The Aging Revolution 

As baby boomers stress an already challenged long-term care system, a collection of Missoula caregivers look for new and radical ways to change how we think of older people

On a late Wednesday morning, a handful of residents gather in the lobby of Pearl Garden, a memory care unit located inside Missoula's Village Senior Residence. The occupants of Pearl Garden are mostly in the later stages of dementia, like Alzheimer's, and this morning they sip cappuccinos and watch HGTV while an aromatherapy diffuser steams spearmint and lavender into the air. Heidi Whyte, a life enrichment assistant, reminds the eight residents from time to time that they are awaiting a "special surprise guest."

The guest, it turns out, is a huge St. Bernard named Gus. The Pearl Garden residents meet Gus every month for an hour, but they usually don't remember, so each meeting is as exciting to them as the first.

The visit from Gus is just one of many activities Whyte plans for the residents. They take walks in the morning to beat the summer heat and play games in the afternoons. There are times for bingo and Bible study and even Wii bowling.

"It's all about having fun and keeping people active," Whyte says. "We have a structured schedule, but we adjust it and come up with new ideas. It's all about being flexible."

Whyte got her bachelor's in community health from the University of Montana's Health and Human Performance Department, and during that time she studied the physiological benefits of mindfulness and meditation in the Mind-Body Lab. Since joining the Village two years ago, she has been leading meditation classes and employing aromatherapy for the residents. In addition, they just launched a program called "Ages Entwined" where residents spend time at least once a week with little kids from daycare or college students.

"There is so much our elder population has to offer," Whyte says. "They have a lot of inspiration."

When Gus finally arrives, he barks happily, leaning his big head on the laps of every person who will let him. Teddy, one of the residents, asks all kinds of questions: "What does he weigh?" "What's his name?" "How old is he?" And she repeats the questions again every couple of minutes.

"Thank you for bringing him," Teddy says, wrapping her arms around the dog's neck and grinning at his owner, Juli Cusker, who also works at the Village. "I just love him."

Gus inspires the residents to reminisce about the dogs they once had. A former rancher talks about his working dogs, who always knew how to bring the horses back from the pasture. They talk about their childhoods, their children, where they met their spouses. When someone asks Teddy where she grew up, she leans in conspiratorially and says, "I'm still growing up," and everyone laughs.

click to enlarge i29cover.jpg

Turns out, Teddy's line isn't just for laughs. It happens to coincide with one of the key missions at Pearl Garden and a growing number of nursing homes, memory wings and aging programs around the country and, more recently, in Missoula. The goal is to move beyond the historically bad reputation of institutionalized long-term care and foster an environment more conducive to community involvement and, yes, personal growth.

This is no small undertaking, but local administrators are working to change practices and perceptions with a sense of urgency. The current long-term care system has just a few decades to adjust to an unprecedented influx as the baby-boomer generation ages. According to the Census Bureau, about 50 million people in the country are over 65, but by 2050 that number will be somewhere closer to 80 or 90 million. With this increase, the number of Alzheimer's patients is also projected to grow. According to the latest reports from the Alzheimer's Association, 5.3 million people are currently living with the disease. By 2050, there will be 16 million.

Montana is one of 19 states that will see the biggest percentage changes, with a projected 42 percent rise of Alzheimer's cases. According to experts in the field, current resources—whether at long-term care facilities like Village Senior Residence or for in-home care—are inadequate. The costs to improve the system—for taxpayers, as well as people aging into long-term care—are daunting and, in many cases, prohibitive.

As professionals in the aging field work to address the immediate issues, many other health care workers, gerontologists and activists see these challenges as an opportunity to create a new model—one that embraces aging in a much more radical way.

Independence from ageism

On Fourth of July eve, Kavan Peterson, editor of the blog Changing Aging, posted a "declaration of independence from ageism." He wrote, "Like the colonial British Empire, ageism won't roll over without a fight. We will have to mobilize, recruit allies and fight tyranny with every weapon at our disposal."

Peterson is a 37-year-old Missoula native, former journalist and longtime social justice advocate who has thrown himself fully into a growing national movement focused on changing society's approach to aging. He treats the subject with the kind of bombast—and humor—one would expect from an environmentalist or foodie activist.

The Changing Aging blog was co-founded by Peterson and William Thomas, a doctor of geriatric medicine and international expert on elderhood. The site highlights progressive pro-aging projects around the world and offers blunt criticisms of nursing homes. It dissects misconceptions about dementia and proposes alternative approaches to aging issues with pieces like "Elders as Secret Activists."

The culture change movement in aging has been around for decades, but it is just starting to gain momentum in places like Missoula. It's a next step in a long evolution, one that starts with a dark history of poorhouses and asylums and led to the birth of the nursing home. That institutional model, which is based on the hospital- and military-style efficiency of packing people into one place, continued to be the norm for decades.

click to enlarge Teddy, a resident at Pearl Garden, pets Gus the St. Bernard as life enrichment assistant Heidi Whyte watches. “It’s all about having fun and keeping people active,” Whyte says. - PHOTO BY LOUISE JOHNS
  • photo by Louise Johns
  • Teddy, a resident at Pearl Garden, pets Gus the St. Bernard as life enrichment assistant Heidi Whyte watches. “It’s all about having fun and keeping people active,” Whyte says.

"Nobody says they want to die in an institution," Peterson says. "But we have done absolutely nothing to help people achieve that goal and in fact we have created a society that makes it extremely difficult to do that."

Peterson has long been passionate about social justice issues. He grew up in Missoula, graduated from Hellgate High School and earned his journalism degree at the University of Massachusetts-Amherst. He started working for in Washington, D.C., in the early 2000s and he covered a wide range of policy issues, but most notably he gained a reputation for being an expert reporter on gay marriage. In 2004, he wrote a 50-state rundown on the issue for the Pew Charitable Trusts and contributed to coverage for National Public Radio.

"I thought journalism was one of the most important professions in any society and it would help improve the world," he says. "I always cared deeply about equality and, as a reporter, whenever I saw public policy issues in government or large institutions, if there were severe inequalities I was passionate about it." After covering education reform, immigration policy and the death penalty, Peterson started to feel a pull toward advocacy work.

"I didn't feel like I was that objective anymore," he says. "I felt like I was an activist."

Peterson was hired to do PR for the University of Maryland-Baltimore, which included work for a new program called the Erickson School on Aging. The long-term care system wasn't entirely new to him. In fact, his mother, Kathy Hammond, is the executive director at Village Health Care Center in Missoula, and all three of his sisters have worked there.

"I had reported on aging issues before," Peterson says, "specifically on how they impacted the states. And like most reporters I had looked at it exclusively as a negative issue—as a crisis issue. I wrote stories about how retirement of the baby boomers is going to be a brain drain on state governments, and that as baby boomers age they are going to bankrupt the country and it's going to be a huge burden on our social safety nets and our long-term care system. That's how media frames stories about aging, and that had been my experience."

That is until he met leaders in aging like Thomas who champion radically different views on the issue.

"They look at how we are going to plan for the aging of the baby boomers as a social justice issue, as an equality and civil rights issue," Peterson says. "It's more about the way society thinks about older people than it is about budgets and welfare and social security. And this thrilled me."

Thomas is best known for two major contributions to the culture change revolution. He created the Eden Alternative, a set of education programs aimed at deinstitutionalizing long-term care—not just in care centers, but also in regard to in-home care. It turns the perception of old people from being sad, helpless victims into elders who still have something to offer their communities. Thomas believes post-adult life is simply another stage of personal development or, as Teddy put it at Pearl Garden, where people can continue to grow up.

Thomas also created the idea of Green Houses. Nursing homes were mostly built in the 1950 and 1960s, and by the early 2000s they were up for repair. "Dr. Thomas recognized, 'Why on earth would we start investing all this money in baby boomers to recreate a system that is deeply flawed and based on practices that are almost 50 years old?'" Peterson says.

With funding from the Robert Woods Johnson Foundation, Thomas created a model that was designed to work within the very complex regulatory system that nursing homes operate under. With Green Houses, everyone gets a small private home with their own things and their own personal certified nursing assistants who cook and eat with them.

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