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.

 

WONDER

14 Oct
October 14, 2015

A report from the Slow Lane

Like Mystery, everything seems to be shot through with wonder! The spaciousness that flows from these places, within all parts of reality, leaves me breathless. I am disturbed, by living within so much magnificent mystery. Because this is so, I’m finding it harder and harder to think and comment about anything. Probability seems to dictate that no matter how I look, or which way my attention is drawn, I behold a certain amount of wondrous uncertainty. Its all so much, so mysteriously undetermined, while being solid, that I wonder if I can even sensibly write about it.

Reflecting, as I am, on this aspect of my experience, and trying to find words for it, is, no doubt, part of the foolishness I was born with. Somehow, without any intention on my part, I’ve become aware of something so thoroughly palpable because it isn’t there. I mean, rather crazily I’m sure, that what isn’t there is what seems to accompany what is. And, even more strangely, gives it shape, dimension and meaning.

I was never prepared for this kind of perception. And it seems, that uttering anything about it is hopeless. Still, I keep thinking that there should be someway to talk about it. There seems to be something about reality that contains a probabilistic something that keeps everything connected and free. How is that possible! I don’t know, but I have noticed. The perception thrills me, and it leaves me befuddled. I can’t adequately articulate this aspect of my reality, yet it is so awesome I can’t ignore it either. I feel compelled to share it, and at the same time, I am aware that I am not really able to describe it.

So, what am I talking about? I can’t really say. I am trying not to use, over and over again, the words mystery, uncertainty, wonder and unknown. They need a rest, and only dimly refer to what vibrates in the background. I want to convey, and hear other’s perceptions about, this quick-silver facet of each moment, because somehow sharing such befuddlement is deeply reassuring. Maybe that’s what I’m doing here, noticing the wonder that keeps my heart beating.

Anyway, it seems like, in my dottage, this awareness has come on stronger than any past point of my life. I have a mixed reaction to this awareness. I love it. It seems so freeing. I have been released from all assumptions about what is going on here. Simultaneously, I feel a sense of foreboding. It is making me a more eccentric old man. I am being herded by Life into a smaller and smaller corral. Becoming more unique, is hard on a social animal, like me.

All I can say, honestly, is that I am growing more and more impressed by the sense of wonder growing in me.  My life is changing. I can feel it. Maybe this is death setting in, or maybe, I’m finally coming to Life. I no longer can say. Whatever is happening, is unbidden, I know that, or do I, maybe in my childhood, I called in this late-life sense of wonder. All I seem to know now, is that the flow is carrying me, through this canyon, where the walls are made up of a kaleidoscopic experience that bedazzles and befuddles me.

I could say Life is wondrous. That seems true. Putting that awareness alongside of my awareness of how cruel, destructive, hateful and arbitrary Life can be, leaves me on-edge. I teeter between hope and hopelessness. I don’t know why I can see all of this, but I do. Some days it hurts, some days I feel so lucky. All I can really say, and think, is, isn’t it a wonder!?

l/d

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For more pieces like this, go to www.elderssalon.blogspot.com (2010 thru 2013) and http://www.elderssalon2.blogspot.com  (2014 on)

To hear archived versions of our radio program Growing An Elder Culture go to www.elderculture.com

To read excerpts, or otherwise learn, about Embracing Life: Toward A Psychology of Interdependence go to http://www.davidgoff.net

 

Thoughts From My $499/day LTC Bed

23 Sep
September 23, 2015

I’m back at Phoebe Ministries for another round of recuperative therapy and rehab following my third pneumonia smack-down in as many years. Phoebe, located in Allentown, PA stands as a testament to the concept that skilled nursing care is not an oxymoron. Yes, the food still leaves something to be desired (I was here exactly one year ago), but the people are nothing short of amazing – I’ve never met more dedicated, helpful and happy aides, nurses, doctors and admin staff. I highly recommend the 100+ year-old Christian chronic care/rehab community.

***

I watched the 3-hour Republican candidate’s debate. It was delicious. “The Donald” was as entertaining as always in his clown campaign to save democracy from itself. And he appears to be succeeding.

***

Almost everyone I’ve ever shared my dreams with has described (in detail) what I’ll call the “ill-prepared test” scenario as a recurrent theme. That’s where you find yourself walking into a classroom with a sinking feeling that you failed to study for an immanent exam (My version of the dream includes me standing in my underwear) . I find it surprising that so many successful baby boomers seem to share a gene for this kind of self-repression slumber. Any comments?

Same Ol’ Same Ol’

19 Aug
August 19, 2015

download (1)

LGBT equality groups getting shut out of Pope Francis meeting in Philadelphia

Washington Post

LGBT groups planning events in Philadelphia around a massive Catholic family gathering there next month – which Pope Francis will attend – say the parish hosting them has reneged after a conversation with local Catholic officials. The news Tuesday follows the announcement by Philadelphia Archbishop Charles Chaput that people advocating for gay equality would not be given a platform at the World Meeting of Families, a once-every-three-years global meeting about family issues in the church.

*****

This post addresses the uncertain post-Windsor legal landscape from the perspective of LGBT elders and older adults. The demise of DOMA (Defense of Marriage Act) has enhanced access to federal benefits, but it has also increased the complexity that LGBT individuals and their families face as they begin to plan for retirement and beyond. Additionally, marriage equality-even when it is recognized nationwide-will not help LGBT elders and older adults tackle many of the obstacles they face when trying to navigate the challenges of aging. Fully addressing these challenges will require comprehensive legal reform and social change that includes greater recognition for chosen family, legal protections that span the life course, and broad-based cultural competency awareness with respect to LGBT aging and related issues.

 

WHEN THE CUCKOO BIRD FLAPS ITS WINGS INSIDE YOUR HEAD

23 Jul
July 23, 2015

There is a well-established relationship between Parkinson’s Disease and mental illness.

I know.

After 20 years of Parkinson, and a life-altering medication mistake by an Emergency Room physician, I’ve endured my share of neuro-psychiatric demons.

I’ve also felt it’s a truism that the “creative brain is a troubled brain,” but I’ve never had the science to back it up.

Until now.

A genetic link between creativity and psychiatric illnesses

a_genetic_link_between_creativity_and_psychiatric_illnesses

The idea of a link between “madness” and “genius”, no doubt brings to mind a few notable examples: Vincent Van Gogh, the recently deceased John Nash, Virgina Woolf, the list goes on. Added to this, previous studies have shown that psychiatric disorders tend to run in families where creative professions are prominent. Despite the seemingly obvious connection of psychiatric illness to creativity, scientists have not been able to pinpoint whether the association is due to common genes or simply shared environmental factors. That is, until a recent study published in Nature Neuroscience found a common genetic link between creativity and the development of schizophrenia and bipolar disorder, implying the underlying mental processes also partly overlap. The results were based on an analysis of genetic data from 86,292 people in Iceland; revealing genetic risk scores for both schizophrenia and bipolar disorder were significantly higher among those defined as ‘creative’.
Would you be defined as ‘creative’?

Researchers define ‘creativity’ as someone who takes “novel approaches requiring cognitive processes that are different from prevailing modes of thought or expression.” In the study by Power et al., creative individuals were defined as those belonging to the national artistic societies of actors, dancers, musicians, visual artists and writers.
Does this answer the age-old question of “nature vs. nurture” for certain psychiatric illnesses? The answer to this question may best be put into words by the author himself, Dr. Robert A. Power: “Our findings suggest that creative people may have a genetic predisposition toward thinking differently which, when combined with other harmful biological or environmental factors, could lead to mental illness.”
Power et al. (June 2015). Polygenic risk scores for schizophrenia and bipolar disorder predict creativity. Nat Neurosci.

 

 

 

 

 

The Family Of Man

15 Jul
July 15, 2015

iStock_000026972563Small

As we stand on the brink of extinction, we become mindful.

In a Petri Dish, standing shoulder-to-shoulder with seven billion, we become mindful.

Living in a house of cards, whose foundation is the threat of terror and the fear of scarcity, we become mindful.

Watching children become joy-resistant strains of self-detonating predators, we become mindful.

In a country where 6% of the planet’s population own over 50% of its wealth – and are chronically unhappy – we become mindful.

In an Oval Office where the name of the Nazarene is passed around like Pez; and biblical scholars and theologians search in vain for the elusive reference to collateral damage, we become mindful.

In the offices of corporations who turn shares of Plough into swords; and men with tiny hearts live on glaciers of ambition, we become mindful.

Seeking refuge in the unity of nations, we turn to the five permanent members of the UN Security Council, only to discover they are the world’s five largest arms dealers, we become mindful.

In becoming mindful, we rise above our feral nature to discover the the pure, inexhaustible waters of compassion, and learn to turn that stream of compassion inward.

In becoming mindful, we open ourselves to transcendent hope: kernels of human potential and opportunity that exist in the vortex of challenge and adversity.

In time, mindfulness becomes an indefatigable commitment to wisdom, personal courage and self discovery despite the psychotic brutality of terrorism: the ultimate act of anti-evolution.

The Family of Man reaches out like an empty hand to remind us of a simple truth: the source of our greatest strength is without shape or form, subject neither to birth nor death. And that which is beyond birth and death is also beyond terror. And no IED or car bomb in the universe will ever alter that.

FEAR SWALLOWER

16 Jun
June 16, 2015

Joy Loverde

Virtually every day for the last ten years – barring overextended itineraries(hers) or medical emergencies(mine) – I log into Skype about 6:00 AM EST  and place a call to my dearest friend on the planet – Joy Loverde.  Author of The Complete Eldercare Planner. This successful author, mother and eldercare advocate is not only my friend; but over the last decade our friendship has blossomed, like a special flower, rooted in mud and pond scum, to rise through murky waters and become a Lotus.

A couple of  weeks ago, she configured her smart phone to stream video and treated me to a visit at Chicago’s Lincoln Park Zoo – just two blocks from her home. I enjoyed the virtual tour immensely, especially in the moments that this fearless woman spent with the zebra, lion and tiger. As we approached the protective barrier for each animal, they seemed to stop what they were doing and focus completely on Joy. What I’ve learned from this amazing woman is the topic for another post.

 

Today, I’d like to introduce you to David Goff’s Salient Risk.

Salient Risk

A report from the Slow Lane

There is only one way I know that takes my worries and anxieties and turns them into growth and maturation. This is a move that, in my mind , is equivalent to turning a pile of straw into gold. This, however, is not a DavD-tale task, it is a real-life escape into freedom. When it comes to living fully, balls out, gut-extending, risking, then I think that one has to make an intentional effort. And when one does, by actually going to bat for oneself, then one has to use their head and come up with something I call “salient risk.”

A salient risk is one that is personally cooked-up for the express purpose of putting one’s sense of self on the line. The personal part is where the salience lives. This is the kind of risk-taking that can only come from the inside out. That makes it a rare form of risk, which many people have a hard time conceiving of. It takes self-knowledge. Real self-knowledge, not the kind made-up to make oneself feel good, but the kind that unfailingly haunts one, with more than one wants to know about one’s self. This kind of self-knowing, the kind that isn’t based on certainty, resides in our self-doubts.

It is not-knowing, feeling greatly uncertain, being dubious even, about one’s own character, which makes this form of risking so powerful, and so on-target. There is a hair-raising, harrowing quality, that is extremely germane, central even (to one’s fears), that empowers this kind of risk-taking. It is like a ropes course, only without the safety harnesses and nets. People go to this extreme, in themselves, because they love the idea of being themselves. And one cannot find out who one is without salient risks.

This is the self-administered test, the one where there is really doubt about the outcome. Strangely, the benefits that come from this kind of risk-taking, are exactly proportional to the amount of uncertainty aroused by it. This is both the confidence-builder, and the test for hubris. The good news is that one gets a better, more accurate picture of reality no matter what. Simply risking everything, throwing one’s self into the grave, has the paradoxical impact, of strengthening the self. So, one of the best formula for growing the self is putting it to the test through salient risk-taking.

I first came up with the idea of salient risk when I was learning about ways of undermining chronic anxiety. You know, the “what-if” stuff that keeps one anticipating some disastrous future. I found that a burst of acute anxiety, anxiety grounded in the reality of the moment, had an effect upon one’s ability to tolerate chronic anxiety, so it didn’t tend to run the show. The effect is, that by weathering the storm, the spike of real in-the-moment acute (higher than usual) anxiety, one develops one’s tolerance for anxiety, and this feels like being less anxious. There isn’t really any important change in one’s level of chronic anxiety, but there is a new level of tolerance of anxiety, and this translates subjectively into a greater confidence.

I didn’t know it yet, but I had stumbled into a discovery of the emotional immune system. It turns out, that each of us is equipped, by Nature’s providence, with an on-board system for dealing with the emotional character of this ride through Life. In other words, each of us can become more solid, and resilient, by looking for anxiety-provoking circumstances of the right magnitude, and putting ourselves through them. Later, I realized this was a kind of self-building process. After that, I have been on the look-in for these kind of opportunities.

Maturation, it turns out, is partly self-directed. We are all like our cousins, the salmon. It is our desire to be all that we can be, that takes us out to sea, but it is the even greater desire to fully be ourselves, which draws us back to the source. Risking ourselves is how we swim and develop the capacity to deal with obstacles.

We live in a society that doesn’t provide many ladders, that has very little idea of the source, that doesn’t easily regard inner evolution. So it is up to each of us, to create for ourselves the wherewithal to turn ourselves free. The real ladders, desire and source are all within. Salient risk unlocks the inner door, and each of us must muster the courage, in the face of the pressing unknown, to motivate ourselves, and enter.

There are no free lunches. There is no ride through life, where Life itself, doesn’t ask things of us. Salient risk-taking is one of those things. One can live without it, but how one lives, and how much of Life one embraces, depends upon the saliency of the risking involved

l/d

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For more pieces like this, go to  http://www.elderssalon2.blogspot.com  (2014 on)

To hear archived versions of our radio program Growing An Elder Culture go to www.elderculture.com

To read excerpts, or otherwise learn, about Embracing Life: Toward A Psychology of Interdependence go to http://www.davidgoff.net