Beginning in the 1970s in one of the most challenging environments imaginable, Barry has been working to build a movement to transform the role of the elderly throughout society.
The New Idea
The field of gerontology has long espoused a holistic approach to elder care. However, until recent years there has been little effort to make such an approach possible. With increased demand and dwindling resources for quality elder care, Barry recognized that the solution lies in the residents themselves and the people who live and work with them. Barry’s idea has been to form interdependent communities among elders in long-term care facilities. His approach shifts the focus from what elders need to what they can contribute and helps nursing homes create a culture of respect and support in which the elders have themselves become the antidote to the circumstances of civic disgrace that have institutionalized the environments that care for them.
Barry offers a new architecture based on the belief that nursing home residents are the elders of our people—that they deserve respect and honor and have a right to seek happiness, hope, and meaning in the last years of their lives, and that they have much to contribute and share with future generations. He is committed to accelerating the journey of civic transformation in which nursing homes become havens where people live, regenerate and ultimately die with grace, meaning and self respect. From the day Barry began working with a handful of some of society’s most disempowered and challenged people in an old age home in 1977, he has demonstrated that when peoples’ self perception and role shifts from neglected victim to joyful, growing, learning, sage who connects the generations, they can bring healing to themselves, their families and to those who serve them.
Barry is working on two major levels with the goal of building a national movement: 1) to accelerate the transformation of nursing homes by establishing the cultural infrastructure to turn institutions into elder centered communities; and 2) the creation of the Elders Guild for all elders regardless of where they live.
The Live Oak Project engages family members, care giving staff, and the community in a new way to support and champion elders as they learn, teach, grow, and complete the tasks required to leave a legacy for future generations. Everyone’s morale is raised, use of medication declines, health outcomes improve and homes retain a loyal cadre of staff.
The Elders Guild creates interdependent communities that bring meaning and connection and enables and provides a context for co-caring in an age when our social safety net is eroding daily. It provides wisdom paths so members so elders can pursue the lifelong learning that culminates in master and wisdom that enables old people to become active and engaged sages. It provides a collective framework for elders to contribute their resources and their time to consciously work on leaving a better world for the generations to come.
Barry’s fundamental working hypothesis has been that the meaningful and cost effective solutions to virtually every social problem can be achieved by empowering and harnessing the untapped resources of those who bear the brunt of the problem. Our society is confronting an enormous and growing challenge. In the United States, 5 percent of people over 85 live in nursing homes. By 2010 there will be 34 million adults over the age of 65 and six million over the age of 85. The baby boomer generation will increase the numbers to 76 million by 2030, while the number of working people will only increase by 18 percent. The Social Security Trust Fund is becoming insolvent, increasing the urgency to create support systems and networks for America’s elders. These problems are further compounded by policymakers who focus on reducing the financial burden associated with the health maintenance of this population while providing the bare minimum standards for their care.
At the same time it is common for people to actively deny and resist the prospect of our own aging in a youth obsessed society. There are few models in the culture for a healthy role for elders and for a meaningful old age. Society suffers from a lack of elders who can provide intergenerational continuity and who can take an active role in creating an active legacy for all who will follow.
There also exists a conflict between civic society and the entrenched medical model that pervades the nursing home industry. The support networks of the elder generation have eroded due to a shift to smaller, often geographically diverse families and modern lifestyles. As heads of family, elders used to play crucial roles, advising and mentoring the young. Even if elders were frail, their family role made life meaningful. By contrast, nursing homes divest elders of meaningful roles and promote their exclusion from society. The collective wisdom of the older generation is not being captured and passed on to future generations—rather, it is being locked away behind nursing home walls.
Operators of long-term care facilities perpetuate a medical model that leaves them exposed to lawsuits, fines, and negative publicity. They focus on regulatory compliance and operating costs as they struggle to stay in business. Their primary goal is to meet industry standards, not to ensure patient or customer satisfaction. As a result, nursing homes are often little more than sterile, lifeless holding rooms that merely accommodate the aged until the end of their days, often with little or no regard for their quality of life. The whole system is ineffective. Nationally, annual staff turnover among nursing assistants, the frontline caregivers, is more than 100 percent. While reimbursement rates decline, operating costs increase as administrators fill vacancies by hiring contract nurses.
Most organizations in the field work to meet the medical and financial needs of the elderly and to monitor the present inadequate and often inhumane, system of care. The American Association of Retired Persons (AARP), the nation’s largest organization for the aged with 35 million members, has yet to define a role beyond research, lobbying, and discounts. A few organizations have made significant progress in changing the culture of institutional life for elders, but they have yet to profoundly influence the whole culture of aging. The Eden Alternative redesigns the physical space and organization of nursing homes, directly taking on the “learned helplessness” residents acquire in a dependent-patient culture.
By building a broad network of support, Barry has been able to found his strategy for a cultural shift in eldercare upon a network of community members and constituents. The emphasis has been on building the movement—not the Live Oak brand. In fact, Barry used the first seed money for Live Oak to build the Pioneer Network, a national movement for the transformation of elder care and the culture of aging. Live Oak is the hallmark example of what the movement desires to accomplish. Thus the spread of Live Oak and the growth of the movement are mutually beneficial. In 1997 the Pioneer Network was launched with 37 people. In 2004, more than 850 people from 44 states came to the organization’s sixth national conference. Through the Pioneer Network and the methods of Live Oak, Barry has been able to bring his ideas and approaches to elders, nursing home operators, professionals, direct care givers and policy makers throughout the country.
Live Oak specifically promotes the “Regenerative Community” model of long-term elder care. Through Live Oak Barry and his team are piloting numerous social innovations. Principal among them, Alameda Elders Communities serve 250 elders with 150 workers in its three homes. These homes serve as research and development centers for the refinement and testing of Live Oak’s programs, methods and practices which can then be marketed on a wider scale. The long term care communities and all their members help shift the culture of aging through their work with staff, elders and families. Thus all community members become community developers. These methods help operators meet the demands of residents and family members for quality care and give them a competitive advantage: higher satisfaction, lower staff turnover, and more private pay patients.
Among the products and programs that are being refined in cooperation with management, elders and staff are the Elders Guilds. The Elders Guilds initiate members into the responsibilities of elderhood and provide steps to advance in key areas of knowledge and personal growth. The wisdom of elders thus increases and emerges as a set of practices to be passed from one generation to the next. The Elders Guild Handbook, called The Millennial Elder: Guilding the Future, will provide a template to enable the development of Elders Guild Chapters throughout the country and around the world.
Live Oak has just entered into a strategic agreement with the Michigan Quality Improvement Organization (QIO) to sponsor the testing of the next level of the Live Oak Project in 12 to 15 additional nursing homes. The Michigan QIO has begun raising the $350,000 development money necessary to bring this project to the next level of scale. Barry and team are also preparing to roll out the Circle of Champions, an intergenerational organization of people whose work provides a supportive safety net for elders. Live Oak is currently developing a strategic partnership to develop the Circle of Champions to a national scale.
Barry continues his work with the Pioneer Network and the national movement, helping to draft and build a national consensus around the Intergenerational Declaration of Interdependence to be ratified at a major conference called Let Freedom Ring in Philadelphia in 2006.
Live Oak and its programs are driven by Barry’s team of medical, geriatrics, psychology and research professionals, who ensure that the holistic approach is maintained. The biggest challenge is coordinating an organization with such a far-reaching agenda. Since obtaining investment capital can absorb so much time and energy, Barry is also seeking shorter term strategies for replication and sustainability. Barry and the Live Oak team will use strategically placed incubators in joint venture projects to prepare his social innovations for large scale implementation. Each of these has the potential to accelerate change in specific aspects of aging and society. Barry’s capacity-building strategy has been to supplement fees and in-kind support from the Alameda sites by going first to grant-makers with whom he has longstanding relationships and cultivating relationships with larger investors. In time, earned income from consultations, training, and product sales to nursing homes will make the program largely self sustaining, supported by a dedicated team.
In recent years Barry encountered his own mortality in a life threatening illness that brought him to face his own aging. After years of serving the elderly, he now feels that he is among them.
Barry was born into a multi-generational household and neighborhood. Growing up, he spent countless hours with his grandmother. The whole family revolved around Grandma and Grandpa, weaving an intergenerational framework for each person’s role and identity. When urban renewal scattered the family, Barry’s widowed grandmother went from one adult child’s home to another, eventually entering a nursing home where she was “the center of nothing.” No one knew her or sought to be connected to her. She dwelled on the past, living in an isolation that no one deserves. Barry has dedicated his talents ever since to creating a community for elders that transforms the way elder Americans experience life.
In the 1970s Barry moved to the Berkeley area and created the Live Oak Institute. With his wife Debora, he opened and operated a nursing home that demonstrated the effectiveness of the principles and practices he developed. Today, thanks in large part to Barry, thousands of people have enjoyed their elder years, and there is a national movement to change the way we view, support, and expand the experience of elders. Barry has left the business of running nursing homes to turn his attention toward establishing the Elders Guild model nationwide. Building upon years of networking, consciousness-raising, and supporting the work of colleagues, he is forging alliances with national elder care providers. The common ingredient in all Barry’s endeavors is his understanding of how to work within a community to create a culture. He is partnering with Ashoka Fellow Dr. Bill Thomas to establish Councils of Elders and Circles of Champions in The Eden Alternative network.
Barry believes that we have a small window of opportunity to fix the culture of aging in our society and its nursing homes so we can turn a looming social liability into an asset for future generations. In 1995, the National Citizens Coalition for Nursing Home Reform identified four organizations that are changing the culture of nursing homes; Barry’s program, Live Oak Center, was one of those selected (along with Bill Thomas’ The Eden Alternative). In 1997, Barry co-founded the Pioneer Network, a national association of leaders in the field of aging. He called for a national movement. Thirty-two people attended the first meeting, each taking on a particular aspect of the work; eight hundred people attended the Pioneer Network’s fourth national conference in 2004. From the start, Barry has been the champion and point-person for culture change through development of elder centered communities. Barry sees this as a starting point for a “strawberry patch” replication that will change the culture of aging in nursing homes across the country.