Hospice Care

Dear Linda:
       As a result of multiple strokes, my 92-year-old father is in a long-term care facility suffering with various challenges. He's beginning to lose weight, sleep more, and talk less. When he does talk, it's clear that he's suffering with uncontrolled pain and depression. Should I be considering Hospice care?
Sadie in Fort Worth

Dear Sadie:

       The symptoms you describe are sometimes indicators of the beginning of the end, but no one has a crystal ball, and doctors will be the first to say so. All the family can do is ensure that their loved one's health and comfort is optimum.

       Hospice is an excellent program that is under-utilized and often called so late in the process that many beneficial services go unused. Though the purpose of Hospice is to provide compassionate support and extraordinary care for people in the final phase of a terminal disease, the program's goal is to enhance the quality of life regardless of its duration.

       Subscribing to a holistic approach, a Hospice team includes a medical director, physician, nurse, certified nurse assistants (CNAs), social worker, spiritual care coordinator, therapists and counselors. Volunteers provide companionship and emotional support to the patient and respite services for the patient's caregiver, including shopping, errands, childcare, and light meals.

       Begin with discussing your dad's condition with his doctor, who must certify to Hospice that he is no longer thriving or that his disease is terminal. Ask your physician to recommend the best Hospice provider or call the National Hospice Organization at 800-658-8898 or visit www.nhpco.org for valuable information and recommendations.

       Once a patient has been examined, records reviewed and medications evaluated, a care plan is developed. Then Hospice will provide all necessary equipment, supplies and medicines, whether the patient is at home or in a facility, and the cost is covered by Medicare, Medicaid or private insurance.

       The final phase of the journey need not be feared. With help and support, the last moments in our loved one's life can be peaceful and uplifting.

Giving Advice--Helpful or Hurtful

I’m struggling with knowing when to advise others or to keep my mouth closed. I know the best course of action is to wait until being asked before giving advice, but my dilemma with that wisdom, and I do believe it is wisdom, is what to do when the person making a mistake is unaware that they are doing so. Do I let them experience the consequences of their bad choices or try to help them avoid the inevitable pain?

The first difficulty with giving advice is presuming that we always know the best way…assuming there really is such a thing. If we realize that there are many paths to the right end, then we will take greater care in how we offer our solutions.

The second problem is that we don’t really know all the details of another person’s experience, so we should consider giving advice a great risk. If we don’t take great care, we can harm more than help.

And the third issue to consider is that the person may just want a listening ear and sympathy that comforts. Advice offered to a person in pain can be viewed as condescending and judgmental rather than helpful. We must also know that a person who is in pain can’t really hear what we’re saying anyway. You might have a chance at making an impact if you listen carefully to them first.

Author Uzi Weingarten has determined three simple steps for handling giving advice that I like very much:

1. Listen first. While this rule is true for all good communication, it is doubly true when we wish to give advice. Issues are often more complex than they initially appear. By first listening, we open a space for the speaker to more fully describe the situation and for us to more fully understand it. What is the point of offering advice based on partial information?

In addition, when we listen first, it makes it more likely that the other will then listen to what we have to say. In the words of Dr. Marshall Rosenberg, one needs “connection before correction.” It is empathic listening that establishes the connection.

2. Ask permission. Unsolicited advice is a major cause of grief among friends and family members. It can be experienced as unwelcome intrusion into personal business. It might also be seen disrespectful, as implying that a person is incapable of caring for himself and resolving his own issues.

Asking if our advice is desired shows respect for others and prevents resentments. Here is one way to do this: “As I listen to you, there are some ideas coming up for me that you might find useful. Would you like to hear them?” It is very important to ask that question without attachment, from a place that both “yes” and “no” are equally acceptable responses.

3. Offer without insisting. It is worth keeping in mind that even after we have listened, we can never know with certainty what is best for another person. There is so much that we are not aware of. So we should offer our insights, experiences and ideas, with the attitude that our advice is another point of view, and then we must trust the listener’s inner wisdom to discern what is right for him or her.”

Perhaps the most important thing for us to remember is that people need validation far more than correction, empathy more than solutions, and though I understand this all too well intellectually, emotionally I still feel the need to help. It is the way I show my love, and it is very much my personality to solve problems. So…I too must keep asking myself if, barring criminal acts, is there really anything that can’t be corrected with time?

If we shower the person we hope to help with love and sympathy, perhaps they will then be willing and more able to hear what can only be a suggestion that you have that may or may not be right for them.

That's my best advice on the subject. See...I just can't help myself!

Be Thankful for Friends

We will soon celebrate the Thanksgiving holiday. Besides turkey, all the fixings and my son's favorite chocolate mousse cake for dessert, my family has a tradition before eating. We pray and then share what we're most grateful for.

I took some time and thought about what else I had to be thankful for besides my family. I have a home that is lovely and a comfort to live in and share with others. I have work that I love and is a way to give back, and I have the physical health and financial security enough to allow me to live a full life. That's a lot to have, and I am truly grateful.

The most important thing to have though, as we grow older, is friends. As many of you have experienced: husbands come and go, children leave and forge their own lives, and even the most fulfilling work meets only some needs, but friends....ah, they can be the mainstay of our lives.

My oldest and very best friend of 42 years has been one of the most important constants in my life. Though she does not live close by, we talk weekly for several hours. She is the one person who knows all—the  good, the bad and the ugly, and she loves me anyway, and the reverse is true.

We have a relationship that allows telling each other the hard truth when it's been necessary, sharing in each others hardships, and earnestly cheering on the successes. It's a rare gift to have a friend such as this. Most of us can count on only one hand how often that type of relationship comes into our lives, and I am grateful to be one of them.

I am also grateful for my other girlfriends. Some I relate to often and others I see periodically, but all offer help, wisdom and laughter whenever I need it. As we grow older, it is critical to have a circle of friends on whom we can depend for these things, but, also as we grow older, having that becomes more and more difficult.

Friends we made when our kids had common activities often disappear when the activity stops. Friends move to other areas. Some of my very best friends live all over the country now, and sometimes friends are only that for a certain season in our life, and, for various reasons, the relationship stops, as sad as that can often be.

Forging and maintaining new relationships takes time and work, and often we don't have that time or the energy to do what it takes, especially when isolation is so much easier. This is dangerous thinking though especially as we grow older. It leads to fear, loneliness and depression. 

What should you do about it? 

Become a joiner: Bible study at church, the rotary if you've worked, the toastmasters group if you like speaking and listening to others, a book club if you like to read, or a social or dance group.

Don't stop learning: take classes at the college (they're often free to the older generations), learn a new craft, or take lessons in something you've always wanted to try. They say now that avoiding dementia and Alzheimer’s is as a result of learning new things. That’s what keeps the brain younger.

Make sure you have some fun: start a card group, a dinner club that forces your friends to gather regularly, and have movie parties. Don't watch your new video alone. Ask friends over, make some popcorn, and share the tears or laughter.

It doesn't take a lot of time to organize these moments, and maybe you'll be the only one of your friends who will. Don't worry about that. The dividends to you will be too great to wonder why you're the social director in your life. 

 

Ageism in the Workplace

Dear Linda:
 
My mother is 58, has worked at her company for 18 years, and had been promoted regularly throughout her tenure. Lately, promotions to which she was entitled were given to younger workers, often less qualified. We think it’s ageism. What are our options? 

Joan’s son

Dear Son:
 
Ageism is a bias against someone because of their age. If that bias impacts how an employee is treated, the employer has broken the law. The Age Discrimination in Employment Act (ADEA) protects applicants and employees who are 40-70 years old from employment discrimination based on age with respect to hiring, firing, promotion, layoff, compensation, benefits, job assignments, training, terms, and conditions. The ADEA applies to employers with 20 or more employees, to employment agencies and labor organizations, and to the federal government.
      
Despite the law, however, ageism has increased from 6-to-8% for workers overall, and from 11-to-16%  for workers 65 years and older according to the National Social and Quality of Employment Survey. Because firms are 40% more likely to interview younger applicants, 63% of senior applicants said they’d hide their age and 18% said they’d have plastic surgery before applying.
     
In the past two years, the U.S. Equal Employment Opportunity Commission (EEOC) has received more than 20,000 complaints of ageism. That number will grow dramatically as Americans, 65 and older, double in population to 70 million over the next three decades, and those over 85 (the fastest growing segment of the population) will surge from 4-19 million.
      
Though millions of dollars have been paid in settlements, attorneys say discrimination is difficult to prove. Only 1/7 of the cases have benefited the complainant thus far.
      
The International Longevity Center (ILC), administrated by Dr. Robert N. Butler, who coined the term ageism in 1968, is publishing a detailed study in February, 2006. Visit www.ilcusa.org or call 212-288-1468 for information.
      
Read The Older Job Hunter’s Guerilla Handbook by Gunthar Manusson for how to combat ageism, and contact the EEOC at 800-669-4000 to report cases.