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197 Chapter 16 What If? Mapping Our Plan B Proponents of the alternative models in this book hope that by providing people with that simple human connection, they will be able to avoid, or at least delay, institutional care as they grow old. But it’s too soon to tell. Some communities are beginning to struggle with what to do when one of their own gets alzheimer’s, for example—certainly one of the toughest challenges. even with the progress people are making to be more intentional about their Third age, the persistence of denial seems as deeply rooted as an ancient oak. too often, as I interviewed people, when I asked the difficult question, “What if?” the answer was far from reassuring. I was told, in a vague sort of way, if a member of their community or household became frail or had dementia , she would have to move, usually to an unspecified assisted living facility (the dreaded nursing home was rarely mentioned). But I was hoping for more. are there ways that we can still hold close our friends, neighbors, and relatives who can no longer manage in their own homes? Is aging in place (or in community) still just a way station rather than a final destination for many people? “a lot of times what happens is that these groups start and folks don’t realize what they’ve set themselves up for,” reflected katie McDonough, director of Capitol hill Village. “they go into it really determined to do what they say they’re going to do [help people age in place], but sometimes I wonder if Villages, even Capitol hill Village at its inception, if they really know what it takes to actually, honestly live out that mission.” (In fact, I heard one Village director say she thought more of her members should move to assisted living.) Some organizations have gone the route of referring members to agencies that provide services such as care coordination. The Community Without Walls (see Chapter 7), when it became clear that some of its members needed more support, helped establish a spinoff, Secure@home, in partnership with a local social service nonprofit. NOrCs, such as Penn South and Greenbelt, have a raft of services to extend the time people can remain in their own 198 With a Little Help from Our Friends homes, including care coordination and some home health services. Still, as Nat Yalowitz noted, every year Penn South loses some of its members who move to assisted living or a nursing home. a few transformative solutions hold the promise that nearly all of us might be able to remain in our own communities. What may be most surprising is that some of these solutions cost far less than the options of assisted living, nursing homes, or full-time paid home care. They require an investment of time, energy, and planning—in short, the sort of forethought that allows us to break through our mass delusion of “It won’t happen to me.” Radical Community although many cohousing communities would not be able to pull this off, Songaia, near Seattle, provided extraordinary support to a founding member, support that allowed him to remain at home until the end. When Fred was diagnosed with “Lou Gehrig’s” disease (amyotrophic lateral sclerosis or aLS), he called a community circle to let everyone know. “Then he did something that was quite remarkable,” Oz ragland recalled. “he invited anyone who chose to, to be part of his final journey. he didn’t say what that would be like. he said, ‘some will say I don’t want to watch you die, and some will see it as a rich learning opportunity.’” The response from many community members was equally remarkable. as he became incapacitated, unable to move his body from the neck down, some of his cohousing friends were willing to provide personal care. “So we were feeding him at our common meals and helping transfer him with a hoyer lift,” Oz said. Nine months before Fred died, the family hired a part-time caregiver because it had gotten to be more than informal caregivers could manage. With Fred’s hospice benefit, the care was affordable. The children of the community were also very much involved in Fred’s care. eleven-year-old Ian rubbed Fred’s feet every night, to help with loss of circulation. “There’s these relationships that are very deep,” said Oz. another kid, Lucas, came over and took...

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