TIPS and TOPICS
from David Mee-Lee, M.D.

Volume 8, No. 4

July-August 2010

In this issue

SAVVY Aging by the numbers; and tips on eldercare

SKILLS Facing your fears, saying good-bye, and planning the future

SOUL What is Your Legacy?

SHAMELESS SELLING The new Tips n Topics book just released! Plus a freebie

Until Next Time

Welcome to a combined July-August edition of TIPS and TOPICS.

With summer vacation on our mind (here in the northern hemisphere at least), I took it easy these two months. But what I include in this edition is not light summer reading. It is, in fact, a topic I have not addressed before in any detail partly because it can be a sad and depressing focus for discussion. I’m speaking of aging, elder care, dying and death. Still want to read on?

SAVVY

What’s on my mind these past two months is obviously influenced by my 95 year old mother’s fall (her broken and repaired hip), her slow convalescence and changed level of function and independence.

TIP 1

Statistics on why aging, ailing parents and end-of-life issues will increasingly be on your mind.

Source:2007 Study released from American Association of Retired Persons (AARP)

> It’s estimated that 34 million Americans serve as unpaid caregivers for other adults, usually elderly relatives, and that they spend an average 21 hours a week helping out. Millions more grown children are calling regularly, flying into town every few weeks or months or just stopping by to take Mom or Dad to the doctor.

> AARP estimates that the economic impact of this “free” care was about $350 billion in 2006. That’s more than the U.S. government spent on Medicare in 2005. It exceeded the size of the federal budget deficit in 2006.

> Reference: http://www.usatoday.com/money/perfi/eldercare/2007-06-24-elder-care-cover_N.htm

Source: SeniorJournal.com / October 19, 2005

Scope of Survey

>A survey of 815 baby boomers (born 1946-1960; spanning age 64 to age 50 yr. olds) and elderly parents (aged 60-90) examined how both groups interact when the senior parents are ill.

Findings & Conclusions

>13 million baby boomers are caregivers of sick parents and are deeply involved in every facet of their parents’ care, according to a 2005 survey.

>56% of the boomers and their parents surveyed agreed that elders received assistance at least once a week. 25% of those boomers and 22% of those elders agreed that the care was daily.

>Baby Boomers have much more trouble discussing sensitive matters about financial planning, medical care and end-of-life issues with their senior citizen parents than do these parents who are now in their ’70s.

>Reference:http://seniorjournal.com/NEWS/Boomers/5-10-19 BoomersCare4Parents.htm

Source: 2009 Survey by AARP and the National Alliance for Caregiving

Thrust of Survey

> To look at facts on care giving

Findings & Conclusions

>Nearly 11 million people take care of the 5.3 million Americans with Alzheimer’s, a number that’s expected to grow to almost 16 million by 2050, according to the Alzheimer’s Association.

>The survey found that caregivers (most commonly middle-aged women caring for a parent) give more than 20 hours of their time per week.  Most say it interferes with work, and the longer someone is a caregiver, the more likely her own health is to suffer.

>Reference: Los Angeles Times:http://www.latimes.com/news/health/la-he-alzheimers-caregivers-20100726,0,2361716.story

Source: Study from the University of Southern California’s Leonard Davis School of Gerontology

Scope of Survey

> This research is one of a set of studies looking at attitudes and behaviors toward caring for aging parents using the USC Longitudinal Study of Generations, which followed individuals from 333 families over two generations.

> For this study, Gans and co-author Merril Silverstein, professors of gerontology and sociology at USC, examined expected behaviors of adult children towards their aging parents over the 15-year period from 1985 through 2000.

Findings & Conclusions

> The study found that the generation born in the 1950’s and 60’s are more committed to caring for their aging parents than their own parents were.

> The findings, published in the December 2006 Journal of Marriage and Family, run contrary to the popular notion that the institution of the family is in decline.

> Among their findings, an adult child’s desire to care for an aging parent peaks at the age of 51 when individuals are most likely to be called upon to provide parental support. Women consistently express stronger familial obligations towards their parents than men.

>The study also showed that the oldest respondents, presumably those most in need of care, valued the care the least. The researchers say this illustrates that as parents get closer to death, they become more altruistic toward their children – that is, they make fewer demands of them in spite of their growing needs and increasing dependence.

>”Very old adults give priority to their adult children and grandchildren and want to see them thrive, even if it means getting less care then they may actually need,” said Silverstein.

> Reference: http://www.medicalnewstoday.com/articles/58056.php


TIP 2

Tips for Baby Boomers Taking Care of Their Parents

The following tips are excerpts from the May & June 2005 AARP Magazine. They put into words a number of issues which have confronted my brother, sister and me.

· Face Your Fears

Parents’ demands can trigger elemental fears-the looming specter of one’s own mortality, the scary knowledge that a parent’s decline brings us all a step closer to our own old age. However only by facing fears can we defuse them and put ourselves back in control.

· Say No-but Gently

It’s not easy-especially when we’re faced with a request we’re not prepared to argue against.  It can even take practice.  Enlist a spouse or friend to act out a scenario in which your parents make an unreasonable demand.  Write dialogue out in advance, supplying your helper with a list of your parents’ usual defenses. Formulate responses to all their potential harangues.

· Separate Needs From Wants

There’s a chasm of difference between a crucial need elderly parents may have (food, clothing, shelter, and basic kindness) and something they want (two-hour visits every day, your kids to be quiet at the table, a bigger condo in Boca Raton).

· Make Fun a Priority

Many people mistake quantity for quality when it comes to spending time with their parents. I would argue that it’s better to spend less time with them and make sure those hours are truly satisfying. Plan activities that will bring you together as human beings. If possible, hire caregivers for routine chores; save your own time and energy for more meaningful interactions. Join a book club with your mom, escort your father to an exhibit of Civil War memorabilia. If they are not able to get up and about, find audio books you can listen to together.

· Do Your Share of the Work

Family dynamics tend to build to a fever pitch when the care of an aging parent is involved. While it’s true that some siblings may be more suited to the task than you, don’t assume they are okay with the situation.  Ask them periodically how they feel about it. And remember, there is plenty you can do from afar-researching a medical procedure on the Internet, subsidizing home care, and sending care packages.

Reference:  You can read more on this at:

http://seniorjournal.com/NEWS/Boomers/5-10-19BoomersCare4Parents.htm

SKILLS

Our clients – Increasingly the people we serve will themselves either (1) be older adults moving quickly to a time when they will need eldercare, or (2) be the children of such elderly parents, where they’ll struggle to cope with the practical demands of physical care and emotional support.

Ourselves – Though professionally we are clinicians and providers, as human individuals we are all aging and will inevitably face these issues someday.  Because I have been blessed so far with good health, it has been easy to fend off facing issues of aging, sickness, death and dying. I feel nowhere near my age.

These past two months have forced me to confront issues easy to ignore until now. I invite you to do a little inward-looking also.  This will be useful to you and your family, and positively spill over to your clients (and their families) as well.

TIP 1

1. Reflect on these: Stop this Train and Facing your Fears

John Mayer is one of those musical artists who not only entertains, but makes you think. His song “Stop this Train” speaks to his fears that life is moving on quickly (he’s only 32 now); he would like to get off the speeding train and slow things down. I can identify with the earlier statement: “Parents’ demands can trigger elemental fears-the looming specter of their mortality, the scary knowledge that a parent’s decline brings us a step closer to our own old age.”

This is how John Mayer expressed it in some excerpts from his song:

“Stop this train I want to get off and go home again

I can’t take the speed it’s moving in

I know I can’t

But honestly, won’t someone stop this train

Don’t know how else to say it, don’t want to see my parents go

One generation’s length away

From fighting life out on my own

So scared of getting older

I’m only good at being young

So I play the numbers game to find a way to say that life has just begun

Had a talk with my old man

Said help me understand

He said turn 68, you’ll renegotiate

Don’t stop this train

Don’t for a minute change the place you’re in

Don’t think I couldn’t ever understand

I tried my hand

John, honestly we’ll never stop this train.”

TIP 2

Practice these:  Be present; Set boundaries; Have fun; Say good-bye

My sister is geographically and emotionally close to my mother.  My brother and I live thousands of miles away – oceans apart from her.  It is easy to be present and devoted, to set boundaries for a week at a time, for a couple of times a year. But for my sister who is just as devoted to her nuclear and extended family, it is not so easy.

Practice being Present

>How does someone strike the balance – between attending to the increasing physical and emotional needs of a frail parent and the daily demands of the rest of the important family relationships which need ongoing nurturing?

>How do you determine what you should do- i.e. to meet an older adult’s needs without infantilizing them and inadvertently stifling their confidence and independent functioning?

e.g.  Do I rush to take over the task of setting the table as my mother starts placing out the silverware and plates?  Or is it better to let her feel she is still capable of providing for her children and is not an invalid?

e.g.  Do I ask her to wait at the door while I drive the car right to her?  Or would it be better to assist her to walk to where the car is parked 30 feet away so she can get the exercise and stay as mobile as she can?

It’s tricky to be caring without being over-protective and stifling her sense of competence.

Set Boundaries

What are the most effective ways to attend to the crucial needs of parents and older adults (food, clothing, shelter, and basic kindness) and yet set limits on something they might want which may be unrealistic or unachievable (two-hour visits every day, your kids to be quiet at the table)?

Have Fun

> The challenge: How do you plan activities that will bring you together as human beings especially if you have short visits a couple of times a year? How upsetting is it to be fully present with your parent for a few days or a week or two, and then leave them high and dry? My mother says she has to “steel herself” every time I go away, and that is from a woman who is very stoical, supportive and philosophical about where I live and work.

> If you don’t live right near your aging loved ones, it is comforting to reflect on the tip above: “Many people mistake quantity for quality when it comes to spending time with their parents. I would argue that it’s better to spend less time with them and make sure those hours are truly satisfying.”

Saying good-bye

I never had the chance to say good-bye to my father. He got suddenly sick and was in intensive care before I could fly to Sydney all the way from Boston. I doubt he knew who we were by the time all the siblings arrived to see him. I certainly didn’t get to converse and have a meaningful and heart-felt exchange. That is not the case with my mother. At 95 heading to 96, she is still quite cognitively clear. In a few weeks, I want to start saying good-bye. I don’t want her to go, but she is tired and would just as soon “go to sleep”. And who knows when that will be, but here is the opportunity to do what I could not do with my father.

Just as it takes some deliberation and attention in the termination phase of a psychotherapy relationship, this is even more profound.

TIP 3

Plan for the future; Share the Decisions and Share the Work

Planning for the Future

Advance Directives; End-of-life decisions about “Do not resuscitate” orders, Power of Attorney, Wills and Executor of Will; Funerals- what kind? Cremation or burial?; Long-term Care Insurance; Assisted living environments, Nursing home or living with family members; and the list goes on……

Then there is planning for the sunset years (or whatever is the current palatable term): retirement accounts? If and when to retire? When to downsize and move into the condo or the retirement village? Preserving resources in case of long life or severe illness requiring those savings? Or decisions to travel, to gift family, to gift charities, to spend one’s money versus preserving resources for a possible future problem?

Sharing the Decisions

Here are other important issues to consider for your family and in those of the clients we work with:

Because “family dynamics tend to build to a fever pitch when the care of an aging parent is involved”, it is never too late to compare values and opinions of the older adult and the reactions and opinions of family members about such issues as:

· How do you feel about being in an institution like a nursing home versus living with your children or other family members?

· In your heart of heart, do you feel your children owe it to you to take care of you in your old age; or would you want to avoid the “burden”, cost and interference to their families?

· Have you made plans for end-of-life, extended care insurance? Or are you relying on the government or your family to take care of any needs you may have for long-term care?

· If you find yourself needing 24 hour care, would you rather die than have all medical and surgical procedures be done to keep you alive? Is your answer different depending upon whether you are cognitively clear or not?

· If you reach a level of function where you don’t feel like eating, walking or socializing (and medical and psychiatric illnesses have been excluded) would you want loved ones to urge and encourage you to improve functioning? Or would you rather they respect your wishes to fade away?

Sharing the Work

This is one I know from personal experience. Due to geography, personality, gender and a host of other factors one of your siblings may be more suited to the task of eldercare than you are. While being sensitive to this, don’t assume the ‘designated” sibling is always okay with the situation.

· Ask the “designated” sibling periodically how they feel about it. What can I do to help you? (Who cares for the carer?)

· Again there is plenty you can do from afar-researching a medical procedure on the Internet, subsidizing home care, calling your parent frequently so that emotional support is not the sole responsibility of your ‘carer’ sibling.

· Visit in person as frequently as you can. Take over duties to give your sibling a break: arrange doctor appointments when you are there; do the food shopping; do the fun trips/ fun activities to allow your sibling to be “off duty.”

Overwhelmed yet? But it is time to start the conversation.

SOUL

Forty US billionaires have taken up the challenge from Berkshire Hathaway CEO, Warren Buffett, and Microsoft founder, Bill Gates, to pledge a majority of their wealth to charity. This is not just about having so much money you don’t know what to do with it. It is about giving back to society and leaving the world a better place.  This is what you think about when you become older and realize you aren’t going to live forever – especially if you are way past the survival level of existence.  Billionaires tend not to think about how they’re going to get food and the rent money.

Getting older can put you in a reflective mood, wondering what you have contributed to make the world a better place and what will you be remembered for. Not that I have done much reflecting yet because I am still “in denial” that I am all that old. Then I read about poor old George Ferris.  Actually it was poor young George Ferris because he died penniless and unheralded in 1896 at the age of just 37.

I love going to the California State Fair each year!  Every August about now, in Brisbane, my hometown in Australia, they are holding the equivalent to the State Fair: it’s called the Royal Queensland Show at the Brisbane Exhibition Ground, affectionately known as the “Ekka”.  As a kid, each year I couldn’t wait to go to the Ekka organized by the Royal National Agricultural and Industrial Association of Queensland.

That is where George Ferris comes in. You guessed it! You can’t go to a state fair or an amusement park without seeing a Ferris Wheel or two or three. George, an up and coming engineer, created America’s answer to the Eiffel Tower for the Chicago World Expo of 1893.  Sadly he died not knowing that in 1904, his great invention was advertised for sale as scrap metal.  None of Ferris’s paper or plans survived and no one knows where his remains are buried. Yet his name lives on and his invention continues to bring excitement and joy to millions every year.

So who knows what your legacy will be?

Preoccupation with our legacy shouldn’t be the driving force of what we do every day anyway.  But I will make this promise right here and now….that when I become a billionaire, I pledge to give a majority away to charity.  You heard it here and you can hold me to that!

SHAMELESS SELLING

Just released…..

I am excited to announce the publication of……

“Tips and Topics: Opening the Toolbox for Transforming Services and Systems”

by David Mee-Lee, MD with Jennifer E. Harrison, MSW.  (158 pages; Sells for $19.95)

I invite you to read it and use the material to translate theory into practice; concepts into clinical services; and be a change agent for people, programs, payers and policy makers.

FYI- Here is a preview of the chapter headings:

Chapter 1: Changing a System of Care is not for the Weak

Chapter 2: Attracting People into Recovery, Even When You Don’t Feel Like It

Chapter 3: Screening and Assessment: Finding Your Audience

Chapter 4: Level of Care…or now you’ve got them…what’s next?

Chapter 5: Turning Paperwork into Peoplework

Chapter 6: Let’s Make Sure That’s What We’re Actually Doing

Chapter 7: Consolidating Systems’ Change: Celebrating Successes, Grieving Loss and Resolving Conflicts

Special Offer !

For the first 800 buyers, I will include a second book, Dynamic Health, for free!

Dynamic Health is a 142 page book of interviews with expert health practitioners, featuring prominent ones such as Bernie Siegel, MD (Patient Empowerment) , Dr. Earl Mindell (Nutritionist & author of the Vitamin Bible), Dr. Norman Rosenthal (best known for describing Seasonal Affective Disorder.)  I was invited to contribute to Dynamic Health, and was interviewed about Co-Occurring Mental and Substance-Related Disorders.

How to buy

Call The Change Companies at (888) 889-8866.

Ask for the Tips and Topics book and the free Dynamic Health book offer.

or
Go online and get started on ordering at www.changecompanies.net It sells for $19.95.

As always, the TNT monthly newsletters are free and online at www.changecompanies.net.

UNTIL NEXT TIME

Thanks for reading.  See you in September.

David

David Mee-Lee, M.D.