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My wife and I live in a beautiful 3200 sq. foot home in the mts. of CO. We only use the master bedroom and bathroom. I use the kitchen to prepare very easy meals. My wife had an AD diagnosis 5 yrs. ago but was probably showing signs several years before that. She is in stage 5+ of the disease. I plan to take care of her for the rest of her life (I am 81 and in good health, she is 78 and in good health except for the AD). I would like to know what is needed in this apartment that our daughter and son-in-law are going to build. Any specific types of furniture, bathroom aids. Types of toilets, showers, etc. Kitchenette facilities. A/C, fans. Types of beds. I am assuming that the apt. will be basically one large room and that is all we need. Being close to our daughter and assistance will be very helpful. Now we live about an hour away from Boulder or Golden, CO. I have always been very capable of building and preparing construction but now I need more specific advice to confront circumstances that are brand new to my wife and myself. Any advice will be greatly appreciated.


I have done a lot of research myself but we are entering uncharted territory and I would love any voices of experience from people who have been down this road before.


Thank you. Eddie B.

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While I don't have any specific knowledge to help you, I'd wonder about having the space built on the second floor, above the garage. It will not be accessible if you or your wife have even a temporary condition that impairs your mobility. Depending on the size of your daughter's lot, adding a one story wing on her house or building a small "accessory dwelling unit" in the yard might be a better option. Of course these options depend on the zoning whee she lives, the configuration of her house, etc. Maybe your daughter's family could use the space over the garage, if the garage is attached and the space can be made accessible from the house, and then part of the downstairs main house could be converted to a private area for you and your wife.
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newbiewife Sep 2019
I forgot to include the link about accessory dwelling units. https://accessorydwellings.org/what-adus-are-and-why-people-build-them/
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If you are preparing a home that will work until the end then you must prepare for the physical decline that comes with late stage dementia. Do some reading on universal design.

If you are starting from scratch make the bathroom completely accessible with a roll in shower and enough room for lifts if needed - a wet room would be the ideal - and of course all the usual grab bars. Consider a bidet toilet.

Leave enough space in the bedroom for a lift and space enough around furniture to maneuver a wheelchair or for twin beds - or you might like to have your own sleeping area. A hospital bed will be a welcome accessory as her needs increase.

Consider the width of halls and doors. Consider how you will be able to get into/out of this apartment since it will be on the floor above the garage, steps are not senior friendly.
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In addition to all the considerations to accommodate a disabled person. They need to go to the local zoning board to learn if they are allowed to do this...then, they need to get a copy of the local building code. They may realize it is cheaper to build a small side (ground level) addition for a small in-law apartment, and separate entrance.
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1.   Zoning:  your daughter and/or SIL should check with the local community before planning any building, to ensure that a room(s) can be added to the garage.   Insurance agent should be consulted as well, insuring that they'll cover this kind of addition.   

Extension of water and electric should be addressed now as well, with the specific plans to be worked out.

2.   I've been told by AT&T that by the end of next year they will have d'c'ed land line phones and allegedly will be tearing down telephone poles (which is ridiculous b/c all the electric lines on the poles would have to be relocated).   Consider though how you'll communicate within and outside your daughter's home.

3.    Medic alert pendants may be necessary.  Worse case scenario:  if either of you are incapacitated but need help, how will you get it?    Monitors (like baby monitors) can be used so your daughter & SIL can either monitor and/or communicate with you on a regular and emergency basis. 

4.   One issue concerns me the most:   ingress and egress to a second floor over a garage.    Stairs wide enough for EMS stretchers, safety for walker, rollator, and/or wheelchair use should be considered carefully, as should a protective weather covering.    If either of you eventually need a wheelchair, you don't want to be drenched by a storm.

5.   Fire emergency options, especially for immediate escape,  just b/c it's California.  Alternate living arrangements on a temporary basis should be considered as well.

6.   If you and your daughter & SIL have Area Agency on Aging caregiver expos (held in October in my area of Michigan), attend them, and especially visit the adaptability booths.   Contractors familiar with retrofitting display, provide brochures, and can offer good ideas, including on adaptations to vehicles for external wheelchair lifts.

7.   Consider carpenter installed grab bars by exterior doors, interior doors, next to the toilet, in the bathtub or shower area, in configurations similar to that in rehab facilities (horizontal and angular).    Familiarize yourself with shower chairs (slide overs from outside to inside the shower/tub area), or a more expensive option of bathing with a walk-in door.  

8.   Acquaint yourself with senior centers not only in your current area but in CA, to learn of transportation arrangements and shopping assistance if necessary, activities, etc.   My father's wonderful Senior Center has arranged for seniors to participate in flight simulation training.  I'm going to learn to fly a 172 Cessna, all on the ground in a flight simulator!   

There are also a lot of seasonal activities in which Seniors can participate and interact with others.   And, there are Meals on Wheels programs if you get to the point that you don't want to cook.

9.   I would seriously consider more than one room.   Separate rooms provide not only for privacy but there are more walls for more handholds.   You'll want some privacy, and separation probably if you have visitors, but especially since downsizing from 3200 sq. ft. to something significantly smaller will be a real challenge.   Consider at least a kitchenette, as you will need storage, plenty of closets and open storage for walkers and wheelchairs.

I'd also put grab bars in areas that will be open w/o anything to hold onto - i.e., long walls.

10.   Beds:   space on either side for chairs, to help when walking becomes challenging.   Not too high, and not too low, but w/ very firm mattresses.

11.   Central air definitely, with a thermostat for your area, as well as ceiling fans for alternate localized cooling.

12.  Furniture:   easily cleaned, definitely soft and padded, no sharp edges, and definite side arms to assist getting up and out.  No folding chairs or chairs w/o arms.   Floors:  No throw rugs, but beyond that I don't have good suggestions.  Wood or tiled floors can't be slippery; carpeting can be difficult to traverse with walkers.
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RB2019 Sep 2019
Wow, these are excellent, practical suggestions! I’m going to print your list for future reference!
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A door with a code key on it, to prevent your wife leaving your apartment unescorted (once she can't remember the code, that is).

I admire your dedication and determination (you should look at OldSailor's posts, by the way, I can't think of a better role model for husbands - or wives, come to that) but you ARE going to need downtime. However fit you are, the going will get hard. So look into respite care and support services in your new area.
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You need hospital bed, commode, hoyer or stand assist lift..depending if her walking/standing stopped. She needs recliner wheelchair with seat cushion that prevents skin sores. She needs air mattress too. If you have stairs, put in elevator or stairlift. You can do bed baths eventually or transform shower into roll in shower...for this you’ll need rolling shower chair with hole on bottom. You need to buy adult diapers, bed chucks...disposable & washable. This will be what you’ll use to turn her in bed. Oh..also plenty of A&D ointment to rub all over her behind so she don’t get sores & skin breakdowns. Also keep on hand diaper rash cream Zinc Oxide in case she develops an irritation. Oh & I almost forgot she needs anti fungal cream for her vagina in case she gets an itch & starts scratching. You also need to get to Neurologist so she has medicine for agitation.

Having a life alert system is helpful....with automatic fall detection. Also, cameras so you can check on your smart
phone if you go out. ..& leave her with Aides.

Have I answered your question?!?
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Second floor? Worried about the up and down of it. Just thinking for myself, my knees, etc, the stairs are what is hard for me now, nothing else; the toilet raised and good assistance aids in the bathroom. Not certain I wouldn't eliminate a tub altogether, too difficult to get up and down in. Not much other advice but I do worry about that second floor thing over time.
I am assuming this has been thoroughly discussed. Sorry to bring up a sore point, but you, the oldest, are now in pretty great shape. At our ages, however (I am 77) it is to be understood that this could change in two seconds. IF it does change, and you are BOTH needing care, does the daughter understand she could be caring for two elders? I think be very very frank with one another. A good sit down with ALL who live in the household, including any kids over the age of teens.
Otherwise, sounds so good.
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Why go to all of this work and expense? Why not go into a good assisted living near your daughter? You'll have resources to help with your wife.
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Eddie...great plans but make that BUT...
Your wife will not be able to do stairs well for much longer, and frankly maybe you won't as well.
BUT
If you intend on doing this..
No carpet. Solid floor that is water resistant some are rated for 24 hours, some less.
Large bathroom with ROLL in shower. That is a shower with no lip on it that you have to step over. This will allow you to get a shower wheelchair into the bathroom so you can easily shower. The bathroom should also be large enough that you can get 3 people and equipment in and have enough room to move around. ADA height toilet with elongated bowl not a round one. (The shower pan for a roll in shower is usually set below so there will be a "boxed" in area that may show in the garage below the bathroom)
If money is no object an elevator.
As open concept as possible.
As for furniture. Hospital bed. But you can get that through Hospice. And you can get all the equipment you will need though Hospice. I got the hospital bed as well as a Hoyer Lift and the Broda Chair and a Wheelchair.
And this brings me to Hospice PLEASE call them (you are probably thinking about that 6 months thing..) My Husband was on Hospice for over 3 years. As long as there is a decline the person will qualify to remain on Hospice. You will get so much help from the CNA's, the nurses, Social Workers and the rest of the team. Well worth a call to find out if she qualifies.
There are quite a few companies that design for "adapted living" you might want to consult one just to get some ideas.

If all this is daunting you might also want to look into Assisted Living this will make it easy for you to get help when it is needed. You would be able to get out yourself once in a while. Most AL facilities have Memory Care also so she could spend some time there if you wanted to go out. And if worst case arose you could place her in Memory Care knowing she will get professional help and you would be in the same building and cold be with her at any time. (I am also aware of Memory Care facilities that allow an undiagnosed spouse to reside with their loved one in Memory Care and the healthy spouse can come and go as they wish but always come home to be with their loved one.)

I wish you much luck, please keep us posted as to what choices you have made and what suggestions were helpful.
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lealonnie1 Sep 2019
I would never live in memory care with my spouse if I didn't have dementia, never. I would, however, live in the regular Assisted Living section and go visit him daily in memory care. Lots of couples do this in the community where my mother lives and it works out well. I know of NO couples who reside together in memory care where one is not diagnosed with dementia. To each their own, I suppose.
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Eddie, lots of excellent advice posted, but I also must ask if this is a walk-in apartment? If not, you really need to consider something else. Plan for worst-case scenarios, not the best. Worst health, worst finances, etc. Don't plan for how things are right now as that will surely change. Then at least you will be truly prepared. We optimistic Americans tend to romanticized aging. It rarely goes how we "picture" it. In CA will you be in easy walking distance of public transportation? Is the county one that has robust resources and services for seniors? Is there a high-quality facility nearby in the likely case she or you will need it? Also, please go into this with your eyes wide open, and especially your daughter, who needs to just read the thousands of posts on this website about caregiver "burnout" written by all those loving family members who wanted to do just what she is now planning but had no real idea of what they were signing up for. I have told my 3 sons that in no way do I expect (or want) them to care for me and my husband like that. Wishing you wisdom and peace!
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Eddie--

In theory this is a good idea--except for the stairs. They will need to be quite wide and you should definitely install a "lift" as you're building. I kind of chuckle, DH and I are downsizing to a home with one set of stairs and we won't even use the basement daily. We have tons of stairs and I hate them all, and I am only 63!

How big is the space? A double care garage can be huge or tiny---realistically, the space is going to close in on you pretty quickly, as you find that you are basically living in a hospital room.

We built an 800 sf apartment on to my brother's home 23 years ago and it is packed to the gills. Mother is alone there now, and brother has said he regrets doing this every day of his life. He wishes we had moved mother and dad into and Assisted Living Apartment, with step up care as dad grew sicker.

Mother cannot lift her feet a single step, so the long flight of stairs up to the family's "living area" are impossible. She has not been up there for 12 years.

You are riding on the hope that your health holds out and all will be well--and that's a good attitude--but the stairs---that would be huge for me.. How many times a day would you be up and down those? We're talking about 12-15 stairs.

The one very large mistake made in mother's apartment was that they did not plan for wheelchair access into the bathroom/wider doors--basically a wheelchair could go down a short hall to the kitchen, but daddy could not walk the last year of his life and we had to do all the washing, toileting, etc from his room. He nearly went bats from the lack of space to move around.

Now mother is hoarded into this small apartment, is cranky b/c she wants more space, but you can't make something out of nothing. She, too, wishes she'd moved into an ALF apartment. She'd have more help and more freedom.

Just a thought--is there space on the property to build a small home for you two? I'd personally prefer that to living above the garage. I've seen a lot of plans for very cozy, usable space in small house living. I guess zoning will help you with all that.

It's very admirable of you to want to take care of your DW like this. I would personally want my own space--a room I can go into and close the door! Open concept is great but so is small, cozy bedroom or den. After 3200 sf of space, 800-1000 sf is going to close right in on you. My upstairs in my current home is 1000 sf and it is NOT spacious. Also not "elder friendly' by any means.

Wish you luck. Don't jump into anything until you've checked out your options.
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Two red flags,

Stairs are not your friend at this point. Sure you an buy an expensive stair lift, but what if you need to call an ambulance? How will the paramedics maneuver a stretcher with your wife on it down stairs?

when my step dad went into hospital a year ago it was a huge challenge to get the stretcher down the stairs.

2 who is paying? What about Medicaid look back? Will you be paying for the Reno? Or paying rent?

if you are paying how will you get your asset out? We had a situation in our family where Aunt R sold her beautiful condo and gave the kids the proceeds to use as a down payment on a house with a suite. Aunt R did not have her name on the title and when the kids divorced wound up in low income housing.
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Wow, What wonderful responses! And I thought I had everything all thought out. You all have given me so much to think about, especially about having an elevator instead of stairs. I can't imagine not having the ability to walk up and down stairs but then my wife and I also had never imagined her becoming ill. I want to thank you all for your well thought out responses to my problem and I can assure you that I will be talking with our daughter and our son and their families so we can get even more input into our problems and hopefully solutions to some of these problems. My father used to say during his final year that "growing old was not for sissies" and I can really see what he was talking about. Thank you for your kind and thoughtful responses.
Eddie B.
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I agree with all the comments about stairs. My former mother-in-law, age 93, was diagnosed with Alzheimer's disease about 11 years ago. She has not walked in at least two years and so uses a wheelchair. She is nonverbal. She swallows and can ingest regular (soft) foods but cannot feed herself. Her caregiver (my ex-husband) has had to help her with toileting for several years. If you saw her, you might not think she's alive, but she is not close to death, as far as we can tell. My ex has to pick her up from bed and put her into the wheelchair. Also vice versa. He can get the wheelchair up and down the two or three steps into their house but a full set of stairs would be dangerous and close to impossible. She has probably been bathed on the rare occasions she has been in a facility for respite care but she has not had a bath in the tub or a shower at home in at least five years.
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Hi Eddie,

You've received very good advice here. I don't know how much you are looking to spend, and have no idea of the cost, but I would absolutely sit down with a couple of architects who are familiar with designing under the ADA (American with Disabilities Act). There are so many different designs and products made specifically for making any area accessible. It may cost you a little bit but it will be well worth it to see what your options are.

Because you are building from scratch these professionals could be invaluable and could save you a lot of future headaches.
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Eddie, I too am concerned not only about the stairs, and I see a small elevator has been suggested which I think is great. But not knowing how your weather is there, I would think about the heating and airconditioning over an unheated garage. If the weather is anything like upstate N.Y. my bonus room over my attached but unheated garage is sometimes hard to keep warm enough in the winter or cold enough in the summer even though our central air/heat have plenty of registers up there. Would it be more cost effective/ easier to maneuver around a small apartment on a slab on the side of the garage?
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My engineer BIL had a lift put into their new house for my sister in a wheelchair, as well as all the disability access options. It was a much better option than a stair-side elevator, but it was very expensive indeed. Get a quote before you firm up your ideas. Their lift is rated to carry four people. My engineer husband (they’re everywhere!) says to check your power supply as well. With the weight of the lift itself, the mechanism has to be able to lift over a ton, which requires more power than many suburban power line systems are capable of supplying.
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Before you go too far in your planning, check with the planning, zoning and building offices in your daughter's location. Read gardenartist's post carefully. That area of California may even require earthquake grade construction that may not be possible on her home. The room and/or kitchenette above the garage may not be permitted due to fire codes. A second water tap may be required depending on local requirements, which can be very costly especially in California.

Accessibility as many mentioned will be a challenge with anyone that is aging, more so if they have dementia. If no kitchenette, then are you three times daily going down for meals? Or are you just sleeping in the room above the garage and staying in the home the remainder of the day? How would that work for everyone?

If you are thinking about paying for this, consult with an elder law attorney as to how to protect your investment in case you find this was not a good idea.

It is a wonderful idea but, you need to think about the practical side too. Does this really make sense? And does daughter work? If you needed help caring for wife would daughter feel obligated to quit to help? Is that what you would really want for her? These situations are inclined to tear many marriages apart or develop an incredible amount of discord and dysfunction.
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My only input is, at your ages - should you really be considering living up a full flight of stairs? If your wife walks out of the apartment, will she (or you) be in danger of falling down a steep flight of stairs?

Going from 3200 square feet to a room the size of a garage? That alone is enough to give me the willies. It's like your entire living space will be the size of your livingroom and maybe not even that big - and you expect to squeeze in a kitchen and bathroom?

Is there no better alternative than to move and live over a garage?? This doesn't sound like a good alternative to me and I would never consider it.
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You might want to look up ADU accessible dwelling unit, also referred to as granny pods.
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Hi Eddie , The county in which you will be living in will have building codes you can learn what is expected .
A motorhome may be a good answer instead but you may have already considered that .
Your wife's disability details will help you decide what is best .
Every AD diagnosis is different .

Sometimes people just have a live in caretaker so they can have breaks from the stress of care .
Often the caretaker will take room and board for some of their pay .

I mention this because in consideration of your situation at this time , you sure could use some help at least for short term . Let me know the county you'll be living in and I can send you information on building the addition .
Lynn
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It might be best to hire an architect rather than just a contractor. An architect will know all of the codes and regulations to create a living space friendly to adults with disabilities concerning bathroom measurements, hallways, stair widths, electrical access, grab bars and wheelchair accessibility like counter height, flooring material, and door handles. Also, if you know someone in a newer assisted living facility, you can take note of these features there.
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AlvaDeer Sep 2019
My experience of contractor versus architect is just the opposite. I find the latter interested only in how it will look, not at which end the plumbing comes in on. So I am all for a really good contractor. Someone who is monitoring the permit process will be bad enough with the code things. It is still those stairs that bother me.
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The stair issue has to be resolved. Also once inside think zero step for everything- shower entry, all thresholds.
I would compare cost of remodel compared to cost of a community already designed for what you will need.
However with your plan, you get family right there which can be so good for you and your wife. If that is what you go for, definitely get a stair lift or elevator.
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Don’t! It sounds like you and your wife will be isolated and confined to one main room. Yes, you will have your daughter and her family there but they shouldn’t be the only ones you have contact with. Look into independent/senior living with assistance where you not only can get the help you’ll need down the road but also where you can engage with others in your situation. You can visit your daughter and she can visit you. Your time together will be much more enjoyable.
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AlvaDeer Sep 2019
I think this is really good advice. Just the stairs alone scare me, but the fact that you will be somewhat dependent on just the family for socialization is not really a good plan.
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Eddie, for a gabillion reasons Don’t Do It!!!!!!! Independent living can be lovely. U can get something close by your daughter and visits can easily take place. Love and peace to you and your wife on this journey❤️
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gabillion - that's a new one! Might use it!
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Listen to what others are saying. Do not do this. You are not building a home you will be in essence building your own 2nd story prison. If fact, if she were moving into a memory care home, many states would not even let someone with your wife's condition be on the 2nd floor for life safety and fire regulations. Move to an independent living, AL, MC community where you can have socialization and support. Do not isolate yourself in a 2nd story room and limit your life to being a caretaker. This is not healthy for you or your wife. If you do not take care of yourself you canot take care of her. If she needed heart surgery you would not say "let me do it" you would trust a professional, same if she was being sued in court - you would get a lawyer. You need to realize it is the same with caring for end stage ALZ.. you cannot stay awake 24/7 and keep her safe and comfortable 24/7. Your job is to make sure she is well taken care of, but that doesn't mean that you have to physically be doing this, it just means making sure it is done. Do not feel guilty for letting professionals do what they were trained to do and you were not.
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Barb53 Sep 2019
I thoroughly agree. It is better to move to AL facility where you can socialize and also be with your wife.
Plum9195 is spot on!
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Agree with posts re: Upstairs. That sounds dangerous for someone with stage 5 AD. Even with a stair lift - can she cooperate to use it? Not to mention down the road will you be able to handle the stairs day in and day out? Assuming you intend to sell your home - that should pay for an apartment in an assisted living community/facility. (Many available in CA) You can always pay for a caregiver to give you a break and daughter can help, too.
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If this is above garage how are you able to access the room?
You may be able to climb stairs now, but what about future?
Also you will need accessible bathroom, walk in shower with grab bars and bench. You should contact a contractor that is familiar with ADA construction.
Be sure to check him out and and get references.
You do not know what the future holds and it needs to be totally accessible for the unknown future.
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I would have a shower you could roll a wheelchair into and all handicap access. Being upstairs, you may need a chairlift to go up and down as she progresses and looses her physical capabilities.
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I want to change my answer people are right do not do this you will be isolated from help and social contacts
Look at an apartment in a building that can provide help for your wife and give you social contact s.
Your daughter and her family are not your social contacts.
Look at places that can help you with your wife do not isolate yourself and your wife.
Living above a garage is not safe hot either one of you physically or mentally
DO NOT DO THIS
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