Former interns with the Pacific Institute GeroWellness Program Hammond Care reflect on their experiences while working at AgeSong in the program.
Here is the inspiring video that prompted the discussion below. This is”Changing Lives through Art” from HammondCare’s Centre for Positive Ageing and Care – Arts on Prescription program.
These three former interns, Melissa, Anin and Dede share and comment on Hammond Care Center’s video about ‘Changing Lives through Art.’ In this discussion that took place on Facebook the GeroWellness interns who each worked at AgeSong communities during their internship talk about what the experience meant to them.
Melissa D’Antoni had this to say about her experience in the GeroWellness Program:
“This is SO awesome to see! When I was doing my clinical internship in expressive arts therapy in San Francisco it was Nader Robert Shabahangi and Doris Bersing who believed in me and the power of creative expression to support me in starting a program at for elders at AgeSong assisted living facilities. We had painting, drawing, drama, yoga, sandplay, dance and music, it was incredible. Can’t forget Dede Estey and Anin Utigaard for all their training and support as well! Such fond memories. My clients at AgeSong and Zen Hospice taught me so much about presence and stillness. This IS the way of health & wellness care.”
Former intern Anin Utigaard commented on Melissa’s post:
“Thanks for sharing this Melissa. Yes, my time at AgeSong was also very rich and heart opening, and I have you to thank for that. I just saw several interns from AgeSong on Friday night and we were reminiscing about our time there and how much we learned from the Elders. It changed us in a good way – wonderful experience. So glad you’re continuing to bring your magic to your community. Creativity is such a powerful resource for all of us. I can’t imagine what life would be without music, art, dance, drama and poetry.”
Former intern Dede Estey shared this comment about Melissa’s post:
“So happy to see this and be reminded of all the great interns I met at AgeSong and Pacific Institute. you are a bright light in a difficult time in the world. So happy your work fulfills you and now you can share your love of art and people with your daughter.”
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.
My brother is in the hospital. For the past 40 years, he has been a primary source of support for family, friends and colleagues. Now he needs support. A medical doctor in hospice care, he cares for others. Now he needs care. Doctors lead a fast-paced life, with many responsibilities. My brother was always healthy, rarely sick. Now, recovering from an operation, he has much time on his hands, can read novels, sleep and heal. He now has the unexpected, and not particularly welcome, opportunity to experience what his patients feel.
Elderhood comes suddenly. Most of us are unprepared to manage the challenges of aging. Pacific Institute’s Gerowellness Program educates students in social work and psychology to learn experientially about elders in AgeSong’s assisted living communities. For the past three years, the interns have produced Encounters of the Real Kind: Book III, a book in which they describe their experience through poetry and prose, being with and learning from elders. My brother values meaning. Now, confined to a hospital bed, he has an opportunity to reflect on the meaning of life.
Working with elders is an amazing experience. Every day is meaningful because elders in hospitals or assisted living tend to live in the present. As driven as I am in my professional role, on a daily basis, I learn from my elders, some of whom are my age or younger, how to slow down, listen, breathe, and pay attention to the moment. It’s a dance, and the writings in Encounters of the Real Kind: Book III poignantly describe the dance of being with and learning from AgeSong elders.
Reading and writing about being with elders is a cathartic experience, not something most of us have the time to address in our everyday hustle and bustle. I wouldn’t wish being a hospital patient or living in assisted living on anyone, but I am thankful to have this opportunity to connect deeply with my brother and to work in assisted living environments.
As Nader Shabahangi, AgeSong founder, writes in the introduction to Encounters of the Real Time: Book III:
Elders show us what our heart needs, what it years for. As such, elders may be the solution to many of the problems we face today. Our lives may never be the same after such encounters of the real kind.
Encounters of the Real Kind: Book III will be available soon throughElders Academy Press and through Amazon.com. It is now available at the Front Desk of all the AgeSong communities. For more information, view http://agesong.com and link to a community.
The AgeSong Guru Week Video: AgeSong Interns Discussion shares a discussion between AgeSong Interns and Guru Project doctors Dr Richard Taylor, Dr Allen Power and Dr Nader Shabahangi. This group session of AgeSong’s Guru Week includes discussion about how to look at Forgetfulness (Dementia/Alzheimer’s) from different perspectives, how to have a different viewpoint about the behaviors associated with Forgetfulness, how to continue to evolve therapies and treatments for Forgetfulness and how to reduce stigma associated with Forgetfulness.
From an AgeSong Guru Project perspective Dr Taylor, Dr Power and Dr Nader Shabahangi talk with the AgeSong Gero-Wellness Interns on how “Forgetfulness” affects the patient and how to interpret the behaviors.
Dr Richard Taylor talks about being a person who has been diagnosed with “forgetfulness,” dementia of the Alzheimer’s variety. The AgeSong interns ask him questions regarding what he experiences. He talks about how the changes in his brain and learning to live with them. His insightful talk covers his experiences of the fear and frustration that accompanies the changes that happen in a persons brain. He gives these as examples of the types of things that can be behind what are called the “acting out behaviors.”
Dr Allen Power adds to the discussion by suggesting a talk about “terminology.” The APA in recognizing the stigma attached to the term has dropped “Dementia” from DSM-5 and is now using “Major and Minor Cognitive Disorders.” At AgeSong they use the term “forgetfulness.” In writing his first book, “Dementia Beyond Drugs” he rewrote the definition of ‘Dementia” because he acknowledges the stigmas around the words we use “behavior problems,” “acting out” are so powerful he believes that the make it difficult to see new solutions. In his book he re-defined it as a “shift in the way a person experiences the world around her or him.” Because this discussion is with the Gero-Wellness interns Dr Power jumps ahead into the more person-center approaches. He discusses the “Needs Based Dementia Compromised Behavior Model.” That basically says when people have expressions or actions it is often the result of unmet needs. Dr Power suggests that might not cover it completely…what about aesthetic enjoyment? If you just use this model and you have Alzheimer’s then everything you do gets pathologized as unmet needs. Dr Power suggests a model he has been working with which is a modified version of Maslow’s Hierachy of Needs. He goes through the pyramid diagram and describes his thoughts on the “needs.”
Nader talks about taking cues from the Existential Humanistic Psychotherapy model and not do psychotherapy as cognition but as emotion. Dr Shabahangi suggests that one of the gift sthat people with forgetfulness can bring in our lives is to give us the opportunity to be able to live more emotionally in the moment and not so much in our cognitive mind.
The AgeSong Interns and Guru Project doctors continue the topical discussions touching on more subjects including dealing with our aging society, the changes that have occurred within the last 30 years in psychology, the challenges inherent in Existential Humanistic based eldercare.
The last 25 minutes of the video is a fantastic back and forth between the AgeSong Interns and doctors.
The AgeSong Guru Project is a year-long initiative which focuses on comprehensive care partnerships with elders to understand need-driven behaviors and minimize risky use of psychotropic medication.
To complete this project AgeSong has engaged in a partnership with Psychiatrist and Pacific Institute board member Dr. Richard Patel; Geriatrician, Dr. Allen Power; and Psychologist, Dr. Richard Taylor.
“I am honored to have the opportunity to partner with three of the industry’s leading experts in the area of mental health to thoroughly explore the approach of care for those who are in various stages of forgetfulness, what is commonly diagnosed as Alzheimer’s and/or Dementia, with reduced use of medications,” AgeSong CEO and founder, Dr. Nader Shabahangi said. “The AgeSong Guru Project will focus on learning directly from elders who are living with the changes brought on by forgetfulness (Alzheimer’s/Dementia). Much of the industry resources focus on “instant gratification” medications that often restrict the life of the person, whose lifestyle is shifting due to mental and physical changes. This project is solely based on what elders verbal and non-verbal communication is trying to tell us. We will look at any behavior as an expression of need we, the observers and care partners, must explore and understand more deeply.”
In this video of session 3 of Day 2 of the Agesong 2014 Intern Orientation Sally Gelardin, Enrichment Director and Kyrie Cox, Enrichment Liaison, present a discussion on “What AgeSong Groups are About.”
Through exercises and group discussion Sally and Kyrie cover the main points about successfully and safely facilitating AgeSong Groups within the AgeSong Residential Communities.
What an AgeSong Group Look Like
It is about Safety first.
It is subjective; it is not about the objective of the group that is important it is about the subjective -It about being with and have fun!
It is about Connecting.
It is about Passion.
It is about being Inclusive.
It is about Accessibility.
It is about Sharing.
It is about being Authentic; being yourself.
Rules – An Exercise in the Reasons Behind the AgeSong Group Rules
To start off the first exercise the Interns are broken up into groups to go over set “Rules.” These Rules are an evolving document based the experience of group facilitators and care partners within AgeSong. They include general safety rules and specific rules and guidelines for the facilitation of groups.
Each group of interns is given a section of the “Rules” and asked to answer questions about that topic: about why this is statement is a “Rule.” They were asked to discuss within their group and bring answer of “why” this topic is included in the “Rules.” The interns where also instructed to add a suggestion to the “Rule” topic they were assigned. The groups then present their answers to the questions. The reasons as they understand them behind the “Rules” and give their suggestion for that topic.
Group I – Front Desk Binder
A.Put Participants of your group into the binder. This is so we can track who is participating and their interests. Use of the book ALSO keeps a record of what that particular resident has been participating in.
B. Signing out Residents if going outside: Maintaining records and safety. Some residents can wander so we need to know if those residents are with a group.
C. Safety: Signing residents out means we can know where the residents are if there is an emergency. In the event of an emergency we also need to be able to tell whom we are NOT looking for.
Suggestion: The binder is a Written file–make digital? to reduce possible issues with handwriting legibility.
Group II – Emergencies
A. How to deal with Emergencies safely and effectively. AgeSong uses a two person system of co-facilitators. This is for safety. In the event of emergency if a facilitator needs to leave the room to get assistance the other facilitator stays in room with the participants.
B.Have a phone available: Call a Nurse or Care Partner or 911 if life-threatening.
C.If there is a fall: do not attempt to pick the resident up; if it is going to be a moment before a nurse or care partner arrives make them comfortable and provide reassurance to the group that the situation is being handled and everyone will be safe.
Suggestion: First Aid courses for the Interns/Facilitators?
Group III: Safety and Two Facilitators in the Groups
A. When using the Public Rooms with the Residents having two facilitators ensures safety of Residents in that space. Public spaces do not have staff assigned to them so need to be sure you have two facilitators or a facilitator and care partner for your Group Activity in the public room. This will ensure coverage for bathroom breaks, emergencies, the unforeseen or if a resident would like to leave.
B. If you are on a residential floor be respectful that you are in someone’s living room and home. We are guests in their private space.
C. Give yourself 15 min to escort residents to and from groups. Remember that residents can have mobility needs and might need assistance to get there or while they are there.
D. If doing movies keep some lights on…you can keep an eye on residents, know if someone is falling asleep and if someone has to get up then there is enough light to see.
Group IV – Materials
A. Be prepared – Make sure you have your materials set up and equipment working
Enough materials for all
B. Keep scissors in your pocket or secured under your control at all times. Do not leave sharp objects out – knitting needles etc. Keep an eye on small objects- so they are not ingested.
C. Make sure the group activities are things all of the participants can do within their capabilities. Help Residents who need more physical support.Make sure you have the support needed for residents who need extra assistance.
D. If applicable have on the ready all of the handouts agreements and rules for how the group is to be conducted
E. Ensuring everyone is on the same page – communication – make sure everyone knows the time and place.
Suggestion: Self Care for the people who are facilitating is important. So you can be fully “present”
Group V – Group Walks Safety and Comfort of the Residents on Walks
1 escort is the group leader and one is follower, why? Have a shared sense of direction. And it is more organized to have one leader.
Members of the community do not push wheelchairs. For the safety and comfort of the elders. Physical concerns.
Make sure the residents are dressed appropriately for the outing- walking shoes for walking – coats, jackets hats and long sleeves.
Suggestion: Check in with residents to see if there is something they need for their comfort.
What Makes a Great Group Leader: A Guided Imagery Exercise
Think of the Facilitator or Teacher or Leader who really admired. What is it that inspired you or does inspire you. Then share with the person next to you the qualities of the person whom you really admire.
Group discussion on “What makes a great group leader?” The interns shared the qualities they admire in a Leader: On topic, Charismatic, Flexible, Engagement, Deep Listening, Inclusiveness, Selfless, Ability to clear up confusion.
Quote about Leadership Shared by Kyrie
“A real leader can somehow get us to do certain things that deep down we think are good and want to be able to do but usually can’t get ourselves to do on our own. Like how a real leader make you feel; the way you find yourself working harder and pushing yourself and thinking in ways you couldn’t never get to on your own. A real leader is someone who can help us overcome the limitations of our own individual laziness and selfishness and weakness and fear and get us to do the things that we cant get ourselves to do no our own.”
David Foster Wallace
What Types of Groups are held at AgeSong?
Scheduled groups: Meet at regular times and same topic
Being With blocks of time: Going to that space and using intuition to see what would fit right then.
Suggestions for Successfully Facilitating AgeSong Groups
Tap into your own Authentic Self Authenticity might be the trait that ensures group success: Be yourself so the residents can be themselves. Look at the needs you see and pair that with what you are best suited to share. Let what you are passionate about be your guide.
Use a Framework to have Consistent Therapeutic Underpinnings Recommended Handout: Irv Yalom’s 12 Factors for Group Therapy – Handout will be shared.
Look to Laslow’s Hierarchy of Needs
Body- Attend to basic physical needs- if a resident needs to use the bathroom, is hungry or cold- take care of those items -ensure group comfort.
Safety- Use the rules to ensure a safe group experience
Bring Authenticity to your Groups
Kyrie on Authenticity and the experience of working within AgeSong’s Vision shares:”That is one of my favorite things about this place(AgeSong) it really let’s you be the best version of you. For the residents and for us. Which is just, I mean, so lovely in a clinical setting, I think.”
Get to Know the Community Members
As you get to know the people who live here and join in the spaces with the residents, you will be inspired to come up with groups that you feel will fit. If you see a need and have an idea how to fulfill it be willing to be the owner and facilitator of that idea!
The AgeSong 2014 Intern Orientation: AgeSong Groups video is one of the AgeSong Educational Series videos. The video of the session is one of many filmed during the two-day orientation for the AgeSong Gero-Wellness. These orientation sessions are the first training sessions that the interns will engage in during their 1-year internship in the Gero-Wellness.
AgeSong Guru Project partners, Dr.’s Richard Taylor and Allen Power, engage in a roof-top AgeSong Guru Week Community Discussion on Forgetfulness Care (Dementia/Alzheimer’s) at AgeSong’s Laguna Park residence. The open group forum includes AgeSong Community Residents, CarePartners and Interns from the AgeSong GeroWellness program.
AgeSong Guru Week Community Discussion on Forgetfulness Care
The video opens on a frank discussion starting with Dr. Richard Taylor. Included in this group discussion are AgeSong Residents, AgeSong CarePartners and AgeSong GeroWellness Interns. The participants share views both from the caregiver’s perspective and from the perspective of those with varying levels of forgetfulness (dementia/Alzheimer’s). Topics include the types of things we can do in a community like this that will give resident’s the fullest life possible, regardless of their mortality or abilities. The residents, interns and doctors discuss truth-telling in care, white lies, communication, being “present” with patient, labels and stigma associated with forgetfulness, dementia and aging.
What are the types of things we can do in a community like this that will give resident’s the fullest life possible, regardless of their mortality or abilities?
The AgeSong Guru Project
The AgeSong Guru Project is a year-long initiative which focuses on comprehensive care partnerships with elders to understand need-driven behaviors and minimize risky use of psychotropic medication.
“I am honored to have the opportunity to partner with three of the industry’s leading experts in the area of mental health to thoroughly explore the approach of care for those who are in various stages of forgetfulness, what is commonly diagnosed as Alzheimers and/or Dementia, with reduced use of medications,” AgeSong CEO and founder, Dr. Nader Shabahangi said. “The AgeSong Guru Project will focus on learning directly from elders who are living with the changes brought on by forgetfulness (Alzheimers/Dementia). Much of the industry resources focus on “instant gratification” medications that often restrict the life of the person, whose lifestyle is shifting due to mental and physical changes. This project is solely based on what elders verbal and non-verbal communication is trying to tell us. We will look at any behavior as an expression of need we, the observers and care partners, must explore and understand more deeply.”
Dr. Richard Taylor
Dr. Richard Taylor is a retired psychologist and author of “Alzheimer’s from the Inside Out.” As a doctor with dementia himself he has experienced not only the change of state that happens internally but that which happens in external relationships also. He has experienced the change that occurs within the circle of family, friends as community. Dr. Taylor eloquently discusses his experience of living well with dementia.
Dr. Allen Power
Dr. Allen Power, is a board certified internist and geriatrician, clinical associate professor of medicine at the University of Rochester. Dr Power is the author of paradigm shifting books including “Dementia Beyond Drugs: Changing the Culture of Care” and the latest, “Dementia Beyond Disease.” As a practicing internist he discovered he was questioning the paradigm and efficacy of just using medication to treat dementia;that perhaps the “deficit-based view that focuses on neuropathology and tends to blame brain disease for distress” is not the best care paradigm for these patients. Instead he suggests: “the experiential approach holds that the best way to care for a person living with dementia is to understand them as a person and their individual experience; so I use the very holistic definition that “Dementia is a shift in the way a person experiences the world around her/him.” This idea of changing perspective is something to which we all can relate, and this commonality helps us build a bridge to better understand the person’s needs.”
This fourth session of the AgeSong 2014 Orientation discusses Existential-Humanistic Psychotherapy. Nader Shabahangi and Vincent Siekiewicz each discuss how E-H Therapy pertains to the AgeSong communities. Nader discusses how the Gero-Wellness Interns can engage in existential-humanistic relationships with the residents in the coming year.
AgeSong 2014 Intern Orientation: Day 1 Session 4 video
Nader Shabahangi starts the session off by polling the group with the question of what they think Existential-Humanistic Psychotherapy is.
There are great responses from the group including:
It is a person to person centered approach
To be really present with other
Be open to all kinds of ways of looking at life
Being a witness to the journey
Be with the other
Lose myself to be open to the other
As Nader points out the concept of being “present” is antithetical to traditional therapy where the therapist is supposed to have a “hypothesis” about what is going on with the client.
Vincent Sienkiewicz talks about how E-H Therapy pertains to working with elders at AgeSong communities. He discusses Jim Bugental’s view that E-H Therapy is another level beyond Cognitive Behavioural Therapy and Psychodynamic Therapy.
Here is an excerpt from Vincent’s discussion on Jim Bugental’s view of these levels:
“Existential-Humanistic Therapy is the ability to not just kind of understand who you are, but to also realize the greater freedom of existence and the ability to kind of adjust that greater sort of picture and to change, you know, with the times. ”
And the connection that this has with this population is the fact that these older adults have been through alot of these changes.
I believe that this population is particularly ripe for exploring these issues of existence, who they have been in the past and who they are now, who they’d like to be and how to shift it.”
Nader finishes the session with a discussion into the differences between “process comment” and “content comment” and how it pertains to the work within the “moment.”
This is one of the AgeSong Educational Series videos from the 2014 Gero-Wellness Intern Orientation. The AgeSong 2014 Intern Orientation: Day 1 Session 4 video is just one of the 14 videos included in the 2014 orientation and training series.
Session 1 of the AgeSong 2014 Orientation and Training is a group “icebreaker” activity.
The pairs of interns who did not previously know each other introduce their “partner.” The group does a fantastic job of introducing each other and are able to share an interesting fact about each intern that perhaps no one else in the group is aware of.
This is the second video in a 14-part series of videos from the AgeSong 2014 Gero-Wellness Intern Orientation. Check back with us to see more of these videos Video Library Page. All of the 2014 series will be conveniently available for you to watch on the Video Library page here.
Dr Nader Shabahangi Opens the AgeSong 2014 Intern Orientation and Training Sessions
New Interns and Returning Interns get introduced to the Gero-Wellness Program, Christina and Vincent as well as each other with an “icebreaker” activity that has interns pairing with someone they do not know and interviewing them. The pair will then introduce each other to the group in the first session of the day.
This is the first video in a 14-part series of videos from the AgeSong 2014 Gero-Wellness Intern Orientation. Check back with us to see more of these videos Video Library Page. All of the 2014 series will be conveniently available for you to watch on the Video Library page here.
As a participant in the AgeSong 2014 International Visitor Program Léonard Chatelain spent part of his summer here at AgeSong. He has created this video to share his and his fellow participants experiences at AgeSong.