Uncategorized

On the topic of Death

Most people I know don’t want to think or talk about death. However, death is the one thing in life that we can count on. Why is the subject so taboo especially here in America?

Today I spoke with Gary Wederspahn who is on the board of Final Exit Network (“FEN” as he calls it). I reached out to him to learn about how he became involved with FEN. Gary said he spent the 1960’s and 70’s overseas serving as a Peace Corps Director in Guatemala, Costa Rica and Ecuador and also traveled in over 20 countries.

Due to his cross cultural experiences and life oversees, Gary observed many end of life rituals and traditions that normalized death and gave joy to both life and death. Upon his re entry to the United States, he was shocked at that contrast.

Gary has written a book and many articles on cross cultural communiations as well as end of life rituals and traditions. He is now 84 years old and lives in Minnesota. He welcomes discussion around end of life and right to die. He also wants to reduce fear by having agency and resources.

Check out some of these resources to educate yourself and maybe even invite discussion.

Home

https://finalexitnetwork.org/

https://www.thegooddeathsocietyblog.net/

End of life University https://www.eoluniversity.com

care management, healthcare resources

How to age well

Working as a professional in healthcare, often alongside a patient facing a drastic change in their quality of life, provides one with many valuable life lessons.

For starters, one should regularly take pause to ask what gives your life meaning. How can I maintain my voice and independence as long as possible?  Am I putting off what matters to me “until later when I have the time”?  Make the time now to be conscious of what matters so you are deliberate in your choices moving forward.  Here are a few specific questions to ask yourself:

  • What do you want your life to look like as you age?
  • Who do you want surrounding you? 
  • Do you want to remain in your home (“age in place”) and pay for home renovation to assure your safety at home?   Or do you want to choose a supported living setting where you can live with all your needs met?
  • Do you want to travel and where do you want to go?
  • What activities do you want to access to maintain your quality of life? eg  belonging to clubs, volunteering,  attending musical events?  Having a pet?  Take an art class?
  • What would you like to do now that you could not while you were working full time?
  • What are your retirement dream/s?

Controlling your destiny requires Proactive Planning (as opposed to reactive responding!!). A proactive planner is generally a person who gets up each day with a purpose, gives to others, goes outside to breathe and move their body every day.  These qualities also make them more resilient to the aging process.  In general,

  • Proactive planners consider their personal choices, anticipates their possible medical and psychosocial-emotional needs, their living options and the associated financial costs of “aging well”. 
  • Proactive planners generally take the time to sort through their life’s accumulations knowing they will feel less burdened by their “stuff”.  They can pivot if a life or health event occurs because of this sorting.
  • Proactive planners think about their legacy and make a plan.
  • Proactive planners ask how they want to live but also consider how the want to die.  They take the time to complete their legal documents including Advanced Directives and a POLST form.  They carefully select a durable Power of Attorney and a health care representative. 
  • Proactive planners consider how they will fund their vision of a quality life and make plans for the losses that occur with aging. 
  • Proactive planners are people who think about the impact on their aging on the important people in their life.   
  • Proactive planners know that in order to minimize their cognitive, psychological, and physical decline, they need people. They regularly engage with others, preferably of different ages and viewpoints. 
  • Proactive planners who are “solo agers” consider who will support or advocate them when they cannot.  This role may fall to a health care manager who you select for just that reason.

Controlling your own destiny also requires you to form your TEAM of people.  Select them carefully and share your vision of what aging well means to you.  Ideally, your team should include a wealth manager, an elder or estate attorney, a health care manager, your durable power of attorney/health care representative, your primary care physician and perhaps a financial planner to help with day-to-day bills/spending.  Each member of your team should know who is on your team, should be given permission (A release of Information form) to talk with one another on your behalf and should know your wishes for aging well.

Perhaps the least understood role on your team is the health care manager (also known as geriatric care manager, Aging Life Care Professional ®).  A care manager is a healthcare professional who is the expert on aging, knows you, anticipates your decrements in aging and works to monitor and advocate for your care with your wishes at the forefront.  They have the healthcare background to communicate to all your team on your health care needs, the associated costs and the possible resources given your previously expressed vision on living and dying. 

Recently, I met with a retired teacher who was given a diagnosis of dementia. I asked her, what are you missing right now in your life?  She said without hesitation, “I need more laughter and music”.  She thought some more then said, “I need healthy food that I don’t have to prepare and children.  I want more children in my life.” 

So, ask yourself now, what do YOU need in your life to age well?  What gives your life meaning, value and quality?  You may not be able to go fishing anymore but perhaps you can look out your window and watch people fish.  Follow those images up with proactive planning and don’t forget to surround yourself with a strong team!

care management, healthcare, healthcare resources, medication management, medication managment, Uncategorized

And what about your meds/vitamins and supplements?

Have you ever questioned the interactions of the medications or vitamins or supplements you take? When should you take them? With food? On empty stomach? What’s the real value of each one and when taken together…..WOW! Who is paying attention to all your medications? Your PCP? Your neighborhood pharmacist that changes regularly?

Further, I am increasingly aware that I am getting prescribed more and more as I age, including vitamins and supplements. Vitamin D and a Calcium supplement have recently been added to my list of medications. There are so many brands and versions of these and I realize their effectiveness can be limited by what and when I eat and anything else I put in my mouth. YIKES!!!! 

Recently I met two pharmacists who know this to be real and a very concerning trend as more and more pills are consumed by Americans. Thus, Irene Croswell and and Carol Van Horn joined together to offer personalized clinical pharmacy services. They call themselves Coordinated MEDucation Team https://meducationteam.com/ . 

The following is written by Irene Croswell, PharmD for my blog. Thanks Irene!!!

This is a true story. Maggie lived in her own home for many years. She had several health conditions and took many medications – prescription, over the counter, vitamins, and herbal and nutritional supplements. Some of these medications caused serious side effects. And some of them, even the supplements, interacted with each other. Eventually, her medications did not work as well to manage her health conditions. Maggie began to lose her eyesight and the prescription labels became harder to read. She began to fall occasionally but did not recover as quickly as before. She did not go out to lunch or go shopping with her friends as much. Eventually, Maggie moved into a care facility. Unfortunately, Maggie had never had a medication management review.

All of us have different health challenges that may change over time for a variety of reasons. Sometimes things get worse when we make certain choices such as seeing several doctors or other healthcare providers, using multiple pharmacies, ignoring signs that our medications may not be right for us, or being afraid to ask questions or speak up about our concerns. A patient advocate can help you navigate some of those challenges and work with you and your healthcare team.

Another valuable resource is a specially trained, clinical consultant pharmacist who can partner with you to complete your personal Comprehensive Medication Management Review (CMMR). The process of a CMMR includes collaborating with you and your healthcare team as well as reviewing all of your medications, your health concerns, your challenges, your preferences, your lifestyle, or even your individual genetic makeup that may influence if or how a medication works for you. You are given a comprehensive report that you can share and discuss with your healthcare team. If your health changes, we could do another CMMR and work with you and your healthcare team to update your care plan. The Comprehensive Medication Management Review serves as a compass to help you navigate and improve your health. The goal of a CMMR is to help empower you take control of your well-being, optimize your health, and make the best use of your health care spending.       Your story doesn’t have to be like Maggie’s story. You Can Make A Change for Life !  With us, it’s all about person-centered care at Coordinated MEDucation Team.   Please email us at carol@meducationteam.com  OR  irene@meducationteam.com

Uncategorized

Volunteering at Hopewell House

Hopewell House is Portland’s only dedicated end-of-life residence, and their newly reopened home is surprisingly comforting. Everyone who works, volunteers, or visits ultimately feels it. 

The beautiful 1927 Tudor-style house, a rolling lawn nestled in the Douglas fir forest, sets the stage.  The friendly volunteer face greets you.  Daily homemade soup and baked goods by a cook named “Honey” are available and regularly offered by the volunteers who support running this residential care facility.

Most longtime Portlanders like me have heard of Hopewell House, the hospice that opened in 1986.  I grew up regularly driving by the well-regarded hospice in my SW Portland neighborhood.   Hopewell reopened this January (thanks to Friends of Hopewell House) just as I felt ready to come out of my Covid hibernation and into a new volunteer experience. 

Last week when I walked in the door as a volunteer, another volunteer passed small bowls of flower petals to all.  I heard a volunteer harpist playing soothing music, and I realized that I was about to experience my first “walk out,” a ritual that honors a resident who had just passed.  We all stood quietly and sprinkled the petals on the resident as they were escorted to their personal resting place by a few family/friends.  A handmade quilt sewn by volunteers and offered to each resident covered the body. 

Following the loving escort, the three family members returned inside and gathered at one of the many dining tables.  I was there to ask them if they would like one of Honey’s signature dishes.  Initially, they declined the offer but later changed their minds, letting me serve them various homemade items made earlier that day.  As I brought out the mouth-watering comfort food, I thought to myself that Honey was a perfect name for one of Hopewell’s cooks.  Her food reflects Hopewell’s motto of “living well in the presence of death.”  Unsurprisingly, one of the family members stated, “I hope to be back to Hopewell as a volunteer,” and the twin brother added, “I counted 17 faces.  This is a magical place.  Thank you.” 

Yes, this place called Hopewell House is back and doing this magical work for Oregonians and those from other states where the right to die is not legal.    I am honored to be invited to volunteer and proud to be one of the thousands of volunteers who give their time to this very special place.

Visit Hopewell House for more information.

Uncategorized

Acute Care and Then What?

After a 911 event like a stroke or car accident, the person becomes a patient who needs medical evaluation and care in a hospital setting. Of course, the patient needs to be evaluated and stabilized.

Soon after, the Acute Medical Rehab team may be consulted by the hospital team. This may include a swallow evaluation (by SLP/Speech-language Pathologist) for safe oral intake as well as a simple cognitive and/or communication evaluation. The PT (physical therapy) may be asked to evaluate the patient’s strength, mobility, and function while the OT (Occupational therapist) may be consulted on upper body function/mobility/strength for self-care activities, including feeding, grooming, and dressing. This can all happen in the first few days and will contribute to the next steps.

All of these medical and therapy evaluations as well as the patient’s previous medical issues, contribute to the patient’s options, e.g., the next step. What’s the discharge plan? In fact, from the moment a patient enters the medical system, discharge plans are in the works. Can this patient return to their previous setting? Is this patient a rehab candidate? What are the patients’ resources, e.g., family and insurance?

My experiences working in health care started in 1990 at the University of WA Medical Center. Back then, medical and subsequent acute rehabilitation stays were usually weeks to months, rarely days. Some medical social workers walked with the family and supported them in considering the next steps. Minutes were not calculated in every interaction. Today. The average hospital and following rehab stay is 12.4 days. The social workers are called discharge planners, and they rarely can take the time to sit and talk with the family.

This partially explains why I have become an Aging Life Care Consultant, a private pay advocate who can step in and help you and your family navigate healthcare options. I believe health care is more confusing and expensive, and therapists and medical providers are no longer encouraged/reimbursed for helping their patients weigh their choices or seek resources particular to their needs. I am saddened by this change, but I am here to help.