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wayne stephen
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Location: Western Kentucky-Climate Unpredictable Zone 6b
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People care , of course , must include elderly people . The word "elderly" triggers a train load of definitions and cultural references . Mick Jagger sang "What a drag it is getting old !" . I , for one , am looking forward to it . What is the alternative ? Die young and make a good looking corpse ? I am already past that stage . Might as well follow through with it . So , while we permies are planting our food forests and envisioning the first forest crescendo fifty years in the future we had best envision our human forest through the generations also .
A food forest or any sustainable project must by definition become intergenerational . The real yields with minimal inputs will be achieved by our children and grandchildren . Will they want to stay and continue our efforts ? Are we making that attractive to them ? Will your kids want to care for you when you are aged and less productive ? How will we care for our parents ? What kind of world are we making for ourselves to age in ?
At this present time our societies default system for an aged parent is the nursing home . Keeping an elder at home can be exhausting and impossible without a team effort from the extended family . By the time we reach middle age we our up to our necks in careers and income production . We cannot stop our overly busy lives without going bankrupt it seems . Obviously permaculture speaks to that . We will need wiggle room in our most productive decades in order to keep Mom and Dad within our own circle .
I believe I have something to share with you about this topic . I have been a long term care nurse for nearly 23 years . I know of some fine alternatives to the traditional nursing home . I would like to read of your efforts to keep your parents and grandparents well at home or integrated into the social fabric . What does your culture believe about aging and an elders place in society ?
The society we create today is the society we hopefully will grow gracefully aged in . The problem is the solution . Logically therefore , aging must not be a problem but a direction for all to go purposefully and fearlessly . What says you ? Onward Crew !
 
Michael Forest
Posts: 81
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I and others have touched upon this dilemma under "aging in place". What your talking about is something which is derived from a culture's soul. Unfortunately the United States doesn't have reverence for the elderly as part of it's foundation. Here is an excerpt from a recent Bill Moyers program,interviewing David Suzuki:

BILL MOYERS: Don't you think that we hope to grow old but dread old age?

DAVID SUZUKI: Well, yes. I mean, no one, I called myself an elder reluctantly. But having seen the role of elders in First Nations communities, it's something that I now feel very proud to say I am an elder. Elders in a First Nations community, go to a feast or an event, when an elder walks in the room they're like rock stars, you know. They're the repository of all of that long traditional knowledge that's been again hard won over thousands of years. And that is passed on.


Contrast that with our main modern concern about aging - economics. People are worried about being able to afford the nursing home (if needed), let alone even beginning to think about what it,the nursing home, symbolizes and says about our society.

It's good you bring this topic up. It is a long evolving process which involves a sense of community and deep understanding of place as well. It will take more than a few generations to begin to take root here. If we don't strive to move the discussion into the realm of public discourse there won't be much of a chance for aging to gain true value.

As Wendell Berry was asked ( in a interview with, I think, Naomi Klein) about how do we Americans who live so much through our computers find true home. His reply was to find a place and begin the thousand year process.
 
Landon Sunrich
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Location: Western Washington
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This is one of about a million things which has drawn me to permaculture. Let me sound incredibly conservative here for a second. I think that the dissolution of traditional family structure has had major often negative effects on our society. I really don't like the idea of fragmenting family and outsourcing the responsibilities to others. From raising kids to taking care of elder family members. Its these sorts of social bounds which I believe have largely defined us (and many high order mammals) as a species. And I think it has been to our detriment that we've outsourced these and in effect estranged ourselves from our families, clans, and natural life cycles and basically turned quality of care into a commodity.

My mom lives just up the street*. And while she is still in her prime, each year the ages roll and she is less and less able to 'do everything'. For me being within walking distance to help out whenever she needs wood split, heavy lifting done, her dog watched for the weekend et cetera is a high priority for me. She certainly isn't in possession of a vast fortune which would make her capable of hiring a pool of servants to do it for her. And whenever I have a surplus of eggs or get a major score mushroom hunting she is always the first beneficiary. Nutrition is important to aging well I believe.

So I live where I always have lived and try to take care of those who have always taken care of me. This seems so simple and it seems like a model that has trationally worked and been successful, but in modernity the powers that be .... (rant rant rant rant rant rant rant)

Anyhow - This seems SO common sense to me. I am shocked how many mechanisms our currant 'culture' has put in place to make this sort of thing excedingly difficult. In part, I think, of what has been a pretty successful (and detrimental) attempt to monetize everything.


Edit: *Our properties are actually contiguous, I can get there without even using the public road
 
wayne stephen
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Location: Western Kentucky-Climate Unpredictable Zone 6b
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A quandry awaits those of us who have chosen to live and heal ourselves outside the norm . Those choices we make may not be available to us if we slip into a delirium or become mentally feeble . Do you prefer to heal yourself with herbs and food ? Actually those choices are not readily available to cognitively impaired adults . Medicare and Medicaid , most or all health insurance companies do not pay for those alternatives . No long term care facilities offer wholistic treatments or diet . Your loved ones may be accused of elder abuse by withholding conventional treatment from you .

Here is a sample of an Advanced Directive . I have seen many of these , this one is very thorough . As you can see , it offers little in the way of communicating a desire for alternative medicine and therapies :


I, _____________________________________________________________, write this document as a directive regarding my medical care.

In the following sections, put the initials of your name in the blank spaces by the choices you want.

PART 1. My Durable Power of Attorney for Health Care
______ I appoint this person to make decisions about my medical care if there ever comes a time when I cannot make those decisions myself. I want the person I have appointed, my doctors, my family and others to be guided by the decisions I have made in the parts of the form that follow.

Name: ______________________________________________________________________________

Home telephone: ____________________________ Work telephone: _______________________

Address: ____________________________________________________________________________


If the person above cannot or will not make decisions for me, I appoint this person:

Name: ______________________________________________________________________________

Home telephone: ___________________________ Work telephone: ________________________

Address: ____________________________________________________________________________


______ I have not appointed anyone to make health care decisions for me in this or any other document.

PART 2. My Living Will
These are my wishes for my future medical care if there ever comes a time when I can't make these decisions for myself.

A. These are my wishes if I have a terminal condition
Life-sustaining treatments

_____ I do not want life-sustaining treatment (including CPR) started. If life-sustaining treatments are started, I want them stopped.

_____ I want the life-sustaining treatments that my doctors think are best for me.

_____ Other wishes _________________________________________________________________________

Artificial nutrition and hydration

_____ I do not want artificial nutrition and hydration started if they would be the main treatments keeping me alive. If artificial nutrition and hydration are started, I want them stopped.

_____ I want artificial nutrition and hydration even if they are the main treatments keeping me alive.

_____ Other wishes _________________________________________________________________________

Comfort care

_____ I want to be kept as comfortable and free of pain as possible, even if such care prolongs my dying or shortens my life.

_____ Other wishes _________________________________________________________________________

B. These are my wishes if I am ever in a persistent vegetative state
Life-sustaining treatments

_____ I do not want life-sustaining treatments (including CPR) started. If life-sustaining treatments are started, I want them stopped.

_____ I want the life-sustaining treatments that my doctors think are best for me.

_____ Other wishes _________________________________________________________________________

Artificial nutrition and hydration

_____ I do not want artificial nutrition and hydration started if they would be the main treatments keeping me alive. If artificial nutrition and hydration are started, I want them stopped.

_____ I want artificial nutrition and hydration even if they are the main treatments keeping me alive.

_____ Other wishes _________________________________________________________________________

Comfort care

_____ I want to be kept as comfortable and free of pain as possible, even if such care prolongs my dying or shortens my life.

_____ Other wishes _________________________________________________________________________

C. Other directions
You have the right to be involved in all decisions about your medical care, even those not dealing with terminal conditions or persistent vegetative states. If you have wishes not covered in other parts of this document, please indicate them below.

__________________________________________________________________________________________

__________________________________________________________________________________________


PART 3. Other Wishes
A. Organ donation
_____ I do not wish to donate any of my organs or tissues.

_____ I want to donate all of my organs and tissues.

_____ I only want to donate these organs and tissues: ___________________________________________

_____ Other wishes _________________________________________________________________________

B. Autopsy
_____ I do not want an autopsy.

_____ I agree to an autopsy if my doctors wish it.

_____ Other wishes _________________________________________________________________________

C. Other statements about your medical care
If you wish to say more about any of the choices you have made or if you have any other statements to make about your medical care, you may do so on a separate piece of paper. If you do so, put here the number of pages you are adding: _____________

PART 4. Signatures
You and two witnesses must sign this document before it will be legal.

A. Your signature
By my signature below, I show that I understand the purpose and the effect of this document.

Signature ________________________________________________________ Date ____________________

Address ___________________________________________________________________________________

B. Your witnesses' signatures
I believe the person who has signed this advance directive to be of sound mind, that he/she signed or acknowledged this advance directive in my presence and that he/she appears not to be acting under pressure, duress, fraud or undue influence. I am not related to the person making this advance directive by blood, marriage or adoption nor, to the best of my knowledge, am I named in his/her will. I am not the person appointed in this advance directive. I am not a health care provider or an employee of a health care provider who is now, or has been in the past, responsible for the care of the person making this advance directive.

Witness #1

Signature ________________________________________________________ Date ____________________

Address ___________________________________________________________________________________

Witness #2

Signature ________________________________________________________ Date ____________________

Address ___________________________________________________________________________________



Obviously , this standardized form will need a little tweaking to assure you continue recieving your prefered treatments while temporarily or permanently impaired .
 
wayne stephen
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Many , many elderly people live their lives at home either independently or with family . However , the vast majority that live in nursing homes are there due to functional losses , not advanced medical problems . They need assistance with transfering from chair to bed , bathing , eating , incontinence . Families {or intentional communities} could certainly learn these skills in no time . Though ,as I said above , nursing homes are still the default choice available when a person is no longer able to care for themselves . These institutions are very generic with little variation in their models . Very little .
In the 1990's Dr Bill Thomas created the Eden Alternative . This was a model to change the psycho-social enviroment of nursing homes . There is no funding for this , and the nursing home can not be reimbursed for these changes . The model is inspiring but has not produced a revolution in nursing home enviroments . Here is a link :

http://www.edenalt.org/about-the-eden-alternative/

The Eden Alternative is a way to restructure existing conventional long term care institutions . Dr Thomas then created the GreenHouse Project . These facilities are the Eden Alternative built from ground up . They do not resemble a nursing home in any way . In architecture or management . They are intentional communitities for the aged . Here is a link to the wiki page :

http://en.wikipedia.org/wiki/Green_House_Project

And the youtube video :

https://www.youtube.com/watch?v=l4Ap1ByNgKE

 
wayne stephen
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Posts: 1793
Location: Western Kentucky-Climate Unpredictable Zone 6b
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If you tour a conventional nursing home for the purpose of placing your eldered parent or for yourself you will be greeted by an admissions coordinator who will steer you through the facility . That person will be promoting the services available and hoping you choose "us" . I am not condemning the nursing home as it is . It is an institution that presently provides a place that the rest of society does not seem to be stepping up to. However , a conventional nursing institution is an institution at best . A trade off occurs between the individual and the institution . "We" will meet many of "your" needs but "you" will have to surrender a portion of "your" individuality to the institutional process . This frustrating process begins from moment one upon entering the facility . Most people react to any insane enviroment in which they have no control over by becoming depressed , anorexic , agressive , agitated . The default method for dealing with these personality changes is to medicate the individual not change the enviroment . However there are a few shining stars { as in my post above } trying to create institutional changes .

Naomi Feil is a social worker who created Validation Therapy . A system of communicating with cognitively impaired / demented individuals with the intent to enhance their life . As opposed to making it easier for the institution to cope with your reactions to it . Here is an example of her at work:

https://www.youtube.com/watch?v=CrZXz10FcVM

Then a program using ipods to stimulate the mind and memories of a an elder obviously reacting to the effects of institutionalization :

https://www.youtube.com/watch?v=NKDXuCE7LeQ

Carry On , Crew !
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