Trees: the Best Medicine?

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By Lisa Santora, MD, MPH

In 2015, I relocated my family from Los Angeles to Marin County for trees. Yes, trees. There were two moments that crystallized my decision to move: watching my son touch his first earthworm when he was 4 years old, and hearing my 3-year old daughter exclaim, “It’s a farm!” when we landed at Philadelphia International Airport. I realized that I couldn’t stay true to my purpose of nurturing a healthy, joyful family in the concrete jungles of LA. My family and I needed nature in our lives.

Nature is scientifically proven to improve our health and well-being. But when most people are diagnosed with high blood pressure, high cholesterol, or diabetes, their next stop is often the pharmacy. For many of us, the next stop shouldn’t be picking up a new prescription, it should be visiting one of our many parks or open spaces to walk, bike, hike, or shinrin-yoku. Since the 1980s, shinrin-yoku, or “forest bathing”, has become the cornerstone of preventive health care and healing in Japan. Forest bathing has been shown to reduce cortisol (stress hormone) levels, lower blood pressure, and moderate nervous system activity. It measurably, objectively and subjectively, improves your health.

The County of Marin strives to make its parks and open spaces accessible for all in Marin. On the first Saturday of every month, Measure A Day, you can enjoy free entry and free parking at all Marin County Parks. Marin County Parks has an Inclusive Access Plan to ensure visitors can use its 16,000 acres of marshland, forests, creeks, and rolling hills according to their own abilities. Now, “other power-driven mobility devices,” like mobility scooters, can be used on trails by individuals with mobility disabilities. Marin County Parks has also partnered with Marin Health and Human Services and community partners, including Marin City Health and Wellness Center, to promote the Parks Prescription Program.

Next time you see Mt. Tam rise majestically before you, think of it as a reminder that it is time to shinrin-yoku.

More resources to help older adults enjoy the outdoors:

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Downsizing to where?

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From Program Director Linda Jackson: 

We decided to downsize this year. Our family home, long an empty nest since our youngest ones flew away, is simply too large for two people. There were rooms we didn’t go into, parts of the yard that we never saw, and decades of stuff that seems to reproduce when we weren’t watching. Most of all, we had a home that deserved to be full with a new, happy family.

The challenge was: Where would we move to in Marin? We wanted a smaller place in a neighborhood where we can walk about, close to restaurants, shops, and the movies. After months of searching, we found what may be be very last new unit in Marin. With little new housing being proposed in Marin, others will find it even more challenging to downsize to a smaller place.

No doubt about it, the process of downsizing is daunting.

It took months of sorting, a moving crew of millennials, and many boxes to give away and donate the things we don’t need anymore. It’s been a sweet good-bye journey, leaving the house we called home the past 28 years. It’s also been great fun to explore our new neighborhood near downtown San Rafael.

I can’t help but wonder how much harder it would be to do this if we were in our 70s or 80s? What options are there for older people in Marin as their lifestyles change? Will there be enough resources for people who want to grow older in their home and community? For those facing dementia or declining health, will they have what they need for safety and companionship?

The question for Marin is: what percentage of residents are going to choose to stay in San Rafael as they grew older? According to a national survey by AARP in 2012, about 90% of older adults intend to stay in their own homes for the next 5 to 10 years.

Have you heard of NORCs, which are a “naturally-occurring retirement community”? The parameters vary in the field, but I like this simple one: if 50 percent of a community’s residents are over 50, then the town is considered a “NORC.” Marin County hasn’t reached NORC status yet, although in 2010 the median age of Marin residents was 44.5, and there were 5,000 more people aged 75 and older than those five and under. There are some Marin places close to having a majority of residents over 50. In Belvedere, 41 percent of its residents were over 50 in 2010. A few communities in Marin have already reached NORCdom, such as the unincorporated community of Dillon Beach, where 62 percent of residents in 2010 were over 50! (You can look up fun census facts at factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml#)

People working with older adults are aware of the issues facing people as they grow older. Will there be housing for others who want to downsize? Will there be enough housing for the people who work in Marin – those who are caregivers, healthcare managers, and homecare experts? What about low-income people who need affordable housing, or people who need extra care, like assisted living or memory care? The recent report Older Adult Housing in Marin: Planning for 2030 estimated that 7,000 of today’s older residents need affordable housing, and that there is a shortfall of hundreds of assisted living and memory care units to meet the 2030 demand.

One small part of the housing solution in Marin is to support, fund, and streamline the process to create more accessory dwelling units. The new units can be for a caregiver, a family member, the homeowner (who can then rent out the main house), or a close-by neighbor, and can provide extra income for the homeowner. In San Rafael, the number of new accessory dwelling units doubled last year, and the city is on track to double that again. We need to do this across Marin!

This month, A.A.I. is working with our partners to ask local Councils and the Board of Supervisors to budget and prioritize funding, support, and streamlining for accessory dwelling units in 2018-19. Join us by talking this month with your elected leaders and challenging them to support this housing option for older people in Marin.

Working together, we can make a difference, starting with a place to call home.

Now, off to unpack some more boxes!

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6th Convening Recap!

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Shirin Vakharia of Marin Community Foundation presents at AAI’s 6th Convening.

From Program Director Linda Jackson:

The highlight of last month was the Aging Action Initiative’s 6th Convening.

We had a full room, dozens of new people, and beaucoup de enthusiasm for the sessions.

Our six Convenings have attracted nearly 500 people. They represent over 130 agencies, nonprofits, and organizations in Marin; 24 agencies have sent three or more people to at least one convening. Our reach is growing because people understand the value of what AAI brings to the work of an age-friendly Marin. Here are some “best parts” comments from this year’s evaluation forms:

  • I was inspired by the four individuals who opened the day. An entertaining and introspective start to the event.
  • So much concern & energy re. making Marin a healthy, secure, safe place to live.
  • Meeting new people; learning about what’s happening in community for seniors and how I can get involved more.
  • Opportunity to network; blend of public, community, and health perspectives.
  • Lens on Aging Equity — questions and discussions at our tables.
  • Reframing aging to be more effective in talking about issues facing older adults.

AAI educates! The morning began with ‘listening in’ to four Marin residents reflect on aging. Read Terri Dowling’s comments on growing older here.

Most of the day was dedicated to learning, thinking, and talking about equity. Laura Eberly of YWCA SF & Marin led two sessions about our own equity-related experiences and perceptions, and about the structure and outlook of our own organizations. You can learn more about the work and offerings of the YWCA at www.ywcasf-marin.org. This history lesson through the eyes of an African American is most insightful: www.youtube.com/watch?v=dw_mRaIHb-M

Shirin Vakharia of Marin Community Foundation moderated a session titled “Bringing Home More than a Tee-Shirt” about the just-concluded national American Society on Aging conference. Not all of us were able to attend the conference in San Francisco, so we brought it back with a panel discussion of highlights and table talks about what people learned. What did we talk about?

  • Livable Communities: housing, transportation, open space
  • Integrated health care models, social determinants of health, and LTSS + CBOs
  • Stigma-resistance and denial and the need to reframe public thinking for acceptance of supports and services for older people
  • “Solo aging” — people without kids who are now without family or spouse support
  • Isolation and health impacts
  • Caregivers: Housing and finding caregivers, workforce/immigration concerns, services in rural communities
  • Hospice/palliative care in home

In addition to equity and the ASA conference, we also talked about ageism and reframing, or revising the way we talk about older people, and the benefits and challenges of growing older.

AAI advocates! The last session of the Convening was all about the four issues we are focusing on this year: housing, aging-in-community, economic security, and transportation. Here are some of the inspirational protest signs made in the afternoon:

  • Work Here. Live Here. Stay Here.
  • End Social Isolation – Visit a Neighbor
  • Reframe our Game to Everyone’s Gain!
  • Livable wages for caregivers now!!!
  • Keep Older People Mobile

AAI promotes service collaboration! The whole day was about this — 74% of attendees reported making at least five new connections and a third of attendees met more than 10 new people.

Thanks to all who came and shared and connected! This is one of the reasons AAI came into being — to make the most of our connections so we can do the most for older people in Marin.

See you around Marin~

P.S. Miss the Convening? Email support@agingactioninitiative.org with your name and organization to request access to panel summaries and presentations.

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Ten things I learned at the Aging in America Conference

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From Program Director Linda Jackson:

Our network was in luck this year: the Aging in America Conference, hosted by the American Society on Aging (ASA), came to San Francisco at the end of March. This full immersion into the world of learning about and advocacy for older people across the United States met all expectations. General sessions covered tantalizing topics such as technology reinventing aging, community-based organizations (CBOs) at the forefront for health interventions, ending senior poverty, and innovations in Alzheimer’s.

Marin had a high profile at the conference. The Aging Action Initiative hosted a peer group discussion on successful approaches to advocacy, education, and service coordination within a collaborative network. Shirin Vakharia of the Marin Community Foundation was one of the five co-chairs on the Conference Leadership Committee and moderator for the “Creating and Sustaining CBO Business Partnerships” session at the Managed Care Academy Boot Camp. A.A.I.’s Steering Committee chair Joe O’Hehir was a highlighted speaker at that Boot Camp. The Buck Institute for Research on Aging sponsored a tour of its I.M. Pei-designed Novato campus. And, Erin McAuliffe of Marin Transit and I volunteered for the world cafe discussions at the Second Annual Summit on Livable Communities, which focused on age-friendly planning.

Here’s my top 10 list of things I heard or learned at the ASA conference:

#10 Over 50% of older people are on Facebook! Older people are increasingly using Facebook to connect with each other and with services, and to learn about opportunities to advocate for change.

#9 The program Silver Sneakers allows eligible adults to access thousands of gyms and fitness classes at no cost. Check it out: www.silversneakers.com.

#8 “We’ve added a decade to our lives, but we are likely to need help in that decade, with more and higher health care costs.” Medical facilities are realizing that when people go home with access to community-based supports, there are fewer readmissions, health care costs go down, and employee satisfaction goes up. As more people grow older in Marin in the next two decades, A.A.I. collaborations can play a pivotal role in ensuring that people can age and die at home, rather than in the ICU or an institution.

#7 “Five percent of the older population are ‘complex patients’ accounting for 58 percent of medical costs.” CBOs need to be mindful in health care partnerships about the time and staff needed to provide services to patients with multiple physical and mental illnesses.

#6 Health = 80% social determinants + 20% genes. Many speakers noted how social determinants of health (poverty, race, immigration status, etc.) are coming of age as a common theme nationwide. This leads us to #5 . . .

#5 “Under the new administration, money is going to tech startups and not CBOs. Funding is going to the disruptors who are not as aware or capable as CBOs in partnering for health care.” Arggh! Keynote speakers pointed out that to reduce emergency room visits, readmissions, and the length of hospital stays, health care institutions need to look for “social practitioners.” CBOs already know about the needs of their communities. They know what it means to be poor, hungry, or an immigrant. The greatest potential today to transform medical care is to partner health care institutions with CBOs and the public sector for more responsive and cost-effective health care.

#4 “Health care happens in the home.” No surprise here: most health care is at home, where people are most comfortable. As I checked out the Exhibition Hall, I came across these fun no-maintenance responsive pets: https://joyforall.hasbro.com. There is a wealth of technological innovations making it possible for people to stay at home for as long as possible.

#3 Alzheimer’s researchers are looking for people for clinical trials. We can help spread the word: https://www.nia.nih.gov/alzheimers/clinical-trials

#2 “We are moving from working individually to working collaboratively.” Several speakers celebrated that the recently-adopted budget in Washington included an increase in funding for older Americans, despite an original budget that cut funding. Working together, advocates were able to not just stop cuts to Meals-on-Wheels and others, but to convince elected officials to approve an increase in funding!

#1 We must stop using language that triggers negatives, creates a fear about aging, and repels potential supporters.” The collaborative Reframing Aging project by eight of the leading aging organizations in the U.S. has the goal to reduce ageism through changing public perceptions about growing older. It provides a wealth of resources for you to use in your organization. Check out this online toolkit. At AAI’s 2018 Convening, we introduced ‘reframing,’ and you will hear more from A.A.I. about this transformative approach this year.

I came back to Marin and our lively 2018 Convening on April 3. Over 100 people came this year! We had a lovely day in Tiburon. In this newsletter, we have A.A.I. Steering Committee member Teri Dowling’s inspired reflection on words from Buddha. In case you missed the Convening, here’s your peek into what we talked about: https://www.ted.com/talks/ashton_applewhite_let_s_end_ageism (Ashton Applewhite TED Talk about ageism). I promise that A.A.I. will share more about this transformative approach in upcoming months.

See you around Marin ~

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AAI SPOTLIGHT: Reframing Aging

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Reframing Aging: A New Strategy to Shift Attitudes and Policies

March 1, 2018 | Want to make real progress in promoting active aging? Change the conversation about it. If we experts and advocates strike the right themes and use the right language, we can reach the public in new ways, we can shift attitudes and we can create new policies. This is the conclusion of Frameworks Institute, an award-winning nonprofit comprised of cognitive and social scientists. As the research partner for the Reframing Aging Project, an initiative of Leaders of Aging Organizations, Frameworks has intensively studied how our communications and outreach can drive more informed conversation and policies about aging.

Changing language will change minds

Frameworks is the research partner for the Reframing Aging Project, an initiative of Leaders of Aging Organizations: AARP, the American Federation for Aging Research, the American Geriatrics Society, the American Society on Aging, the Gerontological Society of America, Grantmakers in Aging, the National Council on Aging, and the National Hispanic Council on Aging.

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Frameworks has intensively studied how our communications and outreach can drive more informed conversation and policies about aging. Among Frameworks conclusions: stark disparities divide expert and public views of aging. For example, while experts decry rampant ageism, the public has yet to acknowledge it. Experts regard aging as a continuous process, sometimes difficult, but often rich and rewarding, but the public tendency is to view aging fatalistically, as a period of decline and deterioration.

In viewing aging as something that happens to others rather than to all of us, the public regards aging challenges as matters of personal moral responsibility. If some seniors can run marathons and swim oceans, others older can conquer lesser challenges. By contrast, experts and advocates recognize the social determinants of aging and look to policy changes – new workplace practices, Medicare reform and more—to improve the aging process for everyone.

We should use more neutral phrasing such as “older people”

How can we better align public and expert views? According to Frameworks, changing language will change minds. We should be inclusive in our phrasing, saying things like “as we age” or “what we need when we’re older.”  We should avoid using words like “elderly” or “senior citizen” that reinforce negative stereotypes. Instead, we should use more neutral phrasing, such as “older people.”  In addition, we shouldn’t lead with scary statistics or demographic shifts—the silver tsunami, for example—because these will perpetuate the fatalism and negative perceptions associated with aging.

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To shift attitudes and preferences, we also should embed in our communications several Frameworks—tested “frame elements” or themes. For example, sounding a theme of JUSTICE rather than trying to elicit empathy will more likely move people on issues like social isolation. Using a BUILDING MOMENTUM metaphor will reinforce aging as time of possibility and counteract the negativism perpetuated by military metaphors like fighting or battling aging. Similarly, calling on INGENUITY to address aging challenges will resonate with the spirit of American innovation and agency that has spawned societal solutions in other arenas.

Aging related agencies around the country are working hard to digest and incorporate Frameworks’ guidance. Among them is the Community Living Campaign (CLC), a San Francisco-based nonprofit started by long-time community leaders devoted to making the city world class in its inclusion of seniors and adults with disabilities. CLC recently launched a new program, SF ReServe, which provides older adults and people with disabilities paid, part-time work with nonprofits and public agencies.

Many of us in the field have known for a long time that older people want what we all want: to be respected, to connect, to contribute.

CLC has incorporated Frameworks’ themes of justice, ingenuity and momentum into SF ReServe marketing materials.  For example, to distinguish SF ReServe from just another jobs program or handout, SF ReServe flyers and fact sheets speak to opportunity, using headlines like “Tapping a Reservoir of Talent.” The materials underscore the irony that despite San Francisco’s reputation for social reform and innovation, “many of those (older people) who helped create our vibrant city are unable to find work and make ends meet.” They go on to describe older workers as representing “a vast pool of experience, wisdom, insights and relationships.”

Logo_MYotOACLC’s Executive Director, Marie Jobling, welcomes incorporating Frameworks’ guidance into SF ReServe materials, and, hopefully soon, all of the agency’s communications.  According to Jobling, “many of us in the field have known for a long time that older people want what we all want: to be respected, to connect, to contribute. We’ve been working hard to combat negative images of aging and to call people on their biases, but we’ve needed a more disciplined, effective way to talk about what we do. Frameworks provides potent tools that aging experts and advocates can wield to bring about change.”

You can access Frameworks’ Aging Communications Toolkit here , and to see an example of putting theory into practice, read about SF ReServe here.

–Diane Krantz, Strategic Consultant and AAI Steering Committee Member


Aging Action Initiative (AAI) is a collective effort of more than 65 different agencies, grassroots organizations, commission and neighborhood groups, funded by the County of Marin and coordinated by MARINSPACE, collaborating for an age-friendly environment. For more information visit agingactioninitiative.org or connect with us on Facebook.

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