The Citizenship Approach to Community Living

The Citizenship Approach to Community Living

Health, community and housing are three vital and intertwined components associated with healthy longevity. For community to be achieved, Nexus Insights believes we need to shift from the current primary focus on what is done ‘for’ and ‘to’ older adults, to a focus on what is done ‘by’ and ‘with’ older adults.

Nexus Fellow and President & CEO of Christian Living Communities, Jill Vitale-Aussem, recently led a discussion on the importance of community. CLC’s citizenship model is rooted in the belief that each individual, at every age and level of abilities, has gifts, passions, talents and experience that make the community stronger and better.

She was joined by Maddy Chapman, the Associate Executive Director at Holly Creek, and Andrew Sharp, the Community Life Director at Clermont Park, to discuss how citizenship helps to revolutionize aging services.

“Citizenship is the ultimate goal of a person-directed culture.” Jill Vitale-Aussem.

Continuum of Person-Directedness

Previously, the traditional framework was provider-driven, where management made decisions for elders and staff, but organizations like Christian Living Communities have moved a new model – one that CLC calls the citizenship model – where elders contribute to their community and play important roles.

Provider Directed – Management makes most of the decisions with little conscious consideration of the impact on elders or staff. Elders are expected to follow existing routines.

Staff Centered – Staff consults elders or put themselves in elders’ place while making the decisions. Elders have some choices within existing routines and options.

Person Centered – Elder preferences or past patterns form the basis of decision-making about some routines. Staff begin to organize routines in order to accommodate elder preferences, either articulated or observed.

Person Directed – Elders make decisions every day about their individual routines. When not capable of articulating needs, staff honor observed preferences and habits. Staff organize their hours, patterns and assignments to meet elder preferences.

Citizenship – Elders influence their community, they are problem solvers, share responsibility for each other and are expected to contribute. The organization, leadership, management and staff support others to exercise autonomy, connection and well-being, and work to remove systemic barriers.

(Source: Pioneer Network, Continuum of Person Directed Culture, modified by Christian Living Communities to include the Citizenship model.)

During the presentation, Sharp shared a video, “I am”, from Clermont Park where residents explain their roles. “It’s ‘I am’ because it’s right now. Not I was or back in the day I did. It’s ‘I am’,” said Sharp. Examples of residents’ roles included Gallery Committee Chair, Conversation Connections, Campus Gardner, Chronicle Editor, Ambassador, and Researcher.

The Five Rs of Citizenship

The Five Rs of Citizenship published by the Journal of Community Psychology are Rights, Responsibilities, Roles, Resources and Relationships. In reference to community living, rights refer to the Rights of the residents that need to be upheld. Responsibilities are the duties residents are responsible for. Roles are the titles the residents hold. Resources are time, money and training that need to be given to residents. Relationships are people getting to know one another.

“We need a life with purpose. We need true belonging. We need roles to play. There’s not been one study that says to live a long and healthy life you should live a life of leisure and have everything done for you.” Jill Vitale-Aussem

Disrupting Aging Services Through Citizenship

Watch the full discussion:

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Future of Aging

If You Hated 2020, You’re Going to Despise Old Age: A Nexus Op-Ed

It’s safe to say that none of us want to experience life as it was lived in 2020 ever again.

We missed our friends and family during the era of “social distancing.” In the short term, most of us could handle the loneliness. But as the pandemic wore on, we found that Zoom meetings and virtual happy hours, at first novel and fun, were a very poor substitute for authentic human connection and became tiresome and annoying. We grew frustrated with the monotony of a limited life. Netflix binges, family game nights and jigsaw puzzles eventually lost their appeal.

Most of us are tired of rehashing what life was like during pandemic lockdowns, but there are important lessons to be learned. Sadly, not everyone has the option for a life filled with purpose, autonomy, and variety. What we experienced during 2020 is the life many older adults living alone in their homes or institutional care settings experience every day – both before and after the pandemic. COVID lockdowns gave younger Americans an unpleasant taste of the “medicine” that millions of elders swallow every day.

We learned lessons during the height of COVID that we can — and should — apply to older Americans. The time is now!

What would it take to have older people live where they wish without becoming socially isolated? What would it take for older people to be viewed as valuable members of a society that desperately needs their lived experiences and knowledge? What would it take for those receiving care in congregate settings to have lives filled with purpose, meaningful relationships, and, dare we say it, joy?

Read the full article, If You Hated 2020, You’re Going to Despise Old Age, authored by Nexus Insights’ Fellows Jill Vitale-Aussem, Caroline Pearson, and Dr. Bill Thomas, on LinkedIn, and join the #NexusVoices conversation.

What do you think we have learned? How can we improve the future of aging in America?

About the Authors

Jill Vitale-Aussem, President & CEO of Christian Living Communities, and Nexus Fellow, has over two decades of boots-on-the-ground senior living leadership experience, transforming organizations by creating age-positive, ability-inclusive community cultures of growth, belonging and purpose.

Caroline Pearson’s deep understanding of public and private health insurance informs new financing models that leverage healthcare dollars to fund non-medical support for older adults. Caroline is the Executive Director of The Peterson Center on Healthcare, and a Nexus Fellow.

Dr. Bill Thomas, Nexus Fellow, founder of The Eden Alternative, The Green House Project and Minka is a serial creator of scalable models and an innovator in the field of housing and services for older people. He brings to Nexus his belief that people, properly equipped and prepared, can solve the most difficult problems of living.

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solo aging

Nexus Fellow Sara Zeff Geber Shares Solo Aging Expertise this Spring

Solo aging and retirement expert, Nexus Fellow Dr. Sara Zeff Geber, has been drawing attention to the challenges of aging alone, and urging aging services to address these challenges, for over a decade. With the recent demand for Dr. Geber’s expertise on the subject, it sounds like organizations across the United States are finally starting to listen.

And they should. The statistics show it’s past time to start thinking about solo agers. According to a Forbes.com piece authored by Geber, “Twelve million adults over age 65 live alone. That is 27% of the population–the highest rate in the world. The majority are women. By age 75, the rate of women living alone rises to 44%. With the mobility in today’s society, many family members live far away. Among boomer women, 19.4% never gave birth, so there are no children or grandchildren at all to pick up the mantle of caregiving. These numbers are very different from those of preceding generations.”

If we don’t address the needs of this sizable population, we’re in trouble. Who’s going to help them coordinate care? How will they combat the risk of loneliness and find community and purpose?

Dr. Geber wrote, “Essential Retirement Planning for Solo Agers: A Retirement and Aging Roadmap for Single and Childless Adults,” which was selected as a “best book on aging well” by the Wall Street Journal in 2018.

If you want to learn more from Geber, the pioneer who coined the term “solo ager,” check out her upcoming speaking events below:

Upcoming Events

Meeting the Challenges of Solo Aging with Sara Zeff Geber – Acacia Creek

April 13, 2023 – Union City, CA

Learn the best tips and tricks on solo aging at the Acacia Creek Retirement Community

  • Planning for a life with meaning and fun after 65
  • Building community later in life
  • How to meet the challenges of aging

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It’s Past Time to Think About Solo Agers – 2023 LeadingAge Leadership Summit

April 18, 2023 – Washington, D.C.

Hear from the expert who wrote the seminal book on solo aging, along with a panel of diverse providers and older consumers on how your organization can empower solo adults aging alone to make decisions about their future and thrive while aging solo.

The Panel

  • Sara Zeff Geber, Consultant & Educator
  • Stephanie Chong, Executive Director, Northwest Neighbors Village
  • Karen Zuckerstein, Member, Northwest Neighbors Village
  • Kera Wooten, Executive Director, Westminster at Lake Ridge
  • Jacqueline Evans, Resident, Westminster at Lake Ridge

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Solo Agers Are Knocking at Your Door – Leading Age California Annual Conference

May 2, 2023 – Monterey, CA

Solo Agers, adults over 60 who have no children or are aging without family support, will need a community around them as they age. As Solo Agers begin to recognize this need, life plan Communities and other continuing care residential options will look appealing, but will those communities be ready to serve them in a way that supports who they are and who they have been?

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Innovation Challenges in the Aging Services

What Makes Innovation Challenging in the Aging Services Industry?

This week we are proud to highlight Nexus Fellow and industry expert, Jay Newton-Small.

In this Nexus video clip, she describes the unique challenges of the aging services industry and why it’s so difficult and complicated to innovate and make a meaningful impact.

“It’s such an inefficient industry and it’s so highly regulated. It’s a very intractable system that requires patience in innovating and ingenuity in innovating that other industries don’t require.”

Challenges for startups coming into the aging services space include selling into healthcare organizations that are under intense pressure due to rampant staffing shortages that have left them in a sustained state of crisis and placed a huge financial burden on them to maintain operations and meet basic regulations. The environment has been one of extreme stress, with little bandwidth or budget to invest in innovation or quality initiatives.

Information security protocols and other legal standards required to access patient data, while critical for protecting patient privacy, are also hard for small companies to meet on limited runways. And current fee-for-service payment models leave little room for innovation in holistic, person-centered care innovations.

“From the get-go, this is regulated in a really intense way, and there’s no way around that. So you have to think through, what is a way that we can innovate here that we can be able to have an impact, but also not harm people, which is a super important thing about health care. And also how can you find a way to make a profit and make your company viable. It’s one of the most challenging areas to innovate in.”

Newton-Small is the CEO of PlanAllies and the CEO and founder of MemoryWell, a tech-enabled patient engagement platform and SaaS that uses Natural Language Processing and “conversational interactions” proven to engage seniors and help Medicare Advantage plans lower churn. Unlike chatbots, MemoryWell uses journalists—or can train callers to interview like journalists using their proprietary software— to create real, effective dialogue with older Americans.

 

As a national journalist, Jay Newton-Small brings a unique perspective to the field of aging, insight into politics and policy, and a media platform. She also brings the heart of a personal-lived experience that led her to found her company, MemoryWell.

 

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Longevity in Aging

Longevity in Aging: The Need to Address Healthspan and Wealthspan

People are living longer, and that’s a good thing. It’s not unusual or uncommon for people to live into their 90s. But how is their quality of life? Are they in good health? Can they afford living expenses? As lifespan increases, it is critical we pay attention to healthspan and wealthspan. According to Nexus Fellow Ryan Frederick, CEO of SmartLiving 360, healthspan is “the number of years we live in good health,” and wealthspan is “the number of years we have the financial means to support our desired lifestyle.”

“Advances in longevity create the prospect of longer, healthy lives but will we be purposeful, socially connected, and financially secure over these additional years?” – Ryan Frederick

In part three of the Six Key Drivers Shaping the Future of Senior Living, Nexus Founder and NIC Co-Founder and Strategic Advisor, Bob Kramer, also remarks on the effect longevity will have in terms of where Boomers will choose to live.

“Purposeful longevity means our new customers are determined to thrive,” said Kramer. “They are looking for community and a sense of connection. I call it the ‘engagement’ concept of retirement and aging which focuses on purpose, experience, and enjoyment. Paraphrasing a report by the McKinsey Health Institute, our customers aren’t just looking to add years to their lives but add life to their years.”

So how do we improve the quality of life for older adults?

“Researchers point out that longevity is largely driven by our lifestyle rather than our DNA,” wrote Frederick in a SmartLiving 360 blog post. “By some estimates, lifestyle and our environment account for about 93% of our longevity outcomes. Therefore, we have agency over our longevity. Lifestyle decisions also impact our quality of life.”

Frederick goes on to say, the “key is making sure you are at the right place at your stage in life – and one of the reasons the average person moves a dozen times in their life. An openness to change and the ability to act – however overwhelming it can be – is critical to make sure where you live matches your needs and desires at a given time.”

Read more from Ryan Frederick on the SmartLiving 360 blog.

 

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Human Growth and Nursing Homes

Human Growth and Nursing Homes – a 2002 Interview with Dr. Bill Thomas

What can the United States do to make senior housing and the lives of older adults better? This is a particularly hot topic throughout the nation, especially in the aftermath of COVID-19.

A recent report with seven bold, actionable and important recommendations was recently released by the National Academies of Sciences, Engineering, and Medicine. These recommendations, when implemented, will transform nursing home care, to make it person-centered, transparent, affordable, and create living situations that are good for residents, families, and staff.

Where did these revolutionary ideas come from? Let’s turn our calendar back a few decades and spotlight Dr. Bill Thomas, a physician specializing in geriatrics and a visionary ahead of his time. Thomas founded The Eden Alternative, The Green House Project, Minka and is currently the Chief Independence Officer for Lifespark as well as a Nexus Fellow. He has long been a driving force behind the vision that is transforming care for seniors. And he has been putting his vision into practice, piloting his ideas to demonstrate that nursing homes can be places for elders to thrive. We are delighted to have him on-board as a Fellow for Nexus Insights.

In a PBS interview that aired 20 years ago, Thomas said, “There has to be a commitment to ongoing growth…Even the frailest, most demented, most feeble elder can grow…And those words, human growth, nursing home, they’ve never gone together before.”

Thomas explained the inspiration for his ideas. “In the early 1990’s I took a job as a physician at a nursing home…and I fell in love with the work. And I fell in love with the people. And I came to detest the environment in which that care was being provided. The nursing home takes good loving, caring people and plugs them into an institutional factory-like arrangement. And it’s no good. I believe that, when we make a place that’s worthy of our elders, we make a place that enriches all of our lives, caregiver, family member and elder alike.”

“He was right and ahead of his time 20 years ago. He’s still right today. Unfortunately, the tragedy of COVID has revealed how much we devalue the lives of our older adults,” said Bob Kramer, Founder and Fellow at Nexus Insights.

“We need to be concrete about it. If we want to improve life for everybody in our society, one of the very best places to begin is changing how we think about, care for and honor our elders,” said Thomas.

Read the full interview.
See a clip from the PBS 2002 broadcast.

 

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solo aging and urgent call to action

Solo Aging and Senior Living’s Urgent Call to Action!

For the last 12 years, Sara Zeff Geber, author of Essential Retirement Planning for Solo Agers, and a Nexus Fellow, has been studying what she calls “solo aging.” It’s a concept that came to her when she realized that all around her, Baby Boomers were taking care of their aging parents, running errands, moving them into senior living communities, helping them with doctors appointments and insurance, and spending a great deal of time helping them navigate their lives as they aged. She began to think about herself and the many others without children, “Who is going to do that for us?”

“At least 70% of people are going to need some kind of assistance as they get older,” she explained, but solo agers won’t have adult children to help them with it. “We have a situation coming in 10 or 15 years that is going to take both the senior living industry and the government to help resolve.”

Sara Geber coined the term “Solo Ager.” She is the foremost thought leader in solo aging and is passionate about creating change in senior housing. More than anything, Sara wants to drag baby boomers out of their denial of aging and point them toward positive planning. Learn more about Sara Zeff Geber at Nexus Insights.

 

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Bringing together different perspectives with a common passon

Bringing Together Different Perspectives with a Common Passion

Nexus Insights is a think tank comprised of a diverse group of thought leaders and stakeholders in aging and health care (Nexus Fellows) with a shared vision to advance the well-being of older adults through innovative models of housing, community and health care. The goal of Nexus Insights is to affect change by sharing innovation across traditional silos, convening leaders from different perspectives in our Nexus Voices salons, and bringing positive, life-affirming ideas into the public domain.

What makes Nexus Insights truly unique is the diversity of our Fellows. We bring together different perspectives and different backgrounds, leaders with expertise in academic research, government policy, private sector startups, and successful businesses serving older adults. It’s the diversity of perspectives, together with the common passion, that drive the disruptive thinking within Nexus.

Bob Kramer is broadly recognized as one of senior living’s most influential and high-profile thought leaders and connectors. With over 35 years of industry leadership, he has earned the reputation of “agent provocateur” in the seniors housing and care industry and aging services field. He has been described as an ice-cutter and scout in identifying industries and trends that will disrupt the future of seniors housing, aging services, and aging more broadly. Learn more about Bob Kramer at Nexus Insights.

 

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Aging in Place to Aging in Community

From Aging in Place to Aging in Community: A 2020 Virtual Talk by Dr. Sara Zeff Geber

Aging in place can be a recipe for isolation and loneliness, according to solo aging expert and Nexus Fellow, Sara Zeff Geber, PhD. In a 2020 virtual presentation, she explains the risks, which include cognitive decline, depression, high blood pressure and more. The result? A decreased quality of life.

According to Geber, there are three types of loneliness:

  • Intimate/Emotional: Longing for a close confidante or intimate partner;
  • Relational/Social: Yearning for quality friendships and social companionship;
  • Collective: Hunger for a network or community of people who share a sense of purpose and interests.

In her presentation, Geber also explains:

  • What makes us happy in later life;
  • The importance of relationships and where they come from;
  • Opportunities to build community;
  • How building community can lead you to the right place to age.

Watch the full presentation:

The event was co-sponsored by Newton Free Library, 2Life Communities, Temple Shalom, and Newton Department of Senior Services.

 

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aging in place baby boomers

Why Boomers May (or May Not) Want to Age in Place

There are so many options between aging-in-place and a nursing home. Open-minded baby boomers should explore them all.

While many people plan to “age in place” and remain in their homes, it isn’t always the best plan, the best location, or the best house. It may not even be an option in later years when unexpected health or mobility issues, or even loneliness, play a factor. Does that mean the only other option is a skilled nursing facility? Absolutely not. According to an op-ed written in the Sun-Sentinel by Nexus Fellows Ryan Frederick and Sara Zeff Geber, PhD, other options include “age-friendly apartments, active adult communities, independent living senior communities, home-sharing, co-housing and accessible dwelling units (ADUs).”

What makes a place the right place, or the best place, when it comes to a happy life? Purpose, engagement, and social connection, according to findings from the Rush Memory and Aging Project. Frederick and Geber go on to explain how policymakers can support this, and how Boomers can make the right choice for their “bonus” years, the 21 years beyond retirement.

Read the full piece, ‘Aging in Place’ is not a plan. It’s denial – and it ignores an opportunity.

Ryan Frederick and Sara Zeff Geber are fellows of Nexus Insights, a think tank advancing the well-being of older adults through innovative models of housing and healthcare. Frederick is the author of “Right Place, Right Time: The Ultimate Guide to Choosing a Home for the Second Half of Life (Johns Hopkins University Press, 2021). Geber is the author of “Essential Retirement Planning for Solo Agers: A Retirement and Aging Roadmap for Single and Childless Adults” (Mango, 2018).

 

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