Wednesday, January 18, 2023

Increased Oversight of Antipsychotics: A Good First Step, Not a Substitute for Enforcement

 

wednesday, january 18, 2023



What I have with this entry is a copy of the letter sent out by an 

advocacy organization, Long Term Community Coalition.  It 

addresses the all-too-common use of  anti-psychotic

medications to "control behaviors" of residents living with 

dementia.  

Anti-psychotic (AP) drugs are designed to aid persons with 

psychosis. Dementia is not a psychosis. These AP drugs are used

as chemical restraints when prescribed for persons living with 

dementia.  Beyond the sedating impact of these drugs (They're 

sleeping, so they are not a problem – or so the thinking goes) there 

are other harmful side effects.

Why am I sharing this on this blog?  For anyone who loves someone living in a nursing home, if you have any responsibility -- moral or 

legal – this information is important.

For those Congregations of Sisters who depend on licensed 

nursing home care, whether that care is provided by the 

Congregation's own nursing home, or in another public licensed 

retirement center, this information is vital information. Quality of

life is of the essence in this issue as well as quality of care

considering serious negative side effects and the inappropriate use 

of these chemical restraints.


In desiring and in expecting the highest quality of life and the 

highest quality of care for our Sisters, as mandated by Federal 

and State Nursing Home Regulations, those Sisters who have the appointed responsibility for their Sisters receiving long-term care 

must know what those standards are in order to be effective advocates.

And here is the letter with links as provided in the original letter.

 

Good morning,

 

Today, CMS announced it is taking additional steps to strengthen 

nursing home safety and transparency by increasing oversight of inappropriate antipsychotics use. These steps include:

  • Targeted auditing of nursing homes to determine accuracy of 
  • schizophrenia diagnoses, and
  • Posting citations under dispute on Care Compare.

The inappropriate use of antipsychotic (AP) drugs and other 

psychotropic drugs to chemically restrain nursing home residents is a persistent and widespread problem. In particular, AP drugs are too often used on residents with dementia because a facility is unwilling to hire sufficient staff, with the appropriate competencies, to employ non-pharmacological approaches to dementia care (as professional standards of care require).

 

We and other advocates have been calling on CMS to improve 

oversight and accountability for many years. This has resulted in some improvement, but not nearly enough. As found in our recent report, "A Decade of Drugging," ( A Decade of Drugging - NursingHome411 approximately 20% of nursing home residents are currently receiving these dangerous drugs. That report cites an October 2022 federal report which found that a shocking 80% of nursing home residents are receiving some form of psychotropic drug.

 

In what other setting would we allow so many living things to be drugged into submission? If it was discovered in an animal shelter, it would be all over the news and heads would roll. But when it comes to nursing homes, we not only accept the unthinkable, we bankroll it: super-rich investors and operators are making millions, thanks to a steady stream of public dollars and minimal oversight. Meanwhile, residents suffer 

avoidable pain and degradation.

 

CMS's announcement  ( Biden-Harris Administration Takes Additional Steps to Strengthen Nursing Home Safety and Transparency | CMS )  is a good first step. 



By cracking down on false diagnoses of schizophrenia, it has the potential to help address one of the ways in which nursing homes hide the inappropriate use of antipsychotic drugs. However, it is not a substitute for vigorous monitoring and enforcement of longstanding minimum standards of care.

 

 

 

Monday, November 14, 2022

 November 13   Sister Nicholas Hinkes   1966.   Age 93

This is what greeted me yesterday morning as I looked at our Congregational “Pilgrim Book” which lists birthdays, feast days and death anniversaries of our Sisters. I know that I always smile a bit each November 13, noting Sister Nicholas’ death anniversary.  We had a ‘history’.

During my two years of initial formation before my novitiate, each Sunday afternoon (weather permitting) we postulants and candidates went over to St. Joseph’s Hall, our “infirmary” with an assignment. Janet Griffin and I were assigned to Sister Nicholas.  We helped her into her wheelchair and made our way outside. Janet and I wheeled Sister Nicholas over to our beautiful Lourdes Grotto with its flowerbed of roses nearby. We often walked the path of the outdoor Stations of the Cross.  After an hour or so each Sunday, we would make our way with Sister back to her room.

Sister was an amputee and her getting into a wheelchair with only one leg took some maneuvering. I remember Sister’s eyes big with apprehension while Janet and I helped her into her wheelchair, and until she was carefully, safely seated.

What did we talk about? I don’t remember. I do know that neither Janet nor I ever asked her about her earlier life, ministry, community experiences, or the family she left in Germany.  As I looked at her notice yesterday morning, I realized that she knew Mother St. Andrew, was just a young woman in her late 20s when Mother St. Andrew came home from her patriarchally imposed exile. Oh, how I wish I had asked her for stories about Mother St. Andrew!  It is a regret that won’t go away.

There is another reason I smile and it is in recognition of and gratitude for the intentional intergenerational relationships these Sunday afternoons provided.  I am reminded of a workshop I attended some years ago when the speaker asked us to share the first time we ever went into a nursing home. I told the group it was when I was in my 40s and my parents were moving from their home into a nursing home. But I had to correct myself.  I remembered Sister Nicholas. I remembered the times we Junior Sisters took our hour keeping vigil with dying Sisters. “Wait,” I told the workshop speaker. “My first visit to a nursing home was when I was a teenager.  It was at our convent, but I didn’t think of it as a nursing home because it was home; it was part of our convent home. The Sisters were part of our home.”

 

 

Thursday, October 6, 2022

 

“We have produced our own narrative of diminishment.”

 

Sister Tere Maya, CCVI, addressed our Congregational Assembly this past June and among the riches of her presentation was the sentence repeated in this post’s title.

Several years ago, our Congregation was engaged in a strategic plan process which engaged the membership in very rich, participative committee work. One committee within that process was the Viability Committee. At our very first meeting, a Sister with the appropriate professional background had graphs and charts of Congregational demographics.  You know what I’m talking about, the same kind of charts we see from CARA that show smaller and smaller numbers and a higher and higher median age across Religious Institutes in the U.S.

After a short presentation, committee member Sister Maria Carolina expressed her discontent with the material.  “I don’t want to see just these figures. They don’t show us where our Congregational vitality is or where the potential is for deeper life among us.”  I warmed to that response and that perspective immediately!

Sister Maria Carolina’s response gives voice to concern about a fallacy too easily succumbed to when we look at numerical data.  Jay Wellons, M.D., in his medical memoir1 illustrates this well in a story he tells of his mentor, Dr. Miller, a pediatric general surgeon and professor. This doctor had removed thousands of coins from children’s gastric or air passageways throughout his pediatric practice. Miller kept each coin and catalogued them. He tabulated his data and determined which coin was most commonly involved.  They were coins from the Denver mint.  “Beware those Denver coins”, he would tell his students, then continuing his lecture, making the point that statistics can easily be misused to find a “meaningless answer.”

Miller is not alone. LCWR, in its work on the emerging future of religious life has, in the persons of Sister Ann Munley IHM and Sister Carol Zinn SSJ, given similar responses when presenting those CARA graphs to LCWR members. Both of these women encourage participants to look beyond the figures, not stopping at the numbers.  What other ideas, issues, questions do those figures raise, these Sisters ask us.

In my own reflections, I ask, “What is the challenge of smaller numbers and a higher median age?  How is it viewed? As a threat or an opportunity? And however we see the data, to what actions, to what new mindset do they call us ?

I don’t have a clear answer to those questions, but I am so eager to engage with others about them. It’s hard because, I believe, it is so difficult to make the mental turn away from the prevailing social and cultural constructs. It is hard to unlearn that bigger is better, and that young is good and old is bad.  That’s what our western culture tells us, what it has instilled in each of us since our toddler years.

But a countercultural perspective is precisely the prophetic witness that we women religious are called to live and witness in this time. It will be realized through prayer, long and frequent communal conversations, deep listening, sharing our dreams and daring to act.  For me as a Sister of Divine Providence, it is also daring to trust God’s Abundant Providence with abandon!

We live into the future by how we live the present.  Through God’s Providence, “We are the ones; we are enough.”

 

1Wellons, J. M.D. All that Moves Us: A Pediatric Neurosurgeon, His Young Patients, and Their Stories of Grace and Resilience. New York: Random House, 2022

 

Friday, February 11, 2022

A 'Dear John' Letter. You will agree with every bit of it

I share here a post from "Being Heard" from blogger Sonya Barsness, a friend and ally in working to transform the culture of nursing homes.

Sonya if not only right on target in this post, but makes her point in a very creative style of writing.  Enjoy this two-minute read here .





 

Friday, December 3, 2021

Sacred Silence

The Sisters of Mercy have a beautiful Advent series of reflections available on their website.  I quote here from Sister  Victoria Incrivaglia's post of November 22, shortly before Thanksgiving.  This excerpt is a reflection of some of the Mercy Sisters around their experience of the COVID-induced isolation.  I found it very stirring and share it in that spirit.  To read the entire article click here  .

"I asked some community members to reflect on their experiences of COVID-19, especially those who had to go into quarantine and isolation. One individual shared how she needed to regain her grounding. There had been a feeling as if a curtain had been lowered, and she had no idea of when it would be raised or how long all of us would be in the dark. In time, she found her prayer and reflective moments to become more real and intense. She described how this type of quiet and solitude seemed to wrap the Earth with a giant blanket of peace and stillness.

"A member of the Visitation Community, who resides at Catherine’s Residence, the retirement center in St. Louis Missouri, described the isolation as similar to the first 15 years of being in her cloistered monastery, prior to changes within their Community; it felt to her like a long silent retreat. When she tested positive for COVID, she experienced feelings of fear about what could happen. The healing brought relief and gratitude.

"Other members of Catherine’s Residence described the experience as constricting, lonely, being in solitary confinement, challenging. Meals arrived with a human carrier, there were extended hand waves to neighbors across the hall and the ongoing change of seasons witnessed through the windows. The time also presented a deeper side for reflection: Who am I? What do I believe?  Prayer became that of an anchoress.

"These realities of having a home, being well-fed and cared for during the pandemic, brought insights, and the experience emphasized our privileged status. The return to routine of gathering for Liturgy, prayers, meals and socials deepened the gratitude of belonging to the Community of Mercy.

"The movement through COVID-19 demonstrated the resilience of our members. In the absence of noise, movement and chaos, silence manifests the voice of God who calls to us each day."

 

 


Tuesday, September 7, 2021

You can't tell about a book by its cover

My Congregation uses an electronic bulletin board, as do many, as a means of communications with and among the membership. Yesterday a Sister wrote that she had been told by a friend of a very good book that the Sisters might want to know about: 

A friend "sent a notice of a book she thought might interest us. It is 'Embracing Age: How Catholic Nuns Became Models of Aging Well' by Anna Corwin, published by Rutgers Press.


I felt compelled to respond, in the interests of the passion I have for getting the REAL facts of aging and later life to others, especially my Sisters around the world .What follows is my critique of this book.

I was asked by Rutgers University Press to review the book last Fall, pre-publication, and I was eager to do so as I heard just a few weeks earlier from a colleague that this professor at St. Mary’s in Moraga, CA was doing research related to Sisters and aging. (She writes from her lens and research methods as a linguistic anthropologist.) However, I was greatly disappointed by the book and told the editor I could not recommend it. This is what raises red flags for me about Corwin’s work and what I noted to Corwin’s editor. 

Corwin lived with a community of Franciscan Sisters here in the Midwest (Illinois or Indiana) for quite some time in doing her research with them. Anthropologists study cultures. Her research data comes from that one group, that one culture. However, she draws conclusions about the attitudes of Sisters across the country, lacking any data beyond one Midwestern Congregation. Overreach, clearly. 

My connections with many congregations over the past several years bears out the lack of validity in such sweeping conclusions, reaching far beyond Corwin’s limited scientific investigation. As much as we Sisters are called to be countercultural, we’re not, in many areas. LCWR’s focus on racism and its encouragement that member Congregations delve deeply into this injustice bears that out. The implicit, unconscious bias of ageism in our Western society blinds us to recognizing and thus addressing it. 

She comments on the meaning of the vows, community life, leaving home, etc. and how Sisters feel about this life-event without any real validity or research data. She does try to buttress her conclusions with referenced footnotes, but they are rather generic references and outdated. One of them is a reference to medieval monastic rules. Throughout, there is no sense, much less, any expression of a Vatican II understanding of the vows or of religious life. 

Then there are the young women in Mexico in initial formation that she writes about. She describes them as having being “woke” to a national political awarenesses and a subsequent new sense of “body” which brought them to speak of their vow of Chastity as “Jesus in our Wombs”. No commentary by the author. 

That kinda did it for me! 

We do need to know more about aging. I have come to know that we Sisters/women need TWO talks about the facts of life: the first one that explained the real facts about sex, dispelling crazy teenage myths like,’ you can’t get pregnant if you have sex standing up’. The second talk would be the real facts of aging, dispelling all the negative myths that we have absorbed since we were toddlers. There are much, much better books and other resources out there about the actual process of aging and all its potential. It would be wonderful to see a few of them in our library.

Thursday, September 2, 2021

Aging and ________

What word are you inclined to pair with aging?

Some very common pairings may come to mind because we hear them frequently from retreat directors, university professors, noted writers and/or presenters, even consultants to religious communities. The following often-heard pairings come to mind quickly for me:

Aging and diminishment

Aging and loss

Aging and decline

Aging and illness

Aging and poor health

Aging and letting go

Just this morning I read an article by a Sister who stated her age as 57. The thesis of her piece was that as we age, we should acknowledge that we will be moving on from employment to retirement for one reason or another, and that we should do so "with grace".

The author gave several examples of signs that tell her, "I really am getting old." She notes trouble with her knee and hip; a loss in her hearing acuity; her need for trifocals. She ends that listing by noting, "I can still do everything I used to do, but I do notice I'm slowing a bit."

 Ageing is indisputably accompanied by physical decline. However, physical decline does not define us! Our personhood is not circumscribed by our physical decline. Additionally, physical changes are uniquely individual.  As Ashton Applewhite writes in her book, "This Chair Rocks", when you see one 80-year-old, you're seen one 80-year-old.

Our culture has oppressed us with the social construct of equating aging with decline. I would say to this Sister, "With your 57 years of life, 57 years of experience, what do you experience within yourself beyond the physical changes that you note?"  I can imagine Sister could tell me of her long-term, meaningful friendships she has garnered over the years, both inside her community and beyond, and how they have enriched her life. She would acknowledge the deepened skills, insights and nuances of navigating her ministerial role as a high school classroom teacher that only years and experience can provide.  She might be aware that because of her life experiences, she reads a novel, or the newspaper, or a biography with much more insight than she was capable of twenty or thirty years ago.

Gene Cohen, in his book, "The Mature Mind: The Power of the Aging Brain" depends on years of research around aging to reach his conclusion that we must turn our present paradigm of aging on its head! Cohen doesn't just give us a "positive" view of aging, in the sense that what he says is said to make us feel good.  Yes, it does make us feel good. The important factor is that his work and his conclusions are based on data!

Another Sister spoke about aging in my reading this morning. She sees with a different lens, not the social construct of aging and decline.  Sister Mercedes L. Casas Sanchez, FSpS , of Mexico, addressed the Leadership Conference of Women Religious in August and her comments included this:  The nuns (and it applies to every old person) "walk like trees loaded with fruit, bent over with fruitfulness."

 "Bent over with fruitfulness" Ponder that.

Friday, August 20, 2021

Why Pogo is so loved

 

In a post some months ago, I introduced my readers to Pogo.  The pictures accompanying the  post showed one Sister after another, each with a warm smile, interacting with or just appreciating Pogo.

What I did not include in that post was a little more information about Pogo himself. I didn't remark that Pogo is an old dog. And another thing, Pogo has only three legs.  He's crippled. When he was still a puppy, he was hit by a vehicle, necessitating the amputation of his right leg at the hip. When he was adopted from the shelter, Pogo had already lost that leg.

Are those harsh words, not-to-be-used words, 'old', and 'crippled'?

The word crippled is considered offensive because it describes, Pogo in this case, in terms of his limitations or disability. It is an ableist term. Ableism discriminates against persons with  physical limitations in favor of able-bodied persons.

Of itself, the word old is neutral, neither offensive nor unwarranted in its use for a person or, in this case, Pogo who has lived a long time. It is society's view of old age that make this word unacceptable in the eyes of some. You know,  the attitude that 'old is bad and young is good' screamed to us in our culture every day through every possible medium.

If one would ask any of the Sisters about Pogo, I daresay that, to a person, the response would be an immediate smile and some words of affection for that little dog, that little dog that brings so much joy and happiness. Not a single person would say, for example, "Oh, that poor dog. He's old, you know.  And he is crippled. He just needs to be someplace where somebody can take care of him. The poor thing.  It's really sad --- old and crippled."

The universal outlook is to see and experience Pogo first and foremost for his strengths, his lovability and the joy and the richness he brings to all he meets. Not a bad perspective! Why don't we react the same way about old people?  Do we first and foremost see "decline" and lock our view of old people into that terrible, negative little prison?

There is a growing awareness among thought leaders in the aging services profession that it is a much more valid and certainly a healthier, life-giving perspective to see older adults in their communities first in terms of their strengths and their gifts. Prior to the sheet in the medical record that lists diagnoses and comorbidities should be a sheet with the narrative of the gifts and strengths which that person brings to the community. How will their gifts, talents, skills and passion contribute to a more vibrant community? And how will the community provide an environment that encourages and facilitates the use of those gifts?

Jill Vitale-Aussem is one such thought leader. She is quite passionate and articulate around this concept of recognizing and honoring strengths in older adults.  Moments ago, I stepped away from my blog and went to check my Facebook news. By God's Providence (no coincidence!) Jill had just posted a piece on this very topic of seeing and honoring the gifts that older adults bring and want to utilize. Jill writes about a letter she had gotten from a woman who had moved from her community to another State. In that letter, the writer shared with Jill her memories of life in that retirement community. Spoiler Alert!  The woman did not talk about all the fine services available to her in this retirement community. She wrote about the joy and sense of contentment that comes from having purpose and meaning in life -- yes, even in a retirement community.

It is less than a two-minute read, and you can find it here.

 

Friday, May 21, 2021

 

                                       Meet Pogo

Pogo lives in a happy convent home on our motherhouse campus with Sister Bernadette. Pogo spreads happiness much beyond that one household, however, when Sister Bernadette takes Pogo over to the main convent building to visit the Sisters who live there. See for yourself!

 



 


It is trite to reiterate the fact that animal companions bring us joy, or to point to the voluminous research documenting the psychological and physiological benefits bestowed on us humans by non-human animal companions.

But I don't write about that today.  I show the joy Pogo brings to my Sisters, the gift that Pogo is.

In my next post, I offer a few other thoughts about Pogo and those who love him within the context of how unconscious social  constructs influence our responses.

Unil then --

Thank you, Pogo, for being who you are and for what you have always and continue to bring to all those you meet. You are so loved!

 

 

 

 

                        

Tuesday, November 3, 2020

"Providence Reflections"

 Last Spring, early into the pandemic, we Sisters of Divine Providence were invited to share  our "Providence Reflections".  Twice a week we find a response to this invitation on our electronic bulletin board. Many times the short message refers to thoughts about life, prayer,  Providence values, compassion, or ministry during the pandemic; at time a members of our elected leadership team may send a message of an administrative update, or a reflection.

Recently Sister Ramona, who lives at our motherhouse, shared a reflection and I have her permission to share it here. When I read this message, I was so aware that these signs, these marks of pandemic time, circumscribe life in so many motherhouses and provincial houses today.  And what I also know to be  present still is an ongoing intentionality of seeking ways to be of service to others.  What shape does this service to others take? I've read of mask-making, phone calls to one's 'pandemic partner', and letter-writing. A major communal effort is the private and communal prayer for justice, equality and foro comfort for so many suffering and oppressed as a consequence of the pandemic, 

Sisters' lives have been lives of service to others through some exercise of the physical and/or spiritual works of mercy. I believe that one of the major frustrations of this pandemic time is looking for ways to continue this service as we are confined to our physical spaces and physical distancing. We are a resilient group, though, and we will find a way!

Meanwhile, my gratitude for being a part of this global circle of women.  

From Sister Ramona:

To "read the signs of the times" is a common practice of ours. We have done it for years. Some signs remain relevant: poverty is all around us, family life cries for support, discrimination and racism are alive and well in our country.

But now there are very different signs unique to these pandemic times. Everyone in our building wears a mask. Some wear shields or plastic cover garments. Employees wear gloves and carry bottles of Sanitizer. Our place of worship looks strange when we come together to pray. Worshipers sit far apart; the chapel looks empty – almost vacant. Yet some have to go to another space to worship via technology. Signs throughout the buildings control the movement of people within. The masks, the distances, the sanitizing. I ask myself: what do these signs say to me? Am I hearing God's call? What is it? Have I connected all these signs to our Chapter Statement: "To hear the cry of pain and anguish of the poor, the immigrants, women and Earth"? Some tough questions to answer. Yet there they are.



Friday, October 30, 2020

Hearts Starve as Well as Bodies

In the effort to keep nursing home residents safe, there have been strict guidelines resulting in -- 7 months now -- of isolation, or these older adults being confined to their rooms. Period. The results of this prolonged isolation show themselves in the physical, mental and emotional decline. The link to both a video and the printed transcript of the 3-minute news clip illustrates this in the stark reality that it is.


For those who have appointed or elected authority for the care of their Sisters, these months have been very stressful with a full focus on "keeping our Sisters safe". That sense of safety and security also applies to one's sense of well-being, of being connected with others, of finding joy and comfort in what the day brings. It is a tall order to fill in this time, but that does not lessen the mandate that care must go beyond physical well-being.  It is stated well in the words of a beloved labor song, "Bread and Roses" -- "Hearts starve as well as bodies. Give us bread but give us roses too."


The link to the video is here





Wednesday, July 1, 2020

BE OLD AT HEART


The following is a passage from the book, This Is Getting Old: Zen Thoughts on Aging with Humor and Dignity (Shambhala, 2010) by Susan Moon:

“It annoys me when people say, ‘Even if you’re old, you can be young at heart!’ Hiding inside this well-meaning phrase is a deep cultural assumption that old is bad and young is good. What’s wrong with being old at heart, I’d like to know? Wouldn’t you like to be loved by people whose hearts have practiced loving for a long time?” 

A very fine reflection on the social construct that young is good and old is bad.  It belies the age denial mechanism that says ‘age is just a number’.

Let us be counter-cultural, prophetic believers in a God of Infinite Love who made ALL creation --- all through the life span --- “good, very good.”

If we hold that value-laden stance, how differently would we see our aging body, for example, or the aging bodies of others?  The waistline that has expanded as we grow from youth to middle age and later is worthy of respect and honor.  That double chin is “just perfect”.  Therefore, I, the person – so much more than just  the physical -- am worthy of rerpect and honor and am “just perfect” as I am.

And of course this is true for our neighbors as well as for the strangers who cross our paths.

Tuesday, May 19, 2020

Opening nursing homes again

Information from this post comes from a Forbes Magazine article, “The Trump Administration may reopen nursing homes to visitors, but it must be very careful.” May 11, 2020.

The painful and isolating experience of living in a Covid-19 quarantine continues.  Until there is an adequate access to testing, until there is a proven treatment or vaccine, the common good will continue to call for restricted contact.

Howard Gleckman lays out political considerations that may underlie plans being set forth by the Centers for Medicare and Medicaid Services (CMS) and then says plainly, “If not done carefully, this would be folly, and could put residents, staff, and families at risk.”

The possible move on the part of the Trump Administration (thus, CMS) has surprised nursing home operators and their professional trade groups, LeadingAge and American Healthcare Association. These two trade organizations have also been working to create universal guidelines for their members, with the expectation that they would be not be finalized until late June or July.
“Facilities (Nursing homes) could begin allowing limited visits once they report no cases for 14 days. They could   increase access, as well as communal activities, if they go another two weeks without an active case.
“The problem, of course, is a facility (nursing home) may go weeks with no cases. But if a visitor brings COVID-19 in, it will spread like wildfire.”
“Residents are paying a severe price for being isolated in long-term care facilities. While we don’t know for sure, it is likely that they are suffering from more loneliness and depression. They also are at greater risk because their families are not able to advocate in person for them —an especially important role in the difficult environment COVID-19 when care is likely to go wrong.
“But it makes absolutely no sense to reopen facilities to visitors now. Nursing homes still don’t have enough coronavirus tests. Assisted living has even less. And tests often take many days to produce results. Absent immediate results—like those available to the White House staff—opening care facilities puts staff and residents at risk from visitors, while at the same time placing those visitors at risk.”
“Reopening also requires an ample supply of masks, gowns, and gloves for all visitors, and proper training in their use.  
“Nursing home and assisted living operators at horrified at the idea of reopening prematurely to visitors. Some are reluctant to have family members adding to what already is a chaotic situation, with staff shortages and jury-rigged efforts to isolate COVID-19 residents.”
“Facilities (Nursing homes), families, and state, federal, and local government need to work together to design a safe way for families to visit their loved ones. But this has to happen in a careful, well-considered, and properly timed way. And it should be based on careful benchmarks that all parties adhere to. The US has failed to establish coherent, enforceable protocols for much of its COVID-19 response. It would be a tragedy if it fails to do so when it comes to opening up long-term care facilities that have seen so much death already.







Thursday, May 14, 2020

Social Distancing, not Social Isolation


As the days of quarantine continue, Action Pact, a Culture Change training and consultant organization reminds us that although we practice social distancing, we do not want those living in nursing homes to experience social isolation.  Each week Action Pact offers resources for this very purpose. Here is a link for this week's issue.  Scroll  down the page to access this week's flyer.

Please feel free to share with persons who are Administrators or "Activity Directors" for use in the nursing home where they work.

Monday, May 11, 2020

Heroes


Last week I happened to be near our local hospital when I saw a nurse leaving the building after her shift.  I waved, smiled and said in a loud voice, “Thank you!” The nurse smiled and waved back.

A few days later I was in a Zoom event with individuals who have leadership positions in myriad aging community settings. In an interestingly and somewhat related conversation, one of the participants raised the subject of nursing home care providers being called heroes. He said that this appellation is a burden for hands-on individuals and upsetting to them. These labels put pressure on individuals, he said. “They tell me they are not heroes; they say, in fact, they are afraid many times as they carry out their work in the nursing home.” The implication was that being called a hero laid too heavy a burden for them in their eyes.

My take is a little different as I remember so many news stories paying tribute to a citizen hero. Almost universally, the interviewee denies that label of hero, saying they were just responding to the event at hand. Then there is a neighbor, a young man with a family, who is a police officer in a crime-ridden area of our greater metropolitan area. He absolutely loves his work. When I ask if he is ever afraid, his quick but smiling response is, “Every day.” One can be a hero and still be fearful. It’s probably the norm.

For those caregivers who cannot accept that they are heroes, there are other simple and direct ways to instill in every person on the staff the conviction of the nobility, dignity and sacredness of his/her work especially at this time. Yes, people are supposed to show up every day on time for work.  But is there a special smile or nod to greet the faithful staff who are there? A reminder or pat on the shoulder when we see someone going beyond mere duty to respond to a need? In staff meetings, do we acknowledge the stressful time we are in, and the spirit of generosity and sacrifice that these times call for, and then a thank you to the staff for meeting the mark in all this?  Building the self-image of any staff member, and thus deepening his/her self-confidence, is a great aid in furthering the mission of the community.

Finally, I hope the following is a given: Any compliments or other gestures of recognition must be truthful and must acknowledge actions that are aligned with the standards and values of the community. Otherwise it is fake. And employees can smell it a mile away!




Wednesday, April 8, 2020

Finding Hope in Isolation: Springfield Dominicans Open Hands, Hearts During Global Pandemic



This post comes  directly from a Facebook entry from the Dominican Sisters of Springfield, IL. To see the original post, which includes wonderful pictures, you can find it here. The article reflects the spirit of service that is at the heart of apostolic religious life.  The Springfield Dominicans show creativity and imagination in their practice of service during this never-before time.  What a gift to be  a part of this circle of women across the country and around the world!

Finding Hope in Isolation: Springfield Dominicans Open Hands, Hearts During Global Pandemic
by Sister Beth Murphy, OP., Communication Director for the Dominican Sisters of Springfield

You can't grasp hope
“Hope isn’t anything you can grasp,” Sister Kelly said, pausing for a thought then adding “It has to be received.” Then, as she stretched out her hands and looked at them, you could see the insight before it arrived. “To do that you have to let go of what you are holding,” she said.

The impact of Sister Kelly’s insight on her conversation companions was visible on their faces, even though they were stretched across the midsection of the nation, dotting a map that stretched from her convent in Jackson, Miss., to central Illinois, and Chicago, linked together on a now ubiquitous teleconference platform that’s becoming a staple in the lives of many.
This is just one way hope is revealing itself through the lives of Springfield Dominican Sisters. There are plenty of examples, as the sisters join three-fourths of humanity ordered to stay close to home under the influence of a viral pandemic that is changing the face of the world.

 Steep learning curve
When Sister Pat Francis received her shelter-in-place orders she faced a steep learning curve, needing, in a hurry, to become familiar with the therapeutic teleconferencing software she’d need to keep appointments with the clients she sees at Central DuPage Pastoral Counseling Center in Carol Stream, Ill. She is in awe of the work done by the office support staff to help all the counselors in her practice transition to virtual counseling for their many clients who, already struggling with their mental and emotional health, now must cope with this unprecedented situation. A few weeks into the experience, there is still a learning curve, but in a different way, she says. “The insurance companies require different billing codes for telehealth appointments. That’s a bit of a challenge. I’m keeping up with a full caseload of my usual clients, and many of my colleagues are experiencing an influx of new clients. We are all keeping quite busy.”
Sisters in educational settings had similar transitions, moving to teaching from comfortable classrooms to tiny spaces in their convents and homes.

No hoarding
And many sisters, unwilling to hoard the precious time they’ve been given for prayer and contemplation, have shared their time and compassion in outreach, have engaged in countless small acts of charity.

Many other sisters are reaching out by phone to vulnerable friends and relatives to keep them connected and to check on their needs. Others are assisting vulnerable elders with runs to the grocery store or pharmacy.

Sister Elyse Marie Ramirez, in a burst of energy early in the shelter-in-place, handwrote notes of prayer and solidarity and distributed them to the neighbors who live on blocks adjacent to St. Rose Convent on Springfield’s near westside. She promised them prayer and looked forward to the moment when the quarantine would end: “Many days myself or others of my sisters walk by your house on our daily walk. Hopefully, when this pandemic is behind us, we can stop and chat and wish each other well in person!”

"Many hands make light work"
Evoking sisters’ favorite mantra “many hands make light work” three local communities of sisters in Springfield shared cooking duties for a meal served at the winter warming center in Springfield. The shelter, which is normally open only in the winter months, has extended its operations to help assure a place for warm meals and safe harbor through the month of April.
And at Sacred Heart Convent, where 93 Springfield Dominican Sisters live, much has changed since the shelter-in-place began on March 17.

Sisters are making masks, serving food in the dining room, drying dishes, and checking in on one another. They are social distancing even in chapel, where they gather for Morning and Evening Prayer each day and for two hours of daily prayer before the Blessed Sacrament, praying for the needs of the world during this extraordinary time.
The sisters also have a unique opportunity to fulfill the Dominican Charism of study. Sister Mila Díaz Solano, who is a member of the General Council and a biblical scholar, is taking advantage of her unexpectedly clearer schedule to teach a course for the sisters on the Gospel of Matthew.

In a message she sent to the community Sister Rebecca Ann Gemma, the prioress general wrote: “We are bound together, by the invitation of Christ, to follow him, not just as individuals, but in the interdependent richness of community.” It is a time, she said for us to “discover Christ anew: in ourselves, in one another, in global needs, and in the creative world which is being given a pause from overuse into hope-filled revitalization.”

Friday, March 13, 2020

"Do Not Let Residents Escape"

Recently I was speaking with a colleague who told me about  the sign she saw as she approached the front door of a nursing home.  It read:  "Do Not Let Residents Escape".

Does reading that 'sign' make you  gasp or recoil?  If so, it is because of the dichotomy between what that sign signifies and your mental concept of those persons living in that nursing home. The flip side of this is that when we use such words without thought or intentionality, they deepen our dehumanizing reflection of personhood. Along  with a dehumanizing reflection of aging --  ageism in action.

So -- as a reminder of my post on March 4th -- gather your team, your peers, your staff  next Friday and participate in the Action Pact-sponsored webinar.

See my March 4th post on instructions for registration.

If we change our words, we can  change the world!

Wednesday, March 4, 2020

Not My Usual Kind of Post

This post is different from any of my other entries. The information below is profoundly important to anyone in any type of relationship with elders who depend on supportive services -- care partner, staff leadership position, family member, Board member of a nursing home,  position  in elected leadership in a Religious Institute -- . Where those services occur may be at home, in a public assisted living community or nursing home, or in a convent non-licensed or licensed retirement setting.

In earlier  posts, I have repeated the statement that words shape our concepts while also reflecting our concepts.  That is very true, as is  the fact that if we change our language, we change the culture. Changing our words related to elders and elder services to reflect true and positive concepts erases ageism and institutionalism which is so common in even good, traditional nursing homes.

It is for these reasons that I post the announcement of a webinar later this month that is sponsored by Action Pact. In the interests of full disclosure, I have no fiscal or formal relationship with Action Pact. Publishing information about this webinar is motivated solely by my experience with the quality work that Action Pact and Carmen Bowman do, and the very valuable and essential information to be gained by exploring the topic of the words we use.

The one-time payment makes this webinar available for as many people as can fit around the computer, or can see it projected onto a larger screen. It is also available for viewing for thirty days after the actual presentation. I urge you to register for this event and to encourage all individuals engaged with elders in any official capacity to view it.

ACTION PACT

March 20, 2020

The Power of Language to Create Culture 

Presented this month by our hostess, Carmen Bowman

Unfortunately, the language of long-term care can be institutional. Even CMS notes this by encouraging the elimination of labels at Tag F550.

Are institutional words like these heard in your culture?
Facility,
beds,
frontline,
work the floor,
toileting,
non-compliant,
behaviors,
difficult,
activities,
dietary,
resident,
elope,
expire,
feeder

Consider a personal and community-wide commitment to use softer, more dignified language. The great news is that changing language costs no money yet does wonders to shift an institutional culture to a natural, normal, culture of home instead.

Join Hostess Carmen Bowman as she shares from the paper of the same title, which she co-authored.

Non-institutional language raises the bar: it drives practice, improves life satisfaction, and is required by CMS requirements.

Join us to talk about how we talk!

$99 per community
Register one person, view as a group (live and/or recorded show).
Fit your group around your computer monitor, or project it on the wall and fill a room.

Go to this website to register: 



Meet Carmen Bowman
Carmen owns Edu-Catering: Catering Education for Compliance and Culture Change turning her former role of regulator into educator. Carmen was a Colorado state surveyor for nine years, a policy analyst with CMS Central Office where she taught the national Basic Surveyor Course and was the first certified activity professional to be a surveyor.
Carmen co-developed the Artifacts of Culture Change measurement tool and is the author of several Action Pact workbooks.


Action Pact | 7709 W. Lisbon Ave., Milwaukee, WI 53222

Thursday, January 23, 2020

“Letting Go”



That phrase, “letting go” is a well-used one within my age cohort and among those who would tell us how to age well. “We have to let go.” It is a phrase that has always gone against the grain for me – not because it is not true, but because I believe that in its common usage it only tells half the story. Inasmuch as the phrase is a half-truth, the hearers and the speakers of this phrase are victims of the great, self-harming prejudice of ageism.

Life is a series of letting go experiences.  We had to let go of our baby teeth to make room for permanent teeth.  We let go of familiar relationships with our parents when we left home to go to college, or to the convent, or to a new home with a marriage partner. Those earlier parental relationships did not wither and die; they changed into differently nuanced relationships, different, more mature, but built on the familiar. And who would argue that one would naturally want to return to the teenage or early adulthood parental relationship?  We recognize the gifts of deepened relationships which developed as a consequence of our leaving home, of our letting go of a familiar relationship.

Most commonly the expression of letting go in later life is used as if it were something different from experiences earlier in our life of letting go, something which leaves us experiencing emptiness and (oh, I rage at the context of this next word) diminished. The message is that we let go and let go and let go as we are hurtled on a downward slide until death greets us at the bottom of the hill.

What is left out of this common usage is the second half of letting go:  we let go in order to grasp the new. This is a one-minute clip that shows, in a physical dimension, what letting go in order to grasp the new looks like.

Not many of my readers are trapeze artists, I’m sure. And the physical balance, coordination, agility and endurance is beyond most of us at any age.  Our letting go to make space for the new is the space for further growth and development. What might that be?  Deeper insights about one’s self, deeper perspective about life, peace, surety about things we used not to be so sure about, nuances in relationships, wisdom, -----.The letting to make space for the new holds a psychic and spiritual energy that parallels the physical energy of the trapeze artists in the video.

The new we make space for will not be in the physical agility dimension.  Arthritic conditions will not disappear; the five-mile jog each morning will not reappear; the sense of breathlessness on the last set of stairs will not absent itself. However, let us never equate or limit our “self” with our “physical self”.

Perhaps instead of the traditional understanding of the half truth of "letting go" we should see it in its totality --  "let's go!"



Friday, December 20, 2019

Review of This Chair Rocks: A Manifesto Against Ageism

Throughout my adult life,  there have been a small number of books that are such treasures in wisdom, insights and new knowledge that I have been impelled to announce to friends, colleagues, and at least once or twice to elevator companions, that the book is something that they just  MUST treat themselves to because it will change how they think, how they view the subject at hand.  One of those books is This Chair Rocks by Ashton Applewhite.

What follows is a review that I provided at the invitation of a Sister in elected leadership in  her congregation for their Provincial newsletter.

We’ve all been there:
--  Shocked, unhappy at the growing expanse of gray hair --- or maybe just the growing expanse!
--  The dissatisfaction with hair that is getting thinner, the chin that is becoming a double chin
--The embarrassment that it is not always so easy to open that sealed jar of olives
--The embarrassment that it takes a little longer to get up that last flight of stairs
In This Chair Rocks: A Manifesto Against Ageism, Ashton Applewhite sets all these experiences around aging in perspective, showing how almost universally we respond to these physical changes as negative. She calls it “age shame”, seeded and nurtured through the false, negative myths of aging that we have absorbed all our lives. We have never assessed these suppositions about age; we have just believed them and have been taken in by them hook, line and sinker! Believing all these negative myths about aging is a profound prejudice against our future selves and is profoundly harmful to our well-being
When God looked at Creation on the seventh day, God said, “It is good, very good.” God did not say, “The first forty years or so of human life are very good, but after that it is pretty much downhill”. This Chair Rocks releases – without ever using a religious context - the Gospel News that God’s creation of us is “good, very good”, not just for the first half of life but throughout the lifespan. Read it and it will turn your ideas of aging on their head! This is the good news that we should be preaching today in our works of mercy through word and example!