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What Does Healthcare in a Sustainable Urban Village Look Like?
Recently, a group of Santa Fe residents with careers in a variety of health fields gathered to discuss and brainstorm what a sustainable community would look like, specifically in the area of healthcare. We recognized that for any community to become viable, it has to provide opportunities for citizens, while honoring and recognizing their intrinsic value throughout their Cycle of Life – from pregnant women and their infants to our senior citizens. Each neighbor has much to give. Our idea of health creates an environment where those gifts are respected, honored and nurtured. When we looked at what we value in such a community, health and well-being were core values.
Our vision of a healthy community includes a community garden to grow organic vegetables, a health food store, acupuncture and body workers, a gym/physical fitness center that would offer swimming, classes on fitness, yoga, dance and a spa; a healthcare professional teaching health-related classes, spiritual/meditation centers, and mental health counselors on site for the residents. There will be a family-practice physician with knowledge about integrative medicine; a broader-scope, whole-patient approach to help meet optimal levels of health, including exercise, nutrition, stress reduction and emotional well-being. This could be modeled after the Duke Integrative Medicine Wheel of Health (www.dukeintegrativemedicine.org) or the model advocated by Andrew Weil, M.D., director of the Integrative Medicine program at the University of Arizona in Tucson.
Our discussion envisioned a community that establishes senior citizen centers that recognize the value of mature wisdom, and consequently utilizes these resources to provide advice and instruction for younger citizens. These centers would interface with daycare centers for the community’s children. The community gardens would also provide additional opportunities for the interaction of generations.
When we talk about this Cycle of Life, we are incorporating birth-to-death and how we can move beyond our fears of death and of life. This is why we are looking at health on a continuum from not just physical, but our mental, emotional and spiritual well-being.
We would also incorporate end-of-life coaching, hospice and counseling on death and dying, to reduce the fear that comes from not talking about uncomfortable subjects.
Lacrosse, Wisc. has a progressive perspective about healthcare management, and deals honestly and compassionately with the end-of-life issues the American medical community has been unwilling, by and large, to talk about. This 15-year-old program has 96% community involvement. In patients 75-80 years of age, extreme interventions have shown to effectively extend the quality of life in only 5% of the cases. The cost of these valiant efforts averages around $39,000 per patient. Once La Crosse physicians began spending several hours with their aging patients discussing the options, the vast majority decided they really didn’t want to be on life support once their quality of life headed downhill and had a small chance of recovery. La Crosse healthcare costs for the last six months of life dropped dramatically. Some patients chose extreme intervention, but many did not. The average last six months’ end-of-life costs dropped to $17,000 per patient in Lacrosse, the lowest in the nation.
Another program that needs to be created is to deal with the uncomfortable subject of Alzheimer’s disease and dementia.
Jutte Lokvig has started a monthly Alzheimer’s Café in Santa Fe to create a supportive environment to give those with Alzheimer’s a chance to be with others in the same predicament. “People can be themselves with no judgment and no expectations; they can come and socialize,” Lokvig said. The café also gives caregivers a chance to socialize on their own, knowing that the person in their care is safe.
Future discussions of the sustainable healthcare group will focus on how we can provide our children with not just a traditional education but the skills to engage a new world. We envision schools providing children with the emotional intelligence to make the best choices in regard to perpetuating a healthy lifestyle throughout their life cycle. The schools should involve children in volunteer projects and social commitment, as well as exposing them to the arts and literature.
The number of Americans who have an unhealthy diet and a sedentary lifestyle is astonishing. As these unhealthy Americans approach the end of their lives, the medical costs for standard care will be astonishing. A healthy lifestyle transitions naturally at a lowered cost. Just as health insurance premiums are less for non-smokers and good drivers, we imagine the day will come when those with healthy lifestyles will pay a greatly reduced premium.
Our hope is that the sort of vision we have described will provide the framework for not just a healthy community, but by extension, a healthy society.
Kathleen Beneke is a Santa Fe-based mental health counselor and has also been a nurse for 35 years. Other people who contributed to this article include a pediatric nurse practitioner, a critical care nurse, and a hospice/palliative care nurse with extensive end-of-life care experience.
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