"Can the Environment Hold the Vision?"

©  Imelda  Maurer, cdp  August 23, 2016

One of my Facebook friends posted the following poem this morning.  

You Start Dying Slowly by Pablo Neruda

You start dying slowly

if you do not travel,
if you do not read,
If you do not listen to the sounds of life,
If you do not appreciate yourself.
You start dying slowly
When you kill your self-esteem;
When you do not let others help you.
You start dying slowly
If you become a slave of your habits,
Walking everyday on the same paths…
If you do not change your routine,
If you do not wear different colours
Or you do not speak to those you don’t know.
You start dying slowly
If you avoid to feel passion
And their turbulent emotions;
Those which make your eyes glisten
And your heart beat fast.
You start dying slowly
If you do not change your life when you are not satisfied with your job, or with your love,
If you do not risk what is safe for the uncertain,
If you do not go after a dream,
If you do not allow yourself,
At least once in your lifetime,

How true all of this is. I read it through the lens of any older adult.  That passion, that purpose and meaning is so vital to being fully alive as long as we have breath.

There are two necessary factors necessary for living with purpose and meaning: the initiative required on one's part to live  precisely with that passion, and the environment in which one finds oneself.  If elders are to find purpose and meaning, there must be possibilities within their environment for that to be present, facilitated and nurtured. I am reminded once again of the statement repeated again and again in a presentation I heard on a totally different topic two years ago:  "Can the environment hold the vision?" This question should be posed and studied and returned to often by any individuals or teams responsible for providing aging services -- in any setting!

I Can't Abide It!

© Imelda Maurer, cdp   

I'm in a "red hat" mood as I write this morning -- the 'red hat' indicating that part of my personality that instinctively reacts with strong emotion to issues/events I consider valuable or important.

The issue is about how aging is too, too often presented to Sisters.  As a gerontologist, I studied the aging process and the various theories of personality development.  What I know about aging is rooted in a solidly grounded knowledge base, affirmed by my own experiences as a woman in her eighth decade of life.

The women in whose circle I am so honored to be a part are characterized by their life of selfless service to others.  They want to do good; they want to be good.  If and when they are given directives on how to be good -- and I refer specifically to the issues around aging -- if the words come from another Sister, those words, validly or not, are empowered with a special credibility by the audience.

My most recent exposure to such a presentation to elder women and men religious held the same familiar pessimistic view of aging only as an experience of loss and decline.  The spirituality suggested is that of "letting go".

We experience loss throughout the life cycle. Losses are not experienced for the first time when we leave "active ministry".  We do not have to learn -- for the first time -- how to deal with loss when we are in our later years. This concept and lived reality merits its own chapter!

Aging does not always bring physical or cognitive disability. Additionally, how we age is uniquely individualized. When we generalize otherwise, we are guilty of ageism.

I groan for my Sisters when I become aware of common presentations on "aging and spirituality" because
---  "letting go" is only half the story
---   "letting go" is not an experience unique to our later years; and
---    because spiritualizing myths and negative biases about aging does not provide a solid foundation of spirituality,
---   this false foundation does not reflect the God of Mercy, Compassion and Abundant Providence who planned the whole of life for those so cherished by the very action of creation.

As I listened to the address I'm referring to, I had to take a break and view something that shows an entirely different picture of aging.  I've had this clip on my blog before, but I think it is so affirming of the other half of "letting go" that I  share it again.  It is an ad for women's health, but it is so marvelous in presenting so many qualities of life in our later years.

Treat yourself to this one minute clip here

"I have found my tribe"

At a Pioneer Network Conference some years ago, Karen Schoeneman who directed the nursing home regulatory section at CMS talked about her initial experience with the Pioneer Network. Actually Karen was present as a co-founder of this wonderful organization, the Pioneer Network.  Karen expressed her strong identification with these other co-founders, persons who believed that residents in long term care settings should be in the drivers seat this way:  "I felt that finally I had found my tribe."

Those are strong and profound words from a  person who might have become just another bureaucrat in Washington DC writing nursing home regulations, but who instead maintained her integrity as a passionate advocate for changing the culture of aging and aging services.

That spirit within this pioneer network continues and it was deeply sensed and acknowledged by certified nursing assistants who attended this year's annual conference held in New Orleans.  One of those CNAs wrote of his experience at this gathering in New Orleans in the blog at CNA EDGE.  You can access that blog here entitled "Among Kindred Spirits" here . I encourage  you to read it.

If You Are a Family Member BE AN ADVOCATE

©  Imelda Maurer, cdp

If you are a family member or a friend of someone who is receiving aging services in any environment -- home, assisted living or nursing home setting -- it is so imperative for the well-being of that person or those persons with whom you have this relationship that you see your role as an advocate for that person or those persons.

Acting as an advocate is a work of Mercy. Pope Francis has reminded us during this Holy Year of Mercy that true mercy is not practiced by words only, but by actions.

My suggestions here do not imply that staff is not maintaining clinical standards, or that things in the aging services organization or not what they should be.  Rather, I urge a healthy collaboration with the interdisciplinary team, providing a second pair of ears and eyes as well as a loving heart. What I suggest and urge are three aspects of advocacy for your family member

1)  Informed consent. Never take the direction or interpretation of any healthcare provider as the final word without an adequate explanation. If a new medication or therapy is prescribed, or if a change  in either is recommended, an advocate should have sufficient information to either consent to or to refuse the recommendations. It goes without saying, of course, that if a family member is capable of making decisions, then s/he should receive the information necessary to make such an informed decision to accept or to refuse treatment. In such circumstances, the advocate can best serve by listening to the desires and needs of the family member and by helping to answer his/her questions if there are any.I

2)  Know the standards of care. To be an effective advocate, you must know the standards of care. You cannot advocate for another if you don't know "what the rules are."

I'll give an example from my early days as an advocate, embarrassing as it is to reveal!  I was in my beginning weeks as an ombudsman. The daughter of a nursing home resident told me that her mother complained that on mornings when she needed to use a bedpan, if she were eating her breakfast (from her tray on an overbed table) no staff member would bring her a bedpan, telling her she had to wait until after breakfast.  When I approached the administrator about this, she told me with great confidence, authority and good humor why no bedpan was offered under the circumstances at hand: "If the CDC got wind that we were doing that, we'd be fined like you wouldn't believe!"

I remember being puzzled, but I didn't know what to do with the answer I had received.  This administrator, one with a great lack of integrity in this instance, got one over on the advocate -- because I couldn't answer her explanation.  I wouldn't have had to quote a regulation, I would only have to say that this nursing home resident has a right to have her needs accommodated -- whenever they arise.

3.  Be that second pair of eyes and ears.  As a family member you visit often and take time to sit and listen to your family member.  Because you really know that person you pick up nuances of mood, physical and/or mental changes.  You may well become aware of issues that even good staff may miss merely because you know the person so much better.  So discuss these observations with the charge nurse, or with the home health nurse that comes in.

I saw a chart that is recommended for nurse aides to use for this very purpose.  I offer it here  for your use as a guide, not to be checked and handed in, but to be used as a guide and as talking points if you detect changes in your family member.

(When you click on the link, you may get a warning about viruses.  The site is safe.)

Making Connections

©  Imelda Maurer, cdp

As I write this, it was two days ago to the hour that we gathered for the final session of the Pioneer Network Conference, our luncheon and its stirring program.  Since my return, I've been doing the mundane tasks of getting back into my routine as well as addressing some issues with short deadlines. 

At the same time, I'm aware that I have several business cards here on my desk, indications of new connections  I made at the Conference.  I'll do more than just adding this data to Outlook.  I'll be in touch with these new-found common-visioned colleagues.  I've also been  mulling over my experiences at the Conference and, as at every conference, I came home with ideas about how to implement some of my "what if", some of my "why can't . . . " visions.  There are two projects I will work to implement this coming year.

A CNA who was at the Conference has already reflected on one experience that provided a clear connection between what she heard at the Conference and how it applies to her work every day as a CNA.  The following is the core of what Yang writes in reflecting on a conference experience:

This really is “what it’s all about.” A person centered environment means that as we approach and respond to our elders, we pick up on the cues that provide us with an awareness of how they as individuals are perceiving the situation and use this as the context for our interaction with them. An unhurried and indirect approach with a light touch creates an atmosphere of cooperation and reassures our elders that they are in control.

The full entry can be accessed here.

The investment of time and money involved in participating in a national conference is totally wasted if new ideas learned are not put into practice back at home.  Does your organization  have and implement a policy about staff bringing back conference ideas and insights?  Is there an expectation that these ideas will be shared with staff and stakeholders?  Fiscally, it is just being responsible. Ethically, I believe we are morally impelled to act on what we know helps to move from INSTITUTION, even if it is a "loving institution", to HOME.