Aging in Place

Reflections on aging in Montgomery Village: Opening a conversation on challenges and opportunities.

by Sam Korper

I have just returned from my walk through parts of the Village, a daily opportunity to appreciate the natural beauty of earth and sky, greet passing walkers and their pets, and think about “stuff.”

Ever since retirement some five years ago, after nearly forty years of federal service— the last 25 at NIH—I have had more time to devote to a variety of volunteer activities, much of which builds upon my training as an epidemiologist and my career in aging research (over twenty years as associate director of the National Institute on Aging, NIH).   Now serving as a commissioner on the Montgomery County Commission on Health and as liaison to the Commission on Aging, I have been able to extend my career interests to direct local involvement in aging-related matters.

Thus it is probably inevitable that my musings include consideration of Montgomery Village as a retirement “place,” one in which to ... well ... age in place. Undoubtedly, maintaining family ties, health status and resources, the state of the economy, housing, transportation and safety are equally on many minds, but I also suspect that advancing years have lent a special emphasis—if not urgency—to these concerns. My walk-about conversations often touch on these subjects.

Following up on his brief note concerning MVF interest in assisting older residents to remain in their homes in the Aug. 28 Montgomery Village News, EVP Dave Humpton, (along with Board President Bob Hydorn and several MVF staff) has encouraged me to assist in an exploration of   “Aging in Place,” provide some general background on the concept, report on the several evolving initiatives elsewhere in Montgomery County, and what this might mean for the Village. In this series of articles, I plan to touch on a variety of subjects related to experience gained elsewhere, important services and supportive policies that would assist residents to retain independence and to remain in their homes, and thus combine both professional and personal interests.   

Future articles will look at such issues as definitions of “healthy aging,” models of the aging in place approach, and topics such as demographic trends, accessible housing issues, emergency services, and older drivers—to name a few. We will be able to amplify the column by utilizing the MVF web site to provide more detail on the issues discussed as well as provide links to additional information. I intend to fill in some background, describe what is happening elsewhere, and report on what has been learned, both pro and con. The articles will include ways that you can contact me to ask questions, suggest future issues and provide general comments. With MVF encouragement and your interest, we can make this a true dialogue.

Let me end by saying that while I have followed the evolution of “Aging in Place” for several years, I do not have a position on next steps or whether there is an appropriate off-the-shelf adaptation or “solution” for the Village, nor, I suspect, does the MVF. Perhaps together we can determine an approach—formal or informal—that best suits our vision and needs for the future.

Reflections on aging in Montgomery Village: Opening a conversation on challenges and opportunities.

by Sam Korper

Over the past few years, my “drop-in” conversations at the barber, coffee shop and gas station have gone like this: the weather, top news, sports, again the weather, and a comparison of current ailments which are often amazingly personal and clinical. Sounding like the geriatric “Top Ten,” it’s a reminder of the old quote attributed to the late actress Bette Davis: “Old age is no place for sissies.”

Surely aging is not a simple concept, but to address the question, “What is aging?” requires us to understand that, as the one biological phenomenon common to us all, organisms age from the moment of conception. Chronological aging—referring to how old a person is—is arguably the most straightforward definition of aging and may be distinguished from “social aging” (society’s expectations of how people should act as they grow older) and “biological aging” (an organism’s physical and physiological state as it ages).   

Over time, the discussion of “aging” has become ambiguous. It is increasingly popular to talk in terms of “successful” (or “optimal,” or “healthy,” etc.) aging. Three components of “successful” aging generally appear to include: low probability of disease or disability; high cognitive and physical function; and active engagement with life/society.

Distinctions are made between “universal aging” (age-related changes that all people share) and “probabilistic aging” (changes that may happen to some, but not all people as they grow older, such as the onset of type 2 diabetes).  There is also a distinction between “proximal aging” (age-based effects that come about because of factors in the recent past such as an environmental exposure) and “distal aging” (age-based differences that can be traced back to a cause early in a person’s life, such as childhood poliomyelitis). 

Most current research studies of aging ask the question, “What is normal aging?” In general, today’s thinking can be characterized by the following notions:  First, no single, chronological timetable of human aging exists. It is essentially a unique phenomenon: genetics, lifestyle and disease processes affect the rate of aging between and within all individuals. Second, decline occurs over time, but these changes, in-and-of-themselves, do not inevitably lead to diseases such as diabetes, hypertension or dementia, among others (i.e., a number of disorders that typically occur in older age groups are a result of disease processes, not normal aging). 

It is a fact of life that despite living longer and healthier, the later years of a person’s life often require seemingly drastic changes in the face of ‘relatively’ minor changes in physical condition. Threatened independence as a consequence of inevitable decline creates multiple dilemmas. It often feels as if the health care needs of growing older and the maintenance of our aging housing—indeed our capacity to age in place—go hand-in-hand.

It is the intent of these articles to explore the relationship among the health of older persons, our capacity to remain at home and individual and community approaches to many of these issues. While the articles cannot address personal concerns or offer individual advice, I plan to raise questions and issues that are relevant to older people and their families here in the Village. Neither I nor the Montgomery Village Foundation want to do this alone. We want to hear from you.

Reflections on aging in Montgomery Village: Opening a conversation on challenges and opportunities.

by Sam Korper

As the snow(s) slowly receded last month, so did my occasional flights of fancy about living in a year-around climatic paradise—a constant 80-ish degrees and just enough early-dawn rain to create jewel-like dew on the perfect grass. Soon enough, I found myself snapping back to a 40-degree-induced-reality, walking through a newly cleared waist deep channel cut into the hills of snow covering the sidewalk along the curves of (previously impassible) Stedwick Road.

I also thought about the many snow-related acts of kindness—spontaneous, random and otherwise—that I witnessed. These acts of neighbors helping neighbors occurred in my cul-de-sac “place,” and, I suspect, in others as well. For a moment I thought we had a classic village, and gradually as the temperatures warmed, so again did my feelings about remaining—and aging—in this place. My informal discussion with other residents, my research and my instincts tell me that I am not alone.

Most seniors want to stay in their homes as long as possible. Ninety-five percent of respondents to the AARP 2005 study Beyond 50 did. Our own Montgomery Village Foundation 2009 Survey of residents found that about a third of the (268) respondents believed that Montgomery Village would be a “good” or “excellent” place to retire. Several national studies of seniors, as well as those conducted here in Montgomery County, suggest that a majority of seniors would prefer to age in place.

The findings of the 2005 55+ Housing Preference Survey conducted by the Montgomery County Department of Park and Planning, which conducted interviews with 1,200 Montgomery County residents aged 55 and older, are quite compelling. When asked where they will be living in the next ten years, some 58 percent of the respondents thought that they will always live in their current residence. Nearly half have lived in their current residence for over 20 years, and some 30 percent for greater than 30 years. Nearly a third thought that they will move eventually, but can't say when.

More than 80 percent of respondents to the 55+ Survey did not prefer seniors-only housing as an alternative, although some 30 percent said that they would be interested in “Active Adult” communities. One interesting area of the survey dealt with the question of “why move after retirement?” For those who eventually plan to move, the top five reasons are: economic, traffic congestion, better climate (so perhaps I am NOT crazy), desire to be closer to children, and a foreseen lack of accessibility in their current housing. This last reason relates importantly, of course, to problems with daily living activities such as difficulty climbing stairs, meal preparation, bathing and housework.

The concept of “acceptable living conditions” is, of course, highly individual. Beyond one’s own physical capabilities, the deteriorating condition or safety of the home is often not fully appreciated by residents. Sometimes other family members don’t see the current home as safe or supportive as the older resident does, and stress and conflict can result. These findings barely scratch the surface of available information on the subject, and future articles will examine several of these issues in greater detail.

The Montgomery County Commission on Aging has actively explored these topics and recently produced a report entitled “Aging in Place.” The commission adopted the following definition of Aging in Place:

         “ .... a choice made by older adults who wish to remain independent in their community (an/or their homes), living with or without assistance. To do so often involves questions of safety, health, affordability, accessible services, socialization, transportation, recreation and other supports.”

The commission determined that living independently does not preclude the need for some assistance. Older adults may require access to a variety of services designed specifically to enable them to remain in their homes or neighborhoods safely and in a manner that is both physically and psychologically healthy. The costs of various alternatives to the problem remain elusive, and there are no local studies that compare the costs of providing services designed to support and keep older adults in their homes with the cost of equivalent congregate facilities. What is clear, however, is that few communities will have sufficient resources to provide, on an unlimited basis at reasonable cost, the range of services seniors will need. Therefore, approaches that allow older folks to successfully age in place will, of necessity, have to evolve. But in what manner and form?

The population of Montgomery Village is now almost 40,000, of whom only some 3,000 (13 percent) are aged 65 years and older. So, while the Village may be a place to retire, it cannot reasonably be called a “retirement village.” But can it even really be called a “village?” The short answer is “no.” This is because the U.S. Bureau of the Census combines the relevant census tracts of Montgomery Village into a Census Designated Place (CDP) and makes us generally indistinguishable from Gaithersburg. Much more will have to be learned about our specific characteristics before the best options in support of aging in place become apparent.

The Articles of Incorporation which proclaim the “promotion of health, safety and welfare of the residents of Montgomery Village” in the mission statement for the Foundation were written in 1966. Now, more than 44 years later, with our steadily aging population, and more “boomers” being added to the numbers daily, we need to think about what kind of “village” we want to become at middle age and beyond.

Reflections on aging in Montgomery Village: Opening a conversation on challenges and opportunities.

by Sam Korper

We’ll get to Harry in a minute, but first, Clarence and Milton. I’m talking about the Montgomery Village ‘Founding Brothers,’ the Kettlers, of course. Recently, I have been rummaging through boxes of early Village documents to better understand the ‘vision’ for Montgomery Village and create a historical context for my current interest in our village as a retirement place.

At a March 1964 meeting in Gaithersburg City Hall of the Montgomery County Council, Milton Kettler laid out his vision for Montgomery Village: “We are building here for the future, a place where thirty-five thousand people can live together in harmony with each other and with nature.” Twelve years later, in a 1976 interview in Living in Montgomery Village Today, Kettler Brothers’ President Clarence Kettler said:

“ … when you build a new town over a period of years, you have to change a hell of a lot of things. Markets change, costs change, fuel and energy problems develop, family size and structure changes, peoples’ needs and desires change, their senses of value change. That’s my biggest job—to understand and sense change.”

These expressions of the original vision for Montgomery Village have remained pretty durable over time, but recognizing and heeding the need for flexibility in the face of change is also valuable to consider. And now, close to the Village’s 45^th anniversary, it is clear that much has indeed changed. Inevitably, many of our residents, like the housing itself, have aged. The demographic changes occurring in America—the aging of our society that will be with us for the foreseeable future—have important implications for the nation, the state and county, and not least (and perhaps most important!) ourselves and our immediate surroundings.

In the end, aging is, of course, a very personal transition. While losses may occur at any age and stage of life, it is our loss of the ability to function independently that is, perhaps, the most disconcerting. The term ‘independence’ has a variety of meanings that are reflective of social, political, and economic conditions, and the attitudes and values brought by and towards older people. This is tough stuff, and psychological aspects—ranging from simple frustration and inconvenience to severely complicated feelings of anger and fear—are at the heart of the loss of independence. Reactions to loss of independence vary, but numerous surveys have documented that older adults fear loss of independence more than death. Did I say this was tough stuff? And, despite their threatened independence, many are quite uncomfortable asking for—or accepting—assistance, particularly from beyond immediate family. So, what can be done? That is a fundamental question to these articles.

In an earlier article, I reported on findings that a great majority of people aged 65 and older want to stay in their current homes a long as possible, and would prefer not to live in seniors-only housing. To make this desire a reality, across the U.S. (and around the world), numerous examples of elder-friendly communities or ‘villages’ have evolved. Closer to home (pun intended), Montgomery County has responded to the challenge in a dynamic and supportive fashion. Either modeled on community experience elsewhere, or devising local adaptations, some 15 or more local communities have begun or are in the planning stages of such an effort. Future articles in this series will be examining this evolution, and considering possible lessons for us here in Montgomery Village.

This brings me to Harry. Harry Rosenberg has been the visionary and change agent in creating a nonprofit organization for his neighborhood to help senior and disabled neighbors age in place. That ‘place’ is the Bethesda neighborhood of Burning Tree. Harry’s vision (along with Leslie Kessler and Barbara Filner) is Burning Tree Village, a nondenominational volunteer organization established to help people remain in their homes as they age. The Burning Tree neighbor-helping-neighbor village became operational in 2008, is open to all regardless of age, and builds upon volunteer efforts and has evolved partnerships with other organizations that complement the volunteer activities.

Burning Tree Village identified an array of services which include neighbor-to-neighbor assistance; concierge service and vendor recommendations (i.e., such as plumbers, carpenters, electricians, etc.); wellness services (i.e., blood pressure testing, health aides, etc.); educational programs (i.e., seminars on topics such as home accessibility modifications, reverse mortgages, etc.); and social activities (i.e. organized trips, etc.). In addition, a particular focus has been on transportation, and Burning Tree Village has chosen to establish a partnership with The Senior Connection, a long-established volunteer organization that has provided driver services in Montgomery County.

Burning Tree’s progress to date has been deliberate and incremental. Along the way, a great deal has been learned—and is constantly and cheerfully shared—with other communities in Montgomery County which are exploring the possibility of creating something similar … or unique according to their local needs. Of course, there are a variety of alternatives to be explored and innumerable administrative questions to be resolved. Despite all the changes that are inevitable, all that is going on elsewhere in the county, and with the support of the county government and the Montgomery Village Foundation, it is not clear to me that the residents of Montgomery Village will be interested in actively considering this approach to aging in place. That’s why these articles are being written.

Reflections on aging in Montgomery Village: Opening a conversation on challenges and opportunities.

by Sam Korper

Since this series began, a dozen Village residents have contacted me expressing their interest in aging in place, and their support for a future meeting of Village residents to informally share ideas on the subject. I am most appreciative of these expressions—both in print and as I meet and talk with folks in person—and look forward to the opportunity for more direct participation.

This article continues the update on current aging in place developments in Montgomery County. Perhaps the best place to begin is with recent discussions of aging in place that have been taking place in the Montgomery County Council. On Sept. 17, 2009, a council work session about community efforts and services related to seniors and aging in place was supported by a very thorough background report entitled “Naturally Occurring Retirement Communities and Neighborhood Villages” prepared by the Office of Legislative Oversight (OLO—Report Number 2009-11, June 16, 2009, by Leslie Rubin et al.). The OLO report can be accessed online via the Montgomery County website at http://www.montgomerycountymd.gov/content/council/olo/reports/pdf/2009-11.pdf.

The OLO report is an important resource, and is recommended reading for those of you seeking good background information, as it describes some of the early history surrounding the aging in place movement (reviewing such prototypical “villages” as the Beacon Hill Village starting in 2001 in Boston, Massachusetts and Capitol Hill Village in Washington, D.C. among others). It also discusses common challenges for seniors aging in place and the aging-related demography of Montgomery County, and describes several of the neighborhood villages that are evolving in Montgomery County, such as Burning Tree Village, that I mentioned last month.

As a brief summary, the most obvious thing about villages evolving in the county is their wide variety and, of necessity, adaptability to local circumstance. The common service elements appear to be transportation; information and referrals for services; friendly visitation or phone calls; assistance with household repairs and maintenance; and social and educational programs. Of course, safety, health care and personal care are also important areas of concern expressed by seniors attempting to age in place.

The OLO report also examines the future implications of the growth in the senior population forecast for the next two decades. Projections show that in nearly all county planning areas, the senior population is growing at a faster rate than the non-senior population. By 2030, almost all areas will experience a larger number and higher percentage of seniors, and Gaithersburg is expected to surpass Bethesda/Chevy Chase as the planning area with the largest number of seniors in the county. For many such analyses and projections, Montgomery Village is often not specifically identified or distinguished from Gaithersburg, which poses some difficulty in trying to develop precise estimates for us here in the Village.

The OLO report summarizes the county government’s active support for neighborhood villages. The county’s Office of Community Partnerships, the Department of Health and Human Services’ Aging and Disability Services, and the Regional Services Centers are involved in sponsoring community forums, resource exchanges, an electronic discussion listserv, volunteer training and a village “Tool Kit” (which includes survey forms and other materials), all of which would be available to assist analysis and discussion in Montgomery Village.

Most recently, on Feb. 4, the Montgomery County Council held a follow-up discussion about neighborhood villages, receiving additional briefings from county executive branch representatives and addressing questions of demand, cost and alternative policy approaches. In addition to Burning Tree, three county neighborhood villages or organizations are Bannockburn Neighbors Assisting Neighbors, Chevy Chase at Home and Cabin John. Neighborhoods currently exploring the development of a village are Garrett Park, Carderock, Fallsmead and West Bradley. Several others are in an early discussion stage.

A background paper prepared for the council noted that “a policy to help guide the development and prioritization of county programs and services for seniors is essential given the demographic imperative and the older adult population.” It is likely that the current economic condition of the county will negatively affect the pace of the aging in place developmental activity as much of it is sponsored by the county. However, much background experience and guidance exists upon which Montgomery Village might draw.

As we consider the future, I believe the social impact of the demographic changes occurring in the Village should receive some attention and assessment in parallel with the upcoming visioning process seeking to determine “... what Montgomery Village will look like in terms of land use over the next 20 plus years,” as described in the recent Montgomery Village Foundation 2009 Annual Report.

Looking again at the description of the visioning process, it is difficult to find much mention of an assessment of the inevitable changes and social adaptations that match the attention to be paid to the physical environment. I wonder whether we might give this some thought along with land use, new facilities and roadways, asphalt, bricks and mortar. To do so is consistent with the purpose of the Foundation to promote health, safety and welfare of the residents as stated in the Articles of Incorporation and anticipated by the Village's founders. This vision should be intergenerational as well as intragenerational, acknowledging the important relationships and ties that exist within and between generations.

Next month I will provide additional information about specific neighborhood activities, and discuss some of the trade-offs and policy decisions that aging in place alternatives demand. In future articles, I plan to discuss specific issues such as transportation and housing, and welcome your thoughts and suggestions for future topics.

Reflections on aging in Montgomery Village: Opening a conversation on challenges and opportunities.

by Sam Korper

This is the sixth article in the Village News series on aging-related issues in Montgomery Village, and it is probably time to take stock of where we are, where we are headed and whether a community-wide discussion of these topics is in order. More than a dozen readers have expressed interest in this topic and some have volunteered to assist directly in this effort.

Given its unique characteristics, Montgomery Village will have to find its own unique solution. But so far, even the right questions remain to be identified. In order to move forward, a wide variety of concerns will have to be addressed, answers found, and strategic decisions made. Previous articles have referenced experienced resources available here in Montgomery County and elsewhere throughout the state and country that are available to assist us in this effort. Articles, studies, surveys and check lists abound.

Amid this wealth of easily accessible guidance, it is easy to forget that there are two essential conditions for moving forward: leadership and commitment. Numerous individuals over the past few years who are involved in the consideration of aging related questions in general, and the village movement in particular, all speak to this prerequisite. Harry Rosenberg of the Burning Tree Village in Bethesda, which has formed to help neighbors remain in their homes (“age in place”), provides the following advice: “we believe the following are essential ingredients to making villages happen in Montgomery County and elsewhere:

1. Leadership and commitment. From our experience over the last two years, we believe that it is essential to have a core of neighborhood leaders—an organizing committee if you will—who are willing to give time, energy, and effort to create a village.
2. Collect information about neighborhood resources. It is essential, we believe, to conduct a survey to find out who in the neighborhood is willing to volunteer services and what particular skills they have to offer.
3. Communication mechanisms. There has to be an effective way to communicate with neighbors. This can be by telephone or e-mail, as well as using volunteers to distribute fliers. Information about telephone numbers and e-mail addresses should be part of the neighborhood survey.
4. Strategic decisions. Strategic decisions have to be made on a number of issues among which one of the most important is how to link volunteers with those who request services.
5. Funds. Some funds are essential to operate the village. At a minimum, funds are necessary for photocopying, renting space for meetings, possibly for a telephone and for legal filings if the village is to become incorporated and, therefore, eligible for grants.
6. Liabilities. Liability issues can arise. Even when a kind-hearted neighbor helps another neighbor, something can go amiss. For example, there can be an accident in a car, in a home or on the sidewalk. Volunteers and the village need to be cognizant that liability issues can arise.”

(The complete document from which this excerpt is taken is available online: www.montgomerycountymd.gov/Content/PIO/senior/doc/10_village_appendix_positionpaper.pdf.)

Perhaps the biggest question is: ‘why this, why now?’ A particular challenge is “convincing people to join sooner rather than later,” according to Katy McDonough, director of the Washington, D.C. Capitol Hill Village, in a recent article entitled: “Villages are growing—with growing pains” by Glenda C. Booth in the May, 2010 Washington Beacon.

Many folks don’t think of themselves as in the midst of age-related challenges which might be reduced or resolved with or by neighbors. Villages are designed to assist with health, housing, transportation and a host of other “problem areas” facing our aging residents. How many Montgomery Village residents are now—or will soon—face these problems? Without surveys and discussion, we can’t know what we don’t know.

In these tough times, thinking about the future is perhaps too hard. But is it? In previous articles I have asked whether a Social Visioning Process might be conducted in parallel with the ‘bricks and mortar’ planning of Vision 2030. In a recent “Letters to the Editor” comment by a Village resident, a plea to consider “citizen-centric Strategic Plan Goals” was put forward (Village News, Friday, June 11, 2010). This is precisely the kind of undertaking required to understand the current requirements of our aging residents.

Clearly there is much to be done. To move this effort forward, it is important that you let me or the Montgomery Village Foundation know of your interest. Please contact me or the MVF in writing or e-mail at the addresses at the bottom of this article.

Web sites of organizations large and small, public and private, offer materials for hands-on application here in Montgomery Village. Examples include AARP (http:// assets.aarp.org); Partners for Livable Communities (www.aginginplaceinitiative.org); Met Life Foundation (www.n4a.org); Maryland Department of Aging (www.mdoa. state.md.us); Montgomery County (www.montgomerycountymd.gov/content), among literally hundreds of others.