Aging Gracefully

[Music]

it was

late evening when my phone rang and i

was surprised to hear

my 87 year old mother say can you come

pick me up and take me home

i ask where are you and she said i don’t

know

you need to know that my mother had not

been out of the house after dark in at

least a decade

she had given up driving years ago i

didn’t know anyone who would just

leave her somewhere and most importantly

i was in california and she was three

thousand miles away on the east coast

i asked do you see a piano

hesitantly she said yes

i realized she was in her house where

she had lived for 60 years

i asked can you see a door be on the

piano she said

yes so i said look i’m going to hold on

while you walk to the door look in there

see if you see a bed and a bathroom

and then come back and tell me i’ll hold

on she came back and she said

yes i see them i said i know where you

are

i can’t pick you up right now but you’re

in a very

nice safe place the

bathroom is clean the bed is clean

you can lie down pull up the covers and

go to sleep

nobody will bother you and in the

morning the caregiver will be there to

help you get up

mom’s alzheimer’s disease was not the

usual short-term memory loss

she could remember everything but she

had confusion around time and place

mom did have caregivers 24 hours a day

but when the bill reached 10 thousand

dollars a month

it was clear that the more cost

effective way

to spend her dwindling savings was to

move her to a memory care community

when confronted with the news mom

dropped to the floor

wrapped her frail little arms around the

leg of that piano

and wailed i will

not leave my house

if you ask me for one word to describe

old age

i say loss not only loss of cognition

or home but loss of work loss of roles

as a provider

parent spouse neighbor your friends die

your spouse dies you live in a society

that finds little relevance or respect

for old age

you lose physical strength and energy

suddenly

you have gray hair wrinkles and sagging

skin

nothing in your body works the way it’s

supposed to and one of the biggest

losses

your driver’s license independence

for most of our lives we define

ourselves and find

meaning and purpose through what we do

work sports school in old age we lose

more and more of the doing the purpose

our identity and all that loss

leads to suffering our society and even

health and senior care

view old age as a series of losses or

deficits of function as an aging baby

boomer who has worked in health and

senior care for 20 years

i am terrified of the future that awaits

me there

i am more than an aging body

we all old and young are so

much more the physical

and material are important but

a balance is needed with what i

call the spiritual today i invite you to

explore the fullness of life

that i describe as spiritual

to consider five categories of spiritual

needs

and see how lack of care for them leaves

a void

in today’s patient-centered care

and finally to discover the greatness of

purpose

and joy that spiritual care can bring to

your life

let’s get started with the word

spiritual

in old age there’s a lifetime of

spiritual development

qualities and accomplishments like

creativity insight wisdom

developing skills and honing talents

in excellence virtues like love

patience kindness honesty empathy

we recognize and value the spiritual

development when we see it in other

people

because it produces beauty

order tranquility purpose

and happiness not only to an individual

life

but to society in general

i became aware that if we can value

each other for how we can spiritually be

in addition to what we can physically do

then we can ease the loss

and suffering of old age and redeem our

own futures

so excited i wrote a book about it

but meanwhile i was working in health

and senior care

not only with seniors and their families

but also on the business side

i met amazing doctors nurses

and senior care professionals who truly

cared about patients and residents

but i saw limitations and i saw problems

that affected patient care

one ceo of an agency that received

referrals from medical doctors told me

80 satisfaction rate was good enough

really i think medicine should always

aim for a hundred percent i saw

differences among senior care

communities

some were full of purpose and joy

residents loved living there

employees loved working there others

had bored lonely residents and staff

just

going through the motions the difference

was spiritual care it’s needed

in the workplace for owners managers

and employees

the united states spends far more money

on health care than

any other country in the world 3.6

trillion dollars

so don’t you think we should have the

best health care in the world we don’t

year after year compared to other

wealthy

industrialized nations americans are

more likely to be sick

disabled and die actually our lives are

three years shorter

according to the world health

organization the united states is ranked

37th in the world on

patient outcomes outcomes

are measurements of quality of

excellence

when the united states spends more money

on health care than

any other country in the world it’s not

a material problem

lack of quality lack of excellence

is a spiritual problem

when you do anything write a report

swing a golf club remove a gallbladder

to the best of your ability with focus

intent and care that’s

the pursuit of excellence that’s

spiritual

when the spiritual needs of people are

ignored

their humanity is ignored

it becomes easier to justify every

decision

on the basis of material gain

excellence quality is replaced with

financially acceptable levels of

liability

or how many lawsuits can we afford

as a for-profit business american

healthcare values production

and consumption individuals become

patients

on an assembly line designed to maximize

patient throughput there’s not a lot of

humanity in that process

but growing old seems to be a

billable condition and there is a lot of

revenue in that

another example of ignoring humanity for

material gain

is the practice of denying millions of

health insurance claims

totaling billions of dollars every year

a friend on dialysis needed replacement

for a stent in his arm

the physician’s order was rejected three

times

finally the insurance company sent

approval

on the day of his funeral

he had bled to death at home the week

before

meanwhile the average pay to a health

insurance company’s ceo

is 20 million dollars a year

there’s more than enough money it’s just

not

spent on patient-centered care

a spiritual problem cannot

be solved with money a spiritual

problem requires a spiritual

solution

in her early 80s my aunt ethel

lived alone on a farm in a southern

state

gardening running a successful catering

business

and enjoying an act of social life she

announced to the family

that she wanted to move into the local

skill

nursing facility where she had been

visiting so many friends

because there were so many interesting

things to do

and lots of visitors

well ann ethel did eventually move in

and she loved it many of the residents

had known each other for decades their

families

knew the families of staff members and

the same family had owned the skill

nursing facility

and hospital for three generations

all the churches for miles around sent

volunteers

sunday school teachers pastors choir

groups

even flowers locally grown

fresh vegetables were enjoyed at meal

time

the activity director baked from

scratch cakes pies and cookies

and between bites residents evaluated

recipes

she turned butter and residents

reminisced about milking cows and caring

for livestock

everyone went outside to watch a hog

barbecued on an open air spit

banter over the best sauce for ribs fill

the air

along with that delicious distinctive

aroma i was there

the skill nursing facility wasn’t

perfect

and the care wasn’t perfect but the

residents and the staff

and the owners were thriving in a

community

where mutual respect and mutual

dependence pervaded their daily lives

they truly cared about each other

there was a waiting list of older adults

who wanted to move in

employees were fairly paid received

generous benefits

and staff vacancies were immediately

filled with the most qualified nurses

the facility was clean bright cheerful

and well maintained

even though 90 of the residents

were on medicaid nothing

was worn or needed paint or repair

this was a low-income

medicaid long-term care

facility in the middle of nowhere

that was wonderful

if medicaid can do this any place can do

this

spiritual care is cost effective

here are my five categories of universal

spiritual needs and care

one purpose how powerful is the search

for purpose

what contribution do you want to make

to the world what gets you out of bed in

the morning when your joints hurt you

think no one really needs you

you need glasses to see hearing aids to

hear and your energy’s gone after

getting dressed

in a senior care community a frail

little lady sat in a wheelchair by the

front door

every morning and afternoon beaming and

calling out a friendly hello

to all who entered occasionally a

visitor would take time to sit and talk

for a few minutes to

make a heart-to-heart connection

and upon leaving the little lady would

take their hands and hers and say

i’m old blind

sitting in this wheelchair i can’t do

much but

i can pray for you purpose

category two social cohesion unity

the secret of success of ant ethel

senior care community was the love

care and concern that each

person had for the other those

virtues created unity trust

a sense of wholeness for every member of

the group

science has proven that everything on

the planet is interconnected

we accept this physical oneness but

spiritually

we don’t always see ourselves in others

or them and

us this lack of connection

is negatively affecting our health for

example

the respected rosetta study in northern

california

showed people living in a close-knit

community

with social support and cohesion have

half the heart attacks of people in the

region

and half the heart attacks of all

americans

a successful community is one where

every individual acts with concern for

the well-being of all

members that equity evolves

to justice and then to unity

category three spiritual safety

think of a time when you felt

emotionally vulnerable how did you feel

vulnerability dependence isolation are

real for older adults

with physical and mental decline like

my lost mother phoning for the ride home

or

clinging to the piano leg terrified of

losing her home

questions like who will take care of my

wife when i die

i’ve left my home and live with

strangers

will i like them will they like me

will they take care of me

i was inspired by a nun

who got into bed with a hospice patient

cradling her in her arms and promising

her

she would not die alone

when expectations for quality care met

trust emerges faith in the community

emerges optimism and loyalty

of both residents and staff appear

category four connection to the divine

have you wrestled with a difficult

problem and suddenly when you weren’t

even thinking about it the solution pops

into your mind

or comes to you in a dream have you lost

track of time and place and a bliss of

creativity

has a chance meeting or perfect timing

changed your life

these examples of inspiration creativity

and synchronicity

are spiritual powers it’s

where we reconcile the tension between

our self

and a greater good where we find meaning

for the losses in

our lives and in understanding and

acceptance

the end of suffering

spiritual power can be stronger than

physical power

just ask any hospice nurse who’s watched

a dying parent linger

waiting for a favorite child

category five spiritual air food

and water well just as our physical body

needs air food and water to live and

grow so does our spirit

for example prayer and meditation or

spiritual

air that can relieve despair anxiety

and stress scripture poetry inspiring

stories

or spiritual food that provide hope

comfort and courage nature

is spiritual water with power to immerse

and refresh us we need to hear our

favorite music

it lifts our spirits oh we need virtues

we need to see beauty and delicacy

to feel love and kindness to receive

fairness and justice to hear truth

everyone young and old and older adults

with dementia

needs this basic care

in closing some of these spiritual needs

are already part of senior care but

they’re not considered vital

they’re not written down and measured in

a spiritual

care plan not reimbursed by insurance or

medicare

and what doesn’t get measured or

reimbursed

doesn’t get done health and senior care

are based on a biological model of care

with some psychological and sociological

needs addressed

these three are important but we also

need recognition of spiritual needs

we need to name them measure them talk

about them and learn how to fulfill them

because caring for the spiritual heals

the physical lessens pain relieves

boredom and depression gives purpose

a reason to get out of bed and leads to

better quality of life

old age is inevitably a time of physical

loss but it

can be a time of spiritual greatness

how do you want to live