In this video from the 2015 Intern Orientation and Training at AgeSong, Nader talks with the GeroWellness interns about interns connecting with the AgeSong staff. The interns have been given introductions to the different staff at AgeSong Communities to help begin the familiarization with the staff they will be working with on a regular basis.
Tips for Interns Connecting with the AgeSong Staff
During this orientation and training we have purposefully brought up the different members of staff because we would like you to see a visible manifestation of the multi-disciplinary approach used within the AgeSong Communities. To integrate into the communities you need to be able to relate to the myriad of different staff at AgeSong.
One of the first things that can help interns connecting with the AgeSong staff is what you do you when get onto a floor within the AgeSong Community. Most important to check in with the CarePartners on each floor. Find out what has been going on. They know what is currently happening in the community and what has happened recently and what will be coming up.
If you have not been introduced to the CarePartners on the floor, then please introduce yourself. We want to cross any barrier of perceived rank that might occur between interns and carepartners so we ask that our interns make the first move to engage. Please do not wait for the carepartners to engage with you, be proactive and engage them.
Dr Nader Shabahangi, CEO of AgeSong talks to the incoming Pacific Institute GeroWellness interns about the CarePartnering program employed in the AgeSong communities. He discusses with the interns the difference between carepartnering they will see at AgeSong and caregiving found in more traditional models. Nader also discusses why AgeSong uses the more empowering carepartner system.
An Introduction to CarePartners at AgeSong
What does it mean to become more “psychological”? To develop a more psychological attitude?
Awareness of others and their emotions? To have that you need to be interested in the other’s awareness, and emotions, and behavior. You need to be able to have answer the question behind the others emotion and behavior, you need to know they “why?” Why is the big one. You’re talking about meaning, what happened? What is behind it?
At AgeSong t is not only about giving care but it also about partnership. We want to give the Elder the feeling that they themselves have something to offer and that they are partnering with us in their care.
Nader gives an example of the difference between caregiving and carepartnering. “One is I’m relating. I’m asking for permission. I’m asking “where is she?” Where is she in her world? Does she feel like she wants to take a walk? Does she want to get up? Leave me alone, I had a bad dream. Who knows? But, I am actually relating with her first. And I’m asking what kind of help does she need, if any? So I am partnering in the care, rather than assuming, “Ok, let’s go. And this, “Come On Let’s Go,” is what we call custodial care.
Custodial care, custody, control, means I know what is good for you. Which is basically, in many ways, kind of a mainstream care operation, eldercare operation, hospital operation. The nurse knows best. Right? We know what’s good for you. And certainly when you are in an ICU you want a doctor to tell you what’s best for you. You cant think very much about whether you want this or that medication or surgery or not. So custodial care works very well in an emergency situation. But that has been exported to everywhere. So now in a care environment that is supposedly based on psycho-social care we are also now using custodial care. And we want to change that. To create more of a respectful interaction.
Creating a more respectful interaction is something that you can help us teach our CarePartners. Because you as a therapist are all about relationships. That is your bread and butter, relationships. Relationship with a client to him or her self, relationship to others. Ninety-nine percent of the world’s problems are about relationships, all relationships.
In the system of relational care there are no problems, there are challenges. So really what’s the problem? We are the problem, we are being challenged all the time by certain behaviors. When needs are not met then what happens over time, or maybe quickly? Something happens. All behaviors, in some way or another, any kind of expression that we call aggression and that’s also a difficult word. Because what is aggression to you might not be aggression to another. So we are saying all the issues that we are facing, behaviorally speaking, and that’s really what were dealing with as counselors, are really about unmet needs. ‘
Unmet needs again bring us back to the question of “why?” Why is this person behaving in the way that they are behaving? And we have a dominant model that is saying: because there’s a chemical imbalance or we need to do a behavior mod. Our model would say no, there is a need that I am not understanding. If I understood them better I could meet their need. That is the foundation of what we want to do here.
The bias in existential work is that if I can understand your world. My goal as an existential therapist is to understand your world. It is not to fool with it, change it, make it different, I want to understand your world.
In my trying to understand your world you become more self aware of what that world actually is. Because most of us don’t really take time to understand who we are. When was the last time you sat down to understand who you are? Often it only happens actually when you are sitting with someone else, right? In the mirror of the other. You need the other its actually almost impossible to sit down yourself and figure out who you are because you are stuck in your own mindset. You’ve got your own thinking. You need the other who says hey wait a minute what are you thinking? You need conflict for crying out loud. Without conflict you do not ever grow. And you need to suffer. There’s a word I almost forgot. The foundation of consciousness is suffering. therapy or work is a little bit about being in discomfort because if you are not then why change?
In the video, An Introduction with Blanca Reyes, AgeSong CarePartner, we meet Blanca one of the CarePartners who specializes in Forgetfulness Care at the AgeSong Laguna Grove Community.
An Introduction with Blanca Reyes, AgeSong CareParnter
Blanca welcomes the new 2015 Pacific Institute GeroWellness participants to AgeSong Laguna. Blanca speaks about her Forgetfulness Care work on the second floor of AgeSong Laguna where residents include those with severe forgetfulness (dementia.) Blanca shares some extra care and caution that should be taken when working on the second floor. Some of the elders on the second floor with forgetfulness no longer communicate in the same ways they used to and it is important to understand each of them because each of them is different. Blanca has a special affinity for working with the elders on the second floor and encourages the interns to come to her. She can introduce the interns to the individual elders she works with. Interns are always encouraged to work with the CarePartners in getting to know the elders they will be working with. The CarePartners in each community are those with the most detailed knowledge and understanding of each of the elders residing within an AgeSong community. The CarePartners can work with the interns to show them the ways relational care works with each individual elder and help them get to know the elder, to build a relationship with the elder.
In this video, Introduction with Betty Dominici, AgeSong COO, Betty talks to the AgeSong Pacific Institute GeroWellness 2015 Interns. She speaks about a non-judgmental attitude, relational care and getting to know the residents during their internship.
Introduction with Betty Dominici, LVN, AgeSong COO
Betty Dominici expresses the wish that a goal this year at AgeSong, is to not judge the elders we work with. She speaks to how AgeSong is different in it’s approach to care. AgeSong uses relational care to get to know the elder. This emphasis on relational care is different from the mainstream. Relational care is how AgeSong works to address what is happening with the residents. She recommends that interns do not jump to conclusions about an elder, or look at an elder as their diagnosis or view them medically. At AgeSong we first try to understand the elder. By doing that we find the reason why the person is exhibiting the behaviors they are. Perhaps there is an unmet need. The only way to do that is to be accepting, to really get to know them and gain the understanding needed to meet that elder’s needs.
Betty finishes with a preview of her talk to come on assisted living operations and what it means to be an AgeSong Assisted Living Community.
In the GeroWellness training there are more talks and training on relational care at AgeSong and how it helps the CarePartners, Nurses, Engagement team and Interns meet the AgeSong residents needs.
Dr Nader Shabahangi speaks with the 2015/2016 Pacific Institute Gero-Wellness Program participants about “Wherever you go, there you are.” He encourages the interns to be themselves and how their engaged involvement will help shape their internship/practicum year. Nader also touches on the meaningful impact their engagement can have in the AgeSong Community they will be working in.
Wherever You Go, There You Are
This year there is a great opportunity to have a deeper understanding of how our professional comes into the personal and how the personal comes into the professional and how there really is very little no difference, if any. Wherever we go, there we are. We show up and we show up as who we are.
There is an idea in standard psychology that we are a psychotherapist or LMFT and we are in that role. We are a somehow an expert and we are not ourselves anymore. They call you and I relating “therapy.” I thought we had a relationship. So the moment we call this “therapy” we have instrumentalized the relationship that you and I have.
You are starting the year and there are expectations. You have ideas. And really all of us are dealing with issues. What are some of the things that we might be working on this year? We are working with frail elders, forgetfulness, we are working with “end of life.” At AgeSong in working with elders we are working with the most marginalized group within our society. Frail, vulnerable, people who are often not that verbal anymore. That get judged. This is also an organization that tries to change how elders are being looked at. So you will deal with the mainstream which does not seem to be dealing with the aging phenomenon.
All you will be dealing with the mainstream that doesn’t have too much of a useful purpose for elders. And that attitude is manifesting itself in the way physicians social workers, psychologists, therapists, and hospital admins are helping or not helping our cause.
As GeroWellness interns you will be in the middle between the mainstream and the AgeSong vision. You will want to get in there and make a difference. You will want to make a change. And you will see obvious inadequacies. When that happens remember that AgeSong is an organization wanting to make a difference. Be on our side, talk to us, the change begins with you, you will have the opportunity to be an agent of change. Bring your ideas for change to us and let’s see if we can help you manifest the changes you seek.
What is wonderful about this internship is that Elders are very accepting kind and caring and they allow you to be yourself. Interns can bring themselves to the internship and effect change by being themselves in an accepting and inviting environment.
Jamie Slyter, AgeSong Engagement and Enrichment Director and Nader Shabahangi, AgeSong CEO discuss Engagement and Communication during this video, An Introduction with Jamie Slyter. Jamie Slyter encourages intercommunication between interns and Engagement teams at Communities and talks about the engagement opportunities available to residents at AgeSong. Nader speaks about the evolution of the AgeSong Engagement and Enrichment program.
An Introduction with Jamie Slyter: AgeSong Engagement and Enrichment Director
Jamie finds the most helpful and important piece at AgeSong is having open lines of communication. Communication between interns and staff is very important to keep staff apprised of what you are working on with an elder. Also the interns should look at all of the staff as resources, the Engagement team, the CarePartners, the Nursing staff, all of these people can be sources of insight into working with an elder. Communication ensures collaboration.
The Enrichment and Engagement team work with the elders to ensure that elders have a sense of fulfillment each day. The elders at AgeSong have mobility they are able to go shopping, to go out to eat. The residents are in an assisted living facility so AgeSong works to ensure that they are assisted in having choices and freedom.
Nader Shabahangi Shares the Evolution of the Engagement and Enrichment Program at AgeSong
Originally the program as described by the State of California was just called Activities, even though AgeSong works to bring more a relational emphasis to the program. Then the AgeSong program morphed into an Enrichment program but that seemed to imply that there is some sore of a lack and did not wholly describe the work being done in the Communities. The foundation of therapy is being heard. As the At one point the idea of engagement was brought into the mix and the word Engagement really describes what the current program brings to the Communities. A wonderful way the interns can contribute as relational counselors is to work with the residents to engage with each other. The Enrichment and Engagement program is not about entertainment. Nader encourages the interns when they do their Groups that they think about what they love to do. The content of the Group is not as important as doing what you truly love.
An Introduction with Cherese Holland: The AgeSong Eldercare Community
In this Introduction with Cherese Holland, the Executive Director at AgeSong talks about Eldercare at the AgeSong Communities. Cherese discusses how the internship program works with operational team at AgeSong in identifying the different prongs in a multi-disciplinary approach to meeting Resident’s needs in the Community.
Cherese starts off by re-iterating that yes, AgeSong “really IS alot of what Nader talks about but there’s a lot of fun to what it is that you all get to do with us in the Intership as well.”
One of the items that Nader talks about is how resident’s have their needs met or not met. This is a big focus within Community. Each intern joins the AgeSong teams in looking to meeting the residents needs, one of the most powerful tools is using a multi-displinary approach to accomplishing this goal. What the interns also bring to the table is sharing insight with the operational team into how a need can be met using the multi-disciplinary approach.
Cherese expains, “Yes, it is a collaborative effort for us with the prime focus being meeting the resident’s needs. The multi-disciplinary approach is how the rubber hits the road at AgeSong. Collaboration in a multi-disciplinary environment is how we get things done” and Cherese extends and invitation to the Interns to work with her to accomplish the AgeSong goals.
As Cherese says in closing “together we can do a whole lot more than we can as an individual. So ‘Welcome to PI!”(Pacific Institute)”
An Introduction with Sally Gelardin: Engagement at AgeSong
Dr. Sally Gelardin, AgeSong’s Regional Engagement & Education Director, welcomes the 2015/2016 Gero-Wellness interns to the program with a talk about engagement in AgeSong’s Eldercare Communities.
Sally opens her introduction with a short description of her background. Then she describes what Engagement means. She says:
Engagement is the meaningful connections we make and this is not just activities, because activities are something that you do. Engagement is something you experience. It’s not enough to facilitate an activity. What you really want is to see each person’s eyes light up. You’d like to see eyes light up in every member of your group. Even if you are with a person one-on-one, you want to see that person’s eyes light up. That means you have made a meaningful connection.
Sally talks about working with elders as the most rewarding job of her life, as well as the most challenging.
She gives an example of a writing group, which might include elders with a wide range of abilities. Perhaps only a few members in the group can write without assistance. How can you facilitate a writing group when only a few members of the group can write? The key is volunteers and family members to help those who cannot express themselves in writing.
As she explains, “Meaningful communication can be expressed in many ways. You initially see someone who doesn’t move a muscle, is in a wheel chair, and can barely move her head. When you see her eyes light up, it makes your day. It’s incredible. ”
Sally closes her introduction with a “Welcome, Enjoy!” to the 2015/2016 participants of the Pacific Institute Gero-Wellness Training Program.
This video starts the discussion about how at AgeSong we view Elders as our Teachers. We would like to help you have a shift an attitude in how you view elders. We want to re-vision how we view the residents, because our views will be picked up by them. We want to encourage ourselves to look at them in a new way, with new eyes. Re-frame our thoughts so we are honored to be in their presence irrespective of what their condition is. It is a privilege to be with them in all of these different situations. If they can feel that you have that kind of vision, they also feel valued and they also have a purpose. The elders feel they can be teachers and can help us become deeper, more grounded, more centered, more caring and more compassionate people.
Engaging with Elders Inside AgeSong Communities and Joining with them out in the Local Community
Interns at AgeSong have the ability to engage with residents in a myriad of ways that can be effective therapeutically. If you feel the resident can use some quiet time just let the Care Partners know. You are in charge in that way, you have permission to make that happen.
In America we do not see elders out on the street very often. So having the ability to bring elders out into the local communities is really positive. Give people the thought when was the last time that they were with an elder. We strive to have the kind of Communities that are desirable to people of all types, that are integrative and encourage age groups of all kinds to interact and engage.
Elders give to us.
They give to you. Let go of the worry that you have to give to the elders in the community. Be of the mindset that when you are around elders you dont have to give them anything other than who you are in terms of being present. You might not feel that until you have had some time to be immersed in this environment. Your experiences of being immersed here will stay with you.
Learning how to say I don’t know.
Sitting with an elder and you don’t have to feel that you have to “do something.” You will arrive. Everything slows down. Let go of the anxiety of having to say or do something. The client knows what is up, where to go. Follow the clients process. “Elders are our teachers,” is one the taglines of AgeSong. When was the Give them the gift of your presence. Have them be your teachers. One of the things we like to do at AgeSong is learn to say “I don’t know.” A foundational precept is that you do not have to do anything other than follow the clients process. To follow their presence all you have to do is be present. What is a foundational technique to being present? Slow down and be aware of where you are and how do we impact others. Be here.
Center Before you Enter
Come here and take a deep breath. Forget about the rest and be “here.” Now you enter. Saying hi to people and acknowledging them helps us to get into being here.
What we Learn from Elders? To summarize:
In learning from elders we realize that we do not have to give of anything but ourselves, our Elders give to you. The pressure is off for the rest of the year.
You have nothing to do, you don’t know. That is a big thing. You learn to say I don’t know, you learn to feel I don’t know. Only when you learn to know that you do not know can you be open to the other bringing you something in. This is because if you know something already the other cannot get in. Be open to the mystery.
We are doing an immersion here during the Intern and we are learning by doing. We are re-framing or re-visioning how we look at things. Finding other ways of seeing things.
At AgeSong we practice a non-pathologizing attitude. We do not look at something as disease. For example the term “assisted living.” Assisted Living gives the meaning of that which needs assistance. This is defining people by their needs instead of as individuals. At AgeSong we call ourselves an Elder Care Community or Elder Community. This allows us to view the community members as individuals and allow them to teach us. Elders help us to be here, to be in the moment. Be deeper and more grounded.
Self awareness informs the therapeutic work engaged in by the GeroWellness Interns at AgeSong Communities.
Self Awareness While using the DSM
What is the DSM? What is it telling you? The Diagnostic Statistical Manual, what kind of system is that? It is impersonal. It is kind of like a box that you put people in. Labels that you can use as a therapist. In some ways the DSM wants to teach you how to see and it tells you how to see. Then it tells you how to diagnose based on that seeing. Then it tells you how to treat based on that diagnosis. We can label all day long, we all do but at least you have awareness that that is what you are doing.
Self Awareness in the Upcoming Year’s Work at AgeSong
Become curious about why am I doing and feeling and thinking the way that I am thinking, feeling and doing. That is the foundation of awareness. Self awareness. Because you are the therapeutic instrument. It is not the books that you are going to read that are going to make you a good therapist it is your awareness of yourself. This is a year packed with experiences, that you can use to understand who you are. It’s a journey of self discovery. It’s about you. This is you who you are working on.