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.

 

 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.”

 

 

 

“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 stomachs 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

 

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 .

 

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.

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.

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.

 

 

                                       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!

 

 

 

 

                        

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

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.

“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 go 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!"

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!

We are so immersed in it.

Each Wednesday’s local paper always includes a Food section. The feature article this past Wednesday was a story about Mr. ____ who makes dozens of fruitcakes each year, using a recipe that is at least three generations old.  The columnist wrote, “He doesn’t do all the work himself anymore.  Mr. ______ is 85, so most of the work is done by his grandson”

Hmmmm.    So Mr. ____ is described as being limited “because he’s 85”.  That is an expression of ageism:  categorizing a person based on chronological age.

Why might Mr. ____ not do all the work anymore? 

n  He may be mentoring an excited young adult who wants to carry on this family tradition.

n  He may be recuperating from surgery

n  He may have a bad back and can’t lift the heavy utensils holding ingredients for dozens of cakes.

Whatever the reason, the choice, if it is seen as due to this man’s chronological age, it is ageist.

As I read this sentence, I wondered how many readers would even question it. I was reminded of the story of the two young fish swimming along one morning when an older fish passes in the opposite direction and asks, “How’s the water, boys?”  The two young fish look at each other and ask, “What’s water?”  Immersed in it, they could not identify it.  That’s like ageism in our society.  It is so pervasive, we are so immersed in it that we do not recognize it many times.

Ashton Applewhite calls ageism the last acceptable prejudice in our society.  It is also the most perverse because every living person is subject to it.  Geography, gender, and socioeconomic factors have an impact on how much ageism affects given individuals.

Let’s begin to see the metaphorical water we are immersed in and resist it as a matter of justice work  --- and a healthy self interest.

“I must confess, I was dumb.”

© Imelda Maurer, cdp

Do you recognize those as the words spoken by Senator Bernie Sanders following his recent heart attack?

Here is Sanders’ statement in a fuller context:  "Thank God, I have a lot of energy, and during this campaign I've been doing, in some cases, three or four rallies a day all over the state, Iowa, New Hampshire, wherever. And yet I, in the last month or two, just was more fatigued than I usually have been. And I should have listened to those symptoms."

Sanders said this is what he has learned from this cardiac episode and he wants to see that other people learn it too.  “I should have listened to those symptoms.”  Very wise words of advice.

Because we – all of us – have internalized the negative and false ageist message that old age is synonymous with illness, aches and pains and decline, we can fall into the trap of accepting any “symptom” as just old age creeping up on us, as something we just have to live with. This mindset fits in with the model of the body as a machine with many parts. Our body, this false theory says, is going to fall apart just like an old car.  In reality, some parts do wear out.  We can replace hip and knee joints; we can replace the teeth that are typically good for sixty years or so. Beyond that, our bodies are awesome in the ability to heal, to regenerate, to form new neural paths in adapting to some loss in order to continue function.  Listen to your body and respect what it is telling you.

Senator Sanders’ has given us a powerful public lesson.  Listen to your body. If there is something different going on and it persists, seek advice. Do NOT assume it is just part of growing older.

Let Senator Sanders’ experience be a valuable lesson for all of us.

   

Fall and the Seasons of Our Lives

© Imelda Maurer, cdp

This morning I turned the heat on in the house for the first time this season to take the chill off, as we say. Fall has finally come. The trees have lost a few of their leaves. The lawn is sparse with them, fallen before they revealed the fullness of their fall colors.

How many times have you and I read a person of high regard in religious circles, or heard a retreat director speak and compare our lives with the four seasons of the year.  Here we are in the fall of the year, and for me and some of my readers, the fall of our lives.  The typical rendition of this life/season analogy is that just as the leaves fall from the trees and die, the challenge we face in the Fall of our lives is to let go.

Now there is nothing inappropriate with the concept that in our lives we must let go in multiple dimensions of life.  Actually, we live through letting go throughout our life, not just in our later years. Initially, in experiencing birth, we “let go” of the unique and deeply intimate relationship with our mother in her womb.  I resist the typical understanding of “letting go” that is associated with Fall and the falling of leaves because it sends the message that the Fall of our life is defined, is circumscribed by loss and the subsequent challenge (as in ageist Aging and Spirituality lectures) to let go. Nothing is further from the truth. We experience the potential for growth and development throughout our life cycle – not just Spring and Summer but Fall and Winter also! The field of gerontology has confirmed this via a growing field of research. Fall is a time of fullness and richness!

Actually, nature gives us a similar positive message.  Those Fall leaves --- they do more than just fall from the tree and die. They spread awe and wonder, delight and joy as millions of people around the world view their majestic colors.  Those pigments have been a part of each leaf all its life. It is only in the Fall with the declining hours of daily sunlight and lower temperatures that the chlorophyll breaks down and disappears revealing the colors that have always been there!!  It is only within the later stage of its life cycle that the glorious colors become visible.  Think about that! Beauty, continued growth and development becomes possible and visible precisely because of our aging.

Another image of Fall as a time of richness and fullness was made obvious to me during a prayer  at a gathering focusing on aging. The prayer was a kind of litany about Fall. This one line has stayed with me and I smile every time I think of it:

"It is fall. Our barns are full." Indeed they are!

How a sense of advocacy makes life better for residents of our communities

Jill Vitale-Aussem is not only President and CEO of the Eden Alternative, she has authored a recently-published book entitled  Disrupting the Status Quo of Senior Living: A Mindshift (© 2019 Health Professions Press, Inc.)  I look forward to purchasing my copy of Jill's book this weekend when I am at the Pioneer Network Conference in Louisville, KY.

What I offer here is a link to an excerpt from Jill's book that is worthy of your time in reading.  She begins by noting that when prospective residents are looking at a community, the bulk of conversations is what the community can offer to the prospective resident. There is never a conversation addressing what the resident brings to the community.  Person-directed living is predicated on Knowing the Person; the all-too-often ignored part of what the resident brings needs to become operational. How can we facilitate purpose and meaning in the lives of our residents if we do not know each person we serve?

The story in this excerpt revolves around a series of thefts in an Assisted Living Community. It has a happy ending because of the sensitive insights and strong sense of advocacy the administrator exhibited.

Read the story  here.

Francis speaks of imagination and creativity as elements of effective love

“Those who love use their imagination to discover solutions where others see problems. Those who love help others according to their needs and with creativity, not according to preconceived ideas or common conceptions.” - Pope Francis, February 14, 2019

Often I have mused that as Sisters we assume the following false logic: “We love our old Sisters.”  That is an undoubtedly true statement and feeling. But the assumption goes on, “So, of course, we take good care of them.”

Unfragmented, the whole thought is this: “We love our old Sisters. So, of course, we take good care of them.” Love is essential, but it must be proactive if it is to be sufficient. Pope Francis speaks of this directly in his Valentine’s Day message.

In our society, where ageism is so pervasive that we do not recognize it, ageist stereotypes clearly seep through convent walls. This ageism impacts how we view aging, old people (including ourselves), and what is the norm for an appropriate environment and services for these old people (commonly referenced as “they” or “them”). Francis’ statement speaks to the heart of how Sisters can and must approach and implement programs for their elders who need supportive services.

Love drives us to use our imagination to look at what happens and how it happens in our retirement centers with new eyes, with imagination that can envision what can be for our Sisters, not just what has always been.

Francis calls for creativity necessary to meet the needs of our Sisters according to their needs, not according to preconceived ideas, or common conceptions.  Do ageist views of what old age is bind us to preconceived ideas, and blind us to new visions of what creativity could open for our Sisters, and therefore for the world?

Francis is calling for an active love which will transform the present culture of how we view aging and aging services.  In the field of aging services, we call this Culture Change! This movement is a few decades old, and has bold, courageous leaders across the country carrying it’s message forward. It inspires me to know that among this number is a handful of Congregations of women religious whose leaders have listened to and responded to their instinctive knowledge that there can be more for our Sisters in their later years. These superiors have taken seriously their pastoral and canonical mandate to facilitate and nurture the highest possible quality of life for their elders. It is a part of completing the mission for each individual Sister who has committed and spent her life in service to the Church through her particular Religious Institute.

This ministry of service to our own members is merely another facet in the jewel of the works of Mercy which has defined Sisters’ ministry of service as a response to the signs of the times since we first came to the United States as missionaries.

"The Ugly Truth About Ageism: It's a Prejudice Targeting Our Future Selves"

  ©   Imelda Maurer, cdp  September 17, 2018

This blog title is that of an article in The Guardian recently.  I certainly cannot improve on the concepts or the writing, so I include just a few paragraphs from an informative and thought-provoking piece. The entire article can be accessed here.

"We love the elders in our lives and we all hope to grow old, so why does this personal interest not translate into public policy?"  (My own editorializing here ---  it could read, 'why does our love for our elders so rarely translate into environments, policies, procedures, programs and practices that make this love and respect  visible and self-evident to our elders as well as to any observers or visitors to these communities?')

"You see them in most aged-care facilities, seated on pastel-colored lounges, being babysat by a TV they are mostly not watching. Some are asleep, some are sedated, some are cognitively impaired. Seeing them like this, it’s hard to remember they were once young, vital and independent. What’s harder is thinking that it might one day be you."

"So why have we failed to do better by our elderly needing care? Why do we settle for conditions that leave many of them bored, lonely and poorly fed in a way we would never tolerate for ourselves?"

"One underlying cause could be deeply entrenched ageism. It often begins with the language we use. According to writer Ashton Applewhite, if we diminish our regard for the senior members of our society verbally, we are likely to do the same when it comes to the way we frame policy – removing their dignity and sense of agency in condescending generalizations that assume vulnerability and dependence instead of resilience and independence."

"Unlike other prejudices such as racism and sexism, which are manifestations of fear of the other, ageism is unique in targeting our future selves."

 “No prejudice is rational,” says Applewhite. “But with ageism, we have internalised it. We have been complicit in our own marginalisation and it will require active consciousness-raising to correct that, just as the women’s movement did."

Are we ready to engage in active consciousness-raising around issues of ageism?  For my readers who are women religious, there is an urgent call here for us to engage on this issue for the social justice issue that it is! 

Culture Change: Let's Not Make it a Cliché

Wednesday, November 7, 2007

Reissued September 5, 2018

There is a wonderful revolution taking place in (albeit all too few) nursing homes across the country. As long as there are parents who say to their children, ‘Promise me you’ll never put me in a nursing home,” or any of us groan to think that we may spend our last days in a medical institution that is foreign to any feel or sense of “home” with all its deep and deeply personal implications, then there is need for this revolution, this transformation, to spread.

It goes by several names: Culture Change; Transformative Nursing Homes: Resident-Centered Care; Person-Centered Care; Green House Model; Household  Model, Wellspring

What all these terms have in common is a philosophy that holds to the following values and attitudes:

•           The resident is put back into the driver’s seat, making as many choices about his/her daily life as possible. One implication is that activities and care revolve around the resident as much as           possible, as contrasted with an institutional model where schedule and staff convenience take precedence.

•           It is an environment that honors the culture of aging as life-affirming, satisfying, humane and meaningful.

•           The place has the feel and look of HOME. Just two evidences of change in the environment:
            No medical carts rumbling down the hallways.
            No centralized  nurses' station

Although the culture is not transformed by merely instituting programs, or doing away with a centralized nursing station, studies have shown that in communities where the culture has transformed to a resident-first culture, certain practices/programs are present. That information can be used as somewhat of an evaluation of how far along on the journey of culture change a community has come. It is accessible at this link:   http://www.artifactsofculturechange.org/ACCTool/  .

Once on that page, scroll down to the "Artifacts of Culture Change Downloadable Version".

Culture change is a deep, challenging transformation of attitudes and values which is dependent on strong, knowledgeable leadership. The leader must have a deep belief in these transformative values and the leadership ability to shape staff so that these values permeate every cell of their being. Anything short of this is not transformative change and the result will not be ‘culture change.’

The win-win part of culture change is that this transformative mode of operation costs no more than traditional, institutional care. In fact, there are many reasons why the cost is probably lower. That’s a topic for another day.

Steve Shields, CEO of a transformative community in Manhattan, KS speaks of what made it possible for him and his staff to move forward in their journey of transformative change. He is quoted in Beth Baker's book, Old Age in a New Age:  When Action Pact consultants first introduced the concepts of culture change, "The vision was painted so strongly and in front of everybody that it became holy. Truly."

I spoke with Steve about that quote and asked him what he meant by saying that culture change is ‘holy.’ He said simply and straightforwardly, “It is holy because it liberates our elders and returns hope to them.”