Grandma's Dirty Little Secret

Mabel and Joe were observed holding hands as they walked down the hall..The staff commented on how cute they looked together and thought nothing of seeing the two of them benignly holding hands and smiling..Later that night, the C.N.A. calls the nurse to Mabel's room...Mabel and Joe are sound asleep in the nude, snuggled under Mabels blankets...both elders suffer from mild dementia; and Mabel is not Joe's wife..his wife Mary is at home...Is this a crime, an incident that bears reporting to regulatory agencies, or a lawsuit waiting to be filed? or is it simply part of our human/animal existance that has us seek out the comfort of pleasure in it's most raw form when we are stressed, confused and alone?

Ah yes..the dirty laundry of dementia and adults; yes folks we still want,seek and need the comfort of sexual release when we are old, gray, and even at the end stage of our dementia and aging processes..Social acceptable? good heavens no, at least for the current generation of elders being cared for in any setting outside of home. Will the next generation finally break the code of puritan values and norms that are currently in place that restrict and make normal human desire and comfort a social deviant behavior? I hope so..

This topic was brought to light this week on MSN. For the first time someone outside of our industry has brought to light the skewed value system in place for elders who desire sexual intimacy and comfort. The article; a reprint/connection from Slate.com focuses on a situation of two real elders who resided in an assisted living facility. Both suffered from mild dementia; both sought each other out for sexual release and intimacy. Their families; who due to power of attorney and legal authority; requested that the facility separate the two and keep them from "having relations". The result? depression and weight loss for the female, and rapid decline and sudden death for the male partner.

As squirmy as this topic may make you; it is the harsh reality of aging..Are we, or will you be willing to give up control of the intense pleasure associated with sexual release when you are an elder? Do you want your patient advocate, or power of attorney to determine with who; how often or where you are allowed to express yourself sexually?

I wonder why as a society we freely accept sexual expression in our music, art, advertising and filtered in our daily lives; yet, when we get down to the base act we apply a rigid value system of what is acceptable and not...elder sex is a taboo subject and one that most of find very uncomfortable to think about; or discuss..In fact, when we do talk about being "old" and having sex; we bring up things about body image issues; functionality; and whether or not we will need pharmacological support to make it happen..It is the epitomy of joke fodder for most comedians..

Yet when faced with the reality of it happening to Grandma; we become highly agitated and desire to control Grandma's frisky behavior with outrage and disdain that it "was allowed" to occur...

Reality check...Grandma probably had sex figured out at some point in her life; or you wouldn't be here to shout outrage....and Grandma has stored that wonderful pleasure feeling in her basic animal instinct portion of her brain; and she knows what she likes and how to make it happen over and over...it is not rocket science; it is pure pleasure and comfort..two things all humans need to survive. Do you want to face aging alone, demented, and devoid of the most basic form of pleasure and release?

Show Me the Money...

Interesting..Sitting and reflecting in Reagan National airport after a two day lobbying junket...I love the democratic process. It was a great opportunity to actually feel the process at work. A special thanks to my state rep Mike Rogers and his staff for hosting our visit. We actually got to "meet" on the house floor after a vote was finishing. First hand experiencing the democratic process was outstanding and uplifting..

As a non-baby boomer; I have watched the coming storm with such trepidation and anxiety..How are "we" the future generations going to pay for our health care? How are "we" going to survive financially? It has become the hot topic for domestic policy and the upcoming elected President's first agenda issue.

As an observation; it is interesting to note that the previous generations attitude regarding aging and entitlement, ie: "I have worked hard all my life" the government should take care of me now", has come full circle. My generation, cynical realist that we are; have started a new mantra..."personal responsibility" is our adage..we will seek/push/fight for government programs that are incentive based/tax lowering in structure that reward our financial frugalness and saving of our own money for our elder care and services.. In fact I predict that my generation will not only change the IRS code, we will fix it to be fair and equitable via a flat tax that is bipartisan supported.

I predict that we also will figure out how to fix the hemorrhage known as our national debt and deficit..Or we will learn Japanese...(little known fact, we owe them significant payment on loans that we yes we the U.S. citizentry via our government; has borrowed). How will we fix this financial problem? Taxes...and decreased domestic spending.. We will fix the tax code to be fair and equitable; capture the internet commerce, home based cash businesses, and large corporate over seas avoidance tactics...

In exchange for higher taxes, we will demand better infrastructure, and a clear tax code that rewards us for saving for our future health care, and the education of our children..

My theory is that not only will my generation change this, we will understand and educate the government to recognize that those of us in the "middle class" that bracket of families earning 75,000 to 250,000 per year; will no longer stand for being the highest taxed/under rewarded group of individuals in this country..We will demand and demand loudly a fair and equitable system for all..We want to help those in need; we want to eliminate poverty and the literacy issues..but not at the expense of getting our children educated or taking care of our needs when we age...

If we are to survive not only as a country and world power, but as a culture and generation; we must speak loudly about the "show me the money" attitude of the government...I am willing to show them the money, when they show me a realistic and practical plan that the majority of Americans agree upon..

Finding Sanity in the Chaos..

So..wonder where I have been? I have too...It has been a personal journey of chaos..The words written here tonight are of a very personal nature; not at all the typical musings I write about professional angst and change...but for those scratching their head, wondering, or saying "I don't understand", or simply "why"? perhaps this will enlighten you..thank god I have had preceptors of a strong nature to guide me..Tackling personal growth and change is something advisable and recommended..but I don't think we can every predict or anticipate the end result of that journey...

In our intellect we think we know and can predict the outcomes of our personal growth plan with a sane rational perspective.. but even the best sense of intellect cannot predict the emotional result of growth..Until we have gone through the growth, the pain, the agony, we never truly know the cost and change personal growth will bring into not only our lives; but the lives whom we touch...Planning for the end result with precision execution; will still net results unknown..We are after all humans...

So my journey into personal growth...some of you have watched and wondered..some have cheered, others have watched in trepidation...Let me assure you that while the pain is still fresh in some areas; and I am feeling very vulnerable about many things; the end result has been beyond measure...my life has clarity..I know what I want...I know what I need...and I am now capable of working on both, knowing that life is worth living and I have purpose...

Curious about how this happened?

About 4 years ago I was given two opportunities..One to become a member of a group of women on a personal growth/learning journey..(I call in group awakening, or personal development and learning in a shared female spirit based journey). The other was a job taken at a facility far from the comfort of my small town roots; away from my friends and supportive cocoon of people who I loved and trusted..

About 6 months into the group development I had a moment of clarity...It happened over a sinkful of dirty dishes...I was learning about who I was as a female leader..what motivated me; what drove me to do the things I did..Who I was as a person to my staff and peers...not all good, but an open honest learning/critical analysis of what kind of leader/peer I was...and what in my personal life/development had gotten me to that point in my personality and life..As I stood and washed those dishes, I realized that while my professional side was developing, my personal life was not fulfilling and supportive of the professional side..would it ever fill the tool box necessary to keep up the pace of what I saw as my future and who I really wanted to become in the next 25 years of my life?

Panic attack aside, the reality of what my life looked like thru the new lens I had placed on it scared the hell out of me...I was a then 36 year old female with a great career ahead of her; but at home my life was a very different scenario..I was married; dealing with the empty nest at an age when my peers were becoming parents; a husband whose career was a rigid patterned choice; and not alterable from my view..and the marital relationship lacked any sense of good communication or support for either of us..we both lacked the tools or experience necessary to be a team.. Knowing the wall I was up against at home I had to make choices..should I stay and try to make my career needs work with the marital needs? If so how would that work and look? Could I stop my passive/aggressive form of communication in the marriage and if so how?

Looking back, I realize that my strength of character was only strong enough to work on the professional side of growth..The personal relationship side had eroded into a scenario that I felt was hopeless and given the fact that I felt very alone and not supported in the need to find growth for the relationship, I avoided doing the work alone.. Believe me when I say, I did place several well positioned warning shots across the bow of the marital boat to say "hey, we need to work on this", "it is not good"...the warning shots went unheard and ignored...

Fast forward to the climax of the story...(always the best part..) About two years into my growth journey I was given the opportunity to return to my previous job setting..back to my friends and community! The building was in a storming of transition..people who were key players were jumping ship, chaos, negativity and blame were being placed..people were crazily unhappy..my team was falling apart..and I too was falling apart at home...Professionally I was growing, I had started to gain some self confidence, my insight into the behavior of others was developing and I was starting to get the rhythm..but my people needed me; and I needed to be close to home..I felt the need to give it one more go by...Looking forward I felt the need to do right by this group of people..getting them to channel energy forward facing would put them in a position no other facility could touch..they got it..they made the job easy, they just needed a kick in the butt, and some tlc...I got a do over...this time with open communication and learning for me, and for them...

I loved the year I spent there...it was a transition and opportunity to learn/guide and give like no other..Opening communication to them and taking it from them taught me so much..but it also gave me the insight and clarity to realize that while I loved the opportunity; that this journey would be a short one.

My personal life was disintegrating..I take blame for my half..no more, no less..My personal growth, and self awareness had opened me to realize that my marital relationship would not grow beyond where it was stuck...despite any effort of work, the issues were beyond repair, and my personal goals no longer fit into the mold of the rigid vision my spouse had of his life...So, I told him...pivotal point in any story..the telling...the hurt, the anger... Just post the "I want out" conversation, an opportunity arises..I can move jobs..change...try out the wings on a new challenge...So I leave...thinking perhaps we can try to make it work...Spent one week working away from home, living in a suitcase...The reality of my emotion and making peace with what I felt hit me..I needed to move my life beyond my past..What had been given to me was an opportunity of completeness..Those who know me know that completing a project from start to finish is a struggle..I revel in the change, the idea and the thoughts..but the finishing sucks the life out of me at times...I sat in my hotel room; recognizing that completing the end...getting the relationship to the ending point was in my hands, and I had to finish this task...So, I did...hence where my head and heart have been for the past 6 months..

It has been a struggle...it has hurt. I have lost friends and family. The negative, hateful words we both spewed...oh so not good...trying to maintain a professional level of work, while dealing with the personal angst in my life...has pushed my sanity envelope at times...shredded any sense of self right to the very core of my being...I have put 10 years of living into 6 months..trying to figure out who I was and what I really needed personally to support the professional need..

But I now know what I am about..who I am...I am me...professionally, I know my strengths and weaknesses. I can now recognize what I have to offer...what I have to give, and what I can expect from those whom I serve and work with..I get the tasks...I get the vision...and to achieve and complete both, I have come to recognize who and what I need from my personal life to fill that tool basket. It has occurred to me that to be truly successful as a leader, it is not as simple as having the skills alone; it is the support and nurturing of those you surround yourself with that make you feel complete and right in your role as leader.. Simply put it is having that person or persons in your corner who get what you need on a personal level to make the professional side that much better..

It is the banter and communication of far fetched ideas and outlandish venting without judgment or sarcasm...It is the simplicity of having a true ear that listens, absorbs and supports...It is the shoulder rub and dinner served on a crazy, horrific day...It is the giving back when spontaneous support comes your way unexpectedly..It is appreciating the gifts of self others give you..It is recognizing that simple gestures and kind words repair and heal better then any purchased superficiality..


So my journey has taken me thus far..I am on the healing side of change..both personally and professionally. I am seeking sanity amidst the chaos of the change I instituted..knowing that the future holds a very different picture..but one where I have the ability to fill my tool basket with the emotional support and nurturing necessary to lead and create change..

I look good in orange...

Busy..can you say it like a four letter word? My life has been a ball of chaos, but the storm is in full force now and the momentum of change is taking over...so..life is grand..right where I enjoy it the most....on that note..I am a tad fired up about a bit of information that was given to me last week, and the more I have had time to digest,dwell and ponder, the more irritated and angry I have become. So, in typical fashion I am going to vent. Enjoy..Jana

I wonder how many of my esteemed collegues, like I; wake up mid night drenched in a panic/nightmare sweat of being arrested for something that happened while their building was under their watch? Yes America, we have criminalized care and you all have not only allowed it but condone and encourage it. I have decided that if something bad is going to happen, a mistake getting made, a rule broken, and I am ultimately responsible for anothers actions, my only saving grace is that orange is a good color for me. No longer is it just my personal actions that come under scrutiny, it is any action, mistake,regulation not followed that could lead me to hand cuffs and the orange jumpsuit..and quite frankly I have asked myself after every nightmare why do you do this to yourself? What is worth this personal torture? I have decided that either I am a glutton for punishment, or I am a fighter and am willing to put myself out there for what is right and worthy; damned be the consequences....

Up until last week, fighting against a known entitiy, unneccesary regulations that are subjectively imposed; and attorney generals who enjoy using nursing homes as a back bone for campaign strategy...Those were my two known potential handcuff wielders..Now? Our own physicians have entered into the "punishment" arena as a means of obtaining notice for their agendas. Apparently, we, nursing home administrators make nice targets for public scrutiny and out cry. Yes we are a criminal bunch; the whole lot of us.

Currently in Michigan there is legislation proposed that will offer up some form of "punishment" for nursing home administrators of homes that have too many patient/elder discharges back to hospitals. Confused? So am I. As an administrator, I do not wield the pen/phone/fax that sends people to the hospital; the Dr. does. So how does criminalizing me, (by the way, I have been told that the original legislative proposal has been watered down to eliminate criminal action against my type, it is now simply fines and money penalties to be levied against us/our buildings.) make this stop residents from going to the hospital uneccessarily? As an elder advocate, this legislation frightens me on several accounts..

First, as an elder I should have the right to demand hospitalization when I feel it is needed...It is my right as a patient/resident. Second; the Dr. should retain his medical judgment to determine the need/necessity of hospitalization. Third, few administrators are clinical based individuals, why would you want them to determine who goes and who doesn't?

I understand somewhat the need to stop unneccessary hospital admissions and discharges from nursing homes. It is costly; it can be cumbersome. But companies who benefit from keeping residents in care facilities, (check with your managed care/HMO provider..they tout this as a selling point) are pushing this agenda, as it benefits them in the long run..My uneducated but rational mind tends to wonder if this legislation isn't a tad self serving to these companies that make money by keeping people in the nursing home; and avoiding hospital stays? It is their reward/payment system set up by our government.

So in my mind, by using us, Administrators; they are hoping to put fear in our hearts to keep residents in our building, and money in their pockets. Nice..and it should scare you that the HMO/Managed care organizations behind this proposed legislation has partnerships with physicians who provide services in many Michigan nursing homes. Do the pieces of this puzzle fit for you now? They certainly do for me..and the entire story is leaving me more then a tad ill. To think that the very Dr.'s who provide services in many of our homes; would bite this hand that feeds them; to gain a tad more in the other hand.

Huh, and we wonder why american's are apathetic about their government really representing the best interests of all.....

Goals Realized...

Just a short congratulations to my previous building..WAY TO GO! I am incredibly proud of every member of the team at Yale..wow..you are a highly successful, highly trained and most importantly great people who get customer service and the impact it has on each other, your company and the people you serve..


I hope each of you wear this honor with pride..Your abilities and dedication continue to amaze and impress...I am so very proud to have been your leader for a brief but incredibly fun moment in time...

Awesome job!


jana

Thankful

Today represents not only a national holiday but a turning point in my life. I am officially 40 years old today. I am still thinking about where my life has been, and how quickly the time has gone by. Wow..I really understand what my residents speak of when they talk about how quickly their lives were spent.. On that note; I have taken much of their saged wisdom to heart and am living my life with a purpose and intent instead of simply living. (thank you to my two female elder mentors!) I am so ever thankful for the elders who have crossed into my path on this journey of living.

With that said today represents so very many things to people. Many spend it with family, many spend it at home watching football and resting. Others get out and do things like run a 5K in the snow, (Detroit today has 6 inches of snow on the ground, and it is freezing drizzle/snowing still. Not exactly great running weather!) There are also people who get out and do for others today; working at homeless shelters, handing out meals to shut ins and those in need.

The people I am most thankful for are the employees and care providers who right now across America, are working to take care of our frail, forgotten, and neediest of Americans. Yes they are getting paid to do this..However, on any Holiday they are there working to assure that these individuals are cared for and remembered. In my facility like all across America, a big Thanksgiving meal is being prepared for noon. The dietary staff in any given facility is prepping for that meal as we speak.

I am sure in most buildings, the staff and residents spend this day enjoying the day together. Holidays in a nursing home are chaotic for staff; yet rewarding. Families come into visit in large numbers; many have not been in all year and they will have questions and concerns about how their loved one is. The staff will take the time to respond to every one. Many elders will have a sad day; as their families fail to visit or worse; they have no one to visit and observing the many visitors it reminds them of their all alone in the world status. Again, the staff will recognize this; and offer comfort and empathy; in return the elder will smile, say thank you or give a great hug and both may shed some tears in silent understanding of the emotional connection that occurs.

It is this spontaneous nurturing and giving that occurs that I am so ever thankful for. Outsiders - those who have no inkling of what really happens in care facilities; do not know of the symbiotic relationship that exists between elder and staff. It is a giving/receiving/giving cycle that occurs when true care exists.

As I have focused my life; it is this very element of care that I strive to teach, role model and educate others on. We can create beautiful structures; we can give outstanding clinical care; but without the humanness of giving selflessly; we fail as care givers. It is perhaps the most difficult element to teach, and grasp; it is not visual, nor tangible; it must be felt. Yet, once understood and recognized, it becomes an intrinsic part of the heart and soul of every great caregiver. It is this giving that outsiders "feel" when they come into homes that practice this.

Happy Thanksgiving to each of you. May you recognize the gifts you have given, and those that you receive. Continue to share and allow others to share with you. Be thankful for the simple things..they matter the most in the end..

Life Lessons Can Not Be Risk Managed...

I received a great article yesterday from a colleague regarding children's authors in England being "censored" for writing about risky behaviors. According to this article, authors are being told to re-write scenarios in their books that may encourage children to engage in behaviors that could lead to harm. The scenarios? Simple things that we did as children...like climbing trees... Yes you read that correctly, according to this article these types of books could lead to children engaging in behaviors that could lead to harm..

I guess this puzzles me. As a child, we did all sorts of stupid things that could have lead to our impending doom; yet by the grace of God we survived with minimal damage; and great stories for our children. None of the incidents were premeditated or directed by something we read. In fact they were usually spontaneous actions brought about from three creative female imaginations deciding that some activity would be fun. The three female minds were myself and accomplices of at least two of my three sisters. One would come up with an idea, and the others would follow or add additional embellishment to the original thought. For example the time we had a significant snow fall; and the drifts were so high that we could climb to the top of the wood piled against our garage and then slide down the roof of the garage, over the wood pile and get significant distance into the yard...Needless to say the neighbor ruined our fun by calling attention to our mother that we were on the roof...Lesson learned? Mom indicated we could break our neck from falling off the roof, or worse at least a limb; and that the neighbor was in on her anxiety.

So why do we feel the need to "protect" our children from all risks? There are inherent lessons to be learned from taking on risk. Stifling a creative story will not stifle risk. Giving parents false hope that by eliminating any "idea stimulator" will decrease the risk to their children is wrong. We are human beings; and like any animal we learn from attempting behaviors; and our minds work so that ideas and decisions can be made spontaneously.

As a parent I always hoped that I had done my best to teach my child how to way decisions and make responsible choices. Yet, he has had some significant learning from taking on risks and then dealing with the consequences. I believe he will be a better adult and person because of it. As a parent it hurts to see them suffer from their consequences. It is natural to want to protect and eliminate; but the learning is lost in overzealous protection. Ironically, the lesson takes longer to then learn.

Why was this story sent to someone who works with elders? Because, it is the same thought process that care providers deal with every single day. We are to manage/control risk for our elders; and in some cases their rights be damned. The regulations are conflicting in this case. Yes you have rights; but I also am required to protect you from all harm. Even that harm which you could cause to yourself from (gasp!) being human and having an inquisitive determined mind. For example, walking. If we (your care provider) feel you are not safe to ambulate by yourself, we must do everything possible from allowing you to ambulate unassisted. Imagine sitting in your room; and seeing your roommate drop her Kleenex box on the floor. Your mind and spontaneous thoughts tell you to "get up and hand it to her". Wrong! your thoughts are no longer allowed to govern your own behavior... Welcome to a new life lesson....