Thursday, August 1, 2013

The Trouble with Assisted Living

This morning, Diane Rehm held a discussion about assisted living centers on her morning NPR show. The reason they were discussing the seemingly innocuous topic is Frontline's recent expose into the wild west of assisted living centers.

I haven't read through nor yet watched Frontline's report but there are a few quick things I'd like to say about assisted living in general. During the radio show, a critical point was raised detailing why there is a lack of regulation.

Due to the newness of the entity/business model, it isn't really categorized properly. Zoning and regulatory bodies don't see them as healthcare facilities but rather housing/apartments that happen to have some caretakers employed.

One of the first questions is why the explosive rise in number of assisted living centers across the country. The overly simplistic answer is due to an aging population, more specifically, an aging population bubble. However, that doesn't explain the specific new concoction that is the assisted living center nor the long chain of events that allows for the creation and proliferation of such an entity. Cities and nations have had population bubbles before and will after the baby boomers. Yes, the world does not indeed revolve around you.

The deeper and more complex answer is the disaggregation of complete communities and the empowering and nurturing care of physical, economic, and social bonds of walkable neighborhoods into single-use, single purpose, isolated land uses, reducing the complex world into a reductive color code on a map.

I specifically say walkable neighborhoods because 'complete' neighborhoods that empower all ages to participate socially and economically do not exist without walkability. Nor do the complex social bonds that are formed in tight-knit communities. Tightly knit both physically and socially.

I explored the relationship between physical and social connections when discussing Eric Klinenberg's concept of resilient neighborhoods in the face of disaster. In his talk, he made the excellent point that the real first responders are your social bonds, your family and closest friends. Assisted living centers never existed before because assisting the still living was what friends and family do...did.

There is a reason that college towns and places like the Upper East side, Charleston, Key West, et al are prominent places of retirement. They are NORCs or Naturally Occurring Retirement Communities. They empower. They keep the aging still active and engaged within their community.

However, with the loss of complete neighborhoods and walkable communities, not only have we lost places for the retired and elderly population to stay active, but we've also fractured their social bonds. And without those physical and social connections, we're effectively just warehousing our family members, like some sort of nuisance, while their life earnings are sucked dry by the substituting business model in the place of community. Not exactly the respect our elders deserve. Not so coincidentally, we do the same with our kids and wonder why our education system is failing. Maybe it's the bottom-line driven economic model that treats our students and elderly as consumers rather than future and past leaders that is failing us.