Thursday, October 29, 2015

Aging in Place (Part 2): The Village & Beyond

The Village

Two additional models have emerged as workable for those open to aging in community: the Village and Care Circles. The Village is designed for people who want to develop the kinds of supports for their old age that families used to provide (some still do), but which are increasingly rare for a variety of reasons.

Villages are sustained by members or their caregivers, who contribute financially, with costs depending on how extensive the level of services and number of members. For example, overall costs for members of a "typical" Village run about $80,000 for start-up expenditures and $20,000 to $200,000 to maintain it each year.

A group of Boston seniors in the Beacon Hill District initiated the first Village in 2001 to help one another live as long as possible in their neighborhood. Now the Beacon Hill Village is an independent, non-profit organization, governed by the members themselves and supported by members’ dues and external donations and grants. A host of "partners," including preferred providers, member volunteers and community services help its members to age in place and connect with their broader community.

Over a 13-year period, 140 established Villages have emerged with more than 200 on the way, with budgets ranging from $1,000 to $674,000, depending on the size of the membership.

Villages promise a higher quality of life by coordinating paid and volunteer elder services with a single phone call. The more developed Village provides a dense network of volunteer, agency and professional intervention that can sustain an older person and their caregivers over time. Services range from education on aging/caregiving issues and elder law to geriatric care and money management.

Preferred providers are vetted by the Village, who oversee the quality of services, and paid professionals are encouraged to offer discounts to members. Volunteers play a significant role in this project, as younger and healthy people "pay it forward" to bring various services to disabled seniors, helping them with chores, meals, home maintenance and other services. In turn, volunteers receive benefits or assistance in the future, especially gratifying for older volunteers. All Villages depend heavily upon trained volunteers, which can substantially reduce costs for members.

Care Circles

Another highly successful model for aging in place, the Care Circle, offers a more nurturing approach, operating on the principle of "a step forward in giving back." Initially, care circles were developed by the Australian government in the 1990s to reduce the Aborigine people’s social problems. Transplanted to North America, care circles have become a substitute for the extended family or small community for better addressing the needs of disabled and elderly persons.

Care circles are privately organized social networks of friends, family, neighbors and volunteers that help seniors experience round-the-clock attention through individualized care plans. Care circles work on the premise that shared lives and real relationships define the central values of aging in community.

These networks stress interdependence, not merely independence, among those in need. Multifaceted by design, care circles move beyond the delivery of services into a full-fledged model of care, support and shared lives, ultimately helping elders to maintain the life they desire in community with others. A few highlights of the care circle:

1) Operates in any neighborhood, larger community or care facility;
2) Embraces all age and income groups;
3) Aims to lessen the caregiver burden by offering hands-on assistance to caregivers working with ill and disabled seniors without cost (unless seeking professional or business assistance);
4) Addresses head-on the incredibly difficult role of middle-aged caregivers, the "sandwich generation," who are squeezed between the stresses of caring for both parents and children; and 
5) Recognizes the priorities established by the World Health Organization to influence the health and quality of life of older people, including transportation, social participation and connectivity.

To create your own care circle program, you can seek technical assistance from an organization, such as Lotsa Helping Hands, that will schedule medications, transportation, meal planning, and the like to fit the needs and lifestyle of the elderly person. Volunteers sign up through the website, and choose a specific assignment for assisting a needy person.

Numbers tell the story. Members of Lotsa Helping Hands have offered mutual help and care for seniors and their caregivers to more than 1.3 million members and 70,000 communities, successfully delivering 1,400,000 meals and a multitude of other services since its inception.

Volunteers sign up to help only one person at a time on a regimented, yet flexible, schedule. This ensures that no one volunteer will be saddled with excessive duties nor will the elderly person or their caregiver be swamped with surplus attendants. The one constant throughout the process of aging is change. Local care circle members’ roles and responsibilities will undoubtedly undergo transformation as a result of elderly persons’ changes in vision, hearing, physical stamina, sleep habits and nutritional needs.

Private companies that charge for setting up services, such as CareCircle SAP, have now entered the arena. The company works with both patient and family/friends to develop a care plan that will accommodate a variety of patient needs: visits, meals, housekeeping, transportation and chores, as well as assist with drug delivery or schedule medical and social services. The company offers a free app through iTunes that helps patients and their families find the best care practices from experts and caregivers around the world.

Aside from assembling health and welfare collaborators and expanding the circle of mutual support, both Villages and care circles offer a host of "little things" that people can do for each other. The goal is to make it easier for older people to stay in their home or care facility, and enjoy their time with family and friends. For many seniors, it can be an empowering experience.

Caregivers can gain a measure of freedom when they know it’s possible for their loved one to get a ride to the doctor, receive a hot meal or have a regular visitor. Volunteers can also help seniors make a home or life in a facility more comfortable and user friendly as the senior ages. It’s remarkable how relieved caregivers can be with a volunteer checking in on their loved one from time to time, especially if the caregiver is working or the senior is living alone.

Without doubt, these innovative programs—Eden Alternative, Green House Project, Villages and care circles—address the many issues of aging in place in our diverse communities across America.

Excerpt from The ABCs of Caregiving, Part 2: Essential Information for You and Your Family, available in paperback and Kindle on

Friday, October 9, 2015

Understanding Aging in Place (Part 1)

When we hear the term, aging in place, we think of keeping our loved one in the comfort, convenience and safety of their own home, as opposed to a health care facility. What exactly does this encompass?

Aging in place implies that an older person, ideally with adequate assistance from a caregiver, can help maintain a full range of normal daily activities, including transportation, shopping, cooking, cleaning, home and garden maintenance, and a host of ordinary tasks that are taken for granted among younger, healthy people.

And a living situation that works at 70 years of age—when independence is less likely to be an issue—may not be the case for a frail 90-year-old still residing in the family home. Along with the older person’s caregiver, family, friends and neighbors can pitch in from time to time, but the optimal scenario requires a community effort to make aging in place a reality over the long term.

Aging in Community offers a more broad-based approach than the limited notion of staying in the family home or down-sized condo. Baby Boomers have watched their overtaxed parents struggle with aging by themselves, often isolated and lonely. Now these mid-lifers are seeking a more expansive model for their own aging, which embraces the idea of being "in community."

The newer model has two primary elements: staying active and involved as long as possible in their chosen home and reimagining existing care facilities. This could easily incorporate living in a long-term care facility—assisted living or skilled nursing—but without the trappings of an institutional setting, which are habitually overcrowded, understaffed, impersonal, and monotonous.

Eden Alternative 

Dr. Bill Thomas was primarily concerned with emotional well-being when he conceived of the Eden Alternative in the early 1990s as a way to alleviate the loneliness, helplessness and boredom that permeated the nursing home he operated in New York.

"What good is quality of medical care if your life is miserable?" he asked. Thomas’ original vision of the Eden Alternative focused on partnering with nursing homes to help them change their culture and environment to "create a habitat for human beings rather than facilities for the frail and elderly."

An Eden-certified nursing home moves away from the sterility of the long-term care environment toward creating a setting where personal care dominates and cohesive principles enliven both residents and staff. Eden homes aim to:

1) Create a home-like atmosphere;
2) Make a difference in elderly people’s lives;
3) Change the culture of care;
4) Train and support staff; and
5) Love, care, and live together as a family.

The Eden principles have been incorporated in pre-existing long-term facilities, where a menagerie of dogs, cats, birds and children (who may be part of an in-house daycare program) create appealing and warm living spaces. Happily, measurable medical benefits followed Thomas’ inventive approach. After two years, his first Eden facility had 50 percent fewer infections and 25 percent fewer deaths than a comparable non-Eden nursing home. Other studies show that even bedsores and dementia can be significantly reduced using the Eden Alternative.

Green House Project

Moving away from institutional settings, Thomas went on to develop another innovative method: The "Green House Project." Now, more than 100 homes have been built, starting with the idea of helping companies and individuals convert or build residential homes.

The Project’s primary goal is to provide high levels of care for persons who do not wish to be in a nursing home setting. Among other supporters, the Robert Wood Johnson Foundation has funded an innovative design, involving clusters of smaller "green" homes, built for six to ten senior residents, with outdoor space and gardens. Each resident has a private bath and bedroom, and has access to shared areas of the house at any time, enhancing sociability and autonomy, streamlining delivery of services and creating a homey environment.

Excerpt from The ABCs of Caregiving, Part 2: Essential Information for You and Your Family, available in paperback and Kindle on