For decades we have been hearing about the juggernaut of the Baby Boomer Generation approaching retirement. There are dire predictions that caring for us will overwhelm services for the elderly and potentially bankrupt the country. Unless there is substantive change in policies and strategies for care, this may be true.
But wait! Aren’t we the generation of change? The generation that changed society in so many ways, from natural childbirth to “green” internment? The generation that invented the internet and demanded a say in our medical care, introducing concepts like holistic treatment and prevention and being proactive?
We are already seeing paradigm shifts in geriatric care that break the cohort into groups like the young-old and the old-old. We are not 60 and 70 the way our parents and grandparents were 60 and 70. I predict that the job description of Geriatric Care Manager will expand to include activities that are more about consulting, planning and advising. After all, who wants to be managed?
One sign of these changes is the rise of alternative housing strategies. For example, the Beacon Hill Village in Boston (http://www.beaconhillvillage.org/index.html), where seniors, determined to stay in their homes, created their own non-profit organization to manage the services that support their autonomy. To quote one of the founders: “I don’t want a so-called expert determining how I should be treated or what should be available to me…the thing I most cherish here is that it’s we, the older people, who are creating our own universe.” (New York Times, 02/09/06). They are not patients and victims. They are members of a community. More to the point, they are employers of the people who provide care—a very different power-dynamic than your basic nursing home. Similar villages are springing up across the United States, such as the Elder Spirit Community in Virginia (http://www.elderspirit.net/), whose founders wanted to live in a center that would “provide a spiritual setting for older adults…resonating with traditional associations of ‘elder’ with wisdom, leadership, dignity, and ritual.”
Sometimes the motivation to create alternatives stems from a desire for safety and freedom of expression. For example, there are an estimated three million gay, lesbian, bisexual and transgender Americans over 65. GLBT individuals often experience covert and overt discrimination in heterosexual senior housing and nursing homes. Like many other seniors, they want not only safety, but also the chance to create community with peers (http://www.thetaskforce.org/).
What’s significant about these projects is that they are organized by the seniors themselves. Planning takes priority over crisis management. Seniors are employers, not a captive population being forced into pre-existing care management structures. All sickness is local. When people need care, they need it in some place. Building in provisions for care before it is needed, so it can be accessed as needed, is efficient, cost-effective and, perhaps most important, it preserves self-respect.