Monday, October 12, 2009
We C.A.R.E.
Each year, our board members and staff get together for a day-long retreat. In addition to some good fellowship and getting out of the city, we take a close look at our organization, evaluating our programs, and reviewing our mission, vision, and core values statements.
This year, we focused our energies on our evaluating our core values and I think we really honed in on those values that make Desert Ministries what it is: a conduit for service, and an advocate for senior quality care. After several hours of filling the walls with flip chart notes, and energized dialogue, we distilled our thoughts to these four core values:
Community – we are a diverse and intergenerational community, unified by our faith in God, committed to the protection of and service to our elderly.
Action – we are who we are, because of our elders; we must protect who they are.
Relationship – with joy and compassion, we establish relationship with our elderly, showing them respect, honor and acceptance, giving them the dignity they deserve by listening and caring.
Elderly – we value our elderly by honoring their history, wisdom, and joy. We gratefully accept their values and traditions as the foundation upon which we build our lives.
I cannot overstate the impact of working with older adults has had on my sense of well-being, my fulfillment, and hope. In each of these words, community, action, relationship, and elderly, I have story after story of how an older person has helped me to think and sometimes rethink each of these words.
Our community is not just one group or another, it’s not just this age group or that age group, it’s “us.” Community is all of “us,” regardless of age, and we need to take care of “us.” No one should be alone. One of my favorite portions of scripture: “God places the lonely in families;…” from Psalm 68:6 shows us the importance of communities supporting their elders. Even though biological families may be separated by distance, we can still be family for one another. No one should have to live their final years, alone.
It’s not enough just to “know” there is a need. It is incumbent on each of “us” as members of our communities to act and react to the needs of the older adults living in our neighborhoods, and in long-term care facilities, particularly those living in skilled nursing homes. They of all groups tend to be forgotten. We cannot simply say that the challenge is too large, or the solutions are too complex, or unattainable. We must take steps, even if they seem small. We must see that our frail elderly are well cared for. Actually, I don’t believe there is such a thing as a small step. Any step can have large ripple effects. Recruiting, and training people to visit people in nursing homes is one of the steps we are taking every day in Desert Ministries. While each volunteer, singularly, may feel inadequate, together they are positive force within the long-term care community and in their communities. Feedback from care staff and the nursing home residents tell us this, and feedback from persons in our community tell us that the ripple effects of our “small” steps are causing the ground to shake.
No one should be alone. We are built to be with “others.” Removing “us” from “others,” can lead to depression, suicide, neglect, abuse, and even physical problems like dementia. The absence or the withholding of relationship has dire effects. It is costly as well. I know anecdotally that some part of depression can be relieved through a caring visit from a volunteer. One resident when asked if the volunteer visit was something she looked forward to, she said, “It’s not family, but it’s not bad for someone off the street.” All to often, we turn to medications to address depression when, I believe, many times a simple “I was thinking about you today,” would go a long way towards their healing process. On another occasion a resident remarked after one of my visits: “They think we need this, [holding up a handful of pills] but what you just gave us[relationship] is what we really need.”
The elderly, who are they? What do they want? What do they need? Now approaching the age of 56, I am discovering that I am still for the most part, “me.” The outside of “me,” may have changed but the interior, “me,” well, it still seems to believe that it hasn’t changed all that much. That “me” is still a young man with hopes and dreams, but admittedly a few more life experiences. Nevertheless, I don’t feel “old.” I feel alive, and ready to participate in my community. I think most older people would also tell you that they feel this way. Our elders need to be offered opportunities, and invited, to stay in the game. In that process, of spending time with them, we learn from their life experiences. I’ve even had the experience of them becoming my cheerleader. “Hey, I made it! So can you!” They can be our confidant, our mentor, or a good friend.
Our core values: Community, Action, Relationship,& Elderly, (CARE). We do care, and I believe most people care. Let me invite you, if you are not already a part of our community, to consider doing something that will bring you great fulfillment and a sense of making a real difference by giving your treasure or your time to this outreach, and to the people we serve, our elderly. Visit our website to learn how you can show that you care too.
Friday, September 25, 2009
What is the ROI for senior care?
Ok, so we're spending billions and billions and billions of our dollars on long-term care for older adults, senior citizens, frail elderly, old people, widows, widowers, the forgotten, has-been's, grandmothers, grandfathers, mothers, fathers, brothers, sisters, neighbors, & eventually "me." Why?
It is such a waste of money. We should do what the Spartans did. If you get sick, then the next stop is the landfill for you. It's a lot cheaper, and a lot less messy. All this touchy feelly stuff about wisdom and transferring values is for the birds. What we need is a nice, clean system for getting rid of frail people, a let the healthy people have more money in their pocket.
So where should we draw the line on who lives and who does not get to live. Nowhere. You don't like the color of your baby's eyes? Get rid of it. You're mother is costing you too much? Get rid of her. There's plenty of people around to take their place.
Two things: 1. It's sad to think how many people think this way. 2. It's sad to think you read this and went back to your televison.
It is such a waste of money. We should do what the Spartans did. If you get sick, then the next stop is the landfill for you. It's a lot cheaper, and a lot less messy. All this touchy feelly stuff about wisdom and transferring values is for the birds. What we need is a nice, clean system for getting rid of frail people, a let the healthy people have more money in their pocket.
So where should we draw the line on who lives and who does not get to live. Nowhere. You don't like the color of your baby's eyes? Get rid of it. You're mother is costing you too much? Get rid of her. There's plenty of people around to take their place.
Two things: 1. It's sad to think how many people think this way. 2. It's sad to think you read this and went back to your televison.
Thursday, July 16, 2009
Why Care for the Elderly?
In the next few months, our healthcare system will change. How it will change remains to be seen, but I am certain that the frail elderly of our society will take a back seat to everyone else. As far as I can tell from history, this is nothing new.
Yet, we wonder how so many of our nation's children get into serious trouble. Could it be that the very people, who, after a lifetime of experiences, and education are dismissed as having no value.
We need to care for the frail elderly in order that during the caring process they have the opportunity to transfer a lifetime of accumulated wisdom to us.
An African proverb comes to my mind: "When an older person dies, a library burns down."
How many libraries will be abandoned and even lost today?
Yet, we wonder how so many of our nation's children get into serious trouble. Could it be that the very people, who, after a lifetime of experiences, and education are dismissed as having no value.
We need to care for the frail elderly in order that during the caring process they have the opportunity to transfer a lifetime of accumulated wisdom to us.
An African proverb comes to my mind: "When an older person dies, a library burns down."
How many libraries will be abandoned and even lost today?
Wednesday, July 8, 2009
"Your walking becomes ambulation..."
I'm reading "Gray Areas: ethnographic encounters with nursing home culture." The book is a collection of articles written by various experts, and edited by Philip B. Stafford.
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Just getting through the introduction of this book is difficult. Immediately, I think of all the people I've met over the years living and working in the long-term care system, and for the most part good and caring people. Yet they along with the elderly they care for, must endure a system that is neither good nor caring. In fact, the system is notorious for transforming good people with passion into disallusioned workers who leave the profession. Burnout is common among the staff. Turnover rates can reach 300%, even among management the turnover rate can reach 80%. The front door to the nursing home is a revolving door. One third of the 17,000 facilities in the U.S. have been cited for abuse, neglect, and other actions that led to the premature death of the people under their "care."
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If that isn't enough, fraudent claims for services that never happened or are exaggerated, cost the taxpayer somewhere in the neighborhood of $20 billion every year. That's a lot of money. Lawsuits are common, that is family members suing for negligence or wrongful death. In fact, one large nursing home chain, owning some 1,500 facilities, had so many lawsuits against them they had to change the name of the chain just to insulate themselves against all the bad publicity. And that's another trend, it's becoming increasingly difficult to know who even owns the facilities.
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But for me, the worst of all of these crimes is that the older person, who has managed to survive into old age, is not respected nor revered, instead they are robbed of their personhood. The title of this blog comes from Gray Areas, the Introduction on page 12. In it, Stafford writes:
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Just getting through the introduction of this book is difficult. Immediately, I think of all the people I've met over the years living and working in the long-term care system, and for the most part good and caring people. Yet they along with the elderly they care for, must endure a system that is neither good nor caring. In fact, the system is notorious for transforming good people with passion into disallusioned workers who leave the profession. Burnout is common among the staff. Turnover rates can reach 300%, even among management the turnover rate can reach 80%. The front door to the nursing home is a revolving door. One third of the 17,000 facilities in the U.S. have been cited for abuse, neglect, and other actions that led to the premature death of the people under their "care."
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If that isn't enough, fraudent claims for services that never happened or are exaggerated, cost the taxpayer somewhere in the neighborhood of $20 billion every year. That's a lot of money. Lawsuits are common, that is family members suing for negligence or wrongful death. In fact, one large nursing home chain, owning some 1,500 facilities, had so many lawsuits against them they had to change the name of the chain just to insulate themselves against all the bad publicity. And that's another trend, it's becoming increasingly difficult to know who even owns the facilities.
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But for me, the worst of all of these crimes is that the older person, who has managed to survive into old age, is not respected nor revered, instead they are robbed of their personhood. The title of this blog comes from Gray Areas, the Introduction on page 12. In it, Stafford writes:
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"When you enter the nursing home as a patient, you experience a loss of self, of personhood. Your walking becomes "ambulation." Your food becomes your "diet." Your eccentricities become your "behaviors."
Your life becomes your "record."
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Of all the aspects of this system, that one can critque, I believe this is the worst of them all. Why? Because, many of the people living in nursing homes are survivors, great people who have endured life's trials. They perservered. They didn't quit. They worked hard all their life, getting educated, marrying, having and raising children, making major contributions to our society, only to move into the final stage of their life to be reduced to something less than human, to be stripped of their identity and forced into a "purgatory," suspended between the living and the dying. Is it any wonder that many of them will say to me, "I wish I would just die."
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Growing old in America, can mean having to learn how to live in this world of "suspended animation." Our ageism, deeply embedded in every corner of our culture, perpetuates this system. Ageism is in our workplace, in our entertainment, in our families, and even in our worship. As a society, we are blind to it. Like other forms of prejudice, our blindness results in the wrongful death of many valuable people, and in this case, the premature death, of literally thousands of older people living in nursing homes.
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So what can or should we do? The first step is simply to admit that we are blind. Then we need to begin the task of finding ways to correct our vision, our thinking. I believe one of the best places to start is in our faith communities. Does your programming reflect ageism? Is your community segregated by age? Do segregated groups ever mix? Does your programming promote intergenerational contact? Exposure to one another is the most powerful way to break down false stereotypes, untrue myths, and provide the catalyst for change.
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If we don't address this bastion of "hate crimes," and that is exactly what they are, wrongful acts based in the hatred of our elderly, then the ground will remain drenched with the blood older people. I think we can do better.
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I quote Isaiah 1:17 often:
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"Learn to do well, seek justice, relieve the oppressed, defend the fatherless and plead for the widow."
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Let me encourage you this week to carefully read, and meditate on Isaiah 1:11-29.
Wednesday, May 20, 2009
"Remember Me"
This weekend coming is Memorial Day, and I hope that all of my readers will have a great holiday, and stop for a few moments to remember and honor the men and women who gave their lives defending our way of life and keeping us safe.
I was thinking about what to write today, and the words, "...remember me," came to my mind. Some time ago, I was invited to speak to a group of pre-school children about the work that Desert Ministries is engaged in. Well, how do I explain all this to someone so young?
As I looked across the room at all the young bright-eyed, smiling faces, I asked them, "How many of you were brought to school today by your parents? A majority of those tiny hands went up almost immediately.
Then I asked them, "Has your mother or father ever forgotten to pick you up from school?" Again, quite a few hands went up. I asked, "How did you feel about that?" One girl spoke up and said, "Scared!" Another child piped up and said, "Afraid!" And yet another piped up and said, "Alone!" These responses led to an avalanche of responses from the rest of the children. Each one identifying with the terrifying fear, the feelings of being vulnerable, and the feelings of fear when one is forgotten.
Once the children quieted, I looked at them, and the adults who were standing in the back of the room, and quietly said, "That's exactly how someone feels who lives in a nursing home."
Remember them.
I was thinking about what to write today, and the words, "...remember me," came to my mind. Some time ago, I was invited to speak to a group of pre-school children about the work that Desert Ministries is engaged in. Well, how do I explain all this to someone so young?
As I looked across the room at all the young bright-eyed, smiling faces, I asked them, "How many of you were brought to school today by your parents? A majority of those tiny hands went up almost immediately.
Then I asked them, "Has your mother or father ever forgotten to pick you up from school?" Again, quite a few hands went up. I asked, "How did you feel about that?" One girl spoke up and said, "Scared!" Another child piped up and said, "Afraid!" And yet another piped up and said, "Alone!" These responses led to an avalanche of responses from the rest of the children. Each one identifying with the terrifying fear, the feelings of being vulnerable, and the feelings of fear when one is forgotten.
Once the children quieted, I looked at them, and the adults who were standing in the back of the room, and quietly said, "That's exactly how someone feels who lives in a nursing home."
Remember them.
Wednesday, April 1, 2009
April Showers Bring May Flowers...
Ok, what can I say? I've been saying that little rhyme for years, and I couldn't resist it. But as I as stop to think about it for a moment, I hope that May is full of flowers. We need to look at something lovely. It will help distract me for just a few minutes and soften the very deep concern I have and sadness I feel for what is happening inside our nursing homes.
It used to be that once in a while I would hear a story about an older person being neglected or receiving poor care. Lately, it seems like a daily event. For years, I've known and have talked publically about the decline of our long-term care system, but I believe now that what may have been interpreted by some as "nay-saying" is now an horrific reality.
It's well known that much of the funding for long-term care comes from Medicaid. In our current economic crisis, funding for Medicaid is receiving increasing scrutiny, as it should, since some 20-30 billion dollars of fraudulent Medicaid claims. This of course needs to be cleaned up. However, skyrocketing costs will probably lead to capping benefits, and/or restricting benefits. We simply cannot collect enough tax money to pay for all the long-term care that will be required.
Compounding the funding issue is the staffing issue. Staff shortages are severe and getting worse. I've seen projections for staffing shortages reaching as high as 29% over the next three decades. Currently, we are experiencing about a 9% shortage. Translated: there are about 125,000 nursing positions open.
What does this mean for the vulnerable old person who needs nursing care? At best, it is a dismal picture. Poor care, as a result of neglect,and sadly abuse is not the exception any longer. On the other side of the coin though and in fairness to the people who are working in nursing homes, nursing home workers are doing the best they can under difficult circumstances.
The average rate of pay for a nursing aide, the person who is on the frontlines, i.e., bathing, bathrooming, feeding, grooming, dressing, people, is $8.50 per hour. Jobs at fast food places pay more than that. The reimbursement rate on Medicaid invoices is 60 cents on the dollar. Translated: A nursing home loses about $15 per bed per day. If I have 100 beds in my nursing home, that's $1,500 I will lose each day. Oh, I can't forget to mention the 300% turnover rate. All of this adds up to disaster.
I've seen firsthand, great people, great workers with great work ethics, great attitudes, caring loving people, burned out after 18 months of working in a nursing home, and then like the majority of their co-workers, quit, leaving behind the frail elder who has little or no say in what is happening to them. Imagine how frightening that must be for them.
Once, during a major exodus of nursing home workers, I heard a old woman look up into the face of aide and ask: "Are you leaving too?"
Well, if I stare into this "picture" too long, I get depressed. So I need to take a periodic break and find something nice to think about, something lovely like a field of newly blossomed flowers. I really do hope for all our sakes that April showers will bring May flowers, especially to people living and working in nursing homes.
It used to be that once in a while I would hear a story about an older person being neglected or receiving poor care. Lately, it seems like a daily event. For years, I've known and have talked publically about the decline of our long-term care system, but I believe now that what may have been interpreted by some as "nay-saying" is now an horrific reality.
It's well known that much of the funding for long-term care comes from Medicaid. In our current economic crisis, funding for Medicaid is receiving increasing scrutiny, as it should, since some 20-30 billion dollars of fraudulent Medicaid claims. This of course needs to be cleaned up. However, skyrocketing costs will probably lead to capping benefits, and/or restricting benefits. We simply cannot collect enough tax money to pay for all the long-term care that will be required.
Compounding the funding issue is the staffing issue. Staff shortages are severe and getting worse. I've seen projections for staffing shortages reaching as high as 29% over the next three decades. Currently, we are experiencing about a 9% shortage. Translated: there are about 125,000 nursing positions open.
What does this mean for the vulnerable old person who needs nursing care? At best, it is a dismal picture. Poor care, as a result of neglect,and sadly abuse is not the exception any longer. On the other side of the coin though and in fairness to the people who are working in nursing homes, nursing home workers are doing the best they can under difficult circumstances.
The average rate of pay for a nursing aide, the person who is on the frontlines, i.e., bathing, bathrooming, feeding, grooming, dressing, people, is $8.50 per hour. Jobs at fast food places pay more than that. The reimbursement rate on Medicaid invoices is 60 cents on the dollar. Translated: A nursing home loses about $15 per bed per day. If I have 100 beds in my nursing home, that's $1,500 I will lose each day. Oh, I can't forget to mention the 300% turnover rate. All of this adds up to disaster.
I've seen firsthand, great people, great workers with great work ethics, great attitudes, caring loving people, burned out after 18 months of working in a nursing home, and then like the majority of their co-workers, quit, leaving behind the frail elder who has little or no say in what is happening to them. Imagine how frightening that must be for them.
Once, during a major exodus of nursing home workers, I heard a old woman look up into the face of aide and ask: "Are you leaving too?"
Well, if I stare into this "picture" too long, I get depressed. So I need to take a periodic break and find something nice to think about, something lovely like a field of newly blossomed flowers. I really do hope for all our sakes that April showers will bring May flowers, especially to people living and working in nursing homes.
Wednesday, March 11, 2009
People who have seen thier "better days."
There's nothing more disconcerting than turning on the radio on the way home and listening to someone rationalizing for their listeners reasons for not providing health care for people and I quote: "...who have seen their better days." The rationalization is that, as one would expect, the money would be better spent on children.
More distressing is, once the program host shared this profound wisdom, the number of listeners who called in and agreed. The tension between providing for children versus providing for older adults is nothing new in human history. Let me suggest that this conflict is not one of capacity to provide, but one of will. Watching the government print trillions of dollars and extending bailout money to banks and corporations shows that if we, as society have the will to do something, we will do it.
The issue then is not do we have enough money. The issue is do we have enough heart to care not only for children, but for older adults as well. We owe our older population a debt of gratitude for providing for our home, our education, and our quality of life.
Theologically speaking, the Ten Commandents address the care of our parents. The first four commandments instruct us in how we are to relate to God. The next five commandments instruct us on how we are to relate to each other.
Starting the second group of commandments,is the commandment to "...honor our father and mother:"
"Honour thy father and thy mother, as the LORD thy God hath commanded thee; that thy days may be prolonged, and that it may go well with thee, in the land which the LORD thy God giveth thee." Deutronomy 5:16.
When I hear pronouncements like the one I referenced in this blog, I can understand why God would highlight the care of parents. When we prioritize need for support, the elderly will naturally fall to the bottom of the list. Why? Because we can see no apparent return on our investment, (ROI).
Knowing how we think, God then places this commandment first in the series of how we relate to one another, and different from the other commandments, God adds two promises, and if I may paraphrase: "Take care of your mother and father, and if you do, I will make sure you have a long and prosperous life, and not only for you, but for the nation in which you live.
Of course, some people will think that this is simplistic, but I do not. I think it is this simple. I believe if we made the care of our older adults a top priority, many, if not all, of our social ills would vanish. Why? Because, first it would force a change in our own thinking, and God would indeed fulfill His promise to us.
However, reading the history of the treatment of older adults does not leave me optimistic. But you never know, we might actually be the first society in history to take God at His word. As for those people who are described as "...having seen their better days," you know well that you are living in your best days now.
What do these kids know anyway?
More distressing is, once the program host shared this profound wisdom, the number of listeners who called in and agreed. The tension between providing for children versus providing for older adults is nothing new in human history. Let me suggest that this conflict is not one of capacity to provide, but one of will. Watching the government print trillions of dollars and extending bailout money to banks and corporations shows that if we, as society have the will to do something, we will do it.
The issue then is not do we have enough money. The issue is do we have enough heart to care not only for children, but for older adults as well. We owe our older population a debt of gratitude for providing for our home, our education, and our quality of life.
Theologically speaking, the Ten Commandents address the care of our parents. The first four commandments instruct us in how we are to relate to God. The next five commandments instruct us on how we are to relate to each other.
Starting the second group of commandments,is the commandment to "...honor our father and mother:"
"Honour thy father and thy mother, as the LORD thy God hath commanded thee; that thy days may be prolonged, and that it may go well with thee, in the land which the LORD thy God giveth thee." Deutronomy 5:16.
When I hear pronouncements like the one I referenced in this blog, I can understand why God would highlight the care of parents. When we prioritize need for support, the elderly will naturally fall to the bottom of the list. Why? Because we can see no apparent return on our investment, (ROI).
Knowing how we think, God then places this commandment first in the series of how we relate to one another, and different from the other commandments, God adds two promises, and if I may paraphrase: "Take care of your mother and father, and if you do, I will make sure you have a long and prosperous life, and not only for you, but for the nation in which you live.
Of course, some people will think that this is simplistic, but I do not. I think it is this simple. I believe if we made the care of our older adults a top priority, many, if not all, of our social ills would vanish. Why? Because, first it would force a change in our own thinking, and God would indeed fulfill His promise to us.
However, reading the history of the treatment of older adults does not leave me optimistic. But you never know, we might actually be the first society in history to take God at His word. As for those people who are described as "...having seen their better days," you know well that you are living in your best days now.
What do these kids know anyway?
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