The Art of Aging

I've been writing about anchors that keep me grounded in the face of changes attributed to aging, some of which have thrown me for a loop. It happened fast; by no small miracle, I jumped from 40 to 65 in the blink of an eye.  Each day is a reminder I have less time left than I have already lived -- a sobering thought.

After a few weeks of being sullen and withdrawn, I was getting bored with myself and decided I'd had enough of the self-centered negativity.  Determined to do something about my attitude, I searched my life for all the things that keep me grounded in reason and make me happy.  I re-discovered the importance of exercise and friends, two anchors that keep me from drifting into a droopy, depressive state of being.   In the last couple days, I've identified five more anchors, without which I'd be aimless and more self-absorbed than ever.  The first three fill my creative needs; the fourth takes me out of my head and into action on behalf of others; and the fifth ties them all together.

                                                       

Art, writing, and photography keep me focused and challenged.  When I write something that comes together well, paint a flower that closely resembles the real thing (or matches my imagination about it), sketch the image of an animal, or take a photograph that captures morning or evening light, I'm filled with joy.

My interest in writing and photography started in earnest back in 1986, when I first moved to the Columbia River Gorge.  I knew I had landed in heaven, and I was driven to express the feelings of wonder that overcame me every day.  That relocation also marked the beginning of a painful transition; I had become a long-distance mother.  I wrote in journals as if there were no tomorrow, and then I moved into the world of poetry.  Both methods of writing got to the heart of my awe, and at the same time, tended to my emotional wounds.  

It has only been in the last decade that I started getting serious about water colors.  With each effort, I get better.  With each painting, I tell the little girl in me who felt she had no talent, she doesn't have to envy LC from elementary school any more.  When I go into an art gallery, however, and see what other artists have accomplished, I shrink back in humility.  Still, I try not to compare; my art is just what it is....my art. 

What I know for sure is that my own personal best will come when I paint every day, rather than when the mood suits me.  Since I was born in autumn, I start re-evaluating my life in late September; it's my time of renewal and my favorite season of the year.  I delight in the array of gold, orange, and burgundy; brave flowers that hold on until they can bear the cold no longer; an angled sun that gently brightens and softens wet leaves and boulders; and a harvest moon that shines through our bedroom window and prompts my nightly prayer.  By the time January arrives and others are committing themselves to New Year's resolutions, I am well on my way.  By early November, my goals are set.  This year, one of them is to make more room in my life for painting.

I'm beginning to see aging as an art form of its own.  I'm the artist who takes advantage of natural light to bring out the contrasting shadows, who makes my composition dynamic and interesting, simply by choosing the right perspective, and who throws on as much color as I can.  Like art, life is all about practice and trying to get our work to look the way we want it to look.  We screw up and try over again, but we remember our mistakes and learn from them.  I rarely throw a painting away; the really poor ones are my teachers, just as my life-mistakes have been.   

My fourth anchor is volunteerism; and it has taken several years to value its role in my life -- enough to finally do something about it.  All communities thrive through the work of  volunteers, and this community is no exception.  We are blessed with people who give of their time and talents to our youth, disabled, elderly, homeless, veterans, and others. Volunteering gets me out and about, meeting incredible people and making new friends.  I never cease to be amazed at how connected we all are, no matter the role we play.

Exercise, friendships, writing, photography, art and volunteerism will steady my life as I age; and I am grateful for them.  Gratitude, my last anchor for now, balances the fear and dread that come with the unknown.  Expressing thanks is the most important anchor of all; and it strengthens my faith that all is as it should be.     

There is no way I can know what the next few years will bring and what challenges will be set before me.  But I have today, and I'm relieved I broke through that terrible feeling of loss and anxiety.  My anchors have always been here, and they will continue to keep me grounded if I'm receptive to them.  Therein lies the greatest challenge of all; but I am more determined than ever to make the best of this life I have.  

                            
                      Oh Sis.  Let's enjoy our old age as much as possible.    CZJ


Author's note:  I write this post as millions of people suffer the losses caused by severe, powerful, and devastating weather.  Homes are gone, people have died, and life will never be the same.  My prayers and thoughts go out to each and every one.  That I can sit in my comfortable studio and think about my own challenges is a blessing in itself.  Life is one hit after another; yet somehow, through our anchors and faith, the human spirit is able to rise above it all. 

(c) Sally Z McBain

Friends

                    Make new friends, but keep the old; one is silver and the other gold.

Special friends

                               


 Introverts are known to have fewer friends than extroverts.  For me, it's about a limited energy level and wanting to engage in deeper one-on-one relationships, which also require more time.  Sometimes, and this is one of those times, I am reminded of the special role each friend has played in my life.   

There was Sally (her husband had the same first name as my husband and they lived next door to us), who listened to me process my first divorce.  On many occasions, I'd wander over to her kitchen for coffee and a conversation that was always about me.  She never advised, inserted an opinion, or judged; she just listened and supported me during the most difficult phase of my life.  

There was Diane, a new friend who loaned me money when I was down to my last few dollars, telling me to take my time paying it back.  Through her trust and generosity, she literally pulled me out of hell.  Women like Sally and Diane have blessed my life over and over again in the last 45 years; without exception, they helped define me.

These last few weeks have been difficult (refer to entries Anchors and Aging and Twelve Questions); I've been down in the dumps and fearful of the future.  It all began when I looked in the mirror and studied the deeper lines, disappearing eyes, and sagging skin.  My changing appearance became much more than mere vanity; it represented the harbinger of things to come.  At that very moment, I knew I was entering a new and challenging phase of life, fraught with all kinds of change and loss.  I knew I'd better embrace this process and all that comes with it, or be disappointed and depressed the rest of my life.  All of a sudden, and not knowing where to start, there appeared an emotion so strong, I felt like I was being dragged out to sea by an undertow.

It took a long walk with a confidante to realize how vital my friendships really are and how they serve as one of my anchors.  Like my friend, Sally, my close pal listened for a full mile or more as I told her what I was putting myself through.  A couple times a month, we walk on a park path that is just about a mile around; and if we have a big topic to discuss, we measure its importance by how many rounds it will take to sort things out.  That being determined, the other person is all ears as the ground is laid; and at some point, she is informed enough to ask gentle questions or share her wisdom pertaining to the issue at hand.  Often, we joke about the other's agenda and ask just how many rounds it will take to get to the heart of the matter, knowing full well, time is not an issue.  We put the other first in all those discussions, and we do it fully present for one another. 

My friends have given me gifts of generosity, compassion, kindness, and love (and a large dose of patience), asking nothing in return.  Without them -- friends from early childhood, school, college/post-graduate studies, and my jobs; friends who were mothers of my sons' friends,  neighbors, or wives of my husband's colleagues -- I would not have learned how to be a friend myself.  These women are not only anchors that keep me grounded; they are my teachers and mentors.  

A new friend recommended a video done by Shawn Achor (www.ted.com/speakers/shawn achor.html).  Achor (in some places, 'Anchor') is the ceo of Good Think Inc., who teaches  positive psychology.  I was struck by one thing he said about social support: it is the greatest predictor of happiness and success.  But, he adds, when it comes to social networks like Facebook, the friends who add most to our lives are the ones we've actually met. 

I've been all over the map with Facebook, not knowing whether to silently slip away or stick with it.  My real friends draw me back in, mainly because I want to see their lives evolve through photos and comments.  Looking at the precious photos of Nancy's granddaughters provides me with enough happiness to last several days.  It's inspiring to see how well Robyn is adjusting to a new town - with energy I envy; and it's inspiring to watch, in real time, Jan brave chemo with strength and courage, continuing to do what she loves.

There are times I forget that friends are critical to my sense of self and well-being, that each one brings a happiness and supportive element to my life that I couldn't get elsewhere.  Each one accepts me for the hermit I am, which adds to my joy. 

Walking and talking with my friend gave me a boost -- so much so, that I was reminded how much I value all the sensitive, caring women whose paths have crossed mine....and how much I need them still.   I can only hope, in some small way, I have given them something in return.  What I owe them now, is to keep their legacies alive in all the friendships I continue to value and try to nurture.  



(c)  Sally Z McBain



 

Twelve Questions

                                                              


Row row row your boat, gently down the stream.  Merrily, merrily, merrily, merrily, life is but a dream.    Children's nursery rhyme


To celebrate my 65th birthday, I'm going on a retreat.  I want to answer questions I've been asking myself for a long time, but have not fully answered.  Most of us know the glee of being away from phones, e-mails, have-to's, and anything else that distracts us from getting something done.  I need to face myself and my fears so I can move into a space of acceptance, self-confidence, and discovery.  Though they sound like a trite list of words, what I really want is inner peace and joy as I age; one cannot survive without the other.

The vanity issue I addressed in my last entry (Anchors and Aging) leads me to a tale of two older women.  I remember one homebound elderly client, tears welling up, who told me she no longer looked in the mirror.  She couldn't stand to see how she had aged, and she hated herself; she said she was 'disgusting'.  Her solitary confinement (dictated by disability and depression) made it worse, since she didn't see people who could validate her and give her reasons to celebrate life. 

My sister tells me her neighbor says the same thing about her face and body.  She avoids looking in the mirror so she doesn't have to think about it.  Rather than focus on her physical appearance, she moves ahead with her life.  These two women were/are in their late 70's; one was depressed, while the other is in a place of either contented resignation or mature acceptance.  Either way, she isn't miserable, nor is she isolating herself from others.  I have a feeling my sister's neighbor has several anchors in the water, many of which I shall be able to claim as my own...eventually.

Following are questions I will ask and answer before I go much further.  I realized I needed to come up with these questions after I wrote to a family member:  I'm doing a lot of personal work, mainly with self-acceptance.  I have been spending a lot of contemplative time assessing my sense of purpose, figuring out what I have yet to contribute to society, and thinking of ways I can give my creative self more space to grow.  Though in my heart I know differently, I feel like I'm entering this incredible new phase of life without much grounding.   I'm changing before my very eyes, and I want to meet those changes with strength and confidence.


What am I doing when I'm happiest? 
How can I rein in my constant need to accomplish something?
What do I love most about my life right now?
Where and from whom do I get my inspiration?
How have my priorities changed and am I giving due attention to them?
What is one new and/or positive thing I have learned about myself this last year?
What messages about me, or expectations from others, can I finally release?
How am I being true to myself?
What power am I going to give to the role money plays in my life?
What can I do on a daily basis that will help me deal with forgiveness, old guilt, and fresh sorrow?
How can I honor my introversion and still be present for those I love?
What do I feel the need to finish or do before I die?


I received several touching e-mails after my last blog entry, three of which were written by individuals on either side of 40.  Each person wrote about the challenges he or she is facing and how those relate to getting older.  As we age, it seems many of us become more introspective, realizing each day is a gift to be opened with care and thought.  We want, more than anything else, to be able to say, "I gave it all I had, and lived my truth in the process".

I am happy to report (though I'm still self-conscious about its seemingly rapid progression), I am no longer obsessed or depressed about the notion of looking old.  What I am, however, is determined to make these next 10 or 20 years as meaningful and rich as I can.  I want to be aware of what I'm feeling and doing, so this incredible dream becomes one I will remember when I'm on my last legs, and not one I forget because I spent too much time madly rowing.  In order to take in the beautiful scenery, I will need to lower another anchor. 

Next time:  my second anchor and how a friend helped me find it


(c)  Sally Z McBain

Family Advocacy

In the long term care business, advocacy is critical to providing the best care.  In conjunction with orienting new residents and families to nursing home schedules and protocol, the service of a professional advocate would have been helpful to my family during Mother's four years in and out of the assisted living and long term care facilities.

I experienced the need for an advocate when I complained to top administration in between my mother's nursing home stays.  Several times, I encouraged my father to get home-based help.  I called the head of the home care program to set something up.  After three unreturned calls, I gave up.  At the height of my frustration, I wrote a letter to his boss, the chief executive officer.  I received no response.  If you've gone directly to the top without satisfaction, what other recourse do you have?  Like many tired and stressed out caregivers, I was at my wit's end.  My parents were residents of an aging community that offers a wide range of services to which they should have had immediate access, but we were blocked from getting them.

A family advocate would have been an answer to a prayer.  An advocate would have followed up on our behalf.  In many health care centers, patient advocates come in the form of case managers, often connected with Medicaid.  Private pay residents, on the other hand, usually have to make their way through the system on trust.  It is the case manager who co-ordinates services for elders bouncing around on the contiuum of care; and it is because of the presence of state-funded case managers that I have always thought residents on Medicaid were assured the same basic services and care as those provided to private pay residents.  I have not researched the presence of private case managers today; but five years ago, there were none in the area my parents lived. 

An advocate would have done wonders for our comfort level; instead, we had to be ever vigilant ourselves.  I'm sure staff were very frustrated with my dad and me at times.  We asked a lot of questions and had a lot of concerns about my mother's care.  Sometimes, assurance is all a family member needs; but when real problems occur, the advocate would also serve as a liaison to medical staff.  There are patient advocates (i.e state ombudsmen), but families need advocates, too.

Family members have to keep an open mind and do their best to appropriately connect with the peole who are providing these critical services.  If there is no professional or volunteer family advocate available, it falls on staff shoulders to let us into their world without making us feel like we are an intrusion.  

Busy people are intimidating; doctors and nursing home staff are always pressed for time.  Unfortunately, in a hectic work place, we encounter professionals and employees who avoid eye-contact, who don't smile, and who are in a hurry to get somewhere.  They put us off; and whether consciously or unconsciously, this may be their intent.  When I worked in a facility, I too, was guilty of rushing up and down hallways, hoping no one would come between me and my destination.  Time was short, and every encounter, intense.

Family advocacy is the answer; a consistent, friendly, "I'm here-for-you" attitude is all some of us need.  An advocate would help family members navigate the system, or facilitate communicaiton when there is a problem.  Many families don't need a thing; others, like mine, needed more support and information.

Most importantly, an advocate would provide the soul connection we all need.  Volunteer programs can train advocates to listen and follow through.  The advocate doesn't necessarily have to be a nurse, case manager, social worker, or chaplain, though advocacy is a natural part of their jobs.  An advocate can be an empathetic communicator whose main role is to help families make sense of life in a long term care facility.


(c)  Sally Z McBain

Nursing Home Families

I used to believe families who didn't visit their institutionalized relative were uncaring; and I judged them harshly.  I knew nothing about them or their lives, yet I judged.  So many elders are lonely; and volunteers and staff try their best to help.  But watching an older adult sit for hours at the door or window, waiting for someone who isn't coming, is heart-breaking; it always made me angry. Obviously, as a new admissions co-ordinator, I had a lot to learn about families.

After taking the time to get to know family members, it was clear my judgement was unfair, and in most cases, unfounded.  Family members who purposely avoid the nursing home are rare.  They are faced with many challenges:  dealing with their own health issues, trying to raise children or earn a living, or having to travel great distances.  Elder care facilities are a necessity for those who can't check in on a regular basis, let alone take care of their loved one at home.  At best, a daughter or son may only have time to visit once a week.  Sure, there is the occasional avoidance of an uncomfortable situation when a family member says, "I don't want to go in there any more than I have to; it's too depressing."  But most families do their best; they agonize just as I did when my mother was a resident; and they visit when they can.

On the other end of the spectrum are family members who regularly enter the long term care facility to check on a relative.  A 70-something daughter good-naturedly told me, "While my friends are taking cruises all over the world, I'm cruising to and from the nursing home."  Another daughter came twice a day, every day, to feed her 90-year-old mother.  She knew the older woman needed loving, relaxed attention during hectic meal times; in general, however, she was not convinced her mother was getting the best care possible.  There always seemed to be a shortage of staff, which meant some residents had to wait for help; and she wasn't going to chance it.

These two women and my father, who was at my mother's side most of the day, every day, are the ones who have something to contribute to institutional culture.  They are part of the connective tissue holding the system together.  A wise head nurse once said to me, "We send our children to school, but do not presume the teachers will take over total responsibility for their rearing.  The same is true for nursing home care.  Families can't expect a nursing home to meet al the needs of a resident.  It isn't that they don't want to; it's just one of those facts of life.  Staff have to focus on a resident's physical health needs first." 

The trouble with encouraging family involvement is that family members can be time-consuming and an emotional drain on staff.  Some relatives are tenacious in their quest for answers and solutions.  If they get nowhere with line staff, they head for the director of nurses or administrator.  Starting out on the defensive, the relatives gird themselves for condescension and excuses. From the get-go, there is fear and distrust.  There are others who prefer to complain to a staff person with whom they have bonded, but who then has to take the message to a supervisor, who has to take it to the next level -- all of which takes a lot of time, reassurance (sometimes, false reassurance), and tact.

As long as they are appropriate and non-threatening, family members are entitled to intervene on behalf of a relative who may be frightened of retaliation or too weak to advocate for herself.  Sometimes, however, staff do not view angry family members as appropriate; and they don't always know how to work with them.  Tragically, nursing homes have been known to bar an aggressive family member from their premises.  If a resident cannot see her closest relative, what is the effect on the resident's overall health and well-being?

Open and honest relationships, along with quick attention to problems, are two major ways to avoid misunderstanding or confrontation in a long term care facility.  There were a couple cases where, had it not been for my good relationship with the head nurse on Mother's floor, I would have called the state omudsman to report neglect.  My concern about a call bell that hadn't been fixed for at least two weeks should have been a priority.  Instead, I had to mention it several times, while trying to calm my parents each day we waited and were told it was being worked on.  This highly respected nursing facility finally provided us with a door bell that sat on her night stand.  The bell did not ring through to the nurses' station; but we were told they would hear it if they were in her hallway.  If they were in her hallway?  On many occasions, and for stretches of time, her hallway was empty. 

This episode did not make any of us comfortable, given my mother's increasingly deteriorating health needs.  She was discharged before the call bell was repaired.  Any trust I had was gone; and when it came time for her to return the last week of her life, even with a Hospice nurse coming in now and then, I was more watchful and present for her than ever.

Families don't just sit around and think up things to complain about.  They complain for good reason, and it is incumbent upon the rest of us to listen carefully and act on those complaints immediately.  It takes a concerted effort on everyone's part to tame emotions and solve problems.  For the family member who has stepped over the line, who has no time to participate in a parent's care, or who is coordinating care from three thousand miles away, there should be a family advocate.


(c)  Sally Z McBain

The Helpers

The whole idea of compassion is based on a keen awareness of the interdependence of all these living beings, which are all part of one another, and all involved in one another.    Thomas Merton

Describing how a nursing home is run and what actually takes place are two different things.  Nursing home staff are generally dedicated to making life pleasant and safe for residents; but with staff retention problems, ever-changing state and federal rules, and soaring numbers of elders needing care, it is an ongoing challenge.

Families and people in the helping professions have lives separate from their responsibilities to an aging relative or their jobs as caregivers.  They struggle with personal issues of their own.  They, too, are lonely and afraid at times, just as are the residents.  We have all met employees, professionals, and family members who are frustrated, tired, not focused on the task at hand, wanting desperately to be somewhere else, and feeling no one cares about them or appreciates what they do.  But the focus on elders must remain paramount, since they are the ones receiving (and paying for) care.  This presents us with a conundrum, because it is the need for attention, love, and human connection that gives helpers the necessary compassion and stamina to maintain that focus.  They relate to the pain, frailty, and dependence of another person because they've been there themselves in varying degrees; it is this ability to relate that requires a new look at how we do business in aging communities and care facilities.  We need to connect with one another on a more personal level, to appreciate those feelings we all have in common.

Institutional life is challenging on a good day; but when emotions run high and problems are overwhelming, we think we don't have time to tend to the people who are trying to make things better.  Instead, we see them as part of the problem.  By doing so, we point the finger away from ourselves.  Everyone blames someone else for a responsibility we all share.  While we are busy placing blame, we miss the opportunity to see what makes up an institution.  At its core is a congregate of individuals.  An institution is not just 200 beds filled with frail elders or disabled adults; they are separate individuals, just as are the people who deliver compassionate care -- the paid staff, the volunteers, and the families.

Improving care to the elderly must include active support of the helpers.  Active support includes training, mentoring, advocating, and counseling.  If we focused more on the helpers, what would happen?  Would family members be less worried about the care of their loved one?  Would it reduce the staff turnover rate?  Would it save money?  Would it increase tolerance and eliminate the opportunities for abuse?  I think the answer to each of these questions is 'yes'. 

Working with people day in and day out requires tact, validation, compassion, and a lot of patience.  If helpers are drained of energy and hope, then we need to change the way we think about institutional care by changing the way we help the helpers.  


(c)  Sally Z McBain

Soul-level Care

Even with the shift in national attention towards elder care, problems still exist.  There is a gap between what facilities advertise in glossy brochures and what they actually practice.  Many of these places are built and purchased as investments; as with all investments, the bottom line is profit. 

The success of long term care of any kind, whether at home or in a facility, depends on the staff providing the care.  They too, are part of an investment -- not only of money, but of the soul kind.

Most people go into the elder care business because they are dedicated to the well-being of elders.  The problem is that many of these individuals are in danger of burn-out, which leads to exhaustion and turn-over, which lead to low morale all around, which can lead to verbal or physical abuse if not recognized and managed quickly.  It may seem like an obvious conclusion, but challenges faced by staff in elder care facilities are directly related to the level of care and attention given to residents.   We must address these challenges.  

Only after months in and out of the nursing home which housed my mother, endless hours observing dynamics between residents and staff, and then finally having the chance to talk with staff members -- only then, did I come face to face with what I perceive to be the main threat to the delivery of good care.  In spite of what some administrators and nursing home owners may think, it isn't just about needing more operating capital.  It is as much, if not more, about the need for soul-level connections between people who reside, visit, and work in elder care facilities. When that is accomplished, less time will be spent on problems that arise out of fear, hopelessness, anger, and exhaustion. 

Soul connections, those life-changing 'I honor you' moments that are exchanged between two people, are at the heart of Soul Portrait. When we start to look at institutional care more closely, one role at a time and one person at a time, attitudes and practices will change.  Each of us needs the soul- connections that validate us as unique individuals -- whether resident, professional, or loved one.  It takes very little time to make such a connection, yet it's not a priority in the delivery of care.  We are too busy tending to physical needs and dealing with everyday problems; we can't be bothered with learning more about each other or getting to know one another on a deeper level.

My perspective on nursing home care and my opinions about improving that care developed not only out of my career, but also out of my role as a daughter-caregiver.  Both roles frustrated and angered me at times; I felt helpless to change the system.  Being a resident's daughter, however, helped me break through my paralysis; I mustered up the courage to write a letter to the 25-member volunteer board of directors of the aging community in which my parents resided and my mother died.  I wrote about my experiences and specific concerns regarding Mother's care.  Neither administration, management, nor board members responded.

As the weeks passed with no response, I began to feel invisible, just as I did when I walked down the corridors of the nursing home trying to make eye contact with busy personnel who wanted to avoid a connection. 

No one was willing to take a step out of his or her comfort zone to ask pertinent questions about what I had experienced.  Later on, I figured the total lack of response from anyone (including the chaplain to whom I sent a copy) had come out of advice from their attorney.  Was I just another trouble-making family member, or worse yet, a lawsuit waiting to happen?  They were afraid, and one way to deal with fear is to deny the existence of a problem.  Because my family had long been connected to this church-owned community, I let it go; I was tired and grieving for both my parents.

Over time, and when my anger and disappointment passed, I got more determined to search for answers to the elder care dilemma.


(c)  Sally Z McBain