Reflections on Eldercare Today and the Future

The Senior Care Industry at one point only saw its role as one that assisted elders with basic living needs, not to help them live in meaningful communities that provide continued integration of elders in and with society. The former approach often led to the valid criticism of senior care providers ‘warehousing’ elders. This warehousing criticism was based on an overall simplistic approach to eldercare which led to large profit margins in the industry.

Now developers and operators have a difficult time letting go of such margins. But in order to provide more sophisticated and intelligent care, more professionals in social work, psychology and other human services need to be employed, all people who cost more. The carepartners, who belong to the lowest paid people in the United States, yet are tasked with helping our elders (one time that will be you) in the most intimate and relational ways – are tired of working two and sometimes three jobs to make ends meet.

The profit margins of yesterday belong to an outdated concept of who are our elders: not useless members of society but rather highly mature, experienced as well as knowledgable people whose wisdom must be used to steer this planet and people in more sensible directions, whose experience can maintain certain ethical and rational standards of sustainability for both civil conduct and care of our planet.

Elders are a resource, not a liability. Aging allows us to mature, not to decline. This shift in attitude towards our elders and anyone being older than what is considered young (and has that not moved to a younger and younger age with teenagers now being used in marketing and on billboards everywhere?!) – this shift, indeed, is the challenge ahead of us.

Senior care providers can either help or obstruct the much needed and wanted attitudinal change towards valuing our more mature members of society. Doing so will not only be better for planet and people but, in the long run, will make sure that our present assisted living industry will not become a dinosaur because it was not able to adapt to new needs and attitudes.

~ Nader Shabahangi, PhD, CEO and CoFounder of AgeSong, Eldercare Communities

A Review of “Deeper into the Soul” by Tru

[*Updated on Feb 26 to include current book availability]

Book cover of Deeper into the Soul by Nader Robert Shabahangi & Bogna Szymkiewicz

Those who work in assisted living are finally listening to the message that Nader Shabahangi has been spreading for years – the value of slowing down and learning from elders.  Following is a review of  “Deeper into the Soul,” a charming book that explains this belief system through different perspectives. It can take a lifetime to really absorb and apply this philosophy and belief system.  It’s worth it.

This review comes from Truthful as posted in August of 2014, on her wonderful blog Truthful Kindness:

Tru here. I deeply appreciated the book “Deeper into the Soul: Beyond Dementia and Alzheimer’s Toward Forgetfulness Care” by Nader Robert Shabahangi PhD and Bogna Szymkiewicz PhD.

Some excerpts from introduction are quoted below:
“In this book we highlight a basic attitudinal shift:

  • Dementia is our teacher.
  • Rather than simply a disease, dementia has purpose and meaning.
  • Rather than being people simply in need of our care, people who forget can teach us about life and living.
  • Rather than a burden, people with dementia offer us an opportunity to deepen ourselves, to go deeper into our souls.” …

And later: “Being with forgetfulness indeed takes us deeper into the soul.  Whether we experience forgetting in others or glimpse it in little moments within ourselves, forgetfulness offers us a gift, if only we are capable of seeing it as such.  Perhaps loss is always a gateway to the real gains …”

And last but not least, this excerpt; “For those who can truly lay aside their aversion or discomfort and learn to accept what is, the gifts of the soul await; equanimity, intimacy with the dream-world and its magical ways, slowing down to the speed of soul essence.”

It took several tries for me to understand the text of this book, but even on the first try I could understand the brief blurb-balloons for the cartoon explanations that go with each page. VERY much appreciated the positive perspective offered by this book. Publisher http://pacificinstitute.org/eldersacademy.php#deeper still has it available $14 (softcover) and $20 (hardcover).

Tru Blog Review of Book “Deeper Into the Soul by Nader Shabahangi and  Bogna Szymkiewicz POSTED ON http://truthfulkindness.com/2014/08/06/bk-deeper/

Deeper into the Soul Books

Deeper into the Soul is currently available in both hardcover and ebook from Elders Academy Press.
Deeper into the Soul paperback is currently out of stock. Elders Academy Press expects to have it back in stock in April, 2016.

Related Post:

Featured Book | Deeper into the Soul Now Available as an eBook

 

AgeSong’s Central Vision

by Nader Shabahangi, AgeSong Founder and CEO

AgeSong and Pacific Institute are vision-driven organizations. This means that people who belong to these organizations understand their work as contributing to a larger vision of a more loving and aware world that makes room for the many diverse expressions of all there exists. At its core, AgeSong is grounded on the belief that we live in an interdependent world where all is related with and to each other. As such, AgeSong emphasizes a relational model of working together as opposed to a model that believes in absolutes, that is in one right way of being and doing.

At AgeSong’s elder communities, we strive to create, both in theory and practice, a place where we can allow people to be who they are, a place where the intention of those with whom they interact, such as carepartners (commonly termed caregivers) staff, interns, family, and volunteers) is to understand more deeply about the Other facing them. As such, AgeSong desires to create learning organizations where we ask such basic questions as the following: Who are we? What helps? How do we help? What does it mean to live, to age? How do we age? At AgeSong, our intentions are to take a stance of curiosity rather than knowing, to understand how we best care for the other and to appreciate difference as much as homogeneity.

At AgeSong’s elder communities, AgeSong and Pacific Institute implement the foundational belief that all phenomena we humans experience are meaningful and important for a deepening of human awareness and for the enjoyment of life. This belief understands phenomena normative society designates as undesirable, even deviant – through labels such as disturbance, disorder, illness or disease – as essential for understanding and living human life. Among the phenomena mainstream regards as unwelcome belong also aging and old age and often any behavior different from what we consider normal, ‘appropriate’, or ‘well adjusted’. AgeSong elder communities share in the belief of the meaningfulness of all phenomena through by creating therapeutic environments at its elder communities. In this spirit, AgeSong works together with Pacific Institute to combine resources, apply internship training, and implement AgeSong’s varied and diverse specialized programs. These specialized programs are modeled on an existential, processwork philosophy and psychology that are non-comparative and do not pathologize. Such a philosophy and way of life do not separate the world into good or bad, right or wrong, better or worse. As such, this philosophy and practice stands in contrast to present-day mainstream perspectives with their emphasis on dividing the world into things that are more desirable and less desirable.

At this time, the following programs are being implemented at AgeSong senior communities:

• Community Living (Assisted Living Care)
• Forgetfulness (‘Dementia’) Care
• Engagement and Outings
• Expressive Arts Therapies
• Gero-Psychological Care
• Spiritual Care (Interfaith)
• Palliative (Hospice) Care

The intent of these seven programs is to address the many different facets and dimensions of aging, old age and of being human in as comprehensive a way as possible. The central concern of all of these programs is to educate and train carepartners, staff and interns in a basic attitudinal shift. At the heart of this shift is learning to perceive life as meaningful. Though seeing something better than something else, such differentiation and judgment are necessary in some parts of life, applying this attitude without discrimination to the care of the human being marginalizes and perpetuates suffering.

Towards an Attitude of Curiosity and Acceptance

An existential, processwork-oriented attitude that lies at the foundation of an AgeSong therapeutic environment approaches human beings and the world we inhabit with an attitude of curiosity and acceptance. It is this attitude of curiosity and acceptance in which both AgeSong and Pacific Institute would like to train carepartners, staff, volunteers, and interns. Such an attitude welcomes and enjoys difference. It understands perceived difference as an opportunity for growth, and thus wants to learn from it.

Stated personally:

“From each difference I perceive in the other allows me to see a part within myself that may as yet be unfamiliar to me. That which I perceive as different is different because I do not identify with it or know yet. What I know already I do not regard as different or ‘other’. It is my attitude towards difference that is essential here.”

I have a choice to reject or accept difference. In rejecting difference I state that the ‘other’ is not part of me, is not worthy of being understood further. But would I not want to understand what I don’t know if it could help me understand myself better? In accepting difference I state that there is something I can learn from the other, something that deepens my awareness of myself, hence the world within which I live.

This attitude of acceptance and curiosity translates into the way each of the specialized programs is carried out. For example, in assisted living care the special needs of the elderly residents are met with an attitude that understands each need as a way the elderly communicate their unique difference to us. All kinds of possibilities can lay behind a community member’s tentative or slow walk, need to be fed, or desire to be quiet for a long time. Rather than ‘seeing’ these ways of being as aberrant, we might understand them as ways of expression in their own right. This holds true as well for those elderly who seem to forget what they once knew, appear confused to us in the way they go about their daily lives. If we do not judge forgetfulness or confusion as abnormal, but rather as the way this particular individual now lives his or her life, then we could see the wisdom behind this change and difference. As importantly, we can enrich our own lives with another way of being we did not imagine or ‘see’ before.

Educating and Training a New Generation of Carepartners and Interns

The central task in teaching and educating a new generation of managers, administrators, supervisors, coordinators, interns, carepartners and volunteers is to start with showing how each of us holds certain beliefs, values, ways of seeing people and the world. The purpose here is to have us become clearer about how our beliefs shape our perception and thus determine how we see our world. It is important to show how, for example, what we judge to be undesirable or aberrant can also be seen as something valuable, even enjoyable. Working primarily experientially, we are invited to probe in ourselves for character and behavior traits with which we would normally not identify. In this way we may begin to first notice and then counter the tendency to judge whatever may be in front of us.

Another training consists of learning to make contact with one’s own ‘inner elder’. This training conveys a connectedness to the wise part in oneself. This part allows us to learn to look at life and living from the ‘long view’. In such a perspective all phases of life are seen as important for the creation of a full life.

Central to the attitude of acceptance and curiosity is learning to be cognizant about our expectations. Noticing our expectations, becoming explicit of them, helps us be in and with the moment. We develop a ‘beginner’s mind’ attitude where we feel more and more comfortable with not knowing what will be, what should happen. This attitude allows us to enjoy what is. Enjoying the beauty of the moment means enjoying life, enjoying all that happens. This enjoyment is based on us being present with the unexpected events that often go unnoticed: the graceful movement of an elder, the faint smile, the warm hand I touch, the green plant I see, the food I taste, the raindrops I hear.

Important in this shift to an attitude of acceptance and curiosity is learning the art of listening. This involves as much noticing our desire to speak as our tendency to assume what the other is saying. Language, however, both verbal and non-verbal, is very complex and difficult to understand fully. Every word, movement and expression contains multiple meanings, often unknown even to the person communicating. Here trainees will learn ways to listen and understand, to take time paraphrasing and helping the other search for understanding.

Warriorship of the Heart

What we want to communicate to the world ought to be congruent with our message itself. At AgeSong we desire to communicate to others that we would like to re-define aging as an important phase of life. This phase of life is given special importance through re-establishing the role of eldership in our culture and society. To be truthful with others we need to model the ways of elders ourselves: being attentive listeners who continually practice being aware of what occurs in the moment, within and without.

The Seven Specialized Programs

All seven programs are based on the same attitudinal shift towards a loving curiosity and acceptance of the other. The only difference is the form this loving attitude takes. In assisted living care, carepartners practice their loving attitude of acceptance and curiosity when they bathe, groom, feed, walk, and otherwise help, support and sit with our residents. In forgetfulness care, carepartners and interns practice an attitude of curiosity and acceptance when they work with elders’ attempt to remember, find their room, walk the hallway, search for contact, do activities or engage in the many different forms of communication and relating. In expressive arts therapies, interns, staff lovingly follow community members’ many diverse attempts in being creative and expressive. In our spiritual care program residents encounter a safe place where they can express their struggle for meaning and their search for the transpersonal aspects of life. In our memory improvement, interns in training work patiently and lovingly with elders’ desire to remember and to stay cognitively active. In hospice care, elders find acceptance in the way they are and need to be as they move through their process of dying.

Once the attitudinal shift to a loving curiosity and acceptance of the other – whether the other be community members, family members, or carepartners, staff, and interns – has been made, the above programs meld into one. This means that whether we do expressive arts, memory training or assisted living care, the basic attitude with which we undertake each program always follows the process of the elder moment to moment.

A Different Model of Doing Business

At AgeSong we try to walk the talk. The way we care for our organization, for people and things ought to reflect the way we would like to care for community members. This is what we mean by staying aware of the Circle of Care – as I do to do, you will do to others, to yourself. This circle of care extends not only to the people who work with AgeSong, but includes the community and environment, the larger world in which our organization lives. As such, our organization desires to stay aware of this interrelationship by paying attention to how it cares for and relates to this world. Concretely, we try to remember that there are different bottom lines, that return on investment does not only refer to a monetary return but also to what we return to our workers and our community, near and far.
For additional reading and study, please view:

Process Work on the Arni and Amy Mindell website.

From Mindell:
What is Processwork?
“Processwork is the art, science, and the psychology of following the nature of individuals, communities, and eco-systems.
What is this nature exactly? It appears in the descriptions or self- descriptions of nature and people, as well as the subtler often missed signals and deep experiences of everyone and everything involved. Following this nature is often a great help for everyone involved. Following nature often gives meaning and necessary change.
Processwork, also called process-oriented psychology, is a multicultural, multi-leveled awareness practice including people and their natural environment. It is an evolving, trans-disciplinary approach supporting individuals, relationships and organizations to discover themselves.
Processwork uses awareness to track psychological and physical processes that illuminate and possibly resolve inner, relationship, organizational, and world issues. Processwork theories and methods, skills and metaskills are available for anyone to experience and can be tested.
Processwork Applications:
Processwork can be used to help people in all states of consciousness, that is in so called normal awareness states, or in altered states such as psychotic or extreme states, comatose and near-death states. It can be applied to psychological problems, body symptoms, groups, organizations, governments, and has been used for very young and very old people.”

More Info on Processwork

Read more about What is Process Work?

Books by Arnold Mindell:

City Shadows: Psychological Interventions in Psychiatry 

The Quantum Mind and Healing: How to Listen and Respond to Your Body’s Symptoms

The Shaman’s Body: A New Shamanism for Transforming Health, Relationships, and the Community

Dance of the Ancient One

The Deep Democracy of Open Forums: Practical Steps to Conflict Prevention and Resolution for the Family, Workplace, and World

 

 

AgeSong CEO Speaks on Spiritual Purpose of Aging

[This post was updated October 9th, 2015 to include the videos of the workshop and exercise.]

AgeSong CEO and Founder, Dr Nader Shabahangi presents a workshop on the “Spiritual Purpose of Aging” to the Openhouse SF Community on August 27th, 2015. This interactive group workshop was facilitated by Chaplain Renee and hosted by Openhouse SF in partnership with the Ministry of Presence Institute.

AgeSong CEO Speaks on Spiritual Purpose of Aging

Video is now available of the workshop where Nader Shabahangi, the AgeSong CEO, interacts with the Openhouse SF Community the on Spiritual Purpose of Aging
Tune in and watch the Spiritual Purpose of Aging Workshop video created by AgeSong.

Watch the Spiritual Purpose of Aging Workshop Exercise video here. This is the companion video to the Workshop video.

Find out More!

Read more stories  about Aging here.

Explore more videos in the AgeSong Video Library

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Towards an Elders Academy – A Future Vision

The role of the elder was once the most revered role in our human communities. Eldership as a role and position within a human community started within the tribal traditions. There we find an emphasis on elders as guides and leaders. This indicates that they are experienced and wise and are fit to lead the tribe and teach the young. Elders also resolve social concerns and are expected to make final decisions about the direction communities will take on the many social and individual issues we humans must face.

Today, however, elders are scarcely available to guide and initiate the young and lead our communities to make wise decisions. There is an absence of elders also because the old have not been given the skills and ability to be elders. Moreover, in the last few centuries, the status of the elderly as respected members of their societies has declined.

Paralleling this decline has been a diminution of the elders’ role in their respective communities. We need to train elders if we want to help individuals living in our communities and societies with the important tasks of supporting and guiding the younger in age and experience. For being older does not make an elder. The qualities of eldership must be acquired through much training, learning and practice. If we recall, for example, how monks in the various spiritual traditions are initiated over many years into becoming a respected member of their communities, then we have a glimpse of what it will take for an older person to grow into becoming an elder.

There are a few organizations in the United States that try to implement this vision of eldership into practice. Notably the Eden Alternative programs (www.edenalt.org), AgeSong (www.agesong.com), AgeSong Institute (www.agesonginstitute.org), and Mather Lifeways (www.matherlifeways.com) are at the forefront of making this change.  I do hope that other individuals, organizations and corporations will swiftly follow their example.

For it is our elders, their life experience, skill, knowledge and wisdom that will help usher in a new era of understanding how we can live in harmony with planet and people. And it is our elders who, together with the young, will lead the way to help establish a sustainable way of life, both in terms of matter and spirit.

The stakes are higher than one might think. The value set based on youth also brings with it an attitude and approach to life that must be balanced by the wisdom and experience of age. Though this seems obvious at first glance, the divide between the generations is widening, not decreasing. Modern technologies, their apparent wizardry and standing in the world as benchmarks of civilization, are advancing to such a degree and speed that a counter movement has already begun to take hold. Elders need to be infused in the decision-making processes in the world. Their experience and natural attitude towards sustainability is needed to help protect and guide people and planet.

 

 

The Concept of Meaning and Unmet Needs

It is common to talk in eldercare communities about difficult residents. Those are residents who do not fit in with the expectations of peace and quiet in an eldercare community. They seem to have more energy than others, seem disruptive and even appear aggressive and loud. The problem is seen as one that belongs to those disruptive residents. The approach is thus to engage in behavior management or, as is more common, to look for medication to extinguish the behavior. This attitude of simply blaming the disruption on the person who seems to cause the problem is convenient for the staff as it is the residents who are being asked to change. This approach, however, ignores that there might be reasons for residents’ behavior, that we have something to learn from them.

A major shift in the conceptual understanding of looking at so-called difficult residents is to believe that their behavior is expressing an unmet need thus far overlooked. This attitude does not make residents wrong for being who they are but rather understands their behaviors as important signals to be explored and understood.

The concept of “unmet needs” is not at all a new way of thinking about behavior. As a matter of fact, our own bodies are designed to express pain if something is wrong and most parents would not ignore a child’s cry or otherwise unusual behaviors. Rather, they feel naturally drawn to want to understand such expressions further. Similarly, elders living in an elder community are not any different, especially if their language capabilities have changed over time. They often express their needs through subtle and not so subtle changes in their behaviors. We need to learn to understand such behaviors, and primarily, we need to believe that any and all behaviors have meaning.

The concept of ‘unmet needs’ moves us away from a pathologizing attitude to one of wonder, curiosity and further exploration. Not the elder or client is “wrong” or needs “fixing;” but we care-partners need to deepen our awareness and understanding about human beings and life.

From Caregiving to Care-partnering, from Custodial to Relational Care

In assisted living and eldercare in general, it is common to refer to assistants as caregivers. This implies a one-way direction of care: I give care to you. Understood as such, care-giving can easily lead to a one-way, custodial type of care where the caregiver is in control of the care he or she administers. This can also lead to a diminishing of the elder for whom we care: rather than being sensitive to what elders are still able to do for themselves, we override those abilities and do for them rather with them. This points out the difference between a custodial type of care directed by task completion and a relational type of care directed by the deepening and nurturing of the relationship with the elder for whom I care.

By being present to the person whom we encounter, we value relationship. Valuing the relationship means we feel ourselves as partners with the person with whom we relate – not superior or inferior, not better or less good. We meet in our shared humanity. As in an existentially based psychotherapy where therapists understand themselves as partners in the journey towards a deeper understanding of their clients’ lives, so those helping elders in eldercare communities understand themselves as care-partners in the care and services they provide. Only through such an attitude of equality can a genuine relationship be formed and continually nurtured. And only through such an attitude do we human beings ever feel valued, ever feel loved.

 

The Language of Eldercare

The poet Ingeborg Bachmann stated aptly that a new world requires a new language. In order to move away from the idea that human beings are biological objects in decline that can be manipulated, objectified and thus “commodified”, we need to make a change in the language used to describe aging, old age and elder care. Foremost, we need to become aware of the gain-loss paradigm that permeates our culture. Given we equate aging mostly with human biology, it is easy to look at the changing body and observe losses: inability to run as fast as in earlier years, less vision and hearing, forgetfulness, and so forth. The story of gain and loss can be replaced by a more complete viewpoint, one that does not interpret what it thinks it sees but rather stays with the phenomena. For the phenomena themselves speak a language of their own. They simply express: we are changing. Without a measurement stick and standard, all we truly can observe is that we are a body and mind in process of change. It is our interpretation that wants to either make it good or bad, desirable or undesirable, define it as gain or loss. Who is to say that we do not need exactly the changing body to help provide the ground for our deepening?  That we need to go more slowly so we can live more wisely? That bone-density needs to be less dense in order for us to be more accepting? That muscles need to be softer so the mind can think more compassionately? After thousands of years of pondering, we have yet to understand the relationship between body and mind. What we have learned is that it is increasingly more difficult to know where one ends and the other starts. Moreover, it is important to remember that words such as body, mind, and soul are only roughly pointing to something we have yet to understand, let alone define.