- [Narrator 1] Production and distribution of City Club forums and Ideastream Public Media are made possible by PNC and the United Black Fund of Greater Cleveland Incorporated.

(upbeat music) (bell dings) - Hello, and welcome to The City Club of Cleveland, where we are devoted to conversations of consequence that help democracies thrive.

How about last evening's hearings in Washington?

It's Friday, June the 10th, and I'm Peter Whitehouse, professor of neurology at Case Western Reserve University, and founder of The Intergenerational Schools here in Cleveland.

And it's my pleasure to introduce today's authors in conversation and health innovation series forum featuring my friend, Anne Basting, professor of English at the University of Wisconsin.

I've known Anne for over 20 years since we worked on a multimedia project, Talk Back Move Forward on the 100th anniversary of Alzheimer's.

Anne's portfolio of work includes many community and nursing home-based theatrical and storytelling works, including her signature program, TimeSlips for people with cognitive challenges.

She's written several amazing books, including her latest "Creative Care: A Revolutionary Approach to Dementia and Elder Care", which we will be hearing about today.

Anne's work inspires the International Reimagining Dementia Project, where social scientists, artists, and a rare neurologist dare to ask how we reframe our thinking and valuing about people with so-called dementia.

And in that process, we reimagine our own humanity and sense of community.

We've all seen it, a viral video as an elder's eyes light up as they listen to Sinatra through headphones and begin dancing perhaps.

Are our own Cleveland Naomi Feil singing "Jesus Loves Me" to a woman who begins to speak again.

Or the great-grandmother struggling with dementia, but as she sits at the piano and expertly plays her favorite concerto, a talent others thought was long forgotten or lost.

It is no mystery that the arts can stir some of our most fundamental emotions.

So what if we use the arts to radically change how we interact with elders in each other?

And what if we did not dehumanize and stigmatize people with dementia in the first place?

About 30 years ago, Anne walked into a nursing home and her life changed forever.

She noticed that our elders, especially those experiencing dementia are often isolated in nursing homes or segregated in elder care settings, making the final years of their life feel lonely and devoid of meeting.

Since then, Anne hopes to bring about radical change, and she is.

Dedicating her work to ensure that no one, including herself and myself ever have to stop playing with imagination and growing.

As a part of her work, Anne has developed arts and creative approaches that combine evidence-based therapies with methods from theater and improvisation, such as "Yes, and..." This approach fosters storytelling and active listening, which you're gonna do today, right?

Allowing elders to freely share ideas and story without worrying about getting the details correct.

Now used around the world, including here in Cleveland, Timeslips has brought light and joy to the lives of elders everywhere.

For over 20 years, Anne has researched ways to infuse meaning-making in care settings.

She is striving towards a moment when the arts are fully integrated into health and social care systems.

Her innovative work is both a community engaged artist and scholar has been recognized by the MacArthur Foundation Fellowship, the Ashoka Fellowship, a Rockefeller Fellowship, a multiple major grants.

So if you have questions for our speaker, you can text them to 330-541-5794.

That's 330-541-5794.

You can also tweet them @thecityclub.

City Club staff will try to work them into the second half of the program.

Fellow members, I'm a member and friends of The City Club of Cleveland, please join me in welcoming my friend and the friend of every other cognitively challenged older adult, Anne Basting.

(audience applauds) - Well, goodness.

Thank you, Peter.

And thank you all for having me here today.

It's a real pleasure.

It reminds me of, can I actually call this a revolutionary approach to dementia, an elder care as the subtitle of my book when I've been doing it for 25 years.

(laughs) The revolution I think is endurance in continuing this work.

I'm gonna share, I know this might come as a shock, a story with you today.

That's gonna be be how I open and carry you into the work that I do.

In May of 2019, I found myself in a large, bright day room of a nursing home in a tiny town in Kentucky.

Across from me stood a rather formidable gentleman, a serious man with square shoulders and absolutely perfect posture.

Clearly, he did not work in this nursing home.

He was unhurried, he was standing still.

I wondered about his presence.

And when he saw me looking at him, he started to walk over to me, and I got a little nervous.

"Are you in charge of this?"

He asked me.

I was.

But did I want to admit that?

I did not know.

I was there as part of a two-year training project, a team of artists, training staff to infuse creative engagement and meaning-making into daily care practices into every inch of their nursing home.

At this very moment, we were rehearsing a climactic scene of an original play, a reimagining of the story of Peter Pan, in which the audience demonstrates their belief in the value of older people, people in wheelchairs, people with dementia, people living in nursing homes.

Not by clapping.

If you remember the story of Peter Pan, Tinkerbell, you're supposed to clap and believe in fairies.

We weren't gonna do it by clapping, we were gonna do it by having the elder performers simply reach out their hand to the audience.

And when the audience came up and met the outstretched hand, that would show their belief.

When each elder's hand was met.

And I'll tell you, that was a moment of trust as a performer to actually just put your hand out and hope someone comes up to meet it.

They always did.

I'm happy to say.

When each elder's hand was met, the group of elders and caregivers who were pushing the wheelchairs from behind began a choreographed dance to Frank Sinatra's "Fly Me To The Moon" on full blast in the dining room of the nursing home.

The staff and residents had all designed their own costumes, an amazing mixture of lost boys, pirates, and fairies and all overlaps in between.

They went a little crazy with the glue gun.

(audience laughs) Residents who hadn't been out of their rooms for months were coming out early to each rehearsal and lingering after to talk with staff and artists talking about how it had gone, how it had gone, and making plans for how it could go better.

The scene that day in that day room was truly jubilant, and I decided to own up to it.

I'm the producer and writer.

"Yes," I said to this mysterious gentleman.

"Oh, well, I'm the police chief," he said.

"Okay, what could we possibly have done wrong?

Did I park in a bad place?

What is going on here?"

"I work next door," he said.

"The last time I was in this building, I was 12 years old.

My grandfather died here and I wanted nothing to do with this place since then."

To him, this nursing home was a place where old people went to die and not die very well.

It was a place of sorrow best kept hidden.

Even though it was next door, best forgotten.

But he went on.

"I can't believe what I'm seeing here right now.

I wanna help.

How can I help?"

I took a deep breath and I summoned over my collaborative partner, the inimitable Angie McAllister, who is head of culture change for the Signature Health System.

She would be able to give this gentleman a long list.

"Let me tell you of ways to help."

He ended up working with the mayor to close the city offices the next day so the staff could come and experience the performance themselves.

"They would need to see it to believe it," he said.

And he connected us to the beloved small town DJ at the radio station down the street, where an elder, an artist, and a staff member, Angie, would do the interview the next day.

Meaning and wonder.

It's really easy to scoff at those.

To think that meaning and wonder are entirely too fluffy to have enough impact to merit any investment of time, thought, money, scientific rigor.

It's not a cure after all.

Aren't we fighting for cures?

It's not a pill.

It won't get approved by the FDA or distributed through pharmacies or advocated for by powerful lobbying forces like the Alzheimer's Association.

Maybe it should.

Meaning-making and wonder, their power is like oxygen.

We can't see it, but it fills our lungs with purpose.

It is the why and why keep going.

With a reason to keep putting one foot in front of the other no matter... And I think of my mother here, how hard it is to push through the neuropathy and the arthritis to lift that foot to put one foot in front of the other.

During the pandemic, we all likely felt the power of meaning and wonder as suspended in time and isolated from others, the disordered state that was soothed by music, watching stories on Netflix, getting into a flow state with puzzles or baking, God help me, I can't keep baking.

Gotta stop baking.

We all likely felt the psychological ache that comes from suspended animation of purposelessness, the longing to be in the physical presence of loved ones or even strangers.

And since 930,000 of the nearly 1 million lost to COVID were over 50, if you know someone over 50 and I'm willing to bet we all do, you also likely felt the psychological ache of actual loss and not being able to be with the dying or grieve in the ways we have grown accustomed to.

In man's search for meaning, Viktor Frankl writes, "Being human always points and is directed to something or someone other than one's self, be it meaning to fulfill or another human being to encounter."

the more one forgets himself by giving himself to a cause to serve or another person to love, the more human he is and the more he actualizes himself.

I feel like reading that again, but I trust you to remember it.

(audience laughs) As we as humans are meaning-seeking and meaning-making creatures, Ernest Becker suggests that human beings obsessively lay the bricks of meaning to wall off thinking of the great void of mortality to ensure that our lives matter.

Wonder is part of the meaning-making process.

It is the engine, that little engine.

I just like I took key and hear it rev when I say that.

It is the engine of curiosity that compels us toward discovery and creation.

It is the fresh eye that enables us to see or consider the world around us in new ways.

Now, research suggests that a clear sense of purpose, a feeling that life is worthwhile, is connected to a whole range of physical and emotional outcomes, including better relationships, less loneliness, better mental and physical health.

And that from a UK study by Andrew Steptoe and Daisy Fancourt in 2019.

And that research is just piling up now.

There's a lot of it growing.

I just pulled one from within the three years.

Meaning and wonder are treasured in childhood in the fantastical tales of childhood books and movies, in imaginative play, in classrooms and children's museums.

My kids are older now and I miss going in there.

It's so weird if I just go in there by myself.

I really wanna go in.

But somewhere along the line, Western cultural systems decided that adults don't have the need for play or play in that same way.

And wonder became solely the playground of we artists and writers and creators and the occasional scientist.

Over the last 20 years, museums and libraries, arts and culture organizations have begun to design and offer programs to support meaning-making among their older community members and those of all ages with disabilities.

But in general, our health and social service systems still do not integrate meaning-making into their services as a way to meet this core, core human need.

I can imagine no greater need as we approach the end of life than access to wonder and meaning, to learning and growth, whatever our cognitive or physical challenges.

The question then becomes, how?

How can we bring meaning-making opportunities and wonderment to late life?

First, we can do it individually for ourselves and those we care for.

We can do it at home.

We all have the ability to turn to another human being.

And I promise for the people in the room, I won't make you do it.

So you can breathe.

Just go, "Oh, she's not gonna make me do it."

We can turn to another human being and invite them into meaning-making.

It's a really simple process that Peter mentioned a little bit in the introduction.

You just find a prompt, something to look at.

There's a mural over there.

That's a huge prompt right there on the wall.

You just find a prompt, something to look at, something to feel, something to listen to.

You open the process with what I've come to call a beautiful question, which might be the prompt itself.

A beautiful question is one that opens a shared path of discovery.

There's no right or wrong answer.

You compel the process forward with improvisation.

"Yes, and..." Now that seems really simple.

And some of you, when I say improvisation are like, "I don't do comedy."

I'm like, "That's not what I mean."

Improvisation is just simply the core method of it is "Yes, and..." And that is a radical act.

Because when you say, yes, you're observing everything in front of you that's given to you and you're accepting it, not rejecting it, you're accepting it.

That is really radical.

And then when you say, and, you're adding to it in a positive way.

Now for the people who do do comic improv, you'll know that what you never do is undercut someone and go with a negative response.

You always add to it in a positive way so that that person can then respond in turn, in a positive way out of a place of strength.

That is the radical act.

And you may know that a lot of improv is now making its way into medical education, which you can probably see the value of.

So you compel the process forward with improvisation, accepting all that is given to you, whether you understand it or not.

And I'll tell you, in the 25 years I've been doing this, I have radically accepted languages I do not speak, complete nonsense words and language.

It turns out some of those words that I echoed were swear words in Swedish, which I came to learn later.

But what is that harm?

It doesn't harm me.

I didn't know what I was saying.

Finally, you affirm it with proof of listening, echoing or writing it down, showing in your face and your whole body that you understand the emotional intent of what that expression is.

And really at its core, that's what we're doing.

We're learning, like in ballet, we're learning to communicate emotionally with your whole body.

That's what the arts are.

They're symbolic and emotional communication.

So I will repeat that.

A beautiful question.

Improvisation.

Proof of listening.

These are the core concepts of the Timeslips approach to creative engagement.

The core, the root of creative care.

You can open a moment into shared meaning-making process with a simple exchange of wonderment.

Sitting with my mom now in memory care, looking out the window at Lake Michigan, we're so lucky like you all to have a big lake to look at.

I ask her, "How is the water moving?"

And I echo her movements.

I ask a beautiful question and a prompt in and of itself, "If you could lift your arms right now and fly anywhere, where would you go?"

I echo back her response and invite more exploration.

"What would you see?

How do you feel?

Who would you bring?"

And here I point to Timeslips, which has a free family and friend training at timeslips.org, the family and friend membership with its online training and support resources for how to invite an elder who might be experiencing the pain of isolation from physical or cognitive challenges into creative meaning-making into wonder.

I would also guide you into my pandemic effort, which some days, all I could muster was a photograph and a little tiny...

This was my writing for two years.

Me who writes so many books, all I was doing was Instagram posts.

There's many of them, but they're short little letters to my parents.

Throughout the pandemic, my father had been caring for my mom experiencing dementia and I tried to give them just a little gift of wonder as close to every day as I could.

Just a snapshot of something that caught my eye on a given day, usually on a run or a walk, sometimes rounding a corner in the house and a short little letter to them modeling how to catch the day by surprise.

"How to," as Julie Christie's character says in away from her, "See yellow for the very first time."

The unique thing about this approach is that it isn't an intervention that just benefits the recipient.

It benefits the facilitator too.

It is a relational process with relational impact.

That makes it tricky.

It's not like a pill.

When you give a pill to someone else, imagine if you benefited from that pill that you gave someone else, makes it hard to measure the impact.

On this personal level, collaborative meaning-making creates a shared sense of discovery, a shared vulnerability and risk in the creative process, a shared sense of creating something meaningful together.

That personal level is an amazing place to work, and anyone who is seeking to live in the moment, that is where you're gonna find it.

But to be really felt fully and broadly, we need to get this approach out through systems change.

We need the health and social service systems that have been established separately from arts and culture and meaning-making to infuse meaning-making into their delivery systems.

Now the big how comes back.

Here's how we've done it.

Projects I've worked on over the last decade in collaboration with professional theater companies like Sojourn Theatre, my university where I use students to go out into the care settings and train them to do this.

From congregate care settings to meal delivery systems, home care providers and volunteer groups, you study the system.

How do they reach the person?

And you pour creative engagement right into the system.

You find places and existing services, where meaning-making can actually take place, and you create feedback loops.

You invite the expression, you gather the expression, you build on it and care for the expression and you share it back with the people who originally gave it to you and the broader public, because just knowing that this kind of experience is possible helps us change our perception about aging and disability.

Participants should feel part of something bigger, something valued, something that matters, something beautiful.

As an artist, this is what I've come to see as my medium.

I'm not a painter.

I do paint.

I'm not a poet, although I do write very bad poetry.

I am an artist of systems and elegant feedback loops.

What do I mean?

Before the pandemic, the team I work with at Timeslips had been piloting what we called Telestories.

A program to reach elders living at home alone.

And it's important to note here that 35% of Iowans, older Iowans live alone at home.

Back in 2012 to 2014, we worked on a collaborative project with Meals on Wheels, a home care company and a non-profit that provided companion visits and well-check phone calls.

We studied the system, we created a series of feedback loops.

We invited responses to simple and compelling beautiful questions.

We gathered those responses.

We built on those responses.

Turned them into radio segments, turned them into art exhibits.

We shared them back with the people who gave them to us and the broader public.

During the pandemic, we rolled it out with social service agency that had taken on checking in on elders who were no longer able to come to the senior centers.

We trained the callers in shaping stories that emerged from the beautiful questions.

"If you could see anything out your window right now, what would you like to see?

What is the recipe for a good life?

How are you courageous every day?

What gift would you give to the next generation?"

10 facilitators called 10 elders each week for 30 minutes, shaping stories together for 12 weeks.

That would then be shaped into a final project.

We did pre and post loneliness scales.

And this simple meaning-making exercise reduced loneliness with its myriad negative health impacts, 50% in the elder participants and up to 70 in the artists, the facilitators themselves.

We also delivered the questions by meals as well and offered an 800 number for response.

And here is where you get to actually hear somebody's voice other than mine from the 800 numbers that called in.

- [Elder 1] I had gotten a card sent to me called Timeslips.

And on there, they wanted to do what gift would I give to the next generation?

And I just wanna put hope and the sign, Betty.

Thank you very much.

It was a very thoughtful way of get reaching out to people.

Bye-bye.

- [Elder 2] I'm responding to "If you could look outside your window and see anything you wish, what would you want to see and why?"

If I looked out my window, I would like to see a very large garden of roses, of all different kinds of roses and different colors.

And the reason I would like to see this is my husband was very good with roses and each of the two homes that we owned while he was alive had beautiful, beautiful rose gardens.

I could pick roses all the time and share them with my neighbors.

I would love to look out now and see roses.

- I got to listen to hundreds of those.

Lucky me.

(chuckles) We're now piloting and working with National Meals on Wheels in five cities to integrate this into their delivery systems.

And then another five after that.

The trick is to get it so simple that the meal drivers who are already under a huge load, just like family caregivers, it has to be super simple so that they can really feel confident in bringing it out.

Meanwhile, back in Kentucky...

Didn't think I was gonna go back there, did you?

After the Frank Sinatra number, after the audience met the hands of the elders to show they believed in them, after the grand finale in which the whole place staff, residents, and audience members saying, "I'll fly away together."

And after cake in conversation in the post show, the police chief began to see the nursing home as more than a site of dying.

It was a place of meaning, where beauty and meaning could be made every day by people with profound disabilities who happened to be close to their end and the caregivers.

Over the two years of that project, we trained staff in facilitating meaning-making, in how to shape long-term projects that asked beautiful questions, ones that changed activities from being merely distracting to profound.

Ones that were so interesting that families and volunteers actually wanted to come to the nursing home or the long-term care community.

We've worked in all levels of care, not out of pity, but interest in co-creating something together.

Through the process of creating the interactive performances at the Kentucky Nursing Homes, we transform them from stigmatized places to wait to die into cultural centers, where meaning could be made every day, where beauty was made, where artists were everywhere.

This approach is to insist on the human right and the human need to make meaning, to see it as a vital part of health.

Without a why, without purpose, human beings wither.

The artist is simply the person who can model it and shape the feedback loops.

The staff, the caregivers themselves can turn and invite another human being into wonder and meaning-making, whether it is the family caregiver, the home care worker, the CNA, the meal delivery worker, the grandchild, the activity or a life enrichment coordinator, the nurse, the dietary staff, the doctor, the student volunteer, the social worker, the neighborhood, the neighbor reaching out.

This process is relational and benefits both sides.

Both the people who invite the person and the person themselves.

So what is next?

What is the biggest possible vision for this approach?

The work of acknowledging and measuring the impact of social determinants of health, which is a magical phrase to me, like access to food and housing and social networks, that should continue.

And screening questions should always include loneliness and purpose.

And when those answers come back troubling, imagine that health systems are actually partnered with cultural systems to provide information on access to collaborative meaning-making programs.

Imagine a statewide network of all cultural programs supporting isolated elders beyond senior centers and people with dementia and their caregivers who are trying to stay at home.

Like the social prescribing systems in the UK, Canada, and Australia that give us so much great data on the impact of these cultural programs, those programs are also funded.

Service learning and volunteer engagement programs in schools are trained to facilitate co-creative meaning-making, not just what I call story extraction or entertainment.

Every library, every museum offers accessible programming for older adults, for people with cognitive challenges and physical challenges.

Every community health center has an artist in residence.

Okay, now I'm getting fanciful.

(chuckles) But it's true.

It really would work to deepen engagement.

Arts is therapy continues.

Of course, as it should.

But artists trained in meaning-making and engagement are regularly hired in care systems and settings to help shape those elegant feedback loops and final public sharings of the work.

And that work is measured for meaning and purpose, social connectedness and joy, pleasure.

We arrive in the very near future at a place where health and social care systems no longer appear separate from arts and culture, from the meaning-makers.

I leave you with three beautiful questions.

How do you make meaning?

When do you want to stop making meaning?

How's never?

(chuckles) Why should we ever imagine that others would want to?

Thank you.

(audience applauds) - Hello, I'm Dan Moulthroup with The City Club, and we're about to begin the Q&A with the audience.

We're joined today by Anne Basting.

She's a professor of English at the University of Wisconsin.

She's an artist, and she's the author of the book we're discussing today "Creative Care: A Revolutionary Approach to Dementia and Elder Care".

We welcome questions from everyone, City Club members, guests, and those of you joining us via our live stream at cityclub.org, or our radio broadcast at 89.7 WKSU, Ideastream Public Media.

If you'd like to tweet a question, please tweet it @thecityclub and our team will work it into the program.

You can also text your questions to 330-541-5794.

The number again for our radio audience is 330-541-5794.

And our staff will work it into the program.

Now we have our first question.

- We're gonna do a text question first and then we'll go to our audience Q&A.

All right.

You mentioned that imagination is often siloed to the young.

Can you speak to the intergenerational approach like having Pre-K centers located inside elder care facilities as a solution?

- Yes, there's really exciting work.

One of the things we've done in this country is segregate the generations.

There are some amazing organizations in Intergenerational Schools as one and also Signature Healthcare, the collaborative partner on the Kentucky project, Angie McAllister started summer camps as well for the children of the staff mostly, but also anyone else in the community that wanted to do it.

And they had separate programming as well as integrated programming.

Just normalizing the presence of the generations together, I think is something...

The first step is just realizing how segregated we are by generation and ability, which when you start, it's almost like you buy a red car and then you see everyone has red cars.

It's like all of a sudden, you're gonna just see age segregation everywhere when you start to become aware of it.

And then there are models of integrating children and elder care, particularly in day programs, which is great.

One thing is to make sure that... Well, I'll back up and say, that's a sense of purpose that older adults can find purpose intending to and helping shape the lives of young people.

That's not a choice for every elder, so always to embed choice, especially some people who might have some cognitive challenges that make overstimulation really, really difficult.

Thinking of like Lewy body dementia, where you have to just attend to people's individual choices and needs.

But that movement toward intergenerational collaboration, reading programs, reading tutoring programs across the generation, all of those things are just fantastic.

- I bet in the process of working in nursing homes, as we know a lot of immigrants often work there, and I bet for the cultures to come together in this way, you saw some really meaningful things.

Did you?

- As far as immigrant... - [Audience 1] Immigrant staff and working with the patients?

- Yes.

Yes.

I would say, if you look internationally, particularly looking at aging cultures, one of the most rapidly aging cultures is Japan.

And one of the reasons they have such a crisis in care is that they do not have a lot of immigration.

(chuckles) Their solutions are coming through robotics.

And this is a very challenging ethical area.

I would lead to say that there are some really great advances with robotics in care and the care needs that this country is facing now and will face in the future.

It cannot only be solved by technology.

Loneliness is a human issue with human solutions.

Purpose is can be tech assisted, but it is also a human solution.

We are lucky to have immigration to be able to have a layer of care.

It's not the only people doing care in this country, but it is a significant and helpful portion for us.

One of the crises is, that we do not pay our caregivers enough.

And I think the other challenges that they often do not have their own healthcare.

And so it creates a real difficulty in providing consistent and well-trained and reliable care in that way.

So that's one of those challenging areas that we have to talk about.

And oftentimes, not just generational differences, cohort differences of life experiences, but deep cultural differences of life experience can be used as an education and bonding point through meaning and wonder can also be a point of conflict.

And so you just need to navigate that as well and frame it in a way of joint strength and mutual learning and growth.

There's been a movement in the care systems for person-centered.

Another framing can be relationship-centered care.

And when you're attending to the needs of both the caregiver and the elder or the person receiving the care, that's when the real growth happens.

I think it's that relational model, where the nurturing across difference can really happen.

I hope that answered your question.

- Anne, thank you.

It's great to have you back in Cleveland.

How do you ask a wondered-based, curious, beautiful question about the potential ugliness of revolution.

You mentioned several times pills and doctors of which I am one, and recently the Alzheimer's Association who also mentioned, and relatively few number of dementia experts and certainly the pharmaceutical industry had the FDA approve a drug that was not demonstrated to be clinically beneficial to people.

And CMS eventually said, "Whoa, what's going on here?

We're not gonna pay for this."

And that was a great thing.

But there's power.

How do you as an artist, and I know you've given a lot of thought about speak truth to power when the power seems to be so strong at dominating what we mean by health in our society.

How can you be an artistic activist?

- Well, Peter... (laughs) Let me say that I have a PhD in theater and part of that studying was how theater was used for activism and social change, and a lot of studying of the Act Up movement, and how theater really was quite powerful in getting funding in some of the first treatments for AIDS and insisting on that.

I have read about and heard calls for the Act Up of dementia and Late Life Care, and I look around the network of activity professionals.

Are there any in the room?

I do not...

Awesome.

And that we wildly underestimate and perhaps need to shake up the activity structure to invite people to become active through activities into shaping the world they want to be in.

I think artists and activity programmers could become much more active in their communities in shaping the worlds that they want.

It has to be collaborative with the elders themselves.

That is who has the voice.

And we can shape it in a way that speaks back to insist on meaning, to insist on opportunities to be engaged in a larger way, to shape and direct those voices toward policy change.

There's no reason why.

I did one activist project with elders in Milwaukee because one of the senior advocacy groups said, "We're having trouble.

There were several older adults pedestrians who were killed by..." We're having a lot of reckless driving issues in Milwaukee.

And this happened again, another burst of reckless driving in the pandemic when everyone was at home and everyone just sort of took to the streets and went crazy.

And we had older adults who were like, "We want to be able to have the freedom to walk and to cross the street."

And so we organized performative, little performances called Crossings in Milwaukee.

We did it with the narrative of we have bridges downtown 'cause... You guys have rivers too, right?

And so our bridges go up and come down and that was our narrative for our performance.

It was, you hear the guardrail that we had triangles that would be dinged, and then you would see these huge PVC pipes come.

The student performers would run out into the road with these PVC pipes like the gates and then come down and then, darn it, if people, older adults and kids and civic officials didn't cross holding all these sails, they were like these tall masted sailboats that have to come through when the bridges go up.

And then the boat crossed and then the guard rails went up, and that was the performance.

And it was learned to see and stop for pedestrians.

And also we asked an elder.

We did little video vignettes for social media.

The dialogue with drivers right now is really limited to kind of...

This is the radio, to middle fingers and shaking fists.

And in Wisconsin where it's, you've got your windows up almost all the time.

You don't hear each other.

So if you could really communicate to a driver, what would you say?

And this beautiful tiny woman who wrote a wheelchair looked right into the camera and said, "I'm worth stopping for."

I'm like, "Well."

(audience laughs) That blew me out right there.

And that became our motto, "We're worth stopping for".

And we did a whole pedestrian campaign.

We identified multiple intersections, we invited all the civic officials to cross with us, multiple levels of government.

Nothing changes the duration of a light faster than when the mayor of that town can't make it across.

(laughs) I'm telling you, the next day those lights were lengthened.

And then they put in a plan for the city to make an assessment of that intersection around which there were five senior apartment buildings and a grocery store, and all of those senior apartment buildings, I kid you not, we're running vans to the corner to get to the grocery store.

I mean, it was like, "Let's think about it."

So that's just a simple, tiny way to organize an activism campaign.

You can do it, you can speak back to the drug industry, you can speak to the cities around needs that you have or wants that you have.

It's a matter of figuring out.

We ran a lot of the questions, beautiful questions were policy-based.

One of them in the Meals on Wheels system was, is there an intersection you wish you could cross on foot, but don't feel safe doing it?

We got hundreds.

Some of the cards had like 15 intersections, right?

And this, we called it data of longing because it wasn't crash data, it was data where people had given up.

There was no way they were ever gonna get that data, right?

We had it and we gave it to the city.

Same thing with, if you could get a ride anywhere right now, where would you go?

Because subsidized rides for elders were only supporting to the doctor or to the grocery store.

Well, they wanted to go to the art museum.

I'm not kidding.

They wanted to go to the park and they couldn't get there.

So again, it was data of longing.

And then we mapped all of those things.

And that was really beautiful and really powerful.

So the beautiful questions can be mobilized.

Another performance I saw was older adults who are getting evicted for a wide range of things.

And they would put up these little eviction performances to demonstrate what was happening.

So I work a lot with the Center for Artistic Activism and their model of identifying performance that is close to a policy change.

So I would recommend people look to c4aa.org for that model.

Long answer.

Whoo.

Had a lot to say.

Thank you, Peter.

- All right, so we have another text question.

You mentioned Japan earlier.

Both Japan and the United Kingdom have both established the government positions of Minister of Loneliness to reduce loneliness among elders and the general public.

While the government may not be thought of as a place to facilitate creative caring for older adults, what can the public sector do better to infuse imagination, joy, and wonder among our local elders?

And have you seen examples nationally that can be modeled as a best practice?

- Oh gosh, I wish I knew who that was 'cause I wanna give 'em a big hug for that question.

(laughs) Or a fist bump, right?

Wow.

How do I even start?

Gosh!

I've done a lot of work on this.

And first, I'll start out by saying, I'm now directing the Center for 21st Century Studies at the University of Wisconsin, Milwaukee, which is an interdisciplinary center for arts and humanities.

Our motto is building a community of scholar to address scholars to address the pressing issues of our time.

And our whole last year, our programming was centered on, it's called Lonely No More, The Making and Unmaking of Loneliness, Isolation, and Connectedness.

And next year is called Nourishing Trust, The Power of Gathering and Food and Land Justice.

And then after that, we're gonna tackle trust the vote.

Wish me luck.

(laughs) So there is a lot of research we've done on loneliness and isolation.

I think that one of the ironies is that there's been a turn toward this research before the pandemic.

The National Academies of Science issued a giant report, huge thorough report on all the research on this.

It landed on the internet February, 2020, and you could read all about it as you were entering isolation for the pandemic.

I thought that was really bad timing, but ironic.

So we can study it better.

The National Academies of Science that I think, to me, the hopeful thing and the connection I see between all that incredible energy and research on loneliness and isolation and the arts and culture is that, for a long time and still, and I think we should still be doing it, we've been getting very medical about our research on arts and culture.

You'll see reports like music triggers this thing in this part of the brain and this is great for this particular condition under these particular circumstances.

And I'm like, "Okay, so now the musician, the music programs are gonna be saying, 'We're the best, music's the best.'

And then dance will say, 'No, no, no, no.

Dance does this thing and it's the best thing for this reason.'"

And I'm like, "Oh, stop it, everybody just stop it."

It's social connection, it's meaning-making, it's joy, it's purpose.

So the mechanisms, I think we have to take a step back to look at common mechanisms underneath all the arts approaches and just take them all and say, "This is what we're doing with this."

And I think the micro research is helpful.

The NeuroArts Blueprint group out of Johns Hopkins is doing great work with that specificity.

We could use a big investment in research into more general mechanisms around this.

And I think really creative work is happening around social prescribing.

Because to me, as the arts and culture programs grow, it's about information sharing across those systems in health and social services.

They just need to be made aware of each other and create more opportunities for that in the collaborations between, say, the National Institutes of Health, National Endowment for the Arts.

Those things have been happening.

I think they can keep happening.

So there you have it.

And I see my friend's here.

(audience applauds) - Thank you so much, Anne.

Thank you for joining us here today at The City Club.

Our forum today is part of our authors and conversation series presented in partnership with Cuyahoga Arts & Culture and the John P. Murphy Foundation.

Thanks also to our book sellers at Mac's Backs on Coventry.

It's also part of our health innovation series in partnership with Medical Mutual.

We're grateful for the support of all of these organizations.

We would also like to welcome guests at tables hosted by the Benjamin Rose Institute on Aging, the Carolyn Farrell Foundation for Brain Health and The Center for Community Solutions, and specifically the Council on Older Persons there.

Thank you all for being with us today.

We have two forums next week.

First, we'll hear from former Secretary of Education, Betsy DeVos on Wednesday, June 15th, and then on Friday the 17th, we'll learn about 75 years of ingenuity and innovation from GOJO's president and CEO, Carey Jaros.

That brings us to the end of our forum today.

Thank you so much, Anne Basing.

And thank you members and friends of The City Club of Cleveland.

I'm Dan Moulthroup.

Our forum is now adjourned.

Have a wonderful weekend.

(audience applauds) - [Narrator 2] For information on upcoming speakers or for podcasts of The City Club, go to cityclub.org.

(upbeat sting) - [Narrator 1] Production and distribution of City Club forums and Ideastream Public media are made possible by PNC and the United Black Fund of Greater Cleveland Incorporated.