This month’s three-day Legacy Film Festival on Aging (LFFoA)
featured “Stay, or Move” program, exploring where we’ll live as we get older and what kind of role place plays in the quality of our lives:
staying put in our homes (aging in place) or moving on to communities (aging in
community).
Staying inside an air-conditioned theater was respite from the heat wave inSan Francisco San Francisco
Staying inside an air-conditioned theater was respite from the heat wave in
Sunny skies brought smiles to LFFoA Director Sheila Malkind
with Mother, Child filmmaker Tin Pang
and his mother Kitty, outside New People Cinema. As volunteer, I had awesome opportunities to
meet and greet filmmakers and audience members when they arrived to the theater. Tin
and Kitty had friends and family from Australia, Toronto and Brisbane
(California) attending LFFoA.
Stay, or Move
Bay Area filmmaker Kristi Denton
Cohen answered questions about Stay or Move from Arlene Reiff,
LFFoA Board member and Transition Network’s San Francisco Bay Area chapter co-founder. Some films (like Stay or Move) shown at LFFoA are freely available online, but it still
pays to attend LFFoA, which facilitates community dialogue with filmmakers
about important issues like housing, transportation, long-term care, etc.
Kristi and Arlene took questions from the audience. An
award-winning filmmaker with over 25 years of experience, Kristi explained that
she had no children and decided to make a series of short documentary films
exploring housing options as we get older because she wanted to make the
decision for herself before someone else did.
LFFoA showed the following short films from Stay or Move:
· Deciding to Stay or Move: UC Berkeley Social Work Professor Andrew Scharlach discussed warning signs when
it may be time to move (fall risk, can’t get out to places where they want to go, no longer connected to
community) and advised finding an “environment that
you’d like to live in where people will be part of your life forever – any age, so you’re not alone in the world, people really know who you are.”
· Staying Put:
building an Accessory Dwelling Unit (ADU) for Multigenerational Living and accessing supports from Marin Villages of the Village Movement
· Moving On: affordable housing with onsite resident
services coordinator at Strawberry Creek Lodge in Berkeley
Dial-A-Ride
Dial-A-Ride (2016) was a short documentary featuring the bonding of passengers
on board a UK community bus
that provided weekly door-to-door transport for isolated older people living in
remote and rural South Wales with no public
transport nearby. The pleasant driver provided commentary, noting his
interactions with passengers always provided "something interesting or a
surprise." The film’s website provided this Director’s statement:
“With
government funding for a community transport cut by half in 2016, it is a
tragedy that invaluable services like Brecon Dial-A-Ride are being shut down
around the country. These buses are a
lifeline for many older people in the UK UK
The Green House Project
Stay, or Move’s website includes
a three-minute video, Celebrating 10
Years of the Green House Project, as a nursing home alternative under Moving On. At LFFoA, Sheila
decided to screen the 25-minute documentary The Green House Project (2004), showing the development of the first Green House in Tupelo , Mississippi
LFFoA Board member Paul Kleyman talked about his hero, Dr. Bill Thomas, and the Pioneer Network leading culture change to revolutionize long-term care institutionalization and replace nursing
homes. He also spoke about home and
community based services, like PACE (Program of All-Inclusive Care for Elderly) through IOA
and On Lok Lifeways, as alternatives to nursing homes.
Last
year, Dr. Thomas told The Washington Post: “We need to get people out of hospitals, we need to create a rich set of
community-based alternatives… [the goal is] normalizing the entire lifespan
instead of separating and stigmatizing one part as something different.” In moving beyond nursing homes by setting up
Green Houses, Dr. Thomas noted an advantage of their small size: “Within six weeks, they had to send a truck
around to pick up all the wheelchairs …You know why most people [in nursing
homes] use wheelchairs? Because the buildings are so damn big…The
buildings disable elders.”
In an interview with filmmaker Dale Bell (of And Thou Shalt Honor, a 2002 PBS
caregiving outreach project ),
Dr. Thomas discussed his Green House Project model, based on principles of The Eden
“The
nursing home takes good, good, loving, caring people and plugs them into an
institutional factory-like arrangement. And it's no good… the best alternative
I can think of is a garden…a place that's worthy of our elders, we make a place
that enriches all of our lives, caregiver, family member and elder alike… we
call it the Eden Alternative.”
Green Care Farms offers a nursing home alternative closer
to a garden (as described in blog post coverage of IAGG World Congress). More recently, Dr. Thomas introduced Minka, an
affordable age-friendly, small-scale dwelling.
Mother, Child
Sheila facilitated Q&A with Mother, Child (2017) filmmaker Tin Pang and his mother Kitty. Mother, Child
is a short film based on Tin’s own experience as carer for his mother after she
suffered a stroke in 2015, just 10 days after her retirement at age 65, and
then she endured a long rehabilitation to relearn how to talk and walk. Only child Tin dropped everything in Sydney Australia
Tin told Sheila that he filmed “Mother, Child” in just one take! After meeting Tin and Kitty
in-person and then seeing their intro trailer, I actually preferred the charming
and dynamic Tin and Kitty over the actors Lawrence Leung and Gabrielle Chan who
played son and mother.
Tin reported that after 8 months in the Gold Coast, he and
Kitty moved to a smaller apartment in Sydney.
Should the need arise, I would be like Tin and drop everything
to care for my own parents so they can age in place. In the meantime, I continue exploring options
for aging in place and community.
·
After age 85, the risk of Alzheimer’s reaches nearly 50 percent
·
Compared
to only 4 percent of the general population, 75 percent of the people with Alzheimer’s
will be admitted to a nursing home by age 80.
As a nursing home alternative for
people with severe dementia, Hogeweyk Dementia Village in the Netherlands is designed like a small village with residences (each home
houses 6 to 8 people with the same lifestyle), courtyards, a grocery store,
restaurants and a movie theater.
Residents can move freely inside the house and outside, though they can’t
venture outside of the periphery doors of the village on their own. All staff members are trained in dementia
care.
“The act of engaging in community …about
developing a more personable and comprehensive way of treating disease...The
countless studies reinforcing how many dementia patients feel lonely or
isolated, juxtaposed with Hogewey’s considerable success with these residents,
call into question how much of dementia
is a result of disease, and how much is a result of how we treat it.–
Josh Planos, “The Dutch Village Where Everyone Has Dementia”, The Atlantic (Nov. 14, 2014)
In Dementia Beyond Drugs: Changing the Culture of Care (2010), geriatrician G.
Allen Power, M.D., proposed doing away with segregation of people with dementia
in living areas labeled after a disease (like “dementia care” or “memory care”)
to rid the institutional mindset that reduces people to their deficits. He criticized dementia-specific living
environments (specialized physical design, specialized staffing,
dementia-specific activity programming, lock-down exit systems, isolation of
people with behavioral symptoms, complaints of others who don’t want “those
people” in their living areas):
1.
physical
design does not look and feel like home:
living in an unfamiliar environment creates unmet needs that trigger behavioral
expressions, so it’s best to dismantle the institution (long halls, double
rooms, nursing stations, alarms, call bells; lack of relationship, autonomy and
meaning) and recreate a comfortable home (Green House Project).
2. civil rights issue: treating
people with disabilities as “separate, but equal, not in our neighborhood” reflects
fears and misconceptions about the disease, and sells short the potential for
growth and engagement that still exists in people with dementia.
Dr. Power noted that the Green House Model
followed a process similar to that used to deinstitutionalize people with developmental and psychiatric disabilities using group homes. The Green House blends people with and without
dementia. Instead of segregation, Dr. Power noted the advantages of a diverse community such as the creation of a nurturing
interdependent community.
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ReplyDeleteusps change of address request
My aging mom didn’t want to be a burden. And that was a burden.
ReplyDeleteMelanie P. Merriman Dec 9
My mother’s words sounded harsh — “I never want to live with either one of my girls” — but I didn’t take offense. It was her way of saying she never wanted to be dependent on us, or anyone.
…“I just don’t want to be a burden,” she said anytime the subject came up.
The last five years of my mother’s life, when she declined both mentally and physically, were difficult for all of us. This fiercely independent woman needed assistance, and both Barbara and I re¬arranged our lives to make sure she got it. Paradoxically, whatever burden there was in caring for her came not from her need for help but from her heels-dug-in resistance to accepting it and my own resistance to usurping her autonomy.
Desperate to stay in her Florida condominium where she had lived for 35 years, my mother pretended to be doing well on her own, even after she started to slow down…I pretended, too — telling her I was coming to visit because of a business meeting nearby when really I just wanted to check on her, and then accepting her apparent well-being at face value even as she edged into her late 80s.
Eventually, as Mom approached 90, her best friend, who saw her several times a week, wrote to me and made me face the truth. My mother could not live on her own forever, and it wasn’t fair or even possible to expect her friends, who were also getting older, to step in. She would need to move somewhere closer to either Barbara or me.
Mom’s reaction to the idea was heartbreaking. “I’m too old to start over somewhere new,” she said, and I knew we had waited much too long to have this discussion. My mother’s condo and the surrounding community had become a comfortable cocoon. She couldn’t seem to understand that staying there, even with some kind of in-home help, would have been a true burden on Barbara and me; that in case of a fall or some other health crisis, one of us would have to fly in, leaving our own families and work.
My insistence that we preserve Mom’s autonomy for her sake, not ours — so that she would not feel like a burden — only made things worse. I refused to acknowledge that her overwhelming sadness and fear made it impossible for her to assess the situation clearly. I wanted her to make the choice, and I prolonged everyone’s agony by exploring unrealistic options in my desire to let her have her way.
I looked for services that would allow Mom to stay in her condo…considered an assisted living facility near her condo so that she could, at least, stay in her own community. But her friend told me this would only isolate her more as still-active senior friends would not be likely to visit. Also, this option still kept Mom too far from either me or Barbara.
My mother’s friend again provided the necessary dose of reality. “You and Barbara will have to make this decision,” she wrote.
…if I could do it over again, there are things I would do differently.
First, I would pay better attention to the signs that my mother needed help as she got older: her growing isolation as she stepped back from community activities and stopped driving except to places she went often, her weight loss and her forgetfulness. I would see that her ability to manage alone in her condo did not mean that she could thrive there.
Second, I would be more realistic about the overall trajectory and consequences of aging. I had worked with hospices. I had studied aging and illness. I knew my mother would decline both physically and mentally. Still, the longer she seemed to do well, the easier it was to engage in magical thinking, also known as denial.
Finally, I would talk to her about a plan for her future long before either of us felt it was time. I now know that when everyone is ready to talk, it’s already too late to be proactive…
author of “Holding the Net: Caring for My Mother on the Tightrope of Aging.” https://www.washingtonpost.com/national/health-science/my-aging-mom-didnt-want-to-be-a-burden-and-that-was-a-burden/2017/12/08/c5bcb598-b446-11e7-a908-a3470754bbb9_story.html
A Better Kind of Nursing Home
ReplyDeletePaula Span
THE NEW OLD AGE DEC. 22, 2017
Lots of things look different when you step into a small Green House nursing home…
At conventional nursing homes,...struggle to provide even a smidgen of personal autonomy…
The Green House Project, which in 2003 opened its first small nursing homes in Tupelo, Miss., counts just 242 licensed homes in 32 states to date, with 150 more in various stages of planning or construction…That’s a droplet in the bucket of the nation’s more than 15,000 nursing homes.
But few aspects of aging generate quite so much anticipatory horror as nursing homes, and so Green Houses have attracted disproportionate attention, including media coverage.
They seem to embody change. “The numbers are still modest, but it truly is a different model of care,” said Sheryl Zimmerman, a gerontologist and health services researcher at the University of North Carolina at Chapel Hill…
The group’s study of nearly 100 Green Houses compared to standard nursing homes, funded by a $2 million grant from Robert Wood Johnson Foundation and published in the journal Health Services Research, showed that Green Houses don’t fulfill all their goals and promises.
Though “control over the rhythms of the day” represents a pillar of Green House life, as one of its brochures declares, the researchers found that about a third of the homes didn’t allow residents to decide when they awakened, and most restricted when residents could bathe or shower. Compared to conventional nursing homes, Green Houses also are far less likely to offer formal activities.
But overall, the studies, incorporating nine years of data, add up to a positive report card. “Compared to traditional nursing homes, no doubt about it,” said Dr. Zimmerman. “It’s a preferable model of care.”
Among the reasons:
* Green Houses practice what’s called “consistent assignment,” meaning that the same aides care for the same few residents. “People know you. They know your likes and dislikes,” Dr. Zimmerman said. “There’s more trust and familiarity. Relationships develop.”
An aide (in Green House lingo, a shahbaz) who knows residents well is also better able to spot health problems early on. “Because aides were in closer and more consistent contact, they were more aware of changes in residents’ conditions,” Dr. Zimmerman said.
A Green House shahbaz spends many more hours on patient care: an average 4.2 hours per resident per day, compared with 2.2 hours in conventional nursing homes. (At Green Houses, that includes tasks like preparing meals and doing laundry.)
* Compared to residents in traditional nursing homes, Green House residents fared better on three of eight federal inspection criteria, and did equally well on the others.
The researchers found that Green House residents were 16 percent less likely to be bedridden, 38 percent less likely to have pressure ulcers and 45 percent less likely to have catheters. Avoidable hospitalizations and readmissions were also lower, reassuring observers who wondered if the Green Houses’ emphasis on quality of life meant sacrificing quality of care.
* Though Green Houses are expensive to build (including a $200,000 payment to the nonprofit Green House Project for training, design and support), with 8 percent higher operating costs than standard nursing homes, they save Medicare 30 percent per resident per year. (They charge residents or their insurers somewhat more than regular nursing homes, however.)…
Critics who deplore the state of American nursing homes have called for a “culture change” for at least 20 years. That means “deinstitutionalizing nursing homes, making them more like the way we’ve lived all our lives, with our own routines and familiar objects,” said Robyn Grant, public policy director for The National Consumer Voice for Quality Long-Term Care…
https://www.nytimes.com/2017/12/22/health/green-houses-nursing-homes.html
SF Chronicle, Jan. 21, 2018
ReplyDeleteCPMC to shut down Alzheimer’s program; residents scramble for alternatives
By Catherine Ho
One of San Francisco’s only subsidized residential care centers for Alzheimer’s patients will shut down by the end of 2018, prompting worry among family members, caregivers and officials about the dwindling availability of affordable care for dementia patients in an aging city.
The Irene Swindells Alzheimer’s Residential Care Program, operated by California Pacific Medical Center in the city’s Presidio Heights neighborhood, will close as part of the hospital’s plan to move its campus on California Street to a newly constructed center at the corner of Van Ness Avenue and Geary Street. The new facility is scheduled to open in 2020.
The Alzheimer’s care center, which opened in 1997 and houses 18 elderly patients, is the only service that will be discontinued after the move…because the health system is focusing on acute care...
Family members and caregivers of the Swindells residents — some of whom have severe dementia and are incontinent — worry they may not be able to find an affordable alternative for their loved ones in San Francisco. Other residential care centers in the city have waiting lists, cost thousands of dollars more each month, or are primarily for patients whose incomes are low enough to qualify for Medi-Cal, the insurance program for the poor. But Medi-Cal covers only skilled nursing centers, which are not always the best environment for patients with dementia, medical experts said.
…The number of residential care centers for the elderly in San Francisco has declined 20 percent since 2012, from 96 to 77, according to a 2017 report by the San Francisco Department Public Health, Department of Aging and Adult Services and the Hospital Council of Northern and Central California. The number of beds, however, has declined less dramatically during the same period, from 3,225 to 3,153, or 2 percent.
Meanwhile, the proportion of the city’s population older than 60 is growing. This population has increased 18 percent since 2000 — far faster than the 4 percent rate of growth for the city overall, according to a 2016 assessment by the Department of Aging. This growth is anticipated to continue as the Baby Boomer generation ages.
The average cost per month to live in a skilled nursing home in San Francisco is $11,700 to $14,200, according to the city’s 2017 report. The average cost to live in a residential care center in San Francisco is $4,300 a month.
Skilled nursing facilities have registered nurses on duty 24 hours a day, whereas residential care centers have certified nurse assistants and some registered nurses, and are typically less expensive because residents do not need round-the-clock medical care but still require help with daily activities.
At Swindells, which is considered a residential care center, residents pay between $3,000 and $9,000, according to relatives of several residents. Many pay on the lower end of that spectrum because their fees are subsidized as much as 50 percent with the help of philanthropic contributions to the California Pacific Medical Center foundation.
…Vacancies at residential and long-term care centers in the city, especially those that are affordable for middle-income families, are scarce.
…Most long-term care and residential care centers are not covered by private insurance or Medicare, leaving many families to pay the cost of care on their own. The exception is if patients are on Medi-Cal, which covers stays at skilled nursing homes. Most residents at other major long-term care facilities in the city, Laguna Honda and the San Francisco Campus for Jewish Living — formerly known as the Jewish Home — are on Medi-Cal.
https://www.sfchronicle.com/business/article/CPMC-to-shut-down-Alzheimer-s-program-12513655.php
Woman, 92, allegedly killed son who wanted to put her in a nursing home
ReplyDeleteBy Nicole Chavez, CNN
Updated 8:26 AM ET, Wed July 4, 2018
(CNN)A 92-year-old woman allegedly killed her son in Arizona because she did not want to be sent to an assisted living facility, authorities said.
Anna Mae Blessing was charged with first degree murder, aggravated assault and kidnapping after authorities found her 72-year-old son dead Monday at their home in Fountain Hills, Maricopa County Sheriff's Office said.
Blessing hid two pistols in the pockets of her robe and shot her son several times in his bedroom, the sheriff's office said in a statement.
Her son's girlfriend was also in the room and said she heard Blessing telling her son she was tired of the way he treated her, court documents said.
"From my understanding, she had thought about it for a few days because there was a dispute regarding her son wanting to put her in an assisted living home," Maricopa County Sgt. Bryant Vanejas told CNN affiliate KPHO.
Blessing then pointed the gun at her son's girlfriend, who struggled with her until she lost her grip of the gun. When Blessing pulled out the second pistol from her robe, her son's girlfriend also knocked it out of her hand, the statement said.
Once she was disarmed, Blessing sat on a reclining chair until deputies arrived and arrested her, officials said.
"As the suspect was being escorted from the residence, she made a spontaneous statement to the effect of 'You took my life, so I'm taking yours,'" court documents said.
Blessing moved in with her son and his girlfriend about six months ago, the affiliate reported.
She told deputies she had purchased one of the guns in the late 1970s and that her husband gave her the other pistol, court documents say.
Information on her attorney was not immediately available.
https://www.cnn.com/2018/07/04/us/elderly-woman-son-death-assisted-living-trnd/index.html
San Franciscans are getting older fast. NEXT Village helps them do it with dignity
ReplyDeleteAnna Bauman Dec. 30, 2019
…The pair’s recent morning jaunt was part of a weekly routine designed to help slow the progression of Van Bueren’s Parkinson’s disease. The meetups are coordinated by NEXT Village SF, a nonprofit organization that serves the city’s fastest growing population: seniors.
Adults older than age 60 will make up 23% of San Francisco’s population next year, and 27% of all residents a decade from now, according to the city’s Department of Disability and Aging Services.
NEXT Village, whose name stands for Northeast Exchange Team, seeks to help seniors in that corner of the city — which has San Francisco’s highest concentration of elderly residents — remain in their homes as long as possible. The work is vital in a city known for its high cost of living, as well as its many steep hills.
The organization is part of the national Village to Village network, which has more than a dozen branches in the Bay Area and 240 nationwide. The hyper-local groups were modeled after the first “village” created in Boston in 2002.
Many of NEXT Village’s clients face daunting issues such as navigating the streets alone, landlords attempting to push them out of rent-controlled apartments, social isolation and loneliness.
“So many of our members didn’t marry and didn’t have kids,” said Jacqueline Jones, NEXT Village’s executive director. “So, we’re it.”
Supervisor Aaron Peskin, whose District Three includes North Beach, Chinatown and Nob Hill, called NEXT Village a “godsend” for his older constituents.
“With a pittance of city dollars, and an incredible amount of local volunteer and neighborhood support, NEXT Village SF has helped my neighbors age in place and get services big and small that they need to have a good quality of life,” Peskin said.
NEXT Village, now in its 10th year and serving roughly 220 members, plans to expand operations in January by adding biweekly events in the Marina. The membership-driven organization charges clients $600 a year, while low-income seniors can pay a $120 fee supplemented by city funds.
Neighborhoods served include North Beach, Telegraph Hill, Polk Gulch, Russian Hill, the northern waterfront, the Marina, Nob Hill and the Financial District. The goal is to “fill in the gaps of whatever people might need,” Jones said.
For Van Bueren, the biggest need is a steady walking partner.
Doctors told him exercise could help slow the progression of his nervous system disorder, which has no cure. Medication boosts his stamina in the morning, but by the afternoon Van Bueren can hardly muster the energy to inch through his apartment on a walker or reach for his reading glasses.
The morning walks remind him of the active lifestyle he used to enjoy, backpacking and yoga, before several falls and brain surgery. The conversations Van Bueren and Wales have are as colorful and winding as the path they usually take.
…Volunteers such as Wales help members buy groceries, drive them to appointments and teach them how to use techology. NEXT Village also hosts lunches, book clubs and painting classes to give seniors a chance to socialize outside the house.
…NEXT Village identified social isolation as one of the biggest issues facing seniors in San Francisco, after the city’s aging department estimated that nearly 30% of older adults live alone.
… “It’s like extended family,” she said about the friends she’s made through NEXT Village.
https://www.sfchronicle.com/bayarea/article/San-Franciscans-are-getting-older-in-a-hurry-14922804.php