Boom?

Our local newspaper arrived in the mail yesterday - it comes weekly on Thursdays, and is full of news about our community's kids' sports activities, from pre-school soccer through high school sports.

It's also the vehicle for a monthly insert that has always been titled "Senior Lifestyles."

Yesterday the insert had a new title: "Boom!"

Clearly, we boomers are now the "senior lifestyles" target audience, as all of us are approaching those lovely Medicare years, and some have even arrived. Tellingly, while content inside dealt with issues we face - caring for our parents, figuring out when and how to start drawing Social Security - the full back cover was an ad from a plastic surgery center.

While I’m a little (OK, a LOT) disconcerted about now being both a boomer and a “senior” (I’m not, though – really, I’m not!), it is telling that as WE age, the language will change.

It will change because we’re demanding changes in the way we’re viewed, and in the way we’re treated.

And as senior care professionals, we’d better be tuned into those changes and be ready and prepared to change OUR language of caregiving, too.

Because the language, the expectations and the outcomes will change, whether we’re in the lead, or frantically trying to keep up.

A Fear Greater than Death

Last weekend my father-in-law decided to get out in the delightfully sunny fall air and rake up some leaves in the yard. A few minutes later, he was flat on his back, unconscious, with an ambulance on the way.

At the hospital, the ER physician asked my dad-in-law, “What the hell were you doing raking the leaves at age 93?”

Both the physician and my husband’s family used this as an opportunity to encourage my in-laws to proceed with their long-discussed – and postponed – move into a retirement center.

My in-laws are no different than most older persons: according to several recent studies, leaving home and losing independence are the biggest fears most seniors have. According to “Aging in Place in America,” commissioned by Clarity and The EAR Foundation (as reported in last week’s Senior Journal.com) only 3% of seniors feared death, compared with 26% of seniors who most feared losing their independence.

From our perspective, and, to be perfectly honest from my father-in-law’s perspective, too, moving out of a home environment into a retirement center is an opportunity to increase companionship, social stimulation and activities, as well as a chance to let someone else do the leaf-raking. It’s my mother-in-law that fears losing her things that have such meaning and sentimental value, the things she’s surrounded herself with throughout her adulthood.

Interestingly the study found that the children of seniors worry most about their parents being mistreated in nursing homes (82%); 89% worry about their parents being sad. Certainly that reflects the media attention that abuse or mistreatment in nursing homes receives; it also reflects our fears as boomers that we won’t personally be able to balance everything – our work, our kids and our parents. If we can’t have confidence in the care they’ll receive in a nursing home – or any other senior care setting – we’ll continue to worry about them and continue to feel the “Sandwich” squeeze.

It’s time to start a new perspective on aging options, whether retirement community, assisted living or skilled nursing. It’s time to think of these as options to ADD to our live, and to the lives of our parents, rather than options for TAKING AWAY: independence, freedoms and decent and honorable treatment.

It’s time, as members of an already too-stressed generation of people caring for parents (and grandparents), children (and grand-children) to see the advantages of getting help in providing care and services to our parents.

It’s time, from the professional perspective, to put into place methods and systems for family members to consider these options worry-free, and guilt-free.

Maybe it's even time for my father-in-law to put down his rake - but only if that's what he really wants to do (one can rake leaves even in a retirement community, dad)!

It’s up to us, as the baby boomer generation with the most challenges and stresses related to this issue our nation has ever experienced, to start making the difference.

Choices

Here's one advantage to our jumbled system of senior care: we have a lot more choices now. Less than 50 years ago seniors either moved in with family or moved into a nursing home. There were no other options available.

Today, in-home care is readily available in almost every community in the US. Assisted Living has added another level of care to the mix, allowing seniors to live in an independent, residential environment while accessing support services. Granted, the level and type of support varies widely - from state to state and even from building to building - but no longer does a person needing care have to move into a skilled nursing community to receive assistance.

Barbara Quirk, a geriatric nurse practitioner, writes about yet another option that boomers may well choose in the future: shared housing arrangements.

The fact is that it is not a bad idea to consider moving in together with lifelong friends and hire whom you choose for your helpers. This may be a far better option than the traditional assisted living. For starters, you would be with people you know and enjoy, rather than strangers.

My immediate response is, "Yes, but then I'd still have to cook and clean!" I like the idea of someday moving into a senior living community where I simply show up at the dining room when I wish, and leave the day-to-day worries to someone else.

My mom has been living in a cottage in a retirement village now for over 6 months. She was sharing her experience with friends who had come to visit her for the first time - and who were speechless at how friendly everyone there was to them.

"We were just walking down the sidewalk and people would stop to talk. Come to find out, we have friends in common with more than one person living here!"

My mom is happy, has tons of new friends, and says she truly feels like this is now "home" for her.

My friend, on the other hand, receives calls daily from her mom who, recently widowed, is alone and lonely on her countryside home.

“I lied to my mom for the first time yesterday when I told her I was busy and couldn’t go with her on an errand,” she said. “I was simply worn out from daily calls for help – but mostly for companionship.”

Caregiver stress and the medical ramifications are well documented today. This stress affects families who are trying to balance it all, as well as paid caregivers who don’t have access to the training or support that they need to do a demanding, often thankless job.

I like what Barbara Quirk says in her comments about shared housing and other options we have now:

With all of the housing options available today, plus a few that haven't even been thought of, it pays to at least consider what would be acceptable to you.

And, perhaps even more importantly, consider – and discuss - what would be acceptable to your loved ones. Giving that some attention now may take some of the stress off all of us when needs arise in the future.

Caregiver Crisis Memories

I've been talking to a lot of people lately about two issues that are on my mind: The coming caregiver workforce crisis and the need for caregiver respect as a profession.

The projections on the coming caregiver crisis are dire; they make the shortage we experienced in the 1990s seem insignificant. I recall only too clearly what those days were actually like for an owner and operator of several senior care communities, which was my work at that time.

Before that time we had policies against hiring multiple persons from one family. During the shortage, we began asking every employee if he or she had a brother, sister, aunt or mother who would be interested in this work.

Before that time, we could keep our staff roster full with only periodic advertising. During that time, we put sandwich boards on the sidewalks that said “Now Hiring Caring People” – and left them there week after week.

Before that time we’d put two-line ads in the local newspaper and actually have applicants to interview and choose from. During the shortage, we got creative in our descriptions (“seeking people with a sense of humor only”) and ran ads in everything from the daily paper to the Nickel Ad sheets.

While we were trying everything we could to find people to fill positions, we were working every staff member overtime – lots of overtime. I worried constantly about fatigue and the results on the quality of care that a caregiver provided, not to mention the increase in abuse potential when a caregiver was exhausted.

And I have to admit we hired a few doozies, too. I remember a couple of people with tattoos from head to toe - neatly covered during the interview - that had colorful language and questionable motives for applying in the first place. Some got hired, and almost always we regretted the hiring choice.

Our managers worked night shifts, then came in the next day to do their own jobs bleary eyed and fatigued. We had residents who simply needed 24 hour care, and we had committed to providing that care to them, whatever it took.

Looking at the demographics, that experience was nothing compared to what is coming just ahead. Better Jobs Better Care reports:

Shortages of qualified, committed paraprofessionals are likely to worsen. In the coming years, the U.S. will experience a tremendous increase in the size of its­ elderly population as baby boomers age. At the same time, the number of middle-aged women who have traditionally filled these jobs is not growing fast enough to meet the increased demand for services. The result of these demographic shifts is an emerging "care gap" that could severely curtail our nation's ability to provide long-term care.

Tomorrow I’ll address the second part of my recent conversations: how to enhance the role of caregivers as professional. I can’t help thinking that these two subjects are directly linked, and are essential to our understanding if we’re going to make a real difference in the care we provide – and the care we receive.

Caregiver's Language of Caring

Clearly the topic of the words we use in talking about caregiving is a concern to many. Roy G. Gedat wrote,

This came up as a priority at the recent Direct Care Alliance national convention of direct care worker associations. 18 states were represented and our goal is "to help determine universal terms for DCW issues."

The words we use do reflect how we feel about people and about tasks. One of the words I've struggled with in the past is "resident" to reflect people who live in our care communities.

Although moving to "resident" is an improvement from "patient", I used to teach my staff to refer to the folks living in our assisted living communities as "the people who call this their home." It helped remind us that this WAS their home, and to communicate that to others, especially guests and prospective families.

The problem, of course, is that we've replaced one short word with 7 words - not an easy solution. As I look at many word suggestions for replacing other words that don't reflect our current view on caregiving, I see the same pattern. A challenge, clearly, if we are to replace words with new terms that gain broad usage.

I have to chuckle, speaking of words, at the creative language people use to talk about their experiences as members of the "sandwich generation." Colorful language - all in an effort to help communicate how truly challenging this role is for many of us.

Some have referred to feeling like an open-faced salami sandwich, lying face-down on the sidewalk. Others have talked about feeling like a smushed flat PB&J. Judy Steininger describes the feelings of living your life when, out of the blue, you get a phone call that a parent has suffered a serious mishap. Meanwhile, you're busy balancing your kid's soccer game and dinner for the family.

Just like that, you’ve become the newest member of the Sandwich Generation. If you’ve always liked your lunch served on wheat or rye, in the months or years ahead, you’ll learn to appreciate sourdough.

I think this generation is perfectly equipped to handle the task of creating a new language of caregiving. We're talking the Baby Boomers, Sandwich Generation - or whatever term you want to use - but we're talking about people who are all about creating a new language!

The Sandwich Generation: Good enough isn’t good enough anymore

For the past 20 years, I have taught about, written about, and thought I understood the Sandwich Generation experience: the adult children, still caring for children of their own, and also caring for aging parents.

Now, however, I do more than understand – I am living the role. Last night, standing in the checkout line at Target with all the essentials needed to set my mom up in her new retirement apartment, I realized that I had done the exact same thing just a few months ago with my eldest daughter, who was moving into her first apartment.

I had the same exact cart contents, too: shower curtain, laundry soap, kitchen essentials, sheets and towels.

As I rushed from unloading my mother’s purchases to pick up my youngest daughter at dance class – 15 minutes late . . . again – I thought, “I am living the Sandwich experience.”

I, and nearly every one of my friends and acquaintances.

Melanie has been sitting at her dying mother’s side for the past two weeks, leaving only to attend her high school daughter’s performances. She’s learned more about hospice, caregiving, and end of life choices in the past two weeks than I have in the past two decades.

Carol, a professional with a thriving private practice, has gradually reduced her work week to three days as her kids have completed college. Last week, Carol started working five days a week again to help cover the costs of two parents in need of high-level assisted living care.

My husband is taking tomorrow off work to accompany his parents to the doctor to learn how his 87 year old mother’s recently diagnosed cancer will be treated, and to support his 93 year old father in handling the news.

Clearly, we’re not alone. Both CBS and NBC are currently airing segments during their evening news broadcast that focus on this exact challenge which is facing millions of Americans today.

Many of our parents need care in assisted living communities, nursing homes and retirement centers. And you can bet your last dollar that every one of us will be picky, annoying, and demanding. We’ve grown up demanding more, and we’re accustomed to getting it.

A promotional announcement for the upcoming Assisted Living Federation of America conference featured a Disney University past executive speaking on the topic of “Learning from Disney, Where It's Not About Satisfaction.”

While Disney seeks loyalty by offering the best vacation experience imaginable, we in senior care have felt smugly successful if our clients are merely “satisfied”.

As my generation of self-centered Baby Boomers enters the long term care system – as advocates for our parents or as consumers ourselves – beware: We’ll be looking for an experience that far surpasses simply “satisfactory.”

Yesterday I interviewed a young woman for an office position. She told me of an earlier job she’d had in a care setting where she had been excited to help, but left after just three months.

“I was thrown right into the work with no training at all – just another employee to get me started,” she said. “I would have loved the job, but I couldn’t do it without training.”

No wonder our turnover rate is so high – over 70% annually, according to the most recent survey by the American Health Care Association (AHCA), as reported by the National Clearinghouse on the Direct Care Workforce.

This one thing I know: As a profession of senior care providers, we are not going to be ready to meet the high demands of my generation if we don’t aim higher.

Higher in our training of frontline staff.

Higher in our own expectations of happy customers.

Because for me – and for millions like me – it is no longer just a job; it’s personal.


Links:
ALFA: http://www.ALFA.org

ALFA Conference (May 15-17 in Dallas, TX): http://www.alfaconferenceandexpo.com/whoattend.shtml

Fred Lee, author of If Disney Ran Your Hospital (Amazon link) http://www.amazon.com/Disney-Ran-Your-Hospital-Differently/dp/0974386014/sr=1-1/qid=1172180888/ref=pd_bbs_sr_1/103-7876113-5071805?ie=UTF8&s=books
AHCA: http://ahca.org/

Direct Care Turnover Statistics: http://www.directcareclearinghouse.org/s_state_det.jsp?action=view&res_id=52