Here we go....

Nothing is written in stone, as a career is an unpredictable journey.  

-Zlatan Ibrahimovic

If you've known me for a while, you'll understand the appropriateness of the above quote relative to my life (and if you really know me, you rolled your eyes when you realized who I quoted).  For those who weren't aware, my career journey is taking another left turn:  I have decided to leave my position as a fulltime, tenure-track assistant professor of occupational therapy in order to start my own non-profit organization.  A lot went into making this decision and perhaps in a future post I will elaborate more, but essentially it came down to this:  I continually see unmet needs in the community and wish someone would do something about it...I finally realized that I can be be the someone to do something.  I have the knowledge and skills, I have the professional and community connections, really the only thing left was the confidence (and guts) to take the leap, and I finally got there.

I am starting this blog as a way to document the process of taking an idea and turning it into an organization.  I am fortunate to have so many people cheering me on, this blog will be a way to keep you all up-to-date on what's going on, where I am in the process, and ways that you may be able to help.  So buckle up and let's get going!

 Get a good idea and stay with it.  Do it, and work at it until it's done right.

-Walt Disney

At this point you're probably wondering what my big idea is that is so important that I am willing to leave a secure, well-paying job to pursue.  Well, here it is:

You know all those fancy retirement villages in Florida you read about, those ones that sound like you're going back to college: daily programming of sports, games, fitness, arts and crafts, educational seminars, social hours?  I want to bring those types of activities and services to low income older adults aging in place.  And when I say bring them to older adults, I literally mean bring them to older adults.  Like, to where they are, to where they live.

Many of you know I've spent the last five-ish years working working with a university-led program to provide care coordination and wellness education at low-income senior housing complexes - we actually go to the apartment buildings and set up shop to provide services where the people live. The focus of the program has been on traditional medical/health care related needs: chronic disease management, navigating the complicated health care and insurance systems (helping to make appointments, figure out insurance issues, coordinating with pharmacies for prescription delivery, etc); importantly the program also works to address social determinants of health like access to food and transportation.  The services provided by this program are essential and the impact we've had on people's lives has been great.  But. (there's always a but.)

Think about your life.  Think about your health.  Why do you want to be healthy?  Does the test result in and of itself impact your well-being:  good news, your A1C is 5!  It's not the number, the diagnosis, the condition that matters.  What really matters is that because your A1C indicates your pancreas (or medication) is working correctly, that you will not experience negative symptoms that can occur with uncontrolled blood sugar levels, which means you can do the things that are important to you in your life: go to work, make dinner, have drinks with your friends, attend yoga class, read to your kids.  As an occupational therapist we call these meaningful activities we all do every day occupations.

Our health system is beginning to understand that health is more than the absence of disease, and in acknowledging and beginning to address social determinants of health, the system is finally recognizing that we need more than just medical treatment to have good health.  But we continue to be stuck on medical outcomes as the be-all-and-end-all:  we'll make sure you have access to healthy foods to reduce your risk for obesity, diabetes, heart disease, etc. But those medical outcomes are just just proximal outcomes....the outcomes that ultimately matter are our ability (or not) to engage in meaningful occupation.  This is not to say that we don't need medical care; we need medical care to ensure our bodies are working the best that they can so we can engage in meaningful occupation.

Our life roles (student, mother, worker, friend, retiree, etc) shape the occupations we engage in, and what we do, and how we spend our time is central to our identities; occupation provides meaning and purpose to our lives.  Research has found that having a purpose in life - having goals and a sense of direction - is associated with positive health outcomes, wellbeing, and quality of life.   I'm sure everyone can think of stories of someone retiring after a lifetime of work and then feeling aimless or depressed because they have not found new meaningful occupations to fill the void.  The solution to this seems simple: after retirement, provide folks opportunities to do all the fun things they didn't have time for when they were working.  Of course!  The importance of socializing and staying engaged in older age is clearly understood, hence the abundance of retirement dorms (I mean communities), marketed to the wealthy, and the senior centers and senior-focused programs for the average older adult.  But the folks that I work with have access to none of that.  

Most of the older adults I work with have incomes of less than $15,000 annually, many less than $10,000.  They pay one third of their income for rent.  Think about having just $700 month to pay for everything beyond rent: food, medicare supplements, insurance co-pays, medicine, phone service, electricity, toilet paper, ... Physically getting to a senior center is a barrier, and even if transportation can be arranged, the costs for the programs are often out of reach for people down to their last dollar and debating whether to get their medications or their food (this is an actual dilemma people I work with have experienced).  On top of that, while most of us had the means (both financial and time) to develop hobbies and leisure interests throughout our lives, many of the folks I work with didn't.  Between working long hours at low paying jobs, raising children, and making just enough money to get by, there was no time or money for anything else. So retirement comes and they lack an awareness of what leisure activities and hobbies are available and may be of interest to them.

So what does where does that leave us?  A whole lot of low-income retired folks without access to meaningful occupation. So they do nothing  (in occupational therapy we call this occupational deprivation and occupational alienation), and the longer they do nothing, the more frail and unhealthy they become.  And the more frail and unhealthy they become, the more medical care they will require and the less likely they will be able to continue living independently in the community. So while we must continue to ensure that these folks have access to health care and that social determinants of health are addressed, without also ensuring they are able to engage in meaningful occupation, they will never truly reach wellness. Our healthcare system hasn't quite caught up yet with the importance of occupational engagement (at least beyond the basics of self-care), especially when it comes to addressing social and economic barriers to engagement vs physical/cognitive disability-related barriers.   So that's where I come in.

My organization will fill this gap by providing opportunities for social participation, leisure, and other meaningful occupation for low-income older folks living in senior apartment buildings.  Think of it like a mobile senior center: I'll bring the activities to them.  

Phew, that was a lot of words! But that's the big picture of where I'm going with my life, and why.  There are still lots of details to work out, of course, but every journey starts with an idea, so let's see where this idea takes me!

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