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