I've learned the sad truth that a hard drive can be like an attic or a basement: It too can get very cluttered. I've spent several evenings thinning out and organizing files in "My Documents." This evening I came across the article below. I believe I wrote it with the intention of posting it. However, I do not see it listed in my 6 years of blog posting, so here it is! It was written in 2010 prior to the publication of Dr. Al Power's marvelous book, DEMENTIA BEYOND DRUGS.
-- -- -- -- -- --
Isn’t it amazing how often compassion and common sense aren’t validated until there is an official study or series of studies that address the issue involved.
Within the past year or so there has been one news report after another indicating the prevalence of nursing home residents with dementia being prescribed anti-psychotics. This exists in the face of Black Box Warnings by the FDA indicating that elderly residents with dementia are at an increased risk of death when certain anti-psychotics (Seroquel is a big one) are part of the drug regimen.
Recent Research
A study in Australia was reported in the September issue of Caring for the Ages. The residents in that study all had progressive dementia “with persistent behaviors that made it difficult for staff to care for them.” One group of caregivers was provided two-day training in person-centered care with dementia residents. The residents were tested with scientifically valid check lists to indicate their level of agitation at the beginning of the study and then at four and at eight months after the beginning of the study.
Results
After four months, those residents with dementia receiving “usual care” showed an increase of agitation of almost 9 points on the scales that were used. By contrast, those residents who were cared for in the person-centered care model, showed a decrease of 9 points on the same agitation scale.
So there’s the scientific proof --- medical professionals refer to it as “evidence-based” approach to care –
Drugs prescribed for patients with dementia are not always unnecessary. But it is clear that reaching for a prescription pad the moment a behavior is observed is not good medicine even though it is a prevalent practice in too many nursing homes. Dr. Al Power is a geriatrician and certified medical director who practiced at St. John’s Home in Rochester, NY. He has a book that will be published in the early part of 2010 on this very topic of non-pharmacological approach to dementia care. In his own nursing home practice, Dr. Power told me, an average of six percent of his dementia patients at St. John’s were on anti-psychotics. That’s a wonderful contrast to the national average among nursing home residents with dementia of twenty-eight percent
The call to liberate our elders
When this evidence-based, person-centered approach is used, these elderly residents have been set free from the shackles of unnecessary drugs. Let the work go on!
Thursday, January 16, 2014
Tuesday, January 14, 2014
My Mother . . . . Mama
Recently I received an e-mail from an acquaintance, Lucille I’ll call her, after a long gap in our communications. It was a one-line message: “My mother will probably die today or tomorrow. Please pray.” I responded immediately, sending my prayers and my support. My message included the following: “Regardless of the path there has been in any mother-daughter relationship, I feel it is always the little girl in us who loses her mother.”
Later that same morning I received another e-mail from this woman: “Mama just died at 11:15.”
Consciously or unconsciously, I felt that Lucille had affirmed my feelings about a daughter’s loss of her mother. No longer ‘my mother’, but ‘Mama” what we as children called our mother.
Among the many emotions surrounding my grief at my own mother’s death was one of loss, and the knowledge of the unremitting absence of death that the “little girl” in me felt so keenly. My mother died while she was a resident in a nursing home in the Dallas metroplex. At the time I was living and working as a community organizer in South Carolina and received a shocking phone call one evening from my brother with the news that my mother had died. I had spent an extended period of time with my mother just six weeks prior, as I did regularly and periodically.
My first morning back in Dallas I went to the nursing home as soon as possible. I wanted to learn as much as I could about my mother’s last day. As I walked from the entrance down the hallway, the administrator, Mrs. Wesley, saw me; she left her office, met me, put her arm around my waist and walked me back to her office. I don’t remember a single word of our conversation in her office. I only remember her warmth, compassion and empathy.
For those of us who work in aging services, we walk this path with so many families as they lose a parent. It is part of the day-to-day tasks in our line of work. May we never allow these events to fall into the category of the ordinary lest we not be ready to share our warmth, compassion and empathy with an adult child who just lost his/her Mama.
Later that same morning I received another e-mail from this woman: “Mama just died at 11:15.”
Consciously or unconsciously, I felt that Lucille had affirmed my feelings about a daughter’s loss of her mother. No longer ‘my mother’, but ‘Mama” what we as children called our mother.
Among the many emotions surrounding my grief at my own mother’s death was one of loss, and the knowledge of the unremitting absence of death that the “little girl” in me felt so keenly. My mother died while she was a resident in a nursing home in the Dallas metroplex. At the time I was living and working as a community organizer in South Carolina and received a shocking phone call one evening from my brother with the news that my mother had died. I had spent an extended period of time with my mother just six weeks prior, as I did regularly and periodically.
My first morning back in Dallas I went to the nursing home as soon as possible. I wanted to learn as much as I could about my mother’s last day. As I walked from the entrance down the hallway, the administrator, Mrs. Wesley, saw me; she left her office, met me, put her arm around my waist and walked me back to her office. I don’t remember a single word of our conversation in her office. I only remember her warmth, compassion and empathy.
For those of us who work in aging services, we walk this path with so many families as they lose a parent. It is part of the day-to-day tasks in our line of work. May we never allow these events to fall into the category of the ordinary lest we not be ready to share our warmth, compassion and empathy with an adult child who just lost his/her Mama.
Wednesday, December 18, 2013
If the doctor says this to you, RUN!
This is a recounting of true events, a telephone conversation I had just yesterday. Names have been changed. The woman I spoke with had just lost her husband to a short-lived diagnosis and a painful death. She told me that her husband’s physician encouraged good nutritional habits and exercise. That’s a good thing. However, when her husband continued to complain of ongoing symptoms such as los of energy, loss of stamina and arthritic pain, the doctor’s response, according to this woman, was not to investigate his complaints further, but to say to her husband, “You’re just getting older, George.”
Ageism – alive and well in the medical profession – alive and well in too many of those in whom we place our trust and, indeed, our lives. So yes, if any health care provider uses your age, or the age of anyone for whom you advocate, as the overriding explanation for expressed concerns RUN!! Run to find another physician. Before you run, fire your physician.
AARP The Magazine carried an article addressing this very problem in its August/September 2013 issue. It is good reading and I highly recommend the article: “Is It Time to Find a New Doctor?”
http://www.aarp.org/health/conditions-treatments/info-08-2013/physician-patient-relationship.html
Ageism – alive and well in the medical profession – alive and well in too many of those in whom we place our trust and, indeed, our lives. So yes, if any health care provider uses your age, or the age of anyone for whom you advocate, as the overriding explanation for expressed concerns RUN!! Run to find another physician. Before you run, fire your physician.
AARP The Magazine carried an article addressing this very problem in its August/September 2013 issue. It is good reading and I highly recommend the article: “Is It Time to Find a New Doctor?”
http://www.aarp.org/health/conditions-treatments/info-08-2013/physician-patient-relationship.html
Friday, December 6, 2013
"It just isn't right" . . . Nelson Mandela
There has been uninterrupted comment on cable TV about Nelson Mandela following his death less than twenty-four hours ago as I write this. Mandela was profoundly driven by his dream of a democratic South Africa where all its people would be treated as equals. This dream, this passion permeated his being and was the molding force of all his actions. One fact in particular about this man of deep integrity and persistence has moved me deeply. I learned from Charlayne Hunter-Gault that Mandela’s consistent response to the existence of apartheid was simply: “It’s just not right.”
His deep passion for freedom and democracy expressed itself in that simple phrase and was trhe motivation for his life’s work. I have thought about how our society views aging and how this negative attitude of aging, called ageism, expresses itself too often in the oppression of our elders.
How does ageism show itself even among the most well-intentioned and loving people?
-- In the institutional approach to aging services where tasks are carried out and regulations/policies are implemented without spirit and without the priority of person-before-task;
-- In decisions that are made for and about elders based solely on their chronological age or their place of residence;
-- In the society-accepted practice of segregating elders from the rest of society. Carter Catlett Williams spoke eloquently of this from her own experience when she convened the annual Conference of the Pioneer Network this past August; http://pioneernetwork.net/Events/2013Conference/Convener
-- In any policy that is directed to persons solely on their chronological age;
-- In loving, middle-aged adult children who are convinced that they know what is best for Mom or Dad and force these decisions on the older parents;
-- The same attitude can prevail in well-meaning, good-hearted individuals who by election or appointment have some dimension of authority/responsibility for elders.
In every instance of ageism, of impersonal, institutional responses to elders, we must be that contingent who says, “It just isn’t right” and then follows that conviction with strong, appropriate, persistent advocacy, be that advocacy for ourselves or for others.
His deep passion for freedom and democracy expressed itself in that simple phrase and was trhe motivation for his life’s work. I have thought about how our society views aging and how this negative attitude of aging, called ageism, expresses itself too often in the oppression of our elders.
How does ageism show itself even among the most well-intentioned and loving people?
-- In the institutional approach to aging services where tasks are carried out and regulations/policies are implemented without spirit and without the priority of person-before-task;
-- In decisions that are made for and about elders based solely on their chronological age or their place of residence;
-- In the society-accepted practice of segregating elders from the rest of society. Carter Catlett Williams spoke eloquently of this from her own experience when she convened the annual Conference of the Pioneer Network this past August; http://pioneernetwork.net/Events/2013Conference/Convener
-- In any policy that is directed to persons solely on their chronological age;
-- In loving, middle-aged adult children who are convinced that they know what is best for Mom or Dad and force these decisions on the older parents;
-- The same attitude can prevail in well-meaning, good-hearted individuals who by election or appointment have some dimension of authority/responsibility for elders.
In every instance of ageism, of impersonal, institutional responses to elders, we must be that contingent who says, “It just isn’t right” and then follows that conviction with strong, appropriate, persistent advocacy, be that advocacy for ourselves or for others.
Friday, November 15, 2013
Reading and Re-reading
Earlier this week when I was enjoying the wonderful opportunity to make some homemade bread, I took advantage of the opportunity to listen to some podcasts on my MP3 player as I prepared and kneaded the dough. This particular podcast was from a program that originally aired on NPR’s TALK OF THE NATION back in March, 2011.
Rachel Hadas, author, poet, and professor was the guest. The topic was her book, STRANGE RELATION: A MEMOIR OF MARRIAGE , DEMENTIA AND POETRY which tells of her life as the wife of a brilliant man, George, professor of music at Columbia University and composer, diagnosed at age 61 with dementia.
A few things struck me in this fascinating 30-minute interview
Rachel used her intimate, long-lived knowledge of George in evaluating and analyzing the changes in his life and his ongoing needs. Rachel , in other words, took on the role of advocate for her husband. This reflected her role while he still lived at home and when she found it necessary to place him in a long-term care ‘facility’ as she calls it.
Rachel provides the podcast audience with a wealth of resources from classical and modern literature which describe and/or apply to the reality of dementia in a person’s life. I found Rachel’s descriptions of these literary references quite illuminating. In particular I appreciatede her reflections on the poem, “Walls” by the Greek poet, Cavafy.
With no consideration, no pity, no shame,
they have built walls around me, thick and high.
And now I sit here feeling hopeless.
I can’t think of anything else: this fate gnaws my mind—
because I had so much to do outside.
When they were building the walls, how could I not have noticed!
But I never heard the builders, not a sound.
Imperceptibly they have closed me off from the outside world.
She continues: “Clearly those walls beg for a figurative reading and you could say they are depression or old age or illness, isolation. But this time around the walls looked like dementia.”
Rachel also commented early in the interview that anything worth reading is worth re-reading. She says we miss most of the content in the first reading. Hearing that, I immediately thought of the Constitutions of Religious Institutes of women and men. When we go back to those documents and read them with new eyes we see visionary and challenging calls to read the signs of the times.
One of the signs of the times is the current demographics of the membership of Congregations of men and women religious. What if we read our Constitutions and other significant documents in the context of our present signs of the times? How would that change how we view the ministry of service to our own elder members?
If you are interested in hearing this podcasst, go to the following URL:
http://www.npr.org/2011/03/10/134428733/Spouses-Dementia-Leaves-Poet-A-Strange-Relation
Rachel Hadas, author, poet, and professor was the guest. The topic was her book, STRANGE RELATION: A MEMOIR OF MARRIAGE , DEMENTIA AND POETRY which tells of her life as the wife of a brilliant man, George, professor of music at Columbia University and composer, diagnosed at age 61 with dementia.
A few things struck me in this fascinating 30-minute interview
Rachel used her intimate, long-lived knowledge of George in evaluating and analyzing the changes in his life and his ongoing needs. Rachel , in other words, took on the role of advocate for her husband. This reflected her role while he still lived at home and when she found it necessary to place him in a long-term care ‘facility’ as she calls it.
Rachel provides the podcast audience with a wealth of resources from classical and modern literature which describe and/or apply to the reality of dementia in a person’s life. I found Rachel’s descriptions of these literary references quite illuminating. In particular I appreciatede her reflections on the poem, “Walls” by the Greek poet, Cavafy.
With no consideration, no pity, no shame,
they have built walls around me, thick and high.
And now I sit here feeling hopeless.
I can’t think of anything else: this fate gnaws my mind—
because I had so much to do outside.
When they were building the walls, how could I not have noticed!
But I never heard the builders, not a sound.
Imperceptibly they have closed me off from the outside world.
She continues: “Clearly those walls beg for a figurative reading and you could say they are depression or old age or illness, isolation. But this time around the walls looked like dementia.”
Rachel also commented early in the interview that anything worth reading is worth re-reading. She says we miss most of the content in the first reading. Hearing that, I immediately thought of the Constitutions of Religious Institutes of women and men. When we go back to those documents and read them with new eyes we see visionary and challenging calls to read the signs of the times.
One of the signs of the times is the current demographics of the membership of Congregations of men and women religious. What if we read our Constitutions and other significant documents in the context of our present signs of the times? How would that change how we view the ministry of service to our own elder members?
If you are interested in hearing this podcasst, go to the following URL:
http://www.npr.org/2011/03/10/134428733/Spouses-Dementia-Leaves-Poet-A-Strange-Relation
Wednesday, October 30, 2013
Job postings and their impact on the organization
I find it fascinating to read ads announcing an opening for key positions in aging services. It’s sort of in the same vein in which I read obituaries, about which I wrote recently. An obit can tell ‘just the facts’ – birth, death, survivors, services, and which charities are preferred recipients of memorials. Such an obit reflects nothing of who the person was, how s/he influenced and touched those s/he loved, or what made him or her the unique person each of us is. The deceased person remains an unknown entity.
Job postings are much the same in certain respects, I believe. The content of job postings reflects the degree to which the organization is consciously mission-driven, and reflects the priorities of qualities the organization is looking for in candidates.
Here are two examples of postings for the position of Executive Director that I read just today. Each of these organizations is a church-sponsored, not-for-profit organization.
1.
A non-profit community with a strong foundation of faith and person centered care, is seeking a campus Executive Director who is responsible for leading and directing the community in accordance with resident needs, government regulations, and internal policies and procedures.
Successful candidate must possess a passion for serving older adults, Bachelor’s Degree (MS preferred), . . . . The post continues with a listing of educational requirements and nine skills the candidate should have.
2.
Historic CCRC with nearly 500 residents and 300 employees, on 100 acres, provides a modified Life Care program in the beautiful Shenandoah Valley
Applicants must possess skills in CCRC management, performance improvement and program development, finance and planning skills. Senior leadership experience essential. NHA and five years of experience required. MS preferred.
When the right people are not hired for key positions, an organization can and will face many difficulties, only some of which include high turnover, low morale among staff and executives, organizational listlessness, frequent crises that erupt because of the inadequate placement of key persons, and the list goes on and on. All are issues which affect daily life of staff and residents as well as the “bottom line” on the Income/Expense Statement.
On the other side of the coin, consider a good, qualified, value-laden candidate who is seeking a position. If you read each of these job postings through the eyes of such a candidate, which organization do you believe such a candidate would be drawn to?
Persons responsible for writing ads for job openings should consciously reflect on what the organization really needs most and see that those values and priorities are articulated in the job posting in order to attract quality candidates.
Job postings are much the same in certain respects, I believe. The content of job postings reflects the degree to which the organization is consciously mission-driven, and reflects the priorities of qualities the organization is looking for in candidates.
Here are two examples of postings for the position of Executive Director that I read just today. Each of these organizations is a church-sponsored, not-for-profit organization.
1.
A non-profit community with a strong foundation of faith and person centered care, is seeking a campus Executive Director who is responsible for leading and directing the community in accordance with resident needs, government regulations, and internal policies and procedures.
Successful candidate must possess a passion for serving older adults, Bachelor’s Degree (MS preferred), . . . . The post continues with a listing of educational requirements and nine skills the candidate should have.
2.
Historic CCRC with nearly 500 residents and 300 employees, on 100 acres, provides a modified Life Care program in the beautiful Shenandoah Valley
Applicants must possess skills in CCRC management, performance improvement and program development, finance and planning skills. Senior leadership experience essential. NHA and five years of experience required. MS preferred.
When the right people are not hired for key positions, an organization can and will face many difficulties, only some of which include high turnover, low morale among staff and executives, organizational listlessness, frequent crises that erupt because of the inadequate placement of key persons, and the list goes on and on. All are issues which affect daily life of staff and residents as well as the “bottom line” on the Income/Expense Statement.
On the other side of the coin, consider a good, qualified, value-laden candidate who is seeking a position. If you read each of these job postings through the eyes of such a candidate, which organization do you believe such a candidate would be drawn to?
Persons responsible for writing ads for job openings should consciously reflect on what the organization really needs most and see that those values and priorities are articulated in the job posting in order to attract quality candidates.
Friday, October 18, 2013
They get good care there
The New York Times has a blog entitled “the New Old Age.” Today’s posting, entitled, “A Beep in the Night”, recounts a daughter’s experiences with her mother during her mother’s last months. The column begins with the writer’s mother mimicking the doctors saying, “She’s confused; she’s confused.” That observation followed the mother’s awakening in her hospital bed at 3 a.m. and asking for coffee. “How hard could it be for someone to bring some decaf?” an aide says to the daughter.
The daughter, a physician herself, responds to this incident by taking every effort to assure that she is called at any time that her mother has any problem or is confused.
The column is a touchingly poignant account of a daughter’s solicitude for her mother at a time when her mother was so dependent on others. Reading the article brought to mind a phrase I often hear about nursing homes – spoken often – in a positive way – by people who have friends or family in the particular nursing home spoken of. “They get good care there.”
Of course we wouldn’t want any less for anyone we know, anyone we love, who is in a nursing home. We hope for and expect good nursing practices. What always gives me pause when I hear that phrase is another phrase: “Life is more than ‘care.’” Life is more than attention to the physical body. Life is about relationships,home,choice,respect, dignity,privacy, continuity of exercising preferences in daily life insofar as possible.
It is precisely these latter values that transformational culture change attempts to bring to life for residents in nursing homes. It is what “Culture Change” is all about. It’s putting the person before the task.
For more information on this transformational, humane movement to change the culture of aging and aging services, go to:
Pioneer Network
Culture Change Now
To read Dr. Feld’s post, go to A Beep in the Night
The daughter, a physician herself, responds to this incident by taking every effort to assure that she is called at any time that her mother has any problem or is confused.
The column is a touchingly poignant account of a daughter’s solicitude for her mother at a time when her mother was so dependent on others. Reading the article brought to mind a phrase I often hear about nursing homes – spoken often – in a positive way – by people who have friends or family in the particular nursing home spoken of. “They get good care there.”
Of course we wouldn’t want any less for anyone we know, anyone we love, who is in a nursing home. We hope for and expect good nursing practices. What always gives me pause when I hear that phrase is another phrase: “Life is more than ‘care.’” Life is more than attention to the physical body. Life is about relationships,home,choice,respect, dignity,privacy, continuity of exercising preferences in daily life insofar as possible.
It is precisely these latter values that transformational culture change attempts to bring to life for residents in nursing homes. It is what “Culture Change” is all about. It’s putting the person before the task.
For more information on this transformational, humane movement to change the culture of aging and aging services, go to:
Pioneer Network
Culture Change Now
To read Dr. Feld’s post, go to A Beep in the Night
Sunday, September 22, 2013
Nancy Pelosi and Pope Francis
This statement from Nancy Pelosi on national TV was just too good not to pass on.
Nancy Pelosi represents San Francisco and when I lived in San Francisco, she was my congressional Representative. (Imagine my culture shock when, on moving to St. Charles, MO., I discovered that I was in Todd Akin’s district!!)
In addition to being the first woman Speaker of the House and a very progressive Democrat, Nancy is a strong Catholic.
Sunday morning on CNN’s “State of the Union” news program, host Candace Crowley interviewed Nancy about issues political of course. Then she asked Nancy, “As a prominent Catholic, what is your response to the Pope’s interview that has been so widely reviewed?” Nancy smiled broadly and said, “He’s beginning to talk like the nuns!”
What a breath of fresh air! What a new breath from the Spirit!
In case you have not read the interview itself, I encourage you to do so. It can be accessed here:
http://www.americamagazine.org/pope-interview
Copy and paste this address into your browser address box.)
Nancy Pelosi represents San Francisco and when I lived in San Francisco, she was my congressional Representative. (Imagine my culture shock when, on moving to St. Charles, MO., I discovered that I was in Todd Akin’s district!!)
In addition to being the first woman Speaker of the House and a very progressive Democrat, Nancy is a strong Catholic.
Sunday morning on CNN’s “State of the Union” news program, host Candace Crowley interviewed Nancy about issues political of course. Then she asked Nancy, “As a prominent Catholic, what is your response to the Pope’s interview that has been so widely reviewed?” Nancy smiled broadly and said, “He’s beginning to talk like the nuns!”
What a breath of fresh air! What a new breath from the Spirit!
In case you have not read the interview itself, I encourage you to do so. It can be accessed here:
http://www.americamagazine.org/pope-interview
Copy and paste this address into your browser address box.)
Monday, September 16, 2013
Ageism within the healthcare profession
The line from a physician, “What do you expect, you’re 75>” -- or 79 -- or 84 or --- is not just an innocent joke punch line. It may well reflect an ageist attitude on the part of the provider.
Ageism is alive and well within the medical field as evidence by research and all-too-common anecdotal accounts. The current issue of The AARP Magazine has an article entitled, “Signs it might be time to find a new doctor.”
The author reflects that many times older adults are hesitant to “fire” their doctor because of the respect that generation has for positions of authority and expertise. We are reminded that the doctor works for us.
Along with suggestions on how to leave your doctor graciously and respectfully, the following checklist is offered.
It’s good information for any of us personally and for those of us who care for older adults, including supervising medical care, or accompanying them on visits to their physician.
1. There needs to be “chemistry” and mutual respect between you and your physician. If there is no, “there’s an issue.
2. If a younger person accompanies you, does the physician address his/her remarks to “that person rather than you?
3. Does the physician dismiss every complaint, blaming age instead of considering other causes?
4. Does the physician insist that nothing can be done?
5. Does the physician write a prescription for medication without a thorough discussion, or without a workup to determine the need/efficacy of the prescription?
6. Does the physician describe a variety of medications and procedures, or keeps referring you to more specialists without your seeing any improvement?
Ageism is alive and well within the medical field as evidence by research and all-too-common anecdotal accounts. The current issue of The AARP Magazine has an article entitled, “Signs it might be time to find a new doctor.”
The author reflects that many times older adults are hesitant to “fire” their doctor because of the respect that generation has for positions of authority and expertise. We are reminded that the doctor works for us.
Along with suggestions on how to leave your doctor graciously and respectfully, the following checklist is offered.
It’s good information for any of us personally and for those of us who care for older adults, including supervising medical care, or accompanying them on visits to their physician.
1. There needs to be “chemistry” and mutual respect between you and your physician. If there is no, “there’s an issue.
2. If a younger person accompanies you, does the physician address his/her remarks to “that person rather than you?
3. Does the physician dismiss every complaint, blaming age instead of considering other causes?
4. Does the physician insist that nothing can be done?
5. Does the physician write a prescription for medication without a thorough discussion, or without a workup to determine the need/efficacy of the prescription?
6. Does the physician describe a variety of medications and procedures, or keeps referring you to more specialists without your seeing any improvement?
Friday, September 13, 2013
Negative bias toward aging
I’ve pledged to respond to incidents of ageism when I am subjected to or exposed to them. An aspect of ageism includes statements that infer that the gift of years is a negative quality rather than a positive one. Clearly the negative bias toward aging makes no sense when one considers that the alternative to not growing older, not having another birthday is death.
So today I report experiencing negative bias toward aging in a public venue, in a situation in which a presenter addressed some 40 - 50 people, all of whom work with elders. It was an “innocent” enough statement. In her introductory remarks, the speaker asked how many in the audience were parents. Then she asked how many were grandparents, but quickly added, “Oh, no one here is old enough to be grandparents.” Clearly, the majority of the participants were old enough to be grandparents, and many of us old enough to be great-grandparents.
The speaker caved to the broader society’s value of the worship of youthfulness, to valuing youthfulness over maturity and old age. That is a negative bias toward aging. As such, it is an example of ageism.
I dare say that the vast majority of the participants did not recognize this “innocent” question as rooted in an, albeit unconscious, ageist attitude. To state again the obvious: Ageism is so prevalent and so deeply imbedded in our culture that we are not aware of it and we do not recognize its presence.
It is not logical to place a value, positive or negative, on a person based solely on their chronological age. Since most of our society’s biases toward aging are negative, those subject to ageism are devalued by this bias. This cohort of elders, seen through the bias, the prejudice, of ageism becomes marginalized and oppressed.
We cannot address this societal prejudice until we are first consciously aware of its pervasive presence.
So today I report experiencing negative bias toward aging in a public venue, in a situation in which a presenter addressed some 40 - 50 people, all of whom work with elders. It was an “innocent” enough statement. In her introductory remarks, the speaker asked how many in the audience were parents. Then she asked how many were grandparents, but quickly added, “Oh, no one here is old enough to be grandparents.” Clearly, the majority of the participants were old enough to be grandparents, and many of us old enough to be great-grandparents.
The speaker caved to the broader society’s value of the worship of youthfulness, to valuing youthfulness over maturity and old age. That is a negative bias toward aging. As such, it is an example of ageism.
I dare say that the vast majority of the participants did not recognize this “innocent” question as rooted in an, albeit unconscious, ageist attitude. To state again the obvious: Ageism is so prevalent and so deeply imbedded in our culture that we are not aware of it and we do not recognize its presence.
It is not logical to place a value, positive or negative, on a person based solely on their chronological age. Since most of our society’s biases toward aging are negative, those subject to ageism are devalued by this bias. This cohort of elders, seen through the bias, the prejudice, of ageism becomes marginalized and oppressed.
We cannot address this societal prejudice until we are first consciously aware of its pervasive presence.
Tuesday, September 10, 2013
"Never throw away old pantyhose"
The title here is a headline I saw earlier today at Yahoo.com. It is actually the first line of an obituary for Mary Maloney, a mother and grandmother and so much more, who died early this month in Wisconsin. The Yahoo article is quite moving as it quotes part of the obituary.
Explaining why the family created and published this unique obituary, Kevin, one of Mary’s sons said, “We wanted it to portray who she was and her love for people and just her funny ways of going about it. She was an extraordinary person in an ordinary way. ‘Survived by so and so and accomplished this and that didn't capture that.’"
I’ve often wondered why we Sisters don’t pay public tribute in a similar way when one of our own dies. When we note the passing of our own now, most of us in the community have known that Sister for 40 or 50 or 60 years. We’ve ‘grown up together. We experienced Vatican II and post Vatican II religious life together; we have sat in circles or at the breakfast table and talked about profound things and not so profound things; we have shared in the ups and downs of our birth families, sometimes of struggles and victories in our personal, professional or community life. We have prayed together, laughed and cried together. We have known how she was loved and appreciated by those she served in ministry, how she brought life to a local community - - - .I agree with Kevin Maloney, ‘Survived by so and so and accomplished this and that’ doesn’t capture that.
And from another perspective: is there not much to say about our cherished members, about the life they lived with grace and honor, the life and love they brought to us and to others throughout their lives? If a young woman reads an obituary which only states ‘daughter of’, ‘served in . . . ’, ‘services are . . . ’ would that obituary stir a curiosity or interest in religious life.
What if a young woman reads an obituary that includes this statement: “Sister will be remembered as a talented, innovative and caring teacher and a gifted poet.” And the statement from an alumna: “She left an indelible mark on the hearts and lives of our family."
It seems to me that this latter example of an obituary accomplishes more than one purpose: it shows due honor to a cherished member of the congregation. Really, aren’t we more than where we taught or what we taught? What schools or hospitals we administered? This more personal obituary also puts a spotlight on a single life of love and service, lived uniquely and received uniquely by those whom she served and the Sisters with whom she shared her life.
My gratitude to the Religious of the Sacred Heart, Atherton, California for the obituary I just quoted. It appeared in the St. Louis Post-Dispatch on August 21, 2013, marking the death of Sister Anna Mae Marheineke, RSCJ
(If you want to read the entire obituary of Mary Maloney, a tribute to and beautiful portrait of an undoubtedly loving, lovely and special woman, you can copy and paste this link into your browser: http://www.feerickfuneralhome.com/notices.php?id=1036 )
Explaining why the family created and published this unique obituary, Kevin, one of Mary’s sons said, “We wanted it to portray who she was and her love for people and just her funny ways of going about it. She was an extraordinary person in an ordinary way. ‘Survived by so and so and accomplished this and that didn't capture that.’"
I’ve often wondered why we Sisters don’t pay public tribute in a similar way when one of our own dies. When we note the passing of our own now, most of us in the community have known that Sister for 40 or 50 or 60 years. We’ve ‘grown up together. We experienced Vatican II and post Vatican II religious life together; we have sat in circles or at the breakfast table and talked about profound things and not so profound things; we have shared in the ups and downs of our birth families, sometimes of struggles and victories in our personal, professional or community life. We have prayed together, laughed and cried together. We have known how she was loved and appreciated by those she served in ministry, how she brought life to a local community - - - .I agree with Kevin Maloney, ‘Survived by so and so and accomplished this and that’ doesn’t capture that.
And from another perspective: is there not much to say about our cherished members, about the life they lived with grace and honor, the life and love they brought to us and to others throughout their lives? If a young woman reads an obituary which only states ‘daughter of’, ‘served in . . . ’, ‘services are . . . ’ would that obituary stir a curiosity or interest in religious life.
What if a young woman reads an obituary that includes this statement: “Sister will be remembered as a talented, innovative and caring teacher and a gifted poet.” And the statement from an alumna: “She left an indelible mark on the hearts and lives of our family."
It seems to me that this latter example of an obituary accomplishes more than one purpose: it shows due honor to a cherished member of the congregation. Really, aren’t we more than where we taught or what we taught? What schools or hospitals we administered? This more personal obituary also puts a spotlight on a single life of love and service, lived uniquely and received uniquely by those whom she served and the Sisters with whom she shared her life.
My gratitude to the Religious of the Sacred Heart, Atherton, California for the obituary I just quoted. It appeared in the St. Louis Post-Dispatch on August 21, 2013, marking the death of Sister Anna Mae Marheineke, RSCJ
(If you want to read the entire obituary of Mary Maloney, a tribute to and beautiful portrait of an undoubtedly loving, lovely and special woman, you can copy and paste this link into your browser: http://www.feerickfuneralhome.com/notices.php?id=1036 )
Monday, September 9, 2013
Relationships -- it's all about relationshps
One of the heroines in my life is Carter Catlett Williams, a geriatric social worker. She has also been a tireless advocate for elders, going back some 30 years or more. It was a visit to a nursing home resident, a man, who was sitting in a wheelchair restrained with a posey vest that set her on her quest. His words to Carter haunted her and would not let go of her: “It’s a terrible thing for a man to lose his freedom.”
Armed with these words and their implications, Carter began speaking of restraint-free care at every opportunity. She was always told by health care providers that physical restraints were necessary to keep frail elders safe. On one speaking engagement, there was a physician from Sweden in Carter’s audience. He invited Carter to “come see how we do it in Sweden.”
The “Untie the Elderly” was one campaign in the late 1980s which was sparked by Carter’s advocacy. Today, I say with much gratitude and joy, there are young professionals working in the field of aging services who have never seen a posey vest!! Cater was a pioneer in raising a professional consciousness that tying people to their chair or their bed did not keep them safe, but in fact, caused damage to every system in their body as well as to their spirit.
Another core value of this noted social worker is embodied in her statement, “Relationships are the heart of life.”
Just one application of this central value is reflected in a recent article by Megan Hannan of Action Pact. Megan reflects on the role and value of pets in our life, and especially for elders living with dementia. She shows that living with pets provides opportunities for both giving and receiving. This is the link. I encourage you to paste the link in your browser and read it.
http://blog.actionpact.com/2013/06/07/caring-for-a-pet-helps-meet-essential-human-needs/
Armed with these words and their implications, Carter began speaking of restraint-free care at every opportunity. She was always told by health care providers that physical restraints were necessary to keep frail elders safe. On one speaking engagement, there was a physician from Sweden in Carter’s audience. He invited Carter to “come see how we do it in Sweden.”
The “Untie the Elderly” was one campaign in the late 1980s which was sparked by Carter’s advocacy. Today, I say with much gratitude and joy, there are young professionals working in the field of aging services who have never seen a posey vest!! Cater was a pioneer in raising a professional consciousness that tying people to their chair or their bed did not keep them safe, but in fact, caused damage to every system in their body as well as to their spirit.
Another core value of this noted social worker is embodied in her statement, “Relationships are the heart of life.”
Just one application of this central value is reflected in a recent article by Megan Hannan of Action Pact. Megan reflects on the role and value of pets in our life, and especially for elders living with dementia. She shows that living with pets provides opportunities for both giving and receiving. This is the link. I encourage you to paste the link in your browser and read it.
http://blog.actionpact.com/2013/06/07/caring-for-a-pet-helps-meet-essential-human-needs/
Saturday, September 7, 2013
The role of advocacy in our life
A Sister-friend who works in a Catholic health care system sent the following reflection to me earlier this week. For any of us who have family members or friends in any aging services community (nursing home, assisted living, independent living) we should consider seriously the primary role of advocacy our relationship with them imposes. This reflection sets advocacy in a broad context that I thought was worth sharing.
Reflection on Advocacy
• There is no reason to believe that advocacy belongs to specialists such as attorneys, educators, social workers, clergy and public officials. To advocate for someone is simply to speak out with strength, knowledge and wisdom on his or her behalf. We do that all the time, whether or not we are aware of it: in conversations at work, in our children’s schools, in our places of worship, in our neighborhoods. To advocate for another person is to know what you want the world to be like - and to be willing to stand by that.
• Advocacy misses the mark when it is not a course of action we have chosen consciously in order to make an explicit point. Busy, too attentive to long-range goals at the expense of the momentary opportunity, or afraid of the fallout from an unfavorable response, we give up too easily. Advocacy by default is weak, unclear, often misconstrued. You can’t advocate effectively for someone unless you are willing to take the time to know what he or she really needs. Many of the actions we do initiate lack focus, miss the bigger picture, and fail to communicate what we believe to be the valuable core messages of our lives. To advocate for someone is to paint with conviction, with a wide brush, on the canvas you have been given.
• When you advocate effectively for another person you are acting out of your deepest integrity and clarifying your sense of mission. The Sufi mystic poet Rumi, in speaking about the transformative power of advocacy, compared it to the single-minded quest of a wild animal for the nourishment to sustain life: Think that you’re gliding out from the face of a cliff like an eagle. Think you’re walking like a tiger walks by himself in the forest. You’re most handsome when you’re after food. Spend less time with nightingales and peacocks. One is just a voice, the other just a color. The safest and most reliable way to learn who you are meant to be is by finding your place in genuine community. To advocate for someone is to find your true voice and your true colors.
• You don’t think anyone wants to hear your opinion?
• 1. If you don’t express your opinion, it’s as though you don’t have it.
• 2. Be sure your opinion is worth being expressed – do you need to give it more time and thought to ensure that it won’t cause more harm than good?
• 3. If you have expressed your opinion clearly and respectfully - in the right place, at the right time and to the right person – you have begun to be an advocate.
• 4. The next step is to double-check how you are being perceived and understood. If you’re not sure, ask.
• 5. In general, try to avoid making assumptions about a person or a situation, because a wrong guess or poorly developed theory can end up invalidating the good points you are raising.
• 6. Taking the trouble to establish your credibility can give your advocacy a surprising influence. To advocate effectively empowers you for future service to others.
• American poet Emily Dickinson wrote: If I can stop one heart from breaking, /I shall not live in vain;/ If I can ease one life the aching,/ Or cool one pain,/ Or help one fainting robin/ Unto his nest again,/ I shall not live in vain. At its most basic, advocacy is the ability to recognize the worth of another person and act out of love for the sake of his or her well-being without counting the cost. To advocate for the healing of another person, even one, ensures that your life’s meaningfulness will contribute to the healing of the wider world. – Rev. Enid L. Ross
God is in the slums, in the cardboard boxes where the poor play house. God is in the silence of a mother who has infected her child with a virus that will end both their lives. God is in the cries heard under the rubble of war. God is in the debris of wasted opportunity and lives, and God is with us if we are with them. – Bono, lead singer of U2
The world is a dangerous place, not because of those who do evil, but because of those who look on and do nothing. – Albert Einstein
Only those who respect the personality of others can be of real use to them. – Albert Schweitzer
Thursday Reflection Service at University Medical Center Brackenridge
September 5, 2013
Reflection on Advocacy
• There is no reason to believe that advocacy belongs to specialists such as attorneys, educators, social workers, clergy and public officials. To advocate for someone is simply to speak out with strength, knowledge and wisdom on his or her behalf. We do that all the time, whether or not we are aware of it: in conversations at work, in our children’s schools, in our places of worship, in our neighborhoods. To advocate for another person is to know what you want the world to be like - and to be willing to stand by that.
• Advocacy misses the mark when it is not a course of action we have chosen consciously in order to make an explicit point. Busy, too attentive to long-range goals at the expense of the momentary opportunity, or afraid of the fallout from an unfavorable response, we give up too easily. Advocacy by default is weak, unclear, often misconstrued. You can’t advocate effectively for someone unless you are willing to take the time to know what he or she really needs. Many of the actions we do initiate lack focus, miss the bigger picture, and fail to communicate what we believe to be the valuable core messages of our lives. To advocate for someone is to paint with conviction, with a wide brush, on the canvas you have been given.
• When you advocate effectively for another person you are acting out of your deepest integrity and clarifying your sense of mission. The Sufi mystic poet Rumi, in speaking about the transformative power of advocacy, compared it to the single-minded quest of a wild animal for the nourishment to sustain life: Think that you’re gliding out from the face of a cliff like an eagle. Think you’re walking like a tiger walks by himself in the forest. You’re most handsome when you’re after food. Spend less time with nightingales and peacocks. One is just a voice, the other just a color. The safest and most reliable way to learn who you are meant to be is by finding your place in genuine community. To advocate for someone is to find your true voice and your true colors.
• You don’t think anyone wants to hear your opinion?
• 1. If you don’t express your opinion, it’s as though you don’t have it.
• 2. Be sure your opinion is worth being expressed – do you need to give it more time and thought to ensure that it won’t cause more harm than good?
• 3. If you have expressed your opinion clearly and respectfully - in the right place, at the right time and to the right person – you have begun to be an advocate.
• 4. The next step is to double-check how you are being perceived and understood. If you’re not sure, ask.
• 5. In general, try to avoid making assumptions about a person or a situation, because a wrong guess or poorly developed theory can end up invalidating the good points you are raising.
• 6. Taking the trouble to establish your credibility can give your advocacy a surprising influence. To advocate effectively empowers you for future service to others.
• American poet Emily Dickinson wrote: If I can stop one heart from breaking, /I shall not live in vain;/ If I can ease one life the aching,/ Or cool one pain,/ Or help one fainting robin/ Unto his nest again,/ I shall not live in vain. At its most basic, advocacy is the ability to recognize the worth of another person and act out of love for the sake of his or her well-being without counting the cost. To advocate for the healing of another person, even one, ensures that your life’s meaningfulness will contribute to the healing of the wider world. – Rev. Enid L. Ross
God is in the slums, in the cardboard boxes where the poor play house. God is in the silence of a mother who has infected her child with a virus that will end both their lives. God is in the cries heard under the rubble of war. God is in the debris of wasted opportunity and lives, and God is with us if we are with them. – Bono, lead singer of U2
The world is a dangerous place, not because of those who do evil, but because of those who look on and do nothing. – Albert Einstein
Only those who respect the personality of others can be of real use to them. – Albert Schweitzer
Thursday Reflection Service at University Medical Center Brackenridge
September 5, 2013
Saturday, August 31, 2013
THIS HAS JUST GOT TO STOP!
Yes, we’ve just got to put a stop to ageist remarks and attitudes. Like every ‘ism’ ageism unfairly characterizes a group of people because it judges all of these people based on one characteristic: chronological age.
Melissa Harris Perry has a two-hour program on MSNBC on Saturday mornings and I watched it this morning. I like MHP for her political views and her ability to bring a fresh perspective to many social and cultural issues. A remark that Melissa made, which I’m sure was totally unscripted, stunned me. Stunned because her comment was so blatantly ageist.
I’ve reached the point where I can’t just shrug such incidents away. I feel an obligation to address ageism just as emphatically as I would address examples of racism. I wrote the following letter to Melissa. If she responds, I’ll post her response.
Dear Melissa,
This morning you asked a guest to explain to the “75-year-old little old ladies” what a particular sports phrase meant. Please, please do not stereotype people by their chronological age. Ageism is so pervasive and so deeply entrenched in our culture that we do not recognize it. I know you meant no harm and that you did not mean to disparage women 75 – or older. But the term “little old lady” is especially pejorative and reflects a negative bias toward persons based solely on their chronological age.
Senator Dianne Feinstein of California is 80 years old. Would you refer to this woman, or does the Senator deserve to be characterized by anyone as a “little old lady?”
One of the highlights of my leisurely Saturday mornings is to watch your program, Melissa. I have a high regard for the work you do in your position to raise awareness and to critique so many social and cultural issues. Your remark this morning was way out of step with your usual sensitivity to those very issues. I know you understand the power of language to create or change a culture and I implore you to monitor your use of phrases that reflect an ageist attitude.
Thank you so much.
Sister Imelda Maurer
Melissa Harris Perry has a two-hour program on MSNBC on Saturday mornings and I watched it this morning. I like MHP for her political views and her ability to bring a fresh perspective to many social and cultural issues. A remark that Melissa made, which I’m sure was totally unscripted, stunned me. Stunned because her comment was so blatantly ageist.
I’ve reached the point where I can’t just shrug such incidents away. I feel an obligation to address ageism just as emphatically as I would address examples of racism. I wrote the following letter to Melissa. If she responds, I’ll post her response.
Dear Melissa,
This morning you asked a guest to explain to the “75-year-old little old ladies” what a particular sports phrase meant. Please, please do not stereotype people by their chronological age. Ageism is so pervasive and so deeply entrenched in our culture that we do not recognize it. I know you meant no harm and that you did not mean to disparage women 75 – or older. But the term “little old lady” is especially pejorative and reflects a negative bias toward persons based solely on their chronological age.
Senator Dianne Feinstein of California is 80 years old. Would you refer to this woman, or does the Senator deserve to be characterized by anyone as a “little old lady?”
One of the highlights of my leisurely Saturday mornings is to watch your program, Melissa. I have a high regard for the work you do in your position to raise awareness and to critique so many social and cultural issues. Your remark this morning was way out of step with your usual sensitivity to those very issues. I know you understand the power of language to create or change a culture and I implore you to monitor your use of phrases that reflect an ageist attitude.
Thank you so much.
Sister Imelda Maurer
Tuesday, May 28, 2013
Does the Nursing Home You Visit Sound Like Home?
What sounds do you hear in your home?
Soft music from the CD player or digital cable TV?
Bird songs from the yard?
A dog barking in the distance – or maybe right there in your front room?
Cars passing by?
Children’s exuberance at play next door?
A public address system announcing through amplifiers throughout the house that you have a phone call?
Bells and harsh-sounding alarms going off at any time with no apparent rhyme or reason?
Are those last two probabilities of sounds heard in your home jarring? Such would be a natural response. Of course we don’t want those kinds of disturbances in our home. They shouldn’t be part of the environment either for people who live in nursing homes, or in any community setting that provides aging services. For the last three or four years there has been a growing clamor to remove bed and chair alarms, used all too often under the guise of preventing falls and keeping residents “safe.”
Research – and common sense – reveals that alarms do not keep residents safe and that, far from preventing falls, alarms may increase the risk for falls. As with any restraint, and these alarms ARE restraints, whatever the State Regulators say, every single system in the body is adversely affected as is the emotional and mental well-being of a person fearful of moving lest that *$%@*# noise go off again.
Adding to the harm of such alarms, all too often the common response by poorly-trained staff when an alarm goes off is to say, “Mrs. Johnson, sit down,” rather than try to determine what Mrs. Johnson needs or wants, and then accommodate her needs or preferences.
Progressive nursing homes are eliminating these alarms and realizing that individuals are doing much better and that the number of falls is decreasing. An article in The Patriot Ledger, Quincy, MA just this morning details such a move.
If you want to read this short article and the reasons why alarm restraints are being eliminated, this is the link.
http://www.patriotledger.com/topstories/x863235157/A-GOOD-AGE-Silencing-the-alarms-in-long-term-care#axzz2Ub9TJ5ey
Soft music from the CD player or digital cable TV?
Bird songs from the yard?
A dog barking in the distance – or maybe right there in your front room?
Cars passing by?
Children’s exuberance at play next door?
A public address system announcing through amplifiers throughout the house that you have a phone call?
Bells and harsh-sounding alarms going off at any time with no apparent rhyme or reason?
Are those last two probabilities of sounds heard in your home jarring? Such would be a natural response. Of course we don’t want those kinds of disturbances in our home. They shouldn’t be part of the environment either for people who live in nursing homes, or in any community setting that provides aging services. For the last three or four years there has been a growing clamor to remove bed and chair alarms, used all too often under the guise of preventing falls and keeping residents “safe.”
Research – and common sense – reveals that alarms do not keep residents safe and that, far from preventing falls, alarms may increase the risk for falls. As with any restraint, and these alarms ARE restraints, whatever the State Regulators say, every single system in the body is adversely affected as is the emotional and mental well-being of a person fearful of moving lest that *$%@*# noise go off again.
Adding to the harm of such alarms, all too often the common response by poorly-trained staff when an alarm goes off is to say, “Mrs. Johnson, sit down,” rather than try to determine what Mrs. Johnson needs or wants, and then accommodate her needs or preferences.
Progressive nursing homes are eliminating these alarms and realizing that individuals are doing much better and that the number of falls is decreasing. An article in The Patriot Ledger, Quincy, MA just this morning details such a move.
If you want to read this short article and the reasons why alarm restraints are being eliminated, this is the link.
http://www.patriotledger.com/topstories/x863235157/A-GOOD-AGE-Silencing-the-alarms-in-long-term-care#axzz2Ub9TJ5ey
Monday, April 22, 2013
HUGE things happening in the small town of Perham
Much has been written about the documented dangers of prescribing antipsychotic drugs to elders diagnosed with dementia. This off-label use of these powerful drugs are often prescribed to "manage" "behavioral problems." Several of these commonly used drugs have had Black Box warnings from the Federal Drug Administration (FDA) for years. Those warnings include things like increased risk of death, stroke, and heart attack. There are numerous other unpleasant side effects from the use of any antipsychotic.
I have addressed this issue here at this blog several times. If you are new to the topic, those links are provided below.
But first, hear Marilyn's wonderful success story, a story that reflects good nursing, good doctoring, and a good life for all those blessed to live in a place like Perham Living!
Marilyn wrote this just weeks agoabout the decreased use of antipsychotics at Perham Living in Perham, MN. where she served as Director of Nursing and was highly instrumental in initiating and implementing that nursing home's journey to Culture Change.
Marilyn Oellfke:
We at Perham Living saw a significant impact on the use of anti-psych meds with the implementation of the households. If we think about it, the household model meet all or most of the principles of dementia care: quiet setting of home; no distracting noises like overhead paging; normal conversations; and a routine that is based upon the resident's desires - rise at will, eat when and where the resident wants to, bath when the resident chooses and is ready, etc.
I think the fact that the residents are able to sleep better at night helps also. The resistance to care behaviors we used to see all but went away with the household routine. We went from 17% to 3% use of anti-psych meds and have maintained that rate since 2005. (Emphasis mine.)
We also spent time teaching the nurses not to call the physician with the first sign of behavioral symptoms - often the physician's first response (sometimes with the nurses urging) was a med. They look for the cause of the behavior "what are they trying to tell us" and modify the care plan. We also work with a Geriatric Psych NP who is very conservative when it comes to meds.
We find that it takes residents who are admitted with behavior issues a period of time to adjust - sometimes meds are needed initially - but once the resident is responding, we begin looking at how we can reduce and ultimately eliminate them. The few residents that we do have on meds are R/T a psych diagnosis requiring them.
FYI: Perham Living is a 96 bed skilled facility with 6 household of 16 residents each. We do not have designated memory care areas - all households are safe and prepared to meet the needs of residents with dementia. We have never had a separate dementia care unit and wanted to create a place where all residents could age in place without having to move because of change in diagnosis. It works well for us.
http://www.providencewomen.blogspot.com/2013/01/selling-well-being-in-pill.html
http://www.providencewomen.blogspot.com/2012/12/would-you-give-your-mother.html
http://www.providencewomen.blogspot.com/2012/10/information-about-psychoactive-drugs.html
http://www.providencewomen.blogspot.com/2012/10/are-you-advocate-for-someone-living-in.html
http://www.providencewomen.blogspot.com/2012/08/when-are-antipsychotic-medications.html
http://www.providencewomen.blogspot.com/2009/09/drugs-and-dementia-care-unnecessary.html
I have addressed this issue here at this blog several times. If you are new to the topic, those links are provided below.
But first, hear Marilyn's wonderful success story, a story that reflects good nursing, good doctoring, and a good life for all those blessed to live in a place like Perham Living!
Marilyn wrote this just weeks agoabout the decreased use of antipsychotics at Perham Living in Perham, MN. where she served as Director of Nursing and was highly instrumental in initiating and implementing that nursing home's journey to Culture Change.
Marilyn Oellfke:
We at Perham Living saw a significant impact on the use of anti-psych meds with the implementation of the households. If we think about it, the household model meet all or most of the principles of dementia care: quiet setting of home; no distracting noises like overhead paging; normal conversations; and a routine that is based upon the resident's desires - rise at will, eat when and where the resident wants to, bath when the resident chooses and is ready, etc.
I think the fact that the residents are able to sleep better at night helps also. The resistance to care behaviors we used to see all but went away with the household routine. We went from 17% to 3% use of anti-psych meds and have maintained that rate since 2005. (Emphasis mine.)
We also spent time teaching the nurses not to call the physician with the first sign of behavioral symptoms - often the physician's first response (sometimes with the nurses urging) was a med. They look for the cause of the behavior "what are they trying to tell us" and modify the care plan. We also work with a Geriatric Psych NP who is very conservative when it comes to meds.
We find that it takes residents who are admitted with behavior issues a period of time to adjust - sometimes meds are needed initially - but once the resident is responding, we begin looking at how we can reduce and ultimately eliminate them. The few residents that we do have on meds are R/T a psych diagnosis requiring them.
FYI: Perham Living is a 96 bed skilled facility with 6 household of 16 residents each. We do not have designated memory care areas - all households are safe and prepared to meet the needs of residents with dementia. We have never had a separate dementia care unit and wanted to create a place where all residents could age in place without having to move because of change in diagnosis. It works well for us.
http://www.providencewomen.blogspot.com/2013/01/selling-well-being-in-pill.html
http://www.providencewomen.blogspot.com/2012/12/would-you-give-your-mother.html
http://www.providencewomen.blogspot.com/2012/10/information-about-psychoactive-drugs.html
http://www.providencewomen.blogspot.com/2012/10/are-you-advocate-for-someone-living-in.html
http://www.providencewomen.blogspot.com/2012/08/when-are-antipsychotic-medications.html
http://www.providencewomen.blogspot.com/2009/09/drugs-and-dementia-care-unnecessary.html
Thursday, April 11, 2013
Where is Perham Minnesota?
Tuesday’s post noted the meaningful ritual around death and dying at Perham Living, a nursing home that operates with the resident as the center. Not the schedule, not the task, not the staff, the resident. This is the essence of Culture Change. It turns the “normal” ( actually a system that is lethal to staff and residents) way of running things on its head. That’s why a whole new understanding of the role and exercise of leadership is of foremost significance. It too is turned on its head. Really, it’s transformation. Seeing things with new eyes. My goodness, this sounds like Easter! Transformative culture change DOES generate new life for residents and staff! And it is budget neutral!
So where is Perham? It is a small town in western Minnesota. Perham Hospital was originally owned and operated by the Franciscan Sisters of Little Falls, MN. Many years ago the Sisters turned the hospital over to the county who still owns and operates the hospital and the retirement complex.
I visited Perham Living when it was offered as an onsite visit (and 6 CEUs!) opportunity of the 2006 Pioneer Network Conference. The nursing home was five years into it transformation from a mni-hospital model of a nursing home to HOME. An interesting question and even more fascinating answer was part of an interactive discussion period:
“Do you have a short-term rehab program?”
“Yes.”
“How many do you presently have in that program?”
“None presently. However, a very high percentage of individuals who come for short-term rehab choose to continue to live at Perham rather than exercise their option to return home.”
We as a group were pretty amazed. However, it was clear from our tour and conversations that people who live at Perham Living ARE at HOME! That’s the goal!!
So where is Perham? It is a small town in western Minnesota. Perham Hospital was originally owned and operated by the Franciscan Sisters of Little Falls, MN. Many years ago the Sisters turned the hospital over to the county who still owns and operates the hospital and the retirement complex.
I visited Perham Living when it was offered as an onsite visit (and 6 CEUs!) opportunity of the 2006 Pioneer Network Conference. The nursing home was five years into it transformation from a mni-hospital model of a nursing home to HOME. An interesting question and even more fascinating answer was part of an interactive discussion period:
“Do you have a short-term rehab program?”
“Yes.”
“How many do you presently have in that program?”
“None presently. However, a very high percentage of individuals who come for short-term rehab choose to continue to live at Perham rather than exercise their option to return home.”
We as a group were pretty amazed. However, it was clear from our tour and conversations that people who live at Perham Living ARE at HOME! That’s the goal!!
Wednesday, April 10, 2013
A comment from yesterday's blog entry
I enjoyed reading about the dignity quilt and walk of honor that has been established in one nursing home to honor those residents who have died. As a former Department of Health surveyor for long term care, I would often ask the Director of Social Work what was done when a resident passed away. One nursing home places a rose on the pillow of the deceased resident’s bed to honor them. They felt this would be comforting to the resident’s family when they came to their room to pick up their loved one’s personal belongings. A very thoughtful gesture in my opinion.
Cynthia H. Adamowsky, LMSW
Sisters of St. Francis of the Neumann Communities
Director of Aging Services
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Thank you, Cynthia, for sharing your experience. I know how comforting it is for family members and friends of the deceased who come after a death and see that the room is still being honored as a dwelling place, as still holding a special meaning and sacredness.
I have seen other meaningful practices in nursing homes which include – especially in Sisters’ retirement settings – a Scriptural verse or some other signification quotation printed and formatted appropriately and then posted on the door of the recently deceased.
It is so much more sensitive doing things this way rather than the task-oriented approach in which a CNA is assigned the task of clearing the room as soon as the body of the deceased is removed. I have heard of the shock of family members who walk in and find the bed and the room already stripped bare.
Even writing of such a thought-less practice evokes very negative and sad feelings for me. Let’s focus on and implement the actions and practices that reflect thought and sensitivity as well as respect and honor for the deceased, the staff and friends and family members.
Cynthia H. Adamowsky, LMSW
Sisters of St. Francis of the Neumann Communities
Director of Aging Services
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Thank you, Cynthia, for sharing your experience. I know how comforting it is for family members and friends of the deceased who come after a death and see that the room is still being honored as a dwelling place, as still holding a special meaning and sacredness.
I have seen other meaningful practices in nursing homes which include – especially in Sisters’ retirement settings – a Scriptural verse or some other signification quotation printed and formatted appropriately and then posted on the door of the recently deceased.
It is so much more sensitive doing things this way rather than the task-oriented approach in which a CNA is assigned the task of clearing the room as soon as the body of the deceased is removed. I have heard of the shock of family members who walk in and find the bed and the room already stripped bare.
Even writing of such a thought-less practice evokes very negative and sad feelings for me. Let’s focus on and implement the actions and practices that reflect thought and sensitivity as well as respect and honor for the deceased, the staff and friends and family members.
Tuesday, April 9, 2013
Wonderful Things Happening!
Yes, there are wonderful things happening in some nursing homes! The following post is taken from a Web-based group-by-invitation that I belong to. It is a forum open to individuals who have participated in Action Pact’s week-long workshop, “Choreography of Culture Change.”
In this post, Marilyn describes the evolution from awareness to action around the issue of honoring death and dying in a nursing home and supporting those who have lost someone through that death: family members, other residents and staff.
The rituals which which became a tradition at Perham Living reflect staff sensitivity to the reality around them. It reflects a response to “the signs of the times.”
There is no one-size-fits-all in any such significant ritual. What is common in all meaningful practices is the intentional response and value-based philosphy undergirding them. There may be ideas that Marilyn’s article stirs in you. If you have any connection with e! nursing home, you may have experiences of a similar approach. You would enrich us all by sharing them in the comments section or by e-mailing your comments to me so that I can post them. (ilmcdp@yahoo.com)
To the article!
By Marilyn Oelfke former Drector of Nursing at Perham Living, Perham Minnesota
Perham Living began their culture change journey in 2001. As the households evolved, it became apparent to everyone that we needed to find a way to help family members, the other residents in the households and the staff cope with death. We wanted to treat residents with dignity and respect from the time they entered the home until they left. As relationships grew stronger, the loss of a resident was more difficult for everyone to manage. We had tried to find new ways of addressing the need and nothing seemed to be really effective. Until one day when a household lost two long-time residents within 5 minutes of each other. The families, other residents and staff were deeply affected - something needed to be done....It happened that the first resident to pass away had been lovingly called the "jungle nurse" by her family as she had served in the Korean War. We had a quilt in the living room that had a vine quilted around the edge. Someone took the quilt to the room and placed it over the gray zipper bag that the funeral home typically used. Her body, draped in the quilt, was brought to the living room in the household where a brief prayer was said and everyone had an opportunity to share. When we were ready, everyone escorted her out through the town center to the front door to the waiting hearse. Our new tradition was born - each house now has a dignity quilt for use when a resident dies. The "Walk of Honor" is done on all shifts.
The practice was well received in the community of Perham - we heard many positive comments. The hospital adopted the practice as well. They too use a Dignity Quilt and the Walk of Honor when a patient dies. The Funeral Home staff have been very supportive of the practice and give residents, family and staff as much time as they need to say their "goodbyes".
This may not work in all facilities - it happened so naturally out of a need at the moment and everyone was involved in making it happen. It has made a significant difference for those at Perham Living and certainly worth consideration for other households.
We also have Memorial services for residents if the family wishes. One difference is that the service is prepared and done by the residents and staff in the household.
In this post, Marilyn describes the evolution from awareness to action around the issue of honoring death and dying in a nursing home and supporting those who have lost someone through that death: family members, other residents and staff.
The rituals which which became a tradition at Perham Living reflect staff sensitivity to the reality around them. It reflects a response to “the signs of the times.”
There is no one-size-fits-all in any such significant ritual. What is common in all meaningful practices is the intentional response and value-based philosphy undergirding them. There may be ideas that Marilyn’s article stirs in you. If you have any connection with e! nursing home, you may have experiences of a similar approach. You would enrich us all by sharing them in the comments section or by e-mailing your comments to me so that I can post them. (ilmcdp@yahoo.com)
To the article!
By Marilyn Oelfke former Drector of Nursing at Perham Living, Perham Minnesota
Perham Living began their culture change journey in 2001. As the households evolved, it became apparent to everyone that we needed to find a way to help family members, the other residents in the households and the staff cope with death. We wanted to treat residents with dignity and respect from the time they entered the home until they left. As relationships grew stronger, the loss of a resident was more difficult for everyone to manage. We had tried to find new ways of addressing the need and nothing seemed to be really effective. Until one day when a household lost two long-time residents within 5 minutes of each other. The families, other residents and staff were deeply affected - something needed to be done....It happened that the first resident to pass away had been lovingly called the "jungle nurse" by her family as she had served in the Korean War. We had a quilt in the living room that had a vine quilted around the edge. Someone took the quilt to the room and placed it over the gray zipper bag that the funeral home typically used. Her body, draped in the quilt, was brought to the living room in the household where a brief prayer was said and everyone had an opportunity to share. When we were ready, everyone escorted her out through the town center to the front door to the waiting hearse. Our new tradition was born - each house now has a dignity quilt for use when a resident dies. The "Walk of Honor" is done on all shifts.
The practice was well received in the community of Perham - we heard many positive comments. The hospital adopted the practice as well. They too use a Dignity Quilt and the Walk of Honor when a patient dies. The Funeral Home staff have been very supportive of the practice and give residents, family and staff as much time as they need to say their "goodbyes".
This may not work in all facilities - it happened so naturally out of a need at the moment and everyone was involved in making it happen. It has made a significant difference for those at Perham Living and certainly worth consideration for other households.
We also have Memorial services for residents if the family wishes. One difference is that the service is prepared and done by the residents and staff in the household.
Wednesday, March 13, 2013
Hand in Hand
This information was provided in an earlier post, but what I alluded to is SO important, I believe, that I want to share it again -- with a special focus on our many convent retirement settings which, because they are not licensed, do not have the same easy access to information from CMS.
I want to share some information with Sisters and lay person who serve our Sistsers about a marvelous resource, the "Hand in Hand Toolkit". My copy of this resource arrived a couple of weeks ago. After reviewing it, I highly recommend it for use in your retirement setting. Added to this good news is that the resource is FREE to all, available upon request!
The Center for Medicare and Medicaid Services (CMS) has created this training tool that emphasizes person-centered care in the care of persons with dementia. There are six modules, each one hour in length, four of which relate to dementia and caring for residents living with dementia. The two remaining modules deal with the recognition and prevention of abuse.
The Patient Protection and Affordable Care Act (commonly called Obamacare or the federal healthcare law) mandates that licensed nursing homes provide CNAs regular training annually on caring for residents with dementia and on preventing abuse. Licensed or unlicensed, the information contained in this resource is vital information for caregivers and for those who act as family members to our Sisters in the retirement setting.
The two-inch thick manual provides step-by-step guidance (like a teacher’s manual!) for effective presentation of each of the six modules. Suggested teaching materials are also included and can be duplicated for each participant trainee.
There is a very helpful glossary and a rich resource section in the Toolkit.
Karen Schoeneman, a major player in the development of resident-centered regulations at CMS and Dr. Al Power, author of the outstanding book, DEMENTIA BEYOND DRUGS, each give a short audio-visual introduction, and overview on the first of the DVDs included.
This is how you request this FREE, EXCELLENT resource: go to this link:
http://www.cms-handinhandtoolkit.info/Downloads.aspx
(Enter the name of your convent or the name of your retirement center for “facility”.)
I encourage you to forward this letter to any appropriate parties, to request a copy of this valuable resource, and encourage your team in the retirement center to engage in the use of this excellent training. Our elder members as well as our devoted staff will be the beneficiaries.
I want to share some information with Sisters and lay person who serve our Sistsers about a marvelous resource, the "Hand in Hand Toolkit". My copy of this resource arrived a couple of weeks ago. After reviewing it, I highly recommend it for use in your retirement setting. Added to this good news is that the resource is FREE to all, available upon request!
The Center for Medicare and Medicaid Services (CMS) has created this training tool that emphasizes person-centered care in the care of persons with dementia. There are six modules, each one hour in length, four of which relate to dementia and caring for residents living with dementia. The two remaining modules deal with the recognition and prevention of abuse.
The Patient Protection and Affordable Care Act (commonly called Obamacare or the federal healthcare law) mandates that licensed nursing homes provide CNAs regular training annually on caring for residents with dementia and on preventing abuse. Licensed or unlicensed, the information contained in this resource is vital information for caregivers and for those who act as family members to our Sisters in the retirement setting.
The two-inch thick manual provides step-by-step guidance (like a teacher’s manual!) for effective presentation of each of the six modules. Suggested teaching materials are also included and can be duplicated for each participant trainee.
There is a very helpful glossary and a rich resource section in the Toolkit.
Karen Schoeneman, a major player in the development of resident-centered regulations at CMS and Dr. Al Power, author of the outstanding book, DEMENTIA BEYOND DRUGS, each give a short audio-visual introduction, and overview on the first of the DVDs included.
This is how you request this FREE, EXCELLENT resource: go to this link:
http://www.cms-handinhandtoolkit.info/Downloads.aspx
(Enter the name of your convent or the name of your retirement center for “facility”.)
I encourage you to forward this letter to any appropriate parties, to request a copy of this valuable resource, and encourage your team in the retirement center to engage in the use of this excellent training. Our elder members as well as our devoted staff will be the beneficiaries.
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