AGING WITH GRACE - seminar summary 10.27.2007
by Veda Lewis

Synopsis of Aging with Grace Workshop

By Veda Lewis 10/27/2007

(You can download the .pdf version of this summary here.)

At four o’clock this particular Saturday afternoon, the participants in
the Aging with Grace workshop were virtually transported beyond beautiful
Burlingame Hall. Travel accommodations were provided by the sweet harmony
of the Threshold Choir. They are nine women volunteers who work with
hospice patients, providing loving melodies to them and their caregivers,
families, and friends. Joyful tears from the heart emerged from around the
room as the choir embraced the audience with love and engaged everyone to
join in with the life celebrating songs they shared.

This was a fitting conclusion for a day that was filled with information
about the diseases of aging, estate and long-term care planning, and the
world of hospice care. About 75 people attended the workshop, organized by
the Forum Committee, our lay ministry group which brings timely topics to
the congregation and the wider community. The group is comprised of Kathy
Aanestad, chair, Helen Rowntree, Nancy Ladd, and Nancy Denken. These women
did an awesome job and with the help of excellent speakers and a crew of
volunteers, pulled off a great day.

Following a welcome by Reverend Nancy Taylor, she recognized the hard work
of the late Suzanne Bristol, who revitalized the Forum, the speakers began
the day. Dr. David Greenberg, Ph.D., M.D., from the Buck Institute on
Aging, in Novato provided a detailed, but layperson-friendly, look at
stroke and Alzheimer’s disease. He explained that patients have a brief
three hour window following the onset of a stroke where thrombolytic, or
clot-busting, drugs can be useful. It is critical that doctors assure that
the stroke is from a clot and not a blood vessel break first. After 12
hours, the impacts of the stroke are lasting and drugs cannot help. Currently, research is focused on the possibility of repairing brain
damage after a stroke. Research is showing that new brain cells in rodents
migrate toward the area of the brain where a stroke has had an impact.
These findings are encouraging research in the process of injury repair at
the cellular level.

Alzheimer’s disease was described 100 year’s ago in a 45 year-old female
patient. The characteristics of the disease are dementia (a progressive
deterioration of cognitive function), prominent memory loss, and a
progressive onset of symptoms. Early evaluation is important to assure
that a treatable cause of any of these symptoms is identified. Not all
dementia is Alzheimer’s disease, nor is all prominent memory loss. Dr.
Greenberg described it this way. If you can’t remember where you parked
your car right away; that’s one thing. If you never remember where you
parked your car and you don’t find it, that’s a more serious matter.

Unfortunately, treatment for Alzheimer’s disease is not very good. There
is no laboratory test you can take to really diagnose it fully. Research
is currently focused on boosting brain levels of acetylcholine, a
neurotransmitter, by inhibiting the action of the enzyme that breaks down
this molecule. In practice, this is thus far ineffective.

Only about 20 percent of Alzheimer’s occurrence is genetic. Unfortunately,
there is no proven prevention regimen for the disease. Mental and physical
activity may or may not be a factor.

Stroke prevention may center on keeping hypertension and heart disease at
bay, avoiding smoking, keeping a healthy diet, and possibly low-dose
aspirin, unless you have contraindications for that.

Dr. Greenberg did an excellent job of balancing the graphs and pie charts
with a healthy dose of humor and skillful fielding of questions from the
audience.

Stacy Turner, Esq, elder law attorney with Freitas, McCarthy, MacMahon &
Keating, LLP in San Rafael, brought with high energy and a wealth of
knowledge to two very meaty topics. She delivered the essentials of estate
planning prior to the lunch break, and tackled long-term care planning
after the break. Ms. Turner answered questions on the fly throughout,
careful not to go into too much detail where a little knowledge can be
dangerous. Instead she focused her talk on the basics of trusts and wills
and why they are so important. It was helpful to have graphics depicting
how the various instruments work together when we are living and after
death. For example, revocable trusts and advance health directives are in
effect through health, incapacity, and after death. A durable power of
attorney for finances ends at death, and obviously, a will takes effect
then.

Ms. Turner went into important detail in the area of potential for
financial abuse of seniors, often aimed at pushing seniors to estate
decisions using fear tactics and false information. In addition, she spent
a significant amount of time on prizes, lotteries, and scams aimed at
seniors. Legitimate prizes, she emphasized, never require a fee, or
purchase to collect your winnings.

The majority of financial crimes against seniors are committed by family,
friends, and caregivers. Warning signs of potential abuse and a variety of
ways to protect yourself were provided in the helpful handouts of her
slide presentations. One such measure is to tell a number of people your
care and financial plans, thus deterring one party from deceiving others
who may not be familiar with your wishes.

She covered the selection of a trustee, and successor trustees, which was
shown to be an important decision, not to be taken lightly. This person
must have the ability to follow the directions of your trust, a legal
document. When preparing a trust, she stressed, you must include any
possessions that you want to be a part of the trust. Real property must
have the deed recorded in the name of the trust and any other possessions
must be specified and recorded in an acceptable manner.

As you might expect, there were many questions. Ms. Turner handled them in
the group setting and individually, through the lunch hour. Tasty bag
lunches prepared by Mary Evelyn Arnold were well-received and included in
the modest $10 registration fee for the event.

During the lunch break, participants also had the opportunity to talk with
representatives from a variety of local elder services. Hospice by the
Bay, The Meadows (Napa), Sonoma Health Care, Sonoma Hills, and Avalon
provided staff at tables throughout the day, one group providing free
blood pressure readings upon request.

After lunch, Debby Cooper read a poem written by Sara Ladd and Travis
Woods. The poem was a twist on the well-known “When I am old, I will wear
purple” in tribute to Nancy Ladd’s late mother-in-law Louise. To give you
a taste, it begins, “When I am older I shall live in San Francisco and
live on the 14th floor. And while waiting for the elevator, I will always
check that my hair is perfectly coiffed.”

Not missing a step, Ms. Turner outlined planning for long-term care.
Long-term care insurance is not all the same, she explained. It is
critical to ask questions such as the following: When does the policy
start to pay? What is the daily benefit? Does it adjust for inflation?

Medicare and Medi-Cal were demystified. Medi-Cal, in particular was
approached from the direction of assets and eligibility. Family dynamics
were identified as an important consideration when planning for long-term
care needs.

Some members of the audience (I was one of them) shared how an elder law
attorney had been significantly helpful in their dealings with loved ones
who needed to go through the complicated process of applying for these
programs and working with nursing facilities. A very small investment,
about $300, yielded a high return and helped the caregivers stay sane
through the process. Transferring parts of your assets to others, spending
down cash, and gifting must be done with caution. Otherwise, Medi-Cal may
have justification to deny eligibility.

It was surprising to learn that if you have taken Medi-Cal benefits, after
your death (if you are single) or after the death of your spouse, the
government can come calling for reimbursement of what was provided for
your care. I was shocked to learn that since Medi-Cal is technically a
federal program administered by the states, same-sex domestic partners are
not recognized by the program. As a result, it could potentially put a
widowed survivor in jeopardy of losing their home should reimbursement for
a deceased partner’s benefits be an issue. Let’s say Jane gets sick, uses
lots of Medi-Cal benefits, and dies. Her same-sex partner Mary could lose
the roof over her head (their home) because she is not afforded the same
protection provided to heterosexual married couples.

This scenario is only one of those that points out the need for
professional assistance. Changes in the law are crucial to the ongoing
process of estate and long-term care planning.

Mid-afternoon brought us to the topic of hospice care at the end-of-life
when dealing with a terminal illness. Erin Henke, director of
communications and community relations for Hospice by the Bay took a
different approach to planning for future healthcare decisions. She
outlined how our increased life span is changing the ways we die. In the
early 1900’s we could expect, on average, to live to age 46 and die a
quick death from infection, accident or childbirth. Today, the average
life expectancy is 78 years and over 60% of deaths are from heart disease,
stroke, and cancer, often after a prolonged illness. When it comes to
end-of-life decisions, about half of us will not be able to participate in
making those decisions.

Ms. Henke provided an extensive look at a variety of terms, from advance
health care directive, to ethical wills and DNR’s (do not resuscitate
order). If there was one action item to take from the session, she
emphasized, it was to prepare an advance health directive as soon as
possible. Most of us are familiar with the sad case of Terry Schiavo and
would not want that situation to occur in our lives. The advance health
directive is a simple form that you can prepare and have witnessed
yourself.

Ms. Henke went into important detail regarding what your designated health
care agent can do should you be incapacitated. Importantly, you need to
inform your designee so he or she can appropriately act in your behalf.
Distribution of copies of your directive is critical; while the location
of the original must be provided to your health care agent. In addition,
all copies of superseded directives should be destroyed. The information
table provided by Hospice by the Bay included ample copies of advance
health directives and another document called Five Wishes. According to
the description in the booklet, Five Wishes is the first living will that
talks about your personal, emotional and spiritual needs as well as your
medical wishes. It is recognized in 38 states, including California.

The CPR option for elders yields some sobering statistics. Only 15% of
people in general survive CPR. Frail folks only survive 5% of the time.
DNR’s (which must be obtained from your physician) may or may not be
respected by paramedics, according to one account from a workshop
participant.

Want to write a love letter to your family which would be opened while you
are still alive? Consider an ethical will. This document, increasing in
popularity, allows you to share values, memories, life lessons, etc. You
might forgive or ask forgiveness. This is not a legal document, rather an
opportunity to record what is important for you to share with your family
and friends before you die.

During Ms. Henke’s session, she went into great detail regarding questions
to ask when considering your wishes for care should you become chronically
or terminally ill. What kind of treatment would you want if you were in a
state of prolonged unconsciousness and were not expected to recover? Hard
question, but now is the time to ponder it. Otherwise, your health care
agent may have to struggle and guess what you might want from their life
experience with you. Since this does not come up in polite American
conversation, you should share the answers while you know you can.

Hospice was designed as a six-month program. Physicians frequently wait
until patients are much closer to the end-of-life since it is not always
possible to predict accurately how long a person may have to live until
their illnesses are too much to bear. Hospice services have a family focus
on quality, value, and care for the patient and everyone involved in their
care. There is a six-month Medicare benefit for hospice services, and
Medi-Cal has something similar. Everyone gets the same level of service
and Hospice by the Bay has been able to provide service, regardless of
ability to pay.

What happens if you go beyond six months? Not to worry. Patients can be
recertified for hospice. It can be complicated in some cases, but use the
energy you might spend worrying about it to consider designation of your
health care agent.

Hospice care is a tough topic, but Erin Henke made it interesting as well
as informative.

I have had personal experience with the hospice services of Reverend Kathy
Speas, who was the final speaker of the day. Along with our pastor,
Reverend Nancy Taylor, Rev. Speas provided a blessing shortly after the
death of my partner’s mother only six weeks ago. Rev. Speas brought the
same spirit of hospice chaplaincy to Burlingame Hall. She slowed down the
pace with poetry celebrating the seasons of our lives. After a day dealing
with disease, law, taxes, and death, we celebrated spirit.

She outlined the cycles we go through as we age. We move from striving
towards achievement in our youth, to reflection and acceptance. We spend
less time in roles and move to a more grounded sense of self. Our
priorities shift from outward to inward. This is good news because
spirituality is related to health. A spiritual connection helps strengthen
immune systems, lower stress, and is associated with faster healing and
recovery.

What does she tell a hospice patient who complains that they are too weak
to do anything ‘useful’? They can always pray. She shared her belief that
prayers may be more powerful when we are less distracted.

Nourishing the spirit as we age and spiritual life review were identified
as important parts of a different type of ‘estate’ planning. Storytelling
provides an opportunity to pass on the pieces of our lives that give
meaning to others when we are gone. Our stories are the most sacred thing
about us, she states. Rev. Speas recommended that we tell those stories at
family gatherings. Handing down heirlooms is another important way to
respond to your spiritual life review. She shared her joy of having her
late mother’s 1940’s copy of the Joy of Cooking, along with other cookbook
mementos. These items are ‘gold’ for her.

At some point in our lives, most of us encounter a situation where we must
determine how to support friends at critical times in end-of-life
situations. What do we say? What do we do? Rev. Speas explained that many
religions direct us to just be with the person, to “stay here and watch
with me”, as described in Christian scripture. Compassionate presence is
challenging in a society that puts so much stock in doing and fixing.
Compassionate presence requires that we face what we do not control.
Practical considerations, excerpted from a list prepared by Rachel
Stanworth (included in the workshop handouts) focus on matching the energy
level of the person who is ill. Decreasing stimulation is important
because the key is that you are there with the person. Offers of practical
assistance can focus on specific activities that you see might be needed.
Rather than the standard question “Is there anything I can do to help?”
ask if you can do the laundry, go grocery shopping, or something else
specific. Take care of yourself in this process of being there for the
other person.

As a person who generally talks a lot in certain settings, it was helpful
to learn that hearing is the last sense to shut down when a person is near
death. We can continue talking to our loved ones, especially telling them
that when they go, part of us will die with them so they will never be
alone.

Rev. Speas told the story of spending time with a hospice patient who
appeared to be sleeping. She sat with her awhile, provided communion as
requested and left. All the while the woman did not appear to be connected
with what was going on. A few days later family members related that the
woman told a vivid story of being in a garden, where a woman gave her
communion and then left.

“The stillness of your own heart is where it starts”, according to Kathy
Speas from Hospice by the Bay.

I started this synopsis with the Threshold Choir, who serenaded us
following Rev. Speas’ presentation. Although you may not hear them at this
moment, I hope you can find a still place where the birds are singing and
the sweet smells of nature surround you. Then you will hear them, even if
you were not at the Aging with Grace workshop.

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