No Place Like Home for Aging Parents? Maybe, Maybe Not (Follow Up)
Leslie Peters was my guest on a recent blogtalk radio show I host (http://www.blogtalkradio.com/solie/2009/11/07/no-place-like-home-for-aging-parent-maybe-maybe-no). I asked her to provide me with a “list” of questions that would help aging parents and their adult children screen potential senior living accommodations. She was kind enough to send me a list of questions that “often go unanswered.” I think they are excellent. Here they are:
Parent company:
Who owns and operates the community?
How can you find out about the parent company’s fiscal health?
Are there documents such as annual reports or audits that you can have copies of?
Is the company for-profit or not-for-profit? What’s the difference?
How long has the company been in business?
Staffing:
How is the transfer to a higher level of care determined?
Is there someone on staff whose job is to manage transitions from one level of care to another and coordinate communication with the residents, their family members and the physicians?
Are there state and community regulations that determine who is appropriate for each level of care?
What medical and other support services are available on site?
Is there a way of checking to make sure that your Independent residents are up and around each day?
Miscellaneous:
Ask the Marketing person to set up a lunch or dinner with some residents so you can hear firsthand what it is like to live in the community.
Adult children might also consider talking to some of the children of residents to hear about their take on the community, staff and services.
How are new residents welcomed into the community?
Thank you Leslie…
Topics: Aging in place | No Comments »
A Blog Worth Repeating
Dr. Patrick Roden has a wonderful blog entitled “Aging in Place.” Below is the link to his latest post on September 14, 2009. It will do your heart good…
Successful Aging: A Man Named Pearl.
Topics: Aging in place | No Comments »
Sibling Infighting: How Do You Recover?
The real work of families is recovery. In the volatile landscape of family systems, everything is exaggerated, both good and bad. One of the predictable “bad” events in the drama of aging parents is sibling infighting. It can be triggered by anything, but it is mostly about money, power, and affection. Once provoked, it extracts an emotional toll on the entire system that resists recovery. Here is a case in point.
A daughter and her husband step in to help organize and manage her widowed mother’s finances. The goal is financial sustainability. The plan appears to be working until her other siblings, the “local ones” who live close to her mother, intervene with their own advice and unspoken needs. Her mother is torn between competing children. In the end, she opts to relinquish control of her finances to the “local” siblings. Affection gives way to betrayal, and the siblings splinter.
As in Shakespeare, winners and losers never stay put. The local siblings’ victory proves short lived. Financial stability quickly unwinds and an urgent plea goes out to the rejected daughter for advice and, of course, money. “What are you going to do?” her husband asks. Indeed, now what?
Justice in families is tricky business. The rejected daughter was understandably angry and wanted justice. She refused her siblings’ request for more money, and for all practical purposes, went incommunicado with the rest of the family. Then she waited.
Nothing. No apology. No request for forgiveness. Her mother and the other siblings continued to smolder in their financial crisis, and then things got worse.
Her mother fell ill. The rejected daughter hesitated by finally flew home. It was worse than she thought. No one was capable of managing the situation. Money, hygiene, and morale were all about to run out. The rejected daughter was angry all over again that the an even bigger mess had been dumped in her lap. You’re the court of last resort her husband advises, the last lap available in the family. Step in or step out. Either way, I support your decision.
Being right is easy, but not a strategy for healing families. The rejected daughter opted to step in, not alone and not without conditions, but she did step in. A geriatric case manager was hired, money was managed through local trust company, and her mother was moved into an assisted living community. It wasn’t easy, and it wasn’t without confrontations, harsh words, and strict boundaries. But a fatal mess was reversed.
It turns out that recovery is not about happiness; it is about unmerited actions that families need, again and again to regain their balance and move on. In this case, it was about forgiveness, courage, self-sacrifice, and honoring an aging parent. And for this family, it came not a moment too soon…
Topics: Siblings | 2 Comments »
The Talk of Life: Organic Legacy, Out Loud
“What’s so important about saying it out load?” I was asked a few months ago during a Q&A session at the end of one of my presentations that talked about “creating an organic legacy.” Good question I replied. What is so important about trying to get our aging parents to speak openly to us about the story of their lives? The short answer is “in the nick of time” insights.
It is easy to think of life review as simply a reconsideration by our aging parents of the important relationships and events in their lives. Certainly that is a big part of it, but certainly not all of it. There are unexpected discoveries, things you never saw coming, to be had in the actual telling of stories out load. The emotional and spiritual surprises that are not revealed through “private brain chatter.” They are the product of the telling out loud.
In this way, the telling out loud uniquely facilitates the legacy process. It helps our aging parents discover among other things hidden truths and forgotten strengths. It doesn’t matter how well they know the details of familiar stories or how often they have been repeated in the past, at some point the retelling reveals a new insight that catches everyone by surprise. But these are “aha moments” only occur in the actual telling of the story to someone who is empathetic to occasion. Older adults need a safe opportunity to hear themselves and then to ultimately use the raw material of these exchanges in the ultimate crafting of an “organic legacy.”
By way of background, organic legacy is a concept I created in my work on the developmental tasks on the last phase of life and is discussed at length in my book How To Say It To Seniors.
How To Say It To Seniors by David Solie
Legacy is not optional.
When understood as a developmental need, legacy insists on being addressed, either consciously or unconsciously. It’s the end product of life review, a developmental mandate of those privileged to survive into old age. Once we enter this stage, we constantly reconsider our lives to determine how we want to be remembered.
Returning to the past is not pathology.
Life review and the creation of a legacy are a natural evolution of where we need to be developmentally at the end of our lives. Legacy surfaces when control issues abate. If control issues are not resolved, they dominate our developmental mandate, and we never get to focus on legacy.
In searching for an organic legacy, events that may have been misinterpreted, misunderstood, or unrepaired in the past are reexamined.
This process reinterprets events and, if necessary, invites us to make amends. This process is difficult because of many factors:
The number of experiences we have stored up over a lifetime;
The tremendous mental focus needed to do it right;
The physical energy required to remain highly involved at a time when physical strength is ebbing each day;
Unfacilitated control issues.
Creation of an organic legacy offers the potential for healing.
Forming an organic legacy means that we have dedicated considerable time, energy and insight into what has happened in our lives, and tried to determine what everything means. Packaging the essence of that journey provides future generations with a perspective that fosters understanding, forgiveness, acceptance and resolution of values that may or may not have been appreciated during our lifetimes.
Legacy is not simply a summary of what we’ve experienced.
Part of our legacy is what we lived and part of it is what we may not have lived, but what we admired. Both parts of legacy contain values for which we would like to be remembered. Legacy coaches facilitate the articulation of these values.
Legacy gives us a chance to play an active role in the future.
Through organic legacy, we are able to create a vehicle that has the potential to influence people beyond those we encountered during our lifetime. The goal is to be part of a conversation 100 years from now, even though we are not physically present, because we set in motion a series of events or memories that live on after us.
Topics: Aging Parents, Creating A Legacy | 1 Comment »
End of Life Convesations: From A Doctor’s Perspective
My wife Janet shared with me a very moving article about end of life conversations from a doctor’s perspective entitled: Talking Frankly at the End of Life. Here is the link.
One of the most important aspects of the article is the issue of telling the patient the truth about their medical condition. “Am I doing more harm than good?” the author asks from her physician point of view. She cites a recent study in JAMA that asked 300 terminal patients “if their doctors had ever discussed care at the end of life.” As important, after the patients died, the researchers looked at the type of care the patients received prior to death and then interviewed the caregivers six months after the death to see how they were adjusting.
The results indicated that the patients who discussed care at the end of life were more likely to have a better quality of life at the end of their lives. They were not more depressed. They had less aggressive medical interventions. They went to hospice earlier. As important, their caregivers fared better.
What we want to know at the end our life is a personal choice. We all want some version of the truth but in different degrees and different doses. The key is being offered, more than once, the opportunity to hear it from the person who holds so much sway over our lives: the doctor. It is a natural part of our leaving, the slow dance we all take to step away from this life, preserving our dignity and saying our final goodbyes. Ironically, to do this we may need to remind the doctors who take care of our aging parents as well as ourselves, it’s okay to talk about the end, more than once…
Topics: Aging Parents, Quality Of Life | No Comments »
Artificial Aging: The Developmental Implications of Dying Too Soon
A woman in her early sixties was dying of a terminal illness. Her parents were gone, which left a younger sister as her only means of family support. But there was long standing disagreements between the sisters that had left them distant and disconnected. Now the younger sister was struggling to do her best to help her older sister but was feeling frustrated, unappreciated, angry, and guilty. “What should the younger sister do?” a friend of the family asked me. It was a good question I had not considered before.
The main focus of my work has been on the developmental agenda of the last phase of life of older adults, the need for control and legacy. But what about the developmental agenda of a life cut short from its normal longevity? Does a terminal illness in younger adults usurp their normal developmental stage by superimposing the final agenda of older adults? I didn’t know, and that’s what I told the friend of the family.
I also told the friend of the family that under the circumstances, I thought it was worth considering. If I was right, the need for control and legacy had taken center stage in the older sister’s life. As with older adults, I suggested that the younger sister initially reframe her conversations and energies around control issues. Specifically, how could she help her older sister preserve control in a world where all control was being lost to such a devastating illness? This could give the sisters a common cause that might be the basis of a more effective partnership. The friend of the family shared this idea with the younger sister. “At this point, “ the younger sister said, “I am willing to try anything.”
“Anything” began to open a door. The older sister’s burden of fighting for control in the face of a terminal illness was in desperate need of reinforcements. Instead of being rejected, the younger sister’s overture to assist her older sister with “control management” was accepted. Their differences became less important and a new, more effective dialogue began to emerge. “Now what?” the friend of the family asked me? Add legacy I told her. The door swung open.
The same legacy questions that opened up heart felt conversations between adult children and their aging parents offered the sisters a new, deeply personal way to communicate. Not surprising, the older sister’s life review took center stage, and with it came powerful remembrances, joy, regret, sadness, healing, and legacy. They were able to cover critical emotional terrain before the older sister passed away, being there for each other until the end.
I now believe that the last mission of life can come either on time when we are old or it can come “too soon” when are not old. Either way, it brings with it the overpowering need for control and legacy. Either way, it offers a way for all of us to partner with those who need understanding, care, and comfort at the end of their journey.
Topics: Boomer Issues | 4 Comments »
Too Close For Comfort: Navigating the increased risk of Alzheimer’s disease
Alzheimer’s disease extracts a toll across generations. Its diagnosis in an aging parent creates an immediate crisis for the offspring who must come to terms with their increased risk of winding up with the same affliction.
New high tech imaging further complicates the emotional upheaval of discovering Alzheimer’s disease “in the family” with its ability to supposedly identify offspring who are appear to be “on track” for the same outcome years before the first symptoms arrive. Painfully, this breakthrough in early detection does not come with a breakthrough in early treatment. Currently, there is no early treatment for “anticipated” Alzheimer’s disease.
For many of the offspring of parents with Alzheimer’s disease this is all too much too soon. They elect to not know the details of their familial risk and simply take their chances. But brain research may be offering some relative “good news” to this “to know or not to know” dilemma by providing important insights about the brain and how to keep it healthy.
First and foremost, brain research is starting to change our minds about the very nature of the brain itself. We are seeing more impressive evidence of “neuroplasticity,” the profound power of the brain to overcome, work around, and even reinvent itself in the face staggering set backs. Norman Doidge captures this new understanding in an intriguing book, The Brain That Changes Itself. It reminds us that the brain is still revealing its uncanny ability to side step disease and misfortune.
Brain research is also starting to offer new insights about the mind-exercise connection. While our techno-evolution into immobile, 24/7 screen watchers may be good for the information-curious brain, it is clearly bad news for brain health. It turns out that our cultural sluggishness creates nutrient and perfusion deficits our brain can ill afford. John Ratey makes a compelling argument for the brain’s fundamental need for exercise in his fascinating book, Spark. It reminds us that we are not simply bystanders in the drama of brain health.
In a similar manner, brain research is starting to sort out other factors that can preserve optimal brain health in addition to exercise. While diet is a hot topic, the findings so far have yielded mixed results. What we do know is that foods that are good for the heart appear to be good for the brain. But beyond that there are no magic brain bullets, expect for possibly one. Blueberries. Sue Halpren’s personal journey through maze of memory research in Can’t Remember What I Forgot, found that blueberries appear to benefit brains unlike any other food. It reminds us that the battle for optimal brain health needs to be waged not only on the treadmill, but also in the grocery store
Lastly, the battle may also utilize new software programs specifically designed to improve the health of older brains. Halprens’s book discusses a program by Dr. Mike Merzenich called Brain Fitness for auditory processing and memory. Initial clinical research suggests that that it does indeed improve cognitive function (http://merzenich.positscience.com/). It reminds us that the recipe for brain health will include an integrative mixture of life style habits, technology, and possibly medications. As important, it means that the offspring of Alzheimer’s patients have more options than simply to wait and hope for the best.
Topics: Alzheimer's Disease | 1 Comment »
When The Bottom Falls Out Mind Map ™
Here is the When The Bottom Falls Out Mind Map ™ that I created for a family where the aging parents told their adult children they were going to wait until they “needed to plan” (Double-click on the image to enlarge it).
The goal was to provide the adult children with a way to visually show their parents the type of decisions that would have to made if the bottom falls out. They simply told their parents they would “do their best” when things fell apart and gave them a copy of the mind map. These are the things we are going to have to decide with or without you they said. No scolding. No lecturing.
A few weeks later their parents brought up the mind map. They has some questions. It was a start.
We are all visual people. Check lists, brochures, and passionate pleas may fall on deaf ears. But a mind map lays out the interconnecting parts, a global view of the complexity that lies ahead. In essence, the When The Bottom Falls Out Mind Map ™ is the current marching orders until further notice. One way or another, it helps settle what really is going to happen…
Topics: Aging Parents | 7 Comments »
Magical Thinking and Aging Parents
Aging creates complexity and emotional burden. Aging parents find themselves facing situations and decisions that are hard to figure out and even more challenging to manage. They feel overwhelmed and understandably look for ways to simplify complexities and ease burdens. One of the quickest and most effect techniques is magical thinking.
Magical thinking is the respectable cousin of denial. It doesn’t pretend there isn’t a problem. Instead, it offers an unrealistic solution. Problem solved. Here’s an example.
Ann’s parents are finding it more difficult to keep up their home. Ann has tried to introduce the idea of “other” living alternatives but her parents cut her off with the statement, “we will stay here until something happens and we have to move.”
While offered as a reasonable solution, it is pure magical thinking. Ann’s parents want to stay in their own home as long as possible, but any discussion about alternative living arrangements that involves leaving their home is emotionally overwhelming for them. The quickest way to get rid of this discomfort is to find a simple, magical solution. In the case of Ann’s parents, it is “stay put until the bottom falls out.”
The good news is that magical thinking works, if only momentarily. It allows Ann’s parents to defer the unbearable complexity and emotional burden of sorting out living accommodations to an undefined future event. Unfortunately, this strategy comes with a severe surcharge: the unnecessary loss of long-term control.
By refusing to admit that a conversation about future living accommodations, though uncomfortable and complex, is necessary to maintain optimal long-term control, Ann’s parents are betting their quality of life on a hope that things will simply fall into place when a major medical set back invades their lives. Now what?
Despite their persistent refusal to discuss the “what if” housing issue with Ann, she needs to find a way to break through this communication gridlock. One effective way is to create a “When The Bottom Falls Out (TM)” mind-map that visually represents their current “magical thinking” marching orders on a single sheet of paper. This diagram will help her show her parents the impact of “we don’t want to talk about and will wait until things change before we plan” approach to long-term control. It will give Ann the opportunity to diagram the myriad of complex and unanswered questions that will surface when the “bottom” does fall out.
The “When The Bottom Falls Out (TM)” mind-map is a simple and effective reality check that affords Ann’s parents a global overview of their choices and an opportunity to reconsider other options. If they hold firm to their magical thinking strategy, then Ann has less guilt about their decision. She did her best to reframe their choices in an effort to discuss other strategies, but was ultimately rebuffed.
But the good news is that in some cases a simple one-page diagram can be a change agent. It puts magical thinking solutions in a logical, non-judgmental context and exposes their limitations and untoward consequences. It also draws an important line in the caregiving sand for adult children. It says, “Here are my marching orders as I understand them” until further notice. Many times this is all that is needed for new conversations about non-magical options.
Topics: Aging Parents | 11 Comments »
Caregiver Brain Changes
Much has been written about the brain issues of aging parents. Less has been written about the brain issues that impact middle age adults. Given that the majority of caregivers of aging parents are middle age, it is important to know how middle age brains are changing and how this impacts the demands of caregiving.
The most significant change in the middle-aged brain is a decrease in “executive function.” Executive function is the hub of multitasking and occurs in the frontal brain. It is responsible for prioritizing and keeping track of long lists of complicated, interconnected transactions. As this capacity begins to wane, it becomes harder and harder for middle-aged adults to keep “everything together.”
Complicating this setback in multitasking capacity is a concurrent decrease in the brain’s “staying on task” function. The impeccable filtering of distractions that comes so easy in youth begins to give way to the irresistible pull of distractions in middle age. The result is that middle-aged adults suffer from a failing attention span. Things get put in the wrong place, scheduling errors increase, “why I did I come in here” moments are more frequent, and “retrieval time” of information slows. This unwelcome and annoying distractibility has qualities that mimic ADD and make it harder and harder for middle-aged adults to “stay on task.”
Both of these brain changes complicate the job of caregiving for middle-aged adults where keeping everything together and staying on task are essential.
What can make this better?
1. Consider a “one-list” system Multiple “to do” lists can lead to disaster. It is more effective to work off a single, dynamic list that is constantly annotated, revised, rewritten, and reviewed. It becomes the focal point of a “keep track of things” system that is always identifying the most important short-term priorities and then quickly repositioning these items to the top of the list.
2. Fight the urge to “binge” multitask Binges of multitasking only exacerbate distractibility and prove inefficient and unhealthful. With the natural tendency of middle age brains to wander or lose their location “threads,’ it is better to focus on a the task at hand and “turn off” as many distractions as much as possible (music, cell phone, email dings, etc.).
3. Optimize the continuum Mind-Body health is an interconnected continuum. The simple but powerful things that optimize bodies, optimize brains. Exercise, prayer, music, meditation, writing, dancing, being with friends, healthy food, support groups, and large does of humor open caregiver hearts, and, as importantly, give caregivers the creativity they need to build a new partnership with their middle age brains.
Topics: Brain Issues | 1 Comment »