Five Thousand, Two-Hundred, Fifty-Three [5,253]

23 Jun
June 23, 2016

This week, an epiphany of sorts. For the 100th + time, I heard someone refer to an Assisted Living Facility as ‘God’s waiting room’. It wasn’t funny the first time I heard it and it’s not . . . Hey, wait a minute. There’s some truth to this quip. Just enough to drive home a single salient point, but true nevertheless.

My father, just two years ago, called me at 4:00 AM., frazzled and out-of-breath. But before I tell you about the call, a little backstory: My father, Howard Kenneth Bayne, was afraid of nothing.  At age 29, the last of his seven children was born. Imagine that. Could you have handled seven children when you were 29? Me neither. In all the years he worked (a District Manager for the Prudential), he never took one day off. Not for a migraine, or a UTI, or more than two dozen kidney stones, or for anything. Sorry. I forgot. He took two days to recover from cancer surgery.

Anyway, when I was young (8-18) we didn’t get along. At all. In fact, when I called on my data storage units while writing this piece, one of the more graphic memories is one in which my dad and I were standing toe-to-toe over the Gulf of Tonkin Resolution. It was a nasty fight. But all things pass. When I turned sixty, I could honestly say my dad was my best friend. Until he died at 85, we spoke on the phone every day. And not just a pro forma call, either. We usually talked for an 30 or 40 minuites.

Here’s the cut-away: One of the characteristics of a member of The Greatest Generation is their reluctance to generate drama when it’s not called for. An example: the two of us were driving down to Virginia about 25 years ago to attend a family reunion, he tells me in a calm, even tone: “I’ve been an alcoholic for 40 years. ” And I say, “But Dad, I’ve never seen you with a drink, my entire life.” To which he replies: “I was a ‘functional alcoholic,’ the whole idea was to drink without detection.”

“Well, it worked,” I said.

And like two little boys who lifted a bag of Oreos and a bottle of milk from the neighbor’s house, we smiled and never said another word about our little secret.

OK, back to the phone call.

I’m holding the phone in my hand, listening to my father pant as if he had just run the Boston Marathon.

I didn’t know his lymphoma had caused his immune system to go south and he was very, very sick. He never mentioned to anyone in the family that he was quite ill. And it never even occurred to us at the time. In retrospect, I can see it now, but back then, he’d managed to hide the fact that he was dying.

“Read to me.” he said”

“Of course,” I said. “What should I read.”

“It doesn’t matter, Son” he said, “Your voice is a tonic to me.” Twenty minutes later he was asleep, the first time, I found out later, in nearly a week.

Later that day he was taken from his apartment in Westchester, PA to a hospital, and subsequently transferred that same day to a hospice where he died three days later.

Back to God’s waiting room . . .

I’ve seen fear, panic and terror in the mind and hearts of elder care residents who die without ever having the opportunity to talk about it in an open forum. Let’s give them that forum, make it freely accessible and encourage its use.

Almost forgot. The number 5,253? It’s the number of days I’ve been a resident in assisted living communities. Roughly 14 years.

I’ve watched a great number of people transition from this life to the next during my time on this planet.

May all our journies be filled with blessed awe and joyful reunion.

Martin Bayne

Derek Rosseau, (Manor) Care Ambassador

24 Feb
February 24, 2016

Goldenes-Zeitalter-1530-2

Lucas Cranach the Elder – The Golden Age

I was recently hospitalized in three Skilled Nursing Facilities (SNFs) for a triad of 2-3 week short-term, rehab admissions.

One of those communities was Manor Care, in Bethlehem, Pennsylvania. It was here that I met a CNA who reinvigorated my opinion of mankind-in-general, and caregivers, specifically.

Derek Rousseau is a 32-year-old recent LPN graduate who reminded me how important we are to each other, and how that relationship becomes magnified in a long-term care setting.

Derek, through simple and genuine in-the-moment care giving, accomplishes what no Madison Ave. ad campaign could – the precept that we are important to each other, in ways that often defy definition.

I hope Manor Care realizes the value of employees like Derek Rousseau LPN, and encourages them to share their insights with admin, staff, and other aides.

 

 

 

World Mind Part II – Elder Warrior

07 Jan
January 7, 2016

We  are told by a prominent and highly-respected geriatrician that the three plagues of growing old are loneliness, helplessness and boredom.

I respectfully disagree.

If you have not conquered loneliness, helplessness and boredom by the time you begin to “grow old,” chances are, you never will.

For example, when was the last time you heard of an 85-year-old entrepreneur discussing a new business start-up opportunity?

World mind says “never,” but Warren Buffett, ‘the Oracle of Omaha.’ would disagree.

What’s my point? Just this . . .Does Mr. Buffett impress you as a lonely, helpless and bored Octogenarian?

No? Me neither. (In fact, I know Zen Buddhist monks who would be envious of his courage, joy and ‘life in the moment’ commitment)

There will always be those — young and old — who hunger and thirst in a valley of sadness and suffering. That is the nature of life on this planet.

And there will always be those who, despite almost impossible odds, choose the life of a true warrior.

Which path will you travel?

 

 

World Mind

03 Jan
January 3, 2016
In Japan, some married couples — when faced with advancing age and the “empty nest” syndrome — choose to spend their final years in Buddhist monasteries.

The monastic environment offers a number of advantages:

In a like-minded community of both young and old trainees, ambient despair (the disability, dementia and depression that exist in an aging secular community) appears with much lower frequency. (anecdotal)

Because zazen (meditation – sitting quietly) is  integrated into every aspect of a trainee’s life, this simple, but powerful tool – after diligent practice – fills every moment of the trainee’s life. Thus, there is no need to “kill time” with hours of Bingo and Pinochle. Time itself becomes infinitely valuable.

Trainees ultimately learn that everyone: Buddhist, Hindu and Atheist alike possess the Buddha Nature — our original, primal nature. Therefore, it’s no surprise that when fellow monks become old and infirm, they still retain value. This is when long term care takes on a new dynamic. People, regardless of their level of ADL failure, are treated with respect and compassion.

Everyone dies, yet to grow to grow old and not know who you are — this is the profound sadness of “world mind.”

And while it is tempting to cast blame on “evil corporations” and “reckless REITs”  for imperfect SNFs and CCRCs, rarely do these equations balance. Seniors are rarely held accountable for their lack of determination and vision. Our parents are not helpless victims and it’s time we stopped treating them as such, world mind or not.

Phoebe Ministries Nursing Home Workers Demonstrate Their Unity

21 Dec
December 21, 2015

Workers vote overwhelmingly to hold a 1-day strike to protest unfair labor practices.

ALLENTOWN, PA – With growing concern over the future of senior care in their communities, and frustration that management refused to release important financial information regarding the home, workers at Phoebe Allentown and Phoebe Berks voted by an overwhelming majority to approve a 1-day unfair labor practices strike.

What: Candle Light Vigil For Quality Care
Who: Phoebe workers, Faith leaders, community supporters
Where: Outside Phoebe Ministries, Allentown: 1925 Turner Ave., Allentown
When: Tuesday, December 22nd 3:30pm
Photo opportunity: Hundreds will hold candles, speak out and share their stories. Prayers from local religious leaders

“No one ever wants to go on strike, but we felt like we had no choice,” said Sandy Fehnel, an LPN who has worked at Phoebe for 27 years. “We have been trying to work with management for months to reach a fair agreement, but their final proposal was a blow to the very foundation of what makes Phoebe home a special place with incredible care.”

Phoebe Ministries has consistently received high ratings for care and was named “One of the Best Places To Work” by the Allentown Morning Call earlier this year. The home has been known for having very high standards in employment, and their family-sustaining wages have allowed workers to spend decades serving residents and building relationships with families.

Now management is asking workers for over $2.7 million in concessions, including:

· Wage cuts of up to $4.14 an hour for 66% of workers.

· A hike in some health insurance co-premiums, making it hard for healthcare workers to afford healthcare for themselves;

· Nearly a half-million dollars in cuts to worker’s 401ks; and· Changes to overtime, short term disability, and holiday pay.

Meanwhile, the top six executives at Phoebe enjoy $2.1 million in total compensation. (see EXTRA!)

“It’s hard to be treated so unfairly,” said Eric Szopacs, a CNA at Phoebe for 12 years. “And it’s frustrating that management has refused to provide us with more financial details or work with us on cost-saving measures we had discussed.”

Workers offered proposals that would have saved Phoebe Ministries $1 million/year, including an alternate health care plan which was more cost effective for everyone. They also offered concessions, including some wage cuts, reducing their annual paid leave by up to 12 days, reducing their holiday pay, and agreeing to pay more for dependent healthcare coverage in an to avoid the deep wage cuts that could jeopardize quality care.

Low wages are linked to a reduction in quality care, because homes are unable to retain a dedicated and skilled workforce, or keep the workers they have. High turnover disrupts continuity of care and can lead to staffing shortages.

“I care for my residents like they’re my own family, and I want the very best for them” said Ann Dee Morris, who has worked at Phoebe for over 30 years. “I work in housekeeping, but if I know one of my residents is at the end of their life, I will sit there and hold their hand just to make sure they’re not alone. They don’t deserve any less than that.”

Workers will be joined by residents’ families and community supporters for a candle light vigil on Tuesday, December 22nd beginning at 3:30pm in front of Phoebe headquarters in Allentown. The one-day strike will be held December 30th at the Allentown and Berks locations – details to come.

 

EXTRA!

“A Community Of Faith, Called By  God”  . . . at $340/hr

Capture

 To illustrate management’s proposed $17/hr salary cap for Phoebe employees in perspective, I’m posting the wages, per hour, of Phoebe’s top wage earners as filed with the IRS in 2014:

Scott R. Stevenson          CEO          $340/hr     ($707, 029 annually) 

Lisa Fichera                     COO          $173/hr         

Sandra Massetti              EVP          $124/hr

Revena Rossi                   EVP          $103/hr

Cynthia Richart              Dir Pharm    $92/hr

 

 

STUFF

17 Nov
November 17, 2015

A report from the Slow Lane

I’ve been sick these past few days. Coughing, sleepless, and sore, my attitude has gone into the dumpster. I don’t know about you, but when I’m sick, I begin thinking more about death. During the worst of my illness, when I am desperate, tired and alone, I begin fantasizing that death is near-by.  I don’t know if it is wishful thinking on my part; I am ready for my sickness suffering to end, or, if it is some kind of dread that dying will be just as lonely, energy-less, and debilitating. In any case, I’m not my best when I’ve been ill for a while. All of this, left me thinking this week about growing old, and trying to come to terms with living/ dying.

One of the things that came to mind was about locating myself in terms of being an elder-in-training. I know I’m intent upon moving along an elder path, but I’m wondering if there is a way of recognizing movement forward. While I was sick I thought about this some more, and decided there was. I came to the conclusion that my relationship with the ‘stuff’ of my life was a good indicator. If I was letting go of stuff I was on course, and if my stuff was mostly in charge of me, I wasn’t.

Now this thought benefits a lot from the conversations I’ve heard in the last months.  Old people have sat in circles discussing their relationships with things. Each of them is facing their own mortality, knowing they aren’t what they used to be, and that they are being reduced as they age. In talking about the difficulties in facing their stuff, and getting rid of what is no longer relevant to who they presently are, they shared something of the exacting rigors of growing older. A lifetime of necessary and unnecessary acquisition was giving way to a different way of meeting the future. Letting go of stuff, was like letting go of parts of the self. It was painful, and these old people also knew, it was liberating.

Such an exquisite pain!

There is something about growing older that is so poignant and beautiful. There is so much surrender involved! The process is like moving into a series of smaller and smaller houses. Each move requires letting go of some things. Amazingly, some old people, grasp the freedom that this shedding brings. Along the way, though, is a kind of forced march, a period of loss, an era of giving up aspirations, dreams, accomplishments, hard-earned competencies, identities, and lots and lots of stuff. Wriggling out of old skins is painfully difficult, even while it is liberating.

Stuff is the detritus of a life, while the real thing is the liver — the one who has grown ripe by going through many stages and becoming multi-layered, nuanced, and complex. Losing is part of that complexity, a necessary ingredient, that liberates all of the flavors that contribute to a real richness, a bountiful character, an inner fullness. Knowing this aspect of what it means to be human, of getting to be alive, is a gift that comes primarily to the elderly. It is a gift that comes with an exacting pricetag. It is ours, it comes to each of us, but the price is high. To gain what is our birthright, we must give up everything. It is a trade that can only be made in the secret recesses of the individual heart.

In my sickness I could see all of this. I wonder if I am up to it. Can I let go of everything? I like my life now. I never imagined it could be this good, despite being disabled, poor, and marginalized. Still, I know I have more letting go to do. Everything that can be lost, will be.  Going toward the light, means lightening up. That is easier said than done.

Stuff is the most visible dimension of a much deeper process. It indicates something about how that process is going.  Meditation training should include the dictate, “I’m not my stuff,” as well as “I’m not my Body.” They are both very similar, and both things that will be left behind.

In the meantime, though, stuff is a good way to grasp where one is viz. a viz. the exacting nature of Life’s reduction of us into essence.   —  David Goff

Now Is The Time To . . .

16 Nov
November 16, 2015

prayer

Phoebe — Part II — Everyone Loses

05 Nov
November 5, 2015

“I have been employed at phoebe for six years. These people are family to me. They are well taken care of and loved by our staff. It breaks my heart that it has come down to this absolutely horrible situation.” Sharon

“As an employee for 20 yrs. Starting as an CNA and transferring to a LPN, this is disheartening . I have stayed here because of their reputation, even though I moved to NJ and could’ve gotten a higher paying job. In my 20 yrs I have never seen anything like this.”   Megan

“I have been an employee at Phoebe for 27 yrs. I always took pride in saying that. Not anymore. I am ashamed at what they are doing to my residents home. I just want to cry.” Sandy

“I’ve been at Phoebe for 13 years and feel strongly that if you want to provide quality care, you must first provide quality jobs.” Jackie

What do Phoebe Ministries’ Executives Scott R. Stevenson, CEO, Lisa Fichera, Executive Vice President and COO, Sandra Massetti, Executive VP and Chief Healthcare Officer have in common?

From their bios, it’s clear this management team is highly skilled and proficient at what they do. (And though I’ve not met them personally, I’m sure they’re engaging and charming as well.)

But the employees who weighed in at the top of this page about the current labor dispute also remind us that this management team has lost touch with Phoebe’s “front line” — the human interface between the residents and aides, therapists and the veritable army of support personnel that wash our clothes and prepare our food.

In my capacity as both journalist and 13-year assisted living resident, I’ve had a number of conversations about Phoebe and the level of care that has become the standard for Pennsylvania’s Lehigh Valley.

And I can assure you that during these discussions, not once did Scott Stevenson’s name come up. Rather, the conversation was always about Hellan, Mike, Margurite, and the other amazing aides as well as the hundreds of employees who dispense their affection and caring in the laundry and kitchen, at the bedside and commode, and in the shower.

These are also employees I’ve overheard talk about their greatest fear — not that  they’re being forced to make wage concessions — but rather “What will happen to my residents?” during the labor dispute.

Thus, from where I sit, this dispute is without a winner — everyone; the resident, the staff and management — loses. The only question is. . .

when the shouting stops and the smoke clears, will it even be possible to glue the disappointed and shattered Humpty back together again?

 

 

 

 

 

Phoebe to Health Care Workers: “Get Used to Less”

30 Oct
October 30, 2015

logo On more than one occasion I’ve sung the praises of Phoebe Ministries, a multi-facility, not-for-profit health care organization founded in 1904 and affiliated with the United Church of Christ.

Their Skilled Nursing Facilities (SNF) rank among the finest in Pennsylvania’s Lehigh Valley. In fact, I write these words from their Allentown community, where I’m spending the next 2-4 weeks in rehab, following an acute care hospital admission.

As a long-term care consumer advocate, I appreciate the personal care I’ve received from the staff at Phoebe: care that is consistent and reliable. I’m also grateful for the little “extras” I find at Phoebe and nowhere else.

Yet, in a larger sense, this level of care is not surprising. If you pay your employees a respectable wage, they will usually rise to meet and exceed expectations. It’s not a complicated algorithm; just Human Behavior 101.

Health care employees at Phoebe are some of the best paid in the region.

And it shows.

It’s not unusual to find employees with 20 and 30 year tenure; as opposed to the average “revolving-door” you find at most senior living communities, where  six-months of aggravation is often the limit for most employees.

And having lived the last 13 years in assisted living facilities, I’m surprised the employees last even that long.

OK, back to Phoebe . . .

The organization, in the middle of a multi $million face-lift, recently released a letter to its unionized employees (Service Employee International Union) stating: “In an effort to address the financial challenges from significant decreases in government reimbursement and the implementation of the Affordable Care Act:

It is critical for us to make adjustments in wages and benefits to bring them in line with market standards. This means that your pay and benefits are comparable to your positions at similar nursing homes in our area. The proposal concerning wage concessions is specific to categories of workers who are paid significantly above market standards for that specific position.”

I spoke with an employee who has 14 years under her belt as a Certified Nursing Assistant: “I love working at Phoebe, but they’re going to cut my current wage of $19.20/hr. to $17.00/hr.” she said. They’re asking me to choose between loyalty and my family.”

The overriding question for me, as a journalist and health care consumer, is this:

Has management warmed also warmed up to the concept of wage concessions?

I’m guessing, dear reader, you and I already know the answer.

Denture Capital & Custodial Care, Circa 2040

17 Oct
October 17, 2015

SNF - circa 2030Bill Thomas, in response to an earlier essay I posted on his blog,  asked me what I imagined custodial care would look like in the future.

Shortly thereafter, I was hospitalized with pneumonia for the fourth time in as many years — each hospital stay followed by an average of three weeks of rehab in a Skilled Nursing Facility (SNF). At the conclusion of physical and occupational therapy, I returned to the assisted living community where I resided.

In fact, over the course of the last twenty years, as I’ve stayed the course in my battle with Young-Onset Parkinson’s, I’ve spent time as a resident in three Assisted Living Communities (ALC) in two states, more than ten acute-care hospitals and roughly a dozen SNFs.

In light of these facts, I believe it’s safe to state that today, now 65, I bring no small measure of personal experience to a discussion on the future of custodial care in the US.

First, let’s define our terms: Custodial Care (CC) is supervised, long-term care. The word “custodial” itself means “providing protective supervision; watching over or safeguarding.” The terms “custodial care” and “Long-Term Care (LTC)” are interchangeable and refer to the kind of care one receives when in need of assistance with activities of daily living (eating, bathing, toileting, etc).

In the mid-nineties, when I had the opportunity through my blogMr. Long-Term Care, to interview Hillary Clinton, Jimmy Carter, Clint Eastwood and other prominent individuals on the subject of  LTC, we tended to conjugate our verbs in the future tense. (i.e. the inevitable and catastrophic cost — in financial, emotional, political and personal dynamics of LTC was always an event that was going to happen.)

Today, two decades later, we conjugate those same verbs in the present tense.

The train that Jimmy Carter used in our discussion as a metaphor as in ” . . .the dining car is filled with sated Americans traveling 200 mph on a stretch of track from NY to Washington, unaware of the train-wreck around the next bend,” is finally heading into that bend with dozens of derailed cars on the tracks, and we are truly ill-prepared population and what awaits them. Now let us return to the question at hand . . . How do I perceive the future of custodial care in the future.

As the Great Generation fades into oblivion, and  77,000,000 Baby Boomers move in and take their place, I perceive an American phenomenon I call Denture Capital — money initially designated as testamentary, second-generation gifts, caught in a power struggle between parents with expanded LTC needs (as they continue to live beyond expectations), and their children, who’ve always fancied themselves behind the wheel of an XKE Jaguar.  

But I digress . . .

Let’s stay on topic; namely, custodial care circa 2040.

What will LTC look like in 25 years?

Here’s a hint — didn’t we learn anything from warehousing  the mentally ill?

Bleak, institutional living didn’t work for the mentally ill in the 50’s and it won’t work today for those who need Activities of Daily Living assistance.

If we are to create a custodial care system that actually works, we need to look closely at three components:

(1)Size; I have a friend who left a 75-bed assisted living facility as its medical director and created a very successful 3-bed “sanctuary” for advanced Alzheimer’s patients in her home . (Complete with horses, a beautiful parcel of land and a deep personal commitment. All this becomes possible when you adjust the SIZE of your resident population. The days of the 100-bed assisted living facilities are over.)

(2)Service: Americans, once proud and vigorous volunteers in a wide range of worthwhile projects have forgotten their heritage. John Kennedy said it best at his inauguration: “Ask not what your country can do for you, ask what you can do for your country.”   We need a national long-term care volunteer program the likes of the Peace Corps.

(3)Community: While my sister Linda lay dying of cancer in her Toronto home in 2001, the communities of Buddhists and gay women – both integral parts of her life – appeared in such numbers that many spent nights in sleeping bags on floors throughout the house.