The Care of Aging Parents: Making the Last Laps Rich (Part II)

In Part I on this topic, I centered the post around the idea of setting an intention of what we want in the healing and transformation of the relationship with one's aging loved one.  Opening to the feeling aspect of what it is we want prepares the ground for the details, and helps sees us through the challenges of what is put into play—what, hopefully, we and our parents want.  In this Part II, I will deal more with the nuts-and-bolts of how to provide the sustenance that makes these last laps rich and meaningful for you and them.

Once the intention is set, it is good to determine how you and your elder are going to work together.  Are they handing everything over to you, abdicating all control?  Or do they want to be co-determiners as long as possible?  How will this work, how is it imagined?  Part of the healing in the relationship is the sublime relating we do with them, and they with us.  The confronting the hard things in a soft way, the 'yes' and the 'no's. The disagreements, fears, the sensitivity to the taking control and having little say.  It's this territory that is fertile, if not a challenge to navigate.  This is where we attempt to optimize our Listening,  our Attending-to/Attention, our Observing.  This is where breath and a nuanced appreciation for what Is can transform the difficult transitions.

You see your elder aging, having a more difficult time doing basic things, like laundry, cooking and cleaning.  You might even notice a hygiene deficit or important memory lapses (not taking medications in a timely manner, forgetting to pay bills, etc.)  By this time, it's late in the game.  It's late in the game, because of Denial.  Denial on everyone's part.  Experiencing or noticing a decline in a loved one or self is not easily accepted and often minimized.  We want the old homeostasis, even though change is well underway.  We think it's ok for them to be left alone for a few hours, or even though their balance is somewhat shaky, it's ok as long as their cane is nearby.  This lack of acknowledgement of a decline is denial and it is dangerous.  The primary concern we should have is safety.  Are they safe 100% of the day?  They aren't if they're forgetting medications, leaving the kettle on when on the stove or not being hygienic.  Always best to err on safety's side.  Have more coverage, not less.

Decline comes in all gradations;  gradual to quick.  It's important that once it is underway, there are watchful others around regularly to gage needed interventions.  It might start with grocery runs, housekeeping every other week, or help with a weekly shower.  A decline in social engagement outside the home is a subtle marker as well.  This often happens when an elder realizes they are losing memory (uncomfortable conversing with people who know them but whom they don't remember knowing) or have lost a physical fitness that makes it uncomfortable to be more active.  Losing memory can be very subtle and effectively hidden  by vague responses.  Dementia is masked by depression and sometimes vice versa.  He/she that has created an intention to be the 'observer' engaged with the elder becomes responsible for this watching and deciding/co-deciding with the elder when intervention is required.

Every situation is so different. There are myriad ways people can creatively care for loved ones, and also myriad situations in which the caring transpires.  It may be a collective of family members, or a trusted caretaker or group of them who reports to an adult child who is far away.  Determining the elder's wishes (early on, if possible) is helpful in determining what can be set up (home care, elder care in a senior community, etc).  And of course what is physically and financially possible for the adult child.

Early on, it is vital to consider obtaining power of attorney and/or a medical healthcare proxy for your parent.  It is easier for you to manage your parent's finances this way, and there isn't any holdup when it comes to healthcare decisions.  Outside sources that may be of help are your elder's doctor's office (might have referrals to home care agencies, social workers, etc), and local community senior centers which have programs during the day. Also seek information about alternative resources to support your loved one's needs, be they day/night companions, meals on wheels, rides to doctor appointments, groceries, etc.  If your elder is coming from a hospital situation, case managers and hospital social workers are knowledgeable goldmines regarding external resources and medicare/medicaid insurance payment of needed medical supplies; mine them fully.  Visiting Nurse organizations will do a full home assessment to determine level of care required and make suggestions.  Often, Medicare/Medicaid and private insurances pay most of this service.

When deciding on an elder institution (if that is an option you are considering), ask a lot of questions, field them not only to the 'home', but other professionals.  Hospital nurses that deal with the geriatric population often have an interesting perspective.  They see people come in from different places in different conditions, they hear and are aware of the best and worst places.  From institutions, ask for family references.  What are the activities (i.e.,  are residents ever taken off campus?), is there music, art, plant, pet therapies? What is the ratio of care, caregiver to resident?  Is there a "care for the caretaker" program helping with staff burnout? You should be able to get a rating on the establishment from the better business bureau, possibly AARP, etc.  Once an institution is decided upon, it behooves you to form congenial, informed relationships with the staff; they see you frequently, they know your expectations, they are aware of your strong advocacy for your parent.  When things go awry, a steady, calm, rational response is much more powerful than a reaction.   The former elicits respect from staff.  The latter elicits defensiveness and does not bode well for the care of your parent.  This being said, uncharacteristic strong reactions infrequently provided (and merited), are a heads up, pull-up-your-socks reminder to caretakers, which can go a long way to improving care.

For all caretakers, at any level of care, at any point in time, it should be assumed burn-out, compassion fatigue, will develop.  It is a huge undertaking having the welfare of another in your hands.  Being connected to one's breath, finding nourishing quiet moments for oneself helps to soften the hardness, opens one to another type of rest and rejuvenation.  Take care of yourself; make sure those caring for your loved one are also taking care of themselves.  It is through this regular practice where the quandaries, obstacles and difficulties are often relinquished.  Less tension in your body and in your life allow for another understanding, a possible spark of creative genius in solving a problem, an attraction to the thing or person that is needed in a moment.  This is the miracle of this process.  The process of healing a relationship, transforming a life in the middle and at the end.  This is what makes the last laps so rich, even while it is so hard.

Dispassionate Empathy

This oxymoronic term resonates curiously with what is (possibly) true.  And the seeming truth of dispassionate empathy is that it is momentary, usually fleeting and almost always misunderstood.  Why is this?  Dispassionate empathy is a delicate (yet powerful) experience that can never be static, contrived or a destiny to be reached.  Like presence or wisdom, it's a movable feast, something we travel in and out of on a momentary basis.  Our human propensity is to make and understand things hard and fast, to have things known, to be static; black and white.  Dispassionate Empathy can not be a given known.  It's an experience in an often 'gray' moment, not be harnessed.

dis·pas·sion·ate  not influenced by strong feeling; especially : not affected by personal or emotional involvement*

Dispassion is a place a lot of caretakers find themselves after having their compassion take one too many trips on the heart-pull roller coaster.  It's a survival place, a space to operate from where one can feel accomplished in their skill efficacy without taking the risk of entering the healing relationship.  It keeps them emotionally safe, fairly free of confusion and armored to the hilt.  Being habitually armored is a slow, numbing soul death, not to be wished on anyone. All caretakers are required to be compassionate, yet struggle to maintain a professional distance to avoid over-involvement.  This is between a rock and a hard-place.  Burnout is a given when sitting between these two stools, or hanging open or closed hearted; it is to be expected when a study and a practice of a therapeutic (double sided) empathy has not been seriously undertaken.

em·pa·thy: 1. the imaginative projection of a subjective state into an object so that the object appears to be infused with it;  2. the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another of either the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner*

I almost did not include the first definition of empathy above, as it seems to be counter to the second definition.  But I am curious and appreciate the other side of the coin, as it completes the entirety and ultimately the whole rings more true.  The imagination (being an integral part of the human makeup) is open to coincide with being available to impressions.  In that act, one's knowledge/experience base is recognized and tweaked; one feels a twinge of familiarity.  Having experienced well a feeling scenario one can:  project it onto another (if a healing hasn't been had and self asks to go there again to be healed) or if a healing has been had, one usually feels compelled to merely be with it while witnessing another find their way, somewhat separated and internally active while being externally passive (another intriguing oxymoron!).

This is a practice.  It's also a spiritual quest.  The spirit is infused in the back-and-forth of the dual action/effort of separating and resonating.  Listening, staying close to the response (not the reaction), witnessing the pull and resistance that moves from inside to out and back again.  The practice of dispassionate empathy is allowing light to filter into the quiet of an observation, remembering one's place, applying restraint when necessary and affirmation otherwise.  Mostly, dispassionate empathy is about maintaining one's inner and outer vertical, losing it and reclaiming it again, repeatedly.  It is a practice.  Some moments we are better at it than others.  When it arrives, we hope to celebrate its manifestation.  When our personal tension keeps it at bay, we hope to forgive ourselves.


* m-w.com

Memory and the Body (Part II)

As an umbrella term including all age related cognitive impairments, dementia in industrial and developing countries is epidemic. The number of cases of dementia worldwide in 2010 was estimated at 35.6 million.(1) Rates increase significantly with age, with dementia affecting 5% of the population older than 65 and 20–40% of those older than 85. (2)  While western medicine is trying to figure out the "cure" and management for this condition, it also would be useful to understand and explore the energetics and the relationship of the culture at-large to this malady.

In science terms, what is happening to those experiencing some form of dementia?  This is a neurological disease, meaning that the neurons and the connections in the body that serve them (synapses, transmission factors) are impaired.  This may be due to an accumulation of protein plaques as part of normal aging, atrophy of vessels effecting subtle communications to the brain, inflammation, inadequate blood sugar, and traumatic brain injury.  In energetic terms, it could be said, there is a block or impingement in the flow of qi or prana:  an energetic (and organic) circulation problem.

We are energetic beings living in layers upon layers of an energy charged world. We are influenced by these layers of energy (universal and material) and we concurrently influence the macrocosmos in how we tend and don't tend our own energy fields.  Life force (the condition of our energy fields, qi, prana) is thinnest at both ends of life's spectrum: infancy and old age.  Because of this, these two populations (as well as the ill) are extremely sensitized to energy.  They are practically osmotic in their internal reception to energy.     They are supremely (non-cognitively) aware of surrounding tensions and are impacted profoundly by even mild (negative, tense) stimulation.  In past posts, when I have mentioned the term "a deeper listening capacity", these populations are living there.  Not out of choice (which would be ours if we choose to nourish that in ourselves) but because their energy fields are thin (or "holey"); there is little to no buffer for them. For most of the rest of us, we have the buffers of ego and personality which usually supersede  these delicate places.  The daily dying we do, the moving in and out of sleep and dream states, straddling these (energy?) "other" worlds are transitions those experiencing dementia obliquely traverse.

For the infant and elderly populations, cognition and reason are not available (not developed yet or disease altered).  Hence, an experience of pain does not always register through the brain's pathways, but is nonetheless energetically experienced.  The sensitized "outsider" looking on would recognize its manifestation as irritability, restlessness, uncharacteristic (negative-based) behaviors.  Between 25% and 50% of older adults experience persistent pain. Seniors with dementia experience the same prevalence of conditions likely to cause pain as the elderly without dementia. Pain is often overlooked in older adults and, when screened for, often poorly assessed, especially among those with dementia since they become incapable of informing others that they're in pain. Beyond the issue of humane care, unrelieved pain has functional implications. Persistent pain can lead to decreased ambulation, depressed mood, sleep disturbances, impaired appetite and exacerbation of cognitive impairment, and pain-related interference with activity is a factor contributing to falls in the elderly. (3)

In the dementia literature, it is stated 40-50% of patients with the illness are depressed.  From my observations, depression and anxiety are prevalent as a past history in these patients.  What's first, the 'chicken or the egg' is the question that comes to me.  From a qi perspective, experiences of anxiety and depression are blocks in the flow of emotional health; it is the plaque in our feeling center that prevents joy, gratitude and acceptance.  Whereas there is an organic, physical/mental atrophy present in dementia progression, considering the flow of qi, life force in our emotional lives is also an imperative.

Finally, one of the things not often considered in the global dementia epidemic, is the place of the larger community.  For those in robust health, entertaining the notion we all are dying a little bit each day, navigating the dying process through dream states, minute loss of one function or another, is difficult to entertain.  As was said, we have the ego and personality buffers that are considerably removed from the truth of momentary dying.  But putting ourselves in the experience of one with cognitive deficits, means to enter that supremely sensitized energy state.  It is possible to straddle the cognitively 'clear' world one lives in while being in a rich and interesting relationship with someone who doesn't have those attributes.  It means listening more deeply, becoming more observant to energy manifestations and intrigued by the being that Is.  It means detaching a bit from what I think is Real.  It means setting aside my preconceived ideas as to what is meaningful and the probable emphasis on rational thought.

1.  Alzheimer's Disease International (2009). World Alzheimer Report 2009. p. 38. Retrieved 11 March 2012.

2.  Sadock, Benjamin James Sadock, Virginia Alcott (2008).Kaplan & Sadock's concise textbook of clinical psychiatry (3rd ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. p. 52. ISBN 978-0-7817-8746-8.

3. Hadjistavropoulos, T et al.; Herr, K; Turk, DC; Fine, PG; Dworkin, RH; Helme, R; Jackson, K; Parmelee, PA et al. (2007). "An interdisciplinary expert consensus statement on assessment of pain in older persons". Clinical Journal of Pain 23 (1 suppl): S1–43. doi:10.1097/AJP.0b013e31802be869. PMID 17179836 

Shega, J; Emanuel, L; Vargish, L; Levine, S.K.; Bursch, H; Herr, K; Karp, J.F.; Weiner, D.K. (2007). "Pain in persons with dementia: complex, common, and challenging". Journal of Pain 8(5): 373–8. doi:10.1016/j.jpain.2007.03.003. PMID 17485039.

Blyth, F; Cumming, M.R.; Mitchell, P; Wang, J.J. (2007). "Pain and falls in older people". European Journal of Pain 11 (5): 

A Right Rest

For most of us, when the need to rest arises, the first choice taken is to lie down or nap/sleep.  The awareness that other types of reprieve are possible if we follow the availability of the body's call, is often unavailable.  This requires a more nuanced listening.

Rest is required when we have expended considerable energy, negativity has created a leak in my energy channels, or the failure to shift my energy through another type of activity (or too much repetition of even a good thing) can be draining.  Sleep is not often the only or best resolution.  Evolving one's own individual care-taking approach is possible.

There I was, wrapping spring rolls for 60 people, about 100 in all.  It was a lovely task:  the beguiling stretchy rice wraps, fresh vibrating herbs and slivered vegetables in interesting layers, ending with a careful tuck .  It was a small motor hand coordinated, delicate operation-- very pleasing to the senses.  About two hours into the task, it became apparent a gear switch was necessary.  A fatigue came over me, my legs had been in one place for hours, my hands in a small repetitive pattern for same.  I picked up a broom and vigorously started to sweep the floor.  I then mopped it with big wide sweeping arcs, a sort of dance that was fully enjoyable, a static containment getting released.

An entire day of large, challenging movement, considerable perspiration in extreme heat conditions, with a concentrated attention to a myriad of tasks --called me to rest.  I took half an hour, went into an air conditioned room and crawled under a large work table. (A vague recollection of spending a lot of pleasure time under tables as a child came to me.) There, I rested on my back, pulled my knees up, rolled side to side, enjoyed some prone stillness, played with my hands and elbows and provided a rolling touch to mostly unrecognized places like ankles, groin, back of legs near buttocks, sacrum, moving and smoothing (energy?) layers of self.  I followed impulses, some surprising, all of them deeply restful. I finished by rolling out from under the table, picking up a water loaded watercolor brush on the table and ran it across a piece of paper, appreciating its movement and action.  I completed the period by adding  a dot of color at the end.  Sublime satisfaction.

Unexpectedly, I spent most of a morning with someone with a consistently mild thread of sarcasm running through their dialogue.  By the end of the morning I was feeling depleted and fatigued.  Realizing, despite my efforts not to let that particular brand of negativity impact me, I had indeed been influenced.  I took a "bathroom break" and instead went out into the drizzle and energetically walked around the block, feeling the hips, femurs in the sockets, my arms swinging up and wherever they felt like going, the cool heavy precipitation dampening my exposed arms.  It wasn't an easy start; the body was halting and apparently in a stuck rhythm at first.  But before long, attention to the way the movement was unfolding and the almost joyous arm swings had me emitting small yelps of pleasure and the shift was made. I did a few chi (energy) baths at the end for good measure.

The common aspects in these different scenarios is awareness of the need for a change in energy and a willingness to let the body play (a type of rest/release any child would attest).  Rest for the weary can be finding play in the heart, mind and body. The right configuration is limitless, it just depends on following the call to where the awareness is leading you. Fingering a delicate branch of a plant, submerging oneself in water and receiving that new impression.  Lying still or allowing fingers to find their expression through another media or their own manifestation.  Sleep is a delicious mode of respite.  But a rightful, authentic rest can be found in our own nature's beckoning if we listen a little closer and respond.

Witnessing: Attention, Intention and Healing

When we think of healing ourselves, the thoughts and focus revolve around me, myself, I-- my needs alone, and what is necessary to become whole.  Antennae should sprout up whenever a concern or effort becomes self-centric, because that type of concentration isn't healing, it's actually antithetical to healing.  That type of focus is small, cramped, without space or breath.  And a healing is not possible when I am living in that compressed space.

\Counter intuitively, holding someone or something fully in your attention is an act of self-healing.  This is so because your energy is in flow, moving from inside to out and back again. It's not a masochistic "you come before me", but more an inclusive acknowledgement that a universal love flows in and outside myself, connecting, interconnecting.  A salve completing the Whole.  In physical terms, this might resemble the infinity symbol, the horizontal figure eight.  In that act of interconnecting, we allow ourselves to let go of ego's narrow agenda and we enter a universal connection.  Because of this unconditional attention to someone else, paid attention becomes a prepayment I benefit from.  This paid attention benefits the environment, myself as well as others.

\ I've written about materiality and energy in space (Place, Space, Materiality and Health), wherein I speak about the influence of energy on space, humans and nature.  We all have felt an environment or space blessed by a smudge stick, prayer or meditation.  And alternately, we have felt the tensio\n in the energy of a space that has had a recent argument or violence in it.  We don't consider the vitality of this energy, how it supports or undermines a flourishing.  Similarly, we don't consider the energy of a full attention on an other or on a space.  Humans are designed to connect.  It is in this connection, these exchanges of energy that create a healing.

How could it be that this simple act of observing another (without an agenda) could be so nourishing to another and oneself?   Giving attention, to be a witness is to be in a relaxed, tension free place in oneself.  Our bodies and more whole self relax into the rightness of the Self in this state.  This unto itself is a healing.  It rights (normalizes) hormonal releases (endocrine system), the neurotransmitters that dictate hormone releases from our central nervous system, it hosts a more relaxed, stress-free environment from which to act from, to Be in.  In this state, one creates a slower, more accepting self environment that impacts relationship.  This type of energy nourishes the atmosphere around it, as mentioned above. One can feel the difference; this ripples out.  And as indicated above, it circles around and cultivates the same within.  Mutuality.  Healing is never singular, but always exponential.

What does intention have to do with an attention that heals?  For many, an intention is a mental formation directed.  An intention might start with an idea, but if it is true, it is surrounded by feeling.  It is something that does not wince at not knowing and uncertainty.  Feeling supports intention in a language with non-words the cognitive self cannot understand.  It is a connection to this type of feeling that allows the Witness to suspend the monkey-mind's goings-on, permitting a deeper attention, which saturates an atmosphere with a more relaxed openness.

\

Active Listening

This blog pretty much centers around  the concept that health and healing can't be separated from relationship; relationship being the container that holds all healing and therapeutic collaboration.  This idea of relationship depends on a deeper listening, also called Active Listening or Therapeutic Listening.  There are several versions of what this is.  There is an actual teaching structure to learn:  ActiveListening.  There is another version that includes an awareness of body language.  In addition, my own  sense of this includes individual and collective energy awareness.

The problem with spelling-out and structuring something as natural as listening, is the danger that the structure and learning of it becomes mechanical.  It doesn't take into account the unknown moments and energy cues, the subtle energy exchanges that can't be qualified nor quantified.  Mechanical is the antithesis of what Listening is. Most of these teaching models do emphasize cultivating "awareness", awareness being mentioned as an almost aside in the methods. But awareness seems to be the crux of listening (and hence, the center of most understanding); awareness is dimensional and requires a commitment to engage more of oneself.  Most of these methods include sounding back word for word what another person has said.  This is helpful for the other person (they hear their own words back and know they've been received) and it's helpful for the "hearing" person as well.  That particular "parroting" tactic if primarily used in an attempt to listen, can be (in my experience) trying especially if it is done automatically and mechanically.  Nevertheless, it is not a bad first step in relating.

Like most things, one can be instructed to learn listening skills.  Also, as in most things, a foundation in skills involving knowledge is partial until an understanding ensues.  An understanding transpires with a lot of practice.  A practice which not only includes the foundational skills, but a building of attention, awareness, humility and patience.  And also importantly, a curiosity.  Curiosity is an imperative part of the process because, once curiosity is absent to another's manifestation (or your own in the engagement), humility goes out the window and judgement moves in.  At this point, the delicate, multi-dimensional act of listening becomes something else closer to reaction.

Active listening isn't something we do with our hearing organ (ears) alone.  It includes all of me.  It actually means to have an active attention, something none of the skill-building methods mention.  Probably because an active attention is challenging to cultivate and involves parts of oneself that are new to that activity.  How do we become practiced in awareness?  How do we build a layered and more acute attention?

All practice starts with oneself.  The Active Listening literature calls for allowing for silences and empty space in exchanges.  So it is with oneself.  Many people cultivate this through meditation, taking time to sit quietly, which activates other more subtle parts of oneself that become witness to what goes on when one is sitting still, sensitizing, breathing more fully.  These more subtle parts don't get a chance to be "practiced" unless these quiet moments are allowed.  They don't come forth readily without that room being made ready, the presence of a more expansive and spacious territory that often is accompanied by acceptance and empathy.  Meditation and a relationship to our own nature is not a cultural more in this country (although may be becoming so).  If it was culturally more "usual", perhaps these practices would be built into our lives and our neighbor's lives.  But they are not, so instigating it in oneself can be a struggle without a community's support.

Another aspect of a deeper listening which is not mentioned in Active Listening literature is the fact that listening is a dual action.  It's an attention on oneself as well as on another.  Practicing being with oneself while taking in tone, words and general energy of another is tricky.  It's a bit like riding a wave.  You're with yourself one moment, than in the next moment, find you have dipped down into the wave's tunnel (lapsed attention), in danger of  becoming attached to something the person you are listening to has said or indicated energy-wise or in body language.  It's a dance of energetically moving back and forth, finding the alignment between oneself and another.  And to further complicate things, there are always the inevitable distractions.  Other noises and movement present as well as the reactions that occur in oneself and the other.  It's usual to be taken by all or any of these things.  Our bodies are lightning rods to energy sources, extremely sensitive to the smallest manifestation.  Listening becomes complex.  Attention is tenuous.  This practice is dependent on the renewing of the curiosity place in oneself, the place that is interested and intrigued by the small and opaque, by the contrasts and paradoxes without getting caught up or attached to them.

Because listening is complicated and layered, to try listening experiments with inanimate objects or animals before intentionally taking on other human beings can be helpful.  Sitting quietly with objects or pets and watching/listening to the play of energy, thoughts, associations going on within oneself and the thing's response, simplifies the listening experience.  Feeling into the life and nature of the thing that is more simple than human beings, gives us a chance to experience this deeper listening in ourselves, to ourselves and to another.  Exploring a sensitized energy exchange in this circumstance is helpful in building a stronger awareness, attention and listening capacity in oneself.

To practice "listening" with and to inanimate objects might seem an eccentric thing to attempt.  But everything has materiality and all materiality has energy and therefore its own truth.  Doing this sort of exercise with say, a door knob, is revealing.  The door knob has an energy of its own and has been influenced by people energies (touch).  From a sensitized place, its materiality speaks (subtle) volumes, its energy is noteworthy.  Giving an object a quiet attention creates an interesting relationship to it; the nuanced "listening" factor revealed.

Therapeutic Listening - A Total Approach
Power to Change – 10 Tips to Effective & Active Listening Skills
Active Listening - Steps and Instructions
The Center for Nonviolent Communication | Center for Nonviolent .