engAGINGconversations's podcast

Nursing is a tough career choice. No doubt. But how much can you expect anyone to do? I talk today with another nurse. Three years into her career. We talk about what it's like to be a nurse. And how nurse burnout can affect YOU.

We also discuss Question one, on the Massachusetts ballot for the November 6, 2018 election. This question proposes a legal mandate for nurse:patient ratios in acute care settings. On the surface, it sounds amazing. Please listen to this podcast to hear a different perspective from two nurses. One early in her career, the other perhaps a little sullied.

Why is this important to you?

• It may impact the care your parent receives
• It may impact the care you will need to provide to your parent
• It may impact you as a patient
• it may impact you as an employee
• It may impact you as a tax payer

I hope you listen. And I would love to hear your take on this. Even if you don't live in Massachusetts. Because it didn't start here, and it likely won't end here, unless it does...

What do you want the end of your life to look like? If you haven't considered this, and talked about your wishes with your loved ones, you should. If you don't, you risk ending up on the "end of life conveyor belt". A situation that occurs when your family members can't agree about what you would want when you can't speak for yourself, they can't let you go, and when physicians offer the next treatment modality (because that's how they're trained and it's available), and don't know how to say no. Not a good thing, unless that's what you want. Where all stops are pulled, every last ditch attempted. Even in a futile situation.

Dr. Jessica Zitteris an ICU physician with years of experience. She comes from a family of physicians trained to treat and cure. It took an ICU nurse colleague, Pat Murphy RN, accusing her of "torturing" a patient to start her evolution. She began to understand that just because treatment modalities are available, it is not always in the best interests of the patient. That the need to prolong life at any cost is not necessarily a good thing, unless the patient has expressed these wishes. And if they haven't, this leaves everyone else trying to do the right thing. Which can balloon into the wrong thing.

Dr. Zitter believes that this conversation needs to begin in high school. She is a proponent of Sex Ed and Death Ed. That the conversation starts in adolescence, and a person's wishes can change over time. We both believe that the earlier these conversations occur, the more likely that a culture shift can occur and we can stop this "conveyor belt" for those that want to get off (or not get on in the first place). She offers resources to help you sort this out.

Extremisis a documentary, currently on Netflix, which follows 2 families through the process of decision making for their loved ones who are intubated in the ICU. It is a raw account of the families and professional caregivers struggles to make the right decisions for the patient. It's a very real picture of what goes on every day when conversations haven't been had, and documented, as well as an excellent visual about the necessity of advanced care planning.

Dr. Zitter's book, Extreme Measures: Finding a Better Path to the End of Life offers stories of patient/family ICU experiences, as well as valuable tools in the appendices for guidance to help you process this information and develop your own advanced care plan.

Other resources she mentions:

Vital Decisions, a company whose mission is to be the force, the catalyst in this country, to fundamentally change how individuals are cared for during an advanced illness.

Serious Illness Care , a joint health system innovation center working to save lives and reduce suffering, started by Atul Gawande

The goal is that everyone gets the opportunity to live the way they want to live, all the way to the end. Our job as health care providers should be to help family members navigate the process, based on their loved ones wishes. Because with the advances of technology, there will always be that one next thing. The issue is, would you want us to go there for you...

How do you become a part of a community when you don't even know that community exists? When your friends aren't going through this experience at the same time you are, it's easy to feel alone. Elizabeth Miller started on her caregiver journey doing what many do...Googling. She first came across the term sandwich generation, which fit her circumstances, and then family caregiver. She had no idea she was a family caregiver. She just thought she was being a daughter. Putting things together on her own, she was struggling to take time for herself. And knew that it was important. She needed to figure out how to take care of herself through the process of caring for her kids and her parents.

Elizabeth documented her personal journey (a background in journalism comes in handy). Starting with 100 days of healthy on Instagram, then blogging and podcasting, Elizabeth shares what worked for her and is now helping others. As a certified caregiver consultant, she wants to help you find ways to be a happy, healthy caregiver.

Find her at HappyHealthyCaregiver.com as well as links to her social media. And check out the 3rd National Caregiving Conference, happening 11/8/18-11/11/18 in Chicago. There is a virtual attendance option for those who can't get to Chicago. And look for Elizabeth's book, which will be launching at the conference: Just for you: A Daily Self Care Journal

Other resources Elizabeth mentioned:

The Dutiful Daughter's Guide to Caregiving by Judith Henry

daughterhood.org

AARP's livable communities program has one goal. To help communities work better and become great places to live for everyone. What makes a community "livable" varies by location, but some of the attributes on the list are access to transportation and public spaces, a range of housing options, and community engagement.

The livable communities program has TONS of resources on their webpage AARP.org/livable . From access to their weekly newsletter, which comes out on Wednesdays, to a document called Where We Live , which provides an annual report on the state of communities, to a map of what communities are involved...and so much more, check it out!

Funding for the changes necessary to make a community more livable can come from a variety of sources. Some can be as simple as thoughtful planning about existing public investments in infrastructure. Talking to your local planning committee to see what is on the docket for upgrades and asking your city government to be involved are great ways to start.

One of the biggest takeaways for me was the results of the 2018 Home and community preferences survey. Danielle tells us that ~7% of respondents have accessory dwelling units or "granny flats", but ~33% would like to build one. With the number of people over 65 increasing every day, I can only see this number increasing. In order to see these units become accessible to more homeowners it's going to take rezoning or perhaps policy change. For the one off, it can require a variance. Some may not want to see a change to their neighborhood or town. But there are pluses for both sides to having these units. Having your aging parent in the backyard vs. across the city (or country) will make your life easier. Having your parents close by can provide a source of care for your children. And finding a space that can accommodate both your and your parents, can allow you to live in a home or area that you might not otherwise be able to afford. All things to consider.

Find out about their national conference, happening November 12-14 2018 in Charlotte, NC. This conference has ~100 slots open to the public. You can learn more here: 6th Annual AARP Livable Communities Conference 2018

Find AARP's livable communities on social:

Facebook: AARP livable communities

Twitter: @AARPLivable

Modernizing and medicalizing death is something our culture has become very good at. And there are both positives and negatives associated with this. Michael Hebb's life experience with death, at an early age, set him on a path that most of us don't encounter until much later in life. What were devastating life experiences for a child, molded Michael into a deep thinker. Someone who is able to help us all face difficult transitions. And conversations.

It is never too early to talk about death. Michael's early life experiences were, in part, what prompted him to launch "Death Over Dinner", a program that utilizes the dinner table to have difficult conversations with our family and other loved ones about death. About how to honor our loved ones by following through with their wishes. This starts with conversations with them about what they would want if they were unable to verbalize them. He also believes that in having these conversations, it allows us to know ourselves better and deeply connect us with our "communities", our family and friends that we would have these conversations with.

But with ~75% of people expressing wishes to die at home, yet only ~25% of people do, there clearly is a disconnect. Death Over Dinner can help start these tough conversations. As a result of the many positive experiences of the Death Over Dinner movement, a book was born, which shares some of these great, inspirational stories. It's called Let's Talk About Death (Over Dinner)

Don't assume that your loved one doesn't want to have this conversation. Often they don't want to upset YOU and start these "difficult conversations". Just ask. And it often takes more than one conversation. But if you start the conversation, each time your broach it, it may become easier. And Death Over Dinneris a tool that can help you have these difficult conversations.

Click on the links above to access resources, and follow Michael and Death Over Dinner on social media :

Facebook: Death Over Dinner

Twitter: Death Over Dinner

Geriatric Care Managers or Aging Care Specialists, are an important member of an elder's care team. They are the conduit between the patient, family, and medical team. They assist is determining the best use of resources based on individual needs and because they go into the home, they can see the big picture. They advocate for the patient with discussion about what the patient's wishes are. They can be nurses, social workers, or elder care workers with a special certification. They can work for insurance companies, physicians, or can be independently employed.

Tara Cunningham RN, shares her perspective as an eight year veteran Geriatric Care Manager and as a nurse. She offers great advice for families which include open discussion about end of life wishes, and suggests several tools to help with the conversation: The 5 Wishes Document and The Conversation Project

She also offers suggestions for finding out if you or your family have access to a Geriatric Care Manager:

• check with your insurance company
• ask your primary care physician
• Check with your local council on aging
• Do an online search

Medicare's annual election period runs from October 15-December 7. It's mid-September now. This is an important PSA that can save your family thousands of dollars, hours of stress, and many sleepless nights. Danielle Kunkle knows her stuff. And she knows how to help you and/or your parents. Medicare is complex. It has many moving parts. You have to know:

• when to enroll
• what choices are "permanent"
• what can be changed annually
• why you would want to change your options
• when these changes can occur

We all get SO much junk mail. If you or your parents are enrolled in Medicare, make sure to look for the Annual Notice of Change , coming to you or their mailbox in Mid September. This is an annual opportunity to make sure you have the coverage you need. Premiums go up, coverage of specific drugs can be eliminated, and physicians may leave a plan, which can have a huge impact on out of pocket costs. So pay attention. And if you have questions, ask. Look at resources listed here:

Medicare's plan finder tool

boomerbenefits.com

Facebook: @boomerbenefits

instagram:boomer benefits

YouTube: Boomer Benefits

At 27, Christina Britton Conroy,found herself responsible for the care of her 80 year old father as his physical health declined and he suffered with dementia. Twelve years of care that she never wanted to provide, led her down a path to professional caregiving. Using her background in theater and music, she became a music therapist for seniors in a variety of settings. She continues to provide music therapy to many, in spite of her role as a caregiver for her husband who was diagnosed with Parkinson's dementia.

Through her years of experience as both a personal and professional caregiver, she has developed much insight. Her advice for caregivers:

• Expect the expected
• Take time for yourself
• You will always feel guilty. Accept it and do the best you can
• Allow them to say "no"
• Crying is necessary, and good

check out her book: How To Have Fun With Your Aging Parent

And find her on social media

Twitter

Instagram

Catherine Hodder, Esq. was a corporate finance attorney and a Mom to two young children when her father was hospitalized after a series of mini-strokes and spent several months in the hospital. Although her dad was very organized and had "his affairs in order", she still ran into problems she could not have anticipated, even with her legal expertise. She became a member of "The Sandwich Generation". As a result of her experience, she changed her legal focus to estate planning. Now retired from law practice, she writes many helpful articles and books, and has recently published

Estate Planning for the Sandwich Generation : How to help Your Parents and Protect Your Kids

In today's interview, Catherine tells us these 3 things will make your life easier when it comes time to help your parents:

1. Early Communication--talking to your parents about their wishes, finding out where they keep their documents, and who is in charge of their finances.
2. Prepare/plan as much as possible--find out if they have filled out documents, whether they have long term care insurance
3. See a lawyer--banks and healthcare providers often need specific language in you power of attorney documents. Terms vary from state to state. Spending a little money up front to know that when you need these documents, they are the right ones can save you much aggravation that you will not have time to deal with.

She also suggests getting your own estate planning in order. When you are the one everyone else depends on, what happens if something happens to you?

In addition to her website, HodderInk.com

you can find Catherine on Facebook @sandgenlife and Twitter @sandgenlife

Cycling without Agewas founded in 2012 by Ole Kassow in Copenhagen. It now includes chapters in 35 countries, with approximately 150 chapters in the US. It was born of Ole's desire to return mobility to seniors in nursing homes. To let them feel "the wind in their hair". It has also had some amazing unintended side effects! For the passengers getting back out into the community has:

• brought joy and a sense of "normality" back
• improved mood
• promoted new relationships

For the volunteers (called pilots) this shared experience has:

• helped develop new purpose in their lives
• provided opportunity to learn history, from the people who lived it, in the place where it was lived
• provided priceless resources of wisdom (and friendship)

To find out more about the program, list to Ole's TED Talk

To find out how to start a chapter in your community or follow on social media, go to the website:

Cycling Without Age (US and Canada)

Cycling Without Age (International)

Instagram: #cyclingwithoutage

Facebook: Cycling Without Age