Friday, May 15, 2009

Some thoughts on our last morning

Dear Colleagues:

I woke up this morning realizing that for me, the learning here has been to see how any truly successful approach to transforming activities needs to be encompassing, from individual learning to a societal shift of perception and policy. I made these notes, recognizing that my understanding is surely very partial compared to those of you who have been focusing for decades on these questions. I hope that beginner's mind will be of some value!

All best,


* * * *

Transforming activities is an encompassing process, involving every dimension from individual awareness to a global transformation of understanding and action. Instead of treating public issues like private troubles, what’s needed are interventions at every level, to relieve the burden on families and reframe aging as a universal human process, not a medical problem. This involves learning, providing services, rethinking institutional practices and changing public perception ands policy from the grassroots on up.

Where the rubber meets the road, everyone has the capacity to transform activities for those in need of long-term care or in structured environments, by “enchanting” even mundane tasks and simple play through creativity, remaining present and responsive to the whole person, rather than treating an individual like the embodiment of his or her deficits.

In every setting, at home or in institutions, key elements of actualizing this potential are:
  • Prioritizing more than physical well-being, giving equal weight to quality of life in all dimensions;
  • Eschewing or supplementing assessment tools and standards of judgment that privilege what is easy to measure while omitting the deeper human story;
  • Valuing and making use of creative individuals such as well-trained community artists, who naturally work in these ways;
  • Choosing and supporting people with the necessary outlook and sensitivities to work with those in need of care;
  • Supporting partnership and leadership at all levels.

But things to need to change to fully realize this potential.

For families and individual caregivers, some key needs are:
  • Education and training in what’s possible, delivered in ways they can receive and use;
  • Encouragement and support in building community, learning from other families and sharing the burden;
  • Aggregating voices to shift public policies to provide meaningful economic and social support, such as policies where money follows the individual, whether at home or in an institutional setting, and a paradigm shift to universal healthcare.

In day centers and long-term care facilities, some key needs are:
  • Supporting leaders in bearing and managing the risk of culture change, being willing to risk failing in new ways rather than settling into familiar failures;
  • Using hiring and evaluation processes that prioritize the needed qualities of openness, presence, caring, responsiveness and understanding;
  • Developing and using assessment tools that measure progress toward what we actually want to happen, not just what someone else thinks is important or easy to measure;
  • Active openness to and support for partnerships with artists, not as a frill but as an integral aspect of care.

For everyone, some key needs are:
  • Reframing our understanding of aging, so that people are not written off as their capacities change, but continue to be seen and valued as whole persons;
  • Transforming media portrayals of aging to convey this deeper understanding;
  • Transforming aging policy at every level, reversing the privatization of suffering to bring about a public culture of care and support.

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