“Optimal” aging

On a recent visit to one of the legion of doctors I have been seeing recently (don’t ask) I picked up a pamphlet called “Optimal Aging.” The tag line featured on the front of the trifold is:“There’s no place like home. Let us help you stay there.”

It is a straightforward pitch by the Providence Healthcare System that staying home is optimal 2“better.” Just what it is better than is not mentioned . Why it is better varies some, too, in the reasons offered, which is enough to raise my suspicions.  The pamphlet doesn’t raise security issues at all, but if they wanted to, they could borrow this picture: Safe at Home!

When I begin complaining about this pamphlet, which is what I am about to do, you might feel that I am getting all exercised about a very small issue. I’d like to give you two reasons to pause and consider.

The first is that I am, myself a person who has chosen Option B, the one never mentioned in the pamphlet. I live at Holladay Park Plaza, a very good continuing care retirement community (CCRC) in Portland, Oregon. None of the reasons I chose it—the range of activities, the resilient and accepting community, the easy access by public transportation to the events of the city—are so much as hinted at in the brochure.

In fact, if my goal were the goal they presuppose in the brochure, we would still be living in our house in southwest Portland because we would still be able to. The goal they have in mind is to find a way to help older people stay in their homes.  That’s a good goal for them, but it might not be a good choice for you.

The second reason is that I have heard variants of one single conversation over and over optimal 5since I moved here. It goes like this. “If I had known things could be like THIS, I would have come here years ago” What they mean by THIS varies a little as you would expect, but very often it has to do with the services we offer—those are the same services the pamphlet pitches as part of the “stay in your own home” message—and also with the new options that are available here, but not “there.” Coffee group? Right downstairs in the Bistro lobby. Exercise? The room with the machines is always open and the swimming pool is usually available. Library? Right at the end of the hall.

The point here is that there are quite a few things that can be a good deal better than you could have them living in your own home and all of those are screened out by asking only how you can manage to continue staying where you are.

“There’s no place like home.”

That’s true, but for a lot of aging seniors, that are places that are a good deal better than home. “There’s no place like home” is the sentimental appeal and I don’t begrudge them that at all.On   the other hand, the claim they actually make for this—that it is “optimal” is fraught with difficulties. [1] “Optimal aging” means that it is the best kind of aging. That means that it is better than the other kinds of aging—that is, after all what a superlative form is for. And to make that judgment, you really ought to know about the alternatives.

And that is the place in the argument where I start to get snarky. There is nothing in this pamphlet about other kinds of aging situations. That makes it hard to justify a claim like “best.”

And that may be why, as you fold the top of the trifold back, you come right away to the second standard, which is that these services are for “older adults who’d rather stay home.”

That is a great deal more justifiable. People should be able to do what they prefer. But then I remember all the conversations with new residents that begin, “If only we had known…” In staying in their own homes, they were doing what they preferred. But they are not doing what they WOULD HAVE PREFERRED had they known that a place like Holladay Park Plaza [2] was available. And when I read this particular defense in the brochure, those are the conversations that come to mind.

And why is that?

Three separate reasons follow. The first is not really a reason; it is just a restatement of the tag line. It says, “Who wouldn’t want to stay at home as long as possible?” I won’t deny that the phrasing gives it an appeal, but the answer is, “Anyone who would live a richer life somewhere else and knows that is possible.” Notice that in “as long as possible…” the question becomes “are you able to” rather than “do you choose to.”

The second is a reference to “the obvious comfort” of living at home. This is a little on the optimal 4dicey side because again, the words go one way and the meaning goes another way. I think “comfort” probably stands for “familiarity” here. I am not less comfortable here at Holladay Park Plaza than I was at our house in southwest Portland. For all practical purposes, we simply moved our familiar way of living across the river to northeast Portland and plunked it down. Nothing is going to be more familiar than continuing to remain where you are, but when you shift to “comfortable,” you are requiring a comparison of here with there and they would not win that argument.

The third reason (set of reasons) deserves to be quoted in full.

When you stay at home, you can keep working on your hobbies, easily see your friends and neighbors, and be with pets that need you as much as you need them.

Whether you can “keep working on your hobbies” at a fully equipped CCRC depends, of course, on what your hobbies are. The comparison is stacked, as it should be in a pamphlet intended to persuade, toward the services Providence Healthcare is providing and that slant is clear in “keep working on.” It is the continuity that is highlighted. If the CCRC is a much better place to work on your hobbies, and the chances are pretty good if you are a woodworker or a weaver or if you work out in a gym or swim in a pool, that it is easier to do here.

“Easily see your friends and neighbors [3]” is a better reason because they mean the optimal 1friends you already have—not the new ones you will make—and the “neighbors” you will have at the CCRC will be just as much your neighbors as the people living next door. [4]  I think that this picture captures “the alternative” the brochure wants you to imagine.  It’s not a pretty picture, I grant, but pictures like this are not a good reason to refuse to consider a change.

The point about pets is probably the best one in the brochure. Many CCRC’s are pet-free [5] and if you want to take your pet with you, you will have to be sure that the center you are considering will allow it. Many will, of course, and as the next generation of oldsters—more pet-oriented than their parents’ generation—begins to look at CCRC’s, there is likely to be a wholesale change. And the turn in which the pets need you as much as you need them is a stroke of genius.

Choosing the kind of life you want to live

If you have any notion at all of the kind of life you want, you are in a position to ask where and with whom [6] you want to live it. “We choose this kind of setting/community rather than that one” is the format of a really good choice. “What do we have to do to be able to stay where we are as long as possible” is the format of a really bad choice. That doesn’t mean the choice itself is a bad choice for everyone. For any particular elder or older couple, staying where you are might be just the perfect thing to do. I’m considering in this essay the way the question gets raised, not what the best answer is.

I’ve been accused, every now and then, of being more intentional than I should be. Most of the time, this language is just a “stop and smell the roses” sort of plea and I probably should stop more often to smell the roses. But at other time—most of the time, I think—it is a confidence that just continuing to do what you are doing will produce the results you are looking for or it is an expression of hope that “things will work out.” In writing this essay, I have given those critics everything they need to make their case and I wish them well.

On the other hand, Bette and I got here, where we are, by asking what kind of life we wanted to live and it seems to have turned out pretty well.

[1]Optimum is the neuter singular form ofoptimus, which means “best.” It is the superlative form of bonus, which means “good.”
[2] Or any of several other CCRCs in Portland. I don’t mean to exclude them, but I live in only one, myself. As Secretary of State Dean Rusk said, “I hate to keep referring to personal experience, but that is the only kind I have ever had.”
[3] I always see the “nigh” in “neighbor.” All you have to be to be a neighbor is to be close. And if you have what we call here, “mobility issues,” close actually matters more than it did in the old (suburban) neighborhood.
[4] It is true, as they say, that “you can’t make new old friends.” It is also true that you don’t have to give away the old friends when you make new ones.
[5] I get a kick out of the alternative metaphors now in use. In place of the old -less, as in helpless, we are using two strongly inflected forms. The first is -free, as if some negative value is being referred to and anyone would want to be free of it. “Tax free” is a good example. The other strongly inflected form is –friendly, as if refusing to permit some action was an unfriendly thing to do. A hotel with a reputation for discretion might advertise itself as “affair-friendly,” for instance.No one seems to have any trouble reading the meaning, the the flavors of these several alternatives are distinctly different.
[6] I don’t mean just a spouse. If there is a kind of people you would really like to age with, going to where they are wouldn’t be a bad thing to do.

About hessd

Here is all you need to know to follow this blog. I am an old man and I love to think about why we say the things we do. I've taught at the elementary, secondary, collegiate, and doctoral levels. I don't think one is easier than another. They are hard in different ways. I have taught political science for a long time and have practiced politics in and around the Oregon Legislature. I don't think one is easier than another. They are hard in different ways. You'll be seeing a lot about my favorite topics here. There will be religious reflections (I'm a Christian) and political reflections (I'm a Democrat) and a good deal of whimsy. I'm a dilettante.
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