Redefining Prosperity

 

Vulcan salute

If I were to fulfill Mr. Spock’s blessing to “live long and prosper”, I guess I would die a rich old man.

Somehow, however, that dream feels a little hollow. Yet, it’s at the core of the American economy, right? We are told that we depend on people getting rich to create the jobs that fuel increased consumption and continued economic growth. And staying young forever is, of course, the desired state of every baby boomer consumer, according to Madison Avenue.

I have a growing suspicion that the prospects for every American to enjoy riches are as dim as the prospect that we can all live to 120. Acknowledging the reality of one’s own mortality is the first step to understanding what it means to age well. Acknowledging the reality of our economic limits can be the first step to a new definition of prosperity.

As this year’s fabulous Community Matters ’10 conference was held in Denver, I had an opportunity to meet planners, government officials, and resident activists from multiple small towns in the Mountain West and High Plains. Many of these communities are struggling economically, often due to the decline of traditional  industries (mining, logging, ranching and farming) in the face of worldwide competition. One common consequence of this trend is the departure of young people from their home communities and the subsequent increase in older age-density, creating what Dace Kramer has referred to as “naturally occurring retirement regions” (NORR’s). This has been accompanied by an influx of new retirees seeking amenities not typically provided by sunbelt retirement communities – incredible natural beauty, skiing, hiking, recreational ranching, etc. As one might guess, local economies are shifting to a “service” base as the population ages, due to both aging in place and in-migration.

While recognizing aging is a major driver of population and economic change in the New West, I have come to realize that, with respect to local economy, it’s impossible, better said, impractical, to discuss aging without reference to youth, and vice versa. If people are to age well in the New West, they need robust youth to provide services of all kinds. If communities are to provide opportunities for youth that enable them to stay put, they need the monetary investment of elders.

Seems like a simple dollars and cents issue. But it goes deeper. In the practical sense, attachment to place requires dollars and cents. For a young person, it equates to a job. For an elder, it often equates to cost of living. The converse applies to both. In a deeper sense, attachment to place is not a monetary issue. We are attached to a place because we feel we belong there. We know the place and it knows us. We nurture the place and it nurtures us.

When we reach the right place, we don’t need more because we have enough. We have loving relationships. We have the sense of fulfillment that comes from the beauty of the quiet order around us balanced by the sense of delight that comes from the unpredictable and creative spirit of nature and of youth. To appreciate what we have means we must regularly view our place from the outside, which can simply involve embracing those strangers who are our future neighbors, friends and family.

When we reach the right place, we are prosperous. Yet, we may very well be spending less, not more, which in the current scheme is anathema to our American economy. We are told that, without wealth-creation, America will become a “second-class economy.” The “new normal” means a lower standard of living. If that’s true, is this bad? These days, both young people and elders are the new pioneers in the so-called lower standard of living. Should we not notice that they are discovering the difference between standard of living and quality of life? Should we not be listening to elders who can teach us how they survived hard times and to youth who can teach us how to live more lightly on the planet?

Addendum:

Through the generous support of the Orton Family Foundation, and others, the participants in the Community Matters ’10 conference came together to explore and develop a new “heart and soul” approach to community planning. This approach is based on the belief that a slavish adherence to growth in every direction threatens the heart and soul of our communities – the things that, in the end, attach us to place and define who we are. Economic growth and quality of life are not necessarily antithetical. But a corporation is not a person (despite the Supreme Court decision) and capital is, too often, not attached to place. Planning that reveals and promotes the heart and soul of a place is essential and, indeed, many local companies are loyal to their communities and help define heart and soul. Storytelling and story sharing are critical tools for “heart and soul” practitioners. For a wealth of connections to this growing and exciting area of community planning and activism, visit the Orton website at: http://www.orton.org

Spend some time with the site and be sure to look for the Heart and Soul Community Planning Principles.

The Deep Meaning of Home

Attention to the deep meaning of home takes us to a kind of figurative commons, where we can have a serious discussion of the ubiquitous phrase “aging in place.”

For many practitioners and elders as well, aging in place has traditionally been equated with aging in one’s current residence – be it house or apartment. In fact, this is precisely the meaning taken in the AdvantAge Initiative survey in Indiana, which asked 5,000 older Hoosiers whether they agreed or disagreed with the statement “What I’d really like to do is stay in my current residence for as long as possible.” Moreover, 94% of Hoosiers 60+ agreed with that statement! Clearly, staying put is the preferred choice for the vast majority of older adults in Indiana, and elsewhere. Our ethnographic research on the meaning of home in Bloomington offers some clues as to why people feel so strongly about the issue.

Home is a deep concept, far more significant than “house.” In the Bloomington research we encountered individuals who have lived in the same house for over 75 years! Imagine the sediments of memory that have been laid down over such a period of time. It requires a virtual archaeology of memory to peel back the deep meaning of a life in such a place. These memories, good and bad, are codified in the physical contents of the place. As she walks through the house, the owner walks, again, through life. Photos, furniture stains, knick knacks, postcards, window vistas, even dents in the woodwork signify and embody important events, episodes, and individuals in one’s life. How could one be expected to easily leave behind the door jamb marked by pencil with the advancing height of one’s children?

Home is a physical support. Over time, home and body coalesce, a hand in glove. We can walk through our home with our eyes closed because we maintain its physical representation within our body. This is very comforting. Managing the home (sometimes trivialized as homemaking) anchors daily life, provides markers for our temporal experience, and provides cues and incentives to keep our body and mind active.

Home is a financial cushion. For older homeowners (87% of older Hoosiers), the home is often THE primary financial asset. According to Michael Hurd of the RAND Corporation, home values during the current financial crisis dropped somewhere between 10% and 33% (according to different surveys). One can understand why, these days, older persons might be reluctant to tap their equity through the sale of their home.

Home is an aesthetic. You design its appearance for self-satisfaction and display to others. The aesthetic reflects your own sense of self just as importantly as does your clothing and your car.

Home is a social base. When you are home, it’s your territory, your turf. You control who enters. When you are home you are at the node of a social network of friends, neighbors and family. Home is a launching pad for connections with the immediate neighborhood and the wider community. This is why it’s so important to get out on the front porch and make it to the mailbox. (More on that later.)

With all these things in play, the home becomes a mirror for the self. It represents you to yourself and, as such, provides a constant reminder of your uniqueness and contributions to your family, your neighborhood, your community. Is it any wonder why someone would want to stay put?

What practitioners, family members, friends and neighbors know, however, is that staying put is not always the best solution if it results in social isolation, depression or unmanageable risks to health and wellbeing, notwithstanding the desires of an elder; and particularly so when the elder’s judgment is clouded by dementia.

Practically speaking, this “tension” between staying put or moving on often results in conversations and negotiations around “acceptable risks.” In fact, dichotomizing the choices as one or the other can be non-productive. Better to openly discuss the adaptations necessary to accomplish either goal. Staying put, indeed, does not mean “not adapting”. There are many adaptations we all likely need to make just to stay put. It’s not black and white – change or no change.

Acknowledging the complexity and difficulty of staying put, in light of the deep attachment to place, was one secret to the success of a home modification initiative created by residents, leaders, and providers for a NORC (naturally occurring retirement community) neighborhood in the little town of Linton, Indiana, population 5,000, in the spring of 2009. Having received a grant to spend 18 months assessing needs and building relationships with and among seniors in the neighborhood, the NORC leadership determined that improving mobility, broadly defined, should be a priority. The group wisely inferred that mobility in the home itself should be a starting point for any effort to assist elders to connect in the community.

Knowing that a foundation of trust was essential, a well-known and beloved community member (Crystal Woods) was hired to introduce the concept of home modification and repair to neighborhood seniors.  Senior members of the NORC advisory group began talking about the project with their neighbors. A few older residents consented to a “home safety” check by Crystal. This provided Crystal an opportunity to initiate conversations about possible things that could be done in the home to make it more comfortable or safe. Additional visits were provided by nurses from the only home care agency in the community. Local, trusted contractors were then introduced into the home by and with Crystal to begin estimating jobs. Budgets were developed for each project, without assuming that every recommendation would be either necessary or approved by the elder and their adult children (who would only be invited into the conversation at the request of the elder). When a handful of projects were ready to propose, the neighborhood seniors on the advisory committee were empowered to select what could be offered to each homeowner, given the overall project budget available ($45,000). Soon, contractor work began and it was revealing to see the contractors themselves developing close relationships with their customers, often doing more than the job required -all closely shepherded by Crystal, from beginning to end. Once a few seniors were “hooked” they told their friends and, within a period of four months, 19 homes were modified or repaired, several with significant improvements such as new bathroom floors and fixtures, new assistive features, ramps, and handrails!

This is what I call a “down home” solution to a major community challenge. And I use the word home in the best sense of the term.

Note: I hope you enjoy reading my blog. Your thoughts and additions to the conversation thread are most welcome. You can reply publicly right here on the blog. For additional reading on the meaning of home I suggest checking out: Graham Rowles, Claire Cooper Marcus, Wendell Berry, Scott Russell Sanders, Gaston Bachelard, and others. These authors are acknowledged and the ideas explored in more depth in the chapter entitled Being and Dwelling in Old Age, in my book Elderburbia: Aging with a Sense of Place in America (Praeger 2009). For a discussion on the sense of home and place in long term care facilities, see my chapter entitled Homebodies: Voices of Place in a North American Community, in my edited volume Gray Areas: Ethnographic Encounters with Nursing Home Culture (SAR Press 2003).

In Indiana, we are working towards some state legislation called Hoosier Communities for a Lifetime. At the end of November, I am presenting a two day workshop on communication and dementia. For info about these things and more, just click back to the website at www.agingindiana.org

In October, I enjoyed the opportunity to participate in an amazing conference – Community Matters ’10. When I get a chance, I’ll blog a bit about the growing movement towards “heart and soul” planning.

Till then,

Phil

Walking as a Narrative Activity

In response to an earlier blog (March 15), friend Lyman Orton, founder of the Vermont Country Store, picked up on my comment about remembering old ladies and their small grocery carts coming home from the Jewel Tea store in my neighborhood. “Are these things still for sale somewhere?”, I asked.  Well, indeed they are, and it’s no surprise that the Vermont Country Store is the place to find them, visit the catalogue here and voila’ . 

The Vermont Country Store is the source for much of the “good” from the good old days. While nostalgia is fun, the store sells more than nostalgia. Simpler toys,simpler appliances, simpler (and often organic) products are the store’s stock in trade. For Lyman, and his family, the Vermont Store has come to represent an attitude towards life and an attitude towards community that values local activism, livability, and philanthropy. Indeed, the Orton Family Foundation has heavily invested in citizen participation planning initiatives that tap what Lyman calls the “heart and soul” of the community. (See Orton Family Foundation) Not just for the sake of pitching clothes lines in his catalogue, Lyman is also at the front of the “right to dry” campaign, which fights against covenants and ordinances banning clothes lines from backyards. In light of our national energy/environmental crisis, it’s hard to imagine that anyone could wish away the sight and smell and fresh air experience of hanging clothes in the springtime breeze. I should mention, I suppose, that you can also find those great old wooden clothespins in the catalogue, you know… the ones with the metal spring (which, as a kid, we reversed to create neat matchstick guns). You can even order pins printed with the “right to dry” slogan!

Now those little grocery carts don’t work too well if there are no good sidewalks. How is it that sidewalks came to be seen as “amenities” rather than part of the essential community infrastructure. Nowadays, we have to incentivize developers to include sidewalks on both sides of the street. I guess that’s a step (backward) in the right direction, but it galls me that we have to reward behavior that should be expected.

But a sidewalk is, after all, a means to an end, a conveyance. We should also consider, as we think about the quality of our communities, whether the sidewalk leads to valued destinations and, perhaps more importantly for people with time (elders and children) the sidewalk provides the journey. Walking, and maybe I should say strolling, whether on foot or in a chair can be a rich narrative experience. As we walk, the surrounding environment, built and natural, becomes part of our sensuous world. Being physically open to the world, we see, we smell, we hear, we feel, we belong in a way not experienced in the automobile. The time it takes to move through the environment enables us to reflect, remember, retell the story of the neighborhood to ourselves. Over the years, I’ve watched that root gradually lift the pavement; I remember that old lady in the bonnet who used to live there and tend to her flowers; I recall with pain the cinders that would grind into your knees when you fell off your bike in the alley; I react  with fear at the house where my friend’s mean Dad was taken away in the police car, his mother on the porch bruised and sobbing.

Years ago, I came across an essay by Michel de Certeau called “Walking in the City.” (In the Practice of Everyday Life, 1984) He noted that people in positions of power (city authorities, planners, developers) tend to be enamored of the “birdseye” view of the city. Their grand maps, looking from above, are a testament to their control, to their ascension. Yet, the meaning of the city, the story (text) of the city, the life of the city  is produced by people walking. This is how the city is truly inhabited. As William H. Whyte said, “the meaning of a place is a product of the users, not the planners.” As I see it, the first step in planning and creating good places to grow old (and grow up) is a literal one – a step along the sidewalk.

Awhile back we invited kids in the local public housing complex to “walk the neighborhood” with us. Before we started, we had the kids draw maps of their neighborhood and, typically, we saw “elevation” maps – as if you were standing on the street and looking out. After walking the neighborhood, the kids began relating to the birdseye view. They were “ascending” to power, if you will, and beginning to see the larger context of connections among the parts. This is a good thing, where citizens understand that “maps have teeth”,  in the words of geographer Doug Aberley, and take back the human cartographic impulse  from the professional mapmakers, who haven’t done such a good job designing our towns lately.

A Sticky Message: “Community is the Smallest Unit of Health”

Wendell Berry, author of the quote following the colon, would not likely have thought of his message as sticky. But it has sure stuck with me over the years and I use it often in describing the need to re-frame our understanding of aging away from the body and toward community. This week, I learned about the concept of sticky messages.

Made to Stick: Why Some Ideas Survive and Others Die, C. Heath and D. Heath, 2007, was the inspiration for a portion of a terrific workshop provided by John Beilenson, President of Strategic Communications & Planning on June 24, 2009 in Indianapolis. 35 participants from around Indiana’s expanding aging network attended.

John’s an outstanding resource, so it’s no surprise that he is working with the National Council on the Aging in a major consulting capacity. The workshop, coordinated by the Center on Aging and Community, brought together an energetic and engaged group of professionals and activists working locally to create “communities for life” – or elder-friendly communties that just happen to work well for all ages.

With gracious permission, I’m posting John’s slides with this blog. Communicating for Communities for Life

Phil

Building Community in the Nursing Home?

Gerontology students in Indiana have been participating in a week long facebook discussion to celebrate Careers in Aging week. This post elaborates on a thread related to the possibility of creating community in long term care facilities. I believe it can be done, but that many factors mitigate against it. What follows is an abstract from my forthcoming book Elderburbia: Aging with a Sense of Place in America, on this subject…

A good place, then, is also a “keeping place” – it holds people together through their common participation in its qualities. As Wendell Berry put it in another essay…”a human community, then, if it is to last, must exert a kind of centripetal force, holding local soil and local memory in place” (1990:155). Perhaps our chief criticism of the institution we call the nursing home, then, should be that it too often erases memory. Now this may be difficult to perceive at first for we are talking about noticing absences and silences – the semiotician’s zero signs. How do you notice something that’s not there? I’m suggesting that we think not about what we see, or hear, or smell, when we enter the nursing home, but what we don’t see, don’t hear when we enter into this space. In evaluating the quality of this environment then, we might ask:

Where is the memory of this place?

Where is the evidence that people have lived here?

Where are the personal traces of former residents?

Where are their pictures, their mementos, their trophies, their headlines, their

            scrapbooks?

Did they laugh? Did they cry?

Were they loved? Did they love?

 

…and where is the evidence that people died here?

Where are the memorials, the funerals, the survivors?

…and did anyone make an impact here?

as a worker?

as a volunteer?

as a family member?

 

Too often, we look and do not see. Traces have been obliterated. Death has been spirited out the back door. The room has been cleared and cleaned to receive another. Valuable possessions are bagged, tagged, and gone with a family sometimes eager to never look back.

By the same token, the good nursing home remembers its residents to us. It celebrates their presence and enables them to create place. It creates home through enabling its occupation, its dwelling, through bodily practice. It invites former residents to return (yes, they do exist). One sees previous family members returning to sustain ties with friends of the deceased. One sees memorial services to acknowledge death and graduation ceremonies to celebrate the triumph of rehabilitation (see Shield 1988: 76 ff). Yet, it is a struggle to enable the creation of place where so many factors mitigate against memory making:

 

„          the lack of temporal depth in relationships due to staff rotation, the fear of approaching the sick, and death itself

 

            At the Crescent Nursing Home, where anthropologist Nancy Foner studied the working lives of nursing assistants, the turnover rate is remarkably low (as low as 5%). She attributes this low turnover rate to the relatively high wages and job stability offered to the predominantly Caribbean and Hispanic workers in this unionized setting (as compared to most nursing homes around the U.S.). The long tenure of most nursing assistants positively reflects on the caring and enduring relationships engendered among staff and residents in this facility (Foner 1994:17). Compare this with the average turnover rates ranging from 40% to 75% annually in most nursing homes around the country and the very real problem, as I have seen, with nursing assistants coming and going so quickly that they have no real possibility of forming lasting relationships with patients and families. Foner also acknowledges that nursing assistants who spend too much time with residents may risk the ire of nursing directors or other staff who follow on the next shift and must pick up the “bed and body” work left undone. J. Neil Henderson, in his ethnography of Pecan Grove Manor, noted how superficial the interactions between nursing assistants and residents might be. In the words of his interviewee, the Director of Nursing:

All of them (CNAs) are needed for basic care, so that the emotional side is kind of left (undone)…It is hard to just sit down and have eye-to-eye contact and really feel close to the patient when you are giving them daily care…(1995,45).

Renee Shield, in her ethnography of Franklin Nursing Home, notes how peer relationships among residents are clipped by the limits put upon exchange and reciprocity. The development of horizontal relationships with potential friends is conspicuous by its absence, as residents who lack possessions, strength, and health have little to exchange with peers (1988,155). Hence, residents attempt to develop vertical relationships with staff (albeit dependency relationships) to survive. When residents do provide staff or visitors with little gifts of kindness, there is often an attempt made to refuse them, sometimes with a citation of official policy. As Shield has observed, staff and visitors often do not want to be put into the position of having to reciprocate out of guilt, nor being trapped in an escalating structure of exchange that cannot, ultimately, solve the fundamental existential problem (Shield 1988, 172-173).

Shield adds that avoidance of enduring relationships may have some self- protective, though perhaps not adaptive consequences:

Nurses remark that new residents often try to make friends after they have begun to settle into the nursing home routine. But if a friend dies or becomes ill, the new resident learns that it is dangerous to make friends. Keeping interactions to a minimum protects the self against the emotional trauma of these losses. The emotional distance that staff members keep from residents is similarly self-protective. People-work activities, shifting schedules, and frequent changes in nursing assistant-resident assignment prevent continuity. In these ways the nonenduring nature of resident-staff relationships is per­petuated (1988,166).

In the end, it may be the illusion of timelessness, the denial of aging and death, that prevents the establishment of “communitas” in the nursing home setting (following Turner 1969). In “normal” life, outside of the institution, definitional rites of passage mark time and place individuals within the context of a supportive cultural matrix. Typically, rites of separation, followed by a liminal period, are closed by conjoining rites of incorporation, wherein the initiate rejoins the cultural fold, albeit in a changed state. The nursing home, as Shield argues, is characterized by an ongoing, neverending state of liminality. The resident qua patient leaves society but neither re-enters nor fully achieves a new status.

The illusion of timelessness belies the certainty of how limited the resident’s time actually is. The time of future peril that intact residents perceive as their fate threatens the quality of resident interactions rather than intensifies them. The residents interact superficially and guardedly. There can be little chance of communitas where the present is benignly misrepresented as safe and timeless, the future is known to be uncertain and perilous, and individuals serve as reminders to one another of their present fragile security and future certain danger (1988,208).

 

„          the dementia which robs people of memory-making capacity

 

While dementia or Alzheimer’s disease may not be the primary diagnosis for most  nursing home patients, the disorder is, nevertheless, ubiquitous in the setting. A typical study (Hing 1989) estimates that 66% of the nursing home residents in the U.S. have at least one mental disorder (generally dementia). One widely recognized epidemiological study puts the rate of moderate to severe dementia among community-residing persons over 85 at 47%. As the over-85 group is the fastest growing segment of the population, it is no surprise that the condition is very common in nursing homes. While Alzheimer’s dementia is popularly thought of as memory loss (and indeed, the loss of long term memory is undeniably present in more advanced dementia) it is the inability to make new memories, which causes functional problems for the individual. Alzheimer’s disease is, in this light, a learning disorder – the patient is unable to impress events and thoughts upon the brain for later recollection and use. Events of the remote past may be recollected with pleasure. Core elements of identity may be sustained through the active support of others (as Silverman and McAllister 1995 have shown). Even the current flux of the present can provide great pleasure and meaning. The recent past, however, the anchor of new relationships, may not be sustainable in memory. Small scale environments, such as adult day care centers, have the best chance of supporting the development of new relationships and marking events ceremonially. These markers – these memories – enable participants to maintain a sense of the passage of time and the body’s participation in a web of meaningful human relationships.

 

„          the restrictions of the physical environment which prevent intimacy from developing among residents and others

 

 

Most ethnographers of the nursing home scene have commented on the difficulty of maintaining privacy in the institutional setting. Indeed, the medical model which dominates the architecture of the nursing home constitutes a virtual panopticon in which most activities of the residents are capable of being scrutinized by the powers that be (c.f. Foucault 1979, Stafford 1997). Fire and safety codes, the wishes of family members regarding sexual conduct of elderly parents, the rarity of single rooms and small private spaces, the dispensability of small modesties, and the enforced familiarities of well meaning staff and visitors, all combine to create an environment which, as Goffman (1961) and Henry (1963) mave noted for total institutions, strips the inmate of his/her individuality and important, unique markers of personhood and biography.

As Verbrugge and Jette (1994), and many subsequent observers have noted, disability, health, and aging are not located in the body so much as in the relationship between the body and the environment. Hence, our attention is turned to the more politically sensitive notion of “disabling environments” which, being poorly designed, distort sound, amplify glare, restrict mobility, and sanitize smells.

 

„          the undeniable diminishing of the body’s capacity to extend fully into space due to impairments in vision, smell, hearing, mobility, taste, and touch

 

Yi-Fu Tuan, master interpreter of the spatial experience, notes how the synesthetic experience, in which all of the senses are employed, etches itself on our memory in a way unmatched by the unidimensional memories of the “seen:”

Life is lived, not a pageant from which we stand aside and observe. The real is the familiar daily round, unobtrusive like breathing. The real involves our whole being, all our senses (1977,146).

How can the person with hearing impairment, loss of smell, loss of vision fully experience and therefore fully remember either the routine or the special events which surround one in the nursing home environment?

So it’s not only the erasure of memory but the difficulty of making new memories which works to drain the nursing home of meaning. Professionals are well-intentioned in their efforts to make institutions homelike. Yet, not understanding the bodily experience of memory, nor the role of cultural processes, the professional intervention is often misplaced. As a kind of semiotic strategy, it tries to recreate home through its symbolic representation. It uses wingback chairs, the charade of a library with books purchased by the pound, the false fireplace hearth to create a simulacrum of home. As such, it trivializes the notion of home and, indeed, may have the opposite effect on the resident. The attempt to recreate home too often draws attention to its impossibility.

Bahloul, in The Architecture of Memory, clearly demonstrates how this lived experience of place, this quotidian routine of “taking care of everything,” provides a framework for its remembrance:

Domestic memory focuses not only on images of places but also on images of concrete acts…Remembrance of socialized domestic space is thus based above all on the practice of this space as it is articulated in the repeated inter­actions of its agents…Remembrance of the house is the symbolic locus for the embodiment of social practices experienced in daily life; it constitutes a system of bodily practices (1996,136).

 

If we truly listen to the authentic voices of the residents, we can learn a great deal about the  notion of home, and the role of memory in helping to sustain and create a sense of place.  We can learn that home and self are intertwined. That home and spouse can be identities. That space is transformed into place as it supports a sense of human agency and  partakes of the qualities of the human encounter (Tuan 1977,143). But listening is not enough. An ethnography of place and memory involves us not in its representation but in its creation. As Hack and I recreate the place he calls home we make memories together. By this means do we create place and not merely recollect it. By this means does memory become more than cognition. By this means does memory become transformational in Myerhoff’s sense, a kind of sacralizing process by which the sanitized space of the nursing home becomes the experienced and meaningful place of genuine human interaction.