“Redefining Aging in Place Through the Village Model”
2016 Idaho Summit on Elder Abuse and Exploitation, Boise, Idaho
Keynote by Natalie Galucia, Director, Village to Village Network
I’d like to start off today by discussing our overall theme for this summit - aging in place. “Aging in place” is a phrase that we hear much more commonly these days. What exactly does it mean to age in place? Simply put, it means to age independently and safely in the home and community of your choosing. Aging in place can look different to different people. For some, it means aging in the single family home, apartment or condo that one has spent the last 40 years of their life in. For others, it means relocating to a new house, apartment or condo in a new city or neighborhood to be closer to family, friends, or other needed resources. It could possibly even mean moving into a community such as a retirement community or CCRC. As we explore aging in place a bit more, you will see that it is more than just the physical structure that an individual, couple or family lives in. There are many more components to aging in place, and we will delve a little deeper into that later.
Aging in place has been gaining more prominence in this decade. As a whole, we are shifting from the institutionalization of older adults to other alternative living solutions, drawing upon the resources found in our communities. We know that when asked, adults age 65 and older would prefer to age in place rather than move somewhere else. In the U.S., as in much of the rest of the world, the population of older adults continues to increase. Today, even if every older adult wanted to live in a nursing home, senior apartment or similar facility, there would not possibly be enough room or enough money or time to build these facilities as soon as they would be needed.
I’m sure all of us in this room have heard about aging in place and perhaps about a very similar phrase – aging in community – which is actually what I prefer to use. As I mentioned, there is much more to aging in place than the physical structure one lives in. While the physical structure and updates to the home such as grab bars, walk in showers, and the removal of hazards such as rugs need to be addressed, other needs also should be considered.
Each person’s needs are different, and not everyone needs the in-depth physical and medical care that facilities such as nursing homes provide. There are however, basic principles that each person will need to heed as they age in their communities. Successful aging in community requires that basic needs, shelter, food, and safety are accessible; that there is a component of community engagement; that health and well-being are addressed; and that independence and autonomy are facilitated. This is a successful model for caring for our older adults in their communities.
I mentioned that I prefer the term “aging in community” instead of “aging in place” because I feel it paints a broader picture. Aging in place can be much more narrowly focused on the physical aspects of aging. Aging in community brings in the community engagement piece, connecting sometimes isolated individuals to other resources and individuals in the community itself. The concept of aging in community seeks to shift the view of older adults from frail, dependent, needy individuals to engaged, vibrant and interdependent individuals.
Today, many different models are emerging to help make aging in community more accessible to all older adults. One of these models, the “Village Model,” is what my organization, Village to Village Network, helps foster. As I shift into describing the village model and how it facilitates aging in place, I’d like to begin with a story.
This story takes place on a cold winter’s night in a neighborhood called Beacon Hill in Boston, Mass. A man was concerned about the ice in his roof gutters and set about clearing them as he had always done: his wife holding onto a rope that was tied to her while he dangled out of the window of their three-story home. As she held onto the rope, his wife kept thinking, “There has to be a better way – there just has to be a better way!” The couple was getting older, and she knew they’d not be able to continue doing the things they’d always done. She knew they wanted to stay in this house and this community, so something had to change for this to happen.
The couple got together with some of their friends and began discussing their wants and needs for the rest of their lives. They knew nothing was available that would provide them (and other aging adults) with exactly what they needed: an organization to help them with little things around the house (like changing a light bulb) and provide some social activities connecting them to others in the community. They weren’t going to sit around and wait for the government or someone else to create “it” for them, and they were not going to move anywhere else, so they decided to create” it” themselves. From ice on the roof to meeting with friends and neighbors, ”it’ happened. The Village movement was born.
You’ve heard similar stories. Stories of individuals who find out that doing the simplest tasks around the house has become a challenge for them. They want to find other ways to be connected in their community – many are no longer working, their friends have died or moved away, and their children now have busy lives of their own. As many or all of you know, the number of adults age 65 and older is rapidly increasing across the world. We’re seeing other trends as well: Older adults are living longer, working longer, and need different supports than before. Today’s older adults do not want to be institutionalized or have to rely on the help of their families. They want to remain active in their communities and, live independent, healthy and vibrant lives for as long as possible. The Village model is now one of the most innovative solutions available to help them do just that.
There are typically three main components to the Village model. First, services provided by volunteers. Second, access to vetted (known) service providers, like painters and plumbers. The third component is the organization of a variety of social activities. Depending on the model, Villages can provide or find the things that older adults need to continue to live in their homes and communities. Services to Village members are provided mostly by volunteers. Village volunteers are often other individuals in the community looking for a way to give back. Volunteers are college students, retirees, and professionals, as well as members of the Village. Volunteers provide transportation to the doctor or grocery store, complete light housework and repairs, make friendly visits, prepare meals, and much more.
The second component of a Village is information and referral to service providers. Villages form relationships with other businesses in the community such as appliance repairmen, plumbers, lawyers and home care agencies. These businesses come with recommendations from others in the community, and the Village will conduct background checks to ensure reliability and safety. Many give Village members a discounted rate.
Lastly, Villages provide programming and social activities. Activities range from trips to museums, plays and other cultural events to book clubs, exercise and wellness classes, breakfast meetings, luncheons and happy hours. One of the main goals of a Village is to address the whole person: physical, mental and social well-being.
Pulling all of these components together, a Village is often a “one-stop-shop” for members. For example, if a member needs a ride to the doctor, they call the Village. A Village staff member or volunteer records this service request and contacts available volunteers to see who can provide the ride. Once a volunteer is confirmed, the staff or volunteer lets the member know who will be there to give them their ride.
Sometime there are tasks that a volunteer cannot do, such as repairing a broken refrigerator. The member calls the Village office and the staffer refers to their list of vetted services providers. They can either provide the contact information of service repairmen or even offer to contact them on the Village member’s behalf.
Villages are grassroots organizations, started by individuals in a given community; many are older adults themselves. Each Village is a nonprofit organization. Villages are member-driven: All of these services and activities are recommendations and suggestions that come directly from Village members. It is important that each Village focus on what its members want and need. The beauty of it all is that the Village model is so adaptable. Every community is different. and we’ve found it essential that each Village be able to meet the specific needs of its community members.
While each Village is comprised of a variation of the three main components, there is diversity in the Village model and no one size fits all. This “diversity,” if you will, is why we have seen Villages continue to rapidly spread across the United States, as well as Canada, the Netherlands and Australia.
All Villages strive to not recreate or replicate what is already available. When creating a Village in a community, it is important to start with a survey of what is already available to help older adults. These could be government programs, other businesses and community resources. Equally important is making a connection with the older adults themselves to learn what they want and need. Involve them in every step of creating the Village.
Along with aging in place, there are other “trends” we are hearing of more and more often among older adults. One of is elder abuse. As I’ve touched on, aging in community requires that a myriad of needs and concerns be addressed. Villages seek to address the needs of their members in variety of ways. This includes knowing the signs of and how to address elder abuse if it is affecting any of their members.
Let’s take a look at elder abuse for a moment. Elder abuse is defined as intentional actions (or inaction) that cause harm or create a serious risk of harm to a vulnerable older adult. Perhaps we’ve heard some of the stories of abuse that happen in a care setting such as a nursing home or hospital. But abuse by a loved one in one’s own home? That doesn’t happen, does it? Unfortunately, it happens far too often. Statistics show that 1 in 9 adults over the age of 65 will experience a form of abuse in their older adulthood. But it doesn’t stop there. These numbers are just the reported numbers. It is estimated that only 1 in every 23 cases of abuse is actually reported. So it is happening much more often than we think.
When we talk about abuse, we may think about some of the more obvious signs, like bruising or other injuries, but physical abuse is just one form of abuse. We also need to be aware of financial, sexual and emotional abuse. Perhaps you’ve heard stories of scammers calling or emailing older adults, telling them that a loved one in their family is hurt or in trouble and that they must send thousands of dollars right away. These types of scammers prey on the sometimes isolated and lonely older adults who may not be aware of all of the risks our technological age can bring upon us. This is just one specific type of abuse out of many that occurs regularly among older adults.
Neglect is actually the number one form of abuse inflicted on older adults. Not only neglect by others, but self-neglect as well. Far too often, older adults stop caring for themselves, either because they are no longer able to and cannot or are not willing to get the help they need or because of other underlying issues. These types of abuse aren’t just self inflicted or inflicted by strangers. A friend or relative may have had the intention of looking after their elderly loved one, a caregiver may have even been paid to stop in once a day. Yet, whether done intentionally or accidentally, this person is not looked after and instead is neglected, possibly for long periods of time. There may also be the grandson who has fallen on hard times and comes to visit Grandma knowing he can get a few hundred dollars out of her – what could she possibly need it for, anyway? As much as we don’t want to talk about it, these things do happen.
What can be done about this growing epidemic and, in particular, what can we do to address this danger for older adults who are aging in place? As with many things, education is one key component. It’s important to educate older adults themselves of these risks – about the signs, potential scams and things to look out for. It’s important to educate family members and friends. This is an important role that organizations like a Village can play, too.
Many Villages train their volunteers and staff to be on the lookout for signs of elder abuse. They put on educational seminars and check in on members they don’t hear from regularly. Some Villages, such as Capitol Hill Village in Washington, D.C., have formal programs to help address this and other information needs. The Village Connections program addresses the needs of frailer and more vulnerable members, pairing them for at least a year with a specially trained volunteer. This volunteer interacts with the member at least a couple of times a week, sometimes coming into the home, making sure they’re taken care of, can make it to appointments and have the things they need. By having this regular interaction, threats such as abuse can be reduced.
Of course, this solution takes a bit of initiative from older adults themselves. They must want to be a part of an organization like a Village and sign up to be a member. This may not be the end-all, be-all approach to stopping all elder abuse, but we do believe that the Village model is one way to reduce the likelihood of abuse occurring as older adults age in community.
A Village’s focus is often a lot broader than just serving the needs of individual members by giving a ride to the doctor or educating members on elder abuse. Many Villages also strive to make a bigger impact in the community they are serving as a whole, and they do this in a number of different ways. Some Villages employ advocacy on a number of policy issues important to their members or participate in other types of community work such as an Age-Friendly Community plan.
Age-Friendly Communities are another global trend that has emerged in the past decade. Age-Friendly Community initiatives seek to improve their communities by taking a look at a number of core tenets such as transportation, housing and safety. They assess what the community has and identify where it does not meet standards for being age-friendly, such as quickly changing lights or not enough affordable and accessible housing. The community will then work to put a plan together to correct these shortcomings.
In fact, some villages have played key roles in bringing these initiatives to their cities, or in being resources for the planners and individuals involved in doing the assessments and implementing the plans. Village members in Columbus, Ohio, help do walkability studies, and village members in D.C. have done studies on age-friendly businesses. Together, these villages work with other key players to make sure that their communities are communities where all ages can reside safely and healthily, and where everyone’s needs can be met.
The Village model isn’t just kept to the local level either: We have begun referring to the “Village Movement.” We truly feel that this is a grassroots movement that is going to change the way we age in community. We are seeing it already and are excited to continue watching it grow. Some parts of the country that have a larger presence of Villages have formed regional groups to work together on advocacy and sustainability for their villages on a statewide or regional level.
We also have a national organization: Village to Village Network. We collaborate to maximize the growth, impact and sustainability of individual villages and the Village Movement. The Network provides expert guidance, resources and support to help communities establish and maintain their villages. We started with one village in 2001 in Boston and now have more than 200 Villages in 45 states, with another 130 in the development phase.
Even though the Village Model is still relatively new, we are already seeing a number of positive impacts, thanks to research by the University of California, Berkeley. Studies have shown that Village members often feel healthier, and that they are better able to access health care services and additional community resources. Village members are also more socially engaged through planned events and volunteering opportunities. Through this social engagement, Village members are less socially isolated. We all know that social isolation is a huge concern for the older population; it can lead to depression and other physical and mental conditions. Being engaged with other village members and volunteers and in activities helps lessen these risks. More than anything, being a member of a Village gives an individual a better sense of belonging, which is very important for everyone. Village members feel they are more connected, have more social contact, and have more opportunities for volunteering. Overall, Villages provide their members with better access to help and medical care, and someone to call on. Perhaps, most important of all, being part of a Village provides each member with the ability to stay in their own home and community longer.
As the Village model grows and adapts to each community, we will continue to see villages being much more one-on-one service providers to their members. A Village is not just about transportation and book clubs. The Village model embraces the ideals behind community development and organizing. The village brings together individuals of all ages and many different backgrounds to make their communities better places for everyone to live. Village staff, volunteers and members are active in the community, advocating for policy and environmental changes that can help make their community better and stronger. The Village model impacts more than just one person – it impacts the community as a whole.
We hope that as the model continues to grow, it will strengthen the overall aging infrastructure in the U.S. and the world, and will continue to empower older adults to live their lives how and where they’ve always envisioned.