Peering into the future of aging: interview with John P. Stewart, executive director, Baltimore Commission on Aging and Retirement Education.

Some would call it an interdisciplinary conference, others a crystal ball for aging in America. This September 7-8, the city of Baltimore is hosting a get-together of professionals from various disciplines sharing one thing in common: a vital interest in meeting the needs of cutting-edge baby boomers now entering their 60s. Realization has grown over the past decade that the old paradigms of aging--being cooped up in institutions, isolated in golf course communities--just aren't going to cut it for this group of seniors. Looking now at what could be, demographically, not the last years, but the last decades of their lives, these seniors are expecting to stay active and keep interested and engaged in new adventures and opportunities. And society will, to some extent, have to reinvent itself to respond, creating new social, economic, environmental, and governmental accommodations all focused on "aging in place." Recently, one of the linchpins in creating both the September conference, called "Environments for Aging," and a reinvented society for Baltimore, John P. Stewart, executive director of the city's Commission on Aging and Retirement Education (CARE), sat down with Nursing Homes/Long Term Care Management Editor-in-Chief Richard L. Peck to explore the new horizons of aging in America.

Peck: What is the basic idea of what you're trying to do?

Stewart: We're trying to create a blueprint for the design of an elder-friendly city which, when you come right down to it, will be a citizen-friendly city. What we're trying to do in developing resources for healthcare, transportation, public safety, job opportunities, and continuing education will strengthen the neighborhoods and communities not just for seniors, but for everyone.

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Peck: Is the primary focus of your work on meeting the needs of the urban poor?

Stewart: Well, among cities, Baltimore is not unique--many cities are struggling with large concentrations of low-income minority seniors who have significant issues with healthcare, cognitive impairment, and quality-of-life factors. About 51% of Maryland's low-income minority seniors live in Baltimore. But, in fact, this is a model that applies to our 112,000 seniors, with a major focus on the 18% of low-income minority seniors who are at greatest risk.

Peck: The approach, as you've indicated, is very broad, incorporating many facets of community life. Would you elaborate on this?

Stewart: Yes, our approach involves much more than just housing, it also addresses services and retrofitting for aging in place. About 38% of Baltimore's homeowners are older than 60--the question is, can they afford to stay here? We need programs and services to make that happen. As far as housing itself is concerned, because of the Americans with Disabilities Act and Fair Housing Act, much of what was once senior housing is now occupied by young people with disabilities, including drug problems. This is not a good mix of residents, and the need for creating more senior-focused housing is becoming clear. In doing this, we're aiming at developing a transitional model between independent living and skilled nursing care. We know that, as we move along the aging continuum, housing is not as much about bricks and mortar as it is about services and assistance.

Peck: Just how do long-term care institutions, such as nursing homes and assisted living, fit into this picture?

Stewart: In Baltimore we have 36 nursing homes, with some 4,000 beds, and more than 600 assisted living facilities. Nursing home providers especially are becoming concerned that the population they're seeing today is not the population of 10 years ago--they're seeing very sick elderly, as well as disabled young people recovering from drug problems, gunshot wounds, and the like. I think these providers are just becoming aware that collaborating with others on creating an elder-friendly community is in their specific interest, and we're having more and more discussions on that issue.

Peck: Didn't the Health Facilities Association of Maryland (HFAM), the state's provider association, just introduce what they call a customer-centered approach to long-term care?

Stewart: Yes they did, and it's a very enlightened model. Also, Johns Hopkins' Bloomberg School of Public Health, under Chad Boult, MD, MPH, MBA, has created a program it calls Guided Care, in which nurse practitioners assess patients and families, coordinate the care, and facilitate patients' access to community services. We need all the enlightened initiatives we can get because the demand is great. Under our Medicaid waiver program, which entitles qualified seniors to support at home if it can be demonstrated that the cost will be equal to or less than that of institutional care ($59,805 annually in Maryland), we've been capped at 3,800 slots--and we have a waiting list of more than 7,000. Our legislature allowed us a grand total of 270 additional slots this year. So, clearly, there is room for expansion and greater savings here.

Peck: There has been much discussion of late of the rise of the "Creative Class," very active and involved older people taking a very positive stance on aging. You've said they're a key component of this. How so?

Stewart: You're referring to Richard Florida's book The Rise of the Creative Class, which develops the idea that people in their middle and older ages these days want a continuing lifestyle of stimulating amenities and cultural opportunities. The challenge for those in aging-related housing and services is to provide sufficient attractions in the urban environment to attract older people in this category, including many so-called "empty nesters," to live and pursue lifestyle opportunities in the city. This will, of course, in turn stimulate the city socially and economically.

Peck: What is CARE's plan of action in getting things up and running once this September's conference is concluded?

Stewart: We have 24 programs and services that we currently run, but our immediate priority is to set up a not-for-profit 501(c)(3) "Center for Urban Aging Services and Policy Development" that will oversee the blueprint for an elder-friendly city. Initial focus would be, specifically, on three "incubator" projects focusing on the core elements of:

* Healthcare Education and Prevention: Physical Fitness and Well-Being Centers and Community Life Enrichment Centers--a focus on healthcare education, prevention, physical fitness, and social well-being leading to improved healthcare outcomes and healthier lifestyles for older adults.

* Grandparents Raising Grandchildren Caregivers Support Services Program--to reduce physical, mental-emotional, and financial stress on older adult caregivers, of whom we have some 13,000 in Baltimore.

* Poverty and Social Isolation Counseling and Support Services Program, creating a model program for identifying, reaching out to, and assisting low-income, frail, socially isolated older adults.

The Center should be established to initiate all this by October 2007.

Peck: How will all this be funded?

Stewart: We have a projected budget of about $1 million. We have requested $250,000 from the city and, if that comes through, we will ask for challenge grants to raise the rest of the funds. We foresee the Center to eventually become self-sustaining by obtaining grants, developing revenue streams through public-private partnerships and sponsors, conducting best practices analysis and implementation, and offering practicums and training/internship programs.

Peck: Any final observations on CARE, the Center, or the conference?

Stewart: This conference will allow CARE to present all the initiatives and blueprints we've talked about here to a broad range of aging-related organizations and advocates. Through this opportunity, we will expand our partnerships and collaborations and continue our momentum toward improving the quality of life for older adults in Baltimore and eventually throughout urban America.

For more information, phone [phone] or visit www.ci.baltimore.md.us/government/care. For more information on the Environments for Aging Conference, visit www.environmentsforaging.com. To send your comments to the editors, e-mail [e-mail].