Dec 31, 2012


"If all I have is now, where will I look for Joy?"  Mark Nepo

Where indeed?  We as humans seem wired to strive for something else, some place else, someone else.  As Nepo says, we "stray and dream of lives other than our own."  It is probably a functional quality to keep evolution going.  How would inventions happen, lives improve, things evolve -- if we did not strive for something else?  But.  It can also have a downside, and that downside is that we do not relax and live in our present lives.  As Eckhart Tolle would say, "our NOW." 

This is the last day of 2012.  I am happy to say goodbye to this year, learn from the experiences it brought me, and choose how I want to be in 2013.  I was with a woman this week whose husband died of dementia-related causes.  She and I have supported each other over this long sojourn, and I was happy to take her a hot dish and some compassionate listening.  It must be bittersweet for her, as it is for any of us who are caregivers for someone with dementia.  Our NOW is both sweet and filled with sadness, but I think Mark Nepo is right --- the only way we find joy is being attentive to now.  So, as 2012 ends, I wish you, dear readers, in 2013 boundless joy, optimal health and prosperity, peace, love and the ability to live in the now.

Dec 30, 2012

Exercise Option

"Live Web classes are different every time, and they don't require you to leave the house," Jessica Matthews, exercise psychologist

What a wonderful idea if you live in an area that is having inclement weather.  This is how it works:  you sign up with a live fitness site, choose the class you would like to take, log on at the designated time, and follow along with the instructor.  Two popular sites are EMG Live Fitness and Flirty Girl Fitness Live.  Wello is a site that goes a step further with two-way video that allows your instructor to give you feedback.  You will need high speed internet with video software.  Prices are $5 per class for most of the classes that do not have instructor feedback, and $15 per class for those that do. 

When it is icy outside, I am hesitant to do my usual walking; so this is another option.  Our health as caregivers is enhanced by regular exercise, and exercise helps us sleep better.  This is just another easy option to get the body movement that is supportive of our overall health. 

Dec 29, 2012

Sleeping Peacefully

"The link between sound slumber and good health is indisputable.  Study after study has shown that consistently racking up 7-9 hours of snooze time per night can rein in the risk of problems from depression to type 2 diabetes." William Kohler, M.D., medical director, Florida Sleep Institute

We know the importance of sleep, but how do we get it?  Especially as we get older, and with the additional stress of caregiving, sleep is sometimes elusive.  A couple nights ago my body felt agitated, like I had had too much caffeine - ( I had not had any), and I did not fall asleep until well after midnight; only to awaken at 4:00 a.m. unable to return to sleep.  Dr. Kohler says that insomnia is often caused by underlying issues -- stress, acid reflux, and chronic pain -- which cannot be fixed quickly with sleep medications or devices (such as headband sensors, etc.)  What does work is sticking to a bedtime routine, relaxation techniques and meditation, and avoiding caffeine in the afternoon and evening.  When those techniques do not work, Dr. Kohler suggests we see our doctor.  And, it is important to remember, that the REM (rapid eye movement) sleep disorder is a characteristic of Lewy Bodies Dementia, and there are medications that can help with that. 

Dec 28, 2012

Hand Washing

" Done properly, hand washing is a simple way to avoid getting sick." Mayo Clinic

In this flu season, it is important to consider one of the things we have most available to protect the health of ourself and others.  The following is copied from the Mayo Clinic Newsletter.

"Always wash your hands before:
  • Preparing food or eating
  • Treating wounds, giving medicine, or caring for a sick or injured person
  • Inserting or removing contact lenses
Always wash your hands after:
  • Preparing food, especially raw meat or poultry
  • Using the toilet or changing a diaper
  • Touching an animal or animal toys, leashes, or waste
  • Blowing your nose, coughing or sneezing into your hands
  • Treating wounds or caring for a sick or injured person
  • Handling garbage, household or garden chemicals, or anything that could be contaminated — such as a cleaning cloth or soiled shoes
In addition, wash your hands whenever they look dirty.

How to wash your hands

It's generally best to wash your hands with soap and water. Follow these simple steps:
  • Wet your hands with running water.
  • Apply liquid, bar or powder soap.
  • Lather well.
  • Rub your hands vigorously for at least 20 seconds. Remember to scrub all surfaces, including the backs of your hands, wrists, between your fingers and under your fingernails.
  • Rinse well.
  • Dry your hands with a clean or disposable towel or air dryer.
  • If possible, use your towel to turn off the faucet.

Dec 27, 2012

Caregiving Tips and Resources

"You have to take care of yourself so that you can be the best caretaker you can be." Health Monitor

The Health Monitor recommends being selfish by taking good care of ourselves, leaning on others who will help with the caregiving, and accessing online resources -- like this blog and the official websites for Lewy Bodies Dementia and Alzheimer's Disease.  Taking care of oneself is difficult, especially if you are a 24/7 caregiver; but even if you are not full time, there are many, many demands on the caregiver.  Just the doctor appointments and medication monitoring take many hours, not to count the other tasks we do.  Especially in this season with colds and flu seemingly everywhere, it pays to take care of ourselves.  One simple way I take care of myself is by carrying hand sanitizer everywhere I go, using it often, trying not to touch surfaces that many people touch, and not touching my hands to my mouth, face or eyes -- the most common entries for germs to the body.  What is a simple way you take care of yourself? 

Dec 26, 2012

DLB Characteristics

"DLB (Dementia with Lewy Bodies) has three defining symptoms in addition to dementia:  fluctuating attention and alertness, visual hallucinations, and parkinsonism." Mayo Clinic

It still surprises me when people in the field of elder care do not know what the characteristics of DLB are; afterall, DLB is the second most-occurring type of dementia, after Alzheimer's Disease.  The nurse at the assisted living facility, who has been gone for a few weeks, said to me with apparent surprise, "Dwane recognized me right away."  To which I was tempted to reply, "Well, of course he did."  The memory difficulties we associate with Alzheimer's Disease are not present in DLB.  There are some memory difficulties in DLB, but not the type where the person does not recognize where he or she is at, or the identities of other people.  Dwane still recognizes people he taught many years ago, as well as those people he knows currently.  As caregivers, one of our responsibilities is to help others - including those in the elder care world - understand the specific and unique characteristics of Dementia with Lewy Bodies - because people who have DLB have unique needs and strengths -- quite different from those people who have Alzheimer's Disease. 

Dec 25, 2012

Happy Holidays

"This is a day to let your light shine in the true spirit of compassion and forgiveness that is the heart teaching of all religions." Dr. Joan Borysenko

Whether you practice a particular religion or not, emulating a spirit of compassion and forgiveness bodes well in life.  In this season, which demarcates special celebrations in some major religions, let us look at our lives and notice:  to what extent are we a light unto the world of compassion and forgiveness?  We can be agents of peace in our world, or we can be agents of agitation.  The choice is ours.  Christians celebrate the birth of Jesus this day.  His birth is said to have been a heralding of peace onto all.  How recently have you practiced a gift of compassion without wanting it to be acknowledged?  Today, let us practice peace, compassion and forgiveness toward ourselves and others. 

Dec 24, 2012


"The more you praise and celebrate your life, the more there is in life to celebrate." Oprah

What if the above statement is true?  What if our happiness is in direct proportion to our attitudes of gratitude?  There is evidence that this is true.  Have you ever been around people who talk incessantly about their ill health?  Is it a coincidence that more ill health usually awaits them?  If Oprah practiced her own advice, then we have evidence that praising and celebrating what is happening in one's life causes more circumstances to praise and celebrate.  That does not mean that unfortunate events do not happen, but it does mean that these unfortunate events must not be the focus of our thoughts and conversations.   Today, let us celebrate our lives.  What is there in your life to celebrate?  In my life, I have relationships I cherish, enough health to do the things I want to do, weather conditions that are temperate, and ever-improving vision following cataract surgery.  On this Christmas Eve, whatever our religious orientation, let us celebrate our own lives. 

Dec 23, 2012

Life's Difficult Lessons

"God breaks the heart again and again and again until it stays open." Hazrat Inayat Khan

It has seemed to me in my life that God or Life does allow us to experience situations which break our hearts again and again.  Everyone has difficulties.  No one in this human condition is immune from difficulties, but we can manage how we respond to our difficulties.  Some people become more closed up and bitter.  Another option is to become more open and more resilient.  If it is true that our hearts are broken again and again until they remain open, (and I think it is true) then it behooves us to keep our hearts open.  And, what does that mean?  It means continuing to love, and to hope, and to offer ourselves in service of the greater good.  Many of the ways our hearts are open again and again occur in relationships.  Relationships end, or the other person changes and does not want the relationship as it has been, or the people at the organization do not want us working there any more.  It can also be a health challenge, as it was for Mark Nepo.  He says his first fall from love opened his heart, then his cancer opened it further, followed by a marriage ending to open it more.  Surely, being a caregiver for someone with dementia is a heart-opener.  In what ways can you stay engaged in life?  Hopeful?  Receiving and giving love?   

Dec 22, 2012

Winter Solstice

"Laughter is the sun that drives winter from the human face." Victor Hugo

In the northern hemisphere, yesterday was the shortest day of the year and the beginning of winter.  With there being less sunlight, and perhaps less opportunity to get out, it is prudent to look for ways to have fun and laugh.  I took Dwane to get a haircut and ice cream cone yesterday, and we did laugh together over several things.  He still has a cute sense of humor, and he is good to laugh with.  Our region has missed the major storms that have been predicted, and it was a pleasant day out.  We stopped at the store and bought him pineapple and cinnamon rolls.  He sometimes complains about the food at assisted living, so I try to keep him stocked with some of his favorite things.  This is our first Christmas with him being in assisted living, and I think it is hard for him.  He seems to be feeling left out, even though there is not much to be left out of -- as I have spent recent days having cataract surgery.  As caregivers, I think it is hard to find a balance of living our lives without the person with dementia feeling left behind.  Or, we don't live our own lives,  in order that the person does not feel left behind.  How do you manage this balancing? 

Dec 21, 2012

Doing Nothing is Good for our Brains

"To boost brainpower, take time for reflection and daydreaming.  They may sharpen learning and memory skills." Perspectives on Psychological Science

Another good reason to meditate.  As a child, didn't you spend some time just immersed in play?  If you are like most adults, you probably do not do that much any more.  Our brains as adults are often filled with tasks to do, plans for the future, regrets over the past.  Perhaps today is the day to just sit, for 20 minutes, and let your mind be at play.  I read once that when the respected behaviorist Ivan Pavlov lay dying of a widespread infection before the discovery of antibiotics, he thought back to his childhood and what were his favorite memories.  He remembered playing in the mud in the river as his mother did laundry and told him stories, and he asked his assistant to bring him a bucket of mud.  And, sure enough, in re-creating those memories and that playfulness, his body returned to health.  How can we support our bodies in returning to health?  What memories of playfulness, safety and contentment are powerful for you?

Dec 20, 2012

Telling Truth Is Good for Health

"The average person tells one or two untruths daily.  But lying can be hazardous to your heath." University of Notre Dame research

In the above research, people who tell the truth had four fewer emotional problems and three fewer physical ailments in one week than did those people who lied as usual.  The researchers suggest that honesty leads to stronger relationships, which boosts well-being.  So, telling the truth, helps us with fewer emotional and physical problems AND it helps us to have stronger relationships.  It may seem excessive to think the average person tells 1-2 lies per day, but -- have you monitored yourself?  Do you ever avoid the truth if you know there will be backlash, or to not hurt someone's feelings, or to avoid trouble, or to avoid doing something you do not want to do?  I would suggest we all do some of these things some of the time.  But, here is new research that tells us that telling the truth is good for our health. 

Dec 19, 2012

Plan Ahead in Caregiving

"The average caregiver will provide care for 4.6 years."  Leacey E. Brown, Gerontology Field Specialist

In our situation, we have surpassed the 4.6 years, and, perhaps you have too.  In many respects, we were prepared for the unthinkable:  life when we could no longer care for one or both of us at home.  We had advance directives in place, long term care insurance, and we had watched our spending habits in hopes of  providing for ourselves as we got older.  But, I had not imagined having a spouse who would be unable to see or accept what professionals told us was the reality of his needs:  that he needed the services of an assisted living facility.  Oddly, that has been the hardest part for me.  His resistance to what seems obvious and to what numerous professionals have said is necessary.  So, my suggestion, is to plan ahead for that contingency too.  Plan for when you may be making decisions affecting someone who wants his/her reality to be different from what it is. 

Dec 18, 2012

Staying Healthy

"Cold and flu season are upon us.  Use these tips to stay healthy." Dr. Eric Kuyper

1. Wash your hands.  Most cold and flu viruses are spread by touching surfaces, as the viruses can stay alive for hours and even weeks.  Also, do not touch your face, as most viruses enter through your eyes, nose and mouth.
2.  Eat a healthy diet, to include fruits, vegetables, garlic, yogurt, cayenne, pepper and green tea.
3.  Drink plenty of pure water.  Dr. Kuyper suggests drinking 1/2 your body weight in ounces.  If you weigh 150 lbs, you would drink 75 ounces.
4.  Avoid sugar and any processed foods.  Sugar decreases immune function almost immediately and it takes your body hours to recover.
5.  Take Vitamin D (400-800 IU per day), Vitamin C (1000-2000 mg per day) and a molecularly distilled omega-3 fish oil (2000-3000 mg per day)
6.  Exercise regularly, with 30 minutes per day being recommended.
7.  Enjoy a sauna, as flu viruses cannot survive the heat.
8.  Do not smoke and limit alcohol, which dehydrates the body and can interfere with the liver -- which is a primary detoxifier.
9.  Reduce stress.  Prolonged stress is responsible for 90% of all illness and diseases.  (Caregivers take note!!)  To counteract the stress of life and caregiving -- exercise, meditate and change your thoughts.
10.  Get enough sleep -- most people need 8 hours per night for optimal health. 

Dec 17, 2012

Supporting One Another

"At my first defense no one appeared on my behalf, but everyone deserted me."  2 Tim 4: 16

I would venture to say that anyone who has lived to adulthood in this world has experienced not being defended, and even being deserted.  For most of us, it probably starts in childhood where we may have been blamed for something we did not do.  It seems human nature to be reluctant to stand up for someone who is being spotlighted for being at fault, and it seems to take a very mature person to do so.  We may be part of the onlookers who know the person being accused is not guilty, but as humans we seem reluctant to stick our necks out and speak up.  Perhaps it dates back to the time of the guillotine, where sticking one's neck out resulted in paying the price of one's life.  As mature individuals we do need to speak out when we see a wrongdoing, and we also need to speak out in support of a right doing.  We do not need to cringe in fear.  We can speak up -- for ourselves and others.  It is the right thing to do. 

Dec 16, 2012

Listening to the Stories of Others

"When was the last time you listened to the stories of others?" Question put to the sick by a Native American Medicine Man

At the recent holiday party at the assisted living center, I listened to a resident tell me how she had been homecoming queen in her high school.  As we get older, it seems we yearn for someone to listen to our stories.  And, listening to others' stories is the way of healing in the Twelve Step meetings.  It is in listening to how someone else is placing their feet to more fully stand in their lives, that we can be inspired to stand in our life too.  A dear friend recently emailed me that this blog was inspiration to her; that the subjects I covered seemed to be just the ones she needed to hear on any particular day.  I thank her for that feedback, and I think it is a gift we can give each other.  Having the courage to tell our story, so that others can be heartened to live their lives well; and, listening to the stories of others so that they feel validated.  We can be greatly instrumental in the healing of ourselves and each other by listening to each other's soul stories.  Thank you, dear readers, for listening to mine.  My hope for you is that you have someone to listen to yours.  You deserve it.

Dec 15, 2012


"Only those who have learned the power of sincere and selfless contribution experience life's deepest joy:  true fulfillment."" Anthony Robbins

It is perhaps helpful to think of our caregiving as volunteering.  It may not be as glamorous as some types of volunteering.  A friend of mine is volunteering at Santa's Clearing House in North Pole, Alaska, to help disadvantaged children have a toy for Christmas.  We may feel that we did not even volunteer for this role of caregiving, and - indeed - we may not have.  Whether we have been cast into the role or we have chosen it, it might be helpful to our attitude to think of it as volunteering.  Today I spent the day helping Dwane wrap presents, send holiday cards, and then we attending the assisted living holiday party together.  There were a number of residents who had no family to join them.  Dwane did not thank me for coming, even though it is about 2 hours round trip drive for me, but I hope he did enjoy my being there.  In any case, I went because I felt it was the right thing to do; independent of his reaction.  And, isn't that what volunteering is?  Doing what is the right thing to do to help brighten someone's life, without consideration of being thanked or even having our effort recognized.

Dec 14, 2012

Be at Peace With Your Life

"It may sound odd, but the fastest way to get to a new-and-improved situation is to make peace with your current situation. By making lists of the most positive aspects you can find about your current situation, you then release your resistance to the improvements that are waiting for you." Abraham

Sounds simple, doesn't it?  Except it is not always simple.  When we are beset with difficulties and our coping skills are down, it is difficult to "list the most positive aspects" of our current situations.  Dwane is once again wanting to come home.  While I cannot blame him, it is not possible; and -- if I allow myself -- I can be frustrated that he does not remember all of the doctors who said he needed to be in assisted living.  He remembers so many things.  He is still the person I turn to for a mechanical question, but he seems unwilling to remember the medical doctor, the neurologist, the neuropsychologist who have told him that assisted living is where he needs to be now and in the future.  While Dwane is not entirely content in assisted living, he is safe -- which is my main responsibility.

So, to practice what is right about my current situation:  I am free to choose my attitude and my response in every moment.  I delight in the interactions I have with those people I most love.  I have friends who enrich my life.  My own health is very good, as is the health of the other members of my family.  I live in an area where I enjoy much freedom, clean air, nature, kind people, interesting friends.  My life is bountiful.   What are the positive aspects of your life?

Dec 13, 2012

Surviving Caregiving

"Nearly one-third of us will provide long-term care for a sick, disabled or elderly family member or friend during our lifetime, helping those we love get to their doctor's appointments, remember to take medications and eat right." Lindsey Konkel

Lindsey writes of the difficulty of caregiving for a loved one.  She gives two keys to surviving the caregiving task:  1.  Keep yourself emotional and physically healthy and 2. Ask what you can do to help instead of simply jumping in.  I would say that the number 2 suggestion would work only if the person for whom you are providing caregiving is cognitively able to assess what he/she needs and to respond to you when you ask.  For those of us who provide caregiving for someone with dementia, it is futile to ask what they need.  What they need and want are so distant from what is realistic and attainable.  We also do much more than help the person get to doctor's appointments (although we certainly spend a lot of time doing that!) and helping with medications.   We also help them have social opportunities, protect their financial assets, make very difficult decisions with their best interest in mind, take over all responsibilities for food, maintenance, vehicle repair, yard work, household tasks, fiscal responsibilities, etc., etc., etc.  I agree that the number 1 thing we can do for ourselves is to invest in our own emotional and physical health.  How recently have you had a massage or a long bath or lunch with a friend?  How about scheduling your favorite refresher this week?

Dec 12, 2012


"Almost 1 out of 3 people in America will develop shingles during their lifetime.  A single dose of shingles vaccine is indicated for adults 60 years of age and older." Centers for Disease Control and Prevention

Although I have never had shingles, I know others who have; and it is very painful and can be permanently disabling.  Dwane had shingles before I met him -- so severe that he was hospitalized, and it caused permanent damage to his vision.  We were not sure if he should get the shingles vaccination since he had already had shingles, but his doctor researched it and said, yes.  Even if you have had shingles, getting the shingles vaccination can prevent other episodes.  As caregivers, we need to protect our own health, as well as the health of the care receiver.  One of the easy ways to do that is to get vaccinations.  Shingles vaccination if you are over 60.  Flu shot every year if you are 65 or older and residents in assisted living facilities and nursing homes.  Pneumococcal vaccine if you are 65 or older.  The flu season is upon us early this year.  If you have not had this vaccination, now is the time to get it. 

Dec 11, 2012

Remembering Who We Are

"Fear of loss, abandonment and the withdrawal of love form a shell around our heart and obscure the light of the Higher Self which is always present, always calling us to remember who we really are.  Each one of us has moments of remembering, when we find ourselves present to the beauty of a sunset, the smile of a baby or the light in the eys of a stranger." Dr. Joan Borysenko

Dr. Borysenko has written books to help people shift from the perspective of the fear-based ego into the timeless love and wisdom of the Higher Self -- which she describes as our essential nature.  Our own essential nature may be so covered with masks -- that we have learned to wear in the hope they will keep us safe -- that even we may have forgotten who we are at our essence.  That is one of the many gifts of being around a baby:  the baby shines through as her or his own essential self from the onset.  It is just beautiful to behold, and perhaps it can help us remember to shine through as our essential self as well.  Things in nature can help us remember our essence too.  As I was sitting at my computer writing, a bald eagle glided very low down our narrow valley.  Magnificent.  Dr. Borysenko says we wear masks to make ourselves lovable or at least powerful, but they really keep us from our own true essence.  Let us try to remember who we were before the donning of masks, and let us remember that at our essence, we are love.   

Dec 10, 2012

Boost Memory

"There's another possible benefit of strength training:  a stronger memory."  researchers from the University of British Columbia

The above research involved women in the initial stages of cognitive decline who attended strength-training classes two times a week for six months.  At the end of the six months they showed significant improvement on memory tests compared with women who took only a walking or stretching class.  As we get older, we lose muscle mass.  One way to slow that is strength training:  that means lifting weights or using resistance machines.  I go to water aerobics three times a week and we use weights for most of the exercises.  I find I like this form of exercise better than the repetitive lifting of weights; it is a way to mix fun with strength building.  Whatever form works for you, it is important to have strength training be part of our regular exercise.  Building our strength can also prevent falls which can be disabling or deadly. 

Dec 9, 2012

Be True to Who You Are

"Most of us, myself included, live behind walls that were started by others and finished by ourselves. What I've learned is that the more I risk being who I am -- like a sun daring to shine -- the thinner the walls need to be outside me."  Mark Nepo

Most of us do live behind walls and do not let the full force of our being shine out to others.  A dear friend told me that he read of Marlon Brando that he could decide to fully shine or not.  For instance, if he wanted to shine forth as fully himself, others would recognize him and approach him.  But, conversely, it was said that Brando could also dim himself down so that he was able to be in public and others did not notice him.  There is a lesson in there for us.  Too often our family of origin or the public school experience teach us to dim down the fullness of who we are, and there may be times or situations when we are safer to do so.  But, it is also regrettable.  Perhaps one of the reasons it is so healing to be with a baby is that the baby is fully shining herself or himself.  No one has shamed him or her out of that yet.  It is a risk to be fully who we are.  Some people will reject us.  But.  It is imperative in being true to ourselves that we decide when and where to shine, and that we do not hide out of habit -- or to please others. 

Dec 8, 2012

The Energy of the Seasons

"The earth energy draws us inward in December, while the cultural energy draws us outward to shop and prepare for the holidays."  Dr. Joan Borysenko

The seasons of the year can be instructive to us in our interior journey.  In the northern hemisphere, we are rapidly approaching winter:  the time of going inward.  In nature we see trees and plants have gone dormant, reserving their energy for the coming spring, which signals rejuvenation.  So, too, can we use winter to be self reflective, to take an inner inventory to see if we are showing up in our world in the ways we want to be.  The season helps us as the days are short and the environment covered in freeze and slipperiness (depending on where one lives).  It is a perfect time to stop and consider where we have traversed in life, where we are now, and where we want to go.  Using the time of winter in this way paves the way for new growth to occur -- just as spring follows winter.  This new growth can be nurtured as nature nurtures its growth in the summer, and then we can harvest what we have created in our lives -- as nature harvests in the fall.  Nature, and its seasons, can be very instructive to us on how to live our lives.  We humans and nature can benefit from our respectful honoring of nature and its seasons.

Consider:  What do I want to do differently during this season of winter?

What is Our Focus?

"So many times in life, we focus more on the difficulty than the solution." Jack Sacco

In my observations of my own and others' behavior, I would say this is true.  It is so easy, and we seem trained to do so, to slip into seeing what is wrong about a situation; rather than seeing what is right and/or what could make it right.  That is even true of living with dementia.  There are so many things that are going right.  Dwane is warm, safe, has friends to visit with whenever he wants, and people who love and visit (or call and write) him.  Things are good for me too.  I am adjusting to fixing meals whenever I want and of only what I want, seeing the people I want, and looking for what is good and right about my life.  What is good and right about your life?  Most of us who have computers also have shelter, food, and people who love us.  That is more than a lot of people in the world have, especially in the areas in which there is strife.  Today, let us intend to find 3 things right about our lives, and 1 solution for something that may not be quite right. 

Dec 7, 2012

We Need Hugs

We need four hugs a day for survival.
We need eight hugs a day for maintenance.
We need twelve hugs a day for growth.

--Virginia Satir

Virginia Satir was an internationally acclaimed therapist.  She helped people learn how to be happy and how to be their best in relationships.  I had the very good fortune to attend her trainings while she was alive and still working.  She was amazing in the work she did with families.  Absolutely transformational.  She also believed in loving oneself, receiving love from others, and showing love for others.   So, if we need 4-12 hugs per day, how many have you had thus far today?  Most of us would have to say, 'none'.  Where can we get our hugs.  Support groups, families, good friends.  Let us see where we can get good, healthy hugs.  And, of course, give them. 

Dec 6, 2012

A Day of Shopping

"If we practice self-hatred, then the sacrifice we make of ourselves and our lives is not sacred, for it is then a gift of something we hate rather than of something that we have nurtured and loved." Gwynneve, nun 500 AD

A full day of fun and shopping.  Dwane wanted to do his Christmas shopping, so off we went after PT.  First to lunch, then to a few stores of his choosing.  He is doing so much better with PT re-established.  Walking better, more upright.  We made a list during lunch, to facilitate our trip and make it more efficient, as he tires quickly.  I had already ordered the gifts for the grandchildren overseas, and we got all the rest done today.  Whew.  Dwane had good stamina and was able to walk in the stores more than the last time we had an outing.  Later this week, I will decorate his room for the holidays, we will address cards, and wrap presents.  A day well spent. 

This nun, Gwyneeve, of long ago has good advice for us today.  Self hatred is a poor gift for anyone.  It is so important to have healthy self regard.  Then we are a gift to ourselves and others.  Name one thing you like about yourself today. 

Dec 5, 2012

For Our Health: Stop Striving to be Important

"She was not telling me to stop writing, but to stop striving to be important. . . . . . now I know that health resides in restoring direct experience." Mark Nepo

In the above quote, Nepo is referring to something that Helen Luke said to him: "Yours is to live it; not to reveal it."  Nepo says that he had felt prior to this advice, that he was to reveal life through his poetry; but he came to understand that "living is the original art."  This seems something that most humans can learn.  It is so easy to be distracted by many projects (even very important ones), professional achievements, any ways in which we are 'making a name for ourselves', but - perhaps - living IS the original art.  That might mean that we reevaluate what takes up our time and mental energy.  Perhaps we will discover that our goal has been to make ourselves important; instead of living life directly.  Living life directly is -- in my opinion -- hard to do.  It is so tempting to be distracted by our inner thoughts or some exterior stimuli.  Have you tried recently to just be?  To just experience whatever is in front of you -- without judgment or mental chatter?  Let us notice today if we are present to what is the experience of our lives. 

Dec 4, 2012

Older Adults and Falls

"Each year more than one-third of Americans older than 65 experience a fall and nearly two million end up in the emergency room for injuries due to those falls." Dr. Richard Holm

Falls in older adults can cause fractured hips and arms and head injuries.  The cost to U.S. society is billions of dollars a year, with more than 300,000 hip fractures needing major surgery every year.  Slower reflexes, poorer vision, less muscle strength, balance problems, generalized illness and Parkinson's Disease all increase the risk of falling.  Excess use of alcohol is another cause of falls.  Falling was one of the reasons that required Dwane moving into assisted living.  He had three falls and one head injury in the weeks before moving him into assisted living.  This was in spite of my efforts to make our environment safe, with no loose rugs, plenty of night lights, no clutter on the floors, no exposed cords in traffic patterns.  We need to make our homes as safe as we can; and that may still not be enough to prevent someone with Lewy Bodies Dementia (which has a significant Parkinson's aspect) from falling. 

Dec 3, 2012


"Humor brings insight and tolerance. Irony brings a deeper and less friendly understanding." Agnes Repplier

Irony.  Within the past two weeks, the director of the assisted living facility where Dwane lives has told me -- in what seems to me to have been a knee-jerk reaction to a bad weekend he was having -- that Dwane could not stay there any longer and would need to be moved to a nursing home.  Then, just days later, Dwane told me he thought it was time he moved home, since "no one does anything for me any way."  (We need to remember that he also expressed the opinion that I did nothing for him when he was home.)   A dear friend had warned me (having experienced Lewy Bodies Dementia with her father) that Dwane might continue to off and on insist on going home, but, still, it took me by surprise -- especially with the threat of the director saying he needed even more services than they could deliver.  I have changed the tide of the director wanting him to be moved by getting PT started again (which I had already been trying for several weeks) and getting his medication changed.  Amazingly, in an error between the assisted living facility and the pharmacy, there had been an omission of one of his meds.  Now I will be consulting with the nurse regularly to avoid further problems, but it still amazes me that the error occurred.  I know Dwane would rather be home.  Most people would prefer being home.  But, that is not to be, and it is very difficult for him to understand the need for assisted living -- especially when he seems to believe that "no one does anything for me any way".  As caregivers, this dissonance is something we can expect, but it is still very, very difficult to hear and deal with. 

Dec 2, 2012

Having Dreams

"Living up to a dream is rarely as important as entering it for all it has to teach." Mark Nepo

The above quote follows what Mark Nepo describes as two big dreams of his life:  being a professional basketball player and being a poet.  He says he did not fail at his basketball dream; it is just that being a poet carried him from that dream.  And, later, cancer opened him up to the "uncovered life of spirit" that has carried him beyond poet.   It is important to realize that dreams come and go.  We will not fulfill all of our dreams, and I would suggest that perhaps the Universe has something better in mind for us when our dreams fall by the wayside to make room for something unexpected.  There is wisdom in what Nepo recommends:  that we enter our dreams for all they have to teach us.  I have, off and on in my life, dreamed of being a writer.  My first college degree was in writing.   Other dreams have come and been lived:  My dream of being a stay-at-home mother in an intact family was lived and left.  Needing to provide for my children and me took me through other college degrees and work experiences.  My response to life has been to learn from the experiences life has brought me.  Perhaps now is the time to dream again. 

Dec 1, 2012

Seeing What is Right

One way to become enthusiastic is to look for the plus sign. To make progress in any difficult situation, you have to start with what's right about it and build on that.
-- Norman Vincent Peale

When things are really tough, it is hard to look at what is right.  This fall has been stressful for me:  a medical crisis involving people I love, the assisted living center saying Dwane needed to go into a nursing home, two flat tires, plumbing problems, optical migraines that changed my vision, and a neighbor running into and destroying our mailbox.  Any one of these things could be stressful, but, together they created one of the most stressful periods of my life.  Even in these difficult situations, it is important to see what is right:  The skilled staff in the intensive care unit, the wonderful will to live, the love and prayers and support from caring people, the ability to honor what is important and let other things go, the skill of asking for help, allowing others to love and support us.  And, most of all, the good outcome.  Much that is right, and much to be grateful for -- to build on even better times.  What is going right in your life right now?

Nov 30, 2012


"A good antidote to the poisonous effects of fear based negativity is to remember the sage's advise from old... "FEAR, rightly understood, translates: ." Rev. Richard Kiefer

Some mental health people have suggested that there are really just two emotions:  fear and love.  Whether or not that is true, fear is a frequent companion of the human life.  It seems that fear is at times generated by governments:  whether that be fear of nuclear destruction or the fears about the predicted fiscal cliff that is catching the news in the U.S.   It is helpful to remember the fear that was circulating in the U.S. in the early 1900's that there were never going to be enough horses to meet the needs for transportation and work for the population.  Very soon, horses were not needed at all, as the combustion engine took the place of horse power.  The calamity some people predicted would happen to all of our computers as 1999 turned into 2000 never occurred.  It is not that bad things never happen; it is just that it is a waste of our time to worry about things -- most of which never do happen.  For today, let us look at whatever we fear through the lens of   False Expectations Appearing Real.  Perhaps what we fear is not even real. 

Nov 29, 2012

90-Second Rule

"What makes success is not your genius idea, but the execution and follow-through around it.  Each of us has a 'strike zone' of ninety seconds in which we can easily act on a good idea or opportunity before our brain starts to scream excuses at us." Robin Sharma, author of The Leader Who Had No Title

I have read similar things.  Abraham literature suggests that if we hold an idea for 17 seconds, those seventeen seconds give the idea more power.  So, if we combine the two suggestions:  we have 90 seconds on which to act on an idea before our brains start to dissuade us, AND once we have an idea, if we hold the positive outcome of that idea in mind for seventeen seconds, the idea is helped energetically.  I have seen a third thing happen:  a person has a good idea and talks and talks and talks about it, but never takes action.  What seems to be needed here, and the research around change in our behavior supports this, is the action step.  All of us have good ideas.  The important thing is to take action to bring the idea into fruition.  Even holding the positive outcome of the idea for seventeen seconds is taking action.  Today, let us take action on our good ideas. 

Nov 28, 2012

Monitoring our Voice

"For the next week, don't say anything unkind, untrue, or unnecessary."  Rev. Sally Robbins

The above quote is an assignment from a teacher to a class that Rev. Robbins was in.   She relates that none of the students made it even one day; much less one week without violating the assignment.  The assignment is good practice.  How much would be said if we each monitored our talking to only that which is true, kind and necessary?!  At a recent breakfast gathering with friends, I noticed that I said things that were unnecessary; and we have all been in situations where we have noticed others saying things that are unnecessary.  The discussion at the breakfast was how one town did not treat a neighboring town kindly.  Having history in the area, I related a time when the tables were reversed; and the town being mistreated had been unkind to the other.  Was that necessary for me to contribute?  Probably not.  But it did help the others at the table (who live in the town being treated badly) that at one time the situation was reversed.  Perhaps by their knowing that, they can help stop this cycle of unkindness.  We have no control over what others do, but we each can decide to say only things which are kind, true and necessary.  Are you up to the challenge?  Let us choose for the next week to not say anything that is untrue, unkind and/or unnecessary.  Let us speak ONLY what is kind, true and necessary. 

Nov 27, 2012

Social Support

"Staying in touch is good for your health.  Social detachment is as bad for you as smoking and worse than obesity." Holly Zimmerman

One of the difficult things for 24/7 caregivers is having social support themselves.  Now that Dwane is in assisted living, that is easier for me -- but not as built-in as it is for him.  The secret seems to be to have some close relationships; ones we can really count on.  In a discussion with a friend recently, we agreed that positive and supportive friends are essential.  Some caregivers find support in support groups for caregivers.  Others find support with family who help with caregiving.  Others find support in friendships.   Life coaching, as I have mentioned before in this blog, works for me -- because I am able to process something when someone practices holy listening with me.  Holy listening is:  listening that is based on nonjudgment and has as its intention supporting my best interest.  Whatever form of support works for you, it is essential that you have it.

Nov 26, 2012

Kindness of Strangers

"I have just three things to teach:  simplicity, patience, compassion.  These are the greatest treasures." Lao Tzu

It is amazing how kind we can be to one another.  Recently, I took Dwane to see the movie, Lincoln, which both he and I very much enjoyed.  Based on Doris Kearns Goodwin's well-researched book, "Team of Rivals", the movie depicts the period of time when Lincoln is trying to get the 13th Amendment (the one abolishing slavery) passed.  At the end of the movie, Dwane was unable to get out of his chair.  Usually I am able to get him up out of a chair, but together we were struggling to get him to his feet; when two women walking by stopped and one offered to help.  With one woman on each side of Dwane, we quickly had him up.  I was so grateful for their unsolicited kindness.  It was also an evening instructive of how kindness goes around, as - when I went in to use the bathroom upon leaving the theater, a little girl was trying to reach the soap dispenser to wash her hands.  I was able to pass along to the little girl the kindness the woman extended to us. 

Nov 25, 2012

Honoring Humanity

"Well, there are 7 billion other people in the world.  It doesn't all have to be about me! It took me about 66 years to come to this conclusion." Bette Midler

It takes some people even longer to come to that conclusion:  "it doesn't all have to be about me".  It can be confusing at times to honor ourselves without being so self centered that we think it is all about us.  This can even happen when we take things too personally.  When people offer criticism about you and/or about how you provide caregiving, it is helpful to remember that it probably would not make any difference who was in your shoes -- the criticism is an issue of the person delivering it.  Some people are likely to criticize rather than cooperate, judge rather than have empathy, speak harshly rather than conciliatory.  There just are people like that.  When that negativity is pointed in our direction, it actually does not have much to do with us.  It has everything to do with them.  The 12 Step Program advises us to take the kernel of truth in any criticism and let the rest go.  Great advise. 

Nov 24, 2012

Let's Dance

"New research shows that dancing doesn't just build bones and improve balance; it can even boost brainpower." Journal of Sports Science and Medicine

Dancing twice a week can increase memory and cognitive functioning among older adults.  Dancing is also easy on the joints, it provides social interaction, and it is good for our brains.  I do not currently have a venue for dancing, but in the past I have loved it -- and I will be looking for ways to have it again in my life.  It is so important that we like the form of exercise we do.  So we will stick with it, and -- in my opinion -- liking it doubles its benefits.  So, whether you dance, do aerobics, ski, bike, swim, zumba -- the important part is they you get regular daily exercise.  You deserve it. 

Nov 23, 2012

Successful Aging

"It's especially important for older people to be physically active because it contributes to successful aging." American Heart Association

Physically active older adults have lower inflammation than inactive adults.  Inflammation is a factor in many diseases, to include heart disease.  It's never too late to get started (you might want to have a visit with your doctor to okay your exercising if you have been inactive).  According to the American Heart Association those of us who are physically active have "substantially lower healthcare costs" compared to people who are less fit and active.  So, how about no more excuses?  Let's get moving.  A brisk walk (studies suggest 10,000 steps a day is optimal), gardening, biking, and home maintenance all count.  The important thing is to be moving our bodies.  I also think it is important that we like our form of exercise.  I have found a water aerobics group that is friendly, fun, inclusive and positive.  It meets my needs for exercise and fun, with some added social benefits. 

Nov 22, 2012

Time Spent Caregiving

"According to the National Alliance for Caregiving, the average family caregiver spends 20 hours per week caring for a loved one, while 13% spend 40 hours or more." National Alliance for Caregiving

29% of the U. S. population provides care for a chronically ill, disabled or aged family member or friend. (National Alliance for Caregiving)  Among the tasks caregivers perform:  paying bills, taking the person to doctors appointments and social activities, making sure environments are safe, doing laundry, and much more.  According to the American Association for Long-Term Care Insurance and Homewatch CareGivers, 7.5 million Americans receive long-term care at home, 1.5 million in nursing homes, and 1.1 million in assisted living facilities.  Whatever the setting, caregiving is still a large part of the caregiver's life.  We need to find a balance and make sure our own needs get met. 

Nov 21, 2012

Caregiver Discrimination

"Roughly 42% of U.S. workers have provided unpaid elder care in the past five years." AARP report

The number of U. S. caregivers is expected to rise to 49% within five years.  AARP is urging federal policy makers to look at the current discrimination in some workplaces which penalize caregivers who need flexibility to provide care for a spouse, partner or parent.  (according to Susan Reinhard, director of the AARP Public Policy Institute)  Even if caregivers are self employed, as I am, we are penalized by loss of income for the time spent caregiving.  Even if the person with dementia is in an assisted living facility or nursing home, there are still the tasks of coordinating doctor visits, checking up on prescriptions, arranging for services -- such as PT.  Yesterday in taking Dwane to his doctor for a routine check up, I discovered he has not been getting an important medication since August!!  Unbelievable.  It turns out it was a mix up among the doctor, the pharmacy and the assisted living facility; but it adds another task to my list --- that of routinely checking his medications to make sure they are being given correctly.

Nov 20, 2012

Self Regard

"Your mere presence has always been enough for the birds to sing, the waves to roll, and the sun to shine... so why do you ever feel you should be more?" Tut

Psychologists suggest that we need to love ourselves before we are able to love others, that hatred for others is but a projection of our own self hatred.  It does seem that early life pummels some of our tendency for self regard out of us.  The public school system, whether it is staff or peers, can harm how we feel about ourselves.  So can families of origin.  It seems that having a healthy self regard is a balance of knowing our weaknesses and our strengths and accepting them and ourselves.  Once we truly accept ourselves, we simultaneously are more accepting of others.  Today, let us set the intention for positive self regard.  Let us look to our own counsel, see how we feel about things.  Let us let our joy shine. 

Nov 19, 2012

Care for the Caregiver

"Caregiving often leaves the caregiver feeling depleted, both physically and mentally.  Taking the pressure off yourself is the key." Sally Abrahams, Nov. 2012

Abrahams discusses how important it is to care for the caregiver in her article in the above-referenced bulletin.  She talks about the grief of caregiving, the guilt that you maybe are not doing enough, the exhaustion, and the need for all family members to help with the load.  Good advice, but often the caregiver does the job almost entirely alone.  Self care is very important, and -- if you do not have family who will help, it is imperative that you hire help to give yourself breaks.  Talking about your feelings is also important, whether with a friend or a trained therapist.  This task is too difficult to try to go it alone without support, physically and emotionally.  What supports do you have that serve you?

Nov 18, 2012

Self Compassion

"Research suggests that self-compassion provides an island of calm, a refuge from the stormy seas of endless positive and negative self-judgment, so that we can finally stop asking, "Am I as good as they are? Am I good enough?" By tapping into our inner wellsprings of kindness, acknowledging the shared nature of our imperfect human condition, we can start to feel more secure, accepted, and alive." Kristen Neff speaker on Self Compassion

Those of us who are caregivers may very well benefit from increased levels of self compassion.  During a recent stressful period of caregiving and life circumstances, I began having ocular migraines -- which affected the vision in my right eye.  History would indicate that I have good coping skills and resiliency, but even with those skills, stress can take a toll.  Neff suggests that self compassion is as simple as:   breaking self-criticizing habits, relaxing, allowing life to be as it is, and opening your heart to yourself.   She says that it's easier than you might think, and it could change your life.  Breaking self-criticism would seem to be the big ticket item of the suggestions.  One way I help myself not to criticize myself is by adopting the habit of not criticizing anyone.  It is easier than one might think:  just make the decision to not judge ourselves or anyone else.  Let us live with compassion toward ourselves and each other.  We all benefit from such a worldview. 

Nov 17, 2012

Alternative to Dementia Diagnosis

"About 30% of my NPH patients were told they had Alzheimer's or Parkinson's", Mark Luciano, M.D. Cleveland Clinic

An interesting article about normal pressure hydrocephalus (NPH), which can mimic the characteristics of both Alzheimer's and Parkinson's, and which is treatable.  The Hydrocephalus Association estimates that at least 350,000 Americans -- and 5% of people with dementia -- have NPH.  Surgery -- placing a shunt in the brain -- can cure this disorder.  Another good reason to have your person with dementia have a very thorough physical workup to rule out not only NPH, but also depression, metabolic disorders, etc.  People with NPH can have problems with memory, walking and bladder control.  It is often misdiagnosed.  A good medical evaluation to determine the underlying cause of dementia includes physical exam, lab work, perhaps MRI's or CAT scans, neurological/psychological testing -- at a minimum.  Let's be sure we are not dealing with something that is treatable. 

Nov 16, 2012

Medicare Open Enrollment Ends December 7

"Hikes in fees (of prescription drug insurance plans) range from 11-23% unless you switch to lower-cost plans.  The market has changed again and seniors need to look around. Open enrollment allows you to compare plans and switch to another starting Jan. 1, 2013." Dan Mendelson, Avalere's CEO

Open enrollment for Medicare Part D prescription plans ends on December 7, 2012.  You can change your prescription drug plan now by going to and look under Medicare Plan Finder.  Even though I have saved both Dwane and my prescription lists in the Medicare secure site, it took me over an hour to compare both of our plans and choose new ones.  But the time was well spent.  I saved us over $3000 a year by switching both of us to different plans.  I strongly encourage you to take the time to navigate the site yourself or to call Medicare at 800-633-4227.  It can save you money, both monthly and annually.  The plan finder at automatically does the math for you - after you enter the prescriptions you take (or the person for whom you are completing the form takes)  - to tell you which plan saves you the most money annually. 

Other good news:  Part D doughnut hole shrinks in 2013.  You get 52.5% off brand-name drugs and 21% off generics in the gap, which is a slight increase over 2012.  More insurance plans offer copays at "preferred" pharmacies (the website will tell you if yours is a 'preferred' pharmacy).  Medicare Advantage Plans are still robust, despite the doom and gloom predicted that "Obamacare" would cause these programs to drop out.  Drugs used to treat anxiety and seizures are now covered under the Part D plans.  All very good news for us who are caregivers and need to watch money expenditure and save where we can. 

Nov 15, 2012


Einstein agrees with current spiritual thought that we create our own realities by matching the frequency of the reality we want.  Abraham says we do this by managing our emotions.  Others say we do this by managing our thoughts.  Perhaps both are true.  What do we have to lose by managing our thoughts and our emotions to create the reality we desire?  Seems worth the effort.  Either way we are happier. 

Nov 14, 2012


"Sleep deprivation can significantly weaken immune function, and that can make you more susceptible to infection.  Going to bed at a reasonable hour ensures you will enter cold and flu season with your immune system in top form." Paul Lyons, M.D.

Other ideas for staying healthy in the winter are:  keep exercising and have some of that outdoors, wash your hands and wipe down areas that people frequently touch (I use disinfecting wipes.), get a flu shot, and keep your hands to yourself --- which means consider giving a fist bump instead of shaking hands. (taken from Parade magazine November 4, 2012)  As caregivers for someone with dementia, we need to be vigilant about taking care of our own health, and that includes avoiding the flu.  Above are some ideas from doctors about how they stay healthy all winter.  Let us stay healthy together.  Have you gotten your flu shot?

Nov 13, 2012

More Stress Reduction Tips

"When stress makes you unfocused, caffeine's stimulating qualities may promote a can-do attitude.  To super-size that good feeling, drink your coffee with a little bit of organic whole milk instead of fat free.  The extra protein and fat make you feel more satiated and therefore calmer." Drew Ramsey, MD, Columbia University

Finishing the stress-reducing tips from the December 2012 Prevention Magazine:

  • Eat grass-fed beef because it has good levels of iron.  As many as 15% of women ages 20 to 40 are iron deficient.
  • Natural soothers:  milky oat seed tincture:  2-3 ml instantly relaxes.  Tea with kava.  Lemon, lime and orange scents -- dissolve 15 drops of one of those essential oils in 2 tablespoons of water, put into a spray bottle and mist your house for a pick-me-up, and mist your pillow with lavender oil before going to bed.
  • Think sensually:  Doing things that feel good, like taking a warm shower or listening to a favorite piece of music help support the release of endorphins which make us feel better.
Try any of these stress-reducing tips to feel better and to cope better.

Nov 12, 2012

More Stress Reducers

"Stress triggers the release of the hormone cortisol, which can damage our brains and weaken our cardiovascular and immune systems over time." Rick Hanson, PhD, neuropsychologist

This blog is continued from yesterday with suggestions from Prevention Magazine December 2012

6.  Give yourself a hug.  When you think negatively about yourself, the brain signals the body to raise blood pressure and increase adrenaline and cortisol levels   Wrapping your arms around yourself and giving yourself a big hug can release oxytocin and other biochemicals that promote well-being.
7.  Focus on the exhale:  The most important part of breathing is the exhale.  Try making them twice as long as the inhale.
8.  Just move it -- even a little.  Even 2 minutes of exercise is enough to change your mood, as long as you raise your heart rate -- according to John Ratey, MD, Harvard Medical School
9.  Relax your jaw and tongue.  This sends a message to your brain stem and limbic system to turn off the stress hormones adrenaline and cortisol according to Dr. Marsha Lucas
10.  Nibble on chocolate.  A Johns Hopkins University study reveals that the taste of sweetness on your tongue causes a surge of feel-good endorphins.  In addition, dark chocolate contains compounds called flavonoids that positively impact mood, mental acuity and attitude.

Nov 11, 2012

Stress Solutions

"New findings in neuroscience, nutrition, and psychology reveal the fastest ways to reduce tension and actually change your brain and body for the better." Jessica Baumgardner for Prevention Magazine, December 2012.

As caregivers for someone with dementia, it behooves us to know how to deal with the stress this and other life situations cause.  The latest Prevention Magazine has some great ideas, which are:
1.  Put on a happy face.  Smiling soothes you, even if you are just "faking" it.  So, the adage in the 12 Step Programs to "Fake it til you make it." is scientifically sound.
2.  Think:  Hot Hands.  Fear and anxiety cause the nervous system to direct blood flow to the largest muscles, leaving the hands cold.  When you warm your hands, you tell your nervous system that all is well.
3.  Donate to a good cause.  Giving money to a cause you believe in makes you feel better than buying designer jeans.
4.  Load up on whole grains:  "If you are feeling grumpy, the best idea is to eat an all-carb whole grain snack and you should feel happier within a half hour." nutritionist Elizabeth Somer, RD
5.  Dig in the dirt.  30 minutes of gardening is more relaxing than 30 minutes of quiet reading.  There seems to be a link between a common bacterium (M. vaccae) found in garden soil and increased serotonin levels in our bodies -- which leads to better concentration and less anxiety.  

Nov 10, 2012


"Fear is the cheapest room in the house.  I would like to see you living in better conditions." Hafiz

Fear.  It seems to be a frequent companion of humans.  As caregivers we may fear that we do not have the resiliency to continue caregiving, that we may not have the financial resources to pay for all the needed services, that our own health may be negatively affected.  Statistics show us that all of these things do happen.  There is no absolute way to prevent these things from happening to us --- although careful and judicious planning helps prevent them.  What we need to do is not invite fear to sit down for dinner with us.  As humans, of course, we will be visited by fear; but let us not make fear a house guest.  To prevent that, practice mantras such as, "All is well."  Meditation, exercise, adequate sleep and nutrition -- all help to dispel fear.  Today let us have no fear.

Nov 9, 2012

Building Resilience to Stress

"Here's our two-step guide to regaining resilience and lessening stress." Dr. Mehmet Oz & Dr. Michael Roizen

Practice 10 minutes of meditation a day.  One source:
Get 7-8 hours of sleep
Take probiotics to balance good/bad bacteria in intestines
Start walking 10,000 steps a day -- this regulates body chemistry and emotions
Eliminate from diet any grain that is not 100% whole grain

2nd - to bounce back from stress:
Upgrade the food you eat and the exercise you get, add in support from family and friends, and consciously state things positively (positive statements change the way you feel).

Nov 8, 2012

Help Researchers Find Cure for Alzheimer's

"More than 5.4 million Americans have Alzheimer's disease, making it the sixth-leading cause of death in the U.S.  By joining the Alzheimer's Prevention Registry, you can sign up to participate in clinical trials or research."

According to Mayo literature, Lewy Bodies Dementia is the second most occurring form of dementia after Alzheimer's disease.  Research that helps Alzheimer's has the potential of helping Lewy Bodies as well.  Some of the studies going on involve nothing more than filling out a questionnaire.  Those of us who are caregivers for someone with dementia know how very cruel the disease is.  Perhaps you are motivated to help eliminate it by participating in research. 

Nov 7, 2012

Medicare Class Action Lawsuit

"In a proposed settlement of a nationwide class-action lawsuit, the administration has agreed to scrap a decades-old practice that required many beneficiaries to show a likelihood of medical or functional improvement before Medicare would pay for skilled nursing and therapy services.
Under the agreement, which amounts to a significant change in Medicare coverage rules, Medicare will pay for such services if they are needed to “maintain the patient’s current condition or prevent or slow further deterioration,” regardless of whether the patient’s condition is expected to improve." NY Times, Oct. 22, 2012
Wonderful news for those of who are caregivers for someone with dementia.  Dwane had benefited so much from PT (physical therapy) services, which were helping him with his posture and, therefore, with his back pain; but these services had to be terminated in September because he had met the upper limit allowed by Medicare.  Now I can get him scheduled in again.  I am grateful to the Center for Medicare Advocacy which brought the lawsuit forward on behalf of us all.  If the person for whom you are caregiver would benefit from either skilled nursing or therapy services, check into having these paid for by Medicare under these new agreements parameters. 

Nov 6, 2012

Please Be Sure to Vote

"Plans are useless, but planning is invaluable." Winston Churchill

If you live in the United States, please be sure to vote today in this very close presidential election.  Wherever you live, it is so important that we exercise our right to vote.  The best way we can impact our country is in how we vote. 

I have had some recent experiences that have shown me the folly of making plans.  When one has very, very important things going on in life, all plans need to take a second seat.  Still, planning is important.  How else will I get my vehicle tire fixed?  My snowplow serviced?  Perhaps the secret is to be involved in planning, but to hold the plans lightly.  There come times in life when things far more important are calling for our attention than getting tires fixed.  Knowing what is important to you, what you value, is critical in these times, so that you are focusing your attention on what is truly important.  For me, relationships important to me are the most important thing.  Tires can be fixed another day.  But, for voting in the U.S. in this election, that happens only today. 

Nov 5, 2012

Honoring Others

"If I only have this time on Earth with this person, if I may never see them again, what is it I want or need to ask, to know?  What is it I want or need to say?" Mark Nepo

Mark Nepo says that since his cancer experience he enters every interaction with the above thought.  He says that interacting with others with the above intention "has opened me to wisdoms that would otherwise run silent beneath my time on earth."  Lovely.  It is so important to honor the people with whom we interact in this way.  Yesterday I was out running errands, and my low tire pressure light came on.  I pulled into a popular convenience store, called the tire repair shops in the area and found they were closed for the weekend, so I went inside to ask for help.  A young college woman was at the register, and she said she would help me.  Between the two of us, we got one lug nut off the tire that was going flat.  I waited awhile to see if anyone would offer to help, and then a large van pulled up full of adolescent males.  I approached them and asked if they would help.  The first one referred me to some bigger young men just getting out of the van.  In minutes these two young men, under the supervision of an adult male who was with them, had the tire changed.  It turns out they were a youth group from a regional city.  I am so grateful for their help.  They certainly honored me and my need.

Just as important as these seemingly chance interactions is it that we honor those people with whom we interact the most.  And, for most of us, these are the hard ones.  The little things that irritate us about the people with whom we share our lives, the fact that these people love us so it is sometimes safer to show up in less than our best in behavior with them.  It is important to honor the person with dementia too.  What is it we might want to say to this person or ask this person while we have the chance? 

Nov 4, 2012

Happiness is Contagious

"Happiness is when what you think, what you say, and what you do are in harmony." Mahatma Gandhi

Harvard University did a study of over five thousand people over twenty years.  The research showed that when people became happy, this happiness spread out to people two to three degrees removed from the happy person.  So, happiness is contagious.  We can catch it from one another.  And, how do we get happy?  Gandhi offers us the advice above:  when what we think, say and do are in harmony.  In psychological terms this is called being congruent.  Haven't you experienced a day when something someone said to you made your day?  Or conversely, something someone said to you rubbed you so the wrong way that it turned your day badly?  We each have the power to help ourselves and others have a good day.  It starts with ourselves.  We can choose to bring into harmony our thoughts, words and actions.  We can choose to be at peace and to be happy.  It starts with ourselves and becoming congruent, then it extends to how we treat those people with whom we most interact, and then it ripples beyond that to everyone with whom we come in contact.  For our own sake, and the sake of others, let us choose to be happy.

Nov 3, 2012

Golden Rule

"in the Abrahamic religions, there are hundreds of commandments, but those first ten laws of integrity are based on a fundamental "Golden Rule" -- treat others as you would like them to treat you." Andrew Newberg, MD

What a different world we would have if everyone truly treated others as they, themselves, wanted to be treated.  A human basic need is to belong.  If we would all remember that, and treat others with dignity and respect, it would make a difference in the world.  Research has shown that an act of kindness benefits not only the person giving the kindness and the person receiving the kindness, but all the people who observe the act of kindness.  That has been demonstrated.  So, for today, let us treat each other with kindness, knowing we are benefiting ourselves and the world around us.

Nov 2, 2012

Be a Conveyor of Peace

"How beautiful upon the mountains are the feet of him that bringeth good tidings, that publisheth peace; that bringeth good tidings of good," Isaiah 52:7

Research studies on energy suggest that each of has an energy we bring to any situation, an energy that affects the other people in the situation.  In my life I have noticed that there are people who make a bad situation better, and there are people who make a bad situation worse.  It may be important for us to consider which kind of person we are.  A service person once said of a person dear to me that "she felt better after being around this person."  That person is clearly one who brings good energy into a situation.  What are some ways to be a conveyor of peace?  Calmness, equanimity, charity, nonjudgment are all qualities to practice to be a conveyor of peace to ourselves and those around us.  It is quite possible that the well-known words to a song, "What the world needs now is peace," may be one of the most important things we can contribute to any situation.

Nov 1, 2012

Having Faith

"We should consciously practice having faith just as we would practice to become a musician.  We should take mental exercises to build up our acceptance of good.  The process is simple enough, since it finally resolves itself into very simple affirmations of conviction; but there must be a persistency until finally old thought patterns melt and give way to new ones." Ernest Holmes

Another reminder to replace negative thoughts with positive ones.  As caregivers, it is sometimes difficult to have faith that life is good -- as there is considerable evidence to the contrary.  But, our negativity only makes a difficult situation worse.  The care receiver, as well as ourselves, is benefited by our maintaining a positive attitude --- and we do that by maintaining positive thoughts.

Oct 31, 2012

All Hallow's Eve

"All Hallow's Eve is a cross-quarter day, halfway between the autumnal equinox and the winter solstice. The earth's currents continue to sweep us inward, down through the gates of death, into the womb where wisdom gestates." Dr. Joan Borysenko

What if the seasons have spiritual significance and what if heading into winter is spiritually significant in the way Dr. Borysenko suggests?  "The earth's currents sweep us inward, down into the gates of death, into the womb where wisdom gestates."  hmmmm   Doesn't that imply that the only way to wisdom is to go within?  And, that in going within, we must die to some things and to accept that impermanence is a fact of our human existence?  On the interior journey I found that there were aspects of my personality that I must let go, must let die, in order for me to be a more developed individual.  The things that typically need to die are self absorption, the idea of separateness, fear in all its forms, the human capacity for evil, any smallness or limitation.  The story of the Wizard of Oz shows us some of the things which must be faced and released on this interior journey:  the cowardice shown in the lion, the lack of clear thinking shown in the scarecrow, limiting the extent we love as shown in the tin man.  Today, let us be willing to let go of whatever human characteristics are holding us back in this journey toward being fully human. 

Oct 30, 2012

Choosing to be Happy

"The basic psychological motivation that all people have in common is to be happy and to avoid suffering.  Once we realize that so much suffering is created through our minds, we are motivated to change them."  Dr. Joan Borysenko

Continuing with yesterday's theme that negative thoughts cause our unhappiness, and that we can change our thoughts, Dr. Borysenko suggests we can find motivation in changing our thoughts by knowing any negative thought creates unhappiness for ourselves.  This motivation is increased when we also have a strong desire to benefit others.  If quantum physics is correct in suggesting that any thought we have impacts the well being of everyone else, that can be a strong motivation to change our thoughts.  Another motivation for us to choose positive thoughts is in knowing that all anyone who loves us really wants is for us to be happy.  Isn't that what you want for those you love?  That they are happy, healthy and living a life of purpose?  So, too, is that what those who love us wish for us.  We can become happier, healthier and living on purpose when we choose to entertain happy/positive thoughts and to avoid the suffering that our negative thoughts create for us.  Today, notice your thought content and repeat as often as necessary, "All is well."  Repeat it until you believe it.

Oct 29, 2012

Changing our Thinking

"The ancient practices of mind-training are quite similar to modern cognitive-behavioral therapies.  We begin to observe our thinking patterns and gradually make changes based on those observations." Dr. Joan Borysenko

Cognitive behavioral therapy is the only therapy which is evidence-based, which means it is the only form of therapy that has been proven to produce results.  Most humans are trapped by their minds.  The habitual thoughts of worry, anxiety, irritation swirl around and consume us and our waking (and perhaps even our sleeping) moments.  The way to be free of being enslaved by negative thought patterns is to change them.  I once heard someone say that if you want to know what God you really worship, notice your thoughts at random.  Whatever you think about the most, is -- in respect to where you put your time and energy -- your God.  If you, like me, do not want worry or any form of negativity to be your God, then you, like me, can change your thoughts.  How?  First, notice at random - checking in periodically throughout the day - to see what your thought content is.  Then, deliberately replace any negative thought with a positive one.  A mantra that works for me is very simple:  "All is well."  I say that over and over to myself to displace thoughts of concern.  What works for you?

Oct 28, 2012

Being Right

"Would you rather be happy or would you rather be right?" Jerry Jampolsky

The above quote is so familiar to us that we may not take it seriously.  Recently, I spent some time with someone who has an orientation to needing to be right.  It was a reminder that this seems to be a part of being human.  Perhaps it is groomed in school where - if we could provide the right answers - we got adult accolades (but not always peer accolades).  Perhaps it is based in our inherent curiosity to know things and to know them rightly.  Whatever the cause, needing to be right is a way to keep ourselves at a distance from ourselves and others.  It seems a good practice to focus on being happy.  Another practice is to let other people be right -- that is an excellent discipline to help soften the need to be right in ourselves.  Today, let us set the intention to be happy, and let us let go of the need to be right.

Oct 27, 2012


"To truly listen is to risk being changed forever." Sa'k'ej Henderson

I wonder if that is why so few people really listen.  To risk being changed forever is quite a risk.  Most of us like our comfortable -- if not always highly functional -- ways of interacting with the world.  We like our opinions, our beliefs.  To risk changing them is to risk changing who we are.  And then where would we be?!  Perhaps we would be just where the Divine wants us to be.  Unfettered by the clutter of long-held opinions, beliefs, judgments.  Fully centered in who we are so that we can listen and be changed by information from outside us.  A friend who worked in geriatrics once said that people do not change as they get older, they just get more of who they are.  It is prudent, then, to take a look at who we are; and - if we don't like all of what we see, change.  One of the ways to change is to listen.  Really listen.  Without judgment, opinion, criticism.  Today, let us listen to one other person for three minutes.  What did you learn about yourself by that listening?

Oct 26, 2012

Being Open to New Information

"I am often overgrown with memories and reasons and twigs of mind that block me from the light." Mark Nepo

How often have you been driving and have no awareness of the terrain that has passed?  Or, how often have you been doing something and only to discover that your mind is completely occupied on a different subject.  It is easy to be overgrown with memories and reasons and twigs of mind, and these obstacles keep us from being open to new information.  As Eckart Tolle is so famous for saying, we have only the present moment.  There is no other time.  Too many of us spend a lot of mental time reviewing the past or planning the future.  A little bit of time reflecting on either of these may be good, but not to the extent that most of us dwell on them.  As we go about our caregiving tasks, let us strive to be really present to what we are doing and the person for whom we are doing it.  Both the care receiver and we will benefit from this approach.

Oct 25, 2012

Not Enough Horses

1900's warning to American people:  "In a few years there will not be enough horses in this country to take care of the commercial needs of the country.  Americans, do something about it." Joseph S. Goldsmith quoting the warning

Not enough horses to take care of the commercial needs?!  Within a few years, human's ingenuity had made the need for horses obsolete by devising the internal combustion engine.  Does it ever occur to you that the same fears put out by politicians and others today might be as unwarranted as this one?  The foolishness lies, perhaps, in believing that we can prepare for the future.  Some recent events have made me realize how little I can count on my own future plans, and isn't that a common saying? - - - that, while humans plan, God laughs.  Not uncharitably, I'm sure, would God laugh --- but only at the folly of us humans thinking our wisdom is sufficient for planning the future.  Certainly, we do need to make appointments and make some general plans.  But, to think that this afternoon will unfold as we plan, is folly.  Sometimes it will, and sometimes it won't.  The real lesson here is:  Do not fear.  Trust.  All is well.   

Oct 24, 2012

Our Influence

"Sometimes we are likely to forget what an influence the life of one man or one woman can be.  Insofar as one individual can show forth a measure of health, harmony, inner peace, joy, satisfaction . . . . . . . . ., in that degree, is that person the light of the world." Joel S. Goldsmith

It is easy to forget how we influence others.  Just as in the 100th Monkey Theory the one monkey who washed her food influenced all other monkeys, so too do we influence others by the way we live our lives.  The more we integrate health, harmony, inner peace, joy and satisfaction into our lives, the more we make it possible for all others to integrate those qualities.  I witnessed this demonstration recently in a dear friend who was facing a very challenging life situation, but in spite of her own challenging situation, she was an inspiration and source of hope for all those around her.  Amazing and wonderful to see.  I saw how people's lives were changed because of her graciousness of spirit.  If she can model graciousness in such extreme situations, surely we can model graciousness in caregiving.  It is our choice.  We can be a source of hope, or we can be a source of despair.  Let us choose hope.

Oct 23, 2012


"There's no question that regular exercise reduces the risk of heart disease and diabetes and strengthens bones and muscles, and studies show that if you find a workout fun, you're far more likely to stick with it." Kalee Thompson

Readers of this blog know that I am an advocate for exercise, and I agree with the above statement that if you find the exercise fun, you are far more likely to maintain it.  Many years ago I bought a piece of exercise equipment that looked good in ads.  I found using it tedious, boring, and frustrating.  It soon gathered dust, but from that I learned that buying exercise equipment was probably not a good idea for myself.  I like variety, I like being outdoors, I like group exercise in which one can have fun and lose track of the time.  What do you like?  It is important to consider this because you are far more likely to do it and to stick with it.  I like walking, but not hiking marathons with a group.  I like water aerobics which are fun and done with a group of kind and inclusive people.  I like time alone with nature, either biking or hiking.  I like to do my exercise first thing in the morning, or it tends to fall out of my day.  Think about what you like in the form of exercise, and now:  let's do it.

Oct 22, 2012

Benefits of Chocolate

"A 2012 study found that people who ate chocolate more often actually weighed less -- even though they didn't exercise any more." Beatrice Golomb, M.D.

Ahhh.  A good reason to continue eating the small handful of dark chocolate-covered raisins or almonds.  The above doctor suggests that nutrients in chocolate may plan a role in metabolism, thus helping to offset weight gain.  The study does not say what kind of chocolate, but other sources suggest dark chocolate as having the most health benefits.   Combined with other good health practices like:  overall good nutrition, stress reduction, adequate sleep, relaxation or meditation practices, fun, exercise, relationships which support us:  creating a balance among these factors is a great way to support our own health, especially as we provide caregiving for someone with dementia. 

Oct 21, 2012

Finances and Health

"At first glance, the cost of staying healthy might seem way too high.  Yet, in the long run, maintaining poor health will cost far more."  Rick Kahler, CFP

In saying that staying healthy might seem too costly, Rick Kahler is referring to what a monthly gym membership might be, at $40.  He mentions three ways to stay healthy:  1. exercise  2.  eat a healthy diet  3.  get preventative health check ups.   I agree.  Eating healthy does not have to cost more.  I am sometimes behind people in the checkout stand who have their carts filled with processed and prepared meals.  I would be willing to bet they are spending more on their meals than I do.  I shop the periphery of the grocery store, deviating only for canned goods, frozen vegetables, and laundry supplies.  That means, of course, that I shop mostly in the produce department and some in the dairy and meat.  I do not buy processed foods and choose mostly vegetables, fruits and lean proteins.  Exercise does not have to cost a lot.  There are often specials on during the holiday season, and a local recreation center has a fee of $1.00 for seniors for a daily pass.  Walking is even less expensive; costing only the price of good shoes.  Welcome to Medicare offers preventative screenings free of charge, even colonoscopies.  Please take advantage of them.  

Perhaps those of us who are caregivers for someone with dementia do not need reminders that good health saves money.  We are spending so much money for the care and medicines for the person with dementia that we can see the benefit of being healthy.  I thought recent laws eliminated the "donut hole" cost of prescription drugs, but  I can tell you from experience that it has not.  It is beneficial sometimes to add up what the cost is of living with a terminal and progressive disease.  We can then see clearly that it is justifiable to spend some time and money on maintaining and improving our own health.

Oct 20, 2012

Brain Health

"Harvard researchers studied 16,000 women and found that subjects who regularly ate blueberries and strawberries had brains that functioned as if they were two and a half years younger than non-berry eaters."  Parade Magazine October 14, 2012

As we are caregivers for someone with dementia, it is important for us to protect our own brains.  This research from Harvard is one simple way.  Eat blueberries and strawberries regularly.  Also, if you bike or ski, wear a helmet.  Avoid toxins - to include drugs - that can damage the brain.  Meditate.  Eat a diet of good nutrition, in addition to the berries.  Laugh.  Love.  Enjoy life.  Be happy.  Exercise regularly, especially in a way that is fun for you.  Handle stress by being positive, asking for and accepting support, and relaxation or meditation.  Seek professional counseling if you are unable to handle the stress of caregiving and/or life in general.  These are just some of the ways to take care of yourself. 

Oct 19, 2012

100th Monkey Theory

"Years ago scientists observed on an isolated island a monkey washing her food." Kenn Gordon

As the rest of the story of this theory goes, the next day the scientists reported three monkeys washing their food.  Several days later, 50 monkeys were washing their food, and within a month, 100 monkeys were washing their food.  Then the scientists saw on nearby islands other monkeys begin to wash their food.  These monkeys had no contact with the first monkeys.  Before long, this phenomenon was seen all over the world, and this has come to be called "the 100th Monkey Theory".  This theory is used when a previously rare phenomenon rapidly becomes more common.  It would appear that behavior can spread not just through contact, but also through collective consciousness.  One can see it in many places.  I have read that it takes just one teenager to wear something in Manhattan for it to quickly become the current trend among many.  We can apply this to our living.  When enough of us live lives of kindness, compassion, non-judgment and honor, this can affect the behavior of everyone.  You can be part of the tipping point of the prevalent way of behaving in society. 

Oct 18, 2012


"So, when we slow and open and center ourselves, we breathe in unison with all of life, and breathing this way we draw strength from all of life."  Mark Nepo

Nepo says that if we slow to the pace of creation, truth will sweep in.  Slowing our breathing slows our thinking, and allows us to see the miracles in the ordinary.  Many ancient practices advocate deep and slow breathing, so, too, do modern medical practices.  Our rate of breath is tied to our level of anxiety.  When we breathe deep and slow, we are relaxed.  When we breathe quickly and shallowly, we are anxious.  So, right in our midst we have a tool for relaxation.  Breath.  Relaxation techniques suggest 20 minutes a day of slow breathing can induce deep relaxation.  Yoga practice supports deep and slow breathing.  There may be much about which to be anxious in life, and in caregiving for someone with dementia; but it does not serve us or our health to be anxious.  Notice several times a day if you are breathing deep and slow, or quick and shallow.  Focus on breathing deeply and slowly.  Your body and your mind will benefit.

Oct 17, 2012

Yielding Instead of Breaking

"The hard and stiff will be broken.  The soft and supple will prevail."  Lao-tzu

We have only to look at nature.  Today with significant winds the towering pine trees bend and sway, almost as if dancing.  If they were to stand stiff and rigid, they would eventually fall before the force of the wind.  We can learn from this modeling of nature.  Some people as they get older get more and more rigid in their personality, more rigid in their opinions and habits.  Perhaps those same people are more likely to have arthritis; that is what some who believe in body/mind interaction might say.  Rigid within; rigid without.  Life does have disappointments as the years go by.  So, how do we keep from becoming rigid, which we may think is a protective shell?  Perhaps by recognizing that opinions are only that:  opinions.  Habits of behavior need to serve our well being, or we might consider changing them.  Psychologists say that it only takes 30 days to create a new habit; so if we have habits that are not serving us, we can change them.  For today why not consider creating a new habit to replace a habit that no longer serves us? 

Oct 16, 2012

Self Understanding

"I want to unfold. I don't want to stay folded anywhere, because where I am folded, there I am a lie." Rilke

So many sources tell us that an examined life is the preferred one.  Nepo says we should be like flags where the rips of living let through the blasts of wind too painful to hold.  Of one thing we can be certain, life does contain challenges:  things we might prefer not to experience.  Perhaps being a caregiver for someone with dementia is one of those things.  Having dementia is certainly another.  Even little things -- like the unexpected difficulty adjusting visually to cataract surgery -- can be the events that cause the rips of living in us.  Perhaps part of the secret in living well is to realize what are big events and what are small.  Cataract surgery, while disconcerting in its adjustment, is a small thing.  Dementia, or any other progressive and terminal disease, is a big thing.  Perhaps it is true that in facing the small events, we are better able to prevent the big events from taking us asunder. 

Oct 15, 2012

Family Stress with Dementia

"When a loved one has Alzheimer's disease, family stress is inevitable. To minimize conflicts, address the issues together." Mayo Clinic Newsletter

How true.  When someone develops dementia, family stress is inevitable.  The latest Mayo Clinic Newsletter suggests some ways to help alleviate the stress:  Share responsibility, Be Honest, Do Not Criticize, Meet or Discuss the situation regularly.  Great guidelines, but it is not always possible for all family members to honor these suggestions.  If everyone is helping to share the responsibility of care for the person with dementia, much stress is prevented.  Be Honest:  if you are feeling overwhelmed, be honest but kind in expressing your feelings and your desire for more help.  Do not criticize how the caregiver is doing the job; offer to help instead.  Keep communication open, respectful and direct.  If family members will do these things, much of the stress can be avoided. 

Oct 14, 2012

The Conversation Project
"Talking about dying isn't easy, but it's vitally important. Explore the Conversation Starter Kit and learn how to think about and talk about your wishes for end-of-life experience."

The website cited above is a great resource for having the conversation about how you or someone you love wishes to have their end-of-life experience.  The research states that we, who are caregivers, will have considerably less stress if we know how someone else wants to experience the end of their lives.  It is referred to as the estate of the heart; letting family members know you love them and want to know how they prefer their life ends.  It is also a good website to go to to make your own wishes known.  It is a tremendous responsibility to make decisions for someone else, and this can be made easier if we know what they want and if we have their permission to carry out their wishes.  The website has good information and activities to do that help people get clear about how they want their end-of-life to look.  The information and activities are free of charge.