Better Together, The 8th Annual Green House Meeting and Celebration

By / Posted on November 25th, 2015


The Hitchhiker’s Guide to Dementia

By / Posted on September 10th, 2015

Dr. Al Power will be conducting an all day preconference session along with a plenary and education session at The Eighth Annual Green House Meeting & Celebration in Broomfield, CO from November 16-18th. The annual meeting is for Green House members only and this year’s theme is Better Together.  The title of Dr. Power’s preconference session is “Reframing Dementia.”  His plenary session is entitled “Living Better Together with Dementia: Taking it Further” and his education session is “Real Life Without Antipsychotic Drugs.”  Log-in to the Peer Network website today to register for the meeting so you can hear from Dr. Power first hand!

 

Like most people, I am subject to a regular barrage of media reports, coming from radio, television, internet news outlets, social media and daily RSS feeds. And here is what this information stream has taught me:

If I eat blueberries, I’ll lower my risk of Alzheimer’s. Or was that tomatoes? It now appears that yogurt lowers the risk as well—does that mean blueberry yogurt, or will any old flavor do? Maybe I should have coconut flavored yogurt, because apparently, if all that coconut oil doesn’t kill me with a heart attack, it may make my brain healthier.

And now it appears I may have to replace my plumbing, because a new study suggests that too much copper causes Alzheimer’s; though other medical studies have shown that a high copper intake actually lowers the risk. So which is it? And is lead involved? (I need to know because I tend to chew on my pencils when I do my daily Sudoku puzzles.)

And then there’s the glucose connection, the blood pressure connection, the inflammatory connection, the brain reserve connection, the mood disorder connection, the social connections connection.

And what kind of a teenager was I? Apparently, certain adolescent behaviors raise your risk. One of them is getting drunk; well, thank God, none of us ever did that! Also, it’s a risk if you have a history of adolescent antipsychotic use. (Tell that to the psychiatrists who are finding all kinds of new reasons to prescribe these drugs to young people, from depression to “oppositional disorders”.)

Another risk factor (cue Randy Newman) is being too short. Time to get out the gravity boots? And if that weren’t bad enough, now the folks in Manhattan say dementia can come from exposure to bacterial and viral infections. (Someone sneezed on me just the other day, and I swear my ADAS-Cog score dropped two points!)

Okay everyone, are you listening to me?? STOP! Just…stop. If there were a “Hitchhiker’s Guide to Dementia”, the first words would still be: “Don’t panic.”
Time…to…take…a…deep…breath.

What we have here is a collection of illnesses closely tied to the aging process, and a sequence of changes that may begin decades before we show any outward signs. And we are dissecting all the minutiae of the millions of things we do, eat, drink or experience in our lives—trying to find connections, however tenuous, that we can shoot to the media outlets to fuel the frenzy.

There are a lot of people making money off of our hysteria and paranoia. But it’s much worse than that.

You see, the more we fuel this kind of panic, the more we demonize the condition; and consequently, the more we demonize and dehumanize people who live with cognitive disability. Folks like Dr. Bill Thomas have long warned us that those people who do less or produce less are devalued in our society. It is also now clear that a similar fate befalls those who remember less in our hyper-cognitive, technology-obsessed world.

Here are a couple of known facts to keep in mind: We all die. Many of us who live to a ripe old age will experience changes in various organ functions and capabilities. Many of us will become forgetful as we reach our later years. Those who do are not bad people.

There is so much emphasis on “successful aging” these days—what does that mean? Are you successful if you run marathons until you are 96 and then die in your sleep, or at the completion of some incredible sexual escapade? That’s romantic, but highly subjective and unlikely. More important, this fixation on how we end our lives not only threatens to devalue who we are in our last years, but also how we have lived all of the earlier days of our lives.

And if you don’t make it to the grave with all of your organ functions intact (an oxymoron in itself), what is that called? “Failed aging”? What about people born with developmental disabilities or congenital illness? They would be “failed agers” from the very start. No need to even give them blueberries and yogurt, I guess.

You and I will always be more than the sum of what we can do and what we can remember. So here’s the advice I would put in my “Hitchhiker’s Guide”:

No matter who you are or how you live your life, you have a chance of becoming forgetful as you age. Your risk is never zero, but no one knows your exact “number”. You can almost certainly lower that risk somewhat if you eat well, exercise and do things that are good for your body, mind, and spirit; your risk will probably go up if you abuse any of those. But being obsessive about every little thing you do will likely not improve your odds to a greater extent than healthy moderation.

Find that “sweet spot” that gives you a life worth living. When we stop indulging the fear mongers, we can see the value in people of all abilities. This will help us to visualize a true path to well-being for all.


Music Can Be at the Heart of a Life Worth Living

By / Posted on January 6th, 2015

As a geriatrician, I’ve spent much of my time in the company of elders exploring life beyond adulthood. The shortcomings of our medical system to meet the human needs of elders as they navigate this uncharted territory are too numerous to list. Particularly when it comes to the way in which it treats people living with dementia. Of the 1.5 million people who have been institutionalized for medical problems, about 80 percent have been segregated from the general population because they are living with Alzheimer’s disease or dementia.

Because our medical system treats the trials of sickness, aging and changing cognitive ability exclusively as medical concerns, these people are too often tucked away from sight and treated with powerful psychotropic drugs. The treatment is not aimed at providing relief or a cure, but at making the patient more manageable – at the cost of hundreds of millions of dollars for drugs that provide limited relief and cause significant side effects.

For more than a decade, a handful of passionate organizations and advocates like myself have argued, and proved, that it can be different. Programs like The Eden Alternative, Ecumen’s Awakenings (http://www.ecumenawakenings.org), Anne Basting’s Timeslips (http://www.timeslips.org) and Dr. Al Power’s book “Dementia Beyond Drugs” demonstrate that non-pharmacological interventions for dementia provide meaningful benefits without the cost or the dangers of psychotropic drugs.

One of the most exciting of these new techniques is also the most elegantly simple – providing personalized music to people living with dementia.

The benefits of providing music to a person who has lost access to it include better memory, improved mood, decreased pain, increased engagement and enhanced well-being. Clinical studies demonstrate that it is possible for personalized music to have a greater effect than any medication.

Anyone who has doubts about the efficacy of personalized music can watch the technique graphically demonstrated in Alive Inside, the groundbreaking documentary on music and memory that is now available on DVD and streaming on Netflix.

I was honored to participate in the filming of Alive Inside with director Michael Rossato-Bennett. Time and again, Michael’s camera captured small miracles as life re-ignites in the eyes of people who have long been unresponsive after they are exposed to familiar, beloved tunes.

This simple, elegant film opens the door to a conversation about how we think about aging in general and about what we think makes a life worth living. For too long we have put the fate of our elders – our fate – into the hands of a medical system designed to focus exclusively on the repair of health and ignore what makes life significant. We’re not going to see music in the lives of every old person until we confront our own fear of aging and our own fear of death and demand a long term care system that does more than provide for safety and protection of elders. If we do that, we can build a society where nursing home means “nurturing” home. Where people go there to grow and live and love and laugh and listen to good music.

Music can be at the heart of the conversation about what makes a life worth living.


Leaving to Go Back: Al Power and the St. John’s Home Green House Project

By / Posted on June 6th, 2013

When Al Power was in med school and specializing in geriatrics, he would visit his grandmother in a nursing home. During one these visits, he noticed the nameplate on her door; the last name, “Power” had an “s” at the end of it.

“It was a note to me,” he said. “Of how anonymous she was.”

To Al, such anonymity wasn’t an issue unique to that particular nursing home — it was in the corners of every traditional nursing home. It is evident whenever elders are pushed into an institutional setting and away from their families. Away from the libraries. Away from neighbors. Away from the coffee shops. And away from the streets they know.

In other words, away from the community.

Al Power and The Green House Project are bringing elders back to a space where they know the greater community and the community knows them. It is a space that allows for growth, both for the people who serve elders and the elders themselves.

Eventually, Al left geriatric medicine, but he didn’t leave behind his passion for serving elders — not by a long shot. Even before he had left his practice he had already started working with St. John’s Home in Rochester, New York, and had learned about a new movement to revolutionize elder care embodied and supported by The Green House Project.

The Green House vision was the perfect marriage of the physical and operational change along with the philosophical change we really needed to move elder care forward,” explained Al.

“We talk about trying to create independence,” he continued. “But so many of our systems create dependence, make people shut down and feel incapable. I realized how a normalized environment can really liberate those people.”

Now Al Power and the team at St. Johns are focused on normalization. His goal is to maintain the same kind of life for elders in nursing homes as the one they had before they arrived. To do that, St. John’s took the real home concept of the Green House model one step further.

While many Green House adopters had built smaller, person-centric homes to replace the larger institutional-type buildings on their campuses, Al and his team wanted to build their new homes in existing residential neighborhoods. They wanted to bring elders out of isolation, back into multi-generational communities, where they could go to the local gym and the library and walk down the same sidewalk as other people.

Many nursing home executives try to save costs by having a central campus as a base of operations. St. John’s, in effect, wanted the exact opposite; they wanted to decentralize.

Although individual licensing of resident Green House homes proved to be an obstacle with the Centers for Medicare and Medicaid Services, the Green House Project helped resolve conflicts, brought everyone together, and helped St. John’s succeed in desegregating elders from the rest of the community.

In 2012, St. John’s became the first Green House adopter in the nation to locate individual Green House homes in the community. They built two houses, eleven miles away from their campus, in multi-generational, diverse neighborhoods. And it worked.

“When we saw the results,” said Al. “We were even more convinced that it was the way forward.”

________________

Al Power and everyone on the planning team knew that the St. John’s Home Green House Project would have success stories; they just didn’t know the stories would already be written before the homes even opened.

In preparation for opening day, the St. John’s staff invited family members, elders, and

people from the community to come have lunch. At one table, there was an elder, who Al recognized, sitting with his family. Al also knew that the man needed help from people to lift him up from one chair to another at his traditional nursing home.

Al ended up joining the man for lunch. When they finished their meal, the staff brought over the elder’s wheelchair. But before they could assist him, the man got up and got into the chair — by himself.

When one of the staff asked him how he did it, he said. “I don’t know, I guess over there I’m supposed to be sick.”

Al and the entire team at St. John’s have learned to expect more of the elders they serve. And by raising the bar for long-term services and supports in the community, they are inspiring providers everywhere to expect more of themselves.


A New Definition for Dementia explored at Pioneer Network’s 2012 National Conference

By / Posted on August 5th, 2012

To many, a person with dementia is a complex and misunderstood being, and currently the only way most people treat them is with medication.  Dr. Al Power, M.D., a board certified internist and geriatrician and Clinical Associate Professor of Medicine at the University of Rochester, New York couldn’t disagree more.  In fact, he told conference attendees today that the lessons learned with the culture change movement taking place in skilled nursing facilities could offer insight into dementia care.

Power told the group instead of looking inside the box…we need to get rid of the box!  He offered a new definition for the disease:  “Dementia is a shift in the way a person experiences the world around her/him.”

“Care should be individualized, putting the person before the disease,” explained Power, “We need a paradigm shift, to a person-directed, relationship-based model of care.”   The challenge is on us, the care partner according to Power to find a better way to communicate with those with dementia.  “We put them in places where they can’t succeed.  We need to go where they CAN succeed.”

Part of the approach would include an Experiential Audit, using “Well-being Domains”, i.e. Identity (Is my story known and understood by my care partners?), Autonomy (Do I have opportunities for choice and control throughout the day?), Security (Do I feel safe in my surroundings and do I trust those who provide my care?).

Power believes a physical, operational and personal transformation is needed for facilities and care partners working with those with dementia.  “You feel that when you walk into our Green House homes.”  Power serves as Eden Mentor at St. John’s Home, which opened two Green House homes earlier this year.

For more information about dementia and Dr. Al Power, you can contact him at:  apower@st.johnsliving.org or at his website http://www.alpower.net/


A New Definition for Dementia explored at Pioneer Network's 2012 National Conference

By / Posted on August 5th, 2012

To many, a person with dementia is a complex and misunderstood being, and currently the only way most people treat them is with medication.  Dr. Al Power, M.D., a board certified internist and geriatrician and Clinical Associate Professor of Medicine at the University of Rochester, New York couldn’t disagree more.  In fact, he told conference attendees today that the lessons learned with the culture change movement taking place in skilled nursing facilities could offer insight into dementia care.

Power told the group instead of looking inside the box…we need to get rid of the box!  He offered a new definition for the disease:  “Dementia is a shift in the way a person experiences the world around her/him.”

“Care should be individualized, putting the person before the disease,” explained Power, “We need a paradigm shift, to a person-directed, relationship-based model of care.”   The challenge is on us, the care partner according to Power to find a better way to communicate with those with dementia.  “We put them in places where they can’t succeed.  We need to go where they CAN succeed.”

Part of the approach would include an Experiential Audit, using “Well-being Domains”, i.e. Identity (Is my story known and understood by my care partners?), Autonomy (Do I have opportunities for choice and control throughout the day?), Security (Do I feel safe in my surroundings and do I trust those who provide my care?).

Power believes a physical, operational and personal transformation is needed for facilities and care partners working with those with dementia.  “You feel that when you walk into our Green House homes.”  Power serves as Eden Mentor at St. John’s Home, which opened two Green House homes earlier this year.

For more information about dementia and Dr. Al Power, you can contact him at:  apower@st.johnsliving.org or at his website http://www.alpower.net/


An Innovative Response to Global Aging

By / Posted on June 22nd, 2012

Click here to view an interview of Dr. Al Power, geriatrician, and Dr. Emi Kyota, environmental gerontologist,  as they discuss their new project called, An Innovative Approach to Global Aging: Creating a resilient community for all.  The suggestion within this project is that an essential part of resilience in communities is to create environments where the presence and perspective of older adults is seen as a normal and valued. 

The innovation of this project is a part of the Rockefeller Bellagio Center.  The Rockefeller Foundation Bellagio Center’s mission is to promote innovation and identify impact-oriented solutions to critical global problems. The Center, through conferences and residency programs, supports the work of scholars, artists, thought leaders, policymakers, and practitioners who share in the Foundation’s pioneering mission to “promote the well-being of humanity.”


Moving Day for St. John's in Rochester!!

By / Posted on February 28th, 2012

REPOSTED

Visit the original post at ChangingAge.org

“But let there be spaces in your togetherness and let the winds of the heavens dance between you. Love one another but make not a bond of love: let it rather be a moving sea between the shores of your souls.”

Khalil Gibran

The above quote was posted today by Susan Thomas for St. John’s “Eden Quote of the Day”, in honor of the first three Elders moving into our community Green Houses in Penfield, New York. This is the culimination of an incredible journey for St. John’s Home.

It has been exactly a decade since I went to hear Bill Thomas give a talk in Utica about his latest thoughts about Elderhood. At that talk, Bill described his concept of “doing vs. being”, and his visions for “Eldertopia”.

In 2003, the first Green Houses opened in Tupelo, Mississippi. Our CAO, Veronica Barber went to visit them, and on her return she told our CEO, Charlie Runyon, “We have to do this.”

Then about four years ago, with the encouragement of former DOH Dormitory Authority Director Tom Jung and Assistant Health Commissioner Mark Kissinger, we decided to take one more very big step: we decided to bring Elders back to true community engagement, by moving off campus and integrating our Green Houses into residential communities.

This set off a series of twists, turns and setbacks that pushed us back a few years in our timeline, but what we leanred in that process about our vsision, our strengths and challenges, and about our Eden journey was priceless.

And today is the payoff as, for the first time in our nation, the first pioneering Elders move to a pair of small houses 11 miles away from the main campus, nestled in the multigenerational Arbor Ridge community. Guide Rebecca Priest has been the lighthouse for this journey and her group of shahbazim, nurses and other supportive care partners is truly incredible. Very soon after, the remaining 17 Elders, people with diverse needs and abilities, will follow.

So many people have put their hearts and souls into this journey that it is impossible to mention them all. In addition to the visionary leaders mentioned above, I must make a special note of Joanne Braunle, our Project Manager, who formerly worked on NASA contracts and showed us that culture change really is rocket science! The builders at Pridemark, architects at SWBR, and our pre-design work with Emi Kiyota all made incredible contributions to the beautiful, warm and functionally versatile houses we open today.

And of course, a huge thank you to The Green House Project, especially Robert Jenkens and Susan Frazier for their guidance and tireless advocacy, and to Bill and Jude Thomas and the Eden Alternative, who have helped shape our new vision of Elderhood that will truly be a game-changer in providing living options for Elders with skilled needs across the nation and beyond.

Way to go, St. John’s; my hat is off to you!!


Moving Day for St. John’s in Rochester!!

By / Posted on February 28th, 2012

REPOSTED

Visit the original post at ChangingAge.org

“But let there be spaces in your togetherness and let the winds of the heavens dance between you. Love one another but make not a bond of love: let it rather be a moving sea between the shores of your souls.”

Khalil Gibran

The above quote was posted today by Susan Thomas for St. John’s “Eden Quote of the Day”, in honor of the first three Elders moving into our community Green Houses in Penfield, New York. This is the culimination of an incredible journey for St. John’s Home.

It has been exactly a decade since I went to hear Bill Thomas give a talk in Utica about his latest thoughts about Elderhood. At that talk, Bill described his concept of “doing vs. being”, and his visions for “Eldertopia”.

In 2003, the first Green Houses opened in Tupelo, Mississippi. Our CAO, Veronica Barber went to visit them, and on her return she told our CEO, Charlie Runyon, “We have to do this.”

Then about four years ago, with the encouragement of former DOH Dormitory Authority Director Tom Jung and Assistant Health Commissioner Mark Kissinger, we decided to take one more very big step: we decided to bring Elders back to true community engagement, by moving off campus and integrating our Green Houses into residential communities.

This set off a series of twists, turns and setbacks that pushed us back a few years in our timeline, but what we leanred in that process about our vsision, our strengths and challenges, and about our Eden journey was priceless.

And today is the payoff as, for the first time in our nation, the first pioneering Elders move to a pair of small houses 11 miles away from the main campus, nestled in the multigenerational Arbor Ridge community. Guide Rebecca Priest has been the lighthouse for this journey and her group of shahbazim, nurses and other supportive care partners is truly incredible. Very soon after, the remaining 17 Elders, people with diverse needs and abilities, will follow.

So many people have put their hearts and souls into this journey that it is impossible to mention them all. In addition to the visionary leaders mentioned above, I must make a special note of Joanne Braunle, our Project Manager, who formerly worked on NASA contracts and showed us that culture change really is rocket science! The builders at Pridemark, architects at SWBR, and our pre-design work with Emi Kiyota all made incredible contributions to the beautiful, warm and functionally versatile houses we open today.

And of course, a huge thank you to The Green House Project, especially Robert Jenkens and Susan Frazier for their guidance and tireless advocacy, and to Bill and Jude Thomas and the Eden Alternative, who have helped shape our new vision of Elderhood that will truly be a game-changer in providing living options for Elders with skilled needs across the nation and beyond.

Way to go, St. John’s; my hat is off to you!!


The Power of Choice

By / Posted on November 28th, 2011

I was speaking in Ohio earlier this month and had an experience that reinforced an important lesson for me. I was giving a community talk on dementia and a TV reporter came to interview me before the talk. We put on the microphone and launched into a 10-minute conversation on camera. She asked a lot of good questions, and then as my message became clearer to her, she threw me a curveball. (more…)