nursing homes
Fear is Part of Grief in Coronavirus Times
As we navigate through the uncharted terrain of coronavirus days, weeks and perhaps months, most of us are experiencing: fear, confusion, frustration. Things feel surreal. Where do we turn? What do we do? Can we make plans for the future? Not really.
The immediate becomes paramount. How do we buy groceries today and stay safe? For those of us who are health professionals, how do we teach our patients (and ourselves) to adjust to video conferencing and/or phone sessions?
Some of my clients wonder who to let in their homes. “Can my housekeeper still come? Can my nanny still come when I am working from home and need their help taking care of my kids? What about the construction project going on in my kitchen – can the carpenter continue?”
We are all figuring things out day by day, instance by instance. There is no 
rule book on how to proceed now. What if you work at a grocery store or your family member does? Do you or they still go in to work? What about paying the bills if there is no paid time off?
Yesterday a friend sent me a very insightful article from the Harvard Business Review called “That Discomfort You’re Feeling is Grief”, an interview with David Kessler, the world’s foremost expert on grief.
Kessler co-wrote with Elisabeth Kübler-Ross On Grief and Grieving: Finding the Meaning of Grief through the Five Stages of Loss. His new book adds another stage to the process, Finding Meaning: The Sixth Stage of Grief. Kessler also has worked for a decade in a three-hospital system in Los Angeles. He served on their biohazard’s team. … He is the founder of www.grief.com which has over 5 million visits yearly from 167 countries.
Kessler describes the grief we feel over losses in our daily lives, e.g. going to work, sending the kids to school, going out to eat or to movies, not getting to visit our loved ones in nursing homes or hospitals. (Look at Amy Klobuchar who just gave a poignant interview about not being able to visit her husband who has been hospitalized with COVID19!) Kessler says:
We feel the world has changed, and it has. We know this is temporary, but it doesn’t feel that way, and we realize things will be different. Just as going to the airport is forever different from how it was before 9/11, things will change and this is the point at which they changed. The loss of normalcy; the fear of economic toll; the loss of connection. This is hitting us and we’re grieving. Collectively. We are not used to this kind of collective grief in the air.
Kessler goes an illuminating step further – he teaches that we are also experiencing “anticipatory grief“.
Anticipatory grief is that feeling we get about what the future holds when we’re uncertain. Usually it centers on death. We feel it when someone gets a dire diagnosis or when we have the normal thought that we’ll lose a parent someday. Anticipatory grief is also more broadly imagined futures. There is a storm coming. There’s something bad out there. With a virus, this kind of grief is so confusing for people. Our primitive mind knows something bad is happening, but you can’t see it. This breaks our sense of safety. We’re feeling that loss of safety. I don’t think we’ve collectively lost our sense of general safety like this. Individually or as smaller groups, people have felt this. But all together, this is new. We are grieving on a micro and a macro level.
What to do about these feelings? Kessler recommends being aware of them. Remembering that this is a collective experience – you are not alone in what you are feeling. And, he talks about tools such as I wrote about in my last blog post: being present, letting go, finding perspective, helping others… He ends the interview with a very helpful reminder based on his experience: “This too shall pass.”
This is a temporary state. It helps to say it. I worked for 10 years in the hospital system. I’ve been trained for situations like this. I’ve also studied the 1918 flu pandemic. The precautions we’re taking are the right ones. History tells us that. This is survivable. We will survive. This is a time to overprotect but not overreact.
Much appreciation to David!
Aging, is and always has been, a team sport!
I am a big fan of some of some of the leaders who I consider the pioneers in reshaping how we think of aging in this country. One was Dr. Robert Neil Butler, MD who first coined the word “ageism”, started the first geriatric medicine program in the country (at Mt Sinai Medical Center), was the first Director of the National Institute on Aging and won the Pulitzer Prize for his groundbreaking book on aging called “Why Survive? Being Old in America”. Sadly Dr Butler passed away in 2010. But he left us a legacy of his work.
Another leader who is still very active is Dr Bill Thomas, MD, geriatrician and a professor at the Erickson School at the University of Maryland, Baltimore County. He has founded two movements that aim to reshape nursing-home care: The Eden Alternative and the Green House Project. Dr. Thomas his wife developed the Eden Alternative in the early 1990’s as a bodybuilding-seriously.net philosophy to deinstitutionalize long term care facilities by alleviating the “three plagues” of boredom, helplessness and loneliness. In 2008, The Wall Street Journal named Dr. Thomas one of the 12 most influential Americans shaping aging in the 21st Century. US News and World Report described Dr. Thomas as a revolutionary, “With his startling common-sense ideas and his ability to persuade others to take a risk, this creative and wildly exuberant 46-year-old country doctor has become something of a culture changer–reimagining how Americans will approach aging in the 21st century.”
Here is a sample of some of Dr Thomas’s (for America) revolutionary statements on the plethora of dismal nursing homes in this country:
“One important way we can reduce the fear associated with communal living arrangements, and improve the lives of frail elders and their families, is to abolish nursing homes in America. Currently we have more nursing homes than Starbucks outlets. Our archipelago of institutional long-term care facilities houses 1.6 million elders and adults living with disabilities. Most of them are serving life sentences, stripped of privacy, independence and choice. Ironically, the buildings are aging even faster than the people in them. They won’t survive to house the coming boom of elders. Should we rebuild them, as thousands of developers are already doing, and subject another generation to the cruel embrace of the institution?
The fact that so many people, whose only crime is frailty, are confined in this way is powerful evidence that we live in a deeply ageist society. We dread aging because we associate growing older exclusively with disability, depression, dementia and death. In fact, old age is a complicated life stage with abundant opportunities for growth, joy, meaning and worth. Around the world and through the ages, elders have proven their value as peacemakers, storytellers and sages. They are the glue that holds families and communities together, and we need them now more than ever. “
He writes this in response to the fear that so many old people have about living in groups, and rightly so given the vast majority of the existing models. But, he says, as in the title of this blog post, AGING IS A TEAM SPORT! How I have described it, along these same lines, is that “It takes a village!”, stealing from Hilary Clinton’s old book title. I have seen this over and over, that the highest quality of life belongs to those older people who have a loving and competent circle of family, friends, caregivers, church members, health professionals, etc around them when they need them.
Older people nowadays want to stay home and “age in place”. This is understandable given the alternatives! It’s time for us to create warm, welcoming, vibrant group settings where individuals can have privacy and alone time for contemplation, and friendship and support and connection when they want that to. I’m sure we can figure this out. And we should because the boomers are fast coming down the aging track.
Dr Thomas has started the Green House Project, a new model aimed at creating a real home that provides care but also supports those seeking to redefine the worth and meaning of late life. With support from the Robert Wood Johnson Foundation, more than 100 Green House Project homes have opened in 32 states since 2003, and more than 100 others are in development.
German Nursing Home Residents Featured in Classic Film Poses
Guess Which Film This Pose is From?
These photos are lovely and, best of all, the residents report having had such a wonderful time
preparing for and shooting the photos. The pictures turned out great!
Medical Foster Homes – An Emerging Supportive Housing Choice for Older Veterans
Medical Foster Homes – An Emerging Supportive Housing Choice for Older Veterans
Housing Choices in Later Life
As our population ages, more and more living scenarios are surfacing for how to live out our lives safely with dignity, comfort and with as much control as we can maintain. Increasing numbers of older people remain in their own homes as long as they can in order to preserve their independence. The number of people living out their whole lifespans in the comfort of their homes has increased by 50% over the last two decades.
When living alone is no longer an option, elders often opt to move closer to adult children who can provide assistance and advocacy. Often, additional hourly home caregivers are brought in; at times, live-in roommates exchange services for rent. Full-time, live-in caregivers are another, albeit expensive, option.
“Aging in place” member-driven, non-profit, community-based organizations such as Marin Villages strive to provide the kinds of support that older people are looking for in order to continue to live in their own homes, apartments or condo’s.
Independent living retirement communities serve as well-known housing alternatives for older adults. Assisted living and skilled nursing facilities come into the picture as health declines and care needs increase.
Smaller “board and care” homes are another alternative – with usually 2-6 residents. Board and care homes can be comfortable and safe environments, particularly for those older adults who do not need the full medical services available in assisted and skilled nursing facilities.
A Special Alternative for Veterans
Recently I found out about an interesting project that the Veteran’s Administration has been spearheading for several years called “Medical Foster Homes”. These homes provide an alternative to nursing homes for veterans who are unable to live safely and independently at home or lack a strong family caregiver. The homes are open to vets of all ages but the average age is 70.
Initiated by VA social workers in Little Rock, Arkansas, the program currently serves about 600 veterans and has cared for 1,500 since it began. The program has grown to operation in 36 states and is scheduled to expand to 10 more states soon. Program administrators have reported that 30 percent of veterans who would qualify for VA-paid nursing homes choose instead to live in – and to pay out of pocket for – medical foster homes. This is evidence, they state, that the vets prefer a home setting.
Living in a medical foster home is paid for by veterans from their VA and social security benefits – the monthly costs range from about $1400 to $2500 depending on the applicant’s income and the level of care he/she needs. It should be noted that the VA rigorously screens and monitors the Medical Foster Care homes – only about 1 in 10-15 applicants is accepted.
For more information, read the full New York Times article For Veterans, an Alternative to the Nursing Home or go to the Department of Veterans Affairs Medical Foster Home website. You can also call the Marin County Veterans Service Office at (415)473-6193 and speak with Marin County Veterans Service Officer Sean Stephens. Sean’s email address is veterans@marincounty.org.
Won’t it be interesting if the VA’s valuable knowledge obtained as they continue to grow this popular housing solution can be translated for the general, non-veteran population of older adults? Stay tuned!
Older Adults in Mill Valley
As Mill Valley Commissioner on the Marin County Commission on Aging, in October 2009 I presented my annual report to the Mayor and City Council members on the status for baby boomers and older adults living in Mill Valley. Here is a link to my report presentation notes – I hope you will find it helpful to give you an idea of some of the opportunities and challenges for older people in Mill Valley as of autumn, 2009. Some things have changed – statistics, numbers, contact information perhaps, so do note that this report is from 2009. Older Adults in Mill Valley
“20 Lies Told By Nursing Homes”
Eric Carlson is Directing Attorney for the National Senior Citizens Law Center (NSCLC). He has specialized in long-term care since 1990 and is one of the country’s leading consumer experts on skilled nursing and assisted living facilities.
Mr. Carlson has written many articles on issues related to long term care and advocacy. I came across this one recently and think it is very helpful for consumers. Note: It has been rewritten and published recently as “20 Common Nursing Home Problems and How to Resolve Them” for purchase from this page at the NSCLC .
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Part of the 20 Lies article can be read at no cost in a Powerpoint format.
The basics of the 20 Lies articles are listed below. See Mr. Carlson’s complete article for the details.
1. MediCal does not pay for the services you want.
2. The nursing staff will determine the care that your receive.
3. We don’t have enough staff. You must wake up every mroning at six.
4. We don’t have enough staff. You should hire a private-duty aide.
5. If we don’t tie your father into his chair, he may fall or wander away.
6. Your mother needs more medication to make her more manageable.
7. We must insert a feeding tube; your father is eating too slowly.
8. Your children can only visit you during visiting hours.
9. We can’t admit your mom unless you become “Responsible Party”.
10. Please sign this arbitration agreement; it’s no big deal.
11. Because of your limited needs, you can’t get Medicare reimbursement.
12. We must discontinue therapy because you aren’t making progress.
13. We can’t give therapy. Medicare has expired and Medi-Cal doesn’t cover it.
14. You aren’t eligible for Medicare, so you must leave the Medicare bed.
15. We don’t have an available Medi-Cal bed for you.
16. We don’t have to readmit you from the hospital; your bed-hold has expired.
17. You must pay any amount set by the facility for extra charges.
18. We have no available space for resident or family meetings.
19. You must leave because you are a difficult resident.
20. You must leave because you are refusing treatment.