There are no perfect long-term care communities.
There may, however, be a number of long-term care communities perfect for you.
We’d all like to meet aging on the grass courts of Wimbledon, not the claustrophobic hallways of a skilled nursing facility.
But it’s not always up to us.
In the later example, accessible and assistive technology can both play an important roll in the emotional, physical and financial well-being of those receiving long-term care.
Remember the Whole Earth Catalog?
We’d like to see Organic Aging fill a similar void for those in need of accessible and assistive technology, and we’re going to set aside column space for that purpose every week.
PS Got an itch to help publish the journal? Contact me at 610-625-3330
Friday, January 17, 2014
Senior Housing Forum
re: “Money Money Money -&- Could Migrating Seniors be the next big opportunity.
In your most recent newsletter you state,”. . .It may also mean there are opportunities for senior living operators and developers in other countries. Imagine if Sunrise or Emeritus had senior living opportunities in Mexico or South Africa or Costa Rica; the name association would likely make it much easier for North Americans to transition to a lower cost country.“
It occurred to me you may want to follow up this piece with, “Countrywide: The Financial Brand that Endures”
Seriously, Steve, by picking two of the most ethically controversial companies in the Institutional Aging industry, you’ve set your own bar pretty low as well.
Be that as it may, at least when you use the word “advocate,” we — as consumers — now know what the playing field looks like.
I hired a medi-van and driver to transport me from my assisted living facility to my sister’s home in Bath, PA last Friday. Except for a ferocious wheelchair transfer through my sister’s front door, it was the perfect visit. My sister had already picked up my mom from a skilled nursing facility and brought her home earlier that day. Seeing my mother is always a bittersweet experience. When I look into the eyes of that 87 year-old woman, like a perfect mirror, I see the totality of my own life looking back at me.
That’s the sweet part. The bitter part is accepting her mortality; knowing that “someday” will come too soon, and when that day arrives, I won’t ever hear her voice again, or drink another glass of eggnog and rum after attending Christmas-Eve mass or feel the bond that is singularly unique as her first child. “I never knew love,” I’ve heard her say to others, “until the day my first child was born.” I wonder how I will function during those first hours, days weeks, without her.
It’s not like I’m a stranger to death. I’ve lost three younger siblings . . . Wait! I say to myself, you’ve been down this road before. Enjoy her while she is still here and let the future unfold as it may.
I switch gears.
I look at my four nephews (no nieces) from my two sisters – four great kids. For a brief moment, I am absorbed into the experience of actually imagining how grandparents feel about their second-generation progeny. It is intoxicating. The outpouring of love and affection for their grandchildren takes my breath away.
Howard, my brother-in-law suddenly appears – on his knees, at my feet with a dustpan and broom. “Sorry, he says, “just sweeping up the dead needles from the Christmas tree.” He takes a red bandana from his pant’s pocket and wipes his brow. “These trees are beautiful, but nothing lives forever.”
Ask an 88-year-old woman who lives in an assisted living facility which she would rather have: genuine crystal chandelier in the facility’s dining room OR 30-minutes per week of conversation with a social worker who really cares about the struggles and challenges she faces.
Then ask her, as much as she enjoys her facility’s picture perfect landscaping, would she trade it for a proper introduction and tour provided by a group of fellow residents, the first day she arrives.
And what about this woman’s personal care attendants (PCAs)? You know the ones: many fresh out of high school, who are expected to dress and bathe the resident, help her into and out of her wheelchair, wipe her behind, etc. Start by asking her what effect PCA turnover has on her life. (One out of two PCAs currently change employers at least once a year.)
If you want to take these interventions to their natural conclusions, do what my facility is attempting to do beginning Jan 1st. We’ve decided we will begin an emphasis toward community as opposed to individual by implementing small programs slowly, naturally and gradually. After our regularly scheduled exercise program from 11:00 AM – 11:30 AM, we will now add a 30 min. MEDITATION instruction project. We’re going to use zazen as the meditation vehicle because of its simplicity. (It translates from the Japanese “sitting quietly” and is used in Zen Buddhist monasteries.)
The meditation will ultimately become the “glue” that allows us to try more ambitious programs such as the “Responder Program.” This will pair-up residents undergoing an anxiety crisis with volunteers trained to simply hold their hands, help regulate breathing as they read from MENDELA’S PROTOCOLS.
The principles themselves are the end product of nearly forty-years of meditation with my initial training in both Catholic Benedictine and Soto Zen Buddhist monasteries. MK Bayne
Another Thanksgiving as an assisted living resident! My eleventh to be exact. I navigate my wheelchair through the dining room’s maze of glass-topped tables with festive centerpieces, courtesy of our own octogenarian artisans and park my chair in front of the “Martin Bayne” name card on the table. Locking my wheels, I reach over and move the table display of paper flowers, carefully setting it on the floor. “Now I can see your face, Tom”
Tom is an 86-year-old retired CPA. His wife of 57-years died last year from a rare form of bone cancer, and after surviving a dozen skirmishes with Congestive Heart Failure (CHF) himself, his children — much to his protestations — convinced him to become an assisted living resident.
At first, Tom found the experience almost unbearable. He desperately missed his wife, and the first time an aide (Brenda, 22) young enough to be his great grandchild showed up to give him a shower, it took the Admissions Director and two nurses half the night to convince him not to pack up and walk out that very next morning. But, truth be told, it was the Director who put Tom’s \dilemma in perspective without saying a word. When she walked in that morning, carrying coffee and donuts for the staff, she noted the discussion and listened in for just a few seconds. Then she casually walked into her office, withdrew a business card from her desk and walked out to where Tom was sitting and handed him the card.
Tom took one look at the card, placed it in his pocket, and said, “I’m sorry for any time of yours I may have wasted. If there’s nothing else, I’ll excuse myself and have breakfast.”
Now I’ve seen the Director (Marsha) use what I call “the magic business card trick” on more than one occasion. It’s not pretty and I don’t recommend it, but as a last-ditch effort to get to residents to focus, really focus, on the problem at hand, it’s quite effective. The business card is actually from a local homeless shelter. It usually takes a resident about 20 seconds to connect the dots. Like I said, it’s quite effective.
Today, Tom has an easy smile and offers a generous “Good Morning,”which is returned in kind. He waves a server to the table and seconds later wraps his hands around a steaming cup of coffee. “Just a bowl of bran flakes,” he says to the server, “have to save plenty of room for the turkey.”
I turn to Tom, “They’ve got a big bird this year. Three of them actually . . . “
The server arrives at the table with a pot of coffee.
“I’ll have a cup, and you, Tom? The waiter, seemingly confused, looks straight ahead, avoiding my eyes. “I’m sorry, Martin, but who’s Tom? There’s no one but you at this table.
I look away. Emotions jostle for position: embarrassment, anger, confusion, and sadness. I finish my coffee and slowly make my way out of the room.
“This, too, shall pass, Marty” I tell myself. This, too, shall pass.”
What No One Should Have to Witness
Twenty years ago, at the age of 44 and recently diagnosed with Parkinson’s, I wrote the following
“When first thrust into the role of a long-term care caregiver or patient,
we begin to understand that our adversary is a formidable opponent.
And as the true nature of this adversary is revealed, you begin to realize what’s at stake —everything.
What we all value most — our dignity, independence, family relationships, even our life savings — becomes barter overnight
In essence, our very lives become negotiable. In the mere blink of an eye, the concept of “safe harbor” vanishes from our lexicon.
Against this backdrop I consider my diagnosis of Parkinson’s Disease as a stroke of good luck.
Unlike Christopher Reeve, I’ve had time to familiarize myself with my opponent: to take inventory, to prepare myself.
Unfortunately, a significant number of those reading this will not have the good fortune I did.
You will meet your adversary suddenly, abruptly, with little warning,
And you will meet him, on his turf .
And he will show you little mercy.” MKB
My thinking in those days went something like this:
I will survive Parkinson’s — stave off this wretched disease — until it is my turn to step out of my body and meet my creator.
In my wildest dreams, I never thought I would live to see 65, now just 15 months away.
But here it comes — like a freight train at full speed; thundering down a ribbon of steel, and with it, my greatest fear . . .dementia.
You see, Parkinson’s almost always slides into dementia, and not necessarily because of the disease itself, but rather the drugs used to treat the disease.
And yes, I’ve seen the new “memory enhancement” and “cognitive rehab” facilities.
And they’re exactly like you imagine them to be.
Why am I telling you all this? Because if you’re a Baby Boomer, NOW is the time to create an advocacy relation with someone.
Please, PLEASE take my advice to heart and make sure you have an advocate — a spouse, sibling, or perhaps even a professional.
Because the next time I visit a friend in one of this nation’s new dementia facilities, I don’t want to see you sitting alone in a wheelchair in the hallway, confused, isolated and mumbling to yourself as you stare into space.
LONG TERM CARE TRAIN WRECK
Take a look at the data below. Without saying a word it tells a story. The entire theme of the story is encapsulated into two words. Do you know what those two words are? HINT: you would if you’d read my 2,500 word essay in this nation’s most cited journal of health care policy Health Affairs, articles in the Washington Post, New York Times that drew more than 800 replies, and my NPR Fresh Air interview with Terry Gross. Skeptical? Check out Wikipedia and see what they have to say. Oh yes, the two words. Ambient Despair.
A Profile of Older Americans: 2012
The older population (65+) numbered 41.4 million in 2011, an increase of 6.3 million or 18% since 2000.
The number of Americans aged 45-64 – who will reach 65 over the next two decades – increased by 33% during this period.
Over one in every eight, or 13.3%, of the population is an older American.
Persons reaching age 65 have an average life expectancy of an additional 19.2 years (20.4 years for females and 17.8 years for males).
Older women outnumber older men at 23.4 million older women to 17.9 million older men.
In 2011, 21.0% of persons 65+ were members of racial or ethnic minority populations–9% were African-Americans (not Hispanic), 4% were Asian or Pacific Islander (not Hispanic), less than 1% were American Indian or Native Alaskan (not Hispanic), and 0.6% of persons 65+ identified themselves as being of two or more races. Persons of Hispanic origin (who may be of any race) represented 7% of the older population.
Older men were much more likely to be married than older women–72% of men vs. 45% of women (Figure 2). 37% older women in 2012 were widows.
About 28% (11.8 million) of noninstitutionalized older persons live alone (8.4 million women, 3.5 million men).
Almost half of older women (46%) age 75+ live alone.
In 2011, about 497,000 grandparents aged 65 or more had the primary responsibility for their grandchildren who lived with them.
The population 65 and over has increased from 35 million in 2000 to 41.4 million in 2011 (an 18% increase) and is projected to increase to 79.7 million in 2040.
The 85+ population is projected to increase from 5.7 million in 2011 to 14.1 million in 2040.
Racial and ethnic minority populations have increased from 5.7 million in 2000 (16.3% of the elderly population) to 8.5 million in 2011 (21% of the elderly) and are projected to increase to 20.2 million in 2030 (28% of the elderly).
The median income of older persons in 2011 was $27,707 for males and $15,362 for females. Median money income (after adjusting for inflation) of all households headed by older people rose by 2% (not statistically significant) from 2010 to 2011.
Households containing families headed by persons 65+ reported a median income in 2011 of $48,538.
The major sources of income as reported by older persons in 2010 were Social Security (reported by 86% of older persons), income from assets (reported by 52%), private pensions (reported by 27%), government employee pensions (reported by 15%), and earnings (reported by 26%).
Social Security constituted 90% or more of the income received by 36% of beneficiaries in 2010 (23% of married couples and 46% of non-married beneficiaries).
Almost 3.6 million elderly persons (8.7%) were below the poverty level in 2011. This poverty rate is not statistically different from the poverty rate in 2010 (8.9%). During 2011, the U.S. Census Bureau also released a new
Supplemental Poverty Measure (SPM) which takes into account regional variations in the livings costs, non-cash benefits received, and non-discretionary expenditures but does not replace the official poverty measure. The SPM shows a poverty level for older persons of 15.1% (more than 6 percentage points higher than the official rate of 8.7%). This increase is mainly due to including medical out-of-pocket expenses in the poverty calculations.
*Principal sources of data for the Profile are the U.S. Census Bureau, the National Center for Health Statistics, and the Bureau of Labor Statistics. The Profile incorporates the latest data available but not all items are updated on an annual basis