Friday, May 18, 2012

Posts Tagged ‘David Solie’

Boomer Perspective: Moment of Truth

One sees great things from the valley, only small things from the peak.
—Chesterton

While aging is inevitable, arriving at a healthy perspective about its meaning and potential is not. In our youth-oriented culture, middle age more often than not is portrayed as embarrassing stage of life that is in desperate need of enhancements to stave off the signs of being older. But Botox® and hair transplants can not hold the line forever and at some point thoughts and feelings about aging have to be sorted out at a deeper level, a realty check on what it really means to be older. The outcome of this “aging moment of truth” will have a profound influence on the quality of life for middle age adults. It will either reframe the journey as a continuation of growth and learning filled with unique potential, or see a darker landscape riddled with loss, regret, and limitations. This vantage point from which baby boomers will judge the aging process is called perspective.

Perspective provides a “filter” through which life experiences are assessed, organized, and ultimately judged. Youth has its own filter typified by an optimism found in the first half of life that keeps the metaphoric glass half full. It is a perspective that always sees another opportunity, another deal, or a fresh start that is not limited by health, family, or time. The first half perspective quickly converts setbacks into opportunities based on an unshakeable faith in the magnitude of possibilities that lie ahead. Middle age changes the filter.

Ushering in an era of external and internal upheavals, middle age introduces a different reality that undermines the sustainability of earlier optimism. What appeared unlimited now has restrictions and complications. The unspoken and yet pervasive cultural shame that sees aging as pathology leaves middle age adults holding a glass that is suddenly half empty. In this new environment, the first half perspective can undergo a rapid deterioration leading baby boomers to buy into a more cynical future. Without reframing, this is the anticipatory reality they are stuck with to manage being older. Ironically, this cultural anxiety about aging has no basis in biology or psychology. Growth and learning do not wane in middle age, and creative capacity is at an all time high. But the media’s slight of hand trick that obsesses over youth as the ultimate consumer class delivers a convincing message about the downhill trajectory of the second half of life. This dysfunctional perspective is a trap for middle age adults pointing them developmentally backwards to a phase that is over while distracting and devaluing the rich and immediate next phase on which so much is riding. Avoiding this unhealthy entrapment requires a different type of inquiry into being older. We call this inquiry The Perspective Inventory™.

As a reframing tool, The Perspective Inventory™ allows middle age adults to “test” the critical questions that ask themselves and others about the aging process. As Dr. Marilee Adams succinctly argues in her book Change Your Questions, Change Your Life, questions are the raw material of how individuals size up themselves and their world. They are the building blocks of perspective, the framing tools that either discover hope and opportunity or perpetuate endless cycles of conflict and despair. From a developmental perspective, questions are an ideal vehicle to examine and change concepts. They have the right linguistic packaging to emotionally override long-standing beliefs. They are receptive to the right brain, which has proven to be the informational gatekeeper for middle age and beyond. They are also emotionally generative and as such quickly alter cognition and change behavior. But the benefit of The Perspective Inventory™ is not simply to arrive at a better set of questions about being older, as valuable as they may be. The Perspective Inventory™ offers baby boomers a way to build a new filtering ritual so they can habitually reframe the experiences of aging to facilitate their developmental journey.

First and foremost The Perspective Inventory™ is an inquiry tool. It is allows middle age adults to organize and evaluate the quality of the questions they ask about the aging. It is based Dr. Adams’ premise that most people simply adopt a “questions style” without giving much thought to the impact it has on quality of their lives. Once internalized, these core questions become the ingrained filter for looking at people and experiences. With middle age, the impact question style intensifies in either a positive or negative way. Negative questions such as “Who’s to blame?” and “How can I prove I am right?” extract a heavy price on individuals and family systems. They negate prior success, shut down communication, and close off avenues of collaboration and growth. Even more concerning, they have the lethal potential to undermine confidence at a time in life where confidence is already in jeopardy. In contrast, aging friendly questions such as “What’s useful about this?” and “What’s possible?” lighten the emotional load on everyone. Not only do they facilitate communication but open up new channels of creativity, possibility, and growth. They help restore confidence and optimism to individuals and family systems.

The Perspective Inventory™ is also valuable resource for baby boomers as they engage the predictable dilemmas of their aging parents, experiences and situations that can leave both parties feeling frustrated, guilty, and anxious. Reframing questions surrounding the monumental family tasks of determining the right health care, sorting out living options, coping with the death of a spouse, untangling financial decisions, and coming to grips with the final goodbye can create a more effective and nurturing perspective. Developmentally tuned questions such as “what are the control issues here?” and “what other ways to look at this situation?” can help middle age adults keep their bearings in the midst of an emotional family landscape.

Finally, The Perspective Inventory™ reminds middle age adults that they can make positive alterations in the second half of life; they can opt for a radically different approach from the one they used in the first half. Moving into the upheaval of middle age asks two primary developmental questions:

1. How am I going to manage all this?
2. What is it I really want?

Successfully addressing these questions requires a perspective that is both personal and collective, is about self-fulfillment that is wrapped in a nurturing community of meaningful relationships. This is the heart of the need for authenticity. It is about finding personal clarity and not simply searching for another twenty years of approval or more of the same. For baby boomers that understand this potential, it comes as a welcome relief and an extraordinary opportunity to leverage their experience and education into an unlimited universe of choices and possibilities.

Conflicting Layers of Longevity

As boomers approach the outskirts of being old, a new aging dilemma is beginning to emerge: simultaneous developmental phases with their aging parents. It is one thing to be fifty-something and have aging parents in their mid to late seventies. Both parties are clearly situated in separate developmental phases. The fifty-something adult is navigating the tasks of middle age, preserving stability while at the same time orchestrating a new purpose and direction for the second half of life. Their aging parents, on the other hand, have different marching orders, preserving control in a world where all control is being lost while at the same time creating a legacy before time runs out. The challenge is to find an effective middle ground so both parties can successfully complete their developmental tasks. But what happens when adult children enter their late sixties and their aging parents are still alive, where both parties wind up in the last phase of life?

Seniority appears to be the rule of thumb. While adult child in their late sixties are beginning the battle for control and the search for legacy, these developmental needs are usually “put on hold” for the sake of the aging parent. Practicality dictates that both parties cannot be insisting on control as well as the airtime for life review, but the seniority accommodation is not as simple as it sounds.

Developmental needs are first and foremost embedded marching orders, which are involuntary, unconscious, and consumptive. They are background software for life-long human developmental and exert a pressing influence on perception, cognition, and behavior. When two generations share the same developmental zone, a new type of power struggle emerges over whose needs deserve priority. As with all generational conflicts, a middle ground is hard to find and hold.

The best course for adult children caught in this developmental simulcast is to make a selective course correction while their aging parents are still alive. This involves mapping out “control sustaining” strategies for their personal life (i.e. where to live, how to pay for it, how to manage health, how to foster community, etc.) while supporting their aging parent’s need to control their own destiny. It can awkward, confusing, and unsatisfying, but it defuses the unwinnable argument of entitlement. While everyone is entitled to address their developmental needs, in the context of families, this may require delay, compromise, and compassion for those who are going ahead.

The Transitional Care Dilemma: Good News

Sooner or later aging parents get swept into the complex currents of transitional healthcare. It may be a simple back and forth between the primary care provider and one or more specialist, or it could be a major health setback that sends them into a crisis cycle of hospitalization, rehabilitation care, and finally back home. Big or small, acute or chronic, all of these transitional events require multiple “handoffs” between medical professionals, hospitals, skilled nursing homes, and caregivers, and there’s the rub.

The stories of what can and does go wrong with these transitions are legendary, maddening, and in most cases preventable. The sad truth is that older adults many times wind up back home with defective marching orders regarding their medications, recovery plan, and follow up care. Given the frequency and severity of the problems surrounding transitional events, what can make this better?

The good news is that Dr. Eric Coleman from the University of Colorado Health Science Center has a compelling answer: The Care Transition Program. His program is based on what he calls the Four Pillars?, an integrated transition management system that prevents medication problems, insures information continuity between handoffs, clear, follow up orders, and a protocol that identifies red flags that could crash the process.

It is a practical, brilliant solution that is gaining a growing population of followers across the country.

One key element critical to the program’s success is a Transition Coach?. This is usually a geriatric nurse practitioner that provides in-hospital coaching to both patients and their caregivers to help both parties prepare for the transition. As important, the Transition Coach? does follow up visits to skilled nursing facilities or the patient’s home to insure continuity across the transition.

To learn more about Dr. Coleman’s remarkable program and download a copy of his “Transition Survival Skills,” click here: http://www.caretransitions.org/transitionskills.asp

Pulling the Cardiac Plug

Even the best laid plans of aging can fall apart. Katy Butler’s recent article in The New York Times, What Broke My Father’s Heart, tells a painful tale of the unwanted impact of medical technology in the last and most distressing phase of life (http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?pagewanted=1&ref=homepage&src=me).

But this is no ordinary article about a bad outcome involving aging parents. This is a seminal article about a new and quite sobering level of vigilance that attends our role with our aging parents. The rapidity of events and the ever present pressure of “medical necessity” in the last phase of life can push families into decisions they not only regret but, as Ms. Butler so eloquently and heroically portrays, resist our best efforts to unwind them. If there was ever an article on this subject to read in a quiet, non-distracted moment, this is surly the one…

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Communicate

No Money: No Comment

I was recently asked what to do about aging parents who had little or no savings but refused to discuss any aspect of their “money issue.” It reminded me that our role as adult children is not necessarily about problem solving; it is about compassionate containment. So many of the issues we feel compelled to “fix” have no clear answers. The best we can do is sort out what to accept from what we can actually change. Here was the advice I offered:

The issue of money, like so many other issues in the last phase of life, is about control. The best way to approach it is to reframe money as means of maintaining control. Lack of money takes away control. This link will take you to an article I authored on “communicating touch choices” that offers a practical strategy for how to do this:http://www.aging.org/i4a/pages/index.cfm?pageid=2103&textonly=1

You may also want to consider three strategies that will help you “hedge” your parent’s financial risk:

1. Buy a long term care policy with a two years home care/two years nursing home benefit. This assumes they will cooperative with the process (i.e. signing the applications and answering questions).

2. Start funding a dedicated “side fund” for expenses that a long term care policy will not cover.

3. If you parents own their home, become familiar with how “reverse mortgages work and when they make sense.

Lastly, you need to began discussions with local area agencies on aging to determine what, if any, community resources can assist your parents if they run out of money.

This is a tough end-game, especially if you parents don’t want to talk about. The article will help you frame your conversations. Be patient but persistent in your discussions about control and your desire to help them maintain it.