Myth, Magic, Medicine, and everything in between - two doctors talking.
Hi, welcome again to Myth , Magic, Medicine. And today I have Rebecca Tapia, who is not only a physiatrist? Is that still the term that's used? I see people write PMR. But she's also designing because it for living quarters because she's interested in multi-generational living, for personal reasons, right, Rebecca?
You had your grandmother move in?
Yes, I did. Yeah.
Would you ike to explain a little bit of the circumstances, not too much personal stuff, but you know, just how, how you came to have your grandmother move in with you?
Sure. So first of all, thank you for inviting me to these conversations, I really think that's how people kind of learn and become aware is really just through conversations. And I love that format. So so thank you for having me here. So as you mentioned, and I'm a physiatrist, or pm in our physician, and we're very focused on quality of life and function. And about eight years ago, my husband, I had the opportunity to custom build our home, here in San Antonio. And at the same time, my grandmother had gone to live with my aunt, her husband had passed away several years before, and she kind of bounced around different family members, primarily helping them and getting some help herself. And actually, it's around Easter time when we're recording this. And it was Easter, of 2014 When I went to visit her, and I noticed that she was not able to use the bathroom in the house that she was in and I asked her about it. And she said, Oh, it's too narrow for me to get in with my walker. So I just take a sponge bath and, you know, work around it. And as I like to say my head exploded, it'd be like I was thinking like maybe a dermatologist who's you know, kids are getting constant sunburns or something. It's just, you know, it just was antithetical to me that my grandmother, somebody I loved very much I was very close to, she taught me how to read and write and swim, we grew up very close to each other. And I just felt at that moment, just that I was already going to be building a house and I thought I needed to solve around this and have her come live with us. And then my brain got to thinking, she's so pleasant, and has so many, so many incredible life stories to share that it would be good for my children too.
You have kids how old? How old were they then.
Speaker 2 2:40
So I was a pregnant with twins at the time. So my twins are now eight years old. And so it you know, it was partially selfish, too. It's not hard, you know, it's not a bad idea. Sometimes I have a third adult in the house that can can help or just be around to get packages or things like that
Or even just to have those long, long conversations with two year olds when they just want to come and say stuff to you. And you're trying to do other things.
One of our favorite things, my son had some some difficulty getting the reading part down and I would just send him over, she has a sort of a, what I would call like a mother in law suite, but it's attached an apartment attached to the side of our house. So we have a room, I mean, a door between our house and her apartment. And so I send my son there frequently just to read because sometimes it can take a lot of patience to work with a new reader going through line by line and, and she enjoyed it, he enjoyed it. And so I, you know, there are some misconceptions about multi generational living, that they're always unilateral, that the younger people are taking care of the older people. And that's actually not true. It's more often the opposite as when we were chatting before. That kind of living is really helpful for child rearing or childcare, it can be helpful for socialization, it can be helpful for just sharing the tasks of the house, especially if mom and dad are working and those types of things. So that's how
I remember too that socialization is not a one way street. It's not just that older person is feeling lonely. Children really benefit from having that. More people involved in their lives who clearly love them. Yeah, wonderful. And you had twins, and you didn't really have a split and you could just have grandma look after one and you could concentrate on the other one.
No, it was it's been, I always say it's been one of the most beautiful things I've ever been able to do in my life. And part of that is because of the design. And I became, you know, the design works for us. And we thought about it ahead of time. And I spent a lot of time working on the design to make sure that her privacy and independence were protected, that our privacy was protected and then the flow was good. So this wasn't sort of an afterthought. You know, extra bedroom type of thing. This was a very intentional design.
but it's obviously intended to be a permanent. She's going to remain with you as long as she can in an independent way more or less. it's a fully it's a full apartment, kitchen, bathroom, everything? Yeah,
Speaker 2 5:17
Absolutely. It even has a washer dryer attached to it. And you know, when I was designing it that, I don't know, this is pressure, but I thought, you know, she's going to spend the rest of her natural life in this environment. This isn't somebody who had planned on moving multiple times. And so I really had to design thinking, I'm not sure how long she's gonna live. But I knew what her health conditions were, that were affecting her mobility and her quality of life. And that was really where I started with the design and thinking backwards from there. She's not a wheelchair user, she hasn't been she does use a walker. And it's very conducive to that as well. So I had so much fun doing that. I just kept sort of doing it as a hobby, and then eventually as a business.
Did you did you think ahead so that it would be able to be converted to be wheelchair friendly?
It is all wheelchair friendly. Now? Yeah, it was designed, she just hasn't gotten progressed to that point.
Yeah, we're possibly jumping ahead. But what about what if you if you're a designer, presumably, you aren't going to just design houses for your family? Do you do retro design? Because, you know, I live in a house that was built in 1918. It's not particularly useful for me sometimes, as I approach seventy the stairs, sometimes they're a bit steep. But But I love my house. Right? So do you help people who want to stay where they are, but don't have the luxury of building fresh?
Yeah, so there's the brand new builds, like we did, obviously, those are the most easy to work with. And then there's additions, which are also fairly easy to work with has some space limitations, but renovations are really the challenging part of it. Because you're you're working with existing load bearing walls and those types of things. So I consider myself more of a design consultant, as far as looking at it and editing it and thinking of it through the eyes of a physiatrist or a physician who's worked with people in the aging population or people with with different abilities. And really taking that point of view. So the design industry, unlike medicine, has not really adopted a trans or interdisciplinary approach. Usually an architect and a builder, maybe, maybe an interior designer,
We do need to remember that it isn't age necessarily takes your mobility from you, you can be really young and need a wheelchair.
So Right. And that gets back to Universal Design is another movement, which is a little bit different. But that's this idea that we should be designing all homes to be usable by people of all different mobility levels. You can see it commercial spaces have obviously gone that way, partially because of the ADA rules here in the States. But I truly believe residential will go that way. Eventually, much like we'll look at energy efficiency, we will look at usability of the home.
Right? One of the things that each of the houses, I've all of my houses, this is actually the youngest house I've lived. But one of the things that is always a challenge for me, I always make sure this is downstairs bathroom, and grab bars. But getting people into the house is almost every house I've had has had steps to gain access. So yeah, we have wedges and things. So if I know somebody's coming with a wheelchair, but I would like people to pay more attention to entrance ways, if they could
vary. And I'm glad you mentioned that. So for people who are differently abled, or using a mobility device, it feels very hostile to them. When they are they you know, as much as I've talked to them about it, it almost feels like the home is off limits, they come up and there's you know, eight steps up to the front door. And that's psychological as well, as far as how invited Do they feel to share that space with somebody else? And obviously, people aren't thinking like that when they're buying homes. And sometimes you can't, you know, not be if the homes in the perfect place, and it's going to be that way. But even thinking about the rear entrances, being, you know, smooth entrances or zero, you know, sorry, when I'm saying like it in level entry through the back is, can be really helpful. But if that's through a old garage that's got tons of stuff in it, it may not work either. So considering I'm glad you said that, because obviously there are a lot of young adults that have disabilities and use mobility devices and you never know when your child's friend might have someone is using that and trying to think that as far as you can in that direction. Yeah.
And it's tends to be rather expensive. Do you do you help people with dealing with the various grants and things that are available or is that that's another person's
so usually the the projects I worked on are private get funded. So somebody's you know, renovating or they're doing an addition. And the design work is is really consultative. So I'm not doing necessarily the blueprints and things like that it's much more just doing the edits of, you're not going to like this door here, you're not going to like this toilet position here, you're not going to like the height of this counter. And those are the things in the early phases of design that you can, you know, you can edit very quickly on it with a paper and pen or something. But once it's in real life, it's expensive to edit designs in real life, which is what renovations are.
Right. Right. That's, that's my house. But I'm unlikely to have anybody older move in with me. But of course, nobody knows what what might happen. There's so many things that can affect mobility. We have been speaking before about cultural differences. And I think that sort of, I think Americans are coming around to the I think, do you remember Dynasty? The old one?
They all lived in the big house. Right? I think there was just sort of this picture in people's minds. And then then we got very, very individualistic. And I think people are beginning to go back to realizing that it's nice to have family nearby. And it's nice to have them live with you sometimes. Depending on where you're living in the country, I mean, you could, you know, have back to back houses, you could just be one, one street away that you could, you could remain in your house, and a lot of older people wants to stay in their own home. And where my husband's from, my husband's from the Dominican Republic, and it's standard that you know, grandma lives with you, or or you live with her. It's it's far more common. In England, I think we've, we've sort of I haven't lived in Britain for a long time. But I do have a family there. It's, it's becoming more what I consider standard America, mostly because people are more likely to move away from home for work. And then you marry somebody, and they're from somewhere else, too right, it's more likely and therefore, it, it's less easy to keep an eye on people unless you physically move them in with you. So I think that this is this has broad appeal across the two continents where this podcast is listen, I shall make sure to mention that. I didn't know
that. That's good. That's great. And and you're right, the cultural differences are part of what got me more to where I'm moving now, which is much more into the mindset of caring for aging loved ones, because the design part you would think is straightforward, but it brings in so much baggage, of how to combining families or generations or the financial aspects of that. And I think the cultural aspects are fascinating the differences there in the expectations. And we're at a in an unprecedented era with the number of women who are working in professional jobs, having children later in life, and maybe even working later in life and right about that time that the career is peeking or maybe you're looking around the corner at retirement and you're getting the kids out of the house. And then oftentimes they're experiencing some more either management or caregiving of their parents affairs, health or financial, those types of things. And that's navigating that is what I want to focus on beyond in addition to the design, but just navigating that from a mindset perspective, making sure that we matter too, especially if we're in the mindset of giving and giving and giving to our careers and our guests. And then suddenly, it's you know, you get in the habit, I call it being a ticket taker, and you keep taking tickets and taking days all the time I go to work, take tickets all day, I get home, my kids, I've always tickets for me to take and follow up on. And so it's a very natural movement I see for professional women to kind of exhale and think now it's my time now I can relax and do what I want. And then right on the same time, it's oh, well, can your mother in law move in and so my, my passion right now is creating a safe space to explore that and make sure that it's right for them. I'm not a diehard advocate of multi generational living, if it doesn't work for you, a lot of it depends on just the
as a woman as a woman who cooks my immediate thought is, kitchens because like I barely want my husband in there because he puts things in funny places. It really there's so much part of a woman's identity whether it should be or not. I mean depends on the woman. But But I would imagine the your grandmother grew up cooking for the family. She did have she has her own but she so she lives completely separately at the moment. I don't mean close No, no. It's basically
an efficiency apartment that's attached to her. It's just a continuous with our own home. But what we did, she was a prolific she had seven children and I don't know upwards of 40 great grandchildren right now. So she's the matriarch of our family and and cooked and baked for everybody all throughout years, every birthday, she did my wedding cake. And when she moved in, I was worried about that identity loss because obviously, we weren't going to put a brand new full kitchen in there. So what's in there is an induction range, which is nice because there's no open flame. And she has some visual, some visual issues, and we didn't want her having to navigate, turning on and turning off an open flame. So between the induction range, and she has a ninja type, Instant Pot airfryer type thing in between those two items, she is happy as a clam. She cooks every night for herself, which I think is such an important physical and cognitive exercise to plan it out to complete it. She cooks the food she likes to eat, and she'll will come help us she's you know, she can't keep her out of the kitchen if she hears us making certain things and she'll come inspect and I think that's beautiful. But my husband's a chef and our family I don't cook at all. And it's been really fun to have him have her as a resource. And so she's you know, the the alpha as far as chicken fried steak and some other things that she's here in south Texas and and to have her has been a really beautiful thing. But you're right, I have seen I saw one multi generational home that basically had a double kitchen for that exact reason. There's one kitchen for the daughter and one kitchen for the mother in law. Because I didn't think they wanted to have you know, those crossover?
Yeah. And there may be some issues with depends on No, I've been married for nearly 40 years now. So my mother's passed but had had we have an older family member come in, I'm already established No, it started thinking maybe my daughter in law, that might be harder, no, I might be the other the other generation I might be the bread on the sandwich on the other side. I'd have to think about that hard, it will be hard. It's it's it's a challenge. It's but your domain. i If it's her kitchen, I probably just sit on the couch rather than risk. Getting in, you know, moving stuff that's not mine. My son does not live nearby that I have three sons, my youngest son lives in Flagstaff. And he's recently married. And um, well, I've known her for a long time, it's been at a distance, you know, for passing for a week or two here and there, we don't really know each other in the same intimacy, of intimate way you would if she was living in the same town. So I worry about stepping on people's toes, and I'm sure a lot of people do.
And I'm so I'm so glad you said that. Because I feel like that's really where my my passion is right now is talking about those difficult conversations ahead of time. Because there can be a lot of assumptions, people tend to be very polite, and you know, not not want to impose. And that can create some tension over time. So even if you were to stay, with your daughter in law for three months, part of this would be what are the most difficult conversations that we can have ahead of time, because she may be thinking, I would love to have my mother in law helped me with this, but I'm afraid to ask because she might think I'm not good at being a cook, or, you know, she might think that I'm taking advantage and and you both, you would be shocked at how crazy the stories are both in one person's head and other person's head. And once those are explored, sometimes you see some really beautiful matches that wouldn't have been there if that conversation wasn't had, especially for multi generational living, because that's a more permanent structural combination of two lives. But even going on vacation or planning an event together, I noticed that a lot of people are just afraid to ask those questions up front, can we cook together or, you know, if I misplace something, we please tell me so that next time I can put it in the right place. And a lot of us just think, Oh, it's too much trouble. And I'd rather just avoid it altogether. But when we're really, you know, have a lack of positive social interactions that are not virtual these days, you know, really missing out on something as beautiful as cooking together. I would hate for that to happen because of a design issue or a lack of a conversation
in three words or less. A kitchen that would need to be sort of by level, say somebody was in a wheelchair. And other than that the person is, I mean, I'm five foot two. So half the kitchens I go into aren't particularly usable. top shelves are out of bounds. I can't get to them without a stepladder. As I get older, I don't want to be doing that so much. What kinds of things are you able to do within the limitations of a normal sized kitchen, whatever that may
be? You may add a wheelchair level?
Yes, for both so you can accommodate both people both
right? So it's easy to have a bi level surface meaning so you might have the cooktop at a what you would call a normal surface and maybe 32 inches. And then as a continuation of the island is a step down to a roll up counterspace and that's usually what they have That way that the cutting the preparation, the plating, all of that is done at the wheelchair level, it is very difficult to get a cooktop down to a wheelchair level safely because of the what has to go underneath the cooktop. If you can't put your knees up against something that's hot or, and that's another thing to always think about the skin under you know, of the wheelchair user that's going to be in contact with anything. So there has been burned injuries of people that pull up under a sink, and the sink is running hot water. And if the person is insensate, so there's a lot of protection that would have to go on the pipes. So I've seen a lot of great designs that way. And that includes people not just for the food prep, but also for dining as well. It makes it much easier for them. And then ovens, microwaves and dishwashers are very easy to put at wheelchair heights, the cooktop is probably you've identified what is the most probably the most difficult one, unless you go to something like an induction range. Like you know, like we were referring to, if somebody's comfortable using induction technology to to cook, then that's much easier to do at that level.
If you had an induction range at that height, are there any dangers to the normal standing height for an adult. And if you've got really multigenerational that makes it easier for little ones to get their fingers there, because induction, of course, is safer.
Right, the biggest issue is going to be hot liquids. And so there's all different levels of induction, and the some of them are just a plate that you plug in, and then you put the pot on top. And that would be just as it would with anything else as if the liquid or the food itself is very hot, that can't be within proximity of a dog or a child that would be able to knock it over onto somebody. So you would get a lot of it depends on the context of who you're designing for. And understanding also, I mean, we haven't talked about cognitive limitations, but that's another big one. So if they can't remember to turn something off, or they can't remember that it's hot, and they need to move it out of the way and things like that. That would be another limitation to it.
Yeah, I can see that. But But I how somebody is this week, and how they are this week, next year. Right? It's going to be a moving goalposts, you're going to have to think ahead for a lot of those things.
You just Yeah, so that's why I think that design, I like to call it pluripotent design, where it can be modified without massive renovation when you need to. You don't and I and I talked to people about, you know, we we talk about designing for wheelchairs, less than 4% of seniors actually end up at a wheelchair level. It's fairly rare. Not that we shouldn't think about it, that that's important thing. But I know I in my head, I think a lot of people think well, I'll just progress from a cane to a walker to a wheelchair, then, you know, and so you can you can think in those terms. But sometimes the best idea is not necessarily to collapse the whole design around that one idea. But you're right, having a pluripotent means making sure that the plugs are in places that will work for that person, if they were to ever need a hospital bed or oxygen, a dedicated oxygen outlet, and some of that just understanding what their current health conditions are moving forward.
Yeah, well, I'm triggered to question was that the fact that we will all cognitively there will be some loss, there'll be some loss of response speed. Right, those kinds of things.
Right, yeah, so I'm really big about organization to it should be very easy to organize and very easy to clean. And the more tasks that can be retained by someone as they age, the better it is for their brain. And so I don't like designing out function. So if you don't put the hookups for a washer and dryer, then they're constantly either going to be relying on somebody to do the washing and drying of the clothes, or they're going to have to navigate your house and all of your piles of clothes and your own laundry room. And that was really big and the builder, when I was doing it, the builder pushed back a bit, because it's very unusual to have a second set of washer and dryer in the home. But it has been it has worked out very, very well. And she appreciates that she does it on her own time. Again, it's another cognitive and motor task that she owns. At least for now. She'll be 90 this year in November.
It's a little help for me because I am hoping to replace the washer dryer that we got with the house when we bought it. And I was thinking to go to a tower but maybe that's not such a good idea because I don't want to have to change it again in five years when I can't reach up.
Yeah, and that's funny. You mentioned that because there's a lot of shoulder issues that come up that make it difficult depending on where the dials are.
I'm thinking wet towels, right?
Yeah, yeah. But But that's it, you know, talk to people if you're doing an addition brand new. Just put the hookups for the washer dryer even if you're not going to put them in now, only because to add those later is extremely expensive. Those are special See, that's a specialty hook up there, you can't just have a regular outlet, you'd have to have water there as well. And when they're doing it in the design phase before the sheetrock is up, you know, that's a, that's a little, you know, one little turn in the water lines. It's not a big deal. But obviously after the fact, you're pulling out stuff. Yeah, you don't want to. That's expensive. Yeah.
What other advantages? Do you think there are? Be? Are you are you sort of pushing for people to have? Or are you trying to remove the barriers to people having multi generational homes.
The one of the reasons multi generational living is increasing is because of the scarcity and cost of housing. In the United States, we enjoyed a period where houses were relatively inexpensive. And I think that fueled a lot of the, you know, spreading of families that they could live anywhere, they can move from their best job and, you know, maybe end up throwing down roots in a different area. And as we move towards that, my sentiment is, if we're going to do it, let's do it well, and do it, through good decisions at times where it doesn't cost extra money, that's been my focus, not so much that there's so many emotional and psychological implications for living with someone, especially a mother in law, that I'm very sensitive to understanding that that's not right for everybody. So I don't come out advocating because I feel like it's a very personal decision who you want to share your dwelling with. It happened to be an incredible move for us. And like I said, one of the best things I've ever experienced, but so I'm of the mindset if you're going to do it. And to be honest, obviously, there's resources, you'd have to have ahead of time to even build and do those. So I want to acknowledge that there are a lot of socio economic factors that wouldn't put people in a position to be able to think about this, a lot of the time, they're just going home and clearing out a back bedroom, because that's all they can do. But if you're a professional and have the resources to design it smarter from the beginning, to make life easier to extend quality of life and function, that's really the space I'm in, you know, again, if we're gonna do it anyway, let's do it with these other things in mind and make the design durable, and make the design serve that person longer term than it would is just versus an off the shelf generic, you know, ensuite design with a bed and a bath.
Now, if you were my consultant, I would have to ask you, what do you think about elevators? Because I have, like, there's no space to add on? Right? Not not cost in a cost effective way, at the ground floor level, they end up with no, no yard at all. So really, the only way would be to have an elevator to at least take people from the ground floor to the the main bedroom area.
So there are very
They are pricey
Well, the price is one. The second is very few homes are structurally built to the codes that would be required to get an elevator. And that's another example of you know, if you're in the design phase of a brand new build, you can put, you could select a closet area, and you can build it out to support an elevator in the future. From the from the ground level, you know, I guess getting in at the very beginning. And I've seen people do that. And you'll see a closet on the first floor and a closet on the second floor and they're they're stacked on top of each other on the floor plan. And the reason for that is eventually you would have the elevator, I will say the cost is prohibitive for the vast majority of people and then the maintenance there, they're particularly dangerous. And don't google elevator accidents, a horrific rabbit hole of home elevators not being quite as safe as even the ones we use, you know, in commercial settings. But that's where you get into the stair lifts and, and those types of things and between the cost and the other thing is, if it's a wheelchair user, we go back to is their cognitively safe to use the elevator correctly. And and sometimes those things are mutually exclusive. So they might be in a wheelchair, but then also not safe to use an elevator and that's another way to think about it. So there's very few homes that are by the time you get one and and get it costed out is that that's a good solution for them.
Interesting because that's often their selling point is put in an elevator, stay in your own home don't have to move.
Right. Right. Another thing is, you know, whoever the intended user is going to be is to ensure that they want the elevator I've seen so many renovations put in homes and it ends up that person is just not going to use them. So I've seen people have stair issues even if there's a stair lift there, they want to continue using the stairs and so some of it is a really thorough discussion
if they can walk slowly enough to not have fall potential then actually would be better for them to have that activity. But
right so we are not always pro stairlift if the stairs are safe at that time they can be those can be put in fairly quickly. Those are not you know, like an elevator, that's a whole engineering thing. But stair lifts not as much. Obviously, the the, you know, area needs to be able to hold the equipment but but yeah, so that you end up getting to a design point. And then at that point, there's that tricky gray area. And I know you've seen this in medicine, of accommodating and accommodating, but then the medical needs can outpace the home. And that is a really, really difficult place for families to be in. Because at one point, we're thinking, well, there's a lot of falls, you know, are they going to be in an assisted living, or skilled nursing facility, and that is really a hot button, talking about an explosive topic that is, even in my own family. You know, the anti assisted living anti nursing home sentiments very high, almost to a point where it's very challenging to even talk about it, they have such strong sentiment against that. And that can be cultural, that could be just how our family does things. And that can make those conversations even harder.
Now, if you've got a big enough house that you could have live in help as well, but they can't
afford it live in another generation. Yes. And sometimes, you know, the design would need to accommodate a living caregiver. So your design challenge is even a little bit different. And then part of the design is also making sure the caregiver has enough room in the shower, the caregiver has enough room in the bathroom. If you just go straight 36 inch doors and level transitions, that's fine for an active... somebody's got to be with, yeah, somebody's got to be with them. And if you forget about that person, or that person gets injured, because the design isn't thinking about them ahead of time, then that can that makes it harder all over, you know, to keep a caregiver for that person.
What kind of qualifications do you have for the work that you're you're offering now, because clearly this wasn't covered in residency, it was a lot of your information came up.
Right. So most of them, I mean, obviously, from the design standpoint, most of it, I draw from my clinical experience of working with people that have trouble discharging from the hospital because they can't go home, or the homeowner accept them back or isn't suitable for their needs. And then my personal experience designing with my grandmother. And then there's also a certification certified Aging in Place specialists, which is through the National Home Builders Association. And that can be for building professionals, some occupational therapists and things like that. But there are certifications that you can get another one of them is called the Certified Living In Place Professional or the CLIPP [clip certification]. And that will give you enough tools to move forward. I don't market myself as an architect, I'm certainly not. At that level. I'm much more of a design consultant, and editor in that space,
and an explainer of what those things might write might be coming. Yeah,
think of it more like a design advocate that I look at it. And I think completely differently about the person who's going to be in that space, and then offer ideas and solutions that will make the space more suitable for that person.
Right. But you could consult for example, should I suddenly have lots of money, you could consult so I could find out how you think it might be a good idea for me to alter my house so that my daughter in law and I share a kitchen? Yes. You know, as we get older, it could come to any of us that would be helpful. And I'd love to have more people living in my house. Because I do come from a culture that's we have my grandmother lived with us for years. Oh, nice. Yeah, she had osteo and rheumatoid arthritis. And very before people had their hips replaced on a regular basis.
What was that experience like for you? Because I would imagine, yeah, love. Do you love it? What did you love about it?
She was actually fairly bedridden. She wasn't able to do very much. She was in the boxroom, and I was, in Britain is just a room that wouldn't qualify as a bedroom, but people can put beds in there. And it was just great. It was an extra person to listen to my woes as I entered it, I was pre adolescent, that sort of 10-11 age group. And it was just it was just lovely. We had three sisters. I was the eldest so I could go moan to my grandmother about my mother carefully. But I mean, it was just it was just lovely having her with us.
What did your mother think about it? What was her experience? As
I'm pretty sure she was quite happy with it. She did a huge amount for the family. Because we also had at one point in our three bedroom house. Also four of my cousins because my aunt became ill, so she had four she had eight children in the house. I'm not necessarily different from a lot of people on the street, there were other people who had seven children of their own. So it wasn't, you know, it wasn't particularly remarked on, necessarily, but she had an a six month old. Stuart was maybe pushing two, and then sort of in then the rest of us sort of merged. So we were like, 10 through six months. So yeah, as and as I pointed out, so we're trying to on this podcast, I'm old. Therefore, we're talking 1950s 1960s. A lot of the mod cons we have now, we don't have. Disposable diapers, are you kidding?
Well, I love having that reference point around. My kids were complaining one day about getting up early for school and my grandmother chimed in. Well, I used to get up at 3:30 in the morning, and milk cows and work on the dairy before I went to school, and that shut them up. It's very nice to have some, you know, reality checks as kids have a very luxurious lifestyle compared to where she grew up in the 30s and 40s. So that that's always a fine add on.
I'm old enough to remember our first telephone, telephone and our first television set. No, wow, we were one of the first people on street that had a television set. Probably 1957.
Would you be comfortable? If I asked you some questions about sort of your own?
I can edit away. Go ahead. Okay. So
I want to part of, you know, like, we talked about the design, and my thing that I'm really focused on right now is the conversations before the design and what sort of the expectations are? And I'm wondering, you said you're around 70. Right.
Well, my next birthday I'll be seventy.
Awesome. And so my question is, how have you approached your own advanced directives or life planning? And how have you shared that with your children?
Well, to will and copies and advanced directives, that that's always the three sons share it, and they'll hit them in order of arrival. We're all pretty much on the same page. So I don't think that's been it wasn't a difficult conversation to have, just as we had conversations about organ donation, when when the kids were quite small. That was lovely. Yeah.
Well, so it's, uh, you didn't, there was no drama about having a meeting about it. That was very matter of fact. And
no, they all knew verbally, we just when we got our wills re-drafted, we just made it official. That was it was always very straightforward. The issue of who's going to live with whom we've that sort of a rolling thing so far, the other two, the older sons are very close by. Neither of them have living conditions where we could move into them, so they'd have to move into us at this point. But, yeah, and we also have, I don't know, if it's very common, we're pretty comfortable the idea that money belongs to the family. I don't mean it's, you know, we're not trust babies and stuff. But it's just like money as a tool. Whoever needs it gets it. So I those conversations have been pretty comfortable, I think. And that's what I usually get when I tried to say something, right? Of course, you've got this and this and this, and you'll get this, you'll get Would you shut up mom? Like you're not supposed to pop your clogs yet?
Well, I would love that. That's so open. And I think that has to start really young. Like those kinds of conversations. We just normalize that we have, you know, difficult conversations, what what have you talked to them about, if any? Or what would the expectation would be if you needed assistance in the home that your your spouse was unable to provide for whatever reason, would that the idea is that one of them will move in and help or that one of them would get a caregiver or what does that looked like?
We haven't decided who would do what but I mean, somebody might surprise me and act what I would consider out of character. But I think pretty much the whole family has that same mindset. We have that with my parents. My sisters, and I think it's just I suspect it's a cultural thing. And we've passed on to them even though they were American.
Well, that's all I'm going to ask about because you're that's kind of the melting pot of the different cultural approaches. And so how did you? Has this been an overt open conversation that when I need help I expect you to move in? Or is it when you say an understanding I'm calling
a family meeting? No, it has come back on On occasion, we've said, I mean, the kids have spontaneously told us when they were younger, that they, they will help and you know, they're gonna, they're gonna decide where their house will be depending on you know, we, I can't be at the top of a mountain because you wouldn't be able to get in not right that kind of stuff, those kind of spontaneous conversations, but we don't, we haven't had we had a conversation when we lost it or redid our wills about who would be the executor because they were all perfectly competent. And so who would be the most likely to be findable. And who would have the most time available, be the most organized, those kinds of those can be a little bit because, you know, it's sort of birth order assumption,
first order on geography, right, and
geography wins at the moment.
And a lot of it comes down to modeling. And so you're modeling for your children as young as however young they were, that we go and take care of this loved one in this way. And it varies quite a bit. And, and there's a lot, there can be a lot of mental drama over how far somebody is able to go either financially, or career wise. And you know, a lot of careers can't afford somebody to, you know, stop working for that long that period of time. And it really just brings up a lot of interesting questions that each each individual experience is so different, but the cultural influence is strong. And it sounds like, although you and your husband are from very different cultures, they kind of converge on this specific topic fairly nicely. Is that right?
Yeah. Actually. Somebody said, you know, why did you marry her not in a nasty way. But it said, for him, it was, we obviously have the same feeling about family,
you know, there has to be money to fuel a lot of the caregiving activities. Oh, yeah. And it'd be like, well, this mom gonna use her money, or I'm going to use my money and, and the familiar beliefs about money, or into even that phase of life, and who's going to pay for what, and the bigger thing I see in my age group, I'm in my 40s Is that a lot of us, understandably, for privacy reasons are completely unaware of the financial situation of the parents, it could be anywhere from, they've saved a lot of money. And you know, they have a great retirement and are going to have great benefits down to, you know, I thought they had money, but they're actually have a lot of debt, which was going to limit some of the caregiving options long term. And that's a sticky, you know, it's a sticky privacy, autonomy type type thing. But there are several states in the United States that have what are called filial laws, where the state can come after children. If the their parent is costing the state money and doesn't have Medicaid coverage. It's not enforced in most states. But the fact that
would be a nightmare, when you consider some of the family dynamics, I come across
Absolutely. And that's why they're probably not enforced. But just the idea that in in the States, they're in a written differently by state, but basically, essentially, there's a person who ends up in a state funded Medicaid type program, nursing home, and Medicaid, or they'd come into a nursing home and the state is paying for it. But they don't have coverage than they have the right to find the next of kin, a child. And that person has means to go after that as well.
It's so very forward thinking, what are they going to do when they retire? And
I don't know that it makes any sense. But when I started researching this, and found this is not in the state I live in, in Texas, but again, they're not easily enforced for all the practical reasons you can think of and most people when they need Medicaid, can get qualify for Medicaid. But the other issue is Medicaid does have a five year look back. And so if a child was getting, say 10,000 a year, for the last five years, Medicaid can surely go back and they will go back and reclaim that money. So that's probably that's the more actual thing that's happening is they're going after anybody who's given money in that timeframe, and then reclaiming that, and then reclaiming the home when that person passes away. So that's how the state makes up for what you'll see is the the rapid expansion of, of nursing homes, especially here in Texas, I'm sure it's everywhere else. But you know, we can't drive down any street and not see a new skilled nursing facility going out. And part part of that is just the housing issues. The A lot of people are not in position to help take care of parents or grandparents those types of things.
Yeah, well, here in the northeast, at least and probably across the country that younger people have a hard time affording anywhere to live anyway. So they may well choose or be forced to go and live with their parents. They've got multi generational, the other way
that was the largest, the largest growth during the pandemic of multi generational living was young adults moving back in with their parents, it wasn't adults moving their elderly parents in with them, it was the reverse of what you would think. And I've even joked with some people about trying to design out the possibility for your child to come back home and one of my good friends is buying a house right now. And she said, I think that secondary bedroom is kind of small. And I said, maybe that's a good dish, leave the secondary bedroom, very small and not something that any 25 year old can get too comfortable in. And, you know, to help motivate them out of the house, too. So I love thinking of design as a tool, just like you've been, you know, mentioned, we have so many different tools we can use and design as one of them to, to bring about behaviors and feelings that you want and try to, you know, design against things that you don't want. So there's a behavior that you want, I love the idea of designing that behavior into the home at the beginning, whether it's a reading nook, or an exercise area, or, you know,
are you in favor of sort of the kitchen being sort of part of the living room, I don't know what you call, it's completely open plan.
Open plan. That's interesting, you ask that, that that's a very personal preference, depending on who's in the kitchen. So some people love the idea that they're cooking. And they keep a mess that the biggest complaint one of the bigger complaints about the open kitchen, is that a lot of people when they're cooking, create a lot of mess isn't the right word. My husband would not like that word, but but there's a lot of pots and " evidence of their work". And if they're particularly clean, you know, or pride and you know, having a very clean surface, mixing sort of the dining room and living room in with that space can be challenging. So I have seen some kitchens going back to a more private setting, but a lot of that's the personal.
I like to just be me in the kitchen, but all of my kitchens have been eat-in, although I have a dining room. And usually if I'm cooking and I have people over there in the kitchen anyway. say get out, which will be rather rude. I just you know, we just put up with it. Sometimes people will start doing the dishes. Sometimes they'll put things in the wrong place. I'll live
Oh, yeah, no, we have a completely open kitchen design. But my grandmother was you know where she lived before when she was still raising kids and grandkids as she had a basically a galley kitchen to herself.
But yeah, and your grandmother's generation might when I think back to migrant the grandmother that lived with us. Her her original house. In fact, her sons ended up living there until they died, was a what we call a 2 up 2 downYou went into in the very narrow hallway. There was a reception area sort of on the side. And then you went into the dining room and through to the kitchen. It didn't have a bathroom when I was a kid the bathroom, the toilet was outside. And then steps to the two bedrooms upstairs. She had eight kids well,, seven surviving children. And her kitchen had bathtub in it. And she was a professional cooker. So she made it she would go out to work she did catering stuff. Oh, wow. But so when I think about right, my complain about how little space I have in my kitchen, no matter how big it is, it's never going to be big enough because right? horizontal surfaces tend to get things on them all the time. But when I think about I mean she had a standard small stove Draining board that she uses a cutting board. I know I think she had a table in there. But I think it's a long time ago. A table in there and she had pantry because there aren't fridges so you open the pantry and there was marble to keep the milk and cheese and the butter.
It's funny you mentioned I think I've mentioned you that my my mother's second husband is from the UK. He's from Solihull. And when he came here about 10 years ago, he just remarked at how massive the house is and seemed to him and he's currently living in about a 1400 square foot three bed two bath and he's he's like this in my area would be a mansion This is so much space and he loves cooking and it is so interesting to have that different perspective because that's I think that is kind of the standard floorplan standard kitchen size and it's all perspective right? And he was telling me just how cramped the the the areas can be in and when we were talking about stair lift it was his mother who they wanted to put a stair lift in for and she was going up and down the stairs on her bottom and refused to ever have the stair lift put in she said that she didn't need that and and so that even that cross, you know Atlantic conversation was was going on just in the last couple of years trying to make her more safe but a lot of it was personal preference. She absolutely. She ended up passing last year but absolutely refused that the entire time. And she said, I don't need that. So I always thought about, I've never got the chance to go to that house, but I just heard how narrow it was. But then she had a beautiful garden in the back. That I wish I could have seen. I saw pictures of it. But yeah, so hit the perspective has been nice to have somebody here from the UK in my family that talks about just how lucky we are to have the size of kitchens we have a lot more cleaning to that's what he always tells us a lot more.
You also could have had that experience had you done your residency in New York City, because then you would have had a shoebox?
right. Yeah. Well, they say everything's bigger in Texas, and Texas just has so it's such an expansive, like, geography here. And so the most countries so Right, exactly. So we were very spoiled, and in that direction. But yeah, so it's been it's been nice to have somebody from a different perspective.
I don't remember why when I looked up the size of the King Ranch one time, I was interesting, the square the square mileage of Delaware, Delaware, which is a tiny state, we have less than a million people. And I don't know what it was that made me look at it, but But the King Ranch is [more than] three quarters of the size of Delaware. Insane!
I don't doubt that Yeah. Yeah, there's a lot of houses on that ranch too. So I've always been wondering what was out there. But yeah, that's I didn't know that. That's a cool factoid.
Anyway, we are definitely out of time. I'm gonna have to cut lots of bits out. I've enjoyed very much. Thank you so much. It
was so much for having me. I appreciate it
in please, please come back. When you when you have something else you have to say, oh, and I will put all of your details. Of course in the show notes for people. Do you have a website? Or is it just word of mouth at the moment?
My website is Rebecca Tapia md.com.
And they can contact you for design ideas,
or I have some some a way to contact me about design and then I'll have a course coming this summer to talk about mindset for supporting aging parents, thank you so much for having me.
Thank you so much. Q for joining us at myth magic medicine. If you have found this episode useful, you can apply for free CME credit through the link provided in the shownotes. If you're not a medical professional, please remember, while we're physicians, we're not your physicians, so please consult with your own healthcare professional if you think something you have heard might apply to you or a loved one. Until next time, bye bye
Transcribed by https://otter.ai