Elder Care: Institutional or Home Care?

EldersThere has been much in the news about bed closures in care facilities, new nursing homes opening, and the stress for the elderly of being moved. According to the Skylark Senior Care center, many issues should be taken into consideration when deciding if an elder care facility is the right choice.
 
A mid-eighties couple I know illustrates the latter point. After decades together, failing health has forced her into a care facility. He walks there every day and visits with her for a few hours. If he had to go into care, but couldn’t be with her, or if she were moved to another facility that he couldn’t get to, it would probably kill both of them. Either event would take away the last thing that gives their lives meaning.
 
The Holocaust and other wartime trauma comes back to haunt the elderly…
 
There is, however, another less-discussed issue involving eldercare. Most people as they age experience some diminished cognitive capacity, usually starting with short-term memory problems.
 
It is emerging that as holocaust survivors go into nursing homes, the old holocaust traumas resurface. With diminished capacity, survivors can’t tell the difference between the nursing home and the death camp—strangers in uniform, orders, medical procedures, regimentation and frequent deaths. The setting triggers flashbacks for many. The nightmares, absent for 5 or 6 decades, return nightly. They live and die in terror.
 
Estimates are that there are over 100,000 holocaust survivors still alive in North America. Jewish organizations worldwide are trying to keep them out of nursing homes, mostly by organizing groups to provide homecare.
 
What happens to other trauma victims as they age?
 
Many Canadian veterans remember the trauma of WWII and the Korean War. Some were in prison camps, others were injured and most had friends die around them. The worst trauma for some was having to kill other people just to survive.
 
Some living Canadians, as civilians living in England, Germany or other European countries, were subjected to the trauma of ongoing bombings and deaths.
 
Some of the survivors never recovered from the effects of war. I hear about those souls through the lips of their adult children and grandchildren.
 
Most, however, went on to live normal lives. However, as they get old, cognitive capacity diminishes and they are increasingly vulnerable to the old traumas re-emerging.
 
A man I will call George served in WWII in Europe, and then came home to live a normal life. At 82, he got a friendly call from another veteran and that triggered ongoing flashbacks and unremitting nightmares about combat and being taken prisoner. He was sufferring full-blown “Post Traumatic Stress Disorder, Delayed Onset,” When I met him. In his case the delay was over 60 years. Fortunately for him, he lived with a supportive family, received homecare,  we were able to conduct appropriate trauma reduction therapy.
 
Could George have adapted to living in a nursing home? I doubt it. Moreover, his life would have ended in terror. George died a little over a year later. His wife commented on the peace he enjoyed in their final year together.
 
This is not an indictment of elder-care facilities. I have seen friends and relatives adapt and enjoy their lives in extended care facilities. If that time comes for me, I think I personally would adapt and be happy.

What I am trying to say is that for the many among us for whom going into a nursing home would make us relive wartime or other extreme trauma, we as a community need to come up with more non-institutional alternatives so that all our elders can live out their lives with relative peace.

Not to do so constitutes elder abuse at the community level.

Moral Evasion through Pop Psychology

not your faultPop psychology has worked its way into our culture. If a man makes a mistake, its OK to blame it on something he ate or an addiction he has. Has pop psychology made it so people no longer have to accept responsibility for their own actions? Is pop psychology making us a society of victims?

A defense attorney once asked me how to use the “alcohol blackout” argument. His client had bludgeoned a relative to death. (Dozens of blows to the head with a hammer tends to be deadly.) He knew he could not get her off, but perhaps he could get her a reduced sentence by claiming alcohol blackout. I told him it might work if he had an expert witness who was incompetent or willing to fabricate. He would also need a judge who was naïve about alcoholism and alcoholic blackouts.

A man killed a homosexual who made a pass at him in San Francisco. The argument was that his violence was “an involuntary triggering of sexual attitudes induced in him by his sheltered, small-town Texas upbringing.” Fortunately for all of us, the judge did not buy the “panic” defense.

However, a body builder did avoid jail time by using the anabolic steroid defense after he broke into six homes, stole money and set fire to three of the homes. He was ruled in a Maryland court not criminally responsible because his use of anabolic steroids left him “suffering from organic personality syndrome.”

After a chief judge Sol Wachtler was arrested for extortion and threatening to kidnap his ex lover’s teenage daughter, his defense was “a prescription drug cocktail and manic depression made him do it.” A prominent medical psychologist wrote that the judge “was manifesting advanced symptoms of…Clerambault-Kandinsky Syndrome (CKS)…a devastating illness.” Translation: irresistibly lovesick and therefore blameless.

I invite you to join me in reflecting on what the medicalizing and psychologizing of bad behaviour into bad diseases is doing to societal values. To hold no one responsible is to make us all victims.

Pop psychology has been a willing participant in the evasion of moral values. We now have chocolate addiction as an excuse for gorging on chocolate, caffeine addiction as an excuse for road rage, love addiction as an excuse for staying in a dangerous relationship and gambling addiction to excuse gambling excesses. I remember this one time I was using Fhats Casino – and literally the same scenario happened. And isn’t the whole point of being a sex addict to justify aberrant sexual behaviour and feel less guilty about it?

Kevin Mitnick was accused of hacking into a corporate computer system and stealing a valuable security program. The judge saw him as a victim of “computer addiction” and sent him for treatment for his impulse disorder. Mitnick later established Mitnick Security Consulting, L.L.C. and had a movie, “Track Down,” made about him.

The alcohol-made-me-do-it argument is still alive and well. Last month, 24-year-old Ronald King received a suspended sentence after pleading guilty to sexual intercourse with a child under 10. (She was four.) The judge told Mr. King during sentencing that drinking “leads you astray and makes you do terrible things.”

What happened to the bad people? Has pop psychology made them all ill and therefore not responsible?

A functioning alcoholic develops a serious heart condition and is told that continuing to drink will kill him, so he stops drinking to save his life. Thousands have done it. We laud him for his choice. However, if the same man chooses to drink and drive, and then kills someone, people are quick to conclude that the alcohol, not the man, was at fault.

Do you agree with me there is something wrong with this picture?

What To Do When Your Marriage Lacks Communication

communicationDeveloping communication skills in marriage is a very important step toward maintaining a happy marriage. When you as a couple have taken on a pattern over time of not talking an issue through to some sort of resolution, and you want to change that pattern to save your marriage, what can you do?

Marriage relationships can be tricky. The suggestions below apply just as much to the one who is stuck in terminal rightness as to the one who doesn’t talk. The former is the bully. The one who doesn’t talk can be either keeping the peace or bullying the other through silence.
 
If you find yourself with some variation of this in your marriage, you are likely in a lonely and unfulfilling place.
 
To understand what to do about it, think back to the very beginning of your relationship when you did talk freely with each other. You enjoyed listening to one another. Yes, you did talk and listen because that was the only way available to get to know each other. Furthermore, it was the getting to know each other that led to your finding you liked each other, and ultimately, committing to each other.
 
A million things can come along to interrupt the initial pattern of talking and maintaining good listening skills —jobs, children, financial stress, hobbies, new friends, education, illness, deaths and old family patterns—in other words, life.
 
I hear repeatedly from couples in trouble excuses like, “But I know what he’ll do,” “I know what she’ll say,” “I know what he’s thinking,” and “That’s just the way she is.” With each such claim, the other sits in total frustration for being so misunderstood.
 
What is totally missing from statements like these is any acknowledgment of the fact that we all grow and change throughout life. They are reacting to what they remember, not what is now. They cannot possibly know what is now, if they do not have communication in their marriage.
 
I watched a man once rail against his wife for her nasty treatment of him over the weekend. She sat calmly until he finished his tirade. Then she said, “I was out of town all weekend.” Undaunted, he retorted, “Yes, but that’s what you would have done if you had been home.”
 
Fortunately, even in cases this extreme, there may be a solution short of separation and divorce, especially if other marriage-enders such as infidelity or disdain are absent. Your solution is to set aside the lie that you already know your partner, and then get to know them.
 
Eileen and I have been talking with each other for thirty years and we still learn new things about each other almost daily. If we are apart for a few days, we have a lot of catching up to do. So how could you possibly be up to date on whom your partner is if you have not been communicating?
 
You liked each other once when you were doing lots of talking and listening. The chances are you will connect again if you get to know each other again. Get into each other’s head and heart. How does the world look through their eyes? As you get inside of your partner’s world, what are you learning about yourself? Share this.
 
It is possible, of course, that when you truly get to know each other again, you will make the mutual decision to part, but now you can do it with dignity and respect.

The Support Group Groupie

Group SupportMutual support can be a double-edged sword. Joining a support group can lead to renewal, likening it to pressing the REFRESH button on life. However, a support group can also keep you stuck pressing the REPLAY button and hearing the same thing over and over. The picture of your life can get out of focus.

Human beings are social creatures. We need to support one another and we need support. Barak Obama is right when he says we need to work together. Businesses are failing. People are losing jobs and even homes. There is a lot of pain out there; and wherever there is pain, you will find support groups…

Bob and Jim both lost their jobs in the forestry sector. A government agency had organized a series of information meetings for unemployed workers. When Bob and Jim started going, they met other unemployed workers who had been attending for a while.

It was not long before both had picked up some good ideas for getting back to work. And by being with other recently laid-off workers, both had shed some of their feelings of failure. Besides being practical, the meetings provided needed emotional support.

After a couple of meetings, Bob stopped going and put his energy into trying some of the back-to-work ideas he had gained. He felt relieved, because the majority of the ex-workers were pessimistic about finding work and the negativity was getting him down.

Jim, on the other hand loved the get-togethers. He reveled in the mutual support because they all had the same wound: being unemployed. He did not look for other work, because, after all, “There are no jobs.”

Six months later, Bob was working in a different field and Jim was still going to his “support group.” Bob had pressed the REFRESH button and Jim was still pressing REPLAY. Jim had become a support group groupie. This is an example of the same support group serving both the REFRESH and the REPLAY functions.

In any community, there are ongoing groups with a variety of themes.  Some are positive and renewing of spirit. A dance class, a choir, a woodworking group, a book club, a motorcycling club and a gardening club are good examples. some may be positive in the short term, others in the long term, as did Jim’s unemployed forestry workers group who got together and reviewed as many sites like www.thetoolboss.com to keep their fingers on the pulse of the industry.

Go to a grief group if you have suffered a loss, but keep asking yourself the question, “Is this speeding up my healing and recovery so I can move on?” Go to an AlAnon group or an AA group if it helps, but keep asking the same question you would of a grief group.

If you find yourself not moving on, press the REFRESH button by trying something else, like volunteering at the SPCA, joining a hiking group or seeing a therapist.

How do you tell if a group is likely to be of the REFRESH variety or the REPLAY variety? First, notice whether the group is organized around an activity. If it is, and the activity is something you would like to try, go for it. Learning and trying new things is renewing and adds meaning to life.

On the other hand, if the group theme is a wound rather than an activity, be cautious. You may gain excellent information by joining a support group that dwells on what’s wrong, but it can become a trap after you get the initial knowledge. Some groups will even resort to using guilt and shame to hold you there.

If you attend a couple of meetings and discover that they not only dwell on the wound, but also hold the wound to be progressive and incurable, how could that possibly help you to live a fulfilling life in spite of your condition? Do not press REPLAY. Run; don’t walk.

If you were looking for a good therapist because you had lost your job, were drinking too much or were feeling powerless, you would look for one who could help you in as few sessions as possible to get to a place where you did not need him anymore. I encourage you to do the same thing in seeking a support group. Find one that will help you to not need it anymore. Then press REFRESH and move on to activity-based support.

Join the resistance and refuse to ever become a support group groupie.