Although the services themselves are interesting, what fascinated me most is the deliberate, carefully-crafted strategies to broaden the organization’s programs.  In the former case, it was a board-driven process where an annual “town meeting” looks at questions about where/how to grow and determines what level of risk is appropriate.  In the latter case, it was a charismatic leader who pushed the organization into unchartered territory.  Both are enormously successful.

The field of aging needs lots of imagination and envelope-pushing.  JCHE will be reflecting on the bold moves of these organizations and choosing a path that builds from our strengths and anticipates the population of the future.  Stay tuned!

But overwhelmingly what I took was the importance of simplicity of purpose.  While Humanitas is a big and diverse organization with thousands of apartments and millions in service dollars, at core Dr. Becker can describe it all as:

• Goal=happiness
• Principle=self-determination
• Method=YES culture
• Need=community
• Funding=diverse

Of course there are nuances within each of these basic truths, but those are in some ways beside the point.  So, with the imperative of simplicity, I’ll leave it at that!

Dr. Becker recognizes that along with the benefits of this approach, there are limitations.  With more experimentation and empowerment, there are more failures and errors.  Without extensive rules and rigid protocols, there are moments of chaos.  With people remaining in housing at extreme old age, there are those who question their desire to live in the complex.  And there are times when people’s self-determination bumps up against their own well-being.  Dr. Becker urges the staff to use common sense in all of these cases and wants managers to back up staff in their desire to try new things.  He further pushes managers to remove “creativity barriers” such as perceived lack of time or money.

Despite the challenges, Dr. Becker’s PhD dissertation proved through academic research methodology that the benefits deeply outweigh the costs.  The mistakes and false starts are far less expensive and time-consuming than the endless meetings and time spent analyzing and dismissing new ideas.  People’s ability to do for themselves often reduces demands on staff.  And increased staff morale due to being trusted and valued reduces absenteeism.

JCHE is sponsoring Dr. Becker’s visit because we are an organization committed to reflective practice.  In reading Dr. Becker’s dissertation to prepare for his visit, I was encouraged to discover how many elements from his practice we have already adopted:

• He argues for non-hierarchical management practices.  We are one year into our culture change process, where the primary philosophy is “mutual respect, mutual accountability” and we have been working collectively to create an open, respectful environment.
• He believes in shared “one-liners” to tell the story internally.  Our “principles of practice” posted in all common areas are 12 one-sentence imperatives derived from democratic, inclusive staff participation sessions.  [Admittedly, ours are wordy and could benefit from modeling from the simple language of Dr. Becker’s principles.]
• He says telling stories is critical to help stakeholders and the public understand the importance of the work.  For the past 3 months, we’ve been posting one story/day, written by anyone from the JCHE community who chooses to participate.
• He argues that attractive, engaging public spaces are essential to continued stimulation of mind and body.  We have more of these public spaces than I’ve seen in any other affordable housing development.
• He advocates extensive offerings to engage mind, body and spirit with cultural sensitivity.  We work hard to be culturally competent and employ staff from diverse backgrounds and raise money annually to continue art, music, intellectual and community programs.

Nonetheless, the Humanitas complexes take our achievements one step further in the ability to provide nursing home and assisted living care right in people’s apartments, and in the way they welcome the public into their common areas for dining, culture and entertainment—and extend their care offerings beyond their 4 walls.

We’re always trying to improve and learn, and we hope Dr. Becker will help us advance the cause.

Then, after hours and hours of emptying cabinets and drawers, scrubbing even in the corners and throwing out half-full boxes of things, there’s that magic moment when it’s DONE—every surface is clear and sparkling, all the drawers and cabinets are totally empty and everything smells and seems new and we declare the kitchen ready.   We go into the attic and bring down the boxes of Passover dishes, pots and pans, utensils, cups and mugs, silverware, Tupperware and the like.  And at that moment I know that I will do it all again next year.

Why?  Yes, for sure part of it is the tradition—it’s what we do.  But also I had this sudden realization this year that it is something you can start and FINISH!  So much of my work and my life is perpetually ongoing—it’s rare to actually complete anything—sure, maybe you finish a report or a letter, but then there’s the follow up and the next letter.  And the list of phone calls you haven’t yet returned.  And the emails to send……….

With Passover cleaning, there’s a moment where it’s actually completed.  You can look around the kitchen and think there’s nothing else nagging at me, no other drawer that needs clearing.  We accomplished this seemingly-monumental task!  And so I’ll remind myself of this feeling of satisfaction as next year I feel daunted by the challenge.

Fairness and government rules prevent us from granting the unit to the former group, but force us to systematically plow through the latter bunch until we find a ready-resident.  This is right—it should be on a first-come, first-serve basis and these rules ensure no favoritism and that’s good.  But it feels bad—just as we are denying someone a unit, someone else is simultaneously denying our offer—but we can’t flip them.

The long-term goal is to help people who are on the list to understand what an incredible opportunity is in front of them so that fewer end up in the group that’s begging later.  But it’s beyond that—almost never do we have someone move in and say (after the initial adjustment period), “Gee, I wish I hadn’t come—I’m moving out” whereas almost every time we hear “Gee, I wish I had done this earlier”.  The facts all support a move to senior housing such as ours, with a deep sense of community and an array of programs and services to remove barriers to achieving one’s goals for the senior years.  But people rarely make decisions based on facts.  We, and our colleagues throughout the industry, need to work to help match people’s feelings with those facts.

His message, though, was that his father’s inherent goodness shone through the haze and that the professionals who cared for him are admirable.  People who worked with elders, he said, are daily performing acts of hope and faith.

He suggested we re-frame how we describe what we do.  We do not simply do “care-giving” as we often say—rather we do “love-giving” and that our work is profoundly impactful and important

• The story where during the flight from Egypt, Amilech’s forces pounced on the stragglers and killed them.  She points out that while most commentaries focus on the evilness of Amilech and his people for attacking the weak (most likely the elderly and disabled), Rabbi Greenberg sees the passage as a message to us to better care for the weak members of our community.  After all, she says, if we hadn’t left the weak to straggle behind, they would not have been vulnerable for Amilech’s forces.  The story is a sign for all generations that it is holy to embrace and protect the whole community.
• The story of Moses smashing the tablets containing the 10 commandments when he saw the people worshipping the golden calf.  Moses gets a second set, but when the people carry around that new set in the holy arc, they included all the smashed pieces too.  Rabbi Levy says this teaches us to be mindful of how we treat our elderly—the years may have broken down their bodies, perhaps even parts of their minds, but even broken, they are our treasures.

While she acknowledges how difficult the aging process can be, she also points out it has blessings: life without work, grandchildren, perspective, link to our past, wisdom.  We can GROW older and actively choose to live, learn and develop—and those of us who work with our seniors can help each one realize his/her desired future.

There is simply no way to convey, in 1-2 minutes, the impact Francine Godfrey has had on the entire population of Dnepropetrovsk, Ukraine and by inference the hopes of all the lost Jewish communities of the FSU.  At one time, Dnep was home to the 3^rd largest Jewish community in Eastern Europe.  It was virtually wiped out physically during WWII and the Soviet aftermath—but not spiritually.  Boston was paired with Dnep in 1992 and since then we have witnessed the complete rebirth and revitalization of the Jewish community there.  And Francine has been integral to every part of that.

The pairing meant that 7 Jewish agencies pooled resources and expertise.  Can you imagine any 7 Jewish individuals agreeing on anything, much less 7 agencies filled with Jewish people?  Well, they do—they all agree that Francine is the rock star of the Dnep rebirth and continued vibrancy.

Francine began her involvement by playing a pivotal role in the development of Beit Baruch, the first Jewish assisted living facility in Ukraine.  Francine has become the coach, trusted advisor and dear friend to the entire staff—they look to her not only for the fitness program she created and continues to oversee, but for every aspect of running the facility.

Just a minute, though, about the fitness and wellness program.  Before Francine, the residents had never participated in a structured exercise and wellness program.  On her first trip, she brought her passion and her expertise AND a suitcase filled with low-tech fitness equipment.  In a nutshell, she has brought participation up from 0% to 100%!  Yes, I did mean 100%!

In case you ask, so what?  Here’s just one story: a 73-year-old bed bound man came to Beit Baruch—deemed unlikely to ever walk again.  Francine devised an exercise program and guided the fitness instructor through daily visits.  Over time, he transferred to a wheelchair.  Over more time, a walker.  Then a cane.  Today, he walks without any mobility devices and his depression has lifted—enough for him to ask Francine to find him a new bride!

For Francine, her 10 trips and regular phone calls to Dnep is a labor of love and comes from a humanitarian  place deep in her soul.  For JCHE, Francine’s involvement does something beyond bring us nachas and make us look especially good to our fellow agencies (although that’s significant).  In one of many long meetings of Jewish agencies execs, I was asked “why is it worth it for JCHE to invest so much in Dnep?”  It took me less than a millisecond to answer honestly: “If we got nothing else from this partnership, it would be totally worth it simply to keep Francine happy—she’s just that good, that productive and that valuable to our organization.”  I think this award is giving her an extra boost, and for that, the 1500 residents of JCHE and I thank you all from the bottom of our hearts.

There are many ways to celebrate, but I especially love two Purim customs.  The first is the giving of little baskets of goodies to friends and neighbors, called mishloach manot.  I came to work on Monday and there was a lovely plate of treats from one of our Brighton residents, David Schonfield—can you imagine how wonderful it was to come into that?

The second is the tradition of giving charity to the poor, called matanot la'evyonim.  JCHE is only able to offer the extensive programs and services because nearly 1,500 people give us donations (not all on Purim) to support our work.  Tonight, at the Brighton Purim dinner, three thoughtful members of the community spent their evening helping us serve, clean up and party with our residents.  Judy Levenfeld, along with her college-bound son Eric Hollenberg, and Debbie Debotton provided that extra boost that made everything run smoothly—a gift from their hearts.

I appreciate that when we feel happy, as we do on this holiday, our responsibility is to share that with others, and this Purim we saw ample evidence of that loving spirit.

• This appears a place for happy aging.  It’s enticing—the opposite of depressing (as they had expected).
• So much activity—so much connection.
• Residents are starting a poetry group at Shillman House.
• The exercise classes at our sites demand a high level of aerobic energy and build serious strength.
• Our chess club has very serious players.
• Our properties are amazingly clean and consistently well-maintained.
• Our resident service coordinators know the name of every resident, and often the names of their families.
• The book groups at our sites are reading very challenging books.
• This is worth trying to replicate!

The goal of the strategic plan is to develop a clarity about, and shared understanding of, how JCHE would like to be in the future.  The pieces will include a vision and mission statement as well as an action plan with specific strategies for implementation.  The strategic planning committee will be the guardian of the process—to be sure it’s inclusive (everyone on the board and staff should have a chance to have input), transparent (so it is clear to all stakeholders how we got from A to B) and truly broad-thinking (while maintaining a connection to the practical implications of decisions)—incorporating both the best of our collective experience and good data/information about the environment in which we operate.

We have a strong foundation—together we will choose a path that allows us to go from strength to strength.

Last week I had the honor of celebrating the upcoming new year with the Chinese Tenants of Brighton.  I learned that the snake is the sixth of the 12 animal signs—ancient Chinese wisdom says a snake in the house is a good omen.  Good omen or not, I do not wish to see any snakes in our housing—and I know our maintenance team does such a good job keeping things in ship shape that I don’t really worry.

According to various internet sources, the 2013 year of the snake is meant for “steady progress and attention to detail.  Focus and discipline will be necessary to achieve what you set out to create.”  This seems well suited to our tasks ahead—2013 will be the year of the strategic plan for JCHE.  As we consider how to build upon our considerable strengths and accomplishments and work-to-date, we will focus our thoughts on becoming what we ideally want to become—we will not shy away from big thoughts and bold ideas, but we will consider them in the context of realism and capacity.

Part of the process will include reaching out to hear what others think of our work.  Want to be among the first to advise us?  Post a comment and we’ll bring it into our strategic discussions!

Amy Schectman, JCHE CEO
February 5, 2013

At JCHE, both traditions resonate.  We have become increasingly active in reducing our carbon footprint and being green.  We recently installed co-generators in our Brighton campus and have already (less than one year later) seen significant reductions in our greenhouse gas emissions (and utility costs!).  Shillman House, our newest building, was built with geothermal heating, solar electricity generation and super-insulation and uses a small fraction of the energy/unit of our other buildings.

The appreciation for the bounty of the earth is also important to JCHE.  Most our of residents have experienced periods of shortages or lack of plenty—as such they are most grateful for the life JCHE allows them to now experience.  The affordability of rent means that even on a small budget, no one has to choose between heat and food.

And of course there’s the ever-present metaphor of the tree.  We build JCHE on the roots of our culture and the work of the earlier leaders—we nourish the organization with current effort and passion—and we hope everyone in the larger community will join us in helping us grow stronger and taller!

Happy Tu Bishvat.

But when the conversation turned to what WE will want as we age, there was much more skepticism and reluctance to embrace the supportive senior housing model.  Some of it, for sure, is the remoteness of that reality—no one I was with is thinking about retirement as anything but an abstract notion.  But everyone was pretty clear that our generation would require new models, even as they acknowledged the fact that the core issues are community, companionship and efficiency of service delivery.

So I suggested that our group of friends purchase an entire apartment building, each capture one unit, and carve out some common areas—and pool resources for bringing in supports as needed.  This seemed to almost everyone as a very cool idea.  They loved the notion of our existing community coming together to live our senior years together.

Is this very different than JCHE housing?  Not really, except that one’s neighbors here may be people that become friends after you move in rather than before.  And that the staff has years of experience navigating the systems to bring in the range of services you might need.  And that the buildings are designed with aging in mind—without the physical barriers that can impede mobility.  But somehow the two concepts seemed extraordinarily different.

An interesting question is whether what we’ll need is to take this information and “sell” it, or whether we need to re-think how we organize our communities to meet new needs.

Luckily, I failed to ask in advance for a projector, so I had to just talk.  Mostly I focused on the measurable impacts we are having on critical outcomes:

• Avoiding or seriously postponing nursing home admissions—by roughly 9.25 years;
• Protecting income/benefits of our residents;
• Increased health from regular social interaction—citing Harvard School of Public Health research that demonstrates that regular, meaningful social interaction can reduce the rate of cognitive decline by more than 50%;
• Promoting volunteerism and how much that adds to the economy; and
• Longer lives—citing the U.S. Department of Health and Human Services research suggesting this type of housing adds 5 years of expected life.

To my surprise, the other directors seemed genuinely surprised by the information and appreciative of the data.  Now these are highly-educated, well-informed, plugged-in leaders—and they didn’t know this stuff.

This is the challenge for JCHE—to combat the general lack of concrete information about the aging process.  We have learned so much over the years about what it realistically takes to age successfully—and we have a genuine desire to share this information, but in a way that does not seem self-serving or self-congratulatory.  Any suggestions?

January 14, 2013

“Old” is almost never articulated as a positive thing.  And yet, when one has a chance to reflect on life so far, at 60 there are many more accomplishments, deeper friendships and truly more wisdom and perspective than ever before.  Sure, we forget the little things like where we put our keys (OK, yes, he has been doing that since first we met in our 20’s, but now I do it too!), but we have gained so much from going through life’s ups and downs, the losses and gains, the joys and sorrows.

Working at JCHE I’m not going to deny there are many real challenges to the aging process, and it inevitably includes loss.  But every day I see the value of good judgment and deep connections that are built over lots of time.  I see seniors sharing that knowledge with children and young adults and loving to provide that valuable hard-earned perspective and guidance.  And I vow to help others understand how precious it is to have rich and varied experiences over many years’ time.

• There were ~80 of our residents, dressed up in lovely party clothes.   Everybody looked great!  The big smiles on their faces added to the look.
• The food was fabulous—lox and bagels and whitefish and kugel and mimosas.  Ideal.
• The tables had lovely tablecloths, flowers for a centerpiece and nice-looking dishes and cutlery.
• There was a pianist playing lovely tunes throughout the event.  Some tables were singing, too.
• As I stopped at every table to give new year’s wishes, people wanted to tell me how much they love living at Coleman House, how they’ve made such wonderful friends at JCHE, how everyone who works at JCHE is top notch and responsive and kind and thoughtful and talented.

I was so thrilled to be invited to this delightful celebration. This was an afternoon of community-in-action and it may well keep me smiling throughout all of 2013!

I’m not backing off from personally supporting the President’s agenda, nor from believing that sequestration (the automatic, across-the-board cuts to federal government funding that occur if a more specific resolution on the debt is not approved) would be extremely harmful to JCHE and our residents.  I simply learned that charging forward with a political message, without taking the time to focus exclusively on what part of the issue relates directly to JCHE, was offensive to some and off-putting to some others.

Fortunately, a few of our friends took the time to respond thoughtfully.  Rather than simply write off JCHE, they explained that they are big supporters of what we do, but not necessarily of other programs that the federal government funds, and expect us to have a more nuanced presentation.  We will in the future.

For now, two things strike me.  First of all, the bipartisan support that our work receives speaks volumes about the common values we all share, something which we hear to  little about today.  Secondly, a huge thanks too people who take the time to make this job an opportunity for life-long learning!

The briefing began with Valerie Jarrett (widely thought of as President Obama’s closest adviser) and Cecilia Munoz, the Director of the White House Domestic Policy Council, laying the framework.  Last year’s legislation to extend the debt ceiling which puts in place automatic spending cuts and taxes if there is not an affirmative deal to provide a more nuanced solution. Without a deal, “sequestration” occurs which will result in across-the-board spending cuts of 8.2%--very dramatic—to achieve $4 trillion in debt reduction. 

The President won a decisive election victory and has a profound commitment to resolving this situation without placing the burden on the backs of seniors, they assured us.  Rather than discuss “entitlements” such as Medicare, Medicaid and Social Security, the Administration refers to these crucial programs as “earned protections” and believes the American people want him to preserve, protect and strengthen these guarantees—not renege on them. [Social Security is solvent at the moment and not on the table in any of these current deficit discussions.]

The President will insist on a balanced and fair program of deficit reduction.  He already submitted a budget that yields $1 trillion in spending cuts.  The President is advocating not extending tax cuts on the top 2% of earners—those earning over $250,000/year—which will yield another $1 trillion.  He advocates ending tax loopholes which will yield another $0.6 trillion.  [Note: the nonprofits in the room questioned the potential impact of removing exemptions on charitable giving—the Administration is planning to take the deduction down from 28% to 20% and acknowledge this could have some consequences but given the choices, may be the least harmful. They are treating this particular deduction with more TLC than the other ones, in recognition of its role in operations for nonprofiits such as ours.]

The first step the President has taken is to submit a bill to Congress that protects middle class taxpayers by extending the tax rate reductions from several years ago for another year.   They expect this to also have a very positive effect on the economy—both stimulating spending and encouraging the markets.

Then Jason Furman, Principal Deputy Director of the National Economic Council, spent a long time taking us through various scenarios and went into some detail about the fiscal cliff threat and the President’s plans.  For example, he explained that the fiscal cliff is especially threatening to programs in 2013, since it would take effect in January 2013 but requires cuts to the entire fiscal year, which began on October 1, 2012—thus they would need to find these 8.2% cuts in only 9 months of the year.  An economist, he articulated that income inequality has been increasing dramatically over the past several decades, and the Affordable Care Act is a major step in reversing that trend.  He pointed out that with the $1 trillion in spending cuts already planned by the President, our domestic spending will be at its lowest share of the economy since Eisenhower.

Most importantly, Mr. Furman says the President is committed to avoiding this fiscal cliff, but not at the expense of vulnerable populations.  He will not sign a bill that keeps tax rates for the top earners at their current rates.  He plans to use the political capital he gained in the election to protect Medicare and insist on fair tax burdens for high income households.

He summarized the Administration plans: (1) extend middle class tax cuts now; (2) negotiate a “grand bargain” to solve the deficit with a fair, balanced program by the end of 2012; (3) move on to other important national issues at the start of 2013 by having this behind us. 

I asked him if there was room to explore, post-cliff, the relationship between investments in one government silo (HUD) and savings in another (Medicaid) and I shared JCHE’s findings there.  He replied that they really believe in that approach and wanted to explore it more in the near future.

We then had a panel from advocacy organizations so we could learn about the excellent efforts going on across the country to support the President’s plan.  These are multi-faceted: call-in days to Congress, op-ed pieces and letters to the editors of local papers, candle-light vigils to emphasize the vulnerability of seniors, position papers which calculate the impact of cuts in human terms and more.  Over the next few days, I’ll be figuring out the best ways for JCHE to fit into these crucial efforts.

Finally, Jon Carson, Director of the White House’s Office Public Engagement, gave the charge.  The President is deeply committed to protecting the services and programs for seniors.  We need to support him and be very vocal about that support.  He summed it up by saying “everything is at stake” for the country’s future—sequestration would be a disaster for seniors, for the economy and for the country.  We can help by articulating—loudly, locally and frequently—what the federal government’s dollars do for our constituents. He believes many people think home-delivered meals, Medicare and housing supports come from local government or charities—we need to be clear about the positive role of federal dollars in ways people can understand.

And we must articulate this not simply as we are trying to avoid budget or even program cuts.  Rather, it’s a values proposition—there is a choice before us now.  We can ask the wealthy to pay their fair share OR we can cut critical supports to our most vulnerable populations.  We can illustrate for our constituents, friends, supporters and ultimately our Congressman that we understand that a rich people’s tax cut is not the better choice than our programs.

December 3, 2012

I will be listening to learn facts that can be useful to all of us “in the trenches” and will tweet live from D.C.  It’s such an honor for JCHE to be seen as a player here.

Before I go, come join me at our annual fundraising brunch at Bloomingdale’s women’s department (entrance: Route 9 at the Chestnut Hill Mall).  Here’s a fun twist: you can help us raise money but don’t have to pay to come!  The brunch is free, 9 a.m. Sunday (December 2) morning—and we’ll send you off for private shopping time with special discounts—and then Bloomingdale’s will donate 10% of the value of our friends’ purchases to JCHE.  I’ll happily listen to any pre-White House advice you want to give!

• In the U.S., it is a universal holiday—no matter your religion, country of origin, cultural identity, region of the country in which you reside, political affiliation (or not), Thanksgiving is open to you.
• It is ultimately a very personal holiday.  Every family chooses how to celebrate, and each person has a chance to think about what is most meaningful in their life. 

JCHE also strives to be universally welcoming and open to all while priding ourself on offering a broad array of programs and services in the context of a supportive community, but supporting each resident to choose individually how they want to participate (or not).

I heard from virtually all residents at the parties that they are thankful for the opportunities JCHE provides them and for the high quality work of the JCHE team.  I heard from almost all staff that worked the events that they are thankful for the relationships with residents and the meaningful nature of our work.

Rabbi Hamilton’s remarks were based on this week’s Torah portion (parsha). It described the influence of a non-Jewish priest name Malkitzedek at the time that G-d made the covenant with Abraham, our forefather. The significance of an outsider --  a “foreigner” – at this pivotal time is noteworthy. Rabbi Hamilton sees this encounter as a testament that wisdom comes from all faiths, people and places.  The message to the Jewish people is clear: you are Jews and you are citizens of the world.  Our lives are greatly enriched when we are open to others. 

This is demonstrated daily at JCHE. As an organization we are clear as to our identity. We are proud of our Jewish heritage and traditions and we are continually enhanced by our residents and staff who come from other faiths and who are part of the JCHE family. 

1. Governmental structure—while we know that housing and community-based services save the government vast dollars by diverting people from expensive, Medicaid-funded nursing home care, there is the reality that to expand, the dollars saved and the dollars spent come from different buckets.  By increasing HUD budgets to build more affordable senior housing, we can save a more significant amount of public resources in the Medicaid line item. This Administration has worked on cross-agency collaborations and joint planning—to their credit—but crossing silos to this degree is a huge barrier.
2. Supply within the timeframe we’ll need it.  We all know the demographic tsunami’s coming and our current supply of housing is inadequate (JCHE has 1000 households on our waiting list alone).  But we also know the barriers to creating more housing and community-based services are great. 

These are big challenges, but as Americans we share the optimism and can-do spirit of our country—a belief that with focus and commitment, we can solve our common problems.  And we appreciate that this Administration is a partner in our work.

So let’s look ahead. The facts suggest that we can all agree to some basics:

• We will need to expand every piece of the continuum of care—from day programs, home-care services, supportive housing and nursing homes.
• The non-profit, mission-driven agencies combine the service-orientation of the public with the entrepreneurship of the private sectors—and have the ability to draw in philanthropy.  Non profits can leverage private dollars to stretch scarce public ones.  We recently built Shillman House on the Weinberg Campus. Because of our non-profit status, we were able to leverage federal dollars thrice during the development of Shillman House:HUD’s $7.6M capital advance, matched with a promise of long-term subsidies for 50 units, drew in $6.5M in private equity in the form of tax credit proceeds, more than $5M in state money and $4.7M in philanthropic dollars.  Plus, the fact that we have private investors shifts a good deal of the monitoring burden to the private sector—the discipline of investors is a powerful check on our operations.  We are seeing this same drive for ongoing measurement and monitoring from our philanthropic investors as well.
• We can and must achieve efficiencies in service delivery. For example, at congregate housing developments, in-home services can be clustered. Rather than a spending two to three hours each day traveling from house to house, home care workers can spend their entire 8 hours/day with clients who live down the hall from one another.  And think of the avoided carbon footprint!

JCHE and our colleagues around the country have created structures that give true peace of mind for seniors, for the children of those seniors, and for those seniors without children.  The challenge and opportunity in front of us is to approach this holistically across the silos. Regardless of program definitions, if we can understand the impact each piece of the puzzle can add up to a different whole when combined right—we can do it!

1)   Avoiding/postponing nursing home placement

2)   Reducing government rent burdens by helping individuals protect income

3)   Increased health via social engagement and

4)   Spurring volunteerism

1)   Avoiding/postponing nursing home placement: JCHE has 1200 apartments. Residents in all of these units have access to a rich array of services and programs that offer support. To make these available, we raise $1M/year in private philanthropic dollars. Only 3% of our residents move out to nursing homes each year. So if you live at JCHE, you are unlikely to end your life in a nursing home. For the 97% who remain at JCHE, about one-third have been deemed eligible for Medicaid funded nursing home care. However, for those JCHE residents who do go to a nursing home, they do so on average at age 88.25.* The average age of admission to a nursing home across the country is 79. For just our residents who actually go to a nursing home, those 9.25 years saves Medicaid over $9.8M (using HUD’s figure of $50K/year for nursing home care. Most studies cite costs twice as large, which would even further increase the savings). In the last 10 years alone, little JCHE, which serves only 0.00049% of the senior population of the U.S. avoided at least $98M in Medicaid nursing home costs. You can calculate the impact of replicating this scenario throughout the country! With the demographic tsunami projected and the incredible demands coming at Medicare and Medicaid, the JCHE model of supportive housing offers one way to make these demands more manageable.

And if that’s not persuasive, let me put a human face on this. Simon and Paulina have been married over 60 years. She has become increasingly frail and requires almost round-the-clock care. Simon is doing everything in his power to care for her but he’s suffering from some health challenges befitting his 89 years. JCHE arranged for home care workers to provide some basic services, although Simon believes in doing his part so they are receiving fewer hours than they are qualified for. He recently told us, “if I lived anywhere else, my beloved would be torn away from me at the time she needs me most – who knows how often I could visit her at a nursing home. Thank God for JCHE.”

[* The average age of JCHE residents upon entry to a nursing home was based on data from the past three years.]

2)    Protecting Individual Income: We also save the government money AND improve lives by helping people secure all resources available to them. For example, Ruth lives at Golda Meir House and pays one-third of her income in rent. Part of her income is from a lifetime annuity that was abruptly stopped by her financial services company. Ruth was then in her mid-80s and the company reported that she had used up her allotment. Our resident services coordinator called the company and fought the good fight – and won! So that portion of her rent does not have to be covered by HUD. In this case, it’s probably $100/month – when you multiply that by the number of seniors who experience this, it adds up to millions! And Ruth breathes a bit easier and feels safe. Someone is on her side and we that’s priceless.

3)    Health via social engagement: Folks living in senior housing and community settings where there are opportunities for regular social engagement live not only happier lives, but healthier ones. (and therefore, less expensive for Medicare). The Harvard School of Public Health found that social isolation is an important risk factor for cognitive decline in the elderly. Seniors with the highest social integration scores had less than half the rate of memory loss of those without such regular engagement. Neuroscientist John Cacioppo used brain scans, monitored blood pressure and analyzed immune function to conclude that chronic loneliness should be recognized as a serious health risk factor with consequences as life-threatening as smoking and obesity.  He documented a rise in stress hormones, altered gene expression in immune cells and higher blood pressure. We all know that these morbidities have a high cost associated with them. Living in senior housing means daily opportunities for engagement (the best antidote) by just walking down the hall. As Edith pointed out: I came here because I saw my mother spend the last years of her life ‘aging in place’ where she had always lived. But those were years of bitter loneliness. Here I feel challenged. I have met people who have had very different experiences. I read books I never would have even looked at. I have attended lectures and listened to music I didn’t know would interest me. Now I’ve got it all – friends, safety, social activity, intellectual stimulation and financial peace of mind.”

And yet, about half of all women over age 75 and one-third of all baby boomers live alone without any close family nearby.

4)    Volunteerism Adds Value: And with all the challenges facing society today, we can’t ignore the vast underutilized resource of our nation’s seniors, which is why we promote volunteerism. One resident, Natalie, points out that society tends to marginalize older people, but here everyone rises to the highest common denominator. She and her friends get on a bus twice a week and go to a troubled school in a poor section of Boston to tutor at-risk kids. And no one misses a single session all year. They not only love the experience of helping the children and the rewarding feeling of seeing progress in reading skills, the women love riding the bus there and back. They share experiences, offer tips to one another on how to reach the kids, and enjoy the camaraderie. At JCHE, more than 20% of our residents volunteer – that’s 300+ people adding value to society. Sari adds. “I once heard my daughter talking on the phone, saying wonderful things about tutors working in the inner city and making an impact – and then I realized she was talking about ME. In one instant, I went from the old lady who never graduated high school to a tutor worthy of respect.