Our Thoughts

From Serving Iowa Elders for Over 20 Years

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I’ll Be Me

I’ll Be Me is the autobiographical account of musician Glen Campbell’s diagnosis of Alzheimer’s disease and his remarkable final concert tour.  Glen Campbell, his wife, and his musical family has given us a wonderful and generous gift.  This film rings very true to our experiences with early-to-moderate Alzheimer’s disease.  Mr. Campbell allows us to observe his failing memory and inability to concentrate with genuine candor.  The film reminds us of all the marvelous music the Rhinestone Cowboy sang when most of us were focused on the Stones and Beatles.  We are stunned by his ability to continue to perform in top form in major venues while so sufficiently impaired he had to be reminded to stay within the circle drawn for him on stage, lest he wander into the audience to have a chat with someone mid-song.  We can marvel at his professional musicianship despite impairment and how deftly his family and supporters helped him continue to live his life “to the last minute.”   In many forms of dementia, music continues to be a mode of communication when routine speech malfunctions.  Apparently music knowledge and skills are stored in many cerebral locations, allowing people to sing when they can’t speak and sway to the beat when otherwise immobile.  There is nothing sad about this movie, other than illness sucks and life is never long enough.

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Entertaining Education

Entertaining Education

We like books a lot.  I even have a theory, completely without any substantiating evidence, that reading helps the brain in ways we don’t understand.  The simple act of moving the eyes back and forth repetitively while thinking, aka reading, is remarkably similar to Hypnosis and EMDR (eye movement desensitization and reprocessing therapy), a current star among trauma treatments.

Books give us both information and the pace to integrate that information into the rest of our thoughts.  Most everything we could want to learn is in some book out there.  When we veer from non-fiction into the world of imagination, there are no limits.  We can put ourselves in the shoes of anyone, anywhere, past, present, and even future.  The depth of wisdom we can get from vicarious experience is phenomenal.  It is one way we mature as individuals.  It seems to me especially beneficial that reading gives our brains the time to process what we read.  In my opinion, this makes reading intrinsically superior to other forms of “infotainment.”

We are living in an age of multi-media entertainment.  Personally, during my first decade of life, I saw only one Hollywood movie, Mary Poppins.  On television, I suffered though plenty of boring football yardage awaiting the animated Hamm’s Beer bear.  Captain Kangaroo was actually spellbinding.  Real entertainment was in the back yard, not on a video screen.  Our current crop of kids watches hours of entertainment daily, mostly created for just their age groups and interests.  Unfortunately, these kids also see images that are likely damaging to their age-based development.  All of us now have access to enough entertainment to educate and amuse us 24/7 for the rest of our lives.  It is a mind-boggling shift in how we receive information and experience life.

When we first started talking about doing a blog, we wanted to share books and other entertainment with you.  So here we go . . .

Non-fiction for reference

We have a long list of recommendations written last year.  Now that the blog has begun, we want to watch our list of movies again and add some notes as we share them with you.

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Is Honesty Always the Best Policy?

Honesty is a universal value, applicable to the general population and to specific professions.  We all can understand what it means to be an honest person and behave honestly.

People in our area of human services have some major challenges when it comes to honesty in every situation.  Our peers have called them “geriatric fiblets.”  This “fibbing” is particularly troubling for me.  I value truth and honesty as highly as any personal value.  If you ask my family for the one thing that will set a usually mellow me fuming, they will all tell you “lying” or “dishonesty.”  I find life is challenging enough without being given deliberately misleading information.  Attempts to be truthful are a critical component of communication.  Without it, “Oh, what a tangled web we weave.”*

Yet, we find ourselves recommending judicious dishonesty when dealing with some cognitively impaired clients in some circumstances.  The rationale for lying to a client is easiest to understand by example.  Mr. and Mrs. A had a spectacular marriage of 75 years.  They were always honest with each other, as we expect all good couples to be.  During twenty of those years, Mrs. A’s mother had lived with them.  When Mrs. A began to lose her memory, she would look throughout the house for her aged mother.  She would come to Mr. A often to help her find “Mama.”  Mr. A understood well that his wife was confused and unable to remember many things.  He would try his best to present the truth to her, as he had for 75 years of a close and honest relationship.  He would tell her as gently as he could, “Honey, Mama died in 1998; and she’s in Glendale Cemetery.”  Mrs. A received this “news” by bursting into wracking sobs as if her beloved mother had just died this day.  It broke her heart to hear her mother was no longer with them.  She had the wherewithal to understand death and her personal loss but her memory could not retain the grieving she had completed decades earlier.  Mr. A was unwilling and even unable to lie to her.  His persistent honesty, though with stellar intentions, caused Mrs. A such pain, it bordered on cruelty.

In situations like this, we strongly suggest setting aside one’s impulse to be honest.  Our preference would be to tell Mrs. A that her mother was “fine but not home at the moment.”  If pressed, we would invent something that would pacify her worry but not break her heart.  Perhaps her mother was visiting a friend.  Simply changing the subject can be effective in some situations.  We can try looking for Mama together until Mrs. A can be distracted by some other concern around the house. Direct honesty sometimes has to be weighed against the pain and frustration it can cause.

A completely different situation arises when there is a mistake rather than a lie.  When someone says the day is Friday, while the rest of us know it is Tuesday, s/he isn’t really being dishonest.  Nonetheless, the error is intriguing.  Before simply correcting the mistake and moving on, pause to consider what the error may mean.  Does it mean the person is losing his or her sense of time?  Did she decide it was Friday because she had prematurely taken Wednesday’s and Thursday’s pills?  Is she still waiting for something she expected to happen on Tuesday?  Also, consider the effect of us making a simple correction.  If this person is making frequent factual errors, how will being told she is repeatedly wrong make her feel?  It is certainly hard on the ego and can make the person feel less confident at a time when she may be losing her ability to think clearly anyway.  We once had a client, Ms. D, who insisted her nurse was stealing her stockings.  Ms. D wore garter style stockings with many runs in them.  The nurses were insulted to think they would want such things, much less steal them.  There was no point in correcting Ms. D.  She would only argue more vehemently to protect her ego and her wobbly sense of reality.  When her stockings were missing, she couldn’t tolerate the idea that she was the guilty party herself.  Best to blame others.  Those who got wrongly accused could take comfort in the fact that their egos are less fragile than Ms. D’s.  Ms. D made a mistake about her missing hosiery, but correcting her would be a harmful error on our part.

Honesty is still the best policy for the vast majority of life’s communications, regardless of age and impairment.  However, when someone presents an inability to remember and cope with what the rest of us perceive to be the truth, we are offered an opportunity to step back and ask “why?”  The need to be shielded from some truths can be a consequence of cognitive change.  If the person’s cognitive capacity has become limited, as in the case of Mrs. A, it is up to the rest of us to learn to adapt to her “reality.”  We would not recommend that the death of Mrs. A’s mother be kept secret from her.  However, we do caution that pressing the cognitively impaired person to accept painful information may not be wise or necessary.  Protecting the elder’s emotional health is very much an expression of love and kindness.

*Quote from Sir Walter Scott, Marmion.

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Some thoughts on Ethics.

It seems appropriate that my first blog entry (Mary Alice) should be about ethics. Long ago I began my academic education in the philosophy department, with a particular foci on logic and ethics. Applying ethical principles has been a important value in my life. Now as a licensed social worker, I take several hours of continuing education in ethics biannually.

People don’t discuss ethics as much as they get outraged at the unethical. Unethical behavior makes headlines. We read accusations of dreadful conflicts of interest among financiers and bankers and politicians. There is nearly universal condemnation for being unethical. Yet, there is very little discussion of being ethical. This discussion is how I want to start my blogging adventure.

Merriam-Webster defines ethics as: “Rules of behavior based on ideas about what is morally good and bad.”

One would think that being ethical is pretty easy. People assume they know what is the “right” thing to do. We learn right from wrong as children. We learn The Golden Rule. We are taught, “Don’t poke your sister with a stick.” How hard can it be to continue to do “right” and avoid doing “wrong?” Hopefully, we adults have all stopped poking people with sticks.

The challenges for ethical behavior arise when life presents choices which are not so simple. “To poke or not to poke” becomes “which poke is less painful?” There are times when there are no “good” choices at all. Even more complications arise when people disagree on what is really good, sort of good, a little good, not very good, not too bad, etc. Is “sort of bad” better than “not too good?” What do we choose when your good is bad for me? When we start to look closely at real life situations, the right thing isn’t always so obvious.

Thanks to all the philosophers and ethicists over the centuries, we have some guidance on how to make the complicated choices. Like the dictionary says, ethics involves “rules” of behavior. Even in complicated situations, the Great thinkers guide us with rules and their reasonings about those rules. Some are aimed at humanity in general and some are developed for specific areas of human interaction.

As licensed social workers we are guided by the Code of Ethics of the National Association of Social Workers. This includes the principles that we profess as social workers and which underlie our approach to human interactions. As care managers, we have an overlapping Code of Ethics developed by The National Association of Geriatric Care Managers. You can read these in their entirely at http://www.socialworkers.org and http://www.caremanager.org.

These codes of ethics both include many obvious “rules,” like respect people, keep confidentiality, make good records, know our limitations, etc. However, there are a few “rules” that pose some interesting challenges for our style of practice. These will be the subject of my next few blog entries. Stay tuned.

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What Does It Mean to Be a Senior Citizen?

As geriatric social workers, we notice that there are certain times in a person’s life when he/she begins to contemplate this question:

*When one is approaching a significant birthday
*When someone feels ill and/or disabled
*When a person assumes the care of a senior citizen
*When one’s own parents, grandparents, aunts, uncles, and/or neighbors become senior citizens
*When a student has an assignment for school about senior citizens
*When someone gets a job working with seniors
*When someone approaches retirement

So, what is the definition of a senior citizen? Who is a senior?

These two questions are easily answered by an unhelpful but true statement, “It depends.”

It depends upon how you as an individual define it or how your employer defines it or how your government defines it or how a business defines it, etc. Thus, the answer to “Who is a senior?” is as varied as the individuals and/or entities asking and defining the answers. This begs another set of questions that need to be explored in this discussion of what it means to be a senior citizen:

Who is defining this period of time in our life, how are they defining it, and why are they defining it?

Who? The answer to this question is huge and probably never-ending. A few entities and individuals come to mind, including:

*American Association of Retired People
*Life Insurance Companies
*Health Insurance Companies
*The World Health Organization
*The US Department of Health and Human Services
*The Department of Medicare/Medicaid
*Retirement Communities
*Travel Agencies/Cruise Lines
*Car Insurance Companies
*Our employers
*Financial Institutions
*US Department of Revenue
*Our children
*Our religious institutions
*Physicians and other medical providers
*Our neighbors
*Our extended family members

How is senior citizen defined?

Is it defined by age? Is it defined by our work history or retirement? It is defined by our physical ability or disability? Is it defined by our monetary worth as an employee? Is it defined as our productive worth as an employee? Is it defined by our relationship to others that are younger in our family and/or community? Is it defined by our mental abilities or disabilities?

Asking, “How is senior citizen defined?” really starts to get at the “meat” of the definition of being a senior citizen and accentuates the problem with defining this period of life. We, as social workers working primarily with senior citizens, find that definitions of being a senior citizen change throughout their lives. This definition changes depending upon the age of the person, the physical and/or mental capabilities of the person, the employment status of the person, the mental health of the person, the life experiences of the person, and the expectations of life for the future of each individual.

Why is senior citizenship being defined? Is it being defined in order to classify a group of people for a study? Is the definition used to exclude or include certain people for housing, government programs, or reduced rates at businesses? Is the definition used to determine rates for insurance? Is the definition used by an individual to access whether he/she should be capable of doing certain activities? There are many reasons why the image of “senior years” is defined. It is important to understand the reasons why the definition is being created while considering the definition.

As discussed today, the definition of being a senior citizen is complex and varied. As expected there is no one right answer to this question. The answers are as varied as the reasons for asking the question. We hope that this discussion will stimulate you, our readers, to think about your own definition of what it means to be a senior. Please feel free to share your thoughts about this subject and your personal definition of senior citizenship in our comments section. This discussion will start out fairly academic but quickly morph into talking about how “academic” and “official” definitions of being a senior citizen affects our personal expectations, stereotypes, fears, concerns, and planning for this period in our life.

In the next blog, we will explore some of the definitions of senior citizen that exist currently.

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Planning our Blog Topics Together: What do we know that would be worth your time?

We are writing this blog together riding in a car on I-80E returning to Des Moines, IA on a Saturday in January in 2015 discussing our ideas for our blogs. After 20 years of case managing many elders, some of who are still on our case load 20 years later, we think we have knowledge that we should share. Mary Alice has started some drafts on ethical issues and Pamela is thinking about various definitions of being a senior.

Why do we think we know anything? What makes our thoughts worth your time to read?

We think we do a pretty good job at what we do but most everyone thinks they do a good job. We hear our clients and their families tell us we do a good job but due to confidentiality we can’t give you specific names of our “happy customers.” We both have masters degrees in social work and have been working in the field of social work for over 20 years but many other social workers can state this. Our business, Elder Concerns, L.C. has been around for over 20 years but many businesses have longevity. We bend over backwards to give assist our clients in living well but again due to confidentiality we can’t give you details.

So what can we tell you to “prove our worth.” We think the above paragraph almost says it all. We are highly educated in our field our business has been around a long time doing the same type of work, we have worked specifically for over 20 yeas and we have successfully helped many elders and their families over this time. We are licensed in Iowa at the highest level for social workers and we continue to stay abreast on elder issues.

We frequently get phone calls from seniors and/or family asking, “What do you do?”
This is a difficult question to answer. Our working theory model of business is to listen to what our client wants, look at the situation (assessment), and then assist the client to sort out what’s important and how to make it happen.

But that still doesn’t give you any particulars. When our inquiring callers ask, “So what do you do? We say, “We do what the client needs.” “We think of ourselves as geriatric problem-solvers.” The caller then asks what problems do you solve? What client needs do you do address?

We really don’t intend to be evasive or frustrating. We tend to prefer to start a conversation of their specific situation and concerns.

So we will try in this blog to give examples of various activities that we have done over the years to help our clients. These activities do not limit us in anyway from carrying out different activities in the future for others.

We’ve done something different for every client we’ve had. The list of our possible job duties is as long as there are variations in our clients and their needs.

Now we believe you are thinking, “Quit the mumbo jumbo you two and give us readers specifics.”

We have:

*helped doctors listen to the patient
*coordinated moves
*arranged, transported and accompanied people to the Mayo Clinic, Creighton University Clinics, and the University of Iowa Clinics for second opinions
*relayed data between medical care providers
*facilitated the patient’s ability to comply with medical instructions
*set mousetraps
*explained and/or remind clients why they are doing what the doctor ordered
*helped clients understand their medical conditions
*helped clients understand their choices and options
*helped clients keep bills paid
*kept track of client’s appointments
*transported clients to routine appointments and contributed to the appointment discussion if needed
*helped clients send birthday cards to family and friends
*helped clients sort mail
*communicated with the client’s family with client’s permission.
*assisted clients in managing their businesses
*assisted clients in organizing investments
*assisted clients in describing symptoms and providing clues to medical providers in order to get the most accurate diagnosis
*planned funerals
*celebrated birthdays
*helped people plan and understand placement options
*helped hospital and nursing home patients understand their rights
*assisted clients in understanding their insurance benefits
*helped clients find medical providers

Some people request a formal assessment report. Whether we draft a report or not, our thought processes cover all the areas of a formal interdisciplinary assessment, including but not limited to:
*emotional health
*spiritual health
*medical health
*physical health
*mental health
*family and social relationships
*activities of daily living
*general quality of life
*specific care needs

So, here we go…..attempting to share our experiences and ideas with you, our readers, in our upcoming blogs. Please feel free to comment, question, or disagree with our “wisdom.”

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An Introduction to Elder Concerns, L.C. Blogging Styles and Formats

As any reader will soon notice, Mary Alice and I (Pamela) have different opinions, writing styles, reading habits, and movie and television watching norms.  Our strengths and weaknesses are different and we feel that we work together and complement each other well.  Our likes and dislikes in the work environment are also very different.  All of these differences will show up as we begin to really put time and energy into this blog site.  Hopefully you as the reader will like seeing the differences between us and our unique perspectives on the world in which we live and how that impacts our lives as we grow older.  We enjoy working with each other and with the clients that we serve.  We also enjoy other activities in life and will share those enjoyments with you in these posts.  I also predict that you will be able to read about our disappointments in the services, systems, and opportunities available to seniors and how we hope that these negative aspects of being a senior can be changed for the better.  Stay tuned for our blogs as we hope to be informative, uplifting, and/or thought-provoking about life as a senior in Iowa.

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Elder Concerns, L.C. Presents elderinterests.wordpress.com

Elder Concerns, L.C. is a small, private, geriatric care agency located in Des Moines, IA which has provided master’s level social work case management of Iowa seniors for 20 years.  Elder Concerns, L.C. is owned an operated by a single individual, Mary Alice Butler, a master’s level licensed social worker who has dedicated the last 20 years of her life to making life better for Iowa seniors.  She also employs another master’s level social worker, Pamela Nelson-Grotrian who has worked with her approximately 16 years of the 20 years she has been operating Elder Concerns, L.C.

To celebrate our 20 years in business, we are attempting to utilize digital media to help seniors and their families navigate the myriad of needs, concerns, interests, and services that confront them for the first time in their lives.  Being a senior can be wonderful.  It can also, like any other life stage, be a bit overwhelming.  It is too bad that there is no road map to life’s questions.  We would all like to feel like we know where we are going throughout life.  But, needless to say, life is not that easily figured out.  Being an elder is the same as any other “stage” in life.  As you’ve never been there before, everything is new, nothing is familiar, and the choices either seem endless or appear as if you have entered a dead end street.  We at Elder Concerns, L.C. haven’t entered the stage of life called “elderly,” “senior,” or “aged” but we have traveled along the paths of some remarkable seniors in our 20 years of business serving the elderly and we would like to share our thoughts, feelings, knowledge, and insights with you.  We feel that we have much to share with today’s seniors, their friends, and their families and we hope that you, our readers, get some tidbit of knowledge or slice or wisdom (or just laugh at our screw-ups) from our experiences and opinions.

We are planning to have this blog contain many different types of articles.  We want to share concrete services that we know exist.  We want to share advice about searching for help and services for seniors.  We want to state that being a senior does not need to be all “concerns and worries” and as such will share ideas about activities and opportunities unique to elders.  We plan to share our favorite books and movies.  We plan to talk about opportunities for personal growth as a senior and how best to watch for scams of all types.  We are excited about this blog and hope that you become “interested” in elder topics and join us regularly.

We also want to say that this is our first time blogging online; that even as we are experienced working with seniors, this is the first time that we’ve ventured into web development.  We have a website that has remained static for years.  We plan to link this blog page to our website and begin to shape our website into something that reflects the current ability of computer media to talk about our business.  Thus, we hope that you forgive our technological blunders as we attempt to get our views to you.

For those interested in who we are and what our business is..our website is www.elderconcerns.com