Will You Go to a Nursing Home?

images-1In a recent AARP study, nearly 75% of adults 45 and older said they strongly desire to stay in their current home as long as possible if they have a chronic illness or need long term care. Many baby boomers state that they would never cross the threshold of a traditional nursing home. But what happens if a spouse is not able to take care of you or you can no longer get around your home?

Many assisted living residences have replaced nursing homes to provide care to those who are chronically ill or have lost their mental capacity. But Increasing numbers of baby boomers will seek out new alternatives for independent living where care can be provided.

Intentional communities for philosophical, religious, and lifestyle groups are emerging. Wikipedia describes an intentional community as “a planned residential community designed from the start to have a high degree of social cohesion and teamwork. The members of an intentional community typically hold a common social, political, religious, or spiritual vision and often follow an alternative lifestyle. They typically share responsibilities and resources.”

Alex Mawhinney (jamlll@charter.net) , a developer of retirement communities for over 25 years, reports that “intentional elder neighborhoods are becoming the new paradigm for elder living.” He states that boomers will no longer be interested in “the older generation of elder living options that were available to our parents that follows this model:

  • Age in place — in a home not designed for aging in place, and eventually aging alone
  • Move in with children or other relatives
  • Move to an institution — and pay dearly for care delivered by strangers, under their rules and according to their schedules. The institution might be a nursing home, an assisted living facility, a rest home, a retirement hotel, or a continuing care retirement community with multiple levels of care.

There are SOTELs (service-oriented technically enhanced living—like an upscale Embassy Suites); ecovillages; senior cohousing; and the new lifestyle communities like those being developed by Canyon Ranch.These elder neighborhoods are taking many different forms.

The common traits of these new alternatives are that they are:

  • Human scaled (not large and impersonal)
  • Relationship-based
  • resident managed/centered, with an overlay of lifelong learning, later-life spirituality
  • giving back to the community

Dr. Bill Thomas, came up with an alternative that he describes as “Green Houses”  in the 1990s,  based on “a really radical idea: Let’s abolish the nursing home.”

Thomas, a geriatrician from upstate New York, had patients then who lived in nursing homes, and he realized “that the medicines I was prescribing were not treating the true source of suffering, which was loneliness.”

He also realized that traditional nursing homes were going to have to be replaced soon anyway. “Most of them were built in the 1960s and ’70s, and, you know, their time is done. So I got to asking the question: What comes next?”

What came next were the first Green House homes, which opened in Tupelo, Miss., in 2004. Now, with 148 Green House homes nationwide, there’s enough research to get an idea of how they’re working.

And they’re doing pretty well.

Each resident has their own private room. There are no strict schedules at Green House homes, so while many of the residents gather at the table for lunch, they can have their meals sent to their room. David Farrell, director of the Green House Project nationwide, explains that those private rooms aren’t a luxury — they’re safer than a traditional nursing home, where two or even three people might share a room and also share a bathroom with the two or three people in the room next door.

Research also shows that Green House residents maintain their independence longer than residents of traditional nursing homes, where hallways are long and schedules are tight. “So people really are kind of relegated to a wheelchair in order to efficiently move them around,” Farrell says, “and they quickly lose their ability to walk.”

This program of private rooms and personal service sounds like it could be much more expensive than the traditional nursing home, but Green House home costs have shown to be about the median for nursing homes nationally.

There are now about 150 more Green House homes in development, where residents will be able to enjoy the privacy of their own rooms or the company of the communal table. It’ll be their choice.

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Will Hospice Shorten Your Life?

images-1Many of us might believe that when we choose to accept hospice care at the end of our lives, our lives will be shortened as a result. After all, hospice patients often stop painful chemotherapy or other interventions that are expected to prolong their lives.

But a number of studies have proven this not to be true. A landmark study from the Massachusetts General Hospital in 2010 made some startling findings. Researchers randomly assigned 151 patients with Stage IV lung cancer to two possible approaches to treatment. Half received the usual oncological care. The other half received the same oncological care with additional visits from a palliative care specialist. These specialists focus on preventing and relieving the suffering of patients.

Those who saw a palliative care specialist chose to stop chemotherapy sooner, entered hospice far earlier and experienced much less suffering at the end of their lives. And they lived 25% longer that those who did not receive palliative care!

Atul Gawande, M.D. ,in his groundbreaking book, “Being Mortal”, states that “Like many other people, I had believed that hospice care hastens death, because patients forego hospital treatments and are allowed high-dose narcotics to combat pain. But multiple studies show otherwise.”

He adds, “For some conditions, hospice care seemed to extend survival. Those with pancreatic cancer gained an average of three weeks, those with lung cancer six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer when you stop trying to live longer.”

Gawande, a practicing physican in Boston, reports that most terminally ill cancer patients have had no discussion with their doctors about their goals for end of life care despite being within months of death. But those patients who enrolled in hospice, suffered less and were better able to interact with others forlonger period of time. “People who had substantive discussions with their doctor about their end of life preferences were far more likely to die at peace and in control of their situation and to spare their family anguish.”

Are you a good health care agent?

One of the most important jobs you may ever have is to be designated a health care agent or health care proxy for another person, possibly your parent. In this role you will make heath care decisions for them if they cannot make them themselves. One of the best sources I know of for the forms to designate a health care proxy is provided by www.agingwithdignity.org Their forms are approved in more than 40 states.

Aging With Dignity recommends that you do the following things to be a good health care agent/proxy:

1. Know your loved one’s wishes ahead of time. Ask questions when discussing their wishes with them so that you understand what they want.
2. Introduce yourself to the doctors and nurses caring for your loved one. Make sure that they know you and know how to reach you. Make sure that they have a copy of the document naming you as the health care agent/proxy.
3. Ask questions of the doctors and nurses and follow through with them as they are treating your loved one so you know that your loved one’s wishes are being followed.
4. If you run into problems, ask to speak to the social worker, patient representative or chaplain of the hospital or institution your loved one is in. If a doctor or nurse does not want to follow their wishes, contact the ethics committee of the hospital, hospice, or nursing home.
5. Be courteous but be firm. Sometimes doctors or their staff ignore a patient’s wishes if the health care agent/proxy doesn’t push for them.
6. Obtain a HIPPA release form and have your loved one sign it giving you authority to see their medical records. Without it you will be often be denied any information about their condition or health.

Aging With Dignity provides a document called “The Five Wishes” which allows your loved one to specify in detail exactly how they want to be taken care of. It also has a place for them to name their health care proxy/agent. It combines both a living will and health care proxy into one form. Once it is witnessed by two people and signed by the person it becomes a legal document in more than 40 states. Call 1-888-594-7437 or go to the website www.agingwithdignity.org to order the form.