By Carol Milano

The new fitness and aquatic center at Vista Del Monte Retirement Community, Santa Barbara, Calif., allows a variety of shallow warm-water exercise classes; about half the residents actively use the facility, which is also open to the public for a fee.

With residents aging in place and keen competition nearby, 36-year-old Presbyterian Home at Meadow Lakes was ready to revitalize both its image and campus.

To shift residents' and prospects' views to what Executive Director Sharon Eldridge calls "good health, empowerment, and enjoying life more," the Hightstown, N.J., retirement community developed a wellness program--reflecting a new and growing trend among America's senior communities.

"Wellness" can encompass physical, intellectual, social, emotional, spiritual, vocational and environmental health. "It's a lifelong process of consciously optimizing one's well-being," maintains consultant John Rude, president of John Rude & Associates. "The human organism has the capacity to develop throughout life--at 80, 92 or 110. If you've lost physical abilities, you can still grow in mind and spirit."

Designing a Welliness Program

A wellness program needs realistic goals. At Vista del Monte Retirement Community, Santa Barbara, Calif., personal benefits to seniors are the program's first aim. The second, organizational benefits, includes image, marketing, and improvements for residents and staff. A third goal is "becoming an active participant in Santa Barbara by expanding our services into the greater community. Our research convinced us that wellness would do all those things for us," says Charles Frazier, executive director.

Despite the apparently obvious advantages of wellness, providers should anticipate some misperceptions about a new program. As Eldridge's team began planning, residents (average age 87) asked, "'Are you out of your mind? What will people our age do with this stuff?' Some said we were only doing it for marketing," Eldridge recalls. Gradually, residents who attended private health clubs, and a retired physician who believed in exercise, helped erase doubts.

A wellness program won't succeed unless its intended audience sees what's in it for them. Before Havenwood-Heritage Heights in Concord, N.H., launched its program, Director of Rehabilitation Bart Pruszak repeated his presentation on the benefits of strength training and staying healthy 10 times, so every resident and staff member could attend.

A senior living center is not a health club, where vanity often motivates. Older adults need practical applications: rising from a chair unassisted, lifting a grandchild, taking a cross-country trip.

AAHSA members' programs offer classes and senior-friendly fitness equipment. At Meadow Lakes, a new indoor pool and Jacuzzi complement the older outdoor pool. A workout room has treadmills, recumbent bikes, free weights, dumbbells and Nu Step (a seated stepper with handles, designed for upper and lower body exercise). What's most popular? Group exercise classes, from aqua aerobics to Tai Chi. Up to 30 people attend monthly "Lunch And Learn" lectures on balance and fall prevention, osteoporosis, avoiding low back pain, and other health topics.

Vista del Monte's new, free-standing fitness and aquatic center offers shallow warm-water exercise, strength training and conditioning, and classes such as yoga, aquatic Tai Chi, and Strike-A-Balance. About half the residents actively use the facility.

Activities can be adapted to residents' different abilities. At Meadow Lakes, for example, residents with dementia or serious physical problems do water exercises, if they can walk in the pool (which incontinent residents may not use).

People with cognitive limitations do want to exercise, Pruszak finds: "We don't separate them from other residents. They can come to supervised classes; our staff helps when cognitive or physical assistance is needed."

Arthritis limits participation more than any other problem, says David Wernick, Fitness Director at Meadow Lakes. "We have water exercise classes, Joint Effort, geared to this population." At Vista del Monte, a pool program taught by the Arthritis Foundation is open to members of both organizations.

Some communities design their own wellness programs; others hire outside advisers. After a consulting firm helped with planning, Meadow Lakes contracted with the local YMCA to run its program and provide trained staff, including Wernick. North Shore Senior Center (NSSC) in Northfield, Ill., works with Alliance Rehab, a subsidiary of Health Resource Alliance, Oak Brook, Ill.


Start-Up Considerations

Safety is a major concern. Usually, a resident who wants to exercise must receive medical clearance. "People put their bodies under some degree of stress in a serious fitness program. An older person's medication mix and physical condition may change from day to day," Frazier notes.

Frazier points out that it can be very difficult to get physicians to provide such clearance for the senior population. "It is simply impossible for our staff to remain up-to-date on everyone's current condition or monitor their every activity. After careful review our legal counsel developed an indemnification and general release form which places primary responsibility on the participant in consultation with his or her doctor." Frazier says the facility takes its responsibility very seriously and exercises that responsibility by: making certain the program meets both regulatory requirements and professional fitness standards; having trained supervision of the program at all times; and engaging an experienced firm to train all staff and volunteers in CPR, use of external defibrillators and other safety practices, and to conduct periodic unannounced safety inspection visits and written reports.

A successful wellness program "requires qualified personnel, trained in exercise science and able to initiate prevention programs. Often, retirement communities delegate programming to activity directors who are trained more in social and/or recreational sciences," Rude observes.

Wellness programs at NSSC and Meadow Lakes are staffed by professionals from Alliance Rehab and the YMCA, respectively. Two physical therapists and an occupational therapist handle the fitness rooms at Havenwood-Heritage Heights; the department of therapeutic recreation helps run classes.

At Vista del Monte, a staff member is always on hand, assisted by volunteers, which Peggy Buchanan, director of fitness and aquatics, calls "one of our best practices. Over 50 senior volunteers (residents or outside community members) were trained as lifeguards, receptionists, and assistants in our strength training room, answering questions and helping instructors." (Volunteers receive a modest discount on fees.) An internship program for those interested in geriatrics brings capable student volunteers from local universities.

Time is significant: "You need a structured schedule to keep your population coming on a regular basis. It's easy to overlook fitness if it's not at a set time," Buchanan reports. Vista del Monte's center is open from 9 a.m. to 6 p.m. on weekdays, and half-days on weekends (with no scheduled classes). Meadow Lakes' workout room and pool are open from 8 to 3 weekdays, half-days on weekends; balance classes meet after 3 p.m. Havenwood-Heritage Heights' fitness room is open around the clock. "Independent residents receive training and safety instruction, and can then use the equipment on their own. For residents with limitations, we provide supervision," Pruszak explains.

Integrating Wellness Into Your Community

John Rude describes wellness as "an umbrella over the whole institution, not just a program." This means that principles of health and wellness must be observed by employees in all departments and integrated wherever possible.

As Meadow Lakes was planning its new program, residents began asking, "What can we do to eat well and stay healthy?" Eldridge reports, "We eliminated our small, outdated casual dining space and built the Lakeside Cafe, a casual dining bistro with a 'zest for life' theme, adjacent to the fitness center." Nutrition was added to the monthly educational series.

Principles of health and wellness must be observed by employees in all departments and integrated wherever possible.

Some centers reach into the larger community. Vista del Monte collaborates with the Arthritis Foundation and the Braille Institute, which offers safe shallow water exercise for blind or vision-impaired seniors. A junior college sends nursing students who act as personal trainers for residents who use wheelchairs (earning credit and free use of the fitness facilities). Havenwood-Heritage Heights wrote all local physicians a letter introducing its new wellness program, to warm response.

Not all residents are eager to exercise. Havenwood-Heritage Heights surveys residents about what they want for wellness. "They asked for a new treadmill and other machines," says Pruszak. "We listened; this program is for them, not for us." Other incentive ideas may include premiums or gift certificates for attendance in classes.

Impact of a Wellness Program

Wellness works wonderfully for marketing. Meadow Lakes held a full week of opening events, inviting the general public and its waiting list. "Prospects and families walk into a bright, lively, cheerful place where residents are obviously enjoying themselves," says Eldridge. "The fitness and aquatic center is a key element in our marketing success, and helped set us apart. We've been overwhelmed with demand and had to temporarily close our wait lists," says Frazier.

Awards and recognition enhance marketing impact. Vista del Monte received a National Pinnacle Award for best senior fitness program (2000) from NuStep Corporation. Meadow Lakes' cafe won the 2001 Order Of Excellence in Food Service Award from Contemporary Long Term Care. NSSC's new center garnered a Chicago Building Congress Award for structures that have an impact on the community in 2001.

A wellness program can even be a revenue source. "The cost of building the facility was a major concern of our board," admits Frazier. "So was its cost of operation. In our second year, we are projecting revenues of at least $375,000 against expenses of about $250,000."

The most important outcome is improving residents' quality of life. Three months after the wellness program began, residents told Eldridge, "'This is a whole new place! It's full of energy and enthusiasm.' People over 100 are going in our pool," she marvels.

Health benefits are measurable. Meadow Lakes tracked 75 participants for the first 90 days of their fitness program. Static balance (standing on one leg) improved 137 percent. Lower body flexibility rose by 72 percent. Lower body strength increased by 30 percent, upper body strength by nine percent. After one year, residents in Pruszak's program reported improved muscle tone (63 percent); greater stamina (42 percent); better balance (38 percent); improved mood (25 percent); and better sleep quality (19 percent).

Wellness need not be expensive. Little more than open space is necessary for some fitness classes, and small hand weights, benches and other simple devices can go a long way.

Keeping an Edge on Life

One Havenwood-Heritage Heights resident who took up strength training had been unable to leave for church suppers that required climbing stairs when she got there. She's attending them now. A woman in her mid-70s who had been in poor physical condition wrote to Johnson, "I can walk up or down five flights of stairs, without hanging onto the bannister. I've lost weight and people say I walk like a younger person. I do Tai Chi, dance and feel very strong and happy. Thank you so much!"

Frazier thinks "some seniors participate in our fitness center because it's a positive place to go. It feels good to be where people are maintaining, not losing, their edge on life."

Carol Milano, a health writer based in New York City, is the author of Profitable Careers In Nonprofit (John Wiley & Sons) and three other nonfiction books.

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