When bingo is not enough

It’s a small group, nine in total, the eldest of whom is 103. Beyond the facilitator and the program’s creator  – the remaining seven participants are long-term care residents at Schlegel Village’s Wentworth Heights in Hamilton, Ontario. The group is one of many that gathers once or twice a week in the site’s non-denominational chapel to sip coffee or tea, sing a few songs and talk “into” an Aboriginal talking stick. The stick serves as visual cue meant to signal respect for the speaker and, passed upon request from participant to participant, ensures everyone gets a turn.

After the opening upbeat sing-along, a participant picks a topic from the dozens listed in a guidebook resting on the centre of the table. Being Yourself? Making Amends? Death and Dying? No, today they are talking about gratitude, a general theme yet one that seems to inspire folks to drill deeply into their own experiences. One woman talks about living through the bombings in England during WWII when she was a child, and how she credits this with making her a better person. Dementia-related issues cause her to pause occasionally when the right word escapes her.

“Oh, what do you call them …” she asks herself aloud, but without fluster. “Soldiers! Yes, soldiers.”

Another participant shares how the accident that has left him in a wheelchair changed his life, but also has made him more appreciative of it. Yet another tells us that although he’s always been thought of as a man, he is grateful for experiencing what it was like to want to be a woman.

Welcome to Java Music Club, a program launched in 2011 and now in place in 600 senior homes across Canada and the United States. Based on the premise that supporting and helping others increases one’s happiness, it is recognized as an effective antidote to some of the problems plaguing senior living communities such as loneliness, depression, and senior-on-senior bullying.

Its creator, Kristine Theurer, hopes the program’s success will spark what she calls a social revolution in senior homes. For too long, we’ve got it wrong, she says.

Theurer, a 57-year-old PhD candidate at University of British Columbia, got her start in gerontology as an accredited music therapist working at senior facilities in BC back in the 90s.  She remembers being shocked by the absence of peer-to-peer support groups, that is, intimate gatherings at which participants who share a common struggle get together to share experiences.

“I couldn’t believe that nothing like this was available for residents, many of who were feeling such despair,” she recalls. Theurer was, by then, a big believer in the power of support groups. “I come from a family with a history of depression. My mother suffered severely. My brother committed suicide. So when I was struggling with depression as a younger adult, I attended support groups and they helped me profoundly.”

Certain that residents would benefit from such an offering, Theurer convinced the powers that be where she worked to allow her to start a small pilot program at the facility. The program took off, was implemented in a handful of nearby homes, and after years of testing and development has morphed into the shining star of Java Group Programs, Theurer’s small Toronto-based company.

Its other programs include Java Memory Care, an adapted version of Java Music but for people with advanced stages of dementia; and Java Mentorship Program where community volunteers team up with residents (both high functioning and those requiring assistance) to reach out to fellow seniors who don’t attend programs, have few visitors, and are socially isolated.

“The common thread which runs through the programs is the belief that empathy -- the ability to imagine how others are feeling -- builds bonds that foster new and deeper relationships. Once you have empathy for someone, you care about them and have a stake in their wellbeing. This empowers participants with a greater sense of purpose.”

Mean Girls (and Guys)

Feelings of helplessness, loneliness and depression have long been the bane of senior living communities. Theurer references a study done in the 60s by Dr. Peter Townsend in England and Wales that found loneliness was common, and 44 % of residents had symptoms or a diagnosis of depression. Fast-forward to 2010 and a Canadian Institute for Health Information study of over 50,000 Canadians living in long-term care homes revealed the exact same 44% statistic applies.

“It gave me a chill down my spine to learn the stat hasn’t changed in over 50 years in spite of the creation of beautiful new buildings, new medications for depression, and social calendars filled with activities.”

In fact, the proliferation of  “light” social events from games to trips to live entertainment, all planned and implemented by staff and indisputably well-intentioned, has given rise to a new term, cruise-ship living.

“Its the notion of sailing around indefinitely, as in for the rest of your life, with a lot of things to do but nothing to get out of bed for. Although these activities provide enjoyment for some, residents continue to report lack of meaning and influence in their lives, and limited opportunities for contribution.’

It stands to reason then that such activities would do little to counteract yet another demon of senior living -- bullying.

Remember the mean girls and guys from high school? It may surprise you to learn that they exist in many senior homes across North America. They’ve aged, yes, but their patterns of behavior are familiar. Often they find power in cliques that exclude or socially ostracize targeted individuals they perceive as different. It could be one’s cultural or socioeconomic background, a physical or mental disability, sexual orientation, style of dress, quirky habits or even age.

“There’s no doubt that living with a wide variety of people with different values and lifestyles can be difficult,” says Theurer. “For some people, moving into a senior living situation can create feelings of fear and helplessness. Although there are multiple reasons for bullying, it is often associated with loss and a need to regain control.”

Fear rises, Theurer adds, when our social status is at stake. For example, when we are the ‘new kid on the block’, or when a new person moves into our social circle and upsets the social hierarchy.

In the book, Bullying Among Older Adults (2016), penned by Robin P. Bonifas, bullying is defined as someone intentionally and repeatedly causing another person injury or discomfort. The act requires some social skills and cognitive ability, and so it tends to happen more in retirement homes, where it has been documented in 50% of residents, compared to 20% in assisted living where more residents are living with dementia. In any setting, however, social interactions that create meaningful relationships help targets and lower instances of hurtful behaviour.

Says Theurer, “It’s hard to bully someone you have empathy for.”

The Happiness Factors

According to John F. Helliwell, professor emeritus of economics at UBC, co-director of the wellbeing program at the Canadian Institute for Advanced Research (CIFAR), and the co-editor of the World Happiness Report, the problem with discussions about anything negative that happens in institutions including senior facilities, is that they often lead to what he dubs the lockdown mentality.

For example, if a wallet is stolen, the response is to lock all the doors and drawers, which creates greater feelings of mistrust. If someone bullies, all social interactions are controlled even though evidence shows that things like meanness tend to come out more in over-regulated settings than open ones.

 “So the very thing we do to cut the risks of anything bad happening to our loved ones is to put them in a situation where they’re very safe ... and very lonely and unhappy,” says Helliwell.

Interestingly, the findings of the World Happiness Report, which ranks more than 150 countries by their happiness levels, reveal that indeed happiness is related to age but not in the way you might think. In many countries, including Canada, happiness appears as a U-shaped pattern, with its lowest point falling in one’s early fifties.

“It tends to go back up from there into the mid-70s,” Helliwell reports. “But how much it rises and for whom it rises depends a whole lot on the social context in which people live.”

Although residents of institutions are not represented in the Report, Helliwell asserts that the key factors influencing happiness are relevant to residents of an eldercare facility.

“In the World Happiness Report we have six factors that turn out to be important. Two of the obvious ones are income and health, which of course are key issues as one gets older. The others are social support – do you have someone to count on in times of trouble? And generousity – how generous are you and how many people look after you in your society? Another one that feeds into the elder care issue is freedom – do you have the freedom to make your own key life choices? The other is trust – how much do you trust those around you?”

If these factors are not considered in an eldercare facility it can be more like a “benevolent jail”, he says, than an enlivening institution.

Helliwell cites a CIFAR study, which took place in the UK surrounding eldercare residents who were moving into a new facility. On one floor, residents were given a beautiful and professionally designed social space but on another floor, residents had to design and create their own. The latter ended up using their space twice as much, enjoyed better health reports, and were overall happier for having been part of this collaborative action.

“This taps into three important things. Doing things. Doing things together. Doing things together for a good purpose. And, maybe there’s a fourth, doing things together for a good purpose that includes helping other people.”

Shifting from institutional to inspired living

Christy Parsons, the vice-president of support office services at Schlegel Villages, which has 16 homes in Southern Ontario including one attached to the Schlegel/University of Waterloo Research Institute on Aging, attests that a life with purpose underpins a cultural shift in the industry from that of hospital, say, to one of community.

“We’re moving away from an institutional model to more of a social one that creates opportunities for authentic relationships, and more meaningful, shared activities,” she says. “Residents want to live and grow. They want their lives to have purpose. They want to pursue their passions.”

Programs, which were once always prescriptive, are more spontaneous with residents creating and running programs with minimal assistance.

At Schlegel’s Kitchener location, a group of women (average age: 91) recently released the third edition of Calendar Girls, a fundraiser for cancer research. The women not only created and produced the calendar, they also served as models, posing semi-nude for its artful and very playful collection of images.

“They did it for a good cause and to help fight ageism,” Parson says but adds the fun, camaraderie, and sense of empowerment experienced by the group will no doubt ensure the calendar’s place as an ongoing, annual project.

Another program Parson calls attention to is Wisdom of the Elders, in which residents share their insights and expertise within the community. For example, a former registered nurse may be brought along on a health-related visit to a fellow resident.

If such programs seem limited in terms of reach – one or two individuals here, a small group there – know that many programs take place multiple times per week involving multiple residents. At Country Terrace, an OMNI Health Care home in Komoka, Ontario, the number of Java Music Club participants has grown from 9 to 63 representing more than half of the home’s population. The staff created separate interest groups to keep gatherings intimate.

Group shot 1.jpg

Reverend Sharon Pearce, the Chaplin at Wentworth Heights, believes small numbers are not a bad thing, in fact, therein may lay a programs’ efficacy.  “We used to have this idea that the bigger the event, the larger the group, the better the program. But that’s not normal living. People can feel very alone in big crowds whereas a cup of coffee with a few friends is more apt to reflect the life we used to have and the quality of life we want to continue.”

What happens in Java Music Club stays in Java Music Club as the saying goes, but in truth, the empathy, camaraderie and support it fosters ripples out into the entire senior living community.

And happily, happiness is a contagion.

This story appeared in Zoomer Magazine - May 2017. Do you feel Canada's senior care facilities are due for a social revolution? Please send along your comments -- would love to hear your thoughts!