245 | Improve the Quality of Your Retirement Years: Aging in Place with Carol Chiang

Carol Chiang

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What does it mean to “age in place,” and why does it matter? Those questions motivated my conversation with Carol Chiang, today’s guest on the Love, your Money podcast. 

 

We’ve been taught to fear aging, and most people prefer to focus on maintaining their youth than thinking realistically about care and comfort later in life. But aging is inevitable, so why not focus on setting your future self up for success instead of chasing the idea of youth?

 

According to AARP, 9 out of 10 retirees say they’d prefer to age in their home, and it’s safe to assume that most people want to age with their dignity, grace, choice, and freedom intact.

 

But. Only 15% of people have done any preparation to support aging in their current home–and that’s why I brought Carol onto the show. She is the founder of Evolving Homes, which provides expert consultations to homeowners who want to age in place.


From maintenance of health and functionality to structural adaptations for your physical living space, there are so many ways you can minimize the chance of injury and build multi-generational mobility support into your existing space.

 

Carol’s goal is to help people understand those potential aging costs, so they can make a purposeful decision about saving for their future self. It is incredibly expensive to delay care–and if you don’t know what your options are, how will you know how much to save?

 

Any proactive planning you start *now* will pay off in both dollars saved and quality of life preserved.

 

So hit download on this episode, listen in, and check out the show notes at hendershottwealth.com/podcast/carol-chiang to get all the goods about setting yourself up to successfully age in place. 👇


(Oh–and if you like this interview, make sure you subscribe to the Love, your Money podcast, because you won’t want to miss what’s coming up next week. I got to chat with a Decision Engineer, and I think our conversation will pair well with this one!)

Here’s what you’ll find out in this week’s episode of Love, your Money:

  • What it means to “age in place,” how you can be proactive about taking care of your future self, and the compounding returns of beginning early 
  • How to build an accessible and age-inclusive space without sacrificing elegance and smart design
  • Why proactive planning is a long-term cost-savings opportunity, especially for future caregiving costs or structural adaptations
  • How home modifications, lifestyle mentoring, physical fitness, remote monitoring, and “age tech” impact successfully aging in place 
  • The difference between an Occupational Therapist, Physical Therapist, and other healthcare professionals involved in caregiving
  • The tipping point where Carol will recommend a client move out and find a new space vs aging in place
  • Our signature LYM question: If Carol’s money were writing her a love note, what would it thank her for?

Inspiring Quotes & Words to Remember

“After a couple decades, your function is going to be affected, and that’s normal. But it’s not necessarily that it is inevitable."

“...you could hire somebody 24/7. But currently there is a serious caregiver shortage. Care is expensive. So, most people, it’s in the $20,000 a month zone. That’s shocking for people to digest.”

“...people in that sandwich generation, 40s, 50s, if they have had to take care of parents before, and especially if that involves a two-story house, guess what they’re buying next time around? They have learned. Experience is one of those things that really teaches you the value of planning ahead.”

“I tell people, think about grab bars like you would a safety belt in your car. I mean, why would you even let your child get into a car if a safety belt could save their life?”

“It's about choice. You’re making choices by choosing what you’re doing 20 years prior to retiring because those are the consequences you’re going to reap after.”

“Having a plan actually makes everybody calm down around you.”

“It is akin to when you were 25 years old, you had your first job. They signed you up for the 401(k), and you were like, okay, I can put $2,000 in there this year, right? And that’s how you start. And you amortize that cost over many years. And when you arrive there, you’re more prepared than you could have otherwise been.”

Resources and Related to Love, your Money Content

Enjoy the Show?​

[INTRODUCTION]

 

Hilary Hendershott: Well, hello, money lover. This episode is for those of you who are aging. Oh, wait, is that all of you? Well, then you should probably tune in. It’s for those of us who are aging and who know people who are aging, who want to do it with dignity, grace, choice, and freedom. Did you know AARP reports that nine out of ten retirees say they’d prefer to age in their own homes? Part of this is to maintain independence. But the other part is you know how expensive full-time care is. And of course, residential options are even more expensive. So, it’s no mystery that most people want to age in their own home. But also, according to AARP, only 15% of people have done anything about their desire to age in their own home, including maintaining nutritional health, physical fitness, and even the process of slowly and proactively making changes to your physical living space that minimize the chances of injury and maximize their chances of success.

 

So, today, I’m talking about just that with Carol Chiang, the founder of Evolving Homes, which provides expert consultations to homeowners who want to age in place. She’s an occupational therapist by background. She focuses on helping people by being goals based and holistic in her consultations. She specializes in implementing luxury accessibility, not just junky accessibility or ugly. And you’ll hear her talk about that. And she can even tell you if moving to a new home is more cost effective than remodeling an existing home.

 

She is featured as an expert on AARP’s Conversations for the Future: Finances, Health and Housing, and she spoke at MIT Age Lab’s 2023 PLAN Forum on how financial advisors can prepare their older clients for purposeful aging in place. Here’s my conversation with Carol Chiang.

 

[INTERVIEW]

 

Hilary Hendershott: Carol Chiang, welcome to Love, your Money.

 

Carol Chiang: Thank you for having me. Super excited to be here.

 

Hilary Hendershott: Give us the Reader’s Digest version, how you end up doing what you do?

 

Carol Chiang: How do I end up doing what I do? So, I am an occupational therapist by training. And my favorite thing to do is to work with people in the home. So, I got started doing home health, that traditional rehab kind of stuff. And 15 years ago, Medicare was still supporting aging in place, and being able to have care in the home was cheaper than being able to take care of someone in inpatient rehab. Inpatient rehab, you’re looking at $1,500 a day. At the home, they were thinking, hey, we have visiting nurses, maybe a few hundred. So, we never had any kind of stipulations against how many visits you could have. As long as somebody was making progress and we could document it, we were good to go.

 

So, I saw stroke patients three times a week. Six months, I got to see them going from complete paralysis to writing a note to their friends. So, you got to see that entire spectrum. I could be there to help them order equipment and help them go through that painful process of teaching them how to dress with one arm. And it takes months. But I got to see that whole process. And maybe about five or six years ago, somebody upstairs realized that we were going to run out of money.

 

Hilary Hendershott: I keep hearing that.

 

Carol Chiang: And what happens when people start to run out of money? They panic, right? And they panic and they start going like, “That’s it. Moratorium on spending. We’re not doing this and that.” And what that translates to for health care professionals is an increase in justification of services. So, you need to complete this checklist. And this person needs to look at less visits. And really, for me, the breaking point got to a point where they had put the whole burden on home care agencies and said, “Look, we’re going to give you a bucket of money, and you are going to have to take care of this patient for this bucket of money, no matter what that you think that they would need because they don’t have a caregiver or their home situation is different. Okay?”

 

So, the home health agencies had figured out that 20 visits was their break even point. So, 20 visits now need to be shared between the physical therapist, the occupational therapist, the nurse, speech therapy, and if they were going to have respiratory. And if you do the math, it’s not very nice. And another cost-cutting measure in that was decreasing the assistance, so having the assistants do it.

 

Long story short, I said that’s enough of this terrible care. I am not going to treat a full hemi-stroke like this with two visits or four visits or whatever. There’s no progress possible. Even if patients will have to pay for my services out-of-pocket, so be it. At least there’s that possibility. Because by that point, they had… Medicare had said, we’re not paying for anything that a caregiver could do on their own, i.e., ordering things on Amazon, helping them with figuring out an install process or all of those small things that really make it easier for them to manage at home better.

 

So, that’s how I started really focusing on in the home, aging in place. So, either the hospital-to-home transitions or more importantly, those proactive adults who are the ones answering AARP survey, saying, “Hey, look, I’m one of the nine out of ten that plans to age in place, but I have no idea what I need to do or how to get ready for this.”

 

Hilary Hendershott: So, what does it mean– oh, man, nine out of ten. We need to circle back to that.

 

Carol Chiang: Nine out of ten.

 

Hilary Hendershott: Yes, I know. You hear it all the time. And sometimes, it comes down to, well, what are you actually able to do? So, it breaks my heart when people aren’t able to do that for whatever reason. But we’ll come back to that. What is it to age in place? And how is what you do? I imagine because of you’re trying to help people avoid the outcome you just described, that part of what you do is preventative consultative. So, talk a little bit about that.

 

Carol Chiang: Absolutely. So, aging in place is that purposeful decision that you are going to stay in your own home as you get older, so that you aren’t just going to go by the wind and whatever happens, happens. Okay, so you are deciding that this is the place that I’m going to stay and I’m going to get older here. Preventative is super important because one of the biggest problems I find is it’s really hard for us to imagine ourselves any different than we are right now.

 

And I suspect that one of the reasons that people think that my plan is to age in place here is just because that’s the default plan. I’m currently here, right? I don’t have to do anything and I’ll just stay here. That’s my plan. Is that really a plan? It’s not really a plan if you’re not considering the idea that you’re going to be 20 years old or 30 years older. There’s a real thing called…

 

Hilary Hendershott: The inertia plan.

 

Carol Chiang: Right. The “I don’t do anything and hope for the best” plan. Like, oh, that’s an accident waiting to happen. But I try to remind people that there is a real thing called sarcopenia. Aging is not a disease. Aging is a process. And sarcopenia is that loss of muscle mass, half a pound of muscle mass, and you’re gaining 2 pounds of fat every single year after 35 as a natural part of your aging process, right? So, do the math. You lose that much muscle in a certain amount of years. After a couple decades, your function is going to be affected, and that’s normal. But it’s not necessarily that it is inevitable. So, these are all preventable things, but preventable things in a way that some people don’t love.

 

So, things like exercise or eating right or sleeping better or taking their meds on time, or keeping a routine, that seems boring. And I’ll tell you, I have a lot of people who say at 65, listen, that’s it. I got up at 5:30 in the morning every morning for work for 40 years. From now on, I’m sleeping until noon, I’m going to eat what I want, and I’m going to sit on the couch and watch Netflix. And unfortunately, those are the ones who, 5 to 10 years later…

 

Hilary Hendershott: That’s the wrong time of life to be doing that. Yeah.

 

Carol Chiang: Right. And I’m thinking, is this really how you wanted to spend that retirement? I understand you want to do something different, but be kind to yourself and try to think about how could I create a better quality of life, not number of years of life, right?

 

Hilary Hendershott: I think most people imagine the fork in the road. So, I’m in my home and maybe I’ve done normal disability accommodations, I’ve got handles in my shower. But let’s say I fall and I have a hip injury. I think most people relate to it like my options are to bring in round the clock in-home care. So, that’s three 8-hour shifts a day. So, you’re paying three full-time professionals. I’ve heard people quote this. Or I’m going to go to a care facility, like an old people’s home. Can you add some nuance to that? What are the other options? Talk about someone in that position.

 

Carol Chiang: Totally. So, especially if you’re talking about a sudden fall, this is generally the wake-up call. So, I said, most people can’t imagine themselves at that point. The wake-up call will often happen with something as small as tripping over your garden hose. So, you walk outside and oops, like the grandkids pulled the hose over, you didn’t realize. And boom, there you go. And there’s your first fall, right?

 

And yes, so you could hire somebody 24/7. But currently there is a serious caregiver shortage. Care is expensive. And that is one of those sticker shock problems that people get. So, most people, it’s in the $20,000 a month zone. That’s shocking for people to digest. And if you try to multiply that by multiple months, I mean, it’s a lot. So, going to a care facility for a little while just to get stronger, that totally works. But I try to send the message of, how about we just rewind the whole situation? And if you stayed really strong and you invested your time, money, and energy into a personal trainer, into having a nutritionist…

 

Hilary Hendershott: An active lifestyle.

 

Carol Chiang: Yes, people who could support you in creating a situation where you don’t even need to go down the 240k a year zone, or you don’t even necessarily need the grab bars. I mean, I don’t see this as a continuum of, you get older, you learn to walk, you go to college, and then as you get older, you go from a cane to a walker to a wheelchair. I mean, that’s not how this works, right? You don’t have to do that. That is not a given. That is one of those things that people think is a continuum of life, but it’s not.

 

You can absolutely be, starting at 35, to figure out your routines, get stronger, get into better habits, figure out what it is that you like to do. The best exercise is the one you’ll do. I don’t care what it is. You just have to figure out what you can do. Yes, please, just do something because any amount of strength that you’re maintaining is money that you’re saving on the back end. And that’s money that you’re not paying for expensive care, which is crazy, but also the home modification piece in it.

 

Of course, I love super accessible spaces, just like a hospital. Nice big open areas where you could move a wheelchair if you wanted to, or just feel free to ambulate in a walker and feel safe, right? But that’s expensive stuff. I mean, especially these days at post-COVID, the materials cost, the labor costs. They jumped like crazy. I would guess, almost doubling. I mean, I used to be able to build a bathroom for $35,000, full gut.

 

And now, I mean, I just recently did one where it wasn’t even a full gut and it was $70,000. And we did our due diligence. We interviewed. I work for the client. I do not work for the contractors, anything. I am on the call with them. We interviewed together six different guys, and all of them had the same cost. Okay, so it’s just what the market will bear and you don’t want to do that. You want to have more control over your life. And you can do that by being proactive and really, taking those pieces and understanding, okay, what am I like? What do I want my future to look like? And how do I make sure I save for it? And how do I make sure I know what the options are for it?

 

Hilary Hendershott: So, then, at what age are you recommending people make accommodative remodeling changes to their home? What do those look like?

 

Carol Chiang: Yep. So, you know what? I tell people when you buy your first house, you should be thinking about it. And not necessarily that you’re going to live in that house, but that every remodel, every routine remodel that you would do, that ugly pink bathroom has got to go when you bought that house, you knew that. So, when those walls are down, you put up the lumber, you put up the backing so that you could throw grab bars on that wall at any time. Maybe it’s not for you. Maybe it’s for grandma who comes over to stay with you because she happened to buy a two-story townhome and that maybe wasn’t the best downsizing idea, but you have the potential to do that later on. And it’s so much cheaper to do then.

 

And there are so many reasons for it that even beyond your own benefit. If you look right now at the housing in the US, only less than 5% are even mobility friendly, less than 1% is wheelchair friendly, less than 5% is mobility friendly. And if you look at that math, that means that if 90% of people are planning to stay in place, 95% of homes need to be adjusted, right?

 

Hilary Hendershott: And it sounds like they’re in the six figures of…

 

Carol Chiang: Oh, my gosh. It’s expensive. And forget about the cost, think about the hassle. Like, the contractors coming in and out of your house, the dust, not being able to use everything. All the appliances are in a weird place. I mean, it’s not something that is a fun thing for older people to have to go through and have to tolerate all at once. So, if you can do all these things when you start and if you are young and you are going ahead and making those changes, even if you sell that house later, that’s social responsibility. You are helping the next person who buys that house or even adding back to the housing pool of homes that could be accessible for somebody who really does need those accommodations.

 

Hilary Hendershott: So, you’re really kind of more of an activist. You really want homebuilders to build with this kind of thing in mind. And I’m sitting here thinking, nobody thinks anything about, oh, your friend is coming over with her baby. And we immediately baby proof the living room. And yet, we don’t do that for grandma and grandpa.

 

Carol Chiang: Right. Well, and you know what? They can’t get to your living room if they can’t get into your house. I have this video of my sister. She has a house in Toronto, and they’ve got four big giant steps. And you can see her just hauling her two-year-old inside of this stroller, just bumping up these steps. And it is so dangerous. I mean, I’m looking at that going my back hurts watching you. Never mind if you hurt yourself. And you are now trying to take care of a child, I mean, the consequences are enormous for this. So, it is about babies. It’s about visitability. And it’s also for you. What about the new furniture that you’re bringing in? Those poor guys who are lugging things like up those steps, don’t you feel bad for them as they’re coming up there?

 

Hilary Hendershott: I do, every time.

 

Carol Chiang: It’s horrible. It’s horrible.

 

Hilary Hendershott: Okay. So, in a perfect world, then, I mean, the housing exists how it exists. So, at what age or what phase of life should someone start paying attention to your kind of messaging and how should they think about it as being for themselves or for their aging parents or family members?

 

Carol Chiang: So, one of the areas where I’ve really noticed people change is if they have been caregivers before… people in that sandwich generation, 40s, 50s, if they have had to take care of parents before, and especially if that involves a two-story house, guess what they’re buying next time around? They have learned. Experience is one of those things that really teaches you the value of planning ahead for these, thinking about what that’s going to look like later on. So, of course, my activist in me says, as soon as you buy your first house, we should be talking to our new newlyweds about how important it is. Okay, they probably aren’t listening unless they’re thinking rationally about, hey, look, baby strollers, if I have twins, trying to get in the house, right? That’s important. But definitely, in those 40s and 50s, looking to see, what if my parents come to live with me? I mean, you don’t have to be the recipient of an easy-to-live-in house. It can be also just that you want to have other people come and stay with you as well.

 

Hilary Hendershott: You’re doing those changes.

 

Carol Chiang: You’re making those changes. And one of my big advocacy points is that people think about those changes as being what they see at Olive Garden bathrooms, right? You’re going, like, I am not putting those ugly grab bars in my bathroom. Why would I even think about creating a space that looks like this? And the problem is, there’s no role models. People don’t realize that what you see at Home Depot is not what’s out there. There are so many beautiful, gorgeous designs that you would be happy to put into your spaces.

 

And in fact, I’ve had this feedback many times where people have walked into a bathroom I’ve created and they’re like, “Where are the grab bars?” And I’m like, “Well, you’re looking at…”

 

Hilary Hendershott: Really?

 

Carol Chiang: Yeah, because these days, everything is multi-functional. You can buy a grab bar/towel bar, grab bar/toilet paper holder, grab bar/corner shelf. I mean, you don’t need to be shouting that this is a space for that. There are a lot of stories out there that can really show you that everybody benefits from this. I mean, I have a friend who knocked herself out from blow drying her hair upside down because you have your head upside down, and she had an inner ear problem. So, she knocked herself out, woke up on the floor. And of course, what was she trying to do? Reach out and grab at the wall for something to hold on to.

 

I mean, and even fit people… ya know, there was an astronaut. I can’t think of who it was now, but he was in his 40s and had slipped coming out of the shower. Same concept. He got a head injury. I have a friend who has a toddler that slipped in the bathroom right? They’re wiggly, and they jump around in the soap and bubbles. And then they slipped and they hit their head on the tub faucet thing, and off they go to the ER.

 

So, grab bars, it helps everybody. It helps everybody make their life safer. And in terms of grab bars, beautiful grab bars exist. I tell people, think about grab bars like you would a safety belt in your car. I mean, why would you even let your child get into a car if a safety belt could save their life? So, why would you even think about getting into a shower if that’s something that could prevent a fall, right? It makes no sense.

 

Hilary Hendershott: Okay, this is new thinking. This is blowing my mind. I was not expecting you to blow my mind today. So, now, I’m thinking about the house we just bought in Puerto Rico. And I’m thinking because my husband is about to turn 60, and I’m thinking, “Oh, wow, we really missed an opportunity there.” But luckily, it’s all open space. It’s all open space, so there’s no honeycombs, nothing that seems to me like it couldn’t be amended in due time. So, before I hit record, you were talking about how everyone is coin operated. I say everyone has their price. Let’s talk about your mindset about this being a cost savings opportunity.

 

Carol Chiang: Absolutely. So, if you look at just structural, if you are making those changes while you’re doing those routine remodels, you’re saving a whole bunch of money because that wall is down. You’re putting in the things that you need. You’re thinking ahead and making the floors nice and flat. From a money saving point of view, with your health, you are saving tons of money by staying active and staying socially engaged as well for your brain, that cognitive health, because you’re saving money on caregivers, you’re saving money on expensive memory care. I mean, I don’t know if you’ve heard about the cost these days, but most care facilities, they’re going like $7,000 to $10,000 a month for memory care.

 

And memory care dementias are super on the rise because exercise is something that can also help with it. But there’s an entire generation where exercise to them meant calisthenics and fast food, right? Like, some habits that we, in a next generation, can do better with and we can maintain better brain health and consider all those forward deposits to be able to not have to have a huge withdrawal later.

 

Hilary Hendershott: Yeah. There’s that saying, you can either have the pain of discipline or the pain of regret, something like that.

 

Carol Chiang: And you know what? That is a conversation I do have with clients too, which is, listen, what’s the reality? Okay, we can, of course, like, in a perfect world, gold standard, everyone’s exercising and they’re eating organic food and they are thinking about the remodels in their home. Okay, but what’s the reality? We are all human. And so, some people are just not capable of doing that. And that’s okay. Because as long as you save for that piece, it’s okay. But you are making an active decision that I hate exercise. I’m okay with some muscle loss. I’m okay with paying like, people to come in and dress me and bathe me and manage all those things, that’s a decision. It’s the same decision tree as grab bars or not, or equipment or not, or whatever. So, it’s about choice. You’re making choices by choosing what you’re doing 20 years prior to retiring because those are the consequences you’re going to reap after.

 

Hilary Hendershott: Wow. I really feel like you must have a huge prefrontal lobe. Most people don’t think 20 years forward unless they’re 40 and realize they have nothing saved for retirement. So, this is impressive. Let’s talk about what I see on the screen in front of me. For those of you who are listening, on her Zoom screen, it says at the top Evolving Homes. So, that’s who we’re talking to. She says, home modification, lifestyle mentoring. I get those too. Physical fitness, very clear, and then remote monitoring.

 

Carol Chiang: Yes.

 

Hilary Hendershott: One of these things is not like the other. Tell me about these.

 

Carol Chiang: One of these things is not like the other. So, these are my cornerstones. This is what I imagine, when I look at a house and I’m thinking, look, what are the things for successful aging in place? I’m looking at environment, making sure that you don’t have trip hazards, right? I’m not against rugs. I just want to see that there are no rugs in your path of travel. That physical fitness part we talked about, right? Staying healthy, staying strong, the lifestyle part. It’s not aging in place if you’re in and out of the hospital. If you’re not taking your meds on time because you’re sleeping at a weird time or you are not drinking enough water so you’re getting urinary tract infections. These are not successful aging in place.

 

And then the last issue about aging in place is it’s not aging in place if you are not seeing anybody all day. You’re socially isolated. So, this is remote monitoring is technology. It’s looking at, like, did that person get up this morning? Are they still stuck on the toilet after eight hours, which these are all real stories, right? I mean, these are all people that have called me and said, listen, I fell upstairs and nobody found me for four days. And we had to rip up the carpet and everything up there because I was up there and think about their mindset, right? The helplessness that you feel because I broke my hip on the way down and couldn’t get help and nobody was around. And people don’t even think to check upstairs. They just figure, oh, you’re at the gym because that’s what you would normally do, because you go to the gym three days a week. But you never know. Emergencies happen.

 

You can’t be this island of your home living alone without having access to the outside world. And luckily, that’s what technology is doing for all of us post-COVID, right? We all know that you can reach people by Zoom. And these days, technology specific to aging has a term. It’s called age tech. And age tech is the fastest growing area of development to solve a lot of these problems. So, everything from social isolation to pattern tracking, I know of a company where you literally just plug in this thing and you have these waves going around in your house, and as soon as you get up and you get into your living room, you disrupt those waves. Well, an alert just went off to your daughter to say, “Oh, mom’s up. She’s in the living room. There she goes.” I mean, the technologies that people are developing are crazy. I know another one that’s a military.

 

Hilary Hendershott: Is that what pattern tracking is?

 

Carol Chiang: Well, pattern tracking can be predictive, where I know what happens when you fall and I see that you’re doing that pattern. Therefore, I’m predicting that you could fall.

 

Hilary Hendershott: Oh, they might have that on the Apple Watch.

 

Carol Chiang: That’s the gait one. That’s the gait step length that they’re trying to track because step length is associated with falls as well, but it’s also associated with dementias. When your gait gets shorter and shorter and you start getting more shuffly, could be indicative of Parkinson’s, of any other neurological things. It could be just weakness. And even things, like hand strength, is indicative. Those are correlated to falls as well. So, your grip strength is your measure of your overall body.

 

So, I think what I’m really saying with remote monitoring is that you need a way, even for your docs, to be able to get information if you’re not driving there, like virtual visits. But you also need socialization. It’s using technology to be able to compensate, maybe for a lack of caregiver, maybe a lack of strength, a lack of driving, I don’t know, like access. It solves a lot of those problems. So, those are my four areas where I say, look, if you’re going to think about nothing else, really consider these areas and think about what you can do to make that a little bit better. It increases your odds of being able to age in place.

 

Hilary Hendershott: Okay, well– okay, so who’s your ideal client?

 

Carol Chiang: Well, I’ll tell you, I have three buckets. The clients who kind of come to me fall into three buckets. It’s usually those ones that are sudden, emergent needs. Somebody fell and everybody is freaking out because prior to that, totally fine, right? Then you get your neurodegenerative, some of Parkinson’s specialists, you get those ones. But my ideal clients are those proactive aging adults. And do you know what’s really funny? Those fall into two primary categories – dentists and lawyers. And why do you think that is?

 

Hilary Hendershott: Because they fall and knock their teeth out and because they don’t want to get sued.

 

Carol Chiang: Because they know how expensive it is if you delay care, right? What happens if you… You’re like, oh, I don’t feel like going to the dentist for that cavity. What a pain in the neck. And then the next thing you know, you’re at the endodontist which is about 10 times as much. These guys know that if you kick this can down the road, you’re going to be paying for it later. So, they’re like, okay, look, let’s talk. I know the value of your services.

 

Hilary Hendershott: I’ll just do all the things.

 

Carol Chiang: I’ll do it, right? Same with lawyers. They know. They know what happens. Don’t avoid situations. If you avoid it, you will pay twice as much later.

 

Hilary Hendershott: Wow. Okay, and so, tell me– sorry, but I don’t really know the difference between an occupational therapist and a physical therapist.

 

Carol Chiang: Absolutely.

 

Hilary Hendershott: What does that mean? And how does that contribute to what you do?

 

Carol Chiang: Yeah. Easy thing. So, most people have experience with physical therapy because they injured, they tore a muscle or hurt something, right? Physical therapy tends to be a lot more bone and muscle. Occupational therapy is more holistic. We’re backing up from the situation and looking at, how do you function in your spaces. So, yes, it’s about your motion, but it’s more about how does that motion affect what you’re doing.

 

So, we define occupational therapy in two categories. One is self-care. So, can you dress yourself, bathe yourself? Can you take care of yourself? Can you get in and out of the bed, up and down from the toilet, in and out of the shower? Can you bathe yourself? But then there’s another section of activities of daily living, which are, can you take care of your house? Can you cook? Can you clean? Can you do laundry? And then think about the things that you have to do outside the house, right? Those groceries didn’t just appear magically in your fridge. You had to drive there. You had to use your credit cards, so financial understanding of this, balancing, all of those aspects of it.

 

You have to maybe mow your lawn, bring in dog food, organize the HVAC guy. So, all of those things fall into occupational therapy, as well as caregiving. Who are your caregivers? What are the biomechanics behind that? Can we make sure that the caregiver doesn’t hurt themselves? Because if that caregiver is out, who’s taking care of you? Now, maybe you are going to a home or some short-term rehab that is going to cost you a lot of money in the end.

 

So, if I was to try to sum it up, it’s really that OT is very much an art and a science, but looking at the whole person and how do we function and what’s important to us, because what’s important to you may not be important to me. Cooking is not necessarily important to somebody who’s been a homemaker for 40 years. She may be, like, no thanks, I’m out, right? I’m not doing this anymore. Been there, done that. Whereas, I love to eat, so that means I love to cook. So, cooking as an activity and hobby is important to me.

 

So, we as OTs try to look and personalize. What is it that makes you you? What’s important to keep in your life? And how can I make that happen? So, I’m a professional problem solver. My husband is a teacher, so really easy for people to understand. And when people would ask him, “What does your wife do?” And I said, “Let’s just tell them I’m a professional problem solver,” because that’s legitimately what I do, because there’s no one answer. There really isn’t. It really depends on the mix of the person, their preferences, even the chapter they are in their life. You asked you the same question when you were 20. It’s different than when you’re 40, when you’re 60, when you’re 80, your priorities change.

 

Hilary Hendershott: It’s funny because I tell my team that we’re professional problem solvers. We have something in common.

 

Carol Chiang: Well, and I really do think that anybody in finance and anybody in health care doing what I do are the same kind of brain because we’re both trying to bring people to a goal in the future that they can’t see yet. We’re trying to just walk them through those steps to think, like, how do I prepare for that?

 

Hilary Hendershott: Keeping that goal front of mind.

 

Carol Chiang: Right, right. And you asked me before about like, well, when do you start thinking about this? And I sometimes throw it back to other people and I say, “Well, did you start saving for college when your kid was 16?” “No.” Right? You started… And why? Because it’s expensive. It costs a lot of money and people don’t recognize that– one, they don’t recognize that Medicare is not paying for this, and they don’t recognize how expensive care is until they start to look for it.

 

And it’s a serious shock to them. And I tell them, you need 20 solid working years to be saving up for that. There’s a reason that they sign you up for a Roth IRA or an IRA when you get your first job, right? But beyond that, right, care in general, cost of care has gone up so tremendously that I just don’t think that is enough either. I really think that you want to be making a purposeful decision about what your retirement looks like and understanding what those costs are. Like, can I afford that really cool walk-in tub? And is that important to me? So, unless you know what your options are, how will you know how much to save? And you won’t know what your options are unless you’re willing to be brave and look at yourself, what your future self is going to want then, and make those decisions.

 

Hilary Hendershott: Well, this is really empowering. Let me ask you a question, and maybe you don’t have an answer for it, but is there a decision tree or a set of situations, a set of conditions, someone comes to you or a client that you’ve worked with sort of devolves or doesn’t improve, gets worse in terms of their physical abilities, at which point, you say it’s actually now time that you need either in-home care or to leave your home and go to a different place to live?

 

Carol Chiang: Yeah. And I 100% would never tell somebody it’s staying at home. And I even have a service called age in place or find a new space. It’s not the perfect environment for everybody. And generally, the people who are able to successfully age in place, where the cost is not astronomical, are the ones who have been proactively healthy. And they have put in the time and energy to declutter their spaces, so it’s nice and open, and they put in the work to remodel adequately.

 

The ones where I just don’t think it may be worth it is if they have significant medical conditions. So, if they are needing a lot of nursing care because– maybe it’s wound care, maybe it’s COPD or something where they can’t improve with that, I definitely will say, “You need to consider either maybe bringing somebody in four hours a week to take care of those responsibilities and then keep adjusting as you get older and decide, okay, now it’s time to go.” So, it’s not a finite decision, like I’m going to age in place. I know the AARP say, like, “Oh, yeah, nine out of ten are going to do this.” Well, let’s talk realism right now, okay?

 

Hilary Hendershott: That’s not how it turns out.

 

Carol Chiang: Right. And they also have research that says, “Yes that’s true, but only 15% have done anything about it.” So, what do you think the chances are that 90% are actually going to make it to the end of that rainbow? I don’t think so. Because if you haven’t done it, there will come a time where that breakeven point is not worth it, or it’s just too much of a struggle. Like, not every wife or husband is built to be a caregiver. And it’s unfair to think that that is your backup plan, like your backup plan isn’t going to stay home and what? And she’s going to cook all the meals and take care of everything. I didn’t sign up for that for 20 to 30, 40 years or whatever, right?

 

I mean, I think it’s a dynamic process and it’s one of those, you think about it every year. But if you can plan ahead for both the best-case scenario and worst-case scenario because you’ve gone and you’ve identified those backup plans and visited facility or communities and you know how much do they cost, what are they like. When I walked in there, did I feel like I was at home? Or I was like, oh, man, these guys are way– there’s too much exercise going on in here for me. Like, I need a bridge place and a place for Long Island Iced Teas at 10 a.m. on Sunday, right? You got to find your people.

 

And every community, really, every community is totally different. And working with advisors, like local people, who understand the personalities of each of those, that will help you get closer. And I just tell people, look, you’re not signing up on a rental agreement to say you’re going in there. You’re just putting it in a folder of your backup plans, just like your will, just like anything else. And you’re saying, like, if we get to this trigger point, it gets to be this amount of money for care or whatever, here’s my plan. This is what I’m going to do.

 

And some people will call that a survivor plan. They’ll say that when my spouse, whichever one of us passes away, the plan is, is that the other one will enter one of these facilities so that they aren’t lonely and that they have the support that they need. And that’s a plan, right? It’s a plan. And it’s different for everybody. And it just requires the mental space to take those steps towards it and make sure that you are looking at all the potential pieces that might be important to you.

 

Hilary Hendershott: Well, I’m glad to hear that you’re consulting on the spectrum and that you’re open to all those outcomes. I do know sometimes people tell me, “I will not leave my home.” And they remind me of the guy who refuses to vacate and there’s a wildfire taking over the whole town. You know what I mean? And it’s like, what are you proving here? Because you’re just making the lives miserable of the people who love you.

 

Carol Chiang: You are. And having a plan actually makes everybody calm down around you. I tell people that all the time, especially with technology. If somebody is refusing technology, but their daughter is calling and you don’t pick up the phone and she’s like jumping in her car thinking the worst-case scenario for the 10-minute drive over, right? She’s not happy. And you’re not happy because you’re not getting the freedom you want. So, technology and those kinds of things, too, can give you that freedom that you want to be able to live your life how you want it to.

 

Hilary Hendershott: Where can people find you on the internet, all the things that you do?

 

Carol Chiang: I am at EvolvingHomes.com, and I have lots of free resources on there, blogs, webinars, and things that I’ve done that people can just listen and just start to immerse yourself into it. I mean, I think this is something that people have never thought about. So, it can be very overwhelming. I just tell people, just take little bites, little bites of it. And if it’s scary, you go into it and you do that exposure therapy thing and you run away and you don’t look at it for life for four more weeks and you come back and then you try it again. And have that conversation with your kids, right?

 

Hilary Hendershott: It is akin to when you were 25 years old, you had your first job. They signed you up for the 401(k), and you were like, okay, I can put $2,000 in there this year, right? And that’s how you start. And you amortize that cost over many years. And when you arrive there, you’re more prepared than you could have otherwise been. Thank you so much for coming on Love, your Money. I do have one remaining question for you, and that is if your money were writing you a love note, what would it be thanking you or complimenting you for?

 

Carol Chiang: I think it would be so happy that I had realistic expectations of how it could help me, that it could give me the power to not be stressed if I have a future preparation. If I just, thoughtlessly, spent my money willy-nilly and then I found myself in a situation, it wouldn’t have any resources to help me. So, I think they would be very happy to say thank you so much for remembering that we’re here to protect you and that you respected that and you sacrificed and put in the effort to not overspend and keep yourself fit and like said no to the ice cream and yes to the vegetables. You made those sacrifices for me so that I could protect you later on if you had an emergency or something unexpected happened.

 

Hilary Hendershott: Wow. You really do think differently than most people, Carol. Thank you so much for your time. I’m really inspired and I want to talk to many of my clients about this now. Thank you for your time on the show.

 

Carol Chiang: Thank you so much for having me.


[END]

Disclaimer

Hendershott Wealth Management, LLC and Love, your Money do not make specific investment recommendations on Love, your Money or in any public media. Any specific mentions of funds or investments are strictly for illustrative purposes only and should not be taken as investment advice or acted upon by individual investors. The opinions expressed in this episode are those of Hilary Hendershott, CFP®, MBA.

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