Advancing the Livable Community Agenda

January 26, 2012
old lady with canes

photo by emilio labrador, Rouens, France

Last week I had the privilege of meeting with a group of funders and a few organization folks in Phoenix, Arizona. As an EngAgement Initiative grantee *, the Arizona Grantmakers Forum has sponsored three gatherings to address critical issues emerging from the changing age demographics in the state. This last meeting focused on the concept of “communities for all ages” – territory that is familiar to many Arizonans due to the good work in several communities funded by the Arizona Community Foundation and, more recently, W.K. Kellogg and supported by Temple University’s Intergenerational Center.  We were introduced to remarkable projects in Tucson and in Ajo, Arizona ǂ.

Of significance in this effort to advance an important initiative is the partnership with the Maricopa Association of Governments, which hosted the meeting and is providing valuable technical assistance and leadership into the future as Maricopa County, and eventually the entire state, work to create more livable communities across the lifespan.

Dozens, perhaps scores of cities and towns around the U.S. (and globally, in fact) are enthusiastically embracing a “livable community” approach to making our places work for people of all ages and abilities. Often, livable community initiatives acknowledge that elders and people with disabilities benefit from livability improvements but, I would argue, these categories of experience are not often foregrounded in the community development model. Age and disability can both provide critically important lenses through which we can better understand the relationship between people and their environments. Until livability advocates can fully engage the broadest range of experience of those who have been marginalized by age or disability, we will continue to need “elder-friendly” and “inclusive community” planning  models. I should add childhood and youth to those categories of experience we need to better understand.

The Phoenix discussion was useful in helping identify some of the key questions and imperatives that will drive the livability agenda forward. I encourage blog readers to add their observations and proposed solutions to some of the dilemmas and opportunities.

  • With respect to aging in our communities, we should try to understand the forces that lead to age-segregation.

Unlike segregation by race, disability, or other forms of difference, age-segregation is not typically seen as a form of discrimination. (For purposes of discussion, I am not including age discrimination in employment in this argument.) As I mentioned in the discussion, “We have a kind of separate but equal thing going on with age-segregation.” As an academic might put it – we haven’t problematized age-segregation in our society. We all observe that youth, adults and elders, in many respects, go their separate ways and “hang together” with their own and, moreover, “that’s ok.”

But is it ok? What are the consequences of age-segregation? I would suggest they include:

  • Intergenerational misunderstanding, sometimes leading to conflict.
  • Loss of community memory.
  • Most importantly, the failure to tap incredibly valuable resources that benefit the entire community.

So what are the forces that lead to age-segregation?

  • Public policy in education that isolates children from adult society.
  • Public policy in housing that segregates age groups from one another through funding, design, marketing and suburban development patterns.
  • An economy that promotes transience through its dependence on the portability of labor and the lack of local economic opportunities for young adults.
  • Inadequate community design features that, as a consequence, limit physical access to mainstream environments by elders, people with disabilities, and non-drivers such as children.
  • And underlying all of these realities, fundamental cultural attitudes and presumptions that reinforce ageism while, at the same time, promoting niche marketing that segments age groups and leads to diverse lifestyles and, ultimately, age-specific  communication patterns and language.

What is perhaps interesting about overcoming age-segregation is that this may not be solved through incremental litigation and direct action (a civil rights approach) so much as by a collective, collaborative, community development strategy. If this is true, some important questions need to be asked at multiple levels…

What are the underlying conditions that will pre-dispose a community to success in creating a livable community for all ages and abilities?

            What leadership will be required?

            What degree of capital is required (social, cultural, natural, economic, human, physical, cultural)?

            When is a community “ready-to-proceed?”

            How do we recognize success?

            How do we sustain success?

What is the appropriate scale for our efforts?

            Neighborhood?

            Municipality?

            Region?

            State?

            Federal?

What are the points of leverage we should be addressing?

            Local policy and practice?

            State legislation?

            Federal legislation?

What forms of education and professional development will best prepare future leaders of this movement?

            Place-based education?

            Community organizing?

            Service-learning?

How can we cross boundaries in language, policy, funding, and practice in order to break down siloes that prevent cross-sector thinking and collaboration?

Can we identify and focus on budget-neutral changes in society that will lead to greater age-integration?

Do cultural blinders lead us to particular kinds of solutions, and make us miss others? Does one definition of livability hold up across cultures?

There are certainly other issues and themes to identify and address as we think about ways to create more livable communities – needed research, forms of advocacy, where programs fit into the infrastructure, best practices in design, resident participation strategies and others. Too much for one blog, I dare say, so I’ll close once again with two simple questions that represent the beginning and the end of effective livable community building:

As we look at multiple environments throughout our community, can we see “old people everywhere?” (after C. Alexander)

and

Can we answer the question: “Where do the children play?” (after Yusuf Islam, formerly Cat Stevens)

*Grantmakers in Aging (GIA) is an educational nonprofit membership organization for staff and trustees of foundations and corporations, and the only national professional organization of grantmakers active in the field of aging.

±  Communities for All Ages (CFAA) is a national initiative that helps communities address critical issues from a multi-generational perspective and promote the well-being of all age groups.

http://communitiesforallages.org


Redefining Prosperity

December 7, 2010

 

Live long and prosper

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.


It’s not a vision. It’s a memory.

June 18, 2010

I had the privilege this week of observing a planning forum for Fifth Ward seniors, held at the JW Peavey Senior Center in central Houston. Programming for the predominantly African-American neighborhood is provided by the venerable Neighborhood Centers, Inc., an outstanding non-profit serving Houston for over 100 years.

Using the facilitation method known as Appreciative Inquiry, over 100 elders spent three hours reflecting on the strengths, not the weaknesses of the neighborhood. From small table workgroups they produced creative and powerful images of the kind of neighborhood that would enable individuals to remain in place as they age, typically focusing on an infrastructure that would enable people to move about with safety and security, accessing vital services and relationships with friends and family.

Though produced as a vision for the future, my friend Jane Bavineau wisely observed that the group was merely wanting to get back to the way it was, before drugs, prostitution, crime and disinvestment changed their stable, strong neighborhood.

So it’s not a vision. It’s a memory.

While it’s common, and usually a good thing, we “facilitators” of the world often engage groups in envisioning exercises to help create a template for actions that can lead to a better future. Perhaps we need to spend more time with memory. Unlike a dream, memory is based in a reality, albeit sometimes rose-colored by nostalgia. Being reality-based, moreover, the examination of memory can lead us to consider the real forces, political and economic, that led to negative (and positive) change… that led us away from home, so to speak. Asking how we arrived at this point is a worthwhile premise for discussing how we move forward. For how can we move forward without targeting the fundamental forces and power structures that keep us where we are?

This group at JW Peavey is indeed politically aware. They vote. They call their elected officials, en masse. They see that their efforts to create a good place to grow old means that everyone, all ages, will benefit.

Children have dreams. Elders have memories. How interesting that they produce a common image. How powerful  it would be to mobilize the energy of children’s dreams and the wisdom of elders’ memory to transform our communities “back to the future”.

Don’t leave yet… speaking of community planning, I want to draw your attention to several new tools recently published to our www.agingindiana.org website. With support from the Daniels Fund of Denver, Colorado, we engaged several national experts to produce tools organized around the Indiana state planning process we are coming to call Communities for a Lifetime. As access to mental health services emerged as a key issue in the Indiana AdvantAge Initiative survey, we have produced a community guidebook to enable citizens groups to learn the basics and mobilize around evidence-based solutions to improve the mental health of elders in their communities. Likewise, as many communities in Indiana are addressing home modification needs, we have produced “How to Develop a Home Modification Coalition.”  In addition, as communities begin to formulate social marketing campaigns to raise awareness about key issues, they can now take advantage of a Communications Guidebook, organized specifically around the AdvantAge Initiative’s 33 indicators of an elder-friendly community.

You might also find interesting, in the research reports, a new table illustrating similarities and differences in our survey results across urban to rural areas. And to top it off, this growing and rich resource of data for Indiana now includes GIS-producted visual images of variation across Indiana planning and service areas around some very interesting indicators – obesity, diabetes, awareness of services, etc. Check it out!

While you’re at it, visit our “founding” home page at the Center on Aging and Community, Indiana Institute on Disability and Community, Indiana University, to join the Facebook group, follow tweets, and link to other Center projects and websites. See http://www.iidc.indiana.edu/index.php?pageId=31.


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

June 26, 2009

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?

April 21, 2009

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.

 

 


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