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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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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Sarah Thomas new lifestyle membership model

A New Lifestyle Membership Model Development by Sarah Thomas

Early in 2019, before the pandemic, Sarah Thomas led the development of a unique wellness membership offering with partners Transforming Age and Seismic. Thomas, CEO of Delight by Design and a Fellow with Nexus Insights, is an accomplished leader of innovation, with over 20 years dedicated to transforming the aging experience. Seismic designs and produces Seismic Powered Clothing, an innovative fusion of apparel and robotics, designed to reduce muscle strain and fatigue by providing the person’s core with extra power and stability.

In Jan 2019, after taking the stage at CES, the largest consumer electronics show in the world, Thomas announced, “Well ahead in recognizing that wellness is already a dominant American lifestyle value, Transforming Age, a wellness and lifestyle network that serves older adults, is the first industry company to partner with Seismic, in an early-stage membership program designed to offer advanced access of Powered Clothing to people living across the lifestyle brand’s modern retirement communities.”

The VIP membership offered members access to community events, early-access to transformative technologies, expert trainings, and educational programming customized for each member, with a focus on wellness. The program was delivered via an upscale studio, where Thomas and her team created a premium experience-design for each guest in Transforming Age’s Seattle-based brick and mortar studio.

At the beginning of the pandemic, senior living veteran and visionary Lynne Katzmann, founder and CEO of Juniper Communities, demonstrated for the industry the importance of the membership model for committing to a lifestyle of personalized well-being. Thomas and her team at Delight by Design were brought in to do what they do best— design experiences, brands and spaces that delight the consumer at every age. Two years of productive partnership helped launch Catalyst, an exciting new “wellspan” lifestyle program, which was recently featured in McKnights Senior Living.

Other senior living providers are also forging new paths towards promoting a healthier lifestyle, building programs to meet the unique wellness needs of their current and future residents. Essex Communities, for example, is working with Thomas and the Delight by Design team to create an exciting new wellness lifestyle brand. It will be exciting to see more as they enter the market with their new wellness offering.

At Nexus Insights, our Fellows develop new ideas and models for the future of aging services. Sarah is a great example of the thought leadership these Fellows bring to re-think aging from every angle.

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Biases in product design for aging populations

Biases in Product Design for the Aging Population

This week we highlight Nexus Fellow, Sarah Thomas who is the CEO of Delight by Design. In her feature video, she shares why she is passionate about her work and expertise in aging services.

“One of the biggest challenges we face in this industry is our own inherent biases around the aging experience, and how we build products, services and spaces. It even affects how we attract our workforce, how we bring new talent into our workforce, and how we create space.”

“If I’m a senior living operator, I don’t just want functional design that’s accessible for a wheelchair or a walker, I want it to be beautiful and delightful, and to have a human-centered approach for how we experience our lifestyle at every age. I want standards to be improved across the agespan and across the lifespan. And when we approach product design, whether I’m using a new technology or I’m using a new product to make my life easier, I want it to be exciting and beautiful… We need to look at things through a different lens.”

Sarah Thomas is an accomplished leader of innovation, with nearly 20 years dedicated to transforming the aging experience. She serves as a global aging expert, advising startups, large corporations and investors. Learn more about Sarah Thomas at Nexus Insights.

 

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The Green House Project and Pioneer Network Partner to Improve the Lives of Older Adults

A new partnership between the Green House Project, a not-for-profit dedicated to creating alternative living environments for seniors, and Pioneer Network, a not-for-profit advocating person-directed care, is being cultivated to improve the lives of residents in nursing home communities. According to Skilled Nursing News, “the joint entity will serve as a full-continuum consulting, advisory, and education partner for eldercare organizations.”

Industry visionary, Geriatrician and Nexus Fellow, Dr. Bill Thomas, has a long history of improving the quality of life and purpose for older adults. In the 1990s, he co-founded the Eden Alternative, the Pioneer Network and in 2003 he founded the Green House Project.

“For years, the Green House Project and Pioneer have collaborated on a variety of eldercare reform initiatives, driven by our shared history and mission to improve the lives of nursing home residents today and in the future,” said Pioneer Network President & CEO, Penny Cook. “Together, we will go farther than we could as parallel travelers on the same path.”

Read more at Skilled Nursing News.

 

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Cost of Ageism in the United States

The Cost of Ageism in the United States

Ageism is not only painful for those it disadvantages, it’s also costly – an estimated $63 billion per year. Furthermore, it contributes to mental health issues and is the leading cause of suicide in older adults. At a time when people are living longer, healthier and more productive lives, the rest of society persists in seeing older people as obsolete. This is according to an article published in Seniors Matter.

Dr. Bill Thomas, a geriatrician and a Nexus Fellow, points out ageism in the United States in the documentary film The Roots and Consequences of Ageism in America. “Society holds up very young and inexperienced people as being the paragons of virtue and strength and idealizes them while setting aside real elders with real lived experience making them virtually invisible.”

“Ageism is common, but it doesn’t need to be inevitable,” says Erica Harrison, the author of the article, and expands on what can be done by individuals to change the narrative.

  • Be inclusive
  • Don’t make assumptions
  • Avoid ageist language
  • Call out ageism

Read the whole piece: Seniors Matter.

 

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Seniors in group living situations are less lonely and more optimistic

Seniors in group living centers are feeling less lonely now and more optimistic

By Jacquelyn Kung, Robert G. Kramer and Ed Frauenheim

Contrary to popular opinion, recent studies show that older adults are not languishing in lonely isolation. “In fact, a large percentage of seniors in our communities are not lonely,” said Robert Kramer, Founder and Fellow of Nexus Insights and Strategic Advisor for NIC. “The common perceptions —  they’re wrong, ageist and miss the hopefulness of seniors in their finding a sense of community, even in the midst of the pandemic.”

In the past, we have seen people come together during national emergencies “to form communities around a common threat and a common need,” Kramer explained. “The one group we don’t expect it from at all are older adults in senior living communities —  but they are, and they are demonstrating it,” Kramer said.

Authors Jacquelyn Kung, Robert Kramer and Ed Frauenheim point to our elders as role models for healing the nation, and showing us how to live more fully than ever, in their recent column in the Dallas Morning News.

Our poor elders.

Given the COVID-19 pandemic, and media coverage of seniors, you might think basically all seniors today are traumatized and lonely, right?

Wrong.

The stereotype of isolated, forlorn elders belies recent surveys of older adults in senior living settings.

Just 20% of senior living residents are severely lonely, according to a new 64,000-person survey from software firm Activated Insights. In fact, this survey of seniors in assisted living and other congregate living settings reveals a potential decline in loneliness among elders in retirement communities from before the pandemic. Prior studies before the pandemic of community-dwelling older adults found higher rates of loneliness.

We would argue that we as a country have a biased — and potentially ageist — narrative when it comes to elders living in congregate settings.

In fact, we should learn from the resilience of elders in the face of formidable challenges.

The stereotype of isolated, forlorn elders belies recent surveys of older adults in senior living settings.

Granted, the recent Activated Insights survey does not include most nursing homes, where particularly frail elders live. And the number of older adults in senior living settings overall, roughly 2 million people, is a fraction of the total U.S. senior population.

Still, the new research offers inspiration to the rest of the county as we work to construct our post-COVID reality and battle what some have deemed widespread languishing.

A key lesson from our elders in this moment is the power of community, friendship and gratitude.

Consider Patricia Finick of Dallas, co-author Jacquelyn Kung’s mother-in-law. By any measure, the 81-year-old has been through a lot. Her husband of more than 50 years died in 2019. After sitting in an empty home for half a year, she chose to sell her house in Connecticut, 20 minutes from where she was born, and relocate to Dallas.

In January 2020, she moved into Highland Springs, a senior living community in North Dallas. Finick swapped a 2,200-square-foot home for a 900-square-foot apartment. And then COVID-19 swooped in, isolating her in her new home before she had a chance to meet new friends.

Despite a very difficult year, Finick doesn’t feel beaten down in this moment. No, life is looking more hopeful to her. And she’s excited about engaging in more activities. “As long as my legs will let me, I’m going to go out and do it,” she says. “And if my legs don’t work well, I can get a walker.”

A key lesson from our elders in this moment is the power of community, friendship and gratitude.

One key to her optimism is her Catholic faith. Another is her set of friends, both long-standing phone buddies as well as some new friends she has met at Highland Springs over the past year. She’s part of a breakfast club, a group of residents who gather most mornings. “They’re really, really friendly, and we have a lot of laughs together,” Finick says.

Finick’s contentment is echoed by other residents of senior living settings, according to the Activated Insights survey of residents and family members during the first half of this year.

Many elders in these settings expressed gratitude, both for the sense of belonging they experience and for the caring they received from staff members of their communities.

Consider these survey comments from seniors:

“I’m more than satisfied with life. I feel safe and am especially grateful for the careful response to COVID-19. Gratitude and blessings.”

“(I had) a feeling of safety during a time of great vulnerability. Having the opportunity to make new friends helps a lot.”

These aren’t cherry-picked quotes. Before COVID, when asked for comments about the best thing about the senior living community, 20% or fewer responses were about belonging, community, appreciating the staff and being safe. This year, though, 60% to 70% of “best thing” comments mentioned those themes.

As a nation, America could use a booster shot of resilience. Observers note a kind of COVID hangover, or apathy.

Seniors in congregate settings, who in some ways bore the brunt of the pandemic, offer guidance for a brighter path forward. These older adults may be more willing than younger Americans to acknowledge our interdependence as human beings, experiencing the support they receive not with resentment but appreciation.

Far from feeling fearful, sad and isolated, seniors are showing us how to live more fully than ever.

A few months ago in The News, we authors urged the country to rethink how we view senior citizens and engage elders in the work of healing the nation.

The latest data suggests seniors are already doing this work. Far from feeling fearful, sad and isolated, many of them are showing us how to live more fully than ever.

Patricia Finick, for one, looks forward to more dinners and concerts with her new friends. Together, they are eager to put the last vestiges of the pandemic behind them.

Says Finick: “There is a whole world out there to explore.”

Read the article.

Jacquelyn Kung is CEO of Activated Insights and a Nexus Insights Fellow.

Robert G. Kramer is a Nexus Insights Founder and Fellow, and Strategic Advisor & former CEO of the National Investment Center for Seniors Housing and Care (NIC).

Ed Frauenheim is co-author of several books on organizational culture, including “A Great Place to Work for All.”

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Mind games help with long-term brain health

Mind Games – Significance of Lifestyle Interventions to Prevent Cognitive Decline

Humans have long been looking for the fountain of youth. Medical advances mean that most of us can expect to live for a long time. But how we live is an important component of successful aging. Originally published in June, Mind Games is an essay that explores the current understanding of best practices for maintaining a healthy brain as we age.

With my first book coming out in the fall, I am paying more attention to bookstores. I’m finding an increasing number of titles related to aging. It’s probably not surprising as the bulge of baby boomers – the oldest of whom are now in their mid-70s – are looking to successfully age, where a longer life span is matched with a correspondingly long wealth span and health span.

A number of these books focus on brain health. It makes sense as, according to one prominent researcher, Alzheimer’s is the most feared disease, even more than cancer. The loss of independence is devastating and requires comprehensive assistance to manage life. The burden on caregivers, often a spouse or family, can be overwhelming, too. A long life span and wealth span may be of little use if health deteriorates significantly.

It’s no surprise that the recent approval of Aduhelm, Biogen’s new drug for Alzheimer’s, has received significant attention. Its impact could be transformational for millions of people, perhaps with a greater impact on society than the vaccines produced to combat COVID-19. While critics point to scant evidence of its impact on the disease, if successful, it could usher in a new wave of effective innovations to fight cognitive decline.

“We may be soon entering an era without dementia. It could arguably be just as significant as a world without cancer. Such a milestone would be one of mankind’s great achievements.”

Significance of Lifestyle Interventions to Prevent Cognitive Decline

The good news is that many of us can take measures to prevent or delay cognitive decline without relying on a pill. A range of lifestyle interventions can reduce the risk of mild cognitive impairment, characterized as problems with memory, language, thinking or judgment, as well as the risk of dementia, such as Alzheimer’s. Mild cognitive impairment is often a precursor to dementia.

Diet

We are learning more about the role of a healthy diet to help prevent dementia. The MIND diet, which is a variant of the Mediterranean Diet, focuses on whole grains, berries, green, leafy vegetables, other vegetables, olive oil, poultry and fish. Researchers have found that strict adherence to the MIND diet for older adults resulted in about a 50% decrease in Alzheimer’s diagnosis. Even more encouraging is that you don’t have to be rigorous in adhering to the diet to experience a positive impact. Simply eating fish once a week and incorporating greens into a meal each day could be an achievable goal that makes a difference.

Exercise

Scientists are still determining the causes of mild cognitive impairment, but some evidence suggests that a reduction in blood flow to the brain can be a factor. Regular exercise amplifies the healthy flow of blood to the brain while exercising and afterwards. Recent studies show that regular brisk walking is particularly effective in helping older adults with mild cognitive impairment. As last month’s blog emphasized, it’s valuable to move regularly, even if the measures are as simple as taking stairs or parking farther away when shopping or commuting.

Social Connection

The impact of loneliness has been well-documented: it has been found to be as harmful as smoking 15 cigarettes a day and can increase the risk of premature death by as much as 30%. But loneliness is particularly harmful to the brain. Studies have shown that loneliness can increase risks of dementia by 26% and mild cognitive impairment by 105%. Regularly reaching out to friends, whether they live close by or far away, could have a greater impact on your brain health than you realize.

Sleep

Sleep is the single most effective thing we can do to reset our brain and body health each day. Sleep helps cement positive memories, mollify painful ones, and meld past and present knowledge, inspiring creativity. Conversely, insufficient sleep wreaks havoc. Insufficient sleep, or routinely sleeping less than six or seven hours a night, increases the odds of dementia. As we age, we tend to sleep less efficiently and wake up earlier, so it is important to go to bed earlier.

Hearing

Hearing loss has been shown to be a factor in cognitive loss and may also be one of the biggest potentially reversible factors. Hearing loss for a long period causes shrinkage to areas of the brain associated with memory. Proper diagnosis of hearing loss is important, as are interventions such as hearing aids.

Don’t Forget the Role of Place

Place has important direct and indirect impact on our brain health. Some places are objectively poor for our cognitive health. One study found that living near major roads is linked to an increased risk of neurological diseases, including dementia, Parkinson’s, Alzheimer’s, and multiple sclerosis. It is believed to be caused by excessive exposure to air pollution and the incessant noise of vehicles.

Place also has an indirect role, by nudging us to healthy lifestyles. A pervasive culture that values healthy eating makes it easier to eat healthy; environments that are conducive to exercise embedded in the normal course of life are beneficial; areas that promote social connection amongst neighbors can help stave off social isolation and loneliness.

An Era Without Dementia

With advances on various fronts, we may be soon entering an era without dementia. It could arguably be just as significant as a world without cancer. Such a milestone would be one of mankind’s great achievements. As Dr. P. Murali Doraiswamy, Director of the Neurocognitive Disorders Program at Duke University School of Medicine and co-author of The Alzheimer’s Action Plan, says, “It’s a hopeful time.”

But, even if Biogen’s Aduhelm is unsuccessful, we can be hopeful, because the right mix of diet, exercise, social connection, sleep and hearing may just be the antidote we need to keep our minds strong. And don’t forget the role of place, the foundation that helps pull it all together.

Mind Games was originally published on SmartLiving 360.

Place plays a significant yet often unacknowledged role in health and happiness. Ryan Frederick, CEO of SmartLiving 360 and a Nexus Insights Fellow is the author of the upcoming book Right Time, Right Place, in which he explores more deeply the idea that where you live matters enormously – especially during the second half of your life.

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Dr. Sara Zeff Geber on Senior Isolation and Solo Aging

Strategies for reducing isolation among solo agers – an interview with Sara Zeff Geber

Sara Zeff Geber, an expert in solo aging and a Nexus Insights Fellow, noticed something interesting. A lot of Baby Boomers were spending a lot of time, resources, and money taking care of their aging parents. And it occurred to her to wonder, for childless seniors like herself, “Who’s going to do that for us?”

That question launched a new line of research for her, and ultimately led to her book, Essential Retirement Planning for Solo Agers.

Zeff Geber was interviewed recently by Dr. Namrata Bagaria and Dr. Paul Merkley of Seniors Junction on their podcast “Ending Seniors’ Isolation, One Conversation at a Time.” The two asked Zeff Geber for her insights into reducing isolation and loneliness for solo agers.

Among the many insights she shared:

  • Solo aging is becoming more common. “Almost 20% of Baby Boomer women didn’t have kids.”
  • Everyone, even married couples, should plan as if they will be solo agers. “One spouse will almost always pre-decease the other, and you don’t have a crystal ball.”
  • “The research shows that isolation and loneliness are more deadly to us than 15 cigarettes a day,” said Zeff Geber. The most important thing, she suggested, is to build and maintain a social network.
  • As Bagaria points out, “Paul and I have learned on our journey that some people are naturally proactive about connecting and building a network and some have to pick up that skill.” Said Zeff Geber, “Learn to be a joiner; find a group that interests you; it could be a golf club, a book club, a dog-lovers group, or a similar-minded group at your church or synagogue”

Listen to the full podcast.

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