Sunday, April 11, 2010

More thoughts on aging

What a difference a few months make! I have begun to quite assertively self-identify as a senior. Not because my health or functioning has aged particularly, but because I have come to understand that political action is necessary if my future is to unfold as I believe it can and should.

The occasion for the change of mind, which has been gradual, is that I completed the four focus groups on Aging Well in Haliburton County - I was in the midst of them in my last blog - and participated in two 4-hour analysis sessions, where a group of about 20 people who had been involved in one of the focus groups (or more, in the case of myself and staff from the three host agencies) considered the data that had been collected in the groups, facilitated by someone who had not.

It was a fascinating process. The person who facilitated was familiar with the principles of inclusion research; she'd been involved in the Cardiff project focused on young children, and she'd subsequently hired me to do a one-day workshop, which she attended. She had paid good attention, and the process was lean and clean. The quality of the data was also very good, perhaps the best in any inclusion project with which I've been involved, because the intern who was my partner in data collection was a whiz at the keyboard and captured the material almost ver batim, as well as identifying speakers. We were a very dynamic duo, me facilitating and using the charted material to move the group to consider themes and inter-relationships of the specifics offered, and her capturing it all.

The outcome of the Aging Well in Haliburton County analysis process was, I thought, quite exciting in that the people said (as people always do if they are appropriately invited and heard) that they owned their expertise in the process of aging in place, specifically this place, and thought they should be in charge of figuring out how to go forward in making the changes necessary for this place to be age-friendly. And, interestingly, they made remarkable progress in conceptualizing the issue areas as similar Social Determinants of Health, and with interesting differences from the 8 issue areas that had been identified by the World Health Organization in the paper that informed the format of the data-collection instruments.

One of the crucial changes from the WHO conceptualizing was that the Haliburton group specifically decided to exclude 'health and community services', meaning medical systems, out of the mandala they created. The rationale was that if all the other elements were in place, health would result; whereas the existence of medical services did not guarentee that they were indeed accessible when needed, or that they would create health. There was some comment that having medical services be one issue area would lead people to think about aging as a medical process, when in fact it was a normal part of life. We begin to age the moment we are born, maybe even conceived... Having medicine as an issue area would draw attention away from the other areas which would undermine health. Because...medicine becomes important when you aren't healthy, not when you are; medicine is the absence of health, not a condition of health. Doctors do not make you healthy, they treat you when you're unhealthy. No, more than that (me here, not the group), they treat you when they recognize you as ill. And that recognition has more to do with seeing something they can treat that having something that needs treating. More on that another time...

So, fast forward to February 2010, Fay & Associates was again contracted to help the Aging Well Committee to develop an organizational structure that would support them as they moved forward in implementing the findings of the research, which was now completed and in the final stages of being written up for the funder and the other engaged institutions (I'll post it on the website.) During the focus groups, people were cynical that anything would come of this exercise of asking people what they think, because nothing ever did. So there was a specific undertaking that there would be community meetings to feed back the information to the people who contributed to the research process. The challenge facing the Committee -- and the host agency staff -- was how best to manage that process. I was hired to help.

So began a series of meetings with the Aging Well Committee (which I suggested should re-conceptualize itself as a Roundtable, which I think more accurately captures its function and relationship, but it was resisted, primarily I would say by the host agency staff; the committee members didn't really care as long as it got on with business.) The meetings were weekly, and considered a structure and draft terms of reference, identified 8 Issue Committees which were conceptualized as the 'work horses' for implementing action projects to address identified priorities, and planned presentations by the committee members in each of the four communities in which focus groups had been held.

My final piece of work was to suggest resources going forward, as the initial research grant was exhausted. Although the story may not yet be finished, it appears that the host agencies aren't sure that further resources will be needed to support the work of the Aging Well group and/or that they don't have or wish to make available the time necessary to acquire or manage more resources. We'll see what happens going forward.

And now we get to where I started, that this experience has raised my awareness that seniors will need to use the political clout they have or can get to ensure that their rights as citizens are retained as they grow older. I believe that seniors in rural areas are vulnerable. Differently, and perhaps more, than their urban counterparts. It gives me a sense of satisfaction to understand that all the skills and passion that Michael and I, for our entire working lives, have made available to the disadvantaged and marginalized are now needed to protect -- or maybe create -- our own well-being as we age. Us, the class of 'seniors', sub-set: living in rural areas. I am who I am fighting for. Me, and others like me. I am the other. It's the first time in my life that I have felt that.

I've been doing some interesting reading that informs my thinking and will share them -- more regularly, I hope, now that I know why it's important to do so.

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