Thursday, May 31, 2007

Away From Her - a Movie we can relate to

Here's a movie that just came to my attention. Clearly, it wasn't on my kids "gotta see" list, but it's now on mine: Away From Her, a story about a woman with Alzheimer's whose husband admits her to a (beautiful) nursing home and then watches as she slips away from him.

Just the trailer brought tears to my eyes: the woman, played by Julie Christy, begins to relate to another resident rather than her husband because "he doesn't confuse me."

Guess in between Pirates 3 and other new releases, this one slipped in. I'm headed to see it. I'll let you know...

Thursday, May 24, 2007

SEIU Unionization of Caregivers at Assisted Living Communities - Is this the Answer?

Sometimes changing the way business is done takes extreme measures.

While many senior care communities are beautiful environments filled with compassionate, loving caregivers, many, especially those for the lowest economic segment of seniors, desperately need that culture change we keep talking about.

Many of us have been working hard to improve the quality of senior care in all segments of senior care for many years.

And still the care can be appalling in some communities - I've experienced it first hand with my mother's recent stay in skilled care.

But is unionization of staff the answer? It certainly is an extreme measure; it certainly will get the attention of the companies that own and operate senior care.

But here's my concern: adding a layer, even one with a strong employee rights and advocacy emphasis, means increasing the distance between owner and caregiver. It also means adding a layer of cost.

Who will pay for this additional layer? Not the caregivers, many of whom make just a little over minimum wage. If union dues come out of their wages, will it truly help them? Will those individuals who are genuinely committed to care be able to continue caring if they can't even pay the rent?

And if dues come from another source, what would that be? There is only 1 source of revenue for most senior care communities: the fees they receive from residents, families or the government to pay for care and services provided.

So who's going to pony up more money? The family? The state?

Last week ALFA sent out an ALFA Alert to members titled "10 Steps to Address SIEU's Assisted Living Campaign," noting that the union is stepping up efforts to unionize assisted living workers, maintaining that their focus is to "make sure assisted living communities provide quality, safe housing, and services at a good value" (

ALFA recommends that assisted living managers educate themselves about these unionization efforts, and work diligently to resolve any problems before outside entities, like unions, become involved.

One does have to wonder why the SIEU is targeting assisted living rather than nursing home, where the abuse and neglect headlines still appear on a regular basis.

Here's my guess: it's all about the money. That's the bottom line here anyway. But with extra costs comes extra fees - and that's where the average senior is likely to feel the pain.

Tuesday, May 22, 2007

Telling Our Stories

Blogger Christinemm shares a story in her blog about her grandmother's recent stay in a nursing home. Luckily for her, she is now ready to return to live in her own home. Her family will be challenged to pull together all the resources they need to make this happen and to support her in her own home, but they are happy to do it.

Like most seniors, Christine's grandmother wants to live out her remaining years in her own home - who can blame her? Especially if her experiences in her brief nursing home stay were distressing and negative.

I've encouraged Christine to share her stories - if not publicly, privately to me or to others in the field. It is only by sharing our stories that we can begin to shed light on areas where "culture change" and "person-centered care" are not yet clearly understood by those providing care to our most vulnerable seniors.

I truly believe that the folks actually providing the care - the nurses, aides, CNAs, caregivers and other direct care providers - genuinely care about the work they do.

If we provide them with the tools they need, give them the training they need to do the work, and reward them for their efforts we'll have new stories to tell: stories about people going to extraordinary lengths to care for others and about stays in nursing homes that were life-affirming, positive experiences.

I'm waiting to hear stories about nursing homes that start, "I had always thought going to the nursing home was the last thing I wanted to do until my recent experience," and end, "I have changed how I think about nursing home care forever!"

Saturday, May 19, 2007

MetLife Mature Market Institute and Marshall Loeb's Money Tip - right on the money

Here's an article that may be helpful to others stuck in the middle along with me. I think it's major usefulness comes from the idea of planning ahead. With competing demands for our attention every day, advance planning on this topic and others can help us cope with crises - and they will come, dealing with aging parents and grandparents as we do.

These 10 tips for talking to parents about future needs originally comes from MetLife. Whatever the source, talking about future needs is tough; maybe some of these ideas can help make it easier.

Super Sandwich Generation Ramblings

I like the term "super-sandwicher" to describe people of my generation and our unique challenges.

We're the ones who have parents AND grandparents, both of whom need our caregiving support, advice, attention, as well as having children AND grandchildren, ditto for their needs. Read my friend and employee Wendy's description of her life as a super-sandwicher - I don't think it can really be described much better.

Wendy's grandmother had her kids in her early 20's; Wendy's mom had her at 20 and Wendy had her own kids early. Her son married and had his first child while young, meaning that Wendy is a super-sandwicher at just over 40.

I did it all a little different; had my first child at 30. While I've got two daughters in college (actually, the oldest is graduating in 4 weeks - yahoo!), I've still got one in high school and, thankfully, no grandkids.

That doesn't mean we're not being called into the "can you watch the kids" mode, however. Neighbors saw us pushing the twins stroller AND the single stroller down the street the other night coming home from the park after watching the three toddlers belonging to our good friend who lost her husband 4 weeks before her twins were born; her own mom died 2 weeks after that. We step in on a weekly basis as surrogate grands, although I must admit I prefer the idea of being "Aunt Sharon" far more.

And then there is Sara, a wonderful young woman who used to babysit for us when our kids were little and she was a teen. Grown now, with twin sons of her own, we are both godparents and grands, providing a support network to them.

My own mom, recovering from the auto accident last fall that took the life of my father and left her severely injured, is now living independently and walking a mile or so each day - slowly, with a crooked stride, but resolute in her determination to live life as fully as she can.

She just took the train to visit HER mother, who, at 93, is enjoying this stage of her life in a retirement community. I believe she is on boyfriend number three since moving into the community. The previous two have passed away, leaving her feeling understandably reluctant to make any commitment to this gentleman.

And life goes on. As a person in the middle, I'm in the unique position of being the one both sides turn to for advice, support and physical assistance.

What a priviledge, honor and an exhaustion. I believe I need a nap.

Friday, May 18, 2007

Thoughts from Disney and Gallup on Customer Satisfaction, Employee Engagement and Leadership

I've just returned from the ALFA conference - tired, but with new vision and energy.

Two themes stood out: Leadership and People.

Leadership: as Fred Lee (Lessons from Disney) put it, if you're a manager and you're not shaping your employees' behavior directly, you're a WIMP! And good employees hate having wimps as managers more than nearly anything else. As leaders in providing services to seniors we need to take strong, active leadership roles. Training our team leads and department heads in leadership skills is vital to growing the kind of community we want.

People: Finding and keeping excellent caregivers is a crisis in senior care. As more people need care (with the aging boom) even more caregivers will be needed. Anything a company can to do hire and retain employees will put them ahead of the curve, significantly. In fact, basic survival will depend on the people you have providing the services you give.

One of my favorite speakers (after Fred Lee, one of my all-time favorites) was the speaker from the Gallup organization. I don't know his name; I got to the seminar after introductions were over, and half way through he explained that he was here as a substitute for the schedule speaker, his colleague, who had a family emergency. (As a fully engaged employee, he has a "best friend" on the team whom he would step in for in an emergency - evidenced this day.)

What he spoke about, however, resonated with me in a big way. Gallup works hard to find ways to quantify feelings and opinions - that's their business. You probably know them as the Gallup Poll people - that's their business of quantifying who you would vote for in the election if it were held today, for example.

Finding the exact right questions to ask is important if survey results are going to actually mean anything, and Gallup has this down to a science.

The speaker in this session talked about evaluating your customer satisfaction (by the way, that was Fred Lee's theme, too - satisfaction is a "0" - you've got to aim for a "5" if you really want to measure and build customer loyalty).

The goal is to evaluate the level of customer engagement so you can improve it. Gallup finds that if your staff are engaged and your customers are engaged your outcomes can be as much as 300% greater on those things you can measure.

Do you know what a FULLY engaged customer says about your business? Something like this: "I can't imagine a world without your company/community/product." Those customers are a "5" in terms of satisfaction, loyalty and engagement. Think this is impossible? Think about Starbucks or Google - many people can't think of a world without them.

Could your clients say the same about you? Could mine?

We have work to do, folks! Whether you're in the business of providing caregiving to seniors in a care setting like an assisted living community or nursing home, or some other service to this segment of our society, we've got work to do. Gaining the fully engaged employee is a start (see training imperatives in other entries); gaining fully engaged customers is the goal.

Only strong vision and leadership will make it happen.

Monday, May 14, 2007

AARP, ALFA, Technology - what's next in caregiving

When AARP's monthly bulletin runs a special story (Every Step You Take) on home monitors and other technological aids to independent living you know these advances, designed to promote independence in seniors, are no longer things of science fiction (or of Intel's visioning, like the CAST video that demos things not yet available) - they're here and heading for the mainstream.

We're off today to Dallas for the Assisted Living Federation of America (ALFA) conference to learn what's new in approaches to caregiving in the assisted living arena.

Stay posted - we'll report on the newest approaches to providing excellence in care, and supporting those who do the caregiving as well.

Friday, May 11, 2007

Full Circle Online Interaction Blog: Report from Sandwich Generation Land

Full Circle Online Interaction Blog: Report from Sandwich Generation Land

Enjoy - other sandwichers!

Mother, daughter, grandmother, granddaughter - trying to do it all

In Dr. Mike Magee's presentation at the recent Center for Aging Services Technology (CAST) conference (of which Eric Dishman, a Principle Research Scientist at Intel, is Chairman) he talks about the coming aging of America as a challenge not just of people living longer, but of the family expanding from 3 generations to 5 or 6. The 3rd generation woman is rapidly becoming the “new” sandwich person – stuck between caregiving issues with her mother AND grandmother; her child AND grandchild.

Wendy, a program manager in our office, is a classic “new” sandwich member. She helps her mother provide care to her grandmother, who fell and broke her hip about 6 months ago and refuses to go into a supportive living community even though she requires around the clock care. Wendy’s mom has quit her own job to help care for grandma; hired caregivers round out the day.

Meanwhile, Wendy has 2 children, one of whom is married with a 3 year old son and another child on the way.

To say that Wendy is busy with family support issues is an understatement. Wendy says her two biggest issues being in the super-squished position are TIME and EMOTIONAL/PHYSICAL ENERGY. Here’s what Wendy has to say about her life today:

Your kids move-out (more or less); you are among the 40+ crowd and life looks GOOD!

Having gotten married at a young age and immediately starting a family this is the first time you don't have the major responsibility of someone else's life. You are cruising along, you take a new job you are excited to be able to - for the first time - throw yourself into a job/career without feeling guilty because you should be home when the kids get home from school or you sneak out of work to make that all-important game. It is essentially a new start, a new beginning and it looks exciting.

Hold it!

I receive a phone call from the "help I've fallen and can't get up" company that monitors my grandmother so she can remain at home independently.

Yup, she's fallen and broken a hip. The cycle begins for full-time in-home care. Because she can afford it, it makes perfect sense to her.

However she lacks the ability to understand the management of such a task. My mom, her daughter (who has never in her life worked a full time job or has ever been in a job where her responsibilities were managing people, medical care, and finances) is now faced with all of them.

Since I have experience in all, she calls me.

If only it were that easy.

Mom has two siblings. I can make suggestions and recommendations based on my experience and my mother understands, agrees and respects my knowledge.

Her siblings cannot get past the fact that I am no longer the snot-nosed little kid who wanted to play in the dirt with boys rather than play Barbie's with the other female cousins.

In their eyes I think I will remain 10 years old forever. I know nothing, and the battle begins.

Now we work at how creative my mother and I can become in her suggestions (which are really mine) and convince the other decision-makers of the right choices.

Then there are the calls: “The caregiver didn't show up - can you help take care of grandma?”

I want to help grandma. I want to help my mom. Sure I can help.

Hold it!

My son, who is a young father, has just gotten a new job. A really good job. They offer over-time on Saturdays!

"Sure would be a great way to get ahead, Mom," he tells me.

His wife already works Saturdays in trade for Mondays off to be able to spend more time with their 2 year-old son.

Here it comes....”Can you baby-sit?”

I want to; I love spending time with my grandson - I want to help my kids "get ahead." Sure I can help.

Hold it!

My daughter calls from college.

"Mom, I'd like to move home for 4 months and go to school near home until next fall. Can you help?"

She is the most independent young woman I know. She doesn't ask for help often. I want to help my daughter; she deserves my help as she has likely been put on the back burner for the last few months. Sure I can help.

Hold it!
Attempt to maintain a marriage through this? Have friends? Throw myself into my job? Nice idea.

I often feel as though there is not even close to enough of me to go around. My mom stops by to have me help complete some paperwork from the physician’s office. We walk into the kitchen where the light is better.

I look up at her – “Wow, Mom, when did you get old? You look really tired,” I think to myself.

It’s 9:15 p.m. and she is just on her way home after a full day of caring for grandma. I immediately think to myself, “I need to help more.”

On Saturday afternoon my son and his wife stop by to pick up their son. My daughter-in-law is 7 months pregnant. I look at them and think to myself, “They are amazing kids; they're doing so well.”

I look into their eyes, both of them, and wonder, “When did you grow up? You look really tired.”

I need to help more.

This is a glimpse of the sandwich generation. I could go on and on but there’s just not enough time...

Friday, May 4, 2007

Stuck in the middle again

Sue posted a question on the link above asking for advice balance the competing demands of her child and her aging parents. Sue - we're with you! You, me and millions of Americans are in this exact position. Anything we can do to support each other is a value. Here's what I suggested to Sue:

Welcome the the "sandwich generation" - that growing group of us caught in the middle between parenting responsibilities and our aging parents. While I've been in this field professionally for the past 20 years, I've just now hit it personally, trying to balance the needs of my 15 year old daughter and my aging parents. What a challenge! Some of the things that have helped me are:

1) Give yourself permission to skip a day visiting the parents and spend that day either doing what you want to do, or with your child. You won't get back the parenting days you miss; your parents will probably manage (somehow!) without you.

2) GET HELP! It's hard to ask sibs to help (I'm finally not asking anything more from my sister who has "advice" but no "time" probably know what I mean). There are tons of community resources, however - find them and pay for them. You'll be surprised how far a paid caregiver can get in helping your parent - without all the baggage of family and history, they walk into the situation ready to help - and can do it. Your parents probably have resources - use them. This is what they worked and saved for. If you're busy doing tasks every time you visit, you're missing the opportunity to offer a relationship. Pay someone else to do the tasks; when you visit, sit down and VISIT!

3) Consider an assisted living community or retirement community with support. You'd be amazed at how nice many of them are. My mother finally moved into a cottage in a retirement community and she told me the other night that she's never been happier. She loves the companionship, the outings and trips, the opportunity to share meals with friends every day. She said she feels cared about and valued by her new friends - and what a gift to receive at age 80!

Hope these ideas help you. Good luck - remember, you're in good company!

Thursday, May 3, 2007

Culture Change is a personal issue for a growing number of Americans

Yesterday I put my mom on a train to Minnesota to visit her mother for 2 weeks. It is the first time she’s traveled this distance by herself – probably in her entire life. Following the auto accident last fall that took the life of my father and severely injured my mother, she has been through numerous surgeries, 10 weeks in skilled nursing care, 3 weeks in assisted living, 8 weeks with an aunt and uncle at their home, and finally, 2 months ago, she moved into a cottage in a retirement community about 10 miles from my home.

It’s been a long, challenging journey. She has recovered her full independence, despite surgeons and therapists telling her she’d be in a wheelchair for at least a year, and maybe never walk again. As a professional who has worked with seniors and their families in similar situations my entire adult life, experiencing it personally has given me a completely different view.

While it was fun to take my mom shopping for sturdy support shoes when she decided that she would, too, walk (she ended up with what the kids call “skater shoes”), it was certainly no joy to sit at her bedside in the nursing home and get a reality check about what that level of care is really like. Some days I would cry all the way home, thinking about my strong-willed, physically active mom who has been a nurse her whole career, now dependent on a group of poorly trained nursing aides to keep her from wetting the bed by actually answering her call light in less than 30 minutes. It was never that they intentionally left her waiting as they were, like most caregivers, a dedicated group of hard working individuals. They simply didn’t have the resources to meet her needs in a timely basis.

I’ve long been an advocate for seeking care for a loved one who needs more than the family can reasonably provide, and I must admit I got chills that one morning my mom called me with her “new plan” – the one that consisted of putting a hospital bed in our living room and her living there until she could live independently.

Being a charter sandwich generation member with a young daughter still at home this clearly wasn’t an answer. I knew – and my mother, fortunately, did too – that she needed the care of people who were there just for that purpose.

But it still broke my heart to see how far we have yet to go in achieving a real “culture change” in nursing home care and services – especially when my own mother paid the price.

In her nursing home, motivation to change is likely far off. This was reputedly the best in town, and consequently had a waiting list to get in. It may not be until a facility is economically hurting that real change begins.

Until then, this is not only a societal challenge – it’s a personal one.

Wednesday, May 2, 2007

Technology Promoting Successful Aging is HERE

The impending baby boomer aging bubble, the rising cost of health care and services, the looming staffing shortage and the changes in technology are creating what Eric Dishman, Center for Aging Services Technology (CAST) chairman calls the upcoming “perfect storm.”

CAST, whose mission is “leading the national charge to develop and deploy technologies that can improve the aging experience in America,” held a Technology Day at the recent American Association of Homes and Services for the Aging (AAHSA) conference.

The CAST sessions are posted on their website, and present an exciting insight into the ways senior care communities are using technology to help increase senior independence and quality of life.

And if you think this is something that doesn’t apply to the average nursing home, assisted living center or retirement community, think again. As Dishman so clearly points out, technological advancements are here – they’re not just a thing of the science-fiction future. Those companies and communities that are truly dedicated to their mission of serving seniors will be seeking ways to implement technology now so that they can lead the way to fulfilling their mission in the coming years and weather any upcoming storms of change.

This is an incredible opportunity to catch up for those of us who missed the conference. Check it out - Thanks, CAST!