Posted: Fri Aug 03, 2007 8:34 am Post subject: THE ELDERLY
MHI in his Irshad Mubarak expressed concerns about large numbers of seniors getting lonely with increasing life expectancy and reducing age of retirement. This thread is dedicated to the issues facing the old aged and hopefully that will raise awareness of this issue . The following article explores the changes in the outlook and attitudes towards the old since last century.
August 3, 2007
Being Old, Then and Now
By DAVID BROOKS
Last week, while driving from a campaign event in Keene, N.H., I stumbled upon a used bookstore that I hadn’t seen since I was a teenager. I stopped in — even though I was rushing to catch a plane — and came upon a sad book published anonymously in 1911.
The book is called “Autobiography of an Elderly Woman,” and it’s a description of what it was like to be old a century ago. The woman begins by recalling the stages of her life: the misty days of girlhood; the precious years when she was raising her young; the rewarding times when she and her children were adults together and companions.
But then something changed.
“I do not know when the change came, nor do they, if indeed they realize it at all,” she writes. “There was a time when I was of their generation; now I am not. I cannot put my finger on the time when old age finally claimed me. But there came a moment when my boys were more thoughtful of me, when they didn’t come to me anymore with their perplexities, not because I had what is called ‘failed,’ but because they felt that the time had come when I ought to be ‘spared’ every possible worry. So there is a conspiracy of silence against me in my household.”
She describes how her children baby her. They offer to give her rides in the carriage to run errands when she could just as well walk. They try to prevent her from doing normal housework on the grounds that it’s too taxing. “You count the number of your years by the way your daughter watches your steps; and you see your infirmities in your son’s anxious eyes.”
She describes living in a different dimension. She sees and understands, but her counsel is never sought and she has no ground upon which to act. “We have learned then that we can’t help our children to lead their lives one bit better. There is not one single little stone we can clear before their feet.”
Though writing in the age of the gas lamp, she understands what the latest scientific research is now concluding. “Very soon your children slip from between your fingers. They develop new traits that you don’t understand and others that you understand only too well, for, like weeds, your faults come up and refuse to be rooted out ...
“There came a time when I realized that every child on the street my child stopped to talk with had its share in bringing up my sons and daughters. One week in school was enough to upset all the training of years.”
The book is a lament from a person put on a shelf, bound by convention and by the smothering concern of others not to exert any power on the world, even while seeing more clearly than ever the way power can and cannot be exerted.
It’s a remarkable little book, and when I did some research, I was surprised to learn it wasn’t written by an old woman. It was written by 37-year-old Mary Heaton Vorse, using the voice of her own mother.
Vorse was a bohemian and a radical journalist who wrote for The Masses, hung around Eugene O’Neill, John Reed and Louise Bryant, and she helped found the Provincetown Players.
Using her mother’s perspective, Vorse wrote a sort of “The Second Sex” for the elderly of 1911. It is about a class of people unable to exercise their capacities.
And what she described was real. In “Growing Old in America,” the historian David Hackett Fischer writes that age was venerated in early America. But starting in the first half of the 19th century, youth was venerated and age was diminished.
Thoreau wrote that the young have little to learn from the old. The word “fogy,” which had once meant a wounded veteran, acquired its current meaning. Dinner table seating was no longer determined by age but by accomplishment. Scientific knowledge gained prestige over experience.
Women, who had once rarely lived much past their youngest child’s marriage, now lived on with no clear role. The character in “Autobiography of an Elderly Woman” is a victim of all this.
I don’t know how many of her opinions will ring true to today’s oldsters. Now, elderly are richer, more active and more engaged than their cohorts of a century ago, but are they still living in a different dimension?
Is it now a dimension of their own choosing?
Last edited by kmaherali on Thu Dec 11, 2014 1:09 am, edited 1 time in total
That is why it is so critical to reach out to the aged population in our jamat. Language barriers are apparent and therefore, it is important for the younger members in our jamat to acquaint themselves with our wondeful heritage -the language, culture, religious traditions.
I find it rewarding to just make a simple phone call to a brother or a sister in our faith no matter what their age is and just see how that person is doing....
It may not be shocking to know loneliness dees no boundaries and happens in all ages and gender more so in the aging population.
August 14, 2007
A Grass-Roots Effort to Grow Old at Home
By JANE GROSS
WASHINGTON — On a bluff overlooking the Potomac River, George and Anne Allen, both 82, struggle to remain in their beloved three-story house and neighborhood, despite the frailty, danger and isolation of old age.
Mr. Allen has been hobbled since he fractured his spine in a fall down the stairs, and he expects to lose his driver’s license when it comes up for renewal. Mrs. Allen recently broke four ribs getting out of bed. Neither can climb a ladder to change a light bulb or crouch under the kitchen sink to fix a leak. Stores and public transportation are an uncomfortable hike.
So the Allens have banded together with their neighbors, who are equally determined to avoid being forced from their homes by dependence. Along with more than 100 communities nationwide — a dozen of them planned here in Washington and its suburbs — their group is part of a movement to make neighborhoods comfortable places to grow old, both for elderly men and women in need of help and for baby boomers anticipating the future.
“We are totally dependent on ourselves,” Mr. Allen said. “But I want to live in a mixed community, not just with the elderly. And as long as we can do it here, that’s what we want.”
Their group has registered as a nonprofit corporation, is setting membership dues, and is lining up providers of transportation, home repair, companionship, security and other services to meet their needs at home for as long as possible.
Urban planners and senior housing experts say this movement, organized by residents rather than government agencies or social service providers, could make “aging in place” safe and affordable for a majority of elderly people. Almost 9 in 10 Americans over the age of 60, according to AARP polls, share the Allens’ wish to live out their lives in familiar surroundings.
Many of these self-help communities are calling themselves villages, playing on the notion that it takes a village to raise a child and also support the aged in their decline. Some are expected to open this fall on Capitol Hill; in Cambridge, Mass.; New Canaan, Conn.; Palo Alto, Calif.; and Bronxville, N.Y.
“Providers don’t always need to do things for the elderly,” said Philip McCallion, director of the Center for Excellence in Aging Services at the State University of New York at Albany. “There are plenty of ideas how to do this within the aging community.”
Although not a panacea for those with complicated medical needs, the approach addresses what experts say can be a premature decision by older people to give up their homes in response to relatively minor problems: No way to get to the grocery store. Tradesmen unwilling to take on small repairs. The isolation of a snowy winter.
As these small problems mount, sometimes accompanied by pressure from adult children, experts say, the elderly homeowner is caught off guard. Remaining at home without sufficient help is frightening. But moving to an assisted-living center is often an overreaction that can be avoided or postponed.
“A few neighborhood-based, relatively inexpensive strategies can have an enormous effect,” Mr. McCallion said. “If people don’t feel so overwhelmed, they don’t feel pushed into precipitous decisions that can’t always be reversed.”
For inspiration, the nascent groups looked to Beacon Hill Village in Boston, which pioneered the approach six years ago. Beacon Hill’s 400 members pay yearly dues — $580 for an individual and $780 for a couple, plus à la carte fees — in exchange for the security of knowing that a prescreened carpenter, chef, computer expert or home health aide is one phone call away.
Experts in aging say the self-help approach provides a sense of mastery, often lost with the move to an institution or even an adult child’s spare bedroom. That can-do spirit is attractive to baby boomers like Alisia Juarrero, 59, who is a board member of the Allens’ group, which spans the Palisades neighborhood, an enclave of single-family houses northwest of Georgetown, and Foxhall, an adjacent area of attached Tudor homes.
Ms. Juarrero is mindful of the future because of the struggles of her 89-year-old mother and 92-year-old aunt in Coral Gables, Fla. “This is where we’re all headed,” she said. “If I help set this up, it’ll be there when I need it.”
So far, most of the villages are in places where residents are well connected and skilled in finance, law, medicine and philanthropy as a result of their own careers. That raises the question of whether the model is viable only in neighborhoods of privilege. But experts point out that most care for the elderly is already out of reach for all but the wealthy.
The amenities of an assisted-living center are far more expensive than a village’s membership fee. Medicare does not pay for long-term care, and private help is costly. Only the destitute are protected in old age because Medicaid pays their nursing home fees.
A few villages are cropping up where low-income families live, such as in the Richmond District of San Francisco, with its recent wave of Russian immigrants; Falmouth, Mass., where year-round residents struggle when the summer crowd is gone; and in pockets in Westchester County, like Yonkers, with diverse populations.
In such locations, social service organizations are likely to organize the project, instead of the older residents, and they rely on volunteers or bartered services to keep fees down. One member fixes another’s faucet, banks the time and in exchange gets a ride to a medical appointment.
Groups also share expertise online and at local and national conferences, including several this past spring. Some have access to regional resource centers that help with matters like hiring an executive director or buying liability insurance.
In terms of government support, New York State is at the forefront, with a 20-year-old model known as a NORC, or naturally occurring retirement community. Since 1995, the state has financed social services, including nurses and case managers, in many apartment buildings with a concentration of residents over 60. Last year, it added a few suburban neighborhoods, so-called horizontal NORCs.
On the federal level, Congress authorized experiments in aging in place in the 2006 Older American Act but did not finance them.
The sprawl of suburbia presents challenges to the elderly once they cannot drive. Amid the rolling hills of Fairfax County, Va., one group is grappling with how to serve prospective members in a place with a single general store and five-acre lots. Taxi vouchers may be too costly when running errands can take hours. Recruiting volunteer drivers from 118 home owners’ associations and 17 churches presents liability issues.
“The question is distance and time, and the money that relates to that,” said William Cole, 77, the founder of the group. Mr. Cole anticipates yearly dues of $1,000, which may be prohibitive for neighbors who are real estate rich but cash poor. One likely service, Mr. Cole said, will be advice about reverse mortgages.
Many of the villages are concerned about whether they can provide adequate support once the founding members, who tend to be vigorous regardless of age, decline either physically or cognitively. In this regard, the New Canaan group, with annual dues of $360 and $480, may be less vulnerable than most. The suburb already has a home health care agency, an assisted-living center and a nursing home, thanks to years of advocacy by a local physician, an 87-year-old board member.
Because of that, “we have the confidence to live without these problems getting the best of us,” said Tom Towers, 69, the board president of the group, Staying Put in New Canaan. “And if they do, we can take care of it right here.”
The first village in the Washington area is expected to be on Capitol Hill. When it opens for business on Oct. 1, annual memberships will be $750 for a couple and $500 for an individual.
Among those eager to join are Marie Spiro, 74, and Georgine Reed, 78, who share a rambling house that they insist they will only leave “feet first.” Between them, Ms. Spiro, an emeritus professor of art history and archaeology, and Ms. Reed, a retired designer of museum exhibits, have already endured three knee replacements and an array of other ailments.
Ms. Spiro describes huffing and puffing while grocery shopping; Ms. Reed is increasingly reluctant to visit friends across town. Both women, who are childless, would already welcome help with meals, transportation and paperwork. If they need home care, Capitol Hill Village will be able to organize that.
“I’ve never had to rely on other people, and I never wanted to,” Ms. Spiro said. “But I’d rather pay a fee than have to ask favors.”
Members of all these groups share an independent streak — and the willingness to plan for the future. Those characteristics were on view recently in a living room in Hollin Hills, a post-World War II development in Alexandria, Va., where a half-dozen neighbors who once organized baby-sitting co-ops are now organizing for their final years.
Now, in their 70s and 80s, they still drive, play tennis and travel the world. None has yet lost a spouse, but they fear what will happen to the one left behind.
“The vast majority of people don’t have the capacity to be realistic,” said Ruth Morduch, 71. “We don’t know what’s going to happen in X number of years, but we know we’re going to need help. In my own home, that’s less likely to be humiliating. And an organization like this gives me a sense that we’re all in this together, our last grand adventure.”
--- In Batunimurid@yahoogroups.com, Hasan Essa <hasniessa@...> wrote:
> Dear Shaila,
> As senior I am glad to hear you are putting together
> an article on lives and struggles of our senior community.
> To be a senior, specially for those who live in developing
> countries is no fun because, most of them never seem
> to plan and know how to enhance their life when they
> reach their retiring age.
> Unfortunately, despite our leaders trying their best to
> inspire them most of our seniors refuse to change their lifestyle
> and participate in social activities, other than just socialize
> among themselves in groups and eat and be merry.
> I am sure you have listened to our Imam expressing His
> concern for our seniors during His speech at Aiglemont
> that He is worried, and advised our leaders to look into
> plight of our seniors and work out some plan how to enhance
> their remaining years to make it fruitful.
> For many, retirement is a time to pursue dreams; a time to
> travel, volunteer, try new things, and enjoy the company of
> family and friends.The reality however, is not always as rosy
> as the dream.After enjoying a few months of freedom, many
> retirees find themselves asking, "What's next ?" Figuring out
> what to do with your retirement is a process.From the time
> you are little ,you always know what's next.After first grade,
> it's second grade.After high school is college, then job.
> It's all one step in front of the other..... and then we retire
> and except for the fact that, hopefully,you put some money
> aside, almost no one plans for the social and psychological
> implications of what's next at this stage.
> What's next ? we' ve all known people who, without a clear
> path to follow, find themselves overwhelmed and instead of
> jumping onto a new path, retreat to the sofa in front of the
> TV set.What's next ? is all about making the second half
> of life as dynamic and fulfilling as the first half.
> Sincerely, Ismaili community is not yet equipped to handle a
> rapidly aging population.It's going to be a complete paradigm
> shift in the next few years, and people are going to have to
> wake up and understand that growing older isn't a bad thing.
> It's life.We need to learn about aging and jump in with both
> feet.Starting the process is daunting, as seniors are
> encouraged to step outside their comfort zone and try something.
> But, it's never too late to start.
> Experts offer advice on health and wellness, learning skills,
> relationships,volunteer and career opportunities, and just
> generally give people tools to create a life filled with
> meaning and joy.
> I am a semi-retired Ismaili enjoying my senior life with gusto,
> running a small business which has reference library,computer
> and a television, which keep me busy in my business, readings,
> and writings on internet.For information on seniors, I would write to
> what'snext@... ,and for readings, go to www.ericksontribune.com,
> which has wealth of senior news for you to gather.
> Hope you'll find above news of mine something to go by
> in your project.
> Best regards
> Hasni Essa
> Shaila Abdullah shailaabdullah@... wrote:
> To: Batunimurid@yahoogroups.com
> From: "Shaila Abdullah" shailaabdullah@...
> Date: Thu, 16 Aug 2007 10:23:48 -0500
> Subject: [Batunimurid] Need help on an article for seniors
> I am putting together an article about the lives and struggles of
> senior members in the USA jamat. I would love to hear from people on
> this list who are over the age of 50 who would like to be interviewed.
> Please feel free to contact me directly with any questions you might
> Shaila Abdullah
> Author: http://www.shailaabdullah.com
> Designer: http://shailaabdullah.com/houseofdesign/
> Hasni Essa
> Peace & Pluralism
The world's population is aging at a rate without parallel in human history, says a new United Nations report. And the "irreversible" demographic changes under way, it warns, will have major consequences for all facets of human life.
Since 2000 alone, the number of people age 60 or older globally has jumped by 100 million, to more than 700 million, says a report by the UN's population division.
About 11 per cent of the world's people are now over 60.
That percentage is expected to double by 2050, when the over-60 population is projected to hit two billion.
Already, there are more people over 60 than children under 15 in the developed world.
In developed regions of the world, one in five people is already over 60, a proportion that's expected to rise to one in three by 2050.
In the developing world, by contrast, older persons currently constitute just eight per cent of the population, though that will rise to 20 per cent by mid-century.
But rapid aging in developing nations means that will also be true globally for the first time by 2047, the report says.
Today's median age of 28 is projected to rise to 38 by mid-century, when the median age of South Korea and Macao will reach 54 years.
The increase in average ages is pervasive, affecting nearly every country, the report says.
It's being driven mainly by reductions in fertility that have become virtually universal.
"Because fertility levels are unlikely to rise again to the high levels common in the past, population aging is irreversible," the report says.
"The young populations that were common until recently are likely to become rare over the course of the 21st century."
Globally, the number of those 60 and older is growing by 2.6 per cent per year, more than twice as fast as the population as a whole. "Such rapid growth will require far-reaching economic and social adjustments in most countries," the report says.
Population aging will have an impact on economic growth, savings, investment, consumption, labour markets, pensions, taxation and inter-generational transfers, it says. It will also influence family composition and living arrangements, housing demand, migration and health care. And it may shape voting patterns and political representation.
The UN report also ranks the world's 192 nations using the "aging index," which represents the number of people 60 or over per 100 persons under age 15.
By that measure, Japan again ranks first, with an aging index of 201, meaning there are two Japanese 60 or older for every child under 15. Canada's aging index is 110.3. Niger, with an aging index of 6.6, ranks last.
Posted: Sat Aug 18, 2007 5:11 am Post subject: Jalal ad-Din Rumi's poetry of AGING
RUMI’S POETRY OF AGING
By HARRY R. MOODY
Subscribe to Aging Today
Jalal ad-Din Rumi (1207–1273) was, by common assent, the greatest poet in the history of Islam. He wrote in Farsi and his work is known and loved throughout the Islamic world and beyond. More recently, according to Publisher’s Weekly, Rumi has become the most widely read poet in America.
In many poems, Rumi deals with aging and old age. In “A Man Talking to His House,” reproduced on page 9, Rumi opens with a message, a sweeping statement that the “caravan” of life, or succession of generations from young to old, is actually a pilgrimage of sleepwalkers. No one is fully “awake” to the human condition and to the possibilities for higher consciousness, which would entail “waking up” to a different reality. The mystical branch of Islam is known as Sufism, and one of the goals of Sufism is to “die before you die”: that is, to “wake up” right now, in this life.
LIFE UPSIDE DOWN
Harry R. Moody
Rumi is telling us that our ordinary picture of life is upside down, which is of course a difficult message to express as well as to receive. In Rumi's allegory, ordinary life is like sleepwalking, and while we sleep, a “thief” proceeds to steal what is most precious to us. The poet understands that his message is not likely to be well received and he states flatly, “You're angry at me for telling you this.” At this point the poem abruptly shifts tone. Having risked angering his readers with bad news, the poet now proceeds with a joke: The human body is compared to a house that is constantly breaking down, and Rumi imagines a man speaking to his house, which is his body.
Despite recently diminished disability among the young-old, those in their 60s or early 70s, more people than ever now survive to advanced ages, when the body will remind them of their mortality in stages of deterioration. In effect, the body says, “I'm leaving; I'm going soon.” Rumi's final warning, therefore, is once again blunt and serious: “Don't hide from one who knows the secret.”
Rabbi Harold S. Kushner wrote an inspiring book titled When Bad Things Happen To Good People , reissued by Anchor Books in 2004. But Rumi turns Kushner's idea upside down by inviting us to consider so-called bad things as a message, a wake-up call. In another poem, “The Guest House,” Rumi expands on this theme:
This being human is a guesthouse.
Every morning a new arrival.
A joy, a depression, a meanness,
some momentary awareness comes
as an unexpected visitor.
Welcome and entertain them all!
Even if they're a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still, treat each guest honorably.
He may be clearing you out
for some new delight . . .
Be grateful for whoever comes,
because each has been sent
as a guide from beyond.
Rumi's metaphor of the mind as a guesthouse gives readers another way of thinking about negative states of mind. Think of this “crowd of sorrows” as perhaps “clearing you out” for something greater. But how do we make this transition in thinking? Contemporary culture puts roadblocks in our path; the American emphasis on cheerfulness makes it ever more difficult to accept the inevitable losses and sorrows of later life. Consider the depth of shadows conveyed so profoundly, for example, in the late self-portraits of Rembrandt. What both Rembrandt and Rumi understood is what may be called a transpersonal approach to sorrow. For Rumi, this approach is suggested by the technical distinction between the “ego” ( nafs ) and the “spirit” ( ruh ). The ego represents a limited dimension of selfhood and conceals a transpersonal spirit, which is much more vast.
In the second half of life, people may find themselves discovering that things are not what they seem, a realization that can give rise to disillusionment and depression. Alternatively, this realization can stimulate us to a quest for something greater in our lives. The psychologist Viktor Frankl, a survivor of the Holocaust, called this process self-transcendence in his book Man's Search for Meaning .
The final lines of Rumi's poem “The Guest House” offer a clue as to what the shift to self-transcendence entails. Not only should we see our changing states of consciousness as temporary “guests,” we should cultivate an attitude of gratefulness “for whoever comes.” A transpersonal perspective reminds us that each of these “guests,” even sorrowful or troublesome ones, can be appreciated “as a guide from beyond.” An attitude of transcendence ultimately depends on our affirming something that is “beyond.”
Self-portrait of Rembrandt, 1658, at age 52.
Another of Rumi's poems is a very explicit account of old age:
Why does a date-palm lose its leaves in autumn?
Why does every beautiful face grow in old age
Wrinkled like the back of a Libyan lizard?
Why does a full head of hair get bald?
Why is it that the
Lion's strength weakens to nothing?
The wrestler who could hold anyone down
Is led out with two people supporting him,
Their shoulders under his arms?
“They put on borrowed robes
And pretended they were theirs.
I take the beautiful clothes back,
So that you will learn the robe
Of appearance is only a loan.”
Your lamp was lit from another lamp.
All God wants is your gratitude for that.
Note Rumi's utterly unsentimental attitude toward aging. There is no optimistic sense here of “Grow old along with me, the best is yet to be!” as in Robert Browning's “Rabbi Ben Ezra.” Rumi understands the losses of aging. He poignantly describes the aged wrestler whose power has ebbed and who has become utterly dependent on others. The picture bears no resemblance to the modern celebration of one's “locus of control” or the idea of “decrement with compensation.” What one might ordinarily choose to celebrate as successful aging, Rumi saw as just one more version of sleepwalking. The losses associated with age, like the guests in the guesthouse, are important, even necessary reminders to us of who we really are.
In Rumi's poem, the images of loss each begin with a question: Why, why, why? Can caregivers for the very old and frail escape asking this question? The accomplishments of our lives, so arduously built up in the first half of life, begin to diminish with age. But were these accomplishments ever ours to begin with? In Rumi's account, these accomplishments and strengths were really “borrowed robes” which, later on, God takes back. Those who see life otherwise are, like the travelers in the caravan, “asleep.” When those borrowed robes are taken from us one day, we will know the true nature of our relationship to God.
A LEARNING OPPORTUNITY
Rembrandt and Rumi understood what may be called a transpersonal approach to sorrow.
Rumi's final point in this poem is that the whole of life was only a kind of learning opportunity, a chance to wake up before we die. The second half of life, from midlife to old age, is a series of reminders that the lamp of our consciousness was actually “lit from another lamp.” In this phrase, Rumi invokes an image from the Koran's “Verse of Light,” where transpersonal consciousness is depicted by analogy to an oil lamp (Koran 24:35). What does the world look like when this lamp of higher consciousness has been lit? In a single word: gratitude.
In Rumi, for those of us who work with elders, is a message that is practical and very relevant to helping those who have experienced great loss. None of us can take away the pain of loss for another person. But each of us, in our own lives, retains a capacity to wake up and reframe the experience of our lives, as Scrooge did in Dickens' A Christmas Carol . In Scrooge's act of life review, the old man experiences a transpersonal breakthrough, a shift in perspective that the gift we have comes from another lamp.
Rumi's message is not unique or limited to the Sufis but is echoed by great mystics and spiritual teachers the world over. For example, the great Christian mystic Meister Eckhart put it this way: “If the only prayer you say in your lifetime is ‘thank you,' that is enough.”
Harry R. Moody is the director of academic affairs at AARP.
A MAN TALKING TO HIS HOUSE
By JALAL AD-DIN RUMI
I say that no one in this caravan is awake
and that while you sleep, a thief is stealing
the signs and symbols of what you thought
was your life. Now you're angry with me for
telling you this! Pay attention to those who
hurt your feelings telling you the truth.
Giving and absorbing compliments is like
trying to paint on water, that insubstantial.
Here is how a man once talked with his house,
“Please, if you're ever about to collapse,
let me know.” One night without a word the
house fell. “What happened to our agreement?”
The house answered, “Day and night I've been
telling you with cracks and broken boards and
holes appearing like mouths opening. But you
kept patching and filling those with mud, so
proud of your stopgap masonry. You didn't
listen.” This house is your body always
saying, I'm leaving; I'm going soon. Don't
hide from one who knows the secret.
September 23, 2007
More Profit and Less Nursing at Many Homes
By CHARLES DUHIGG
Skip to next paragraph
Analyzing the Data
For this article, The New York Times analyzed trends at nursing homes purchased by private investment groups by examining data available from the Centers for Medicare and Medicaid Services, a division of the Department of Health and Human Services.
The Times examined more than 1,200 nursing homes purchased by large private investment groups since 2000, and more than 14,000 other homes. The analysis compared investor-owned homes against national averages in multiple categories, including complaints received by regulators, health and safety violations cited by regulators, fines levied by state and federal authorities, the performance of homes as reported in a national database known as the Minimum Data Set Repository and the performance of homes as reported in the Online Survey, Certification and Reporting database.
Habana Health Care Center, a 150-bed nursing home in Tampa, Fla., was struggling when a group of large private investment firms purchased it and 48 other nursing homes in 2002.
The facility’s managers quickly cut costs. Within months, the number of clinical registered nurses at the home was half what it had been a year earlier, records collected by the Centers for Medicare and Medicaid Services indicate. Budgets for nursing supplies, resident activities and other services also fell, according to Florida’s Agency for Health Care Administration.
The investors and operators were soon earning millions of dollars a year from their 49 homes.
Residents fared less well. Over three years, 15 at Habana died from what their families contend was negligent care in lawsuits filed in state court. Regulators repeatedly warned the home that staff levels were below mandatory minimums. When regulators visited, they found malfunctioning fire doors, unhygienic kitchens and a resident using a leg brace that was broken.
“They’ve created a hellhole,” said Vivian Hewitt, who sued Habana in 2004 when her mother died after a large bedsore became infected by feces.
Habana is one of thousands of nursing homes across the nation that large Wall Street investment companies have bought or agreed to acquire in recent years.
Those investors include prominent private equity firms like Warburg Pincus and the Carlyle Group, better known for buying companies like Dunkin’ Donuts.
As such investors have acquired nursing homes, they have often reduced costs, increased profits and quickly resold facilities for significant gains.
But by many regulatory benchmarks, residents at those nursing homes are worse off, on average, than they were under previous owners, according to an analysis by The New York Times of data collected by government agencies from 2000 to 2006.
The Times analysis shows that, as at Habana, managers at many other nursing homes acquired by large private investors have cut expenses and staff, sometimes below minimum legal requirements.
Regulators say residents at these homes have suffered. At facilities owned by private investment firms, residents on average have fared more poorly than occupants of other homes in common problems like depression, loss of mobility and loss of ability to dress and bathe themselves, according to data collected by the Centers for Medicare and Medicaid Services.
The typical nursing home acquired by a large investment company before 2006 scored worse than national rates in 12 of 14 indicators that regulators use to track ailments of long-term residents. Those ailments include bedsores and easily preventable infections, as well as the need to be restrained. Before they were acquired by private investors, many of those homes scored at or above national averages in similar measurements.
In the past, residents’ families often responded to such declines in care by suing, and regulators levied heavy fines against nursing home chains where understaffing led to lapses in care.
October 23, 2007
The Elderly Always Sleep Worse, and Other Myths of Aging
By GINA KOLATA
As every sleep researcher knows, the surest way to hear complaints about sleep is to ask the elderly.
“Older people complain more about their sleep; they just do,” said Dr. Michael Vitiello, a sleep researcher who is a professor of psychiatry and behavioral sciences at the University of Washington.
And for years, sleep scientists thought they knew what was going on: sleep starts to deteriorate in late middle age and steadily erodes from then on. It seemed so obvious that few thought to question the prevailing wisdom.
Now, though, new research is leading many to change their minds. To researchers’ great surprise, it turns out that sleep does not change much from age 60 on. And poor sleep, it turns out, is not because of aging itself, but mostly because of illnesses or the medications used to treat them.
“The more disorders older adults have, the worse they sleep,” said Sonia Ancoli-Israel, a professor of psychiatry and a sleep researcher at the University of California, San Diego. “If you look at older adults who are very healthy, they rarely have sleep problems.”
And new studies are indicating that poor sleep may circle back to cause poor health. At least when it comes to pain, a common cause of disrupted sleep, a restless night can make pain worse the next day. Then with worse pain, sleep may become even more difficult — a vicious cycle common in people with conditions that tend to afflict the elderly, like back pain and arthritis.
The new view of sleep emerged from two parallel lines of research. The first asked what happened to sleep patterns when healthy people grew old. The second sought to uncover the relationship between sleep and pain.
To find out what happens with aging, some investigators, including Dr. Vitiello, studied older people who reported no sleep problems. They actually make up a large group — nearly half of people over 65. Were these people somehow spared age-related changes in sleep?
They were not. Their sleep turned out to be different from sleep in young people: it was lighter, more often disrupted by brief awakenings, and shorter by a half hour to an hour. Dr. Vitiello reasoned that the age-related changes in sleep patterns might not be an issue in themselves. Something else was making people complain about their sleep.
Dr. Vitiello and his colleagues also asked what normally happened to sleep over the life span. It had long been known that sleep changes, but no one had systematically studied when those changes occurred or how pronounced they were in healthy people.
With analysis of 65 sleep studies, which included 3,577 healthy subjects ages 5 to 102, the investigators had their next surprise. Most of the changes in sleep patterns occurred when people were between the ages of 20 and 60. Compared with teenagers and young adults, healthy middle-aged and older people slept a half hour to an hour less each night, they woke up a bit more often during the night, and their sleep was lighter. But after age 60, there was little change in sleep, at least in people who were healthy.
And even though sleep changed during adulthood, many of the changes were subtle. Middle-aged and older people, for example, did not have more difficulty falling asleep. The only change in sleep latency, as it is called, emerged when the investigators compared latency at the two extremes, in 20- and 80-year-olds. The 80-year-olds took an average of 10 more minutes to fall asleep.
Contrary to their expectations, the investigators found no increase in daytime drowsiness in healthy older people. Nor did aging affect the time it took for people to start dreaming after they fell asleep.
Instead, the biggest change was the number of times people woke after having fallen asleep.
Healthy young adults sleep 95 percent of the night, said Dr. Donald Bliwise, a sleep researcher at Emory University. “They fall asleep,” he said, “and don’t wake up until the alarm goes off.”
By age 60, healthy people are asleep 85 percent of the night. Their sleep is disrupted by brief wakeful moments typically lasting about 3 to 10 seconds. “There is some aspect of sleep that isn’t going to be as good as when you were 20,” Dr. Bliwise said. But he added, “When that crosses the threshold and becomes a significant complaint is difficult to say.”
The real sleep problems, he and others say, arise when people have any of a number of conditions that make them wake up in the night, like sleep apnea, chronic pain, restless leg syndrome or urinary problems. That, of course, describes many older people.
“The sheer number of challenges to maintaining solid sleep in old age is just huge,” Dr. Bliwise said. “You come out with the question, Well, what is normal? What should I expect?”
The new frontier of what to expect, and what to do about it, involves studies of the relationship of sleep to pain. It’s no surprise that pain can disrupt sleep. But what is new is that a lack of sleep can apparently increase the sensation of pain.
Michael T. Smith, the research and training director of the behavioral sleep medicine program at Johns Hopkins School of Medicine, reached that conclusion with a study of healthy young people. One group slept normally for eight hours in the hospital. Another was awakened every hour by a nurse and kept up for 20 minutes. Their sleep pattern was meant to mimic the fragmented sleep of elderly people. A third group was allowed four hours of solid sleep.
Comparing the second and third groups allowed Dr. Smith to tease apart the causes of the problems that arise from fragmented sleep: were they because of the short total sleep time, or because of the disrupted nature of the sleep?
Fragmented sleep, he found, led to severe impairments the next day in pain pathways. The subjects felt pain more easily, were less able to inhibit pain, and even developed spontaneous pain, like mild backaches and headaches.
Timothy Roehrs, director of the sleep disorders research center at Henry Ford Hospital in Detroit, also found that healthy young people became exquisitely sensitive to pain after a night of fragmented sleep.
And getting more sleep, Dr. Roehrs found, had the opposite effect. His subjects were young healthy people who said they were chronically sleepy, just not getting enough time to sleep at night. Dr. Roehrs had them stay in bed 10 hours a night. The extra sleep, he said, reduced their sensitivity to pain to the same degree as a tablet of codeine.
Now, Dr. Smith says, he and others have markedly changed their attitude about sleep problems and aging.
Of course, he said, sleep is different in 20-year-olds and 70-year-olds. But he added, “It’s not normal to get a clinical sleep disorder when you get old.”
Posted: Tue Oct 23, 2007 9:38 pm Post subject: The old aged
I get really cross when I see the elderly being called "the old aged" because I am a pensioner myself and feel it an insult to be addressed as the old aged. Surely everyone KNOWS that the old are of an age but why the need to emphasis this fact?
Wouldn't it be more respectful and nicer for us to be addressed as "The Elderly" or "Senior Citizens".
So how about it?
Can we make a bit of an effort here, please?
--- In Batunimurid@yahoogroups.com, jrdavis <from_alamut@...> wrote:
> It seems that you have identified an important social problem which did not exist when your families were extended. living together closely locally and family took care of their edlerly/disabled. Other faiths have recognized these problems and deal with them appropriately. The Chrisians have always had a long tradition of visiting the sick and visiting non-relatives who are ill or alone.
> Now that you have Identified this problem now what are you going to do? Leadership in religious organizations are usually very slow and conservative to move fast if at all. I would suggest setting up a lay organization and survey your community for those who are in need of visitors. Read up on what the Christians do with visitations and adapt that to appropratiate Ismaili traditions. And then tap the resources of your youth who usually are looking for more interesting things to do than just attending worship services.
--- In Batunimurid@yahoogroups.com, "nas115" <nas115@...> wrote:
> Ya Ali Madad,
> Yes! can you emagine this forgotton man is still a father, a
> husband,a son, a brother, was a successful business man and a
> contributing member of the family, a society and the jamat. The
> wisdom he has gained through life experiances and how valuable this
> wisdom is for the upcoming generations. Even If we consider nothing
> else he is a living breathing human being who has become invisible
> with no fault of his own.
> This problem of abondonment of invalids, the elderly is universal and
> not just attached to third world countries. I think its more painful
> to be forgotton in countries like Canada because of the harsh winters
> that people cannot go out even if they chose very hard to help
> themselves. The depression, the lonelyness is killing. Social life is
> almost non existent for some; its a rat race and if you are immobile
> you become the case of "out of site is out of mind." This forgotton
> man and many others like him had no opportunity to celebrate Golden
> jubilee of Hazar Imam (His Highness Prince Karim Agakhan IV)
> At times its hard for families to avoid leaving their loved ones in
> the Nursing home but there is no excuse to not to visit them. If no
> one is visiting in the nursing homes they are considered abondoned
> and become a target, a punching bag for physical and emotional abuse.
> In my opinion Ismaili institutions has greater responsibilities
> towards Ismailies in crisis to provide them emotional and spiritual
> support on a regular basis weather they have families or not. They
> should not wait for people to approach them because at times these
> people in crises are going through shock, shame, fear and blaming
> themselves for being abondoned, to protect the identity of their
> loved once or any other reasons so cannot reach out for help. They
> have lost the sense of belonging which all of us need as humans. The
> jamat should provide unconditional, unthreatened , discreet,
> confidential support and help bring families in crisis together.
> I would appreciate if you all could forward this mail to as many
> people as you can to make it an urgent issue for Ismaili councils to
> bring these ismaili in crisis some relief. Remember, atleast in
> Canada some funding is there by the government but these people need
> directions, emotional and spiritual support from the communities they
> belong to.
> Thankyou for your time and support for this cause !
> "Where you are I used to be, where I am you will be "
> --- In Batunimurid@yahoogroups.com, mehboob laljee
> mehbooblaljee@ wrote:
> > I thought this was the fate of invalids in developing countries. It
> commes to me as a shock and am not prepared to beleiev that even in a
> country like Canada this is thereality.
> > Mehboob
> > nas115 nas115@ wrote:
> > Ya Ali Madad,
> > For the first time ever I visited an old age nursing home today,
> > in Toronto, Canada. One man perticularly caught my attention. As I
> > talked to him I realised he is an Ismaili and the only Ismaili
> > He was telling me that he is in the nursing home for over a year
> > has NEVER LEFT its doors once. His right leg is amputed and dont
> > much strength in the left leg. His upper body seemed week too. He
> > a manual wheel chair which is hard for him to go around. He has
> > applied for an electric wheel chair but its taking time to come so
> > have no choice but to stay indoors at all times. He doesnt have
> > help, He hardly ever have any visitors. At times he had been beaten
> > badly at the nursing home by some care givers and had no soap for
> > showers or even sufficient water to clean. Inspite of these
> > I saw calm on the man's face, he wasnt miserable about what was
> > happening to him,seemed like he had accepted his fate and that he
> > to live on which made it even more difficult for me to bear.
> > While we were celebrating fifty years of Imamat this man was
> > isolated, sick and suffering emotionally, physically and
> > and forgotton. It made me wonder if Ismaili Council is reaching out
> > to Ismailies in crisis. Even if they are aware of such cases, there
> > are ismailies who are totally abondoned. This Man has not seen
> > jamatkhana in more than twelve months just because he is not mobile
> > and has no help available to him. He is also unable to approach
> > people for help for some reason.
> > I hope the Ismaili Council of Toronto Canada has a reporting centre
> > so they can aid these Ismailies in crisis and provide them as much
> > support as possible in confidence.
> > "Where you are I used to be, where I am you will be "
Canada's seniors need more help
With an urgent demand for geriatric specialists, you'd think students would be lining up to fill the spots. They're not
CanWest News Service
Thursday, November 08, 2007
At a time when Canada's aging population means that seniors are Canada's fastest-growing population group and the fastest-growing segment is 85-plus, Canadian medical schools are barely turning out a handful of geriatric specialists every year.
Even young people are having trouble finding a family physician.
Where, then, does that leave the elderly, often with complicated medical issues that require much more time than the fee-mandated few minutes of an office visit?
The elderly often find a visit to the doctor's office virtually impossible, and instead end up rushed by ambulance into overcrowded emergency departments when a health crisis hits.
Once in hospital, the situation can go from bad to worse. During a week in a hospital bed, they can go from being mobile to being unable to stand, let alone get themselves to the bathroom or do any of the things that were so vital to their independence.
The fortunate ones have family to help navigate their way through the medical system.
But that takes its toll, with caregivers burning out. One elderly Ontario woman recently had to sleep in her car overnight while her husband was being treated for the after-affects of a stroke. They simply lived too far from the only centre that could provide the rehabilitation he needed, and she couldn't afford a hotel room.
The stress can bring out old grievances and sibling rivalries as the debate rages over just how to care for Mom or Dad. As one doctor points out, if your kids didn't get along when they were 16 and 17, they'll still be fighting at 50.
Medical care for seniors doesn't stop with the doctor. Best practices suggests it takes a team, with nurses and social workers involved with doctors and specialists who get to know the patient and their circumstances and liaise with family or other caregivers. But unless you're fortunate enough to live in a centre that has the services, plus live long enough to get to the top of the waiting list, you might be out of luck.
Faced with such an urgent demand for geriatric specialists, you'd think students would be lining up to fill the spots. They're not. Geriatrics is a poor cousin to the more lucrative specialties like cardiology or neurology. Students graduating with crippling loans haveto maximize their incomes to pay them off -- not see one patient in the same time their cardiology colleague sees six.
Yet while students are steering away from a geriatric specialty, the reality is the average doctor will see more seniors than anyone else.
"Except if you are a pediatrician, the classes graduating now will spend 50 per cent of their time with people over the age of 65," said Dr. Laura Diachun, a geriatrician, associate professor of medicine at the University of Western
Ontario and co-author of a study pointing to a shortage of doctors who practice geriatric medicine.
Dr. Janet Gordon, a professor in geriatric medicine at Dalhousie University, did a survey of medical schools across Canada and found that students were exposed to anywhere from seven to 200 hours of geriatrics.
"In medical school, people do close to two years or more of classroom learning and then clerkship, on-the-floor clinical learning," Gordon said. "Only half the schools have people do geriatrics even though all have them do pediatrics."
Gordon said in problem cases set for medical students at her university, she found only seven per cent of the cases had patients over the age of 65 and none included patients over 70.
"I think there is a belief geriatrics is too complicated to teach them early on," said Gordon.
Geriatrics is a complex and challenging field. It's not like a 40-year-old landing in emergency with a heart attack or pneumonia. Treat the problem in the younger patient and chances are the patient will be up and on his or her way.
For an 80-year-old, one ailment may be complicated by other conditions. Is the confused patient suffering dementia or is the confusion coming from an infection and dehydration? If he's sent home, is there someone there to ensure he eats? Takes medication?
In medical school, students spend days and weeks gaining pediatric experience. They spend only hours with the elderly.
"The bottom line is this is not a sexy place to be," said Lynn McDonald, director of the Institute for Life Course and Aging and a professor in the faculty of social work at the University of Toronto. "It is not glamorous like brain surgery or saving children who are dying from leukemia.
"We live in an ageist society; there is the feeling, 'who cares?' They are going to die anyway. . . There is no prize, no glory.
"It is hard, hard complicated work and it is work that requires many disciplines. It is an interdisciplinary team approach. Older people don't just have one problem, they have many problems, it is very complicated and there is a special knowledge base."
McDonald said when she first went to work in gerontology in 1970, no one even knew what the word meant. "Society is catching up, but not fast enough in my opinion. I think it was in 2001, seven doctors went into geriatric medicine in all of Canada -- we need hundreds."
Geriatrics is also lacking in nursing training, McDonald said, but the curriculum is so stretched there is little room for geriatric medicine.
"Maybe we get three or four nurses in the program a year," she said of a multidisciplinary program at U of T in aging, palliative and supportive care.
"That's not very many when you think most old people end up on the medical wards in hospitals and they end up in long-term care.
"Who's looking after them? People off the street -- that's who is looking after them, with a nurse in charge if you are lucky."
McDonald says in the United States, the John A. Hartford Foundation, dedicated to improving health care for older Americans, is putting millions of dollars into training professionals in nursing and social work in geriatric medicine.
"They know they are going to have an age wave," she said. "They are preparing and they are throwing money at the problem big-time, and it works.
"If you start to pay students for doing it, they are a lot happier than if they are doing it because it is noble."
Drawing on the Hartford example, McDonald wrote a proposal for a national centre of excellence in aging focused on the three professions that provide social, psychological and physical care to Canada's older population, the National Initiative for the Care of the Elderly.
"We were shocked when we got this letter saying 'congratulations,' " said McDonald of the success of her proposal.
But the dollars are not lavish. While Hartford is pouring $25 million into a single profession -- nursing -- McDonald said that in Canada, by the time overhead is paid, there will be $1.6 million left for four years.
The centre has put together academics and practitioners working with older people and is focusing on best practices, with the aim of providing community agencies and institutions across Canada the tools they need to work with them.
"That's turning out to be a big winner," she said. "People don't have that information in one spot."
The institute also has a mentorship program for students in gerontology from the three professions, and it pays their way to an annual knowledge exchange.
McDonald said one way to get people involved is to offer scholarships and money for students to do research.
"Once you start to do it, you love it," she said. "People who are in gerontology and geriatric medicine love it.
"It really is a challenge -- it is really exciting when you can make a difference for an older person and their family."
How Scientists Hope to Shrink Aging Effects
• DISCOVER -- DECEMBER
Scientists are increasingly hopeful that controlling inflammation will allow them to turn back the clock on aging, writes Kathleen McGowan in Discover magazine.
Inflammation is already a well-established predictor of many chronic illnesses, such as diabetes, atherosclerosis and Alzheimer's disease. It is a part of the body's essential immune system, and it protects us from biological invaders and damage from wounds. In inflammation's most noticeable form, it promotes clotting to stop bleeding and the spread of germs.
But as the immune system becomes less efficient with age, acute episodes of disease-fighting inflammation can turn into low-level chronic inflammation. As it simmers undetected in the body for years, inflammation increases risks for a range of debilitating and life-threatening diseases. While few scientists believe that inflammation is the sole cause of aging -- human bodies are much more complex than that -- an increasing amount of research suggests that it plays a major role in the process by precipitating many of the most debilitating afflictions associated with old age.
Many prominent gerontologists reason that if these chronic diseases are the product of an overactive immune system, then they can be countered with the right anti-inflammatory drug. Scientists are tantalized by the prospect that they could not only extend lives, but that they could also increase the quality of those final years by reducing the incidence of disease.
"The research is really to prevent the chronic debilitating diseases of aging," says Nir Barzilai, a molecular geneticist and director of the Institute for Aging Research at the Albert Einstein College of Medicine in New York. "But if I develop a drug, it will have a side effect, which is that you will live longer."
I have been reading comments on the Elderly and their care by families and communities, in this column.
I reside in the U.S. but my mother was in a home in Calgary. Ismaili volunteers are very much engaged in taking care of our seniors in homes. Families and volunteers brought Indian food and snacks and brought the Ismaili residents together at meal times
On good days they took the residents outside the home in the garden in wheel chairs and sat with them and talked to them.
I know of a young man who brought the residents together in the afternoon and evening and they recited prayers before lunch and after dinner. He and others made sure the residents ate and often they themselves fed the residents.
On Idd days, families and volunteers brought special meals for the residents and helped feed those who could not feed themselves.
My mother was taken by handi bus every Friday to JK and on all other religious days/functions. She had dementia and could not speak but people knew her and would come over to say hello to her. Sometimes she acknowledged them and sometimes she did not.
Our relatives and friends visited her often and two cousins visited her daily. May Mowla Bless my these two cousins in both the worlds. My mother was well taken care of and so were the Ismaili residents who benefited a lot from the daily visits of the families of other residents and Ismaili volunteers. They all felt like a big family.
Mukhis and Kamadias visited residents on Fridays and Chandrat (beforeer Jamat Khana ceremonies) and gave Chantas. Some volunteers brought Niyaz and sukreet on Fridays for seniors who could not attend Jamat Khana.
When my mother was in the hospital, Mukhi Kamadias came to visit all the sick Ismailis on Fridays and Chandrat and volunteers brought sukreet and niyaz.
Some abled bodied seniors also visited the less fortunate seniors in hospitals and homes and brought fruits and sweets.
So, the picture is not so grim. In fact I was surprised to read that Seniors in Canada were neglected!
Also, Hazar Imam had expressed concern about our seniors during his 2005 visit to Canada and I believe he is definitely going to do something for them very, very soon. He is more concerned about them than us.
Remote Control: Frail Seniors
Embrace Home Monitoring
November 29, 2007; Page D1
Work and Family columnist Sue Shellenbarger learns about new home-monitoring technologies that may allow doctors and families to track the medical condition of seniors from afar.
When John Fowlkes's adult daughter suggested installing an electronic monitoring system in his apartment to oversee his well-being from afar, "I was very skeptical," he says. To Mr. Fowlkes, 86, who has an active social life including an 80-year-old girlfriend, the idea evoked thoughts of Big Brother.
Mindful that a younger friend had fallen at home and lain on the floor for hours before anyone came to help, Mr. Fowlkes, of Raleigh, N.C., gave in. To his surprise, he found the setup "makes you feel more secure."
Overseeing the aged from afar is a hot issue for working caregivers, and the technology needed to do so is available. But policy makers and others have long fretted that seniors would resist electronic monitoring as an invasion of privacy.
Now, Big Brother has arrived -- and seniors are rolling out the welcome mat. As vendors make in-home monitoring systems widely available, seniors are mounting little resistance, and many are embracing the gadgetry as an aid to remaining independent.
Home-monitoring customers total a few thousand nationwide, according to half a dozen monitoring companies I surveyed. The most common systems use wireless motion or contact sensors on doorways, windows, walls, ceilings, cabinets, refrigerators, appliances or beds to track seniors' movements. Temperature sensors gauge heat and air conditioning. If an elderly person enters the bathroom and doesn't come out, or other typical activity patterns aren't recorded in the home, word can be sent to family members, 24-hour response workers or both. The systems also offer hand-held or wearable "panic buttons."
The QuietCare system used by Mr. Fowlkes is monitored by response workers. His daughter, Alisa Washington, who lives nearby, receives email updates several times a day at work. She says it gives her "much greater peace of mind."
• Sue Shellenbarger answers readers' questions2.
Seniors draw the line at some kinds of surveillance. Many protest against the presence of video cameras, says Majd Alwan, who conducted several small studies of monitoring systems as a professor at the University of Virginia. They see motion and contact sensors as less invasive, says Dr. Alwan, now director of the Center for Aging Services Technologies, Washington, D.C., a nonprofit research group.
Also, most seniors need time to get used to the idea. When 94-year-old Christine Martin's son Marty suggested monitoring her in her Sarasota, Fla., home, she objected at first, saying "she didn't want anything spying on her," says Mr. Martin, Buford, Ga.
Nevertheless, if technology helps delay the time when a senior must be admitted to a nursing home, Dr. Alwan's research found, a large majority of seniors are willing to accept it. Ms. Martin cherishes her independence; she also remembers a sad mishap involving her late sister, who died at home but wasn't found until two days later. Soon, she agreed to monitoring, and found she likes it. Knowing Marty "can tell when I'm getting up in the morning," Ms. Martin says, "I feel safer."
To raise the subject of home monitoring with seniors:
• Explain how the technology will help
• Involve them in decision making
• Give them a chance to get used to the idea
• Present it as an aid to remaining independent
Source: Wendy Rogers, Georgia Institute of Technology
Among a total of about 80 seniors in Dr. Alwan's studies, only one mounted any lasting resistance to being monitored; after the research was complete, many protested when the systems were removed from their homes, Dr. Alwan says. The setups also reduced caregiver strain without reducing the time family members spent with elders.
Costs of various systems range from $99 to several thousand dollars to install, plus about $35 to $150 a month. Systems range from simple sensors to video cameras and teleconferencing or even a dedicated WebTV channel to post family news (offered by GrandCare Systems, West Bend, Wis.). The QuietCare system is sold by Living Independently, New York. Other vendors include Alarm.com, McLean, Va.; Caregiver Technologies, Oklahoma City; and Community Management Initiative, Green Bay, Wis.
Also, a growing number of assisted-living facilities are installing monitoring systems to help staff oversee residents, and some allow families remote access to the data gathered.
More elaborate technology is in the works. Researchers at Oregon Health & Science University, Portland, are working on home systems that track changes in seniors' physical and cognitive abilities over time, lining up wall sensors to track seniors' walking speed and computer kiosks to engage them regularly in cognitive tests and games. Such long-term data could provide early warning of such conditions as dementia, says Tamara Hayes, an assistant professor, biomedical engineering.
Write to Sue Shellenbarger at sue.shellenbarger@...3
URL for this article:
CHICAGO — John Holloway received a diagnosis of AIDS nearly two decades ago, when the disease was a speedy death sentence and treatment a distant dream.
Yet at 59 he is alive, thanks to a cocktail of drugs that changed the course of an epidemic. But with longevity has come a host of unexpected medical conditions, which challenge the prevailing view of AIDS as a manageable, chronic disease.
Mr. Holloway, who lives in a housing complex designed for the frail elderly, suffers from complex health problems usually associated with advanced age: chronic obstructive pulmonary disease, diabetes, kidney failure, a bleeding ulcer, severe depression, rectal cancer and the lingering effects of a broken hip.
Those illnesses, more severe than his 84-year-old father’s, are not what Mr. Holloway expected when lifesaving antiretroviral drugs became the standard of care in the mid-1990s.
The drugs gave Mr. Holloway back his future.
But at what cost?
That is the question, heretical to some, that is now being voiced by scientists, doctors and patients encountering a constellation of ailments showing up prematurely or in disproportionate numbers among the first wave of AIDS survivors to reach late middle age.
There have been only small, inconclusive studies on the causes of aging-related health problems among AIDS patients.
Without definitive research, which has just begun, that second wave of suffering could be a coincidence, although it is hard to find anyone who thinks so.
Instead, experts are coming to believe that the immune system and organs of long-term survivors took an irreversible beating before the advent of lifesaving drugs and that those very drugs then produced additional complications because of their toxicity — a one-two punch.
“The sum total of illnesses can become overwhelming,” said Charles A. Emlet, an associate professor at the University of Washington at Tacoma and a leading H.I.V. and aging researcher, who sees new collaborations between specialists that will improve care.
“AIDS is a very serious disease, but longtime survivors have come to grips with it,” Dr. Emlet continued, explaining that while some patients experienced unpleasant side effects from the antiretrovirals, a vast majority found a cocktail they could tolerate. “Then all of a sudden they are bombarded with a whole new round of insults, which complicate their medical regime and have the potential of being life threatening. That undermines their sense of stability and makes it much more difficult to adjust.”
The graying of the AIDS epidemic has increased interest in the connection between AIDS and cardiovascular disease, certain cancers, diabetes, osteoporosis and depression. The number of people 50 and older living with H.I.V., the virus that causes AIDS, has increased 77 percent from 2001 to 2005, according to the federal Centers for Disease Control, and they now represent more than a quarter of all cases in the United States.
The most comprehensive research has come from the AIDS Community Research Initiative of America, which has studied 1,000 long-term survivors in New York City, and the Multi-Site AIDS Cohort Study, financed by the National Institutes of Health, which has followed 2,000 subjects nationwide for the past 25 years.
The Acria study, published in 2006, examined psychological, not medical, issues and found unusual rates of depression and isolation among older people with AIDS.
The Multi-Site AIDS Cohort Study, or MACS, will directly examine the intersection of AIDS and aging over the next five years. Dr. John Phair, a principal investigator for the study, which has health data from both infected and uninfected men, said “prolonged survival” coupled with the “naturally occurring health issues” of old age raised pressing research questions: “Which health issues are a direct result of aging, which are a direct result of H.I.V. and what role do H.I.V. meds play?”
The MACS investigators, and other researchers, defend the slow pace of research as a function of numbers. The first generation of AIDS patients, in the mid-1980s, had no effective treatments for a decade, and died in overwhelming numbers, leaving few survivors to study.
Those survivors, like Mr. Holloway, gaunt from chemotherapy and radiation and mostly housebound, lurch from crisis to crisis. Mr. Holloway says his adjustment strategy is simple: “Deal with it.” Still he notes, ruefully, that his father has no medical complaints other than arthritis, failing eyesight and slight hearing loss.
“I look at how gracefully he’s aged, and I wish I understood what was happening to my body,” Mr. Holloway said during a recent home visit from his case manager at the Howard Brown Health Center here, a gay, lesbian and transgender organization. The case manager, Lisa Katona, could soothe but not inform him. “Nobody’s sure what causes what,” Ms. Katona told Mr. Holloway. “You folks are the first to go through this and we’re learning as we go.”
Mr. Holloway is uncomplaining even in the face of pneumonia and a 40-pound weight loss, both associated with his cancer treatment. Has the cost been too high? He says it has not, “considering the alternatives.”
Halfway across the country, Jeff, 56-year-old New Yorker who was found to have AIDS in 1987, said he asks himself that question often.
Jeff, who asked that he not be fully identified, has had one hip replacement because of a condition called avascular necrosis, the death of cells from inadequate blood supply, and needs another to avoid a wheelchair. Many experts think that avascular necrosis is caused by the steroids many early AIDS sufferers took for pneumonia.
“The virus is under control, and I should be in a state of ecstasy,” he said, “but I can’t even tie my own shoe laces and get up and down the subway stairs. ”
His bones are spongy from osteoporosis, a disorder that afflicts many postmenopausal women but rarely middle-aged men, except some with AIDS. No research has explained the unusual incidence.
In addition, Jeff has Parkinson’s disease, which is causing tremors and memory lapses.
He is in an AIDS support group at SAGE, a social service agency for older gay men and lesbians. His fellow group members also say they find the illnesses associated with age more taxing than the H.I.V. infection. One 69-year-old member of the group, for example, has had several heart attacks and triple bypass surgery, and his doctor predicts that heart disease is more likely to kill him than AIDS.
Cardiovascular disease and diabetes are associated with a condition called lipodystrophy, which redistributes fat, leaving the face and lower extremities wasted, the belly distended and the back humped. In addition, lipodystrophy raises cholesterol levels and causes glucose intolerance, which is especially dangerous to black people, who are already predisposed to heart disease and diabetes.
At Rivington House, a residence for AIDS patients on the Lower East Side of Manhattan, Dr. Sheree Starrett, the medical director, said that neither heart disease nor diabetes was “terribly hard to treat, except that every time you add more meds there is more chance of something else going wrong.”
Statins, for instance, which are the drug of choice for high cholesterol, are bad for people with abnormal liver function, also a greater risk among blacks. Many AIDS patients have end-stage liver disease, either from intravenous drug use or alcohol abuse. Among Dr. Starrett’s AIDS patients is 58-year-old Dominga Montanez, whose first husband died of AIDS and whose second husband is also infected.
“My liver is acting up, my diabetes is out of control and I fractured my spine” because of osteoporosis, Ms. Montanez said. “To me, the new things are worse than the AIDS.”
There are no data that compare the incidence, age of onset and cause of geriatric diseases in the general population with the long-term survivors of H.I.V. infection. But physicians and researchers say that they do not see people in their mid-50s, absent AIDS, with hip replacements associated with vascular necrosis, heart disease or diabetes related to lipodystrophy, or osteoporosis without the usual risk factors.
“All we can do right now is make inferences from thing to thing to thing,” said Dr. Tom Barrett, medical director of Howard Brown. “They might have gotten some of these diseases anyway. But the rates and the timing, and the association with certain drugs, makes everyone feel this is a different problem.”
One theory about why research on AIDS and aging has barely begun is “the rapid increase in numbers,” Dr. Emlet said. The federal disease centers’ most recent surveillance data, from 33 states that meet certain reporting criteria, showed that the number of people 50 and older with AIDS or H.I.V. infection was 115,871 in 2005, nearly double the 64,445 in 2001.
Another is the routine exclusion of older people from drug trials by big pharmaceutical companies. The studies are designed to measure safety and efficacy but generally not long-term side effects.
Those explanations do not satisfy Larry Kramer, founder of several AIDS advocacy groups. Mr. Kramer, 73 and a long-term survivor, said he had always suspected “it was only a matter of time before stuff like this happened” given the potency of the antiretroviral drugs. “How long will the human body be able to tolerate that constant bombardment?” he asked. “Well, we are now seeing that many bodies can’t. Once again, just as we thought we were out of the woods, sort of, we have good reason again to be really scared.”
The lack of research also limits a patient’s care. Dr. Barrett says the incidence of osteoporosis warrants routine screening. Medicare, Medicaid and private insurers, however, will not cover bone density tests for middle-aged men.
Marty Weinstein, 55 and infected since 1982, has had a pacemaker installed, has been found to have osteoporosis, and has been treated for anal cancer and medicated for severe depression — all in the last year. He also has cognitive deficits.
A former professor of psychology in Chicago, he presses his doctors about cause and effect. Sometimes they offer a hypothesis, he said, but never a certain explanation.
“I know the first concern was keeping us alive,” Mr. Weinstein said. “But now that so many people are going to live longer lives, how are we going to get them through this emotionally and physically?”
Well, Lord, the day has come. In many ways I dreaded leaving my home, my security. And now I have to give up some of my privacy and life with other old people.
Help me even now to accept these people as I find them--boring at times, stimulating, and excessively talkative. Help me remember that all these strange people are loved by you. Deliver me from being snappy at meals with people who are cranky -- they may be in pain. If someone wants to confide a problem, help me listen. And may I reach out to those when I feel the urge to strike out.
As I leave my home, give me a sense of call, even as you called old Abraham and Sarah when they left their home on a new journey of faith. If I can love my neighbor there, then I have a mission. Amen.
The Story of 'The Patient' My mother had trouble adjusting to her new life in a nursing home, so I told her a story I knew she could relate to.
By Ellie Braun-Haley
The transition from living in your own home and directing every aspect of your life to being confined to a wheelchair and being dependent on others for everything, is a traumatic change.
Five months after Mother's 91st birthday my mother fell and this one single incident changed Mother's life.
She was in the hospital for months and then moved to a nursing facility. We knew she would never go home again and then came the day when she too knew it. When I visited my mother I recognized she was putting up a brave front, yet I knew inwardly she was questioning her own value.
She was completely helpless, confined to a bed unless someone moved her to a wheelchair. The sinks were not even set up for wheelchairs so she had difficulty even brushing her own teeth. Closets held her clothing up high, as if she had elastic arms. Her legs would barely respond to lift or shift and her conversations indicated she felt as useless as those legs.
Mother was wondering why she was still on this earth. Four infections had drained her to the point where she no longer read or did crossword puzzles or played cards with herself. Wishing to stimulate her interest in something I asked her if I could read a short story to her. She nodded her consent and laid her head back on the pillow.
I told her the story of The Patient...
* * *
The Patient was bedridden and only able to chat a bit and smile. All the nurses looked forward to going into The Patient's room because they were overworked, tired and in need of something -- perhaps the milk of human kindness.
In The Patient's room they fed on the warmth of the smile they received. Each person was uplifted by the good cheer, gentle words, and by the abundant and concerned thoughtfulness of this one senior Patient.
There were some in the hospital who yelled and whined. There were some who cried and others who literally abused the staff with slapping, biting and harsh words, but not The Patient.
No, when the staff entered the room of The Patient it was as if they knew they would find sanctuary! All understood, in this room, with this one Patient, they would always be uplifted.
Cleaning staff, nurses, even doctors fed on the endless supply of benevolence dished out by The Patient, and The Patient, in turn, seemed to understand how very valuable this kind of service was to everyone. The Patient understood her calling, and realized she was needed!
* * *
As I finished telling the story, a light seemed to go on within mother, and she exclaimed, "Goodness, the staff here all say they like coming into my room because I am so cheerful. I never thought about the impact of it before."
It was as if a heavy load had lifted from Mother's shoulders and she looked more relaxed than she had in a long time.
Mother's children have always known she blesses many lives with her loving disposition. How wonderful for mother to now understand her actions make a big difference and her very presence is a gift to many.
Now and then I have heard a saying "grow where you are planted." It dawned on me that mother was growing in a new way. God impressed upon me to tell Mother the story of The Patient and I realized immediately this was indeed the answer to helping her understand her worth.
March 2, 2008
Tapping Into Homes Can Be Pitfall for the Elderly
By CHARLES DUHIGG
Erika Baker was 67 years old, divorced and worried about her job when a saleswoman showed up at her door in late 2006.
A reverse mortgage, the saleswoman explained, would give Ms. Baker instant access to hundreds of thousands of dollars tied up in the value of her home. Such a loan, typically available only to homeowners in their 60s and older, would not have to be repaid until Ms. Baker moved out, the saleswoman said.
And if she never moved, the loan would be settled by selling her house after she died. “Your Home Pays You Cash!” read a brochure the saleswoman left behind.
Ms. Baker, who lives just outside San Diego, jumped at the offer, borrowing a little more than $200,000 through a company called Senior American Funding.
Then the problems began. The saleswoman pressured her to put the proceeds of the loan into complex investments that put her money out of reach, Ms. Baker said. She received only about $33,000 in cash, far less than she needed for her final years.
“I thought this was a safe way to make sure I’d never run out of money,” Ms. Baker said. “Then everything became so confusing. No matter where I turned for help, it seemed like things got worse.”
As the United States has become an older nation, reverse mortgages have grown into a $20-billion-a-year industry, with elderly homeowners taking out more than 132,000 such loans in 2007, an increase of more than 270 percent from two years earlier. In surveys, many borrowers say reverse mortgages have improved their lives and provided money they needed for retirement.
But hundreds of people who have sought reverse mortgages — in lawsuits, surveys and conversations with elder-care advocates — have complained about high-pressure or unethical sales tactics they say steered them toward loans with very high fees. Some say they were tricked into putting proceeds of their loans into unprofitable investments, while sales agents pocketed rich commissions.
“Every scam artist is getting into this business,” said Prescott Cole, an elder-care advocate who has worked with numerous reverse mortgage borrowers. “Because reverse mortgages are so complicated and give you money up front, years can pass before a senior realizes they’ve lost everything.”
Reverse mortgage lenders and brokers dispute those accusations, noting that the loans are heavily regulated and have helped hundreds of thousands of people.
“For a lot of elderly people, their only real asset is their house,” said Peter Bell, president of the National Reverse Mortgage Lenders Association, a trade group. “A reverse mortgage is one of the few ways someone can access wealth that’s otherwise out of reach, while still living in their house for as long as they want.”
However, some borrowers find their wealth is still out of grasp, even after they have sought a reverse mortgage.
For example, Senior American Funding, the company that sold Ms. Baker her loan, has been sued three times in the last 13 months by clients who said they were misled. (Two of those cases were settled out of court for undisclosed sums. The third, filed by Ms. Baker in California state court last month, is pending.)
The company, which is licensed in 16 states, has originated mortgages worth more than $100 million since 2004.
“We never pressure clients,” said one of the company’s founders, Matthew Copley. “We just try to make sure they know about their options.”
However, a former sales agent, Hani Shenoda, and an agent who still works at the company who spoke on the condition of anonymity because of fear of retribution, said in interviews that managers at Senior American Funding encouraged them to pressure older homeowners into unwise loans and investments. The company disputes that assertion.
On Tuesday, after being contacted by a reporter, Senior American Funding announced it would no longer sell combinations of loans and investments like the one Ms. Baker had bought.
“When we make mistakes, we address them as responsibly as we can,” Mr. Copley added.
Ms. Baker owned a home worth about $600,000 but was living paycheck to paycheck, teaching child-rearing skills to low-income mothers for about $400 a week, when she was told in 2006 that her job was ending.
Months earlier, she had received a mailing from Senior American Funding, one of the hundreds of reverse mortgage companies that have emerged in the last several years. She scheduled an appointment with a saleswoman named Laurie Spencer. (Ms. Spencer no longer works at Senior American Funding, according to the company, and could not be located.)
“This saleswoman was so friendly and personable,” Ms. Baker said. “It was like God had sent me a friend to tell me how to survive.”
In the kitchen of the home, where Ms. Baker displays watercolors of dolphins and flowers she has painted, the saleswoman recommended a loan of $218,900, with a variable interest rate initially set at 6.57 percent.
Because reverse mortgages do not require borrowers to make immediate repayments, the interest charges are added to the debt every day, and the total amount owed grows over time. The saleswoman did not explain that within 10 years, Ms. Baker’s $218,900 loan could grow to as much as $400,000, Ms. Baker said. That debt would be paid by selling the house when she moved out or died.
The saleswoman also did not emphasize the high fees, Ms. Baker said. The loan’s fees cost her $17,100 — almost 8 percent of the total loan — which was paid out of the proceeds as soon as the loan closed.
To ensure that borrowers know such details, the federal government requires them to speak to an independent adviser before closing a reverse mortgage.
“We make potential borrowers talk to a counselor to make sure they understand what they are doing,” said Renée Shadel, an investigator with the Washington state attorney general’s office. “These can be great loans for some people, but only if they understand them.”
But critics say these counseling sessions are often brief and unhelpful. Some elderly borrowers, for instance, said their sessions lasted only 10 minutes, rather than the 60 to 90 minutes most counselors say they need to explain the loans.
Critics say some sessions are so brief because reverse mortgage companies are paying for the advice. One of the largest reverse mortgage counseling companies, Money Management International, often asks lenders to pay for providing advice to the lender’s clients, according to a company spokeswoman.
Money Management International, which is a nonprofit company, received $900,000 from reverse lenders last year. By regulation, counselors may not charge clients, though they are allowed to seek support from lenders.
“Anytime anyone gives a counselor a donation, they expect a quid pro quo,” said Buz Zeman, a reverse mortgage counselor with Housing Options Provided for the Elderly, a nonprofit group financed by government grants. “The point of counseling is to make people consider other options. That’s difficult if you feel like your next paycheck relies on convincing someone to get the loan.”
A spokeswoman for Money Management International says it seeks payments from lenders because government grants do not cover costs. The group’s counselors educate clients only about how loans work and do not recommend whether to proceed, she said, adding that the average time a counselor spends with a client is 58 minutes.
“There is no quid pro quo relationship with lenders,” a Money Management International spokeswoman, Catherine Williams, said in an e-mail message, adding that clients receive the same advice whether a lender pays for the session or not. “Funding is not tied to the outcome of any case.”
Even when lenders do not pay for counseling, it can still prove unhelpful. Ms. Baker’s counseling session, which was provided by an agency that does not accept money from lenders, lasted only about a half hour, and she walked away from the conversation still confused, she said.
Then the saleswoman persuaded her to sign the loan forms.
After the reverse mortgage closed, Ms. Baker used the proceeds to pay off a $68,000 traditional mortgage on her home, and she put about $33,000 into various savings accounts.
The remaining $100,000 was used to purchase, at the saleswoman’s urging, two deferred annuities — complex contracts that offer monthly income in exchange for a large lump-sum payment.
Those annuities prohibited Ms. Baker from gaining access to most of her funds for seven years unless she paid a stiff penalty.
Moreover, the annuities were likely to cost her money rather than pay her. Annuities are so complex that it is impossible to forecast precisely how much Ms. Baker will receive from them. However, based on recent payout data for similar products, she will probably earn about $520 a month from her annuities for the rest of her life. Ms. Baker’s mortgage debt is increasing by about $600 a month as the interest compounds on the money she used to purchase those annuities.
If Ms. Baker collected monthly income from her annuities for 10 years, she could receive $62,400. However, the debt she would owe over that period would likely increase by $79,000 to $300,000, depending on how her loan’s interest rate changed.
“Buying an annuity with the proceeds of a reverse mortgage is incredibly dangerous,” said Mr. Cole, a critic of reverse mortgages. Indeed, the practice is so troublesome that many annuity companies and states either tightly regulate or forbid it.
The salespeople at Senior American Funding were richly rewarded for their sales: the company received about $8,750 in commissions from Ms. Baker’s annuities, and $7,200 for processing her reverse mortgage.
Last month, Ms. Baker sued Senior American Funding, accusing it of fraud and elder abuse.
Mr. Copley, the Senior American Funding co-founder, defended the company’s actions and said Ms. Baker consented to every transaction.
However, Mr. Copley conceded that Ms. Baker was given documents with inaccurate numbers and that sales agents, including him, at the time did not fully understand the products they were selling her.
“If we made mistakes, I’m sorry,” he said.
Other lenders have also been accused of pushing older homeowners into unwise deals.
A survey released last year by AARP, formerly known as the American Association of Retired Persons, of more than 1,500 reverse mortgage borrowers found that almost one in 10 were urged to buy other financial products, like annuities.
Lawsuits against reverse mortgage companies, including the nation’s largest, Financial Freedom Senior Funding, contend that those firms helped pressure older Americans into bad investments.
In court filings, companies have denied those claims.
“Financial Freedom is not involved in selling annuities, does not recommend annuities, and won’t even allow borrowers to use reverse mortgage proceeds to buy an annuity at closing,” said Joel Schiffman, the company’s general counsel. “We only pursue a reverse mortgage when it is in a senior’s best interest.”
Some regulators and lawmakers, however, have said that more safeguards are needed, including giving borrowers more information about alternatives to reverse mortgages, disclosing fees more clearly and providing more government money to counselors, so that they do not seek payments from lenders.
New laws governing reverse mortgages are under consideration in Congress, though lobbyists for some lenders are mounting strong opposition, Congressional staff members say.
For Ms. Baker, now 68, such safeguards would come too late. She says she wakes up in the night, terrified there will not be enough money for food, gas or anything else. To cut her grocery bill, she stopped buying meat and fresh vegetables.
“Before, at least I knew my house was safe, and that no one would take that away from me,” she said. “Now, I don’t know if there is anything I can count on.”
For centuries, dreamers have searched for the elixir of life, the fountain of youth and the philosopher's stone.
Their goal has often been greeted with skepticism and associated with magic, sorcery and science fiction.
But Harvard medical school scientist David Sinclair -- whose breakthrough research about red wine bringing longer life has been picked up by Jay Leno, Newsweek and Fortune magazine -- believes a pill is just on the horizon that will keep diseases at bay and allow us to become centenarians with the energy of 40-year-olds.
"I'm quite certain it's going to happen," said Sinclair, a molecular biologist who will present his research at two University of Alberta lectures, this Tuesday and Wednesday.
"This is a radical way of doing medicine where we're preventing diseases so that these animals in our lab, and hopefully humans one day, live longer, but only because they're not getting diseases that kill them."
Right now, Sinclair's "perilously glitzy anti-aging science," as Fortune magazine describes it, is being tested in clinical trials on humans, who take pills containing a immensely concentrated form of a molecule found in red wine to treat diabetes and hold back aging.
"We're talking about a future where your doctor could prescribe a pill to treat your diabetes, and as a side-effect, you will have many more years free of heart disease and cancer and even Alzheimer's as a result of taking this pill," Sinclair said in a telephone interview.
Such drugs were theoretically impossible 20 years ago, but then scientists discovered aging is regulated by genes -- a regulation that could be mimicked with technology and chemicals.
Sinclair found that resveratrol, a molecule found in red-wine grapes, triggered certain cells to live longer. When the molecule was fed to fish, their lifespan increased 59 per cent, equivalent to a human living to age 194.
Mice that ate food laced with resveratrol had the physiology of lean mice and reduced their risk of death by 30 per cent. Later research found they could run marathons without training.
Marianne Williamson is a best-selling author, former minister, Course in Miracles teacher, speaker, and peace advocate. Now 55, she has turned her fierce yet compassionate gaze to conscious aging in her new book, "The Age of Miracles: Embracing the New Midlife." She talks to Beliefnet about how we can reclaim our inherent fabulousness and what the Boomers need to be doing in their pivotal next chapter--for themselves and the planet.
What inspired you to write a book about aging?
My soul has been grappling for several years with no longer being young. One of the shocks of a 50th birthday is realizing the fundamental fact that your youth is irrevocably over. In our society, as people pass out of young adulthood, they tend to relate to themselves more in terms of what they are no longer than what they are now, and that’s psychologically low-grade devastating.
Why do you think people are doing that?
[In midlife] it's as though we have a second puberty. In the first, the persona of the child fades away and the young adult begins to emerge. A wise culture knows to mark this for a child through a coming-of-age ceremony of some kind. Otherwise, the child is moved to subconsciously mark it anyway, often dysfunctionally. It could be body piercing, immoderate sex, drugs, etc.
The second puberty is similar. If we do not create an honorable marking, then that’s what the proverbial midlife crisis is. Somebody running out and doing something crazy or, in women, often an unacknowledged depression.
In the second puberty, you start reaching back in time. We need to create a psychic container to grieve, let go, forgive, and reconcile. Otherwise there’s too much baggage and we can't enter this new phase.
Look at sexuality. In the first puberty, it's like "Yippee! I got it now." Well, in the second puberty, it’s grieving an aspect of it that you don’t have anymore. Now, don’t get me wrong. It’s not like you don’t have something equally fabulous.
I remember I was walking through a store and I saw clothes a 25-year-old would wear. And the conversation in my head was, “I’m not young and fabulous anymore.” But, immediately, there was a voice that said, “No, you can be older and fabulous.” In other words, still just as fabulous, but in a different way.
Can you talk about the moment in the book when you’re looking in the mirror?
Most people, men and women, have had the experience of being 45, 50, 55, looking at a picture of themselves when they were young and thinking, “I thought that was inadequate?” When I realized I was thinking, “If only I was younger, it would be better,” I began to think about what was really true when I was younger. When I was younger, I was thinking, “If only I had another job, it would better. If I only lived in another place, it would be better. If only I was in a different relationship, it would be better.”
So, the real issue was not age. The real issue was the mind struggling against itself.
What makes people feel and look old?
Stress, grief, pain, suffering. By the time we're 45 or 40, few people are unscathed. We all fall down. The issue is not who falls down, it’s who gets back up and how. The new midlife is where you realize that even your failures make you more beautiful and are turned spiritually into success if you became a better person because of them. You became a more humble person. You became a more merciful and compassionate person.
This internal work is so necessary because, at a certain point, you either do this work and transform the energy, or you’re weighed down. You can look at people in their 50s and you can almost tell which choice they made, consciously or subconsciously.
And what if you find yourself with this hardened crust? Is it hopeless?
Absolutely not. First, you have to admit it and recognize it. You can be 20 and carrying around a lot of character defects, fooling a lot of people. But you get to a certain age where your racket is obvious. You have a choice. You can just saunter into this next phase of your life with this racket that’s pathetic and painful and aging and disease or you can realize, this is my spiritual initiation, and you do the work. Some people are saying, “I can’t rise up because of my husband who left me 20 years ago.” Well, who’s the real enemy there? The person who left you or the person inside you who’s let 20 years pass without getting over it?
So, you carry that hardness and that bitterness. From a consciousness perspective, there’s no mystery why love is not just rushing in. And so, there’s forgiveness of self. There's forgiveness of others. There’s allowing our failures to become our medicine because of what we learned.
How do we deal with our aging physical self?
As a woman, who wishes we didn’t have the same thighs that we had twenty years ago, or the same rear end or that our breasts were in the same place? Who doesn’t think wistfully about all that? You can’t just pretend that you don’t. You have to grieve it. Then, something else happens that’s pretty wonderful. I say in the book, “You can’t hold your leg up as high in aerobics class anymore, but you can lift your eyebrow in a way you couldn’t in those days.”
For myself, if I am trying to work on my body because I’m trying to make it what it used to be, I’m filled with angst and stress. But, if I’m working on my body to be a hip and cool and fabulous 55-year-old, it’s a whole different energy and a whole different joy in the process. My chances of even approaching what I used to be are far greater. You’re affirming life, you’re not staving off death. You’re living in the present.
How are the Baby Boomers changing what aging means?
The Boomers thought we were going to make the world much better. If we are honest with ourselves, as if we as a collective were in therapy, we would have to face the truth that, on our watch, things got much worse. The generation that thought that we were going to replace guns with flowers has, more than any generation in history, replaced flowers with guns.
We have one more chapter of our history in this lifetime. If we don’t get it right, we will die having gotten it wrong. For anyone who reaches a certain age, you don’t want to die feeling it was all for nothing. The Jewish prayer book says how sad is he who dies not having sung his song.
There is a confluence here--just at the time our generation feels, “I want to be a sane grownup,” we are living at a moment where, if a critical mass of people don’t become sane grownups, like, very quickly, there is going to be global catastrophe.
So, it’s really the opposite of retirement.
You better believe it. A friend of mine said to me, “Oh, I get it. Don’t retire, re-fire.” In the past you might “do a little something just to stay busy.” This is a whole different thing. This is people going, “You know what? No matter how flashy my career was, it just taught me what I need to do what’s really important.”
Do you have recommendations for people who want to transform for the next step in life?
People want step one, step two, step three. That’s not how a life changes. A life changes because you go, “Oh, wow. I get it.” And that is followed by something else that happens, and you go, “Right.” It’s layers of understanding.
When I was younger, Otis Redding sang "Sittin’ on the Dock of the Bay," with the lyric, "sitting here resting my bones." And I thought that was silly because who rests their bones? So, years later, one day I hear myself saying to my daughter, “Honey, you go outside. Mommy’s going to just sit here and rest her bones.” I freaked out. I panicked. It’s like, it’s all over if I’m resting my bones.
I did this whole study within myself of what it meant that I was sitting down, and I thought about the Buddhist meditation, which I used to do, in which the goal was to enjoy sitting. When you’re younger, there is this hormonally-based adrenaline rush pulsing through your veins that makes it difficult to achieve a quiet mind and a quiet body.
Later, the evolutionary process is such that you find you’re just sitting there and it means something. If in fact the highest, most powerful work is the work of consciousness, then what we could do from our rocking chairs could literally rock the world.
Our generation is becoming contemplative. We are becoming reflective. I look back on so many of the mistakes I made. I would not have made them had I not been moving so fast.
So, we all become yogis by default.
That’s the thing--or we don’t. If we don’t, it’s called a slow cruise to death, and it can be really rough. That’s exactly the point. You either become a yogi or you become pathetic.
How are you taking care of your body and your spiritual practices? How has that changed as you’ve gotten older?
I’ve just taken it more seriously because there’s a higher price to pay for not doing it. At a certain period of life, your karma is more instant. That which you get right bears even greater fruit, and that which you get wrong bears harsher consequences--your ability to forgive, your ability to let go, or your physical exercise or yoga or whatever.
What's the most important spiritual practice?
Pray. The second most important thing, meditate. Third most important thing, do physical exercise and yoga. Then, the fourth most important thing, if moved to do so, read my book.
Do you feel like you’re reinventing yourself for a second life?
Reinvention doesn’t really say it for me. Nature doesn’t reinvent itself every spring. It does what it does. God invents you. As you get older, the spiritual opportunity is to drop that which is false and to reclaim your true self. T.S. Eliot in "Four Quartets" says, “You’re always going home. You’re going back home.” So, it’s not so much that you’re going forward, you’re coming full circle. You are dropping this artificial self that accumulated--the burdens, the disappointments, the fears, the falsehoods.
When I was younger, I didn’t understand how Emily Dickinson basically never left town and could know so much, but I do now. Everything is here.When you’re younger, you just want to go out and get rich--whatever that means. When you’re older, you realize that the issue is to know how rich life is. I think that’s where our nation needs to go, too, because this gargantuan drive to just expand is unsustainable.
That’s what I feel I’m going through in my life. I’m sitting in a room now, and I look at this lamp, and I remember I bought it in Los Angeles. Those silver candlesticks, they were my grandmother's. That bowl, my mother brought to me from Paris. That little ivory piece my girlfriend Victoria gave me for my birthday. That book over there my publisher gave me when I wrote "A Woman’s Worth." That statue over there, the board of directors of the church I was at gave me.
You realize, oh, my goodness, there’s so much in what’s here because once you’ve lived enough, it’s these things that matter. It’s not getting more. It’s learning to just be in such joy with what you have.
Is there anything I haven’t asked you that you would want to tell Beliefnet readers?
When the mirror is no longer telling you what you thought you would like to hear and the culture is no longer telling you what you thought you would like to hear, sometimes that’s when you finally have ears for what God wants to say to you. That’s when you hear him say things sweeter than the mirror ever told you and sweeter than the culture ever told you. That’s when you finally realize that you are loved, and you finally realize you are enough.
When you have really allowed that in, you emerge into a different place within yourself, and from that place life rocks.
May 20, 2008
Older Brain Really May Be a Wiser Brain
By SARA REISTAD-LONG
When older people can no longer remember names at a cocktail party, they tend to think that their brainpower is declining. But a growing number of studies suggest that this assumption is often wrong.
Instead, the research finds, the aging brain is simply taking in more data and trying to sift through a clutter of information, often to its long-term benefit.
The studies are analyzed in a new edition of a neurology book, “Progress in Brain Research.”
Some brains do deteriorate with age. Alzheimer’s disease, for example, strikes 13 percent of Americans 65 and older. But for most aging adults, the authors say, much of what occurs is a gradually widening focus of attention that makes it more difficult to latch onto just one fact, like a name or a telephone number. Although that can be frustrating, it is often useful.
“It may be that distractibility is not, in fact, a bad thing,” said Shelley H. Carson, a psychology researcher at Harvard whose work was cited in the book. “It may increase the amount of information available to the conscious mind.”
For example, in studies where subjects are asked to read passages that are interrupted with unexpected words or phrases, adults 60 and older work much more slowly than college students. Although the students plow through the texts at a consistent speed regardless of what the out-of-place words mean, older people slow down even more when the words are related to the topic at hand. That indicates that they are not just stumbling over the extra information, but are taking it in and processing it.
When both groups were later asked questions for which the out-of-place words might be answers, the older adults responded much better than the students.
“For the young people, it’s as if the distraction never happened,” said an author of the review, Lynn Hasher, a professor of psychology at the University of Toronto and a senior scientist at the Rotman Research Institute. “But for older adults, because they’ve retained all this extra data, they’re now suddenly the better problem solvers. They can transfer the information they’ve soaked up from one situation to another.”
Such tendencies can yield big advantages in the real world, where it is not always clear what information is important, or will become important. A seemingly irrelevant point or suggestion in a memo can take on new meaning if the original plan changes. Or extra details that stole your attention, like others’ yawning and fidgeting, may help you assess the speaker’s real impact.
“A broad attention span may enable older adults to ultimately know more about a situation and the indirect message of what’s going on than their younger peers,” Dr. Hasher said. “We believe that this characteristic may play a significant role in why we think of older people as wiser.”
In a 2003 study at Harvard, Dr. Carson and other researchers tested students’ ability to tune out irrelevant information when exposed to a barrage of stimuli. The more creative the students were thought to be, determined by a questionnaire on past achievements, the more trouble they had ignoring the unwanted data. A reduced ability to filter and set priorities, the scientists concluded, could contribute to original thinking.
This phenomenon, Dr. Carson said, is often linked to a decreased activity in the prefrontal cortex. Studies have found that people who suffered an injury or disease that lowered activity in that region became more interested in creative pursuits.
Jacqui Smith, a professor of psychology and research professor at the Institute for Social Research at the University of Michigan, who was not involved in the current research, said there was a word for what results when the mind is able to assimilate data and put it in its proper place — wisdom.
“These findings are all very consistent with the context we’re building for what wisdom is,” she said. “If older people are taking in more information from a situation, and they’re then able to combine it with their comparatively greater store of general knowledge, they’re going to have a nice advantage.”
Andrew Weil, M.D., a graduate of Harvard Medical School, serves as director of the Program in Integrative Medicine at the University of Arizona, and is the author of "Spontaneous Healing," "Eight Weeks to Optimum Health," among other bestsellers. In his latest book, "Healthy Aging," Weil encourages readers to embrace, rather than deny or fight, the aging process (and explains why he believes so-called "anti-aging" products do not work anyway). He spoke with Beliefnet about the spiritual virtues of aging, why no one should be afraid of getting older, the benefits of meditation, and how he feels about his famous white beard.
You write that aging can be "a catalyst for spiritual growth." How?
Aging as path to spiritual awakening
In the book, I used an example of the legend of the Buddha's enlightenment. When he was the young prince Siddhartha, he was kept by his father in a fantasy palace where he wasn't supposed to see anything that suggested aging and death or anything unpleasant. Then he goes out of the palace and the first thing he sees is an old man. Subsequently, he sees a corpse, a sick man, and a monk-these four sights or visitations are what really stimulated him on the path of enlightenment. So I think there is a way in which awareness and mortality and aging are certainly the most powerful reminders that we're moving in that direction; it can be a profound spiritual awakening.
I also quoted Carl Jung, who said that he thought that the major focus of the second half of life should be mortality and that anything that took away from that was in the direction of not being mentally healthy. I think in our society we see so much denial of aging and ways that people try to pretend to themselves that aging is not happening and I worry about that being a not-healthy direction. I think a common correlation we see as people become older is that they have greater interest in things spiritual or non-physical.
What do you think is at the heart of our fear of aging?
I think the root is the fear of death, which is the great mystery; it's what we don't understand and I think that's really why people turn to religion, turn to spiritual paths, to come to grips with mortality. And aging is a constant reminder that we're moving in that direction. So I think that's the root fear. Then on top of that, I think there are more specific fears: the fear of losing independence, losing pleasure in life, things of that sort.
How can we overcome these fears?
Well, I think by facing them squarely and being honest about them, that's the first step. It is very helpful to seek out people who are examples of healthy aging and see what they have to teach us. Information is a very powerful antidote to fear, having truthful information.
In terms of spirituality, are there particular things that people can do?
Well, I think there are a lot of things that people can do to attend to their spiritual health and well-being. Some of the suggestions I've made over the years include bringing fresh flowers into your house, listening to music that elevates your spirits, reading spiritual literature-inspirational literature that has that effect, seeking out the company of people in whose presence you feel more elevated, spending more time in nature. I think there is an endless list of what people can do.
On a personal level, what does aging mean to you? Is it something you look forward to?
Well, I certainly am not going to deny the aging process. I really want to think about its challenges, particularly how I want to spend my last years, and I'm in discussion with some contemporaries. We've had a lot of thoughts about trying to custom-design some kind of living facility for ourselves in which we all have our private spaces but will be able to do some things communally. That's one example of some ways I'm thinking.
Your beard is such an iconic part of your image, and you write that you have no interest in dyeing it. Do you think of it as a way to keep you mindful of the aging process?
Why I like my white beard
I think so. I started getting white in my beard long ago, I think maybe in my late 30s, the first gray hairs showed up in it so it's something I've lived with and watched for a long time. But I rather like the way it is now. It's a white beard-I think it gives me more authority, and I think a lot of people look at me as a Santa Claus figure. That's fine with me.
You write about many things that become better with age. Can you share an example?
Aging is like whiskey
I had a lot of fun writing about that since I hadn't seen it in print before. The examples I used were whiskey, wine, cheese, trees, violins, antiques. If you look at whiskey, aging of whiskey smoothes out rawness and greenness, it adds depth and complexity and smoothness, it adds flavors, it concentrates what's desirable. At the same time, there is the evaporation of what's less consequential and I think it's fairly easy to see analogies in human life with that process. Aging can increase value by concentrating what is most worthy and by allowing what's inconsequential to dissipate. It can smooth out roughness, add depth of character, so I just find it a useful exercise to think what aging brings out in these other areas of our experience that makes us willing to pay more money for old versions.
So you would recommend that people concerned about aging should explore these positive aspects?
Absolutely. I think in this culture especially, we are so programmed to see aging as a catastrophe and to look only at the negatives and I think it would be extremely helpful if we could look for the positive aspects as well. And I think it's exactly these positive qualities for which elders are revered in other cultures, in many traditional cultures. I think we've just got way off the beam here.
A few weeks ago I had lunch with a scientist-a very hardcore scientist who surprised me by saying that he was 80. I would have guessed his age at 62, so he was doing it very well. He said that one of the qualities that he had observed in himself that had gotten better with age was pattern recognition. When something new came by, he was better able to recognize it and know how to deal with it. And the reason he said was obviously that he's got more stored in his memories, so when something happens, he's got more against which to compare it. Therefore, he knows how to maneuver through the world better than he did when he was younger. That's just an example of something that gets better with age that we just don't hear discussed.
You make a distinction between age-related diseases and the natural aging process.
Absolutely. The main question that I tackled in writing "Healthy Aging" was, is age-related disease synonymous with aging? Does getting old necessarily mean getting sick? And I think the answer clearly is 'no'. It is possible to reduce the risk and delay the onset of age-related disease so the goal is to live long and well and then have a rapid drop-off at the end.
Many consumers are seduced by the claims of anti-aging products. What do you hope your own products, through Origins, can do for people?
The products I develop for Origins are emphatically not anti-aging products. They're not represented that way, they're not sold that way. These are anti-inflammatory products that can improve the health and the resistance of the skin and thereby its appearance.
I have developed products for several reasons: First, I had to identify needs in the marketplace for them and I think with skin products, there clearly was a need. Second, Origins is a company that I feel very philosophically aligned with. We have the same ideas about nature and health. Third, and most important, I wanted to find a way to develop a revenue stream to support integrative medicine education, which is really my mission. So the way that I've set all of this up is that I don't get profits from these products; my profits go to a foundation which is giving grants to institutions that are doing integrative medicine education, so it's a kind of Paul Newman model.
Can you tell us about your own spiritual path?
I was raised in a Reform Jewish household. I did not find that that really answered my spiritual hunger and needs.
How old were you when you figured that out?
I think in my teens, and then when I was 17, I traveled around the world. I went to a great international school and I lived with native families in many countries and I think that really gave me a great interest in other cultures. It got me very interested in Asian culture and I began being interested in Eastern religion, which certainly got me interested in meditation. I would say if there's any body of philosophy that I'm drawn to, it's Buddhist philosophy, although not necessarily Buddhism as a religion or as an institutional system.
How has meditation helped you?
How meditation has helped me
I have had a meditation practice for a very long time. I still find it hard but in looking back, I think meditation has, first of all, really helped stabilize my moods. I think it has also increased my concentration and made it easier for me to be more mindful in all the things that I do in daily life and I think it's made me more aware of my non-physical self.
One of the questions that I ask readers in the book is to think about the part of you that does not change as you get older. On some level, I feel the same now at 63 as I did when I was six, and I'm curious about that. What is that unchanging part of ourselves? I think that's spirit.
You mention prayer a couple of times in the book, but don't really get into it very much. Do you think prayer can help people in the same way that meditation does?
I think it can. I generally make a distinction between spirituality and religion, and my advice is mostly in what I would call the spiritual realm. Because prayer is more associated with religious practice, I don't discuss as much, but I think it certainly can serve that function.
I've also been very interested in the use of mantra, which occurs in many spiritual and religious traditions-repetition of sacred syllables or phrases as a way of centering the mind.
You don't believe in stress "reduction".
There is no such thing as stress "reduction"
Right, because I think that stress is really a constant of human life, and I also think it's a mistake to imagine we have a corner on it in the modern Western world. I think that at any time you live, life is stressful. The forms may change from age to age and culture to culture, but what we can do is learn ways of managing stress or protecting our bodies and minds from its most harmful effects. So I think that's better called stress management.
Do you find that one reason people are attracted to alternative health practices is because they feel more empowered by these approaches than they do with mainstream Western medicine?
I couldn't agree more with that. This is something I've been saying for a long time, and it represents a social-cultural change. People want to be more in charge of their own lives and destinies, and they're not willing to be passive recipients of authoritarian care in medicine. We see this in other areas of society as well, so I think this is an underlying change in world psyche.
I think one of the real secrets of happiness and success in life is to understand that while we can't control what happens to us, we can control how we react to events.
Eight Steps to Aging Gracefully
Recommendations for enhancing spiritual health and well-being.
By Andrew Weil, M. D.
Reprinted from "Healthy Aging" by Andrew Weil, published by Knopf.
Pay attention to your breath. Many cultures identify breath with spirit, seeing the breath cycle as the movement of spirit in the physical body.. Simply minding the breath is a way of expanding consciousness beyond the ego, of experiencing transcendence.
Connect with nature. You can do this by walking or sitting in a natural setting; a city park will do just fine. Allow yourself to slow down, drop your usual routines, and just absorb the influence of the place.
Make a list of people in your life in whose company you feel more alive, happy, and optimistic. Make an effort to spend more time with them. Our spiritual selves resonate with others, and that connection is a healing.
Bring flowers into your home and enjoy their beauty.
Listen to music that you find inspirational and uplifting.
Admire a work of art that raises your spirits: a painting, sculpture, or work of architecture.
Reach out and try to resume connection with someone from whom you are estranged; practice forgiveness.
Do some sort of service work. Give some of your time and energy to help others. The possibilities are endless but do not include just writing a check to charity.
The suggestions above are intended to help you become more aware of your spiritual self. Any activity that makes you feel more alive, more connected to others and to nature, less isolated, more comfortable with change, is beneficial. It will enhance your physical and mental health. It will help you accept the fact of your aging. It will help you to age gracefully.
The 10 Brainiest Places to Retire
by Liz Wolgemuth
Thursday, June 5, 2008provided by
US News & World Report
Just because you hit your 60s, it doesn't mean your brain starts to power down. Just the opposite. Your noodle needs more stimulation than ever, and, finally, you have the time to supply the required intellectual input. And picking a place to retire can be key to that process. For retirees who have no desire to stop learning—and that's, like, pretty much everyone—there are plenty of American communities that boast thriving intellectual centers where cultural activities keep residents (and their brains) as busy and interested as they want to be.
What makes the difference? A city with a large local university might offer a colorful slate of arts or educational events nearly every evening. Some suburbs have found a way to create unique learning opportunities for residents, who still have an easy route into the neighboring metropolis.
More from USNews.com:
• Quiz: Test Your Smarts About the Brainiest Places
• Gallery: The 10 Brainiest Places to Retire
• Best Places to Retire
U.S. News consulted our list of more than 1,000 Best Places to Retire and came up with 10 retirement destinations that attract highly educated folks. (And you can use Best Places to Retire to do more than seek out intellectual excitement: A search tool allows you to build your own list of retirement spots based on your personal preferences, including region, climate, healthcare, recreational and cultural activities, and other factors.)
One brainy spot that won't surprise: Berkeley, Calif., where residents might head for a screening of a film on urban organic farming in Cuba at the local Unitarian Universalist congregation, attend a University of California-Berkeley professor's speech on counterinsurgency in Iraq, or get a tour of the UC Botanical Garden. While traditional bingo is on tap at the South Berkeley Senior Center, residents can also learn a less common skill like self-acupressure or take a class on the millinery arts, says director Larry Taylor.
Across the map in Chapel Hill, N.C., residents might spend their evenings paddling out in kayaks to watch the stars with an astronomy educator from the Morehead Planetarium and Science Center at the University of North Carolina-Chapel Hill.
Boulder, Colo., may be best known for its environmental-protection efforts and green savvy, but this city offers its residents a wealth of cultural activities. Albert Boggess, former project scientist for the Hubble Space Telescope, and his wife, Nancy, also a former research scientist for NASA, retired to Boulder in 1994, drawn by both the climate and an academic community that included many of their colleagues. "It's a university town, which is important to us, and there are all sorts of activities which come with that automatically," Albert Boggess says. "There's lots of good music here, both classical music and popular music. And that appeals to us."
BERKELEY, CALIF. A shopper walks past a sculpture in the Fourth Street Shopping District.
Berkeley Convention and Visitors Bureau
Upper St. Clair, Pa., is near Pittsburgh and has 29 area colleges, including Carnegie Mellon University, while the quintessential college town of Ann Arbor, Mich., offers an array of intellectual and cultural programs through the University of Michigan's Osher Lifelong Learning Institute.
West Lafayette, Ind., is home to Purdue University, which hosts lectures and brings in ballets and plays—"a variety of different programs that you wouldn't necessarily normally get in this size community," says Joann Wade, president of the Lafayette-West Lafayette Convention and Visitors Bureau. The city's nearly 29,000 permanent residents can also get "bigger-city opportunities," Wade says, by driving an hour to Indianapolis or two hours to Chicago.
Hoboken, N.J., and Brookline, Mass., also have the big-city experience close at hand. Hoboken is just across the Hudson River from Manhattan, while many Brookline residents commute the short distance to work in Boston's medical centers and universities.
Some suburbs have a main attraction all their own. Reston, Va., was developed as a planned community or "new town" in the 1960s, and it's only a half-hour drive to Washington, D.C., and its panoply of world-class museums. Out west, Lake Oswego, Ore., hugs the city of Portland but also offers culture and beauty of its own, making the most of its 405-acre lake.
The brainiest places to retire:
Ann Arbor, Mich.
Chapel Hill, N.C.
Lake Oswego, Ore.
Upper St. Clair, Pa.
West Lafayette, Ind.
Copyrighted, U.S.News & World Report, L.P. All rights reserved.
July 1, 2008, 10:15 am
Our Parents, Ourselves
By Jane Gross
Jane Gross’s mother, Estelle Gross, at a nursing home in Riverdale, N.Y., in 2002.
Jim’s mother-in-law has fallen again. For the fourth time this year.
He and his wife meet the ambulance at the emergency room, then try to keep the frightened, old woman distracted through the long wait. They check her into the hospital with several broken bones and an unsteady heartbeat. They spend days at her side, jolly her through the rigors of rehab and finally take her back to her apartment, as they have so many times before.
Along the way, the 60-something couple, friends of mine in Los Angeles, learn which pain medications make an 87-year-old woman delirious and which leave her in a stupor. They learn that Medicare covers orthopedic surgery but not long-term care at home. They learn about stage-three bedsores. They learn that out-of-town siblings can be summoned for a few days respite but don’t fully grasp the relentlessness of the caregiving task.
Nobody wants the old woman to die, but her misery is a heavy blanket muffling many lives. Each mad dash to the ER, each hospitalization, takes a toll. On top of the cost of assisted living, Jim’s mother-in-law needs private duty home care, or else the next fall could be her last. But what happens if and when even 24/7 help isn’t enough? A nursing home? Who pays, at upwards of $100,000 a year? And how long will the money last?
These are the trials many of us face during the final years of our parents’ lives, as we lurch, ignorant, from crisis to crisis. When my brother and I began this journey with my mother, who went from feisty independence to utter reliance on her children in a matter of months, we were making it up as we went along.
We knew nothing about entitlement programs. What do you mean Medicare doesn’t cover the cost of home care or assisted living or a nursing home? We knew nothing about the advantages and disadvantages of hiring companions and aides through agencies or word-of-mouth. What do you mean that the agency aide needs permission from a supervisor before picking my mother off the floor if she falls?
We knew nothing about hospital discharge planning. What do you mean she has to leave tomorrow when we have no place to take her? We knew nothing about geriatric medicine. What do you mean emergency rooms and intensive care units can cause a form of psychosis in the elderly, or that a catheter can lead to an undiagnosed urinary tract infection and even death?
We knew nothing about Medicaid spend-downs, continuing care retirement communities, in-hospital versus out-of-hospital do-not-resuscitate orders, Hoyer lifts, motorized wheelchairs or assistive devices for people who can neither speak nor type. We knew nothing about “pre-need consultants” who handle advance payment for the funerals of people who aren’t dead yet, or “feeders” whose job it is to spoon pureed food into the mouths of once-dignified men and women.
At the time, between 2000 and 2003, my brother and I felt terribly isolated. As leading edge baby boomers and the children of older parents, we were the first of our friends to go through the drawn-out process of watching a mother or father grow more helpless with each passing day until the role reversal put us squarely in charge of everything. Once in charge, we had to rely on each other as never before — sometimes perfectly in synch, other times at each other’s throats.
At work, the assistance available to new parents did not readily extend to our situation, which was as laborious as child care but without the joy or the promise for the future. When I asked for a four-day week here at The New York Times, exhausted from my dual labors, the person in charge of such matters, who readily agreed, noted that I was the first employee to make such a request but surely wouldn’t be the last.
How right he was. Today, in the newsroom at The Times and at places of business everywhere, middle-aged men and women in growing numbers are juggling their jobs, their parents’ increasing needs, frequent emergencies and all the other moving parts of their lives. They look stunned and very tired. I remember it well. Because I chose to write about aging and caregiving in the wake of my mother’s death, gaining a level of expertise I didn’t have when I needed it, they come to me with questions.
How can they find a reliable home health aide? What should they look for in an assisted living community? How long is the waiting list at top-notch nursing homes? How onerous is the paperwork for applying for Medicaid? Is it worth spending money for the guidance of a geriatric case manager? How do you persuade a parent that it is no longer safe to drive, or that the time has come for live-in help at home? What can be done about siblings who won’t carry their weight? Or about siblings who disagree over end-of-life or financial decisions?
The experience of fielding those questions inspired this blog. I intend for it to be a source of information and community for grown children faced with these new responsibilities, for the elderly adjusting to unwelcome limitations and dependency, to employers interested in easing the burden, for professionals in the field and for anyone else who wants to chime in. Whining is permitted. Wisdom, and humor, are especially welcome.
But most of all, I hope you will tell me, and each other, what problems you face and how you have solved them; what changes in American health care policy, in the workplace and in the community would make your lives easier; what has surprised and inspired you; and how your family has changed, for better or worse, as a result of this intergenerational experience.
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July 5, 2008
As Gas Prices Soar, Elderly Face Cuts in Aid
By JOHN LELAND
SOUTH HAVEN, Mich. — Early last month, Jeanne Fair, 62, got her first hot meals delivered to her home in this lake town in the sparsely populated southwestern part of the state. Then after two deliveries the meals stopped because gas prices had made the delivery too expensive.
“They called and said I was outside of the delivery area,” said Mrs. Fair, who is homebound and has not been able to use her left arm since a stroke in 1997.
Faced with soaring gasoline prices, agencies around the country that provide services to the elderly say they are having to cut back on programs like Meals on Wheels, transportation assistance and home care, especially in rural areas that depend on volunteers who provide their own gas. In a recent survey by the National Association of Area Agencies on Aging, more than half said they had already cut back on programs because of gas costs, and 90 percent said they expected to make cuts in the 2009 fiscal year.
“I’ve never seen the increase in need at this level,” said Robert McFalls, chief executive of the Area Agency on Aging in Palm Beach, Fla., whose office has a waiting list of 1,500 people. Volunteers who deliver meals or drive the elderly to medical appointments have cut back their miles, Mr. McFalls said.
Public agencies of all kinds are struggling with the new math of higher gas prices, lower property and sales tax revenues and increases in the minimum wage. Some communities have cut school bus routes, police patrols, traveling libraries and lawn maintenance. The St. Paul Police Department is encouraging officers to use horses and bikes. A number of state agencies, including those in Utah, are going to four-day workweeks to save energy costs and reduce commuting expenses for their employees.
But older poor people and those who are homebound are doubly squeezed by rising gas and food prices, because they rely not just on social service agencies, but also on volunteers.
In the survey of agencies, more than 70 percent said it was more difficult to recruit and keep volunteers.
Mrs. Fair, who has limited mobility because of diabetes, lives on $642 per month in Social Security widow’s benefits, and relies on care from her son, who often works odd hours, especially during blueberry season. “He says, ‘You belong in a nursing home; I can’t take care of you,’ ” Mrs. Fair said.
The delivered meals allowed her to eat at regular hours, which helped her control her blood sugar levels, she said. Last year she lost her balance during a change in blood sugar and spent a month in a nursing home.
With no meal delivery in her area, Mrs. Fair said her home aide, who comes three times a week, must pick up frozen meals from a center in the next town.
“If my aide can’t get the meals, maybe I can get my pastor to pick them up,” Mrs. Fair said. “I can’t travel even to the drop-off center.”
Val J. Halamandaris, president of the National Association for Home Care and Hospice, said that rising fuel prices had become a significant burden for the 7,000 agencies represented by his group, with some forced to close and others compelled to shrink their service areas or reduce face-to-face visits with patients.
A recent survey by the group concluded that home health and hospice workers drove 4.8 billion miles in 2006 to serve 12 million clients. “If we lose these agencies in rural areas, we’ll never get them back,” Mr. Halamandaris said.
The agencies, which have suffered from Medicare cuts in recent years, are lobbying Congress to account for fuel inflation in reimbursement rates and to reinstate special increases for providers in rural areas, a program that expired in 2006.
In Union, Mich., a town among flat corn and soybean farms near the Indiana border, Bill Harman, 77, relies on a home aide to take care of his wife, Evelyn, who is 85 and has Alzheimer’s disease. Mr. Harman has had to use a wheelchair since 2000 because of hip problems.
But the aide, Katie Clark, 26, may have to give up the job. She lives 25 miles away and drives 700 miles a week to provide twice-daily visits, helping Mrs. Harman dress in the morning and get to bed at night, feeding her, doing chores around the house. “And putting up with a grumpy old man,” she said jokingly to Mr. Harman. Her weekly income of $250 is being eaten up by gas expenses, which come to $100 a week.
“Some weeks I have to borrow money to get here,” said Ms. Clark, a single mother of two, adding, “They’re just like family to me.”
Agencies say they are facing a shortage of home aides, because the jobs have low pay and often require long drives for a few hours of work. “They can’t make any money,” said Laurence Schmidt, administrator for the Oswego County Office for the Aging, in rural northwest New York. “So they’ll get jobs in nursing homes, where they can drive to one place and work a full shift. That is a statewide problem.”
Mr. Harman said that he thought a previous aide might have abused his wife, but that Mrs. Harman was comfortable with Ms. Clark. On a recent afternoon, Mrs. Harman called Ms. Clark “honey”; Ms. Clark, walking Mrs. Harman to the bathroom, kissed her nose. Mrs. Harman said she was going home. Ms. Clark said, “You are home, silly.”
For her work, Ms. Clark receives $9 an hour. If she leaves, Mr. Harman said, he could not care for his wife.
He said that when they married, she raised his five children as if they were her own. When Mrs. Harman started to develop Alzheimer’s 8 or 10 years ago, he said, “I promised her, ‘Don’t worry, I’ll take care of you as long as I can.’ ”
Without an aide, he said, he would have to put his wife in a nursing home, and probably need to live in one himself.
For many isolated older people, home delivery of meals provides not just nutrition but also regular contact with the outside world, said Elaine Eubank, president of CareLink, a nonprofit agency that serves elderly people in six counties in Arkansas, delivering 480,181 meals to 18,000 people last year. Because of gas prices, Ms. Eubank said, one center in Monroe County had closed its kitchen, and others were delivering frozen meals two days a week.
Mary Margaret Cox, executive director of Meals on Wheels in Greeley, Colo., which serves meals to 300 people a day, said that her agency was trying to avoid shifting to frozen meals, but that it was getting hard to recruit students and teachers who volunteer during the summer.
“Most don’t have anyone else checking up on them daily,” Mrs. Cox said of her clients. “If we do more frozen meals, they’ll lose that daily contact.”
Many agencies said their revenues — which come from state, federal and private sources — were not keeping up with their increased expenses. “We’ve had one increase from Medicaid in 11 years,” Ms. Eubank said. “But home care and Meals on Wheels keep people at home for a fraction of the cost of a nursing home. The state pays for care once they’re in a nursing home. So our cuts may cost more than they save.”
Sandra Prediger, 70, who still drives a car, said higher gas prices hit her every time she needed to go to the doctor. From her senior apartment in South Haven, she was barely able to pay her bills before gas prices rose.
“I try to help some of the ladies around here, driving them to doctors or to the store,” Miss Prediger said, but a round trip to her doctor or the beauty shop now costs $26 in gas. She has had to ask her friends to pay half. “I hate to ask,’’ she said, “because they have less than me.”
Her Social Security check arrives on the third of the month. For the few days before, her local gas station lets her write a postdated check to fill up.
On July 2, Miss Prediger had no money and owed money to the gas station. “In a few minutes,” she said, “my friend Shirley will probably call and say, ‘Can you take me to Wal-Mart to get needles for my diabetes?’ What else can I do?”
Barbara Blumka, 67, of Buchanan, Mich., said she would continue delivering 15 or 16 meals a week though she could not afford it. She is driving a Dodge Caravan, a “gas guzzler,” she said.
“I see these people’s faces,” said Ms. Blumka, who gets her meals at a senior center. “They’re so appreciative. I think of all the people who took care of my mother in the nursing home. This is my way of giving thanks.”
Christine Vanlandingham, development officer for the three-county Area Agency on Aging, said that in three to six months, the agency would have to start cutting meal deliveries to clients who get them now.
But Ms. Blumka will continue to help the homebound. Her nieces and nephews were buying her an adult tricycle for other travels. “It’s neon blue,” she said. “I’ll ride it to the senior center.”
Caring for another doesn't mean you should forget to care for yourself. Take good care of yourself, and you'll be able to give your family member the loving care he or she deserves. Follow these tips to make sure you don't neglect your health.
Reprinted with permission from Positive Thinking magazine.
Caregivers: What's In a Name?
Will and I both bristle at the term 'caregiver.' But what should we call what we do for our parents?
By Lilit Marcus
My friend Will's father has cancer. This means that after many years of not speaking to each other, Will is now the person responsible for his father's treatment. Will, needless to say, hates it. He's been coming to me for advice, and I finally realized why: my father is deaf, so like Will, I care for my father, albeit in a very different way.
Both of my parents are hearing-impaired. Growing up, I had different chores from other kids. My friends had to take out the trash or help wash dishes; I had to translate for my parents at the bank or make phone calls for them. I was lucky enough to grow up with two parents who loved me, treated me well, and gave me every advantage they could. As for Will, he wasn't so lucky. He came of age with an alcoholic for a father. Now, more than 20 years later, Will is finding himself responsible for a man he had tried to cut out of his life.
When Will first came to talk to me, he referred to himself as his father's "caretaker," although he claims he meant to say "caregiver." I'm not sure if the word choice was as unintentional as he seems to think. "Caretaker" is a word I usually associate with someone who cares for an old country estate, or for a garden. "Caregiver" is a word for someone who is responsible for the care of a person. Considering the relationship—or lack thereof—Will and his dad have had throughout the years, I don't find it surprising that Will talks about caring for his dad the way some people talk about weeding a garden or cleaning out storm drains. Plain and simple, it's his obligation, and not his desire.
I also don't consider myself a caregiver, but not for the same reason as Will. And we're not the only ones who don't like the term--a recent survey in "Today's Caregiver" magazine showed that some 70 percent of their readers responded negatively to the word "caregiver." To me, "caregiving" indicates helping people who may not be able to help themselves. My parents survived just fine before I was born, and they've survived just fine since my younger sister and I left the nest. If pressed, I might say that I "help out" my parents. But for some reason the word "caregiving" doesn't fit.
My parents spent many years taking care of my basic needs, and now, I'm returning the favor in a smaller way. I see translating for them as a quick way to help make things go more smoothly, not as any huge burden.
The Fifth Commandment is "honor thy father and thy mother." This word "honor" can mean different things to different people. I see interpreting for my parents as a simple way to honor them, to show respect for them, to help them, and to be a dutiful daughter. This commandment says that it is our job, our godly obligation, to attend to our parents. Just as my mother helped me learn to walk, I help her to communicate. They once helped me, and now I help them. It's a way of coming full circle, an age-old narrative. Parents care for children, and then the children grow up to care for their parents. That is why families are the backbone of our society. They guarantee that someone always has a support network.
As I listened to him more and more, I realized I don't know how—or even if—the Fifth Commandment applies to Will's situation. Sure, we should honor our parents, but what happens if they don't also honor us? I had parents who raised me well. Will had an alcoholic father who was mostly checked out of his son's life. Should Will have to be the better person and honor someone who never honored him? Or is his father's cancer a kind of karmic retribution? Part of why I've always bristled against the word "caregiver" is that a caregiver can be any number of people, like a live-in nurse or a kindly neighbor. I see family as being on an entirely separate level. Where love exists, there is no giving or taking.
Meanwhile, though, no one person is able to do everything. Will is feeling strained by the money, time, and focus that his father's illness requires, not to mention the existing tension in their relationship. Where Will has an endless list of tasks to complete, I have a list of ways my family can supplement each other. For example, my father is great with money and balancing the checkbook. I'm not. So he helps me do my taxes and gives me advice about my finances. I don't see that as a form of caregiving—I see it as my dad being my dad. To me, that's what family is all about--each person contributing in their own way and helping each other when they can.
If I had to define my role around my parents, it would simply be "daughter." I'm honoring them, as the Fifth Commandment instructs me to do. If anything, we're all caring for each other, the way a family was intended to work. The reason Will's family isn't working the same way is because he has to be the child and the parent.
From the Book of Exodus, the Fifth Commandment is about honoring thy parents. But from the Book of Matthew, there's another appropriate verse: "love thy neighbor." With this in mind, I realize that there's more that I can—and should—do for Will than hash out what to name his caretaking/giving duties. The truth is, I can never fully understand Will or his father or their relationship to each other. Even though he and I may feel very differently about our parents, our opinions are the result of different experiences and backgrounds. But what I can do is love Will for the person he has become, despite the difficulties he endured in the past. What I can do is find the things we have in common, and become his caregiver—or caretaker, or friend--whatever he needs, whenever he needs it.
Lilit Marcus is an assistant editor at Beliefnet and a blogger.
How to Be a Fearless Caregiver
The editor-in-chief of Today's Caregiver magazine shares how his own caregiving experiences inspired him to work with others.
Interview by Lilit Marcus
Gary Barg has dedicated his life to helping caregivers across the country. He is the founder and editor-in-chief of Today's Caregiver magazine and the author of "The Fearless Caregiver." He organizes and hosts the Fearless Caregiver conferences, which have featured celebrities like Clay Aiken, Leeza Gibbons, Montel Williams, and Dana Reeve. He spoke to Beliefnet about living a balanced life, the role of spirituality in caregiving, and what it truly means to be 'fearless.'
Why did you start "Today's Caregiver?"
I got into it the hard way, actually. I was a long distance caregiver for my grandparents, helping my mom who was three states away. And I bet I was coming home once every six weeks just to see how things were, try to help out. But the truth is, you really can't tell what's going on unless you're right in the middle of it.
And so, I went home for two weeks to help her out and see what I could do. The first minute I got there, we were dealing with issue after issue. My grandfather's condition was changing, and so his care setting had to change. My mom was having problems with the insurance company wasn't feeling so good. It was just two weeks of this pain and fear and uncertainty.
I remember sitting with her the last night before I was going to go back to Atlanta and I said I was so glad that I was with her that particular two weeks because of all we went through. She looked at me dumbfounded because, because what for me was intensity I had never felt before, to her was normal.
It occurred to me there had to be a better way.
How would you characterize the average caregiver?
Well, average is a hard word to use for caregivers.
Generally speaking, it is pretty traditional. It's an adult who's caring for their parent, either living down the street or across the country. It is somebody who has really taken on the personal responsibility of making sure that a loved one is cared for as best as possible, shepherded through the healthcare system and making sure that, everything they do has to do with better care for their loved one.
You know, A statistic came out a few years ago from Stanford that said that, when somebody has a loved one living with cognitive impairment, 30 percent of them will die before their loved ones do.
How can we prevent that from happening?
Part of what we try to do is really educate the caregiver, make sure that the caregiver sees that they're really a member of their loved ones' professional care team--there's the doctor and the therapist and the nurse practitioner and the nutritionist. The way to actually help ourselves as we help our loved ones is to realize that we need to learn everything we can about our loved ones' care, about their situation, about the medical procedures and other members of their team. And we need to realize that we have a tremendous amount of responsibility and should get a lot of respect from the other members of the care team.
A side benefit of that is, as we get involved, as we see that we have certain powers, as we become, you know, what I like to call the fearless caregiver, we get more involved and we go to support groups and we go to conferences and we stay up on things. And we get motivated and literally take ourselves, a lot of times, out of the depression spiral that ends up killing us.
I'm sure you've heard of the phenomenon known as "caregiver stress," the caregiver being so focused on the person they're caring for that they forget about themselves. What are some tips that you would give to a caregiver who feels overwhelmed and doesn't know how to take care of themselves?
Job one for any caregiver is to make sure that they're cared for first. You know, it's the old story, I know you've heard it, about being in an airplane when the oxygen mask comes down. You have to put yours on first before you can help the other person.
The first thing you have to do is really look around your community and see who's out there looking to support you. There's all sorts of organizations, there's support groups, even if you're in a more rural area, there are a lot of telephone or web support [groups].
Stopping to make sure that you eat well is not selfish. It's not taking your eye off the ball. The core principle of caring for your loved one, of being a successful caregiver, is making sure that you stay healthy so you can care for your loved one as best as humanly possible.
There are times when a sick or injured person who's being taken care of resents that there's a person who has to come in and help them with things they used to be able to do for themselves. How can you, in that situation, care for the person and still let them feel empowered?
One of the biggest challenges you get is where somebody who basically has been handling a lot of the decision-making for a family now is not able to do any of it.
I think if at all possible, and obviously we're not talking about end-stage Alzheimer's or a situation where cognitive function is not a part of the picture, you need honest, open communication.
And if you can't actually do that without getting support, get support. Stay focused and stay aware and you realize that, as painful as it is for you, it is painful for your loved one as well.
Some people feel that, if you have money, that instantly gives you many more options for caregiving, whether that's being able to afford to not work or to hire a person or anything else. Do you see this problem?
I've done probably 75 interviews with major corporate heads and celebrities--people who seem like they should never be a problem with money. And they have the same fears and challenges and panic and pain that any caregiver does.
Obviously, it may be silly for me to say that money doesn't solve some part of it. I think that the great equalizer is not isolating yourself, and not sitting there thinking that nobody's going through what you're going through, and that there's no support and that nobody can help you.
Because, I think as you look around, there's a lot of opportunity for caregivers, at any financial juncture in their lives, to get support. There's monies available through the government. A lot of the area Agency on Aging organizations have some solutions. The Alzheimer's Association has some solutions.
Also, you can do what we call a reverse gift list. You sit down and think of 10 people who would do any manageable, bite-sized, easy thing to help that you would do for them and they'd do for you.
For example, when a neighbor goes to the store, maybe they'll stop by, pick up your grocery list and some money and go out and get groceries for you while they're getting their own. Maybe you have someone at work that you really like. Maybe they'll come by once a month and have dinner and talk about anything but caregiving.
If you come up with 10 people who would do those easy, manageable things that you'd do for them and they'd do for you, and you ask them for this support, 9 out of 10 times they're simply going to say yes because they're looking to find something to help you.
We need to create ourselves almost as a corporation: Caring For Mama, Inc. And in that corporation you have to look at your resources, and you have to look at people who can offer you services. And you have to look at what kind of support you can get that's available in your community and take advantage of every single bit of it. And that's when you're a fearless caregiver.
One thing that can come up is, if you get stressed or you're busy or you have a lot going on while you're a caregiver, often the person you're taking care of notices that. How do you show them that caregiving's not a burden?
It's that honest and open communication. Whatever you think you're hiding from your loved one, you're not and you're just making it worse. And even if you're dealing with a situation where there is cognitive impairment, the last thing that somebody ever loses recognition of is love.
One of the biggest, I think, challenges with caregiving is we want to make sure that everybody is happy. And sometimes you need to do certain things that's better for your loved one, and you have to get our or you need to get help or you need to have somebody come in in your place. Sometimes you just have to explain it and then make it happen.
We ran a piece called The Reluctant Caregiver that deals with a person caring for a relative they have been estranged from. How do you cope with caring for a person who has been out of your life for a long period of time or who you still have anger with?
It happens so much. One of the challenges is to face yourself and see what you're capable of, what you think that you're able to handle and you're able to do, because now you're dealing in as frank and honest a relationship as you can be with somebody when you're their caregiver.
If you're stuck, and you're there, and it must be you, you cannot isolate yourself. You cannot fume. You cannot sit there and let it kill you.
You have to find a support group, stay involved, stay communicating. And again, if you can't communicate with your loved one, make sure that you're involved in the communicating with other caregivers who can help you through it.
You spoke earlier about words that you don't think should be associated with care-giving, like fear or frustration. Today's Caregiver did a study about words that caregivers don't like and number one was "caregiver". Why do you think that is, and what other words could you use?
According to the National Family of Caregivers Association, the challenge of care-giving or supporting caregivers is that self-identification is the biggest barrier. If you go in a community and you say, "we're here to support caregivers" they say, "I'm not a caregiver. I resent that. I am a daughter or I am a son or I'm a parent. I'm doing what I'm doing out of love. I don't need a new title."
Although I've had caregiver.com and created Today's Caregiver magazine 13 years ago, I'm not so crazy about the word, either. People might think you're talking about professional caregivers, and think you might be talking about family caregivers.
I don't really put as much stock on the word except as a way to identify the context of what we're talking about. Until a better one pops up, the word is caregiver.
One unfortunate reality is that often whoever you're caring for ultimately might pass away. How can caregivers cope when that happens?
There are steps to grieve past the passing of a loved one after you've cared for them. Until you actually go through those steps, that [death] will be something that will always haunt you.
I firmly believe that bereavement groups are important. Aftercare is a huge issue. I don't want anybody to be forced to walk away from their feelings now that someone who was such a big part of your life for so many years is gone. People need the glide path. They need to stay among people who are caregiving. It's very, very important to make sure that that part of their life just didn't end abruptly.
What role do spirituality and faith play in caregiving?
In my experience, people have either renewed their faith, recommitted to their faith, or have a greater belief in the connectiveness of themselves with the world and with their own higher powers.
And you might think that counterintuitive, because all these terrible things are happening that you might think, "Oh, there is no God. There no greater being. There is no bigger reason."
I would hesitate to guess that there's hardly any caregiver out there who hasn't become stronger to their faith due to what they're going through as a family caregiver.
I think that's where a caregiver's strength is. I think that's where the greatest, honest--most honest connection between you and your higher powers are is when you're needed the most. And that the great things that'll happen are greater. You need your spirituality more than any other time in your life. And generally speaking, it's there for you.
Lilit Marcus is an assistant editor at Beliefnet and does not consider herself a caregiver.
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