Independence Day


The care system for older adults has elements of paternalism that should be challenged.  There is nothing more personal than experiencing illness and making decisions for your self about where to live and how to receive care. Older people still have the right to self direct and make autonomous decisions, even if they are sick with a terminal illness or have a cognitive impairment.

Oh, and guess what, you don’t have to follow Doctor’s “orders”.  (And I can say that because my Dad was a physician, he might even have agreed with me..).  At least ask “why” and get the answer to your satisfaction if you have questions.  Don’t be intimidated!

Take these Independent women as a great example who took charge of their own retirement living and chose to try something new!

Happy Fourth everybody!

The Power of One

The Lorax

The new Senate version of the Health Care legislation contains deeper cuts to Medicaid than the House version.  Elizabeth Warren has been a strong voice in recent times.  I thought she articulated the sentiment around the proposed health care changes very accurately when she called the tax cuts ” Blood Money”.  Cutting services to the vulnerable and giving tax cuts to people who have so much more than they need makes is just wrong.  By remaining silent, we are saying that these kind of policies will become our new normal.  We all have to do more.  It’s time to get out of your comfort zone and stand up for what’s right!

Here are 10 steps to follow to let your voice be heard from the Wisconsin Council of the Blind and Visually Impaired:

Step 1: Believe in Yourself. You need to believe your perspective is important, because if you do, your conviction will be apparent when you are having conversations with legislators.

Step 2: Learn Your Rights. Feel empowered, knowing your worth. You don’t have to approach the conversation with a sense of apology or entitlement, but knowing your rights can help you feel confident and knowledgeable.

Step 3: Follow Reputable Sources for Learning about Legislation. Before you reach out to a legislator, do your homework. Follow reputable sources, such as the publications of the Council. Find organizations you trust so you know what legislation is before the lawmaking body, and so you have a sense of the lawmaking climate.

Step 4: Discuss Your Questions and Concerns. It’s OK to ask questions before talking to your legislator. Don’t hesitate to go to your trusted sources and ask questions so you thoroughly understand the legislation.

Step 5: Identify your Connection to the Proposed Legislation. Think about how it will impact you and give concrete, specific examples. Legislators are there to represent their constituents– they work for you–and your real stories matter because they give your point-of-view a personal touch.

Step 6: Contact your Legislators. The first step in contacting your legislator is knowing who your legislators are. The easiest way to contact your state legislators is use the tool found on the Legislature’s home page, at In the right-hand side of that page is a link that says “Find My Legislators!” Type your address in the box below that link to get the names of your state representative and senator. For information on how to contact Federal elected officials, visit You may leave a message for your legislator’s Capitol office or indicate your position on legislation through the toll free Legislative Hotline, at 1-800-362-9472.

Step 7: Communicate in a Way that Works for You. If you are good at having phone conversations and are comfortable making your point by talking, then a phone call might be your best and most effective way to communicate with legislators. If writing is more your forte, put your thoughts down on paper. Remember that a paper letter is more effective and will get more notice than an email.

Step 8: Plan What You Will Say Ahead-of-Time. First, let the legislator know who you are, and that you are a member of their district. Then let them know specifically why you are contacting them, giving a two-three sentence explanation of your story and the impact—positive or negative—the legislation will have on you. If there is something specific you would like the legislator to do, ask, but do not expect an explicit commitment from your legislator. If your legislator is interested, you will notice hints, and they will often ask questions. Respond to any questions they have for you. If you don’t know the answer to a question, let the legislator know and either encourage them to contact the Council, or make a commitment yourself to find the answer and get back to them. Finally, thank them for taking the time to talk with you.

Step 9: Remember that Talking with an Aide is as Important as Talking with the Legislator Directly. Aides are the direct conduit to the legislator. Even though all calls are recorded and all letters will be read, the aides often make decisions about whether they will highlight the call or letter with the Legislator. Treating aides with respect is important, because the aides are often the ones doing the research, and are content specialists who are usually quite knowledgeable.

Step 10: Follow Up and Say Thank You. Legislative relationships are relationships, and whether you agree or disagree with the stand they take, they do work hard, so gratitude is important.

Remember to contact your legislators when you are both happy and when you are concerned. Use your legislative clout wisely, and decide where you want to put your energy. It’s all about building warm and effective relationships. If there are legislative issues that are important to you, contact the Council or go to your trusted sources to let them know.

Older Adults and the Sustainability Mindset 

Black Farmer

Wheat in the front yard and a pig in the backyard.  This was the description of an older woman’s upbringing in an Eastern European county, raised in the 20’s and 30’s.  Many older adults are very experienced gardeners.  Some learned from a farming background.

Now we call it the Sustainability Movement.  It used to be standard practice, more of a practical mindset.  Don’t waste food, don’t take more than you need, simple local and fresh food is best, live in walkable neighborhoods, plant a garden.

Michael Pollan, a well known author and food activist, says don’t buy food with an ingredient list that your grandmother wouldn’t recognize as food.

When my mother in law was living alone in her home, she was generating about one plastic grocery bag of garbage a week.

So as we are all trying to change our behavior to improve sustainability of our environment, many older people have been raised this way.  They don’t need to change their behavior as much as many younger people do.  In fact, they can teach us a thing or two.


Incremental Care

In this article, Gawande describes a different way to look at treatment of chronic health issues.  The approach is based on slow and steady progress and the realization that complete cure is unlikely and that progress can be slow and incremental.  There is rarely an immediate remedy and expectations are lowered.  Doctors partner with patients to measure the problem and work through plans of escalating remedies.  It involves continual measuring and adjusting.  Medical practice can at times convey an “aura of heroism”, like a surgeon operating just in time to save a life.  Data, however, shows that Primary Care (opposite of a specialist) is the area of medicine that has the greatest impact, including lower medical costs.

This approach emphasizes the importance of prevention and maintenance of health, as well as coordination among specialists for problems that have already been diagnosed.

Perhaps this approach resonates because I grew up in a household with a dad who specialized in Internal Medicine, who I believe practiced this type of medicine.  He seemed to know his patients as individuals, many who were fiercely loyal.

I have also seen this approach work well in my 20 years working in the PACE model.  This model sets up long term relationships between interdisciplinary health care professionals and individuals with multiple chronic health issues.

An incremental approach also would address the rapidly rising costs of health care.

It is also related to wellness, defined asis an approach to health care  that promotes the prevention of illness rather than treatment of disease, or health as an actively pursued deliberate effort.

It definitely is a challenge however, because it goes against the fast pace of rapidly developing technology.  Perhaps that’s the point.

Follow the Yellow Brick Road


I was finding my way through a big hospital recently, following the purple diamonds on the floor to get to my destination.  Every time I go there or any hospital, I am struck with how impersonal and institutional these settings are.  The big business of health care takes precedence over the personal experience of people in the midst of a health crisis.

Many times I’ve see a person in a bed rolling past.  The lack of dignity is remarkable.

I am reminded of my own experience with my Dad , a retired physician, when he was ill, walking along side his hospital bed when he was rolled to a CT scan.  It was a helpless feeling and the CT scan wasn’t the answer for him or me. 

We follow instructions because we trust it is for the best.  However, there are some valuable perspectives that challenge our blind faith in health care.  I plan to share some of these ideas in future posts.

Being Vulnerable 


There has been discussion about how Medicaid programs help address the needs of the most vulnerable in our society.  These people are the most at risk from the proposed drastic cuts to Medicaid services.  Here is some descriptions of some of the most vulnerable.

  • A woman who is in her 70’s and is frail from multiple chronic health problems. Her children live out of town.  She lives walking distance from a big box grocery store, but can’t get there due to her mobility limitations. She gently told me that she has not been to the grocery store I over a month and was very low on food.
  • I have met several people in their 90’s who are temporarily in the nursing home following a fall and injury.  There often is a home to which he/she would like to return but they often have limited assets to pay for help in the home. Should they have to stay in the nursing home, which incidentally is about 5 times as costly?
  • The 85 year old man who lives in his home that is so piled up with stuff that he could barely open the door.  He was just discharged from the VA Hospital with a leg amputation and wounds on his other foot.  He can hardly walk and is likely to trip and fall in his cluttered home that he cannot manage.

Please let your elected official know that we as a society are not willing to tolerate cuts to services for these people in need!


But what else are they, other than old?


Sharing a great article about older adults in literature-it’s a long article, but packed with memorable quotes and references. The author suggests that the biggest problem for most older people is not aging but ageism.

The title quote from the article reminds me of a woman I know.  She is named Gertie and introduced herself as:  “Hi, I’m Gertie and I’m a person!”

Of course you are, I say.  

She’s 95.  And needs some help with bathing and getting into bed.  She likes to be independent.  When I ask her to do the memory screen, she says sure, it’s spelled IMBECILE, with a smile.

I’m mortified she feels this way, but it has caused me to stop and think.  Why does she feel the need to tell me she is a person?  Is it because she is so hard of hearing that most of her matters are handled though other relatives?  Is it because she is embarrassed that she is asking for help?  Why does she think a memory screen makes her incompetent?

Gertie has reminded me to be aware of the sensitivity of the subject of independence and the loss of independence that often comes with age.  No one can change that, but it helps to be aware. It is also a reminder to me of why we send out social workers to gather this type of information.

Thank you Gertie for the reminder!