Road Trip!

Have you ever wanted to jump in the car and keep on driving? Just gas it up and go...
Then you find yourself in the middle of traffic, defensively watching for rude and distracted drivers, finding nothing but commercials on your favorite radio station, and realize you forgot snacks and your sun glasses. Ugh! Forget it, just focus on what needs to be done and do it.

It's been 9 months since my last post. My mother has moved in with friends and seems to be looking forward to the first independence from caregiving in over a decade. While she was an RN for 57 years, caring for someone 24/7 without appreciation, a break or compensation is different on so many levels. I know because I got a taste of it. Now I'm trying to pick up where I left off before my mothers illness 20 months ago and I get it. I think people have sympathy for what you go through, but unless they have had a disrupted life, --something that turns your world upside down for an extended period of time, they don't get it.


Construction and Detours: Google insisted on backing up my pictures today. I decided to pick my battles and just went with it. There were so many forgotten pictures of my Grandmother it was like she was saying "don't forget about me!" In a few days it will be the first anniversary of my Grandmothers death and we have unfinished business. We still need to deliver her ashes to the mausoleum next to my Grandfather. She paid for it years ago and even had her name inscribed.  This is on our priority list and may be a reason why I haven't found work yet. Detours in life are tricky and sometimes it means you can't get in the fast lane until the road work (journey) is completed.

Toll Roads and Flat Tires: You may not notice the world changing if you have been in a slow lane for awhile. I've spent the past several months explaining to perspective recruiters and employers why I've been out of work (a traditional job) for the past 2 years. Dealing with a family situation seems to be more "acceptable" than in the past, which is good. The bad part is that there is a price you pay for being in that slow lane. Everything is electronic now and unless you can get a recruiter to read your cover letter, get a face-to-face at a job fair, or find an active network that has more than just unemployed people attending, your kind of stuck. If you are rusty, get the symbolic jack and tire iron out and fix it. It would be so easy to start a rant on this topic. Re-entering the workforce after an extended leave is unfamiliar, uncomfortable and a steep uphill road, but I'm hopeful it won't be impossible (with encouragement and guidance). ~Working through this now.

Scenic Vistas and Rest Stops: This seems to be a turning point. My parents are in their golden years and are fragile. Being an unexpected caregiver or advocate will test your leadership, patience, endurance and financial limits. What I have learned is that you need a balance. Balance so that your passions don't become drudgery and so that you can recharge mentally, physically and spiritually. Take a step back to enjoy the view even if it is just for a few minutes.

Neglect Your Garden - Get Weeds...Or Do You?

Its been a very long time since my last post. It was important for me to take a break to gather my thoughts and determine next steps. I was coming up on a 12 month deadline to take a Project Management Professional certification test, so I restudied and passed the exam. I spent 8 months looking for work and became very frustrated with the whole job search and interview process in California. Being laid off no longer has the stigmatizm it once had, but a 24 month job gap is very challenging to explain if you can get past the online application systems. Once you are able to explain you needed time off to take care of family, it is understood. *Don't give too many details, and make sure to emphasize that all is good now and promise there won't be future disruptions. Don't be shocked. I was asked and advised. 








I recently returned to our empty house in the Dallas area since our renter situation didn't work out. As luck would have it, Texas is successfully recruiting large companies to relocate their headquarters which is creating a thriving economic situation. More to come on my job search journey...post caregiver assignment.
  
I started addressing the weeds in my former garden this morning after 2 years of neglect. They were so tight it was hard to get the shovel in to loosen things up. My husband suggested I spray everything with weed killer to make things easier. I'm not known for doing things the easy way and I don't like to put chemicals in my vegetable and flower beds. To my surprise, in between the pig weed, dandelions, wild grass and every other weed type known in the continental US, I found hundreds of baby carrots! The dirt had worms and the beds were hosting hundreds of ladybugs. It was like everything was waiting for me.



Today life isn't quite the same, but there are remnants of some of the good things that were left behind. I still had to do the work of turning over the dirt in order to discover multiplied treasures. Weed killer might have been fast but so much would have been missed. Sometimes what seems like neglect is just a recovery period. Don't be out of the game so long that the weeds get the upper hand. Take just enough time gain the strength to move on. What do you like to do with carrots??

90 Years Young

2 Jan '55
Dead Mans Point
(Apple Valley Desert)
A cowboy?

Happy Birthday Dad!

My father had his 90th birthday this week. Born in the Netherlands, he is the third oldest of 10 children. In his amazing life, he coped with heartache, disappointment and pain; reached goals of achievement in the midst of impossible odds; learned that discipline and self-sacrifice brings reward; and has found contentment and happiness in his old age. He said that he wouldn't change a thing! 
My father had a work-hard, play-hard philosophy. He was very athletic and enjoyed being outdoors. I'm talking in the past tense because today he has arthritis that has forced him to limit his activity. He was an avid skier, hiker and camper. After injuring his hand in a factory accident in the 1950's, he started his own landscaping business and worked 11 hour days, 6 days a week. I vividly remember the smell of his work truck - cut grass, tobacco and perspiration. As a child, I would love seeing him drive up at the end of the day so I could tell him about everything that happened. He never said he was tired or that his back hurt.   

Sept 1951

Sept 1953
Hospitalized after losing 2 fingers

If my dad had a vice, it was smoking. He started at 16 and didn't successfully quit until he was in his 80's. If you notice, he is smoking in several of these pictures. He attempted to quit several times, and said that it was an extremely difficult addiction. Because of this conversation, I never smoked. I figured that I lacked the self-discipline to stop, so it was better never to start!

1977 - Took my drivers test in this beauty

When we have our youth and health, we rarely think about the effects our actions, environment or culture will have in our later years. You can't always count on genetics to cancel out our bad decisions. Dad appreciates the "good stock" that he inherited. Stirring pesticides with unprotected hands (long term effects were secret or unknown in those days), smoking non-filter cigarettes for 70-something years (given free in the military mess kits in the WWII era), working in the sun without protection, and years of physical labor can take a toll on our physical bodies. What are you doing in your remarkable life today that will impact your health (good or bad) tomorrow?  

90 years young - June 23, 2015

Happy Birthday Dad!

Healthcare Today; Maybe Tomorrow

The 2015 Internet Trend report by Mary Meeker came out last week. For those that don't like numbers, I submit the loch ness monster for your entertainment. The California draught has him beached at the moment which is probably where, as consumers of healthcare, we are headed. This post may be a little dry (no pun intended), or you may ask yourself "tell me something I don't know," but here is the hard data that tells us we need to prepare to pay more for our healthcare and it's going to be harder to know what coverage we actually have. There is no magic pill to make it better, so don't expect a sugar coating.

The 2015 Internet Trend is a broad based report that provides the data behind technology trends.  Kleinerperkins did a fantastic job. I was surprised to find data about the healthcare industry, but the presentation points to technological opportunity in this area to provide more of an 'automated' and 'fun' interaction to manage and prevent chronic disease. This might work with people that understand and use technology, and have time before they are ill, but what about the elderly that don't understand or trust technology and aren't connected today?

First the numbers --

http://www.slideshare.net/fullscreen/kleinerperkins/internet-trends-v1/109

The Babyboomers were born between 1946-1964. The 'boom' refers to the fact that there was a surge in new born children during this time frame associated to men returning from war and ultimately starting their families. After 1964, the surge leveled out and even declined. The average size of a US household today is 2.5 people. I don't know how you get half a person <snicker>. The obvious is that the Boomer generation is now leaving the traditional workforce. Many US social programs like Social Security, Medicare, unemployment, and disability insurance (among others) were implemented during this time frame and were based on the premise that there will always be the right proportion of working people paying into these social programs to sustain them and then collect the benefits when needed, I.E. retirement, disability etc . With fewer people paying into the system, and more people qualifying to receive benefits, the 'money pool', like the California reservoirs, is growing smaller. (tell us something we don't know) News flash: The data above confirms that as of 2015 Boomers are no longer the key contributors to the system.

http://www.slideshare.net/fullscreen/kleinerperkins/internet-trends-v1/103

The data above is specific to social insurance benefits, but I think there is a logical relationship between a certain age demographic no longer working and the number of government benefit recipients rising. 

This week I had a conversation with someone originally from the UK. He said that many European countries adopted social medicine after WWII because so many were in need of medical care. If everyone didn't pitch in to contribute to healing their population, there wouldn't be enough healthy people to rebuild. I think Americans are lagging with this understanding and aren't used to personally contributing to their health insurance.  Complaints about Obamacare are starting to get louder because we are starting to see the increased cost to cover the uninsured segment of our population.

http://www.slideshare.net/fullscreen/kleinerperkins/internet-trends-v1/102

Employers are asking their employees to contribute more toward the cost of health insurance. The data in the graph above supports this. This trend will continue because it is written into the Affordable Healthcare Act. Hang-in and continue reading...

So let's review: Less people are paying into the social insurance system, more people are entitled to social insurance benefits, employers are contributing less, while employees are asked to contribute more.  Still haven't heard anything new? What about the 2018 Cadillac Tax?

http://www.slideshare.net/fullscreen/kleinerperkins/internet-trends-v1/185

I had to look this one up because it was new to me. Just a few articles from April 2015:

Politico: Cadillac Tax the next big Obamacare battle

"At issue is a 40 percent excise tax on the health benefits companies provide their workers above a certain threshold. In 2018, the tax will hit insurance and related perks valued at more than $10,200 for singles and $27,500 for families. So for family benefits worth $30,000, the tax would apply to the $2,500 that’s above the limit."
Forbes: Obamacare 40% Cadillac Tax Hits No Frills Plans Too
"Across the board, the Cadillac tax puts pressure on employers to offer less-generous health insurance plans."

There are so many conversations about this, I must have been living under a rock. To be honest, when I was getting corporate insurance, I naively assumed social benefits didn't impact me, so meh?

The message of the 2015 Internet Trends report is not to set off bells and whistles about the direction of health care in the US. There are plenty of other dedicated sources that are doing this intentionally. I'm using it as a reference source because of the compelling evidence provided by an organization without bias in the healthcare arena. To circle back to my original point about the elderly and their families that are struggling to navigate the complexity of health benefits, we are going to need more than a tool to remind us that we need to take more steps during the day. The data we have today says Medicare will be bankrupt in 2030. I bet this will be accelerated as we put more pressure on the consumer/employee/citizen to buy expensive coverage and lower the entitlement requirements. Let's be honest, it's election season and this should be a platform line-item. No politician wants to be known for hanging the needy out to dry.

http://www.slideshare.net/fullscreen/kleinerperkins/internet-trends-v1/186

Healthcare, home-health, caregiving, medication, chronic illness, a large chunk of our population receiving benefits rather than paying into the system, cost of developing sophisticated technology are things we all need. Why are we trying to reinvent the wheel? Shouldn't we be looking at the countries that have figured this out? 

Move it, Move it

What is all the fuss about staying active? 

If you search Physical Health on the internet, you get about 868,000,000 results in .26 seconds. It seems that everyone has something to say about it. Being active can help prevent or lessen chronic health problems such as heart disease, diabetes or arthritis. There is also evidence that exercise improves brain function as we age. There are four exercise categories that work together to improve overall quality of life: endurance, strength, balance and flexibility. (NIH) This gives a whole new meaning to 'use it, or lose it!'

It is amazing how fast we can lose it if we don't use it. After five weeks in the hospital, my mother was moved to a skilled nursing center for wound care and physical and occupational therapy. Physical therapy focuses on the four categories of endurance, strength, balance and flexibility, where occupational therapy focuses on mental and mechanical coordination like sitting up, dressing in the proper order, combing your hair, eating etc.  Before her illness, she could do moderate to high physically demanding work; yard work, house work, moving furniture, washing windows, climbing ladders, trimming, painting, hanging wallpaper. There wasn't much she asked for help with. Not bad for a 78 year old. When she arrived at the skilled nursing center she could not walk, go to the bathroom, or sit up in bed on her own. The physical therapy sessions were emotionally draining. The first time she put full weight on her legs she cried. I had never seen my mother so weak, and paralyzed with fear and anxiety. She was so willing to give up, but the physical therapists coached, pushed and encouraged her every step of the way. There wasn't a physical reason why she couldn't gain her mobility back.   

Mom on her daily walk

The physical therapists explained that for every day we are in bed (with a cold or whatever), it takes 2.5 days to physically regain our strength. Muscle atrophy starts to set in that fast. Muscle recovery takes even longer for someone over 65. So if you do the math under the best of circumstances...she was hospitalized for 87.5 days. That requires about 219 days to recover... that is without any other complication like a massive incision or battles with infection! The therapists gave her a goal in order to go home. She had to walk 100 feet with a walker. Goals can be a powerful motivator. She came home after three and a half months. She still wasn't able to lift her legs into bed, needed a wheelchair/walker to get around and needed assistance with showering and dressing. Regaining her strength accelerated when she was able to sleep uninterrupted, had a better diet (high protein) and continued her exercise routine. Her will had returned and a little over a month later, she climbed the stairs on Christmas day. 

Notice we are talking about physical activity not necessarily getting 'fit.' Muscle loss in the elderly is called sarcopenia. It starts in our 40's and 50's and progresses at .6%  each year. Adults in the US over the age of 50, participating in resistance exercise is very low (NCBI). According to the US Center for Disease Control and Prevention,  adults 65 years and older require a minimum of two and half hours of moderate aerobic exercise and muscle strengthening exercises each week. Preferably, broken down into 30 minute increments each day. If you think you can't afford that commitment, you can still benefit in three 10 minute intervals. Increasing that to five hours each week will increase the benefits even more. How many of us spend more time than this on the phone, watching television or just sitting quietly?

I had three different conversations with people this week that went something like this: 

"if he/she was living such a healthy lifestyle and still got sick, what is the incentive to work so hard at it if you are still going to get disease?" 

Some of it is genetics, but I'm going to steal the explanation from one of my mothers doctors. "If you didn't take such good care of yourself, you wouldn't be here at all." Bad stuff is going to happen. If you can prevent or lessen the impact of chronic disease, why wouldn't you?  

History is making a case that extreme lifestyles are not good for us. Our great-grandparents were pre-industrial age and wore themselves out in their 40's. Life-expectancy wasn't so good. Fast forward to the technology age and this is the first time medical experts are predicting that children will not live as long as their parents because of sedentary lifestyles. Genetics will only get us so far. We need the pendulum to swing back to center to a work-life balance. I know that term is way over-used, but firmly believe there is truth in this. I was working 16-18 hour days sitting at a desk in a high stress position. Some days I would only walk about 1400 steps (10,000 is the recommended minimum) and that was mostly due to the fact that I had to walk to and from the parking lot. I had trouble standing, sleeping, my balance was off and had become an unhealthy weight. I was going down a path of self destruction and needed to set some boundaries around personal time and dedicate a commitment to my own health. While others around you can help, you have to do the work.

Physical activity is the basis of physical and mental well-being, especially as we age. It has to become part of our life-style. Check out some of the reference site links in this discussion. You don't have to hire a personal trainer. You don't have to dedicate large chunks of time. Just find something you enjoy that gets you and your family off the couch, or out from in front of the computer.  

Here is a motivating song to put a pep in your step. I love the Madagascar series and made this my theme song the first time I heard it...love the dancing granny. ;-)

https://www.youtube.com/watch?v=z0qkUIFEtXM

The Golden Rule

Have you ever had an epic, turning-point week? Maybe you passed a big test, had an important doctor's appointment, received good news about a job interview, or someone came home safely after a long journey. Our family had all of these things happen!

I think the most inspiring conversation that happened this week was with my mother's surgeon. She had her sixth month assessment to determine if she was ready to have the second phase surgery to have the ostomy reversed. The doctor didn't recognize her. The last time she had been to see him, she was in a wheelchair and honestly looked pretty rough. She was told to gain weight and work on getting her strength back. He made it very clear that she wouldn't have the second surgery if she wasn't, at least, as strong as she was before her illness. When she came home, I had to lift her in and out of bed, help her dress, prepare her food, dispense her medicine and assist with basic hygiene needs. Today she does almost everything on her own. We've returned the wheelchair and she takes her dog on a walk at least once a day. Because she had worked so hard, it was a little disheartening that the doctor had to leave the room to read her history to continue our discussion. This appointment was the single goal my mother had for the past 7 months. It was her first thought in the morning and the last thought before she fell asleep. ~He returned after only a few minutes and said, "now I remember you!" He recalled many of the horrible details of being in the ICU for 3 weeks. That is when he told us about the Golden Rule.

"So in everything, do to others what you would have them do to you..."     Matt 7:12

I think it is important to understand a doctor's mindset and his philosophy about having someone's life in their hands. Is it a speed competition or does he see himself and his patient as being one? He proceeded to tell us that his peers often criticize him for being so slow with his surgeries. He said he doesn't care what they think, because of the Golden Rule. And, if they are going to give him such hard time, they need to get it right. He isn't slow, he is thorough. His anxiety, confidence, and success are his patients anxiety, confidence and success. He was once asked if he could operate on his child and he said "yes, because I have the same approach with everyone. There isn't anything I would do different for my child than what I would do for one of my patients." This boils down to trust.

He was open and honest about the complexity of the surgery and discussed potential complications with a backup plan if any problem became a reality.  We didn't feel rushed, we had our questions answered in detail and walked out satisfied that we found the right person to do this. We see him as a person, a partner, not just the surgeon that was on-call.

I think the take-away from this is, do you trust your doctor? Do they follow the Golden Rule? It is critical to have this Golden relationship with your doctor, your caregiver, your financial advisor. Don't settle for anything less.

Have a Remarkable Day

I think about losing all of my precious friends and family and it makes me think of how hard it would be to live in this world under those conditions. I was reminded of a letter of thanksgiving I had posted on my FB page last October. My mother was finally well enough to be asked how to respond to my Grandmother's delusions and depression. She told me that she gathers a bunch of mail (mostly advertisements and cooking magazines) and has her open it with a cup of tea and a couple of cookies. This seemed to help. I had been throwing out the mountains of junk mail and election advertisements in anticipation of moving them and didn't have anything for her. So, I reached out to my FB friends and asked if they would take a moment to send her a simple card for her 101st birthday. It didn't matter if she knew them personally or how much the card cost. She was overwhelmed with the responses. Every day for several weeks she received well wishes. After awhile, I had to lock the front yard gate because she was going to the mailbox on her own checking for mail and I was worried she would fall on the loose gravel. These acts of kindness brought her hours of joy. These wonderful friends of mine also remembered her on Halloween, Thanksgiving and Christmas. She was an adopted Grandmother of my friends and their friends.

Thought for the day:  Can I take a few minutes to reach out to someone that needs an ear to listen, a shoulder to cry on or a smile to get them though a difficult time? Celebrating is easy, but lifting someone up when they need it is remarkable.

Open letter to family, friends and friends-of-friends...
 

Thanks to all of you that sent my Grandmother the heart-felt birthday wishes. It really made a difference in her spirit. For the past month, I have been packing my mother's belongings (trust me, she doesn't have the word down-size in her vocabulary) so that we can move both of them in with my husband and I. I think for someone that is completely dependent on the familiarity and routine of her environment and the caregivers that surround her, my Grandmother is probably suffering from the changes in her life as much as my mom is.

~A special shout out to Cathy. Caregiving is a special calling. You have my admiration.

~An over achievers award goes to my cousin Lorraine. The 80 something cards and letters from the 1st and 2nd graders at St Hedwig school was genius. The drawings and well wishes are priceless as well as my Grandmothers comments. They are all her personal friends now.

~Andrea, thank you for the royal purple "papoochees" (polish for slippers). They match her tiara. wink emoticon
 

I believe that when we feel we are valued and have loved ones that help dry our tears, give a soft pillow to ease our tired bones, or to take the time out of our busy lives to say hi, it gives a little energy and happiness to that person.

BTW, Grandma participated in the group physical therapy session today at my moms skilled nursing center. She was an inspiration.

These acts of kindness don't take much effort on our part, but make a huge impact on those we touch.

 Thanks again, and have a wonderful weekend.