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Posted on Wednesday, December 02 @ 07:34:50 EST by dhf

Posts from Jill

For December, Jill does a "wrap up" of 09 and shares with us her walk with her 96 y/o dad.

01 Dec 2009
Once again, time passes whether we have 'something' to show for it or not. We started this journey almost a year ago 21 Dec 08 on the shortest day and have come a long way together. I will close this year out by remembering and sharing the Transformation of Jack, my 96-year-old father. This saga might be of benefit to others as I claim it has been for me.

Dad came down from Michigan with Mom, in that they had been married 64 years and wanted it that way. Mom passed May 08. This allowed me to make decisions for Dad and keep my promise to Mom to 'take care of him'.

Wow, where do I begin on telling you his health status? I will be brief because I realize each paragraph could be a chapter. He was on 5 prescription medications which gave him side-effects which we thought were the primary problems; dizziness, choking, falling, angry out bursts, infected feet, etc. He ate 3 large chocolate bars daily. He slept 20 of 24. You see he only stopped drinking at age 83 when he got into some trouble and Mom kept it a secret from Psychiatrist daughter and Attorney son for 10 years.

Enough of setting the stage...these three weeks of Dad's story will surprise you like it has me and help you to never give up. You see, I thought Dad would die in about 6 months of Mom's passing and I was so wrong.

02 Dec 2009
So I thought this would be a good time to incorporate what I would call 'A Delta Experience'. We would need to bring together an environment and cultural renovation for father to enable him to flourish. I put myself in his (stinky!) 96-year old shoes and tried to begin a gradual transition away from dis-ease and towards healthful standards. Dad is/has been quite narcissistic, so I thought I would utilize his prideful self in a way that would shape his behavior to our benefit.

I bought him an entire new wardrobe. He loved it. Got his hair cut, went to an internist for medical reassessment, podiatrist for foot care, bought new, stable/safe shoes (he had been wearing the same pair of women’s re-soled tennis shoes for years and fought with mom about any revisions…(he actually had ingrown corn pads in his skin) and with each step he would cry ‘oh, oh, oh, ouch. How did this mess ever happen? His gradual decline was over years of anger/manifested in post depression conservatism.

I washed his feet myself (not a paid attendant) with lavender soaks and started apply anti-fungal treatments. Reflexology on the feet is a huge way to treat diseases in the entire body. He smiled at me when I did this and said, 'Thank you Daughter'...I was different and he was different and the change began.

03 Dec 09
Ok...good I am back after a hectic day of Dad care and three days of commanding the medical group for the Air Guard of NC. All blessings, but time intensive and this writing takes 'being in the moment'.

I think the next issue was 'what was Dad doing all day'? Lying on the couch and watching TV or sleeping rather. You can only watch reruns of Andy Griffin so much and you begin to think you ARE Aunt Bee. While Mom was still living, we got Dad enrolled in the day program of the Coltrane Life Center for 3 days a week. This gave him recovery days in between. Easier said than done. He said NO and I said YES. I basically told him that we needed him to be his best and strongest and if he wanted to stay out of a nursing home, then he needed to get on that bus to Coltrane. Angry yes, but compliant and this was necessary for focus on Mom and then our need for a break from him. We took him to see the VA home that we chose for him when 'the time came'. This decision making, up front, no lies, is the respect that Dad deserves and that I want too when my time comes. We will care for him as long as he does not need 24/7 nursing care and he understands this commitment with thankfulness.

So let me underscore the importance of routine...meals on time, up at same time daily, a schedule that his body understands and expects. We all do best with routine. Think about his behavior as a 2 year old and treat him likewise. I would use the phrase, 'Dad, you would not let me _____ when I was young, so I will not let you now.' Fill in the blank, spit, pick, swear, etc. One issue we still struggle with is consistency with what behaviors he picks up from daycare and what we allow in our home. What a blessing!

04 Dec 2009
What to feed Dad was one of the biggest hurdles. He and Mom had gotten into some type of power struggle over food. Now, this is common in families with the dynamics around food. It is often one of the ways people attempt to show that they still have control in their lives especially when they are loosing control or trying to develop it. Eating disorders are created this way in adolescence. Seems so silly, but our mind sometimes motivates these behaviors and then our environment sustains them. Little did Dad know that having a psychiatrist daughter would help to unravel much of the pathology in behavior created over 64 years of marital behavior. Whew!

He always ate the same breakfast (cooked cereal and toast with postum for a drink). And lunch was always a banana cut with cream and half a sandwich. But dinner was a fight. Scenario, he would sit at the table and Mom would place the plate of food in front of him and then he would say...'I can't eat all that' or 'what is that shit'. either expression, of course, was hurtful to the cook and as you can imagine, would fuel depression, resentment and discourage a woman who took pride in feeding her family.

Dad's caregivers were placed in the same position. What to do? First, get delivered 'meal on wheels' from the local church so that no cook got hurt feelings. Then, when he complained he was questioned, 'do you want me to throw it out?'...and a few times the meal did go in the trash and no ice cream for night-time snack. Now he eats all on his plate, but still complains. We can change, but it takes a plan, consistency and is never perfect.

05 Dec 2009
As part of Dad's healthcare, I am always the one to take him to appointments. As a physician, I could gently question his excellent internist about symptoms and the medications. I got agreement to do a gradual taper off the Parkinson's meds first. I was not able to find any neurological assessment from his doctor in Michigan and I knew that he had a familial tremor (because I have it) which could be confused as a type of Parkinson's tremor. The taper was ever so slow and we added plenty of vitamins with proof that his Vit D and B-12 was low. He started on Fish Oil 1,000mg 2x daily, 400mg magnesium at night for sleep, 10mg Prozac daily. He evolved gradually with better balance, no tremors, improved skin, and more even mood.

Let it be understood, that these changes take time...they did not occur over night and are complex with many variables. We could not control what he eats at daycare for example. He now is in such balance, especially with what I would call 'his bowel program' that small changes have major behavioral impact. He takes a softener daily, drinks a caffeine beverage in the am, yogurt daily and green tea for lunch with boost type drink at night. At breakfast he has a shot glass full of prune juice daily. We were amazed at his reaction to artificial colors and preservatives...they made him toxic! When we tapered his chocolate bars away, he gained weight and his skin improved because he ate more real food. Protein replacement bars, which have high sodium, put him into near congestive heart failure, he got major pedal edema. So Balance is the issue here as well and natural fresh food. It makes me wonder about my balance points and what we ignore as we mature.

06 Dec 2009
After Mom passed, it was time to consider what we were going to do for living space for Dad. When we brought both of them down to Kannapolis from Lansing, we had them living in a house that could be rented which was very close. Mom demanded her independence and the rent thing was what she wanted such that she never would have moved if this arrangement were not available. So in her final days, when I looked at her in pain and said, 'please don't worry about Dad, I will take care of him as I have promised', I wonder what she really expected. We never had those specific words, but I do believe that my promise helped her to pass with less regret about her duty to the one she promised 'until death do we part'...Now what did I need to create for a living space that would allow/encourage health for Dad and keep me from needing to be admitted to a psych hospital?

We decided to design an apartment that would be totally handicapped accessible. We even got an occupational therapist to consult on hand rails, width of door openings and furniture selection and placement. It is beautiful. The view off the large porch is of two large ponds with ducks quacking, pastures to the right with our 2 walking horses and the thick stand of trees with their deep forest evergreen color. Who would not thrive in this setting? Dad had slept on the sofa for at least the past 10 years. Was I going to force him to sleep in a bed now? No way, in fact, I got a sofa sleeper which measured him perfectly and this was part of the buy in I need from him to make this work. He knew I considered his desires and I think I showed my respect.

This apartment with full kitchen, two bedrooms, two baths and a living room is over the garage and on the second story. We installed a chair lift to allow Dad a ride especially for the safety aspect. Come to find out, he can walk this flight of stairs...I never asked him about that. The wall colors are sea green with other neutral earth tones. It feels relaxing and makes me smile as I enter his living space. It is not specifically Feng Shui, but you get the picture.

07 Dec 2009
Did you ever give much thought as to why people choose to use rest homes for their elders? I imagine that our society evolved in a way that we were so busy with our personal lives and these lives were not local in that it made it hard to have 'the elders' in our space. We also purposefully separated our selves from our elders because they did things more slowly, we wanted to prove our independence, we didn't want their effects on our children constantly, or a whole host of other logical justifications. Interesting in this society, we have now created an expectation of not keeping our parents as they age. In fact, it is looked on in wonderment as I made this choice and my friends and colleagues wondered what was up with me. Some understood, some had walked the walk and others had specifically chosen not to for very good reasons.

I saw it as the promise to my Mom, yes, but also a life opportunity that I could not purchase. This would be a time of my life like no other and a time that I would never have a chance for again. It is not convenient and that is a part of the challenge. Each or most days, I have to think and feel what is actually important in the now. Do I delay getting my hair done to tend to Dad if he has an emergent need? Do I fall asleep and not get his teeth soaking because my sleep is more important? I know, I know that being a psychiatrist I probably do more refection on these matters than 99% of the population and so it must be. But, how often do we really get and or take the time to really decide what is important. Most spend their time doing what is expected or what they routinely do and not what they daily chose. This is hard.

I asked my Dad when I was about 14 why he had a family and how he came to that decision. He said that he did what was expected of him and it was what others wanted. I think he would have not partnered if not for those expectations, so in some ways I am perhaps giving him the thanks for my wonderful life. You see these decisions take us to the very core of our ethics, our values and our soul's honor. I see myself in his eyes, they are blue too...or perhaps I see him in my eyes. We are all so much more alike than different no matter what age.

08 Dec 2009
There is a Do Not Resuscitate (DNR) sign on the door to Dad's apartment. How do we arrogantly decide to place such sign on some other beings door? Well, it actually was a discussion that my family had for years around the kitchen table, but more so with a joking attitude. 'Just stuff me and prop me in the corner when I am dead', 'use me for a coat rack', 'feed me to the buzzards', or some such way to mitigate the depth of hurt and aloneness that comes from facing death. It is best to make your own DNR, but most often your brain is not in the place to do this and it is in the hands of others who perhaps have or have not searched their souls.

With Dad's internist, we sat down and talked about emergency treatment. He was in agreement two years ago about the DNR and we have not revisited it again. I find it a comfort. I wonder if Dad thinks of it that way? Mom had a DNR, but it got in the way when she had to go to surgery to repair a broken hip. The DNR gets 'suspended' during the procedure and then you have to decide when to re-activate it. Once again, the medical personnel need clear direction and even if you think all is decided, often the unexpected happens.

I have to look at these matters philosophically and perhaps with some of the humor of my family, because it can just be too much otherwise. I can understand why families argue about these matters and replay the decisions for years after. The phrase that Mom used, 'you can only do your best'...seems to fit. You cannot do what you would have last year or know what you would at peace that you did your best. Life is about not being perfect, but being and doing.

09 Dec 2009
I haven't told you yet about the team of people that it takes to accomplish this feat! This might be another limitation which good intended children find impossible to solve and there by resort to rest home care. It takes dealing with people on a team and meeting all of their needs first before Dad's needs are met.

I clearly have the information being a physician and the management skills to organize my father's care plan. But the real energy drain is the day to day tending, even with the daycare three times a week and the 'meals on wheels'. There are two more levels to Dad's caregivers. The second level person does all of the over site for property management, shopping, organizing the schedule for the direct service person and giving Dad direct care when vacations, school days and other time off is requested. Second echelon provider must also be very savvy about when I need to be consulted. If I get called everyday about this or that while I am in the ER working, the program would fail. This takes about three hours a day and includes doing laundry.

The woman who is the direct live in was recruited for her skills, educational needs and housing needs. Now that we have worked this program for over a year, I think this position could have a variety of people who would be successful here. We at first thought that this person needed to be young and in a healthcare program. I guess I hoped that the personal care educational component would be a huge draw, but perhaps the housing provided in this economy is the best feature. Dad has a 25 year old female who just finished her CNA certification. She helps him shower once a week, gets breakfast daily, lunch 3 times a week, helps him on and off the daycare bus 3 times a week, heats up dinner each night, cleans the apartment and provides front line over site to report any problems developing.

Perhaps you can already perceive that this position has more to do with patience, consistency, perception and honor than good clinical skills. We are learning as we go.

10 Dec 2009
I believe that healthy elder care has more to do with feelings and perceptions then thoughts. Including animals is important for this reason. My Dad had a dog, I think, when he was young and a horse in New Guinea during WWII.

The energy of pets and the animals outdoors is very special. We have three out door cats which he does not care for and that is OK. The cats perceive that he does not want them in his space and give him a wide birth. The two Aussies on the other hand don't take that time to sense a welcome or not and just barge right on into his space licking and sniffing. He does not have time to push back their greetings and this usually makes him laugh. The dogs are not as finicky as the cats. You can be having a blue day, maybe smelly, maybe gassy and they probably love you all the more.

The out door animals are entertaining from afar. Dad will sit out on the porch and count the two horses over and over...1-Black, 1-White. He watches them at the watering trough and galloping in the fields. The hawk flies high overhead, many muschovie ducks swoop the ponds, red fox darts at sundown, tree frogs sing high and bullfrogs sing low with the animal out door parade. If you close your eyes, you can feel their energy...Dad and I have done this on his big porch.

11 Dec 2009
Now here is one that I have to kick myself for...elder vision. After a few months of good food, less toxins, shoes that fit, and proper skin hydration, we noticed gradual and consistent improvement in mood, balance and performance in general. As I escorted Dad to his internist, we made sure his ear canals were clear and his eye health was good (examination of the interior of the eye). I knew he had selective hearing especially when he was asked to do something that he did not like to put his pajamas on. But when I would whisper, 'do you want some ice cream?', he would always hear me.

I made sure that his glasses were clean and then one day he sat on them and both lenses popped out. Eeegads! Frames were all bent. I knew his vision was bad because mine is 20/400. And to think of it...I believe that he has had these same glasses for at least 10 years or so. Well, I guess it was time for a try with a refractive exam. I really didn't know how much the optometrist would be able to do with him.

The eye doctor asked him to read the top line with the instrument set on his old script. He could only read the E. We looked at each other and I thought he was spoofing us. Well, it was true. His eye care had been neglected for years and probably was the cause of many of his falls in their yard in Michigan. He loves his new specs. And when we drive he says, 'cow, bird, tree'... and reads signs instead of just saying 'oh, look at all the green!'

12 Dec 2009
I believe it is time to talk about the providers for Dad and focus on how we need to take care of ourselves in order to be able to be care givers. There is a lot being written now about 'care givers fatigue' in treatment of emotional illness. I use a lot of physical medical analogies to conceptualize my ideas about our psychic selves because the issues are clearly parallel. If I am working my body by shoveling dirt I can easily cause a sprain with using poorly prepared muscles and/or I can just over use them and get tired with lactic acid build up and need to rest to recover (the miracle of recovery is a book itself).

Emotional exhaustion and injury happens just the same. We can be ill prepared and shocked or just get darn tired of what we are doing. As a treatment team, we need to honor the work and importance of each of our roles in Dad's trio of providers. We are interdependent much like my team of providers in the emergency room. All working together provide the desired out come. We must think this to be true, not being resentful or harboring ill wishes or they will be manifest in the quality of care provided. Think about how sensitive a baby is to the energy of the person holding her. We often wonder what is making them cry, but I believe that they can perceive the energy of their environments and that my Father is the same. Neither can speak of it though.

So, as a team, we make/take extra care to honor our requests for time off be it planned or just when 'we have had too much today!'. We listen, although we might not be able to change anything when someone needs to talk something out. We continue to self examine our motives for doing this work and understand that we are all on a life growth path such that we possibly might change our minds and need to stop. Thus, we honor our free will in this endeavor. As much as possible, we address all of the self-care issues in mind-body-spiritual needs knowing that we all meet our needs in a variety of ways, which work for us individually. And for today it is good, but like monetary investments, the today does not predict the future.

13 Dec 2009
Just when we thought that we had Dad's environment perfect we found something to improve it. In the design of his apartment, I took effort to place windows on all sides to help with using the sun in maintaining orientation. The loss of the sun as a daytime guide and also to effect of reducing orientation can quickly lead to conditions called 'sundowning'. The aged and actually all ages are highly affected by changes and reduction in total sunlight and the schedule of light in general. (we have a gland in our brain called the pineal which causes this)

When working the night shift in the emergency, I would wear sunglasses driving home at 0700 so that I would be able to sleep upon arrival. And likewise, I would use a full spectrum lamp for about 30 minutes upon awaking no matter what time of day I awoke. We can shift our sleep cycles by about one hour a day by just sleeping in each morning. All of this sleep information is important, because many of our hormones that come from the central area of our brain are regulated by our sleep/wake cycle and the actual amount of quality sleep that we get.

So, as the daytime got shorter this past fall, we put a full spectrum 'natural light' in the room where dad stays the most watching TV. After about a week, we noticed that he was calmer and more easily directable. This was another small change, but each thing that we can do to 'tweak' his condition has considerable impact on the fragile balance of a 96 year old. I am further impressed at the importance of daily schedule, balance, sunlight, exercise, peaceful thought/prayer and good nutrition has on us all.

14 Dec 2009
I think I need to write about Dad's providers with regard to their internal motivations for becoming caregivers. So, I realize that this is both conscious and unconscious material, but in our work together some of the unconscious is revealed.

I am the daughter. I made a promise to Mother to care for Dad and I think that allowed her to pass with a measure of peace. She had been a caregiver for Dad throughout most of their 64-year marriage. He was the income provider, managed car care, out door work and some house work. Mom did everything else. They had an arrangement that I would not have chosen, but needed to honor. It is the same with my relationship with my Father now. I make all of the 'big' decisions. He has a pension and Social Security. I do not have to do this work, but I honor and appreciate the life he gave me...and so it is. He is not and has not been perfect, as I am not and have not been perfect...we are much alike. I can put aside the issues that cannot change and focus on the positive. The energy is not wasted if we focus on what can be better and let go of the negative. This is an opportunity for me to grow.

The woman who supervises his care is learning about her relationship with her mother and what the future might hold. She is amazed with the improvements in Dad and what is really possible with good care. She is a 'feeder' type of person and has raised a daughter so that she understands the behavior of a 2 year old. She enjoys a challenge and is learning to establish good boundaries. Her personal growth parallels mine.

The 25 year old woman who lives in Dad's apartment with him was interested in being a nurse when she moved in almost a year ago. Now she is talking more about pursuing the ministry and sees the many ways that people can change when we least expect it. The youthful energy is a good balance with his. She is learning patience as well. Just the other day, she took an opportunity of exasperation to ask Dad what was his religious beliefs and practice. This changed the focus of the interaction, created positive atmosphere and build a communication bridge of caring with Dad.

How can three people plus Dad all be growing at the same time? We are all attempting as best possible to support each other, knowing that today is all we have. What a blessing. Tomorrow will be different.

15 Dec 2009
Today I will share the worst day in the past 2 years. Be glad that I did not take pictures and know that this is in an effort to teach about the need for constant monitoring/balance/routine in elder care.

We had noticed that Dad's feet/ankles were swelling some with the right being more than the left. We had been supplementing him with protein bars and in hind site, they had too much sodium. I was thinking about some possible obstruction in his right lower quadrant and goodness knows that he could have had a bit of congestive heart failure, but his lungs stayed clear. We decided to give him some prune juice on a Saturday night. Sunday was hell zone and I was at work. His bowels started moving and did not stop for 12 hours.

His live in woman, Emily, was at church for the day and away as she needed on Sundays. This left Loree to deal with the 'situation'. As soon as he got off the toilet, he would need to get right back on. He needed a full body shower at least 4 times that day and every time he was showered it stimulated another round of diarrhea. He was not in pain, but I was worried that he would be getting fluid imbalance with all of the stools. Loree was calling me about every 30 minutes and I could tell that she was ready to walk out. I was trying to listen and decided if he needed to go to the emergency, because I did not know the cause of the diarrhea. Then she called and said that he had passed 'something' the size of a small child and I said 'save it'. Indeed, he had had an obstruction and all of the stool was trying to move it through...well it worked.

Loree was an emotional mess with such a day and needed immediate relief. I brought two nursing aids with me to supervise Dad through the night. I listened again to the horror stories of the day. Well, we learned not to feed protein bars, make a record of stools passed, have back up home aids that can come in an emergency, and prevention is always best.

16 Dec 2009
Well, this was a day that I did not put in my outline for the 21 Dad days. Dad died 2 hours ago. Emily called us saying that Dad was sick and indeed he was diaphoretic and basically unresponsive. He would/could not follow commands or withdrawal from pain. I thought he was near death, but we called 911 anyway...remember he had a DNR. They took him down the stairs where he hit the 37 degree air and became conscious. He was actually talking as he arrived in the ER and complaining of pain in his thighs. Shortly thereafter, his heart rate fell to the 30's and he became unresponsive. We were at his side...he was not in pain long. The ER staff where appreciative, I think, about how well we had thought through his needs even in these last moments. The physician commented about Dad's 'team of women' a kind way.

I called my brother and reminded him that he was planning on writing the obituary. He said, 'Sis, I really did not want to write it before now because it might have been bad luck.' I agreed.

Just last night, I sat with Dad at dinner and asked him if there was anything that he needed and he shook his head no. I put some Vicks on his feet with fresh socks and new slippers that I did not keep until Christmas. I took the new slippers off his feet at the hospital.

17 Dec 2009
After the events of yesterday I have to emphasize the importance of preparation. We had a hell of an experience when Mom died in the hospital 2 years ago. It was emotionally intense and then there was all of the decision making about funeral homes/cremation issues, a huge mess. Mom had prepaid their cremation and burial, but she now was not in Michigan and many factors were not considered.

Well, for Dad I did not want the same confusion, so as I accepted responsibility for him and went to the funeral home to discuss all of the possible scenarios with care plans in place. This took about 2 hours of prep time. Yesterday went very smoothly. I could take time for my feelings of loosing Dad and not be forced into cognitive energy. The funeral home arranges all of the issues. All I needed to do was some final tweaking in deciding about resting him in Arlington or locally in the state cemetery.

My final point today is not to take all of the responsibility yourself. Often, one of the children, the female, will be the care giver and orchestrate the care. This is fine if everyone is supportive and encouraging for this person. One has to agree to their work. No decision is without alternatives and it is OK to question, change your mind and even say when you have had enough. The care team will benefit from everyone doing what they want to do and not what they feel they have to do. I have been so blessed in this process of parent care. That segment of my life ended yesterday and I appreciate the growth that it has offered me. In no other way could I have addressed my personal dynamics without this process. I needed to walk the walk myself. What do you need to do for yourself?

18 Dec 2009
I am thinking about finishing up these 21 days with a few of the most salient issues of Dad's care. Let's consider exposure to toxins in our lives. Consider toxins that we inhale, ingest, see, hear and absorb through our skin. It is hard to consider all of these in a couple of paragraphs, but this will heighten your consciousness and that is the desired outcome.

Cleaning products need to be 'natural' especially when used around babies (developing brains) and elders (vulnerable brains due to atrophy). If you feel nauseated or irritable after cleaning then look at what you have just used. I will not name products here. You must read and experiment with what works best for your home. If you have 'bugs' like ants, then use a trap type of bait and handle it with gloves. Spraying toxins will contaminate you. If something kills a bug, then it will be toxic to your neurological system and possibly other organs. The effects may take a life time to accumulate so start now to clean up.

Be aware of the smells of different departments as you shop. Petroleum products seep into the air in auto departments, carpet stores, cleaning isles and will often give headaches and/or nasal congestion. You can call these reactions allergies if you want and take anti-histamines which will hide your bodies' ability to warn you to avoid the agents. It is better to clean up your environment.

In a nut shell...'try not to fool mother nature'...we are made with divine plan in a wonderfully integrated organization to continually clean our systems. Live well. Think about what you are doing.

19 Dec 2009
I will try to present a fairly radical idea in a conservative way so that you will be able at least to read and consider the implication in your life. Much of health care is based on the doing aspect and not the being aspect of life. Early in my medical training, the first 10 years...I was intent on knowing the correct diagnosis and letting the care be driven then by traditional therapeutics. These decisions are more about an external and expensive approach to care. It is what I will call body medicine. As a psychiatrist, I saw the mind as the bridge or transition to the core of the person, which I will call spirit medicine. And spirit medicine is more about the being and very inexpensive. Again, after practicing 25 years, I have evolved a blended approach to care that is more intuitive and integrative of these concepts.

The energy or spirit that Dad had each day helped us decide if we needed to make a change in any of his care. We would look at him to perceive his vitality and then confirm things like..'is his urine a good color? Or are there any complaints?' His connection with others who honored him increased his energy. I would make every attempt to address my personal issues, before tending to him so that I would not bring him down and he would benefit from the interaction.

Now...consider this in your life. Are the groups and family that you live with feeding you energetically or bringing you down? Our affiliations can make us sick or sustain our well life. In caring for family, there are often conflicts about control and decision-making. I was lucky, because my brother honored my offer to manage Dad in these last years and continually thanked me for my work.
Elder care can easily become a war zone where unresolved issues are fought, but it does not have to be if one approaches it with good energy. Choose your groups wisely and shape your family energy as best you can. You are to be honored in your work.

20 Dec 2009
Medical care has changed in the past 2 decades. My family had general practitioner who delivered my brother and me, treated Mom and Dad, did my tonsils and pediatrics. We trusted him and he understood all of our medical needs. Today we all need trusted eyes and ears to attend us when we go for medical care. I went with my Father, of course, due to his age, but also because of how complicated even the access to care has become. A medical escort does not need to know medicine, but should be able to take good notes and probably not be a relative. The dynamics of relatives in just escorting or actual decision making can often complicate the process.

So, in addition, to an escort, a medical team of people who can act as consultants would be ideal. If these people could be retired physicians or nurses and serve as a medical 'forum'...this could all be done virtually on line as well. I am thinking of how often my work team in the ER openly discusses medical issues so that they can gain the perspective of a variety of opinions. This has been a huge plus with Dad's journey. I have friends who work Hospice and had already 'lost' their parents so that I felt supported in my daily decisions. These are the healthy networks that I have referenced and are not available to most non-medical people.

This is the medical care necessary for healthy longevity for 2010 and beyond. The ideal resource would provide a ready access to reliable information, care plans for maintenance of health and change plans for recovery items, a network of supporters who hopefully are also walking a health-walk, volunteer escorts for all appointments and a team of medical consultants or 'medical forum' to assist in the decision making. This sounds like a cultural change and it is about time, we need it yesterday!

21 Dec 2009
It seems fitting to end the 21 days with what is actually the beginning of a new way to approach health. As you have been reading over the past year and especially these past 21 days including Dad's death on day 16, we have been providing a culturally innovative approach to healthcare. I would call it a 'Delta Code of Care'. Dad has helped us to test it, indeed he taught us and made us believers.

The Delta Code of Care is an ever-present mindfulness about what we are doing and why we are doing it. It is being always in the moment and responsible for the now. It is showing patience and honor for our mind/body/spirits and not looking for a quick fix by pharmacology to reverse years of bad habits. It is being conservative...speaking less, listening more, thinking green, planning for the future, having a back up plan, seeking healthy community, demanding quality in food and water, recycling, showing respect for all life, seeing the good in people before the bad, judging less and believing that what we do and who we are makes a difference in this world.

I know these things to be true. I started Delta Health Foundation a decade ago with inheritance from Dad's sister Roberta Hendra. She needed this type of help and never got it. Well, the Delta Code of Care is birthed and proven. We will continue to refine these concepts to assist in the provision of excellent healthcare for all. Thank you in peace.

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