI might just look to be the same.
00:24:19
Speaker
One of OT's superpowers is our ability to focus on function and the observation and that match between you know what's going to fit the client's needs and preferences and goals and what isn't going to work. Obviously, I'm biased in this regard, but I think everybody um should have access to an occupational therapist as a trusted resource and guide to them ah in later life.
00:24:47
Speaker
Yeah, thanks so much for sharing those reflections with us. It sounds in your role, you're needing to stay up to date, obviously, with many of the offerings and products that are available to clients and their families. And I'm curious, how how do you go about staying current with those things and and current with what the best options are for supporting aging in place?
00:25:14
Speaker
and so I think as somebody who is naturally curious and values education and learning, I appreciate the opportunity not only to learn from occupational therapy, best practices, so connecting with colleagues, certainly reading the academic and periodical journals is important, attending OT-based conferences or webinars taking courses that are offered through the provincial and the national associations. And then because I would you know suggest the diversity of my interest and particularly my strong passion around
00:25:56
Speaker
home modifications and accessibility. I really value looking outside of healthcare and outside of occupational therapy and ask and attend conferences and even things like home shows.
00:26:11
Speaker
but talking to industrial designers, interior designers, architects. What's happening in those spaces? And even recently in Calgary, the age well conference, which focuses so much on the use of technology for healthy, safe, successful aging. There's so much opportunity to learn.
00:26:34
Speaker
that you almost, not to say you can't avoid it, but yeah, there's lots of opportunities. And I think as much as I have a whole bookshelf of books and I continue to order books, including some from the United Kingdom and internationally, because there's a lot of good work that's done outside of Canada, but also inside Canada around whole modifications, but looking to international colleagues and experts as well is another opportunity and resource.
Supporting Clients with Cognitive Impairments
00:27:05
Speaker
And so speaking of home modifications, I wonder what are some common home modifications that you recommend and also how you work with different industry partners or funding partners or vendors to help to make these happen.
00:27:22
Speaker
who will it um On the one hand, I can say every client is unique and different. And so the whole modifications I would recommend are are obviously going to be individualized to them. But when I reflect on, again, 30 years of practice in this area, I can say that I always not only conduct my own assessment, but when I'm providing that kind of education and explanation to clients and then obviously making recommendations, I focus on essentially three primary areas. It's how you get in and out of your house.
00:28:03
Speaker
how you move around within your home. And obviously, if people are living in multi-level homes, that includes circulation on the stairs. And then not exclusively, but because when we think of function and safety, it's not uncommon to need to look at the bathroom. It's how can you safely and as independently as possible ah use your bathroom. So the types of home modifications I often find myself making are things like stair safety. So that's making sure that there's railings ideally on both sides of the stairs.
00:28:40
Speaker
that stairs are in good repair both outside and inside about things like even what we might consider to be minor thresholds and level changes again at a main entrance but also inside the floor if you've got carpeting and hardwood and some tile, especially in a home where an older adult or a couple might have been living for 50, 60 years and done a lot of home renovation projects over that time, it may not be unusual to see a lot of small but potentially significant
00:29:16
Speaker
changes in level on one floor, let alone looking at how they're getting between floors. And for example, where it may be necessary and beneficial because the occupant wants to continue to do their own laundry. um We may not be moving it up to the the upper floor, but we may be moving laundry from the basement to the main floor.
00:29:39
Speaker
um In the bathroom, not surprising to most occupational therapists, presumably, but it's going to be things like grab bars by the toilet and in and around the shower or the bathtub, non-slip mats, and and obviously removal of any kind of scatter mats or or mats that could could slide around.
00:29:59
Speaker
in the bathroom and out. And then if people need different supports for transfers, so that could be, again, grab bars around the toilet and in the shower, but also things like a toilet riser or a bath seat.
00:30:16
Speaker
And then also looking at um how people are getting in and out of bed, and if things like a bed assist rail or a transfer pole might assist them with those kinds of transfers. And then one of the biggest and most common, I guess I should say, because it's actually very minor um in the grand scheme of things and certainly relative to some potentially more expensive renovations is lighting. It's not unusual for the clients that I work with that, again, where they may have been living in the same home for dozens of years, if not 30, 40, 50 years, they feel like they can walk around that space and probably they can with their eyes closed.
00:31:00
Speaker
But as we age, and especially as we're going into the shorter periods of daylight in Canada and the Northern Hemisphere with the with winter coming on, I can't emphasize enough the importance of good lighting and the more lighting the better. It's one of those no-brainers that can really help to uncover some potentially hidden tripping hazards.
00:31:27
Speaker
And that is also a good example of a home modification that is equally applicable for somebody with a physical limitation as well as a cognitive limitation. Imagine if you had altered visual perceptual skills or cognitively your brain was telling you that you were seeing somebody standing in a corner when in fact it's clothing hanging on a coat rack in a shadowy corner. So thinking about renovations from the whole from a holistic standpoint, and and that I think leads into or ties into your other part of of the question in terms of working with vendors, with contractors, with funders.
00:32:15
Speaker
It's really important when I'm meeting with clients and families, one of the first things I ask is, are you planning to stay in your home or are you planning to move? Because if somebody is thinking about a move in the not too distant future, that's probably drastically going to change the the level of, or maybe even the types of renovations I'm recommending.
00:32:38
Speaker
And then the other piece is is that it is important to bear in mind what the funding ah sources are available. not It's not uncommon for people to understand they have to spend some money on their home to make it safe and accessible for them or a family member. But it's equally true that it can be very challenging to convince older adults or couples and sometimes even family members to spend even $10,000 or $15,000 or less on some minor modifications to help make it safe and possible for somebody to continue to live in that home. I provide information about certain tax credit or other funding sources, but in reality, there's very limited
00:33:31
Speaker
funding that is currently available in Canada for home modifications for accessibility, unless somebody um is ah very low income or lives in a part of the country, so certainly not in the southern Ontario in Toronto where I work.
00:33:49
Speaker
where home values exceed most of the eligibility criteria for for certain funding um ah programs. And in terms of working with other members of a team to help people achieve and realize the home modifications that they need, it really runs the gamut. I always ask clients if they either have a designer or an architect or a contractor and then i like to work with that person because there's that no one trust factor on the client's part and where they may not have somebody or know somebody and there don't have any friends or family who who can recommend.
00:34:30
Speaker
Then I certainly i like to network and I like to meet the contractors and the product suppliers that are in the industry and in my area in order to maintain those professional relationships, but then also to be able to bring forward to my client and confidently recommend individuals and corporations or companies that I know do quality work, they're professional, they're recently reasonably priced for the value of the service that they offer. And certainly for the people that I like to work with, they get that accessibility and aesthetics or attractiveness
00:35:12
Speaker
they don't have to be mutually exclusive. And again, that's a myth that I often have to work with clients and families to overcome because they're like, oh, I don't want my home to look like a hospital. And I'm like, if we do this right,
00:35:27
Speaker
It won't. In fact, in some cases, people may not even notice that we've made the space more accessible or functional and usable for you and everybody or anybody who comes through these doors because it's just good design. the More kind of leaning towards that universal design piece.
Collaboration with Designers and Contractors
00:35:48
Speaker
Exactly.
00:35:50
Speaker
I wonder, are there any additional considerations for working with clients with dementia or cognitive impairments if we're thinking about aging or thriving in place? Is it possible for these clients? And if so, what does it look like?
00:36:08
Speaker
fool Certainly a number of the clients and families that I work with are living with the effects of cognitive impairment of some degree or another. And it absolutely is possible for those individuals to continue living in their home or their neighbourhood. What I have seen um and experienced and advise clients and families on is that it's really important to introduce as much the physical ah supports in terms of home modifications that may be necessary, but really the social supports and the service supports. So it may be around medication management and working with their local pharmacist.
00:36:59
Speaker
It may be around introducing either a day program or seniors activity group, certainly focusing on nutrition and hydration. And then if there is is one thing, and I know there's many things that COVID has taught us is the importance of socialization. And it's not just being friendly or saying hello to the cashier if we're not all using self checkouts now at the grocery store or the pharmacy but it's actually actively taking steps to avoid social isolation so many of the clients that i worked with before covered and throat covered.
00:37:42
Speaker
Everybody took a big hit, psychologically, emotionally, and cognitively. And one of the realities of aging is that while many of us fortunately can do the hard work or just as a result of passage of time, we can bounce back. um As we age, that resiliency muscle and just even our body and our spirit and our mind's ability to bounce back there are some things that we may never bounce back from or not bounce back as high and so for people living with dementia as i described really important to start wrapping arms around those individuals and again i worked with enough clients and i've seen this time and time again.
00:38:32
Speaker
There is a phase, especially for people living with cognitive impairment, where they may be living alone, where they get very protective of them themselves and they almost don't want anybody in their space.
00:38:48
Speaker
And it's very hard to stand by and to support the client and their family and basically say, you know, not that there's nothing that we can do, but where the client still has the capacity and definitely, because we hear it, I see it adhered all the time, to say, no, we can't force anybody. And in those cases, what I do and and what I encourage families to do is to maintain contact, to continue to check in, where people have neighbors, be a good neighbor. And then I try to provide that reassurance to to family and friends and and support systems to say the time will come.
00:39:32
Speaker
Where your loved one won't fight us on this and we'll be ready when that time comes but we can't force it because otherwise we're just going to or they are going to push us away and Everybody's going to end up frustrated Mm-hmm and also speaks to that coercion piece as well right where we don't want to be in that position either and No. Yeah. what One of the lines that I use and I always encourage you people to take ah it and use it for their own purpose if they find it helpful. When I'm working with clients with a cognitive impairment and I've experienced it both with personal relations as well as professional, I say that
00:40:13
Speaker
Many of those individuals often are at a point when I get involved with them where they can still make decisions for themselves, but they probably should no longer make decisions by themselves. And it's that idea of I'm not pushing or the family's not forcing, but let's be there. And again, it goes back to that idea of environmental press.
00:40:37
Speaker
Let's just put some safety nets without imposing our beliefs or judgments or our wishes on somebody, but just putting a few guardrails on to say, you absolutely can make these choices. And as family or as a professional, I want to share with you at whatever um level of detail is appropriate that the individual can comprehend, I want to share with you what our concerns are or what we're seeing and to then present maybe a couple of options. And again, when people have the choice
00:41:17
Speaker
And this is going a little bit, taking a bit of a diversion. But the other piece is, and this plays into the patient navigation role that I do, I have to sometimes put on my pointy boots and say, we don't have to like the choices, or we can't we don't always have the luxury of liking the choices, but what a gift it is to have choice.
00:41:47
Speaker
It's when you no longer have any choices because for any number of reasons, right, people might just have over the course of their life made choices and painted themselves into a corner. And that wasn't necessarily intentional, but it was a consequence of some of their actions or their behavior.
00:42:07
Speaker
And in other cases, there may be very real constraints. It could be financial, it could be social, et cetera, or health, where there there are actually very few choices. But hopefully, i again, I think this is how I was raised. It's always look for the choices, look for the options, and then weigh your pros and cons. We don't have to love all of them. But if we remember what we're trying to do and why we want to do it, what our values are,
00:42:37
Speaker
invariably that will guide us towards the best choice for us at that point in time. Yeah, really profound way to consider all of those different but important aspects of making these decisions. and And like you said, maybe we don't like all the options, maybe we don't even love them, but to be able to consider them is a gift.
00:43:03
Speaker
Yeah, and certainly I've had, whether it's family or people who don't have family, but they have close friends who've served as power of attorney, substitute decision maker, it's not been unusual for those individuals to come to me and say, I just don't want somebody to look at me and say, I didn't do the best that I could. So that's where, but again, I just keep my mouth closed and my ears open.
00:43:30
Speaker
But then at the appropriate point, I invite them or c probe a little bit because invariably where people are worried and they're making fear-based decisions because they're worried about making the wrong decision or they're not taking any action or making any decision because they don't want to make the wrong decision.
00:43:53
Speaker
And I'm a huge proponent of just being a practical problem solver with my clients and their families. And one of my favorite lines that I use ah when I'm communicating with people is everything is figureoutable. There's almost nothing that we do, no choice, action or inaction that we make.
00:44:13
Speaker
that we can't change or we can't at least modify. So it's just even giving that peace of mind and letting people breathe through what is otherwise maybe a ah very tension filled and difficult and emotionally trying time. It's it's going to be okay.
00:44:33
Speaker
And even as a clinician, right, what a gift to approach situations with that mindset as well, because then we're approaching it with curiosity. How can I collaborate and pick this apart with this client in this situation to come up with a solution?
00:44:49
Speaker
fool That speaks also to I think who we as occupational therapists are. We're very focused on that process thinking. And that's why as well, I think why I like the design thinking because it's very much process oriented. And I have encountered clients and family members over my career.
00:45:08
Speaker
who are very task-oriented and they're they're just like, stop stop up with all the the probing and the educating and the option offering, just get to the solution. And that's always, I can laugh about that now, but it's a humbling experience because it's, I can i can roll with that too, but it's just, oh, there is another way of approaching this. Always a good reminder, that's for sure.
00:45:35
Speaker
So switching gears a little bit here, I'm curious to know how you do work with different companies as a business consultant regarding aging in place. but There's a few different ways that I do that. Certainly, I have ah really enjoyed collaboration that I do with an industrial designer from Vancouver, British Columbia. um Her name is Callie Ryan, and she has a design company called Capella Designs.
00:46:03
Speaker
And so she's an industrial designer and much lived experience herself around designing a range of product solutions that are functional and accessible but don't look anything like what you might find, all due respect, in a home health care store. um In that sense, she and her partners do a whole lot of ideation, and then they may choose one, two, or three different products that they're going to design for a a season, if you will. And then she and I spend not an inordinate amount of time because she is so good at what she does. She'll pick my brains on a virtual call for an hour or so and get my seed back.
00:46:48
Speaker
So that's one really concrete way. Another ongoing collaboration that I'm very fortunate and happy to be able to be involved in is with some contractors who, again, they may or may not specialize in senior home renovations or aging in place, although many of them are now starting to market aging in place home modifications as a particular style of home modifications.
00:47:16
Speaker
So, for them, but then also in some cases some vendors, so maybe product suppliers or ah equipment suppliers, they really value my ability to be able to go in and often without them initially do my assessment with the client and then together we come back and we collaborate on my recommendations together with some design preferences of the clients, but then the very real architectural structural issues or the the practical issues of new soundproofing and accessibility that a contractor has to do in that person's home.
00:47:59
Speaker
And yeah, it's really it's refreshing because the work that I do now, I actually started a business over 20 years ago. And while people were curious and interested to know what I was doing,
00:48:16
Speaker
there wasn't the appetite and the market, if you will, for the services that I offer. So to be able to have you know that kind of welcoming collaboration, and I should say as well, there's a number of interior designers that really get inclusive, universal design, and one of them who organizes a either an aging of place or an accessible and inclusive design pavilion at the Toronto Home Show every year. Her name is Linda Casca, and she has livable designs, livable Canada. Sorry, Linda, I've forgotten the name of it. But she regularly invites me and actually another occupational therapist as presenters, so we're speaking to the public.
00:49:06
Speaker
but then also inviting the provincial as well as the National OT Association to contribute information resources and promotion of occupational therapists as really being integral to successful design.
00:49:23
Speaker
um And it sounds what you're describing like this kind of merging of all of these different skill sets and working together to achieve the best outcome for what inclusive spaces and um thriving in place, aging in place can look like.
00:49:40
Speaker
Yeah, no, i e exactly. And there there wouldn't be any client or architect or designer that would want me trying to dip my toe in or nudge my way in to their area of expertise. And similarly, as much as I think there are some things that are really exclusive on hardcore occupational therapy, I welcome, again, interior designers, industrial designers, contractors, builders who get the philosophy But then when it either comes at a residential level to the individualized assessment and recommendations for solutions for that client and family, or if it's more on a commercial side of things, how can we design more public spaces to be universally inclusive? that there's There's a rule for everybody. And yeah, I think it it is it just, it warms my heart.
00:50:35
Speaker
to see that collaboration, because again, that's one of my core values, is how do we collaborate to bring the best possible outcome to fruition, as opposed to people trying to work in silos.
Resources and Upcoming Workshop
00:50:48
Speaker
And it's probably 60, 70, maybe 80% of the way there, but why wouldn't we bring warheads together and really knock it out of the park?
00:50:58
Speaker
Yeah, of course. um Now, as you've discussed about all of these different topics or as you've dove into all of these different topics, you've mentioned several different resources and and you know conferences.
00:51:16
Speaker
I'm curious if there are some other great resources for clinicians that you'd recommend that want to really further expand their knowledge and their skills in this area. cool Sure. So certainly I would be remiss not to call out the workshop, the virtual workshop that SAOT is offering that I'll be teaching in 2025 about the OT role and home modifications. So I would flag that for your listeners, for your audience, and certainly CAOT offers that as well. CAOT also has actually two new
00:51:53
Speaker
and they're no longer called position papers. I think they're called practice documents. So there is one on occupational therapy, home assessments and modifications. And then they have just i got word, I think yesterday or today, that they have published a similar practice document for occupational therapists on older adults.
00:52:16
Speaker
which there is a nod to aging in place. So I would encourage occupational therapy clinicians to check those out. The other thing in terms of actual books, resources, the occupational therapist guide to home my modification practice by Liz Ainsworth and Dijon, two therapists from Australia, I believe. That's, as far as I'm concerned, that's the Bible, like any OT that's specializing in home modifications.
00:52:43
Speaker
ah You need to have that resource available. There was a edited book produced by Lori Letts and others, and it's called Using Environments to Enable Occupational ah Performance. So that has a little bit more of a theoretical basis, but again, there's lots of good practical examples. And then I would highlight Julie Sawchuk,
00:53:09
Speaker
who is an individual who happens to be a wheelchair user. She continues to teach. She was a teacher before her injury, and she continues to do that now on the accessibility front. And so she has not only her, I think it's weekly or maybe monthly, newsletters and posts, but she also has written a couple of books. And then out of the United States, um Sarah and Scott Pruitt and their team with the Universal Design Project. They have a podcast called Good Fit for Fit. And I'm not sure how many episodes they're up to now, but they've really um spent quite a bit of time over the last several years and often involving students and some projects.
00:53:55
Speaker
and fairly specialized um kind of consumer reviews of different kinds of products and solutions. i I would certainly, whether you're a podcast enthusiast or a reader or books, um or to to watch and ah read online um ah posts that people are making, there's lots of great resources out there. And of course,
00:54:17
Speaker
Yeah, it where where you can have the time and the energy and the finances if you can attend a workshop would certainly encourage you to do that as well. Yeah, thank you so much for sharing and and for our listeners. Margo's workshop is happening. The first date I'd like to mention is the early bird registration deadline, which is November 30th. And the workshop itself is happening virtually over four days that are half days as I understand it. And that's happening from January 30th to 31st.
00:54:49
Speaker
and then again on February 6th and 7th. And this is happening with a co-presenter as well for the Alberta Lens, and that's Catherine Eckersley. I'm sure there'll be a lot of great insights from what you've shared with us so far. It's been such a joy to hear you speak about this area of practice. Your passion really comes through, and and your wealth of knowledge really is quite remarkable.
00:55:16
Speaker
And so I'm sure that our listeners will have a lot of value, a lot of value add added having listened to this podcast. Great. Thank you so much. And thank you for you letting me expand on on all of the great questions that you asked. um As you say, I'm very passionate about this and equally passionate about sharing what I know with others. So this is has been a lot of fun and I really appreciate the opportunity. Thank you so much. We really appreciate your time.
00:55:47
Speaker
If listeners liked what they heard and are interested in registering for Margo's workshop, it is entitled Home Modifications, Creating Accessible Inclusive Housing. And this is happening with co-presenter Catherine Eckersley on January 30th and 31st, as well as February 6th and 7th. It's a four-day virtual workshop with half days. um And early bird registration discounts are expiring on November 30th, so there's still time to get that early bird registration in and join Margo for her upcoming workshop for SAOT.