While it is never the case that the Spy has received a bad answer from our “Ask Irma” host, Irma Toce, we were a bit surprised by her response to our most recent inquiry this month.

Our inevitable question was, in this December of COVID, how do the region’s seniors survive the challenge of not seeing loved ones during the holidays.

Rather than offer tips for planning and envisioning a different kind of celebration, she started our conversation with the simple recitation of lyrics she had found on social media with no author attributed. In listening to it again, we saw no reason not to make this her formal response to the most challenging of challenges for families.

This video is approximately two minutes in length. For more information about Londonderry on the Tred Avon please go here.

I’ve been a Registered Nurse for more than 20 years. As a hospice nurse, I have been up close and personal with death and dying. I’ve held space for patients and their loved ones through difficult and challenging times.

The pandemic, social distancing and hunkering down have given me time to reboot. I’ve reprioritized my life, coming face to face with my own mortality. The possibility of my own death prompted me to update my Advanced Directives and have further conversations with my sons. It has also given me renewed purpose to share my knowledge and experience.

As a hospice nurse, I’ve helped hundreds of people with their end of life experience, ranging from young adults to someone who was 106 years old. Women, men, affluent, poor, from grocery clerks to US Senators, doctors, lawyers, CEOs of multi-million dollar corporations and farmers. Some were better prepared than others and had a more peaceful end of life experience. For those who struggled, the most common denominator was fear.

The fear of death

The sense of fear was palpable when I entered a patient’s home. Family members often said, “I feel like I am signing a death warrant.” They ignored the fact that a disease process was ravaging their loved one’s body. This prevented meaningful conversations which could have helped them understand what their loved one was thinking and feeling and what they wanted. The family and loved ones now had to guess.

Fear adds to the suffering that accompanies death. It causes people to miss the beauty and sacredness of the end of a person’s journey on Earth. To be present and validate a person’s existence is very powerful. Unfortunately, most people miss this amazing experience because they are afraid, unprepared, or too busy with chores. They don’t have the emotional wherewithal to be present. After witnessing this for many years, I made a decision to leave hospice, even though I love that work, to pursue my calling.

Connecting the Dots in Healthcare

I understand that people can’t accomplish all of the important conversations in the last two weeks of life. That’s why I founded Connecting the Dots in Healthcare. It’s a way to help people plan their end of life journey, not their imminent death. It’s a service that provides information and guidance to help people formulate a meaningful end of life plan that reflects who they are. Most people want to avoid thinking about death but those who do make things so much better for themselves and the people they love.

Meeting Tom

When I was a new nurse working the hospital night shift, I cared for a kind, sweet gentleman who was a dialysis patient. I’ll call him Tom. He was in his 70s and had been a frequent patient because dialysis was no longer working. He needed hospitalization to regulate and support the function of his organs which were deteriorating because his kidneys were failing.

One night when making rounds, I noticed that Tom was awake and asked if he needed anything. He told me that he just couldn’t bear the thought of more dialysis treatments. He loved his family and they loved him very much. They needed him to keep fighting.

I asked Tom if he told his wife how he felt. “Oh no, I couldn’t do that,” he said. “That would hurt her too badly.” I asked if he realized why he had so many hospitalizations. Tom said that the dialysis treatments weren’t as effective but I could tell that he didn’t see the big picture.

I looked into his eyes and asked Tom if he wanted to know what it all meant. He nodded. I explained that dialysis had benefited him in the past but now the stress of the treatments and the disease process were causing other organs to fail. I took his hand and explained that none of these treatments were going to restore his health. He wasn’t going back to a normal life. His life was going to be a series of extended hospitalizations with more dialysis treatments and tests until he died. Or, it was possible that he might die during the treatment.

Tom was silent for awhile. I asked if he wanted me to help him have a conversation with his family. He agreed, so arrangements were made with his wife and daughter to visit while I was working. I helped initiate the conversation and Tom was able to take over. There were lots of tears as his family came to grips with reality. This gentle man was finally able to have a meaningful discussion with the people he loved most. When they understood how he felt, they made a decision based on love. This wonderful man went home and was able to enjoy his remaining time without being hooked up to machines or being poked and prodded by strangers. He died surrounded by the people and things he loved.

Several weeks later I received a note from Tom’s daughter. She shared how difficult it was for her now that her father was gone and how sad she was. She was grateful for having that hard conversation. The brief time at home with her father was beautiful with many meaningful conversations. She and her mother had no regrets. They never had to guess whether they made the right decisions because Tom told them what he wanted.

I will never forget that experience. It taught me the power of open, honest communication.

Clara’s story

Working as a hospice nurse years later, one of my patients was a 96-year-old woman with end-stage dementia. We’ll call her Clara. She had been cared for by two of her seven children. She had a very large wound as a result of extended bed rest and she was totally dependent for all of her activities of daily living.

Unfortunately, Clara never talked with her children about her end of life care and now dementia made it impossible. As with many families, caring for an aging parent usually falls to one or two children who make significant sacrifices. They perform every act of care including physical care which can be very taxing.

When Clara was in hospice, the children who never contributed to her care arrived and began challenging decisions. This resulted in verbal altercations which escalated. Family meetings were arranged and some of the members were banned from the hospice house.

This sweet, helpless woman overheard the chaos. How could Clara have peace in this atmosphere? When this lovely woman died, there was so much arguing and turmoil that the police were called.

There is no single answer to prevent this type of situation because people come to situations with their personal baggage. However, if Clara had talked with her children before she became ill, it may have made a difference. If she had a conversation with her doctor and created an Advanced Directive and a MOLST (Maryland Order for Life-Sustaining Treatment), the daughters who cared for her would’ve known what to do and had legal support for their decisions.

Tell your story

These stories are at opposite ends of the spectrum. The common denominator is communication. It’s important to tell your story so that your loved ones know what you want. You can name a person to make decisions when you no longer can. You get to decide what’s important and ensure that the end of your life reflects how you lived.

Our lives are a journey to our death. There is a beginning, a middle, and an end. Along the way, we prepare for everything, from the food we eat to the clothes we wear, the school we go to, the job we take, where we vacation, whether we marry or remain single, who gets our money and possessions … everything but how we want to die.

We are all going to die. Pre-COVID-19, it was fairly easy to forget our own mortality until it was too late. This pandemic has brought the fear that surrounds death out into the open. People are confronted with it every day and it is forcing them to think and talk about it. Fear is not one-dimensional. It is not just fear of death. There is fear of the unknown, fear of pain, fear of letting someone down, fear of unresolved conflicts, fear of saying goodbye, and fear of dying alone.

Education usually helps to assuage fear. When something is understood there is a sense of control. Take the time now to have important conversations with the people who will carry out your end of life wishes. It will help you and is a very thoughtful gift for them.❖

Coming up in part two: Why it’s difficult to talk about death and plan the end of life plus documents to make the process easier.

Dot Mayorga has been a nurse over 20 years serving the residents in Caroline, Dorchester, Talbot and Queen Aanes counties. She has worked as a medical- surgical nurse in Easton Memorial Hospital, a case manager Home Health, Hospice nurse with Shore Health, and Wound Care nurse with Shore Regional Health System. She currently is a triage nurse with Choptank Community Health Services.

Just as exercise is touted to be beneficial for young and old alike, it has also been proven to be especially beneficial to those with Parkinson’s Disease (PD). This neurodegenerative brain disease is characterized by various movement disorders including tremors, rigidity, stiffness, slowness of movement, poor balance, stooped posture, a shuffling gait and periodic freezing.

The Parkinson’s Foundation specifically recommends at least 2.5 hours of vigorous exercise per week, which can improve balance, flexibility and inflammation. It has also been shown to improve neuroplasticity, the brain’s own way to adapt to changes. It is a natural re-education of the neurons to modify messages received by the brain. Learning new exercises, like learning a new language or mastering puzzles, are all techniques used by those who are aging, as well as those with neurological conditions like Parkinson’s.

Forced Intense Exercise is proven to be the best way to slow PD symptom progression and create these new pathways to the brain.  Rock Steady Boxing (RSB) is a perfect example of this prescribed intense movement.  It is a non-contact fitness program designed specifically for people with PD.  Founded in 2006 by a young onset patient who wanted to challenge his disease, its origin comes from his personal regimen designed by a boxing trainer.

Why boxing?  According to RSB national headquarters, “Boxers condition for optimal agility, speed, muscular endurance, accuracy, hand-eye coordination, footwork and overall strength to defend against and overcome opponents. At RSB, Parkinson’s Disease is the opponent. Exercises vary in purpose and form but share one common trait: they are rigorous and intended to empower people with PD to fight back.” Besides being fun and socially engaging, the program has other reported benefits including increased independence and confidence as well as the many physical improvements.  By the way, the RSB logo of the Statue of Liberty embellished with a boxing glove, was RSB’s founder (Steve Newman) idea: “The inscription on the statue combined with the hope she symbolizes echoed his dream that Rock Steady Boxing would be the beacon of light and hope for those suffering from Parkinson’s disease.”

In order to bring this awesome program to the shore, a partnership was formed between the YMCA of the Chesapeake (Wendy Palmer, YMCA Associate Executive Director); 360 Strong (Lynn Sutton, Owner and RSB Coach); Maryland Assoc. for Parkinson’s Support & the Wells Foundation (coordinator Jack Harrald) and Bayleigh Chase-Acts Retirement Community (Me-Susan Covey, Fitness Director and RSB Coach).  Our group created two Rock Steady Boxing classes offered live pre-COVID at the Y@Washington St. and in Grasonville.  We are currently hosting our classes on Zoom, free of charge to participants twice a week!

Those of us who have become coaches are trained professionals with a clear understanding of PD.  We work with our boxers on specific skills to improve footwork, coordination and strength.  We understand the hesitation some participants may feel and the limitations before beginning a workout program. But, as coaches, we stress the positivity of commitment and emphasize how stretching, strength building and agility all help with motor control and with building those new brain connections to help slow the disease progression.

Personally speaking, as one of the coaches for our local RSB class, I can think of an endless number of adjectives to describe my boxers, my everyday heroes… those who deal with the degenerative disorder of Parkinson’s Disease. Here are just a few:  strong, focused, tenacious, dedicated, supportive, positive, hopeful and fun-loving!

If you are living with Parkinson’s Disease and are looking for a program which addresses all facets of exercise, that will give you social interaction (yes, even on Zoom!), teach you to walk better, fall better, get up and down more safely, increase your body’s rotational abilities, help with your voice activation and give you an opportunity to punch out Parkinson’s and have fun doing it, RSB is the answer! Please contact feel free to contact me at susan.covey@actslife.org for more information.

Susan Covey is the Rock Steady Boxing Coach and Fitness Director for Bayleigh Chase, an Acts Retirement Community.

 

Unlike many who reach retirement age, former nonprofit executive Janet Pfeffer knew precisely what she wanted to do when she stepped down. Motivated in keeping herself in good physical shape, Janet thought the best way to achieve that goal was to become an exercise instructor herself. And in no time at all, she was hired by the YMCA of the Chesapeake to teach her fellow seniors the best way to keep an active lifestyle.

That was ten years ago, and since then, Janet reached such popularity that she added classes at the Londonderry retirement community and the Oxford Community Center. In addition, she hosted a series on the Spy entitled “A Fit Retirement,” where she interviewed her fellow exercise enthusiasts about their daily routines. With all these activities, Janet not only was maintaining her own health, but she was “self-actualizing” in a way unimaginable to her when she started this second life of hers.

But last year, something happened that changed all that. While walking with a friend, she took a misstep on the trail and fell. Unable to get back up, Janet immediately realized that a serious event had happened and soon afterward learned she had seriously broken her hip.

In her Spy interview, Janet talks about that experience and the gained perspective that resulted from the painful and, to her mind, humbling incident. She recounts those early days of shame stemming from the thought of a teacher of so many finding herself a victim of an accidental fall, but also remarkable resilience she saw in herself and the importance of her friends and support network that made it possible to come back stronger and more confident.

This video is approximately four minutes in length. Janet Pfeffer is back at work at the YMCA. For more information about her classes please go here.

While the news is filled these days of organizations and social groups slowly coming back to life as the country adjusts to a new “normal”  world brought by COVID-19, there is at least one segment of the population that won’t be coming back anytime in the near future. Those would be the hundreds of Eastern Shore seniors that used the several senior centers sponsored by Upper Shore Aging and other agencies in many of the small communities on the Delmarva.

What once had been gathering places for social contact, warm meals, exercise classes and card games have now turned into empty facilities since Maryland’s “stay-at-home” orders in March of this year. And while many of these centers continue to provide such essential services like Meals on Wheels and health information to the aged, centers like the Brookletts Place in Easton,

The Spy talked last week with Childlene Brooks, who manages Brookletts Place for Upper Shore Aging to discuss the impact the coronavirus has had on her facility and the heartbreaking separation she and her staff are experiencing with the countless patrons that consider the Talbot County senior center their second home. Childlene also talks candidly about the current lack of guidelines that would allow Brookletts to open its doors again anytime in the near future.

This video is approximately four minutes in length. For more information about Brookletts Place please go here 

 

It’s understandable if your exercise routines and self-care habits have been placed on the back burner in this new era of COVID-19.  Several months into this new reality, most of us are now ready, or even borderline desperate, to reestablish a healthy routine!

You may be feeling a bit off. Why, you ask? Our brain includes a system that contributes to daily wellbeing. It is the body’s internal biologic clock. It keeps our body and behavior synchronized with the 24-hour cycle of light and dark.  Predictable routines keep the body’s internal clock running smoothly and help us feel better. However, in times of major upheaval, we may have trouble resetting these biologic rhythms. Try the following tips for 21 days (that’s how long it takes to make a routine a habit) and see how much better you feel!

1. Forget the old and accept the new. Adapt to change and let go of your desire to go back to how things once were. Change helps us grow and become stronger. Also take comfort that everything happens for a reason.
2. Reflect on what is true for you now and create structure around your current reality.  Look at your current schedule and to-do list.  What has changed?  It helps to write down your priorities.
3. Wake up and go to bed at the same time every day.  This stabilizes your body clock and maintains natural rhythms.
4. Make sure you spend some time outdoors every day, especially in the early morning if possible.  Again, your body clock is regulated by the light-dark cycle.
5. Get your daily dose of vitamin D. If you can’t go outside, try to spend at least 2 hours by a window.
6. Plan the day ahead. Set times for a few regular activities each day. Write it down.
7. Be consistent with mealtimes. Eat meals at the same time every day, even it’s just a small snack.
8. EXERCISE EVERY DAY!  Walk, take a strength class or yoga, work out in the fitness center, or try something new and different. 

As someone with 30 years of experience in health and fitness, I can assure you exercise is vital to re-establishing a healthy routine. You must fight for the life that you want! It’s not enough to say you’ll exercise three times a week.  Mark your workouts on your calendar as you would any other appointment, even set a reminder on your phone.  

Obsess less about the frequency and volume of exercise and focus instead on variety. Mix it up! Variety prevents overuse injuries caused by doing the same movement over and over again. Consider adding strength training to your cardio routine. Studies have shown individuals who do both aerobic and resistance training have a lower risk of obesity. Don’t stress about the length of your workout. Frequent, short sessions of movement work very well. 

Release the all-or-nothing attitude and embrace good enough. The imperfect workout you complete is better than the perfect one you never started!  Strategize what to do when your plans fall through. If you’re too tired for the 20-minute walk, do a shorter walk instead.  

Finally, make each day a little different but always keep activity in it. 

REMINDER:  We are dealing with a virus that attacks the lungs.  Exercise leads to more durable, resistant lungs to help fight the pandemic.

The Spy is pleased to welcome Susan Covey as a regular contributor to the Spy.  She is the Fitness Director at Bayleigh Chase in Easton and has 30 years of experience in health and fitness. She was previously Director of Health and Fitness for about 20 of those years. Susan has a B.A. Sociology and is a certified senior fitness specialist, exercise therapy specialist and FallProof! instructor. She began at Bayleigh Chase as a personal trainer and continues to update her education to develop, modify and enhance her fitness program to keep older residents active and healthy.

 

It has taken some time in America to realize that there are far more choices than merely working or being retired. In the last few decades, those of a certain age, particularly those over 55 years old, are plotting their path for their later years rather than a limited binary selection.

This phenomenon shows up in the extraordinary number of people who have elected to keep working even though they may have saved enough for retirement. Be it a part-time job, starting a consulting firm, or redirecting their professional skills to non-profit organizations for causes they believe in, many see a new definition of being “active” rather than quickly settling into a traditional retirement.

The same can be said for housing.

Thirty years ago, there were very few choices for senior adults. The first was to keep the house one had, including the ongoing maintenance of a home that had long outlived its purpose of accommodating a growing family. Another was to move into a retirement community, which offered first-rate facilities but also tended to classify residents of being very senior citizens. Finally, there was the choice of renting an apartment but came with the loss of homeownership.

This limit in choices hs eventually given rise to the concept of the 55+ communities where more and more adults are finding a better solution.

According to recent data compiled by TRI Pointe Homes, over 32 million “boomers” will consider these age-restricted communities. Starting in Canada on Vancouver Island in 1987, this new approach to residential living started to become popular in the United States, and now close to 400 of them exist today.

The Spy was curious about this option since these communities have also grown in popularity on the Mid-Shore, and particularly in Queen Anne’s County. We sat down with Kathy Bernard, the manager of Bay Bridge Cove at the foot of the Bay Bridge, to understand in more detail what these communities have to offer.

This video is approximately for minutes in length. For more information about Bay Bridge Cove please go here.

Beyond the physical threats of COVID-19, the one that many people are experiencing, particularly those of a certain age, is the profound sense of aloneness and social isolation.

Feeling trapped in one’s home, and missing family and friends, seniors are increasingly confronting the symptoms and the realities loneliness on a scale never seen before the coronavirus crisis began last spring.

Given these circumstances, the frequent question asked of Irma Toce, CEO of Londonderry on the Tred Avon, is how to keep active in this strange time of COVID-19 for seniors as well as their adult children.

 

This video is approximately five minutes in length. For more information about Londonderry on the Tred Avon please go here.

From March 15, when the coronavirus crisis canceled our regular “Ask Irma” monthly interview, the Spy hadn’t actually heard from Irma herself. Given that her day job is being the C.E.O. of Londonderry on the Tred Avon, we realized she had many things on her mind, but that didn’t stop a certain worry for her and her community of close to 200 hundred residents that call Londonderry home during a major pandemic.

So it was with great relief that the Spy and Irma finally sat down last week to continue our conversations on aging that we heard everything was ‘a-ok’ on Port Street in Easton. In fact, since COVID-19 hit the United States, Londonderry (knock on wood ) has not had one single case of the virus.

But that didn’t end Irma’s challenges as she and her team found ways to maintain a sense of a community for residents that would not be able to leave the houses for many months to come.

In our latest installment of Ask Irma, we talk about Londonderry’s response to COVID and the importance of staying in touch throughout the day with those in the hood.

This video is approximately three minutes in length. For more information about Londonderry on the Tred Avon please go here.