Geriatric Management Consulting #7

I know I tend to harp on the fact that everyone in the relationship network is going to experience illness, aging, dying some-way, some-how, some-when. I feel compelled because I often hear people say “if I die.” Not “if I die of this disease.” Not if I die tomorrow” but “If I die.”

I will make it simple. You. Will. Die.

Now that I’ve got that off my chest I want to talk about evaluations and skill sets.

Working as a project manager in both for-profits and non-profits I came to appreciate how crucial it was to evaluate the project upon completion. For example?

What worked?
What didn’t work so well?
What didn’t work at all?
How are people feeling?
What did we learn that we can take into the next situation?
What additional skills, materials, tools do we need for the next time.

Whether it’s business or knitting or making bread, one assumes that the first few times will be rocky but that with time and practice one’s skills (and the product) will improve.

Caregiving is a business and a craft. It is also a team sport---the opposing team members being pain, loneliness, physical want, despair. Any team sport requires a certain amount of physical coordination, skill, focus and the ability to be on a team. There is also love of the business, craft, sport driving us to improve.

I know from my work how wonderful it is to be on caregiving teams---family, friends, neighbors, strangers who become friends. I have worked with the some of the same people over and over in different roles, different groups, different situations. I can see how I’ve grown in skill and sensitivity.

Typically hospice offers bereavement counseling to families, but what about evaluation counseling so they can be better prepared, more skilled for the next time?

Geriatric Management Consulting #6

Interpretation of Maslow's Hierarchy of Needs

Very often holistic can seem too New Agey, too soft as opposed to hard science.

To quote again from Michael Gerber’s The E Myth Revisited:

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…the continuous evolution…of our humanness… (pages xiii-xv)

Decades ago the psychologist Abraham Maslow posited a hierarchy of needs: physiological, safety, social, esteem, self-actualization. If we are looking at a person holistically, then we must take into account these levels of needs. If we are looking at a person in the context of a relationship network, each individual in that network has these levels of needs. Most likely he or she will be turning to others in the network to satisfy some of these needs.

Illness, aging and dying challenge us on every level of need. It doesn’t matter whether we are the person experiencing the crisis in our own body or the people in relationship to us. By the way, I think we all experience the other person’s illness in our own bodies at some level. For example, when one spouse has Parkinson’s, it resonates in the other. How not, if they have shared bodies and a bed for decades?

Too often the emphasis is on the physiological (diagnosis, treatment, transportation, finances, etc.). We have other needs to satisfy: safety, social interaction, esteem and self-actualization. Living with illness, aging, dying as caregiver, client or both at the same time (!) provides opportunities for “the continuous evolution…of our humanness…”

Geriatric Management Consulting #5

Another sentence from the article on the E-Myth website (www.e-myth.com), 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…