(First published and copyright Aging Today, Sept-Oct 2011)
For more than two decades, proponents of culture change in long-term care have worked on transforming the institutional nursing home model. More recently, the focus has turned to assisted living and even independent community housing.
What we see is that America falls short in all living environments when it comes to older adults engaging in diverse communities. How can we optimize the quality of life, across a multitude of settings, for our nation’s elders?
In long-term care, most frail elders are housed in hospital-like institutions, where life revolves around medical and nursing interventions. Even in assisted and independent elder housing, the trend has been to “medicalize” aging, and to insulate people from the larger world. Even less recognized is the isolation elders often face while living in their own homes, as community planning does not accommodate aging adults.
This trend represents a loss for all generations: the lack of daily contact with children and younger adults creates a chasm in the lives of older adults, most of whom are parents and grandparents. But the younger generations also suffer when they lose the wisdom, history and life perspective of elders.
Aging in (Intentional) Community
The best solution for all is to change our dialog about aging in place versus residential care to talk about aging in community. Innovators such as Dr. William Thomas, developer of the Green House Model, have responded by creating intentional communities—groups of unrelated people who come together to share the rhythms of daily life, in pursuit of a noble purpose.
The Green House is not just a 10-bed nursing home. Beyond the physical design of a small house, there are important operational changes that create an environment where elders direct their daily lives.
In traditional long-term care, there is no rhythm of daily life, but instead a life artificially compartmentalized into blocks of time reflecting institutional staffing patterns and creating what psychologist Athena McLean, in a 2007 article for Alzheimer’s Care Today, called “a cult of clock time and task.” There is no individualized care in such an environment, and intergenerational activity only happens through sterile, discrete programmatic episodes.
In contrast, the intentional community embraces the spontaneity that regular contact with children and adolescents can bring. The small-scale and cross-trained staff creates an environment flexible enough to respond to the needs of the moment. Plus close, continuous contact between generations holds many benefits.
Dr. Vicki Rosebrook of the Macklin Intergenerational Institute in Findlay, Ohio, studied the effects on children’s development of daily interaction between preschoolers and a group of adults with dementia. She found that, compared with children attending traditional daycare, these children entered kindergarten with personal and social skills nearly six months ahead of their peers.
They were better able to express feelings, work cooperatively with others and had more basic social graces.
A Non-Medical Answer to Institutional Woes
The Eden Alternative movement (www.edenalt.org) holds that loneliness, helplessness and boredom cause the bulk of suffering among institutionalized elders. These diseases of the human spirit do not respond to medication, but rather to a diverse human habitat.
Rosebrook theorizes that elders and pre-schoolers have reciprocal needs. Young children need interaction, guidance and exploration, which provide the antidote for the loneliness, helplessness and boredom seen in institutionalized adults. As her study showed, even adults living with a moderate degree of dementia served as important role models for the children at Macklin.
A few nursing homes have taken this a step farther. Grace Living Centers in Oklahoma has prekindergarten and kindergarten classes at the homes. Windsor Place in Coffeyville, Kan., has a kindergarten inside the nursing home. The children spend much of their day interacting with residents, doing paired exercises, singing songs, and sharing stories and other activities.
“We felt the acceptance, affirmation and encouragement given to the children by the elders would create a rich and wonderful learning environment for the [youngsters]. But, simultaneously, we felt the children’s acceptance, affirmation and encouragement of the elders would provide new growth and rejuvenate the spirits of those elders living here,” says Windsor Place executive director Monty Coffman. “And we have seen this beyond our wildest imaginations,” he adds.
Some organizations have pursued other ways of reconnecting people in nursing homes with the larger community. Strem, a village of 900 in eastern Austria, was created around a nursing home and assisted living facility, and the village houses many of the employees, with an infrastructure of banks, schools, stores and a post office.
Numerous community facilities have shared uses, such as the chapel and concert hall, so townspeople and elders regularly mingle.
St. John’s Home in Rochester, N.Y., will be the first organization to build Green Houses in neighborhoods around the greater Rochester area. This will give elders living in a large nursing home the opportunity to receive skilled care in small homes in the communities where they lived previously, re-establishing close family and social connections.
Older adults were never meant to be isolated from the rest of the living world. Our excessive focus on the medical treatment of aging has created an out-of-balance world that erodes quality of life. Diverse, intentional communities hold the key to restoring that balance.
In a future installment, we will discuss how elders living at home can be reconnected with their communities.
G. Allen Power, M.D., is Eden Mentor at St. John’s Home in Rochester, N.Y., and clinical associate
professor of medicine at the University of Rochester. He is an internist and geriatrician, and a Fellow
of the American College of Physicians/American Society for Internal Medicine.