Elder & Family Care: A Call to Churches

Our global population is “graying” and multiple generations of family are often separated by great distance. Churches will be increasingly relied upon as a resource for Elders and their families. Now is the time to call ministry teams and develop Elder-adult outreach programs. Older adults need to remain visible to church membership, their families need to remain on the radar for spiritual care. Churches can set the standard for how we care for and with each other across the lifespan.

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To better understand the urgent nature of the “flood” of aging persons and their coming needs,  consider the impact of the following two facts on the family, the church, the community, and the individuals who need care and support.

  • Currently, for every person receiving Social Security and Medicare benefits, there are 4 contributing individuals in the workforce. By 2030, (only 14 years away), there will be approximately 2.2. (Reference available upon request).

Nurses, social workers, doctors, care givers, etc, will be in shorter supply by half. Greater pressure will be placed on Medicare dollars. Supports for aging in place over a longer life span must be strengthened. Churches should be part of the solution.

  • Assisted Livings are marketed as vibrant communities filled with fun and social activities, but it is very easy for older adults to become isolated and discouraged. 13% of institutionalized adults suffer from depression.  Spiritual care is sparse.

Facilities rely on volunteer programs from the community to engage with residents, and church members hunger for support and visits from their “church family”.

I feel an urgency in the call to develop ministries that serve Elders and their families. Whether your church’s focus is evangelism or social justice, the trumpet is sounding and the time to act is now.

  1. Hire a Parish Nurse, part or full time. Look for grants to support the position. RNs can:
    1. Create a program for home visits, medication review, wellness teaching, patient advocacy, and communication with families and medical providers.
    2. Be a medical case manager who can also address spiritual and wellness needs.
    3. Work with Eldercare Advocates to write policies governing the church’s supportive programs for aging adults and their families.
    4. Encourage discussion of Advance Directives, end-of-life care wishes, and emergency contacts. Develop a way to secure that information in the church in the unfortunate event that it is needed.
    5. Discern how to provide spiritual support for individuals facing the end of life. (Hospice chaplains are often the sole spiritual providers at end of life).
    6. Coordinate church staff annual CPR and AED training.
    7. Assures volunteers working with Elders (and children) have criminal back ground checks completed.
  2. Develop a ministry of Eldercare Advocates. EA’s can:
    1.  Host family/caregiver support groups open to the community.
    2. Identify safety and accessibility for older or fragile church members and work with the appropriate leadership to make changes.
    3. Introduce weekly visits Assisted Living Facilities/ Memory Care Units where members or family members reside. Share Bible Study, music, prayer, and monthly worship and communion.  Never assume “someone else is taking care of their spiritual needs now.”
    4. Teach other volunteers, expanding the scope and reach of the ministry.
  3. Scrutinize your buildings and programs for accessibility and safety.

    1. Is there a handicapped accessible bathroom, complete with a cupboard of protective undergarments, disposable gloves and cleansing wipes?
    2. Can mobility-impaired persons get around the building safely in a wheelchair, scooter or using walker, canes or crutches?
    3. Is there a protected “drop off” area for inclement weather? Is there a greeter to help those with mobility needs?
    4. Adapt your “cry room” for families with a potentially disruptive Elder, and include some appropriate interactive items.
    5. Consider hosting an “IT” room for those who don’t have home computers. Computer literate members can teach others to use Skype, email, and social media to connect with distant loved ones. Get them talking!
    6. Create an emergency response plan to contact members who are home bound or have special needs.
  4. Bold congregations can also consider developing:
    1. Adult day care programs to provide respite care and social opportunities. Not unlike a church preschool model, it can include Bible Study, teaching and respite for family members.  For adults with dementia, a routine can includes chapel, music, scripture and creative projects. (This same ministry can be offered in facilities.)
    2. Manage a church run “board and care home” to serve the congregation and others. One efficient, but small scale model is the Green House Project thegreenhouseproject.org/ . Social policies generally support “aging in place”. Some Elders need fulltime assistance when they are no longer safe to live independently.
  5. Communicate and collaborate with local social service agencies to understand the needs of seniors in your particular area. There are likely Foster Grandparents, spouse/caregivers, or seniors living in poverty that would benefit from “adoption” by a congregation. Are there special needs in your area? In 2001, the Faith Based Initiative partnered churches and social service agencies. In the case of Eldercare, it could be revived to promote protection, support, and spiritual nurture of the aging population.

There are other ways to support an aging congregation and its local neighborhoods.  From community gardens to home repair ministries, the opportunities are endless. The first step is to understand the needs that are closing in upon us. May your ministry teams prayerfully prioritize and begin to address these needs within your local congregation.

 

 

Some thoughts on Advance Directives

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Every emancipated adult should have an Advance Directive. Once a child is emancipated, parents can no longer make medical decisions for them by default, should the offspring become incapacitated. Often we limit our conversations about Advance Directives to Elders, thinking they are more likely to become cognitively impaired. However, the age cohort often overlooked are young adults between 18 and 30 who are at risk for devastating traumatic brain injury (TBI) — due to motor vehicle accidents, recreational accidents or substance abuse.
Preceding the Patient Self Determination Act (PSDA) was the tragic, 1970’s case of Karen Ann Quinlan, which attracted sensational media attention and brought the controversy between family desires, medical opinion, ethics and law into the cultural conversation. I have no doubt that her case, and those that followed, helped propel the PSDA into being. Shortly after the Quinlans lost their appeal to have their daughter’s life sustaining treatments revoked, I found myself working in a “convalescent hospital”. There I had the unforgettable experience of caring for a high school classmate, not even 21 at the time. Shortly after graduation, while walking on a lonely road late at night, he was struck by a car. Suffering spinal cord and traumatic brain injuries, his quality of life was undeniably impaired.
I don’t think revoking heroic measures was an option in California in 1978, and this encounter, so close to heated debates about terminating life-support, left an impression on me. In recent years, I have had conversations with young adults that include thoughts about accidents and injury. They are quite clear “I don’t want to be kept alive if there is nothing left of ‘me’”. Youth are as important to include in the conversation about Advance Directives as are their Elder relatives, and for similar reasons. Loved ones can’t act on your behalf if they don’t know what you want.
We don’t like to talk about death and dying, about end of life mystery or transition. Life seems brighter if we ignore the shadow side and go merrily on our way. For us, it might be. If we’ve become incapable of making decisions for ourselves, chances are we won’t care much. Some won’t talk about death because they don’t want to upset their families or those that they love by “making them think about it”. The irony is that by trying to protect those we love by ignoring this reality, we force them into making decisions about us which they are ill-prepared to make. Some people don’t understand what Advance Directives are or how they can help.
I have watched this process when families are unprepared. It is often grueling and painful. The second-guessing about what “mom wants”, the contention between those mature enough to let go and those clinging to hope or fearing death can devastate a family that needs to support each other and prepare to grieve.
Most departments in my hospital, which serves a large retirement age population, assertively broach the topic of Advance Directives, and in my specialty clinic new patients are educated and offered a copy of our state’s Advance Directives workbook.
AD pamphlets read very similar from state to state. They are dry and medically oriented. Recently, I was introduced to a stellar revision of the standard Advance Directives, entitled “5 Wishes”. It reads very similar to the more bland AD pamphlet with three notable exceptions – “How comfortable I want to be”, “How I want people to treat me”, and “What I want my loved ones to know”. Those tools could soften and gently personalize the conversation about end-of-life decision-making.
Those three wishes give the powerless – those who can only stand by while someone they love is dying – specific tasks to perform to enhance the quality of the last days and hours and instill a sacred dignity to the art of dying. I wish that they had been a part of my own mother’s AD process. At 88, however, she was not very open to talking about what she wanted (besides that she didn’t want her children to hurt). Baby Boomer Elders may be more forthcoming about what would make their final passage sacred and meaningful, (or even fun and joyful!) My Depression Era mother was not. We had to guess. How much gentler it would have been if we had known what was important to her, to enhance her comfort.
There are few reasons for any emancipated adult to not have the discussion about end of life wishes — from medical care choices to what music you want playing when you are unconscious or passing — and legally initiate appropriate Advance Directives. Perhaps more people would engage in them if they knew that:
1. They can be revoked at any time by the issuer.
2. They only go into effect if the issuer cannot make medical decisions for themselves due to inability to communicate their wishes.
3. It alters the responsibility for making life-to-death medical decisions to the issuer, having had a discussion about their values and desires with their appointed representative. It is an act of personal empowerment — one is less “victim” to the end-of-life passage, and more a participant.

4. The process of reviewing the choices one must make when completing their advance directives opens the door to conversation valuable in any relationship, “what to do when I am dying”.
5. It is kind for the family to have decisions articulated and communicated in advance.
Inadequate understanding is a barrier to completing Advance Directives. The concept that it is somehow a “death sentence” or supported by “death panels” can link Advance Directives to one of the most emotionally charged phrases to come from the detractors of the Affordable Care Act, though the PSDA precedes the ACA by more than a decade. For those wishing to engage in all means of life-sustaining treatment, it is still important to appoint a representative to direct medical care and long term care choices from home health, nursing home to hospice. The idea that Advance Directives are only for those wishing to halt life-sustaining treatment is a common misunderstanding of it’s purpose.
There is a risk of exploitation and that needs to be guarded against, and is, by the stipulation that the appointed representative cannot be a caregiver or employee of a facility where the issuer receives care. It is possible to appoint the wrong person for the wrong reasons. A representative should be someone the issuer is confident will follow their wishes, who has knowledge of the care they have been receiving and their medical history, as well as their values and desires.
Life is short, the time is now to think about what you would want and who would be your voice if you couldn’t make your desires known. Have the conversation with your children and your folks.

For more information on “5 Wishes” visit http://www.agingwithdignity.org/five-wishes.php