Welcome to the Parkinson's Solutions Summit. I am your host, Dr. Ken Sharlin. I am very, very excited to introduce the next guest we have for this summit.

This is this is really exciting. And I'm going to ramble just for a moment, because if folks watching these medically oriented summits are used to visiting with scientists and physicians and providers that are in the health care field, you're going to hear something a little different today.

It is so relevant and so important. I hope we get the maximum number of folks watching this interview today. It is really in the discussion. My wife, Valerie, this is Austin Miller, and we're going to introduce Austin.

Formerly, he knows my wife, Valerie Sharlin, who used to be the director of a program for older adults. And one of the things that Valerie would talk about is she would say that the greatest transfer of wealth in our country is when folks get older and they get sick and they can no longer live in their home.

And so that nest egg that they say they worked hard for all their lives is then spent on a nursing home that, at a minimum, is probably in the range of about five or $6,000 per month.

And then up and you folks, you don't want to be if you can help it in those low end nursing homes, it can be pretty, pretty awful. But we're talking about spending your hard earned money when if you can stay in your own home, if you could live in your own home, the cost savings alone much less the quality of life of being in your own home, would be so much greater and then there would be less suffering in so many ways.

So we are going to talk about universal design. We're going to talk about aging in place. I want to introduce Austin Miller. He is the owner of Wise Built Custom Homes in the Greater Southwest.

Missouri area is located in the city of Nixa, Missouri, and he can build a home for you. Austin Miller, thank you so much for joining us at the Parkinson's Solutions Summit.

I'm happy to be here. Dr. Sharlin Thanks for having me. Before we get started, Austin, would you give us a little about your own background? How you got into building homes, a little bit about your your passion for the kinds of homes that you like to build?

Absolutely. Yeah. Yeah. So I got started. I mean, I grew up in in southwest Missouri in a in a very grow growth oriented area. And there was houses going up everywhere.

I had a lot of friends that were builders. My grandpa had a HVAC business. I'd ride around the truck with him and look at jobs and that sort of thing.

And I just thought that was so cool to tangibly build something and, and see progress for these these builders that would start with a vacant piece of land.

And then you'd see it dig out and then framing and then bricks. And it just always amazed me and I thought that was something I was interested in. So I graduated college and worked for another builder doing sort of hospitals and power plants.

Went down to New Orleans after Katrina for a while to work for the Corps of Engineers. So I had a diverse background there, but I knew I wanted to always build for myself.

And once the economy picked up, we I started a remodeling business on my own remodeling and building. But took a little while to get to where I was. This building, big projects, you know, small beginnings.

And that was ten years ago this month. And what we really focused in on in the beginning was a need that we saw for building and remodeling accessibly universal design, aging in place, you know, all the different terms and certifications which allow people to live in their home freely and independently and gave them confidence and and made their home a place that they could live safely and securely.

And so and now now I build mostly majority of ideas, custom homes. Some of them have universal design features. Some of them have very little. And so we you know, when you're in the custom home business, you you build what the market wants and what what people wanna spend their money on.

But we always have that conversation of, hey, let's talk about accessibility because it's for everybody. And there are some minor changes that we can make.

Even if you're young and healthy and you only plan on being here a few years, or if you're, you know, building your retirement home and you want to spend your sunset years there and you know that you're going to age in place regardless, are still things you can do that make it accessible for you and easier to live in, you know, for you.

So absolutely. Maybe we should start with just some definitions. Universal design, aging in place. What does that exactly mean? How are they similar? How are they different?

There's a lot of overlap there. And universal design, I mean, the best the best definition I've ever heard, which I've used repeatedly for ten years, is building in a way that anyone age 3 to 103 with any ability, can live in that home, can visit that home and not have any restraints.

The certified aging in place caps is a designation that I hold that is a certified aging in place specialist, and that is more specifically designed for someone who's going to age in the home.

And that way, the greatest transfer of wealth that you referenced. You know, we see so many people, my grandpa included a fall in the home. They never make it back.

They fall. They have to go to the hospital. My grandma is 87, otherwise healthy, fell in the garage, was in the hospital five days and that's where he passed.

And I and it did. I used to say that all the time, long before he passed away, you know and so certified agent place CAPS is the acronym there that is more designed and focused on someone who is in their retirement years who wants to age in place and maintain their independence.

So if we're thinking about this and by the way, you had brought up the idea of renovation and renovation, of course, it's important. There are many, you know, this home, this country and the planet has homes that are already built and we're still getting older. So a lot of folks may be thinking about just, well, should I just renovate my home?

And we probably should talk about the pros and cons of even doing that. But I know, again, I'm just going to reference Valerie, my wife, who would say that, you know, the problem is that you could end up you have something happened yet say you're in the hospital, they're ready to discharge you and you need to you want to go home in three it let it go home.

But the problem is that you need a crew to come in your home and make all kinds of changes from grab bars and handrails and, you know, and oh, my gosh, getting someone to do that kind of work, you might wait three or six months, You know, this work that's under tremendous demand.

That's right. So if it's possible, someone like myself, I'm in my later fifties thinking about what are the next 2030, hopefully, you know, maybe 40 years.

I want to live to be 100, look like I'm going to need to think about can I still stay in my home and either do those renovations while I'm still healthy and able in a proactive manner?

And does is my house even conducive to that? So maybe we can talk about, you know, what makes for a good home that you just simply renovate and what do you need to be thinking about if you're going to be building an aging in place home sort of from the ground up?

And maybe that's maybe that's a good place to start for folks are saying, I have a home, I have a home. Should I just renovate it? What do they need to be thinking about?

Yeah, that's a good question because, you know, some homes are certainly easier to renovate and modify than others. You know, when you look at, you know, my house, my wife and I are young and healthy, but we have a zero threshold entrance from our garage to our house.

We love it. You know, if you're moving a fridge and if you're just carrying groceries, whatever, open the door, you got to worry about tripping. But that's not something you can do after the fact, right?

You can build a ramp. Of course, But then that's going to take up space in your garage and space that you may not be able to park a car. And there are two cars.

So the best solution is typically to start from square one, right, when you're building a house. And I know that's not economically possible for everyone, but there are some restraints if you don't.

And so having someone who can identify come in and say, look, your doorways, you know, a lot of doorways used to be 30 inches and now a lot of them are, you know, 32 or 36.

And so if you are on a mobility device later on in life going in, if you have the room to widen those doorways, great. Sometimes you don't have the room to widen those doorways.

So really having someone who is cap certified or even someone with, you know, an occupational therapist background or something like that, evaluate your home is and I used to do these evaluations a lot.

Go in and look at, okay, start at square one. What's the most what are the most simple things we can do? What's going to be grab bars, possibly a ramp, those sorts of things which make it easier to to live in that house.

But having someone then take it further. Okay. As you are aging in place and we know that mobile devices, mobility devices will be needed at some point, is this feasible or do you need to look at selling this and either building from the ground up or finding a house that's a little more easily model beside.

The some of the features that we're looking for? You've touched on how do you get in from the garage to the house? Is it is there a threshold that you can pass through easily that maybe if you're in a wheelchair or if you have a locker, you're not going to catch that walk or your cane or towel with your foot drop or are not able to lift your feet high?

Yup. Got to pass through into the home. And then we're thinking about also the width of hallways. Yep. And where you need to grab hold if you need that kind of stability.

How about getting in and out of bathroom? So what are some of the bathroom considerations? Yeah, and just to back up to touch on that, really the three areas of universal design, the three main areas is if someone was going to come visit you and or if you wanted to live there and you had some sort of disability.

The three areas are getting into the home, navigating around the home, just general livability. And then, like you just said, bathrooms, right? If you have those three things, then anyone can come visit you.

Anyone could live there comfortably because they can get in, they can move around and they can use the restroom. If they do the first two and they can't use the restroom and no one's going to want to live or visit that house.

But when it comes to the bathroom, there are a number of things one's got to have a wide enough doorway are always like three foot wide doorways if we've done them as well, where the the bathroom has a closed door.

But then if there is, you know, a second room, it's a case opening for a toilet room or something. There's got to be enough room to move around there.

We like a five foot radius of open space at some point, you know, there and around the toilet, grab bars, lower or accessible countertop heights with, you know, shallow sinks and open areas underneath.

Again, some of those are a little more what I would call involved or a little more detail and specific oriented universal design. And some of them aren't just having wide doorways.

Everyone loves the open concept. So having more open area in your rooms goes a long way. But those are those are some of the areas as well as is walking showers.

You know, those are becoming more and more popular even for the market is demanding it for people that don't have a disability. But you know, whether or not they know it, they're building universal design that's going to help them in the long run.

So those shower tubs that were popular and maybe the 50, 6070s and many of us still have maybe one of them in our home, but they definitely are not universal design.

They are not aging in place. You have to be able to actually get into that bathtub. Maybe if it is a bathtub, it can occupy a tub chair. But if it's a shower, is it's is it a shower where you have enough width and space to go into?

If you were in a wheelchair, you know, could you even get a wheelchair into the shower? So we're talking about a pretty pretty big space for a shower.

So these are not minor changes and you have to think about that. How about even let's talk about doorknobs, faucets, plugs, things like that. They they play into all of this.

Oh, man. And the the amount of products that are coming on the market now are just incredible. You know, it's similar to home security systems. You can do that with an iPhone and a ring doorbell now, you know, so the advancement of all those products has done a lot for the universal design world, such as, you know, my wife and I, we have a touchless sink or touchless faucet for our sink and we love it.

And that goes a long way for somebody who doesn't have the dexterity in their hands. Simple things like, you know, the big rock or switches for your light switches and some of the smaller toggles where you could bump it one way or another and not have to sit there, you know, use a lot of fine motor skills.

The door handles levers over knobs, no brainer, and a lot of houses have those already. But it's it goes a long way for someone who has any type of grip, strength, loss.

There are products you know, even Alexa, you know, being able to to turn on and off lights or play music or, you know, entertainment, you know, television, that sort of thing.

It really is incredible how many products we're seeing come on the market. We built a house once for someone who was quadriplegic and had no use below below the neck and know there was we are not at the point where we could live independently and I'm not going to fool someone or throw out that line because that's not true.

He did have to have someone, but the amount of independence we were able to give him through these products for things like watching TV and getting around the house and music and security, being able to lock the door, you know, if there's a noise, outsiders, you know, being able to lock the doors unlocked and all these these functions that just weren't possible ten, 15 years ago, it's it is really, really incredible.

It's pretty cool to see. Yeah, I we visited homes we have a patient who suffers from ALS and welcomed us into his home. And it's very, very interesting gentleman and it's an interesting home in a lot of ways. It's very rustic. But, you know, we talk about where bedrooms are often located, especially, you know, a minimum two story home, sometimes three stories.

The bedrooms are often on the upper level. And, you know, so depending on where you're entering in the home at that split level or whatever. But the point is here that you could be trapped.

You're telling him that you're quadriplegic in a certain part of the home because he can't get to a whole other section of the home. If you're in the bedroom, if that's where you walk in, if you know the first floor, quote unquote, is the the living quarters.

And then you go down to where the rest of the house is, you may never get out of your bedroom then, or vice versa. You may never get to your bedroom unless you get an elevator or an escalator.

You know, these sort of things that can go up the stairs for you. But these are very, very practical considerations and even comes to mind if you're thinking, Hey, could my house be adapted to this time?

And we are seeing, you know, another wave of construction that we're seeing is more generational living. You know, people are saying we want to live there.

But now my parents and I've got my kids or the baby boomers are saying my kids are, you know, just getting that building age. And now we want to we want to have a living quarter for them while they save or whatnot.

And so then it is multi-tiered and multilevel in that sort of thing. But you are correct that that is a huge barrier later on in life. And even, you know, getting into the house, I would speak and do educational events and say if you ask the audience and do a poll, if you were to get an Iraq or some sort of injury and you had to use a mobility device, wheelchair, knee walk or that sort of thing, how many of you could get into your house without the help of somebody else?

And it would be like one or two people out of a roomful, you know, that could even get into their house, which is pretty incredible when you think about it, because that means, you know, 90, 99% of homes are not set up in a way that that we are we're not ready as a country to to to age in place, you know, And so the demand is there is real.

Very much so. I've even heard, like even thinking about your countertops, what color or what shade are they? Because someone who maybe you're talking about earlier, earlier interview about macular degeneration, the eye if you don't see well if you don't have the fine motor control, if you have to take medicine or just have to pick stuff up off the counter, are you going to be able to see what's on the counter?

So things that allow for a lot of contrast be better to have a white countertop, I'm told, or or something close to it? Absolutely. Yeah. We forget about the eye sight sometimes and how much that goes into play.

And even now they have the canned lights because based on eye conditions, you know, people like different warmth of lights and what they can see best.

And so even the canned lights and lights are coming out where you could pop them out and change the warmth. You know, from 27 on 3035, 4K, you know, 4K being the blue light and 27 being more and that's just another another option for people that there's another product coming on the market because you are absolutely correct, the eyesight sort of small changes that you can make in heavy contrast and that sort of thing can really help somebody out.

And then if you're in a wheelchair or you have a mobility issue that doesn't allow you to bend down low or you're low and you can't get up high, we thinking about where plugs can be located, how high, what is the standard height when you're just sort of building a generic home?

How high is a plug? 18 inches. And then if you can, if code I guess, allows you to go higher, how high can you generally go and what would you recommend in an aging place type home?

Well, you can go as high as as you'd like, but a lot of times lot of aging in place will go 30, you know, and that way it's higher and you can reach it just from, you know, the couch without moving or, you know, in a wheelchair without moving.

There are different jurisdictions have, you know, if something's eyesight or eye level for a kid, you know, tamper proof receptacles and how many of those you can have and whether it's a living area or a bedroom area.

And so you got to watch out for your local jurisdictions on that. As far as what they're just talk to the code officials on what codes they've adopted and whether or not that will be an issue.

It's the double edged sword. I guess, but that that certainly helps. And we've done them a lot or, you know, not a great deal higher to where if you're at 30 inches, a lot of times you don't really notice them being that high.

You know, just kind of maybe they're a little bit higher, but it's not something that stands out and it's just easier for everyone to use. So it's kind of a no brainer.

Absolutely. Now, we've seen cabinet designs that would allow they're modular in such a way that when you're standing in front of, say, a sink in a bathroom, maybe you want a cabinet design as you're storing towels and other, you know, toiletries under there.

But if you were in a wheelchair, that cabinet would be a barrier to getting closer to the sink. So that you can they're sort of modular so that you could remove the cabinet itself, but you're not having to rip out the counter.

You're not having to rip out the sink and then you can slide your wheelchair under there, almost like a a table or a desk. Have you seen that? Oh, absolutely. We we've done them where we've we've used completely open space and then there's other more finished looks where we use a very shallow sink and then we, we basically taper off that finished edge underneath of, of the countertop because that is one of the trickiest spots is the sink because, you know, what do you do with the plumbing.

Right. Like a make up think of a make up area or something like that. Make up a bench in a master bath or something that's just leave it open. But when you're dealing with the plumbing, that's where it gets a little bit trickier and you got to be mindful.

And there's also a lot of really cool options for cabinets that have pop out, you know, appliance stations, you know, for KitchenAid mixers or Swivel storage that goes back into a lazy Susan area, which you can just pull out, you know, with one finger and then it comes out and you get all the storage without having to reach back in there.

You've got drop down storage from above, you've got under cabinet lighting that can be done just with, you know, the wave of a hand on the corner in the cabinet.

There's a bunch of products that are just really, really exceptional for for for people that have an accessible needs. And really it's almost overwhelming when you when you look at so.

Many wonderful, wonderful Austin are basic things for any, you know, builders. Building a house is the land that the house is going to be built on. What do you what do you recommend?

What do you look for when you're advising someone for aging in place when they're choosing a piece of property? So single level or universal design is always going to be the best bet, which typically means you want more of a flat lot in our part of the country is, you know, it's it's not flat.

There's a lot of hills more in the Ozarks. So that can be a challenge and certainly land can be manipulated. But at the end of the day, the things like the zero entry or zero threshold entry, whether it be from the garage or the front porch, is is preferred.

And when we built the same new dream home two years ago, that lot had 13 foot a slope and we still built it accessibly. Well. We had to, you know, enter on the side with the least amount of of grade in the front porch was not accessible.

It had several steps up to it, but we had a friend's porch on the side. So both from the garage, you just could go, you know, straight in without taking a step.

And then the side porch, which was very nice as well, you could go in without taking a step. So you deal with the cards that you're dealt, you know, the hand that you dealt.

And so sometimes being able to achieve a 100% universal design house that's just not in the cards. Not, not, not economically, there are a lot of things you can do that are very economical to make universal design.

But when you have 13 foot a slope, you've got to you know, you got to make some decisions there. We also another cool story at Table Rock Lake, which is very sloped on the shoreline.

You know, I'm sure you've been there, but for the audience, it's a real hill. It's in the Ozarks here. And so, oh, we built a house that had a it was over 13 foot slope.

I don't know what that one was, but it was a crazy amount of slope. Well, they wanted the owner, one of their mom, to be able to visit. The mom was in a mobility device.

And so it was like, how are we going to make this happen? Well, we did a sidewalk behind the house that wrapped around two a side entry without any stairs.

So it was a sidewalk with a sloped concrete ramp down to the side entrance, which was all stone and flat and so you couldn't use the front door. But, you know, who cares if she could use the side entrance anytime she wanted?

So again, got to you got to be willing to think outside the box. And as every last part of the build going to be universal design, probably not when you don't have a flat lot to build on, but doesn't mean you can't make it happen in some way, shape or form.

So let's say I'm ready. I'm ready to start thinking about this process. I want to build a custom home. I'm going to start probably with an architect before my engaging a builder early in that architectural process or there are there architects were also certified aging in place or how what is this kind of walk us through the agency process.

Yeah, and there absolutely are architects who focus on universal design the certified aging in place specialist. The specialist is through. I forget the entity that does that.

It's not a building entity as much as National Association of Homebuilders is the one who gives the universal design course, and you get that designation.

So you probably you may find more people with universal design background than Capps, but you could see some of both. And so if you are ready, I always recommend having the builder on board during the design phase.

Architects bring their skill set and so do builders. So anyone who contacts me wanting to build a house, if it's universal design or not, I say, Hey, let's let's have a conversation first.

Let's see what your wants and needs and desires are, what your timeline, what's your budget, what's your style of home? Are you looking at all those things?

You know, just so you know, you the builder is learning about the project and is on the same page and and you want to interview builders, make sure it's a good fit, you know, may not be so once once you I would recommend starting with talking to a builder and then from there go into the design phase and I recommend having that builder through the design phase because architects are going to be able to draw anything.

But the builder can sit there and recommend means methods, pricing, because construction, you know, construction means methods are changing all the time as technology changes the the what our capabilities are and what products are out there.

And so having the builder and architect who have universal design background and and having them work together during that build or during that design phase is going to be highly beneficial.

I'm sure that you have some architects who you've worked with a little bit more vise versa. Folks are out somewhere else in the country. They have an architect that they identified.

They really like their work. Say, Hey, who've you worked with as a builder that kind of works well with you and shares your philosophy and that can kind of be part of the team.

Absolutely. Absolutely. Because they're going to have a good recommendation and there's some that aren't as interested in the, you know, universal design.

And that's okay. You know, they'll want to, but you want to find somebody that is because they're, you know, they're going to be worth their weight in that.

And helping you design that, that home that's that's what they do every day for a living. And I think about things you won't think about or that you haven't thought about.

And another tip I would give is, is get them involved prior to the land. I will meet a lot of people at the land before they purchase it to give them my thoughts on, hey, for what you want, this is a great lot or for what you want.

This isn't going to work so that way you're not making that investment and actually going through the purchase and then called Builder and say, Hey, this is the house I want.

And the builder scratching his head and saying it's not really going to work on this lot. So get involved early and it'll it'll be worth it. So I know Valerie and I had the pleasure of sitting down with you and kind of looking at, you know, what your process is, what you share with the viewers a little bit.

If they say, okay, we're ready, we're we're pulling the trigger on this. We're ready to go, We want an Austin Miller built home. What's it going to look like when we sit down with you?

How does that work? Yeah, so we sit down for that initial consultation, talk about what you guys want and what your your needs and desires are. From there we would look at the property if you have it.

If you don't, that's, you know, that's fine too. But we'll start to outline what a good piece of property would look like for the house that you guys want to build.

Once the property is is located and and identified or purchased, we would start in the design phase and that's where we would bring in an architect and go through that design phase usually takes a couple of months and then from there you'd walk to the bid out and typically the way I do it is a little bit out in a high and a low based on the features that you want in the home.

So that way gives you a little liberty and hey, we really want to spend this much on something as simple as windows or we're fine spending a little less.

And it gives you gives you some some liberty there to choose what that and price point is going to be, because at the end of the day, you're going to need it.

You're going to choose what goes in your home more than I am. And from there you've got to get your financing lined out. I would usually, you know, if you go into a bank is it takes 45 days and then we're ready to build Pre- covid I always tell people eight months to build and I usually tell them ten. Now.

So through that whole process, you know, it can take a year and a half very easily. So that goes back to interviewing a couple builders, finding someone that's going to be a good fit because you're going to be you're going to be dealing with them for a year and a half possibly.

So it's got to be a good fit for both both the builder and the owner. Yes. And of course, mortgage rates are fairly high now, but fortunately, inflation has cooled a bit for those who built over the last couple of years.

That must have been quite an experience for the builder and the builders, if you will. The folks are paying for it because know what you know what what you bit out one day, one month later, those prices are completely different.

Have how do we navigate those costs through sort of that that moving target. Well is very difficult. What about all my hair about turn gray and fell out But because you're right it was a rollercoaster.

And building a custom home is something that is challenging and it's an emotional roller coaster because there's a lot of decisions and a lot a lot of visual progress that people have to be prepared for, for to make decisions and to deal with changes and roll the punches.

But luckily it has sort of plateaued because over the last two years it was very difficult. You know, it was I'm telling someone, hey, we've been this out for that $15,000 system and now it's 23.

It's not an easy conversation to have. I can tell you that right now. And I had to have a bunch of them for two years. And so luckily it's plateaued. It seems there's still some things.

It's a little bit up and down out there, but for the majority, it seems like we're at a level I wish it would. It would come down and sort of tin trend towards some of the pricing would would come down and sort of just plateau.

And but it really hasn't the the good news is I guess is that we're not aiming at a moving target. And so we have a little more stability and we know we're getting into so it was a tough, tough few years, but luckily the horizon is in the last six months or so is really there's been a lot lot more enjoyable climate to build in.

So with that being said, folks, it might be a good time to start thinking about building a home. Maybe with Austin Miller if you happen to be in the southwest Missouri area and if you are not, check out the National Aging Place Association, your local Homebuilders association.

Find out who's doing universal design, aging in place. Get yourself a good architect, talk to talk to the architects, talk to the builder, Make sure it's all a good fit for you and think about moving forward.

This is this is an investment that you won't regret, you won't regret at all. There's another statistic Fidelity Investments talks about the average cost of health care for the couple retiring at age 65 today, what they can expect to spend out of pocket for health care for the rest of their lives.

And that number is about $315,000. And that doesn't include food and other things. So this is why aging in place and functional medicine are so important, because we have to create health for ourselves and create and help ourselves means creating health in the environment in which we live.

And that is most certainly your home. Absolutely. Absolutely. And if I'm happy to help as a resource and wise-built.com, you can get a hold of me with email or phone number.

Even if it's not something in my area, I'm happy to be a resource and something I'm passionate about. So here for questions or if anybody wants to reach out and happy to respond.

Well, Austin Miller, thank you so much. Austin Miller is the owner of Wise Built Custom Homes and Nixa, Missouri has certified aging in place. Builder builds beautiful Homes.

He mentioned they built one of the St. Jude's homes a couple of years ago. Those are wonderful. Is a great charitable opportunity to have done that. So thank you so much for doing that and thank you for joining us on the Parkinson's Solutions Summit today.

Awesome. Thanks. Happy to be here. Dr. Sharlin. All right. Bye bye now.

Austin Miller

Embrace The Principles Of Universal Design