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Anecdotes are the antidotes – Towards a broader definition of health

by Susanne Stadler | June 9th, 2013 | Our Relations | Please Comment

‘Not enough are fearless to move forward’.

So, here we are, people from all walks of life, different professional experience, different training, at different stages of our careers and life, different parts of the country (and Canada) brought together by a workshop/retreat called ‘Ecological Health Across The Lifespan’ sponsored by CHE, the Collaborative on Health and the Environment. Such a workshop is based on the incredible audacious belief in the power of humanity, a seeming throwback to the 60s. Our trainers/presenters are not TED talkers but are seasoned listeners who operate from an accrued knowledge firmly rooted in their respective disciplines and social activism.

We talk about the web of causality, about how system change can be affected, about environmental factors that impact chronic disease, from toxic stress to the lack of beauty in our built environments (good design is not a luxury). We talk about the fact that healthy aging starts before we are born. We talk about spirited citizens and the myth of Alzheimers. We talk about how income disparity is a huge determinant of brain health. We talk about that the average American eats out 6x a week and that 30% of our food comes from these outside sources. We talk about that we do not know anything about the health effects of a lot of chemicals we are currently exposed to.

We talk about aging and disability. How there is a struggle for resources to live to one’s full potential when one’s capacity or abilities are reduced as an aging person.

The story we all have prior to a decline in cognitive functions persists. Being healthy is for this story to continue.

It is necessary to create conditions for such understanding of health, from nutrition to aesthetically authentic and adaptive environments. Who carries the social cost of ill health? There is no incentive to execute this broader view of health unless there is something “in” it.

How to accomplish the shift to a broader view of health?

Some Suggestions:

1. Creating empathy: Personal encounters, personal stories, videos. A personal story creates enormous empathy. How can you ‘upscale’ this story to a general rule, law, tax? Example: Donations flow for individuals whose personal story touches people, less so for general missions that would positively affect many.

2. Creating and fostering communities is part of the health picture. Example: Singapore provides a $50,000 grant to children who move to within 1km of their aged parents.

3. Start messaging much earlier: The target group for change should not only be people who are moving into their second phase of life or are already in it. Messaging has to start earlier to allow for a shift and for actions to become preventative and forward looking. Example: Intergenerational learning.

4. There are different doors we can enter through: We will never have enough social workers. The question is who is trusted to come into your home? They are potentially the ones who can provide service. What gateway and sensitivity training programs can be developed for this diverse group of people. Example: In natural disasters such as Hurricane Sandy, contractors become service learners as they assist people in making their homes livable.

5. Learn from disaster management: Natural disasters are now becoming a regular occurrence, from hurricanes to wild fires to floods. Can we learn from disaster response for dealing with the urgency of a rapidly aging, underfunded population?

6. Economic Incentive: The social cost of ill health has to be distributed more evenly to incentivize preventative action. Example: A mandatory health care system for all.

What can I contribute? Stadler Action List:

1.Empathy and Design for Aging: Continue to promote the understanding of human needs during this phase of life among designers.

2. Connect conceptually to a broader ecological perspective: ‘Activity Environments’, aesthetics as part of human health. Understand better the impact of design solutions on human health and explain this better.

3. Continue work with the interdisciplinary forum ‘At Home With Growing Old’: Foster interdisciplinary thinking and networking.

4.Continue to learn about how design can respond to the complexities of aging: Take my design work further in terms of understanding ergonomics for everyday tasks such as cooking or bathing, how older adults react to sensory stimulus. Collaborate more with occupational therapists and psycho therapists.

5. Continue to further the understanding what ‘age friendly’ means: Test and pilot a ‘lifespan’ home certification and action items under 1. through 4.

6. Interdisciplinary teaching: Continue to educate students and social service professionals about the potential contribution of the built environment (especially the home) to human health and care giving/receiving.

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‘The Arc of the Moral Universe Is Long, but It Bends Toward Justice’ (Martin Luther King)

by Susanne Stadler | April 24th, 2013 | Our Selves | Please Comment

How can you make a complex, very specialized topic accessible and interesting to an interdisciplinary audience (from architects to social workers)? At our recent AHWGO salon Wendy Peterson, director of the Senior Services Coalition of Alameda masterfully introduced the imminent changes in Medi-Cal and Medicare that will combine healthcare and supportive services and will affect many low income seniors and people with disabilities. This is a paradigm shift that is long overdue and represents a break through. It recognizes that  people with disabilities and frailties can be supported in leading meaningful lives through integrated services. In her words this is the result of a ‘steam engine time’ when the powers to be all at once realize that it makes sense to take action in the same direction. It is a win-win situation that does not only move us towards more human centered, integrated services but also plays into the effort by the State of California to save money. A local delivery of such services embedded in managed care plans together with a unified Medi-Cal and Medicare program are meant to achieve this goal. The ‘Coordinated Care Initiative” or CCI was enacted in the California budget of 2011/12 and will be launched in October of 2013 as a pilot in eight California counties with the rest to follow within the next year. It will affect approximately 65,000 people in Alameda county.

The vision is that doctors will have a social worker’s perspective and look at a person’s life and not just at an isolated need. A doctor for example will be able to help somebody with eating problems, not just through medical advice but will also by knowing how the person gets their food and what programs they are already or could potentially be enrolled in.

Wendy pointed out some of the road blocks to a launch of CCI, the scattered regulations, the local differences, the complex choices, the starved support service system, all that will most likely account for a bumpy start of this new standard of care delivery. Flaws are fixable though if people take the opportunity to be civilly engaged to make this a successful, sustainable shift. It is also a call for action to get it right.

For me as an architect, not at all familiar with the landscape of healthcare policies Wendy’s take on policy making is cross disciplinary and wonderfully motivating as she quoted MLK’s words  – ‘The Arc of the Moral Universe is long, but it bends toward Justice’.

Taking this further into the built environment, I would like to see the arc bending towards supporting people with age friendly designs that go beyond design for accessibility but take into account an individual’s abilities and life’s circumstances and support them in continuing to live meaningful lives as they age. The Affordable Care Act carries the seed for integrating age and needs appropriate housing into supportive care services. Maybe the ‘steam engine time’ is also dawning in environmental design.

How to be prepared for upcoming changes:

— Consumers:

— Know what your current coverage is and the date of any imminent coverage changes

— Watch your mail

— Keep notices you receive from Dept. of Health Care Services

— Contact HICAP if you receive a letter and have questions

— Find out if your Doctors are “in Network” of Alameda Alliance for Health or Anthem Blue Cross

— Professionals:

— Be clear about your role (assist vs. refer)

— Get on SSC’s email list

— Attend trainings (NSCLC webinars, CHA trainings, SSC training events)

Resources and Contacts:

Wendy Peterson, wendy@seniorservice coalition.org. Subscribe to mailing list at www.seniorservicecoalition.org

California’s Coordinated Care Initiative

National Senior Citizen’s Law Center and http/dualsdemoadvocacy.org/

SCAN Foundation for policy briefs fact sheets, other publications on senior health and LTSS issues.

Covered California, www.coveredca.com

California Health Advocates

Legal Assistance for Seniors


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A Day In The Life – What Home Means As We Grow Old – ASA Conference Chicago 2013

by Susanne Stadler | April 9th, 2013 | Our Homes | Please Comment

(Presenters: Susanne Stadler, Architect , Cathy Spensley, Family Service Agency San Francisco, Jarmin Yeh, USCF)

Everyday life means often life at home as we get older.  It seems intuitive that this home therefore has to be as supportive as possible of our ever changing needs, emotional as well as physical ones. Reality is a very different one – lowest-common-denominator thinking in housing developments and a lack of adaptability and resistance to change in private homes.

We believe that the reality could be a very different one if the people who shape the environment we grow old in understood how their creative solutions benefited the individual. Who would not be inspired to imaginative solutions if they knew that a well designed stair is not only about mobility but is also about exercise and opportunities for connecting with the community. Who would not want to give priority to imaginative solutions for an accessible entry to a home if they understood that not having an alternative to a stair may become a threat to a person’s identity if their beloved home is a 3rd floor walk up . Imaginative solutions can come both from spatial and social designs, such as through integrating or adding an elevator or providing the opportunity for people to rotate to an accessible apartment within their community.

Whatever we call the outcome, age friendly housing, design for aging in place, life long homes, it is essential to understand what home means to older adults through their own voices and through their own eyes in order to create sustainable, human centered solutions that come from an interdisciplinary and integrative approach to problem solving.

We presented a model for such interdisciplinary inquiry at the recent American Society on Aging (ASA) conference in Chicago. At the core of this presentation was the pilot “A Day In The Life”, a video self documentation of a group of older adults in San Francisco who filmed their home and were then interviewed about everyday life in their home.  Findings and possible design responses were then discussed from the perspectives of Architecture, Social Services and Medical Sociology.

This project  is not only an educational and advocacy tool but also has the potential to contribute to a bottom up theory generating process responding to the heightened interest the  topic of age and place has garnered in the academic community, from medical sociology to geography.

We want to continue this project. Next we will ‘loop back’ our presentation to the protagonists, the people who shared their homes with us and get feedback from them. Then we will do a repeat performance to an interdisciplinary audience in San Francisco and connect with developers, social service providers, policy makers and funders to carry this project into different communities and continue to present to an interdisciplinary audience of elder, students and professionals and encourage others to follow suit.

For a complete view of the presentation and video go to  ‘A Day In The Life’  –  An Interdisciplinary Dialogue On Being At Home With Growing Old’ . We are looking forward to continuing the dialogue.

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