Wednesday, June 22, 2011

Well-Aged Beef

I was recently in a conversation with about a dozen folks who got together to discuss aging in community. It's a tricky topic.

Mostly, when people start an intentional community they're thinking about how to meet the needs that members have in the here and now—not necessarily anticipating the challenges that will come over time, as the community succeeds. At the outset, members are much more focused on survival than on how needs will morph with an aging population.

On the one hand, you can never fully prepare for what the future will bring, and perhaps the best strategy is figuring out how to make it as easy as possible to periodically reassess and make adjustments to evolving conditions. On the other, getting older is not an option in the same way that you can buy a new car or a better washing machine, so why wait? While there's considerable variety about how rapidly and gracefully people age, it's irrefutably a one-way street.

Physical capacity will inevitably deteriorate; recovery from minor traumas will take longer; stamina will degrade; there will a higher incidence of health challenges. Sometimes dementia is a factor. While these are tender topics in their own right, the conversations are made much harder to approach for two complicating factors:

a) We are steeped in a culture that tends to deny death and fears being put on the back shelf in our final years. As a result, there's a lot of whistling in the dark and a general reluctance to look aging straight in the eye.

b) We're afraid to come across as needy, and even if we can find the courage to ask for what we want, it's terrifying to face the possibility that we might be turned down. Some prefer to not ask.

Community generally offers better prospects for aging than what's available for all but the rich in the mainstream culture.
There is, for example, strong evidence to suggest that quality of life in the end years can be dramatically enhanced by:
o Being active, both mentally and physically—in community there's always plenty going on.
o Continuing to contribute in useful ways—in community there are myriad ways that seniors can keep an oar in the water; maybe they can't pull as hard as they used to but there are many tasks that don't require the strength of youth to be genuinely contributing (cold turkey retirement is often a death sentence unless the retiree is self-reliant, resourceful about reinventing themselves, or has established outside interests).
o Having meaningful social relationships—in community, seniors can have connections that are valued across the entire age spectrum, enriching lives in both directions.
o If there are many people involved in home care support, it needn't be such a strain on any one person—in community this broad base of support is far more available.

• • •
While this is good news and community tends to make things better, it does not eliminate challenges, or stop aging. You've still got to talk about it, and what came out in the recent discussion was how difficult that was to accomplish—even in community.

Several people reported, with poignancy, how difficult it was to get traction on this topic in their home communities. In one group, when a cadre of folks who were 55 and up asked for a plenary focus on the needs of their aging cohort, the younger crowd either skipped that conversation or else allowed the topic to die without supporting agreements about what might be done. Ouch! By the time these folks were sharing their story with me, they had a well-aged beef about how their community had let them down, and were still licking their wounds.

Contemplating their pain and confusion, I am inspired to offer the following guideposts for how to get traction on this issue. Some of my suggestions apply generically to any tough topic; some are peculiar to aging.

Having the conversation at all
You can't let anxiety about how people will respond paralyze you into not making the attempt. It doesn't get better as a consequence of not talking about it. In addition to hesitancy that may surface among the seniors, the younger folks may also collude to avoid the topic, for fear that what will be requested will exceed what they're willing to provide, and they'll be trapped between the shoal waters of lukewarm commitments and the whirlpools of guilt (both the kind that we carry inside and the kind that are projected onto us) if they limit their support in the name of tough love. It can get messy.

Navigating the emotional mine field
In addition to the potential for guilt trips and martyr candidacy, aging folks can be in denial about their declining abilities (it's not easy to see clearly through the distorting vapors exuded by fear of loss on control; loss of dignity; loss of relationship).

If anyone in the conversation presents in serious distress, it's important (essential?) that you first bridge to that person's emotional reality—even when they're lashing out. In situations like that I hold the image of the upset person as drowning. While they may hurt people as they're thrashing about, they may be totally oblivious to that as they struggle for oxygen. You can accurately hold their feelings without necessarily acquiescing to any demands that are packaged with the distress.

Making sure all the players hear what's being said
While this admonition applies to any conversation, I'm emphasizing this point because of the tendency to not near what we don't want to hear. Hint: write it up afterwards. That way, if there's backpedaling, at least you can catch it early.

Tracking to see that agreements are kept
If people make agreements, check to see that they're following through. (If seniors with cataracts say they won't drive any more, make sure they don't. If teens agree to clean a senior's gutters each fall, see that it happens.)

Establishing markers that indicate care levels need adjusting
Even if you assessment of today's aging needs is exquisitely accurate, conditions change. Try to determine ahead of time what the observable signs are that a person may need a greater degree of care than they're currently getting… or possibly than they're willing to admit.

Letting the barriers down
You want the least possible obstacles to people asking for what they want. Going the other way, it has to be possible for people to say "no" and not get creamed. Without these two elements in place, the conversations will consistently be incomplete and you'll just be guessing when making agreements.

Balancing the demographics
It probably won't work to have 70% of your population in wheelchairs. Just as it probably won't work to have 70% under the age of five. You need an age balance, so that there are enough able-bodied folks to assist those needing help. This requires looking ahead of the curve. If you wait until you can't support everyone without unsustainable efforts from the able bodied, it's too late. You have to start tweaking your recruitment profile before you're in trouble.

With smaller groups, just a few people can shift the balance. With larger groups, there's more stability, yet it's harder to turn the ship if the ages list to far in one direction.
• • •
These guideposts will not be foolproof in tackling the age-old issue of aging, but they should help tenderize the beefs.

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