So I think I’ve begun a Death Dowry. Like a psychosocial care plan, but with specifics. I will publish it in case my loved ones want to help develop it.

So far—tapioca pudding, Jefferson robe, beach house-St Pete or Clearwater reserved for a month with rooms/suites for all my loved ones to be with me and be having fun. I get an ocean-front room with my hospital bed near the window and a balcony to access. Godiva dark chocolate.

That’s the start . . . something to build on as I endure some of life’s less fun parts. A cognitive activity while proctoring exams, or waiting in lines, or riding the metro. Perhaps once I have my list, I’ll allow myself to remember we are all terminal . . . and if I wear out my robe, there may be another available.

That grace spilled over to her family.  Each of them was as welcoming and accommodating as Cathy.  Things that were done poorly were easily forgiven.  Shoddy care was not ignored by the family, but addressed and forgiven.  When her end-of-life was less than satisfactory, they still showed and spoke a grace that was hard to measure.  It was not a given, they understood where things could have been better, but it was a rising above that really called for thought on my part.

I was put in mind of a Free Methodist lesson that explained the difference between grace in church philosophy.  He described a chasm between  man and God.  Some believe that the chasm is automatically closed by belief in God.  The Free Methodist explained that prevenient grace was in the chasm, but it was not a given that it was automatically going to close the gap.  Man had to ask for the grace to carry him across.   It’s man’s realization of the chasm as well as the presence of God and of Hia grace that results in grace rising to fill in the chasm.  We have free will.

As professional  caregivers we can create many a chasm in our processes.  We have the choice to ignore the chasm and assume the family will understand or not realize; or we can explain our mistakes and ask for their grace.  In the case of Catherine’s family, grace was there for the asking.  That is a powerful message to the roots they’d developed.

Living the smell of roses—a worthwhile aspiration.

As a caregiver, you are very aware of the unique challenges your loved one presents in the face of medication; meals; loss of independence. How is the facility prepared to meet these challenges? Is the nursing staff sufficient? How many hands are available in the evenings, nights, weekends? Is the activity schedule maintained throughout the week?

Too often we, as caregivers, seek placement after months of exhaustion.  We make decisions based on proximity to home; smell; price; an engaging marketer.  If we begin shopping before the need is critical, we can use true alchemy to see if what glitters is indeed gold.

But what really will linger is her grace.  She was one of the few ladies who was gracious with those with memory loss.  She assessed the person with a quick look and then embraced them.  Not a physical embrace but a social acceptance and validation.  And then there are the stories.  Stories of a mom willing to drive the boat for the water skiing children–fast and furious.  Stories of a youth in PA with her brother swimming in the cricks. Wonderful memories of summers at Lake Tahoe . . . she took us to places we’d never been.  She taught us about grace and living life and acceptance of death.   Thank you dear lady—you enriched the lives of everyone who knew you.

My dissertation data collection coupled with helping find Long-Term Care for an elder has left me in a curious position.  I have been a committed proponent of elder healthcare that combines the medical and social model.  Attending body as well as spirit.  The commitment was rooted in two phenomenal work experiences with teams committed to the dual model.  Keep in mind, we didn’t call them by the academic term–medical and social models.  We simply were committed to holistic care at Winter Growth and at Asbury Methodist Village.  Both non-profits had created a team and an environment of care that allowed an elder to thrive, not simply survive.  They have been my banner as I designed my dissertation.

Sadly, as I am exposed to different settings near and far, I am seeing just how rare this commitment is.  As I use a reliable instrument to assess holistic dementia care, I’m seeing just how muddy the water is.  Home-like environments vary and assessment is quite subjective .  Optimal staffing numbers are good, but if staff is not trained to provide more than superior medical care, the quality of life of the elder is seriously compromised.

If I have to choose between long life that has little joy, anticipation, or stimulation or a shorter life with much joy, anticipation or stimulation—-I vote for the latter.  You can put me in the prettiest home-like environment, keep me physically clean and well-doctored, surround me with a bevy of caregivers; but if I am not offered opportunity to play, to contribute, to be integral to the community—-I have a death sentence far worse than a shorter life.

I suspect I’m not alone.  As the later Baby Boomers enter the Long-Term Care market, we’ll expect a far different delivery than what is being offered today.  In fact we are looking for it for our parents now.

He came to us through the labyrinth of university closed doors. Ninety-two years old, Jesse G. wanted to develop a cognitive brain program. He landed on Dr. E’s desk because she has a big heart and hoped to gain future goodwill for research in the assisted living arena. He was a successful business man with a passion to get his peers out of their depression and back into life. By the time our research team met with him, he had formulated an entire program of reminiscence as well as a battery of tests to assess its value. He envisioned starting with 500, we suggested 14.

What we as university representatives had to offer was not what he needed. Our volumes of regulation and preliminary review process would take too long for Jesse. He expressed the desire and need to leave a legacy.

We were able to offer a few student volunteers and a few speakers for his twelve session program: Count Your Blessings, Not Your Toes. He took our advice in protecting the  identification of his participants as well as including a geropsych nurse.  This last was to address any of the fallout that we as academics feared would happen in an unmonitored life review process. Our volunteers helped him apply several standard assessments of cognition, depression, and stress prior to the start of the program.

It was a worrisome day when I met him to share that the university would not be able to conduct research with the project.  But I was able to express the enthusiasm the project deserved and promise what support we could offer.  We left the meeting as successful politicians, shaking hands all around.

The project was almost forgotten, when I received an email requesting that I cover a week of the program.  I was honored to present my psychosocial workshop, Feathering Your Nest on the sixth week. This was the week Jesse returned from the hospital after missing week five due to a heart attack. He was less vital, a bit fuzzy, but still in charge. In the meantime he had recruited key leaders in the Assisted Living to assist as well as applied for a large community grant. He was still dreaming of taking it national. For an hour and a half I had the interactive energy of 14 seniors in the assisted living. Jesse was beaming with the success of the program. Our student volunteers reported similar results for all the weeks to date.

Jesse and the project slipped from my mind again.  One of the students told me when it had wrapped up.

Then this week she stopped in with his final report. His Healthy Brain Initiative Wrap-Up for Count Your Blessings, Not Your Toes. Every one of his assessments showed huge improvement post-program!

And she told me, Jesse is in the hospital and not expected to come home . . .

Legacy–he did it. He has successfully launched a boat that may indeed go nation-wide. Regardless, he knew what he wanted to pass on, and he took the action to get it done. Successful businessman, successful individual.

For us—Jesse opened up our worlds to the real side of Gerontology–the aging side. Hands on action. The data may be flawed, the sample skewed, the results not publishable in a peer-reviewed article. But the peers that mattered were touched. A legacy will be carried forth. Fourteen people were blessed, and the circle of influence spreads out to each of us who had a part in Count Your Blessings.

Hats off to Jesse G.—-an example of imminent action and the value of legacy.  A blessing to all of his peers.