Wednesday, June 30, 2010

Geriatric Management Consulting #5

Another sentence from the article on the E-Myth website (, The Challenges of a Family Business, that grabbed my attention:

“When we stepped back and looked at the business holistically…”

Gradually the medical field is starting to look at the individual holistically---not just a bag of parts. Still the conscious and unconscious contract between doctor and patient is one-on-one as if the person existed as an encapsulated monad. Relationships are ignored or endured as major or minor nuisances.

In my experience, often in order to meet professional standards (HIPAA), geriatric care managers, social workers, hospice nurses, etc. engage with the individual in the same way. Sometimes I also see these professionals hiding behind HIPAA perhaps to avoid those pesky outsiders.

If individuals in a family/friend system are to get quality personal and medical care going forward, holistic has to expand to include the relationship network. The person is going to be drawing on financial resources; require some amount of unpaid labor.

Who else is drawing on these resources of time, money and energy? Spouse? Children? Grandchildren?

Who else will soon be drawing on these resources?

Is there enough to go around?

So often I hear from medical staff instructions issued in the passive voice with the agent unexpressed: Your bandage will have to be changed every day.

Or the instruction completely ignores the individual’s ability to comply without assistance, be it meal preparation or transportation or personal care.

I realize that medical staff have no time for this kind of discussion but that doesn’t mean it isn’t essential. Too often I see families burn themselves out on one crisis. This can breed resentment and actual (realistic) fear in the survivors---what about me when my time comes?

When we stepped back and looked at the family holistically…

Monday, June 28, 2010

Geriatric Management Consulting #4

Image courtesy of Michael Pflelghaar

Recently there was an article on the E-Myth website ( The Challenges of a Family Business written by their staff. It describes the unique challenges family businesses face and why these often fail. It brought to mind a response I sometimes get when I ask family members a question they don’t want to answer: That’s none of your business! I usually respond---but it is yours and it is important. Do you know the answer?

Caregiving is a family business. For me family includes all the formal and informal networks that characterize modern community life.

The article cites the University of Southern Maine’s Institute for Family-Owned Business. “Three underlying causes of failure…:1) unresolved conflict, 2) failed leadership, and 3) lack of shared goals on a personal, family and business level…also differences over management roles, sibling conflict, financial issues, and lack of long-term company vision…”

It is crucial to remember that eventually every person in the family system will need care whether it is acute, chronic, and/or endstage. Facing up to and resolving these challenges will improve everyone’s quality of life. As government sponsored social services evaporate it is the family/friend network that will provide the safety net.

Wouldn’t it be wonderful if that net was woven big and strong enough of the best materials possible, checked regularly for holes and mended in all the necessary places?

Wouldn’t you feel more secure given the inevitability of illness, aging, dying?

Friday, June 18, 2010

Geriatric Management Consulting #3

I will be forever grateful to the colleague who told me about this book, The E Myth Revisited, Why Most Small Businesses Don’t Work and What to Do About It by Michael E. Gerber. His insights and suggestions are so relevant to the caregiving enterprise that I can easily imagine a book entitled The C Myth, Why Most Caregiving Situations Don’t Work and What to Do About It.

“The problem with most failing businesses (read: caregiving situations) I’ve encountered is not that their owners don’t know enough about finance, marketing, management, and operations (read: medical matters)---they don’t, but those things are easy enough to learn---but that they spend their time and energy defending what they don’t know. The greatest businesspeople (read: caregivers) I’ve met are determined to get it right no matter what the cost.

And by getting it right, I’m not just talking about the business.

I mean that there is something uplifting, some vision, some higher end in sight that “getting it right” would serve.

An ethical certainty, a moral principle, a universal truth….this book is not about endings, but about beginnings, about the never-ending game, the delightful and exhilarating process, the continuous evolution of our senses, of our consciousness---of our humanness---which only comes from being present in the moment, from being attentive to what’s going on.

I believe that our business (read: caregiving) can provide us with a mirror to see ourselves as we are, to see what we truly know and what we don’t know, to see ourselves honestly, directly and immediately. (pages xiii-xv)

See why I love this book?

Wednesday, June 16, 2010

Getting Back to Business

My goal lo! these many years has been to configure work that balances money and meaning. Geriatric care consulting is rich in meaning---a combination of social worker, chaplain, geriatric psychologist, and grief counselor. Service opportunities galore!

But how to make a living as an independent?

Consultants typically bill by the hour. This does not work for my practice. After all these years as a caregiver/consultant I know that many of my client meetings (in person or on the phone) might be as short as 10 minutes. Often this is all that the caller can manage given the topic. Sometimes there is just a question or a concern that can be handled quickly. Sometimes it’s about needing a friendly voice. I don’t want the hassle of billing by the quarter hour and I don’t want people to feel inhibited because the meter is running.

My solution is more project-oriented---have clients put me on retainer for a period of time. It might be the duration of an illness treatment cycle (chemotherapy), looking in on a parent once a month or endstage care. Would include phone calls, e-mails, internet research, one or more in-person meetings each month.

So far several families have worked with me this way. They are satisfied and I love it.

Maybe I’ve done it---money and meaning in the same career!.” 

Monday, June 14, 2010

Listening Ever More Deeply

I just got back from an 8-day silent meditation retreat---a week with very few words. No voice mail, snail mail, e-mail, blogs, internet research, social networking of any kind. Letting go of all the relating I do on the horizontal (relationships) in order to focus on the vertical (from the depths of me to the depths of the universe---for me, the Christ).

What has all this to do with caregiving and geriatric care consulting?

The key to providing quality care is listening. Listening takes us beyond the complications into the complexity---the only place where anything real can be accomplished. The listening and the complexity have to match in intensity and dimension.

We all calibrate our listening instinctively---listen with half-an-ear to the radio in the background or our partner’s recitation about the day---all ears for the latest gossip or news about a loved one.

The conversations I’m having with people---aging, illness, dying---complexity to the power of 10. Periodically I need to deepen my ability to listen which means time in deep silence. The silence of bone marrow. The silence between words.

I read once (apologies to the author whose name I cannot remember) that listening in silence is like waiting for the water in a stirred-up muddy pond to settle. The newly stilled water is clear and mirroring. All those pesky complications keep things stirred up---muddy the waters.

Maybe one of our major contributions as consultants is listening the client(s) into their own clarity? I get the sense that complications can be scary and exhausting while complexity can be inspiring and energizing.

Gotta love those depths!