Thursday, October 30, 2008

Aging and Death - a new reality for us all

Last night my husband and I had the pleasure of taking my mom to dinner. My mother, widowed now for two years, lives in a nearby retirement village. It's a small village and a close-knit community of individuals, all of whom waited several years to join and now value their membership. The minimum move-in age is 62, but the average resident age is probably mid-80s.

Last night I was shocked to hear my mom say she doesn't know if she still likes living there.

"There are too many people who die," she said. "I'm not used to losing so many friends, especially close friends."

She went on to tell of a memorial service that was held in the village chapel the day before for a gentleman who lived just across the grassy "quad" from her; a man she counted as a good friend.

"I had to leave after just a few minutes," she said. "The chapel was full, with chairs lining the hallway outside. It reminded me too much of dad's funeral, and I just couldn't take it."

For my mother, this was the second significant loss of a good friend in the last several months. It is, she says, one of the hardest parts of living in a close-knit village of senior adults.

I thought about this conversation long into the night. Here was a solution we'd worked hard at achieving, for both my mom and my husband's parents. Living in a community of senior adults, with special activities, outings and services designed for them, seems ideal.

And then my mom pointed out the one thing I hadn't really given much thought to: death.

It brings to my mind not only questions about how to help my loved ones cope with even more losses in their lives, but also questions about how I'll handle that phase of life.

On an even larger scale, what about the way our society deals with death and dying?

We boomers have had a way of changing a lot of society's standard approaches to living, from our teens through this aging process.

Perhaps it's time to give some thought to the dying process, and how we handle loss and grief. Maybe we can, together, find our way to a place where we better accept death as a part of life, and together learn to celebrate lives passed, rather than suffer grief-filled lives.

I have a feeling that life - and death - won't give us the luxury of spending too much time thinking about it. It certainly hasn't waited for my mom to prepare - and it won't wait for us, either.

Tuesday, October 21, 2008

The View from the Street: It Matters Which Way You're Looking

The other day my husband and I were taking our morning walk. It was a beautiful fall morning. The sun was shining and the sky was a pure, translucent blue - on the right. On the left, the sky was angry and black and looked ready to dump buckets on us any second.

On my daily walk to my office I cross over an old bridge that separates two communities. The Willamette river underneath is broad and swift. On the right side of the bridge is the waterfall; a crashing, thundering, powerful display of water. I always walk on the right sidewalk because I love watching how the waterfall changes with the seasons. I also love the power of the pounding water.

The other day, I decided to cross over to the other side of the bridge. To my surprise, the water view there is calm and peaceful. Fishermen relax in their boats. Ducks gently bob along.

It's the same river, but the views from different sides of the bridge are dramatically different.

It was the same sky that morning, too, but the view to one side was sunny and beautiful. To the other, the sky was frightening.

It's a pretty good metaphor for today's social and economic outlook, I think.

If we look in one direction, we see deep recession and worrisome prospects for our future, both personally and as a society. That direction looks powerful and frightening.

But when we turn our heads just a little we can see the other side of the picture: the side that is filled with great human compassion, creativity and ingenuity. We can see hope for a future for ourselves, our families and our children that is brighter than today; that is calm and peaceful, too.

I think particularly about the view of today's typical family. The middle (sandwich) generation worries about their own eventual retirement. They worry about how to provide and pay for care for their aging parents (and maybe even grandparents). They worry about paying for their children's college education. The view, especially considering the changing demographics and the economic outlook can be very frightening.

And yet when we consider the other view, we see a society that has progressed in a few short years from one in which the average person never lived to see 60, to today's increasingly common centennial birthday. In the past century, in fact, the life expectancy for most Americans has increased 30 years.

During this time, we've developed options for supporting our seniors, too. No longer is it only family care or nursing home care. Now, we not only have assisted living options that are designed to sustain quality of life as well as provide essential support, we have a growing army of in-home care providers, the fastest growing segment of senior care providers.

We have creativity and good old fashioned neighborliness to consider, too. When was the last time you needed help, only to have a "good Samaritan" stranger or neighbor happily step up? It happens every day in our country, and it is only a small indicator of the abilities we possess to share the burdens as well as the joys.

It can be easy to give in to Wall Street's panic and the social prognosticator's predictions of unmet needs. I believe, however, if we just turn our heads we can see the other side of the picture and use our energy to help make that view - the one that is filled with hope and quality of life - a reality.

Monday, October 13, 2008

Nurses and the Bottom Line

An interesting article popped into my email today. It's titled The New Rainmakers, and discusses the role of nurses in hospital budgets.

Nurses cost money. In fact, their salaries are perhaps the biggest staffing cost a hospital must absorb. Over the past few decades, though few chief executive officers like to admit it, those costs have caused many hospitals to encourage their nursing managers to try to do more with less--less nurses per patient, that is.
Staffing is the biggest cost center for all providers of care to seniors, whether hospital, nursing home or assisted living communities. When financial times are tough - and even when they're not - cutting these costs directly affects the bottom line. When revenue slips, usually related to a lower census or occupancy, the biggest area to cut is staff wages - and that means staff hours.

With increasing emphasis being placed on quality and patient satisfaction by health plans and consumers alike, hospitals are realizing that reimbursement increasingly depends on how well nurses do their jobs, making nurses, as a new PricewaterhouseCoopers report says, the "rainmakers" of the hospital.
In my own local newspaper, printed tables display the patient satisfaction scores at all of our local hospitals side by side. Many of us have a choice in medical providers, and viewing these scores will undoubtedly help us choose a provider.

And yet, says Janet Hinchcliff, author of What Works: Healing the Healthcare Staffing Shortage,

"I'm not sure they [hospital administrators] realize the interconnections. This is going to be a big deal for them," she says. "Quality and patient satisfaction scores will show that a great deal of how a hospital is perceived has to do with the nursing staff. So they're a revenue contributor from a payment side, but also in terms of the fact that people are going to those hospitals because the nurses are really good."

What happens when a hospital chooses to spend just a little more in staff wages?

What about training expenditures, especially in the areas of leadership, customer relations and communication?

Repeated studies have shown that adequate levels of staffing and above average training investments DO have a significant return in the longevity of staff and, consequently in customer satisfaction.

Says Lilee Gelinas, another hospital executive (vice-president and chief nursing officer with VHA Inc.)

Nurse turnover among those with three years or less experience at some hospitals is 45 percent to 55 percent. "We can't hold on to the new kids coming out of school. Retention is tied to stability in the patient care environment, it's tied to nursing excellence, and it's tied to patient care excellence."
Excellence in care is apparently a language that the top management level didn't understand. But when the excellence of care and the happiness of patients reflects directly on the bottom line dollars, that's starting to speak their language.

Wednesday, October 8, 2008

It's a Baby Boomer Theme - Caring for Aging Parents

We were at an end-of-summer garden party last weekend. The day was unexpectedly warm and sunny, and we arrived to the beautiful creek-side yard of our friends Lane and Maureen. Many of the people there were friends we had known for decades.

As we mingled and caught up with old friends, we shared what had occupied our time this past summer.

"We didn't go anywhere this summer. We were busy all summer selling my mom's house and helping her move into a small house just a mile away from our home," said Bridgett. "I go over to her house every day just to visit, and most evenings we'll either cook dinner or barbecue at her house so we can eat together. It's been a challenge, but it's rewarding seeing my mom so much happier, and closer to us so we can help more."

"We had to move my mom into a new care home this summer," said Linda. "Her Alzheimer's has been getting worse and worse, and then we were told we had to move her. It took all summer to find a place, get her settled in and hope for the best."

As we worked our way around the party, we noted that every one of us were dealing with similar problems: aging parents who needed our help, work and careers - or making the transition to retirement, which is also a challenge for many, and our own children.

We're not alone. 13 million baby boomers throughout the US - just like us - are all facing the need to care for their elderly parents. Some are worrying long distance, feeling the need to travel as often as possible to arrange care. Some move parents into their own homes, resulting in caregiving close at hand, but often increasing family tensions at the same time.

Health care and financial challenges (how will we pay for all the services we need) are increasingly common topics of dinner tables and garden parties.

For us and our friends, it was eye-opening to hear how many of us are experiencing a different life-style than we planned for this stage of our lives. How many of us are finding that time is our most valuable asset, just when we thought maybe life would slow down a bit, and we could enjoy it a little more.

We're just starting down the path of challenges, too. We'll need all the mutual support, all the resources and all the ingenuity we can dig up to support our own families - and each other - as we face coming caregiving crises.

In the meantime, we'll enjoy these last days of summer, and we'll value knowing that we're not alone in this drama. And maybe that will make it a little bit easier to keep moving on, searching for solutions that fit just right for our families.

Wednesday, October 1, 2008

Compassion Fatigue for a Reason - and why it hurts you

You may never heard of a condition that you might have. It's called by some Compassion Fatigue, and it refers to that point in time when stress, fatigue and tension start overtaking compassion and caring.

It's a feeling common to caregivers of individuals with Alzheimer's disease, many of whom suffer more physical and emotional ailments than the people in their care.

It's becoming increasingly common with professional caregivers, too. These are the home care workers, the nursing assistants and the assisted living caregivers who work for the love of the job and their clients - not the money.

In times of economic downturn, these are the folks who get hurt the most.

Many of them have no company-paid health insurance. Their real wages, in terms of buying power has actually decreased, according to PHI.

This decline in wages is even more distressing when you compare caregivers' wages to wages earned in other occupations.

It's no wonder that many of these hardworking individuals are being stretched even tighter in these challenging economic times.

PHI lists the 9 Elements of a Quality Job. It's their mission to advocate for direct care workers to achieve these elements:

1. Family sustaining wages (we're not moving in the right direction on this one yet).

2. Affordable health insurance (in my state - Oregon, there are 612,000 people without insurance. In tough economic times, this number increases dramatically).

3. Full-time hours (many caregivers work irregular, part time shifts. It's tough for many, especially home care workers, to cobble together the equivalent of full time work).

4. Excellent training (my area of passion; a pivotal area of determining the quality of care that will be delivered).

5. Participation in decisions (empowering employees means greater job satisfaction. It means the good ones might just stay).

6. Career advancement (an opportunity through training to advance through a "career ladder" to increased opportunity and pay).

7. Linkages to services (removing barriers to work for some who would be great caregivers but need support to get started).

8. Supervisors who set clear expectation and encourage and support as well (leadership is one of the greatest needs in health care today).

9. Owners and managers who are willing to truly implement a system of quality improvement.

These 9 element break down into three main areas: Compensation, Opportunity and Support.

Without these elements, those individuals who provide care to my mom and yours will suffer enough compassion fatigue to possibly lose them from the caregiving workforce.

And that will hurt me. And you. And our elderly loved ones.

It's time for all of us to better understand this challenge and continue to advocate for relief for these very valuable, very caring individuals.