"The End of Illness, " An excellent book by David Agus, MD

Reading the information in this book will open your eyes to a new aging paradigm. He believes that preventative medicine will become a norm in our nation within ten years, and his research references are extensive and convincing.

As someone who has always been in love with the way science backs up God, I am in agreement with much of what he concludes from his studies.

We may never see the end of people who don't listen, but the ones who do are likely to enjoy life a little better until we are called home.

I'm adding a video to the sidebar... The words to the song are by Sheila Stovall

I was introduced to this beautiful video by my ethics instructor, and it's worth sharing... The creator is requesting that it be passed on. I will be adding it to the webpage!

Will You Care For Me
By Sheila Stovall

Hello? Who is there?
I dont see well anymore.
Could you come a little closer?
I can hear you at my door.
Since my visions failed,
My boys are grown,
Im feeling so alone.
Is someone there?
Will you care for me?

Will you care for me?
I cant make it on my own.
Will you feed and shelter me
Now Ive made this place my home?
And it is not my fault
That I keep living on and on
But til Im gone will you care for me?

I know that you are busy
Youve got a lot to do.
And I hate to be a nuisance
I just hate to bother you
But the medicine Im needin
You wont find there on that cart.
A loving touch heals an aging heart.

Will you care for me?
I cant make it on my own.
Will you stop and talk to me
Now Ive made this place my home.
And it is not my fault
That Im still here and hanging on.
But til Im gone will you care for me?

I can hear your footsteps coming.
And its a comfort dear
Just to know Im not forgotten
And that you are very near
And your voice wears a smile
Though I cant see it with these eyes.
I know its there and I know you care


Will you care for me?
I cant make it on my own.
Will you love and comfort me?
Now Ive made this place my home
And it is not my fault
The Lord has left me here so long
But til Im gone will you care for me?

But til Im gone will you care for me?

I'm taking "Ethics in Long Term Care" this quarter... and Sharing the conundrums of care with you.

My instructor and I are having a conversation regarding regulations, and how the documentation in a facility can affect how the regulations are "triggered"... Here was my initial answer and responses:
 

After reading these, I really don’t want to document anything, but documentation is a part of taking care of others. It reminds you of things you might not remember when it’s important to remember.

It feels like a simple case of a desire to enjoy things of the past, like wood working or fishing or knitting is now replaced by cards, or bingo, and that with people who may not be able to have a good conversation! Suddenly, because it is a place that requires certain protocols in which to receive certain reimbursements, one’s whole life becomes a fishbowl with no privacy whatsoever. What I see as a normal reaction to sudden life in a structured environment, simply because a person needs help, and the facility can’t replace all parts of a person’s life, the assessments ask young people to respond as to the person’s ability to adapt to a totally unfamiliar life. 

Nursing could document a desire to pursue one’s own activities as much as possible. That might mean reading, and playing puzzles, and maybe for my generation, socializing online. It also might mean the person is simply bored. Nursing could say that the resident doesn’t enjoy community activities. Does that mean a therapy assessment is triggered because one prefers to be alone and spend time with family and friends instead of playing bingo? Who wants to have a monthly birthday party with twenty other people, of whom maybe one person is familiar?

What if he or she is busy with something, and well, it’s time for lunch. Get ready and go to the dining room to wait with fifty other people for trays to come up from the basement. The tray could be delivered to the room, but when? The aides are busy with the people in the dining room. Someone might be physically challenged. For my elder, that meant constant arranging of materials so that she could reach them. As she got older and frail, she had a hard time doing even that.

No wonder Dr. Thomas wants to take a bulldozer to traditional facilities. 

Karen,
Interesting thoughts to ponder. But how do we now take what we know about our elders, facilities, care giving, and regulations to create a home that all can live in and with? What about payment for services, i.e. reimbursements? Kristi

Kristi,

That “How” is why I’m taking these classes! My current pursuit is a Green House style home (with suites as opposed to rooms) combined with a co-housing community (and their community house). Between the people, the tools and good planning, solutions can be found, I’m sure. A few people will recognize the necessity of not depending on society for everything.  I still have some puzzles to work out. 

Having professional help in the community without losing their value as community members was one, realizing I could not keep a community small (30 households or less) and still support a fully staffed (or even a fully occupied) Green House. (That answer probably is subsidizing participation in the (intentional) community by a forgivable loan on six to eight professional homes – I particularly like the idea for nurse’s aides, since they are often just starting out and could use the leg up). Professionals are people, too, and they also need care and sharing. When our government decided that public servants should be paid instead of supported, and they should pay taxes to pay their own income, something went wrong.

Allowing a company to run the facility portion was a possibility, but one would need a way to build several communities (which would each support one Green House even if not all the residents were “theirs.”) The loss of social contact that residents feel, even with a Green House, would be greatly reduced if they had the activity of their designated community house right next door, and they could see the activities going on. Staff would not be limited to the structured activities or finding some way to otherwise occupy a resident.

Such a community would likely be saving a lot of money for society since many of societal ills are a direct result of people not receiving proper attention. Many illnesses also manifest themselves as a result of helplessness, boredom or loneliness. The Green House projects are a great start, but even they are a work in progress.

I’ve considered the possibility that, between medical science and technology, the need for life care will become very short and skilled care facilities will become more like hospice homes. If so, do I need to just wait it out? No. 

My main conundrum is that I do not want to build (or end up with) what has already been done. I am sure there are private homes and groups managing such things somewhere, but they are awfully quiet!  Karen

I'll keep you posted with further discussions as I find them worthy of this blog. Life is interesting, and about to get more so. As I continue in my sixth quarter in classes, with two more to complete the requirements for an Nursing Home Administrator designation, I am still maintaining a 4.0 average. Considering some of the highly technical material, that is a real feather in my cap!

Not one Brick until...

I've been doing a lot of reading and learning. I have another 4.0 under my belt with only 8 classes remaining to my Administrator's license. I am going to get a SMaC list (Great by Choice, Collins) to make sure things are running exactly as they should as this community begins to take shape.

I decided part of my marketing project should be on this blog, just in case some of you decide to read what I've written. Maybe you feel the same way.

1.    Introduction to the program –

Taking care of the caregiver and maximizing the caregiver’s potential (utilizing the 350 Billion dollars spent by America’s informal caregivers annually) to help their loved ones and neighbors is the goal of The Cord of Three Strands Care Center, LLC.  Too many caregivers are “used up” and society then takes over, leaving the caregiver bereft of his or her former duties.[1] The care giving profession takes a toll, with turnover rates well publicized in the long term care industry of 71 percent for nursing assistants and 49 percent for nurses. [2] In the health care industry as a whole, we know that there is a severe nursing shortage and competition for nurses in every facet is stiff.[3]  Most elder care programs just focus on the care for the elder, but, as my doctor put it so well, “Professionals need care, too.”

a)    Nature of product being offered  - 

The product would be multi-generational co-housing[4] for the cared and their caregivers. These could start as small independent-living communities with subsidized housing for potential professional care partners. An entire community of up to 30 households would share resources, including time, in order to maintain a stress free environment in which to keep the frail and disabled within their home community as they age.

b)   What differentiates it from others?

There are no “others” at this stage.  Efforts have been made over the years to meet the ongoing demands of an aging population. Society’s actions at each stage have been to try to assist a growing demographic as a separate “problem” instead of reaching a community solution.[5] The nation’s communities are stretched thin with manpower and funds.

This program combines and shares the resources that are available—then alleviates the stress upon individual families, consumers and medical professionals.

c)    Extent of competition - Currently offered services meet the needs of a small demographic and base the service on age, disability or a medical model (Daycares, adult day services, group homes, CCRC’s, retirement villages).

d) Fee comparison The expense to participate will likely be competitive with CCRC fees. However, this option would likely allow someone the opportunities to share their skills and resources in cooking with a gourmet community kitchen, cleaning with shared tools and time, laundry with roomy and appropriate facilities, landscaping with shared tools and time, gardening with shared tools and time and guest suites outfitted with recovery necessities. Because of the community members’ involvement in reducing costs, living in such a community may end up being a more reasonable option for the community resident in the long term.

2. Issues

Currently, a group of like-minded informal and professional care partners is needed to work on the issue in order to create a community they can live in together. Framing the issue appropriately and selling individuals on the promise of this program is essential.

           It is the next step needed in building this community.

3.  Data Review

Caregivers are being stressed beyond their capabilities to maintain the care level they are accustomed to giving. A search of “Caregiver stress” will yield many stories of burnout and requests for assistance. Currently, stress issues are only relieved by asking others to “come in” to the living situation to help.[6] This project will create a community that will understand the stress issues care givers face and have already planned options for sharing to relieve stress.

Stress yields many physical and psychological results, including high blood pressure, low immunity from illness and absenteeism from work. Stress on elders can lead to confusion, falls, disorientation, and helplessness. Stress on families and the larger community can cost extra money and time for both family and employers.[7]

The Rogers model[8] for the adoption and diffusion of innovation shows we may expect 13.5 percent of the population to be aware of their need and also be unable to pay for insurance or are unsatisfied with the current solutions to their problems. Of those, ten percent might be able to afford and be interested in building this solution. Lincoln, Nebraska had a 2010 census of 258,379 people.[9] Out of that number a potential market of 3,488 people would exist for this initiative. 

4. People who may be ideal adopters of this program include:

·         Aging parents of disabled children; where either the disabled child or the parent is the care partner.

_·          Working people disabled by illness or injury, aging beyond their ability for independence.

·         People in their late 30’s or upward, having waited to bear children, now find their parents in need of care. They are caught between generations.

·         Professionals who understand the stresses they are under and wish to mitigate their stress.

Some people don’t want to abandon their families or friends to the current options available to them. This option will allow people to make a choice that is not yet available, perhaps without government funding.

This community would be a viable solution for the following reasons:

·         As people age, their sense of place becomes extremely important.[10] They are not as adaptable to new surroundings and unfamiliar faces.

o   This solution will allow them to stay rooted in the community they’ve come to be familiar with, to heal (or dwell for the remainder of their life) in the community house (if need be), and to still enjoy the activities that occur in the community house.

o   The result for them will be less depression, less medication, and less falls.[11]

·         Caregivers are a special group of people. They live and work for the good they can share with those around them. They find themselves in situations that conflict with caring, or between situations that require them to be in two places at once. They find themselves stressed and without an opportunity to relax and rest.

o   This solution will let them share duties, arrange care, and share time without requiring them to remove themselves from the caring situation.  Professionals will live right in the community to offer advice or extra support.

o   The result will be a more relaxed caregiving community, sharing where they can, and being able to take time away for the important things without fear of “dropping the ball.”

·         As children grow they need a place of learning and opportunities to stretch their capabilities. Their opportunities to learn are often in the classroom, on the playground, or in front of a computer, because the availability of adult supervision is stretched thin. Single parents who are also working as nursing assistants may find such a community supportive for their families, and giving them new growth opportunities for their family’s future in the long run. Their income often places them in a situation that either forces them out of the “business” of caring or of needing assistance from society to remain in a job which is so satisfying. Considering the outcome for more than a few children born in poverty, this would be an excellent expenditure of public dollars, should the group decide to seek public support.[12]

o   This solution will allow children to learn from elders, professionals, and family within the co-housing community. They will learn how to share and become caregivers themselves as they age.

o   The result will be adults who have learned how society can solve problems together, and will continue that pattern of leadership in all the vocations they choose to engage in.

---

[1] PDF, Valuing the Invaluable, AARP, Valuing the Invaluable PDF AARP

[2] Pratt, Long Term Care: Managing across the Continuum, p. 85

[3] http://jama.ama-assn.org/content/298/14/1623.short

[4] http://www.cohousing.org/

[5] Bowers, A History of American Entitlement Programs, http://www.helium.com/items/316120-a-history-of-american-entitlement-programs

[6] http://www.respitenetwork.org/About.html

[7] The pathology of stress, from Helpguide.org, http://helpguide.org/mental/stress_signs.htm

[8] http://www.valuebasedmanagement.net/methods_rogers_innovation_adoption_curve.html

[9] Census for Lincoln Nebraska, http://quickfacts.census.gov/qfd/states/31/3128000.html

[10] Thomas, William, What are Old People For? P. 202, “Place is vitally important to elders because the smaller one’s world becomes, the more precious the immediate surroundings are.”

[11]  PDF : Kane, et al. Resident Outcomes in Small-House Nursing Homes: A Longitudinal Evaluation of the Initial Green House Program Resident Outcomes PDF

[12] Barber, Nigel, Evolutionary social science: A new approach to violent crime, as published in Aggression and Violent Behavior, a Review Journal, Elsevier 2008, PDF retrieved from: http://www.google.com/url?sa=t&rct=j&q=prison%20population%20poverty%20rates%20literacy%20violent%20crime%20psychological&source=web&cd=14&ved=0CDMQFjADOAo&url=http%3A%2F%2Fwww.psychologytoday.com%2Ffiles%2Fattachments%2F3343%2Fess-new-approach-violent-crime-avb.pdf&ei=Rt3jTsQ94oSwArG93JIG&usg=AFQjCNE_rCEUR4OgzK1s6PhIUA-mnUrMQA&cad=rja