Aging in Community

1
Aging in Community

• A Global Perspective

2
Linear Aging

• Dependence
• Failure
• Bad
• Burdensome
• Institutionalization

3
Delving into Dependence

• Myth Dependence is defined as the need to rely
  on others for the most basic necessities of life.
  A dependent person is, by definition, a burden on
  others.

• Reality Human life depends upon an exquisite and
  ongoing reliance on others. In truth, we are all
  dependent. It is the form this reliance takes
  which defines well-being.

4
Linear Aging

• Independence
• Success
• Good
• Worthy
• Aging in Place

5
Investigating Independence

• Reality Being independent means being able to
  define the manner in which one cooperates with
  others.

• Myth Being independent means relying as little
  as possible on other people.

6
A Bipolar Struggle

• Aging in place is an artifact
• A cultural prejudice against dependence
• The dread of institutional long-term care
• An adoration of independence

Dependence
Independence
7
A Bipolar Struggle

• A Zero-Sum Game
• Fear and dependency driven
• Alienating
• Highly monetized
• Deeply professionalized

Dependence
Independence
8
Aging in Community

• An Answer to the
• Trillion Dollar Question

9
The Social Capital/ Financial Capital Mix
Programs for the Aged
High
High
Childrens Programs
Need For Assistance
Total Social Capital Wealth
Peak Earning Years
Low
Low
Birth
Death
10
Why Old Age Costs More

• Combined government spending on health and
  welfare programs for children is less, per
  capita, than that spent to support older people.
• They are much healthier than older people
• The social capital available to most families
  helps them avoid using entitlement dollars for
  basic needs.

11
The Social Capital/ Financial Capital Mix
High
High
Most families (but not all) can manage the
challenges of child rearing without an ongoing
reliance on health and welfare entitlements.
Total Social Capital Wealth
Need for Assistance
Low
Low
Birth
Death
12
The Social Capital/ Financial Capital Mix
High
High
Almost all families depend on health and welfare
entitlements to help them cope with the
challenges of aging.
Total Social Capital Wealth
Need for Assistance
Low
Low
Birth
Death
13
What If

• We found a way to vastly increase the Social
  Capital available to Americas families?

14
The Social Capital/ Financial Capital Mix
Vastly Reduced Demand for Dollar Denominated
Entitlements
High
High
Total Social Capital Wealth
Need for Assistance
Greater Wealth in the Form of Social Capital
Low
Low
Birth
Birth
15
Financial Capital The Value of paid assistance
The Social Capital Map
High
Assisted Living
College
C-Section
Car wreck
Social Capital The value of friends, family and
neighbors
Birth
Death
Life Span
16
High
Value of paid assistance
Monastic Life intentional community
Social Capital
Low
Birth
Death
Life Span
Community is the engine that creates Social
Capital.
Quality of Life
17
Capital as Wealth

• Social Capital
• The total value created by informal and ongoing
  relationships among a specific group of people
  and over time.

• Financial Capital
• Cash
• Real property
• Monetary value of goods and services
• Gross domestic product
• Need graph of growth of same over time

18
Allocation of Wealth

• Our society uses the marketplace to allocate
  financial capital and foster its growth over
  time.
• Our society uses community to allocate social
  capital and foster its growth over time.

19
Market-Based Society

• Contemporary society has substituted financial
  and market mechanism for social capital and
  common wealth generated by healthy human
  communities.
• This has resulted in a measurable and ongoing
  growth in financial wealth and a parallel loss of
  happiness and well-being.

20
Balancing Social and Financial Capital

• Progress is dependent on avoiding either/or
  arguments in this arena. We need both financial
  and social capital but must learn how to use each
  in the most effective manner.
• The aging of America presents us with a trillion
  dollar opportunity to get this balance right.

21
What Is Community?
Isolation Proximity
Claustrophobia Too small Scale gt150
people Narcissus Shared Need or
Purpose Nudist Colony Amoral Share
Values Family Stultifying
Guidance/Governance Chaos Coerced
Voluntary Intentional Secular
Transcendent Kool-aid Alienation
Time Together No privacy Whatever
Faith/Trust Abuse Inconsequential
Stickiness Proselytizing
Not Enough Dynamic Tension
Too Much
22
Dependency Ratio
1960
1999
Five workers support one retiree
Two workers support one retiree
23
Exploring Interdependence

• Interdependence As human beings, we live by and
  through ceaseless cooperation with othersit is
  our destiny. The nature of our cooperation with
  and relationship to others changes as we grow,
  mature, and then age. These relationships form
  the foundation of all true communities.

24
Aging in Community
Community
Dependence
Independence
25
Non-Zero Sum Strategies
Community
Eden Alternative
Dependence
Independence
26
Eden Alternative

• Mission
• To improve the well-being of Elders and those who
  care for them by transforming the communities in
  which they live and work.
• Vision
• To eliminate loneliness, helplessness, and
  boredom
• Values
• The Eden Alternative Ten Principles
• www.edenalt.com

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Eden Alternative

• A Pioneering approach to culture change in
  long-term care
• Principle driven
• Practiced in all 50 states
• A global non-profit
• Shown to improve quality of life and quality of
  care
• Cost neutral
• No regulatory changes needed
• Founded in 1992

28
Non-Zero Sum Strategies
Community
Eden _at_ Home
Eden Alternative
Dependence
Independence
29
Eden _at_ Home

• A collaboration between AARP and the Eden
  Alternative
• Volunteer initiated and driven
• Pilot project in Arkansas
• Devoted to civic and engagement
• Goal Decrease loneliness, helplessness and
  boredom among elders living at home

30
Non-Zero Sum Strategies
Community
Green House
Eden _at_ Home
Eden Alternative
Dependence
Independence
31
The Green House

• A non-institutional approach to long-term care
• Residential scale (8 to 10 elders)
• Devoted to helping elders experience the most
  positive elderhood possible
• An emphasis on the rhythm of daily life
• Priority given to the social model of care social
  settings
• All elders have private rooms and bathrooms
• All food prepared onsite in an open kitchen
• Obeys all rules and regulations that apply to
  SNFs

32
The Green House

• A national model
• RWJF- 10 million dollar 5 year grant
• U of Minnesota study
• Rapid replication
• Influence on other providers

33
Non-Zero Sum Strategies
Community
Green House
Eldershire
Eden _at_ Home
Eden Alternative
Dependence
Independence
34
Eldershire

• Danish co-housing adapted for the American market
• Single family dwellings
• Common house
• Multigenerational
• A positive vision of aging
• Universal design
• Optional shared meals
• High density construction

35
Eldershire

• Facilitated co-housing
• Occupancy in late 2006
• Resident managed
• Based on idea of Eldertopia

36
Eldershire
37
Eldershire
38
The World of Aging in Community
39
Intentional Community

• Definition
• A small number of unrelated people
• Who deliberately join together
• To share the rhythm of daily life
• In pursuit of some noble aim

40
Intentional Community

• An inclusive term for
• ecovillages
• co-housing
• residential land trusts
• communes
• student co-ops
• urban housing cooperatives
• and other related projects

41
The Commune Bummer
42
Intentional Neighborhood

• Some people in this movement prefer the term
  intentional neighborhood
• It is less accurate
• It is less freighted with preconceptions

43
Denmark

• Co-housing
• Began in 1964
• Often multigenerational
• Aging in community
• Reciprocal caregiving
• Long and often exhausting planning process

44
Co-Housing

• Participatory process
• Neighborhood design
• Common facilities
• Resident management
• Non-hierarchical structure
• No shared community economy
• Source Kathryn McCamant and Charles Durrett 3rd
  North American Cohousing Conference Seattle,
  September 1997

45
Participatory Process
46
Neighborhood Design
47
Netherlands

• Humanitas
• Apartments for life
• Multigenerational
• Aging in community
• Reciprocal care-giving

48
Humanitas Ideals

• Rigorous separation between housing and care
  from care to housing.
• De-institutionalization from facility to home
  care.
• Rich and poor, sick and in good health, young and
  old, migrant and native are all welcome
• No separation from partner.
• 'Use it or lose it' the care is strictly
  suitable and advising too much care is worse
  than too little care.
• 'Give a hand with your hands on your back'
  stimulate independence and self-reliance (up to
  pain threshold)
• Corporate yes-culture meetings cost money,
  enthusiasm produces!

49
The Comfort Project

• The lifetime-proof building
• Exploring the extent to which technology can
  contribute to the lifetime-proof building project
  of the Humanitas housing association in
  Rotterdam.
• An emphasis on sustainable building, safety,
  accessibility and adaptability.
• The goal is to enable people to function
  independently as long as possible.

50
Japan

• Kojikara Village
• pre-school
• child daycare
• nursing school
• adult daycare
• home care services
• skilled nursing homes
• assisted living
• group home
• hot spring

• Bochi Bochi Nagaya
• The name means slow life community
• This is meant as a compliment
• Intergenerational co-housing,

51
The Slow Life
Translated by Emi Kiyota U of Wisconsin
52
Japan

• Kojikara
• pre-school
• child daycare,
• nursing school
• adult daycare, home care services, skilled
  nursing homes, assisted living, group home,
  co-housing, restaurant, hot spring, and etc. The
  intentional community (inter generational
  co-housing) in this village is called Bochi Bochi
  Nagaya.

53
Kojikara

• Self-directed operation by residents in the
  community. Pursues consensus through frequent and
  long discussions.
• Encouraging inconvenience. This encourages
  creativity and socialization.

54
Kojikara

• Creating an environment where people can feel
  "they are needed by others in the community.
• Recreating a sense of community by living through
  both positive and negative sides of community
  life

55
Kojikara

• Not providing totally safe environment. In order
  to encourage residents to create their own safe
  place, they should discuss and decide how the
  community should be operated and changed.

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AARP
Aging in community offers us new perspectives on
public policy, advocacy, messaging and member
value