Neighborhood Centered

Neighborhood Centered
Placing our Elders in the Center, Not the Edge

Monday, February 9, 2009

Where in the World is 132 Abigail Lane, Port Matilda, PA 16870?

I read with great interest Mike Joseph’s recent article I-99 Redefines Landscape describing the changing dynamics of Port Matilda. I was especially interested because, last year, I was awarded a research grant based on the fact the traffic would be reduced so dramatically in that small borough, and the change could be good, or bad, depending on one’s view of the situation. Personally, I thought it was a good thing. But, I also had some other ideas in mind. One was that Port Matilda could become a really great place to live for your entire life, especially considering its newly revealed serenity and furtive proximity to State College. That idea came with a stipulation though. The stipulation was that Port Matilda would need a new economic engine, and that engine would be associated with caring for elders in the borough. Port Matilda could be an Elder-Friendly Community – a good place to live, and retire.

What a change the town has seen!! Thousands of 18 wheelers, throwing up dirt and rocks while cruising far too fast in high gear. Struggling to get out of low gear, the same trucks would belch toxic fumes, and always scream a whine or a whir, a whup whup whup, stealing quiet during a half century of progress. Now, it’s gone. A stillness known only to the old hills and the endless creeks is resting back on the village. Mr. Joseph was right – this is a redefined landscape. According to Mike’s article, Kenneth Moscone liked the mature natural setting of the town. He stated, “Where else can you go to work surrounded by trees and have a stream flowing through your property?” In this day and age? Indeed!

The character of Port Matilda has changed dramatically. Bald Eagle Valley Road (Route 220) was not supposed to be the vital and energetic transportation artery that it became. The road handled far more traffic than anyone could have imagined. Instead, it was High Street that used to be the real business avenue, connecting Phillipsburg with State College, up and down along the Appalachian Plateau and over Bald Eagle Ridge on what are still some wicked and windy old roads. Remnants of those old hey-day businesses still line High Street, leading to a once bustling commuter rail line and a manner of life that just got away from all of us. (BTW, this could easily be reactivated to join Amtrak’s Pennsylvanian Route in Tyrone, just 16 miles away – any angel investors out there?). But it could be so easy to get that kind of life back, especially in such a great little town with good houses, and a tradition of successful small businesses.

And that is what makes Port Matilda so intriguing. It also makes me question why Geisinger at Gray’s Woods deserves a LEED Gold Certification. Now, that was an abrupt segue!

Almost two years ago, I wrote a blog describing how the health care industry would spend $200 billion dollars in the next 15 years building new health care facilities. At that time, I asked the question “How will we spend this money? The same old way we always build – old energy economy? Or an alternative way that would better serve our existing communities – new energy economy?”

The old way continues sprawling infrastructure and forces us to drive our cars to a campus-type development – ever further over. The alternative is to carefully plan mixed-use development in our existing towns (embodied energy), and allow the new development to increase business activity in the rest of the town. Geisinger chose the old way. They spent 35 million dollars, and were awarded Gold status because they used “features that stress the natural over the chemical, the recycled over the new and the renewable over the finite.” (notice the natural – woods, and the chemical – pavement, below)

But, they impacted forever, most of 52 acres of healthy forest. The chosen site forces every person to drive to their single-use facility. That requires a massive parking lot, a stunning storm-water retention pond, massive, earth-retaining walls (evidently, the land didn’t quite work), extensive mechanical and electrical systems that are served by an on-site utility plant, and the extension or expansion of electrical and data, water, sewer, road and sidewalk infrastructures (old energy). Geisinger built one of what they call their “community practice sites.” (??) Although located in Patton Township, they use the address 132 Abigail Lane, Port Matilda, PA 16870. Wha? This will become important when I lose my cool.

They overlooked (probably never even considered) the town where they get their mail. Imagine the impact of $35 million in a town like Port Matilda, population 650. According to Geisinger’s information site, the two-story building encompasses 64,350 square feet. The new building includes 70 exam rooms, 16 procedure rooms, an expanded imaging center, laboratory services and an on-site pharmacy. Primary care services include OB/GYN, pediatrics and family medicine. Specialty services include cardiology, urology, pulmonology and ophthalmology. They even have an Irving’s Bagels – ummm, Irrrviings!! That is so super sweet!!

That might actually be too much development for such a small town. However, some of the services could be placed in newly remodeled business locations on the old High Street. Larger vacant lots could get new buildings, and have an Irving’s on the corner. Clem’s Barbeque would move into the borough, not out of the county. The point is that it would totally and completely revitalize this town and it would better serve existing residents. The elderly could age in place. It would be a true “community practice site.” (now I get it)

Without the cost of new infrastructure, retaining walls, and site work, Port Matilda’s sidewalks and street crossings could have been improved. Lyken’s would thrive on the corner. Geisinger employees might decide to live in town and remodel a home. At least 650 people would not have to drive to the health center. Existing on-street parking could reduce the size of massive parking lots. Geisinger employees could walk to the post office and get their flipping mail (sorry, lost it!). There would be a reason to extend a CATA bus line to Port Matilda. There would be a reason to extend Amtrak rail from Tyrone. Imagine, health care construction resulting in better mass transportation infrastructure!! I guess I’m really just aching for a train ride from Port Matilda. I could get to Pittsburgh in 3 ½ hours, and read the entire way. As Morrison once reported, “Oh, the productivity!

Some may argue that Geisinger chose the Patton Township site because of the Route 322 Gray’s Wood interchange and better proximity to State College. But, let’s not forget what Kenneth Moscone implied in Mike’s article. Ken is moving his business (medical devices, right?) to Port Matilda. He stated, “I-99 access and Port Matilda’s location - inside a triangle with points at Altoona, Philipsburg and State College - can attract employees from all three places to keep the business growing.” Seven miles apart, one exchange is just like the other. Except that the exchange Geisinger chose did not save a town.

Don’t get me wrong. I am very satisfied with Geisinger’s effort to build with an eye toward the environment. I am also happy that they are making an effort to place more health centers within, or very near underserved communities. These are steps in the right direction. Really, I think the LEED rating system needs to start with a category like “distance from an existing neighborhood center.” It should be impossible to achieve LEED Gold if you can’t walk to the building.

This all may be very discouraging to residents of Port Matilda. After all, I pointed out an opportunity lost. But, it is a valuable lesson to all of us, in a time when we should start thinking more strategically about the way that we utilize development opportunities. Geisinger could have more impact. They have the power to single-handedly save economically challenged towns, and they should. That would be real gold.

Wednesday, March 19, 2008

He was. I am.

Formative Years
As I recall my childhood, I remember, very distinctly, a formative moment. My family was enjoying a day at our summer swimming spot near the town where my grandfather was raised. He brought everyone there a couple of times each year, and we would picnic and swim and explore all day long. It was pure heaven. For Pappy, it was more than heaven – it was who he was, and he took care of that place like he took care of himself.

While we played, he was cleaning the riverbank. Not only would he pick up the trash that people left behind at our spot, but he would pick up the driftwood and debris that the river left each time it rose, and fell, and dropped what it carried from upstream. We were always downstream, and he left each time with bottles, cans, bottle caps, and pull tabs.

I must have been four years old. I remember being given a piece of candy that was encased in a paper wrapper. I left with it, unwrapped it, and truly, carelessly dropped the wrapper towards the sandy edge of the river bank - Pappy’s river bank.

The candy never made it to my mouth. He was getting older, but he was fit, and really fast. The wrapper hadn’t even reached the ground. As I was moving my hand to my mouth, my arm was stopped just short of its goal. I felt a squeeze on my wrist, and turned into the largest finger tip I have ever seen in my life. It was like a cartoon finger with a massively skewed perspective between my startled face, and his angry mug. As the candy was taken away from me, I heard these passionate words ring through his lips: “Don’t you ever litter again!” I never did.

I was heartbroken. Not because I lost the candy, but because I had disappointed my grandfather. Even at that age, he was the world to me. He was the patriarch and I knew it. Like a wise and benevolent Pied Piper, he led my brothers, sisters and cousins to his favorite places, and we followed with glee. When we got where we were going, we would explore to our hearts content, knowing he was watching, protecting. He would teach us plant names, and impart his values about nature. We were fearless. He kept the monsters at bay. We always made it home safe. This was just how it was.

That day on the river determined who I was going to be. His presence in my life as a child, his admonishment at that moment, his impromptu lesson given to me as a matter of who he was, made me who I am. It led to a “Save the World” sticker on my pencil box when I was ten. I still have it. It determined my career when I chose a college major. I became a Landscape Architect, a steward of the environment.

As he was declining a few years ago, I watched my mother give up her freedom to care for him in my father’s home, a home that was located in the country, miles from town. In between jobs at the time, I spent time there with the three of them to regroup. I witnessed again, even in late stages of Alzheimer’s, life lessons given by a man who understood what it was all about. He could barely hear, he couldn’t see me, or remember my name, but each time I walked into the house, I asked him “How’re you doin’ today Pappy?” And each time, he would reply to no one in particular, “Anyone I can, and you’re next!” It always made me smile. He taught me to enjoy life right up to the end.

It was during this time that I began thinking about how we care for our elders. My parents are isolated. When it was time to care for my grandfather, my mother moved him away from his home, and into hers. It was a difficult time, but my mother chose to keep him out of a nursing care facility, which was his only other option. My father is battling an illness of his own, and it would take my mother 30 minutes to get them both packed in the car to go 5 minutes up the road to buy groceries. What he did for her, she now did for him. Mom worked hard and there was no respite. But pappy seemed happy. Seeing my parents work so hard, and seeing how content my grandfather was gave me mixed feelings. I started thinking about another option. Once again, my grandfather would determine who I would become.

Why bore you with this little recollection? Because it gives information to two very important issues that we are all dealing with today. The first is how important it is to have an elder in our lives, everyday, to teach the younger about life, and how to be valuable citizens to this planet. The second is how important it is to care for our elders, and for our caretakers. To this audience, this is all very obvious. But it is not always easy to accomplish, mostly because of the physical nature of our health care system, especially for those who may live in isolation.

For the first issue, I want to talk from my professional point of view, as a Landscape Architect and as a steward of the environment. In my career, we are fortunate to learn about a broad range of topics. We often look at these topics as systems. The more systems you study, the more apparent it is that systems often have patterns and act alike. They are interconnected and dependent on the other elements in the system. Think of environmental systems, highway systems, or the health care system.

Elders and Children, the Human Ecotone
As an example, ecological systems can consist of mature forests or younger fields that may someday be a forest if natural succession is permitted to occur. The boundary between forest and field is called an ecotone. The forest has distinctive characteristics and species that make it different from the field. The field is also lively and diverse, but unique from the forest. The ecotone is the fuzzy and shrubby area in between that has life from both places. In this area, there is an enormous amount of life and activity because it shares characteristics of both the field and the forest – the new and the mature. The field will eventually become the forest because the seeds are already there. It only needs time to grow. Because it is in itself a different zone, the ecotone may contain life not found in either the forest or the field.

Looking at the natural human order in the manner that we look at forest succession provides a bit of insight into some of our societal problems. It seems logical that we should be providing a health care setting where children can interact with our elders. In the system described above, there exists a richness of the environment when two distinct groups meet. It is about the information that is passed between groups and the energy that can be created when they mingle. Kids and seniors are automatically drawn to each other. It seems like they are interested in each other, for their similarities and for their differences. A child reaching for that curious, glorious white hair! A grandmother amazed at the internet lesson her five year old grandson just delivered. The human system is dependent on this interaction.

A place that integrates the unique nature of these distinct human forms might be able to create a new kind of environment that does not readily exist today. Instead, we have created a system that separates our children from our elders. This is an opportunity lost, and one that is fairly new to human beings. We have always had our elders to teach us and provide guidance. It saddens me to think of the limited opportunities that exist today for children to talk to their grandparents. So many times kids are cooped inside while their grandparents wither hundreds of miles away, isolated in a care environment that is remote and bucolic on the outside and has wearisome age-precision on the inside. The term ‘being put out to pasture’ comes to mind. Visiting grandma is nearly impossible alone. The path is far too long and has many perilous distractions. The world is too full of big, bad wolves.

Just as a field will become a forest, a child will grow to be a senior. When a grandparent is in a child’s life, self actualization will occur and meaningful seeds will be planted. Formative moments will occur. The opportunity exists to learn where we came from and who we will become. For a child, this is the roadmap that provides a sense of well-being and confidence. It is an opportunity to learn how to be a productive member of society. For an elder, it gives a sense of purpose, an outlet for teaching years of experience and meaning from a life well-lived.

Care For the Caregivers
For the second issue, I also would like to speak as a Landscape Architect and as a person who designs human environments. When my mother cared for her dad, she was isolated and had no place for respite. She was only five miles from a town center, but there were no facilities appropriate for caring for a man with Alzheimer’s or for a man with MS. She never took a day off except for the rare day that my Aunt came to visit. However, my grandfather was happy. I think there were many reasons for this but the biggest was that he was at home, getting home-cooked meals, and he was with his child. My mother and father were there, and they all loved each other. For the record, my parents still do!

Other elders in my life have taught me life lessons and have guided my new philosophy of aging and care. I benefited from an elderly couple who was looking to leave their family farm and move to a small Pennsylvania farming town where their kids went to school. I remodeled their home to be more appropriate for them as they aged, and was entertained for hours with stories of local, almost forgotten history. There was no place for them to go that would permit them to age in place, and convenient healthcare was simply not available. Even home delivered care was limited. That has since changed for their town, but if trouble comes, they will be forced to leave their home. There had to be a different answer in town.

The PatinaCare Model
PatinaCare is a holistic look at elder housing and delivery of care. It looks at models such as the Green House that have successfully determined what a building can be. It also considers successful adult and child daycare centers where intergenerational contact can occur. But it goes further and looks to town centers to provide the physical framework to establish a different pattern of healthcare delivery. It revitalizes the town centers while providing health care and housing for the greater community. It permits people to remain members of their community and be comforted with familiar surroundings. Most importantly, it provides a convenient setting where children and elders can interact, and where caregivers can get some relief.

Some of the most important aspects of senior housing and health care service delivery are the location and placement of the housing and care services. They determine two very important aspects of community; 1) social inclusion, and 2) efficient delivery. In rural areas, where services are more difficult to provide, it is important to consider the fact that people who are part of a broad community, geographically speaking, more often than not, consider themselves a member of a single, localized core community, or rural town. This is often due to church or school association. In other words, a twenty mile radius often has a single town center. That town center is the focus and the draw to the members of the greater community.

If elder care services modeled after Continuing Care Retirement Facilities or a new kind of satellite office of existing home care agencies were placed in that town center, then they could provide for the broader geographical boundary by attracting those citizens into the town at the critical time, or by providing a more efficient tele-health system or monitoring component that would permit rural residents to stay in their home. The town center is the key to efficient health care delivery.

In urban areas, this is much simpler. Even cities have definable neighborhood centers. These are the core communities. Once determined, the PatinaCare model can make health care delivery accessible at a much different scale by utilizing existing population centers. Imagine walking to a senior health care facility to get your morning coffee. While you were there, you could drop off your child and visit your grandmother.

Currently, the options for elder health care are 1) staying at home with home care support- the most desirable for the majority of elders and baby boomers, 2) moving in with relatives or moving into an ECHO cottage that is attached or detached to a family member’s home, 3) moving in to an elder-ready independent cottage with or without support service, 4) moving directly into personal care or assisted living, usually outside of the community, and 5) moving into full time nursing care, also outside of the community and an option that is more and more pre-designated to existing situations. More options are being developed by the day, mostly because the boomers are not going to deal with the kind of facilities where they placed their parents. Most health care providers I speak with do not want to live in the places in which they work.

Staying at home would require the help of local Area Agencies on Aging. With additional help from occupational and physical therapists, local home care agencies, and certified aging in place specialists (NAHB, AARP), home modifications necessary to stay in the home could be determined and completed. Technology could be placed in the home that permits monitoring from the newly placed town-center health-service (Smart Spaces).

When the choice is made to leave home, assisted living and independent cottages would be found in the town center. In this manner, the elderly are still members of the community of which they associate themselves. Kids can interact with elders on a daily basis because the new facilities would be mixed-use, complete with coffee shops and fitness centers, and combined adult and child day care centers. After all, many adults needing care often have the same needs as children. Care is local and autonomous, and assurances are made that care will be available to all existing residents giving members of the community a healthy sense of well-being and association. Graduated care is available directly in their town.

This scenario relies on the placement of new facilities. Currently, facilities are placed where the developers decide and the markets determine they should be placed. It is based on an errant zoning history, one that separates institutional, residential and commercial uses. Zoning has become a bad habit for both developers and financiers. Fortunately, strides are being made to roll back some of these development policies as city officials and planners recognize the problems that they cause.

Future policy may give greater incentives to place elder facilities in existing town centers. There is already a LEED (Leadership in Energy and Environmental Design) for Neighborhood Development certification system being tested that rewards new buildings for their use of vacant sites and existing infrastructure. Especially in PA, where there is a disproportionate amount of new, suburban development in regards to population growth in the state, it does not make sense to place new health care facilities and elder housing apart from our existing core communities. In fact, it could be a state-wide policy to place new facilities and housing within our core communities in order to promote social inclusion and efficient delivery of health care service – even to rural residents.

Ideally, facilities-based providers could begin to rethink the manner that they provide care. Imagine a CCRC and its components. It has independent cottages, assisted living, and nursing care available. It often has other services that mimic downtown streets. In the campus environment, these are usually separated building types. Often, even the assisted living branch and the nursing branch are in different units, or at least bridged with a common area. Now imagine how this might look in an existing town, especially one with many vacant lots and underutilized buildings. Sprinkled in the downtown would be the assisted living and nursing portions, adjacent to, and sometimes in combination with a coffee store, a bagel shop, a flower shop, a beauty salon, and other ‘active’ places that reach out to Main Street. One block behind Main Street, imagine an active Elm Street, with independent cottages that blend with other homes in the existing residential neighborhood.

A provider could give care in the same manner as usual, possibly in an even more compact location. At the same time, the provider could reach out to its new neighbors, providing care and a promise for graduated care right in the homes of the people that already live there. All the while, the town has new business life and human participation, which is likely to draw even more human activity. Efficient delivery is given at the point source of population density.

Developers will build a proven model. To get them into the mix, proven models need to be researched, considered, and tweaked. Many facilities that are healthy lifestyle-centered are making a lot of money. So are facilities that are day-care based, or those that combine different uses. If a plan were developed that utilized profitable, proven models in new ways, then steps can be taken to implement newer versions of previous solutions. For instance, the Green House model is doing well and is being replicated all over America. And coffee shops tend to make money. Instead of building a Green House on a campus, place it in the town center, add a coffee shop, place a fitness center on it, add a day care center, and call it a day. Four different uses in the same building that all make money, but they also cause social interaction. One can feed the other. Better yet, adaptively reuse an existing, vacant building or fill-in that ‘green ghetto,’ the one that is sprouting wild sumacs and fire-thorn cherries. It can preserve the town’s heritage, and provide distinctive architecture.

PatinaCare In Action
Just like any grass roots effort, PatinaCare relies on the talents of various professionals and concerned citizens. This is what is happening in Kennett Square, PA. No less than 22 different people and organizations, including town planners, developers, public health nurses, adult day care operators, facilities-based providers, politicians, designers, and resident citizens are moving forward with plans to revitalize their town by integrating affordable housing, senior health care, and intergenerational opportunities. PatinaCare offers a framework and a vision to help rally and organize the local troops to realize elder-friendly communities.

While still early in the process, the players are at the table and significant decisions are being made that will enable this entire town to age gracefully in place with efficient delivery of health services. A needs assessment will begin in the next few months that is being jointly funded by a facilities-based provider and pursuit of a “special project” grant from the county planning commission. This assessment will be an interactive process to determine the ‘elder-friendliness’ of the town. Local and state governments will contribute revitalization money to elder housing and care projects. I repeat. They provide money that is not allocated to health care services that will directly pay for a health care environment.

Kennett started with a vision of creating a place where children can interact with elders. The kids wanted it. The seniors wanted it. And oh yeah, the adults in between are seeing the logic of the human ecotone. It has blossomed into a grass-roots effort to provide all aspects of well-being and dignity to the resident-citizens of the Kennett region.

With caregiver numbers shrinking, the cost of healthcare soaring, and the funds of Social Security disappearing before our eyes, I see this as the inevitable outcome for healthcare and housing for the elderly in all of our existing communities. Everything else that we do is unsustainable and our children will pay the consequences. The system is crashing because of these inefficiencies, the physical nature of our health care system and the fact that the normal human order is not being considered or served. When we utilize a model that is holistic and integrates all the components of the system, then we will be able to care for everyone. We should create more opportunities for the human ecotone. We need to change the physical layout of the continuing care spectrum and nurture our towns to nurture our people.

When Pappy died, we automatically went to the river. We buried him late that afternoon, and as night fell, we descended to his ‘spot,’ the same spot where I lost my candy. We became children again. Before long, in the dark of the night, we were all in the river, playing and splashing, and as always, he was watching us and keeping the monsters at bay. We lit candles and watched as they followed the gentle current and spun on the slow eddies, until they finally rounded the bend just down the river. It was one of the best days of my life, and a memory that I will never forget. Being there, that night, we celebrated who he was. As we climbed out of the water, my aunt asked if we were all healed. It was something my grandmother always said that the river would do, something relating to sulfur from an old, upstream coal mine. I was healed. So was my family. Pappy was delivered, and we were healed. What an impact he had on us. I know who I am.

Wednesday, January 2, 2008

Long Term Storage – Fade Out, The End

This article was written for a trade magazine intended for Long Term Care Administrators. The web-published version, in the January/February 2008 edition of Advance for Long Term Care Management, was edited, slightly, to be more palatable for that audience. Here is the original version.

Do you remember the last scene in Indiana Jones, Raiders of the Lost Ark? The internet, in its all-out-information-glory, permits me to jog your memory – exactly how it happened. According to the revised third draft, submitted by Lawrence Kasdan and George Lucas for Medway Productions, Inc, (1979) it went a little something like this.


160 The Ark of the Covenant sits in a wooden crate. A wooden lid comes down and hides it from view. The lid is solidly nailed to the crate as we read the stenciled message on top--
The hammering is completed and hands shift the heavy crate onto a dolly.


A Little Old Government Warehouseman begins pushing the crated Ark down an aisle. Soon we see that the aisle is formed by huge stacks or crates. They come in many shapes and sizes, but when it comes right down to it, they all look like the one that holds the Ark. All have markings like the message we've just seen. Pretty soon we're far enough and high enough away from the Little Old Government Warehouseman to see that this is one of the biggest rooms in the world. And it is full. Crates and crates. All looking alike. All gathering dust. And then we notice that the Little Old Government Ware-houseman, pushing his new crate ahead of him, has turned into another aisle and disappeared from view.


I remember this scene vividly. After all, Indiana Jones is my fantasy alter ego. But now the scene reminds me of something else. It reminds me way too much, of moving day. That is, moving day to a Long Term Care Facility. The day that our parent or grandparent moves out of their home community and into Long-Term Storage. Dropped off. All looking alike. All gathering dust. Fade out. The end.

Long Term Storage facilities. They all look and act very similar. They are all miles out of town, have a nice long entry driveway through a pastoral setting that ends at a drop-off porte cochere that enters a massive building that houses 50 to 100 residents in a setting that is quite unlike the home these residents have left behind. It is far away from their social network. And, this is really the only option for a lot of people. The only option, by default, is the best option. Also by default, it is the worst.

How can this possibly be our best answer to elder care? This option dramatically alters the way our seniors have lived their lives. Continuity ceases. Something changes at a very basic level, at a critical time in life, in a very disconcerting manner. It seems heartless. It seems like taking a dog out for a long drive, and letting it out of the car. When we leave the storage facility, I’m sure we rarely look back.

Why have we lost compassion for our elders? Why have we obliterated their place in our daily lives? Moving day might as well be the last day of a life of quality, a long life of usefulness and meaning. Imagine, today, if it were to happen to you. Imagine being sent to a place that will be your last, temporary address, and you know it. More importantly, imagine being taken out of familiar surroundings. The surroundings that provide both strong family and friendly ties, and loose social networks that combine to give you a strong sense of community, a strong sense of belonging, a chance to matter, an everyday chance to be a part of a child’s life, a chance to teach that child how to be human, a presence when a parent is too busy making a living to care for a child. This is how human beings live.

Do we really think it is any different for people who are older than we are?
Suddenly, your advice no longer matters, old man. Your wisdom is old and tired, old lady – just like you. Your life-time of experience is not informing my broadband life, you crazy old coot. We just don’t need you anymore. We can do it alone. We can find anything on the internet. We can find wisdom on the internet.

I found this little nugget there:

“Where is the wisdom we have lost in knowledge and where is the knowledge we have lost in information?” T.S. Eliot

We have crated our wisdom keepers, and nailed the lid tight. Our hammering is complete. We are lost in new information. What do we know?

We all know we are missing something. We know we are missing each other and the wisdom of our fathers. We have forgotten how human beings live. How we have lived for thousands of years. How we have formed communities in order to protect and support each other, and provide for each other’s needs, and look out for each other’s well being. How the grandparents care for the children because the parents are finding food and providing shelter. How the town is full of different people, all doing different activities, and contributing in a mutually beneficial way. How everybody matters and everybody has a place. The butcher, the baker, the candlestick maker…turn ‘em out knaves all three. By the way. Why were three grown men together in a tub? Maybe grandma knows…

Raymond Unwin was a preeminent landscape architect, urban planner and social scientist. About 100 years ago, he said “Cooperation among men of different capacity is the secret of enhanced power and progress: it is limited only by their ability to understand each other’s differences, and to appreciate their value.” He was talking about everyone’s value. The old people too.

In my mother’s church, she is an elder. In this use of the word, she is valued for her wisdom, and accordingly, is valued as a responsible decision maker for church activities. Why did humanity give the word elder that meaning? Why did the church? Why don’t we value the root cause of that word in the same way? When did our seniors lose their value? When did they lose their wisdom?

In terms of social science, I think the writer of the abandoned HBO series Deadwood understands community as well as anyone today, and possibly as well as the omnipotent Unwin. David Milch has described humans’ need for community as providing “a more confident sense of their identity as members of something larger than themselves.” In other words, we know ourselves by being a part of a community. He states “If you go to any small town, you'll see in the center of town signs that advertise the weekly meeting of the Lion's Club and the Optimists and the Kiwanis. You know, a bowling team, a bridge club? All of those things express our impulse to recognize that our most confident and satisfied sense of our individuality is found in relating to something outside of us.”

Why do we think this is any different for those who came before us? Do we really think that they have forgotten what makes them human? Do we think this when we send them into the warehouse? Do we think they are wise, or are they complete idiots?

Just when our elders are at their frailest, their most vulnerable, and when they are finding themselves very alone and isolated, we rip them from the places they know the best, the places that root them when nothing else does. This may be the most brutal part of moving day. Everything that is familiar is no more. The rose bush, the wind chime, the stain in the carpet, the walk to the mailbox that will never be made again. It is our every day.

At the same time, our children are getting home from school, looking for their latchkey, turning on their Wii with greasy, unnaturally orange Dorito fingers, and grandpa is asleep twenty miles away, in isolation chamber 314 B, in a room that looks eerily similar to storage locker 214 B. I wonder if grandpa ever gets off the elevator a floor too soon and ends up in bed with someone else’s grandma. Not that there is anything wrong with that. It happened to me a couple of times in college. But that was college. This is life.

There are others among us that know more about the needs of people than I know. However, just like Raymond Unwin, I am a Landscape Architect. As my friend and colleague likes to tell people, “Oh, I’m sorry I don’t know the Pythagorean Theorem or the square root of Pi. I just make the world a better place for human beings and oh, I save the environment too.” Don’t be jealous, it’s just what we do.

One of the ways that we do this is by creating places for the way that people actually live. We understand that buildings, and homes, and civic spaces can and should influence how people react to that place. We also understand, as many facilities’ directors are learning, that appropriately designed spaces, both indoors and out, can help people to heal and relieve stress. Conversely, poorly designed or maintained spaces can actually contribute to the decline of a person’s health. Some of the more institutional facilities can cause you to give up, loose hope, and die. Evidence-based design is showing this to be true.

In contrast to that drab thought, providing a sense of community can contribute to a person’s well being and add meaning to a person’s life, especially if inclusive opportunities are available for community participation. Just as Dr. William Thomas has suggested, most Long Term Care Facilities lack any sense of community. When people are ripped from their community and placed into a LTC facility, they are forced to resign in that participation. They are forced to end their citizenry. They no longer matter to the community, or more importantly, to the child.

Cut to wisdom. There is wisdom in our old towns. They grew out of the way that people lived. The eight mile radius of a horse. The walkability of a neighborhood. The caring of a neighbor. Food from the local field - not dog food from China. The Walton’s under one roof. A child and a grandma in every house. Or at least just down the street.

In our newfound-influx-of-information-overload, we have developed a new manner of living. It relies on the car, separates commerce, houses and institutions, and it fragments age groups. Zoning did this. Zoning was information that spread like a wild fire. This is a new way of living. It has never happened before in humankind’s history, and it is not the way in which wisdom would have it. We have never separated the old from the young. Ever. It must be wrong to do it.

It must also be wrong to take community away from our elders, or take our elders from their communities. It must be destructive to the core of their built-in knowledge of humanity, and their age-old sense of community.

But community still exists. In fact, it exists right in our existing towns!! Those same towns that Jimmy Stewart brings to mind. The Bedford Falls. The quintessential American town that we all recall as vibrant, energized, and friendly. But something sinister is happening to them. They are being abandoned for new suburban developments with segregated uses, keeping business away from homes, and schools far away from a sidewalk. And guess what? Almost without exception, Long Term Care facilities are placed outside of our towns, designed as a campus, as they feebly try to provide what the town already provides while stealing a life’s-worth of community participation from those who contributed to the town’s success.

To be fair, Long Term Care facilities meet a need, and are necessary, and they are not necessarily bad. They just need to be reworked, rethought. They need to reflect the way that we really live. We need to sprinkle in the wisdom of humankind’s legacy of community. The ancient voice that “speaks to our frailty and how tentative our understanding of ourselves is.” Our heritage of “a togetherness brought upon by circumstance.” They need to be like home. They need to be centered in our existing neighborhoods, they need to provide well-being and continuity in life, and they need to be integral to all of our lives. Standing alone in an old corn field will not be adequate any more. Not when we are emptying our towns and spreading our development. Not when we know we are missing ancient wisdom.

So there is wisdom in our towns, and wisdom in our elders. Why have we separated them? Why not put them back together and see the result? Why not use them both?

Patina Consultants, LLC has developed such a model of elder care. This model is fully embedded within the wisdom of our existing neighborhoods and community organizations, as a response to the shortcomings of current Long Term Care campuses that dislocate the elderly from their communities. It also recognizes the value of all those old people, and connects them to young people.

Our elders wish to remain at home for as long as their health will permit. When their health fails, they should be able to rely on home delivered care, as part of an organized care delivery system, one that is becoming more and more ambulatory, and therefore, less expensive.

The new model is called PatinaCare™ and it combines a holistic, neighborhood-centered system of aging gracefully in place with a series of design guidelines that enable municipalities, health care providers, citizens and developers to implement this massive shift in the manner that we house and care for our elders. It examines the way we really live, and it makes the nurturing home-like and neighborhood centered. It expands the role of non-profit home health care and extends care into rural areas.

By redeveloping our existing communities, we can enable a setting for civic participation. Infill lots, grey-field sites, and underutilized buildings can be rebuilt with dispersed components of Long Term Care facilities that can be remodeled to be more reminiscent of humans, living, in the manner that our towns function. The model offers a financially viable alternative to declining towns that wish to revitalize once active communities.

The PatinaCare™ revitalization elements repair and replace declining infrastructure. As an added benefit to existing neighborhood residents, new facilities provide opportunities for community engagement and active participation in a safer, walkable, and more integrated setting. Every resident is welcome to utilize a true community-based health care setting complete with interactive adult and child day care, a connected and personal health care center, and options for independent, assisted-living and ambulatory care arrangements, as well as options for hospice and palliative care.

At a time in our history when health care costs are soaring, the elderly population is exploding and state and federal programs are funding more home-based, community-centered options for elderly housing and care, this model makes sense. At this crucial time, communities that embrace the PatinaCare™ model will be better able to provide for the present and future needs of their residents. It will provide an opportunity to remind all of us that our elders have value that will benefit each of us.

As energy costs rise, the PatinaCare™ model efficiently focuses housing and care options where they are needed most, around existing population centers, instead of recreating weaker community networks on green-field sites where none have existed and the cost of creating new infrastructure is more and more prohibitive. This model directs funding where a dollar for senior aid and a dollar for revitalization efforts can be shared, reducing overall government involvement and cost, and giving each municipality increased local autonomy and identity.

This reawakening of community consciousness considers all of us, both young and old, and it can help to reestablish traditional family and neighborhood structures, providing a setting that brings generations together. It is a philosophy that permits the elderly to age in dignity, among family and friends, and in familiar surroundings where everyone who wishes can contribute in a mutual and meaningful manner. It is a rediscovery of the wisdom of our elders.

The Ark of the Covenant is a sacred container. It contained the wisdom of a nation. Why are we storing our wisdom in Long Term Storage? Why don’t we engage our elders and our existing towns. After all. They need some new life.

Thursday, August 9, 2007

An Open Editorial to Your Town

In his book, "The Rise of the Creative Class - and how it’s transforming work, leisure, community, and everyday life," Richard Florida concludes that ..."creativity has emerged as the single most important source of economic growth, [and] the best route to continued prosperity is by investing in our stock of creativity in all its forms, across the board." He lists the arts, music, culture, design and related fields as a means of attracting and keeping the talented, creative members of society that are the catalyst for today’s economy. Just as importantly, he lists the character of the physical community; its sidewalks, parks, natural resources, infrastructure, bridges, train stations, courthouses, shops and other buildings. All those tangible things that make a place authentic also attract the kind of people that attract and build wealth.

I think Mr. Florida has the same obsession with old towns and their main streets that I have. For me, it is the buildings that represent a moment of tremendous craft and pride. But it was also a moment when America received abundant, cheap, and skilled laborers who found an opportunity here in all the places that were reveling in the industrial expansion of our cities and towns. I have always been attracted to the physical characteristics that made the 'place' interesting. The towns that had the most interesting landscape, or the most ornate architecture would captivate me. We don't seem to do it that way anymore.

I have left my hometown three different times in my lifetime. Each one was for good. But, I kept looking back, and eventually I found my way there again, and again. Each time, I was reminded why I left. First it was the street trees. Mostly maples and london planetrees, they were cut in order to preserve the sidewalks. It didn't seem to occur to anyone that the sidewalks had already been heaved - maples are notorious for this. Now, my hometown has broken sidewalks, and no trees. Walking is tanning.

The second time I was reminded by the fact that none of my friends were still around. They moved all over the country for different jobs and different lives. Living in a rural area is not for everyone, and high paying jobs are scarce. Their priorities were elsewhere as mine have been. I have wondered once or twice what it would be like if we all moved back home, with our skill sets rightfully compensated, in a weird kind of after prom life and soap opera community. Well, I guess I've already imagined how that would turn out.

The fact is, there is nothing left there for me and my generation. The population is aging and people are moving away. That has been the trend in rural Pennsylvania for decades. It is only getting more profound, and Mr. Florida is right - other places are really good at mixing the ingredients that attract my generation. I have lived in some of those places and they are really fun. Baltimore is still my favorite, and Camden Yards is but one attraction to a city that I look at as a second home, one that is really authentic.

Most towns in Pennsylvania are losing their authenticity. Maybe that is one of the reasons why my generation has looked elsewhere. It isn't always about the job. Most people have strong enough family bonds to stay in some kind of proximity to their home town. But if the authenticity of a place is replaced with something less than unique, it might not be interesting enough to stay. It follows that the wealth builders will leave to find an authentic place that provides the amenities that they seek, beyond a high paying job. Sometimes the amenities are as simple as a coffee store, a bagel shop, or a bookstore, where people gather, can meet and linger and attract other people. Other times, it is history. Historic architecture and historic street patterns add to the charm and interest that many people seek.

Just as I always have, many people search for just the right character in a house or neighborhood or city block. If they bring an idea or business with them, they can dramatically add to the local economy by providing jobs for others. But the "place" needs to be right. When the place is compromised, the innate charm of a community diminishes, and so the community may not attract the talented person with ideas and jobs to give.

Every old building that is torn down and replaced by a generic office space or parking lot is another strike against a town’s economic future. One building at a time, a city can chip away at its charming foundation to become a city that is not special, and therefore not attractive to the kind of investment that will support and create new and interesting architecture. Any town can let a big-box retailer come in, rip apart a hillside, build a berm for temporary swamps, pave over acres of field and forest, and then send all of your local money to a main distribution area somewhere in the southern U.S. But it takes a special place to resist such easy tax money, to build on its past, renovate downtown buildings, and provide specialty retailers with a rich and diverse place to sell their wares.

These towns attract interesting and clever people. These people react by reinvesting in their community and the community grows and prospers. Too many times, the leaders of a community take the easy way out. Instead of combing the region’s business leaders for investment in their own community, a town opts to push a building over, erasing one legacy of triumph and authenticity for a new legacy of mediocrity.

The local business that does reinvest in a community should be commended and made as an example for smart growth and preserving a town’s economic future. The responsibility of a community lies within every member of the community. But, the leaders must lead, sometimes by painful example, other times by quiet philanthropy. Your town is special - for now. Keeping it special is up to each of you.

Retaining talented young people should be the most important goal of your town. Think of how many intelligent, talented young people you helped to raise that no longer live in your town. They are giving freely, their talents, to someone else’s home town. They went to school, found a job in a creative center, and are now enjoying the benefits that a different "place" is giving them. The place they live is interesting and lively and provides them with many options to entertain and employ. That place has found the key ingredients to attract and keep new residents. The specific ingredients can be found and implemented anywhere, in any town, whether or not jobs currently exist. When investment is made in placing the ingredients, creative people and then jobs will follow.

Almost every town has physical, historic, and natural assets to provide initial interest. When these are identified and enhanced, they will attract attention. At one time or another almost everyone looks back to their hometown for new opportunities and a chance to succeed. If the right ingredients are there, they might be willing to "come home" and bring their, now worldly skills and experience with them. But if they come home to find that extremely rich and elegant four story brick building on the corner that they loved as a kid, in a heaping pile of bricks pushed into the middle of a desolate city block replaced by a plywood sign hanging on two posts with a colorful piece of vinyl stretched over it advertising the bank, the builder and the new Rite Aid, they might think twice. After all, they already have a Rite Aid, and it looks just like the one they’re building in that spot where they used to buy their Keds and get a fountain soda.

These talented young people have the ability to enrich your town in ways that no one can imagine. It is as important to bring talent back as it is to retain talent in the first place. When people go away, they see the manifestations of other creative genius. They may be inspired to greater genius, or they may just provide the vehicle to transport a good idea back home. Regardless, they, and your town, are better off if they return home and stay. They provide new ideas and change that is required for a town to grow and prosper.

Those service jobs that the big-boxes provide don’t add to the creative faculties of your citizens or the economic future of your town. They might as well be a signal for your imminent decline and the death of your downtown. Nourish your old town, provide the ingredients to attract and retain your young people, plead with your business leaders to invest in young talent and old buildings, and watch your town have an awakening.

Thursday, July 19, 2007

Confessions of an Addict

We all have secrets, little things we keep private, moments in our lives that we hope the world will never see. Somehow though, these things eventually find their way into public view, where the exposure is amplified and put on trial. Often, that new knowledge becomes a media frenzy. Other times, it is less public, but more hurtful, and comes in the form of a patronizing and judgmental glances from whispering circles of the innocent.

Sometimes, the secret boils inside us with a vengeance that cries to be heard, like a Poe conscience, under the floor, knocking on the grain of our guilty souls. Well, my soul is knocking, and I wish to confess.

Several years ago, I became an addict. For years I walked the straight and narrow. I was the one casting the penetrating glances on the afflicted. Maybe that was why I fell. I was feeling really good about myself and thinking, somehow, that I was better than all the rest. Now, I know I am just a brother in life, trying to figure out this complicated and wonderful place called earth. I am more able to see others when they are in their moment of weakness, and lend a hand, because I’ve been there.

Every now and then, I feel the tingle of my own weakness. Lately, it has been stronger. For that reason, I am exposing my addiction, to increase my accountability and let the public know my weakness. I wrote the following letter to a friend after my only rehabilitation. Every day, I fight the demons that lead me down the road to that horrible addiction. Every day, I fight to stay clean. This letter was the first of many, and tells the story the best.

March 6, 2001

Dear Micah:

I know this might come as a surprise to you, but I’ve already been a member of CAW (Citizens Against Walmart). However, the inherent dangers of being "too close to the enemy" have finally caught up with me. Let me tell you how it happened. One fateful Sunday morning, while protesting outside a Wal-Mart in Kalamazoo, I felt the need to get a cup of coffee. The night before, me and a fellow CAW member, while caught up in the passion of our cause, found ourselves entangled as lovers; we fell madly in bed with each other. Before we knew it, we found ourselves looking at 6:00 AM, already late for our consumer clash scheduled for the morning. Although it was a night I won’t soon forget, it left us both weakened and exhausted; I was unable to think clearly - I wondered if I could put a fight up for the day. But, I pulled myself together and somehow made myself believe that I could still be an effective member of the protest team. I asked two team members to prop me up in between a stack of plastic kiddie pools and a lot of Igloo coolers. The coolers, I noticed, were at the unbelievably low price of $19.99 and each one included a beverage jug and a four-place setting. I knew we were in for a long day. The enemy was already pulling all the stops. I remember thinking to myself just before I began to doze, "Don’t they understand, ‘buy it quality, buy it once’. This plastic throw-away world called Wal-Mart doesn’t really save you money!! The Edison light bulb still works!" Fighting off the sleep, clearly not in a useful frame of mind, I thought of my alternatives. Give up? Certainly not - this was a fight for which I would die. Stimulants? Maybe. But before long, I began to doze. Every now and then, I would wake up, reminded of my night of passion from extremely cramped toes. But still, I fought to stay awake. It was then that it happened. In my crippled state of mind, I thought to myself, "What would it hurt if I just went inside and bought a cup of coffee at McDonald’s?" Even though we learned at CAW prep school that the conglomeration of Wal-Mart and McDonald’s was one of the consumer industries most effective strategies ever put into effect, I thought that I was strong enough to handle just getting a cup of coffee. But, what I never learned in prep school was how they placed the McDonald’s at the far end of a long row of falling prices. Little did I know, the onslaught had begun. From the moment I walked into the building, I was bombarded from every direction, Salad Shooters for $10.54, Jumbo Ladies Panties - 4 to a pack for $8.77, a folding cardboard model of Heidi Klum (when did she join this corporate monster?) For $34.89. It had motorized accessories. I started thinking our little brigade couldn’t beat this evil super power. This enemy was relentless. Still, they fired all their weapons. A giant pink panda bear filled with confectionary hearts and HoHo's, only $23.76, my mind began to waver, a set of 28 different philips-head screwdrivers, only $5.33. It never even occurred to me that no one needs that many philips-head screwdrivers. And then it came. The fatal blow. I was dizzy from the falling prices when I saw, out of the corner of my baby-blue-light-special-eyes, a collector’s set from the movie Titanic, with never-before-seen pictures of Leo getting dressed in his Titanic one-piece swimming suit; and interviews with Kate, "Did she have a secret crush on her sexy, boyish co-star?" I had to know. It included six audio cassettes ("What was on those tapes"), the making of video, and a pop-up scrapbook. Micah, it only cost $49.56. I never knew. I had to have it. I forgot about the coffee. I felt like I was alive for the first time in my life. I saw the whole world with new eyes from the inside of this big box. Like the undercover drug enforcement agent who becomes addicted to the drug he meant to take off the street, I was addicted to falling prices. From that day on, I spent all my money at Wal-Mart. When my money was gone, I hit my mother over the head with a 12-pack of Bounty (only $6.25) and I stole money from her vacation fund. It wasn’t until I found myself collecting week-old falling prices signs in the dumpsters behind Wal-Mart that I finally hit rock bottom (not to be confused with rock bottom prices). It was then, with the help of several compassionate friends, that I finally sought help. I learned that I wasn’t alone. There are thousands of people around the world who are addicted to falling prices. It doesn’t matter that most of them are retired and live in Florida, we all have the same addiction. I admitted myself into the Hillary Rodham Center for Falling Prices Addiction in Little Rock, Arkansas, and began a 10 step program to recovery with my fellow octogenarians. That is one reason I’m writing to you. I have reached my final step to recovery. Micah, My name is Greg Olsen. I am addicted to Falling Prices. I am so sorry that I did not emphasize enough, the dangers of shopping at Wal-Mart, their stealth attack of falling prices, and their big box retail outlets. I apologize to you and I will apologize to everyone I’ve ever known for the failure that I've been. Please Micah, never shop at Wal-Mart. If you recognize this story as your own, or one similar to it, please seek help. Wal-Mart sneaks up on the strongest of us. And remember, they contribute to the decline of small town America. I love you man. No man is strong enough. The truth is out there.
Your friend in recovery:

I am obsessed with rejuvenating small towns. I need help.