Staying alive: three takes on today's senior living; Based on interviews with Judah Ronch, PhD, Erickson Retirement Communities; John M. Parrish, PhD, MBA, the Erickson Foundation; and Jamison Gosselin, Sunrise Senior Living

Nursing Homes, August, 2006

Who knew it could be this way--people having fun in their retirement and on into their long-term care years. Retirement was once thought of as a time to kick back, relax, and put up one's heels until one's toes turned up. As for long-term care--well, let's not go there. Much of that thinking persists today--witness President Bush's moans about "getting old" as he turned 60 this July. But as it turns out, that thinking is outmoded--in fact, it is being turned around 180 degrees by today's pioneers in organized senior living. Two companies that have developed reputations for keeping aging residents "up and at 'em" in literally hundreds of ways are Erickson Retirement Communities and Sunrise Senior Living. Erickson has 18 communities serving more than 17,000 residents in eight states. Sunrise has 423 communities serving 51,000 residents throughout the world. Both have developed experience and research that shed light on the challenges faced by long-term care facilities looking to survive the market that confronts them in the early 21st century. Recently, top spokespeople for those organizations shared philosophies and insights on the new senior living regime with Nursing Homes/Long Term Care Management Editor-in-Chief Richard L. Peck.

Judah Ronch, PhD, Vice-President for Resident Life, Mental Health and Wellness, Erickson Retirement Communities

Much of this starts with an excellent book published in 1998 by geriatricians John Rowe and Robert Kahn called Successful Aging. Their basic message was, we have research evidence that you can have a positive impact on your health status if you don't take old age lying down. We know now from hundreds of studies, including some done right here by The Erickson Foundation [see John Parrish's comments below], that an active lifestyle can be beneficial to aging adults. If we can support independent functioning to the extent possible, this can have a major impact on quality of life. Backed up with appropriate medical services, and engaging with life (social, intellectual, spiritual, and physical), an individual can stay living in his or her apartment for a long time.

This goes directly counter to the traditional way of looking at aging; i.e., a time when one slows down and disengages from life. This protective, or self-protective, approach was based actually on an artifact of the aging research conducted during the mid-20th century. When aging was studied, it was studied in nursing homes, involving obviously the most needy and frail of the elderly, but extrapolated to the general population. A viewpoint opposite to "disengagement" is that successful aging means maintaining an active lifestyle. George Maddox, PhD, at Duke University, however, found that successful aging is actually a combination of both. At any age, one should do what one enjoys and is capable of and let go of that which one can't or prefers not to do anymore. And stress isn't necessarily the enemy. Rather, successful aging is a matter of managing stress successfully, not avoiding it entirely.

At Erickson we translate this approach to actual resident lifestyles by getting to know each resident personally at the time of admission. Once we have determined preferences and needs, we can help to link each resident throughout his or her stay with the appropriate resources to engage with life and optimize good health. Also, our staff is formally trained to observe and evaluate each resident's behavior in terms of that individual's "norm." Servers in the dining room, housekeepers, and transportation drivers, for example, don't look at stereotypical behaviors of aging, but rather at a resident's personal patterns of behavior and any noteworthy deviation from those. They're trained to report apparent deviations the same day to their supervisor, who will then notify the resident's social worker. I've come to be amazed at how well our employees get to know residents from day-to-day contact and observation. Another check on things comes from the resident community itself, which is quite alert to changes in individual members' behaviors.

We are geared, of course, toward accommodating increasing disability with age. But we have a very strong emphasis on promoting fitness and function to the extent possible and not falling back too easily on the next level of care, such as assisted living.

Do all residents make the effort to live actively? No, not everyone does, but many do. They're finding they can do things here they couldn't do at home because the services and supports are here and readily available. But even for those who don't wish to be personally active, just sitting and watching activities--so-called "passive participation"--can in itself be beneficial.

In general, the normative of aging is changing with our resident population--it is moving away from the traditional view of aging as a time to disengage. A lot of this has to do with personality--some people are naturally more adventurous and less limited by social expectations, and those are the people who thrive here. But even those who tend toward a more conservative stance are beginning to understand that there are realistic possibilities for them here. Both they and their families are becoming aware that there are ways for a resident to avoid becoming too dependent on others too soon. As for those families who tend to be overprotective, I found during my years as a provider that setting up a "negotiation" between them and their loved ones can be very productive in reaching a viable compromise, while keeping the provider out of having to side with one party or the other.