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Unlimited Options for Aging: Developing Community-Centered Living

By Joe Carella, May 30

In 2001, I was part of a team that opened the Scandinavian Living Center, (SLC) an assisted living community that put into play principles developed after a research trip to Scandinavia. The SLC was purposely designed to stay clear of the institutional values and traditions that typical US nursing homes implement, such as multi-resident rooms, a hospital-style design and a staff tasked with doing the majority of the care for the residents. At the time, when we designed the SLC, we developed it on three principles: creating a residential reality, maintaining the lifestyle and dignity of residents and encouraging autonomy. Eluding to it in the initial research, but having an appreciation of its importance, we also incorporated a fourth principle to our model for an assisted living community that allows the population to age while remaining engaged: community-centered living. Creating a Residential Reality Creating a residential reality in an assisted living community, nursing home or other elder care facility means creating a setting and expectations to which the residents are accustomed. What that looks like differs from person to person, which is why this can be such a challenge. In Scandinavia, when a person moves to a nursing home they bring their most valued furniture and possessions with them. The only institutional item is a bed, which is often separated from the room by a screen or alcove to make the room feel more like an apartment or home. (When’s the last time you had friends to your home for coffee, for example, and invited them to gather around your bed?) Institutional reality means that we limit choices or options by design. In a residential reality, we use design to overcome obstacles, so we can focus on the individual needs or goals. At the SLC, this means nixing the idea of multiple beds to a room or the hospital design of rooms on either side of a hallway. Instead, rooms open out into a hallway with windows into our courtyard. We provide residents with the opportunity to have familiar surroundings instead of institutional living arrangements. With each design choice, we aim to create a comfortable, home-like environment that the residents can adapt to their own residential reality. Maintaining Lifestyle & Dignity By creating a homelike atmosphere at the SLC, we foster our residents’ ability to continue their habits and maintain their lifestyle. In Scandinavian culture, aging is not looked upon as a sickness; it’s seen as a health process, and shifts the point of view with which staff at the SLC look at the residents. We provide residents with as many opportunities as possible to continue the life and interests they had before moving into the SLC; we don’t expect them to develop an entirely new one, but to remain active and engaged. We also encourage residents to take personal responsibility for their care. A typical elder care staff person in the US are often seen as caretakers and provide full service for residents, but the truth is that many residents can often continue to perform many of these tasks on their own. In the Scandinavian style, which is backed by research, we encourage residents to continue their own caretaking and employ the assistance of the staff as needed Encouraging Autonomy One of the major hallmarks of Scandinavian elder care – one that is supported by a wide range of research – is providing and encouraging autonomy. We allow our residents to maintain responsibility for their own choices. Studies have shown that when held responsible and accountable for their choices, they become more active, engaged and happy. Develop Community-Centered Living While we built the SLC 15 years ago with the first three principles in mind, this fourth philosophy of community-centered living was also developed along the way, and it really does create the glue that holds the rest together. Community-centered living starts with a well-designed building that promotes social interaction. Fifty percent of our building is dedicated to common spaces. These include a performance venue, fitness center, offices for other nonprofits and businesses, a library and even a café, all of which are open to the public at different times in the week. When we opened, we invited Scandinavian clubs and organizations in the community to make our building their home base, but it quickly became clear that a well-designed building wasn’t enough. We had to foster natural connections. A great example of this came early on. We spoke with the Newton Recreation Department and learned that they needed our Nordic Hall as a venue for their local card playing groups. It was our hope that the residents would join the card players and interact with their new neighbors. To our surprise, the SLC residents resisted because they considered the card players “the outside community.” It became eminently clear that a well-designed building didn’t automatically break down the invisible institutional wall. We still needed to find a way to create natural connections to this “outside community.” At first, we had the residents play cards in a separate part of the building on the same day as the card group. Eventually, we moved the residents and their card group tables alongside the card group during the same day. It took time, but eventually some of the residents joined the card group, and then some of the card players moved into the SLC as residents, making the community interconnection real. Why Does It Matter? Aging well means creating less confining communities and maintaining natural and normal connections to family, friends and neighbors. As the elder care industry in the US heats up (studies show that 20% of the US population will be over 65 by 2050), we see more and more country club style elder care “communities” pop up. As we forge ahead in creating an elder care system to accommodate this growing population, I hope sharing the four principles from “Unlimited Options for Aging” will help to mold facilities that take the well-being of residents – and the community at large – into account. Wonderful design and amenities are not enough. An honest commitment to dignified opportunities for human connection will bring benefit to all generations. Joe Carella has spent his life researching and enacting a Scandinavian model for senior living that allows elders to remain an integral part of the community at large and eschews segregation. Joe has been the executive director of the Scandinavian Charitable Society of Greater Boston since 1990. In his role, he has studied the elder care system in Scandinavia and led a team that designed, developed and built The Scandinavian Living Center, a modern assisted-living housing option that focuses on community-based housing. Carella is the author of Unlimited Options for Aging: Commonsense Answers from Scandinavia and will be publishing an updated edition of the book in 2016. He has spent his career as a senior care administrator and advocate. He holds an MBA from Babson College and is frequently interviewed about and speaks on elder care issues.

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Keeping Seniors Safe from Illegal Online Pharmacies

June 7

eCareDiary will speak to Libby Baney, Executive Director of the Alliance for Safe Online Pharmacies, an international non-profit organization about educating seniors and caregivers about risks in buying prescription medications online and tools to ensure their safety from illegal online dealers.

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