Nancy Griffin talks to Esther Greenhouse, CEO of Silver to Gold Strategic Consulting, about her “Enabling Design Approach" to safe, affordable housing and communities.
Nancy: Please tell us about your background.
Esther: Well, I'm a unique professional. I am an environmental gerontologist, so that means I'm an expert in helping older adults thrive by design. My background is a constellation of expertise and sectors. I have degrees in design, gerontology, environmental psychology, and community planning. I have an important mission to change built environments to enable people to maintain their physical, cognitive, and financial Independence. What’s amazing is that when you do this for individuals, everyone benefits.
I started on this path at age five when my maternal grandmother who lived with us started using a walker as her rheumatoid arthritis progressed. She couldn't get in and out of the bathroom independently because the door was too narrow, so she ended up needing to move to a facility. The huge variable was the design of our house. So, this set me on a path for paying attention to the way environments affect our functioning and well-being.
When I was an undergrad at Cornell University in the department of Design and Environmental Analysis, I read in the brochure about how design will impact people's behavior and functioning no matter how well, or how poorly, places or products are designed. For me, that was an “aha moment.” That began my career focusing on the impact of the built environment on older adults.
Nancy: What types of services and clientele do you work with at Silver to Gold Strategic Consulting?
Esther: Silver to Gold provides paradigm-shifting services, education, awareness, and inspiration. Our solutions are offered in a variety of ways. We provide trainings and workshops, summits and forums, and develop strategic initiatives. We also advise and consult, particularly on building and community development projects. So that means we work with a wide range of clients, including municipalities and states, senior living and care providers, non-for-profit organizations, and professional associations. We also work with higher education, corporations, architecture and design firms, and builders and developers.
Nancy: Talk to us about the Enabling Design Approach you've developed over the years.
Esther: The Enabling Design Approach was developed in response to what I was seeing in the world around me. There are three pillars. The first is about person-environment fit, where the goal is to find an optimal fit between a person and the environment. Optimal fit means the demands of the environment should tap into a person's abilities. We're striving for optimal fit because then a person can function at his/her highest level of independence and can thrive. This doesn't mean they won’t need support from people, products or services, but they are going to be at the highest level possible. What we're seeing in our society, and in many places around the world, is non-optimal environmental fit where there is a gap between a person's abilities and what the environment demands of them. This creates a form of stress called environmental press which pushes them to an artificially lower level of functioning.
The second pillar is the status quo of design, which mean environments are created that are ideal for a subset of the population, and that population is the average height male between the ages of 20 and 40. How do we arrive at that very specific type of person? Well, it's because we tend to design for the highest physical, cognitive, and sensory abilities, and we ask everybody else to adapt. With older adults, we are not even asking them, we are forcing them by default to try to function in places that were never designed for them in the first place. I need to back up a and say that it's not just older adults. I myself am 5 foot 1 and I have a visual processing disorder so I'm often struggling with the built environment, e.g., reaching things or lighting, and that's not even age-related.
The third pillar is strategy which includes cost:benefit analyses, economic development, and programs and policies that incorporate the first two pillars. The 3 pillars as a whole, combined with the goal to enable people to thrive, is the Enabling Design Approach.
When it comes to the older adult population, we need to radically shift our thinking. We don't have to radically change the way we design. We're not advocating for everyone to live in a spaceship or a geodesic dome. What's needed is a radical paradigm shift, where we understand person-environment fit. We understand that the Status quo is disabling and that it's costing our society in terms of quality of life and enormous amounts of money.
Nancy: What can you share about the house you built for your mother?
Esther: The continuation of the story that began with my grandmother ended with providing care for my own mother. My husband (who was a custom home builder at the time) and I designed and built a house for my then 80-year-old mother to enable her to successfully age in place. We didn't do anything radical, there were wider doorways, no-step entries, appropriate flooring without changes in level. We installed a custom kitchen with lower height counters, because she was very short.
We enabled my mother to delay moving to a facility by five to seven years, and gave her a good quality of life. We estimate that those design features and the overall design of the house saved the family over 500,000 dollars by delaying the move to a facility. If she didn't have any money and needed to move to a subsidized facility, that would have been paid for by government funds.
Nancy: What is standing in the way of what you call Equity by Design?
Esther: The number one issue is knowledge and awareness. Part of my career has been in academia, which I thoroughly enjoyed. But one of the reasons I shied away from academic research is that I felt the concept of person environment fit—especially coupled with an understanding of our disabling status quo—was crucial information that needed to get out there.
One of the reasons I developed the Enabling Design Approach is to create awareness that society is a closed system of interdependencies. If our housing disables people and creates what I call forced frailty, we pay for that—again, not only in human cost but through increased long-term care costs. And thinking again about my mom as an example, there's data that shows that a 65-year-old woman can expect to pay almost $50,000 more over the course of her life than a 65-year-old man. There are variety of reasons for this. Women live longer with chronic diseases, typically about 12 years, whereas for men, it's about three years. The other issue is that women tend to be the caregivers. So while a man may have his wife and an adult daughter or daughter-in-law available, it's less likely that a woman's husband will provide care because he may not be alive or be unable.
So, we need to be concerned about things that are happening societally, for example, that fewer people are having children, that there's more divorce, and that there is still a gender wage gap. We need to look at the amount of care and the amount of money people will need as they age. If we understand all this and shift to Enabling Design for the status quo, we would be designing houses and communities that promote physical, cognitive, and financial well-being and longevity.
Nancy: As an expert in aging and design, what is your opinion about the whole age-tech craze?
Esther: This is a terrific question because as you said there a craze over “gerontechnology.” Technology can be a wonderful tool and resource, but we really need to look at where can that technology can fill the gap between environmental fit and press. There is also too much emphasis and excitement over technology as a silver bullet or a magic wand that is going to solve everything in age-related needs and long-term care.
So, while that excitement and investment is important, it's ridiculous to focus on technology solutions when we're not doing the basics—when we still are building new housing with doorways aren't wide enough and without zero step entries because we're not designing for the age continuum and ability. We need to shift how we design our housing and communities, then use technology in a supportive way. We need to make sure that technology is bridging the gaps in needs and services and freeing people to do what they do best.
Secondly, we need to make sure we have the infrastructure to support technology. Many senior living communities lack adequate broadband. I always like to share as an example is that in 2015, before the covid pandemic. The Coachella Valley School District began parking Wi-Fi enabled school buses in the remote areas so all students could have internet access to do their homework. We need that kind of out-of-the-box thinking, but we also need a massive investment in infrastructure.
The third thing is that technology must be designed to be successfully used by older adults.
Nancy: What gets you most excited these days?
Esther: I love the work that I do and I'm so grateful for being able to do it. We face a population that is growing older. In 2010 we had approximately seven potential caregivers for everyone older adult; by 2050 it will be less than three. So the question I'm really fascinated by is: How do we provide quality care when demand is growing exponentially and supply is already constrained and is declining?
I have the answer. We can apply the Enabling Design Approach to leverage the design of our built environments, to reduce demand for long-term care, and enable people to thrive.