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The Periodic Midlife/Longlife Update E-newsletter September 2005
The Periodic Midlife/Longlife Update E-newsletter
is devoted to sharing information and enhancing excellence in ongoing faith and holistic formation for maturing adults from midlife through end of life.
Bill Prather, Founder and Director of Partners In Pastoral Care
seeks to provide members with an ongoing flow of practical information that leaders/models can use directly with adults of all ages. Training is also offered through the educational arm of Partners in Pastoral Care.
All opinions expressed herein are those of the author. Permission is granted to reproduce this issue in whole or in part as long as its source is identified.
Most of what I have to say in this issue comes out of my recent experience of caregiving, being present at, and helping with the surrounding issues and concerns of, my father’s death. A man I loved very much died September 1, 2005 at the age of eighty-seven.
In This Issue:
After a Loss
Ten Things Every Family Needs to Know as Loved Ones Age
Talking With Parents About Future Life and Living
Being Grateful Is Good For Health .
Pastoral Care Week gives opportunities for organizations and institutions of all kinds and types to recognize the spiritual caregivers in their midst and the ministry which the caregivers provide .
1. As with all things, there is a natural sense of loss when the need for caregiving is over. This rang ever so true a week or so ago when my mother, sisters and I were sharing our sadness. Mother is facing a double sorrow of the recent death of her beloved of sixty-three years, and her role in their married life. Her statement said it all: “I just don’t know what I’ll do without him in the days to come.”
Maybe you have faced this same thing; today there could be men and women under your care who are struggling with this quandary.
For many of our colleagues and us, leaving the pastoral position can result in very difficult times, whether we left for retirement, health reasons, or were ousted. At the least, we feel lost, lonely and useless. We may not feel grounded without that important function of taking care of “all the people.” A good friend who was “let go” from the Senior Adult Minister’s position described it to me in these words: “The future looks bleak and empty.”
May I say with all loving-kindness that if our self-confidence is based on the ministry we performed or are performing, we will probably experience a negative shift in self-esteem. In that case, it becomes very hard to pick ourselves up and start over again, especially during the later part of our lives.
The first step after any kind of loss is to allow and accept our feelings. We must acknowledge this shift in our lives and the feelings it may provoke. It is possible that we’ll feel relief that we don’t have to work so hard any longer, and then feel a sense of guilt for feeling such relief. We may be angry with ourselves or someone else for letting us down. All of these are natural reactions and it is important to express our sadness, anger, loneliness and regret.
While we are trained to listen to others, it is most difficult for us to listen to ourselves and appreciate what we feel as we mourn our personal losses. But it doesn’t make it any less important. It is imperative to accept reality and forgive ourselves and others now that the loss has occurred—not easy steps for most of us. Yet we know and have even preached it: “Healing depends on our willingness to let go of past emotions, resentments, regrets, and disappointments.” The future is in God’s mind and we have a choice as to how we approach Him.
The task ahead is new beginnings. I know—we don’t like to change! Understand, change occurs whether we like, dislike, agree or disagree with it. Grieve, yes. But accept the newness as God’s creation while you grieve over the loss. Take a deep breath and take hold of the fact that your new purpose in life is a fresh beginning. We can ill afford to avoid the fact that change is what is demanded of us now, as much as we try to sidestep it. It may seem a monumental task to create new living and ministry patterns. For some, this is where they stick their head in the sand in denial. Others battle until they are completely worn out and die early.
Starting over for those under your pastoral care and maybe for you has been like climbing a mountain that is too rocky and too steep. For others, even though it may feel like a blind walk through a forest, starting over is something we’ve done before. For those who deal with life as an adventure, there may even be some excitement at discovering the new, unexplored lands or places that lie ahead after the loss of someone or something. However, no matter what our reactions to starting over, God remains in control and has us in His plan and is gracious in leading us creatively step by step.
2. I believe that to be successful, preparation always has to precede participation. As pastors/leaders of those aged 50 and older, caregivng is and will become a very large area of ministry. You, personally, may be presently in the caregiving process! I know many of my colleagues here in Florida are. You may be one of those providing pastoral care for a parent or parents. Most of us in the pastorate are like those we pastor: unprepared for the many daunting issues we're likely to face as a loved one ages, becomes ill or faces injury. Maybe I can help.
There are certain things that every family needs to know as loved ones age or become ill. Following are ten specific things we suggest every family understand and address:
GETTING INVOLVED - Families often wait until a crisis situation occurs before they get involved in a loved one's life and recognize or acknowledge a person's limitations or needs.
If a loved one is facing any type of illness or disease, chances are he or she is, or soon will be, facing some sort of limitations. Try to observe loved ones in a variety of situations to determine if they might be struggling with such things as driving, preparing meals, personal hygiene, handling finances and more.
THE BIG PICTURE - People tend to focus on the issue at hand, not recognizing the bigger picture and how their decisions are likely to have implications or consequences.
Whenever someone is facing a challenge or making a life-altering decision, consider the many associated lifestyle, emotional, administrative and memorial issues. Considering the bigger picture often helps families avoid getting blindsided by unexpected issues.
DIAGNOSIS vs. PROGNOSIS - People should give as much (equal or greater) consideration to the prognosis as they do the medical diagnosis. There is a tendency for people to focus on the illness or condition without realizing how a condition is going to impact a loved one's life.
When a medical condition is diagnosed, it is essential to focus on the prognosis to understand how an illness or disease is going to become apparent in a person's life and how it is likely to impact a loved one's daily functioning (mental/physical) and care requirements.
INTERACTION CONSIDERATIONS - Family and friends often treat a person differently once they become aware of a medical condition or limitations. This tends to frustrate care recipients as opposed to helping the relationship and situation.
Treat each person the same as before a medical condition existed. However, what you should treat differently are the circumstances. For example, if a person is experiencing hearing loss, you might reduce background noises, speak slower and louder, and enunciate your words more clearly.
CAREGIVER BURNOUT - Caregivers often do not realize that if they are not careful, they can quickly reach burnout. There are warning signs that caregivers should be aware of.
Become familiar with the Caregiver Bill of Rights. Many people make the mistake of focusing solely on the loved one needing care and unknowingly begin to neglect their own life and other responsibilities.
SENIOR MOMENTS - Family members often have a hard time distinguishing between normal aging, what might be considered a 'senior moment,' and a more serious condition that may merit attention.
Dementia, depression and delirium are often confused with one another, as the symptoms can be similar. If you notice a change in a loved one's behavior, seek medical attention right away.
REACHING AGREEMENT - Families often make futile attempts to reach decisions or to solve a problem before they know what it is that they are ultimately trying to accomplish.
The following five-step process is designed to help families solve problems and reach agreement:
Accurately define the issue
Agree upon the issue
Address the needs - not the wants
Assess the options
Agree on a solution
LEGAL DIRECTIVES - People who complete their legal documents and advance directives often make the mistake of not sharing or communicating their intentions with loved ones who might be called upon to provide care or make decisions.
Families should discuss their wishes and expectations. Unless a loved one's wishes are communicated and understood, they cannot be carried out. Common questions include: "What are your wishes should you require care? What assumptions have you incorporated into your retirement plans in terms of illness and life expectancy? Do you believe your health insurance coverage is sufficient and have you considered long-term care insurance?" Ask these and other questions.
GOVERNMENT SERVICES - People qualifying for government services are often unaware of the specific programs, enrollment periods and options that are available to them.
Take time to become familiar with the government programs that you and your loved ones might be entitled to. Make sure you understand the benefits and coverage that is, or is not, available.
FACING DEATH - People often view death as a taboo subject and as a result do not give it much consideration.
Give consideration to end-of-life planning. Often there is a lot that families can do to make each day count and have fewer regrets if they prepare for the inevitable.
The ten things every family needs to know as loved ones age or become ill are presented in greater detail in The Caregiver Seminar, workshop subtitle: Things You Need To Know Before You Know You Need Them. For more information, call our Florida office at 239-466- 8664 or visit www.partnersinpastoralcare.org.
3. After my father died, my sisters and I became concerned when our mother made the choice of living alone immediately after his death. Our parents had been married for sixty-two years and had virtually never been out of each other’s presence for more than a few days, when one or the other was hospitalized.
Mother’s physical health is very tenuous, as she has diabetes and degenerative arthritis. She has been taking ten different medications per day, but has not developed a disciplined time to take her medications nor, for that matter, has she been eating properly. Although a strong spiritual woman, she has shown signs of emotional weakness over the past few years and her grief has now been an added concern. Our parents owned their home but now the income mother receives is cut in half. Further concern surrounds the issue of her ability to budget her meager income.
Our father and mother are of that Builder generation that came through the depression and WW II, surviving by their own stamina, grit, faith and hard work. They always made their own decisions, without input from us children—those types of people that are “I’d rather do it myself” folks.
Realizing all these factors, along with our own grief, love and concern for our mother, we became stressed out and confused, not knowing what to do when mother announced that she wanted to stay in her own home, without a caregiver.
Not unlike most, we had not talked with our mother about money.
Often, the conversations we need to have with our parents about long-term planning don’t happen until there is a crisis. Then we have to try and catch, up, stressed by the many details that need to be addressed under very trying circumstances. Carefully considered decisions—an essential part of caregiving—are hard to come by.
Although I have facilitated many workshops, seminars and counseling sessions with people across this country concerning long-term care planning, I found it difficult to know when and how to have this conversation with my own parents. In my case, I was reluctant to bring up the subject so as not to offend my parents or to imply that they were becoming sick or frail.
Parents may fear that we are planning on moving them into a facility, as opposed to trying to help them maintain their independence. It may seem that no time is the “right” time to bring up this topic.
Through my fresh experience with my mother I found that it was easier to start the conversation by sharing my own experience. For you, it may be a story from the newspaper. And the media is filled with positive and negative stories. You might say, for example, “I decided I needed a will and consulted an attorney,” or, “I saw an article in the paper about senior services.”
When talking about present and future needs, it is important to plan with your parents, not for them. Looking back, I see that my sisters and I missed opportunities to set a date and time to have a conversation about long-term issues. I believe that the likelihood of success in a plan would have increased considerably if we had talked.
The way we started with mother was to ask her to talk about her perceptions of her needs, now and in the future.
Although each agenda might vary, it might include:
Health care wishes
Financial information
Wills and trusts
Names/addresses of close family friends
Doctors’ and dentists’ names and phone numbers
Insurance policy information
Additionally, you might discuss any changes that may need to be made at their home in order to accommodate their physical or emotional needs. Possibilities are increased lighting, grab bars for the bathroom, or people to help with cleaning, cooking, gardening or transportation.
It might be uncomfortable to have these conversations. We might find ourselves resistant to bringing up these subjects and we might be met with anger or resentment from our parents when we do. If this happens, remember, you don’t have to discuss everything all at once. Start small and with things that might not be so emotionally loaded. Continue to talk about these things when you get together the next time.
Let your parents know you are concerned and care about them. And remember, as long as your parents do not have dementia, they have a right to “bad” decisions or “bad” planning. I guarantee this will make your role harder, but you nor I are to bully them into doing things they are not ready or willing to do.
Now, if you think your parent does have dementia, you need to proceed differently. First, confirm the fact and work with your parent’s doctor. Second, determine whether talking about these subjects might make your parent more scared or resistant to talking. Third, ask help from a trusted friend or pastor of your parent to be a calming and reassuring influence.
Stay away from the natural tendency to take over and start organizing things without understanding and/or permission from your parents. This will generally make matters worse. In our case, it was a matter of my sister saying, “I know sometimes you forget things; I would like to help make it easier for you to organize taking your medications.” This helped in allowing mother to feel respected in giving up the task she was accustomed to doing. For others, mentioning memory loss at all could lead to defensiveness. In that case, this might work better: “I’d like to help you. Can you tell me what I can do to assist you?” It could lead to further conversations about long-term planning and letting you help your parent. If your parent says everything is fine, you then might try pointing out one little thing that you noticed that might need doing, e.g., ironing the clothes or pruning the roses. That will help your parent feel less threatened about your “taking over” his or her life.
It may be that you are a pastor/leader of Seniors and you know some of your precious people have no children or other family in the area. You sense that some of them need to have a conversation about their needs. From that sense, you are called to facilitate such a conversation. We at PIPC can help you navigate the communication that can lead to good care planning with those under your care. Feel free to call PIPC at 239 466 8664, or email partnersinpastoralcare@aol.com
4 . Robert A. Emmons, PhD, a professor of psychology, reports that a recent study showed that grateful people tend to be more optimistic, and that seems to boost the immune system. He says they are more likely to eat well, exercise regularly and obtain preventive medical care.
Dr. Emmons does not mention it, but I believe with my entire being that the pastor/leader that facilitates a time of “personal testimony” in their gatherings, also facilitates an avenue of spiritual health.
My experience with this sort of thing is that people “kick it up a notch” in their wholeness when beginning to keep a journal, regularly writing down things for which they are grateful…creating a list of good things in their life and expressing their gratitude for them. As their leader/pastor, my goal is to help them look at all situations in the most positive way possible.
As you experiment with “gratefulness sharing” with your group, you will find that it becomes contagious…hesitation in participation will not last long. The hearing of someone grateful causes a falling domino effect which, in turn, brings a new health to the group dynamic.
Don’t wait until that Thanksgiving gathering to facilitate a “what are you thankful for this season?” but try it every time you gather. Even on trips or other events.
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