1. Creativity Matters: The Arts and Healthcare
The arts help to humanize healthcare environments, and serve older Americans and caregivers as powerful aids in times of emotional vulnerability by bringing beauty into the stress-filled healthcare world. The arts provide older adults with a new appreciation of their innate ability to express themselves and a safe outlet for their emotions. The arts touch spirits that seek solace and encouragement. The arts help to celebrate and build community. Shared arts experiences strengthen communication and relationships between generations—older adults, their families and caregivers. Creating and experiencing art produces a rejuvenating affect on everyone involved thereby celebrating and nurturing the entire community.
The arts in healthcare encompass a broad array of arts disciplines, including music, dance, drama, storytelling, poetry, design and visual arts. Arts programming takes place in inpatient and outpatient settings, hospitals, nursing and convalescent homes, assisted living facilities, rehabilitation centers, hospices, mental health facilities and community health centers. Medical colleges use the arts to encourage positive doctor/patient relations as well as to help caregivers process the emotional effects of death and dying.
The visual arts (i.e., sculpture, wall and floor mosaics, and murals) provide directional assistance and points of familiarity within often large and confusing facilities. Sanctuaries and healing gardens provide destination choices for patients and visitors at a time when the range of choice and personal control over clothing, room, dining and scheduling are often taken away. The arts provide relief from anxiety, distraction from pain and respite from boredom.
Comments by Gay Hanna, Ph.D., Executive Director, Society for the Arts in Healthcare, and Larry Polivka, Ph.D., Director, Florida Policy Exchange Center on Aging
Hanna noted that in ancient ritual, arts and healing were inextricably linked. In the modern era, the connection was severed, most likely due to an emphasis on the “medical model”—treating the illness and not the person. Fortunately today, there is renewed interest in integrating the arts and healing. Hanna reported that Dr. Linda Emanuel recently referred to the arts as “an emerging aspect of critical care.” “The arts,” Emanuel added, “are a vehicle for empathy.” Hanna acknowledged Gifts of the Muse, a Rand Research in the Arts Report funded by the Wallace Foundation that encourages increased consideration of the intrinsic benefits of the arts in healthcare and notes the limitations of current research in this important area.
Referencing the issue agenda of the WHCoA, Hanna commented on the connections between arts and healing, and “our community,” “health and long-term living” and “social engagement” as follows:
|Our Community||Sharing information and resources.|
|Health and Long-term Living||Redefining healthcare and cultural institutions so that healthcare centers become cultural centers.|
|Social Engagement||Integrating generations through the arts.|
Hanna reported that 2,000 U.S. hospitals (slightly more than 50 percent) have arts programming, according to a survey organized by the Society for the Arts in Healthcare and Americans for the Arts in cooperation with the Joint Commission Accreditation of Healthcare Organizations. Further, 73 percent of hospitals with arts programs have permanent displays of art; 48 percent present performances in lobbies and other public spaces; 36 percent have bedside activities; and 55 percent have arts activities geared for the health care staff.
Polivka commented that the interest in arts and healthcare would continue to grow, and that, as baby boomers age, the demand for cultural activities would increase. He added that access to cultural activities is as important as access to healthcare. To support this claim, he stressed the importance of documenting existing programs, finding a reliable and stable source of funding, and advocating for language in the Older Americans Act that allows area agencies on aging to use federal funds for cultural activities.
2. Universal Design: Designing for the Lifespan
Universal design is the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design. Universal design is not a passing trend, but an enduring design approach that assumes that the range of human ability is ordinary, not special. Contrary to the negative assumption that attention to the needs of diverse users limits good design, the experience of imaginative designers around the world has revealed that universal designs can delight the senses and lift the human spirit when integrated into the overall concept.
Universal design is a holistic and integrated approach to design that can and should play a significant role in resolving the economic, demographic and social challenges facing our society now and in the future.
Universal design can help to:
- Eliminate discrimination by eliminating segregation caused by non-accessible and non-integrated services spaces and systems.
- Empower people by allowing them to remain independent longer.
- Advance human dignity by enhancing independence.
- Enhance business by enlarging markets to include people who previously could not use inaccessible facilities.
- Assure equity by giving every access to the goods and services offered in our society.
Comments by John Salmen, President, Universal Designers & Consultants, Inc., and Robert McNulty, Director, Partners for Livable Communities
Salmen explained that universal design works for the entire population including older persons: accessible design meets minimum government standards for people with disabilities. The goal of truly universal design, he added, is “always receding” as we learn how to better and better design for all people. Salmen reviewed the seven principles of universal design as follows:
|Equitable Use||The design is useful and marketable to people with diverse abilities.|
|Flexibility in Use||The design accommodates a wide range of individual preferences and abilities.|
|Simple and Intuitive Use||Use of the design is easy to understand, regardless of the user's experience, knowledge, language skills or current concentration level.|
|Perceptible Information||The design communicates necessary information effectively to the user, regardless of ambient conditions or the user's sensory abilities.|
|Tolerance for Error||The design minimizes hazards and the adverse consequences of accidental or unintended actions.|
|Low Physical Effort||The design can be used efficiently and comfortably, and with a minimum of fatigue.|
|Size and Space for Approach and Use||Appropriate size and space is provided for approach, reach, manipulation, and use regardless of user's body size, posture or mobility.|
Salmen cited examples of universal design including Target’s Design for All marketing campaign (http://designforall.target.com/), and Oxo’s kitchen tools and house wares. In addition, he listed products such as talking sign systems, light switches with rocker panels, public toilets, and public parks with tactile maps and wind chimes to help visitors locate the entrance. Salmen also described features of a universally designed home, noting that, according to AARP, 71 percent of older Americans live in a single family home. Universal design is the result of the users’ involvement in the design process, Salmen stated. Further, it is “design for the 21st century.” Universal design makes the most of architecture, personal assistance, procedures, equipment and medical intervention to provide cost effective and elegant solutions that work for all people.
McNulty, addressing the topic of universal communities, commented that the Arts Endowment has funded design and architecture since 1967; perhaps the agency should direct some of the grant dollars toward universal communities and design. He reported that the vast majority of communities are not conducive to aging in place with limited housing options and few group homes. In addition, communities are typically designed around the car without easily accessible and affordable public transportation. Aging in place is also complicated by policies, rules and regulations that provide funds and services only to those who live in group facilities. McNulty expressed his opinion that universal communities require policy change in social service, culture, recreation (developing parks and libraries as NORCS—Naturally Occurring Retirement Communities), education (encouraging lifelong learning), healthcare delivery and organized religion. The definition of creativity also needs to be expanded to include those over 60. Effecting change will be difficult, McNulty added; there is a dearth of municipal leadership even thinking about community design. McNulty stressed that taking on this challenge is important because it is “about our lives,” how we define society and our desire to create a community that embraces all ages. Moreover, older adults are an economic asset and not a liability.
Citing The City: A Global History, a new book by Joel Kotkin published by Modern Library Chronicles in April 2005, McNulty commented that “thriving cities are those that serve as sites of security, sanctuary/values and economy.” Cities are less successful at cultivating a community and common identity among their diverse inhabitants. McNulty suggested that any urban strategy needs to include older adults. “Culture and age,” he noted “are mutual values.”
3. Lifelong Learning and Building Community Through the Arts
Older adults are too often isolated from mainstream education and community life. Yet, the arts are essential toward creating an American culture in which older people may continue to learn and have the opportunity to pass on their wisdom.
The arts can be a tool for creating community in the second half of life; they will be an important aspect of the baby boom generation with their emphasis on healthy, productive aging. Furthermore, the creative arts provide continuity and community within the continuum of care settings, and between older adults, families and staff. Finally, intergenerational service learning projects through the arts offer opportunities for civic engagement.
Community arts programs for older people span a wide range of art projects from mural making, intergenerational exchanges through all art forms, arts exhibitions and festivals as well as community art classes in senior centers, community centers, libraries, museums and schools.
Another aspect of intentionally including older adults in late life learning is the “the life long learning” trend in which institutions welcome older learners to study the arts. This movement has taken on many forms such as arts extension divisions in colleges and universities that encourage older adults’ participation and institutes for retired professionals in which older artists conduct classes for their peers.
Arts in education has provided support for arts learning in the K-12th grades. With the change in demography and the demands for life long learning, there is a need to shift the arts councils’ vision to include older people and implement policies for lifelong learning in and through the arts. Education can add vitality and meaning to life at any age.
Comments by Susan Perlstein, Founder and Executive Director, National Center for Creative Aging & Elders Share the Arts, and Rick Moody, Director of Academic Affairs, AARP
Perlstein commented that the arts reach the whole person and weave together disparate parts of the community. They are the “cultural connectors.” She emphasized the role of the arts as a catalyst for both social and civic engagement, and coalition building. Older people, she said, “are the keepers of our culture.”
Perlstein suggested that funding in the following areas could be directed toward lifelong learning and building community through the arts:
- Folk Arts: Funding for apprenticeship and mentorship programs
- Arts Education: Funding for partnerships between senior centers and schools, and for lifelong learning, not only for K-12.
- After-School Programs: Funding for intergenerational programs.
- Community Exhibitions and Performances: Funding for living history arts festivals.
A significant barrier to community-based programs, Perlstein added, is the lack of sustainable funding.
Perlstein described how various types of community institutions are already using the arts to work with older adults; for example:
- Senior Centers: Senior Arts of Albuquerque, NM, and Center in the Park, Philadelphia, PA
- Long-term Care Facilities: On Lok, San Francisco, CA
- Higher Education: New World School of the Arts, Miami, FL
- Professional Arts Companies: Stagebridge Theatre Company, Oakland, CA, and Liz Lerman Dance Exchange, Takoma Park, MD
Perlstein also highlighted the Art of Aging: Creativity Matters public awareness campaign that includes—to date—town hall meetings, petitions about the importance of using the arts to work with older adults and a panel from each state to be displayed at the WHCoA. In conclusion, Perlstein stated, “we know who we are, and we are well organized.”
Moody began his presentation with the question, “Does virtue make us healthy?” If the arts are part of the healthcare delivery system and the “health industrial complex”, he noted, “you may get evidenced-based art.” “Be careful what you wish for,” Moody warned. He advised the arts community to think about the larger context, which is the political economy of aging. With respect to economics, Moody added that the current system does not reward preventative healthcare. Indeed, where are the sustainable resources for prevention? He referenced Taoist medicine in which a person only paid the doctor if he/she got well. “Don’t neglect the possibility,” Moody said “that people will actually pay for what they value.” The older population does, in fact, have disposable income; Elderhostel is the largest educational travel organization in the world.
The arts, according to Moody, “are not just positive.” “Pain can be a source of creativity,” he added. Consider, for example, Gospel music and the Blues. Quoting Immanuel Kant’s three metaphysical questions, “What can I know? What should I know? What can I hope?” Moody described art as the “essence of hope.” Lastly, he recited excerpts from Sailing to Byzantium and The Circus Animals’ Desertion, both by William Butler Yeats.
Sailing to Byzantium
William Butler Yeats
That is no country for old men. The young
In one another's arms, birds in the trees -
Those dying generations - at their song,
The salmon-falls, the mackerel-crowded seas,
Fish, flesh, or fowl, commend all summer long
Whatever is begotten, born, and dies.
Caught in that sensual music all neglect
Monuments of unageing intellect.
An aged man is but a paltry thing,
A tattered coat upon a stick, unless
Soul clap its hands and sing, and louder sing
For every tatter in its mortal dress,
Nor is there singing school but studying
Monuments of its own magnificence;
And therefore I have sailed the seas and come
To the holy city of Byzantium.
O sages standing in God's holy fire
As in the gold mosaic of a wall,
Come from the holy fire, perne in a gyre,
And be the singing-masters of my soul.
Consume my heart away; sick with desire
And fastened to a dying animal
It knows not what it is; and gather me
Into the artifice of eternity.
Once out of nature I shall never take
My bodily form from any natural thing,
But such a form as Grecian goldsmiths make
Of hammered gold and gold enameling
To keep a drowsy Emperor awake;
Or set upon a golden bough to sing
To lords and ladies of Byzantium
Of what is past, or passing, or to come
4. Communicating the Impact of the Arts to Policy Makers
Pat Williams, Director of Citizen Membership, Americans for the Arts
Williams reminded participants that the report from this meeting is limited to a description of the issue, a list of the barriers and proposed solutions. While the goal is to have the creativity and aging issue discussed at the WHCoA, it is important to push for action at the state and local levels of government. Gibson-Hunt agreed, advising participants to be pragmatic and to “form a basis for the future.” Williams suggested that this issue might be an effective catalyst for partnerships with the U.S. Conference of Mayors and the National Governors Association. She also mentioned the value of incorporating arts performances and exhibits into the WHCoA.
If “a dedicated, sustainable source of funding” is a recommendation emerging from this conference, Williams urged participants to think both long- and short-term: it could take 10 years to find new resources, whereas re-directing existing resources could take less time. Williams also commented that it is more effective in the policy arena to focus on the economic argument than to emphasize the intrinsic value of the arts. The creative industries argument could also be expanded to include older adults.
Liz Lerman responded that both the intrinsic and extrinsic arguments are valuable, and it is necessary to “have the language to encompass both ends of the spectrum.” Mary Luehrsen expressed her disdain for “bean counter public policy.” “We have to be better strategists,” she stated, “and look at our audiences. Let’s get organized.” Referring to audiences, Cohen noted that economic factors motivate policymakers and understanding mechanisms motivates the public. Williams added that standard-setting bodies like the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and factual surveys help inform public opinion. Jim Modrick shared his opinion that focusing on outcomes avoids the debate over intrinsic vs. extrinsic value. He explained, “Spending other people’s money means what I do has to be valuable to other people.” Michael Patterson recommended, “We also have to find the intrinsic value [of creativity] for society.” Cohen reiterated that all of the arguments—creativity matters, and qualitative and quantitative research—are valuable. He added that those who provide services to older adults will soon face the “Beyond Bingo” generation.