Aging/Gerontology

Staff Development Workshops and the Topic of Aging

Last week I had the fortune to attend a staff development workshop at my work. Richard Adler, who is in the field of aging and technology at the Institute for the Future in Palo Alto, California was in town. He gave a wonderful presentation to a packed room of over 200 people the night before. This time it was to educate the staff and facilitate a discussion on trends in aging.

Technology is a huge piece of this. His message, ‘Never forget the older you are, the more credibility you have.’ He talked about technological innovations for seniors/older adults. According to statistics there will be more individuals in the 65+ demographic than in the under 5 demographic in the future due to all the baby-boomers; those born after WWII. This is around the world and not just in North America. Are we ready? In some ways yes, but in many ways no. Technology has improved tremendously over the years, people live longer and the ‘forced’ retirement age of 65 has increased to 67, but many do not want to retire or financially are not able to.

Businesses/employers need to adjust and realize that many ‘older’ employees will want to lead productive employment/work lives after reaching 65 or 67, many may want to work part-time and in some instances there are no qualified younger workers to fill the gaps. Trade jobs are an area that need more workers or those returning to the workforce to be trained. A university education does not guarantee one a job anymore. More skills are needed, a more well-rounded individual who has volunteered and has other interests in addition to using/being aware of the new technology.

There are some wonderful initiatives in place already and others being established to meet the needs of the 65+. Mr. Adler discussed Sarasota, Florida with the highest concentration of older adults and their response of: The Institute for the Ages. The typical retirement village or residence is not on the minds of the new wave of ‘seniors’ and creative solutions have been created with more needed.

Beacon Hill, MA with: Beacon Hill Village

Paris, France with BabaYaga’s

Older adults are the roots of a community and as one ages, the community should rally to make sure services and professionals are available to assist their residents who are aging. Planning has to happen now, not in 10 or 20 years when those that are currently 65 turn 75 or 85.

I welcome your thoughts and resources on this topic!

Victoria Brewster, MSW

Book Review, End-of-Life, Grief/Grieving/Bereavement, Social Work/Helping Profession/Mental Health

Book Review and Interview: Julie Saeger Nierenberg and her self-published book: ‘Daddy, this is it. Being-with My Dying Dad’

I always marvel at the connections one can make thru social media. I have had the benefit of making many positive connections on LinkedIn and because of my involvement there, connected with Julie Nierenberg. We both have similar interests re: death, dying and end-of-life issues and we both write. While I have not written a book yet and my focus is blogging and articles, eventually a book may come. Julie has already taken that leap and on such a personal topic.

Within the first 2 pages my eyes were tearing up…Julie writes from the soul. It is obvious she had a close relationship with her father. I also have a close relationship with my father; perhaps that is why this book resonated with me. Julie writes to her father, describes their friendship/father-daughter relationship while at the same time she shares his diagnosis of cancer, and the 3-year process and journey with his deterioration in his health until his death.

It is hard to be a long-distance caregiver, but thankfully for modern technology the phone, email and even Skype can bring that distance closer, not that it can ever replace face-to-face contact.

The stories that are shared are very personal. The manner in how the family was told that hospice was the next step by a physician who was not aware that the patient and family had not been told by the oncologist that further treatment was not an option; basically there was no hope….. that the cancer had metastasized and spread to internal organs. This should not have happened. Because of so many physicians being a part of the picture, communication between them was lacking. No patient or family should have to hear that a loved one is dying in such a manner. My heart goes out to Julie and her family.

I was pleased to read that the explanation of hospice and end-of-life options were shared in a very professional manner and any questions were answered along with educational pamphlets given.

Julie’s description of the end-of-life process will touch your heart and make you want to learn more.

Interview:

What made you write this book? Firstly, my dad and I discussed writing “our story” in the few days before he passed. He had written his own book of memoirs, a collection of his life experiences ranging from young childhood, his time as a conscientious objector during WWII, being a Civil Rights activist, his social work career, etc. He never backed down from the hard topics, and sharing his struggles and feelings was what made those stories resonate with readers. He thought his own End-of-Life journey would make a good story. I agreed with him and told him I’d pick up the pen where he left off. Secondly, and what really spurred me to write, was my own grief process. When my despair and sadness peaked, I turned to the exercise of journaling as a way of coming to terms with his physical absence. This book was the result of my grieving, inspired and channeled into a way of touching others’ hearts.

Do you feel the end-of-life care for your father was good? His needs were met? Indeed, they were. Family members and friends offered their care and supportive presence at every possible turn. Knowing they could be there when I was not was an immense comfort. Hospice and skilled nursing personnel were attentive, responsive and often proactive in preparing us and reassuring us. Dad was almost sightless, and this presented an extra challenge to all, especially to him. He was in loving hands in a caring environment.

You discuss difficulty in answering your father’s questions in the book, “Are you and I finished? Are you ready to release me?” I imagine this was a tough question to answer in the moment. What advice can you share with others? I recommend considering how important such a conversation would be to the dying person, if he or she chooses to speak of “completion.” In our case, we had no “old baggage” to clear up, resentments or unresolved issues. It was easy to affirm that we were at peace. Nonetheless, it was hard to be ready to say, “I release you. When you are ready to go, I am ready to say goodbye.” Difficult things are often very important things to say. It was important to my dad, and so it was important to me. So, be strong, be vulnerable, show up, and be present in every way that you can. Listen to what the dying one needs to say; say what you need to say to the dying. Death can be “an event full of life” for all concerned.

You make a comment re: being in ‘awe’ that your father was able to say goodbye to each family member in a personalized and individual way with such love and kindness considering he was also in pain. Yes, I am still in awe of his presence of mind and heart. He was the ultimate example of courageous possibility, good humour, and loving affirmation. He directed the process by reaching out to each of us and accepting what we could (or could not) give in return.

Describe the Celebration of Life that was held after your father’s passing per his request. Setting the tone was a poem that my brother composed as a farewell to my dad. A choral group from the retirement centre sang songs that my dad had selected. My stepmother had previously written a humourous song about my dad, and her family members sang it. My brother shared remarks about my father’s life, highlighting the impact that his socially conscious leadings had on our lives. In keeping with my dad’s Quaker faith and practice, those in
attendance were then invited to share. One after the other, family members, friends, former clients and colleagues offered their personal reflections and words of gratitude. The event was perfectly orchestrated by his lasting effect on all of us, a true legacy of love expressed in a few minutes of gathered sharing.

Do you think your father’s social work background provided him with the skills and knowledge to be ready when he entered hospice to be accepting of the fact that he was dying? Yes, I do think it helped him. He had a full range of human feelings about his End-of-Life and he owned them all: anger, denial, sadness, fear, and then acceptance. In the end, his physical struggle inspired him to embrace the transition. He prepared himself and all of us most lovingly and with his own sense of humour sprinkled in. He was ready when the time came.

Julie Saeger Nierenberg is a writer, editor, author coach, and artist. Her website is: http://www.createwriteenterprises.com

Daddy, this is It. Being-with My Dying Dad is available in paperback or as a Kindle book from Amazon.

[http://www.amazon.com/Daddy-this-Being–Dying-Dad/dp/0991920708/ref=la_B00C2AO52A_1_1_title_1_pap?s=books&ie=UTF8&qid=1382286223&sr=1-1]

A special thank you to Julie for agreeing to be interviewed and allowing me to review her book!

By Victoria Brewster, MSW

End-of-Life, News, Social Work/Helping Profession/Mental Health

Death, Dying and Reflection

End-of-Life issues, care and the topic of death and dying in general need a ‘sexier’ image. I find that many do not want to delve into such conversation. There are no plans in place for ‘what if.’ Family does not know what other family members would want should such a situation arise. I keep reflecting on why people do not want to discuss their own mortality. ‘To be born, one must die.’ Death is part of the cycle of life.

Society celebrates pregnancy, birth and all the events that lead up to death; all the ‘happy’ occasions. Death and dying is somber. What if we viewed the rituals associated with death as a time to celebrate the life of the deceased? People whether family, friend, colleague or neighbor share stories, memories, videos while at the same time reflecting and grieving. Would this make the topic of death easier in a sense?

I have created a list of URL’s below that focus on Death, Dying, Assisted Suicide, Euthanasia. The links will provide stories, information, videos and most importantly make you think about this topic and provide you with lots to reflect on. Please forward any others resources on Death, Dying, End-of-Life Care to me so we can continue to build this resource list. vikki.brewster@gmail.com

http://www.huffingtonpost.ca/2013/09/26/kathleen-wynne-assisted-suicide_n_3996181.html?ir=Politics

http://www.cbc.ca/news/canada/montreal/quebec-tables-bill-on-medically-assisted-death-1.1263943

http://www.theglobeandmail.com/commentary/assisted-suicide-quebec-has-found-a-flexible-approach-to-euthanasia-law/article12853839/

http://www.ottawacitizen.com/health/Little+consensus+among+Canadian+doctors+issue+assisted+suicide/8808520/story.html

http://www.ctvnews.ca/canada/dr-donald-low-pleads-for-dying-with-dignity-in-posthumous-video-1.1468542

http://fullcomment.nationalpost.com/2013/09/25/john-ivison-quadriplegic-conservative-mps-support-for-assisted-suicide-puts-him-at-odds-with-party/

http://www.cbc.ca/news/canada/british-columbia/banning-assisted-suicide-akin-to-torture-b-c-appeal-court-hears-1.1306315

http://news.nationalpost.com/2012/10/05/gloria-taylor-b-c-woman-at-centre-of-assisted-suicide-court-battle-dies/

http://www.cbc.ca/news/canada/manitoba/winnipeg-s-susan-griffiths-dies-by-assisted-suicide-in-zurich-1.1315114

hhttp://www.dyingwithdignity.ca/

http://alexschadenberg.blogspot.ca/2013/07/assisted-suicide-is-not-safe-dr-stephen.html

http://www.dyingwithdignity.ca/resources/blog_news/post/674.php

http://www.businessweek.com/news/2013-09-24/death-dinners-at-baby-boomers-tables-take-on-dying-taboo

http://www.pbs.org/wgbh/pages/frontline/life-and-death-in-assisted-living/

http://www.csa.us/email/spirit/ssarticles/0913Lifestyle.html

http://healthydebate.ca/opinions/dr-lows-legacy-and-a-culture-of-fear

http://yourlegalrights.on.ca/news/supreme-court-upholds-right-life-support-against-medical-advice#.UmFiQWKG-aQ.twitter

Any book written by Elisabeth Kubler-Ross

Victoria Brewster, MSW
vikki.brewster@gmail.com

 

Healthcare, News

Canada Health Transfer Payments

I came across an article on the Canadian Health Transfer payment system in The Record. The more I read, learn and work in and around the healthcare system, the more I want to see it change. Our current system is not working and as the population continues to ‘grey’ even more change will be needed.

Starting next year in 2014,

“In the federal budget of 2007, Stephen Harper’s government announced that the health transfer would be allocated on a strict equal per capita basis beginning in 2014. What this means is that each province will receive a health transfer amount according to the size of its population, regardless of the income, demographic, geographic or other conditions of the province.”

“In theory, the health transfer should uphold the five criteria of the Canada Health Act: public administration, comprehensiveness, universality, portability and accessibility of health services — thereby encouraging a sense of common citizenship even if there are differences in how Medicare is managed and delivered across the provinces.”

This is a concern. A proposal by Gregory P. Marchildon and Haizhen Mou is: an alternative formula that adjusts for two health-care cost drivers over which provincial governments have no control: demographic aging and geographic dispersion. Those provinces and territories with both a more highly dispersed and an older population would receive more of the health transfer. Those that have a younger demographic or are more densely populated (urban) would get less.

I attended a staff development workshop this past week that focused on the trends in aging and technology. Richard Adler was the presenter. He is a great speaker that has passion, conviction, good ideas and he along with many others can identify the changes that are needed. Healthcare falls into this category. Canada has a good basic universal healthcare system, but each province and territory cannot meet the demands of their respective population. If the federal government is going to provide transfer payment bases solely on # of people living in each province or territory and not taking into account the age of the majority, geographic demographics of where many live-in urban area or rural, provinces and territories will have difficulty in best servicing its residents. That means the province or territory has to be creative in how best to provide services and may have to further tax its residents to provide a decent level of healthcare.

Now, I live in Quebec, which is one of the highest, if not highest taxed province. Quebec does offer pharmacare coverage for those that are older adults/seniors, low-income or do not have supplemental health insurance. There are yearly deductibles that must be met and the rate charged depends on one’s income bracket, but I believe it is the only province/territory to offer this. What does everyone else do to purchase/pay for medications in other provinces/territories?

The coverage or basic coverage should be the same in all provinces/territories and if one travels elsewhere in Canada-they should have the same coverage in the province they are visiting as the one they left temporarily.

What are you thoughts? What do you think of the suggestions by Marchildon and Mou? Do you have alternative suggestions or ideas? I would love to hear them……

By Victoria Brewster, MSW

End-of-Life, Social Work/Helping Profession/Mental Health

End-of-Life Care

This is an article worth reading in The Windsor Star on End-of-Life Care. This area is only going to continue to grow as more and more enter the 65+demographic. What is holding health professionals and helping professionals back from bringing this issue to the forefront?

According to Dr. Scott Wooder, President of the Ontario Medical Association, “The most important stat to me is only 20 per cent of Canadians have had a meaningful discussion with their family or substitute decision maker about what care they want to have at the end of their life. We need to improve those numbers significantly.”  I could not agree more!

He also said, “This is usually a very emotional discussion. We have to change the cultural around it. All of us are going to die. We need to change the culture so that it’s OK to have this discussion.”

I find the biggest obstacle to end-of-life discussions is professionals are not so willing to go there. It’s like a client or patient bringing up the topic of sex, some professionals are comfortable and others are not to discuss the topic. Both are a part of life and require ongoing discussion. One tends to be a more joyful topic and the other not, but both are also taboo in some sense. This needs to change. More workshops, trainings and education is needed for both professionals and individuals in society. “To be born, one must die.” Death is part of the cycle of life and as one wants to be involved in life so must one be involved in death……we cannot necessarily control the how and when, but we can decide to some extent in what circumstances we want the control should we be diagnosed with a terminal illness or chronic and progressive heath condition that will slowly rob us of our autonomy.

Think perhaps in the context of, ‘If I was diagnosed with a terminal illness and told I had 6 months to live, how would I want to spend that time?’ How would I tell my family, friends and colleagues? Would I want to be kept alive with oxygen and tubes, medication, surgery, in a hospital or hospice OR would I want no treatment and to be at home surrounded by my family and friends?

Discussions are needed by individuals in society, within the medical profession, by helping professionals and between professionals and clients/patients.

Will you be part of this process or will you continue to hide behind discomfort and fear?

By Victoria Brewster, MSW

Education, News

The Benefits to Participating in Webinars

Today, I participated in a webinar from Financial Social Work on 6 Steps to a Debt Free Holiday. The information was good and focused on the need to be proactive and eliminate stress and anxiety during the holiday season. The process is engagement, education, motivation, validation and support looking at a multi-disciplinary, psychosocial and strength-based approach.

One must remember that emotions and feelings play a part along with a personal, individual and emotional choice. Materialism vs. consumerism, hmmm neither is your friend. Think about what the true meaning and spirit of the holiday season is-gifts, family togetherness, charity, volunteering? “One must take control of their spending to have control over their life.” – Reeta Wolfsohn, CMSW

If one uses shopping to fill a void or provide comfort, overspending could occur. Stick to a budget and seek assistance if needed.

This could be a great topic for a workshop/educational group session for clients to teach budgeting and financial skills.

For anyone who is interested: http://www.financialsocialwork.com/center for more information.

Victoria Brewster, MSW

News

Charter of Quebec Values: Part 2

The saga continues, but I can say as one trained as a social worker, I am happy to come across media that negates what the PQ Minority government is trying to do.

I opened my local Suburban today, dated September 25, 2013 and read many Letters to the Editor that basically say, “Shame on you, PQ.” I smiled when I came across one written by a francophone who admits he voted for Pauline Marois and now wish he had not.

He states, “Shame on you. As a proud francophone living in Montreal, you’ve managed in your short stint as Premier to roll back Quebec and Montreal to the days dating back to pre-1900’s. Even then I do not think it was this bad…….you’ve managed to divide the people of a province, as well as a city. You have managed to ignore what is really important to Quebecers…education and health….”

Another writes, “Only one person could put an end to this dangerous talk of ‘pure lain values’ and she, like far too many politicians lack the backbone, the morals and ethical conviction and the humility to stand up and say, ‘I have made a mistake.’ But they never do that. They never apologize. They never admit to mistakes. The poor, the hungry, the elderly in our society are ignored, the roads crumble, the bridges fall down…..”

Another individual titles his letter, ‘The Charter of Shame.” That just about sums up the Charter of Quebec Values.

These individuals have conviction, morals and integrity to speak their minds and good for them! More need to do this, especially Francophones as the Charter of Quebec Values, targets and isolates immigrants, minorities, those who are Muslim, Jewish, Hindu and of other cultural and religious backgrounds-anyone non-Christian.

As Mayor William Steinberg of Hampstead wrote in his letter to the editor, “I am a member of three minorities, I am English, I am handicapped (hearing) and I am a Jew.”

Montreal is a beautiful city with culture, great food, wonderful activities and is a blend of individuals from all over the world. Quebec, whether it likes it or not, is part of Canada which is a great country that prides itself on its blend of people which includes different cultures, religions, ethnicities…..Canada is a western country with democracy and I, along with others, are wondering if Premier Pauline Marois realizes this as she is coming across as a politician who does not care and does not listen to her residents.

By Victoria Brewster, MSW