LeadingAge Magazine · July-August 2017 • Volume 07 • Number 04

Vision: Bringing the Outside In

July 18, 2017 | by Gene Mitchell

This assisted living center’s principles of “community-centered living” focus on bringing the neighborhood inside its walls rather than creating a “place apart” for residents.

Nonprofit aging services providers put a premium on community benefit, a.k.a., social accountability—the responsibility they have to provide a benefit to the surrounding community. In West Newton, MA, The Scandinavian Living Center, an assisted living community serving 42 seniors, shares that commitment, but the degree to which its residents are integrated into the surrounding neighborhood and the Greater Boston community is unique.

Scandinavian Cultural Center
The Nordic Hall at the Scandinavian Living Center—the primary
performance and exhibition space for the Cultural Center.

The Scandinavian Living Center devotes more than half of its building to common areas, and invites its neighbors into that space to a remarkable degree. Executive Director Joseph Carella estimates his community has 2,000 visitors a month. As members of the greater community, residents have opportunities to interact with some of these visitors.

The Center has 40 apartments surrounding a courtyard, along with 4 conference rooms, chapels, a private dining room, the Nordic Hall [a large meeting space], office space for 4 organizations, sitting areas and a library.

The tenants include Dreher Therapy Associates, a physical therapy provider; Newton at Home, a village organization; Minding Your Mind, an organization that deals with adolescent suicide and mental health; and the on-site Scandinavian Cultural Center, which includes the Scandinavian Library, a public library focusing on Scandinavian culture. Kaffestugan is a café, open to the public and run by volunteers, that has become a neighborhood meeting place. The Scandinavian Living Center also opens its doors to dozens of neighborhood and community organizations.

Carella refers to a number of residents who chose to live at the Center after having come to the site many times for meetings and events when they were still living in their own homes.

Principles

In the 1990s, Carella published a book, Unlimited Options for Aging, and in 2017 has written a follow-up called Creating Unlimited Options for Aging which will be ready to order in the fall of this year. (There is a 2016 e-book version of the original available, but Carella says the soon-to-be-published revised edition with be significantly different, and urges readers to wait for the new one.)

Unlimited Options for Aging was written after an eye-opening visit to Scandinavia. There, Carella saw firsthand how senior care was delivered in those countries, and was inspired to bring those lessons home.

The first edition of his book offered 3 principles for enlightened senior care:

  • Creating a residential reality (i.e., maintaining the setting and expectations to which a person is accustomed, rather than forcing residents to adapt to a standardized reality)
  • Maintaining each resident’s lifestyle and dignity
  • Encouraging autonomy

The 2016 follow-up, Creating Unlimited Options for Aging, added a fourth principle, “Creating community-centered living,” that Carella now believes is by far the most important concept of them all.

We asked Carella to explain the approach behind his organization.

Joseph Carella
Joseph Carella

LeadingAge: You’ve outlined a set of 4 principles, the fourth of which is “community centered living.” Even though it was the last one added, community-centered living seems to have become the core of your philosophy. There’s one sentence in your book that struck me as a good summation: “Aging well means creating less confining communities and maintaining natural and normal connections to our family, friends and neighbors.” Can you elaborate on this idea?

Joseph Carella: This is not just about housing individuals in a building. It’s about creating a neighborhood by breaking down invisible walls. Community-centered living creates opportunities for natural human connections, good or bad, rather than trying to standardize or limit normal interactions that we experience throughout our lifetime.

You must have a welcoming residential setting that makes it comfortable for the entire community to gather during many different times. By doing this you encourage everyone involved to try different things or simply maintain a favorite interest.

We are creating a space and welcoming the community. We’re allowing different interactions to take place, creating opportunities and doing it in a natural way, with a residential setting that feels comfortable, not artificial. When you create the residential, welcoming setting, everyone—not just those living there but their neighbors, friends, all ages—feels comfortable that this is their space even if they don’t live here. Without that community comfort and natural interaction, you risk the possibility for an institutional feel that could lead to the collapse of community-centered-living.

LeadingAge: Your community’s dedication of so much space to common areas is a departure from standard practice in our field. Why is it so important?

Joseph Carella: It’s not just about housing, it’s about creating different opportunities for people to gather and by creating these different “neighborhood-like” experiences, you begin to breakdown the invisible (institutional) walls.

It gives wonderful opportunities for groups to come and go, and if you don’t instill that, you’ve institutionalized the place. We have human connections in life that are natural and not forced. We want to create the same opportunities [here] that we grew up with in our neighborhoods. In our field we’ve decided to segregate our elders to protect them. But [here] we’ve flipped it upside-down to achieve a positive effect. It’s about connecting residents to the whole community.

In assisted living and in [life plan communities], we create these beautiful environments, but we stop short on the common space for the surrounding community members to gather for meetings, events, etc. That’s what has to change.

LeadingAge: One of your guiding principles is encouraging autonomy. How does the Center do that?

Joseph Carella: Autonomy has become a buzzword for the senior housing market. We all believe everyone has the right to autonomy. However, it is not just for residents living at your complex, it is for the community at large. Everyone has the right to come and go and everyone should feel they can make a choice to come to an event at your place. Autonomy can be lost if the residents living in a place are the only ones choosing and their families or friends are not given the same opportunity.

Based on our decisions, we experience these synchronistic connections, these spontaneous and crazy moments, which allow us, like our entire life, to capture the highs (opportunities) and conquer the lows (setbacks). We’re not here to just protect elders, we are here to give them a safe environment and live with the choices. You can’t just simplify and protect, as you would for children when you get to a facility. If you don’t allow people to make choices, they won’t be comfortable with maintaining or trying new things.

LeadingAge: How do the physical characteristics of your building create the “welcoming residential reality” you want to have?

Joseph Carella: The building is fully accessible; we use universal design, including lots of natural light and common spaces for neighbors, friends and community organizations to come in and interact.

The nonprofit world must wrap its arms around this, and by doing so we will start to see a sea change in elder care housing. When all ages are encouraged and welcomed to come to quality facilities they in turn will begin to request this type of design in the future. For example, at a recent city meeting concerning the development of another assisted living facility in Newton, I was (later) told that neighbors started to ask if the developer was going to be like the Scandinavian Living Center as far as the connection to the community.

A special outcome is when children come and hang out here. I love it when they come for an event and don’t have any idea this is an assisted living community.

LeadingAge: What if you were suddenly made the CEO of a more traditionally designed retirement community, and you want to take some steps to try to implement this where there is not so much space devoted to common areas. What advice would you give to other members?

Joseph Carella: If your [building] can’t offer that much common space that’s an unfortunate reality. Maybe start to work with a senior center. This might be pie-in-the-sky thinking, but you have to start that way. Can you start partnerships with community service programs? Look at other community service organizations. Look at nonprofits but don’t narrow your search. Look at it as the best thing to do for the community, not just a marketing opportunity.

Can you expand on your property? Build a common space that can do many different things, but do it with the community working with you.

And of course, you can never give up on quality—quality staff, quality care, quality kindness. However, it is still a priority to find a way to deinstitutionalize your community for everyone involved.

Gene Mitchell is editor of LeadingAge magazine.