Archive for the tag “Fireside Care Management Group”

Tears of all

Today the loss of my father now gone five years slammed into me. It’s the insult of an unexpected burn or a pinched finger in the door. I’m left empty and angry at the pain.

As I age, I find there is less and less that moves me to highs or lows. Offenses that once brought immediate reaction and judgment have little effect. I absorb their assault as being more about someone else or something else outside of me. And the highs from a good movie, a get together, a beautiful gift that one day not so long ago overwhelmed my senses are warmly appraised but are processed in a more shallow, less complex place.

Deaths and births, small individual actions and the beauty of nature however pull strongly at me, shocking me as they evoke immediate and unexpected response. Responses that I cannot control. I cry with abandon at small flower or a child skipping and I am at the mercy of whatever it is inside of me that I seem not to own.

Next month a new grandchild will pull me into the unique beauty of a birth. Every birth is a fingerprint—never to be copied or confused with any other birth. I will wonder at this beginning as if I have never experienced another child entering this world. I know he’s coming, I will probably there as he takes his first breath yet the volcano of emotion will again slam into my heart.  Caught up in the purest connection of all life as one—my father to me, me to my son and now my grandson—I will stop breathing as I wait for his first breath and then tears will flow that belong less to me than to the world of joy and suffering.

susan_bioSusan Cain McCarty

 

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Aging with a Dog Blog

By Susan Cain McCarty

I plan to write a few articles about aging with a dog, a topic I’m passionate about since I am aging and have two Boston’s, Chester who is 3 and Bruin, 5 and a very old yellow lab, Bailey, 16 ½. I’ve not only owned several different breeds of dogs with very unique dispositions and personalities but long ago I groomed dogs (way of earning money while in school) and I trained level-one obedience.

There are several important social and safety issues to consider. From a social perspective, you may want to consider not only your long-term living needs but those of your pet, particularly if you have (or plan to acquire) a young dog and especially if it’s a smaller breed that may live a long time and even outlive you. Also, you will want to consider whether your pet can move with you if you decided to change living environments and if not, what arrangements can be made for his next home. Some assisted living residences accept pets but many don’t. Similarly there are a few adult foster care homes that will accept a pet. In a future blog, I plan to write more about the social aspects of selecting and living with a dog into our aging years.

This blog will focus on safety for you (and somewhat for your pet). Some people agree with and enjoy Caesar, the Dog Whisperer, and others think his methods are too strict. Having worked with many types of dogs, I find his style and methods work quite well. If you watch one or two of his TV shows, you can learn his approach without watching all the other shows: 1) Be the boss or as Caesar expresses it, “the pack leader” 2) Every day, approach your dog calmly and with compassionate authority. If you are anxious or insecure, your dog will sense this and training and your relationship with your dog will suffer.

Those are the keys to a successful relationship with your dog. Oh and one more point—dogs are loving, kind and loyal but they aren’t human. Don’t humanize them. You can’t change dogs into people. They are meant to live in packs and have a leader. They can be your helpmate and your best friend but they are not human and they are not your child. Respect their need to have a leader and be that leader. If you don’t accept that role, they will be the leader and the result is often an axious dog and an aggressive dog. Neither is suitable as an ideal dog. Treat them with respect, consistency, fairness, love and always be the pack leader and you will do well.

One of my biggest concerns is teaching your dog how to be safe in the house with you and when on a walk. Some dogs—often small ones—will circle around you and weave between your legs or jump on you, particularly when excited (perhaps waiting for dinner or for you to attach his leash). This is very dangerous. As we age, our balance becomes impaired and a dog that is underfoot is a tripping and falling hazard.You can end up with a broken arm, leg or hip or at a minimum a bad strain or several bruises. As we age, any physical damage can mean a long recovery. So teach your dog not to run around at your feet nor cross in front of you. You can use your voice, hands or feet to train them to keep their distance until they are called to your lap or to your side.

Some people think it’s abusive to push a dog with your foot. It is if you kick them but not if you are using your foot and leg to gently push them—it’s simply an extension of your arm and you don’t have to bend over. Whether you use your arm or leg, when you push them away, give a one or two-word commandor a noise such as clicking as you are pushing. If you do this often, eventually you can give up the physical “push” and instead use the command or noise (a click or a command such as “move” or “away”). Whatever command and/or noise you use, use it consistently. I click to my dogs just like I did to my horses when I had them and that works fine. Other people think I’m strange and they are probably right but it works for me.

My husband likes to speak in sentences to the dogs. He might say, “Move away you are too close and I’m going to trip,” and he will actually expect them to obey. I’ve told him—remember Peanuts—all they hear is “blah, blah, blah.” Use one or two word commands and you can even use a different language just for fun. But be consistent and they will learn.

Going for a walk

Having a dog when older often means lots of walks—that’s great for you and wonderful for the dog. However, I consider every single walk a training opportunity for myself and the dog.

First and foremost—don’t put the collar on or attach the leash if the dog is jumping and excited. People tend to talk in a higher voice with a dog—a more excited voice or “baby talk” saying, “Want to go for a walk? Walk? Let’s go for a walk”. It’s no wonder the dog is anxious—your voice and probably your body language are axious and excited.Instead, use a calm and assertive voice.

We like to camp with our dogs and when camping, we take them on several walks each day since they can’t roam free. I put the leashes on only when they are calm and not jumping. I then drop the leash on the floor, make them sit and then I open the door and exit. I stand at the bottom of the motorhome stairs and they cannot get up from a sitting position until I say “come” (or “release”—whatever works for you). Once they come to me I immediately pull back gently on the leashes to remind them “I’m the boss and you will start the walk calmly.” They then begin the walk in a relaxed frame of mind and they are listening to me. Whether camping or at home I follow this process. No walk or exiting the house until they are relaxed and following directions.

Second, NO pulling.Maybe you took your dog to obedience training and he will heel but I see few dogs exhibiting such training. So here are simple tips: When your dog pulls on the leash, click or use whatever noise you like and a command like “no pull” while pulling back on the leash (don’t “jerk”—that’s hard on their neck and shows anxiety). There are many devices to help you when walking a dog including different types of collars. Some collars are more like a bridle on a horse and they circle the noise; some are choke chains (never found these helpful and find them cruel but that’s one opinion); some have spikes that push on their skin (they aren’t as gruesome as they look but I’ve never found them necessary); some are a chest harnesses; and some are plain old collars. I think what you use is less important than consistent training techniques. I personally use a mesh harness that puts pressure on the chest;however,what works for me and my dogs and may not work for you. I wouldn’t ask your vet or the person at the pet store for advice—unless they train dogs they probably won’t have the best advice—I’d do some online searching and find qualified trainer advice.

In the beginning, you may need to pull back on the leash with some strength, but if you are consistent, by the third walk using consistent training techniques, your dogshould understand what you want from the gentlest tug on the leash. Do this often—don’t let them pull really hard and for a while before correcting. As soon as they are at the end of the leash and you feel any strain, correct them. Never use more force than is necessary to get the desired result. I keep pressure on the leash with my pinky finger and pull gently with that. That’s all it takes most of the time. One word of advice on leashes—don’t use the retractable ones that typically extend from 16 to 26 feet. That’s too much freedom and you aren’t training the dog to walk close and calmly. More important, I don’t feel it’s a safe choice for the dog (or you). If a dog is extended 16 foot in front of you and something catches his eye and he’s not on his best behavior, he has 16 feet of room to go in any direction including the street or someone’s garden. I use a six-foot leash and find that works great for walks.

Have a plan about how you want to walk your dog. Do you want him to be allowed to pee at several bushes, fire hydrants and car tires? If so, that’s OK but decide whether you will allow this early in the walk or at the end of the walk but after 5 minutes of that, they must “walk on” for the remainder of the walk—no stopping unless you decide to take a break. There’s no reason they have to continue to sniff and pee. So give them a few minutes for that but then the rest of the time they must walk by your side or in front of you but never pulling at the end of the leash.

Don’t let your dog cross in front of or behind you. I have two Boston’s and my daughter has two. I like to walk three or four at a time (one of them is lazy and I like to walk for about four miles so sometimes it’s just three dogs). When I walk with them, I assign a “side” and all must stay on the side they are assigned. They can’t switch places or dash to the other side because something smells beautifully rotten. Again, I use my foot so that I can correct immediately rather than bending over. With the front or side of my foot, I gently push them back into place on the correct side and again using a “click” or voice command. Eventually you should be able to use only one: the voice command, click or gentle push.  HOWEVER, if using your foot causes you to feel off-balance, don’t use this technique. Use your hand and/or words.

I never allow our dogs to smell other dogs (unless I know them and the dogs are “friends”) or bark. I am very attentive to other dog walkers. If I see a dog approaching that is in a highly anxious state—pulling on the leash, barking, jumping or growling, I move to the other side of the street. It’s not because I can’t train my dog to behave but I don’t want to put my dog or myself in a situation that could result in danger to either of us.

Finally, if you want to walk your dog but feel you can’t train him to be safe, bring in a trainer but remember—you must be trained as well.

Dogs are such important companions. I encourage those who love them to have them up until the day you die if you enjoy them and they enhance your life. My mother-in-law is 92 and she lost her beloved “Candy” last month. While she mourned her greatly, she also realized that having Candy was critical to her well being given she could no longer drive and most of her friends had passed. Wisely she wanted and acquired another dog that was older but healthy and well trained.

However, the topic of selecting a dog matching your needs, age, and physical condition is a topic for another blog…

If you have an experience to share relating to this topic or any topic about aging that is of interest to you, let me know. You can reach me at scain@caincom.com or 408-393-4794.

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Susan Cain McCarty spent over 25 years in high-tech marketing and is still consulting in that role today; however, she acquired a late-in-life Master’s in Interdisciplinary studies focusing on Gerontology. She now has a second careerconsulting as a Geriatic Care Manger helping elders and their loved ones plan for aging.

 

 

Freedom is A Phonebook

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As Geriatric Care Managers or GCMs, we deal with some tough, tough challenges: Helping people find a new place to live when they aren’t emotionally ready to move but physically must have more or helping families and the oldest old develop coping strategies as Alzheimer’s progresses. But all the challenges of living into older years aren’t big ones.

Today I was at Target buying an Xbox game for my grandsons and an older woman asked the young clerk working the electronics counter where she could get a phone book. Perplexed, the young woman (maybe 19) said “a what?” and the lady said, “A phone book. I have a GPS because I get lost but it doesn’t help me to have a GPS if I don’t have addresses of the places I’m going and I don’t have a computer to look them up.” The girl shrugged her shoulders and was at a loss to provide any suggestions. After all, who asks for a phone book anymore? Where do they even come from?

Chuckling to myself about the confusion of the young woman, I stepped in and asked the older woman who provided her phone service. She said Verizon but she only has a cell phone, no landline and therefore didn’t get a phone book. I told her to contact Verizon and explain she has a cell but still wants a phone book. I hope they helped her.

As I walked away, I realized what a small inconvenience this woman’s problem might seem to many but this older lady was nearly confined to her home if she couldn’t rely on her GPS and that old tissue paper phone book. Seeing this lady struggle with her small problem reminded me to slow down and observe and listen because sometimes all someone needs to enjoy life is a simple answer to a simple question.

As a Nation we are focused on whether we can afford the 78 million aging boomers and debating which medical programs and high tech solutions can enhance and extend quality of life. But sometimes quality of life is a phone book.

~ Susan

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

 

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

 

 

5 Ways to Shake Up a Caregiving Rut

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Are you feeling exhausted, stressed out, guilty or plain fed-up about caring for an elder? Often when a caregiver is frustrated, so is the elder. Stop doing what you are doing that isn’t working and consider SHAKING IT UP!

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Elder: As we age in to the oldest old years it becomes a time of loss. Elders lose friends, physical abilities, independence, dignity and seemingly anything resembling control. Everyone else thinks they know what’s best for them and often do not bother to ask for the elder’s opinion. Decisions from the unimportant issues like when they may want a bath or what they want to eat to the big life changes like taking away a driver’s license or deciding where they want to live. These choices become dependent on other’s availability or needs rather than the desires of the elder.  Often days are filled with an abundance of time to focus on not feeling well, medication concerns or side effects, next doctor’s appointments, boredom, and how to get some more attention from whom ever can fit you in to their busy schedules. It’s no wonder elders have a reputation for being cranky. Depression and suicide rates are high in the elderly. White males over 80 have the highest suicide rates in the elder population. National Institute Mental Health reports, “Depressive disorder is not a normal part of aging. Emotional experiences of sadness, grief, response to loss, and temporary “blue” moods are normal. Persistent depression that interferes significantly with ability to function is not.” The problem with negative feelings in the brain is when we dwell in negative thoughts we have more negative thoughts, so disruption in the situational sadness may help those with normal mood changes become more engaged.

 

Caregiver: Maybe you love the person you care for, maybe you don’t, but either way you are the one in the trenches doing the work. If you’re lucky you have support from other family and friends, but then again they may be causing a lot of the stress involved in caring for an elder. But still, each day you roll up your sleeves and do it all from errands and medical visits to cleaning backsides and dirty dishes, only to get up and do it all again tomorrow. If you are a long distance caregiver you spend twice as much money as a local caregiver trying to support your elder and panic every time the phone rings, not to mention the struggle with guilt that you want to be with your elder more; or guilt because you are happy to be with them less. You hear about self-care and how important it is, but you are baffled by who has time when your head is down and you are just trying to get through the day, week, and month! Possibly you are part of the sandwich group who have several generations you are caring for at home and another job outside the home.

Does any of this resemble what is unfolding for you in your caregiving journey? Well you are in a very large club. In 2012, 15.4 million family and friends provided 17.5 billion hours of unpaid care to those with Alzheimer’s and other dementias alone. Eighty percent of care provided in the community

is delivered by unpaid caregivers. and the majority of caregivers are women over 45. With numbers like these, being in a caregiver’s rut could be the next national health hazard!

 

So how do we shake it up, find the silver linings or just simply do it different? Let’s begin with deconstructing the pattern…

 

  1. Dialogue ~ look at the routine you have when talking with an elder. Is it utilitarian habit or are you engaged in meaningful conversations? Do you talk to them as a petulant child or cower every time they raise their opinion? Communication tools can go a long way here. If the elder you care for has cognitive disorders, watch some of Teepa Snow’s http://teepasnow.com/wp/ training videos on communication skills for elders with dementia and Alzheimer’s disease or catch one of her talks locally (see her website for details). Some very basic changes can make a world of difference. For mentally healthy elders, communication tools are still very useful. Lifelong patterns over the family life course can make it difficult to change patterns but there are tools to help. Activities that create new ways of talking can be around the elder’s need to share stories. Engage in storytelling tools and activities at a level the person can handle. From computers, journaling, genealogy research or simply inquisitively chatting over a bath or over the phone can make a mundane activity more of an adventure. Elders have a need to tell their stories over and over as a way of processing their lives as time here grows shorter. This is where the details of life live and this rich activity will yield pearls for you as well as the elder.
  2. Outings ~ A friend recently told me that upon visiting her parents a few months ago in another state she took them out for a drive. Her father barely ambulatory and her mother prone to falls were thrilled to be going out. On this journey she surprised them and took them to their favorite Jazz Club where they went when they were younger. She enlisted the help of a waiter and got them situated in the back of the room. As the music played on she said she could see the years melt away and their younger selves emerge. For 3 hours they enjoyed a part of life that had been lost to them. They have a code name now for when she comes to visit so that other family members do not know what they are up to on these outings. How empowering! This could not have been an easy outing for my friend, but it gave her immense pleasure and changed her parent’s outlook completely. If this is too adventurous for your elder perhaps just a drive around town; or closer to home set up a Skype session with an old friend, do some snail mail letter writing or perhaps engage in a beloved hobby like baking where they can sit close by and “teach” you a favorite recipe. If your elder has cognitive issues, setting the table, walking through the garden, folding laundry, or dancing all become enjoyable new adventures. Don’t give into the usual routine; Shake It Up so it is fun for you as well. Portland has a beautiful Alzheimer’s memory garden where you can take your elder (http://www.portlandmemorygarden.org/PMG/Welcome.html).
  3. Self Care ~ OK we are diving in the deep end now. Funds are low, time is scarce and what is self care anyway? Simply put it is a change of environment to recharge your batteries. Connect with the spiritual side by gardening, taking a labyrinth walk, attending church or joining a choir or painting class. Identify something that brings personal joy and fulfillment for a few minutes a day and a few hours a week and a few days a month. No one will give you permission to enjoy something without regard for others, so you must be strong enough to go for it without permission from anyone but yourself. Typically caregivers put themselves last, which makes you the worst advocate for your own selfcare. By putting yourself last, you will likely have less patience and unlikely to find joy in your caregiving role. Magical things happen when you practice self care. Perhaps your biggest challenge is getting a good night’s sleep. If you can afford it, hire a professional caregiver to come in 2 nights a week so you know you will get some relief. If you are long distance, hire a Geriatric Care Manager to pop in and check on your elder and/or his care givers every week or month. If funds are tight, barter with friends to come spend the night in exchange for a homemade pie or watching their elder or child during the day. Get creative and reach out to local support groups and social services that will allow you the time you need when you need it. If you schedule it on the calendar it will happen. There are some ways to combine self care with your care giving activities. Give your elder a sacred foot massage and make a ritual of lighting a candle and using lotion or oil with a scent like lavender or chamomile. Then if the elder is able have them do the same to you. If you can afford to have someone come in and give you both foot massages then make it a weekly or monthly routine. There are many massage therapists who will come to your home. My favorites are Sister Emma at the Franciscan Center in Milwaukie, Oregon (503-794-8542) or Sister Delores at St. Mary’s in Beaverton (503- 944-9641). The important thing is to schedule the time and make sure it happens. Have someone come in for one day a week and you decide what you feel like doing that day. The answer may be nothing or a nap. That is OK! Learning to ask for help is the biggest challenge for caregivers. Do it, you will be surprised where the help comes from. You will be surprised once a routine is in place how your relationship with your elder improves. They may protest at first or even always when you leave them, but the benefits will come.
  4. Empowerment ~ it can be exhausting making decisions for another human being. Too often feelings of guilt or inadequacy flood in even when you are doing just fine. Know that nothing in the world is perfect and you simply being there is an amazing gift. The rest is all gravy. To help cope with the times it can be emotionally overwhelming, try learning a few mindfulness techniques. Our local psycho-therapist Donald Altman (http://www.mindfulpractices.com/) has some great tools for breathing and meditation that can help when things get stressful for you or if your elder is in a funk. Space cannot always be achieved physically, so having techniques to navigate through these times is priceless. These tools can be used by your elder as well. One of the best methods to decreasing your decision fatigue is by giving back some of the responsibility to the elder. Depending on your situation, the answer may be a modified version, but honoring their level of ability to give an opinion can go along way for both of you. Give your elder decision making power whenever possible. You are there to keep them safe. There are also local classes available designed by Legacy Health for Caregiver Help. This course is offered in many places from senior centers, hospitals, and even at the Franciscan Spiritual Center. The course is designed to teach you about community resources, care strategies, support group and self care. All great ideas to Shake Up your current routine.
  5. The Unexpected ~ If you haven’t already, begin building a support network: Online, in-person or host a weekly meeting in your home. Whatever you have to do to be with others going through the same important work you are doing. It is too common to become isolated with an elder. This is not good for you or them. Have some social activities in the home even if your elder does not engage. The presence of others can be soothing or annoying, so be aware of the best format for your situation. Online could be a great way to support long distance caregivers, start a facebook group and open it up for members. As life unfolds with your elder health challenges may increase, a need for hospice may arrive, or a medical need for a move into a nursing home or rehab center may happen. All of these situations can create crisis and stress for the caregiver and elder alike. Having medical, social, and caregiver support nets in-place can make the transitions easier. Our Geriatric Care Manager services can also be part of this safety net, there to pull the resources together to make sure the decisions for your elder are coordinated and serve the elder’s best interest through advocacy and care planning. Our website also offers tools and resources to help with these transitions www.FiresideCMG.com

 

As we advance in life it becomes more and more difficult, but in fighting the

difficulties the inmost strength of the heart is developed.

                                                                           – Vincent van Gogh

 

Ten Minutes

Tired from a turn-around trip that began with a 6:15 am flight out of Portland, I waited at San Jose Terminal B, gate 23 for my return flight on Southwest. I had spend much of the past week preparing for the new business meeting that took me to San Jose. As I sat in the terminal following the meeting, I contemplated business, the slow economic recovery, money and retirement. Looking up from deep thoughts, I noted an older man, somewhat disheveled walking unevenly and tentatively toward the gate counter. With shaky hands he withdrew his ticket from his shirt pocket handing it to the gate agent, “Am I in the right place?” She responded automatically, “Yes” and offered nothing else. He looked around and walked towards the empty chair next to me. Knowing he was uncomfortable, I wanted to make up for the insensitivity of the gate agent.

I began, “Hi, are you flying home to Portland or visiting someone?”

“I’m going to visit my son. I haven’t flown in a very long time and I feel so unsure of myself.”

“It’s fine. Together we can listen for the boarding call and then I can show you where to line up. Has it been a long time since you’ve seen your son?”

Tears filled his eyes as he replied, “No, he and his brothers and sisters have visited me often recently. Their mom died three months ago after being on life support for too long.  It’s an awfully hard decision to know when to say “it’s time’ after more than 60 years of a life together. I just couldn’t let go and I think I made her suffer too long.”

 

Filled with his pain, I offered what seemed like empty platitudes, “There’s no way to know when the time is right and no one can guide that decision. It’s something you worked though, and when you were ready and you felt she was ready, you let her go.  There’s no timeline for letting go of the person you’ve loved so dearly.”

His smile of appreciation felt undeserved.

“I’m John.”

“Hi John. I’m Susan. It’s so nice to meet such a brave man.”

With a weak chuckle he said, “I’m not brave. In fact, I know this will sound bad but I’m not sure I will choose to stay around much longer. That must sound awful to you, but each day when I begin to wake and reach over to the empty place on the bed, I can barely breathe. I lay in bed sometimes till afternoon. Just waiting for the pain to leave, for her to talk to me, for something…I don’t even know what. I’m so empty inside.”

Frozen in grief I couldn’t find words, and I knew that nothing I said could answer his need.  Still the energy connection gripped me. His heaviness was now mine as well.

Slowly and painfully I offered, “I don’t judge you. I have told my children that I when I’m done, I’m done. My father died recently—he was 95 and he very much wanted to die for the last two years of his life. It hurt me terribly to watch him. He even asked me to help him die and I could do nothing.  He thought he wanted to die when he was about 85 and my mother died. The first year was the worst.  After that he began going back to church, getting out a little more, and he found he had more life to live. Meaning and purpose may shift for you too.”

“I don’t know. I can’t see beyond today. I don’t really want to visit my son although I love him. It takes so much energy and I’m exhausted. I’m hoping that if I force myself, I might find some relief.  Traveling is hard on me. I’m uncomfortable asking for help or directions. I feel like people look at me like I’m just a helpless old man. I’m getting forgetful—happens when you are old.”

“John, I’m forgetful and I’m 63. I don’t know when this “forgetfulness” started for you but it started for me in my 20’s when I had four children!  It’s not exclusive to being older. It comes about because we accumulate years and years of to do lists, of birthdays, of 85 years worth of schedules and memories we want to hold onto.  People think so many things are old age related when in fact aging begins the day we’re born.”

He laughed and his hand grabbed my hand and he simply said “Thank you.”

The gate agent called for A boarding—my group. I asked John to move closer to the lines and told him that when they called for B boarding he would line up in the first column pointing to where he should stand. Noticing a seat near the line I suggested he sit until it was time to line up. As we walked together, I noticed a young woman making her way toward the seat. Touching her arm I asked if she’d mind if John sat. She nodded to him and said, “Of course not.”

John looked at her slyly and said, “Or I could sit and you could sit on my lap.”  Pleased with himself he lit up and we all laughed.

I was hopeful as I boarded the plane that his momentary joy might be a brief peek into a life of renewed purpose. He is such a beautiful soul and to have him leave this world early would be a loss for all those whose life he touched, including me. Ten minutes with John and my life is forever changed.

Susan Cain, Sometimes weary but recently enlightened life course traveler

Changing The Discussion From “Age As Loss” to “Aging With Gifts”

Aging into “older” years is often feared and imagined as a sad time primarily marked by losses. The losses begin slowly—for most in their late 40’s: The graying and loss of hair and development of hearing and vision issues; loss of our ideal body image as we lose muscle mass and gain unwanted fat; loss of roles in leadership and power positions within the community and workforce. These may seem significant yet they pale in comparison to the losses yet to come: Of loved ones who precede us in death; of independence as we give up our driver’s license; of dignity as we find ourselves relying on others to help us overcome limitations caused by physical and/or cognitive losses; of our image of “home” as people move into our home to care for us or we move to assisted living facilities. The Government and science dwell on these losses. The Government worries about how to address the wave of Boomers that will all too soon become “needy” for financial support. Science sees dollars and interesting challenges in improving and prolonging life.

Interestingly, at any age or developmental stage, we can measure life by losses rather than gains. Our 30’s—a time of infinite possibilities for many—often includes tremendous loss as we begin our families: Decreased expendable income resulting from the medical bills, day care and education; the concern of childhood illnesses; increased expenses, demanding careers can leave us worried and sleepless. In our late 40’s we are often “empty nested” and find ourselves financially struggling in order to pay for college; perhaps we must downsize our home. Nevertheless, most see this time not in loss but rather as new opportunities to travel, to re-engage with our spouse, to identify a new lifestyle, to get back to a healthy body.

Why is it we aren’t as willing to embrace the opportunities of late life as we are in our younger years? Perhaps because in our 30’s, 40’s and 50’s we have so much life ahead to change our direction, to make new decisions, to experience “more”. Life abounds with external opportunities to prove our limitless selves. In our 70’s and 80’s and beyond, the runway is getting shorter and we become a science and we re bombarded with messages of “age as loss”. Nevertheless research has shown that there are tremendous gifts available to us in our older years that are unavailable to younger adults.

These gifts include the beauty of solitude: of a time when we can spend long hours reflecting on the meaning and purpose of our lives, explore our creative selves, participate in the joy and promise of spirituality. Older adults tend not to dwell on “what if” or “if only”, nor do they become stuck on the “not so good decisions” they made in younger years. Instead life shows itself as a rich integration of each and every experience—the good and not so good decisions. They come together to make us who we have become. This quiet time of reflection, of letting go of the materialistic and even power over our own bodies is a gift that can bring comfort and peace to guide us through the challenging terrain of aging into our final years.

As with any developmental stage of life, this path to an enlightened older self isn’t a direct path and it isn’t automatic or even easy. There is no denying that those experiencing older years will suffer physically and emotionally. However, as we give up control and power, we attain the ultimate gift: the wise spiritual self who is now freed to imagine and embrace that which is yet to come.

The older adult may need support in finding this time as “gift” rather than loss. But that is another blog. If you want ideas about how to support the enjoyment of being an older adult or how to support your parents’ opportunity in older years, watch for my next blog: “Enjoying the Gifts of Aging”.

~ Susan

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