Sept. 15, 2019 Eldercare Discussion

We discussed eldercare & aging issues including practical and Buddhist approaches to difficult care situations, money management and housing options for frail older adults—e.g., personal care homes and The Green House Project.   

Aging & Elder Care

The main theme of this month’s discussion was how to find suitable supportive housing environments for older persons who have memory or mobility limitations or need help with activities of daily living.  We also discussed how care partners could work amicably with their loved one and other family members to remove obstacles that might prevent the loved one from moving to this new housing.

We briefly discussed Hollander Senior Living—an Atlanta-based privately-owned senior living organization with facilities in Sandy Springs and Monroe, GA.  Per one of our attendees, its Sandy Springs location offers monthly rentals of independent living apartments with meals, transportation and other basic and optional support services for about 83 residents.  There is also a separate residential area with trained staff for assisting residents with impaired memory.  See http://www.hollanderseniorliving.com/.

Another short or long-term option for those who need more assistance and prefer a more home-like environment is a personal care home is a smaller, somewhat less-expensive version of an assisted living residence.  The Azalea House is one such home located on a quiet street in north central DeKalb County near the Northlake Mall.  It provides room, meals, and basic utilities for about 18 older adults.  It also offers onsite assistance with daily tasks—including bathing, dressing, internet and TV access, as well as private and shared bedroom and bathroom options.  See http://www.azaleahousecarehome.com/.

We briefly discussed the Robert Wood Johnson Foundation-supported Green House Project, an evidence-based housing and care concept for the long-term and post-acute care of frail older adults, based on a national network of specially-designed, staffed and managed small living units with private room/baths for 10-12 residents per unit.  Per their website a Green House provides a real home environment with an open kitchen, great room, and easy access to the outdoors. See https://www.thegreenhouseproject.org/

Per WikiPedia:  http://en.wikipedia.org/wiki/Green_House_Project

    The Green House Project is an American national non-profit organization dedicated to creating alternative living environments to traditional nursing home care facilities.

     The project creates “caring homes for meaningful lives” for elders where residents have private rooms and baths, can move freely through the home, build deep knowing relationships with each other more and even participate in preparing their own meals. It is based on a philosophy seeking to reverse the “enforced dependency” of life in a traditional nursing home by creating small intentional communities of 7-10 elders designed to foster late-life development and growth.

     Residents of Green House Project homes have shown “increased reports of mobility and social interaction, and fewer reports of weight loss and depression” compared with those living in traditional nursing home facilities.

In a Green House Project Blog posting of July 10th, 2019 titled Transforming the elder experience, Meg LaPorte included an excerpt from a July 8, 2019 article by Carol Silver Elliott that appeared in the Times of Israelhttps://blog.thegreenhouseproject.org/transforming-the-elder-experience/

    What if we viewed elders as individuals with value and purpose?  What if we stopped, as a society, seeing older adults as “them,” as people who are “less than” and who have little to contribute?  How would that change our perception of older adults and how would that change our view of our own lives as we all, inevitably, age?

    That’s the underlying premise of The Green House Project, an organization that’s been in existence for more than 15 years and whose goal is to transform care of older adults.  Green House was founded by Dr. Bill Thomas, a geriatrician, who realized early in his career that the care we provide for elders can be radically different and radically improved.

    Dr. Thomas began the Eden Alternative, bringing plants and animals into long term care settings, based on a theory that having something to look after and care for would have a positive effect on the residents.  It did. But that was not the full answer. Dr. Thomas developed the concept for Green House and today there are hundreds of Green House homes across the United States and internationally.

    Green House homes are founded on three core values, real home, meaningful life and empowered staff.  Each of these play a role in making the most critical element work—creating a non-institutional, normal environment for elders, an environment that is not “homelike,” rather, it is home.

As of April 2019, there were 284 certified Green House homes in 32 states.   However, there are currently no long-term care Green Houses and only two assisted living Green Houses in Georgia (both in Columbus).  The nearest long-term care Green House to Atlanta is in Birmingham Alabama. To find the nearest Green House to you or your loved one, enter your zip code at https://www.thegreenhouseproject.org/about/find-a-home.

For those who do not live close to a Green House, the next-best option might be to find a very well-designed, staffed and managed personal care home or assisted living residence that has similar characteristics and values.  However, it’s important for care partners to investigate such places carefully, as the credentials for opening and running them are not nearly as substantial as they are for nursing homes, they do not have federal oversight and have so far been inadequately inspected and regulated by the state.  Care partners should also be aware that there is much misleading promotional information on the internet and some individuals and groups that offer low-cost help for finding suitable housing are reimbursed by referrals to a limited number of facilities.  We recommend paying an experienced geriatric case manager (like our DLM Eldercare Group member Debbi Dooley, MS, LPC) to help with this search.  

Lauren Hamilton, a Senior Care Advisor at Senior Provisions was recommended by a participant as someone who could help find available resources to families.  She is based in Gwinnet County and conducts a monthly caregiver support group in Duluth, Georgia that is open to all families.  Per the company’s website, among other services, they assist seniors and families in several Southeastern cities to identify suitable Independent Living, Assisted Living, Personal Care Homes, Dementia & Memory Care, and Home Care,options … that represent the best “care-value” for meeting your needs, budget, and location. https://www.seniorprovisions.com/ 

The Atlanta Journal-Constitution has recently begun The ‘Unprotected’, an excellent newspaper series on their statewide investigation of assisted living residences in Georgia

Senior Care Investigation 

    Investigative reporters for The Atlanta Journal-Constitution spent more than a year digging into records of every assisted living community and large personal care homes in Georgia. 

Unprotected – Broken promises in Georgia’s senior care industry – September 30, 2019 by Carrie Teegardin and Brad Schrade, The Atlanta Journal-Constitution

    Georgia’s regulators and public safety agencies know quite a lot about problems at the state’s private-pay senior care facilities.

    Reports of abuse and unexpected deaths and injuries.  Fire safety violations. Missing dementia patients. Thefts.  Outbreaks of contagious disease. Dirty dining areas.

    But even if you are looking for this information, you might not find it. Families facing the gut-wrenching process of placing a loved one in a personal care or assisted living home in Georgia are up against a tremendous disadvantage: a haphazard system of accountability that gives low priority to transparency and informing the public.

    “We want people to be savvy consumers, and we want their money to last as long as possible, and we want them to have the best quality of life,” said Melanie McNeil, Georgia’s state long-term care ombudsman, whose office advocates for residents. “You can’t make a responsible choice if you do not have the information you need.”

Series Background: AJC investigative team examines thousands of public records (article and video).   https://www.ajc.com/senior-care-quality-report/about/

o  AJC Searchable Database on homes that they studied:  https://www.ajc.com/senior-care-quality-report/

AJC Senior Care Quality Consumer Guidesearching for a senior care facility for an aging loved one https://www.ajc.com/senior-care-quality-report/consumer-guide/

One member  said that Thrivent Financial was a Lutheran nonprofit that could be helpful for some older persons who could use help with financial planning and management.  

Per Wikipedia, Thrivent Financial is a Fortune 500 not-for-profit financial services organization headquartered in Minneapolis, Minnesota, and Appleton, Wisconsin and originally founded to serve Lutherans.  Since June 2013, it also serves non-Lutheran Christians.  As a member-owned fraternal benefit society, it operates under a chapter system, serving nearly 2.3 million members.  Thrivent Financial and its subsidiaries offer financial products and services including life insurance, annuities, mutual funds, disability income insurance, credit union products, money management, brokerage services, retirement planning and more. https://www.thrivent.com/.   See also Wikipedia https://en.wikipedia.org/wiki/Thrivent_Financial  

Another member indicated that a financial audit by a trusted financial services specialist could be useful for frail loved ones having difficulty with managing their bills and finances.  Check with your employer human resources department or credit union for recommendations on such specialists. See also the resources available on the AARP website such as this page:

https://www.aarp.org/caregiving/financial-legal/info-2017/managing-someone-elses-money.html

Managing a Loved One’s Money – What caregivers need to know.  February 27, 2018

If your loved one starts having trouble keeping a checkbook or becomes confused about money, someone must act as money manager. If that someone is you, here’s what you should know….[Topics include: joint accounts, legal issues, financial exploitation, fiduciary help, conflict resolution, tips for discussing money matters with family)

At our February 17, 2019 meeting, a member recommended an elder daily money manager service based in Norcross Georgia for helping aging friends and family who have trouble managing their finances,.  See:  https://yourseniorpartners.com/Senior Partners, info@yourseniorpartners.com, 678-278-8410

We also discussed psychological and spiritual ways to resolve conflicts and disagreements among the care partners in challenging family caregiving situations.   Suggestions included making a collage that represents your understanding of the situation to get your unconscious thoughts down on paper and help identify the source of one’s disturbing emotions.  See WikiPedia https://en.wikipedia.org/wiki/Collage

Another suggestion was to do some Proprioceptive Writing, a method for exploring the mind through writing.  A simple method anyone can learn, PW is a powerful tool that can be used to:

        ~ Focus awareness, dissolve inhibitions, and build self-trust

        ~ Unburden your mind and resolve emotional conflicts

        ~ Connect more deeply with your spiritual self

        ~ Write and speak with strength and clarity

        ~ Awaken your senses and emotions

        ~ Liberate your creative energies

PW is widely recognized as an adjunct to the therapeutic arts, a form of meditation, and a valuable writing tool, both for people wishing to write and for those facing writing blocks.  See: http://pwriting.org/

For proprioceptive writing with a Buddhist perspective, a member recommended at our October 2018 meeting the work of Natalie Goldberg, a teacher at the Upaya Zen Center in Sante Fe, Mexico, and author of fourteen books.  Per Upaya’s website, she has practiced Zen for the last forty years and has taught seminars in writing as a practice.  For links to her programs, writings, and dharma talks, see https://www.upaya.org/people/bio/natalie-goldberg.

The Tibetan Buddhist practice of Tonglen (giving and taking) meditation can be a powerful way to reduce conflicts with one’s care partners.  In this practice, one visualizes taking in the suffering of oneself and of others on the in-breath, and on the out-breath giving recognition, compassion, and succor to all sentient beings.  In doing this practice it helps to think of others—including our enemiesas our children [or mothers].  See https://en.wikipedia.org/wiki/Tonglen

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