The eighth P

Steve Gurney’s speech at Vinson Hall on Thursday March 19th 2009 was very compelling and serves as a great platform for discussion for change on how we perceive the role of retirement communities in our society. After planning his move and spending a week at the Paul Spring senior Community in Alexandria, VA, Steve came up with interesting points.

As we all know, the industry is under stress as it needs to answer increasing expectations from residents, residents’ families, and government officials while undergoing a rapid growth due to our aging population. Recent reports show that half of today’s US population will spend some time in a retirement community while 25% of us will actually call it our last home.

The findings of Steve’s experience are elegantly summarized in 7 Ps: Perspective, Possessions, Pricing, Proximity, Purpose, People, Positive attitude. These points highlight “friction points” that are felt by any senior citizen moving into a retirement community.

On the social science perspective, the transition to one of these communities is of extreme significance as the individual will knowingly decide to be “taken care of”. To be “taken care of” has a lot of meaning and is very seldom fully understood. An aspect that is often overlooked is the loss of agency: the philosophical concept of the capacity of an agent (in our case, the resident) to act in a world.

The fact of “being a resident” and the shift in the physical or mental condition are the basis for society, through the retirement community, to exercise power over the individual. In most cases, the loss of agency is not consciously felt as the discourse of the institution and support from the medical body provide sufficient credibility to appease concerns from residents and their family.

This loss of agency actually starts from the moment when the person moves in: it is difficult for him/her to consider moving out. This shift can also be seen as a lot of decisions are taken on behalf of residents and sometimes their families. The loss of control represents one of the main aspects of an already important step in life and is too often misunderstood and overlooked. Therefore it is one of the reasons many Americans do not look forward to moving into these institutions.

This does not mean that residents are powerless agents that suffer from the domination of the retirement communities; there are plenty of organizations that benchmark the conditions of the elderly and monitor abuses. These bodies also provide protection to individuals. Moreover, a lot of communities do a great job including and empowering their customers and taking into account their opinions in important decisions such as budgeting, management and long term strategy of the company. However, these initiatives seldom entirely alleviate this loss of agency.

In addition to the 7Ps that Mr Steve Gurney pointed out, an 8th P should be added: Power.

Power alteration or the shift in one’s agency when moved to a retirement community is a major life event and should be considered and set forth as such.

Some of the powerful avenues to promote the significance of the Power of residents are based on a deep shift in the perception and the role of the institutions. This generally starts by the way the Long Term Care industry represents itself and trains its staff but also in the way technology is used and benchmarks are put in place. One should be confident that the rapidly evolving Long Term Care industry will soon integrate these expectations.

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Blogging from the Proaging event at Vinson Hall Retirement Community

Steve Gurney needs no introduction in the senior care industry: He is a very successful entrepreneur who created the Guide to retirement living which is now a reference in the Mid Atlantic Region and the best resource about senior community offering for families and professionals of the industry – that publication was sold to the Washington Post.

He recently graduated from the Erickson School Management of Aging Services (MAgS) Graduate Program This program is an innovative degree designed to develop leaders in seniors housing and care and aging services.

One day, driving to school, his kids were asking him questions about school and he would them naturally – they trusted his words because they knew that he had gone to school as well. Throughout his career, Steve has been advising and providing information on retirement homes to thousands of people – without knowing what it was really like to move into one of these communities. He realized that he instructs the elderly without knowing what it is like to actually do the steps. This is why Steve decided to move to a retirement community to live the experience!

From there, he had the idea of creating a platform of discussion and push people towards a new way of thinking about the fact of getting old and the way the industry perceives the concept of Aging. As he precisely says: Aging starts at birth.

Before moving in, Steve sent a letter to neighbors describing what he would do and not do, that letter can be found here.

Steve spent a week in the Paul Spring Community and shared his experience through his blog, and tried to immerse himself in the life of a resident.

I had the pleasure of listening about his experience at the Proaging event taking place at Vinson Hall Retirement Community:

Seven P’s of senior living

-Perspective
-Suddenly: he’s filling in an application for himself!
-He sees his furniture in a new room
-Possessions
-He had to do the list of what he had in his house; he could only take 12-13 items – what will you do with the rest? Emotionally attachment to unnecessary items - He won’t need a Crockpot for example
-Importance of memories and to find way preserve to preserve them
-Pricing
-He knows how expensive these facilities are – But now, he paid for it, amount is more than his mortgage!
-Proximity
-Automobile gives the benefit of proximity but in fact suburban neighborhood are very isolated
-Little apartments in communities are actually very good because of proximity to other people and things to do
-Purpose
-Before moving, purpose: work and family – now, this will change. Activities of facility help him find a purpose.
-Helping each other gives a purpose to residents
-No one knows when the end of their life is. Society and the industry have a stigma: communities are for people that are “at the end of their life” – in fact, “we are all at the end of our life, we just don’t know when it is”
-Resident need help to have a purpose.
-People
-Activities secondary, most important: people you interact with.
-Trivia was a history lesson as he learned a lot from other players
-When you move in: it’s like a mandate to make new friends (just like you get to college) not a challenge, actually fun
-Not a senior community, it’s like a neighborhood
-Not about the walls, it’s about the people that live in the wall (Reference to Lock stock and two barrels)
-Going to a college where everybody is a professor
-Positive attitude
-Stay was a weeklong which was perfect and forced him to get outside of his box
-With a positive attitude, you’re more in tune with the community
-Emotion of losing your purpose and having to build a new one – first day was exhausting
-Common experience: transition phase – that establishes a common bond because we’re all people
-Current residents are the best guides in the transition phase
-There are flaws, but way more positive elements

Closing statement:

Facilities are created by people that don’t grow old (like Peter Pan). Anti aging society: It’s not cool to grow old.

If you decided to avoid Aging and live like Peter Pan and move to Neverland, you would look and be like Michael Jackson (horrible picture of MJ in front of his Neverland Ranch)

Q&A:
-He kept in touch with residents and exchange poetry with one lady
-P for Power:
-Power t -leave
-People do stuff for you, they need help in finding their purpose and take power over what they do.
-Experience with the type of facility: notion of power again in the sense that when you are bedridden or wheel chaired, you get t -d -much less
-Healthy body was a limiting factor in the experience
-Stigma of industry: n -one wants t -die in a “old folks home”
-It made him understand importance of marriage and family
-Punch line: “I fully expected t -see something wrong on physical or operation point t -view – but I did not see ANYTHING wrong, what I saw were things I had t -change in my life.”
-What was common amongst all residents? The 7 Ps. Kids together are very much alike, this is not true for seniors (idea borrowed from Dr Bill Thomas)
-Did you feel the effect of Aging: “When I went t -the museum, I saw benefits of walking slowly”

His whole experience is described here:www.everyoneisaging.com

He can also be contacted here: Steve Gurney - 703-992-1118 - steve@proaging.com

Pioneer Network in Culture Change

"Culture change" is the common name given to the national movement for the transformation of older adult services, based on person-directed values and practices where the voices of elders and those working with them are considered and respected. Core person-directed values are choice, dignity
respect, self-determination and purposeful living.

Culture change transformation supports the creation of both long and short-term living environments as well as community-based settings where both older adults and their caregivers are able to express choice and practice self-determination in meaningful ways at every level of daily life.

Culture change transformation may require changes in organization practices, physical environments, relationships at all levels and workforce models – leading to better outcomes for consumers and direct care workers without inflicting detrimental costs on providers.

The Pioneer Network was created in 1997 to develop cross-disciplinary partnerships, collaborations, and networks to advance culture change. Throughout its first decade, Pioneer Network has met with tremendous success in achieving these goals and advocating for a person-directed model of care that places more of the locus of control and decision making in the hands of care recipients and direct care providers. As the Pioneer Network moves into its second decade, its focus is on nationwide adoption of consumer-directed models and on supportive implementation strategies involving more professionals in the field. The following are some of leading highlights to date:

• Formed the new National Life Safety Code (LSC) Task Force to recommend changes to the LSC that will support person-centered care in nursing homes. The recommendations will be submitted to the National Fire Protection Association for review by August 1, 2009. .
• Working with The Hartford Institute of Geriatric Nursing (HIGN), and The Coalition for Geriatric Nursing Organizations to augment the work to date of HIGN in identifying the principles and characteristics of a nursing practice model that includes role definition and culture change competencies of all members of nursing service. Funded by The Commonwealth Fund.
• Articulate the Case for Adoption to support the link between quality and cost efficiency/profitability outcomes at an operational level for homes practicing innovation and person-centered care.
• Small House Webinar series will explore topics around the development, implementation and sustainability of both attached and detached smaller environments and small houses for older adults. The one-hour sessions are scheduled for March 5, 12 and 19 at 1:00 PM EST. Registration is available online only, at www.PioneerNetwork.net. Funded by The Robert Wood Johnson Foundation.
• Hosts a national conference that is a showcase for innovative thought and transformative practices on the long-term care culture change movement. Registration available for the 9th National Conference, Coming Together. Creating Community. It’s Only Natural!, August 12-14, Little Rock, AR. Go to www.PioneerNetwork.net.

You can learn more by visiting their new website, www.PioneerNetwork.net.