Karin & Paula’s Reflection
You can find the story behind why we are developing the TIIN model by clicking here. A foundational principle of this vision mirrors an important neighborhood principle I grew up with. Simply stated; it is everyone’s responsibility to know and support their neighbors. The TIIN model puts some muscle into that concept by adding services, structure and neighborhood staff.
One of my original goals for the TIIN was to reinstate the role seniors historically assumed they would have in their advanced years. The role of wise counselor! A role that includes encouraging and enjoying younger generations and passing on what their life experiences have taught them. This concept is sometimes referred to as “generativity”. Generativity gives seniors purpose and belonging. In our plan, families with young children living at low socioeconomic status and desiring mentoring and support to move forward in life would be among the beneficiaries of senior wisdom. In the TIIN model, diverse people will live side by side and come to know each other’s stories. “This type of intentional community can unite people, with or without biological ties, in meaningful and sustainable ways that improve quality of life and health for all (Eheart, Hopping, Power, Mitchell, & Racine, 2009). Diversity is embraced and enjoyed, and a growing body of evidence suggests that intentional, intergenerational communities can be of particular benefit to vulnerable populations.” (Kaplan, Sanchez, and Hoffman, 2017) Staff will help coordinate efforts so young and old can use their strengths to help serve each others needs. Having a role builds and maintains self-esteem and a sense of purpose and belonging. These are essential ingredients for flourishing in life–at all ages.
At the time this vision came to me; I was mainly a stay at home Mom who was working part time to keep up with our family budget. I was an RN, not a business person and I knew nothing about developing a neighborhood. I started out looking at vacant schools and abandoned hotels and wondering how they could be re-imagined for housing and community spaces. I believed indoor and outdoor community spaces for gardens and healthy fun would be required features. But I could not imagine how to begin! I did not have the skills or the resources. I knew this project was too big for one person–especially when that one person did not possess the needed skills and resources.
However, I believed these ideas could help people and I could not stop thinking about them! So, I started where I could—I took baby steps that felt huge when I took them! The first step came at a time when I had been interviewing for a new job. One morning I received three separate phone calls. I had been offered all three of the jobs I had applied for. With each call, I suddenly realized that I did not really want the positions offered. I thanked each caller and told them I would call them back the next day with my decision. Then I received an unexpected phone call from a friend and colleague. Connie Golden, a geriatric nurse practitioner with a business called Nurse Advisor. She helps set up care systems for seniors in their homes. She also helps people navigate the healthcare system as they manage their diagnoses. Connie called and said, “Karin, I hope you have not taken a job yet! Something came up today and I think you would be perfect for it!” She had a new client that needed an RN in her home. It was a part time temporary position. The opportunity to work 1:1 with a dementia patient in her home sounded like a dream to me! I called my husband and told him I had been offered three jobs with benefits. I added that as the jobs were offered, I realized that I did not want any of them! What I really wanted to do was to take Connie up on her surprise call for a short term private duty job working with a dementia patient in her home. My husband laughed and agreed it felt like a good fit–even though it was only temporary. This short term job turned out to be a seven and a half year journey that eventually gave me the confidence to move forward with the vision that would not leave my brain!
After four years of working with this couple, (my client’s husband) Bill began to worry about what would happen if he died first. I had already talked with my husband about this possibility and offered the option of moving Liz (my client) into our home. At that time our home was filled with three daughters and a dog, but we could offer a bedroom and a bathroom that was accessible enough to accomodate my client. Bill liked the idea. And after he died, we moved Liz in! Our new roommate had 24 hour care needs and was completely dependant on us. She flourished in our home and so did we. After seven and a half years of caring for her, three and a half of those years in my home, she died peacefully in her bedroom surrounded by a loving family of friends! Sociologists sometimes refer to this as fictive kin.
Paula and I talked and shared what felt like a coliseum full of free floating ideas. Over the next few months we talked often. We discussed housing and program ideas but could not quite zero in on anything. One evening, I was thinking about how this could all fit together and I suddenly “saw” (in my mind’s eye) what I could best describe as a neighborhood. I knew that was it, we needed to build a staffed neighborhood with different kinds of housing, connected indoor community space and surrounding green space! My first thought was, “I wonder who is going to do that! I would love to work there!” I loved the idea. I was going to see Paula the next day at a friend’s wedding and could hardly wait to see what she thought. When I told her, she smiled and said “That’s it!” Then we looked at each other and said, “how do you build a neighborhood?” and laughed!
As our children’s summer vacation was coming to an end, I was on the phone with Paula and watching my children playing outside. I told Paula that Liz, was getting weaker and sleeping more. She was nearing the end of her life. So, I reasoned that if we wanted to get serious about developing our ideas, now was the time because I would have more time at home to study and write.. The Small Business Development Center had given me some guidance when I brought Liz into our home. Paula and I agreed that I should call them the day our children started school in the fall. We needed to set a date and start. We both hoped they would be able to tell us if we had a good idea or if it was just too much to go for. We decided that if they took us seriously, we would see if they would help us write a business plan. Paula and I laughed, comparing our situation to the movie, Cool Runnings. In the movie, there are multiple scenes of people in nice suits behind big desks doubled over in laughter after being approached by Jamaican athletes, who had never seen snow–trying to raise support for a Jamaican bobsled team. We figured that if no one doubled over laughing, we would at least try!
The day my children went back to school, there was a family emergency, but I found a way to make the call as promised. To my delight, the same lovely business coach that had helped me before answered the phone. She told me she did not normally work at that time, but was filling in for someone. I was very glad I called that day! Then she listened to the ideas Paula and I were kicking around and said, “This will not be easy. I do not think you will be eligible for any government funding. I have never heard of anyone trying anything like this before so you might be in a pioneering position–which is not easy. And you may not see this happen in your lifetime. But I think it is an idea that should be developed and talked about. If you can accept that, I would love to work on it with you.” So we set a date to begin work on a business plan. That was in the fall of 2003. We committed to start and set a date! That put us on the starting block!
special thanks to Aeron Adams RN, DNP, PMHNP-BC and Paula Reif MA CFLE for collating relavent research for this blog!
I mentioned that when we started working on the business plan for the TIIN model there was very limited research that spoke to the the approach we had in mind. The TIIN model considers long term committed relationships with staff and intentional neighbors to be essential ingredients. Other essentials included looking at the environment with a holistic lens. A topic too big to fully develop in this blog! Yet, in 2010, the World Health Organization (WHO) published the Commission on Social Determinants of Health (CSDH) framework. This relatively new framework, shows patterns of health and disease in both individuals and specific populations (Berkman & Kawachi), 2014. Healthy People 2020, a national health agenda maintained by the U.S. Department of Health and Human Services (USDHHS), defined social determinants of health as “ . . .conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning and quality-of-life outcomes and risks (USDHHS, 2011).
The CSDH framework is based on the premise that health is a social phenomenon that is highly complex and involves several levels of health determinants (Kruize, Droomers, van Kamp, & Ruijsbroek, 2014). At the highest level, political and economic institutions create socioeconomic positions or social hierarchies. Within these hierarchies, populations are stratified according to income, gender, education, social class, race/ethnicity, and occupation. These social hierarchies or socioeconomic statuses then shape specific and individual social determinants of health such as living conditions, biological predispositions, and psycho-social factors, as well as the health system itself (Solar & Irwin 2010)
Located in the CSDH framework is the construct of social capital. A simple definition provided by Kawachi and Berkman (2014) holds that resources can be accessed by individuals as a result of their inclusion in a group. When social capital is viewed from a community level, it becomes a property of that community’s network which benefits the individuals who live there (Kawachi & Berkman, 2014).
The TIIN is an intervention that helps to ameliorate deleterious social hierarchies. It does so by creating a built environment where individuals from different socioeconomic backgrounds, education levels, occupations, and ethnicities agree to share social capital to benefit one another, thereby decreasing inequalities. Examples of social capital provided by seniors includes time to spend with children and adolescents of the TIIN and mentoring of young parents. Young families can offer companionship, vitality, and help with daily chores as forms of social capital that are beneficial to seniors. Within the TIIN, helath promotion will be a natural by-product of social connection and cooperation (Earheart et al., 2009)
Also significant to the TIIN model is the groundbreaking Adverse Childhood Events (ACEs) study by Felitti et al. (1998). They concluded that children who experience traumatic or adverse events such as abuse, exposure to violence, living with a family member who has substance abuse issues or a mental illness are at greater risk for physical and mental health conditions in adulthood. Individuals who experienced a higher number of ACEs were significantly more likely to suffer from chronic and debilitating diseases such as depression, alcoholism, ischemic heart disease, cancer, and chronic lung disease in adulthood (Felitti et al., 1998). Findings concluded that ACE scores were higher in the lower socioeconomic status (SES) population. (Institute for Safe Families, 2013). Mounting evidence suggests that childhood adversities in low SES families can also be related to financial insecurity, parental stress, and living in an unsafe or poor neighborhood (Santiago, 2011; Shanks & Robinson, 2013). The effect of ACEs can be magnified by low SES status as these individuals tend to have less access to resources and coping strategies (Kelly-Irving et al., 2013). Since the publication of the original Felitti et al. article in 1998, our understanding of childhood adversity and its link to poor health has grown exponentially. Toxic stress results from prolonged activation of the body’s stress-response system and causes negative physiologic changes which may lead to learning deficits, behavioral problems, and poor health outcomes over the lifespan (Garner, 2013).
ACEs have the potential to impact people throughout their lifespan. In his book, Lost Connections, (© Johann Hari, 2018) Johann Hari sites multiple sources concluding that if ACEs and shame are not dealt with in safe relationships, the results will be toxic to mental and physical health throughout the lifespan. However, if people are allowed to talk about these experiences with helpful guidance leading to the realization that they should not have been treated abusively, or accepted shame for abusive treatment, their mental and physical health improves.
Current resiliency research tells us that Adverse Childhood Experiences, (ACE’s), have a significant impact on the health, quality of life and educational achievement of children. Everything from abuse to household changes can contribute to ACEs, so there is a potential that most children will be impacted at some point. In her book The Resiliency Workbook ((c) 2012 Resiliency In Action, Inc.), Nan Henderson defines resiliency as “.. the ability to spring back, rebound, and overcome adversity of all kinds.” It is noted on the Resiliency in Action website, www.resiliency.com, that there are three broad categories of resiliency characteristics to transform adverse experiences. “Caring relationships convey compassion, understanding, respect, and interest, are grounded in listening, and establish safety and basic trust. High expectation messages communicate not only firm guidance, structure, and challenge but, and most importantly, convey a belief in the youth’s innate resilience and look for strengths and assets as opposed to problems and deficits. Lastly, opportunities for meaningful participation and contribution include having opportunities for valued responsibilities, for making decisions, for giving voice and being heard, and for contributing one’s talents to the community (Benard, 1991). “
As we work to fully develop the first TIIN Model at Hope & A Future, we are very encouraged by these research findings. We now have more than the intuitive sense of believing that bringing generations of diverse populations to
gether in an intentional staffed neighborhood setting where everyone is both helped and helpful will improve the quality of life for TIIN members and the generations to come. We hope to be a part of not only bringing the generations together, but also to bring about a shift in the paradigm of reaching out to vulnerable populations.