“We are not looking for warm bodies,” says Robyn Stone talking about the crisis in finding enough skilled and reliable caregivers for older people. To her, retention of current workers is more important than recruiting new ones. “I would put almost all my eggs in the retention basket,” she announces.

Among the professionals who have expert knowledge of care-giving for pay, Robyn Stone stands out. Formerly Assistant Secretary for Aging in the federal department of Health and Human Services, she now does research for a national agency focused on caregiving issues. Dr. Stone spoke in Boston recently at a conference of the Massachusetts Gerontology Association entitled “Worker Shortage: Who will Provide Care Today and Tomorrow?”

Keeping current caregivers is a formidable challenge, given what they are paid. You can compare them to the much discussed security workers at airports who are notorious for their rapid turnover. Both groups are paid about the same: as recently as 1998, the hourly wage for nurse assistants in nursing homes was only seven and a half dollars.

In Massachusetts, about one hundred thousand people are currently dependent on long-term care services. That number is expected to grow much larger ten years from now. Nursing homes are having trouble getting sufficient staff and home care agencies find it difficult to recruit workers. And yet, according to Frank Caro, director of the UMass Boston gerontology center, policy makers do not seem much concerned about the situation.

These officials could profit from what Rosalynn Carter has written about the subject. “There are only four kinds of people in the world: those who have been caregivers; those who currently are caregivers; those who will be caregivers; those who will need caregivers.” The fourth and last category is about to get much larger.

The statistics about professional caregivers will dismay anyone concerned that older people receive the attention they need. Thirty-eight percent of home care workers and one-quarter of nursing assistants have less than a high school education. And yet, they are expected to handle stressful situations that make great demands on both their professional and their human resources.

“We can’t underestimate the level of intensity of this work,” says Stone. Somewhat indelicately, she dismisses the widespread idea of this caregiving as merely “butt wiping.”

Instead, this job involves intimate and personal involvement that can be emotionally challenging. Stone compared placing an inexperienced person into a long-term care world to “dropping a Martian into another planet.”

Contrary to the general impression, most professional caregivers are white, typically middle-aged women who are living at or just below the poverty level. Often, they are single mothers who have turned to this activity for lack of better paying opportunities. And, yet, much more often than not, they provide services that are much appreciated by the families of those cared for. A recent study shows how families that communicate honestly with the caregivers and keep at it develop good relationships with them.

Family members of those who receive professional care, ideally should prove the strongest advocates for improving the lot of those providing the services. They know from personal experience what a difference is made by devoted home care workers and others in the field.

Improved training for caregivers is one of the vital needs that demands attention. Robyn Stone believes that the most significant way of doing this is to help these people “to own their work.” That means taking pride in doing a good job and developing the confidence to meet challenges.

In response to Dr. Stone, three panelists added to the case for action. “Our retention rate has always stunk,” Susan Eaton said bluntly. A Harvard Kennedy School researcher, she suggested ways to treat nursing home staff members differently, as by allowing them regularly to take care of the same people and including all of them in meetings for discussion of their work and its problems.

Another respondent, Barbara Frank, agreed that the key issue is “how we care for the caregiver.” She labeled it a “cruel irony” that so many of these staffers in nursing homes do not themselves have health insurance.

Returning to the original question, we do not know who will provide care today and tomorrow and the experts cannot tell us.  However, we do know that most care will be provided by family members, as it has been for generations. A promising development here may come soon when and if the Commonwealth implements a long-standing proposal to pay members of low-income families who take care of their own relatives.

We also can expect the Commonwealth to shift expenditures for care away from nursing homes and other institutional settings to care given at home. But the need for more professional caregivers will certainly grow, as the baby boomer generation becomes old in unprecedented numbers. And the caregivers themselves will still need care, a need that our society does not show signs of meeting anytime soon.

Richard Griffin

Pearl Sabat, now age 84, is happy to call herself a “Forsyth Kid.” She qualifies for that title because from 1925 through 1929, Pearl took the bus twice a week from the Benedict Fenwick School in Roxbury to the Forsyth Clinic for work on her teeth. It was not a matter of cavities alone: “my teeth were marshmallow fluff,” she explains.

I talked with this lively woman at a celebration held at Forsyth for a large number of “kids” who received dental treatment sometime between the 1920s and the 1960s at this famous clinic located in the Fenway section of Boston. Founded in 1910, it was known for several decades as the Forsyth Dental Clinic for Children. In the 1950s it shifted emphasis to research and became affiliated with the Harvard School of Dental Medicine.

In 1999, they changed their name to The Forsyth Institute, in keeping with a greatly expanded research agenda. A striking example of this research came just two weeks ago when Forsyth announced development of a new vaccine that could be sprayed into the noses of young children and protect them against cavities for their whole lives.

During the last few months, Forsyth has been searching for the former children who were its patients, in order to enlist their support for a new campaign to improve the dental health of current children. The kids who received dental care decades ago tend to live in Boston’s suburbs now, in circumstances dramatically different from the poverty in which they grew up.

Another kid, Ralph Shuman, went to Boston public schools located in his neighborhood of Mattapan. Not without emotion, this 68 year old, recalls going to Forsyth starting in 1943. “Every time I go by Huntington Avenue, I remember those days.” Some of the details, such as the people in white coats and the needles, stay fixed in his memory. So does walking into the clinic: “Oh, boy, I sure do remember the turnstile.” Like other old timers, he recalls having to push a nickel into the turnstile at the entrance to the clinic.

Their families were mostly poor, struggling because of the Depression , and glad to have their children treated for problems with their teeth. Often the kids themselves did not know they were poor because everyone else in their neighborhood was in the same situation.

Among the kids who received dental care at Forsyth are Thomas Menino, mayor of Boston; Kevin Fitzgerald, state legislator from the Mission Hill area; and John Harrington, president of the Red Sox, and his wife Maureen Harrington.

To receive care a child did not have to be enrolled in a public school; parochial school students were included. Donald Hann was a pupil at St. Patrick’s school in Watertown when he came for treatment in 1929. Coming with one of his parents, he would get off public transportation at the old Boston Opera House and walk to Forsyth. He remembers the fillings and instruction in the use of a tooth brush. His sweetest memory, however, was going over to the Museum of Fine Arts after the dentistry.

Roman Micciche serves now as vice-chair of the Forsyth board of trustees. In the late 1940s he came to Forsyth on a bus from St. Joseph’s School in Medford. One of the nuns would accompany the kids to preserve good order. About being in the dental chair, he claims to be now “too old to remember the pain.”

During the formal program at the recent festivities, the Forsyth CEO, Dr. Dominick DePaola, emphasized that dental care involves much more than filling cavities. Dentists also respond to infections which can turn deadly and they deal with oral cancer as well as birth defects. These threats to good health need intensive care, something that Forsyth pledges to provide to the low-income children of Boston.  

In his judgment, the best people to spread the word about children’s dental health care needs are the Forsyte kids and their families. He wants them to become “ambassadors of oral health,” spreading the word wherever they go.

When I commented on the rich sugary deserts served at the reunion and  asked Dr. DePaola whether a statute of limitations on such food was in force, he playfully answered, “For these kids, it’s not a problem.” And, indeed, no one among them mentioned the candy of their youthful years.

If you look at the current situation of our nation’s children, the statistics might make you think of the most deprived countries on earth. Nearly one-third of American children have little or zero access to oral health care; among the states, Massachusetts ranks a shocking thirty-fifth. Up to 48 percent of the children living in Boston, Cambridge, and Lawrence need restorative dental care. At one Boston high school, students have four times as many cavities as the national average.

If you are one of the half million Forsyth kids but missed the reunion, the institute would still like to hear from you and get you involved in its children’s oral health campaign. The number to call is (617) 456-7733.  

Richard Griffin

“Yesterday the ancient truth came home. We all live in a sukkah. How do we make such a vulnerable house into a place of shalom, of peace and security and harmony and wholeness?”

These words came from Rabbi Arthur Waskow on September 12th of this year, the day after the devastating terrorist attacks on the World Trade Center and on the Pentagon. They describe precisely the new atmosphere of insecurity, first forced upon us by the raids on New York and Washington, and now reinforced by the warfare over Afghanistan.

Rabbi Waskow also asks the basic question facing all of us, young and old. How is it possible for us to find the basic human qualities that will enable us to live with interior peace and outward harmony with others? Is there any remedy for the tangled feelings that make so many of us lose sleep at night and force us to fret during the day?

I, too, have found inspiration in the sukkahs constructed by Jewish friends and neighbors. As Rabbi Waskow suggests, these fragile structures stand as images of vulnerability. Since they have roofs open to the sky except for slender wooden slats festooned with flowers and fruits, they provide only inadequate shelter. Storms with heavy winds and rain could devastate them.

In this vulnerability, sukkahs are meant to remind believers of sacred history. Specifically, they evoke the memory of the people of Israel who wandered in the wilderness after being rescued by God from their slavery in Egypt. The Jewish community has always looked back to those days when they were vulnerable to the dangers of homelessness and had to look toward their faith and one another for survival.

Other great spiritual traditions have always taught the same message: there can be no foolproof security on earth. At this point in history no one needs to be convinced of this fact. What we do need is light on how to live in such an insecure world. We want to know how to adjust to a new situation marked by threats that cannot be identified in advance.

In some ways we elders have an advantage. Many of us have become used to living with vulnerability. Disabilities have made us aware that it might not take much to do us in. We realize that a simple fall on the floor of our kitchen might be enough to start in motion a chain of events that could result in our becoming physically incapacitated.

Years of coping with physical problems that cannot be solved and chronic illnesses that cannot be healed have accustomed us to coping. Reverses in health that seemed in prospect devastating have become familiar companions. We have learned to make the best of situations that continue to be uncomfortable and threatening.

This experience may have taught us to be more patient with ourselves and more compassionate toward other people. Paradoxically enough, a new wholeness may have emerged from our brokenness and an unexpected peace of soul from our suffering. We may have become veterans in the warfare against personal disintegration, emerging with surprising victories of spirit.

As people familiar with the vulnerability brought on by age, perhaps we older people can cope with the new environment of anxiety in which many Americans suddenly now live. Having wrestled with the demons of inner terror we may have the experience needed to face bravely the outer terrors of the world. At least, we can recognize that we need not have scruples about preserving our inner peace when so many people around us seem to be losing their cool. We can assert our right to stay calm despite the chaos abroad in the land.

That means we can find ourselves equipped to resist letting the latest report upset us every time we hear a broadcast. Allowing the many rumors that circulate at a time like this to throw off our inner equilibrium surrenders our own wisdom. Losing our peace of soul does no one any good and robs us of one of the precious fruits of later life.

All of this does not argue for complacency. The threats to our nation and to the whole world are real. Suddenly we Americans have been introduced to the terrors that have afflicted the other peoples of the world for generations and have become familiar conditions of their lives.

However, we have good reason not to surrender the inner and outer gains of later life. In fact, these qualities, wrung out of long and hard experience, can benefit those people with whom we come into contact. This response may be our best to Rabbi Waskow’s question about how to turn our vulnerable house into a “place of shalom, of peace and security and harmony and wholeness”

Richard Griffin

Whoever chose the site of last week’s conference “Redefining Retirement Communities” was clearly inspired. This two-day meeting, organized and conducted by Chellis Silva Associates Senior Housing, was held in Newton at Lasell College, the location of a new kind of retirement community, perhaps unique in the nation.

This residence opened in July, 2000 under the name Lasell Village, a continuous care retirement community with fourteen buildings and 162 independent living areas. Already the Village houses 205 people whose average age is 79, and has almost one hundred others on its waiting list.

These statistics in themselves will not surprise anyone familiar with the world of retirement housing. What does astonish most people the first time they hear about it is one of its entrance requirements. Those admitted to the Village must sign an agreement obliging them to “create and complete a personalized learning plan of 450 hours a year.” That means committing themselves to courses, lectures, surveys, and collaborative planning.

As Thomas DeWitt, president of Lasell, explained, “The dominant culture is learning, and learning is seen as not just a requirement, but an opportunity.” He admits that the venture was a gamble and he feared for what it might do to the young undergraduates in the college. In fact, the number of students has soared to some 1900 and many of them are engaged with their elders in the Village.

Paula Panchuck, the Village dean, says that the educational program created “almost instant community” among the residents. That’s because the structure of the program encourages people to interact with one another. Residents can choose among 33 courses this semester. Education is “the heart and soul of our community,” according to the dean.

To make sure that what the president and dean told the conference was not simply hype, I asked questions of an old friend and colleague in human services, Hilma Unterberger, formerly of Cambridge, now resident in the Village. Her immediate response was, “I’m absolutely crazy about it.” She loves the location, the classes, and the academic level of her peers. Summing up, she enthuses, “I’m busy as hell.”

In addition to demonstrating, through the Lasell site, new thinking about retirement communities, the conference offered an array of speakers with fresh ideas. Robert Chellis, a distinguished planner and veteran advocate for creative elder housing, skillfully summarized the 2000-year history of senior housing and then posed a series of challenges for current planners. The main challenge, he said, is “to create a retirement community with such a wide range of resources and attractions that, like a favorite camp, or college, people can’t wait to go there.”

The message delivered by Marc Freeman, author and president of an agency that promotes community involvement on the part of older people, was similar. He thinks that the Baby Boomer generation will revolutionize retirement and transform America. Current retired people have been spending half their time watching television, he claimed, thus wasting one of our society’s extraordinary resources  –  their experience. But, he said, we have arrived at a turning point: people now want meaning in their lives and wish to form a legacy to leave behind them.

Another speaker, Dr. Kenneth Minaker of  the Massachusetts General Hospital and Harvard University, provided fascinating details of an unprecedented collaboration between Harvard and the Accor Health Group. Accor operates 2465 hotels in 126 countries and receives 150 million travelers a year. The chief idea behind this partnership is health education, delivered in the hotels through printed materials, exercise facilities, healthier restaurant menus, and many other activities. This will make travel for older people and others into an experience of ways to improve their health.

Among the other speakers, Richard Pais, an environmental scientist based in Scranton, Pennsylvania, registered highest on the applause meter. His slides showing the badly designed landscapes of retirement residences were devastating. But he also demonstrated what creative planning can accomplish to improve the environs.

Pais works with a landscaping principle radically different from the conventional approach. He believes in focusing on what residents of a building see when they look from the inside out and ensuring them the pleasure of watching birds, butterflies, and other features of friendly and inviting landscapes.

Despite the exciting ideas that retirement housing evoked in this conference, I have a problem: most professionals address themselves to housing that only the wealthy can afford. To buy a place in a continuing care retirement community, for instance, you need considerable assets and income. As Tom Dewitt says, “The problem of retirement living facilities is that they serve the wealthy and middle class but not the poor.”

To the credit of conference planners, they scheduled presentations by two Boston-based leaders who have developed innovative programs in low-income retirement housing. James Seagle of the Rogerson Communities and Ellen Feingold of Jewish Community Services explained how innovative housing with an impressive array of services can be developed for older people of modest means. It is not easy to do, they will tell you, but much needed.

Richard Griffin