27 February 2011
8th Sunday of Epiphany
Call me a Marxist, but I have always loved Karl Marx’s slogan: “From each according to his ability and to each according to his need”. Or, to update it: “From each according to his or her ability and to each according to his or her need” (You can call me a Marxist but I for heaven’s sake, don’t call me politically incorrect!) Marx’s slogan seems to me to be a good basis for a just and merciful society.
For that reason, I have always been troubled by the lines in the Sermon on the Mount about the lilies: And why do you worry about clothing? Consider the lilies of the field, how they grow; they neither toil nor spin, yet I tell you, even Solomon in all his glory was not clothed like one of these. It doesn’t seem right. They should be working, too. And why do they need to be clothed better than Solomon in all his glory? What’s wrong with a simple Chairman Mao pair of blue pajamas, especially if we are going to be Marxist about it.
Well, because these lines are in the lectionary readings for today, I decided to do a little research on the word “toil.” It turns out that toil doesn’t just mean work. It means to work with pain and fatigue of body or mind, to weary, to overlabor, or labor that oppresses the body or mind. Painful toil for all of the days of his life was the curse that God placed on Adam after Adam and Eve ate from the tree of knowledge. The Old Testament talks about how affliction, toil, and oppression were inflicted on the Jews during their servitude to the Egyptians.
Of course, I wouldn’t want that for the lilies, or for any of us either. And besides, flowers do work, though their work seems effortless to us and we notice their beauty more. The work that plants do is called photosynthesis. Photosynthesis makes a huge contribution to the protection of our environment by converting carbon dioxide from the air into oxygen, helping to counteract the harmful effects of the burning of fossil fuels. Not only that, flowers contribute to the aesthetics of the planet; they help make it beautiful.
To change the topic, I would like to talk today about aging, how it’s not for sissies, and what we can do to help ourselves and the community around Seekers Church as we, and they, age. I love Dietrich Bonhoeffer’s statement that his role was to “Comfort the troubled, and trouble the comfortable.” Not to compare myself to the great Dietrich Bonhoeffer but if I could offer just a little reassurance about aging for those places in us where we are troubled about it and at the same time stir up some trouble for us in those places where we are entirely too comfortable, I would consider my sermon today to be a success.
About 5 or 6 years ago I was asked to develop an undergraduate course on aging for my department, Family Science, in the School of Public Health at the University of Maryland in College Park. I took on the task with enthusiasm because my PhD is in Human Development and my graduate department (the Committee on Human Development at the University of Chicago) was one of the first departments in the country to develop an active program of gerontological research. Much of the basic theory about aging comes out of the Kansas City Study of Adult Life which was conducted at the University of Chicago way back in the day and many of my former classmates at the University of Chicago are now leading gerontology researchers and theoreticians. So preparing and teaching the course has been in some respects like a journey down memory lane in which I encounter many former mentors and friends. It has also been very personally meaningful to me because I learned, and continue to learn, about cutting edge issues and solutions in aging that are things I need to know for my own journey into old age (which, as you can see, has already kind of begun, though I can’t say I feel at all old. I’m still that awkward 13-year old inside!)
The course on aging that I teach has a trajectory that parallels the trajectory of old age itself.
In the first third of the course, I dispel myths about aging, talk about retirement, active aging, positive aging, productive aging. This is an exciting and exhilarating part of the course for me and the students. In this part of the course we are focusing primarily on the group of elderly called the “young old,” people 65-74. This is a group that, in the U.S. today is not that different from those in midlife. Most elderly in this age group live independently in their own homes, are healthy, and are a benefit to their communities. This is the age group that Marjory Bankson talks about most in her book, Creative Aging, which is about how we can use these years for continued personal growth and spiritual development as well as to serve others.
In the second third of the course, I talk about the physiology of aging: how we lose muscle mass and elasticity as we age, how neurons that die are not all replaced, how our senses decline, how our mental processes slow down, how we are more likely to have a chronic disease such as diabetes, etc. Here the focus is more on the group that has been called the old-old: those who are 75-84. I stay positive. We can function quite well with a number of disabilities and/or quite a decline in our sensory and even cognitive faculties. This is because humans are flexible and adaptable, because we live in families and communities, and because there have been a number of advances in geriatric medicine and technology. Personal growth and spiritual development, of course, continue in these years and most people in this age group report high life satisfaction. The students and I retain fairly high morale throughout this part of the course.
In the last third of the course, I talk in depth about the 3 D’s (disabilities, dementia, death), housing issues, end-of-life legal issues, hospitals, long-term care, and hospice. Our focus here is more on the oldest group, the old old, who are 85 and older, sometimes called the frail elderly. This is the fastest-growing age group in the U.S. Most people in this age group have several disabilities and/or chronic diseases and about 50% have some degree of dementia. This is where the students start getting kind of bummed out, even though I stay positive. It’s true, there are many opportunities for joy and growth, no matter what our age, but there’s not a whole lot in this stage to look forward to. Marjorie Bankson has introduced me to a wonderful and troubling book (if you don’t feel this sermon has troubled you enough, you may want to read it). It’s called Never Say Die.
In this book, the author condemns the youth culture that is so popular in the U.S., the idealization of aging that businesses propagate to sell their anti-aging products, and the widespread belief in the medical establishment that aging is a disease that can be cured. Among other things, this refusal to face reality allows people to remain in denial about the realities of old age and prevents them from planning realistically for it.
Back in the 1980s I went to a day-long workshop with Scott Peck, the author of The Road Less Travelled . Nobody was talking much about aging then, but Scott Peck, always an advocate for facing reality, talked about three older women who were patients of his – he called them his golden girls – who had been blindsided by old-old and then oldest-old age. They felt angry and betrayed. It wasn’t what they had expected. Even before the consumer scam about aging was as full-blown as it is today, they had somehow believed that they would age, but not very much. Peck commented that the people he had observed who were happy and satisfied in old-old age (there are plenty, in spite of the scary things I’m saying), had started thinking about it well ahead of time. They had anticipated the diminishment that very old age would bring and had planned and prepared for it long before it happened.
I thought about this more when I noticed that some of our older Seekers were moving away to retirement homes. More than 60% of today’s elderly live in the suburbs and the proportion will increase as Baby Boomers age. Suburbs are probably the worst places to “age in place” (which is what most elders want to do). In the suburbs, houses are large, often too large for empty nesters, and taxes and utilities are high. Home maintenance is expensive and often too much for the elderly to manage alone. Public transportation and pedestrian walkways are inadequate and there are few retail outlets or community amenities within walking distance. It made sense that some of the older Seekers would want to move to retirement communities that would be more suited to their needs as they got older and that provided more social and support services. But I was sad that we were losing some really special people from our congregation and felt that, for myself, if I were to move as I got older I would want to move closer to my church, not farther from it. I began thinking about how it might be possible for me and for other Seekers who felt the same way to do that.
Was there some way to make the community in which Seekers is located an ideal place for Seekers and others to “age in place,” even as we grow very old? What makes a neighborhood ideal for aging in place? For the most part, the features of neighborhoods that are good for aging in place are the same features that make them good for everyone, regardless of age. Safety, good lighting, good public transportation, pedestrian friendliness, a range of housing types, including accessible housing, places to buy food and pharmaceuticals, and to bank. Also important is a community network of free or moderate cost health and support services for the elderly that can be accessed through a single telephone call. The “Village Movement,” is a national movement to provide such health and support services to aging-in-place elderly through such a mechanism.
Gail Sheehy recently wrote an article about “The Village Movement” for USA Today. She wrote:
“Hell, no, we won’t go!”
That’s the answer I hear most often from seasoned Baby Boomers when I ask if they’re getting ready to move to retirement communities. For starters, they don’t plan to retire before 70. And most want no part of the elder islands where their parents retreated from the hustle of city life into a largely sedentary, age-segregated existence.
The Village Movement is a popular alternative. The drivers of this movement are feisty professional women in their 50s and 60s who are determined to change the experience of aging by empowering and enabling adults to remain in their own homes or apartments to the end of their lives.
The movement, launched eight years ago in Boston with Beacon Hill Village, has spread to Washington, Chicago, San Francisco and more than 50 other cities. Hundreds more are in formation.
The movement is thriving and, according to Sheehy, the only major barrier to membership is people’s reluctance to admit they are getting older.
Another way to make communities havens for those who are aging in place is to provide resources in the community for those who need more care than can be provided in their home. William Thomas has written a book about old age that is called What Are Old People For? One thing he does in this book is describe what he calls the Eden Alternative, an alternative to long-term care that is being brought into being through what is called the Green House Movement. Green Houses are small, local homes for the elderly (8-10 residents) that provide 24-hour care for the old without the institutional features of nursing homes. They are based on an entirely different philosophy and employ entirely different kinds of workers. These homes welcome social and biological diversity in the form of animals, children, plants, and cultural and ethnic diversity. They encourage companion animals to alleviate loneliness and allow residents to give as well as receive care. They also value gardens and gardening for both residents and staff. They are committed not just to the well-being of residents but also to the well-being of the caregivers, or the staff. The residents are involved in decision-making along with the staff and plan their own days rather than being forced into an institutional schedule for the sake of efficiency. Mealtimes are valued: the food is good and the conversation is stimulating. Staff and residents eat together and share their stories to increase their bonds. There is an emphasis on self-actualization and shared development both for staff and residents.
I have become very excited about the Village Movement, about Green Houses, and about other developments that make aging in place an appealing prospect in communities generally, in my community specifically, and in my own personal life. About a year ago, I asked the Growing Edge Fund at Seekers Church to pay for a green House training for me. I also asked them to pay for a year’s membership in the Village to Village network, which helps communities assess their potential for forming a Village Network and then, if they wish, to form one. I have learned that the area around Seekers is a great potential base for both, one or more greenhouses, a Village Network, and all of the other things that a neighborhood that fosters aging in place needs. The community I have in mind is the area around and between the Silver Spring and Takoma metro stops: zipcodes 20012, 20912, and 20910.
Of course, this community already has lots of features that make it livable for elders:
- good public transportation
- availability of apartments, condominiums, small houses, and accessory dwelling units (not necessarily legal) in private homes
- walking distance to drug stores, convenience stores, restaurants, banks, churches, and, in some cases, supermarkets
- a weekly farmers’ market
- hiking and biking trails
- strong Area Agencies on Aging
What more does it need? Well here is my vision of the community in which I would like to age in place. It involves older people in the land use planning process to ensure that their needs will be met. It has eliminated housing codes that restrict or exclude living arrangements such as accessory dwelling units, shared housing arrangements, apartments, or assisted living. It also has eliminated requirements for large minimum lot sizes or prohibitions against placing services or housing in the same building. It makes it easy for older adults to get around by providing and maintaining sufficient and safe pedestrian walkways, having street and traffic signs that are clear and easy to read, and providing flexible and responsive transit and paratransit services as well as volunteer driver programs. It provides an integrated network of health and social support services for older adults at all income levels that can be accessed through a single phone number. It provides exercise and fitness programs that meet the needs and ability levels of the old. It provides mobile health services and transportation to hospitals and doctors’ offices and Green Houses in the local community. It has rich cultural and learning opportunities in which the old can participate and to which they can contribute, including opportunities for intergenerational learning and technology training. It is protected by Neighborhood Watch and other alert programs and law enforcement officers that are trained in detecting and reporting elder abuse.
How do we get there? I’m not sure. I know I can’t do it by myself but I know that a committed group and an engaged community could. So I guess what I’m looking for is some people who are just as eager to create an elderly-friendly community right here as I am and who would want to work with me to do it.
And, getting back to the lilies of the field, my vision of an elder-friendly community does not include toil, in the negative sense of the word, either for the old or for those who help the old as advocates, planners, caregivers, friends and companions, or service providers. In my dream community, elders are cherished, supported, encouraged, and valued. Those who help them are also cherished, supported, encouraged, and valued. Elders rely on the community and are given multiple opportunities to contribute to the community (even if it’s just by breathing out carbon dioxide for the flowers to breathe in!).
I pray that there will be people in this church and in this community who also share this or a similar vision and will be willing to help bring it about. I hope that as the vision takes shape in reality, I will be fortunate enough to be a part of the community because I really want to be a lily in that field!