(excerpt taken from Force, L.T. et.al (2010). Mental Health, Specialized needs and Care found in Gerontology: An Interactive Text,  NSS Press.

            “Over the last century, the treatment for persons with specialized needs, i.e., residential programs and day treatment options has changed dramatically. From a historical perspective, transitions in the family system, the ending of World War II, the impact of changes in the economy and the increase in life expectancy all play a role in the modification of the support system for persons with specialized needs. The early days of large scale institutional care has been replaced with a community-based approach for program and resources.

            In 1946, the National Mental Health Act was signed establishing the National Institute of Mental Health (NIMH). In 1963, the Community Mental Health Centers Act of 1963 was established. The latter part of the twentieth-century saw a revision in what constituted the best-practices of the day; large state mental hospitals were considered to be outdated and the locus of control for treatment shifted to a community-based model.  The Community Mental Health Centers Act of 1963 became the symbol for deinstitutionalization. No longer would the mentally ill suffer mere incarceration (Grob 1994, 2008). The depiction of institutional care provided at Willowbrook State School in New York provided an additional catalyst for change (see Internet Sites below). As the de-institutionalization movement gained favor with advocates, providers, state and legislative policy makers, the development of formalized, certified and government funded services were developed and organized into a community service model administered with oversight by a state entity.

            Beginning in the late 1970’s, as a result of litigation and awareness of care and services in state operated institutions for individuals with specialized needs, efforts nationwide were begun to de-institutionalize individuals resulting in the placement and discharge of individuals into the community. Initial aspects of this change in care included: individuals removed from institutional care by their families and requests by individuals to voluntarily leave institutional care. Of the people in the latter group some were discharged and lived on their own while others moved into generic adult homes or privately operated homes. Some individuals in fact chose to live with staff from the institutions with whom they were familiar. Throughout the 1970’s, 80’s and 90’s, practices and regulations governing the health and safety of individuals with specialized needs, in both institutions and the community, were codified. Specific regulations for ensuring adequate and appropriate care were developed based upon national and local standards of care.

            Discharge from state institutions, in most cases, during this period occurred as a result of court ordered discharges or followed hospital discharge practices which included review of the individual’s health, skills and abilities, after-care services, and success of the after-care system to ensure health and safety.  The discharge and after-care planning generally followed the medical model of inpatient hospital care in use during this time period (Dennis, Monthie, & Force 2009).

            The debate about the strength and quality of community based care continues to this day. Advocates and policymakers speak about the strengths but also comment on the inherent weaknesses found in community based care. A major criticism surrounds the issue of accessibility and the lack of a seamless integration of services. The overarching comments regarding the view of community based services have centered on the separation of care and treatment. As Grub indicates, “We have yet to define a mental health policy that integrated decent and humane care with access to medical services for severely and chronically mentally ill persons”.

            The question remains: Are there better ways to provide care to persons with specialized needs? The answer is: yes. There are lessons that can be learned from a cross-system perspective. For instance, in the aging network and gerontological field there is an emphasis placed on the development of Naturally Occurring Retirement Communities (NORC’s). The benefit of the NORC’s affords older individuals the opportunities to age successfully in place. As indicated by Masotti, et.al. 2006 and Lun, 2008, the increase in the aging population has provided new opportunities for practice interventions on both the micro-practice and macro-practice level. New strategies of treatment and service delivery have been developed.

            Based upon the NORC model, (which is focused on a means-test of age 60 and above), Force, Monthie, Dennis, and Rogers (2009) developed a Naturally Occurring Living Communities (NOLC’s)  model. The NOLC’s provide support to adults with specialized needs across the lifespan. A Naturally Occurring Living Community (NOLC) is defined as a neighborhood, community support network, and/or informal support system that enhances community integration, the sense of belonging and or supports the citizen’s independence, inclusion, self-worth, identity, value for the respondent and to the Naturally Occurring Living Community (NOLC). In essence, the objective of the NOLC is to increase independence and personal choice by further developing an understanding of the needs of persons with specialized needs and their family members and by identifying interventions that can be implemented on both the micro-practice and macro-practice level.

            The NOLC model places emphasis on increasing individual knowledge-base regarding existing services and programs for older adults with specialized needs and their family members, as well as, developing practical strategies on how to access the existing networks and supports for older adults with specialized needs. Within a NOLC, emphasis is also placed on highlighting “the role and voice” of the persons with specialized needs, their families and their self-selected health providers.  In addition, a dialogue between public/private partnerships is encouraged; in order to develop creative “out of the box” thinking as it relates to identifying the components of what constitutes a Naturally Occurring Living Community (NOLC). In essence, the NOLC decreases isolation and stigma for individuals. It is essential that individuals, family members, practitioners and policymakers gain an understanding of the various networks that provide support to people as they age, in their own communities of choice, thereby further enhancing the role of independence found in the power of a Naturally Occurring Living Communities (NOLC).

            The question is, “collectively, what are we doing to promote successful and healthy aging in the community?” and “what are we doing to promote successful aging in the community for persons with specialized needs?”  As a worldwide society, from the frontier of compassion, we have created sophisticated medical interventions to sustain and increase the length of life. However, we appear to be silent and without a clear unified voice regarding the quality of one’s life. Our presence and advocacy must be built upon: knowledge, justice, equity, fairness and human dignity; a true commitment will ultimately enrich the value of one’s own life. We need to harness our resources, reduce our duplication of effort across systems, learn from our history and act like it matters… because it does.”

By RONI CARYN RABIN Published: April 15, 2011

Older people suffering from mild memory and cognition problems may be less likely to progress to full-blown Alzheimer’s disease if they receive treatment for medical conditions like diabetes, high blood pressure and cholesterol, a new study has found.

*************

These findings from an international study show the importance of understanding the complex issues that impact the trajectory of Alzheimer’s disease. Alzheimer’s disease (AD) is progressive disorder that is influenced by physical, psychological and social factors. AD is a disease experienced by the individual in more realms than just cognitive decline. In addition, AD is an experience that the entire family “not only witnesses but feels”. From recent longitudinal studies, one can take away an understanding of the value and importance of maintenance and preventive measures. It is never too early to implement strategies that can fend-off or delay the onset of the disease process. Early intervention is a crucial element influencing the outcome, depth and speed of the disease.  Individuals and families- at- risk have opportunities and solution-based scientific proven options to integrate into their life now.  In the year 2011, the diagnosis of AD is not a death sentence…there is life beyond diagnosis. For additional information and resources please contact us at: www.ageplan.com Dr. Force

http://nihseniorhealth.gov/exerciseforolderadults/toc.html

The information is well presented and provides suggestions to assist seniors on how to incorporate an exercise program into their daily activities.

I have also scanned the printable document into a PDF file with four sections which can be found under the Resource Tab – Health and Wellness section

• Benefits of Exercise
• How to Get Started – Part 1
• How to Get Started – Part 2
• How to Stay Active
• Frequently Asked Questions

In summary – the benefits of exercise to enhance and maintain a senior’s health and wellness is one of the most important personal commitments one can make to ensure successful aging. 

Please feel free to comment, as well as, provide examples of exercises and personal success stories

Posted by Roger A. Monthie, President – AgePlan, Inc.

 http://www.hhs.gov/news/healthbeat/2011/02/20110203a.html

The link above from the Department of Health and Human Services summarized by Ira Dreyfuss of the HHS HealthBeat reports the outcome of a research studies. “Researchers who analyzed data in nine studies involving close to 35,000 people ages 65 and older say those whose usual walking pace was faster tended to live longer”.  

The study in the Journal of the American Medical Association was supported by the National Institutes of Health.

Is it that easy? What do you think? Stay healthy by staying mobile…walking…instead of sitting…as Nike says “Just do it”

Posted by Roger Monthie, President AgePlan, Inc.

Over the last century, the treatment for persons with mental illness and developmental disabilities, i.e., residential programs and day treatment options has changed dramatically. From a historical perspective, transitions in the family system, the ending of World War II, the impact of changes in the economy and the increase in life expectancy all play a role in the modification of the support system for persons with mental illness. The early days of large scale institutional care has been replaced with a community-based approach for program and resources.

 In 1946, the National Mental Health Act was signed establishing the National Institute of Mental Health (NIMH). In 1963, the Community Mental Health Centers Act of 1963 was established. The latter part of the twentieth-century saw a revision in what constituted the best-practices of the day; large state mental hospitals and developmental centers were considered to be outdated and the locus of control for treatment shifted to a community-based model.  The Community Mental Health Centers Act of 1963 became the symbol for deinstitutionalization. No longer would persons with mentally illness or developmental disabilities suffer mere incarceration. The depiction of institutional care provided at Willowbrook State School in New York provided an additional catalyst for change . As the de-institutionalization movement gained favor with advocates, providers, state and legislative policy makers, the development of formalized, certified and government funded services were developed and organized into a community service model administered with oversight by a state entity.

 The question is, “collectively, what are we doing to promote successful and healthy aging in the community in the 21^st Century?” and “what are we doing to promote successful aging in the community for persons with mental illness and persons with developmental disabilities?”  As a worldwide society, from the frontier of compassion, we have created sophisticated medical interventions to sustain and increase the length of life. However, we appear to be silent and without a clear unified voice regarding the quality of one’s life. Our presence and advocacy must be built upon: knowledge, justice, equity, fairness and human dignity; a true commitment will ultimately enrich the value of one’s own life. We need to harness our resources, reduce our duplication of effort across systems, learn from our history and act like it matters… because it does.

Adults with a developmental disability are experiencing an extended old age, and concerns have been raised that their increased longevity has created a demand for services and special attention that localities are ill-prepared to address .  The likelihood of aging persons with a developmental disability living into retirement years and outliving family carers has increased.  This has created a growing need for services and resources for family carers, which have remained largely unplanned.  Further, identification of the needs of older carers and how they can be addressed have not received the attention that workers in the field have indicated they should Aging family carers of persons with a developmental disability are one segment of the aging population which has recently begun to receive systematic attention from community agencies.  These families have traditionally provided a lifetime of caregiving for the person with a disability, often without help from formal service systems.  Now as they themselves are aging, social services and aging agencies are becoming more aware of their existence and circumstances.  Concerns are raised about what kinds of supports they may need, what kind of future caregiving arrangements will be needed when these carers are no longer able or available to provide care, and how agencies may be able to respond to their needs.  Services found within the aging network are increasingly being asked to provide services for this population, and to coordinate their services with those provided by developmental disabilities service agencies.

Financial and quality-of-care-issues are reasons why aging and developmental services agencies should be addressing these concerns.  The lack of attention by the formal service system and the reluctance of families to seek out assistance together conspire to create crises for these families.  When a caregiving parent dies or becomes too ill to continue care, formal agencies are likely to be asked to provide out-of-home care on an emergency basis.  Prior engagement with families, planning their needs, and cooperation among service agencies are more likely to result in the use of less costly and less disruptive service options. 

Three issues make this a population of concern.  First, medical advances have steadily reduced pre and post-natal mortality rates of children even with severe developmental disabilities, increasing their numbers generally.  Second, reduction of past institutionalization and its avoidance today mean that most people of all ages with a developmental disability now live with their families or with community-based service providers. Exploring the lifespan implications of this increased longevity and community based living is a growing body of literature on family care of children and young adults, as well as considerations of the needs and experiences of aging parents caring for adult offspring with a developmental disability.  A particular concern is the welfare of those who are unknown to service systems or who have difficulty in accessing services when they need them. 

A  reasonable question is, to what degree do aging families providing services to older adults with Intellectual Disabilities (ID) pose different demands or challenges for the aging network?  Knowledge of such distinctions can be helpful for both developing the aging network plan and for designing aging network  outreach and services approaches.  Examples include the complexity of the problems that such families or households often pose.  The aging network usually encounters many typical caregiving situations (e.g., the parents or other carers who only need minimal supports, such as respite, transportation, or financial planning information).  Yet, other family situations encountered are quite complex (e.g., the parents or other carers with multiple caregiving demands, such as the elderly woman, living in a rural area, who was caring not only for her infirm husband with dementia, but also for an adult son with severe intellectual and physical incapacities).  Such situations may be typical of the more extreme problems faced by aging network when they encounter carers who have been “lost” to the disability services system.  In many instances, they pose demands on individual workers that exceeded personal and agency resources. 

The challenge is to now determine how agencies should mobilize to address the needs of families providing care to older adults with specialized needs. 

We look forward to your comments.

Aging in America is a process of becoming invisible. The ‘voices’ of the older population in America are muted and overshadowed by our focus on the value of ‘young’.  In fact, Aging in America is a Process of Liquidation, i.e., of resources, interests and individual choices.  Collectively our view of older adults is overshadowed by what value we place in aging.  For example, as was all of America, the recent tragedy in Arizona of the senseless wounding and killing of citizens brought sorrow to many of our lives. However, I was also struck by the interest of the media coverage. There was a major focus on the shooting of a Congresswoman, a Federal Judge and the untimely death of a 9 year old child. There are no words that can describe this horror. However, I was also struck by the absence of focus or media interest on the death of the older adults that were killed. In fact, little is known about them. I think this is another example of how, as a society, we discount age.   

The paradoxes of ‘what we say about the value of aging and how we act’ are found in a number of arenas. I always found it interesting that as program planners and policymakers we have little hesitancy to recommend specific treatment protocols, programs and services for older adults and their families. Although, I do believe that our intent is genuine and heartfelt, as professionals, we would rarely follow our own advice. We have the greatest intent in “doing what we think is right for the older person” but would rant and rave if somebody was trying to do this to us- as individuals.

Isn’t it time, as individuals and a society, to increase our sensitivity and understanding of how we will feel as we age ourselves? Again, Do Unto Yourself as You Want to Do Unto Me, and then we will talk.

Please feel free to comment. 

Dr. Force

 Welcome to the Naturally Occurring Living Communities (NOLC’s) Blog. It is our intent at AgePlan to provide a forum for discussion and resource sharing as it relates to the development of Naturally Occurring Living Communities (NOLC’s) where citizens have access to programs, services and supports that are found within the community.

The Connecticut  initiative began with the development of an alliance between Wecahr, Inc. and AgePlan, Inc. (see PR Announcement below):

Announcement:   Naturally Occurring Living Communities (NOLC’s)  in the Greater Danbury Community- WeCAHR

Western Connecticut Association for Human Rights, Inc.  and AgePlan, Inc. collaborate on development of Community Supports for elderly and disabled citizens.

WeCAHR is currently supporting an Initiative sponsored by the CT Council of Developmental Disabilities-to demonstrate the implementation of the aging-in-place concept with people with developmental disabilities in the greater Danbury region. Our primary focus is with people with developmental disabilities who are already living in the community and who are getting older.

The primary focus of our work is to demonstrate the ability to create a Naturally Occurring Living Community (NOLC) for ageing persons with disability. WeCAHR is currently working with AgePlan, a national consulting agency specializing in promoting successful and distinctive ageing. The joint initiative will: create tools and strategies to assess the community, build on existing networks, as well as, create new networks and technological connections between the ageing networks and supports found within the community.

From this alliance, a coalition network has developed supporting Naturally Occurring Living Communities (NOLC’s) in Connecticut. Why now?  Because, people are living longer; worldwide population profiles indicate that life expectancy is increasing.  (http://www.un.org/esa/population/publications/worldageing19502050/pdf/90chapteriv.pdf)     

With a specific focus on the United States, the demographic profile of the American population is changing. People are living longer lives; the average age of the general population is expected to significantly increase over the next few years. In the year 2000 there were 35 million persons age 65 or older in the United States; over the next thirty years the population age 100 and older will grow faster than any other age cohort. Increases in life expectancy and changes in population structure have resulted from and have affected the nature of society. Definitions of what constitutes aging, quality of life and best practices are being revised,  In response to the increased life expectancy of individuals the dialogue surrounding clinical practice, policy, program and service needs for this aging population continues to be reshaped. The role of individual and family responsibility has changed over time. This change in longevity has implications for the nature and structure of the societal support for older individuals, their family members, and those who provide services to them.

Therefore, as people continue to experience an extension in lifespan, theoretical models and practice interventions demonstrating an understanding of the intersection between age, disease, and emotion will be required.  Students of medicine, social work, and psychology will need exposure to these specialized interventions early in their training.  In addition, seasoned practitioners will need advance training in order to maintain their commitment to professional standards.

Aging within Communities

 The aging of communities across the nation have left many in the areas of government, business, education, research and social policy with questions relating to the support of  individuals who are aging with specialized needs. At the same time, the overwhelming feedback from citizens receiving services indicates that the large majority of individuals would prefer to remain in their own homes rather than having to move to a care facility.

AgePlan, Inc. a company dedicated to “Building knowledge…Connecting people…Creating communities” has developed tools, strategies and resources that can access, analyze and develop a road map to assist communities toward supporting citizens who are aging with disabilities to remain in their home with dignity.

Definition: Naturally Occurring Living Communities (NOLC’s):

A Naturally Occurring Living Community (NOLC) is defined as a neighborhood, community support network, and/or informal support system that enhances community integration, the sense of belonging and or supports the respondent’s independence, inclusion, self-worth, identity, value for the respondent and to the Naturally Occurring Living Community (NOLC).

• In essence, the objective of the NOLC is to increase independence and personal choice by further developing an understanding of the needs of persons and their family members and by identifying interventions that can be implemented on both the micro-practice and macro-practice level.
•  The NOLC model places emphasis on increasing individual knowledge-base regarding existing services and programs for older adults with specialized needs and their family members, as well as, developing practical strategies on how to access the existing networks and supports.
• A dialogue between public/private partnerships is encouraged; in order to develop creative “out of the box” thinking as it relates to identifying the components of what constitutes a Naturally Occurring Living Community (NOLC).
•  In essence, the NOLC decreases isolation and stigma for citizens. It is essential that individuals, family members, practitioners and policymakers gain an understanding of the various networks that provide support to people as they age, in their own communities of choice, thereby further enhancing the role of independence found in the power of Naturally Occurring Living Communities (NOLC’s).

 We look forward to a fruitful dialogue with an emphasis on the continual building of community-based resource networks in Connecticut. 

Aging in your community is not a privilege but rather an individual choice and right of all citizens.