Aging in America

The NY Times has published a nice photojournal of the many living options for elders in our community ( Six different video vignettes show a spectrum of living from total independence to total dependence. They are entirely accurate, well-filmed first-person narratives.

So what’s wrong with these pictures? Watch them and tell me.

Here’s a clue: think about the one-dimensional line between total independence and total dependence and what it does to people. Then think about the possibility of “aging in community”, as opposed to “aging in place”. Then read Bill Thomas’ ( and Emi Kiyota’s ( blogs on the subject.

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2 Responses to Aging in America

  1. I agree the video vignettes are presented along that one-dimensional line between total independence and total dependence, but I think the experiences do highlight a fair amount of aging in community — it’s just that the definition of community always seems somehow more localized than those of us championing real care in relationship would prefer.

    Take the example of the woman profiled in the assisted living piece. To the extent she feels a part of a community there, I bet it’s in no small part because of those select direct care workers (the “good ones”) supporting her with patience and understanding. I’m guessing she feels more herself when that direct care relationship works for her, and she’s then able to more actively build community around her — to more fully be who she is, even in an age segregated place like your typical assisted living residence. AND, I bet the direct care worker (to the extent she/he is supported in their work) is a better parent or wife/husband for it, more prepared to model those values outside of the care setting in the broader community. It’s Dr. Bill’s old “we’ll know change is happening when the children of direct care workers are better off” refrain.

    So, there’s the aging in community possibilities at the micro, person-to-person level, but a bigger hurdle in my book relates to all the misplaced incentives in the broader system (save for PACE models and other examples of enlightened care coordination): The explicit reward of the medicalization of everything…what does aging in community mean in a world where we have a twenty percent 30-day rehospitalization rate among the frail elderly? More like aging in pinball machine…

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