When we caravanned out into the community last week, this time visiting the Gary and Mary West Senior Wellness Center in downtown San Diego, I was really struck by the influence of the environment--both physical and political. I was made particularly aware of the way housing developments, healthcare laws, and transportation affect the way senior navigate through the community and access health. I thought back to the ideal city we had envisioned and realized the difficulty of changing already existing structures and policies to match this ideal. The director gave us a historical tour of the surrounding urban area as well as a greater demographic understanding of most members. The center is a senior day center open 365 days a year, serving predominantly low income senior over the age of sixty. 90% of those coming to the center are at or below the US poverty line, living in nearby single room occupancies without their own kitchen. Most of these elders incomes go directly to rent with little left over for nutritious meals. Understanding this, the center provides two meals a day. As the director explained decreases in section 8 housing vouchers and the potential for the RSO across the street to be replaced by newer more “productive” property, I gained a more heightened awareness of the way policies affecting the built environment often eschew the most basic needs of the elderly. While we may have an idealized vision for a city planning and healthcare policy, current physical structures as well as legal structures are not changed over night. This, however, does not mean that they should be ignored. Understanding the influence the built environment has on people’s access is essential in designing programs, interventions and research to advocate for change. This is something that I think the Mary and Gary West Senior Wellness Center is great at doing.
All those who come to the center have an identification card that they swipe upon entry as well as at each of the services and activities they participate in. While it may seem institutionalizing and dehumanizing, it actually serves purposes that are quite the opposite. This process is not only helpful for the center to know who is coming regularly, but it also allows the center to have concrete evidence of the types of services elders are using and how these services affect outcomes. It is through this sort of surveying process that they have established their own dentist facility on site that should be up and running quite soon. With this evidence, the center can show local governments what type of funding they need. They can also see what programs are or are not working. In this way, other centers can learn from these models.
Although only a few blocks from the St. Paul centers that we had visited just weeks before, the feel of the center was quite different. As we toured the center (the site of old De Soto car dealership), I was quite amazed not simply by the transformation but by the amount of lively activity going on, the services available, and the way the center was used as both a place of service and research to help get further programming. What used to be an open showroom is now an open gathering center with big open windows for elders to mingle and watch the world outside. As we passed the activity room, many were participating in an exercise class. Others were playing chess or working at computers in the cyber cafe. Upstairs we were given a tour of the different health and supportive services available. The one stop hallway as they called it, had a nurses station, social worker, psychiatrists, attorneys, and case managers, many of whom were bilingual to cater to the diverse population. Understanding that elders coming to the center may have trouble coming back for appointments and that they may have pressing issues that can’t warrant a time delay, the center centralize all these services in one place. This allows elders to be lead from one door to the next all in one visit.
During lunch, we had the opportunity to mingle with the elders as well as help serve the meal. I had the opportunity to speak with one of the elders, we’ll call her Judy. She was quite active, telling me all about the weight class we had just observed her participating in and the zumba class she takes at the local library three days a week. She loved to dance when younger and believes dancing to a rhythm helps her stay sharp. I couldn’t agree more. Her still active lifestyle allows her to get around, but I was still amazed by the number of hoops she jumps through just to come to the center each day. To make it to the center, she takes three separate busses, a commute that takes close to an hour. While it speaks to her appreciation for the services, it also highlights the structural barriers many must face in being able to navigate their daily lives and keep the independence they desire.
Being aware of structure--both of the physical environment and governmental policy-- is essential to serving a community and implementing programs. I believe the West Center's model of both care and reporting to government agencies has the potential to keep centers like these up and running and make them more common place so that it won't require three bus transfers to get the services needed.