Wednesday, September 14, 2011

Aging in Community

The Halifax Working Group on Aging has begun placing an article in each issue of the Halifax Shambhala Centre newsletter (the Banner) to stimulate discussion about aging related issues. This article, from the Sept/Oct 2011 issue, explores some issues related to housing.

Aging in Community

Where will we live as we grow old? This question seems to arise more and more often these days. I hear it from friends who are sixty and older, and I hear it in my own mind. Where do we picture ourselves living over the next ten or twenty years?
One vision that seems quite common involves living where we have easy access to contact with family and friends. Some people describe this as “aging in community”.
It sounds great. You have family and friends available for social support and for more intensive help should you need it. But the question is how to achieve the goal of “aging in community”.

Over the past several years I’ve been collecting some possible answers to that question. Partly this has been part of my role as chair of the Shambhala Working Group on Aging, a part of the international Shambhala governance structure. Partly it has been related to my personal situation. I turn 70 in November. In the past two years I see increasing signs of my own physical and mental vulnerability. The idea that I may actually need some frequent support from people beyond my immediate family seems more and more believable.

So here are a few ideas I’ve come upon. They don’t make up a comprehensive survey of how we could live as we get old, there are many approaches and projects I haven’t included and don’t even know about. And I do have my own bias about which approaches are practical. Please keep that in mind as your read this article.
For the purposes of the article I have divided the approaches into two main categories: (1) physical community, with people living in close physical proximity, and (2) virtual community, with people linked together but not necessarily physically near one another.

Physical community: Often, when I hear people talk about aging in community it is in the context of intentionally creating some kind of physical community. That is, moving into a living situation that is physically very close to a number of other people. Here are few examples:

There are some lovely and inspiring projects that have been going on for many years, such as the Camp Hill movement(http://www.camphill.org/). These are almost utopian projects, set in rural settings, with a wonderfully humanistic philosophy of aging.

An interesting current trend is Co-housing. With careful planning, a community is brought together to live in close proximity to one another. There are some lovely co-housing projects for seniors such as the Silver Sage development in Boulder, Colorado (http://silversagevillage.com). Senior co-housing usually does not include the ‘levels of care’ concept used in retirement communities.

Retirement communities with multiple ‘levels of care’ are a popular approach in mainstream North America. You buy into the overall project and start with a nice apartment where you are totally independent. When you begin to need for assistance you can move into a different section of the community where supports are available. Some Shambhalians have looked into the possibility of gathering a group of friends and all buying into the same retirement community. (In a similar way, a group of friends could organize themselves to move into the same co-operative housing building).

There are many "Faith-based retirement communities” (http://www.bestguide-retirementcommunities.com/christianretirementcommunities.html) but very few of them are Buddhist.

However, recently the San Francisco Zen Center has been working on developing a large retirement community in Northern California. They partnered with Northern California Presbyterian Homes and Services, a big non-profit that already runs several large retirement communities. A marketing study has been completed. Their systematic business approach is an interesting model.

Could we, as Shambhala practitioners, create a physical community, a cohousing project, a retirement community? From what I have seen so far the obstacles are that, like any large-scale project, it requires a long and complex process of planning, and major financial investment.

Virtual community: Aging in Place / Aging at Home. Another approach that may less complex and costly is to create a ‘virtual community’ that supports people in their current living situations.

This kind of “Aging in Community” was explored by social workers in the 1980s. They were trying to figure out how to efficiently provide services to seniors living in urban areas. They realized that creating new community housing that would bring the seniors together in a close physical community was both expensive and not very popular with the seniors themselves. Most seniors wanted to stay where they were, even if the conditions were not perfect. The idea of then was to bring the social services to the seniors where they lived, rather than moving the seniors to the services.

The province of Ontario has invested heavily in an‘aging at home’ initiative (http://www.health.gov.on.ca/english/public/program/ltc/33_ontario_strategy.html) that includes home health care and home renovations.

The Village Movement: Recently the basic idea of ‘aging at home’ has been developed in an innovative way by seniors, many with significant financial assets, who want to stay in their own homes as they age, but recognize the need for increased support. Rather than waiting for government or social agencies to create supportive program, they did it themselves.

The innovative process they used was simply to join with other people in a similar situation and set up a group buying organization that would facilitate affordable and efficient access to any extra help you need so you can stay in your current home. These kinds of organizations are appearing in a number of places under the name of the Village Movement (http://www.vtvnetwork.org).

One of the original and most highly developed ‘villages’ is on Beacon Hill in downtown Boston. Their website (http://www.beaconhillvillage.org)provides a great introduction to this approach. It shows the wide range of services to which they provide access. These range from home health care to delivery of groceries to plumbers. One interesting feature is that there are membership categories for people of varying income.

So what is involved in creating a ‘village’? In brief, a group of people (it could be exclusively seniors, or not), form a buying group and negotiate priority access, and discount price, from professional services of various kinds that are relevant to helping the members stay in their homes as they age. In doing so a community is formed. It is interesting that a ‘village’ is not primarily set up to have its members help one another directly, but by participating in the organization the opportunities for mutual support are obviously enhanced.

Conclusion: This article is a ‘finger painting’, rather than a rigorous discussion of housing options. It is intended to stimulate discussion. As we all continue to explore our options for where and how to live as we grow older there are clearly a wide range of possibilities. As is evident, my own bias is that the “village” concept is one well worth considering in more depth.

--David Whitehorn
9August 2011, Halifax

Thanks to Tom Bell, Pam Denicola and Dr. Andrea Sherman for insightful comments that helped shape this article.

Sunday, February 20, 2011

FROM THE HALIFAX AGING STEERING GROUP

After a series of open meetings on aging at the Halifax Shambhala Centre, documented in several postings on this blog in 2010, an aging steering group was formed to guide further development of aging related projects. The steering group has been meeting monthly and has written the following update to be published in the newsletter of the Centre (The Banner) in March 2011. The Banner is available online through the Halifax Shambhala Centre website. The update summarizes the key issues identified so far in the process of working with aging and provides an example of how one Shambhala Centre is relating to the simple fact that a great many of its members are getting old.


CALLING ALL SENIOR SHAMBHALIANS (60 and older).

Remember the 1970’s, and some of us were first connecting with Shambhala. We were young and didn’t think much about being old and the coinciding sickness or disability. Perhaps we recited the reminders of “precious human birth” and “old age, sickness and death”, but our hair was not gray, and our bodies were capable of sitting nynthuns with the main hardship being resisting the urge to scratch an itch or swat a pesky fly.

Nearly forty years later, on a day-to-day basis we may not be aware of how much we have changed. But bump into an old friend whom we haven’t seen for 20 years, and with a shock, we say to ourselves, “wow, has she aged! Gee do I look that old too?” Or do you experience a jolt of incomprehension when you see a photo of yourself these days?

Those kinds of experiences have prompted some of us to feel our age and begin to look into how our aging relates to Shambhala path both as individuals and as a community.

In the spring of 2010 a series of open meetings were held at the Shambhala Centre to explore aging related issues. Through talking circles and small discussion groups, a list of ideas, concerns, questions and needs was generated. These were assembled into general categories as follows:

(1) HEALTH, age related diseases, chronic illness and pain, nutrition, exercise and active living, social isolation and accessibility to Shambhala Centre and health services;

(2) SUPPORT, seniors’ support group/online support network/healing meditation group, caregiver support, the Deleg system as a network for support, phone calls to people who are isolated, information sharing through workshops, support groups, programs; (

(3) LEGAL, wills, estate planning, power of attorney, advanced directives, organ donations, financial resources;

(4) HOUSING, options, group or shared housing, long term care facilities, homecare; (

(5) END OF LIFE CARE, hospice, palliative care, preparing for death and dying, funerals (planning, cost, sukavati ceremony, etc.);

(6) ELDER WISDOM, a formal rite of passage into the status of "elder", a Council of Elders, passing on to future generations, keeping active, and contributing to Shambhala and wider community.

To focus on priorities and begin taking action a steering group was formed that has been meeting monthly. The members (David Whitehorn, Tom Bell, Denault Blouin, Robert Halpern, David and Meera Flint, Myra Donnelly, Yeshe Fuchs and Pamela DeNicola) have identified four core projects/issues:

(1) Survey of needs and attitudes, (2) Seniors Support Network, (3) Programs for Shambhalians 60+, and (4) Council of Elders. The current thinking on each of these projects is as follows:


SURVEY OF NEEDS AND ATTITUDES:
To understand the needs and concerns of Shambhala seniors we need to conduct a survey. The steering group is compiling a list of seniors and contact information. This list will enable us access to distribute the survey to senior members as well as provide a basis for ongoing communication, including connecting with seniors in need. Our next step is to design the survey questions. We hope to be able to have the survey ready this spring. Updates will be posted in the Banner

SENIORS SUPPORT NETWORK:
We will begin to develop a support network by first relaying information through regular newsletters and Banner information and articles.

Survey data will help to focus the need for a support network and how best to design and implement. Some ideas that have already arisen are (1) online support group to share information and enlist support/help, (2) phone group (volunteers who call senior members as well as any member who is suffering from loss, disability, illness, etc.) to check in on those needing support, (3) support group that meets regularly (i.e. Seniors Anonymous), (4) Deleg support network (volunteers in each delek who provide support when needed).

PROGRAMS FOR SHAMBHALIANS 60+:
There are many issues that seniors may wish to explore through organized programs. Recently the Shambhala Centre hosted a weekend with Jacquie Bell and Shari Vogler on preparing for the end of life. The Thursday night Sadhaka class is currently discussing Ponlop Rinpoche’s book “Mind Beyond Death”. And in October Dorje Denma Ling has invited Andrew Holecek for a weekend program, “Dream Yoga and the Art of Dying”. These are wonderful examples of programs that are useful and relevant for everyone, and particularly seniors.

COUNCIL OF ELDERS:
From the Shambala Centre database we know that more than half the current members are 60 years of age or older. Reflecting on this, we can see how important it is for seniors to share our accumulated wisdom with the next generation as they take on more and more responsibility. By doing so, seniors can play an important role in the continuation and flourishing of our lineage and the Centre. As elders we can lend our experience as wisdom and compassion holders. To help with this process, the steering group is exploring the idea of a Council of Elders that could represent seniors within the governance structure of the Centre.

Friday, February 11, 2011

New York Zen Center Program Could Transform Healthcare for Elders

The following article was written by Andrea Sherman, a member of the Shambhala Working Group on Aging.

Our society has made demons out of illness and death. With tireless integrity and compassion, the New York Zen Center for Contemplative Care prescribes the Buddha’s medicine: sanctity of life, vows of service and letting go.”—Roshi Bernie Glassman, Ph.D.

In September of this year, I became a student in the Foundations of Contemplative Care program offered through the New York Zen Center. My motivation came from my desire to integrate spirituality into the training and practice of my professional and personal work in creativity, aging and person-centered care.

For 10 weekends during the year, students with varying backgrounds such as nurses, social workers, priests, hospice workers, doctors, therapists, caregivers, and other professions participated in this Buddhist-centered inquiry into the practice of service to others. The interfaith, experience-based program is geared to professionals with a wide array of experiences in life, caregiving, Buddhism and other spiritual practices.

To complete the program, participants must complete 100 hours of volunteer caregiving, supervisions, readings, monthly reflection papers, verbatim, doing advanced directives, and a final project. Each month there is a focus on a Zen Buddhist precept. This training structure offers ethical guidelines that “frame” each month. The precepts are:
· Not killing.
· Not stealing.
· Not misusing sex.
· Not lying.
· Not giving or taking drugs.
· Not discussing faults of others.
· Not praising yourself while abusing others.
· Not sparing the dharma assets.
· Not indulging in anger.
· Not defaming the three treasures.

Participants consider the precepts from three perspectives: literal, relational, and intrinsic. Another way to translate this is to pose three questions for the precepts: Does the action of my physical body uphold this precept? Does my action free others from suffering, and, not being separate (intrinsic meaning of no separation)?

Contemplative care is an approach to spiritual care and can be helpful to those caring for older adults who are ill, suffering, and dying.

The following excerpts from an interview with Robert Chodo Campbell, Zen priest, co-founder and co-executive director of the New York Zen Center for Contemplative Care, illustrate some of the program’s key concepts.

Question: What is contemplative caregiving?

Campbell: One can only be as intimate with another person as they are with themselves, to find intimacy with one’s self there has to be a capacity for deep introspection and reflection, or we could call that contemplating. I think it’s really important to know who we are on a deep psychological and emotional level if we are professionals taking care of others. Out of a contemplative practice we learn to realize that there is separateness and there is no separation with the other. I think that’s what contemplative caring is, caring for the other, wholeheartedly, without getting lost in their journey. This is their journey, not mine and yet we are companions. In a way we are guiding each other.

Question: What is presence?

Campbell: Presence quite simply is being present to one’s self and other, with no separation, presence is being fully aware of what is occurring in one’s self in each moment. Presence is breath. Presence is inhale-exhale.
Putting the Foundations Program into Practice

In the first meeting of the Foundations in Contemplative Care program, participants learn about the Three Treasures:
· Not-knowing or formlessness.
· Bearing witness of the relationships unfolding within and without us.
· Loving action.

Not knowing is to give up fixed ideas about ourselves and the universe. Bearing witness is to see the joy and the suffering of the world, and the expression of loving actions to us and to others. This translates into practice as I learn to enter the room of the hospice resident, and to “greet the room” as I enter, not knowing, scanning myself before entering the room, and “reading the room energy” I enter, in, to be present. This is attunement, tuning in. The three wheels are:
· Myself.
· The person.
· The time and space of our connection.

Then, I bear witness to the person and to myself, practicing “being” with joy, and with suffering. Feeling the courage, remembering that “it’s not what you do, it’s who you are.” We practice active listening to the person, an older person who is ill with chronic disease, and perhaps listening to someone who is actively dying, contemplating the images that are presented to us. Loving action can be the spiritual presence and energetic space of prayer, allowing the person to be where they are, and opening to the “tender and awakened heart.”

A goal of the program is for us to become “awake” for all of those that we encounter as caregivers, and to respect the dignity of all human beings. Since the program’s inception, contemplative care has been provided to 14,977 hospice and hospital patients, 3,839 healthcare providers and staff, 2,469 workshop participants, 21 units at Beth Israel Medical Center, and 8 hospice suites at VNSNY Hospice.

Question: Do health professionals learn to practice presence?

Campbell: When you leave one patient, before going to the next, take a deep breath. This simple ritual symbolizes being present to what you are fully in this moment—not taking the last patient into the room of the next patient. So where is your breath, where is your mind?

The important thing for any caregiver, particularly for those who care for a dying person is to be fully conscious of the fact that we are dying too. To think differently denies one’s truth. When we realize we are dying in each moment, life becomes that much more precious.

There is no separation between life and death. We are dying from the moment we are born. Life and death go hand in hand. If you could see that you and I are hand in hand then there is no separation. When I am taking care of you, I am taking care of myself. Simple.

Contemplative Care and its practices could transform care for elders and their concerns, fears, and ultimately their legacy and the meaning of life and of death. The contemplative care model includes providing compassionate care for the healthcare community, and creates an integrative and nurturing model of care that is self-reflective and transformative.

Andrea Sherman, Ph.D., is co-founder and co-author of Transitional Keys, a lifecycle transitions program that uses multi-disciplinary arts to ease, assist and enhance change and transitions. She is on the FORSA Editorial Board, and is a student in the Foundations of Buddhist Contemplative Care program.

Robert Chodo Campbell, HHC is a co-founder and co-executive director of the New York Zen Center for Contemplative Care. He serves on the Core Faculty for the Center’s Buddhist Chaplaincy Training Programs, and is a Senior Zen Buddhist Priest at Village Zendo in New York City.

For information about the New York Zen Center for Contemplative Care, please e-mail info@zencare.org or visit www.zencare.org.

This article was originally published in Aging Today Online (ISSN 1949-2464) a quarterly publication by the American Society on Aging for its members and is reproduced here with permission of the publisher.