I was thinking about quality of life the other day – what it is and what it means for residents, directors and managers of Senior Housing communities. My guess is that the goal of every Senior Housing director and manager is to enhance and improve the quality of life of their residents – but while they all might agree with that goal – there may not be such agreement on what Quality of Life actually is – or how to achieve it in their facility.

A common approach to this has been to make the living environment as comfortable and pleasant looking as possible – nice décor, fine dining, good quality carpets, attractive drapes etc. In addition to this, what could be considered a more direct approach to quality of life improvement - ‘Universal Design’ - has made an appearance in some areas of Senior Housing. This is a concept and philosophy that encourages the design of products and environments aimed at making it possible for older adult to live, if not more independently, then at least more comfortably or conveniently.

A whole range of individuals and professions are involved in this concept: architects, interior designers, builders, community planners etc. The primary driving force here is ‘accessibility’ something considered an ever more important factor to seniors as they age. After all what could be more important than being able to negotiate stairs, get up out of chairs, cross the road, open your own jar of pickles etc. Everyday activities of daily living (ADL) such as these that used to be taken for granted become, for the great majority of seniors, increasingly inaccessible challenges to an independent lifestyle. While the "3 D’s" of Senior Housing (Décor, Dining and Design), together with a concern for 'accessiblity' have tended to be in the forefront of the quest for increased resident quality of life, I have observed that the implementation of these approaches mainly emanate from a 'deficit-based' approach that is concerned with (and concerned about) the ‘inevitable decline’ aspect of aging. The two main guiding principles here seem to be “Let’s make it comfortable for these old people by making things look nice (and taste nice)” and also “Lets make it easier for these old people to do things by making those things easier to do.”

I was reading an article recently posted on the GeroDesign page of one of my LinkedIn Groups http://www.linkedin.com/groups?gid=140635. It was written by an architect for the online journal ‘Design for Aging’ who strongly advocated the application of the ‘Form Follows Function’ design principle for senior housing. This principle states that the design or shape of a building or object should be primarily based upon its intended function or purpose. The article listed a range of design suggestions that would reduce necessary functional effort for residents in a variety of ADL and also enhance the accessibility of the building itself: low rise curbs, wider doors, carpet pile height, non-slip floors, ramps, accessible light switch, window blinds, lamps, kitchen appliances, telephones etc. While this was an excellent and comprehensive article which made some very important points, what struck me very powerfully was that the design philosophy so eloquently stated in this article was predicated on a “Form follows (the acceptance of a declining) Function”. Everything was designed to be 'accessible' with far less functional effort required; easier to use, easier to navigate, easier to reach, easier to walk etc.

This is “The Road more travelled” in many older adult communities

I am not arguing against this approach by any means, my point is that by focusing solely on passive, extrinsic approaches (The 3D's and ‘accessibility’) through the prism of a ‘deficit based’ approach we cannot help but give credence to the negativity associated with getting older (e.g. the ‘declining years’). This, if they but knew it, makes the task far more difficult for Senior Housing directors ‘to enhance and improve the quality of life of their residents’.

While decline with aging might be inevitable in physiological terms, the way we think about and feel about and respond to this decline is inextricably tied to the way we think about and feel about ourselves, our physical capacities and so our quality of life. This applies as much to the operating philosophies of Senior Housing as it does to the individuals who live in these communities

I believe it is time to ‘think different’ about aging in older adult communities. Rather than ‘passive, extrinsic, deficit-based’ let’s think about  ‘active, intrinsic, asset-based’.

Such an approach would still predominantly involve issues of accessibility, i.e. the ‘Form and Function’ of the environment etc, but would also include and address the ‘Form and Function’ of the individual! In other words, as well as designing approaches that enable ADL to be safely performed with less functional effort, let us also consider designing approaches that enable older adults themselves to safely exert greater functional effort! After all, as Etta Clark has famously said “Growing Old is Not for Sissies!” http://www.amazon.com/Growing-Old-Not-Sissies-Portraits/dp/0876544782

We can do this by adopting a comprehensive and evidence-based wellness approach which advocates and supports ‘Successful Aging’

This is “The Road less travelled” in many older adult communities

‘Successful Aging’ is not just a phrase for your Marketing or PR department – but like ‘Wellness’ it is a dynamic and purposeful idea – a journey rather than a destination – a process rather than a product – an intention rather than a wish – a commitment rather than a ‘maybe’ – and an ‘I will’ rather than an ‘I should’.

You can watch life’s quality flow past you – or you can immerse yourself in it fully - and actively - to the greatest extent of your abilities. You can let life happen to you – or you can make things happen in your life by taking a pro-active and purposeful part in it. I will be writing more about this in future posts but here are some final thoughts:

Senior Housing managers and program directors can provide a pathway to ‘Successful Aging’ by incorporating approaches to wellness that go beyond “The 3 D’s” and focus on developing an active, and pro-active, wellness culture that becomes part of the fabric of the building.

We have seen the potential of this approach through our highly successful STRIVE strength and wellness program http://www.strivealive.com/access . We have seen the joy in the lives of older adults who are newly able to get out of a chair unaided, to take the stairs – even to forgo their walker and reduce their insulin medication! We have testimonials from older adults who tell us that they have regained the strength they remember from more than 2 decades ago – and how much this has meant to them in their lives – and in the lives of their loved one. Being strong for their health has not only improved their quality of life – it has changed their life! http://www.strivealive.com/access/index.php?c=stories

Physical independence is at the heart and soul of quality of life. One can passively experience life with comforts and physical aids but only physical engagement with life can enable us to fully engage with its quality. To paraphrase the poetry of Robert Frost

Two roads diverged ... and I 
I took the one less traveled by,
And that has made all the difference.

                                                       Robert Frost: The Road Not Taken, 1920

The wellness message for Program Managers and Decision Makers in Senior Housing communities therefore is ...

Take the road less travelled – it will make all the difference

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