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.

SCENE: 160 INT. GOVERNMENT WAREHOUSE

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--
TOP SECRET ARMY INTEL.
#9906753
DO NOT OPEN!
The hammering is completed and hands shift the heavy crate onto a dolly.

THE END CREDITS ROLL AS WE SEE--

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.

FADE OUT.
THE END.

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.