Baby Boomers says “No thanks” to the traditional Long Term Care Community Model

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Have you ever heard the term “walkable urbanism?” If you’re like me then the answer is No. The concept stems from the changing paradigm in senior generations. Seniors from the “silent” generation (born during the World War I era) sought to spend their senior years in communities that provided them with a sense of security. That generation placed a premium on living in a community that provided a sense of belonging. They believed that there is strength in numbers, and thought that they would have a peace of mind in living out their senior years in traditional long term care facilities.

Unlike the silent generation, the baby boomer generation (born between 1946 and 1964) values very different communities and lifestyles. This generation demands access to so much more-hence the emergence of the walkable urbanism communities – communities that provide its residents with choices; that recognize the need for flexibility and therefore provide a variety of experiences for its residents. Some may feel like a hotel, while others embrace a very integrated multi-generational setting. Gone are the days when seniors settled for living out their years in a Long-Term Care facility environment. This generation wants variety and freedom in dining, shopping, entertainment and housing.

Boomers would much prefer to dine in a food court that offers variety in dining experiences, than in the same formal dining room every day. In a Huff Post article I read recently, Jared Green wrote, “Imagine an apartment complex in a highly walkable environment, open to the surrounding neighborhood, with ground floor shops, cafes, and restaurants, and close to multi-modal transit opportunities, parks, plazas, self-storage facilities, and co-working spaces.” New Senior Living Model Needed to Satisfy Aging Boomers | HuffPost. This is the environment in which boomers would rather spend their later years.

So how are we, as senior care providers, meeting the needs of boomers, who demand individualized living experiences? Well we’ve seen a marked increase in home-care providers in the last decade, we have also seen innovative changes in what used to be “facility” care. One such innovation is The Green House Project. These are freestanding buildings where 10 people live and receive skilled nursing level care, in a financially viable home setting, that meets the social and healthcare needs of boomers at the same time.

In this setting the nursing station, medicine carts and dining rooms, are icons of a past era. In its place are storage closets designed to look like furniture, nursing areas that are small alcoves inserted into the design of the home. Medicine is stored in individual room closets, which are locked for safety, but close enough in proximity for the resident.

A model that is my personal favorite, that truly allows the senior to age in their home, is the intentionally elder-friendly community. This is the creation or renovation of whole communities that are intentionally designed to support seniors. These communities are designed to meet the social, physical and mental needs of seniors in close proximity to their homes. These integrated communities adjust their surroundings to include seniors; compensating for their frailties and disabilities and promoting social and civic engagement.

Design principles critical to an elder-friendly community, is integrated throughout the renovation or creation of these communities.

There is a variety of easily accessible transportation systems; business and housing is in walk-able distance; bathroom, kitchens and bedrooms are on the main level, and of course the doorways are wide enough for a wheelchair to access. Community centers and businesses are built with the needs of the young and old in mind. Unfortunately, there aren’t a lot of such communities located in the US. So while 82% of Americans would prefer to age in their own homes, senior care providers are behind on accommodating their wishes.

Having communities that are designed with all of its population in mind would transform how we live out our senior years, and as I often tell my children, if we live long enough, we’ll all be a senior person one day; so wouldn’t it be great to have choices when that day is now?

Happy Thanksgiving

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If life was a rollercoaster, then 2016 would be my personal Kingda Ka. So on this Thanksgiving Day, I must give Thanks for the ride and riders of 2016. And what better way to give thanks than with a List? And since I could never get past 10 things on any list, I’ll limit my gratitude list to 10 😊.  The 10 things I am grateful for this Thanksgiving Day are….

  1. Family and friends – Expressing gratitude for these relationships often becomes perfunctory. But when I remember the many who has an empty seat at their table this year – public figures, colleagues and friends  – I feel a deeper sense of gratitude for my family and friends.  For their love, support, loyalty – and for just being present. I am so thankful for all of you.

  2. Seniors – to our clients who entrust us with their care – THANK YOU. This year our first client passed away. We had cared for him for 8 years. Every Thanksgiving He give us poinsettias. He was generous, kind, engaging, and had a gift for making the stranger feel like a friend. I am thankful for the many lessons we learned from caring for him over the years.

  3. Our staff – I am grateful for the dedication of the men and women, who chose to serve seniors. For the compassion and 100% dedication you give to our clients – THANK YOU. You make our sphere of service a better place.

  4. God – specifically, His grace, protection, provision and love.  His grace and love sustained me through the lows of this year, and His provision and protection are the only reasons for the highpoints of this ride of my life. I am thankful to God.

  5. Caramel Almond Clusters – I know, I probably should think of something more profound to follow God’s grace, but have you had a caramel cluster? Well when you do, you’ll understand that this bite of utter goodness is worthy of making a gratitude list😉.

  6. Growth – this year, more than any other, I have learned to be slow to judge others. To pause as I form an opinion, and look for the panoramic view, rather than snapshots of a person’s life.  To be slow to judge and even slower to act on judgments formed, is a kindness I cherish when afforded,  and therefore should be willing to pay it forward.

  7. Election is over. I know, you’re thankful too!

  8. Laughter – it really is a good medicine. And because I’m thankful that you took the time to read my list, I’ll pass along an app my son loaded on my phone-ifunny – download the app and lol.

  9. Bolt – my 5 year old Shih Tzu. He is love and acceptance wrapped up in a 12 lb package of fluffiness. I am so thankful for him!

  10. Perspective – sometimes I’ve gotten this with time, other times from talking a situation out with another person – this year I gained perspective through life’s experience. I am thankful that I’m alive, that God is gracious, that friends are kind, that life goes on, that growth is possible, and that I thought of this list!

William Arthur Ward said that, feeling gratitude and not expressing it, is like wrapping a present and not giving it, Ditto that!

Happy Thanksgiving!

When Despair visits

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de·spair [dəˈsper] the complete loss or absence of hope: synonyms: hopelessness · depressed. gloomy. disheartenment · discouragement.

We all have experienced that emotional response to bad news – we call it sadness, but when it lingers, when it takes up space and time and refuses to leave, we may call it depression or despair.


Despair is an unwelcome guest that visits us all – rich, poor, young, old, black, white, famous, unknown, powerful and powerless.


When we read about the rich and famous, some of us may even snicker at some of the things they do to invite this houseguest, then seems surprise by his presence, or by his lengthy stay!  Bill Clinton and Michael Jackson comes to mind.


Then there is the friend, or relative who stands on their doorsteps and beckons this houseguest to come in. You know them, they love stuff and spends their paycheck + credit card acquiring more stuff – begging despair to linger for years as they avoid the phone calls and mail from one of despair’s favorite elf – the debt collector!


Or that despair chaser that blindly seeks after fun, knowing the cost is more than they could pay, but fun (and ridding themselves of boredom) outweighs their judgment and despair is the inevitable result – sometimes in the form of an addiction, or imprisonment, or job loss, or disease.


And then there is the sick, the loss, and the pain that results in enduring the presence of this unwelcome guest. While these precursors to despair comes to us all – sick, loss and pain is no respecter of persons– they tend to lodge at the door of the senior person more often than not.


Perhaps because, after years of fighting that unwelcome guest, the senior person has lost arsenal and energy?  He or she is weakened and despair seeks to rest rather than visit? Whatever the reason, despair is more of an epidemic – rapidly spreading like an infectious disease – than a random virus, for the senior person.


It knocks, kicks down the door and storms in at the most inopportune times – recent negative medical diagnosis + loss of a spouse. Outliving an adult child, or a lifelong friend, and deciding about moving to a long term care facility because of this loss.


Despair arrives and declares itself the winner, in a life that was spent battling its presence and lingering effects, and how does the weary war torn soldier respond? More often with these four words, “I want to die.”


As health care professionals we hear these four words often, and our trite response is often, a gentle chide, a sympathetic pat on the shoulder, an unrequited hug.


We may even ask family members to talk with a Psychologist, get the senior person on anti-depressants, or if there is no cognitive impairment, suggest talk-therapy with a professional. But what if the senior only wants you, yes you daughter, son, grandchild? What if just your presence – consistent, not sporadic – presence – listening – laughing – sharing – reminiscing, is all that senior person wants?


What if  your presence, and my presence alone, is the stimuli that causes that unwelcome houseguest – despair – to pack-up, and head out the door, or better yet, to forget it ever knew the address for our senior love ones?



Quality of Life?

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Defining Quality of Life for seniors

In health care we often use the term “Quality Of Life” in connection with  describing an ultimate goal, a service,  or when proposing a full range of care to patients. For some,  quality of life (QOL) may seem unattainable. When faced with chronic health conditions, depleting assets, lack of familial support, limited social engagements, and overall lack of resources-QOL may seem outside their grasp.

QOL is fantastic in theory , however, formulating a plan with QOL at the center requires a deeper and a broader understanding of care. QOL is multi-dimensional in scope and views the care recipient in a holistic manner.  Let’s consider three elements that contribute to heightened QOL.

    • Social Interactions-A general sense of connection to other people, other groups, pets, or whatever brings the person a sense of meaning.
    • Engagement with activities that promote a sense of purpose and feelings of physical wellness
    • Stimulation of the mind in the form of learning, creativity, or idea exchange
    • A fourth proposed element is- Spiritual well-being.

This concept has less to do with religion and more to do with what feeds someone’s “spirit” .  Hobbies, worship, art, etc. Something that brings deeper satisfaction and contributes to deeper meaning. Though, religious traditions and occasions should not be overlooked as unimportant to a person’s QOL. Many religious rituals and traditions have great meaning and could become distressing if not adhered to.  For instance, a client who values the Sabbath or who  has a kosher home has specific rituals and practices that if overlooked, diminishes that person’s view on their QOL.Quality care and Quality Of Life are sometimes used interchangeably, and they have similar approaches, however, QOL is a broader concept. Traditionally, quality care focuses on the issues at hand. Specialized patient care that aligns with current diagnosis and treatment or comfort care. QOL expands on that approach to include fulfillment and engagement in the person’s life, despite cognitive or physical limitations, despite diagnosis- QOL approach considers the whole person-Past, present, and future.The World Health Organization has defined health as a “state of complete physical, intellectual, and social well-being and not merely the absence of disease or infirmity”.

When addressing the client’s QOL holistically, caregivers and health professionals may adopt these four principles:

    • Assessing his/her needs and interest
    • Focus on those needs
    • Develop and implement an activity plan that will address those needs
    • Evaluate success or failures and refine the plan

One example of how this could can be utilized in a practical way:

Mrs. H was an avid gardener and bird watcher. She would sit on her porch for hours watching the birds and planting flowers in her garden. She loved to smell her roses and would always have fresh flowers in her kitchen. One winter, Mrs. H had a massive stroke and could no longer garden or sit outside without company. Her case manager worked with the family to install raised beds with wide edges on her porch where she could still plant smaller plants.  They installed a few bird feeders so she could still sit and watch the birds.  The case manager arranged for home care services a few days a week- the caregiver would assist Mrs. H with her gardening. The case manager made a schedule that included help from other family members.
Her ability to still do what she enjoys-gardening and bird watching, had tremendous impact on her quality of life .

The holistic approach may seem time consuming and tedious but it can be achieved-with help and support. The question to ask yourself is- What if this were me? Wouldn’t I want someone to invest the time to make my later years, quality years? Of course you would.

One way to achieve these goals is to tap into informal support networks. These include, friends, neighbors, church members,  volunteers, and  grand-children..  I have a client who has a live in caregiver but separate from that care, the family created a monthly calendar of events which includes involvement of all family members.  Children, grand-children and  great-grandchildren share in the responsibility of engaging the client. They go out to eat, go for rides, go on trips etc.  they are a wonderful example of what coordination, communication, and love can achieve.

Remember, the key is to first develop an action plan that incorporates-respect, realistic goals, and client responsiveness.

Remember to respect the client’s comfort level with any proposed activity. Honor his/her desire to participate or not. Some activities may require some gentle  encouragement and repeated tries.

The person may find certain activities overwhelming and may resist participation. Set realistic goals based on abilities and not just on ideas.

Keep an open mind, adjust when necessary, and follow the client’s lead when planning activities.

Addressing a person’s QOL is an evolving process. It requires creativity, resourcefulness, and an interest in the humanity of the aging process. The results of your efforts will be well worth the investment of your time. A focus on QOL is a win-win for the older adult, for you, and for the wider branch of care partners. Many seniors feel invisible. This element of care provides an opportunity for them to connect with their whole selves- to feel important, appreciated, and visible.


Cress, C. J (2012). Handbook of Geriatric Care Management.


Aging Wisdom

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Wise Decisions

A few days ago I visited a Senior Center, and met a lovely lady name Irene. Irene, was lively and vibrant and within minutes of introducing herself, she told me her age – 83 years old – but not “OLD,” at least that’s not how she sees herself, she said. Irene, lovely and active and involved in community volunteering, is like most of us in this regard – we see aging in others, not ourselves. Have you ever ran into a High School classmate and walked away thinking, “She looks OLD!” Never thinking for a second that said former classmate is having the same thought?
When we talk to seniors about how our home care services could benefit them, how it promotes the lifestyle they would like to continue – even after the many challenges of aging develops – we usually get an agreeable response; but ever so often, the response is, “I’m getting older, but I’m not THAT old, that I need a caregiver!” Since contact with us is usually initiated by the senior person, or a concerned family member – I know this response is due, at least in part, to the perspective so many of us have – we are not AS old, AS in need, AS…..

I believe that it is our human nature to see ourselves in a rosier light. This tendency protects us from life’s discouragements most of time. If I am not as bad off as the people around me, then perhaps I could, ‘cross that bridge,’ ‘climb that ladder,’ ‘meet that challenge.’ Seeing life better than it really is, helps us survive the moments when life is full of challenges; it diminishes our problems and increases our hope and abilities – and isn’t that what optimism really is anyway?

I would present to you however, that optimism should not factor into our self-assessment as we decide on when the right time would be to get help in our senior years. The sooner the better. It really could be the decision that lengthen our days or shorten our lives.

We had a beautiful senior client a few years ago, who lived in an Independent facility. She hired us to provide her companionship and a driver, as driving was no longer an option, and she dined out often during the week. As we worked with her however, we noticed the need for someone to be there on a more frequent basis, as she was forgetting personal hygiene, missing meals and were having more days where she did not remember to take her medication.

We shared our caregiver’s observations with her son, but he was reluctant to change the arrangement, as Mom did not believe that she needed as much help as the older people she saw in her building. The Independent facility insisted that he hired full-time caregiving after a midnight incident in the lobby of her building; but the decision was difficult to make, as our client saw the concerns of others as, over-reacting, and full-time help as admitting she was old. 

We continued to share our observations on the days we were there, with her son. But even as our concerns for her safety increased, she remained adamantly opposed to additional help. Our client finally relented after our caregiver arrived one morning and had to have the maintenance crew unlock our client’s apartment door, as she was not responding to the customary knock. She had fallen during the night and broken her hip, since she did not remember to wear her alert, she could only lay on the floor hoping that someone would come along and hear her cry for help.

Benjamin Franklin said that, ‘life’s tragedy is that we get old too soon and wise too late.” But do we have to?  … Get wise too late that is?