What's up with Hospice During Covid-19 and into the Future?

Washington State Health Advocacy Association has been presenting Zoom programs on various topics.
Last Monday, June 8, the question was "What is happening in the health system with COVID-19, and what can we expect ahead?"

The presenters were doctors and medical directors with Providence Hospice and Swedish Health Systems, They included Stacey Jones, Bruce Smith, and Dale Reisner.

The good news around COVID-19 is that only two countries in the world--India and Brazl--are currently seeing increasing numbers of new cases. The United States has at the most recent count, 23,000 new 
cases, compared to Brazil's 29,000 new cases. Our numbers are down.

What has changed during the COVID-19 period in terms of patient care? Many of the most ill are under the Hospice program, which is part of Palliative Care. Both programs work to manage symptoms, not to extend life. 


Hospice is for patients whose doctors have signed off that there is a good likelihood that they will not live past six months. Palliative Care has no such limitation. Dr. Smith says, though, that they have a patient who has been on Hospice off and on for five years. 

Hospice is a program, not a place, although there are a few stand-alone Hospice Centers. Hospice can be done in a nursing home, an assisted living community, an adult family home or a private home. The program includes a nurse, a social worker, a chaplain, and home health aids. There is also bereavement support.

These days, the professionals do more of their work on the phone than in the past.  But the face to face visits,with the professional wearing protective gear, are still happening on a more limited basis.. For many, the new protocol works well, especially for those whose loved ones live far away and can't fly to Seattle.

The hospice professionals told of a 90-something woman with dementia who received the surprise of her life. Her sister and daughter couldn't come to visit her. Her social worker asked her daughter,"Is there anything your mother would wish for, if it were possible?"  The daughter didn't take much time to think about it. "She has always wanted to visit the Sistine Chapel. She is a very religious person." Through the magic of a Zoom virtual tour, this woman was able to see exactly what she had pinned her hopes on, and her daughter was able to enjoy the tour at the same time.

For the future, it's likely that some of the new changes may continue. 

Is Your Parent Giving Up Driving? Here are some options

Giving up driving is so hard to do.  Our parents likely have two objections:

I'll be stuck at home and wither away.
I'll go broke paying for alternative transportation.

First, the money issue. Jeannine White, RN, MSN, suggested creating a transportation fund using proceeds from the sale of the car plus savings in the future on automobile insurance, gas, maintenance, etc. From that fund, schedule rides from paid and free sources.

Uber are Lyft and great sources for a ride to the hairdresser, to the airport, etc. Private drivers are also available--check with your local senior center. If your parent is healthy, public transit may work for some rides. And if your parent isn't physically or cognitively able to drive, they may be eligible for the paratransit program, assuming their physician completes the paperwork.

One of my colleagues at Silver Age, Susan Watters, has another transportation idea. She is well versed in her other role as an Occupational Therapist in finding good alternative ideas for seniors. She also happens to do driving assessments.

Her suggestion?  Consider a move to a retirement community. Transportation is provided to medical appointments and shopping, and there are outings and social activities right at the senior's fingertips.
There are also chef-prepared meals, housekeeping and maintenancee.

Silver Age can help you find one. There is life after driving.

Mother's Day 2020: Simple Pleasures Hark Back to Easier Times

Lately I've been talking about Mother's Day, mainly at Zoom meetings. How do we celebrate without hugs, shared dinners, and of course, desserts?

People are putting on their thinking caps and doing the best they can. Lots of take-out dinners served to families at a state park with an effort at social distancing.  And don't forget those masks which hark back to the Lone Ranger. And what about entertainment?

Video games? Absolutely not. Checkers? Definitely not for several reasons--too difficult for the little ones and too much of a temptation to violate the six-foot rule.  Our family has an added bonus--our hosts Tim and Lesley have a corner lot with a huge back yard. Last I heard, the children may play "Charades," "Red Light,Green Light ," and maybe even"Mother, May I?"  After all it's Mother's Day. I do know that I'm not the final decider of such things.

Our agenda will definitely include one activity all of us enjoy:  playing with Tim and Lesley's new puppy, a darling Bernese Mountain dog. The little puppy actually belongs to all of them, but I hear Tim has been taking on the night shift.

Pray for sunshine? Happy Mother's Day!

Jigsaw Puzzles Keep Seniors Going and Going and Going

Marge is 92. But when she's in the middle of a jigsaw puzzle, she's 20, or maybe 30.

For years Marge was all smiles as she searched  for just the right colors of green, or blue, or red to complete the puzzles. The ones with 1,000 pieces or more were favorites. During the holidays after the dishes were done and food put away, she would go for a jigsaw puzzle. It was a great choice--no calories but pleasing in its own way.

Sometimes she worked the puzzles in a group, other times by herself. Did she know in her earlier years that at 90-something she would still have that that gleam in her eye when looking for just the right piece?

Well, she does. It seems like as people age and forget things--and we all do--we remember what we loved.  It's as if our brains hold tight to the precious things: songs, puzzles, fishing, hunting. And even if we can't physically perform those activities, the memories are still there.

I'm so glad that in many senior care communities, and assisted living communities, jigsaw puzzles take front and center  When I worked at a retirement community for 12 years, I would see residents sit at the jigsaw puzzle table, intent on their search.  I would leave the building in the evening, realizing there was more "work" for them to do, and for me as well.  In the morning, I spotted the table once again. Miraculously, the puzzle was finished. The puzzle elves had come and worked their magic.

Yes, Marge still enjoys her puzzles. Here is a picture to prove it.

Grief on a Global Scale, For Elders and Us All

"We are experiencing grief on a global scale," said Trudy James a week ago.  I'd never heard CO-VID-19 expressed quite that way, but it's true.  Grief on a global scale.

Trudy James is a chaplain and experienced grief counelor. She shared the podium April 13 in a recorded public conversation with Robin Shapiro, board chair for the Washington State Health Advocacy Association.

Grief, especially of the aging, was their topic. "Our culture hates sadness. Our tendency is to focus on how we move forward, rather than the sadness we feel," said James.

But grief is a reality.  And it's about loss. "We are losing our normal way of life.  We are losing our connections to other people." The symptoms are many: fatigue, tiredness,  and pains, and numbness. Or we can become angry or ill. And even after we return to our normal life, we still can experience grief.

So what do we do with the sadness we feel?  Here are some ideas to use with yourself, with seniors in your life, or with others who are experiencing loss on a global scale.

• Talking about the situation and your feelings is good. 
• Allow yourself to cry.
• Listen to others without fixing. Not everyone knows how to listen to loss.
• Ask questions of people such as "What is the hardest thing about this time for you?" "What do you miss the most about "regular" life?
•  Spend time in nature, or at least look out the window.
• Do simple acts of kindness for others. 
• Perform a ritual such as sitting in silence. A ritual is an action that carries meaning and insight. 

Grief on a global scale. It's true. How true. My ritual is sitting in silence and gaining strength for today and tomorrow.

Zoom into Easter: Our Virtual Celebration

Our granddaughters at the right are turning 16 and 14 in May.  This Easter, they will star
 in the shortest Easter pageant ever. At least in the history of our family.

Our congregation includes two grandparents, three children, three spouses and 7 grandchildren.  We're not going to let the  coronavirus put a damper on the Easter parade. But this year's celebration will be different.

The three families will all participate virtually in Easter services at their individual churches. There will be 3 separate egg hunts before the family celebration. Zoom calls us to order at 2:30. Our oldest granddaughters are in charge of Zoom.

Our order of worship looks like this

• Shout in unison:  "Jesus is risen. He is risen indeed." 
• Ring bells, key chains, anything that makes noise.
• Grandpa reads the Easter story from the New Testament.
• Tell the Resurrection egg story. These are plastic eggs with symbols of Easter inside.  Usually there are candies, too, but I can't figure out how to virtually pass them out.  Next year. This year we'll focus on the story.
• I will talk about three kinds of prayers:  "Help me, help me,  help me!" "Thank you, thank you!" and "Wow!"
• We are skipping the Hallelujah Chorus, unless someone has a recording of the Mormon Tabernacle Choir.  And we'll each prepare and eat our own food.
• Afterwards the grownups will adjourn and the kids can talk to each other on Zoom for awhile.

No, it's not the celebration we're used to, but it will be Easter all the same.

Coronavirus: it's amazing the difference a few days makes

Note: I wrote the following on March 25 from a cruise ship on our way home from Pago Pago on American Samoa. Now that we're home, I realize our perspective on the the virus has changed drastically. From earlier reports from our daughter and cable television we knew there would be food shortages and fewer cars on the road. We knew about the rising number of cases and the increased need for ventilators, masks, and trained caregivers.

But seeing is believing. And perspective is everything. I'm publishing this because it's what happened to us, beginning on St. Patrick's Day and until March 25, which is my husband's birthday.

Our "suffering" was light at most compared to those directly affected by the virus. Our prayers are with them.

If this post sounds Pollyannaish I understand. Here goes:

St. Patrick’s Day, 2020—My husband surprised me with a pinch.  I’d forgotten to wear green. Other things about this day made me want to pinch myself, to make sure what I was experiencing was true.

I stood facing the window of the cruise ship, the Norwegian Jewel. More than 1700 passengers were on board, 700 of them Americans.

The island in back of us, American Samoa, was shrinking by the moment, as we sailed away bound for Honolulu. We peeked at the port Pago Pago where we had refueled the night before.

American Samoa could be called the Second Emerald Isle, at least from my point of view. Green was the dominant color—no pinching allowed. Palm trees and assorted foliage dominated, topped by jagged cliffs. As our ship sailed toward the ocean, the landscape shrank. Houses, shops, and an oil refinery were all miniaturized and would soon disappear.

A lone American flag stood atop a church.

Why weren’t we able to disembark the previous day to explore this island? Our cruise’s original itinerary included ports in Australia, New Caledonia, Fiji, Polynesia, plus the Samoas. All that began changing when the pandemic coronavirus hit. We began sailing on February 28. Soon country after country began closing their borders and their ports. Eventually this meant we had 13 straight days at sea.

March 25 was the banner day for all of us.  The last load of passengers left Honolulu to fly to other ports of the world, each called home.

The crew on our ship and management of Norwegian Cruise Lines were wonderful. We were cocooned, in a good way. Our hands were sprayed with sanitizer at every turn—before entering the dining areas, the auditorium and other public areas.  The staff has served us remarkably well, making our beds, preparing our meals, and providing entertainment! Even more important, to my knowledge, no one on the ship contracted the virus. We went home healthy if not a few pounds heavier.

Television kept us in touch with the news of the virus and we had limited contact with folks back home. We have been encouraged by the vigilance of leaders in many nations as they fight the virus together.

French Polynesia is still on our bucket list. We hang onto green—the symbol of hope and life.  As our old friend Kermit the Frog croaked, “It’s not easy being green!” No, it’s not. But it shows that we are growing!  By the way, on March 25 my husband celebrated his birthday. In honor of him, no pinches. Instead, birthday candles were in order!

Playing hooky in Australia: I'm taking a break from helping families find health care

A Koala in one of Sydney's animal parks

Greetings from Australia! It's a great place to play hooky from my job in America. I'm taking a vacation from helping families find health care for their loved ones.

What about my keen interest in kangaroos and koalas? For me, it goes back to a little boy named Alexander, the star of three classic children's books by Judith Viorst. One of those is Alexander, Who's Not (Do You Hear Me? I Mean It. Going to Move.)

One of Alexander's pet phrases is "I'm going to move to Australia!" Alexander has been given bad news by his parents. His father's job is taking the family 1000 miles away. He is horrified!  As he says goodbye to friends, the postman, his schoolmates and more, he continually says, " I've not going to move."  Or "I'm going to move to Australia!"

Like Alexander, we all face losses in life. And those losses mount as we age. Take our parents. They have lost spouses, friends, and stature in the community.  The places they knew so well may seem foreign.  If a senior moves to a retirement or assisted living community, there can be more losses to review as well, at least initially..

Maybe you're an adult child, or a professional working with many seniors. You, too, can face losses. The job of caregiving or supporting caregivers can overwhelm, to the point of causing us to suffer what is called "Compassion Fatigue."

That's where Australia comes in. It's a symbol of respite, a break from your demanding work. It's one way of combating compassion fatigue.  A trip, or a period of rest, is one way to resurrect your life.

Back to Australia. I'm already feeling refreshed.

Baby penguins are a big hit!

Valentine's Day: Keep It Simple for Your Aging Parent

When your aging parent was in school, Valentine's Day was a big deal. It still is for many of us. And it's only two days away. What is a simple gift for your parent that they will love and that won't break the bank?

A card with a hand-written note is simple.  My husband sent one to his mother in Arizona.  She loves letters. Not junk mail.

Abby Durr of Silver Age Referrals shares some other ideas:

A cupcake, a flowering plant or a jar of candy to share. A book, if they like reading and you know what kind of books

A puzzle - there are certain ones for people with dementia. Preferably one that is personal. If they like birds for example, a bird puzzle.

A hand towel for kitchen or bath.

A wide brimmed sun hat

Warm mittens

All natural hand cream- for someone who doesn’t have dementia. 

A visitors journal 

Water coloring kit, if they would appreciate it. 

Coloring or activity book.

Bathrobe or slippers

Gift certificate to get their nails done 

Anything from the Alzheimers store

In Memory Care, the Mantra is 'Keep it Simple'

A few days ago I was flying from Phoenix to Seattle thinking about memory care.  Why? Because my mother-in-law lives in memory care and because I've worked for years with families seeking memory care.

From what I've observed, the memory care mantra is "Keep it Simple." Seniors with memory loss may often experience anxiety, and the fewer the complications the better.

SPACE--The room should be uncluttered.  That means a bed, a dresser, and an easy chair or two, one for the resident, one for a guest. One reason for the uncluttered look is that elders with memory loss are often at risk for falling.  Keeping clear paths may minimize falls. Regarding the dresser: it's best to have clothing and other essentials occupy only a couple of drawers. That way, if a purse is lost, a resident has fewer places to look.

DECOR--If possible, the room should have pictures on the wall, including ones the resident is familiar with from his or her past.  A familiar bedspread, throw pillows and possibly an afghan may help bring a sense of "home" to the room.

SCHEDULE--Most memory care communities are consistent about meal times. That's good.  A person with dementia often has much better long-term memory than short-term memory.  They may remember that lunch is at 11:30, since that's lunch time every day. They may not remember that what they had for breakfast or if they had breakfast.

STAFF--Consistency in staff is great!  If the resident knows that Bing is the one who helps her go to the bathroom and that he is kind and caring, she will experience less anxiety.

VISITS--This is a hard one. Families can't always come at the same time, or they might have to skip a visit for a day, a week or more.  Calling staff ahead of time to announce your arrival is helpful.  Also, some residents have trouble saying "Goodbye" without tears, major tears. One family I know schedules the visit an hour or so before lunch. They end the visit with the resident going to lunch and forgetting the tears.

These ideas on simplicity involve both staff and the family.  It's a team effort!