© Imelda Maurer, cdp August 10, 2009
ilmcdp@yahoo.com
My work day started on a great note and I want to provide you the same delight.
Across the country Coalitions on Culture Change are deepening and broadening the involvement of nursing homes in transformational culture change within their State. The link I’m sharing this morning is from the Louisiana Coalition Newsletter, Leader.
KaraLe Causey, President of LEADER (Louisiana Enhancing Aging with Dignity Through Empowerment and Respect) writes on page 1 about the place and importance of choice in her life and how this translates to elders in long-term care settings. You will find the article stimulating and motivating. KaraLe would be as great a novelist as she is administrator. You'll enjoy the article!
On page 2, a Certified Medical Director writes about meaningful and effective activities with residents with dementia.
Page 3 includes descriptions of how some nursing home communities honor the death and dying experience of a resident and the resident’s family by particular practices and rituals. One ritual noted includes leaving a single rose on the bed for 24 hours following the death of a resident. How touching that is, in contrast to the traditional, institutional model in which the bed and room are stripped as soon as the body is removed.
Full disclosure: I have been gifted to know KaraLe since August, 2005 when I volunteered time in her nursing home following Katrina. KaraLe opened a vacant wing at Haven Nursing Center to receive 44 residents from a nursing home in New Orleans. Many of these residents lived at Haven for three or more months before they were able to return to their nursing home in New Orleans.
Thanks, KaraLe, for the wonderful work you and the Louisiana Coalition are doing! See you soon at the Pioneer Network Conference!
Here’s the link. Enjoy!
http://laculturechangecoalition.org/userfiles/Newsletters/2009%20August.pdf
Monday, August 10, 2009
Wednesday, July 15, 2009
"I am richer being able to be with them and serve them."
© Imelda Maurer, cdp July 15, 2009
ilmcdp@yahoo.com
Yesterday I wrote to Sister Mary Lou Mitchell, President of the Sisters of St. Joseph, Rochester, NY regarding the July 9th article in The New York Times featuring their Sisters living in their retirement setting. Below is the response I received from Sister Mary Lou, printed here with her permission.
Dear Sr. Imelda,
Thanks for your note and the wonderful piece you did on your blog. This has truly been a humbling experience for me and for the Congregation. Health promotion across the life span and gerontology has been a passion of mine for many years and I am grateful that the community has allowed me to work on improving the quality of care for our elders. They are such wonderful beautiful women and I am richer being able to be with them and serve them in this fashion.
Let us pray that together we can continue to help our culture know that our elderly are a gift to us and not a burden.
In peace,
Mary Lou
Indeed, we are all and always gift to one another. That reality does not become invalid because of chronological age and/or frailty. All of us who are care-ers for others, through a formal workplace position or from the relationship of sisterhood or friendship can validate Sister Mary Lou’s experience of being “richer” because we are “able to be with them and serve them.”
To all those who, by your conscious and intentional actions, honor our aging members by your care and service – blessings to you. You are the joyfully visible sign of God’s Providential love for all of creation.
ilmcdp@yahoo.com
Yesterday I wrote to Sister Mary Lou Mitchell, President of the Sisters of St. Joseph, Rochester, NY regarding the July 9th article in The New York Times featuring their Sisters living in their retirement setting. Below is the response I received from Sister Mary Lou, printed here with her permission.
Dear Sr. Imelda,
Thanks for your note and the wonderful piece you did on your blog. This has truly been a humbling experience for me and for the Congregation. Health promotion across the life span and gerontology has been a passion of mine for many years and I am grateful that the community has allowed me to work on improving the quality of care for our elders. They are such wonderful beautiful women and I am richer being able to be with them and serve them in this fashion.
Let us pray that together we can continue to help our culture know that our elderly are a gift to us and not a burden.
In peace,
Mary Lou
Indeed, we are all and always gift to one another. That reality does not become invalid because of chronological age and/or frailty. All of us who are care-ers for others, through a formal workplace position or from the relationship of sisterhood or friendship can validate Sister Mary Lou’s experience of being “richer” because we are “able to be with them and serve them.”
To all those who, by your conscious and intentional actions, honor our aging members by your care and service – blessings to you. You are the joyfully visible sign of God’s Providential love for all of creation.
Tuesday, July 14, 2009
New York Times July 9 2009
© Imelda Maurer, cdp July 14, 2009
ilmcdp@yahoo.com
On July 9th there was a lead article in the New York Times by Jane Gross entitled, “Sisters Face Death with Dignity and Reverence.” I have attempted a blog entry about this outstanding article twice since I read the article but the writing has always fallen flat.
Immediately after reading the article online, I called the Sisters of St. Joseph of Rochester, New York to express my gratitude to Sister Mary Lou Mitchell, President, who was quoted in the article. In addition to the print article, there is a slide show on the website which shows in the course of its own story Sister Mary Lou in a couple of pictures expressing warmth, affection and compassion to her elderly Sisters. I did not sense that this woman in congregational leadership was ‘panning for the camera.’ I sensed a woman familiar with and comfortable with expressing those human emotions with her own. A gift to her Sisters and to the world.
This morning I sent an e-mail to another Sister and I included the URL to that July 9th article. When I remembered a quotation from the article of one of the Sisters living in the retirement center, tears came to my eyes. I thought then: “This is what I should write about.”
This is the quotation: Sister Marie, a 77-year-old Sister who lives at the retirement center and who visits the community nursing home frequently is quoted as saying, “We won’t let anyone go alone on the last journey.”
These Sisters of St. Joseph companion their Sisters. These Sisters honor death as a part of living, as the doorway to the fullness of life. They live out the words of Bill Moyer: “Death must be witnessed and attended to.”
Integral to this faith-based vision is the reality that this earthly life is a gift, a precious gift. In the context of these faith values, namely, that life is a gift and that this physical life is for a limited time only, the Sisters of St. Joseph have intentionally provided an environment where life could be lived to the fullest, where appropriate services could be provided, and where these Sisters would “die with dignity and die well.” These values are expressed in an environment which intentionally promotes the services the Sisters want for their frail elderly. It is expressed in recruiting and hiring well-qualified personnel – a geriatrician-physician as the primary care provider for many of the Sisters, and a nurse practitioner on staff in the nursing home. By definition, these are professionals with pertinent and excellent knowledge and skills related to aging and the care of the aging.
A nationally known social worker, Carter Catlett Williams, in speaking of typical nursing homes, reminds us that all too often we absorb the values of our culture. Not so with these Sisters. They have consciously chosen the environment and the services which will result in a higher quality of life for their own and which will allow them a “good death” in the end, in the company of their Sisters.
I am reminded of a piece of poetry/prose that I share with the readers of this blog:
"I will not die an unlived life. I will not live in fear of falling or catching fire.
I choose to inhabit my days, to allow my living to open me, to make me less afraid, more accessible, to loosen my heart until it becomes a wing, a torch, a promise.
I choose to risk my significance; to live so that which comes to me as seed goes to the next as blossom and that which comes to me as blossom, goes on as fruit."
Dawna Markova
Author of Open Mind.
To read Jane Gross’ article, go to:
http://www.nytimes.com/2009/07/09/health/09sisters.html
ilmcdp@yahoo.com
On July 9th there was a lead article in the New York Times by Jane Gross entitled, “Sisters Face Death with Dignity and Reverence.” I have attempted a blog entry about this outstanding article twice since I read the article but the writing has always fallen flat.
Immediately after reading the article online, I called the Sisters of St. Joseph of Rochester, New York to express my gratitude to Sister Mary Lou Mitchell, President, who was quoted in the article. In addition to the print article, there is a slide show on the website which shows in the course of its own story Sister Mary Lou in a couple of pictures expressing warmth, affection and compassion to her elderly Sisters. I did not sense that this woman in congregational leadership was ‘panning for the camera.’ I sensed a woman familiar with and comfortable with expressing those human emotions with her own. A gift to her Sisters and to the world.
This morning I sent an e-mail to another Sister and I included the URL to that July 9th article. When I remembered a quotation from the article of one of the Sisters living in the retirement center, tears came to my eyes. I thought then: “This is what I should write about.”
This is the quotation: Sister Marie, a 77-year-old Sister who lives at the retirement center and who visits the community nursing home frequently is quoted as saying, “We won’t let anyone go alone on the last journey.”
These Sisters of St. Joseph companion their Sisters. These Sisters honor death as a part of living, as the doorway to the fullness of life. They live out the words of Bill Moyer: “Death must be witnessed and attended to.”
Integral to this faith-based vision is the reality that this earthly life is a gift, a precious gift. In the context of these faith values, namely, that life is a gift and that this physical life is for a limited time only, the Sisters of St. Joseph have intentionally provided an environment where life could be lived to the fullest, where appropriate services could be provided, and where these Sisters would “die with dignity and die well.” These values are expressed in an environment which intentionally promotes the services the Sisters want for their frail elderly. It is expressed in recruiting and hiring well-qualified personnel – a geriatrician-physician as the primary care provider for many of the Sisters, and a nurse practitioner on staff in the nursing home. By definition, these are professionals with pertinent and excellent knowledge and skills related to aging and the care of the aging.
A nationally known social worker, Carter Catlett Williams, in speaking of typical nursing homes, reminds us that all too often we absorb the values of our culture. Not so with these Sisters. They have consciously chosen the environment and the services which will result in a higher quality of life for their own and which will allow them a “good death” in the end, in the company of their Sisters.
I am reminded of a piece of poetry/prose that I share with the readers of this blog:
"I will not die an unlived life. I will not live in fear of falling or catching fire.
I choose to inhabit my days, to allow my living to open me, to make me less afraid, more accessible, to loosen my heart until it becomes a wing, a torch, a promise.
I choose to risk my significance; to live so that which comes to me as seed goes to the next as blossom and that which comes to me as blossom, goes on as fruit."
Dawna Markova
Author of Open Mind.
To read Jane Gross’ article, go to:
http://www.nytimes.com/2009/07/09/health/09sisters.html
Monday, July 6, 2009
There’s no place like home
© Imelda Maurer, cdp July 6, 2009
ilmcdp@yahoo.com
Bill Thomas, M.D. has patented a particular approach to culture change in long-term care. The name given to facilities that follow Thomas’ guidelines is “Green House.”
This particular approach is only one way in which culture change is being implemented in long-term care. There are other models. What they hold in common is that they center on the same values and principles: resident-directed environment. Such approaches result in: HOME as opposed to INSTITUTION; autonomy, dignity, individuality, spontaneity in a nursing home resident’s day; more positive outcomes for nursing home residents; and higher morale and lower turnover among nursing home staff. The whole thing, according to well documented research is budget-neutral, though I suspect, in light of greater resident AND employee satisfaction that there is an overall savings in employee training and in medical costs when a nursing home is HOME and not an INSTITUTION.
The Rochester, NY daily newspaper carried an article on July 6th about one such nursing home in that city. You can access it by clicking on the URL below.
Some particularly pertinent statements from the article include these:
It is imperative that there is a change in the organization’s culture if the “model” is to work, if there is to be real change.
“The movement is also prodded by recognition that people treated like parts on an assembly line fail to thrive.”
“Cottage Grove administrator Cathy Allen, a registered nurse who lives in Honeoye Falls, appreciates the close relationships that can form between staff and residents. Allen recently took Chambers (a nursing home resident with some dementia) to buy prizes for games. On the short trip, Chambers repeatedly asked Allen how she had slept and how her day had been, and Allen said she answered cheerfully, again and again. Then at one point Chambers said, "I like being with you."”
http://www.democratandchronicle.com/article/20090706/NEWS01/907060321/1002/NEWS
ilmcdp@yahoo.com
Bill Thomas, M.D. has patented a particular approach to culture change in long-term care. The name given to facilities that follow Thomas’ guidelines is “Green House.”
This particular approach is only one way in which culture change is being implemented in long-term care. There are other models. What they hold in common is that they center on the same values and principles: resident-directed environment. Such approaches result in: HOME as opposed to INSTITUTION; autonomy, dignity, individuality, spontaneity in a nursing home resident’s day; more positive outcomes for nursing home residents; and higher morale and lower turnover among nursing home staff. The whole thing, according to well documented research is budget-neutral, though I suspect, in light of greater resident AND employee satisfaction that there is an overall savings in employee training and in medical costs when a nursing home is HOME and not an INSTITUTION.
The Rochester, NY daily newspaper carried an article on July 6th about one such nursing home in that city. You can access it by clicking on the URL below.
Some particularly pertinent statements from the article include these:
It is imperative that there is a change in the organization’s culture if the “model” is to work, if there is to be real change.
“The movement is also prodded by recognition that people treated like parts on an assembly line fail to thrive.”
“Cottage Grove administrator Cathy Allen, a registered nurse who lives in Honeoye Falls, appreciates the close relationships that can form between staff and residents. Allen recently took Chambers (a nursing home resident with some dementia) to buy prizes for games. On the short trip, Chambers repeatedly asked Allen how she had slept and how her day had been, and Allen said she answered cheerfully, again and again. Then at one point Chambers said, "I like being with you."”
http://www.democratandchronicle.com/article/20090706/NEWS01/907060321/1002/NEWS
Thursday, April 30, 2009
Is Your Loved One in a Long Term Care Facility at Risk for the H1N1 Flu?
The following article is taken directly from the April 30th issue of the weekly e-newsletter of the American Medical Directors Association: "Weekly Round Up."
The H1N1 Flu (first called the Swine flu), is spreading throughout the United States, Canada and Europe. There is lots of talk about this moving into a pandemic—an epidemic of an infectious disease—in the U.S. Daily, the government’s Centers for Disease Control and Prevention is reporting increasing numbers of cases of this flu. As of April 28th, it is confirmed in 10 states in this country, in Canada and several areas in Europe, with Germany as the latest site.
Of course, it is natural to worry about your loved one in a long term care (LTC) facility. LTC facilities have processes in place to try to keep infectious diseases such as flu from coming in and making patients/residents sick. For example, they will request that employees or visitors who have a fever or other signs of illness stay home. Also, they will monitor that staff is washing their hands, not touching or breathing on food, and wearing masks and gloves around someone who is sick. Normally the facility will make sure those patients/residents who are well enough get flu shots and other preventive care. However, there is no flu shot at this time to prevent H1N1 flu.
What are the signs of H1N1 flu? People with the condition usually have the same complaints as people with any flu-like virus, except some people with the H1N1 virus are reporting some nausea and diarrhea. Suspect that someone has H1N1 if he/she has respiratory illness with fever within seven days of close contact with a person who has the illness or within seven days of travel to someplace where people have the H1N1 illness; or they live in a community (like a LTC facility) where people have been proven to have H1N1. Like seasonal flu, H1N1 flu may cause other medical problems to get worse.
Eating pork products does not cause the illness (although it is best to avoid exposure to pigs from Mexico), so you don’t have to worry if the facility is serving ham for lunch.
The medical director makes sure that the facility has flu control practices and policies that go beyond a vaccination program. Such a program is the first step in preventing flu outbreaks, but other steps are needed; and the medical director and his team will make sure that these steps are taken. Facilities have ways to prevent flu illness from spreading if someone gets it. This is often called infection control or outbreak control measures. The facility’s first goal is to protect your loved one and keep him/her safe. So take heart. Doctors, nurses, and others are on alert when there is flu like this going around, and they take steps to try to prevent everyone from getting sick.
Your physician can tell you what you can do to prevent bringing an illness into the facility and how to keep from getting sick if you visit a loved one in a facility where people have or have had the flu. In the meantime, fighting illnesses like H1N1 flu starts with common sense. If you don’t have to go somewhere, don’t—especially if you are sick. Avoid close contact with people who are sick, and wash your hands several times during the day.
Questions to Ask Your Physician:
• What will happen if there is an outbreak in the facility? What outbreak control means will be used?
• How will family members be notified if there is a case or outbreak of H1N1 flu at the facility?
• How will my loved one be treated if he/she gets H1N1 flu? Will he/she have to go to the hospital?
• How will my loved one be protected from getting H1N1 flu if others in the facility have it?
• How can I help prevent the spread of H1N1 flu?
• What will happen if there is a pandemic? Will the facility be closed to the public?
• If a vaccination for H1N1 flu becomes available, will my loved one get this?
• What else will the facility do to prevent patients/residents from getting the flu?
What You Can Do:
• Don’t visit your loved one if you are sick or feel like you are getting sick.
• Wash your hands often.
• Cover your face if you cough or sneeze and then wash your hands.
• Don’t bring small children to visit your loved one if they have been exposed to the flu at school or in the community.
• Let the facility know if you recently visited a country (such as Mexico) connected with a flu outbreak or outbreak of other infectious illness.
• Urge your loved one to tell a nurse if he/she has any signs of the flu.
• Urge your loved one to avoid close contact with others during flu season or outbreaks.
The H1N1 Flu (first called the Swine flu), is spreading throughout the United States, Canada and Europe. There is lots of talk about this moving into a pandemic—an epidemic of an infectious disease—in the U.S. Daily, the government’s Centers for Disease Control and Prevention is reporting increasing numbers of cases of this flu. As of April 28th, it is confirmed in 10 states in this country, in Canada and several areas in Europe, with Germany as the latest site.
Of course, it is natural to worry about your loved one in a long term care (LTC) facility. LTC facilities have processes in place to try to keep infectious diseases such as flu from coming in and making patients/residents sick. For example, they will request that employees or visitors who have a fever or other signs of illness stay home. Also, they will monitor that staff is washing their hands, not touching or breathing on food, and wearing masks and gloves around someone who is sick. Normally the facility will make sure those patients/residents who are well enough get flu shots and other preventive care. However, there is no flu shot at this time to prevent H1N1 flu.
What are the signs of H1N1 flu? People with the condition usually have the same complaints as people with any flu-like virus, except some people with the H1N1 virus are reporting some nausea and diarrhea. Suspect that someone has H1N1 if he/she has respiratory illness with fever within seven days of close contact with a person who has the illness or within seven days of travel to someplace where people have the H1N1 illness; or they live in a community (like a LTC facility) where people have been proven to have H1N1. Like seasonal flu, H1N1 flu may cause other medical problems to get worse.
Eating pork products does not cause the illness (although it is best to avoid exposure to pigs from Mexico), so you don’t have to worry if the facility is serving ham for lunch.
The medical director makes sure that the facility has flu control practices and policies that go beyond a vaccination program. Such a program is the first step in preventing flu outbreaks, but other steps are needed; and the medical director and his team will make sure that these steps are taken. Facilities have ways to prevent flu illness from spreading if someone gets it. This is often called infection control or outbreak control measures. The facility’s first goal is to protect your loved one and keep him/her safe. So take heart. Doctors, nurses, and others are on alert when there is flu like this going around, and they take steps to try to prevent everyone from getting sick.
Your physician can tell you what you can do to prevent bringing an illness into the facility and how to keep from getting sick if you visit a loved one in a facility where people have or have had the flu. In the meantime, fighting illnesses like H1N1 flu starts with common sense. If you don’t have to go somewhere, don’t—especially if you are sick. Avoid close contact with people who are sick, and wash your hands several times during the day.
Questions to Ask Your Physician:
• What will happen if there is an outbreak in the facility? What outbreak control means will be used?
• How will family members be notified if there is a case or outbreak of H1N1 flu at the facility?
• How will my loved one be treated if he/she gets H1N1 flu? Will he/she have to go to the hospital?
• How will my loved one be protected from getting H1N1 flu if others in the facility have it?
• How can I help prevent the spread of H1N1 flu?
• What will happen if there is a pandemic? Will the facility be closed to the public?
• If a vaccination for H1N1 flu becomes available, will my loved one get this?
• What else will the facility do to prevent patients/residents from getting the flu?
What You Can Do:
• Don’t visit your loved one if you are sick or feel like you are getting sick.
• Wash your hands often.
• Cover your face if you cough or sneeze and then wash your hands.
• Don’t bring small children to visit your loved one if they have been exposed to the flu at school or in the community.
• Let the facility know if you recently visited a country (such as Mexico) connected with a flu outbreak or outbreak of other infectious illness.
• Urge your loved one to tell a nurse if he/she has any signs of the flu.
• Urge your loved one to avoid close contact with others during flu season or outbreaks.
Tuesday, April 28, 2009
How much did the Smithfield Easter Ham Really Cost?
© Imelda Maurer, cdp April 28, 2009
For several weeks I’ve wanted to use my blog to write about food. It’s an issue that, for the last couple of years, has stayed with me and it won’t let go. Since the original purpose of this blog included reflections on healthy aging and quality of life in later years, the topic of food is quite apt. The issue goes far beyond issues of the individual, however, because our food choices also impact the animals raised as commodities on factory farms, the environment, the economy, the viability of family farmers, and public health.
Last week I finished listening to the audio version of the book, “The Way We Eat: Why Our Food Choices Matter” by Peter Springer and Jim Mason. Just a few days later, news of the swine flu and its potential to become a pandemic hit the airwaves.
The mainstream media has only addressed the number and location of diagnosed cases of swine flu, number of deaths, the actions of public health officials, etc. None has addressed the cause. Web sites such as The Huffington Post, The Environmentalist, Farmers Weekly, Marion Nestle, however, do clearly make the connection between this global wave of swine flu and factory hog farming. Specifically, Smithfield Foods is mentioned as being the source.
Smithfield, an American-owned meat producer, owns confined animal feeding operations ‘CAFOs’ in Veracruz, México where the swine flu outbreak originated.
We Americans are accustomed to low-priced food. The hidden cost of our grocery bill is in subsidies to the factory farm owners --- corporations such as Smithfield, ConAgra, ADM, Cargill, etc.
One of the ways in which Smithfield is subsidized is by the fact that --- even here in the United States --- there are scant regulations directing the treatment of animal excrement in these CAFOs. A single farm may house (very inhumanely) tens of thousands of hogs. Their excrement far exceeds that produced by humans living in a city of up to 400,000 people. Human excrement is regulated and there is no environmental degradation as a result. On factory farms, excrement is held in ‘manure lagoons’. It is possible, according to several reports that I have read, that the carrier of the swine flu is a fly that reproduces in pig excrement. The fly can infect people by biting.
Smithfield does not have to pay for treating millions of tons of animal excrement. The result is an increase in air and water pollution, respiratory and other health problems of employees, early disability and shortened life spans of these underpaid workers. Think of the costs to city, state and federal agencies in this all-out effort to contain the spread of swine flu. Smithfield gets the break, the bigger corporate profits.
What was the REAL cost of that Easter ham?
What can each of us do to support sustainable farming, individuals and groups who practice humane and healthy farming methods?
For several weeks I’ve wanted to use my blog to write about food. It’s an issue that, for the last couple of years, has stayed with me and it won’t let go. Since the original purpose of this blog included reflections on healthy aging and quality of life in later years, the topic of food is quite apt. The issue goes far beyond issues of the individual, however, because our food choices also impact the animals raised as commodities on factory farms, the environment, the economy, the viability of family farmers, and public health.
Last week I finished listening to the audio version of the book, “The Way We Eat: Why Our Food Choices Matter” by Peter Springer and Jim Mason. Just a few days later, news of the swine flu and its potential to become a pandemic hit the airwaves.
The mainstream media has only addressed the number and location of diagnosed cases of swine flu, number of deaths, the actions of public health officials, etc. None has addressed the cause. Web sites such as The Huffington Post, The Environmentalist, Farmers Weekly, Marion Nestle, however, do clearly make the connection between this global wave of swine flu and factory hog farming. Specifically, Smithfield Foods is mentioned as being the source.
Smithfield, an American-owned meat producer, owns confined animal feeding operations ‘CAFOs’ in Veracruz, México where the swine flu outbreak originated.
We Americans are accustomed to low-priced food. The hidden cost of our grocery bill is in subsidies to the factory farm owners --- corporations such as Smithfield, ConAgra, ADM, Cargill, etc.
One of the ways in which Smithfield is subsidized is by the fact that --- even here in the United States --- there are scant regulations directing the treatment of animal excrement in these CAFOs. A single farm may house (very inhumanely) tens of thousands of hogs. Their excrement far exceeds that produced by humans living in a city of up to 400,000 people. Human excrement is regulated and there is no environmental degradation as a result. On factory farms, excrement is held in ‘manure lagoons’. It is possible, according to several reports that I have read, that the carrier of the swine flu is a fly that reproduces in pig excrement. The fly can infect people by biting.
Smithfield does not have to pay for treating millions of tons of animal excrement. The result is an increase in air and water pollution, respiratory and other health problems of employees, early disability and shortened life spans of these underpaid workers. Think of the costs to city, state and federal agencies in this all-out effort to contain the spread of swine flu. Smithfield gets the break, the bigger corporate profits.
What was the REAL cost of that Easter ham?
What can each of us do to support sustainable farming, individuals and groups who practice humane and healthy farming methods?
Monday, April 27, 2009
When It Comes to Dementia, Forget the Drugs
This article appeared in the Los Angeles Times, March 19, 2009
As Alzheimer's and similar diseases affect growing numbers of people, billions of dollars are being spent on the medications that offer marginal benefits. Instead, let's invest in the human touch.
By Ira Rosofsky
March 19, 2009
Pete Townshend of The Who concluded his baby boomer anthem, "My Generation," with these words: "I hope I die before I get old." And my boomer generation may well still wish for that.
I am 62 -- old enough to cash in my 401(k), too young for Medicare -- and standing with my peers on the edge of a dementia precipice.
Alzheimer's and other forms of dementia afflict up to 5 million people in the United States and about 26 million people worldwide. By 2050, there could be 13 million cases of Alzheimer's alone among U.S. baby boomers and the aging Generations X and Y, according to the National Institutes of Health. Some reports have the global prevalence of Alzheimer's growing to as many as 100 million people by midcentury. The U.S. comptroller general estimates that annual long-term care costs for the elderly -- which includes treatment for dementia -- could quadruple by 2050 to $379 billion.
How should President Obama and his healthcare policymakers, who are working to overhaul our system, prepare for my generation's future? Based on my experience, they can begin by finding a way to end the over-dependence on drugs in treating dementia.
As a psychologist who works in nursing homes, I am intimately aware of the large number of residents who take one or both of two FDA-approved drugs for dementia -- known generically as donepezil and memantine, which together account for more than 90% of the anti-dementia drug market. The most popular brand-name versions, Aricept and Namenda, make up 75% of the market.
I'm also aware of the huge and growing expenditures for these medications -- close to $3 billion annually worldwide for Aricept and more than $500 million for Namenda. Big Pharma spends as many billions of dollars on promotion as it does on research and development.
Examine the documents supporting the Food and Drug Administration's approval of Aricept, and you will see upon what a slim reed this drug's empire was built. Those taking the drug scored, on average, three points better on a 70-item cognitive assessment scale. That's about a 4% difference, mostly reflecting a slower decline rather than positive improvement. And the differences disappear when the drug is discontinued -- indicating that the drugs "do not represent a change in the underlying disease." At best, these effects may be only marginally more effective against dementia than garlic was against the Black Death in the 14th century.
What we do know today, from studies and observation, is that donepezil, memantine and drugs like them fall short on cure and comfort.
Even on Aricept's website, the claims are sketchy on the drug's effectiveness when it comes to cognition: "People who took Aricept did better on thinking tests than those who took a sugar pill."
How much better? The company doesn't say.
Many studies of the effects of drugs for dementia also speak about statistical significance, but statistical significance can be highly overrated if the differences aren't meaningful. Take my extremely nearsighted wife, for example. Suppose a drug enabled her to read the giant E at the top of an eye chart without her glasses, but none of the smaller letters. Her eyesight would show statistically significant enhancement, but -- despite her being a much better driver than me -- I'd still refuse to ride in a car she was driving if she wasn't wearing her glasses.
There are similar effects at play with anti-dementia drugs.
In 2004, Richard Gray of the University of Birmingham in Britain compared hundreds of patients with mild to moderate dementia who were taking Aricept or a placebo. The drug did improve mental functioning, but at disappointingly small levels -- about one point on a 60-point scale. More important, there was no delay in the dementia's progression or the rate of patients' institutionalization. And there were no significant differences in mood, behavior or cost of care.
Based on results such as these, the British National Institute for Clinical Excellence -- the functional equivalent of our FDA -- recommended in 2005 that Britain's National Health Service greatly restrict the use of drugs for dementia. Donepezil can be prescribed only by a psychiatrist or a neurologist, and its use is restricted to cases of mild to moderate -- not severe -- dementia. And memantine is restricted to clinical trials.
Could the thousands of dollars spent annually per patient and the billions overall be better directed?
Yes, says Gray: "Doctors and healthcare funders need to question whether it would be better to invest in more doctors and nurses and better social support rather than spending huge sums of money prescribing these expensive drugs."
A survey released in 2002 by the Kaiser Foundation found that the staffs in a typical nursing home spend a total of about two hours and 20 minutes a day with each resident. For the remaining 21 hours and 40 minutes, residents are left to their own -- mostly medicated -- devices.
Where is the comfort in that?
Some proponents of drug therapy argue that despite some disappointing results, the drugs do slow the worsening of symptoms for some people. But in our medicalized institutions for the frail and elderly, drugs are the first recourse for most problems. And often the second and third recourse.
In the United States, those over 65 consume 30% of the prescription drugs, according to a 2004 report. Dementia sufferers in nursing homes are not only taking donepezil and memantine but other similarly questionable drugs for depression, anxiety, psychosis or for simply being ornery. Many of those without dementia are also on a variety of mind- and mood-altering drugs.
It's easier to medicate than to engage. And when the chemical restraints don't work, nursing homes return to a time before modern psychotropics and use physical restraints.
But why not admit the failure of medication and instead spend some of those billions of dollars on more staff to hold the hands of both patients and their families? Beyond nurturance, much of the savings from giving up on cost-ineffective medications could be diverted to basic research that might yield not only statistically significant but meaningful and large improvements -- even a cure.
There is some comfort in believing, as our medieval ancestors did, that a tangible nostrum -- like a pearl-hued donepezil tablet -- will do some good, but it may be more comforting simply to comfort.
Instead of drugs, I'd bet many patients are wishing someone would just say the words of another ancient rock anthem: I want to hold your hand.
Ira Rosofsky is a psychologist and the author of "Nasty, Brutish, and Long: Adventures in Old Age and the World of Eldercare."
As Alzheimer's and similar diseases affect growing numbers of people, billions of dollars are being spent on the medications that offer marginal benefits. Instead, let's invest in the human touch.
By Ira Rosofsky
March 19, 2009
Pete Townshend of The Who concluded his baby boomer anthem, "My Generation," with these words: "I hope I die before I get old." And my boomer generation may well still wish for that.
I am 62 -- old enough to cash in my 401(k), too young for Medicare -- and standing with my peers on the edge of a dementia precipice.
Alzheimer's and other forms of dementia afflict up to 5 million people in the United States and about 26 million people worldwide. By 2050, there could be 13 million cases of Alzheimer's alone among U.S. baby boomers and the aging Generations X and Y, according to the National Institutes of Health. Some reports have the global prevalence of Alzheimer's growing to as many as 100 million people by midcentury. The U.S. comptroller general estimates that annual long-term care costs for the elderly -- which includes treatment for dementia -- could quadruple by 2050 to $379 billion.
How should President Obama and his healthcare policymakers, who are working to overhaul our system, prepare for my generation's future? Based on my experience, they can begin by finding a way to end the over-dependence on drugs in treating dementia.
As a psychologist who works in nursing homes, I am intimately aware of the large number of residents who take one or both of two FDA-approved drugs for dementia -- known generically as donepezil and memantine, which together account for more than 90% of the anti-dementia drug market. The most popular brand-name versions, Aricept and Namenda, make up 75% of the market.
I'm also aware of the huge and growing expenditures for these medications -- close to $3 billion annually worldwide for Aricept and more than $500 million for Namenda. Big Pharma spends as many billions of dollars on promotion as it does on research and development.
Examine the documents supporting the Food and Drug Administration's approval of Aricept, and you will see upon what a slim reed this drug's empire was built. Those taking the drug scored, on average, three points better on a 70-item cognitive assessment scale. That's about a 4% difference, mostly reflecting a slower decline rather than positive improvement. And the differences disappear when the drug is discontinued -- indicating that the drugs "do not represent a change in the underlying disease." At best, these effects may be only marginally more effective against dementia than garlic was against the Black Death in the 14th century.
What we do know today, from studies and observation, is that donepezil, memantine and drugs like them fall short on cure and comfort.
Even on Aricept's website, the claims are sketchy on the drug's effectiveness when it comes to cognition: "People who took Aricept did better on thinking tests than those who took a sugar pill."
How much better? The company doesn't say.
Many studies of the effects of drugs for dementia also speak about statistical significance, but statistical significance can be highly overrated if the differences aren't meaningful. Take my extremely nearsighted wife, for example. Suppose a drug enabled her to read the giant E at the top of an eye chart without her glasses, but none of the smaller letters. Her eyesight would show statistically significant enhancement, but -- despite her being a much better driver than me -- I'd still refuse to ride in a car she was driving if she wasn't wearing her glasses.
There are similar effects at play with anti-dementia drugs.
In 2004, Richard Gray of the University of Birmingham in Britain compared hundreds of patients with mild to moderate dementia who were taking Aricept or a placebo. The drug did improve mental functioning, but at disappointingly small levels -- about one point on a 60-point scale. More important, there was no delay in the dementia's progression or the rate of patients' institutionalization. And there were no significant differences in mood, behavior or cost of care.
Based on results such as these, the British National Institute for Clinical Excellence -- the functional equivalent of our FDA -- recommended in 2005 that Britain's National Health Service greatly restrict the use of drugs for dementia. Donepezil can be prescribed only by a psychiatrist or a neurologist, and its use is restricted to cases of mild to moderate -- not severe -- dementia. And memantine is restricted to clinical trials.
Could the thousands of dollars spent annually per patient and the billions overall be better directed?
Yes, says Gray: "Doctors and healthcare funders need to question whether it would be better to invest in more doctors and nurses and better social support rather than spending huge sums of money prescribing these expensive drugs."
A survey released in 2002 by the Kaiser Foundation found that the staffs in a typical nursing home spend a total of about two hours and 20 minutes a day with each resident. For the remaining 21 hours and 40 minutes, residents are left to their own -- mostly medicated -- devices.
Where is the comfort in that?
Some proponents of drug therapy argue that despite some disappointing results, the drugs do slow the worsening of symptoms for some people. But in our medicalized institutions for the frail and elderly, drugs are the first recourse for most problems. And often the second and third recourse.
In the United States, those over 65 consume 30% of the prescription drugs, according to a 2004 report. Dementia sufferers in nursing homes are not only taking donepezil and memantine but other similarly questionable drugs for depression, anxiety, psychosis or for simply being ornery. Many of those without dementia are also on a variety of mind- and mood-altering drugs.
It's easier to medicate than to engage. And when the chemical restraints don't work, nursing homes return to a time before modern psychotropics and use physical restraints.
But why not admit the failure of medication and instead spend some of those billions of dollars on more staff to hold the hands of both patients and their families? Beyond nurturance, much of the savings from giving up on cost-ineffective medications could be diverted to basic research that might yield not only statistically significant but meaningful and large improvements -- even a cure.
There is some comfort in believing, as our medieval ancestors did, that a tangible nostrum -- like a pearl-hued donepezil tablet -- will do some good, but it may be more comforting simply to comfort.
Instead of drugs, I'd bet many patients are wishing someone would just say the words of another ancient rock anthem: I want to hold your hand.
Ira Rosofsky is a psychologist and the author of "Nasty, Brutish, and Long: Adventures in Old Age and the World of Eldercare."
Thursday, February 19, 2009
When I Grow Up I Want to be an Old Woman
© Imelda Maurer, cdp February 19, 2009
I’m sitting here this evening in front of the TV answering some e-mail. I just saw the Kaiser Permanente Health Management ad – once again.
The words are sung: “When I grow up I want to be an old woman , an old, old woman.” I like that image in itself. I mean, after all, when do we ever hear anyone saying or even intimating that they want to ‘be an old woman.”
The accompanying visuals show old women – heavier than they were thirty years earlier -- but vital, happy, purposeful – looking in the mirror, keeping time to some music, laughing with friends, playing tennis, enjoying life –
It’s such a refreshing image. “I want to be an old woman.” The alternative is an early death. How often I think of my sister, three years my elder, who died at age 49, that she did not get to grow old along with me so that we could each grow, together, to be “an old woman, an old, old woman”
Kaiser has another ad in which the audio is short and simple: Kaiser: Thrive!
“Thrive” is a medical, nursing term. An inexplicable nursing condition is “failure to thrive” which can lead to death. But we all know that term, thrive, as holding so much more. What images does it bring to your mind’s eye? One thrives in a nurturing environment, in an environment which honors our uniqueness, our abilities, our life story. Above all, one thrives in the circle of loving relationships.
Kaiser has done a great favor in showing these ads because they shed a little light on the adventure and the sacredness of the latter years of one’s life.
I’m sitting here this evening in front of the TV answering some e-mail. I just saw the Kaiser Permanente Health Management ad – once again.
The words are sung: “When I grow up I want to be an old woman , an old, old woman.” I like that image in itself. I mean, after all, when do we ever hear anyone saying or even intimating that they want to ‘be an old woman.”
The accompanying visuals show old women – heavier than they were thirty years earlier -- but vital, happy, purposeful – looking in the mirror, keeping time to some music, laughing with friends, playing tennis, enjoying life –
It’s such a refreshing image. “I want to be an old woman.” The alternative is an early death. How often I think of my sister, three years my elder, who died at age 49, that she did not get to grow old along with me so that we could each grow, together, to be “an old woman, an old, old woman”
Kaiser has another ad in which the audio is short and simple: Kaiser: Thrive!
“Thrive” is a medical, nursing term. An inexplicable nursing condition is “failure to thrive” which can lead to death. But we all know that term, thrive, as holding so much more. What images does it bring to your mind’s eye? One thrives in a nurturing environment, in an environment which honors our uniqueness, our abilities, our life story. Above all, one thrives in the circle of loving relationships.
Kaiser has done a great favor in showing these ads because they shed a little light on the adventure and the sacredness of the latter years of one’s life.
Wednesday, January 28, 2009
What Doctors Get Paid to Do
© Imelda Maurer, cdp January 28, 2009
Jerald Winakur and Dennis McCullough are physicians practicing in different parts of the country but with much in common. They are both geriatricians, each is married to a poet (!) and they are each authors of recently published books emanating from their life experiences in geriatric medicine.
Both men point to the same serious flaws in our healthcare system. One is the reimbursement system which is heavily skewed to procedures rather than what Dr. Winakur calls “cognitive” services. The latter includes taking adequate time to examine a patient,to listen and to watch his/her body language as s/he answers routine questions. We are all familiar with the first visit to a physician which includes the two-to-three page check list we are given to complete in the waiting room: questions about our personal and family medical history and of our daily habits (healthy or unhealthy!). Dr. Winakur chooses to take the time to ask these questions directly of the patient in the examining room, precisely, he says, because of what he learns through the patient's body language, the tone of voice, the hesitation, etc. What a man!
Cognitive services also include a careful review of medications, close monitoring and appropriate adjustments if called for. McCullough refers to this as “taking time for listening and understanding” As a result of how Medicare and private insurance companies reimburse medical services, too many patients are peremptorily “shunted off for various kind of expensive but ‘covered’ technical testing or quickly put on medication based on ever quickening decisions and standardized protocol. Pressures for efficiency and reimbursement plans skewed toward technological interventions routinely overrule more deeply caring and thoughtful responses to individual need.”
Winakur explains in more depth how reimbursement schedules are established. The American Medical Association has much to say about it, but the entire operation is very secretive with physicians such as Winakur and McCullough having little or no voice in arguing the the rightrful place of cognitive skills in the reimbursement schema.
One of the reasons I have heard given over the years as to why there is such a dearth of geriatricians in our country has been that they are not well paid. Now I understand why. Good medical practice for elders may not call for every single test or procedure in the book. (This is not to condone the ageism that is sometime seen when physicians neglect appropriate procedures solely on the basis of a patient’s age.)
Dr. Winakur began his practice as a board-certified internist. He became a geriatrician, he writes, “. . .because my patients and I have grown old together.” (Don’t you love it!) And ‘to keep up with them,’ he writes, I “continued to study the latest developments in clinical geriatrics,” and passed board examinations to become certified with “added qualifications in geriatrics.” Clearly, he’s not in it just for the money. What a man!
There are many good geriatricians out there. Geriatricians are specially trained to care for persons sixty years and older. I encourage everyone so blessed with years to seek one out as their primary care provider. Why a geriatrician at our age over a family practitioner or an internist? The next blog entry!
Perhaps our new President who has already heralded such hopeful signs of change, can help improve our healthcare system with help from an active, engaged public
The books referred to here are these:
Memory Lessons by Jerald Winakur
My Mother, Your Mother by Dennis McCullough
Jerald Winakur and Dennis McCullough are physicians practicing in different parts of the country but with much in common. They are both geriatricians, each is married to a poet (!) and they are each authors of recently published books emanating from their life experiences in geriatric medicine.
Both men point to the same serious flaws in our healthcare system. One is the reimbursement system which is heavily skewed to procedures rather than what Dr. Winakur calls “cognitive” services. The latter includes taking adequate time to examine a patient,to listen and to watch his/her body language as s/he answers routine questions. We are all familiar with the first visit to a physician which includes the two-to-three page check list we are given to complete in the waiting room: questions about our personal and family medical history and of our daily habits (healthy or unhealthy!). Dr. Winakur chooses to take the time to ask these questions directly of the patient in the examining room, precisely, he says, because of what he learns through the patient's body language, the tone of voice, the hesitation, etc. What a man!
Cognitive services also include a careful review of medications, close monitoring and appropriate adjustments if called for. McCullough refers to this as “taking time for listening and understanding” As a result of how Medicare and private insurance companies reimburse medical services, too many patients are peremptorily “shunted off for various kind of expensive but ‘covered’ technical testing or quickly put on medication based on ever quickening decisions and standardized protocol. Pressures for efficiency and reimbursement plans skewed toward technological interventions routinely overrule more deeply caring and thoughtful responses to individual need.”
Winakur explains in more depth how reimbursement schedules are established. The American Medical Association has much to say about it, but the entire operation is very secretive with physicians such as Winakur and McCullough having little or no voice in arguing the the rightrful place of cognitive skills in the reimbursement schema.
One of the reasons I have heard given over the years as to why there is such a dearth of geriatricians in our country has been that they are not well paid. Now I understand why. Good medical practice for elders may not call for every single test or procedure in the book. (This is not to condone the ageism that is sometime seen when physicians neglect appropriate procedures solely on the basis of a patient’s age.)
Dr. Winakur began his practice as a board-certified internist. He became a geriatrician, he writes, “. . .because my patients and I have grown old together.” (Don’t you love it!) And ‘to keep up with them,’ he writes, I “continued to study the latest developments in clinical geriatrics,” and passed board examinations to become certified with “added qualifications in geriatrics.” Clearly, he’s not in it just for the money. What a man!
There are many good geriatricians out there. Geriatricians are specially trained to care for persons sixty years and older. I encourage everyone so blessed with years to seek one out as their primary care provider. Why a geriatrician at our age over a family practitioner or an internist? The next blog entry!
Perhaps our new President who has already heralded such hopeful signs of change, can help improve our healthcare system with help from an active, engaged public
The books referred to here are these:
Memory Lessons by Jerald Winakur
My Mother, Your Mother by Dennis McCullough
Tuesday, January 6, 2009
If You Know Someone In A Nursing Home, You Should Know About Off-Label Prescriptions
© Imelda Maurer, cdp January 6, 2008
I keep seeing it.. Whether it is a newsletter, a professional journal, a TV news story, or just this afternoon a well-written, documented article on the Internet: (http://www.therubins.com/homes/vocal.htm) The article refers to a study I also mentioned in a blog post almost a year ago (January 14, 2008). The study involved 86 individuals being treated for "behavioral problems". One third were given Risperdal; one third another anti-psychotic and another third, a placebo. After a month "behaviors" had "improved". The group with the most significant positive changes was the group receiving the placebo.
There is a stream of information about the use of antipsychotic drugs used on the elderly as a way to address what caregivers mistakenly call "behavioral problems." Behaviors among persons with dementia are not problems. Dr. G. Allen Power, Medical Director at St. John's Home in Rochester, NY believes that the use of terms like "behavioral problems" or "managing difficult behaviors" reinforces the medical view that the 'problem' rests with the person with dementia. Rather, he says, these events should be seen as "symptoms" that occur, not because of a failure of the individual, but rather because of a failure of the care environment to adequately identify and meet the person's needs. This statement is so core to the effective care of persons with dementia, I want to state it again: . . . these events should be seen as "symptoms" that occur, not because of a failure of the individual, but rather because of a failure of the care environment to adequately identify and meet the person's needs.
The Center for Medicare and Medicaid Services indicate that nearly 21% of nursing-home residents who don't have a psychosis diagnosis are on these anti-psychotic drugs. It is a way to sedate a person – in the short run --- but without addressing the issues at hand and at the same time setting the stage for complex negative side effects from the drug.
Three of the most frequently prescribed (I should say mis-prescribed) are Risperdal, Zyprexa and Seroquel. All three of these drugs carry "black box warnings", mandated by the FDA, which indicate that 'elderly dementia patients taking these drugs are at higher risk of death.'
Side effects of these drugs include weight gain and stroke, sometimes resulting in death. There is sometimes an increase in blood sugar levels, intolerance to changes in ambient temperature. A most obvious side effect is that of sedation.
Definition of off-label use of a drug.( From my post on January 14, 2008): When a drug has been developed and approved by the FDA for a certain disease or disorder, but a health care provider prescribes it for a condition other than that covered by the drug’s FDA approval, the practice is called off-label use. Physicians attending nursing home residents in far too many cases prescribe any of these antipsychotic drugs as all-purpose tranquilizers
As I write this, I wonder if the broad, expensive, ineffective, harmful and widespread use of off-label antipsychotic drugs among the most vulnerable in our society is a subtle or not-so-subtle manifestation of ageism. Or is it because in our long-term-care system we don't take the time to really know each individual, know him or her as an individual, not just an old person --- who is going to die anyhow ---. Do we as a society, as Dr. Bill Thomas suggests, view nursing home residents as racing toward the exit ramp of life? Of course none of us subscribes to these views consciously, but are they at work in our society and institutions at a subconscious level?
I keep seeing it.. Whether it is a newsletter, a professional journal, a TV news story, or just this afternoon a well-written, documented article on the Internet: (http://www.therubins.com/homes/vocal.htm) The article refers to a study I also mentioned in a blog post almost a year ago (January 14, 2008). The study involved 86 individuals being treated for "behavioral problems". One third were given Risperdal; one third another anti-psychotic and another third, a placebo. After a month "behaviors" had "improved". The group with the most significant positive changes was the group receiving the placebo.
There is a stream of information about the use of antipsychotic drugs used on the elderly as a way to address what caregivers mistakenly call "behavioral problems." Behaviors among persons with dementia are not problems. Dr. G. Allen Power, Medical Director at St. John's Home in Rochester, NY believes that the use of terms like "behavioral problems" or "managing difficult behaviors" reinforces the medical view that the 'problem' rests with the person with dementia. Rather, he says, these events should be seen as "symptoms" that occur, not because of a failure of the individual, but rather because of a failure of the care environment to adequately identify and meet the person's needs. This statement is so core to the effective care of persons with dementia, I want to state it again: . . . these events should be seen as "symptoms" that occur, not because of a failure of the individual, but rather because of a failure of the care environment to adequately identify and meet the person's needs.
The Center for Medicare and Medicaid Services indicate that nearly 21% of nursing-home residents who don't have a psychosis diagnosis are on these anti-psychotic drugs. It is a way to sedate a person – in the short run --- but without addressing the issues at hand and at the same time setting the stage for complex negative side effects from the drug.
Three of the most frequently prescribed (I should say mis-prescribed) are Risperdal, Zyprexa and Seroquel. All three of these drugs carry "black box warnings", mandated by the FDA, which indicate that 'elderly dementia patients taking these drugs are at higher risk of death.'
Side effects of these drugs include weight gain and stroke, sometimes resulting in death. There is sometimes an increase in blood sugar levels, intolerance to changes in ambient temperature. A most obvious side effect is that of sedation.
Definition of off-label use of a drug.( From my post on January 14, 2008): When a drug has been developed and approved by the FDA for a certain disease or disorder, but a health care provider prescribes it for a condition other than that covered by the drug’s FDA approval, the practice is called off-label use. Physicians attending nursing home residents in far too many cases prescribe any of these antipsychotic drugs as all-purpose tranquilizers
As I write this, I wonder if the broad, expensive, ineffective, harmful and widespread use of off-label antipsychotic drugs among the most vulnerable in our society is a subtle or not-so-subtle manifestation of ageism. Or is it because in our long-term-care system we don't take the time to really know each individual, know him or her as an individual, not just an old person --- who is going to die anyhow ---. Do we as a society, as Dr. Bill Thomas suggests, view nursing home residents as racing toward the exit ramp of life? Of course none of us subscribes to these views consciously, but are they at work in our society and institutions at a subconscious level?
Friday, November 7, 2008
Wisdom and Grace – at an Early Age
© Imelda Maurer, cdp 2008 All Rights Reserved. Permissions: ilmcdp@yahoo.com
Earlier today I took time to watch President-Elect Barak Obama's first press conference. Nothing in the content was surprising or new; Barak has campaigned with a consistent theme these many months. What I continue to be impressed with is his astute sense and practice of creative, effective leadership.
We are in the midst of the worst economic decline since the Great Depression. On September 25th, when McCain was suggesting that the first Presidential Debate be cancelled so that business could be taken care of, Obama had gathered around him a team of the best and the brightest from whom to seek advice. Again today, his press conference was preceded by a 'summit' with some 18 top economic experts. How telling it was, I thought, that those individuals who make up a brain trust in this important area, were invited to share the stage with the President-Elect.
Surely President Obama will make the final decisions because the buck really does stop there in the Oval Office. But at the same time, there is no "front and center", "I'm 'the one', "I'm in charge and I'll take care of it" kind of leadership style with Obama. Rather, there is an extremely confident and intelligent approach that says "I need all of you if this is going to work." "We are in this together and no one of us has all the answers."
It calls to mind once again the words of Sister Joan Chittister when she received the Leadership Award from the Leadership Conference of Women Religious in 2007.
"What we need again is leadership that seeks out, that encourages, that enables, that frees the theorists, the reformers, the revolutionaries and the charismatic models among us so we can all see the light. Enlightened leadership engages all of them together in one great enterprise of fire and flame in a dark, dark world. We need leadership that authorizes the leadership of the rest (of the group). We need leadership that will follow the lights within the group to the edge of tomorrow rather than the preservation of yesterday."
Blessings on you, President-Elect Obama. May our Provident God continue to guide your way in wisdom and in grace.
And thank you, Mr. President-Elect, for stirring the hope that dwells within each of us and for lighting its bright fire once again within us all.
"Hope won."
Earlier today I took time to watch President-Elect Barak Obama's first press conference. Nothing in the content was surprising or new; Barak has campaigned with a consistent theme these many months. What I continue to be impressed with is his astute sense and practice of creative, effective leadership.
We are in the midst of the worst economic decline since the Great Depression. On September 25th, when McCain was suggesting that the first Presidential Debate be cancelled so that business could be taken care of, Obama had gathered around him a team of the best and the brightest from whom to seek advice. Again today, his press conference was preceded by a 'summit' with some 18 top economic experts. How telling it was, I thought, that those individuals who make up a brain trust in this important area, were invited to share the stage with the President-Elect.
Surely President Obama will make the final decisions because the buck really does stop there in the Oval Office. But at the same time, there is no "front and center", "I'm 'the one', "I'm in charge and I'll take care of it" kind of leadership style with Obama. Rather, there is an extremely confident and intelligent approach that says "I need all of you if this is going to work." "We are in this together and no one of us has all the answers."
It calls to mind once again the words of Sister Joan Chittister when she received the Leadership Award from the Leadership Conference of Women Religious in 2007.
"What we need again is leadership that seeks out, that encourages, that enables, that frees the theorists, the reformers, the revolutionaries and the charismatic models among us so we can all see the light. Enlightened leadership engages all of them together in one great enterprise of fire and flame in a dark, dark world. We need leadership that authorizes the leadership of the rest (of the group). We need leadership that will follow the lights within the group to the edge of tomorrow rather than the preservation of yesterday."
Blessings on you, President-Elect Obama. May our Provident God continue to guide your way in wisdom and in grace.
And thank you, Mr. President-Elect, for stirring the hope that dwells within each of us and for lighting its bright fire once again within us all.
"Hope won."
Saturday, September 20, 2008
I WANT TO GO HOME!
© September 20, 2008 Imelda Maurer, cdp
http://news.yahoo.com/s/ap/20080920/ap_on_re_us/medicaid_lawsuit&printer=1;_ylt=Aoi3Z4P_dr7S0rWL6yY9bnZH2ocA
Here is a story (Copy and paste to your browser address box to read entire AP item) of Charles Tood Lee who is fighting mad because he has been "forced from comfort and familiarity into a nursing home." He and the other members of the legal action maintain that Medicaid, the agency now paying for their nursing home care, could just as easily pay for those services to be provided at home.
There are two forces at work here:
One is the ongoing political struggle whereby many providers within the nursing home industry and their lobbyists have been fighting to keep Medicaid reimbursement limited to services provided in the nursing home. They don't want to see their share of Medicaid funds diminished. As if often the case, however, the expenditure of Medicaid funds for nursing home care is higher than for the same care provided at home by qualified care providers.
The other force is the growing movement to provide services at HOME which is finding life from the demands being made by Baby Boomers and also by progressive long-term care providers who honor the deep physical, psychological, spiritual, and social impact of HOME on one's well-being.
I believe it is a movement whose time has come. The traditional nursing home as we know it today is modeled after acute care hospitals. One can tolerate the schedule-first, task-dominated way of life in a hospital for a few days or weeks, but it is no way to live one's life as a matter of course.
Lastly, none of this is intended to deny the necessity of nursing home care at times, for some individuals. Having said that, the environment and every aspect of the nursing home operation must honor the meaning and reality of all that HOME is for each of us.
http://news.yahoo.com/s/ap/20080920/ap_on_re_us/medicaid_lawsuit&printer=1;_ylt=Aoi3Z4P_dr7S0rWL6yY9bnZH2ocA
Here is a story (Copy and paste to your browser address box to read entire AP item) of Charles Tood Lee who is fighting mad because he has been "forced from comfort and familiarity into a nursing home." He and the other members of the legal action maintain that Medicaid, the agency now paying for their nursing home care, could just as easily pay for those services to be provided at home.
There are two forces at work here:
One is the ongoing political struggle whereby many providers within the nursing home industry and their lobbyists have been fighting to keep Medicaid reimbursement limited to services provided in the nursing home. They don't want to see their share of Medicaid funds diminished. As if often the case, however, the expenditure of Medicaid funds for nursing home care is higher than for the same care provided at home by qualified care providers.
The other force is the growing movement to provide services at HOME which is finding life from the demands being made by Baby Boomers and also by progressive long-term care providers who honor the deep physical, psychological, spiritual, and social impact of HOME on one's well-being.
I believe it is a movement whose time has come. The traditional nursing home as we know it today is modeled after acute care hospitals. One can tolerate the schedule-first, task-dominated way of life in a hospital for a few days or weeks, but it is no way to live one's life as a matter of course.
Lastly, none of this is intended to deny the necessity of nursing home care at times, for some individuals. Having said that, the environment and every aspect of the nursing home operation must honor the meaning and reality of all that HOME is for each of us.
Sunday, September 7, 2008
The Colossus
Today's posting is not about aging as such. However, it is a posting that stirs the human heart at any age. We are all familiar with the words that are inscribed below the Statue of Liberty. Enclosed below is the entire poem. Reading the entire poem lends even deeper meaning to those inscribed words.
The New Colossus
by Emma Lazarus, New York City, 1883
Not like the brazen giant of Greek fame
With conquering limbs astride from land to land;
Here at our sea-washed, sunset gates shall stand
A mighty woman with a torch, whose flame
Is the imprisoned lightning, and her name
Mother of Exiles. From her beacon-hand
Glows world-wide welcome; her mild eyes command
The air-bridged harbor that twin cities frame,
"Keep, ancient lands, your storied pomp!" cries she
With silent lips. "Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore,
Send these, the homeless, tempest-tossed to me,
I lift my lamp beside the golden door!"
It seems appropriate to remember the inscribed words and the entire work of Emma Lazarus at this pivotal time in our country's history as we approach a noteworthy Presidential election which will hold consequences that will ripple into the next decades.
The New Colossus
by Emma Lazarus, New York City, 1883
Not like the brazen giant of Greek fame
With conquering limbs astride from land to land;
Here at our sea-washed, sunset gates shall stand
A mighty woman with a torch, whose flame
Is the imprisoned lightning, and her name
Mother of Exiles. From her beacon-hand
Glows world-wide welcome; her mild eyes command
The air-bridged harbor that twin cities frame,
"Keep, ancient lands, your storied pomp!" cries she
With silent lips. "Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore,
Send these, the homeless, tempest-tossed to me,
I lift my lamp beside the golden door!"
It seems appropriate to remember the inscribed words and the entire work of Emma Lazarus at this pivotal time in our country's history as we approach a noteworthy Presidential election which will hold consequences that will ripple into the next decades.
Monday, August 18, 2008
ADVOCATES FOR THE NEW OLD AGE
The Pioneer Network is a remarkable coalition of individuals and organizations who are actively engaged in what has been come to be known as "Culture Change" in long-term care. The vision of this organization and its members is value-laden, based on values of honor and respect for the individual and belief in the potential for continued growth and development in every stage of life.
This coalition has a short (perhaps five minutes) video at the following URL. You may want to view it. I have transcribed some of the dialog here that reflects such basic, wholesome, positive views on aging and conditions in the present dysfunctional system of long-term care that beg to be "fixed."
http://www.pioneernetwork.net/getinvolved/
ADVOCATES FOR THE NEW OLD AGE
We are all aging from birth. Boomers are living longer, healthier lives. But like previous generations we shrink in fear of our own aging and the thought of being cared for by others.
Joanne Rader, RN, MSN author, "Bathing Without a Battle"
"Dependency and loss of control are the biggest fears that we have. Many have observed their parents experiencing lack of choice, dignity, and privacy in care settings. Fifty percent of those over 65 will, at some point, need assistance. And for many the nursing home is the only available choice right now. But the present does not have to be our future if Baby Boomers take action now. Seeing what our parents experience is a powerful catalyst for change because we know we are next."
Transforming how we grow old.
Imogene Higbie, age 89. Independent 89-year old living alone in her own home not far from her daughters. Four years ago she became ill and had to move to a nursing home and to assisted living. Her experiences encouraged her to fight not only for improving conditions there, but for transforming how we grow old in America.
"I went in as a person. I expected to become a patient, but I didn't expect to lose myself – which is what happened to me. And I realized that the system I was in was dysfunctional and needed fixing."
Jennifer Macial, daughter
"The experience was intense on every level and even though she was safe and sound physically, it didn't seem to be the place to heal, to grow, to evolve, to move forward and to contribute."
Pioneer Network is taking on the culture of aging in America.
Beth Baker: author of "Old Age in a New Age"
"There are 4,000 more nursing homes in America than McDonalds, not to mention thousands of assisted living centers. So change will take time. But I found (in researching for her book) a lot to be hopeful about. I found places that look and feel like home. I interviewed dozens of workers who are excited to come to work every day. And best of all I found that a lot of these places were solving costly problems and were affordable to everyone.
"This movement is grounded in values of honoring individuals and creating strong communities. If you can bring those values and that vision to all settings, wherever elders live that will be a very exciting future for all of us, for our loved ones and for ourselves as we grow old."
Since its inception in 1997, the Pioneer Network is showing change can happen. Wherever we choose to live our older years, the fullness of life is possible. Pioneer Network is working to replace the traditional nursing home with settings that are really home in both environments and relationships
Pioneer Network is also promoting new alternatives to live at home and in the community where generations can thrive together.
Imogene Higbie elder, activist, consumer
"I realized that old people, if they are informed and want to change things have a lot of power. I found that in my old age that my activism has been effective because I'm old and informed. And I think that is what happening. I hope people realize that when they get old they can speak up, share their experiences and make things better for their children who happen to be our Baby Boomer generation."
Steve Shields, President/CEO of Meadowlark Hills Retirement Community, Manhattan, KS
"As boomers we can dispel the notion that aging is just a time of loss. Aging is a time of self actualization and growth and hope."
--- And to ponder ----
Do I see my own aging as a time of self actualizaion, growth and hope? If not, why not?
How would life in a nursing home you may know and visit look in the programs of daily life, policies, relationships, organizational structure, rate of staff turnover, quality of life and well-being of those who live and work there, if every person who has power to impact an elder's life, starting with the administrator and the board of directors believed in the concept of aging as a time of self actualization, growth and hope and that s/he will one day be old and perhaps dependent?
This coalition has a short (perhaps five minutes) video at the following URL. You may want to view it. I have transcribed some of the dialog here that reflects such basic, wholesome, positive views on aging and conditions in the present dysfunctional system of long-term care that beg to be "fixed."
http://www.pioneernetwork.net/getinvolved/
ADVOCATES FOR THE NEW OLD AGE
We are all aging from birth. Boomers are living longer, healthier lives. But like previous generations we shrink in fear of our own aging and the thought of being cared for by others.
Joanne Rader, RN, MSN author, "Bathing Without a Battle"
"Dependency and loss of control are the biggest fears that we have. Many have observed their parents experiencing lack of choice, dignity, and privacy in care settings. Fifty percent of those over 65 will, at some point, need assistance. And for many the nursing home is the only available choice right now. But the present does not have to be our future if Baby Boomers take action now. Seeing what our parents experience is a powerful catalyst for change because we know we are next."
Transforming how we grow old.
Imogene Higbie, age 89. Independent 89-year old living alone in her own home not far from her daughters. Four years ago she became ill and had to move to a nursing home and to assisted living. Her experiences encouraged her to fight not only for improving conditions there, but for transforming how we grow old in America.
"I went in as a person. I expected to become a patient, but I didn't expect to lose myself – which is what happened to me. And I realized that the system I was in was dysfunctional and needed fixing."
Jennifer Macial, daughter
"The experience was intense on every level and even though she was safe and sound physically, it didn't seem to be the place to heal, to grow, to evolve, to move forward and to contribute."
Pioneer Network is taking on the culture of aging in America.
Beth Baker: author of "Old Age in a New Age"
"There are 4,000 more nursing homes in America than McDonalds, not to mention thousands of assisted living centers. So change will take time. But I found (in researching for her book) a lot to be hopeful about. I found places that look and feel like home. I interviewed dozens of workers who are excited to come to work every day. And best of all I found that a lot of these places were solving costly problems and were affordable to everyone.
"This movement is grounded in values of honoring individuals and creating strong communities. If you can bring those values and that vision to all settings, wherever elders live that will be a very exciting future for all of us, for our loved ones and for ourselves as we grow old."
Since its inception in 1997, the Pioneer Network is showing change can happen. Wherever we choose to live our older years, the fullness of life is possible. Pioneer Network is working to replace the traditional nursing home with settings that are really home in both environments and relationships
Pioneer Network is also promoting new alternatives to live at home and in the community where generations can thrive together.
Imogene Higbie elder, activist, consumer
"I realized that old people, if they are informed and want to change things have a lot of power. I found that in my old age that my activism has been effective because I'm old and informed. And I think that is what happening. I hope people realize that when they get old they can speak up, share their experiences and make things better for their children who happen to be our Baby Boomer generation."
Steve Shields, President/CEO of Meadowlark Hills Retirement Community, Manhattan, KS
"As boomers we can dispel the notion that aging is just a time of loss. Aging is a time of self actualization and growth and hope."
--- And to ponder ----
Do I see my own aging as a time of self actualizaion, growth and hope? If not, why not?
How would life in a nursing home you may know and visit look in the programs of daily life, policies, relationships, organizational structure, rate of staff turnover, quality of life and well-being of those who live and work there, if every person who has power to impact an elder's life, starting with the administrator and the board of directors believed in the concept of aging as a time of self actualization, growth and hope and that s/he will one day be old and perhaps dependent?
Sunday, August 10, 2008
Lee Chung Hi
"In screaming, Lee Chung Hi had used her only tool for hanging on to herself…"
This blog entry is longer than most of mine. The sacredness, poignancy and deep symbolism of the story that I excerpt here, however, merits its telling. It's a story of a woman with courage, reaching out in the only way left to her, and of an exceptional leader who trusted his gut instincts about his nursing home which kept telling him: 'It can be better. We must make it better.'
The author of the events recounted in the story that follows is Steve Shields, CEO of Meadowlark Hills, a nursing home, in Manhattan, Kansas that Steve guided from "traditional" nursing home to "home", an ongoing journey. I know Steve. He is an effective, professional executive, a leader with qualities stretching across the four types of leadership: intellectual, reformist, revolutionary and charismatic. (For more information about these types of leadership, see Sister Joan Chittister's address at the 2007 LCWR Assembly when she was presented with the Outstanding Leadership award.) Steve's actions flow from a profound faith and contemplative spirit.
I direct you to the book, quoted here, (co-written with LaVrene Norton another faith-based driven advocate for our frail elders). In Pursuit Of The Sunbeam: A Practical Guide To Transformation From Institution To Household. Published by Action Pact Press, 2006.
FROM CHAPTER ONE: 'The Way It Is."
"She screamed for years but nobody ever really heard it until she stopped. It was a shrill, penetrating, constant and unsettling shriek; a noise not readily identified as human. Words were not part of it. She could not form them. Instead, it was the cry of a trapped and desperate animal hoping someone could hear and understand. The howl haunted the nursing home corridors like a shackled ghost intent on settling its business, belying that the source of the sound was less than five feet tall, not even 90 pounds and unable to walk.
Her Asian skin was healthy and beautiful. The Meadowlark Hill staff moistened it with lotion, turned her at night and positioned her at specified intervals. Lee Chung Hi lived year after year, perched in a reclining Geri-chair. It kept her safe and in place. Her graying black hair was brushed and shining. Vital signs were monitored with regularity and her care-plan was carefully executed. She was bathed on schedule at three 'clock on Tuesday and Friday afternoons. By all valued and applied measures in long-term care, she was well cared for. In the nursing notes, and in the minds of all who cared for her, the never-ending screams were the result of dementia . . . an illness of the mind, which surely must have caused her initial placement. But then nobody remembered for sure.
The other residents were routinely lined up outside the dining room to wait for lunch. Lee Chung Hi ate alone in her chair, parked in the corridor farthest from where people gathered. Nobody – residents, staff or visitor – wanted to be near her. Caregivers attended to her dutifully, yet her noise repelled them. She ate alone, sat alone and slept alone.
She became her noise in the eyes of everyone. But nobody could hear her screaming for what it truly was. It never occurred to us that we might be the cause of it – we, who carry out the biddings of a system lethal to the human spirit.
Years passed before we finally understood it. And not until we transformed Meadowlark Hills into a vibrant household community and witnessed Lee Chun Hi's parallel transformation did we realize how profoundly appropriate her screaming had been in response to the dehumanizing conditions in which she lived."
FROM CHAPTER SIX: "The Essential Elements of the Household Model"
"I rang the doorbell and Susan, a household employee, answered the door and welcomed me in. I saw a warmly furnished living room and an adjacent kitchen and dining room; all appointed like any other home in America. The residents, an average of sixteen per household, had moved in less than two weeks before.
The signs of home were already visible amid what previously had been public corridors, cramped bedrooms and large public gathering rooms. The institutional odor was gone. My stomach growled in response to the smells of breakfast floating from the household kitchen. The previous set of monotonous unit style chairs, tables and other office-like trappings had gone to the auction block to make way for more cozy furnishings.
People were visiting with one another and, in stark contrast to the dismal scene of slumping, slumbering elders once parked at the now-dismantled nurses' station, a more inspiring dance of life unfolded. My heart warmed with hope.
But all the blossoming signs of home faded into the background when my eyes found Lee Chung Hi, the lady who screams. She had abandoned her Geri-chair and was sitting comfortably at the dining table, just as my wife had sat at our kitchen table when I left home for work that morning.
It was the first time I had seen Lee Chung Hi when she wasn't screaming.
She was smiling. Her eyes locked with mine, conveying a warmth of well-being that sent me into a suspended sense of time and place. All I could see was her warm smile and radiating eyes of peace, and I felt myself walking toward her as if in slow motion.
I stopped near her table. With her hands at her side, she bowed her head slowly forward and then back up, all the while continuing her smile. This gesture of greeting and respect, practiced in her culture yet universally understood, enveloped my whole being. I found myself returning the gesture in full communion. I was able to return eye contact and nod in mutual affirmation before emotion overtook me.
Her years of screaming, contrasted with the moment we had just shared, represented to me everything we must leave behind and everything we must achieve. The glaring reality was that she hadn't screamed for years because she was sick, but because we were.
In screaming, Lee Chung Hi had used her only tool for hanging on to herself rather than giving in to vacant slumping. She was a fighter -- a screaming indictment of the traditional nursing home system and proof in the pudding that we can overcome; that we have a moral imperative to do so."
This blog entry is longer than most of mine. The sacredness, poignancy and deep symbolism of the story that I excerpt here, however, merits its telling. It's a story of a woman with courage, reaching out in the only way left to her, and of an exceptional leader who trusted his gut instincts about his nursing home which kept telling him: 'It can be better. We must make it better.'
The author of the events recounted in the story that follows is Steve Shields, CEO of Meadowlark Hills, a nursing home, in Manhattan, Kansas that Steve guided from "traditional" nursing home to "home", an ongoing journey. I know Steve. He is an effective, professional executive, a leader with qualities stretching across the four types of leadership: intellectual, reformist, revolutionary and charismatic. (For more information about these types of leadership, see Sister Joan Chittister's address at the 2007 LCWR Assembly when she was presented with the Outstanding Leadership award.) Steve's actions flow from a profound faith and contemplative spirit.
I direct you to the book, quoted here, (co-written with LaVrene Norton another faith-based driven advocate for our frail elders). In Pursuit Of The Sunbeam: A Practical Guide To Transformation From Institution To Household. Published by Action Pact Press, 2006.
FROM CHAPTER ONE: 'The Way It Is."
"She screamed for years but nobody ever really heard it until she stopped. It was a shrill, penetrating, constant and unsettling shriek; a noise not readily identified as human. Words were not part of it. She could not form them. Instead, it was the cry of a trapped and desperate animal hoping someone could hear and understand. The howl haunted the nursing home corridors like a shackled ghost intent on settling its business, belying that the source of the sound was less than five feet tall, not even 90 pounds and unable to walk.
Her Asian skin was healthy and beautiful. The Meadowlark Hill staff moistened it with lotion, turned her at night and positioned her at specified intervals. Lee Chung Hi lived year after year, perched in a reclining Geri-chair. It kept her safe and in place. Her graying black hair was brushed and shining. Vital signs were monitored with regularity and her care-plan was carefully executed. She was bathed on schedule at three 'clock on Tuesday and Friday afternoons. By all valued and applied measures in long-term care, she was well cared for. In the nursing notes, and in the minds of all who cared for her, the never-ending screams were the result of dementia . . . an illness of the mind, which surely must have caused her initial placement. But then nobody remembered for sure.
The other residents were routinely lined up outside the dining room to wait for lunch. Lee Chung Hi ate alone in her chair, parked in the corridor farthest from where people gathered. Nobody – residents, staff or visitor – wanted to be near her. Caregivers attended to her dutifully, yet her noise repelled them. She ate alone, sat alone and slept alone.
She became her noise in the eyes of everyone. But nobody could hear her screaming for what it truly was. It never occurred to us that we might be the cause of it – we, who carry out the biddings of a system lethal to the human spirit.
Years passed before we finally understood it. And not until we transformed Meadowlark Hills into a vibrant household community and witnessed Lee Chun Hi's parallel transformation did we realize how profoundly appropriate her screaming had been in response to the dehumanizing conditions in which she lived."
FROM CHAPTER SIX: "The Essential Elements of the Household Model"
"I rang the doorbell and Susan, a household employee, answered the door and welcomed me in. I saw a warmly furnished living room and an adjacent kitchen and dining room; all appointed like any other home in America. The residents, an average of sixteen per household, had moved in less than two weeks before.
The signs of home were already visible amid what previously had been public corridors, cramped bedrooms and large public gathering rooms. The institutional odor was gone. My stomach growled in response to the smells of breakfast floating from the household kitchen. The previous set of monotonous unit style chairs, tables and other office-like trappings had gone to the auction block to make way for more cozy furnishings.
People were visiting with one another and, in stark contrast to the dismal scene of slumping, slumbering elders once parked at the now-dismantled nurses' station, a more inspiring dance of life unfolded. My heart warmed with hope.
But all the blossoming signs of home faded into the background when my eyes found Lee Chung Hi, the lady who screams. She had abandoned her Geri-chair and was sitting comfortably at the dining table, just as my wife had sat at our kitchen table when I left home for work that morning.
It was the first time I had seen Lee Chung Hi when she wasn't screaming.
She was smiling. Her eyes locked with mine, conveying a warmth of well-being that sent me into a suspended sense of time and place. All I could see was her warm smile and radiating eyes of peace, and I felt myself walking toward her as if in slow motion.
I stopped near her table. With her hands at her side, she bowed her head slowly forward and then back up, all the while continuing her smile. This gesture of greeting and respect, practiced in her culture yet universally understood, enveloped my whole being. I found myself returning the gesture in full communion. I was able to return eye contact and nod in mutual affirmation before emotion overtook me.
Her years of screaming, contrasted with the moment we had just shared, represented to me everything we must leave behind and everything we must achieve. The glaring reality was that she hadn't screamed for years because she was sick, but because we were.
In screaming, Lee Chung Hi had used her only tool for hanging on to herself rather than giving in to vacant slumping. She was a fighter -- a screaming indictment of the traditional nursing home system and proof in the pudding that we can overcome; that we have a moral imperative to do so."
Thursday, May 29, 2008
Do You Remember Evelyn?
On my March 15th entry I recounted the story of Sharon and her siblings as they dealt with their mother Evelyn and her experience with medically induced dementia. Earlier this week one of her older siblings, whom I also taught, wrote to me. In that letter, Jack commented on that entry remarking that what I said was "right on the mark." With his permission I include the rest of his comments
"Mom now talks like she did 10 years ago. You are right. You can't give anyone that kind of mind affecting medication and expect them to cope. I wish health care providers would sometimes just take a step back and really think about the types and quantities of medications they are prescribing for the elderly. As you said the real tragedy is that many elderly people don't have a loved one to help. It really took a toll on Sharon as well as Mom. I'm glad it is over. Mom is physically healthy for her age (85). Now that she is "dried out" perhaps she can enjoy more of her remaining years."
I was moved to post this entry today after reading a story on cnn.com entitled, "Is Grandma Drugged Up?" The link to this story, both a video and a text story, is listed below, documenting what evidently happens all too frequently to elderly Americans. You can cut and paste this URL in the address box of your browser.
http://www.cnn.com/2008/HEALTH/conditions/05/28/ep.age.meds/index.html
"Mom now talks like she did 10 years ago. You are right. You can't give anyone that kind of mind affecting medication and expect them to cope. I wish health care providers would sometimes just take a step back and really think about the types and quantities of medications they are prescribing for the elderly. As you said the real tragedy is that many elderly people don't have a loved one to help. It really took a toll on Sharon as well as Mom. I'm glad it is over. Mom is physically healthy for her age (85). Now that she is "dried out" perhaps she can enjoy more of her remaining years."
I was moved to post this entry today after reading a story on cnn.com entitled, "Is Grandma Drugged Up?" The link to this story, both a video and a text story, is listed below, documenting what evidently happens all too frequently to elderly Americans. You can cut and paste this URL in the address box of your browser.
http://www.cnn.com/2008/HEALTH/conditions/05/28/ep.age.meds/index.html
Tuesday, May 20, 2008
We Are a Pilgrim People, We Are the Church of God
© May 20, 2008 by Imelda Maurer, cdp
On Pentecost Sunday my parish of Saint Agnes Church experienced a meaningful, moving Pentecost liturgy. The opening hymn had as its refrain, "We are a pilgrim people, we are the Church of God." As I sang, 'pilgrim' conjured up the reality that the nature of pilgrim and pilgrimage is that of moving toward a worthy goal as opposed to a permanent, stable position or condition. In that context I remembered my losses through death over the past year of significant others in my life, women with whom I had shared ministry and community life in significant ways years ago. These women have completed their pilgrimage. The rest of us continue on that path. As we do, we remember those whose faces we no longer see, but whose spirits live within us and within the community. Our Congregation has a beautiful and deeply symbolic ritual each summer, remembering those Sisters and Associates who have completed their pilgrimage and gone ahead since our last gathering. It is often poignant when a Sister's picture is flashed onto the media screen, particularly if her death was, by human judgment, too soon in her life or in her illness.
I experienced a similar poignant moment last December while I was on our university campus. I accompanied a lay university professor, the Dean of the School of Professional Studies, to an appointment; our way took us into the entrance of the Main Building. We had just shared a conversation in which she told me how she felt "so called" to be a part of our university primarily because of the high population of first generation Hispanic students and the university's efforts to empower them through a good education.
Of course I had been in that lobby and hallway more times than I can count. But that morning I saw things differently, perhaps because of our recent conversation. I saw again the framed photographs of our university's founding Sisters and of the university Presidents along with other items documenting our history and legacy. Tears welled up immediately with emotions of nostalgia, pride and gratitude. I was so conscious of the richness of my, of our, congregational heritage.
On Tuesday evening before Pentecost, that Main Building of Our Lady of the Lake University, burst into flame about 7:45 p.m., Texas time, the result of an electrical short in the attic above fourth floor. My first call came from a friend in San Antonio when she first saw it on the local TV station. My home phone and cell phone were busy over the next two hours. Calls coming in and going out. No one could grasp the enormity of the inferno, the significance of this loss. The same disbelief followed later as I watched TV website videos taken that evening and the following day.
The loss is a physical building. Like the Sisters who go ahead of us, there is a physical change, but the heritage of our university and its mission live on within us and within the larger community.
The gain is the opportunity for transformation. Fire is itself a symbol of transformation. Joan Chittister addresses the challenge when she reminds U.S. Sisters that though our numbers (Sisters, Sisters who actually are on the staff of our university) are decreasing, "it's not numbers we need. We each have at least as many strong women leaders as we had when we started."
And so we do! I ask the readers of this blog to keep our Sisters and our university in your prayers. We will rebuild. Let us pray that in the process of rebuilding that the mission is maintained --- no, strengthened, born anew through this potentially transforming event. Let us pray that our foremothers who provided this legacy are with us in spirit and grace throughout this task. Let us pray that the Sisters and staff at Our Lady of the Lake University and all CDPs can be engaged "in one great enterprise of fire and flame" (Chittister), that the leadership within all of us will "follow the lights . . . to the edge of tomorrow rather than the preservation of yesterday." (Chittister)
Another part of the refrain of our Pentecost gathering hymn speaks of the Spirit –sometimes represented as tongues of fire: "United in one spirit, ignited by the fire." And so may we all be.
On Pentecost Sunday my parish of Saint Agnes Church experienced a meaningful, moving Pentecost liturgy. The opening hymn had as its refrain, "We are a pilgrim people, we are the Church of God." As I sang, 'pilgrim' conjured up the reality that the nature of pilgrim and pilgrimage is that of moving toward a worthy goal as opposed to a permanent, stable position or condition. In that context I remembered my losses through death over the past year of significant others in my life, women with whom I had shared ministry and community life in significant ways years ago. These women have completed their pilgrimage. The rest of us continue on that path. As we do, we remember those whose faces we no longer see, but whose spirits live within us and within the community. Our Congregation has a beautiful and deeply symbolic ritual each summer, remembering those Sisters and Associates who have completed their pilgrimage and gone ahead since our last gathering. It is often poignant when a Sister's picture is flashed onto the media screen, particularly if her death was, by human judgment, too soon in her life or in her illness.
I experienced a similar poignant moment last December while I was on our university campus. I accompanied a lay university professor, the Dean of the School of Professional Studies, to an appointment; our way took us into the entrance of the Main Building. We had just shared a conversation in which she told me how she felt "so called" to be a part of our university primarily because of the high population of first generation Hispanic students and the university's efforts to empower them through a good education.
Of course I had been in that lobby and hallway more times than I can count. But that morning I saw things differently, perhaps because of our recent conversation. I saw again the framed photographs of our university's founding Sisters and of the university Presidents along with other items documenting our history and legacy. Tears welled up immediately with emotions of nostalgia, pride and gratitude. I was so conscious of the richness of my, of our, congregational heritage.
On Tuesday evening before Pentecost, that Main Building of Our Lady of the Lake University, burst into flame about 7:45 p.m., Texas time, the result of an electrical short in the attic above fourth floor. My first call came from a friend in San Antonio when she first saw it on the local TV station. My home phone and cell phone were busy over the next two hours. Calls coming in and going out. No one could grasp the enormity of the inferno, the significance of this loss. The same disbelief followed later as I watched TV website videos taken that evening and the following day.
The loss is a physical building. Like the Sisters who go ahead of us, there is a physical change, but the heritage of our university and its mission live on within us and within the larger community.
The gain is the opportunity for transformation. Fire is itself a symbol of transformation. Joan Chittister addresses the challenge when she reminds U.S. Sisters that though our numbers (Sisters, Sisters who actually are on the staff of our university) are decreasing, "it's not numbers we need. We each have at least as many strong women leaders as we had when we started."
And so we do! I ask the readers of this blog to keep our Sisters and our university in your prayers. We will rebuild. Let us pray that in the process of rebuilding that the mission is maintained --- no, strengthened, born anew through this potentially transforming event. Let us pray that our foremothers who provided this legacy are with us in spirit and grace throughout this task. Let us pray that the Sisters and staff at Our Lady of the Lake University and all CDPs can be engaged "in one great enterprise of fire and flame" (Chittister), that the leadership within all of us will "follow the lights . . . to the edge of tomorrow rather than the preservation of yesterday." (Chittister)
Another part of the refrain of our Pentecost gathering hymn speaks of the Spirit –sometimes represented as tongues of fire: "United in one spirit, ignited by the fire." And so may we all be.
Sunday, April 13, 2008
A Mission Statement That Gets to the Heart of It All
Southwest Airlines is my airline of choice for reasons beyond its 'byte-sized' fares. I particularly appreciate and enjoy the unique spirit of customer-focused service that is evident throughout its system and the cheerful, friendly ambiance of its employees. Perhaps because of its customer focus, Southwest is the only airline in the United States that has made a profit every quarter since its first quarterly profit as a young start-up company in the early '70s. Even after 9-11. Southwest realized a profit before any receipt of the government subsidies that were provided during this time of crisis for the airlines.
Last week on a Southwest flight, I read with great interest, "Colleen's Corner", the regular column written by Colleen Barrett, President, in their Spirit magazine. Colleen, a part of Southwest since its inception in the early 70's, writes in the April issue about Southwest's Mission Statement.
Speaking for Southwest, Colleen notes that their Mission Statement deliberately never mentions flying airplanes, making a profit, or providing a return to shareholders. All airlines are alike in this regard, she says. "Instead, we use our Mission Statement to explain how we will accomplish these business goals."
Their short Mission Statement has two sections. One addresses their external customers; that's us, the passengers. The second section addresses its internal customers: its employees. Southwest states its commitment, promising job stability and personal and professional development. The company pledges to treat its internal customers the same way it asks them to treat its external customers. Colleen makes clear that Southwest knows that without employees the "Right Employees", there would be, at best, poor customer service. And with poor customer service, there would be no more customers.
For many frail elders, there is no or little choice in where they live their last years. In such cases, "poor customer service" does not mean no customers, unfortunately. For those who reside in retirement communities where the focus is on customer service, both external and internal customers, those elders undoubtedly experience a higher quality of life, and the staff experiences satisfaction in their work, a low turnover rate, and input into how the organization moves toward its goal. (I've just described transformative nursing homes!)
Some retirement communities may not have a written Mission Statement. But whether one exists or not, every organization operates according to some mission statement, a philosophy. The 'operative' Mission Statement is revealed in the values and attitudes that permeate the policies, programs and procedures of the community, and how the employees, from CEO to the newest hire, approach and carry out their work. The goal is always to work toward and to assure that, first, the written words are really what we believe and value, and, secondly, that they are made operable day to day for each elder in the community and each employee.
Colleen's column is available online at
http://www.spiritmag.com/2008_04/colleenscorner/index.php
Copy and paste the above address into the address box on your internet page
Here is the Mission Statement of Southwest Airlines, stated in its entirety, (84 words!) also on page 14:
The mission of Southwest Airlines is dedication to the highest quality of Customer Service delivered with a sense of warmth, friendliness, individual pride and Company Spirit.
We are committed to provide our Employees a stable work environment with equal opportunity for learning and personal growth. Creativity and innovation are encouraged for improving the effectiveness of Southwest airlines. Above all, Employees will be provided the same concern, respect, and caring attitude within the organization that they are expected to share externally with every Southwest Customer.
Last week on a Southwest flight, I read with great interest, "Colleen's Corner", the regular column written by Colleen Barrett, President, in their Spirit magazine. Colleen, a part of Southwest since its inception in the early 70's, writes in the April issue about Southwest's Mission Statement.
Speaking for Southwest, Colleen notes that their Mission Statement deliberately never mentions flying airplanes, making a profit, or providing a return to shareholders. All airlines are alike in this regard, she says. "Instead, we use our Mission Statement to explain how we will accomplish these business goals."
Their short Mission Statement has two sections. One addresses their external customers; that's us, the passengers. The second section addresses its internal customers: its employees. Southwest states its commitment, promising job stability and personal and professional development. The company pledges to treat its internal customers the same way it asks them to treat its external customers. Colleen makes clear that Southwest knows that without employees the "Right Employees", there would be, at best, poor customer service. And with poor customer service, there would be no more customers.
For many frail elders, there is no or little choice in where they live their last years. In such cases, "poor customer service" does not mean no customers, unfortunately. For those who reside in retirement communities where the focus is on customer service, both external and internal customers, those elders undoubtedly experience a higher quality of life, and the staff experiences satisfaction in their work, a low turnover rate, and input into how the organization moves toward its goal. (I've just described transformative nursing homes!)
Some retirement communities may not have a written Mission Statement. But whether one exists or not, every organization operates according to some mission statement, a philosophy. The 'operative' Mission Statement is revealed in the values and attitudes that permeate the policies, programs and procedures of the community, and how the employees, from CEO to the newest hire, approach and carry out their work. The goal is always to work toward and to assure that, first, the written words are really what we believe and value, and, secondly, that they are made operable day to day for each elder in the community and each employee.
Colleen's column is available online at
http://www.spiritmag.com/2008_04/colleenscorner/index.php
Copy and paste the above address into the address box on your internet page
Here is the Mission Statement of Southwest Airlines, stated in its entirety, (84 words!) also on page 14:
The mission of Southwest Airlines is dedication to the highest quality of Customer Service delivered with a sense of warmth, friendliness, individual pride and Company Spirit.
We are committed to provide our Employees a stable work environment with equal opportunity for learning and personal growth. Creativity and innovation are encouraged for improving the effectiveness of Southwest airlines. Above all, Employees will be provided the same concern, respect, and caring attitude within the organization that they are expected to share externally with every Southwest Customer.
Saturday, March 15, 2008
Dementia and Medications - A Personal View
Sharon was a freshman when I taught her in the late '60s. She lived with her other siblings in a nice home in a new part of town. Their dad was a successful businessman. I always experienced their mother, Evelyn, as a warm and delightful woman: devoted housewife and mother; active in church, PTA and school fundraising efforts; always gracious, hospitable, loving and with a great sense of humor.
Yesterday I had a call from Sharon. She was responding to a message I had left on her home phone when I had been unable to reach her mother who now lives in an assisted living community. My apprehensions had been well-founded. Over the past six months, Evelyn had been in and out of the hospital twice, in two nursing homes, in rehab, and finally back to where she has been living for the past several years.
Evelyn was discharged, at some point during this six-month ordeal, from the hospital to a nursing home for some rehab. Sharon is a devoted, faithful daughter. Her love for her mother is expressed not only by her presence, but by her strong and effective advocacy. (Mary Hunt, theologian, would call this "Fierce Tenderness".) Within a week of Evelyn being admitted to this nursing home, Sharon saw her mother decline from a woman who suffers from back and hip pain, to a woman restrained in her wheelchair, drooling, defecating on herself, unable to recognize her daughter, and physically unable to maneuver the simple task of taking a facial tissue out of its box.
"My mother does not have dementia," Sharon told the staff. She asked questions; she studied the nursing home medical chart; she discovered that when her mother would call out for help that the staff would medicate her and physically restrain her (!!). Sharon took the list of medications her mother had been put on to a pharmacist. That was the core problem: a mixture of almost a dozen medications for pain, and psychotropics. Sharon immediately moved Evelyn to another long-term care community where the doctor literally weaned Evelyn off her toxic regimen of medications.
Yes, Evelyn DID have dementia. It was MEDICALLY INDUCED DEMENTIA and therefore, thank God, reversible. (The tragic injustice is that it occurs in the first place.) Sharon says "we have her almost back to where she used to be. I'm just grateful that she does not remember what she went through."
It has been a difficult journey, not only for Evelyn, but for Sharon and her siblings who have companioned their mother during a very long and difficult time. Again, thank God that Evelyn has children who, out of filial love, will look after her best interests. How many residents in nursing homes do not have children who will look after their best interests? Let me say, as a Catholic Sister that would be 100% of us! We Sisters must be those advocates for our frail elderly Sisters now and the younger among us, for us when the need arises.
Childless or not, as I said at the end of my last post, "We will either change it or live it.
© Imelda Maurer, cdp 2008 All Rights Reserved. Permissions: ilmcdp@yahoo.com
Yesterday I had a call from Sharon. She was responding to a message I had left on her home phone when I had been unable to reach her mother who now lives in an assisted living community. My apprehensions had been well-founded. Over the past six months, Evelyn had been in and out of the hospital twice, in two nursing homes, in rehab, and finally back to where she has been living for the past several years.
Evelyn was discharged, at some point during this six-month ordeal, from the hospital to a nursing home for some rehab. Sharon is a devoted, faithful daughter. Her love for her mother is expressed not only by her presence, but by her strong and effective advocacy. (Mary Hunt, theologian, would call this "Fierce Tenderness".) Within a week of Evelyn being admitted to this nursing home, Sharon saw her mother decline from a woman who suffers from back and hip pain, to a woman restrained in her wheelchair, drooling, defecating on herself, unable to recognize her daughter, and physically unable to maneuver the simple task of taking a facial tissue out of its box.
"My mother does not have dementia," Sharon told the staff. She asked questions; she studied the nursing home medical chart; she discovered that when her mother would call out for help that the staff would medicate her and physically restrain her (!!). Sharon took the list of medications her mother had been put on to a pharmacist. That was the core problem: a mixture of almost a dozen medications for pain, and psychotropics. Sharon immediately moved Evelyn to another long-term care community where the doctor literally weaned Evelyn off her toxic regimen of medications.
Yes, Evelyn DID have dementia. It was MEDICALLY INDUCED DEMENTIA and therefore, thank God, reversible. (The tragic injustice is that it occurs in the first place.) Sharon says "we have her almost back to where she used to be. I'm just grateful that she does not remember what she went through."
It has been a difficult journey, not only for Evelyn, but for Sharon and her siblings who have companioned their mother during a very long and difficult time. Again, thank God that Evelyn has children who, out of filial love, will look after her best interests. How many residents in nursing homes do not have children who will look after their best interests? Let me say, as a Catholic Sister that would be 100% of us! We Sisters must be those advocates for our frail elderly Sisters now and the younger among us, for us when the need arises.
Childless or not, as I said at the end of my last post, "We will either change it or live it.
© Imelda Maurer, cdp 2008 All Rights Reserved. Permissions: ilmcdp@yahoo.com
Tuesday, March 4, 2008
Dancing with Rose -- the Book
The author of this book is Lauren Kessler, a journalist whose mother died of Alzheimer's. Eight years after her mother's death, Lauren wanted to learn more about the disease, to confront what she had been too frightened to confront at the time of her mother's illness. She admits that it was an attempt, in part, "to make up for being a lousy daughter."
Her avenue of learning was to take a position as a Resident Assistant at 'Maplewood', an Assisted Living facility which specializes in Alzheimer's Care. (I use the word 'facility' deliberately. As one reads the book, it is clear that despite the love and care of the caregivers, there is, as a result of the corporate model, an institutional approach to care. It is run by schedule; it is not person-centered. It is not a community; it is a facility.)
Undoubtedly the touching descriptions of her bonding with the residents ring true, and leave the reader with a sense of gratitude. Lauren loves those in her 'neighborhood' and she senses that same devotion among many of her peers. She reflects upon a funeral of one of the residents where at least nine staff people from Maplewood are present, some at no small cost. Resident Assistants (RAs) who were scheduled to work that shift have switched with another RA, and they will work a shift for that RA when requested.
One can only conclude that Lauren does not know that long-term care does not have to be in the institutional mode. The transformative power of culture change has not found its way to the corporate offices of the Maplewood chain. Thus, when Lauren reflects on the state of the "eldercare industry", she reflects what is found in the all-too-numerous 'traditional' retirement settings, not the transformative HOME of culture change. This is what she says:
She apologizes to a resident for his having to wait for so long after he told her he needed to go to the bathroom. His response was, "I guess that's my job now, to wait."
"I think about Larry's comment for the rest of the day. I think about the time old people spend waiting, not just in places like Maplewood but throughout the eldercare system – nursing homes, assisted living, rehab, any facility that houses those who are no longer able to take care of themselves. They lie in bed, wide awake at 5:00 a.m. waiting for a caregiver to help them get up and dressed. They sit at the table waiting for meals, the first ones wheeled in fifteen or twenty minutes early because it takes so much time to get everyone in their places. They wait, like Larry, to be taken to the bathroom. They wait for attention.
"The problem is understaffing. The problem is undertraining. The problem is high caregiver turnover. The problem is paying minimum wage. The problem is the eldercare industry. (I could go on and so I will: The problem is undervaluing the elderly. The problem is fear of aging. The problem is fear of dying.) Some problems can be easily fixed and others can't. Whatever the problems they are either ours to solve or, twenty or thirty or forty years from now, ours to live." (emphasis mine)
I hope that Lauren and every future long-term-care resident find a person-centered retirement community and then demand that operational philosophy from long-term care providers. We will either change it or live it.
Her avenue of learning was to take a position as a Resident Assistant at 'Maplewood', an Assisted Living facility which specializes in Alzheimer's Care. (I use the word 'facility' deliberately. As one reads the book, it is clear that despite the love and care of the caregivers, there is, as a result of the corporate model, an institutional approach to care. It is run by schedule; it is not person-centered. It is not a community; it is a facility.)
Undoubtedly the touching descriptions of her bonding with the residents ring true, and leave the reader with a sense of gratitude. Lauren loves those in her 'neighborhood' and she senses that same devotion among many of her peers. She reflects upon a funeral of one of the residents where at least nine staff people from Maplewood are present, some at no small cost. Resident Assistants (RAs) who were scheduled to work that shift have switched with another RA, and they will work a shift for that RA when requested.
One can only conclude that Lauren does not know that long-term care does not have to be in the institutional mode. The transformative power of culture change has not found its way to the corporate offices of the Maplewood chain. Thus, when Lauren reflects on the state of the "eldercare industry", she reflects what is found in the all-too-numerous 'traditional' retirement settings, not the transformative HOME of culture change. This is what she says:
She apologizes to a resident for his having to wait for so long after he told her he needed to go to the bathroom. His response was, "I guess that's my job now, to wait."
"I think about Larry's comment for the rest of the day. I think about the time old people spend waiting, not just in places like Maplewood but throughout the eldercare system – nursing homes, assisted living, rehab, any facility that houses those who are no longer able to take care of themselves. They lie in bed, wide awake at 5:00 a.m. waiting for a caregiver to help them get up and dressed. They sit at the table waiting for meals, the first ones wheeled in fifteen or twenty minutes early because it takes so much time to get everyone in their places. They wait, like Larry, to be taken to the bathroom. They wait for attention.
"The problem is understaffing. The problem is undertraining. The problem is high caregiver turnover. The problem is paying minimum wage. The problem is the eldercare industry. (I could go on and so I will: The problem is undervaluing the elderly. The problem is fear of aging. The problem is fear of dying.) Some problems can be easily fixed and others can't. Whatever the problems they are either ours to solve or, twenty or thirty or forty years from now, ours to live." (emphasis mine)
I hope that Lauren and every future long-term-care resident find a person-centered retirement community and then demand that operational philosophy from long-term care providers. We will either change it or live it.
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