Vital Signs

If you must grow old (and sorry, you must), you may be in the right place.

By Camas Davis May 19, 2009 Published in the December 2008 issue of Portland Monthly

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IN HIS 30s AND 40s, Mark Noonan, like most of his peers, assumed he’d retire at 62, or maybe even as early as 59. As an executive for tech companies in Oregon and California, he’d worked hard his entire adulthood, and he was confident he’d have a hefty 401(k) to tap as he whiled away the rest of his days cooking, camping, or traveling.

Then his wife died in an accident at age 49. And although Noonan, then 51, realized for the first time how fleeting life could be, he also realized his life might just turn out to be quite long. If he lived to 78.1, the average life expectancy of Americans, he’d better make the rest of his time really matter, he thought. And suddenly his long-held ideals about what it meant to grow old—make money, retire, get sick, spend said money on increased health care needs—didn’t seem all that appealing.

So he quit his job at age 52 and earned a degree in gerontology from Portland Community College. In his three decades as a Portlander, Noonan had lived in Cornelius, Hillsboro, Aloha, and Beaverton, but he moved to a one-bedroom apartment downtown, across from the Portland Art Museum. He took a job as a program specialist for Elders in Action, a local senior advocacy group founded in 1968. “I can imagine doing this until I’m 70—it keeps me young,” says Noonan, who is now 55.
And when he turns 70? He just might find a third career.

This all may sound like just another midlife crisis, but according to Noonan and others his age, it represents a general shift in baby boomers’ beliefs about what it means to age in our city, our state, and the country at large. “As boomers move toward retirement, they want to have a mix of experiences,” he says. “A lot of them don’t want to quit work all the way. We want to really craft this next phase of our lives rather than be on the treadmill. That’s why there’s a big movement in the country toward encore careers.”

Noonan says he and his peers are also rethinking where and how they want to live in their later years. “I grew up in small-town Montana, but I’m having the biggest small-town experience living in the core of Portland. I know the people who make my coffee every morning. My barber’s down the street. I’m connecting with my community. Boomers are drawing from their old commune days and pushing new models. They’re thinking about buying big houses together in urban areas, or creating guided communities where they live independently, but in a supportive environment.”

They live in the right place. When it comes to re-examining how we age, few cities are better poised to lead the way than Portland. Last year, AARP The Magazine named Portland one of the top five places to live and retire (along with Atlanta; Boston; Milwaukee; and Chandler, Arizona), based, among other things, on our cutting-edge urban-planning philosophy, our large number of mixed-use developments, and our accessible public transportation. In 2006, Portland was the only American city to participate in the World Health Organization’s (WHO) Age-Friendly Cities Project, a global study that identified solid indicators of an age-friendly city—everything from creating green spaces to offering priority seating for elderly passengers on public transportation and ensuring “psychological safety” in urban environments.

Portland is also home to some of the nation’s foremost visionaries on aging, including Margaret Neal, a Portland State University (PSU) gerontology professor who directs the school’s Institute on Aging and volunteered the city for the WHO study. Neal recently partnered with Multnomah County, the Oregon Department of Transportation, and Metro (Portland’s regional government) to study how the city’s imminent population shift will affect housing and transportation. The Portland-Vancouver metropolitan area’s population of people 65 and older is projected to more than double by 2030, according to Neal’s study for Metro 166,119 to 394,406 (with another 556,805 people falling between the ages of 45 and 64).

Portland may eventually attract more seniors than other cities because it’s the urban core of a state whose long-term-care system has been widely held as the most progressive in the country—it’s certainly one of the oldest.

PSU founded its Institute on Aging in 1969, becoming one of the nation’s first academic institutions to focus its research on seniors. Karen Brown Wilson, one of the institute’s gerontology professors, is credited with having invented the concept of assisted living in the late 1980s as an alternative to nursing homes. Assisted-living facilities provide semi-independent apartments to older adults who don’t require intensive medical and nursing care, but who may need help with daily needs like dressing, bathing, eating, or using the toilet. But in order to fully develop these facilities as well as other, less expensive alternatives, Oregon officials had to come up with funding.

At the time, the federal government allowed Medicaid recipients to use their Medicaid dollars to pay for long-term care only in nursing homes. In 1981, Richard Ladd, then-director of the state’s Seniors and Disabled Services Division, successfully petitioned the feds to allow Oregonians to use Medicaid to pay for any kind of long-term care, making ours the first state to do so. As a result, the number of older adults in nursing homes dropped significantly, and the state used the diverted federal money to develop a diverse long-term-care system that would address a whole spectrum of needs for seniors. By the late 1980s, Oregon had become the only state spending more on community- and home-based services than on nursing-home care. New alternatives ?like adult-care homes (run by one or more caregivers who look after no more than five older or disabled adults at a time) began to proliferate—some 580 adult-care homes today exist in Multnomah County alone. And other states began creating similar systems based on Oregon’s groundbreaking Medicaid waiver.

But now that baby boomers have begun to retire, even Oregon’s groundbreaking models are becoming outdated. “Being 65 in 2008 is different from being 65 in 1950,” says Robert Liberty, the Metro councilor for District 6. “And it’s definitely going to be different than being 65 in 2030. So, first, maybe we shouldn’t even talk about people who are 65 as being seniors at all.”

Liberty also points to Neal’s study for Metro, which proved that older Portlanders are more likely to live in the suburbs and that, on average, baby boomers comprise a somewhat higher share of the suburban population here than they do elsewhere in the nation. Yet seniors want to be able to benefit from a more compact, dense, transit-served, mixed-use, urban setting. Suburbs will have to become more urban as our population ages, Liberty says. If not, more people may begin moving to the urban core, as Mark Noonan has.

Urbanization won’t be our only priority. As baby boomers age, designers and architects will need to meet that group’s growing and diverse needs. In Portland, this is already happening—at least for those who can afford it. On the South Waterfront, for instance, Mirabella, a high-end continuing care retirement community (CCRC), is under construction. CCRCs provide a combination of independent living, assisted living, and skilled nursing care to those who pay to live there. And while such communities have become common in this country, Mirabella will differ in at least one major way. Whereas living at other CCRCs has meant paying a hefty nonrefundable entrance fee (about the same as a home, in some cases), at Mirabella your $300,000 or $500,000 or $800,000 entrance fee (depending on the size of your living space) is 95 percent refundable should you move or die (in which case the refund would go to your kin). The property is already 95 percent pre-sold, and 300 individuals or families are on the waiting list, says Paul Riepma, senior vice president of Pacific Retirement Services, which owns Mirabella. “Baby boomers like the idea of being able to change their minds. And they don’t want to lose their money; they want to hold onto it and know they can take it with them no matter where they go.”

In the Portsmouth neighborhood, in North Portland, a more affordable yet revolutionary model is set to begin construction late next year on the old John Ball Elementary School site. Based on a similar community built 14 years ago on a former military base in Illinois, Portland Hope Meadows will house foster parents hoping to adopt their foster children, as well as seniors who wish to live in a multigenerational environment. The original Hope Meadows was started by Brenda Krause Eheart, a University of Illinois behavioral scientist who believed foster families and seniors could benefit mutually from such an intergenerational arrangement—the families by having extra guardians around for support, the seniors by avoiding isolation.

Portland Hope Meadows will be created via private funding and public fundraising, with technical assistance from Generations of Hope, Eheart’s nonprofit. The community will consist of eight houses for families, 32 apartments for single or coupled elders, shared gardens, and a community center, where elders will volunteer ?10 hours of foster-child mentoring and tutoring per month and received a rent reduction in return. “This would provide elders a safe environment to live in. And it would provide purpose and meaning to their lives,” says Derenda Schubert, the executive director. “The children will also then experience a healthy community life. There’s a sense of everyone looking out for each other.”

But for every older adult who wants to move into a communal setting like Mirabella or Hope Meadows, just as many want to stay in their homes—or age in place, as the gerontological lingo goes—as long as possible, says Frances Spak, a former social worker who heads the Growing Older at Home Project (GOAH) in North Portland’s Overlook neighborhood.

As any building complex, neighborhood, or geographic area becomes more heavily populated with residents who have chosen to age in place, it can apply for Naturally Occurring Retirement Community (NORC) status with the US Department of Health and Human Services. If it qualifies—as Overlook recently did through a partnership between GOAH and the Portland branch of United Jewish Communities, the national organization that has spearheaded the NORC movement since 2001—it will receive funding that can go toward helping older residents stay in their homes longer.

Spak is using the money to prepare a resource list of support services that might include companies like In Your Home, a Lake Oswego remodeling firm whose aging-in-place specialists (certified by the National Association of Home Builders) upgrade homes to be age-friendly (they’ll install anything from grab bars in the bathroom to glare-free lighting). She also plans to coordinate exercise and wellness programs, transportation to medical appointments, and educational workshops and classes like the ones offered through Life by Design NW, a coalition of nine local organizations that offers assessment and advice for older adults seeking new careers or volunteer opportunities. “By gaining NORC status, we can help seniors who want to stay in their homes but who are unable to cope with some of the everyday situations they need to in order to stay there,” Spak says. “It’s things like getting your front steps repaired. Or having someone come to visit you so you don’t get lonely. But we also want to build a community of people who can count on each other and who spend time together—watching movies, having picnics.”

Talk to just about anyone in Portland who has spent time thinking about aging in place, and that’s the one word that comes up again and again: community. “I think you are going to see smaller is better. Seniors are attempting to connect and integrate much more within their community,” says Jerry Cohen, director of AARP Oregon. The blueprints, says Cohen, are already in place, but the ?biggest challenge is finding the money to make such large housing and transportation shifts happen.

Despite Oregon’s progressive history with long-term care for seniors, the past five years have seen funding decrease for early-intervention services such as Oregon Project ?Independence—a program that provides sliding-scale in-home care and case management to individuals 60 and older who aren’t on Medicaid. Funding for that program was reduced by nearly half. As a result of ongoing cuts, the number of seniors in nursing homes is rising again—the very statistic the assisted-living pioneers sought to decrease. “Other states are just starting to adopt Oregon’s models,” says Mary Shortall, director of Multnomah County’s Aging and Disability Services division. “Meanwhile, we’re poised to lose ours.”

Yet Noonan and others remain hopeful.

“In the 1960s, we all wanted to change the world,” says Noonan, the mid-50s suburbanite who moved downtown. “And, of course, we didn’t really do that. But right now, there’s a big opportunity for this whole age group to return things to community, to look for new opportunities. To really change our quality of life.”

PSU’s Margaret Neal says of Portland, “There’s a level of receptivity here.” For instance, last year the Oregon Department of Transportation commissioned the Institute on Aging to study the factors that determine when people stop driving, and to advise the state on how to address the growing transit needs of Oregonians 65 and older. Metro recently partnered with the institute to look at age-related shifts in housing and transportation so that the region can better tailor its growth-management strategy to the aging population. “I think a lot of what we’ve found in terms of research will get implemented,” Neal says. “I’ve never been more optimistic.”

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