“Discovery consists of seeing what everybody has seen and thinking what nobody has thought.”

 — Albert von Szent-Gyorgy

Louis Tenenbaum is the father of the aging in place movement in this country; when he speaks/writes, I for one, pay attention. Here is a guest post by Louis on being inspired in Beantown. Within these words is some gem lying in waiting; enjoy.   

I am an innovation immigrant. 

I don’t often feel inspired. But I am inspired by the incredible third annual Aging Means Business Conference held Friday in Boston associated with the Gerontological Society of America annual meeting.  This was my second time at this conference organized by Greg O’Neill and his team of Sarah Wilson and Dani Kaiserman from the National Academy on an Aging Society working with Mary Furlong and this time with the always provocative and fun (and of course, natty!) Joe Coughlin from MIT AgeLab.

I have been involved with Mary’s events for a few years…having been a semifinalist in the first year of her Boomer Venture $10,000 Business Plan Competition and on the winning team a few years ago. This time the results Mary has been working toward really came together. There was a healthy mix of long dedicated and newly interested business thinkers. The energy was palpable. Just being in this crowd was fun.

The air of excitement started at a Friday night reception hosted by First Republic….a bank that is doing things differently. As we learned in one of the next day’s presentations, they are paying attention to their customers! What a novel idea! The innovation I heard that sounds great?…NO music! (Turns out I am not alone unable to hear and concentrate with music playing in the air around me. I avoid retail and restaurant experiences for this problem. This bank listened.)

Curiously (or NOT- maybe expectably) that issue rose again later in the day. Gretchen Addie and Jose´ Colucci  from IDEO, the quintessential design and innovation consulting firm, engaged us in a process throughout the day rather than just giving a presentation. Innovation worksheets were on the tables when we came in. We were encouraged to state ideas, note the participants, explain the idea, make a sketch and then hang them on a board. Gretchen and Jose´ reviewed them, then shared their take on a few, putting our new ideas in a context of some of their previous projects. We saw how they help ideas grow.

One of these ideas related to the bank practice- Cones of Silence for restaurant tables – allowing diners to dial the background ambiance/noise up or down to balance their desire and threshold for atmosphere and conversation. BOY would I love that!

Matthias Hollwich, the keynoter was a real hit. Matthias is a co-founder of HWKN and the design leader of the BOOM senior communities. Those of us in the senior community design field for many years might say there is really nothing new here, other than wild looking/futuristic house forms. That misses the point. The point is a young, excited and out of the box designer came to this field cold, with no prior knowledge or assumptions and came to the same conceptual conclusions about lifestyle and community we have been promoting for years. That is totally validating! Second, his work is evidence of fresh and growing interest in these opportunities. Third, he brings fresh ideas for reaching the solutions. This young and really pleasant architect and…. just  plain….leader,  pulled together an extraordinary team, bringing real excitement to housing older folks in community.

True to form, Matthias would not be satisfied with the same old survey data. He engaged Hunter Tura of Bruce Mau Design, also new to this field, to develop a tool (looks like an app, folks) to gain customer insight. They hit the nail on the head.

I was excited, but not inspired, when I went to bed. I woke up ready to work, and, reviewing some materials, the inspiration hit.  What turned up the volume? Two more stories.  Do you have the patience?

1. I was so happy to see Jan Hively when I walked into the room Friday morning. Jan Hively, human extraordinaire, is lively, engaged, committed and she gets things done! Jan showed me a brochure from the European Union AAL program (Ambient Assisted Living- the EU term for aging in place or community). The EU has declared 2012 as the European Year on Active Ageing and Solidarity between Generations.  Saturday morning I downloaded the ‘brochure’, a catalogue really, of projects- and started looking for individual project pdf’s to download for reading on the plane home. I was bowled over by the sheer number of ideas they are pursuing in the EU effort.
2. That reminded me of a conversation I had at the conference with Marcus Wilhelm, Research Director from Redstar. Marcus, like Matthias, is an innovation native.  He explained the way his company building company works. They generate eight ideas a month, winnow them down through research with the goal of supporting a few startups per quarter. I had heard this sort of thing before but never got much of a handle on it.

I have been trying to get a handle on innovation for a few weeks. I thought I had it recently- thinking it was about leaving assumptions behind. That is part of it. Now I think it is about the process of rapid idea generation. That fits the pace of the digital/internet world, where I am also an immigrant.

This is exactly what Gretchen and Jose´ did with us.  It clicked for me as I paged through the plethora of ideas being pursued in the EU.  The process of innovation is to generate lots of ideas and consider them. For we immigrants it is a new way to think.

I feel inspired to generate lots of new ideas for the problems I am trying to solve, many of which are identified in Aging in Place 2.0: Rethinking Solutions to the Home Care Challenge

Trust me there was much more to think about and many other exciting, even inspiring, people at this conference. I may get another post or two out of it.

Congratulations and THANKS to those who worked so hard to pull this together. Inspiration is a gift. I appreciate it. I hope I see all of you at next year’s conference November 14-18, 2012 in San Diego.    Why miss a chance for inspiration?

See

Aging in Place Ideas

(photo cupboardsonline.com)

You can’t hide your true colors as you approach the autumn of your life.

- Author Unknown

The Fall is coming

The soft-late-summer-sun streamed through the cracked door the other morning; illuminating a dark corner of the gym. Along with the weakened glow, the first sign of fall blew in as crumpled golden and red leaves, intruding and dispersing haphazardly amongst the dumbbells.

This reminded me of the pending change of season just off shore. In an attempt to hold off the inevitable (fall) I closed the door. This served only to shut out the light/warmth; but the leaves still somehow found their way under the door. The change of season was coming whether I liked it or not. Closing the door (denial) only slowed the process slightly, while cutting me off from the light which accompanied it (wisdom).

Propping the door wide open once again (embracing the change), ambient light deluged across the floor, almost guiding the wind-blown leaves once again to my path. And as I glanced in the wall-mirror the brightness exposed a fit middle-age man; aware of the promised arrival of autumn–but still slightly in denial.

I began another set…

See

Aging in Place: The Myth of Aging Gracefully

Aubrey de Grey: We Can Avoid Aging 

The Autumn Leaves by Doris Day

(photo blueplanetgreenliving.com) 

Then it don’t matter. I’ll be all around in the dark – I’ll be everywhere. Wherever you can look – wherever there’s a fight, so hungry people can eat, I’ll be there. Wherever there’s a cop beatin’ up a guy, I’ll be there. I’ll be in the way guys yell when they’re mad. I’ll be in the way kids laugh when they’re hungry and they know supper’s ready, and when the people are eatin’ the stuff they raise and livin’ in the houses they build – I’ll be there, too.
–Tom Joad
Character in The Grapes of Wrath (1939) by John Steinbeck

I remember as a senior in high school being exposed to the black and white movie classic The Grapes of Wrath in a sociology class. I don’t recall being all that impressed at the time…But, as the Buddhist saying goes: When the student is ready, the teacher will appear…
Many years later I was reading a fair amount of John Steinbeck (you never know when the seeds of influence will sprout). So taken by his prose I was compelled to make a pilgrimage to the land of his birth Salinas, California. The road trip consisted of coffee and Steinbeck audio tapes–I was in heaven.

After several days of long-haul driving, I found myself on the steps of his boyhood home in Salinas. I stood on the porch and tried to imagine the world from his vantage point. Later in the day I visited The National Steinbeck Center and the immersion into literary bliss continued.

The Nobel and Pulitzer Prize winning Author’s observations of the human condition took me places I could never have dreamed existed. The insights and pictures he painted with common words sparked my imagination and taunted my comfort zones.

The Salinas valley is known as “the salad bowl of the world” because of titanic quantities of leafy greens that blanket the lowlands. The fields have been traditionally the domain of the working class and migrants, which greatly influenced the young Steinbeck.

Aging in a place other than home
I mention Steinbeck because of an image I saw recently of 77 year old Lyla Cocburn sleeping in a camper after a foreclosure eviction. The photo is hauntingly Steinbeckish and harkens back to a time of national suffering depicted in The Grapes of Wrath:
“The houses were vacant, and a vacant house falls quickly apart.” Chapter 11, pg. 149

“Grampa didn’t die tonight. He died the minute you took ‘m off the place.” Chapter 13, pg. 186

“I ain’t no good no more. Spen’ all my time thinkin’ of home, an’ I ain’t never gonna see it no more.” Chapter 28, pg. 538

The conditions aren’t as extreme as during the dust bowl or the great depression, but in the spotlight of national politics there is finger pointing, scapegoating; and the gamut runs from unscrupulous opportunists to those genuinely seeking solutions. In the meantime real people are losing their homes. This hits seniors especially hard and threatens the dream of aging in place.

Isn’t it Pretty to Think so
Nia Apartments is a King County Housing Authority (KCHA) project in Seattle dealing with the issue of affordable housing for seniors and people with disabilities. Here, dedicated individuals are keeping the dream of aging in place alive for those who were short on hope.

There is also sobering news from a KCHA report:
• By 2025, the number of seniors in King County will double, representing 23 percent of King County’s total population. The numbers of seniors living in poverty will more than double.
• Currently, the need for affordable housing greatly surpasses the supply. An additional 936 subsidized units will need to be created each year until 2025 just to maintain the current ratio of affordable housing to poor seniors.
• The future needs of seniors will differ in some respects from today’s seniors. The baby boom generation is less likely than prior generations to derive its retirement income from lifetime sources such as pensions or annuities. Instead, more seniors will have to rely on lump-sum sources such as 401(k) and savings plans, which require more attention and are less secure. Seniors are expected to live longer and spend more years with limited mobility and supportive services needs.

What is true for King County, Seattle, is reflective of the rest of the country facing the age wave.

If Steinbeck were alive today he’d witness history repeating itself and observe that human suffering in the land of plenty unfortunately lives on.
For things did get better after the great depression and they will again…In the words of another writer of muscular prose: “Isn’t it pretty to think so.”

See

Modern Day Grapes of Wrath

The Grapes of Wrath (1939): John Steinbeck, The Village Press-James Lloyd.
Quote:The Sun Also Rises (Ernest Hemingway): “‘Yes,” I said. “Isn’t it pretty to think so.”
For more on Seattle and King County see: Senior Digest

(photo twentyfourframes.wordpress.com)

I often hear people say that a person suffering from Alzheimer’s is not the person they knew. I wonder to myself – Who are they then?

–Bob DeMarco

The Present-absence and the long-good-bye of Alzheimer’s disease is heart-breaking. I sat with my once brilliant friend, Frances Gabe, holding her hand and longing for the excursions into the deep end of ideas that we once shared. But that is in the past; to quote Chuck Heston quoting Shakespeare in his statement, they bade farewell and “melted into air, into thin air.”

The unraveling of a life in the mind of a person with Alzheimer’s disease has been described as “the great unlearning,” the “demise of consciousness.” Just what does the disease uncover about the nature of being human? What’s left when memory dissolves “into thin air?” What role does the disease play in our fears of growing older and ageism?

To hear a engrossing and enlightened discussion on these issues listen to Krista Tippett, host of on Being for National Public Radio (click to listen): Alzheimer’s Memory and Being.

See also “Intimations of the Great Unlearning: Inter-religious Spirituality and the Demise of Consciousness which is Alzheimer’s” by Gisela Webb.

The Myth of the Unending Frontier

”The underlying basis of ageism is the dread and fear of
growing older, becoming ill and dependent, and approaching death. 
People are afraid, and that leads to profound ambivalence.  The
young dread aging, and the old envy youth.  Behind ageism is
corrosive narcissism, the inability to accept our fate, for indeed
we are all in love with our youthful selves, as is reflected in
the yearning behind the expression ‘salad days.’  Although
undoubtedly universal, ageism in the United States is probably
fueled by the worship of youth in a still-young country dominated
by the myth of the unending frontier…”

             -Robert Butler, THE LONGEVITY REVOLUTION

See

NIA Home Safety for People with Alzheimer’s Disease

I remember better when I paint

The Soul of BioEthics HR Moody

Aging in Place Technology Watch: Alzheimer’s and Caregivers

“The Aging of America: Triumph or Tragedy?”

Video:

Part 1: http://www.youtube.com/watch?v=oX-zU9svReI

Part 2: http://www.youtube.com/watch?v=nskLQBow7JI

 (Image Anton Christian)

Design is intelligence made visible.

- Alina Wheeler

Each year I attend the ASA conference on Aging and reoccurring themes begin to emerge and persist throughout the week; this session remained true to form. One mantra I picked up early; “Design is for all.”

Design on the Brain

Each of us has a brain equipped with a tightly bundled grouping of nerve cells about the size of an apple wedge located from the top of the spinal cord into the middle of the brain. This part of our brain contains about 70% of its estimated 200 billion nerve cells; or a total of 140 billion cells—and is called the Reticular Activating System (RAS).

Your RAS is a hockey goalie to consciousness—the gatekeeper screening the type of information allowed through and filters everything else that you don’t pay attention to. And it also hones in on what’s important to you. Buy a 1966 Mustang or the new Adison leather large Marielle drawstring shoulder bag, and you begin to magically see them everywhere. Why? Your RAS has now alerted your brain to bring them to your attention.

My RAS for the conference was programmed to “DESIGN” and I was rewarded; because design matters to an aging population.

Democratization of design 

Much of the discussion focused around “Inclusive Design” or “Universal Design” that will accommodate all users regardless of age or level of physical functioning. More than once I heard speakers say: “It’s not just design for the elderly, good design helps everyone.”

Not a new idea, in fact, the barrier-free movement in the 1950s began a process of change in public policies and design practices in response to veterans returning from service with disabilities. The movement has evolved as the democratization of design for all; both in structure and beautiful aesthetics.

Michael Graves, FAIA, famed designer and professor at Princeton University, became a reluctant expert in medical equipment design when an acute neurological disease left him unable to walk or do self-care. Graves turned this into a best-worst experience for design that functioned better (structure) and delighted the senses (beautiful aesthetics).

Graves was noted to have said while lying on a gurney in the hospital in the throws of his acute illness:  “I can’t die here, it’s too ugly.”

His point speaks directly to the heart and soul of the barriers to adoption of countless potentially life-enhancing tools. Gerontophobia (fear of aging) limits my own mother from using a walker which would make possible ambulation to strengthen her muscles, stimulate her brain with exercise, and facilitate balance—and what’s most personal is most universal, she is not alone in her desire to not look old. The sad irony is that this kind of stigma which leads to adoption-failure, actually is a “secondary ager” which speeds up the aging process (atrophy). 

Design Matters: OMHU

Design matters with caregivers and patient outcomes; this has been well established in the literature on environment and health effects. And with the proliferation of new technologies for aging in place, the same barriers in design concerning both structure and aesthetics apply.

One company, OMHU (means “with great care”) exhibited an empathetic understanding and nonpatronizing approach to mobility aids. They’ve successfully combined materials from the world of performance; bicycles, hockey sticks, skateboard, and high performance athletic shoes—and from these made a cane which delights the senses.

Emphasis is on performance; not disability and yet OMHU is not denying the need—after all it’s a cane. They get it, and the underlying philosophy which infuses this product is clever and evokes the will to live…and aren’t we all in this for a better experience of aging?

Robert L. Peters said: Design creates culture. Culture shapes values. Values determine the future. This is important because the demographic transition means a future filled with more and more old people. We live in a world that will never be young again—each generation will grow older than the one before. And I for one would like to see more emphasis on matters of design, not as a nicety, but as a guiding principle of gerontology; our future depends on it.  

See

Democratic Design

Adaptability: Universal Design Michael Graves 

Michael Graves on Medical Devices 

Michael Graves Design Group   

IDeA: Center for Inclusive Design and Environmental Access

Free Subscription to HealthCare Design

Universal Design:

Video #1

Video#2

Video#3 

Video#4 

Video#5

(photo senzumbrellas.com)

Baseball is like driving, it’s the one who gets home safely that counts.
-Tommy Lasorda

With the cry: “Play Ball.” The Major League Baseball season involving both the American and National Leagues began across the nation; and from coast-to-coast fueled the dreams of young and old alike.

Longest Round-tripper on Record

“Round-tripper” is slang for home run. The longest in history is credited to Charlie “Chief” Zimmer. If you strictly measure from home plate to where the ball finally stops, then the famed catcher of Cy Young is hands down the record holder. During a game in the 1890’s Zimmer blasted one over the fence in League Park, which landed smack-dab in the center of a coal train car headed for Fall River, Massachusetts—some 50 miles down the tacks!

Safe At Home or Out?

 A key objective in baseball is to arrive at home safely; hitting the long ball is the most glamorous; yet there are many others—but there are also obstacles in the way. Such as intimidating curve balls that seem to come out-of-nowhere and force you back on you heels; other players who can impede your progress; your own conditioning and skills which can be put to the test; even weather conditions or equipment; and don’t forget those umpires—to mention only a few.

Aging in place too, has the goal of arriving home safely and the challenges are similar to those in baseball.

The signal for “OUT”

Here’s how to be “OUT” at home (not able to stay home as you age):

 1. Mental game: Poor attitude low self-efficacy 

 2. Out of shape and de-conditioned: VO2 Max less than 10ml/kg/min you can’t live independently at home

3. Nutrition: skip meals 

 4. Substance Abuse

 5. Don’t organize your finances and pay your bills on time

 6. Go it alone and don’t take advantage of team mates (community or informal networks)

 7. Hoard and live in clutter

 8. Stay isolated and mentally un-challenged (live in routine) fail to learn: Lack

    Environmental Press (things in our environment we need to respond to)

 9. Don’t plan ahead (or adapt) for physical changes

 10. Live in a Peter Pan House

 These behaviors will land you in an institutional setting and “OUT” at home.

The signal for “SAFE”

Here’s how to be “SAFE” at home (successful aging in place):

 1. Cultivate high Self-Efficacy (the inner belief you can exert control over your life) by

     meeting daily challenges and adequate Environmental Press; be creative; take a class;

     volunteer at your church or community

2. Daily Exercise: You can take the time to be healthy—or you’ll have to take the time to  

    be sick. Join groups like Silver Sneakers if possible; garden; walk; adopt a dog; use in-

    home exercise equipment; find activity friends; See your doctor and dentist regularly;

    take your medications; brush your teeth; bathe often and wear clean clothes; if you

    have a chronic illness such as diabetes, have a good treatment plan and stick with it

   go to a fall prevention class; watch your weight, blood pressure, and cholesterol

 3. Don’t skip meals; eat with others/share a meal; seek nutritional information from your

    health care providers

 4. Avoid Substance abuse; seek help if needed with groups such as AA

 5. Pay Bills on time and get help with finances many local area Agencies on Aging can

    assist with seniors who need it; family resources

 6. Use informal networks of family and friends; the government and many private

   organizations provide services to assist you, for example, there is bus service that will

   come to your door at a specified time, take you where you want to go, and bring you

   home when you are finished; there are organizations that will bring prepared meals to

  your home; you can get help with your rent or utility bills if you cannot pay them; The

   good news is that you don’t have to hunt for these services; Just call your local Senior

   Services and tell them what you need

 7. Clean out the clutter and get help if you are a hoarder

 8. Stay in the main stream; go to church; visit the senior center; read newspapers;

    volunteer; invite family; facebook a grand child

9. Plan ahead for physical changes before your needs get urgent   

10. If you live in a Peter Pan House (for people who think they will never get old)

      find a CAPS remodeler and make a home assessment appointment and find out

      how to plan aging in place remodeling.

Taking these PROactive steps can help improve your chances of rounding the bases and making it “home safe.”

 Have a successful season…

See

Safe at Home

Abbott and Costello: Who’s On First?

Field of Dreams: People Will Come

Universal Design AARP

(Photos  HKsportsfields.com and umpire.org)

“We’re really trying to think about how are baby boomers as seniors going to be different and what types of technologies and services might they use to manage their own personal health and wellness in ways we can’t yet imagine.”

-Eric Dishman

This post is a transcript from Intel’s Eric Dishman, an innovator in the field of aging-in-place technologies and part of the solution:

Last week I had the honor of speaking to the City Club of Portland, an organization founded in 1916 to highlight the diverse opinions, issues, and talents of local leaders and organizations. I often hear their Friday Forums on Oregon Public Broadcasting radio while I am driving home from work, so it was a real treat to be there in person in the grand Governor Hotel in downtown Portland. I very much appreciate the City Club members inviting me and giving visibility to the important issues of Global Aging and what I have frequently referred to in this blog as “gray technologies.”

The title of my talk was “Technological Innovation and the Future of Aging”–you can click here to find a free download of the audio cast of the speech–in which I focused on Oregon’s opportunity to lead in the development of new technologies, services, and jobs that promote independent living for our graying population. I shared some of the research prototypes and findings that Intel, Oregon Health and Science University (OHSU), and the Oregon Center for Aging and Technology (ORCATECH) have developed from our more than ten years of exploration into home-based technologies that can help people to age-in-place with good health, social engagement, purposefulness, dignity, and choice.

I promised attendees (and the many radio and TV listeners who have been writing to me ever since!) that I would post some links where you can find more information. To that end, here are a few that I referred to in my talk…

ORACTECH, the Oregon Center for Aging and Technology at www.orcatech.org, is a passion-driven, grass-roots center founded in Oregon Health and Science University to help coordinate statewide collaborations around independent living technologies amongst universities, companies large and small, non-profits, and government agencies. The funding to get this started came from Intel’s $3 million dollar donation to OHSU and a prestigious NIH Roybal Center Grant awarded to ORCATECH director, Dr. Jeff Kaye and his collaborators. You can join the mailing list by emailing orcatech@ohsu.edu or, if you are local to Portland, come join “upcoming events” announced on the web page.

CAST, the Center for Aging Services Technologies at www.agingtech.org, is a non-profit advocacy organization I helped to develop with the American Association of Homes and Services for the Aging who recently changed their name to LeadingAge. CAST is a national (or actually, now international) version of ORCATECH, designed to bring together providers, university researchers, technology companies, and others to help ignite a wide array of innovative technologies and services to help seniors to age-in-place from the “home” of their choice. Be sure to view the free CAST vision video shown to Congress and the last White House Conference on Aging.

The TRIL Center, or Technology Research for Independent Living, at www.trilcentre.orgbased near Dublin, Ireland, is Intel’s largest investment in independent living technology research with a $30M joint investment with the Irish government. TRIL includes our multidisciplinary Intel team and three universities in collaboration with St. James Hospital in Dublin to invent and test out these home health and independent living technologies. You can learn more about the falls work there at the TRIL Center site, as well as go here to read more about the Shimmer “matchbox-sized wireless computer” I described in the talk.

ETAC, the Everyday Technologies for Alzheimer’s Care initiative, a collaborative program between Intel and the national office of the Alzheimer’s Association, has published informationhere about the grants that we have funded since 2004. This was one of our first programs to start funding university research on independent living technologies and has produced a great international community of dedicated researchers and entrepreneurs focused on Alzheimer’s care specifically.

Care Innovations, at www.careinnovations.com, is the name of the newly formed joint venture between Intel and GE to produce disease management, independent living, and assistive technologies for the home. Full disclosure: I run healthcare policy for Care Innovations (in addition to my Intel role). I didn’t feature our products at the City Club talk because my focus was on the R and D infrastructure that Oregon has built, not a commercial for our products. But I don’t want to leave the impression that everything is stuck in research…Care Innovations (and many other companies) is diligently working to get these kinds of aging-in-place solutions to market worldwide!

And realizing now that I had to fly through my recommendations to the state of Oregon at the end of that lecture (I warned everyone that, without PowerPoint, there was no predicting what I might say!), I want to highlight some of the main points I tried to make last week. My overall thesis was that Oregon has some enormous advantages in trying to become an international leader of independent living technologies and jobs. Just as we have with Wave Energy and Biotech, our state needs to bluntly ask ourselves as Oregonians what future industries we could really lead in?  I argue that Oregon is already a big fish in the small pond of independent living R and D and that we should put forth a state plan to go after this opportunity.

So, why Oregon?  What are our particular strengths?

1) We have a head start: We can build upon the foundational technologies, data, and know-how of ORCATECH, OHSU, Intel and many others in our state who are recognized leaders internationally in this emerging field. Today, we already host numerous Minister of Health and other visitors in our labs, as other countries and states come to see what Oregon is doing. Now we need to make sure our own state knows the assets we have!

2) We have our own fiscal challenges: Oregon itself is already in the top ten of states with the highest percentage of an aging population, and we likely face cuts to our Home and Community Based services as we, like so many other states, try to balance a budget in the midst of a recession. We need independent living and home health technologies just to drive up quality and drive down costs of the care for seniors–and people of all ages–in our own backyard.

 3) We have flexibility. Though many of my friends and colleagues in the long term care industry in our state would like to see even more flexibility, we need to realize that we have more regulatory/licensure freedom to pilot and develop new care models for seniors than do many other states. Less red tape for us means faster innovation cycles and learnings than many other states can produce!

 4) We know high tech. There is a large information technology presence here in Oregon to draw upon–not just Intel but many other technology companies who have intellectual property, innovation methodologies, and entrepreneurs to bring to the challenge of addressing Global Aging.

 5) We are the right size. I believe we are the right size and geography of a state to develop independent living technologies and the care models to use them. It is hard to imagine a state as large as California or as small as Delaware doing this. With our four million citizens living in a mix of rural and urban environments across the state, it is conceivable and achievable to build a state-wide strategy and infrastructure to enable aging-in-place.

6) We can collaborate with Asia. Oregon is already seen as a “gateway to the Pacific Rim” with a wide range of trade and research collaborations going on with Asian countries. Having just keynoted to the APEC (Asia Pacific Economic Cooperation) meeting just weeks ago in D.C., I can tell you that the need and market for independent living solutions in Asia is significant given the longevity in many of the countries there. If done right, our state plan for Global Aging should foster collaboration and export of our Oregon technologies and services to some of these countries.

 7) We have national political leaders for aging issues. It is rare as I make visits to Congress that members know much about gerontology, but when I visit the Oregon delegation, they often end up teaching me more than I do them! Senator Wyden has a background in gerontology, as does Congressman Peter DeFazio, and both have shown a commitment to aging and health reform issues in their political careers. I believe we should be leveraging their understanding and leadership on aging issues to make Oregon the center of the independent living technology universe!

 8) We are committed to healthcare reform. I had the pleasure of hearing last week’s “Think Out Loud” radio segment on OPB that was exploring healthcare reform in the state of Oregon. Dr. Bruce Goldberg, head of the Oregon Health Authority, was clear (and I couldn’t agree more!) that we need to transform our culture and infrastructure to do health reform right. At the end of the day, aging-in-place is not about technology but about transforming our culture of care for seniors, and the technology is simply a tool to help do that. But if we are a state prepared to be at the forefront of acute care/hospital/insurance reform, let’s make sure we do the same for long term care!

9) We have a legacy to uphold. Last but not least, innovating aging is in our blood…is in our history…as a state. Oregon is widely credited as the state who invented end-of-life or hospice care, which became a national standard and movement. Similarly, we are known for pioneering the concept of “assisted living” which is, of course, now common-place and taken-for-granted. In many ways, the rest of the country is just waiting for Oregon to invent “what’s next?” for the care of seniors, so let’s not disappoint them!

We should make no mistake as a state to think that we can rest on our laurels or that we will just end up becoming the leader of independent living technologies without investment or a plan. Other states are competing to create these technologies and jobs; I have worked with officials in New York, Minnesota, California, and Florida who are trying to get their act together on this front. I am biased as an Oregonian to want to make sure it happens here, but at the end of the day, may the most organized and proactive state win!

So what would my calls to action be for Oregon? What should we be doing to capitalize upon this opportunity?

 1. I call upon Governor Kitzhaber to put together a commission to develop a state Global Aging response plan. Let’s bring together industry, community, and academic experts to identify how we can use independent living technologies to care for our own elders and families and also evaluate new business and job opportunities in this segment. I will certainly volunteer my time to participate!

2. Let’s commission an inventory of Oregon’s assets on aging-in-place…let’s show what we’ve got and what we are missing in terms of building out an R and D and new business incubation infrastructure for independent living technologies and services.

 3. We need to identify, with our nursing and medical schools, what new kinds of careworkers and curriculums are needed to enable aging-in-place care for seniors (and people of all ages). If Oregon can develop the models for training and credentialing community workers and volunteers who can use these new technologies to do care delivery in the home, community, and electronically, then we will be the likely creator of the first national call center for electronic care and support for elders. With that asset, we would be a fierce competitor nationwide!

 4. Let’s make sure that our current and future technology infrastructure investments–for broadband, for Electronic Health Records, for insurance exchanges–are being designed and built to support aging-in-place and to carry data/transactions from hospital to home. If all we do is connect and coordinate care in hospitals and clinics, then we will fail to achieve the kind of health reform required to make us fiscally, morally, and medically strong.

5. We need to build upon ORCATECH to develop the nation’s first 10,000 household cohort of seniors who can help test and prove the value of these aging-in-place technologies and care models. Today, we have about 300 households in the Portland metro area who are outfitted with these kinds of systems, but we need 10,000 homes across the state to deliver the statistical and economic data that proves which systems are most valuable, usable, and useful. If we build this kind of large-scale R and D infrastructure, it will be very difficult for any other state to supplant our position as a leader in this sector.

 6. Like many other states are exploring, let’s develop a policy framework for seniors in our state that makes aging-in-place a right. If we set that as an overarching policy goal, then it will help to guide our activities and priorities for the full range of services–meals, medication assistance, transportation, social support, mental health, healthcare, etc.–that are needed to give people a high quality of life at an affordable cost from a place of their choice.

 7. Let’s set an audacious goal–a 2020 vision–to move 50% of care in Oregon out of institutions and into homes and the community in 10 years. We may not achieve 50% or it may happen faster than 10 years, but if we set a goal that everyone knows and can aim for, then we will achieve great progress towards an aging-in-place agenda!

 In closing, I want to reiterate a message I have played over and over again in the pages of these blog entries: we need to prepare for Global Aging much as we do Global Warming. Just as our state (and our nation), are competing to try to become a leader in Green Tech industries to address Global Warming, so too, we should be competing to become a leader in Gray Tech industries for Global Aging. The issues and needs are no less urgent or pervasive; the opportunities for economic growth for the state are no less promising. And if we are truly a state committed to healthcare reform, then let’s make sure that commitment includes long term care as we figure out how to improve cost, quality, and access for people of all ages.

 See

Eric Dishman: Take health care off the mainframe (TED Talk)

Healthcare @ Intel Blog

(photo PortlandCityClub.org)

“A good plan is like a road map: it shows the final destination and usually the best way to get there.”

-H. Stanley Judd

Aging in Place Case Study: Guest Post

(At a meeting last month, the members of NAIPC/Baltimore decided to do a case study that would demonstrate how members could provide various needed services to a potential client.  Conducted via email, the study shows the process as well as the value of an NAIPC chapter. The Baltimore members have graciously given National permission to share the case study with all of you. What follows are excerpts from the exchange of emails:)

Amanda Clinton, Chapter Founder
Net Equity Financial, Inc

We are going to put together a case study that any member can package and take to any location.  We will all run into a difficult situation and the way to put the pieces together may not be clear or easy to figure out and that is the point of the study. The responses we are looking for are not to give a summary of what we do.  We want to know, if you we ran into this client, what would your first steps be?  

Model Client

Prepared by Sheri Redwood, In-Home Care, Help at Home Services,  and Ellen Platt, Geriatric Care Manager, The Option Group/Seniors Management Options

• 72 year old retired PhD scientist living alone in Baltimore County
• In a single family home where she has lived for last 45 years.

• Divorced many years ago, no contact with former husband.
• Only sister lives in North Carolina and; has been asking her to move to a retirement village near her home.
• Client has two grown children with busy families of their own, closest child 1 ½- 2 hours away, and they have not been to her house in over 5 years.
• She usually goes to them because of the large number of people involved. They have busy lives and visit together only every 4-6 months, although they maintain regular phone contact.   She has begun to limit her driving, but still has car, and occasionally uses it. Not sure if she feels safe venturing to daughter’s house anymore, as it’s near DC and; unfamiliar, congested area.
• Her children have no idea of her financial situation, and have let her take care of her own finances/affairs up until now. They are noticing cognitive decline which concerns them, confusion and forgetfulness at times, and they are wondering if she can safely stay home by herself. Family has asked, with her permission, for GCM to do assessment.
• Minimal medical treatment, and has blood pressure issues and heart condition

Assessment Findings:

• Hoarding for years! Stacks of newspapers, trash and discarded household items in every room of the house. Only small path from front door to living room chair, through kitchen, and to bed, only ½ of which is clear to use.
• She has a “nice couple” down the street who is now taking her to store in her car weekly. Recently, she has said they can just keep the car at their house, since she’s not using it anymore.
• Unendorsed checks sitting around the house, in plain view of visitors
• Stacks of opened mail in piles, and she’s verbalizing that she has no idea what it all means. (much of it junk mail, but some investments, retirement package info etc)
• Getting late notices and collections calls on bills due.
• Dish of crackers and milk on kitchen floor to “feed the poor, hungry mice”

• No POA, no advanced directives and no clear idea of benefits available in medical package. Needing medical evaluation/follow up for heart condition and blood pressure matters.
• Confusion that is noticeable upon assessment, but hard for outsiders to detect.
• No support system locally, doesn’t really know neighbors well. Young teen boy will shovel her walkway or take out trash. She prefers to “keep to herself,” and has always been that way.

Ellen Platt, Geriatric Care Manager

The initial assessment was done by this geriatric care manager and a number of issues identified were outlined in the case study.  The assessment took just over 2 hours and the senior was showing signs of fatigue, so the meeting ended shortly thereafter.  It was to be followed up with another meeting to gather further information. 

The initial findings, concerns and safety issues were discussed with senior and family and a report with recommendations was provided outlining: immediate/acute concerns, short term concerns and longer term considerations.  A plan was created and the GCM coordinated services needed to address the concerns and provide an immediately safer environment for the senior, while other professionals were called in to assist with their piece.  The GCM worked closely with senior and family to ensure that all concerns were addressed, while working toward the longer term goals of the senior and family.

Larry Blosser, Elder Law
LifeCare Advisors

From the perspective of an elder law firm with a life care planning background, the first step that we would recommend (with input from the firm’s RN/Care Manager) would be to ask the Geriatric Care Manager, who has been to see the potential client and conducted the assessment:

1.    Did you do a mini-mental exam and, if so, what was the score?

2.    What was the result of your fall risk assessment?

3.    What was the result of the depression screening?

The second step would be to answer the question “Who is the client?”  Up to this point, the GCM has had cooperation from the senior and the family in conducting the assessment, but things could certainly start to change.  If the older adult has sufficient capacity to make her wishes known, to understand the purpose and intent of documents being presented to her to sign, etc. then the attorney-client relationship would most likely be with the older adult.  If it is obvious that this will be a case where one or more of the family members will need to take charge because the older adult lacks capacity, then the answer is different.

The third step would be to try to arrange a meeting (in person if at all possible) with the adult children as well as the potential client to discuss goals and objectives, to gather information about what is already in place in the way of legal documents, financial resources and the available alternatives.

Craig Berman, ESQ., CPA
Law Offices of Craig Berman, LLC

I would try to see if a meeting can be arranged that includes not only the client – but some of her busy family members as well so that all of us are working together. We would attempt to put together an inventory of her assets and try to piece together a financial profile, which would include her insurance coverage. I would then want to review if she has any estate planning documents (Wills, Trusts, etc.) and make sure they are up to date, or draft documents if none are in place with proper power of attorneys and health care directives. I would then work with the geriatric care manager to assist the client and her family with determining the options available for the client’s living arrangements – -she may be able to continue to reside at home with home health care support services or possibly services provided in a long term care setting such as assisted living. If the client’s funds or insurance coverage are not enough to provide such additional support, I would consider whether medical assistance (Medicaid) could be available.

Lynn Berberich, In Home Care
BrightStar of Baltimore City/County

The outcome of the assessment would determine if homecare was a possibility or if the client needed to move to a facility.

Our RN, Director of Nursing would complete a health history and assessment to develop a plan of care.  The assessment would determine the level of care required: Companion/Homemaker or Certified Nursing Assistant to help with ADLs (activities of daily life).  Several alternatives would be explored to determine what was appropriate in the situation.  A written plan of care would be created.

A) In-home care to help the client keep organized and safely get through the day/day and night.  Hours, schedule and level of care all dependent upon assessment

B) Decision that it was not safe or possible financially for client to remain at home with one-on-one care

Ivan Lowe, Reverse Mortgage Loan Officer
Fulton Mortgage Company

A Reverse Mortgage can help.  The borrower can use the monies received to pay for the services needed. For example; in home health care, medical costs, property taxes and others.  POA’s are acceptable if necessary.

Richard Dix, Financial Planner
NL Financial Alliance

From a financial planning view —our first question is always— “what do you want to do with your money”? No one asks this question because they are too busy telling clients what to do with the money. The next questions are— are there any special considerations — needs, care, legacy etc. that you need to deal with?

Amanda Clinton, Reverse Mortgage Specialist
Net Equity Financial, Inc

While I think there are several issues that need to be handled before getting to her mortgage, the mortgage in this case can play an important role in helping her to afford the other services she needs.  I think there are two options that she has in this situation and it would be a decision that she and her family can make. 

The first option would be to stay where she is and take out a reverse mortgage on her current property.  It doesn’t say whether or not she is still making a mortgage payment but I would venture to say she is not since she has been in the home for 45 years and she is not in foreclosure.  This would give her a lump sum of money to help her pay for some of the other services, such as in home care, medical alert and organizing and moving.  This could also possible give her funds to get the house in better condition for her to remain in – such as adding ramps if she needs them, installing a better bathroom to help ensure she won’t fall or anything else that could help her age in place a little more comfortably. 

The second option for her is to sell the home she is in and move to be closer to one of her children.  If she owns the home free and clear, she could sell the home and either buy another home outright and not have a mortgage payment at all, go to a retirement village (as her daughter hopes) so she gets the attention and care she needs and use the funds from her sale to pay for it or use a reverse mortgage for purchase option so that she can keep some of the proceeds from the sale of her current home and use them for services that she needs to live alone. 

Either of these options would help this woman free up funds to pay for some of the other services that she needs and it would be a personal decision for her, if she wants to stay in the home she has been in for 45 years or be closer to family. 

Pat France
Centrol Emergency Response Systems

My emergency response system would definitely be a help to the safety of the resident and peace of mind for the family.  However, again, I stress, in this case, unless someone is appointed to pay the bills, it won’t work!

Rosemary McLean
A Move Matters LLC

Move Matters LLC would be able to assist this client in several ways.  First, as already suggested, the first order of business would be an immediate clear out and clean up of clutter and mess in the home to address safety and hygienic issues.  Second, if it is determined that the client will be aging in place, downsizing and more in depth clean out would probably need to be done as she has lived in this house for 45 years.  Realizing her cognitive decline issues, the downsizing could be done over time, that is by scheduling sessions of 2, 3 or 4 hours of time (or full days) for sections or rooms to be downsized.  Items to be disposed of are then taken away after each session.  This is a much less overwhelming way to downsize.  Third, should our client be moving to an assisted living or retirement community, my company would be able to provide moving assistance including but not limited to packing, unpacking and set-up of her new household. 

Bonnie Blas
The Organizer

The Organizer would collect and put into order, all bills and other important papers and create an easy to use filing system.

In a comfortable and non threatening manner, I would help her to get rid of the stuff not really needed any more. While doing so, explain how much more healthy it would be without the dirt and chaos. All checkbooks and important documents would be put safely out of the sight of others.

I would examine and balance all bank accounts to produce a current financial picture of the client and create a list of all important information – insurance, bank accounts, investments, any medical directives or Powers of Attorney.

Craig Vacovsky, Handy Man
Senior Handy Services

Senior Handy Services could help our retired PhD in many ways. The level of our assistance and the extent of repairs and or modifications would be dictated by the course of action chosen by the family and or the client. We would suggest a no cost evaluation/meeting with the client (possibly including a geriatric case manager or other interested party) to see if we could undertake minor modifications to make the home safer in the near term. This might include grab rails, moving furniture to open space for mobility (this would be a challenge due to the hoarding that was discovered), installing fire and smoke alarms; CO2 detectors, installing additional hand rails on stairways, moving throw rugs that have become a trip hazard, installing additional lighting and maintenance on just about any system in and around the house that could become a hazard if ignored.  We could develop a more comprehensive plan to modify the home for aging in place if this was the wish of the client. The only limits to the extent of modifications is a desire (and ability) of the client to remain in the home and available funding. 

In the event that the home would be offered for sale, we could assist in making the home “market ready” for sale by making all desired and or required (mandatory for certain types of mortgages) repairs.

See

(photo lesfemmes-thetruth.org)

“The woods are lovely dark and deep, but I have promises to keep, and miles to go before I sleep, and miles to go before I sleep.”
-Robert Frost

In life, if you’re lucky and the gods are so inclined, you’ll run into a positive force and life will forever change—for the good. Early one bright October morning in 1992, my fate was about to transform and set me on a course  that continues to this day…Here is the story I sent to Marika Stone of 2young2retire.com in 2001, and she went on to post:

Mavis Lindgren: Grandma Wears Running Shoes

A critical care nurse, Patrick Roden, was a medical volunteer at the Portland Marathonof 1992 when he came to the aid of the celebrated 85-year-old marathoner, Mavis Lindgren. They became fast friends and he has escorted her for other marathons until her last at age 90. “Mavis changed the way I viewed aging,” Patrick said, “The medical model tends to focus on what goes wrong in aging–and neglects to inform us about what goes right. She inspired me to begin working on a Ph.D. in aging and human development.” Here is their story:

Grandma Wears Running Shoes

Night’s chill lingered in the air and the silence was broken by the sounds of songbirds. The sun was just beginning to rise on a crisp October morning in 1992. Suddenly the squeaking brakes of a rental truck and the clanging of folding chairs shattered the serenity. With military precision, the volunteers began to set up the first aid station at the 18-mile marker. I was one of those volunteers and this was the annual running of the Portland Marathon.

It took an hour to set up and go through my checklist. The first aid kit was in order and the communications were working. We were ready. Soon the elite runners would be flying through, followed by a seemingly endless sea of participants. The conditions were perfect: a bright clear indigo sky, golden fall leaves. All of us were anticipating an inspiring day.

The morning had been uneventful at our station. The usual blisters, Vaseline applied to chaffed skin, hydration to the dehydrated, and lots of moral support. One pregnant woman reached the 18-mile point and could go no further so we loaded her in the ambulance. They taxied her to the finish line and her anxiously awaiting husband.

It was now late afternoon and the sea of runners had dwindled to a trickle of determined souls. The frequent and now familiar static that preceded a message from the EMS broke the airwaves. An elderly woman was reported down near the 18-mile mark, in our territory. I waited for a person fitting the description to pass, and no one did. Strapping on my first aid kit, I set out to investigate.

Running upstream, I began to think, how elderly could they mean? Who ever it was, he or she had gone 18 miles, and this was a marathon after all…….50, maybe 60, I thought.  As I rounded the bend I saw a young woman attending the injured runner who looked like Mother Theresa in running shorts! The young woman explained that another runner had cut in front of the injured woman and knocked her down as she stepped towards the curb. As I listened, I assessed the situation.  The injuries included an obviously fractured wrist as well as a small bump on the head. “Her name is Mavis,” the young woman said.

“Mavis, I would like to escort you to the first aid station,” I began… “Young man, I’m going to finish this race,” she politely interrupted. After a few seconds of negotiating, I held up her injured arm and we briskly took off for the station (or so I thought).

Amazed, I blurted out “How old are you?” “I’m 85.” She pointed to her number pinned to the front of her T-shirt. “Every year, they give me the number of my age. This year I’m number 85. “What do you mean each year?” I asked.

Mavis Lindgren had run all over the world. She had appeared many times on TV, radio, and magazines such as Runner’s World, Sports Illustrated, and The New York Times, and been mentioned in books such as Age Wave (Ken Dychtwald) and Grandma Wears Running Shoes (Patricia Horning Benton). She was no stranger to Portland, either. All along the course there were signs encouraging her and the cheers followed her every step! Two middle-aged women ran up and hugged her exclaiming that they wanted to be just like her when they grew up.

Mavis and I reached the finish line arm-in-arm, right into interviews for the 6’oclock news (I have the video). I was asked to escort her for the entire race the next year in 1993, and it became a tradition.

She retired from running at age 90 after the 1997 marathon. It was her 75th and final 26.2-mile outing. Phil Knight of Nike, had a custom pair of “Air Mavis” running shoes made especially for her final marathon. Her two daughters and grandchildren accompanied us and it was an emotional finale to an illustrious running career.

What makes her story all the more exceptional to me is that at age 62, Mavis was leading a sedentary life, spending most of time reading, writing and knitting. She had suffered four bouts of pneumonia in five years and, as a retired nurse, she knew the antibiotics weren’t the long-term solution. Something had to change. A doctor urged her to join an early bird walking group. At age 70, encouraged by her son, she ran her first marathon! Two years later, she established a record of 4:33.05, and for the next eight years, held world’s best time for women 70 and over. And at 84 she finished the Los Angeles marathon in 6 hours 45 minutes-the fastest woman in her age category. “After I started running, I never had another cold,” she said.

Asked what his message was, Gandhi replied: “My life is my message.”This could well be said about Mavis Lindgren.

GeriAthletes

In 1992 Mavis Lindgren (85) was an anomaly; today we actually have a term for seniors on the field: “Geri-athletes.” With the aging population increasing numbers of AARP-types are extending the athlete phase of life into old age. The bad news is older adults are visiting the sports medicine clinics with injuries—the good news is that older adults are visiting the sports medicine clinics with injuries!

Whenever we continue a life-style into other phases of life we run the risk of Hyper-habituation (keep doing what you’ve always done; think Mick Jagger). This can soul-eroding, or it can be inspiring; all depends on how it’s done.

Mavis was inspiring; her efforts were not about performance—but rather about purpose. She passed away at the age of 94; a true example of “compressing morbidity.” 

For an optimal old age meaning making is essential; for Mavis startling athletic feats at advanced age was the vehicle to a spiritual connection with humanity—that’s what kept her going. To me this beats all forms of “anti-aging” in the direct pursuit of longevity… And having a body that’s available to you is a bonus; especially if you plan on aging in place.

See

Marika Stone: 2young2retire.com

Mavis Lindgren SIVault

NYTs: Marathon; At 86 Years Old, Mavis Lindgren is a Road Runner

Running After Age 40 – How to Prevent Injuries and Improve Performance

“Nothing builds self-esteem and self-confidence like accomplishment.”

 -Thomas Carlyle

Design with the Future in Mind

I was reading an on-going blog series about “Beth,” an active, 89 year old woman lives alone in her one level town home. She has lived alone for many years and has a good support network of family and friends from church. She is relatively healthy but deals with asthma.

The post is done by a colleague in the aging in place field, Alesha Churba at Design with the Future in Mind. What Alesha has done is put a human face on aging in place; and made the process accessible by doing so. The narrative is a delight to read as Alesha describes how Beth thinks through the process of making her beloved home accessible and safe to live in—I love this approach.

Self-Efficacy for Aging in Place

A theory that’s mentioned in the gerontological literature, as well as in other areas of inquiry, is “self-efficacy.” This is a very useful concept in describing what can happen as a side-effect of proactive change–the kind that Beth is making.

Self-efficacy simply means the belief that one has the capabilities to have a positive influence over their life; and can be measured on a continuum from low to high. Those with low don’t believe they can effect positive change; high levels equates to increased confidence to over come barriers in life.

For example, elderly with low-self-efficacy feel they have little control over the events in their lives—our culture has a way of infantilizing elders (not talking about Alzheimer’s here) with terms such as “senior-proof” and “elder-proof,” and learned helplessness is the outcome of cultural conditioning.

On the other hand, elders with high-self-efficacy believe they can command some control in life and shape their destiny. The implications for this are wide reaching from open heart surgery recovery success, depression in the elderly, to who participates in exercise programs—and many other aspects of aging.

Momentum of Positive Change

The elderly exert control over fewer and fewer domains in their lives and the importance of self-efficacy cannot be understated. Beth has taken the first small steps to make her home accessible—what she has also done is moved further along towards the high end of the SE continuum.

This spills over to other aspects of life her life and can have a momentum of its own. Now if she wants to take that European vacation she’s been putting off for fear of going alone, she might join a group and go, sign up for a dance lesson, or go to the movies—she can draw on the increased belief in her ability to effect a positive change in life. This is reinforced every time she interacts with her aging-in-place home improvements; as she grows more empowered.

Beth is potentially every senior and the small aging-in-place steps made can change lives in unanticipated ways; increased self-efficacy is one not to be over-looked.

See

Design With The Future in Mind

Self-efficacy: The exercise of control By Albert Bandura

Aging in ACTION: 10 Senior Living Trends

Fear of Falling and Low Self-Efficacy: A Course of Dependency in Elderly  Persons

What Are Old People For?

More Research:

Journal of Aging and Health: Self-Efficacy as a Mediator Between Fear of Falling and Functional Ability in the Elderly

The American Journal of Preventative Medicine: Intervention-related cognitive versus social mediators of exercise adherence in the elderly

Health locus of control and self-efficacy beliefs in a healthy elderly sample

(photo homecaregiverstore.com)