The Power of the Naturally Occurring LIVING Community (NOLC)

The Power of the Naturally Occurring LIVING Community (NOLC) 

Lawrence T. Force, Ph.D.

and

Roger Monthie, M.Ed, MPH

www.ageplan.com 

Overview:

No one is an island. As part of our human condition – we need to live in community and have connection with others.  People need people. Evidence of the importance of this point are strongly highlighted in Dhruv Khullar’s New York Times essay (12/22/16):

How Social Isolation Is Killing Us – Dhruv Khullar, MD

Khullar states: “Social isolation is a growing epidemic — one that’s increasingly recognized as having dire physical, mental and emotional consequences.”

For each person, how one carves out community connections will be dictated individually.  But for sure – options are required.

My Choice: Live Where You Want

Over the course of years, as individuals in the United States have lived longer, the aging of communities across the nation have left many in the areas of government, business, education, research and social policy with questions of how best to support individuals who are aging from a physical, mental health and fiscal perspective. Government agencies and organizations have developed interventions and paradigms to provide support to older adults. Aging-in-Place initiatives have been created to keep people in their communities. The development of Naturally Occurring Retirement Communities (NORC’s0 have been implemented. And, AARP has taken the lead in heralding the value of ‘Livable Communities”. These efforts should be applauded and acknowledged. However, in each case we believe they have fallen short with respect to their expectations.

For us, Aging-in-Place is a wonderful concept – but for us it is just a concept. From the experience of our careers, in working for large public-sector entities, we have found Aging-in-Place initiatives to be a bureaucratic nightmare. Our role from both a clinical, administrative and programmatic perspective was to keep persons with Intellectual Disabilities and Psychiatric needs in the community. The reality is that individuals with specialized needs aged and the ‘system of care’ wasn’t prepared for it. On numerous occasions requests were made to ‘retro-fit’ a community-based home so that persons with disabilities could continue to live there. As an agency, the requests were typically honored. However, as individuals continued to age, more and more of these requests were made. The problem is that resources could not keep pace with the demographics. The result was, not every home could be adapted, and therefore, people had to move. Aging-in-Place could not be implemented, a nice theory but not realistic in meeting the needs of the ‘demographic shift’.

Other paradigms that promote community-based independence are the Naturally Occurring Retirement Communities (NORC’s) and AARP’s Livable Communities. Noble in their effort, however, the problem is there is a significant uplift in costs for individuals, family members, organizations and municipalities to participate in these designs. For the NORC’s, the intent is to cluster services and programs around a group of older adults who may need agency services and programs. The intent is to move the programs and services to the person, rather than move the person to the services and programs. This model can work, as long as there is a ‘density of need’, i.e., you need numbers of individuals to implement this approach.

With respect to AARP’s Livable Communities, a great idea placing emphasis on keeping people in their homes and neighborhood settings. The downside is the large influx of resources required to make the necessary modifications, i.e., widen sidewalks, change trajectory of street traffic, infrastructure modifications…etc.). In order to meet the needs of older individuals, some communities do not have access to the depth of the resources required. The result is that this concept cannot be implemented universally.

History of the Naturally Occurring LIVING Community (NOLC)

In 2009, we participated in a consulting project for a western region state. The Department of Health, from this particular state, had presented a Request for Proposal (RFP) to assist in a project. The state had de-institutionalized 700 individuals in the 1970’s from state-run facilities for persons with a developmental disability. A small number of these individuals, through the guidance of an attorney in a class action lawsuit, were indicating they had been ‘abandoned by the state’. The state had hired a private Investigator to find these individuals. Approximately 550 individuals were located (some individuals – based upon factors of: moving, changing names, dying…etc. were not identified). We (AgePlan, Inc.) were awarded the contract. A team of professionals was assembled and a ‘representative sample’ of the identified individuals were assessed. Our findings were astounding. What we found was that “individuals who did not receive formal services were doing better than individuals who did continue to receive formal agency based services”. Individuals who did not receive formal services were provided a structure of care, support and connections from the communities they had embedded in. For individuals, who were still receiving formal services from agencies, the issues of: stigma, oversight and regulation were present. We then had to formally report our findings to the agency that hired us – and inform them that agency services, in fact, provided an obstacle to full community integration for individuals. The Naturally Occurring LIVING Community (NOLC) paradigm was born.

What is it that we really discovered? We discovered that individuals surrounded by ‘their community of choice’ were actually doing better on a number of variables including, but not limited to, lower levels of depression, higher levels of well-being and feeling more connected to their community. As we described it in our formal report:

Based upon the analysis of the data, interview responses and discussion with interviewers, it is possible to conclude that individuals discharged from state institution who were provided with ‘after-care services’ that followed the policies, procedures and practices of that particular period of time have successfully built a meaningful and healthy life. In some cases, that was based upon family and friends providing supports and guidance and in some cases based upon personal choices. Individuals who required formal care were or have been provided that care in the community (users of services) and individuals who did not require that care or decided to choose not to engage in the formalize system  (non-users of services) were able to determine independently the trajectory of their own life surrounded within the support of their Naturally Occurring Living Community (NOLC). There was no evidence that individuals interviewed in this project are being exploited or living in seriously unhealthy situations

The implications of our findings are far reaching. Is it possible that formal agencies, although good-willed, may in fact impede the integration and support of individuals in their communities. Our answer is: Yes. Followed by an additional statement of truth: ‘Not everything has to be an agency response!’

Building Knowledge, Connecting People, Discovering Communities:

The findings from our study had an impact on the outcome of the class action lawsuit. With this new knowledge base, litigants on both sides were able to move in a new direction. Our findings also had an impact on us as: ‘thought leaders’. Remember, we both spent our professional careers to date in the Public sector, working for and representing a government agency, and now our findings exhibited the limited role of an institutional response.

Over the course of time, the results of our findings influenced the way that we did business. Our initial tagline for AgePlan was: “Building Knowledge, Connecting People, Creating Communities”. And then we realized we didn’t have to ‘create’ what was already there – but rather we had to ‘discover’ what was already in place. We therefore, modified our tagline to read as it does at present: “Building Knowledge, Connecting People, Discovering Communities”.  We have also placed an emphasis on the most important component of our paradigm, i.e., the ‘living’ component in the: Naturally Occurring LIVING Community (NOLC).

What is a Naturally Occurring LIVING Community and how do I find it?

Definition: 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).

(Please note: We refer to individuals who live in the Naturally Occurring LIVING Communities (NOLC’s) as “Citizens”. The intent of this designation is to further promote the themes of: personal choice, independence and self-determination).

With respect to ‘discovering’ your Naturally Occurring LIVING Community (NOLC), we offer the following simple instructions. Imagine yourself going to a 3-D movie. In order to receive the full effect of the experience, you need to don a pair of 3-D glasses. Once you begin to view the movie screen through the 3-D glasses, you immediately see images that were absent to the naked eye. We suggest the same procedure as you are ‘looking around your community’. Imagine yourself putting on a pair of NOLC 3-D glasses, you will immediately begin to see images, connections and support that have been there all of the time – you just haven’t looked at them in this dimension.

As you begin to explore your community, you will notice people, industries and organizations that have always been available to you. The role of what currently exists in the community has been undervalued, i.e., the role of neighbors. Approximately 5 years ago there was a national news release about an employee of Domino’s Pizza exhibiting an admirable action. As the news article indicated an elderly customer would order a pizza and two diet cokes daily. However, for three consecutive days, the elderly woman failed to place her order. The Domino’s employee took it upon herself to investigate by visiting the elderly woman’s house. When she realized that there was no response to a knock-on the door, the employee began to knock on all of the windows. What she heard was the faint sound of the woman from inside the house. The employee immediately notified the Police and they found the woman lying on the floor – she had fallen.

Neighbor Helping Neighbor – Memphis, Tennessee

Fast forward, and last year, the same type of scenario unfolded. Again, it was a Domino’s employee that noticed that an elderly male customer was not following his usual routine of placing an order for Pizza everyday or every other day. The store manager instructed a delivery person to “go and check on the customer”. Upon arriving at the elderly man’s house – the lights were on, the TV was blasting but no response to a knock-on the door. Paramedics were called. Upon their arrival and entry into the house, they found the man lying on the floor as a result of suffering a stroke.

Neighbor Helping Neighbor – Salem, Oregon

The good news is that the actions of concerned citizens of the community helped to save the lives of two people. As a result of their actions, their efforts and the corporate culture of Domino’s Pizza, both of these individuals survived; the employees should be highly acknowledged and applauded for their concerns. The sad part here is that their actions were perceived as newsworthy on a national level – as though their actions were ‘out of character’. Years ago, we had names for individuals who acted out of concern – they were called neighbors.

There are countless stories of  “citizens helping citizens’ in each and every community across this great nation – stories highlighting the watchful eye of neighbors helping older adults. Whether it be informal systems that are set-up between neighbors to alert each other to the status of their welfare, i.e., placing a ‘green card’ on the windowsill to indicate that everything is OK, or to watch for the opening and closing of window blinds as a indication of ‘things are fine in here’, to being alert to mail clutter in a mailbox, lawns not being maintained or cars not leaving the driveway – there are multiple symbols and actions that have been implemented between neighbors. Our belief is that the ‘power of the neighbor’ has been undervalued and lost in our nationwide conversation. The role of neighbor is essential and found deeply embedded in the Naturally Occurring LIVING Community (NOLC).

As indicated, the concern and vigilance of citizens in the Naturally Occurring LIVING Communities (NOLC’s) are essential. However, support concern and care can also be found in the organizations that are inherently embedded in your NOLC.

*** (More to follow regarding the ‘indices’ of the NOLC).