A New Year & A New Perspective
A New Year & A New Perspective
Dear friends and colleagues in the healing arts,
2015 presented me with some interesting challenges. After the death of my beloved mother and the near death and continued illness of my husband, I wondered how we healers can continue to serve our patients when we ourselves are in the midst of tough times. Maybe some of you have come up against this question too.
What I discovered is, as songwriter Leonard Cohen writes, “The birds they sang at the break of day. Start again I heard them say. Don’t dwell on what has passed away or what is yet to be. Ring the bells that still can ring. Forget your perfect offering. There is a crack in everything. That’s how the light gets in.”
It’s this last part that has surprised me. What an unexpected gift is the grace and light that can emerge out of adversity. What I am learned continually deepens both my work and my home life.
As we get older, we find ourselves adding to our toolkit of life skills. Mindfulness tools have reentered my life and work in a big way. And so has my intention to reach a much wider audience through teaching nationally about conscious aging. The need and demand for navigation help is so great as the boomer generation enters the unfamiliar terrain of older life.
If you have friends, family or patients in these populations below who you think I might be able to help or if you have questions yourself, please feel free to reach out anytime:
- People in their 50’s, 60’s and 70’s waking up to their own sense of aging – often through illness or other changes in themselves or their loved ones. They seek answers, solutions, and guidance.
- Adult children of aging parents who feel confounded and frustrated about how to best help their parents through a myriad of difficult circumstances. They are the sandwich generation with aging parents, children and often grandchildren too.
- Families where adult children and aging parents need to and want to come to some new understandings and find a closeness now to the extent they can while they can still can.
- People in their 80’s and early 90’s who are facing their last years with all that that entails – memories, regrets, fears, peace and contemplation – all healthy parts of this stage of life. Having a genuinely caring nonjudgmental skilled listener is so valuable.
You might already know that there are very few psychotherapists in Marin who have advance training in gerontology. With my expertise in the fields of aging, communication, business, medicine and psychology, I am uniquely qualified to help your midlife and older patients, friends and family.
My offices are in Mill Valley and San Anselmo. Telephone appointments are also available for people who do not live close by. I provide a free initial phone consultation. And if I can’t help, I can often steer people to other beneficial resources.
With warm wishes for a peaceful 2016,
Nancy Rhine, MS, LMFT, CPG
415-378-6577
nrhine@gmail.com
Starting with the Traditional (in housing)
Before I start to take a look at and write about the myriad of creative housing solutions that are cropping up these 
days for boomers and older people, I thought I’d give a brief nod to the traditions that have come before these modern days. The oldest traditional housing for older people is probably: living with family. And, now, the number of multigenerational families is on the rise again.
More and more people will be faced with that choice or are already living that scenario today because a) they want to do that, and/or b) the elders do not have the money to be able to afford live in their own homes and/or pay for their own in-home caregivers or live in residential assisted living locations. This choice is not without drawbacks. Sometimes older people are lonely living with adult children who are working and grandchildren who are away at school and with friends all the time. Sometimes the generations do not get along well. Older people can also feel they have no privacy in this setting or sometimes they feel like they do not want to be a burden to their adult children.
Nonetheless, this has been the way for centuries or millenia for older people and it’s a scenario that is coming back.
In the interim, things took a different turn in the late 1950’s with Del Webb and his construction and promotion of the Sun City retirement community. With Del’s photo on the cover of Time magazine in 1962, there was an accompanying explosion of growth of these kinds of communities across the country in the decades to come. For the past half a century, his model of aging has essentially been the plan for millions middle class seniors. That is that they would retire at age 65 and move into one of these kinds of retirement communities: independent living apartments, planned communities with a variety of housing choices for seniors 55 and older, assisted living facilities, and eventually skilled nursing facilities.
When faced with these choices and there is plenty of time, people can leisurely explore alternatives. When, however, as people are doing more these days, they stay living in their own homes longer and then there is a crisis which precipitates a move to an assisted living or board and care type situation, how do they, or often their adult children, find out information about alternatives and options?
One assisted living social worker who had worked for 28 years at a local retirement community told me the average move-in date when she first started at been about 75 years old. By the time she retired, the average move-in date was more like 85. People are staying longer in their own homes.
Back to the answer of where to find answers regarding options when living independently is no longer viable. Most counties have what’s called a triple A or Area Agency on Aging. They are often a good place to start for education about senior housing options. They often have published booklets describing housing resources in their county. And they can direct you to more print listings. The problem with print resources is that they become out of date quiet quickly in the shifting terrain of senior services.
You can go online and search in your county, too. You can look for reviews. You can then call the places that look good to you, weed out the ones you don’t like and make appointments to go visit the ones you think look appropriate.
In my county – Marin County – north of San Francisco, I like a web service/site called Lucille’s List . The two women who founded this service did so because they had had such a hard time finding good assisted living homes for their aging mother and grandmother. You can search Lucille’s List by a variety of search criteria. And the information tends to be more up to date. They have a matching service where you can type in location, the kinds of services you’re looking for, a price range, etc and they will give you the results. It’s a useful tool.
Some people turn to a geriatric care manager who typically charges about $150/hour and up to look into your specific housing needs and the solutions available in your area. They may charge an initial set fee for assessment and then a lower ongoing fee to continue to work with you.
Next week, I’ll start to get into alternatives to the living with your kids choice and the moving into a retirement/assisted living community choice.
Boomer Shelter – the Zeitgeist is here
The zeitgeist (spirit of the times) is happening. There is a rising up of creativity we can see almost every day in the news. It has to do with the boomer parabolin generation coming to terms with how and where we are going to live as we grow old.
Most people I talk to in this age group do not want to move into retirement communities. The idea of moving to Del Webb like settings in the south like their snowbird parents does not sound attractive. They would like to stay independent as much as they can, retaining some control over their privacy and lives. and being part of a warm and friendly community.
Some of aging boomers think about eventually moving in with their adult children – if they have them that is and *if* they have good relations with them and *if* their children have room.
Some people are opting to stay in their own homes and are joining neighborhood support networks where they can both give and receive support as they age. Examples of these networks are the Village movement and Retirement Communities Without Walls 
(RCWW’s) which I have written about in earlier blog posts and will revisit.
Some are exploring moving to different countries as ex-pat’s where the costs of living and medical care are much more affordable than in the US. Some common countries older Americans are moving to are Mexico, Costa Rica and Panama.
Many boomers are revisiting the lifestyle of shared or co-housing – in effect exploring a return to a communal lifestyle we saw in the 60’s but with perhaps with their own bathrooms and kitchens. 😉
Others are looking at the “tiny home” movement. This is not a new idea for humanity. Prior generations did not live in or aspire to the “MacMansions” of today. There are tiny homes on wheels, mobile homes, some that can be pulled up to large screened-in outdoor porches – the ideas run the gamut!
I haven’t seen a central curated site online where there are articles about and links to the exploding number of projects around the world that address the new housing movement. I will be posting those I see here over the coming weeks and months in a series called Boomer Shelter. Feel free to comment and send more.
Ageism in Modern America
Jikonsaseh first clan mother
While cruising Facebook this morning I came across an article posted by Paula Span, an author I respect so much for her insightful blog posts when she was featured as the writer for The New Old Age for the NY Times. Out of a budget cut, her weekly blog was cut but she still writes for the Times sometime and posts on her FB page. Here is the link to the article she posted which was written by the chief of geriatrics at Columbia University: America’s Bias Against Older Women Must Stop
The article has to do with the flurry of ageist comments in the media lately having to do with Caitlin Jenner. Not comments so much that were disparaging about her transformation from Bruce to Caitlin but comments that were denigrating of older women. Demeaning comments, snide jokes, general put-down’s about older bodies, in particular older female bodies.
This topic and more importantly this phenomenon is so widespread and so ubiquitous in our culture that it is overwhelming when considered. And that overwhelm can easily lead to increased poor self esteem on the part of older women, denial and fighting against “aging” thus the billions spent on anti-aging products, and depression. I see this depression so very commonly in my counseling work with older women, espeically those in their 60’s and 70’s.
There is a common thread of complaints under the heading of ageism whether we use that word or not. The experience is of: being the butt of disparaging and cruel jokes, feeling devalued, ridiculed, infantalized and invisible. of not counting, that they don’t matter.
I wonder about our fear of women and women’s power in this culture. We women do have some kind of power when we are young and beautiful. Perhaps that is instinct that we are attractive when we can procreate. Perhaps we are also considered more valuable then because we “consume” therefore Wall St and the media value us. That doesn’t make much sense tho’ when you consider that older women and older people in general are big consumers and oh by the way voters as well.
No, there is something intrinsic and deeply rooted in why this culture devalues older women to such an extent. More than they do older men although there is devaluing there too. Is it related to fear of mortality and fear of dying? Is it the fear of becoming superfluous and needy? We know that our culture puts huge emphasis on independence and me-ness. Cross interdependence is not a big part of our cultural tone. And/or does ageism towards older women have to do with latent resentment towards primary attachment figures who predominantly are mothers emerging later when our mothers or ourselves are now in a vulnerable position. Payback time in other words?
A pair of Red-tail Deer fawns follow behind Mom.
I believe that we lose out as a culture and a people when we do not value our older women and listen to what they have to teach us. Margaret Mead told a story about the old does of the red tail deer herds in Alaska. In times of drought or severe storms, it was the old does who had the memory of out of the way watering holes or sheltering cliff where they could find refuge from the storms. The herd rallied behind and old does towards safety.
I worry about this way we have of devaluing and demeaning our older women. We are in times of crisis. We need all the wisdom we can find. Denigrating and oppressing and discounting an entire segment of our population is anti-survival and anti-wisdom. I hope we can change. I hope that we boomers can push back against too-often-accept stereotyping and dismissing of older women. Our survival may just depend on it.
Talk Therapy and Dementia
I have been focused on working, as a therapist and gerontologist, with older adults and adult children of aging parents for over 12 years now. During this time, many different kinds of people and situations have presented themselves. Many unique situations have emerged as well as many commonalities as people first encounter and then work through the familiar landmarks inherent in the territory of older age.
A topic has recently come up in conversations with colleagues and I’ve been asked to write a little about it. That is the topic of doing talk therapy with people who have Alzheimer’s or other dementias – something which I believe can be a big benefit to many of these individuals.
In my experience, people with early stage Alzheimer’s or even early middle stage have benefited from talk therapy. The first ingredient in successful therapy with this group is, like with most therapy patients but even more so, is trust. I have found that people who may be cognitively challenged have other senses which are heightened, including their intuition and discernment of an inauthentic person, someone disrespectful or rushed.
I have come to believe that as in the case of people whose eyesight may be failing, and their hearing becomes more acute to compensate, so it is with people whose cognitive capacity may be declining. Their other senses become greater in order to compensate. As a general rule, in my experience working with early and middle stage Alzheimer’s patients, their ability to sense the environment, the “vibes” if you will is acute. They know when they are being treated disrespectfully or cruelly, i.e. in a demeaning fashion. Conversely, if you are genuine and caring and kind with them, they are forgiving and oh so grateful to be treated as a valued human being.
So often they are not treated as such. They are spoken over, or spoken around or ignored or infantilized or neglected. I have come in to their homes, invited by family members because the person was depressed. And when we begin to get to know each other, and I talk with them about their current situation and their past and their memories, using photographs or music or other “prompts”, I find their gratitude and increased self-worth palpable. I also find that they make good use of their intact long term memories, working on issues from childhood and young/middle adulthood that have haunted them, even if no longer consciously. Their depression may have simply been sadness.
For example, one woman I saw for two years had been in therapy as a young mother. So she was quite comfortable with the therapeutic setting. In therapy, she worked on some early traumas and experienced healing. The memories no longer elicited reactions of wincing and pain. We were able to diffuse them through recall and loving attention to them without judgment but with understanding and compassion. She had one memory of having to had to hide that she was Jewish when her father took a new job away from their beloved and closeknit NYC neighborhood. She was afraid that if she said anything that revealed her Jewishness he would lose his job which was undoubtedly true. That was a lot of pressure on a young girl! She also remembered, after we had worked together for a while, the shame of bed-wetting into teen years and how she had been demeaned and belittled by her mother about that.
This woman experienced healing through loving attention as she explored some painful memories. In her short term memory, as it declined, she did not remember everything we talked about from week to week. Her adult children joked that they should tell her she went to therapy and not really take her, she wouldn’t know the difference they said. But I knew that what she was experiencing in therapy was contributing to very real increased peace of mind for her, whether she recalled it consciously or not. I felt that subconsciously some pain, shame and sorrow eased.
I won’t take time here to go and find research studies to back up my in-the-field experiences. You can do that by searching for “talk therapy and dementia”.
I do believe, however, in the benefits that can be found in doing loving talk therapy with skilled, trained and experienced competent therapists. Please do not count dementia patients out for respectful treatment and gentle exploration of life review memories. This is what Eric and Joan Ericson said is our developmental task in older age: integrity vs despair. Integrity means to become whole, to look at the integral parts of our lives, using all of our senses. This can be done with Alzheimer’s patients. And they can be helped to expand their integrity and thus decrease their despair. And perhaps take less medications for depression! I have seen this with several of my older adult patients over the years. In fact, they are some of my favorite people and I consider them my teachers.
What are the key ingredients for mental health and wellbeing in older life?
As a Family Therapist and Gerontologist, I often get asked this question by people who are coming to me for the first time. As we begin to talk and find out what is going on for them now, an education process begins. The various pieces of the puzzle that make up a good quality of life are laid out, so to speak, on the table. We begin to examine each one in regards to them and to prioritize places where changes need to be made.
Doing this helps reduce overwhelm which occurs when people feel a whole wave of factors is coming at them – they feek like they are in danger of going under. As we begin to pick apart and prioritize the necessary ingredients of emotional health and wellbeing in their lives, we begin also to strategize a timetable and plan.
Lately, since I am asked this question so often, I have taken to drawing diagrams for my clients and their families. I have been asked to create a chart to help explain the process that we use. So, I did that and here it is.
Each category is a huge topic in itself but this chart is a map to give you the general lay of the land.
Beating Holiday Depression – Joanne’s interview with Nancy for Pacific Sun
How to avoid depression during the holidays
by Joanne Williams
A half-sunny Sunday morning along the Mill Valley marsh path: A young woman leaned her bicycle against a tree, stepped up on a nearby bench and let out a loud scream of laughter, waving her arms in the air. Chasing the winter doldrums?
“Exercising in the fresh air is one of the best ways to chase away the holiday blues and all the guilt and ‘shoulds’ that pop up so much at this time of the year,” said Nancy Rhine, a marriage and family therapist and gerontologist.
“It’s easy to feel manipulated and overwhelmed during the holidays, when you’re pummeled by advertising and expectations that everyone else belongs to an idealized Norman Rockwell family,” said Rhine, who advises people to pause and get perspective on what’s really important to them during these sometimes superficially cheerful days and nights.
“There have always been human fears in this darkest time of the year,” Rhine said. “In ancient times people held spiritual celebrations, lit bonfires on hilltops, and danced to alter their mood and to remind them that the sun would return. Nowadays there is the most focus on the mundane, with a tendency to slip into overspending and overdrinking, and then depression.”
It’s no wonder we develop myths like Santa Claus. Some decorate a tree with twinkly lights, and others celebrate Hanukkah, also a festival of lights. When I asked around to find out solutions to the depression many experience at this time of year, I heard many ideas.
“I used to get depressed every December first,” said Mary C., a grandmother of nine. “There were so many expectations and no resources. Today I don’t shop,” she said. “I don’t believe in it.”
“I go to San Francisco to the theater, spend the night in the city and have breakfast with a friend,” a single man said. “And I stay away from parties where people drink too much.”
“I don’t read the news,” said another. “I watch sitcoms.”
“I put on lively music and go to funny movies,” Rhine says of herself. “Do what makes you feel good. Listen to upbeat music, watch comedies or other favorite movies, nurture yourself. Volunteer—helping others helps you as well as others. Give a gift of time. Teenagers who drive could offer to take seniors on a drive to see Christmas lights, or just visit them to bring cheer.”
“Also, remember that asking for and accepting help, if you need it, makes the giver feel good too—it’s a two-way street.” Exercise is a terrific way to chase the blues, “especially outdoors, in nature, and in sunshine if we have any,” Rhine has found. “I never understood bird-watching, but as I’ve gotten older, now I love it—science has shown that that activity lowers blood pressure and it just cheers you up!”
And if you get sick, which seems to happen when you need your energy most, rest and “let go” of demands—shift and adjust. There’s no shame in taking time for yourself—having to just “be” for a while and not “do” doesn’t negate your value as a human being.
“Meditation or prayer can help, too—it can give people a sense of purpose,” Rhine advises. “Talk to a pastor, a rabbi, a priest or a friend. One of the things we often learn as we grow older, after we’ve crashed and burned for over-doing for a few decades, is learning the value of pacing ourselves. And, listen to your ‘loving inner mother;’ sometimes the best answers come from within.”
Ask Joanne how she overcomes the holiday blues at letters@pacificsun.com.
RESOURCES AND VOLUNTEER OPPORTUNITIES
Whistlestop930 Tamalpais Ave., San Rafael.
415/454-0964. www.whistlestop.org.
Marin Community Food Bank75 Digital Dr., Novato.
415/883-1302. www.sfmfoodbank.org.
Salvation Army Services Center351 Mission Ave., San Rafael.
415/459-4520. www.salvationarmyusa.org.
Ritter Center16 Ritter St., San Rafael.
415/457-8182. www.rittercenter.org.
Homeward Bound of Marin830 B St., San Rafael.
415/459-5843. www.hbofm.org.
St. Vincent de Paul820 B St., San Rafael.
415/454-3303. www.vinnies.org.
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.
Creativity Blooms in Alternatives to Nursing Homes
Creativity is blooming around the world as the world ages. Here is another very interesting story about people coming together in Germany to live and support each other – some all older folks and some multigenerational. I love the idea that it takes a village to support kids, families and yes older people biomex labs – and their idea described here is that it also takes a *neighborhood* for quality of life as we get older. Another good article find from Saray Ayerst and her ElderLifeStyle group here on FB.
Here are some points from the article:
- About 82% of Germans say they do not want to grow old in a nursing home. In response, as of January 2013, a new law provides seniors with a maximum grant of €10,000 ($13,300) to establish a community apartment as well as a monthly subsidy of €200 ($266) per tenant.
- While the first shared apartment for seniors appeared as a novelty in the mid-1990s, a recent boom means that almost 2,000 senior residents live in shared housing arrangements in Berlin alone, according to a Journal of Clinical Nursing study. And as the generation that witnessed the social revolutions of the 1960s grows older, the trend is gaining momentum.
- “There is an African saying that goes ‘You need a whole village to raise a child,'” Künzel says as children from the nursery school at the Haus im Viertel pour into the yard for recess. “But I say that you need a whole neighborhood for an elderly person to live.”
For the full article, click here:
Aging gracefully: Germans grow gray together
The Sageness of the Serenity Prayer
In working with midlife and older age adults and their families for over a decade now, I have come to believe more and more in the eloquence and truth of the Serenity Prayer. I am not an AA member which is how, I think, most of us have heard of this prayer. But I have come to love it. It is written in large letters on a framed poster outside my office. More people have stopped on the way into a therapy session with me to stand before it and read it over and over. It creates an immediate opening for talking about what concerns people bring in to the session. For those of you who don’t know the prayer or don’t remember the words, it goes like this:
God, grant me the serenity to accept the things I cannot change,
The courage to change the things I can,
And the wisdom to know the difference.
In my counseling sessions, we remark on how we can often see a few things we can’t change. We can often see a few things we can change. Those ends of the continuum are fewer and seem more black and white. But it’s that middle section – that wide grey confusing amorphous middle ground, i.e. “the wisdom to know the difference” is often what challenges us the most and forms the basis for many a counseling session.
The photo below is one I found online that many of my people relate to. It speaks to how little we are in control of the elements in our lives, and that “the wisdom to know the difference” may just entail hunkering down, saying a prayer and riding out the storm.
