Live Long, Die Short (36 page)

Knowing is not enough; we must apply. Willing is not enough; we must do
.
—GOETHE

The world we have created is a product of our thinking. It cannot be changed without changing our thinking.
—ALBERT EINSTEIN

I
n 1999, the Masterpiece Living development team, called the Healthy Aging Working Group—or the HAWGs—began a journey of discovery. We were enthusiastic about what was possible, and ignited by a vision of making that happen. What if we could help all older adults age more successfully? How could we make it the norm rather than the exception? What would it take?

We were a long way from that vision. We were facing a stereotype of aging that portrayed decline as the dominant possibility, a stereotype that
focused on caring, comfort, and security with little consideration of growth and potential. We were facing an aging-services industry and a public policy that was based on this stereotype. The task loomed, daunting.

We luckily decided on a kaizen approach of our own. We would take it one small step at a time. As a starting point, we needed a way to help older adults take a look at their lifestyle and get feedback. We needed resources—tools, really—that older adults and those working with them could use to do this.

As much as possible, the tools we chose would have to be reasonably well established in order to provide us with “normative data” (what is normal in a similar population) with which we could compare our data. With Bob Kahn’s guidance, we chose several of the tools used by the MacArthur Study and then modified them to create a Lifestyle Review. To assess physical status, we sought established but easily administered tools to develop a Mobility Review. Lastly, to assess risk, we called in Mayo Clinic to provide its newly developed Health Risk Assessment. These tools would allow us to take an inventory of an individual’s current lifestyle as it related to aging successfully. Next, with the help of Katie Hammond, a doctoral candidate at the University of South Florida, we developed a feedback report that was both educational and, we hoped, motivational.

So, our initial approach was: (1) educate older adults on the research findings and what indeed was possible, (2) give them the opportunity to take the Lifestyle Inventory, (3) provide feedback, (4) discuss the feedback in a one-on-one or group session with a lifestyle coordinator, (5) foster empowerment with a true coaching relationship, and (6) repeat the Lifestyle Inventory in a year. Would it work? Would older adults be willing to take the Lifestyle Inventory? Would the feedback motivate them to make changes? Would the likelihood of their aging in a better way change over a year? After nearly two years of intermittent meetings and prolonged discussions, it was time to find out.

Who were to be our first subjects? With the Westport Senior Living Fund, which my brother Larry managed, we had access to two continuing-care retirement communities in Florida. These were retirement communities that offered four levels of living: independent, assisted, skilled nursing, and memory care. We decided to initially concentrate on older adults living
independently, although we were fully committed to bring Masterpiece Living to assisted living, skilled nursing, and the memory unit.

In the summer of 2001 we began the pilot study at both Florida communities with training of the staff and the education of a small group of resident leaders on the new research. We told the resident leaders about the importance of lifestyle on how we age, and how Masterpiece Living could assist them to age more successfully. After this period of education and training, we launched Masterpiece Living for a small cadre of volunteer residents, mostly resident leaders of various committees. We knew we were limiting the effect of Masterpiece Living in selecting this group. These were adventurous older adults, who as leaders within the community led lifestyles already similar in many areas to that which the MacArthur Study had found more commonly associated with success in aging. So, the “delta,” the amount of change between the before and after, in risk and overall lifestyle, would be smaller with this group. However, we would need them to help motivate their less adventurous neighbors to participate when we expanded the initiative.

The desired outcome of the Lifestyle Inventory and feedback process was to create sophisticated consumers of the programming available at the community. Rather than participate in “activities” designed to keep people busy, an approach we considered paternalistic and reeking of ageism, these educated older adults would now know where they were at risk, whether in the physical, intellectual, social, or spiritual components of their lives, and would seek out programming that would lower their specific risks—i.e., “purposeful programming.” These people would know what they needed and would seek it out.

As planned, we repeated the Lifestyle Inventory on the initial cadre after one year. The results were, as one member of the HAWGs remarked, “stunning.” We saw significant reduction in the Mayo Health Risk Assessment–measured risks, both medical and lifestyle. We saw improvement in overall Mobility Review scores, which measured gait, balance, range of motion, and strength—all correlating strongly with lowered risk of falls. Mean self-rated health (how healthy we think we are), a strong indicator of how someone will age, was the same as that of a group
ten years younger
. We were cautiously elated.

The group all agreed that, despite the initial very positive findings, we should collect a third data point at two years to ensure that the findings were not a fluke. The two-year data, though in general not as dramatic as the first-year changes, were nonetheless strongly consistent with the findings of the MacArthur Study. We were lowering risks of decline.

With some measures we saw growth over a year; with others, we saw merely stability. Dr. Kahn quickly eliminated any disappointment some of us might have had. Stability in the ninth or ten decade of life, he reminded us, was
bordering on miraculous
. The MacArthur Study had been validated. Our applied approach had worked. Our next decisions would be critical to the future of the entire initiative.

With the data showing that the Masterpiece Living approach to the MacArthur research findings and successful aging was effective, Larry and I were ready to begin dissemination of the program. Prior to signing on with the HAWGs, Bob Kahn had extracted a promise from Larry: we would not disseminate until Bob thought we were ready. This was a critical and fortunate promise. Moving ahead at that point would have doomed the entire effort to the status of another holistic-wellness program. For it was what we learned in the next two years of piloting Masterpiece Living that ultimately defined it as a
movement
rather than a program, as a fundamental paradigm shift in our approach to aging. That defining piece of information was this:
Any effort to influence a person’s lifestyle toward one that resulted in successful aging had the best results when it took place within the context of a facilitative culture—a culture that was devoid of ageism, a culture that believed that older adults could continue to grow throughout their lives, even with impairments.
Basically, where you hung your hat was key to your aging. If the place you lived functioned as a cheerleader for you, you flourished.

We were indeed moving toward the conclusion that culture was an important ingredient, perhaps the key ingredient. We were considering developing training for all who worked in the community. This training would address what was possible in aging and change, and what role each staff member had in helping residents age more successfully. But it was Tim Parker, the executive director of University Village, our very first Masterpiece Living community, who showed us just how important culture was.

Tim challenged his directors, all of his directors—in dining, maintenance, accounting, transportation, housekeeping, and every other department in the retirement community—to bring something more to the community. He challenged them to look at the skills, hobbies, and interests of those working in their department (including themselves) and decide what they would offer the residents of University Village beyond their assigned responsibilities. Tim had each department present its offerings at a town meeting, and the residents voted on the most appealing. From that point on, the directors and their departments would be responsible for providing the promised offerings. And that’s what happened. The director of maintenance offered, then led, offsite nature walks. The human resources director led a current-events discussion session, and the director of accounting taught casino gambling!

Tim’s challenge was immensely successful. First of all, it made for an engaging, community-wide event, bringing more of the residents out of their apartments and to the town meeting. It engaged staff members in a way they had never been before. Staff members later related how much they enjoyed the enhanced role. In fact, when the director of human resources had to move back to his home state to tend to family problems, he publicly stated that the part of his time at University Village he would miss most was his current-affairs sessions with the residents. He said he never would have interacted with residents had it not been for those sessions.

The result of Tim’s challenge, which was particularly informative for our group, was an obvious shift in the overall environment at University Village. That single revelation brought the word
culture
to life for both residents and staff. The place became a hotbed of learning, change, and growth. Staff members, as well as residents, welcomed the change. No longer was there departmental isolation—the silo effect—from the real mission of University Village. All were now working to make it place where all would grow.

Culture was no longer an abstract concept, no longer a pie-in-the-sky goal to enhance successful aging. It became a tangible, visible characteristic of the community. Culture was not just about leadership and the lifestyles department talking about successful aging. It was
everyone
believing that they had a role in that culture. And that culture was about growth. Growth for all, no matter what their age or impairment. This culture says, “OK. You’re here. What do you want to do with the rest of your life? What is it
that you have always wanted to do? What is your purpose? Can we (all in this community) assist you in any way? What are you going to add to this community?” These questions are not only stimulants to successful aging and higher quality of life; they’re reminiscent, in an anthropological way, of the kind of environment in which we lived and thrived for most of the time we humans have been on earth. It’s not that these kinds of questions were asked; it’s that the answers were self-evident in these ancestral tribes and villages.

After a third year of pilot data was in, it was clear we were still on the right road. Risks were dropping. Mobility was improving. Lifestyles were leaning more toward the recommended lifestyles for successful aging. Resident data for our pilot population was still comparable to that of people ten years younger. Testimonies from older adults were pouring in. At this point, however, we were no more than a research-based, super-wellness program. We talked about culture change, and Tim’s challenge at University Village gave us a glimpse of what it could be, but we offered little to help a community culture evolve into one of growth. It was time to move out from the rest of the wellness pack. Our next step was to enrich the environments where older adults were attempting to modify their lifestyles.

We spent the next three years developing tools and resources to help a community evolve its culture from one where comfort and security were the defining characteristics to one where growth was the currency, from a culture that provided what a zoo does for its residents to one that provided what a university does for its students: a culture where physical, intellectual, social, and spiritual growth is expected, nurtured, and facilitated. This brought us into new territory, where
every
staff member in the community had a role in culture; where the environment moved from a cruise ship–entertainment approach to one of growth; from a medical, paternalistic, “We’ll help you when you get sick” model, to an approach of “Tell us how we can help you be all you can be.” As you saw in
part I
of this book, we, in fact, were not inventing a new culture, but were dusting off a few hundred years’ worth of dust from one that we humans had been living in for eons. We were, as in the 1985 movie, going
back to the future.

We were chomping at the bit to begin dissemination of Masterpiece Living, but we believed these extra culture-focused efforts would pay off, would define us, would help us achieve our mission to maximize the unique human potential of older adults and build environments where this was more likely to happen. We were correct.

In the spring of 2007, we were ready. We added Emily Parker (now Emily Warren) to our full-time staff of one (that would be me). A remarkably talented young Canadian woman with a passion for helping older adults, she came from a family familiar with the aging-services industry. Our team could have been characterized by Shakespeare’s words from
A Midsummer Night’s Dream
: “Though she be but little, she is fierce.” Fired by our data and passion for making a difference, and still without sales or marketing expertise, we launched into disseminating Masterpiece Living into the world of continuing-care retirement communities. A partnership with Ziegler, a formidable force in the senior living, gave us enhanced credibility in our discussions with potential new partners.

The task of defining who we were and what we were attempting to do was daunting. In a profession with over a century of tradition of providing care, comfort, and security, the idea of facilitating growth was novel. Since aging services were primarily focused on caring for older adults, conservatism and healthy skepticism were understandably a major part of the culture. Once, however, early adopters like American Baptist Homes of the West were willing to give Masterpiece Living a try, we were on our way. And as they began to show similar outcomes to those shown in our pilot data, the task became easier. Today we are able to articulate more clearly who we are and what Masterpiece Living is.