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Mind, body and purpose hold the key while coordinated programs save health system money and struggle for acceptance

PORTLAND TRIBUNE: JAIME VALDEZ - Ruth Greene found affordable rent and a sense of usefulness at Bridge Meadows, where seniors commit to help resident foster parents and their children, including four-year-old LiLianeThe cookie lady is in the house. That's how Estelle Winicki is referred to by the kids at Bridge Meadows apartment complex in North Portland. They know they can knock on her door and there will always be cookies available to them at Winicki's kitchen table.

One ten-year-old girl just likes to come over and sit, sometimes eating cookies, sometimes not, sometimes talking, sometimes not. The kids at Bridge Meadows are all children being adopted out of the foster care system, so they've experienced trauma of one kind or another, and Winicki is happy to provide them a place to just decompress, if that's what they need.

Columbia Pool is two blocks away, and Winicki has been taking two of the Bridge Meadows children there and teaching them to swim. What's especially nice about that, Winicki says, is that the swim lessons don't feel like a volunteer effort, but "just a normal part of the day."

Winicki says she's found more than an affordable retirement home at Bridge Meadows (her rent is $550 a month), she's found the very thing that might help her live longer and with more vitality.

"It gives me purpose," Winicki says. "Every time I walk out the door and I talk with somebody, it's like, what can I give them that will help them?"

Pretty much every afternoon Bridge Meadows resident Mary J. tutors 12-year-old Reba and ten-year-old Lydia, who live with their mom, Reba Chainey, a few doors down. Sometimes Mary J. babysits as well. Last week the four of them drove to Cannon Beach for the day.

Mary J. once taught at John Ball Elementary School, which stood on the full block which now hosts Bridge Meadows. After retirement Mary J. needed a way to feel useful, but she never thought she'd find it right in her own apartment complex.

Juanita Rivera Laush is convinced that living at Bridge Meadows will help her live longer, or at least better. At 93, Laush is the community's oldest resident. A one-time teacher, she now hosts writing groups where she makes adult residents try their hand at poetry, and she teaches Spanish to some of the children who share her Hispanic background. Which is a far cry from the isolated retirement she faced in a Lake Oswego apartment a few years ago.

But what most convinces Laush that the seniors at Bridge Meadows will live longer and healthier is the change she sees when new residents arrive. "You see them kind of bloom," Laush says.

If Oregon Health & Science geriatrician Dr. Elizabeth Eckstrom is right, Winicki, Mary J. and Laush are likely to live longer and more vigorously because of their residence at Bridge Meadows, a unique, inter-generational living experiment. Yes, says Eckstrom, who is on a world tour studying the best places for aging, diet is important, as are exercise, good health care and social connections.

But ask Eckstrom what she's found to be the single most important factor in keeping seniors robust into their nineties and beyond, and she says it's feeling needed and useful. That's what astonished Eckstrom in places such as Sardinia, where men in their eighties and nineties are responsible for pruning the town olive trees. And it's precisely what Eckstrom says she has seen at Bridge Meadows.

Bridge Meadows was conceived as a place to provide inexpensive housing for low-income families (often grandparents) in the process of adopting foster children. Those adoptive families inhabit nine of the Bridge Meadows apartments. The other 36 apartments are reserved for low-income seniors who pledge to volunteer at least 100 hours each quarter helping out the community.

Some Bridge Meadows seniors report that their physicians are telling them their blood pressure has dropped since they arrived, and others are coping better with chronic illnesses such as diabetes. Executive director Derenda Schubert wants to start swabbing the cheeks of her seniors to see if their cortisol levels have been declining. High levels of cortisol in the elderly has been associated with increasing disability.

Schubert's hope is that she can assemble data that proves the benefits and cost savings of Bridge Meadows. If Bridge Meadows foster children get adopted faster and graduate high school at a higher rate than most foster kids, and if the community's seniors have lower medical bills, maybe, she says, social venture capitalists will recognize the value in funding more inter-generational living communities.

What's keeping the Bridge Meadows model from quicker expansion is cost. In the past, similar projects around the country were placed on inexpensive land outside cities. Bridge Meadows is the first to try an urban, residential inter-generational facility.

Bridge Meadows' construction utilized federal housing tax credits among its funding sources, which contributed to a sky-high cost of about $300,000 per apartment. Private donations helped. The old school site came courtesy of a $1 a year lease from the city of Portland — a savings unlikely to be duplicated at future facilities. But the entire project cost over $11 million, and that doesn't include the operating expenses.

Bridge Meadows maintains a staff of nine, which includes an on-site therapist available to foster families and a community support specialist who leads activities such as wisdom circle gatherings where seniors discuss aging. The entire complex is designed with open spaces and community areas that encourage the different generations to bump into each other and mingle.

"That's one of the marketing problems in explaining it," says resource development director Lisa Steenson. "Because there's nothing to compare it to."

She's not having trouble marketing the concept to seniors. A second, larger Bridge Meadows facility will open in Beaverton in two months with 36 senior units and Steenson reports 70 seniors have already called to be placed on the waiting list, even though the application process hasn't opened yet.

PORTLAND TRIBUNE: JAIME VALDEZ - When Reba Chainey (left) stepped up to adopt her own grandchildren, she knew she'd need help. She found it at Bridge Meadows, where fellow resident Mary J. (left), a retired teacher, became an everyday tutor, babysitter and friend.In her visit to Japan, geriatrician Eckstrom was impressed by trained community members who keep tabs on local seniors. Grocery store clerks learn, for instance, to watch for and report elderly customers unable to count their change.

Loren Anderson doesn't speak Japanese, but the Japanese model sounds familiar to him. Anderson

fills the role of unofficial first responder to the elderly, as a bus driver for Providence ElderPlace in Gresham.

A few weeks ago Anderson, a senior himself, noticed a "serious bruise" on the arm of a woman he picked up at a residential care facility to drive to the Gresham ElderPlace day center. He asked about the bruise and the woman said she had fallen in her room but it didn't hurt much so she hadn't told anyone.

When he dropped his passengers off at the Providence day center, Anderson filled out a report and talked to a nurse about the bruise. The woman was taken to the ElderPlace clinic where doctors found she had a fracture.

All 45 ElderPlace bus drivers have been trained to look for bruises, disorientation or deep coughs, and to fill out reports that are given to each patient's health care team. A usually chatty rider who is silent or one favoring her left side when boarding the bus might also spark a report. Sometimes drivers or their supervisors attend morning staff meetings with doctors and nurses discussing each client.

The nine ElderPlace facilities scattered around the Portland metro area serve 1,296 seniors with the goal of emphasizing what is called their health span over their life span. Seniors sign up for all-inclusive care, from physical therapy and rehab to long-term care should they need it. Getting picked up by the ElderPlace bus for a weekly activity at the day center or for transportation to a medical appointment is part of the package.

ElderPlace was modeled after a Chinese-American facility for the elderly in San Francisco called On Loc, which started as a day center for senior activities and expanded its offerings for clients in a culture in which moving to a nursing home was considered shameful.

Senior care is too fragmented, says ElderPlace Medical Director Dr. Maureen Nash. Doctors might not be talking to physical therapists who might not be working with the long-term care facility where a client has gone to live. ElderPlace, using a model called Program of All Inclusive Care for the Elderly (PACE), takes a capitated per client fee from Medicare and Medicaid to provide all living and health care services, including higher levels of care as clients become more frail.

Which means Providence Health and Serivces, which runs ElderPlace, has a financial incentive to keep its elderly clients as well as possible, and living at home as long as possible. Which just happens to be best for seniors, according to a number of studies.

"The goal of good medical care is shrinking that time when one is totally disabled and then dies," says Nash. "That's what we're able to do. Keep them functional longer so there is a shorter period at the end when they need acute care."

The program saves money while serving the three percent of the senior population who are the most medically fragile. Federal studies show the average PACE patient is costing eight percent less in Medicare and Medicaid dollars than similar patients outside the program. The key, Nash says, is focusing on chronic health problems such as heart and lung disease and mental illness, and catching deterioration early.

About seven percent of the ElderPlace clients still live in their own homes. While all the clients have medical conditions that make them eligible to live in nursing facilities, only three percent live there. More than six in ten ElderPlace clients suffer dementia, but only 14 percent are in memory care facilities—another point of pride, says Ellen Garcia, Providence ElderPlace executive director.

Nash's major frustration is that ElderPlace doesn't serve more Portland-area patients, especially those who aren't so fragile. With its capitated payment model, ElderPlace is actually operating like a mini health plan, but one without young, healthy subscribers to offset the costs incurred by the most medically fragile. Getting senior enrollees who are younger and functional but still meet the state's nursing home eligibility criteria is critical to keeping overall costs manageable.

"If we can give them comprehensive care at a younger age, we can help sustain functioning longer. And that's everybody's goal," Nash says. "Everybody wants to be as functioning as possible as long as possible. The ideal death is in your sleep."

In Japan, Eckstrom also studied communities with huge numbers of seniors suffering dementia, and health care systems that are being forced to evolve so those seniors can be cared for at home. Traditional Japanese culture had children caring for their aging parents, but many of those children now live in Tokyo or other large cities and there are few nursing homes or retirement facilities.

To compensate, everyone age 40 and over pays a tax of about $30 a month to fund an extensive home care program. Nurses and aides come out nearly every day to provide therapy, bathe patients or vacuum. Physicians visit elderly patients in their homes about every two weeks.

A Portland version, which is limited to adult home bound Portlanders, is called Housecall Providers, and it has proven to save Medicare and Medicaid money by getting care to home-bound seniors with chronic diseases. In fact, a federal study showed the nonprofit netted a 26% savings in patient health costs ( $830 per patient per month) compared to costs for a similar group of home-bound seniors who did not receive home-based primary care.

The problem facing nonprofit Housecall Providers is the same one limiting the reach of the ElderPlace program—both save money, but they aren't set up to operate in a fee for service environment. The savings come from avoiding hospital and rehabilitation center stays, and by helping seniors continue to live in their homes.

It isn't easy for researchers to prove the benefits of getting seniors more involved in life outside their homes, but Portland nonprofit Geezer Gallery, which provides art therapy in senior residential facilities throughout the metro area, has hooked up with local medical researchers in a clinical study on how the arts programs can reduce depression and increase cognitive functioning in the elderly.

Geezer Gallery founder Amy Henderson is not an artist by background. She's lead gerontologist for Portland's National University of Natural Medicine, and she was inspired ten years ago by Harvard and Yale University studies that showing seniors with positive perceptions of aging lived, on average, 7.5 years longer than seniors who perceived themselves as less capable as they aged.

Henderson wanted to bring art therapy into senior living facilities. She also wanted to open an art gallery to display the work of senior artists. She chose the name Geezer Gallery precisely because it is provocative. Even seniors hated it, and that was fine with Henderson because she wanted them to embrace their age.

"What I wanted to confront was people thinking ducks and doilies," Henderson says. "Why would you think that? That's an ageist idea."

Most of the work on display at the downtown gallery comes from accomplished artists who just happen to be over 60. One work, by a 75-year-old who had been unable to get a traditional local gallery to represent him, sold for $15,000.

Sixty percent of the selling price at Geezer Gallery goes to the artist, and 40 percent supports the art therapy programs delivered to low-income seniors. But what gerontologist Henderson really wanted was data to support a 2006 George Washington University study which showed seniors (average age 80) who engaged in creative arts used less medication, had slower cognitive decline, suffered less depression and fell less often.

Henderson, in partnership with OHSU and the Oregon Center for Aging & Technology, put sensors into the homes of 30 local seniors to unobtrusively measure residents' walking speed, how often they got out of bed at night, and how frequently they entertained visitors. Then the seniors were provided regular art therapy for six months. The home measurements continued, but in addition art therapists and researchers were observing body language, attitude and the skill level of participants.

The sensors showed that while engaging in art programs, the seniors walked faster, left home more often, and had more visitors—all signs that they were less lonely. Three months after the arts program ended there had been some regression, but most of the seniors still maintained better attitudes and more capability than when they had originally been assessed.

Henderson says researchers definitely found the participating seniors had improved their moods and become more sociable, but the study didn't last long enough to tell if the progress of their dementia had been slowed. Henderson is convinced more long-term studies will prove just that.

It's time the Portland area began thinking about more programs like Bridge Meadows, Geezer Gallery, ElderPlace and Housecall Providers, and an environment which might foster them, says Dr. Foy White-Chu, an OHSU geriatrician and director of the school's geriatric fellowship program.

"I wish our communities were having the conversation of how we harness this incredible resource of healthy aging," says White-Chu. "This society idolizes youth. Why can't we idolize inter-generational collaboration?"


PORTLAND TRIBUNE: JAIME VALDEZ - Candyce Scott's mobiles hang from the ceiling at the Geezer Gallery's space at Artists Repertory Theatre. Scott, 68, is the gallery's art program director.A purposeful city held back by backward thinking

Portland has a ways to go if it wants to design a city for what local geriatrician Elizabeth Eckstrom calls "purposeful aging." The Santa Monica-based Milken Institute Center for the Future of Aging has Portland-Vancouver ranked 40th out of 100 large metros in its list of Best Cities for Successful Aging.

Portland scored well on the Institute's wellness, education, transportation and convenience criteria, and middle of the pack for general livability, health care, financial security and community engagement according to Institute spokeswoman Tania Pantoja. It ranked below average for senior employment and living arrangements.

That last is about right, according to Margaret Neal, director of the Portland State University Institute of Aging, who says local housing costs and the job market work against seniors. "There's a lot of ageism here," says Neal. One reason is that a chunk of the local economy is involved with high tech and sportswear businesses, which Neal says tend to retire people early and rarely hire older workers.

Also, according to Neal, there hasn't been as much emphasis here on healthy senior living as there has been on late in life health care.

"One of the things gerontology as a field has not been good at doing is thinking of older adults from a strength perspective," Neal says. "The focus has always been on the vulnerable, the poor, the frail. It's an ageist perspective. It assumes that all older adults need help."


Best Cities for Successful Aging

1. Provo-Orem, Utah

2. Madison, Wis.

3. Durham-Chapel Hill, N.C.

4. Salt Lake City, Utah

5. Des Moines, Iowa

Others

10. San Francisco-Oakland-Hayward

11. New York-Newark-Jersey City

14. Minneapolis-St. Paul

22. San Diego

26. Kansas City

40. Portland-Vancouver

43. Seattle-Tacoma-Bellevue

56. Los Angeles-Long Beach-Anaheim

Source: Milken Institute

For more details:

successfulaging.milkeninstitute.org/bcsa.taf?page=large-metros

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