It has occurred to me that I inhabit a professional world full of apparently impossible problems, challenges, and (one of our faves!) issues. 

The ISSUES of aging receive a huge amount of attention from social workers, therapists, nurses, counselors and organizations whose existence depends on the fact that issues exist and demand attention. 

In my professional world attention is on unmet need, preventing injury, insulating against unhappiness, and providing for every circumstance.  The efforts are governed by regulation after regulation.  Each year there are more hoops to jump through and more rules to follow.

The riches of elderhood, the advantages and gifts are rarely showcased aside from the opportunities and activities designed for healthy elder bodies and minds who fit into the “box” of a younger professional generation’s design. 

There is something important missing. 

Dr. William Thomas’s book What Are Old People For?  grabs my attention,  for he is one of the comparatively few individuals who addresses clearly and unapologetically the blessings and advantages of growing into elderhood. 

I long for the day when growing older becomes accepted as a significant, meaningful and remarkable part of the lifespan; as significant as toddlerhood, the teen years, the time of marriage and raising families, the period of higher education and career development.

The time between 60 years old and 90+ (30 years!) are ours to be lived and shared and celebrated daily, not just on birthdays or anniversaries.  The day that we honor our own experience and wisdom and seek ways to share it with our families is the day we truly come into ourselves and begin living a life of legacy and significance.  

This is living.  This kind of living allows for the grace and wisdom to accept what cannot be changed  and be hopeful and purposeful about what changes are in our power to effect.  

Nancy McCambridge Driskill

December 2010

A LETTER TO MY FAMILY

During my practice in geriatric care management and my work with aging families, I have observed so many wonderful older folks unable to exercise the responsible decision making of their past. Many factors play into this inability or unwillingness, not the least of which may be brain damage from disease process. There is often a strong belief that only those who are really decrepit and miserable require help. Folks may fear getting to THAT place. Accepting help is viewed as an admission that the dreaded time has come. This is scary and we tend to use denial to protect ourselves from those things we fear. As a result of the denial and fear of accepting help, our lifestyle quality begins to suffer, our families must endure very real fears and frustrations as they watch us suffer needlessly, and our options list becomes very short.

Conversely, trusted family and friends can help guide us toward proactive decision making. We then have the opportunity to capitalize on our remaining strengths and use our energy for living life rather than only existing.

A letter to our families written while we are in healthy middle age can clarify our wishes and expectations. To outline those “red flags” that we define as reasonable indicators for a need for change can be helpful to our children when we ourselves begin to demonstrate some of them. Gentle reminders of our earlier wise words can help us make the necessary adjustments. What a gift to one’s family!

The following is an example of a letter that you might use as a guide. Make copies for your children or other family members and keep one for yourself. It would be a valuable family meeting topic where everyone could talk about their ideas about aging and quality of life issues, and values. The better our families know us, the more certain we can be that they will honor our preferences.

Nancy M. Driskill, RN, MS, CMC

11/10 rev

My Dear Family,

I am comfortably aware that my life here is finite. It is my fondest hope that I will be able to age well into my 90’s without the challenges of a failing body and/or mind. I would like to think that I could continue my life in my current comfortable manner and have a myriad of choices among painless care and housing options.

I know that while this is my fondest hope, it is also fairly unlikely. In some effort to ease the burden of responsibility you are likely to feel, here, my dears, are the “red flags” that I now consider sufficient to merit discussion about a change in my living situation.

1. Wearing the same one or two sets of clothes over and over.
2. Refusing to leave the house to do once familiar activities.
3. Failure to prepare and eat regular well-balanced meals.
4. Hoarding food, newspaper, trash, paper goods.
5. Moldy food regularly appearing in my refrigerator.
6. Demonstrated failure to remember to take medications appropriately.
7. Telling the same stories over and over again.
8. Sleeping all day, being awake all night.
9. Change in my housekeeping habits.
10. My refusal to give up driving even after being advised to do so by medical professionals or after an accident.
11. Deterioration of my health such that I must have someone to help me more than three days /week for things like oxygen, insulin, or other critical needs.
12. Chronic debilitating pain.
13. Recurring acute health conditions including urinary tract infections, upper respiratory infections, falls, repeated blood sugar imbalances if diabetic.
14. Evidence of confused thinking, memory loss.

If you see these things, please sit down with me and gently remind me of my words today. Show me this letter. I wish to be proactive regarding the quality of my life and to make choices before I have none left to make. I wish to spend my late life years in positive and loving relationship with my younger relatives, sharing and benefiting from our collective and individual strengths.

I trust you.

Much love always,

Mom (Dad)

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THINGS TO THINK ABOUT…….

The struggles we had as children with members of our families do not just go away.  They do not melt little by little with each year we live.  They do not become resolved just by virtue of the passage of time, our joining with a mate, parenting our own children, becoming grandparents ourselves.

During the latter part of life’s journey, our relationships with parents and siblings can and should continue to grow and develop, to go way past the point at which we “left them” at the time we left our birth home.

Talking about life, memories, hopes and fears for the future, laughing and crying together are the “text books” used in this part of our education process.

Self discovery can be a wonderful gift to share with parents and siblings.  We DO learn from each other.

 Do you have these very important documents?  Does your family know where they are?????

 A durable power of attorney for health care?

A durable power of attorney for financial matters?

CPR Directive?

Living Will?  (Also known as Advanced Directives)   

An attorney is not required to write these documents for you.  Need help?  Call me!

Nancy  McCambridge Driskill, RN, MS, CMC

Those who have contracted for the services of a professional whose specialty is service to older individuals and their families may or may not be aware that the senior service arena is seen as a major business opportunity.  This is not a bad thing in itself.  It IS, however, cause for prudence and care when making deciions for yourself and your relatives.  The National Association of Professional Geriatric Care Managers and its members adhere to a strict CODE OF ETHICS:

Provision of service:  We provide on-going service only after your needs have been assessed, you or the person designated to act for you, understand and agree to a plan, the results that can be expected from it and the cost of service.

Self-determination:  Our plan of service for you will be based on your defined goals and which enhance the decisions you have made concerning your life.

Loyalty: Our first loyalty is to YOU. We will always provide service based on your best interest, even if this conflicts with our interests or the interests of others.

Termination of Service: We will end service only after a reasonable notice and a recommended plan for you to continue receiving service as needed.

Substitute Judgement: We will not substitute our judgement for yours unless we are acting in the role of guardian , appointed by a Court of law, or with your approval or the approval of someone designated for you.

Referrals/Disclosures:  We will refer only to services and organizations we believe most appropriate  and of good quality.  We will fully explain any business relationship we have with any service we propose, and give you information on alternatives so an informed deciion can be made.

Cooperation:  We will strive to assure cooperation among all the professionals involved in providing service for you.

Qualifications:  We are fully qualified in our profession to provde the services we undertake.  We continue to improve our skills and knowledge by participating in professional development programs and maintaining certification and licensing.

Discrimination: We will not promote or sanction any form of discrimination.

Professional geriatric care managers work for the client and the client family.  They take their direction from the client, are partners with the client, and are inetrested only in the well-being and comfort of the client.