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Vitale-Aussem - Look Inside PDF
Vitale-Aussem - Look Inside PDF
STATUS QUO OF
SENIOR LIVING
A MINDSHIFT
by
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I’ve been working in the senior living field for many years, starting
with a part-time job in a nursing home when I was 16 years old. Like
most nursing homes in the mid-1980s, where I worked wasn’t an
especially welcoming place. The hallways were long and the floors
were shiny. The building echoed with the sounds of carts rolling over
tile. Slumped-over residents lined the hallways. The lighting, like the
culture, was cold.
In the mid-1980s, most nursing homes were highly efficient, ster-
ile, and clinical environments. The lives of residents were regimented
and inflexible. Bedtimes, wake-up times, and meal times were dictated
by staff. Nurses were trained on how to properly tie residents to their
wheelchairs, and how to secure the wheelchairs to the handrails in the
hallway to keep people from going where they shouldn’t.
I was a dietary aide. Whether it was the result of my own short-
comings, or the environment I was working in, I wasn’t engaged in my
work or with the residents. I wasn’t expected to be. The kitchen was
set up like an assembly line, and I functioned like a factory worker. My
job was to do as I was told and complete tasks as quickly as possible.
After school for a couple days each week, I would walk to the
nursing home, enter through the back door of the kitchen, clock in,
don my hairnet and gloves, and get to work. While the cook prepared
the food, I would start setting up the tray line—a then common
method of distributing food. I would line up rows of plastic trays and,
on each one, place a tray card indicating each resident’s dietary needs.
The tray card was my bible, telling me what type of dishes, adaptive
equipment, food texture, and drinks to place on each tray. No devia-
tions were allowed.
There were no cooked-to-order options at this home. There was no
menu to choose from. There were no choices at all. Residents ate what
was on the menu, and that was that. Not even our beverage service
offered any variety or choice. Based on historical preferences (which
were usually discovered during admission to the nursing home), each
resident received the same drink on his or her tray each night. If you
said you liked milk and cranberry juice on the day you moved in, that’s
what you got. Every single day.
As dictated by the tray card, I would place feeding syringes on
many trays. The syringes looked like the turkey baster my mom had
in the kitchen at home—a long, graduated, plastic tube with a rubber
bulb at the end. This is how residents needing a pureed diet were fed.
The nurse’s aide would squeeze the bulb to suck up the pureed mixture
from a bowl and would then place the end of the syringe in the resident’s
mouth and squeeze again, injecting the goop into the resident’s mouth.
I recall setting a high percentage of trays with those turkey basters,
though certainly nowhere near that number of people could have actu-
ally needed a pureed diet. I now understand the reason—it was much
more efficient to squirt food into someone’s mouth than to help the
person eat with a fork or spoon.
The pureed food, at least in this nursing home, was made by
throwing every menu item together in a blender. When the blender
blades stopped whirring, the result was a steaming gelatinous mass.
It was disgusting, no matter what the ingredients. But some combina-
tions were positively unthinkable.
I’ll never forget one evening in particular. On the stove sat a huge
pot of steaming chicken noodle soup. Nearby, on the counter, was a
pile of peanut butter and grape jelly sandwiches. I watched in disbelief
as the cook threw it all in the blender together. Three decades have
passed, but I can still smell that awful odor. I had to fight the gagging
sensation of nausea as I ladled the thick gray glop into plastic bowls.
After the food was dished up, I would slide the trays onto shelves
in a metal cart. An aide would then roll the cart to the dining room
where a tray was plopped in front of each resident. It was the epitome of
efficiency. And it was institutional dining at its worst—dehumanizing
and degrading.
Once dinner was over, I’d wash the dishes and mop the floors,
then clock out and walk home. As I passed the building, I could see
through the windows into residents’ rooms. Most residents were sitting
and staring, seemingly at nothing. I remember thinking that this would
be a miserable way to live. And I’m guessing for most of those elders,
it was.
found that most baby boomers want to age in place and, according to
a 2018 AARP survey, 76 percent of Americans over the age of 50 plan
to stay put in their homes as they age.2 Many businesses have sprung
up to support this wish. If you do an Internet search of “aging in place,”
you’ll get thousands of results for home care agencies, transportation
companies, home remodeling specialists, and other organizations that
specialize in helping people stay in their homes as they get older.
Remaining at home is indeed a good option for some people. My
grandmother thrived at home until she died at the age of 92. With the
right physical environment and access to services and social support, peo-
ple can age in place very successfully. Newer options, such as cohousing
communities, intergenerational housing, and naturally occurring retire-
ment communities (NORCs), are promising solutions that combine the
privacy of home with the strength and support of a cohesive community.
Unfortunately, many older adults live in environments that aren’t
well suited to meet their needs. Gerontology professor Stephen M.
Golant at the University of Florida goes so far as to say that these folks
are not so much aging in place as rotting in place.3
The dissolution of traditional neighborhoods and the lack of a true
sense of community in many parts of our country have led to a sad
reality where social support, beyond the provision of basic services,
often isn’t available. In these situations, people may become isolated
when they stay in the homes that they’ve inhabited for decades.
Neighbors and friends move or pass away. The neighborhood
changes. People begin having health and mobility challenges, and it
becomes harder and harder to get out into the world. This isolation
often leads to depression, health issues, cognitive decline,4 and even
reduced life spans.5 Research studies show these outcomes time and
time again. In short, being cut off from the world begins the cycle of
“circling the drain” that is extremely hard to reverse.
And while there is talk about technology as a means of keeping
people engaged while staying in their homes, technology alone may
not be the panacea we hope for. A study published in the Journal of
the American Geriatrics Society found that older adults who have little
face-to-face contact with others have almost twice the risk of devel-
oping depression.6 While social media platforms were not part of the
research, email and telephone contact was studied and did not reduce
this risk. Other studies have found mixed results from the use of social
media, with some finding that the use among older adults reduced iso-
lation and others finding no impact or even an increase in loneliness.7
senior living for many years and who has had the opportunity to learn
from many, many people and situations.
My goal in writing this book is to share the mistakes I’ve made
and the things I’ve learned over the last two decades working in this
field. Along the way, I learned about the role that ageism plays in our
communities and how our current focus on hospitality undermines
many of the things that are important to well-being. I learned about
the importance of purpose, growth, and inclusion, new approaches to
driving organizational change, and the way that building design can
promote a healthier community.
At the time this book published, I had begun to serve as the presi-
dent and CEO of The Eden Alternative; however, the vast majority of
this book was written from the vantage point of a senior living com-
munity operator and includes mostly stories from my time working in
nursing homes, assisted living communities, and life plan or continu-
ing care retirement communities. While the book is focused on my
experiences in mostly market rate and upscale senior living settings,
I think you’ll find that many of the concepts and philosophies can be
applied in a general sense to the way we view and support older people
wherever they may live and are adaptable no matter how living environ-
ments continue to evolve over time.
I must also add a quick word about words. The words we use have
an incredible impact on our thoughts and actions and on the cultures
we create in our organizations. You’ll notice that, unless I’m quoting
someone directly, I use the term community instead of facility and
that I use the terms resident, older adult, older person, and elder inter-
changeably. Elder is the preferred term used by The Eden Alternative
and other culture change organizations, as it refers to someone who
should be held in high esteem. I also refer to “senior living” in the title
and throughout the book. I don’t like that phrase, nor do I like the
word senior, but as of today, no one has come up with a better term for
“congregate living for older people.” It’s a balance finding words that
the reader can relate to while honoring the language of person-directed
care and support.
You’ll find that this isn’t necessarily a “how-to” book. It’s a book
about the mindshifts that must occur to create a different future. In
the same way that AARP’s Disrupt Aging focuses on changing the
conversation about what it means to get older, this book focuses on
changing the conversation about the way that we provide services and
support for older people.