CIRCLES

Lyrics:  Some say / “The walls between us stand so tall” / They don’t see there’s just one sun / Shining on us all.

I recently completed a six week class on the Inner Journey of Aging.  It was facilitated by a former president of the Sage-ing Institute and the person responsible for bringing their conference to Seattle last August.  It was at the conference that I learned about some of the activities growing out of the Institute including Wisdom Circles. It was in a meeting of the Wisdom Circle I was fortunate to find in Seattle, that I learned about the class.  Each week in the class we explored different age-ing themes: Life Review, Life Repair, Leaving a Legacy, Life Completion, and Becoming a Sage.  Typically, we worked on a class exercise, writing as much as time allowed and then sharing what we’d written with a partner.  These exercises were never completed in the one and a half-hour classes but were meant to be completed afterwards.  Well, you know how good intentions go; they quite commonly get lost somewhere.  So now, two of us are meeting on an irregular but scheduled basis to share what we’ve worked on at home.  The sharing was an important and meaningful part of the class and it now serves as the incentive to continue the work.  I am currently working on “Ethical Letters” — a letter to each one of my three sons that will be given to them after my physical body releases my spirit to the next dimension.

Doing our work prepares us as Spiritual Elders to mentor others.  There are good ways to mentor and there are better ways.  In the Wisdom Circle we spend a lot of time listening.  We aren’t there to fix one another or feed our egos by delivering sage advice.  Instead, we listen as each takes their turn sharing issues related to the age-ing process.  When you’re in your sixties, seventies, and eighties, it’s all about the age-ing process.  One person is hoping to resolve the estrangement with a younger brother; another in finding direction and meaning after retirement, and another coping with the declining health of a spouse.  The class exercises and the wisdom circle allow us to go deeper in our process to be our authentic selves.  Does that sound gloomy?  Difficult?  Yes, we are dealing with some heavy topics but there is laughter and hope generated in the sharing.  We learn from each other and we grow together spiritually.  We leave the Circle connected and refreshed.

Lyrics:  I say / “We each choose roads to call our own” / But none of us is traveling through / This universe alone. / And this circle / Just goes on and on . . . (Barbra Streisand from her album Higher Ground.)

Quality of Life

A dickey-bird whispered haven’t you heard/ Spring is here, Spring is here/ A little crow sang a happy hello/ My favorite time of the year.

A friend and I were having a discussion about end of life issues and the subject of Quality of Life came up.  Are you able to define the Quality of Living that you’d want at the end of your life when, for example, your health has taken a turn for the worse, you’re dependent on others for the basics, and your only real company is the TV and an occasional call and visit from a family member?  Defining Quality of Life actually proved more difficult than I expected and the conclusion we reached was that the definition can change with age and condition.

For my dad, it was pain.  He hurt, and at 94 years he couldn’t do the kind of things that had given him pleasure and satisfaction.  The paramedics took him to the hospital where he was admitted but refused all tests and treatment.  This particular hospital offered in-house Hospice care and a doctor’s order was obtained with the objective being total comfort care.  The nurses had a way of assessing the pain level of a Hospice and semi-comatose patient that differs from asking a  conscious patient to rate their pain on a scale of one to ten and dad was kept comfortable with IV drugs.  Harpists from the Chalice of Repose program came in twice and brought comfort to the family including a fussy great-grandchild baby who fell asleep in her mother’s arms.

Ask most people and they cringe at the idea of a nursing home.  Dr. Atul Gawande writes in Being Mortal about a doctor, Bill Thomas, who took the job as Medical Director of a nursing home and was appalled by the lack of Life Quality.  His solution was out-of-the-institutional-box; he brought in two dogs and two cats for every floor and 100 parakeets.  A pair of parakeets was then owned by the residents themselves to look after.  It was transformational.  People now had a purpose, and success of the program was measured in lower amounts of medication needed for anxiety and psychosis.  The residents became more active and lived longer because life was now worth living.  This approach to nursing home care became know as the Eden Alternative  and functions now as a non-profit that provides resources, tools, and ongoing support to Eldercare organizations and home-based consumers.  I found two Eden Alternative communities in Oregon and two in British Columbia but none in Washington State.

The presence of animals would definitely add quality to my life as would a window that looked out on the changing seasons and wildlife.  Recently a hummingbird I stood watching drink from the feeder flew inches from my nose and vibrated there for several seconds before darting off.  Let there be a hummingbird feeder out my window.  I could happily skip yet another rerun of Law and Order or Castle but now and again a concert from Lincoln Center would be nice, a Rick Steves tour of Europe, and a PBS mystery.  And if I’m blessed with good eyesight, let there be books and books to read.  Hopefully I would be interesting enough that my kids and grandkids would want to talk with me and visit — often.

Lyrics: A little frog sang a song on its log/ Lose your blues, lose your blues, lose your blues….  (The Dickey-Bird Song.  1947.  Lyrics and music by Howard Dietz and Sammy Fain)

BEING MORTAL

Lyrics:  I’m gonna live til I die/ I’m gonna laugh ‘stead of cry/ I’m gonna take the town and turn it upside down/ I’m gonna live, live, live until I die.

My mother spent her last two months in an Adult Family Home (AFH).  Had we known that she had only that brief amount of time remaining we wouldn’t have moved her from her cozy apartment in the retirement home.  She was needing more assistance than Assisted Living (AL) could provide and we had found a wonderful caretaker who was even willing to be on site with her 24 hours, however, financially this out-of-pocket arrangement couldn’t be sustained.  Furthermore, we learned that, should her money run out, she would have to be on Medicaid and Medicaid would not pay for the retirement home and AL.  We also learned that Medicaid beds are hard to come by.  Medicaid beds in those retirement homes with continuing care (independent, AL, and skilled nursing) went to those residents, not outsiders.  While Medicaid doesn’t pay for retirement homes, it does pay for Adult Family Homes.

Typically AFH’s are regular homes in residential communities with six private rooms and typically staffed with at least one caregiver round the clock.  The owners of mom’s AFH lived on site, had an adorable four-year old boy, and a West Highland white terrier.  Mom loved it when the little boy ran into her room to visit and when the dog would wander in.  A close friend, an RN who worked for DSHS (Washington State Department of Social and Health Services) monitoring AFHs, told me that the State liked having the home owners with family on site because it usually meant more stability, i.e., it was their home too.  Mom was served simple and nourishing meals and often the smell of fresh baked cookies greeted me when I visited.  She was treated like a family member rather than in infirm patient.  An article in the Seattle Times, dated January 2010 focused in on some of the problems that my brother and I weren’t aware of in 2013; explosive growth of AFHs when nursing home patients on Medicaid were moved into newly created AFHs, profiteers, and lack of careful state regulations.  Perhaps the industry had improved by 2013.  Our mom was tenderly cared for.

I’ve learned a lot about institutional caring for elders reading Dr. Atul Gawande’s book, Being Mortal; Medicine and What Matters in the End.  Gawande is a Boston surgeon, professor at Harvard Medical School and the Harvard School of Public Health, and an award winning author.  He is one of those special individuals who climb out of the comfort box in order to raise awareness and help others.  I will refer to him and this book in future posting.  But, don’t wait for me.  Get this book!

Lyrics:  Gonna dance, gonna fly/ I’ll take a chance riding high/ Before my number’s up/ I’m gonna fill my cup/ I’m gonna live, live, live, until I die!  (I’m Gonna Live till I Die writers: Curtis, Hoffman, and Kent.)