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What's the Problem?

The Green House Project

Our Radio Readers Book Club is talking about aging, death, and dying and I have something I want to get off my chest.  I’m a person of many projects and over the past few years, I’ve spent time helping some of the finest people I’ve ever known raise money to build a new kind of nursing home – neighborhoods or Green Houses like the ones Atul Gawande describes in Being Mortal.

These homes are arranged around spacious, attractive fireplaces or hearth areas with open kitchens around a harvest table where elders and caregivers prepare meals from fresh food, often using a favorite family recipe.

So what’s the problem? 

Back in the late 1960s the first nursing homes were designed to shorten hospital stays. It made sense to make them little mini-institutions where people – patients – who needed long term care could get it. I have to say -- I’ve really never met a nursing home provider who was cruel. Many are deservedly called angels and I can share hundreds of stories of “patients” who lived out their lives in nursing homes where they felt cared for and loved.  Eventually, though we realized that growing old is not an illness, that not all of the elderly are “patients.”

Today, nursing homes are undergoing a culture change in which residents are considered individuals living out their lives in homes where they can receive care and assistance while making decisions and maintaining as much autonomy as they can or as they are allowed.

So what’s the problem?

The problem could be balancing individualism in a reality in which dependence is a given no matter how one denies it.  We celebrate the dependence of infants but we abhor that that accompanies aging. I read of a culture in which one enters a second childhood at age 95 during a ceremony in which he or she is carried about town in a cart and is showered with flowers and with gifts. No second childhoods for us, however.

So what’s the problem?

For those who declare, I’m never going to a nursing home, the problem lies in demographics.  The U.S. Census reports that “90 is not necessarily the new 60.” More than half of us over 90 will require some type of assisted living or nursing home care. That’s a fact.

So, what’s the problem?

I’m thinking that the problem is that we need to have a culture change of our own.  It’s not about denying death or being able to choose whether we die now or later – one family member crosses her arms across her chest as she naps hoping she’ll die in her sleep.  She’s been doing that for 20 years.

Far better to put some thought into the question of, “How do I want to live our my old age?” – now defined as young-old, middle-old and old-old.  “And if I figure out the how, then where?”

The Green House studies are impressive! A study comparing one Green House to a traditional home found the use of antipsychotics was five times lower and reported chronic pain 32 times lower.  I want to live in a nice house with my own room and bath where my family are welcome and there is space for pets, plants and book discussions. I want to make my own decisions about what to have for lunch. I don’t want to clean house the rest of my life, and especially if it causes me pain.

So, I ask again – What’s the problem?

Simply put, if we want to create a different long-term care culture, we’re going to have to stop insisting that we’ll never need it.

We’re going to have to get busy and either build or help build Green Houses or neighborhood type facilities. We’re going to have to toss out our throw rugs and assess our own communities.

We need to study communities like Smith Center, Kansas, where a town of 2,000 is building a Green House senior living complex, or Dodge City, where an existing nursing home is being transformed into one with Green House care. 

We need to give generously to these organizations – or, better yet, volunteer to get involved in creating a culture change in our own lives and in the lives of our own communities. We need to care about how others next door to us, age. Instead of declaring that we’ll never live in a nursing home, let’s decide that wherever we live, it should be a home where every person feels empowered and engaged in his or her life – and that is up to his or her last breath.

What’s the problem with that?

I’m Kathleen Holt of Cimarron, Kansas, for the HPPR Radio Readers Book Club. Find more at hppr.org 

U.S. Census. 90+ in the United States: 2006-2008  American Community Survey.  From https://www.census.gov/library/publications/2011/acs/acs-17.html