Archive for the month “July, 2013”

When I Grow Up I Want to Be Wise

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I asked my 8-year old granddaughter, Sofia, what she thought “wise” meant. Her response: An older person who is smart and makes good decisions. I guess I would say that at age 8 she is wiser than most of us.

I then began to wonder if we aren’t wise at a young age and for some, again in older years. In between, we are deeply focused on gaining experiences, power, possessions and love, creating a false sense of wisdom.

Why “false”? Because true wisdom as Sofia tells us is not only being smart (“experience” smart, not intellectually smart) but also “making good decisions.” Believing that life experiences and success alone leads to wisdom is not a good decision.

The wise elders I’ve known have had a broad range of life experiences—some held powerful positions and were wealthy but most were of lesser means. Some were religious and others more spiritual. What they have in common is a believe in another power because they know that we can’t get through this life alone and the ability to incorporate life experiences at a “soul” level—a place where we can listen, see and “be” without all the layers of judgment that we learn throughout our life.

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Why is wisdom easier in youngest and oldest years? In younger years we haven’t yet incorporated all the taught and lived family and social biases, prejudices and expectations of power and possessions that become the basis for how we view ourselves and others. In older years, as losses accumulate, we realize any success or power or position is fleeting. At that time, the wise elders focus on incorporating all that was good and “not so good” in their past, realizing that all that has happened has made them who they are today and that even in oldest old years we continue to learn, to change, to wake up to a new opportunity to improve and focus on what truly matters in life.

However, choosing a path towards wisdom doesn’t come to everyone. Many become bitter as they view the past as “the best time” or as a time when they made too many mistakes. Meanwhile they exist in a present filled with loneliness and losses—loss of independence, of friends and family, of power and possessions. They may see this as a loss of self and as a time when their God has forgotten them.

Living beyond such tremendous losses and into wisdom that frees us from the weight of a judgmental, power-seeking life is a spiritual journey requiring tremendous faith and forgiveness of self and of others regardless of the injustices we may have experienced. Until we see ourselves as one with all others—those we knew and those we didn’t and one with the universe and with God, wisdom will be elusive.

Finally, wisdom and peace is also about accepting that we aren’t traveling alone. God—whomever that is to each of us—is not only at the center of this journey but is next to us holding our hand, above us watching over each step and beneath us holding us up when we are certain we can’t endure another loss.

Susan

 

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Lessons from cooking

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I love to cook and always have. I learned to cook by watching my mom and as a youngster, the hardest part was patience—putting ingredients together correctly and slowly and waiting through the baking and cooling time. Today as I made a cake from one of her favorite recipes, I reflected on her patience. The recipe required that I fold in beaten egg whites “until there are no white ribbons running through the batter.” When I was younger—perhaps 40 and below, I would rush the process and usually move on to the next step before the whites were fully integrated. Now I take my time. I enjoy the process of watching the small stripes of white become one with the batter.

At 64, I experience life as a time to move more carefully, slowly, living in the “now” and letting the fullness of each event, each word spoken, settle into and become a new bit of “me”. I fold in the whites of day-to-day experiences more completely.

Of course, I am not always able to live in the present—I still worry about the future—the health and happiness of our children and grandchildren, my husband’s and my health as we age, and affording retirement.  These thoughts lead me to the “what ifs”—what if I hadn’t moved or had stayed in that fulltime job rather than starting my own business, etc.

However, increasingly I realize the futility of worrying over the future, or judging past actions and words of myself and others. I find I am able to move out of distracting and often negative thoughts and back into the present. This new ability to live in the moment, to walk away from unimportant thoughts, to forgive myself and others quickly is a gift of aging. In younger years as we rush through daily life to constantly seeking power and success, living in the now is nearly impossible.

I’ve noticed that our older adult clients—many who are in their 80’s and beyond are considerably more expert at living in the now than I am. Like many life lessons that make us better, stronger, and more adaptable, the many losses of later years are balanced by the gift of forgiveness, tolerance and hope of what is yet to come. I am thankful for my clients and for myself that the gift of now is available as a buffer to loss.

Meanwhile, if you want to watch the ribbons of egg whites disappear as you reflect on integrating your life stories, here’s my mom’s recipe for German Chocolate cake that she probably wrote down in the 1940’s when she was a young housemaker and my Dad was in the war.

German Chocolate Cake

4 ounces German Chocolate if you have it otherwise semi-sweet baking chocolate is OK

½ cup of water (I changed this to ½ cup of coffee—coffee enhances the chocolate)

2 ½ cups cake flour (or 2 ¼ cups regular flour)

1 tsp baking soda

1 tsp salt (I use ½ tsp because I use unsalted butter)

2 cups sugar

1 cup margarine (I always use unsalted butter)

4 large eggs separated

1 tsp vanilla

1 cup buttermilk

Heat oven to 350. Grease and flour three 8 or 9-inch round cake pans. I put parchment paper in the bottom as well.

In small pan (I do this in microwave), heat water (coffee) and add broken up chocolate. After it’s melted, let it cool.

Sift flour, baking soda and salt into a bowl and set aside. Beat room temperature margarine (butter) and add sugar until fluffy. Add egg yolks one at a time incorporating before adding another. Beat in chocolate and vanilla.

Alternately add in flour and buttermilk beating until smooth after each addition.

In a small bowl, beat egg whites until soft peaks form. Fold 1/3 of eggs whites into the batter until you can’t see any ribbons of egg whites. Then folk in remaining egg whites completely and quickly. Divide the batter into the three pans and bake. If you can’t fit all three pans in the oven, put the third one in the fridge.

Bake about 20-30 minutes testing for doneness. The cake should spring back when you touch it gently or test with a toothpick.

Coconut-pecan frosting

1 can condensed (sweetened) milk

2 eggs

1 cube margarine (unsalted butter please!)

1/2 tsp salt

1 tsp vanilla

1 ½ cups of coconut (best if you lightly toast this in the oven or in a pan on the stove in advance)

1 cup pecans chopped (I also toast these lightly)

In a medium sized sauce pan over a low flame, slowly heat butter, condensed milk and eggs, continuously stirring. Let come to a slow boil for a couple of minutes (stir carefully so it doesn’t burn on the bottom). Remove from heat, add vanilla, coconut and pecans.

When the cake is completely cooked, assemble the cake, spreading frosting between the layers and on the top of the cake—no need to do the sides unless you want to. The frosting is very sweet so doing the side of the cake can be overwhelming.

~Susan

You found the right assisted care facility but can your parent stay there long-term?

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Be very careful when you help your parents move to an assisted living facility because they may be kicked out just when they settled in and think of the place as “home.”

Why?  Assisted care is just that—“assisting” a person who isn’t doing well at home and needs help with what are referred to as “activities of daily living” or ADLs. These include bathing, toileting, dressing and transferring (from bed to walker or wheel chair, etc) and help taking medications. Think of ADLs as the “personal” chores of day-to-day life. The assisted care staff is more “custodial” versus the “skilled” care of a nursing home. However, an RN is often on staff of the assisted care facility and able to administer some procedures such as insulin injections multiple times each day if needed. The decision about what is offered can vary from facility to facility and the monthly fee usually increases with escalating care needs.

When searching for the right facility for clients, most have said they will even keep the elder if they should suffer Alzheimer’s or other types of dementia.  As long as the client isn’t on an IV or some type of advanced procedure, they would be able to live out their life within the assisted care facility. This is important to older adults and their adult children because transitions are extremely difficult for elders. I’ve known of cases where within a few days or weeks of such a move, the very healthy elder died. The move was simply too much to absorb in a life already filled with losses.

Since few older adults will require skilled care provided in a nursing home, the assisted care facility should ideally be their last move. If they suffer a fall or pneumonia or other disease or injury require skilled care, they may be required to move to a nursing home for a brief stay to recover but then they should be able to return to their assisted care facility.

However in a two situations we recently experienced with elders we knew, the elder was asked to leave the assisted care facility. In these cases, it was determined by the assisted care facility administrators that client’s level of care had escalated and now required skilled nursing care that could only be provided in a nursing home.

On the outset, while sad that the elder must move again, it seems reasonable if the care required had truly gone beyond what was normally provided in assisted care.

However, in each of these cases, the children of the elder and the elders themselves stated that while they needed more support dressing or transferring, etc, they weren’t on IVs, in a coma or requiring advanced medical procedures or experienced nursing beyond medication management.

What these cases had in common was that each of the elders had outlived their personal financial resources and had transitioned to Medicaid support which pays less than the rates typically charged by facilities. In both cases, these facilities said they would keep clients who began as private pay and moved to Medicaid so they couldn’t ask the clients to leave based on the change in finances. However, they could make them leave if they could prove the elder required skilled care. I found it interesting that in two cases mentioned, the assisted care facility had been taken over by a large chain. One can’t help but wonder if the new owners wanted only private pay clients in order to maximize their income potential.

In both circumstances, the elders and/or their adult children filed a grievance and both won their cases allowing the older adult to remain in the assisted care facility.

If you think it’s possible that your parent could outlive her resources when moving to assisted care, be sure you understand the facility’s policies about Medicaid. Additionally, if your parent is asked to move, you can and should appeal.  As part of this process, get an ombudsman involved. If you are in Oregon, go to: http://www.oregon.gov/LTCO/Pages/index.aspx. If you are in any other state, Google “long term care ombudsman in XXX [your state]” or call the local Area Agency on Aging (AAA).

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Finally, when considering the possibility of moving your parent to a facility, call a geriatric care manager (GCM). We are experienced in listening to yours and your parents concerns and needs and advising about programs and support available that may allow them to stay at home. When moving is necessary for safety, we will help select the right facility that will support safety while also encouraging maximum, capable independence.

~ Susan

 

 

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