Gut check: Do you appreciate your aging parents enough?
To find out how you can learn from your elders and improve their quality of life, Family Goes Strong talked with geriatric psychiatrist Marc Agronin, author of How We Age: A Doctor's Journey into the Heart of Growing Old. (He is also medical director for mental health and clinical research at Miami Jewish Health Systems, Florida's largest long-term care provider.).
How do older people find living in a long-term care facility as opposed to home alone?
Living home alone means that they're more isolated, that the resources they need — whether it's meals or meal preparation, visits, or transportation — can be very difficult. In a nursing home or some form of long-term care facility, they can have all that at their fingertips. For many it means going from an environment that's less connected to others to one that's more connected. We too often think of nursing homes as places where people go to die. We have to keep in mind that these are homes for people. Many people go there and they thrive. It really becomes what we're able to put into nursing homes.
Do you mean in terms of extracurricular activities?
I liken it to what we do with schools. You don't simply drop your child off at school and forget about him for the entire day. Parents know who the teachers are, they're involved, they get involved with the PTO, they help raise money for the school, they volunteer. With that same level of interest and activism in nursing homes, you can transform them into really wonderful places for people to be. It's what we bring to it. There are a lot of new models of nursing homes now. They're trying to make them smaller, to bring in animals and plants, to have more of a home environment. These are wonderful trends. But what it really comes down to is what people put into it - staffing, volunteers. Those connections are what make a difference for people. That's why you can go into one nursing home and find it somewhat of a dismal places, and you can go into another and find it a place with a beautiful garden where people are really thriving.
How do you find a thriving place - the kind with that garden?
What I always tell families is don't make a decision in a crisis. Try to plan ahead. If you think some form of long-term care is going to be in the future, get to know what's in the area, what the places are like. Visit them, so at least you can go into it with as much knowledge as possible. Even for people who have Alzheimer's disease or other forms of dementia, a homey environment makes a difference. You can absolutely do that yourself. I work full-time in a long-term care community. I walk outside my office, I see rooms that are pretty bare, and I see rooms that families have transformed into beautiful comfortable settings full of reminders of their past, of photographs.
That's up to you?
That has to come from the family. Most facilities don't have the staffing or the resources to create more than a basic space for someone.
What else can families do?
You have to form relationships with the staff. The nursing staff is most important because they spend the most time with the person
What should families do for the caregivers at long-term care centers?
Have a presence so they know the family and feel supported.
What about tipping?
It's not appropriate to tip necessarily. If you're really happy for the care on the unit, sponsor a breakfast for them. Do they need something new in the unit - a new flat-screen TV? Help with the entire community. That's going to have the best impact overall. Most facilities have a policy that you can't tip anyway. That can create problems. It creates obligations and conflicts. At the very least, just give your time and your presence. Volunteer. Help out. The needs are enormous. Think about it like a school. The best schools have very active parent organizations. They have an active and supportive community. They celebrate teachers. We have to do the same. Celebrate the aging process. Make them see it's a transition. It's not the end of their life — it's a new beginning. There are an enormous number of individuals who are trained to do art, or music, or pet therapy in facilities, which can make all the difference. That costs money and requires coordination. This is where families can help out and bring the resources in. You don't need short-term memory to enjoy pets or school groups coming in. And spirituality is very important, whether it's a church or synagogue or any other religious activities. Often people retain memories of hymns or prayers because they're so ingrained into their memory.
What about long-term care insurance?
It's worth looking into it and weighing it. I always tell people to do some financial planning and consider that as part of it.
What kinds of activities can families encourage aging parents to do?
What our brains really need as we get older is to challenge them, to cross train our brains. If you have everything focused on one activity, it's not as enriching for your brain. One wonderful opportunity is to teach an elder how to get on the computer. A lot of times for individuals in their 80s and 90s, the technology can be absolutely liberating for them. You can be wheelchair bound, and yet you can sit in front of a computer and explore the world. If you really want to make a difference, go to your local nursing home and ask if they need a computer. It's wonderful volunteer work, and it can make the world of difference for people.
So how can families celebrate growing old rather than seeing it as a period of decline?
What gives you gratification? It's the sense you can accomplish things. As people get older, they need that same sense. The brain grows and has a more powerful and deeper potential to have wisdom and build upon one's experience, and we should take advantage of that. When you look at great artists or musicians or sages, they didn't accomplish great things in spite of old age. They accomplished great things because of old age.
What about the future?
Remember that more and more of us are living not only into our 80s and 90s but are achieving that with great health. I can tell you as a researcher for Alzheimer's disease, sooner or later we're going to have an effective treatment or a cure for that. The average person when they hit what we consider retirement age, 65, is going to have a good 30 or 40 years ahead of them to live and explore and change. Think about what will you do with that time. There's only so much golf you can play. You're not going to have the financial resources even to retire so much. People are going to be starting new careers and working.
So old age is not a gloomy time?
Quite the opposite. This is the generation that brought an incredible sense of activism. There's no question that they're going to change the face of aging. It's happening because we're changing our attitudes and our expectations, and we're living longer to be able to focus on that. We're in for some exciting times. We're going to see older individuals play a much richer and more involved role in our society - in some ways a throw back to the role elders played in the past.
So what else can families do for aging parents?
We have to look at our elders, at the oldest members of society, as treasures. We are fortunate if we're able to learn from them. I emphasize to everyone. I'm a psychiatrist in a nursing home. I learn so much and I'm so inspired by these individuals, even as they're dealing with adversity. If you're fortunate to still have your parents and grandparents around, you have to sit down and record their stories and their wisdom. It sends the most powerful message to our children about the value of life. If someone in their 80s and 90s we hold up as a treasure, think about what that says. I love when I see younger kids really getting that. Sometimes they get it more than adults. They're in awe of individuals who are so old.
What's it like to work with the elderly?
People ask me if it's depressing. It's really the opposite. I'm so inspired and so moved. I see people who were eyewitnesses to the most amazing history. I saw someone in my office the other day who was in [General George] Patton's inner circle. I see Holocaust survivors, World War II survivors — individuals who have seen so much history and are able to impart some messages about it.
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