Moira Fordyce’s recommends the resources on the American Geriatric’s Society website

I was speaking with Moira Fordyce from the California Coalition for Caregivers and she told me about the wonderful resources available at the American Geriatrics Society website. http://www.healthinaging.org/public_education/index.php The great thing about this website is that you know you can trust this information because it is coming from physicians who specialize in helping the aging patient and their loved ones.

You may also want to take a look at the California Coalition for Caregivers as they are an advocacy organization and are fighting to make sure that resources and protections are in place for our aging population. http://www.californiacrc.org If you live in California, they will send you alerts when it is time to contact your local representatives about an upcoming bill or iss

Lastly, you might want to download some of the legal handbooks for senior care from Bet Tzedek Legal Services at  http://www.bettzedek.org/publications.html#guides.

Below I have listed the topics from the American Geriatrics Society’s site. They have Tip Sheets, What to Ask Your Doctor, and General Aging Topics. It is like having a trusted friend to turn to for help. Have a kind and respectful day and enjoy the resources.

Latest Foundation Tip Sheets

Caregivers

Guide to Advance Directives

Tips For Avoiding Caregiver Burnout

Healthy Aging

Advice for Improving Your Memory

Cognitive Vitality

“Geriatric Syndromes”

Good Health in Later Life for Older Men

Good Health in Later Life for Older Women

Improving Communication with Your Healthcare Provider

Overcoming Challenges to Healthy Aging

Persistent Pain Tips

Holidays

Tips for Beating the Holiday Blues New!

Top 10 Healthy New Year’s Resolutions for Older Adults New!

Safety

2009 H1N1 Flu (”Swine Flu”) Tips

Emergency Preparedness Tips

Falls Prevention Tips

Home Safety Tips

Hot Weather Safety Tips

Safe Travel Tips

Safe Sex Tips

Safety Tips for Seniors Considering Visits to Retail Medical Clinics

Walking Tips

Winter Safety Tips

Spanish

Spanish Language Health Tip Sheet: “Manejo del “Dolor Persistente” en la Tercera Edad”/“Managing Persistent Pain In The Elderly”

Surgery

Hip and Knee Joint Replacement Tips

Vaccinations and Medications

Avoiding Overmedication and Harmful Drug Reactions

Vaccination Tips

What to Ask?

Questions for Your Healthcare Provider

How We Age
• Physical Activity
• Prevention
Health Care Decisions and Issues
• Health Assessment
• Health Care Settings
o Community-Based Care
o Hospitalization
o Nursing Home Care
• Complementary and Alternative Medicines
• Drug Treatment
• Elder Mistreatment
• Ethical and Legal Issues
• Pain Management
• Palliative Care and Hospice
• Rehabilitation
Elder Health at Your Fingertips
• Cancer
• Diabetes
• The Digestive System
o Disorders of the Digestive System
o Disorders of the Mouth
• The Heart, Lungs, and Blood and Circulation
o Anemia and Other Blood Disorders
o Breathing Problems
o Fainting (Syncope)
o Disorders of the Heart and Circulatory System
o High Blood Pressure
• Hormone Disorders
• Joints, Muscles, and Bones
o Back Pain
o Falls
o Foot Problems
o Osteoporosis
o Walking Problems
• Mental, Neurological, and Psychological Conditions
o Anxiety
o Delirium (Sudden Confusion)
o Dementia
o Depression
o Diseases of the Nervous System
o Dizziness
o Mental Retardation
o Personality Disorders
o Psychological and Social Issues
o Psychoses (Delusions and Hallucinations)
o Sleep Problems
o Substance Abuse
• Nutrition
• Sexuality and Sexual Concerns
o Gynecological (Female) Disorders
o Prostate Disease
o Sexual Problems
• The Senses
o Hearing Loss
o Vision Loss and Other Eye Diseases
• The Skin
o Pressure Ulcers (Bed Sores)
o Skin Diseases
• The Urinary System
o Kidney Problems
o Urinary Incontinence

Topics at a Glance

How We Age
• The Aging Process
• Trends in the Elderly Population
• Physical Activity
• Prevention
Health Care Decisions and Issues
• Talking to Your Healthcare Providers
• Health Assessment
• Health Care Settings
o Community-Based Care
o Hospitalization
o Nursing Home Care
• Complementary and Alternative Medicines
• Drug Treatment
• Elder Mistreatment
• Ethical and Legal Issues
• Insurance, Financing, and Costs of Health Care
• Pain Management
• Palliative Care and Hospice
• Rehabilitation
Elder Health at Your Fingertips
• Cancer
• Diabetes
• The Digestive System
o Disorders of the Digestive System
o Disorders of the Mouth
• The Heart, Lungs, and Blood and Circulation
o Anemia and Other Blood Disorders
o Breathing Problems
o Fainting (Syncope)
o Disorders of the Heart and Circulatory System
o High Blood Pressure
• Hormone Disorders
• Infectious Diseases
• Joints, Muscles, and Bones
o Back Pain
o Falls
o Foot Problems
o Osteoporosis
o Problems with Joints, Muscles and Bones
o Walking Problems
• Mental, Neurological, and Psychological Conditions
o Anxiety
o Delirium (Sudden Confusion)
o Dementia
o Depression
o Diseases of the Nervous System
o Dizziness
o Mental Retardation
o Personality Disorders
o Psychological and Social Issues
o Psychoses (Delusions and Hallucinations)
o Sleep Problems
o Substance Abuse
• Nutrition
• Sexuality and Sexual Concerns
o Gynecological (Female) Disorders
o Prostate Disease
o Sexual Problems
• The Senses
o Hearing Loss
o Vision Loss and Other Eye Diseases
• The Skin
o Pressure Ulcers (Bed Sores)
o Skin Diseases
• The Urinary System
o Kidney Problems
o Urinary Incontinence

Interview with Natalie Buriel, MSW and Linda Alexander-Lieblang, Director opf Regions, Alzheimer’s Association, California Southland Chapter, “Memory Club and other services available at the Alzheimer’s Association”

Listen live or download later to my interview with Natalie Buriel, MSW and Linda Alexander-Lieblang, RMT, MA, Director of Regions, Alzheimer’s Association, California Southland Chapter to discuss the Memory Club and other services available at the Alzheimer’s Association on January 29th, 10AM pacific, on Blogtalkradio.com/kindethics

Whether your you or your loved one has Alzheimer’s or another form of dementia, the Alzheimer’s Association has specialized services available no matter what stage or situation you are dealing with.  I have listed below a number of their services.  Take some time and look through what they have to offer.   Check out their resources at Alz.org.  They also have support material in Chinese, Spanish and Korean.

The Alzheimer’s Association is there to help.  Please reach out to them and get the support and help you need.

Have a kind and respectful day.

Helpline

The Alzheimer’s Association Helpline operates 24 hours a day, seven days a week, in 140 languages. Our staff is highly trained and knowledgeable about all aspects of Alzheimer’s disease. Call us if you have questions about:

· Alzheimer’s disease or memory loss, medications and treatment options, brain health and care options

· How the Association can help you

· Caregiving tips and respite care options

· Services available in your community and referrals

You can also call us for emotional support –– as often as you need. We know that living with Alzheimer’s can be overwhelming at times. Remember, we are here for you –– all day, every day.

Care consultation

Our professional staff is dedicated to helping people navigate through the difficult decisions and uncertainties people with Alzheimer’s and their families face at every stage of the disease. We can provide care consultation services to you by telephone, e-mail or in person. These include:

· Assessment of needs

· Assistance with planning and problem solving

· Supportive listening

Contact us for more information:

Phone: 1.800.272.3900

Support groups

Support groups provide a safe place where people go to learn, listen, share and gain emotional support from others who are also on a unique journey of providing care to a person with dementia.  Support groups are held at various times and in many different communities and languages. Each group is different, and depending on each person’s needs will offer different things. Check to see if there is a group close to you that fits your needs.

Support group listing

Message boards

The Alzheimer’s Association message boards and chat rooms provide an online community for persons with Alzheimer’s, caregivers and care providers. Our message boards have thousands of registered members from around the United States and thousands more who refer to the stories and information that is available 24 hours a day.

Join the Alzheimer’s Association online community.

Publications

· The Alzheimer’s Association offers dozens of fact sheets and brochures.
Click here for a listing.

We also maintain a variety of educational materials (brochures, videos, audiotapes and books) on topics related to Alzheimer’s disease and related disorders. To learn more about our library, call us at 1.800.272.3900.

Quarterly magazine

Our chapter also prints a free quarterly magazine. Click here to view the current issue. If you would like a hard-copy, please call the Helpline at (800) 272-3900.

Educational programs

We offer many educational programs each year that address the specific interests of the general public, individuals with the disease and their families.

Education program listing.

Professional training

We offer classroom and Web-based training for healthcare supervisors and direct care workers in assisted living and nursing homes. Many programs allow you to earn CEUs.

Professional training listings.

Multilingual information

Alzheimer’s disease and other disorders that cause dementia know no boundaries. Many individuals and families in ethnic and cultural minority groups are in need of solid information about Alzheimer’s disease and health resources.

· Chinese educational materials

· Korean educational materials

· Spanish educational materials

Lasman Family Library

The Alzheimer’s Association maintains a multimedia library of books, periodicals, videotapes, CDs, DVDs and other materials pertinent to Alzheimer’s disease and related disorders. The collection covers activities, adult day services, caregiving issues, diagnosis, first-person accounts, legal and financial issues, long-term care options, medical research, memory, stages of Alzheimer’s, and more. There is a selection of children’s books, as well as resources in Spanish and other foreign languages. The library is available to family members, caregivers, professionals and students.

The Lasman Family Library is open from 10:00 a.m. to 4:00 p.m., Monday through Friday. Appointments are required; please call (323) 938-3379 and ask for Judy.

• First time borrowers must register.
• A sign-out card must be completed for each item.
• The loan period for library materials is 30 days.
• Two videos or disks may be borrowed at one time, with a deposit by check of $100.00 for each, to be returned when the item is brought back.
• Four books may be borrowed at one time

Satellite libraries with basic collections are housed at these Southland offices:
Greater San Fernando Valley (Northridge); please (818) 677-4404
Coachella Valley (Rancho Mirage): (760) 328-6767

WE MAKE NO PROVISION FOR LOANS BY MAIL:  ALL MATERIALS MUST BE PICKED UP IN PERSON.

Medic Alert® + Safe Return®

In a move to significantly improve the safety of individuals with Alzheimer’s, the Alzheimer’s Association and the MedicAlert Foundation have created an alliance to bring you MedicAlert® + Alzheimer’s Association Safe Return®.

MedicAlert + Safe Return offers you the best of both worlds:

· Assistance when a person wanders or is lost

· Access to vital medical information in the time of need

Learn more about Safe Return.

Adult Day Services

What are adult day services?
Adult day services are centers where people with memory problems can spend part of their day in a caring environment. What can they do for you?
• Provide time for you to:
• Go to your job
• Make phone calls and run errands
• Take a nap and rest
• Lower your stress
• Provide emotional support   What can they offer the person with memory loss?
• Time to be outside of the home
• Activities with other people
• A chance to make new friends
• A nutritious meal

Learn more about adult day services:
• Types of adult day services
• Steps to selecting adult day services
• Los Angeles County directory of adult day services
• Riverside and San Bernardino Counties directory of adult day services

Local resources and referrals

We maintain updated information on home care, adult day care, care coordination, assisted living, skilled nursing facilities, eldercare lawyers and transportation available in the community. Our staff and trained professionals can help assess whether a specific care provider meets the needs of an individual with Alzheimer’s.
Download the Resource Directory

For more information, please contact us: (800) 272-3900.

Back to top

Clinical trials index

· Clinical studies – what they are, why participate

· Nationwide clinical trials index

· Local clinical trials

· Local clinical trials-descriptions

3 Secrets to Getting the Most Out of Your Dr.’s Appointment

Do you feel like the doctor doesn’t have enough time to listen to your complaints? Is it frustrating to leave the doctor’s office and realize you didn’t get your questions answered?

Let me tell you what is going on and you aren’t going to like it. The doctor has about 12 minutes to listen to you, exam you, figure out what is wrong with you and put together a plan to help you get better.

I can hear you saying, “But 12 minutes isn’t enough.” Of course not, but that is the reality of medicine today.

You can complain but if you are smart, you can learn the three simple steps below to get the most out of your doctor’s appointment.

Here is Secret #1. You have to think like a doctor. Doctor’s think in an organized manner, so we have to give them our information in an organized way. Doctors usually play a guessing game with us as they try to figure out what is our “chief complaint”. But these questions are just wasting our precious minutes. The more organized and prepared you are for your appointment, the better.

Here is Secret #2. The doctor will make more time for you if he likes you better. And if your doctor likes you, you will get better care. I know it doesn’t seem fair but that is just the way it works.

Secret #3 is to make sure you are nice to all of the office staff. They can make it easier or more difficult for you to get in to see the doctor. They control his schedule. So, be kind to them and say, “Thank you.”

Now let’s make it easy for the doctor to help you.

Step 1. Write down all of your medications, occasional cold medicines, vitamins, herbal medicines, natural supplements, etc. And I mean everything. Even things you don’t think are important may be very important to your health. The doctor can’t protect you from things that he doesn’t know about, so write them down. If you don’t want to write them down, then bring all of them to the appointment with you.

Step 2. Write down how you are feeling. Why are you coming to see the doctor? Tell him what is hurting you, bothering you or any other physical complaints? Write down the new symptoms first and then write down the problems that are ongoing.

Step 3. Write down your questions and then circle the 2 most important questions. The doctor doesn’t have time to answer all of your questions so it is up to you to keep the doctor focused on what is most important to you.

And a Bonus Secret, if you want to make the doctor angry, keep your most important question a secret until the end of the appointment, and as the doctor is walking out the door say, “I have one more question …” If you wait until the end for this “Oh by the way” question, the doctor will only have one minute left to answer it. Please, write down this most important question so the doctor can spend time helping you.

If you would like, I have created a form for you to use each time you go to the doctor, Viki Kind’s Office Form for getting more from your doctor. Sign up for my newsletter and I will send you new support tools once a month.  Print out a couple of copies so you have them ready before your next appointment.

Have a kind and respectful day.

Interview with Lise Marquis from “A Place for Mom” - Providing senior care and housing options

Interview with Lise Marquis from A Place for Mom on January 21st, 1PM pacific, 4PM eastern on BlogTalkRadio.com/kindethics. Call in to listen live and to ask your questions at 347-945-5152. Or listen later to the show at BlogTalkRadio.com/KindEthics

The Search for Senior Care….Simplified and FREE

Your personal Eldercare Advisor is Lise Marquis
866-691-2427 (local office) 760-207-9405 (mobile) lisem@aplaceformom.com

ABOUT “A PLACE FOR MOM” (and DAD)
They provide a free comprehensive resource for senior housing and care options to families in need. Each day thousands of families are faced with the unique and complex challenge of finding appropriate elder care. The array of choices and decisions to make can be overwhelming and families are left with too many unanswered questions. A Place for Mom will provide you and your family with one-on-one guidance during this difficult process.

They provide senior care and housing options in the following areas:
Independent Retirement Living
Assisted Living
Alzheimer’s & Dementia Care
Respite Care
Skilled Nursing
Home Care
Residential Care (Board & Care) Homes
Hospice

They also provide resources for:
Financing/VA Aid & Attendance
Legal Services
In Home Therapy Services
Support Groups/Professional Organizations
Touring Checklists

Some kind words:

“Hi Lise - Just wanted to thank you for the excellent referrals for my mom.
I am so impressed with you and “A Place for My Mom”. Thanks for making a difficult task SO MUCH EASIER!”

“Dear Lise, This has been the most stressful week of my life, but I could NEVER have gotten through it without you. You are truly a god send, and I will never forget how much you helped me.”

“Lise, I will pass your name along to everyone I talk to that needs a compassionate, caring person to help them in finding a place for their very special loved one.”

A Place for Mom is the nation’s largest eldercare referral network. They help hundreds of families every day. Their consultation is provided at no cost to families, as their partner communities and homes reimburse them for our services.

Have a kind and respectful day.

The Power of Empathy - Helping people connect to their own hearts

Quote of the month:
“The great gift of human beings is that we have the power of empathy.” Meryl Streep

Empathy

Last year, during one of my lectures about end of life communication, a doctor asked me some questions about hospice care. He explained that his question was about his wife who had end-stage lung cancer. They were still trying to fight the disease but the disease was winning. He wanted to know more about the option of hospice and if it would be appropriate for his wife. I told him I would speak to him in greater detail after the lecture.

After the lecture, he began to tell me about the medical condition and the medical treatments that his wife was going through. This was a man who loved his wife and was desperate to keep her alive. After listening to the story, I asked what his wife would say about continuing with the treatments vs. going on hospice. I wanted to hear her point of view. I asked him directly, “What would your wife tell me about what it is like to be going through this and how does she feel about it.” He then began to tell me about what he was experiencing and how exhausted and overwhelmed he was. I realized I was talking to someone with incredible caregiver fatigue. I listened and tried to be supportive. I recommended support group options and other services that might help him with his fatigue.

Then once again, I asked about how his wife perceived her experience. He couldn’t answer. Again it became about medicine. It was as if he was reporting on an intriguing patient. I found it fascinating that he could not begin to explain or to experience what his wife was feeling. In the hour I spent with him, he could never say my wife would say … or my wife would want… This was not because he didn’t care about what she was experiencing, it was because he cared too much that he couldn’t begin to comprehend what was going on inside her.

So many things were going on. The first issue I was dealing with was denial. He didn’t want to believe that he couldn’t fix this for his wife. Doctors want to heal and even more so, they want to heal the ones they love. He was trapped inside his profession and could only focus on what medicine had to offer his wife. He kept dancing on the edge of the topic of death by asking about what hospice might have to offer but ran away from it as I described the benefits of hospice. To choose hospice felt like choosing death. And he couldn’t begin to accept that death would be taking his young wife very soon.

The second issue was that he was treating his own wife. He was one of her doctors so he had disconnected from her by making her the patient. This is why doctors aren’t supposed to treat their own family or close friends. When a doctor treats their own loved one, he can become blind to what is in front of him. This gentleman was a good doctor and he would have put any of his other patients in this end-stage condition on hospice. But he couldn’t see that as a valid option for his own wife. He was blinded by his love.

The third issue was that he couldn’t empathize with what his wife was feeling. It hurt him too much to begin to imagine what this was like for his wife. This was not a man who couldn’t speak of emotions. He expressed his own emotions about the situation freely. But he couldn’t tap into his empathy for “his patient” or “his wife” because it was too painful. Our brain can only feel what it can survive feeling. It shuts down when it becomes too much. His deep and profound pain was palpable and I hurt for him.

My heart hurt for his wife as well. I tried to explain that his desperate need to cure her was limiting her option of having good end of life support. (Okay, I didn’t say it quite that way.) He told me her pain was not being managed (in technical terms), even though he was trying to help her. I explained that hospice is really good at pain management and he should use them as a resource. I also explained that hospice provide the intangibles such as support for the family, support for him and a safe person for his wife to talk to about her hopes and fears. When communicating about the upcoming death is forbidden, the patient misses out when they are unable to say what they need to say. Her voice wasn’t being heard in the treatment decisions and her existential suffering wasn’t being addressed.

This is one of the best gifts of a hospice. The person has a safe person to talk to when she can’t talk to her own loved one. Or if they don’t have a hospice worker, a good friend or family member can be this person. I wish that the spouse could be this person, but often it is too painful. This doctor/husband was not unusual. He could not bear his wife’s suffering. I meet many people who can not talk to their own loved own about dying. That is why I am there. That is why we have social workers and chaplains in hospitals. Doctors can also be this safe person if they have the courage to take on this role.

I don’t know if he was able to get some support for himself and his wife and if her pain is being managed. I hope so. I know that I can only go so far with someone in denial. I can only dance on the edge of subject with them so they won’t feel so alone or afraid. Eventually, the person will come closer when he or she is ready.

When we want to help others we need to have the courage to:

See the suffering
Acknowledge the suffering
Do something about the suffering, then
Heal our own suffering

“What to look for during your annual visit to elderly relatives” by Mary Twomey MSW. Thanks, Mary and the Center of Excellence in Elder Abuse and Neglect

Special thanks to Mary Twomey, MSW, Co-Director, Center of Excellence in Elder Abuse & Neglect for this wonderful article.

For many of us, the holidays offer a once-a-year time to visit with elderly relatives who live at a distance. These holiday visits are a good time to assess what assistance parents or other elderly loved ones might need. There are many things to consider. Does an elderly loved one require help with chores or housekeeping, personal care, shopping and meal preparation, money management, transportation, medical checkups, or medications? Are they isolated or, do they live with others? If living with another, are they dependent on that person for care? Is that person an appropriate caregiver? During your visit, keep an eye out for warning signs of self-neglect, or abuse or neglect by others. If, before you make your trip, you suspect that your loved one needs extra assistance, plan a longer stay so that you can visit local aging service organizations during regular work hours. Allow enough time during your visit to accomplish necessary tasks.

Make the most of your visits by taking some private time with the elder to discuss future planning. Allow time for them to express anxieties. You can decide together what needs to be done and who can help. Be observant while you are visiting. Realize that you may need to arrange a visit to a doctor for a full evaluation.

Remember that 75-90% of elder abuse is committed by family members. Don’t let denial become an obstacle to planning that could prevent future emergencies. This is not the time to hide your head in the sand, setting the stage for future regrets. Some warning signs of elder abuse are:

Self-Neglect – If the senior lives alone and does not have anyone providing assistance, self-neglect may become an issue. Some things to look for include:
• Senior appears confused
• Senior is no longer able to handle meal preparation, house cleaning, laundry, bathing, or timely bill payment
• Senior seems depressed
• Senior is drinking too much or is overusing drugs
• Senior is falling frequently
• Senior appears undernourished, dehydrated, under-medicated, or is getting care for problems with eyesight, hearing, dental problems, continence, etc.

Neglect or Abuse by others – If the senior lives with others or ostensibly has people helping with care, neglect or abuse may become an issue. Some things to look for include:
• Presence of “new best friend” who is willing to care for the senior for little or no cost
• Recent change in banking or spending patterns
• Caregiver isolates older person from friends and family
• Caregiver has problems with drugs, alcohol, anger management, and emotional instability
• Caregiver is financially dependent on the older person
• Family pet seems neglected or abused
• You find an abundance of mail and/or phone solicitations for money (“You’re our lucky winner!”)
• Senior seems afraid of the caregiver
• Senior has unexplained bruises, cuts, etc.
• Senior has “bed sores” (pressure sores from lying in one place for too long)
• Senior appears dirty, undernourished, dehydrated, over- or under-medicated, or is not receiving needed care for problems with eyesight, hearing, dental issues, continence.

What should you do?
• If you suspect your older loved one is at risk, call your local Adult Protective Services or Office on Aging or go to www.centeronelderabuse.org for more information.
• Seniors may not be aware of a gradual decline and may be reluctant or unable to plan for needed care. Support and guidance from family members can help prevent serious accidents and/or future health complications. Noticing and correcting problems can help keep seniors safely in their homes.
• Learn more about common geriatric conditions, medications and markers of abuse. Refer to Geriatric Pocket Doc, a compact guide book for non-physicians. For info, visit www.centeronelderabuse.org and click Geriatric Pocket Doc in the bottom right corner.
• Introduce yourself to responsible neighbors and friends. Give them your address and phone numbers in case of an emergency.
• Ask your elderly loved ones directly if they are afraid of anyone, if anyone is taking things without their permission; if anyone is asking them to do things they are not comfortable with, or if anyone is putting them down.

RESOURCES:
Center of Excellence in Elder Abuse and Neglect: www.centeronelderabuse.org. A program of the University of California Irvine, the CoE conducts research, training, advocacy, and direct services on the issue of elder abuse and neglect.

Eldercare Locator: Since 1991, the Eldercare Locator, a nationwide toll-free service provided by U.S. Administration on Aging, has helped older adults and their caregivers find local services for seniors. You may visit the website at www.eldercare.gov or speak to an Information Specialist who has access to a database of more than 4,800 entries. The toll-free Eldercare Locator service operates Monday through Friday, 9:00 a.m. to 8:00 p.m. (Eastern time) and can be reached at 1-800-677-1116.

AARP: AARP provides caregiving worksheets and tips on “Long-Distance Issues” http://assets.aarp.org/external_sites/caregiving/planAhead/long_distance_issues.html

Center of Excellence in Elder Abuse and Neglect
University of California, Irvine Program in Geriatrics
www.centeronelderabuse.org 714-456-5530

Advance Directives Part 1 – Choosing your decision maker

Most doctors just hand the patient this form and say fill it out. But they don’t help you fill it out or explain what the decisions mean. I am going to help you think through the process of filling out your Advance Directive.

There are two main decisions you need to make when you are filling out your Advance Directive. Who you want to make your decisions for you and what you would want. After I help you with these two questions, I will then tell you what to do with your advance directive after you have filled it out. At the end, I have included instructions on how to find a form that would work in your state.

Let’s first talk about who you would want to make decisions for you. In your state, your form might ask you to list your agent, proxy or surrogate decision maker. (These words all mean the same thing, but each state its own legal term.)

Who should you pick?

1. You should pick someone who is medically literate. What does this mean? The person should be able to understand what the doctor is saying, be able to figure out the medical words and be able to understand the medical choices being offered. If the person you thought you were going to pick would be confused by what the doctor would say, then pick someone else.

2. You should pick someone that knows you very well, would know what you would want in a medical crisis and would tell the doctor what you have told them in the past. The person you have chosen will be asked to listen to the medical information and then use your values to make the medical decisions. The person is not supposed to use his or her own values, but to speak as if they were you. If the person you thought you would pick wouldn’t respect your choices or has very different beliefs from yours, then pick someone else. You want someone who will speak as if he or she is speaking with your voice, not his or her own agenda.

3. You should pick someone that won’t fall apart in a crisis. It doesn’t do you any good if the person is hysterical, can’t function or can’t stand to visit you in the hospital. You need to pick someone brave enough and who will be by your side no matter how difficult things get. If the person you thought you would pick doesn’t handle his or her own life very well, then don’t have him or her be in charge of yours.

4. You should pick someone that will do right by you even if it is the most difficult thing they ever had to do. Sometimes doing the right thing is allowing the person you love to have a peaceful death. And your decision maker needs to be able to live with the difficult decisions he or she has to make. In reality, he or she is making the decisions based on what you would want, not what he or she would want. But that doesn’t make it any easier. You have to be able to talk to this person ahead of time about what you would want in different kinds of situations. So, if the person you thought you would pick is too afraid to talk about death and dying, then he or she isn’t the right person for this job. And if he or she would refuse to follow through with what you have requested, then pick someone else.

5. You can write down whom you don’t want to be your decision maker. Depending on what state you live in, the rules vary regarding who is in charge of you when you are unconscious or incapacitated. You need to protect yourself.

6. Doctors won’t tell you this but you can pick two or three people to share in your medical decision making. But be careful that you pick people who can work together, will support each other and who you know won’t make things worse for the healthcare team. I had one lady tell me that she picked her two sons to make her decisions and that these two men had never agreed on anything. She is setting herself up for a nightmare as good decisions won’t get made and the doctor will hate having to deal with her sons. You don’t want your doctor to hate your decision maker. Please pick carefully.

7. Some people don’t pick their spouse because they know that it would be too much for their loved one to go through and that their spouse couldn’t make these most difficult decisions. If you do pick your spouse, then you need to be extremely careful about picking the alternate decision makers. The alternates will make your decisions if you and your spouse are injured in the same accident. The alternate should be just as qualified as your first choice.

I am available to speak at your organization or hospital.

Have a kind and respectful day.

Celebrate the holidays today - Take a treat to your doctor’s office or the nursing home today

You may be thinking of doing something nice for your loved one’s doctor’s office, hospital staff, or long term facility where your loved one lives. But don’t do something in December. Everyone brings the staff food and treats in December and a lot of it goes to waste (waist). The staff would love to have your bring something in October or some other month when they can truly appreciate it. And, your efforts will be noticed because it is not just one more person bringing in a treat, but you thinking of them at a different time of the year.

Here are a couple of yummy places where you can order something to be delivered.

Chocolates Gifts: http://tinyurl.com/p8abol
Cakes: http://tinyurl.com/rylvyz
Tea: http://tinyurl.com/nt5gqc
Coffee: http://tinyurl.com/l6×2d5

Have a kind and respectful day.

Cultural Communication Strategies, KindEthics Newsletter vol. 2

Quote of the Day:

Arguing is really saying, “If you were more like me, then I could like you better.”

Feature Article:

Cultural Communication Strategies

What I want to talk about today is the role of culture in our interactions both inside the healthcare system as well as in our daily life. What I want to focus on is our role in dealing with people from different cultures, religions and belief systems. So often we blame others as they are the problem or that they are making it worse when sometimes it is us. Today, I want to empower you to know that you can make a difference and you can make the interaction better. The communication strategies I will teach you will help with difficult relatives or co-workers as well as with your patients. For the next two paragraphs I will focus on the healthcare professional and then after that, everything I will discuss will be helpful to all of us.

Why should we be culturally aware in healthcare? When we ask questions about cultural and religious beliefs we can discover what treatments people are receiving outside of our care. Are they going to a healer, an herbalist, a shaman, an acupuncturist or someone else outside the healthcare system? If so, we need this information in order to protect them from harmful interactions with the treatments we are prescribing. We don’t have to like that they are going to see these people, just realize that they are. You can think what you like but be careful not to criticize them aloud because they will just hide the information from you in the future. If your patient is afraid to tell you the truth about alternative medicines, they may be in danger when they go into surgery.

We also want to know what their values are and how that affects their ability to choose the medical treatments we are offering. Many non-compliant patients are being non-adherent for very good reasons; reasons that are prescribed by their culture or religion. We don’t have to agree with their beliefs but it is important that we understand them so we can work together to find a way to get them to accept at least some of what we are offering them. And at the end of life, we definitely need to ask about how to respect their religion and culture during the dying process.

The most important reason though to be culturally respectful is because we’ve would want to be respected if we were the patient. It is very likely that your own doctor will be from a different religion or culture and you may find yourself in a cultural conflict as well. I would advise you to use “The Platinum Rule®” instead of the golden rule. This states that we should treat others as they wish to be treated, not as we would wish to be treated. (I have attached this article at the end of this newsletter.)

All cultures teach their members the preferred or right way of doing or being. We are each brought up in a family that teaches us the right way to behave. And because this training happens when were so young, we believe that what we’ve been taught is “normal” and “natural” and “right”. I am a Norwegian American, so what I believe is normal, natural and right is based on Norwegian values. So what I believe is normal and what you believe is abnormal. Yes, I just said that. Your beliefs are unnatural and not right unless you believe like I do. Of course this statement is ridiculous. This is a perfect example of the cultural anthropology concept of ethnocentrism. Ethnocentrism is the belief that the customs and practices of one’s own culture are superior to those of other cultures. With ethnocentrism in place, it will increase the differences between us and it will lead us to us versus the “other” thinking. The concept of the “other” is described as the “other” as being less than, less valuable or less intelligent. One might say, “There’s us and then there’s you, the other” in a derogatory manner. We need to realize that one culture is not better or worse, just different. If we were brought up in that other country or culture or religion, we would believe as they do. It just depends on where we were born. I know that there are valuable ideas and values to be found in all cultures even if they’re not exactly like mine. We all want our children to grow up and be happy and healthy. We all want to be able to pay our bills and to provide for our family. We are more alike than different. I encourage you to look for the positive similarities and focus on those during your interactions.

Most people who teach cultural sensitivity would tell you to not judge. I wouldn’t say that. I think it’s normal to make judgments and to have opinions. But we need to figure out how to acknowledge our judgments, then put them aside and not act on them, especially as professionals. Many times I walk into a situation and have a strong reaction to a person but I have to manage that reaction and rise above my bias or first impression. If you feel a judgment or criticism rise up in you, acknowledge it silently and then put it aside and treat the person with compassion and respect. You don’t have to agree with the person, just treat them well. Advocate for them as they may be vulnerable and unable to speak up for themselves because of the cultural or religious barriers. I tell healthcare providers that when you’re about to walk in the exam room or the hospital room, leave your biases or negative expectations outside the door and remember that this person still needs our expertise and support. We can do this anytime we are in an interaction which is getting us upset. We can control our actions and our words during the interaction.

Quite often people are experiencing “relocation stress” during their healthcare experience. Cultural anthropology defines “relocation stress” as the stress one feels when moving from one culture into another culture. Medicine is a culture. It has its own cultural rules, values and a hierarchy for communication. When people come into the healthcare system, unless they work in healthcare system, they don’t know the cultural rules and how to get what they need. And this creates stress on top of the stress they are experiencing about their illness or pending surgery. If you are new to the healthcare process, like my dad was when he went in for double bypass surgery, you need to ask more questions and bring an advocate with you.

So what can we do when we have to deal with people from cultures that we don’t understand or we don’t like. I’m here to tell you, you have a lot of power. Your expectations will affect the interaction. You may have something from communication theory called “selective perceptions”, which is where we only see what we want to see in order to justify our preconceived opinions. Let me give you an example. I have a relative I don’t like. (You probably do too.) Every time I interact with her, I look for things that will reinforce my belief that I don’t like her. So each time, I would find more and more things that confirmed this belief about her. And over time, my dislike grew. Well one day, I realized that I teach other people to have more power over their interactions, so maybe I should put it to the test. (I know, I should have done this a long time ago.) So the next time I interacted with her I looked for something positive about her. I found out that I really respected how well she feeds her children. She feeds them very healthy food and they willing eat it. As I left that interaction, I focused on the positive thing I had found about her and reinforced this new perception as I drove home. Each time I looked for and found more and more things to appreciate about her. Is she ever going to be my favorite person? No. But now I see her differently and in a more balanced and compassionate manner. Just like all of us, she has a combination of good and bad qualities.

The next communication concept I’m going to tell you about is the “halo effect” and the “reverse halo effect.” This is one of my favorites. If you see one positive thing about a person, you will then assume that everything about this person is positive. Or if you see one negative thing about a person, you will then assume that everything about them is negative. We see this with teenagers who begin dating. They will say, “He’s perfect or she’s perfect.” Well, you and I know that nobody’s perfect, but the teenager sees this person with the halo affect and don’t see that the person they are dating are a combination of good and bad qualities. And when we try to tell them differently, they defend that person. They are a victim of the halo effect. The same thing happens when we meet someone from a culture which we don’t like. We use the reverse halo affect and assume that just because they’re from a certain culture, we won’t like them. This is all or nothing thinking and it will get us into trouble. We need to see people as a balance of positive and negative characteristics. Even if there is something you don’t like about a particular culture or religion, it doesn’t have to dictate the whole picture of how you see the individual person. (There are plenty of people I don’t like, but you would never know it as I put aside my opinions and just treat people well.)

One more concept that comes into effect in our daily life is the concept of the “self-fulfilling prophecy”. This is when our negative expectation may lead to us to create that which we didn’t want to occur. Let me give you an example. Every time you go to work, there is a person there that annoys you. (And lots of people annoy me so I can relate.) So when you walk in, you greet everybody warmly but ignore that one person. Or maybe you greet them but choose to greet them in a cold manner. Then you are surprised when the person reacts to you and says, “Have a nice day” with a hostile attitude. This is when most of us will say, “See, look at them they’re always being rude.” But who really started it that day? You did by your attitude and the way you started the interaction. I would challenge you to try another way. The next time you go into work and interact with this person, I would encourage you to greet them warmly with a smile and say something personally kind. This person may be shocked and not know how to react, but over time, they will begin to warm up and your relationship will get better. It may not happen immediately, but if you stick with it, chances are it will get better. Of course it may never be perfect, but I could settle for better. How about you?

One final technique we can use is to realize that things may not always be as they may appear. We may have misunderstood or misperceived the situation. We may be wrong. We need to remember to allow in new information even if it contradicts your stereotype.

In fact, I would encourage you to look for information which breaks your stereotype. Challenge yourself to learn more about the group that you are uncomfortable with or dislike. You may be surprised how much good you can find in them. I would also caution you to be aware of relying on first impressions. Many times we meet people when they are in a crisis or in grief or are overwhelmed by their life. We need to treat them gently, as we would want to be treated if we were in a crisis. An example of this is the patient who comes to the front desk to check in for their appointment and is rude to the receptionist. My first assumption would be that this guy is a jerk. But I know better and don’t jump to that conclusion. (I try not to make assumptions or jump to conclusions because many times I am wrong because I don’t have enough information.) I realize that there might be something going on in his life that I don’t know about. Maybe his wife just died. Maybe he just found out that his son has cancer. Maybe he was just in a car accident. All I know about him is that in spite of his rudeness, he needs my care and support. I also find that when I treat people well and in a caring manner, their rudeness or anger dissipates and interaction goes better. When I treat them better, it gets better. People laugh at me when I say, “Happy Monday” when I come into work or go through the security gate at the airport. But I know that I’m setting a tone and trying to be a positive part of their day. Over time, I have seen offices change their attitude from negativity into optimism, just because I kept saying, “Happy Monday.” Again, I have power over these moments. I can make things better or worse depending on what I bring to the interaction. I have this power and I choose to use it. So can you.

Have a kind and respectful day.

Detailed article describing “The Platinum Rule®”:

What is “The Platinum Rule®” ? Let me tell you how it differs from the Golden Rule. The Golden Rule, which is found in almost every religion says, “Treat people as you would like to be treated or Do unto others as you would like to be done unto.” The Platinum Rule is even better. It says, “Treat people as they would like to be treated or Do unto others as they would like to be done unto.” It is actually a more respectful way of treating people. The Golden Rule assumes that everyone is the same and would want exactly what you would want. But we aren’t alike and we can get into trouble making this assumption. Let me give you an example.

When someone you know has died and people want to give you comfort, “Do you want people to hug you or do you prefer people to not touch you?” Well, I am a hugger so if I use the Golden Rule, then I am going to hug you whether you like it or not. But if I use the Platinum Rule, then I am going to ask you if you could use a hug and depending on what you tell me, I will respect your answer.

The Platinum Rule works really well in America. We are all different. We have different religions, cultures, values and basic preferences. What I personally believe in is respect. Therefore, I will ask how you like to be shown respect and try to honor it. That is why if you tell me you don’t want to have surgery, even though you might die without it, I will respect your answer. I won’t agree with it but it is not my body that has to go through the experience. It is yours. And you are the only one who can say what is right for your life and your body. Now I might ask you if you would consider changing your mind because I don’t want you to die, but ultimately, it is your decision.

I will respect you and I hope that you will consider asking me how I like to be shown respect too.

Have a kind and respectful day.

The Platinum Rule® is a registered trademark of Dr. Tony Alessandra. Used with permission. All other rights are reserved in all media.

Are you treating your loved one like a “Third Party Patient”?

When you take your loved one to the doctor’s office, are you making sure that you are keeping the person with diminished capacity involved in the office visit? Too often, the doctor starts talking to the patient’s family or caregiver and forgets that the patient is in the room. Or sometimes we forget that our loved one is still here and begin to make all of their decisions for them. This is what is called, “Making the person a third party patient.” It is seems like the patient has become invisible.

I know this has happened in my family. Many times, my dad’s doctor would ask me in front of my dad, “How is your dad feeling today?” Then I would say, “I don’t know, ask him.” Or when I would take my aunt, who was in a wheelchair, out for lunch, people would say to me, “What would your aunt like to eat?” And once again I would say, “I don’t know, ask her.” We have to remind people that our loved one is still here. Even if the person has lost some of their ability to think and communicate, that doesn’t mean that he or she shouldn’t be included. Yes, the person with diminished capacity will not be making the final decisions about medical treatment choices, but the individual can still voice his or her opinion.

I know that it may not be easy and it may take more time, but we need to keep the person included. The person deserves our attention and our effort. Face the patient, ask the person questions and be patient when waiting for the answer. Explain to the person what will be happening to him or her in language that can be understood. It is important to include the person for as long as possible and when it is safe to have them have a voice in the decisions.

Have a kind and respectful day.

Next Page »