Looking "Up"

On a recent cross-country flight, I enjoyed the opportunity to watch Disney/Pixar's most recent animated feature, "Up." The main character, Carl, is an elderly and childless man who, upon losing his wife Ellie with whom he'd led a long and happy life, finds himself being forced out of their beloved little house and into a retirement home when he is deemed a "public menace." He and his wife had an unfulfilled, lifelong fantasy of moving to a place called Paradise Falls in South America, and on the day the staff from the retirement home come to take him, Carl ties hundreds of balloons to his house and flies away in pursuit of his and Ellie's dream. Once in the air, he realizes he's accidentally taken along a neighborhood boy, Russell, who had been on his porch attempting to earn a merit badge for "assisting the elderly." The movie is focused on the adventures that Carl and Russell experience while in South America (and I won't spoil the plot, for those who haven't seen it!), but it brought to light some issues and themes about which I often reflect both as a professional geriatric care manager, and as a person who cares deeply about the inner lives of our elders.

Carl is a cantankerous old grump of a character, and Russell is a loud, high-energy schoolboy and "Wilderness Explorer" scout. Through the course of their journey, we learn that Russell is being raised by his single mother, and wishes he spent more time with his re-married father. Russell eventually endears himself to his aged traveling companion, and a deep friendship is born. They learn about the world and about life from one another, and fulfill important roles in each other's lives. It is a sweet demonstration of the value of intergenerational relationships, and I hope that "Up's" younger audiences will internalize this lesson and seek out friendships with the elders in their communities, and value time spent with their own parents, grandparents, aunts, and uncles.

When Carl and Russell's balloon-powered house lands in South America, they realize that they've made it close to Paradise Falls, but have an arduous journey ahead of them, to relocate the house to the precise spot about which he and Ellie had dreamed. When faced with a difficult choice, Carl comes to the realization that "it's just a house." Until then, he had been very focused on it, and the things therein, as essential to his happiness and to the fulfillment of this particular dream. This brings to mind the complex relationship that many elders have with their family homes, as symbols of independence and a source of connection to memories and former roles and relationships. For my own grandmother, leaving her house meant not only accepting a new type of dependence on others, but relinquishing an important role - her home would no longer be the gathering place for celebrations and holidays, and she would no longer be able to provide a warm meal or a bed for visiting friends and family. Warm hospitality was a central feature of my grandmother's character, and looking back with hindsight, I wish we'd found more ways as a family to continue to foster that part of her after she moved into her assisted living apartment. For my grandmother, and for many others, letting go of her house felt like a loss of independence, but was in reality only a shift to a new type of interdependence.

The most important message I received from "Up" was that setting goals and achieving dreams is an ongoing process that should take place throughout our lives. Carl and Ellie had dreamed of children - and did not have them. They had dreamed of Paradise Falls - and did not get there. But they adapted to their circumstances, set new goals, and lived a happy and full life together. When things are looking grim in South America, Carl finds a message that Ellie had left for him before her death, which reads "Thanks for the adventure - now go have a new one!" and is renewed in his efforts. Carl's dreams of a life in South America with his beloved Ellie were not realized, but through the journey and his friendship with Russell, a new purpose for his later life was revealed. We see this in our work with our clients, and know it to be true: we are always growing, it is never too late to set and achieve goals, and there is purpose in every moment lived.

Our Greatest Teachers

Last Thursday September 17th, we celebrated five years of service to San Diego County with several dozen of our friends and colleagues from the community. We enjoyed a beautiful late-summer evening on the promenade in Liberty Station, with food, wine, networking, and our delightful guest speaker, Marsha Kay Seff.

When we created Elder Care Guides in July of 2004, our goal was to design a care management system that does more than simply respond to the needs of the aging population. A skilled care manager can assess an unrecognized need before it becomes a crisis, and we have worked hard to remain flexible and nimble in the face of the constantly-changing needs of our clients and their representatives, and as the larger landscape of long term care undergoes significant changes. We provide services with a spirit of support and collaboration, and our community has responded.

When I asked Marsha to speak on the topic of the hidden powers of elders, she replied with the question, "What is hidden about their powers?" Through beautiful stories about her own parents, as well as the others she has had the good fortune to know through her quarter century of working and writing in San Diego's elder care community, Marsha painted a portrait of "geysers" (not "geezers") who continue to learn and teach, volunteer and contribute in their communities, participate politically, and leave important legacies to their families.

Through the years, we have learned that the challenges of aging are not something to be simply "managed," but that they are a gift, a set of strengths and resources from which we and our clients can learn and continue to grow. We thank everyone who joined us for being a part of an evening that was very special to all of us, and held those who could not be with us close to our hearts.

The Giving and Receiving of Care

On Tuesday afternoon, I made a home visit with a gentleman who has been a client of ours for nearly two years, and who has bonded deeply with his companion caregiver. As he described to me his gratitude for all of her assistance over the time that she's worked with him with tasks like bathing, preparing meals, and accompanying him on daily walks, I perceived his sense that the giving and receiving of care was a one-way street. I turned to his caregiver, and asked her to tell us something about what she has received during the time that she has been working with him. She told us about all of the things she has learned about San Diego from this client (an avid historian), her new appreciation for the beauty of a Protestant religious service (she is Catholic, but attends church with him at his chapel every Sunday), and about how much her English (which is her second language) has improved over the 18 months that they have been working together. Although her English is nearly grammatically perfect, she told him early on in their relationship that she was working to further improve it, and asked for his help when he noticed improper pronunciation or usage. She told us how invaluable she has found his assistance in this regard, how much she appreciates his kind ways of correcting her and teaching her about some of our language's oddities.

This struck me as an important lesson for us all, and brought to light a concept that is well-illuminated by William Thomas, M.D. in What Are Old People For?, his groundbreaking 2004 critique of the American long-term care system. He writes that "... the bulk of the suffering experienced by those confined to long-term care environments is due to the plagues of loneliness, helplessness, and boredom," and calls for a radical transformation in not only the provision of care but our deeply held beliefs about aging. The antidote to helplessness, according to Dr. Thomas, is the opportunity to give as well as to receive care. 

I watched my client's face light up in a huge smile as the caregiver spoke that afternoon, and knew that he was seeing for the first time the positive impact their time working together has had upon her as the care giver, as well as himself as the care receiver. It gave me a chance to reflect on the ways that we as care managers, and all of us who care about an older person, can create opportunities for late-life development. The moments are all around us.