Holy Trinity Eastern Orthodox Nursing Home

By Fr. Nicholas Apostola

OVERVIEW

The Holy Trinity Eastern Orthodox Nursing Home is expected to open in early summer 1994. It will be a 113-bed, level 2, facility. In addition to the usual nursing home amenities, Holy Trinity will have an Orthodox Chapel that will help to provide its distinctive character. The entire cost of the project is currently estimated at around $7.5 million. The project is being financed with HUD secured notes and with an expected capital infusion from donations by faithful that should total $2 million within two years of opening. Current fund raising has yielded $750,000 in pledges (of which $550,000 has been paid); $100,000 in miscellaneous donations; and $150,000 in outstanding loans to the member parishes of the Council of Eastern Orthodox Churches of Central Massachusetts (CEOC) which is the parent body of the project. The Nursing Home Board of Directors (21 persons appointed from the member parishes) has contracted with a nursing home management/consulting firm to administer the home at least through its critical first three years of operation. This will be the first pan-Orthodox nursing home in North America, the result of the cooperation of Orthodox parishes from various jurisdictions in a common venture.

BACKGROUND

The nursing home project is the latest in a long line of successful joint activities by the Orthodox parishes of central Massachusetts through the Council of Eastern Orthodox Churches (CEOC). The CEOC was formed in the early 1950s. Its major focus then was the annual celebration of a pan-Orthodox Liturgy, usually on the Sunday of Orthodoxy, with an invited hierarch of one of the jurisdictions of the member parishes. This remained the focus until the Council went into a dormant period in the late 1960s. It was revived in the late 1970s, but with an expanded focus. While the liturgical concelebration remained the axis around which every other activity rotated, the member parishes decided that they wanted to cooperate in other ways as well. Some of these include: joint retreats, both for adults and youth; a regular Sunday morning radio program; concelebrated, rotating Presanctified Liturgies during Great Lent; a fall lecture series; an Orthodox cemetery; and an emergency food pantry servicing 300-500 persons weekly. The CEOC’s membership includes all 12 canonical Orthodox parishes in central Massachusetts, representing 4 jurisdictions.

It is with this history of cooperation, then, that the CEOC began exploring the establishment of a nursing home. Initial investigations were made in the mid-1980s, but the nursing home industry environment, the amount of capital that would be required at the outset, and the climate within the parishes all tended to argue against so ambitious aproject. The idea was placed on the back-burner for a number of years. In the winter of 1989 a nursing home that was being closed came up for sale. The attractive feature was that it was empty but still had an active license.

The CEOC agreed to purchase the home (and the license, which was the most important aspect) for $1 million, and planned to renovate and expand the existing structure for another $4.5 million. After over a year’s negotiation with the owner of the nursing home around the issue of financing, the CEOC was unable to come to a final agreement with the owner. However, during the intervening time, the CEOC had had the license transferred to the Holy Trinity corporation that had been formed by the CEOC, and it was decided to move to a new site and begin new construction. It has taken almost four years from the initial offer to the beginning of construction. With God’s grace, the Holy Trinity Nursing Home will open more than five years after the initial decision was made by the parishes to embark on this project.

SOME THINGS TO CONSIDER

1) The nursing home industry is extremely complicated, heavily regulated by both state and federal authorities, and financially precarious. No attempt to begin a project such as this should be made without expert advice. This means lawyers, accountants, and consultants who specialize in nursing homes.

2) A project such as this will require the joint cooperation of many parishes. It cannot be done by one parish alone. The needed capital resources alone are staggering. Also, this kind of project cannot be the first attempt at pan-Orthodox cooperation in a region. As mentioned above, the CEOC had a 30-year history of cooperating before endeavoring this.

3) A great deal of educating to the need for a nursing home must be done within the parishes before starting. This idea was talked about for years in the Worcester area before any specific plans were proposed. This should included surveys, lectures, and presentations by professionals.

4) The people involved in organizing the project need to be (a) faithful Christians; (b) professionals involved in business, government, social services, accounting, or law (at least a portion of the organizers need to be this); and (c) in touch with the mood and politics of their respective parishes.

5) Prayer is absolutely critical. The greatest strength of the cooperation in the CEOC is that it is liturgically centered. A number of times the entire project was in serious jeopardy. Its failure would have resulted in the loss of over a million dollars. Special prayer services were held and petitions were added to the liturgies celebrated in the parishes. That we have gotten this far, that the home is being built and will open, is a miracle for which all of the faithful in central Massachusetts are cognizant and grateful to God.

SOME THINGS TO REFLECT UPON

The whole Church in America has reached a new stage in its presence and mission. The Holy Trinity Eastern Orthodox Nursing Home reflects two aspects of this new stage. The first is that the Church has always conceived of its role as providing both material comfort to those in need, as well as spiritual nourishment. St. Basil founded orphanages, hostels, hospitals, and homes for the aged. It is a sign of our maturity that we can now undertake projects such as these. The second is that a united Orthodox witness in America is being built at the local level as well as at the national level. The faithful from various parishes and jurisdictions can and want to cooperate, if given the opportunity, there are many ways to build the whole Church together, but prayer and worship must remain central.

For More Information

If you are seriously considering a project such as this, you should contact us directly for more information and assistance. If you just want more information on the project, you are also welcomed to contact us, at:

Holy Trinity Eastern Orthodox Nursing Home
P.O. Box 195
Worcester, MA 01614-0195
(508) 754-8000

Fr. Nicholas Apostola is Pastor of St. Nicholas Romanian Orthodox Church in Worcester, MA. He is a member of the Eastern Orthodox Council of Churches of Central Massachusetts and a member of the Massachusetts Commission on Christian Unity.

Home Health Care Services

By Nadia Koblosh

The Orthodox elderly, like all senior citizens, and the people who care for them when they become ill or infirm, find they need guidance in knowing what medical and health care services they may be eligible to receive. Senior citizen groups in the community often invite speakers to their meetings to talk on health care subjects.

The local parish is another place that can be helpful to the elderly by providing opportunities for programs, speakers and videos to help answer common questions of a medical, financial or legal nature. When such programs are sponsored in the parish, seniors often feel freer to talk about the given subject and ask questions as they are in more familiar and trusted surroundings.

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Parishes can invite in professional people from agencies in the community. They can also call on their own parishioners - doctors, nurses, chiropractors, lawyers, financial planners, etc. to share their knowledge and point people in the right direction for help. Such sharing is a valuable lay ministry.

COMMON QUESTIONS

As a registered nurse who works in home health care, I’ve had questions from many families regarding health services. The following are a sampling:

My mother lives in a distant city and I’m concerned because she needs treatment for sores on both legs. Is there any way I can arrange for some help to be sure she is doing it correctly?

Your mother will probably be eligible for home care services through Medicare. The criteria for service would be:

1) that she is homebound (which means she does not go out regularly by herself. She may be taken to the hairdresser, doctor’s office, etc. by someone else, but it is a taxing effort for her to leave her home.) that she requires a skilled service which would be performed by a nurse, registered physical therapist or speech therapist. Occupational therapy and social worker visits can also be provided along with skilled visits.

You should contact a Medicare certified home care agency in your area to do an evaluation visit. This information is listed in your local phone directory under Home Health Services. They will contact her MD and make the home visit. They will then make her (or you) aware of what her needs are and if she qualifies for service under Medicare. You may want to have several agencies do an evaluation visit as some are more knowledgeable concerning what Medicare will allow and will be willing to provide it. This visit is usually a no charge visit.

2) If your mother is found to qualify, I would recommend visits by the social worker also to determine her long range needs and assist her in applying for local or state supported services that would begin after Medicare services terminate. A review of financial income is required in order to receive these additional services. Once it is established that she does qualify, the services would be on-going and could include non-skilled help such as help with bathing, dressing, fixing meals etc. (Each state has different guidelines.)

3) My parents are elderly and there is no one living near them to help with household needs. They could also use some help with their personal care. Are they eligible for home care?

If there is no skilled need, they may still qualify for home health aid or chore services provided through a local or state program. Again, contact a Medicare certified home care agency in the area and they should provide you with the information needed to begin the evaluation process by the appropriate agency. It may also be possible to get assistance for people under the age of 65 for these same services if they are disabled.

“My father was told by the home care agency that he did not qualify for Medicare home care services. From the information provided, I feel he does. How can I pursue this further?”

You can contact Medicare directly to get a determination. If you are still dissatisfied, you should contact LAMP (Legal Aid for Medicare Patients). There is no charge for this service and the phone number is 1-800-321-5267.

“What are some conditions that would qualify patients for home care services under Medicare and how many hours a week can be provided?”

Persons who require Vitamin B12 injections (due to pernicious anemia or malabsorbtion syndrome) or other injections, indwelling catheters which require regular changing of same, patients recently discharged from the hospital who require instruction and monitoring, stroke victims or persons with crippling diseases who could benefit from physical therapy or speech therapy, newly diagnosed diabetics or those new to insulin administration or blood sugar monitoring, etc.

As to hours of service provided, Medicare has a 35 hour rule which provides up to 5 hours per day of combined nurse and home health aid services. This is based strictly on need and can be adjusted according to the case. In extreme emergencies the 56 hour, 21 day rule may apply which provides 8 hours per day for nurse and home health aid combined. Both can have additional services of the physical therapist, speech therapist, occupational therapist and social worker.

“My father is dying from a terminal illness and we do not want to place him in a hospital or nursing home. Can we get some help for him in our home?”

Yes. Contact a Medicare certified home hospice agency and they will inform you of what is available to assist you in caring fr your father at home. They can provide skilled services beyond the regular Medicare allowances and have a volunteer network to assist with respite care needs.

Should you have a question in the area of home health services to which you have not been able to find an answer, I’d be glad to assist you.

Nadia Koblosh, an RN, works for a home health agency in Bristol, CT. She attends Christ the Saviour Mission in Southbury, Ct where she is the choir director.

Health Decisions: The Value Of Advance Directives

By Fr. Steven Voytovich

The 21st century dawns with two major realities colliding together in the health care environment. Medical technology is advancing at a rate far ahead of our ability to learn how to be good stewards of it. Sometimes this technology can meaningfully prolong life, but sometimes it also has the opposite effect of prolonging the dying process unnecessarily. At the same time, patients increasingly are faced with health care decision-making that is guided both by a desire to minimize suffering in the face of terminal illness, and an attempt to somehow wade through the myriad of issues related to the use of technology, managed health care spending, and limits on or even lack of insurance coverage. Without contrary indications, hospital medical staff are required by law, and doctors by the Hippocratic Oath, to provide the full range of available treatment and life-sustaining technology to those admitted to the hospital.

ADVANCE DIRECTIVES

One instrument designed to amplify the patient’s voice with respect to the use of technology is the Advance Directive. There are two types of advance directives (AD). Instructional ADs offer direction for care by the patient, determined while competent, to be used when decision-making capacity has been lost. Included in this subset are living wills and documentation limiting the use of resuscitation. Proxy ADs, on the other hand, name alternative persons, called surrogate decision makers, in the event that one is found to be incompetent to make his or her own decisions.

Advance directives, including the role and function of proxy decision makers, vary by state or province. For example, the state of Connecticut specifies two different roles for surrogate decision makers. A Health Care Agent makes decisions only in the area of withholding or withdrawing life support measures, while a Durable Power of Attorney for Medical Decisions makes all other health care decisions except that which the Health Care Agent decides. One person can fill both roles. A surrogate decision maker is best empowered when preferences have been shared and discussed by the person he or she is to represent.

State laws have been drafted regarding ADs. As of 1994: “In the United States, all 50 states have passed laws on either instruction directives, proxy directives or both. Forty seven states have laws supporting the use of instruction directives; those that do not are Massachusetts, Michigan and New York. Forty eight states have laws supporting the use of proxy directives; those that do not are Alaska and Alabama.”...In Canada there is legislation supporting ADs in the provinces of Nova Scotia, Quebec, Manitoba, Ontario and British Columbia” (Journal of Palliative Care, 10:3,1994,111-112).

In addition to state laws, the US Congress passed the Patient Self Determination Act (PSDA) in December of 1990. This legislation requires health care institutions that receive Medicare and Medicaid funding to inform patients at the time of hospital admission of their right to accept or refuse treatment and to prepare ADs. This policy was mandated to be implemented in November of 1991. Four years later, only between 4% and 17.5% of the general population had actually completed an AD (Chest, March 1995, p. 752).

General reasons for this continued low percentage of completing ADs are twofold. First of all, patients without preparation are hit with a barrage of questions, information, and ADs upon being admitted. This often results in patients avoiding discussion of this issue while in the midst of the uncertainty of hospitalization. Surprisingly, little has changed here since the new legislation for ADs. Hospitalization can be an overwhelming experience, and this often predisposes patients against discussing end-of-life issues. Secondly, physicians are, for the most part, reluctant to engage patients in discussing issues germane to establishing ADs.

CASES

Mildred

Mildred was over 90 years old, hospitalized with terminal cancer, and began to fill up with fluids. She was largely unresponsive to any stimulus in the room. Her children, a son and daughter, recognized her as their rock, and would not hear of the doctor’s invitation to move toward comfort measures only. Mildred’s daughter was a doctor herself, and knew the regulations regarding continuing full treatment—which she demanded remain in place. One morning, as Mildred’s children were gathering around the bedside, Mildred stopped breathing. Her daughter flew into action, flagging down staff. A code was called, meaning that all available means would be employed to restart Mildred’s heart and breathing. The last twenty minutes of Mildred’s life were spent being assaulted. Some staff were pounding on her chest, others injected her with all kinds of medications to induce her heart to beat again, while others were dispensing medications and equipment from the crash cart. Still others simply stood by and watched the clock. The room was full, and after twenty minutes all left except for the nurse and Mildred’s children.

Scott

Scott was a middle-aged man who lived life pragmatically. When he learned about advance directives in the course of his annual physical, he immediately set out to authorize surrogate decision-makers to act if he were unable to consent to his own treatment. In addition, he asked in his living will for comfort measures only to be administered should he become irreversibly and terminally ill. His wife and family grew weary of his seemingly tireless efforts of preparing himself and them to act upon his AD.

Several months later, Scott was preparing for work one morning, and began to complain of chest pain. He was having a heart attack. He was rushed to the hospital. Staff informed Scott’s wife that they were trying to stabilize him, and later would prepare him for angioplasty (inserting and inflating a small balloon in the blood vessels leading to the heart) and possibly bypass surgery. She would not leave his side, becoming increasingly frantic. “You’re just going to let him die!” she exclaimed. The bewildered nurse looked in the patient’s chart, saw the AD that was meticulously completed, and immediately returned to Scott’s wife. “Are you worried that Scott’s AD will prevent us from treating him?” “Yes,” she replied. “He made us promise to follow his wishes in the case of terminal illness, but he is too young to die!” The nurse sat her down and explained that his condition was far from terminal, and that they would do everything in their power to help Scott stay alive.

Diane

Diane’s life was a seemingly endless flow in and out of the hospital. She had been diagnosed as bipolar (a psychiatric illness where one’s mental status uncontrollably vacillates between depression and mania), and occasionally had psychotic episodes (an extreme and sometimes extended break from a sense of reality), leaving her unable to make good decisions regarding her care. Moreover, sometimes she got tired of taking her medication and turned to self-medication through heavy drinking.

One day she was talking with her social worker. She had been in an inpatient treatment program and was feeling much more herself. In addition, she felt as though she had been treated as a real person in this setting, not like the one where she had been taken on a number of other occasions, where they treated her and other patients as non-beings. Her social worker sent her home with some information on advance directives for mental health treatment.

Diane knew her parents thought psychiatric illness was just an elaborate hoax, but Diane had a brother who had actually read quite a bit about her illness and supported her through her peaks and valleys. When she was feeling better, she approached her brother about being a surrogate decision-maker, and expressed a desire to include specific instructions that, should she need to be admitted again, the first choice be the facility that seemed most supportive of her care. She underwent special competency tests prior to executing her AD. Diane felt so relieved when all was arranged, knowing that her wishes would be followed even if she were unable to express them. This gave her a renewed sense of investment in staying well.

DISCUSSION

Each of the above cases raised some important points that bear further reflection. They underscore the importance of discussing advance directives before crisis occurs. A common problem when crisis occurs is the narrowed decision-making capacity on the part of the patient; the ability to consider decisions from a number of perspectives is reduced. At the same time, crisis does not have to spell disaster. Instead, moments of crisis can lead to new growth and insight for patients who are supported by family, clergy, or caring medical staff. In fact Advance Directives can help to bring together those making difficult decisions with those who can be prepared to stand with them in the midst of an ever-changing health care environment.

Advance Directives And Those Who Are Terminally Ill

Mildred is an example of a patient who is terminally ill. Her cancer was well advanced, complications were increasing, and the assault occurring during the final moments of her life was plainly excessive. Palliative care, a term denoting pain control and comfort measures, can replace full and aggressive care, and should do so especially in cases of end-stage terminal illness.

It is often the case that family members’, and in some cases even physicians’, recommendations or decisions do not match the patient’s own. Here Mildred’s voice is not heard. Maybe she lived a full life and prepared for her death. Her children had plainly not arrived at a sense of peace or letting go. Differences can also be caused by multiple faith traditions within the family system, some of which hold opposing perspectives on end-of-life care. Had she named a proxy decision-maker, that person’s voice is understood as speaking for the patient. In the absence of a proxy, family members’ voices are ranked in an order of priority as designated by institutional policy. For example, if a spouse, brother, sister, or children are present, the hospital would choose first the spouse, then others according to the hospital’s policy. Oftentimes this is where a struggle ensues. If family members do not agree on how to proceed in caring for their loved one, the patient’s voice is lost, and medical staff are held up in providing care while attempting to sort out the disagreements.

What if Mildred had survived cardiopulmonary resuscitation (CPR)? She would have been among the few to do so. An analysis of several studies in a recent issue of the Canadian Family Physician notes: “For patients whose cardiac arrest is not caused by simple cardiac conditions, the likelihood of success and return to function is low” (April 1995, p. 656). More specifically, for patients suffering from cancer, neurological disease, kidney failure, respiratory disease, or sepsis (organisms in the blood stream), the overall success rate is less than 10%, with most less than 7%. Moreover, for survivors the increase in life expectancy can be complicated by post-resuscitation complications including: pneumonia, congestive heart failure, gastrointestinal hemorrhage (all occurring in greater than 40% of cases), seizures (30%), and others (p. 656). These facts reveal important insights when considering the decision to continue full aggressive care for those terminally ill. Medical statistics can’t always accurately determine patient care, but it is important to know, as a patient, the potential risks and complications one may face as a terminally ill patient with respect to the use of CPR.

Perhaps this helps explain why more than 50% of persons older than 60 years of age with complications related to terminal illness report having completed advance directives rather than the low rate reported earlier. In an article recently appearing in the Annals of Internal Medicine, 400 hemodialysis patients were surveyed. Seventy-nine percent of respondents had discussed end-of-life decisions with family members, and 51% had completed an advance directive. Even more telling is that greater than 97% identified a surrogate decision maker, 93% chose a family member, 88% wanted to include additional family members, while about 36% wanted to include their physician (May 18, 1999, pp. 826,827).

Advance Directives And Getting The Fullest Care

The vignette about Scott raises a fear that is often expressed regarding ADs. Some people wrongly perceive that if an AD has been formulated, it means the person may not get the care she/he needs. In fact, an AD can be changed or even revoked at any time as long as competency is not an issue.

A recent study conducted at a community teaching hospital compared a number of intensive care patients responding to two questions: whether or not an Advance Directive had been made (Y or N), and whether or not an order was written to limit resuscitation (Y or N). Among the respondents, those responding yes to both questions were among the eldest participants. Those who had no AD but did have a DNR order had the highest mortality rate and spent the most time in the hospital. Among those responding yes to an AD and no to a DNR, there were no interventions made (no need to invoke the AD), and these patients on average spent the least time in the intensive care unit (Chest, March 1995, p. 753). Formulating an AD does not necessarily mean one is taking an action to hasten death.

Advance Directives And Those With Psychiatric Illnesses

Diane is certainly not an anomaly in our communities today. Family members agonize over how to care for their loved ones who suffer from psychiatric illness. Beyond the stigmas attached to this illness, our current managed care system in the United States places the most restrictions on this group of patients, including number and length of hospitalizations, and choices available to them regarding treatment options. ADs are not a well-known resource in the area of mental health as they are a recent phenomenon. However, the process of discussing care issues here necessarily brings together patient and family members. This is a far better scenario than what more often occurs. Family members are scrambling to keep up with decisions being made for their loved one who is hospitalized. They may also be some distance away, and/or ambivalent about being “involved” with their chronically ill loved one, and therefore have difficulty responding in a timely fashion. Additionally, patients who have exacerbated symptoms often cannot clearly process health care decision-making.

A final note of consideration here includes the contribution that the formulation of ADs may offer psychiatric patients. Diane chose to include a specific facility that empowered her to feel like a person throughout her treatment. With this decision-making authority expanded across the country, institutions will need to become more tolerant of psychiatric patient autonomy, and will need to assess the level of restrictions placed on their patients. In other words, institutions that admit psychiatric patients will need to focus more attention on their patients’ experience of hospitalization in order that patients like Diane will feel cared for enough to want to return to their facility.

BASIC ORTHODOX TEACHINGS ON END-OF-LIFE DECISIONS

Before moving to some steps toward the exercising of Advance Directives, let us first reaffirm some basic Orthodox teachings around end-of-life decision-making. First of all, the Orthodox Faith opposes any kind of euthanasia, or acts that are undertaken to end one’s life. In addition, terminal or palliative care is an important factor in the dying process. This includes pain management and “comfort measures,” even though the former can, through the principle of double effect, hasten the dying process. Some pain medications, when taken in large enough doses to reduce pain, can actually suppress the body’s normal functioning even to the point of death. The aggressive practice of palliative care is morally appropriate, without which patients would face death with intractable pain and anguish. Finally, Orthodox ethicists do affirm that in cases of end-stage terminal illness, withdrawal of life support equipment can be viewed as compassionate. In terms of brain-death, this action can become a moral imperative, as the person is no longer alive in any religiously significant way, even though heart function, breathing, even food and hydration can be sustained almost indefinitely. (Please refer to the bibliography for some sources of further in-depth discussion of these issues).

If you have read to this point, hopefully your question is “What can I do?” or “Where do I start?” Here are some simple steps.:

1. Anyone can pay a visit to his/her physician, local hospital or long-term care facility, and ask for a copy of current Advance Directive materials. Pastors are especially encouraged to do this, in order to become familiar with the regulations that unfortunately do vary by state or province. Spend some time reflecting on your own responses to the questions raised in the materials.

2. Identify persons in your parish community who may be able to offer further insight into the use or function of ADs. This includes physicians, social workers, nurses, and pastoral counselors. You may also wish to consult with staff from area hospitals or extended care facilities. Work together in exploring options to educate the parish faithful on these issues.

3. Offer an educational program in your parish community. Sometimes staff from the local hospital or long-term care facility are willing to come and talk to your parish community. The parish priest can then include information on ADs specific to the Orthodox Faith. You may be surprised at how many are struggling with these very issues, and yet are afraid to raise them for any number of reasons. Sometimes case examples can serve to provide significant distance from one’s own situation, yet shed light on the important issues.

4. Pastors, be available, along with other identified parish members, to speak to your parishioners and their family members. Sometimes simply being a listening presence can assist family members in hearing one another when discussing these emotionally charged issues. Also, pastors can be a significant resource for hospitalized parishioners, having heard directly what wishes might be significant. This can become vital when family members are enmeshed in agonizing over how to proceed, or are conflicted due to differing faith perspectives or wishes.

5. From time to time, offer educational resources, including sermons, referring to the sanctity of life, and that all stages of it, from birth to death, rest firmly in God’s hands. Stewardship is more than managing time, talent, and treasure. We are further called to be stewards of the very gift of life that has been given to us by God.

It is hoped that this article has at least stimulated your curiosity and interest. Now the rest is up to you. Don’t wait to make these decisions in the heat of the moment, or worse, leave them up to others who may not know your wishes and/or Orthodox practices. You, and those around you, may find peace in discussing and documenting Advance Directives. Real preparations for a Christian death can lead to a better life!

BIBLIOGRAPHY

Beauchamp, Tom and Robert Veatch, eds. Ethical Issues in Death and Dying,Second Edition, Upper Saddle River, NJ: Prentice-Hall, 1996.

Breck, John. The Sacred Gift of Life: Orthodox Christianity and Bioethics,Crestwood, NY: St. Vladimir’s Seminary Press, 1998.

Ginn, Diana and David Zitner. “Cardiopulmonary Resuscitation: Not for Terminally Ill Patients,” Canadian Family Physician, v. 41 (April, 1995), pp. 659-657.

Harakas, Stanley. Contemporary Moral Issues Facing the Orthodox Christian,Minneapolis, MN: Light and Life Publishing, 1982.

Harakas, Stanley. Health and Medicine in the Eastern Orthodox Tradition, New York: Crossroad, 1990.

Hines, Stephen C., et. al. “Dialysis Patients’ Preferences for Family-Based Advance Care Planning,” Annals of Internal Medicine, v. 130, n. 10 (18 May, 1999), pp. 825-826.

Johnson, Robert F., et. al. “Advance Directives in the Medical Intensive Care Unit of a Community Teaching Hospital,” Chest, v. 107, n. 3 (March 1995), pp. 752-756.

Lopukhin, Elisabeth. “Planning Ahead for Health Care Decisions,” Resource Handbook for Lay Ministries, Syosset, NY: Orthodox Church in America, v.1, 1988.

Singer, Peter. “Advance Directives in Palliative Care,” Journal of Palliative Care, vol. 10, n. 3 (1994), pp. 111-116.

Srebnik, Debra and John LaFond. “Advance Directives for Mental Health Treatment,” Psychiatric Services, v. 50, n.7 (July 1999), pp. 919-925.

Archpriest Steven A. Voytovich, PhD is Dean and Chief Operating Officer of Saint Tikhon’s Orthodox Theological Seminary, Director of the OCA Office of Institutional Chaplaincies, a board-certified chaplain and certified Clinical Pastoral Education supervisor.

Twenty-Five Ways to Help the Homebound and their Caregivers

By Donna Karabin and Nadia Koblosh

We are blessed in our Orthodox communities by the friendships we develop and nurture when we greet each other at Divine Liturgy and spend time together at parish events. Those who are absent from parish life because of ill health or disabilities are sometimes forgotten. They may be referred to as “homebound” which means they are unable to independently leave home. Even with the help of a caregiver, the effort is a taxing one.

Families are the mainstay care providers for the frail, chronically ill, disabled of any age and the impaired elderly. Paid outside caregivers are the exception, not the rule. More than one-fourth (26.6%) of the adult population has provided care to a family member or friend during the past year. The caregiver directly provides or arranges for help when a dependency situation arises. He or she provides medications, meals, assistance with such personal care tasks as bathing, dressing and hygiene. The caregiver may have responsibility for arranging medical appointments and providing transportation. One vital caregiving aspect is companionship, necessary for the care recipient of any age. On average, twenty hours of care per week is provided. Twenty-one hours or more is considered to be intense caregiving.

Some sources report that the pool of family caregivers is dwindling, but the Federal Government Administration on Aging states that the degree of caregiver involvement has remained constant over the past decade despite increased geographical separation, a greater number of women in the work force and changes in family life in our culture.

Older persons make up half of all caregivers. In the absence of a spouse, a daughter or daughter-in-law has traditionally been most likely to assume the caregiving role. But new information reveals that caregiving is no longer predominantly a women’s issue. Men now make up forty-four per cent of the caregiver population.*

The Challenges for Caregivers Are Many

The challenges for caregivers are many. Of those caring for an aging parent, eighteen percent live more than one hour away. Forty-one percent care for a child under the age of eighteen. More than sixty percent balance a career with caregiving responsibilities.

Intense, heavy-duty caregivers, especially spousal caregivers, do not get consistent help from other family members. One study has shown that as many as three-fourths are “going it alone.” Sadly, sixty-one percent of intense caregivers have experienced depression. One-third of all caregivers describe their own health as fair to poor, often indicating they are not sure they will outlive their loved ones. In those cases there are two persons at risk. Special vigilance is needed for those in remote or rural areas, one example being Alaska. A saying heard from Alaskan native elders when in crisis is, “Who will cross the river with me?” It is a question that is also applicable to family caregivers no matter where they may live. **

The undeniable resounding message is that families need help! It is our calling as Orthodox Christians to reach out to minister to their needs wherever and whenever we can. We can do so always being mindful of their (and our) safety, their personal privacy and the need for them to maintain as much independence as possible. Spiritual and practical support from the faith community can be a vital component towards the well-being of both the homebound and the caregiver.

How an Individual or a Parish Can Help

The following list has twenty-five suggestions that can guide a man or woman of any age, a family or a parish to undertake an outreach program:

  1. 1. Pray daily for the homebound person and the caregiver.
  2. 2. Offer to assist in bringing the homebound and caregiver to Church.
  3. 3. Offer transportation to medical appointments.
  4. 4. Commit to making a weekly phone call.
  5. 5. If the homebound person lives alone, visit regularly with coffee, snacks and news of the parish.
  6. 6. Commit to regularly scheduled visits so they can be anticipated.
  7. 7. Read to the homebound if unable to read or provide assistance to obtain “talking books.”
  8. 8. Serve as translator with service professionals if a language barrier exists.
  9. 9. Help write letters or cards with the homebound to send to friends or family.
  10. 10. Assist with insurance or other paperwork.
  11. 11. Prepare meals weekly, or have several people take turns 1-3 times a week.
  12. 12. Offer to stay with the homebound once or twice a week, or if possible for a weekend, to relieve the caregiver.
  13. 13. Remember to ask about the caregiver’s physical and emotional health.
  14. 14. Offer to help with heavy housekeeping chores or arrange a “maid brigade” of parish friends.
  15. 15. Offer tools and time to help with household or car repairs.
  16. 16. Mow the lawn or shovel snow when needed.
  17. 17. Offer to pick up needed supplies or groceries when out doing your own errands.
  18. 18. Be sure there is a working telephone especially if the homebound is living alone.
  19. 19. Let them know you would be available 24 hours a day in the event of an emergency.
  20. 20. Offer to help them get an “emergency response system.”
  21. 21. Ask the priest or parish secretary for copies of notices received in the church mail related to community resources that could be passed on to the homebound or caregiver, e.g. energy assistance, tax relief, community services, seminars, etc.
  22. 22. Link the homebound and caregiver to the National Family Caregivers Association (NFCA), a service organization not disease or age specific, for resource materials, advisory support and advocacy: www.nfcacares.org or 1-800-896-3650.
  23. 23. Link them to Children of Aging Parents (CAPS) for resources and assistance: www.CAPS4caregivers.org or 1-800-227-7294.
  24. 24. Link them to the local Area Agency on Aging through the U.S. Administration on Aging Eldercare Locator at 1-800-677-1116 or www.aoa.gov. Click on Elders and Families, then NFCSP for information on the National Family Caregiver Support Program which provides services, counseling, caregiver training and respite care.
  25. 25. Research other Resource Handbook articles at www.oca.org or in the printed format in your parish library, e.g. “Twenty-something Ways for Youth to Minister to the Elderly,” “St. Euphrosynus the Cook Project” (Providing meals for shut ins.), “Ministry to Shut-ins and Hospitalized Patients,” “Home Health Care Services,” “Ministry of Listening,” “No Small Change” (Our attitude toward the disabled.), and the Christian Living Series booklet “Eldercare, The Church’s Ministry with the Elderly.”

* Statistical information was adapted from U.S. Health and Human Services Administration on Aging’s National Family Caregiver Support Program, the National Family Caregivers Association, and CareFirst Blue Cross Blue Shield Vitality magazine, Issue 1—2003.

**Take Care! Self-Care for the Family Caregiver,” Volume 12, Number 2, Summer 2003, “Caregiving in Remote Areas,” p 3.

Donna Karabin is Chairman of the OCA Department of Christian Service and Witness. She is a registered nurse, a full-time caregiver and an active member of St. Luke Church, McLean, VA.

Nadia Koblosh is also a member of the OCA Department of Christian Service and Witness and a registered nurse, facilitating patient and family respite care. She is an active member of St. Nicholas Church, Whitestone, NY where her husband, Fr. Michael, is pastor.

Alzheimer’s Disease and the Church

By Fr. John Shimchick

“Do not cast me off in time of old age; Do not forsake me when my strength fails.”
(Pslam 71:9)

Probably all of as have known or at least read about people who suffer from Alzheimer’s Disease or other forms of dementia. Perhaps we have watched loved ones gradually lose their abilities to talk and reason coherently and to function in normal ways. We may have known or seen families struggle to care for those who, while being physically present, appear to become more and more strangers to themselves and to others.

In this article, the symptoms and complications due to a diagnosis of Alzheimer’s Disease will be offered with a discussion on the practical concerns for family and caregivers. In the last section, the possibilities of support which the church community can provide will be presented in the context of remembrance, the hope inherent within the Christian faith.

What Is It?

Alzheimer’s Disease (pronounced Alz-hi-merz) is progressive, degenerative disease that attacks the brain and results in impaired memory, thinking and behavior. It affects an estimated 4 million American adults.

When it was first described by German physician Alois Alzheimer in 1907, Alzheimer’s Disease was considered a rare disorder. Today it is recognized as the most common cause of dementia.

Dementia is not a disease but a group of symptoms that characterize certain diseases and conditions. In the case of Alzheimer’s disease, the dementia includes a decline in intellectual functioning that is severe enough to interfere with the ability to perform routine activities.

The second most common form of dementia is multi-infarct dementia, which is caused by vascular disease and strokes. Other causes of dementia are Huntington’s disease, Parkinson’s disease, Pick’s disease and Creuzfeldt-Jakob disease.

There are also a number of conditions that cause dementia-like symptoms: depression, drug reactions, thyroid disorders, nutritional deficiencies, brain tumors, head injuries, alcoholism, infections (meningitis, syphilis, AIDS), and hydrocephalus.

Alzheimer’s Disease is distinguished from other forms of dementia by characteristic changes in the brain that are visible only upon microscopic examination. It is more likely to occur as a person gets older. Approximately 10% of people over age 65 are affected by Alzheimer’s Disease. This percentage rises to 47.2% of those age 85 or older. It can occur in middle age as well. The youngest documented case is that of a 28-year old individual.

Alzheimer’s Disease also affects the family of an Alzheimer patient. The emotional, social, and financial costs of caring for an Alzheimer patient are high. Family members also often risk their own health in order to care for the patient at home.

Alzheimer’s Disease has a gradual onset. Symptoms include difficulty with memory and loss of intellectual abilities severe enough to interfere with routine work or social activities. How quickly these changes occur in an Alzheimer patient will vary from person to person. Eventually, the disease leaves its victims totally unable to care for themselves. The course of the disease averages eight years from the time symptoms first appear, although it has been known to last as long as 25 years.

At this time, there is no single diagnostic test for Alzheimer’s Disease. A complete physical, psychiatric, and neurological evaluation by a physician or an interdisciplinary team often found within gerontology departments of hospitals should be obtained when symptoms are noticed.

The examination should include a detailed medical history, mental status test, neuropsychological testing, blood work, urinalysis, computerized tomography (CT scan); a chest x-ray, electroencephalogram (EEG) and electrocardiogram (EKG) may also be taken. Such an evaluation is essential to determine whether the dementia is a result of a treatable disease.

When this kind of detailed examination is done, the accuracy of diagnosis is about 90 percent. However, the only way to confirm a diagnosis of Alzheimer’s Disease is to examine brain tissue under a microscope.

What Will Change?

A diagnosis of Alzheimer’s Disease will bring about many changes—changes that a person might find hard to think about. But knowing what to expect will provide opportunities to plan.

A person can expect to find increasing problems thinking and remembering, reading and writing, learning new information and making decisions. Eventually there will be trouble doing familiar tasks like driving, managing money, or discussing current events. Later on, one may have difficulty in dressing or bathing. These changes in one’s ability will also mean changes in lifestyle and in relationships with others.

Most likely, there will be a need to rely more and more on family, friends, and professionals for help. In time, one will need to entrust responsibilities to them, such as managing a checkbook, preparing meals, keeping house. An independent person or one who is accustomed to taking care of others may find it hard to accept this new, more dependent role. Understandably, one may feel frustrated, angry, or depressed at times.

Planning Ahead

Although a person may feel perfectly capable, it is important to recognize one’s limitations. Here are several practical matters that should be addressed. Taking care of these things now will help ensure that they are carried out according to one’s wishes in the future.

Work

If a person is still working it will be necessary to prepare oneself, both mentally and financially, for retirement. If a business is owned, decisions should be made as to what will become of it when it can no longer be handled personally. One should not hesitate in getting whatever help is needed, whether through a lawyer, a financial advisor, or members of the family.

Money And Legal Matters

Make sure that all important documents—will, insurance policies, mortgae and other financial papers—are in order. Put them in one place, and be sure that someone (a family member, a lawyer, or a trusted friend) knows what and where they are.

Take the time now to designate someone to help manage affairs and make important decisions when this can no longer be done. The advice of an experienced lawyer may be needed to make sure that everything is done according to one’s wishes. A lawyer can also give advice about steps to make sure that one can get the needed health care services and that financial plans are provided.

One should keep in mind that not all lawyers have experience with these kinds of situations and requests. The local Alzheimer’s Association Chapter, the American Bar Association or National Academy of Elder Law Attorneys may be able to provide information on selecting a legal specialist.

Living Arrangements

Make plans with family or friends for adjustments that will eventually take place. This may include discussing where or with whom one would want to live when additional care is necessary. A counselor, social worker, or lawyer may be helpful.

Medical Care

It’s important that one not only choose someone to make important decisions about medical care, but that these wishes be made known in writing. Is there a desire or willingness to participate in medical research? Should the doctor provide extraordinary life-saving measures if a personal decision cannot be made at the time? Have Advance Directives been prepared and responsible people been designated to make the end of life decisions that one would prefer?

The decision to provide home care for a dementia patient often may not seem like a choice. For instance, the cost of community based long-term care may be too expensive to consider. On the other hand, home care is only possible if the caregiver has the practical and emotional assistance of others as well as sufficient financial resources.

Before deciding on a care plan, you might consider the following:

1. Will you have to give up a job or reduce your work hours to care for the patient at home?

2. How much will it cost to use a day care program, paid companion, visiting nurse, or other outside help?

3. Will insurance cover medical expenses, nurses aides, or paid companions?

4. How do home care costs compare with nursing home costs?

5. Are you eligible for financial assistance if you choose nursing care placement?

Most families need professional advice regarding the care needs of the patient. This assistance can be provided by Geriatric Assessment Programs, or qualified Case Mangers.

Some Other Considers Are Outlined Below:

1. Dementia patients may develop the habit of wandering. Can you prepare your home so the patient can wander safely?

2. Caregivers should consider enrolling their loved one or friend in the Alzheimer’s Association Safe Return Program. This service provides an identity bracelet or necklace, clothing labels and wallet cards to identify the memory-impaired person. The individual is registered in a national database and a 24-hour toll-free 800 number is available when someone is lost or found. For more information call (800) 272-3900.

3. If the services of a paid companion or a visiting nurse are needed, do you have enough space for an additional person?

4. Eventually, the patient will require assistance with bathing and toileting. Are you physically capable of helping the patient?

Everybody has limitations. At some time, the patient’s needs may be more than you can handle, or a behavior problem such as wandering may cause you to risk your health. If the time comes to consider placing the patient in a long-term facility, such as a nursing home, look at the situation realistically, practically, and honestly. By acting responsibly in making decisions about care, you are not abandoning your loved one. Your time and devotion will continue to make the patient’s life better wherever he or she lives.

What Can A Church Community Do?

The church community can, first of all, be a source of strength and support for the caregiver(s) and family. Meals can be provided, errands can be run, a listening ear can be offered, and intercessory prayer can be rendered (something which should not be minimized).

For the patient, the church’s liturgical life, either during the complete liturgy or in the form of isolated hymns or prayers presented in the context of receiving Holy Communion outside of the liturgy, can provide a connection to familiar times and places. Many priests have observed how parishioners who may seem unresponsive to conversation will cross themselves at the appropriate times during prayer, will join in during the recitation of the Lord’s Prayer (particularly if they learned it as a child in another language and hear it again in that language), or sing liturgical hymns on their own. One director of an adult day care founded on Christian principles related how in leading a bible study on a passage in which St. Paul stated he was in captivity, she asked the group if anyone else had ever felt in prison. A man with Alzheimer’s disease, who had never actively participated before, slowly raised his hand, tears coming from his eyes.

The Christian community, as the fellowship of those who suffer when one member suffers and rejoice together when one member is honored (1 Cor. 12:26), can be a witness to the transforming power of the Gospel, the reaffirmation that God’s love will triumph over “all sickness, sorrow, and sighing.” The sense of abandonment and loss of memory and function that accompany Alzheimer’s Disease and the other forms of dementia, as tragic as they are both to the patient and family, can only find their redemption in the God who pledges to remember. It is when this God remembers, as is sung at the end of the Orthodox funeral service during the hymn, “Memory Eternal,” that death is renewed by life. It is this God who proclaims that, “even to your old age, I am He, and even to gray hairs I will carry you! I have made, and I will bear; I will carry and will deliver you.” (Is 46:4)

Bibliography

This article was adapted from the following materials, published by the Alzheimer’s Association:

“Alzheimer’s Disease: An Overview.”

“If You Have Alzheimer’s Disease: What You Should Know, What You Can Do.”

“Caregiving at Home.”

For more information, contact your local Alzheimer’s Association Chapter or call the Association’s toll-free number.

Alzheimer’s Association
70 E. Lake St.
Chicago, IL 60601-5997
(800) 621-0379
(800) 572-6037 (in Illinois)

Fr. John Shimchick is the pastor of Church of the Holy Cross in Medford, New Jersey.

Giving Back to the Community

By Popadija Kitty Vitko

Like the rich, young ruler that Christ speaks to in Luke 18:18, Mark (not his real name), a retiree, wondered what more he should do to inherit eternal life. He wanted to be able to use his skills as an engineer, as well as his love for Christ to increase the stewardship of his own time and treasure.

Mark as an engineer was trained to problem solve. During his years in the workforce, and while his children were young, he spent the lion’s share of his time and energy earning a living and being a parent. After retirement, he was able to spend time relaxing, traveling and working on some new hobbies. Still, like so many others, retirement came at a time for Mark when he was still healthy, strong and wanting to be active.

Given the freedom of retirement, he evaluated his options. He knew he wanted to thank God for his blessings by helping those in need. He also knew that seniors who were busy and productive were healthier both physically and emotionally. Mark’s first endeavor was to take a local “Stephen Ministry” course. Stephen Ministries is a not-for-profit Christian educational organization that provides training seminars and resources to lay people who can then provide one-to-one Christian care under the guidance of their parish priest or pastor. Mark’s training there taught him to listen more effectively. Mark wasn’t sure he would ever use his new found skills, but God has put people in his path since then that he has been able to help.

“Christmas in April”

Mark also joined in a local, multi-denominational “Christmas in April” project. Every April the group spends one weekend fixing a house for an elderly or disabled person who doesn’t have the resources for basic maintenance. While becoming more involved in his community, Mark became interested in helping the homeless. He started volunteering at a local shelter. This shelter had many volunteers but very limited financial resources. This is where a lifetime of problem solving came into play. Mark was not in a position to support the shelter financially. He felt God wanted him to be there, but what could he do? Then he realized that he had spent a lifetime not only as an engineer, but also as a fix-it person around his own home. Why not use these skills to earn money for the shelter? He started a handyman business and had his customers write checks to the shelter instead of paying him. He charged slightly less than the going rate. If customers wanted to give more, it was up to them. In this way he used his skills to raise money for the shelter.

Mark doesn’t know how long he will be able to continue this, but he does know that his retirement has been a constantly evolving spiritual journey. His handyman business gives him the flexibility to also spend time with his grandchildren, travel, and enjoy time with friends and parish activities, while he gives back to the community and supports the local homeless shelter.

Other Examples

There are many such examples of seniors becoming involved in the community.
A retired widow spends part of each week going to the local elementary school. Here she listens to new readers. The students are delighted to show off their new skills. When she returned from a recent vacation, the class stood and cheered. What a gift for both her and the students.

A retired comptroller uses his skills to organize the financial records of a suicide prevention chapter. The volunteers have great counseling skills but no fiduciary expertise.

Another retired executive volunteers at a local high school in business classes, helping students learn how to develop a business plan.

Twenty years ago a retired woman opened up her home to women in crisis. That small start grew to three women’s shelters where desperate women find God as well as educational and housing help.

Jesus’ Command

Jesus frequently exhorts us to take care of the poor. After evangelism, the first ministry of the early church was ministering to the widows and orphans—those unable to take care of themselves. After retirement most people have many productive, healthy years to share. What better way than giving of oneself to others. “...as you did it unto one of the least of these my brethren, you did it to Me.” (Matt. 25:40)

If you are an active senior, or know of one who is engaged in using talents to give back to the community, please contact Arlene Kallaur at arlenekallaur@hotmail.com, to let her know what you/they are doing. Additional ideas will be shared in future articles.

Popadija Kitty Vitko is a member of the OCA Department of Christian Service and Humanitarian Aid. She attends St. Luke Orthodox Church in McLean, VA where her husband, Fr. John Vitko, is rector.

A Caregiver’s Support Group

By Diana Pasca

Eugenia Skuby and I, both members of Holy Cross Church, Medford, New Jersey, and caregivers of aging mothers, recognized that there were a growing number of parishioners who were talking with us about their struggles of being a caregiver for an elderly parent or loved one. When Fr. John Shimchick came to bless my home, I asked if we could have his blessing to create a support group for the purpose of encouraging and supporting one another, and he agreed. Quickly we contacted those people, men and women, who were interested in becoming part of this group, and set a date in the evening to meet.

Our First Meeting

Our first meeting was at a neighborhood restaurant, where we began with a prayer and a light meal. Coming from a Behavioral Health Care background, I talked about how peer support avoids categories and roles, but rather emphasizes that peers support one another, we who are moving through difficult situations, and help each other learn how a crisis can be an opportunity for growth and change. Mutual support is a process in which the people in the relationship strive to use the relationship to become fuller, richer human beings. After that introduction, conversation flowed easily, with members sharing their thoughts and experiences, acknowledging each other’s difficulties and accepting our differences in handling our loved ones. We also assured one another of our commitment to this relationship and to maintaining confidentiality.

The General Format of Our Meetings

We have now been meeting once a month for five years over a meal together, sometimes in a group member’s home, sometimes at a local restaurant. Eugenia or I act as moderator, and we always start with a prayer. Our discussions begin while we’re still eating and continue after the meal.

One of us will say something about what has been happening to us during that month as a caregiver, and then ask someone else a simple question derived from what was talked about at our last meeting. The discussion usually flows from there, with members feeling free to bring up different problems or solutions that they’ve found that month. Perhaps they will request a prayer for a particularly difficult situation. If the discussion stalls or strays, I will usually bring the conversation back to caregiving. As moderators, we also try to ensure that each person gets an opportunity to talk. We generally wrap up the evening by determining the next month’s meeting date and location.

A Valuable Resource

Last year Fr. John found a wonderful resource for us that we have read, studied and used personally to enrich both our lives and work with our loved ones and our group. It is entitled Counseling the Caregiver: Addressing the Biblical Responsibility and Care of Aging Parents, by Holly Dean Drew, The Master’s College, May 2002. It can be accessed at http://www.Tren.com, by searching the Tren Database Thesis/Dissertations. This was truly a wonderful resource for us, expanding our knowledge of the compassion needed to be part of the ministry of eldercare. It gave us biblical resources, and re-emphasized the importance of truly listening, sharing our faith in God, reinforcing laughter and joy, touching, gentleness and patience.

We agreed this year to invite some experts to help us: a cardiologist and a social worker specializing in care of the aged. Both happen to be members of our parish. We will also engage in a Bible Study, using Holly Drew’s dissertation resources, cited above.

Over the years a few people have left the group and a few have joined. Our membership expanded recently to include a few women who are struggling with taking care of their aging husbands, and one woman who is grieving the loss of her husband. Sometimes we have social activities, and we stay in touch by phone during the month when there are more trying situations at hand.

Connecting with non-judgmental, non-critical peers who are willing to avoid giving advice, and who will listen while the person figures out for himself or herself what to do, has helped the members of this group to discover skills, recognize strengths, strategies and resources that have worked for them and have given them hope.

Diana Pasca, an active member of Holy Cross Church, Medford, New Jersey is Coordinator of Vocational Services at Behavioral Health Services/Catholic Charities and Agency Liaison to the Riverbank Self-Help Center for consumers of mental health services.

Aging with Alzheimer’s Disease, Work for All the Church

By Matushka Natalie Stavrevsky, BSN, RN, MBA

One of the most beautiful theological symbols of our Faith is the image depicted on the discos at the conclusion of pre-liturgy.  “Here we have the icon of the Church,” I remember learning.  In the carefully arranged particles of bread all are represented, the center-Christ Himself, those present and past, forefathers, foremothers, those living today, old and new, well and infirmed.  We are all part of Christ’s body, we share in his struggles so we may share in his victory.  So is the blueprint laid out for us as we, children of the Church, walk together through this life, loving one another, helping one another. 

Mileva Tatalovich, an Alzheimer’s patient at Saint Luke Church, McLean, VA, was recently awarded a gramata by Metropolitan Tikhon as a church founder and faithful member of the parish’s choir and sisterhood.

Dementia, and specifically Alzheimer’s type Dementia, is a challenge of aging that few in our society can escape within our families.  Estimates published by the Alzheimer’s Association clearly indicate that the more we are granted “Many Years,” the challenge of these years will include some sort of memory disorder, most likely, although not exclusively, Alzheimer’s type Dementia.  Specifically, the data reads as follows:

  • 3% of those ages 65-74 have the disease
  • 19% of those 75-84 have the disease
  • 47% of those 85+ have the disease

The Department of Health and Human Services Administration on Aging gives us yet another perspective to consider.  The blessings of this country and the aging of our country’s most significant demographic escalation, the “baby-boomers,” gives us the following projected population distribution:

YearAgeTotal

% of Population

200065+38.1 million12.40%

200965+39.6 million12.90%

203065+72.1 million19%

In 2010, Alexei Krindatch presented to SCOBA his statistical research of what our parishes look like. 

It is not surprising that in our churches the 65+ population is 21% when our nation’s is at 12.9% since maturity tends to lead many back to a life in the Church. What we must all take note of however, is that in our typical parish of 100 adults there are currently around 20 individuals that are at increased risk for the development of a memory disorder.  This fact should lead us to desire to learn more about this malady so that as a Church family we can all be armed with the knowledge to assist one another without fear or ignorance.  

Having the advantage of today’s information age, it would not be prudent to spend extreme time and effort in this article defining Dementia and Alzheimer’s Disease. The end of this article will contain a Bibliography intended to start one on this important journey. The next few paragraphs are intended to stimulate your interest towards understanding. 

What is Dementia?

Mileva Tatalovich, an Alzheimer’s patient at Saint Luke Church, McLean, VA, was recently awarded a gramata by Metropolitan Tikhon as a church founder and faithful member of the parish’s choir and sisterhood.)

Dementia is not in itself a disease but is rather a syndrome or a group of symptoms caused by over 102 disease entities.  At least 70 of these diseases are irreversible and progressive, ultimately leading to death.  The most common cause of dementia is the disease known as Alzheimer’s.  Discovered by the German Physician Alois Alzheimer, it is by far the most common of dementias accounting for 70% of all cases.  It is notable and telling that when questioned, most individuals would guess that Alzheimer’s disease was first discovered sometime in the mid 80’s, perhaps 70’s.  Dr. Alzheimer discovered this disease in 1906. 

Alzheimer’s Disease

Perhaps the most succinct method of describing the effects of Alzheimer’s Disease on an individual’s ability to function is graphically.  The following computer representation shows on the left, a healthy brain, whereas the right depicts the brain with advanced Alzheimer’s disease. 

www.alzheimers.net

The brain affected with advanced Alzheimer’s has holes where healthy brain tissue once functioned.  Due to the disease process, the brain cells have physically died.  Individuals suffering from the challenges of this disease come from the ranks of everyday, “normally” functioning individuals with everyday hopes and dreams, all walks of life, all professions.  Please note, this is not a psychiatric disorder.  It is a physical, organic disease that leaves an individual desperately attempting to lead a normal life based upon what their brain is telling them; their brain that now has holes where healthy tissue once functioned. 

What To Do?

Alzheimer’s Disease will take a predictable path through our brains. This predictable path enables us to learn about what normal functioning should be for the section of the brain affected and in turn predict an individual’s challenges and positively intervene and support them. 

alzheimerdiseaseinindia.blogspot.com

For example, the disease starts its journey in an area of the Temporal Lobe called the Hippocampus.  This functions normally to store recent memories, converting short term memory to long term memory.  Information is received and placed into storage for later retrieval.  Any of us at times, due to stress or over stimulation, experience this challenge.  However, when the cause of this symptom is due to the destruction of brain cells, the symptom is permanent and life changing.  The path of Alzheimer’s disease generally takes about 10 years to complete its course, but not everyone experiencing changes to their Hippocampus, experiences all the stages of the disease.  In some cases this loss of short term memory, or Mild Cognitive Impairment, may be the only symptom an individual experiences.  Along with short term memory, the Hippocampus also gives us our awareness of the passage of time.  Therefore, references to time frames in relation to upcoming appointments, etc. will confuse this individual. 

Based on this information, we may all begin to draw conclusions regarding certain members beginning to experience these symptoms.  The purpose of this article is not to identify, and then mark certain of our elders, but rather to help us, through awareness, develop a framework of conduct that can in fact benefit all seniors, thereby making sure the needs of all are met.  For example, it is likely that an individual experiencing the challenges of Mild Cognitive Impairment is still driving themselves to church.  The path to church is well imbedded in all of our long term memories.  Offering a ride to an elder who may live along our route to church is a way not only of insuring safety for an individual challenged with memory loss, but also a way to ensure that an elder with failing eyesight, or slow to respond arthritic joints arrives to services safely. 

From the Hippocampus, the disease progresses to the Frontal Lobe.  This part of our brain gives us reasoning and problem solving.  It controls our impulses, emotions, and safety awareness.  When considering impairment of the Frontal Lobe, it is understandable that many may be too worried to attempt to bring an elderly parent or loved one to church with this type of impairment.  Please consider, this section of our brain is the last to mature in our growth and development; some experts saying not until 25 years of age.  Most of us have no issue bringing our children, or even adolescent children to services.  Bringing an elder faced with Frontal Lobe impairment simply means understanding their challenges; observing them and assisting them as we would a young person at the other side of the continuum. At this stage we accept the responsibility to keep them safe.  With Frontal Lobe impairment also comes the loss of ability to sequence.  They don’t know what to do next.  Therefore, a socially adept elder with this challenge will watch all others closely and take their cues from those around them.  We need to make sure they get the information they need, approaching them from the front, carefully and confidently prompting.  Fear and anxiety are emotions that can be easily read and mirrored at this point so relaxing and staying with the normal course of events is essential.  A successful outing to attend Divine Liturgy can be a valuable, positively reinforcing success for an elder provided the elder does not perceive the activity too complicated.

From the Frontal Lobe, Alzheimer’s Disease then takes its course through the areas of the brain that control our speech, visual orientation, and finally the processing of our sensory input: what we smell, see, taste, hear and feel.  Individuals’ abilities to cope with these challenges will of course vary depending on many factors to consider such as support systems, lifestyle habits, etc, so the ability for this person to continue as a present participant in the life of the Church will vary. If it hasn’t already occurred, it is at this time that loved ones, health care proxies, and interested friends will need to consider what arrangements must be made to suit the individual’s needs, safety, and happiness.  The options available and combinations of options are as varied as the individuals needing to be served.  All locales have assistance and advice available for any level of economic need, but often the challenge becomes finding this assistance. 

If the elder happens to be hospitalized or go to rehab for treatment of a chronic disease at this juncture, this is the time to utilize the facilities’ Social Workers to seek out the best options and choices for the individual. They must ensure a safe discharge for your loved one, so advocate to make sure all options are made known to you.  If the individual is residing in the community and needing assistance, contact your area Office for the Aging, a federally mandated, state funded organization that exists in every county throughout the country.  Based upon your financial means, they can direct you to proper case management and/or care solutions for your loved one.

Care Options

Alzheimer’s awareness

It is often thought that the only care option for those with advanced Alzheimer’s or Dementia is within a Dementia Care Community or Skilled Nursing Facility.  Although this may be the best option for some, it is not the only choice.  Seek out advice specific to your needs, your elder’s needs, and take into consideration the strain and stress of everyday life for you and your family.  There are any number of options and combination of options with the goal of keeping the elder safe in an environment that is acceptable to them while providing the care and support needed. 

Some options to consider:

  • Home Care Companions
  • Dementia Specific Adult Day Programs
  • Assistive Technology
  • Assisted Living Dementia Care Communities
  • Skilled Nursing Facilities - often needed once physical functioning has also declined.

Continued Love and Support from our Parish Communities

As always, continued love and support is present from our Parish communities for those among us who have moved along to a different stage in their lives.  Visiting them, in any setting, is certainly appropriate.

Here are some considerations to prepare for the visit.  Depending on the individual’s lifetime habits and/or their current schedule, the time of day of your visit may impact the quality of the visit, so do research if possible.  Don’t expect the individual to recognize you or know you by name.  Honestly, it probably won’t matter to the elder.  A cheerful, warm and loving visit by someone familiar will bring about positive emotions for the elder that can linger on for many hours or days.  Utilize props, rely on reminiscence.  We are blessed with the traditions of the ages.  Don’t hesitate to bring service books for prayer, sing, or listen to church services.  Gather parish archives, either from your picture files or from publications like anniversary commemorative books.  Let the elder view the pictures and reminiscence.  For holidays, bring along individual servings of tasty treats that will bring about warm memories.  Have fun and use your imagination.  You will be assisting them to use theirs.

Bibliography

This article was written in large part using professional expertise of nearly 40 years of nursing practice within the elder population.  Here are some helpful internet links that can get you started learning more.  Utilizing today’s search engines will be able to further enhance your knowledge according to your interests and needs.

www.alz.org
www.nia.nih.gov/alzheimers
www.webmd.com/alzheimers
www.alzheimers.net

Questions for Discussion:

  1. How many of us know of someone – family, friend, or acquaintance – who has significant memory loss?
  2. How are they being cared for?
  3. Based on this article and other thoughts, what are ways that our parishioners can be helpful to those suffering memory loss and/or to their families?
  4. Why do their caregivers usually avoid asking for help from others?  By asking for help or accepting help offered, how are the caregivers providing an opportunity for Christian ministry?
Natalie Stavrevsky is the wife of Father Ken James Stavrevsky and a member of Saint John the Baptist Orthodox Church in Rochester, New York.  She serves as Eldercare Consultant to the OCA Department of Christian Service & Humanitarian Aid.  Natalie can be reached at nstavrevsky@gmail.com.

Personhood and an Aging Mind and Body

By Peter Kavanaugh

A paper delivered by Peter Kavanaugh at the Orthodox Christian Association of Medicine, Psychology and Religion conference on November 8, 2014 at Holy Cross Seminary, Boston, Massachusetts.

I will never forget Susan. She was sitting in her wheelchair when I first met her.  Her hair was disheveled. The expression on her face was incoherent and confused. She looked into the distance with a vacant stare and waved her hand to and fro, senselessly. She did not recognize her family when they came to visit her. She did not remember the parents that raised her, the meal on which she dined that morning, nor the words spoken to her by the nurse only minutes before. Here, in the assisted living home, Susan spent the last several years of her life a frail, quiet, and for the most part, forgotten person.

The final season in life is full of profound changes. In some instances, this is a time of joy, forgiveness, revelation, and wisdom. When given the opportunity to reflect, and share one’s legacy with younger generations, some discover new perspectives on life, and may, for the first time, become concerned with the eternal and lasting. Unfortunately, old age can also be fraught with losses and diminutions. Many suffer terribly when their body stops working, and are afflicted by multiple disorders and chronic pain. Old age may involve a loss of autonomy, self-respect, or even purpose. Susan’s situation is in no way unusual. Alzheimer’s and memory-loss often give rise to the most challenging situations in aging.

In one way or another, these events will affect each of us. Like so many others, I have felt the impact of dementia in my own family, and grieved with loved ones who suffered severely through each stage. As a former chaplain at a memory care facility in Boston, and more currently, a healthcare professional at an assisted living home in Nashville, TN, I have often wrestled with difficult questions and dilemmas. How can we understand personhood in the light of a fading mind and body? In what way can we nurture a relationship with a person with severe memory-loss? Does spirituality have any place in this? What is the role of the elderly in a Church community, and finally, what is the Church’s position throughout all of this? In the following reflections, I hope to explore these issues, by casting them in the light of the Church Fathers, current medical research, and my personal experiences in geriatrics.

Personhood and dementia

Many of us have known someone who resembled Susan. She may remind you of your mother, father, spouse, or dearly beloved friend. If so, you have probably wondered or still wonder, what happened to the person you once knew and loved so well. Since I began to work in senior living homes, I have often heard people say, “She is no longer the same person”, “The spouse I married has disappeared”, or “We lost him years before he died.”

Dementia is an irreversible and degenerative disease in the brain, which affects one out of eight adults over 65.1 Over many years, plaques and tangles build up in the cerebral cortex and destroy millions of neural connections.2 Essentially, the brain degenerates, and a person will lose his or her ability to function on nearly every physical level.3 Short and long-term memories disappear. Common objects and familiar people may become unrecognizable. The disease process elicits strange behavior, such as aimless wandering, uninhibited emotions, depression and delirium.4 Eventually, reason and communication become rare, if not impossible. In the midst of all these losses, it is no wonder that people ask, “Is this still the same person I knew?”

Our assumptions about personhood are deeply influenced by cultural values. Rene Descartes’ influential adage, “cogito, ergo sum”5 ‘I think, therefore I am’, stresses reason and the intellect. America has a pervading reverence for individuality and autonomy. We often link our identity with our ability to act, that is, to teach, engineer, philosophize, or even parent. Many of us could say, “I accomplish, therefore I am.” Dementia, on the other hand, robs a person of his or her rationality, autonomy, and agency. It brings these cultural anchors of identity to a jolting halt; as a result, many conclude that it robs us of our humanity.

A Different Perspective from the Church Fathers

The Church Fathers, however, had a very different perspective. Two central understandings of human nature run throughout their teachings. First, they define personhood in terms of relationship — to be a person is to be dialogic. Second, they insist on a psychosomatic union — that is, that the body and soul share an inseparable unity. By taking a moment to consider these in the context of the aging process, we will discover a new set of lenses for looking at our loved one with dementia.

Human nature is dialogic. Deep down, each of us yearns to be in dialogue, in communion, with God and one another. Metropolitan John Zizioulas illustrates: “To be and to be in relation become identical….  It is only in relationship that identity appears as having an ontological significance.6 Elsewhere he writes, “personhood implies…the ek-stasis of being…a movement towards communion which leads to a transcendence of the boundaries of the ‘self.’”7 Simply put, each of us has an innate drive and propensity to reach out beyond ‘self’ towards the ‘other.’

 

This nature exists because we have a nous, the “eye” or “power of the soul.”8 As the recent theologian, Jean-Claude Larchet, explains, “the nous represents the contemplative possibilities of the human being. For the Fathers it is fundamentally that which links man with God…it is the indelible mark of man’s most profound being, of his veritable nature.”9 If this indelible yearning for communion is so central to personhood, how then do we understand someone like Susan? What is the impact of a dysfunctional body and mind on a person’s nous?

We can answer this question by looking at the Church Fathers’ teaching about the psychosomatic union. They explain that the body and soul are interwoven and commingled, and that personhood is imprinted within this union.10 In St. Gregory of Nyssa’s words, “the nous is equally in contact with each of the [body] parts according to a kind of combination which is indescribable.”11 The body and soul, however, have different functions. He continues by saying that the soul “transmits from itself to an organized and sentient body the power of living and of grasping objects of sense.”12 The soul gives the body life as well as the ability to interact with the material world.

What happens when the body stops functioning correctly?

This is most beautifully described by St. John the Solitary. He writes, “...when one of [the body’s] interior members is injured, be it either the brain or heart, it is not the soul’s nature that is impaired, but the activity exercised through these members that is impaired.”13 St. John continues with the following analogy about a musician and his instrument: “When a cord in a zither, or a pipe in an organ is damaged, it is not the finger that plays upon them that is at fault, but rather it is the artistic activity of the finger that is impeded from sounding forth by the zither’s cords or the organ’s pipe because the defects are in the instrument.”14 To rephrase, when the body stops working correctly, the soul remains alive and present, but it is unable to communicate or interact with the world effectively.

The relevance of this analogy is striking when we consider the person with dementia. The disease destroys critical areas of the brain, sapping a person of basic necessary abilities, but it does not sap him or her of everything. According to an overwhelming amount of research, people with dementia maintain emotions, imagination, a will, and moral awareness even in the most advanced stages.15 The Church Fathers insist that the inner person is present in a body, however demented or broken. Dementia does not destroy a person’s nous, and an afflicted person maintains the need and possibility for relationships. Like the musician struggling to play music on a broken instrument, our memory-impaired loved ones are alive, but cannot play their song as effectively. As each string snaps one by one, certain strings remain unharmed. Our task is to concentrate on the remaining strings, and to learn to listen to the music.

One afternoon, I decided to spend a few minutes with Susan. Like so many others in her state, she said “hello” and lapsed into what appeared to be silent vacancy. I chatted about nothing in particular at first, and soon became silent, pensive and uncomfortable. Then, not knowing how to proceed, I arose to exit. Immediately, Susan turned to me, and with words saturated in emotion and loneliness, asked me: “Where are going?” I was taken aback thoroughly and sat down once again. This time I merely took her hand into mine and gazed into her eyes.

From there on, whenever I entered a room with Susan in it, her face lit up with joy and eagerness. She could not remember me on a cognitive level, but she certainly did on an entirely different level. I learned an invaluable lesson: how to be comfortable with silence, and to simply be present. In this way, we shared conversations through mere eye contact, and formed one of the most profound relationships I have known. I will never forget the brightness, transparency, and life of her eyes. There could be no room for doubt, that underneath the disease, underneath the quiet, vacant, and wrinkled face, there was a living person.

Nurturing a relationship

Reaching out to someone with memory loss can be frustrating, but it does not need to be. To continue with our analogy of the musician and his instrument, we can think of dementia as a series of strings snapping. Family members often become so upset to see the broken strings, that they forget to see the strings that remain intact. Rather than concentrating on what is lost, we can learn to cherish what remains.

Teresa was an elderly woman with dementia who had lost all her post-childhood memories. When her son John came to visit, she mistook him for her brother. Feeling dejected, John repeatedly insisted that he was her son; he wanted to “snap her out of it.” Consequently, these visits always ended in mutual exasperation, and gradually became more and more infrequent. What went wrong? John wanted to reach out to Teresa, but with a condition, an expectation that she behave in a specific way. Because of her condition, Teresa could no longer relate to John as a mother to a son. She could, however, relate to him as a person to a person. She could no longer recognize John, but she could recognize love. But he was not willing to let go of the broken strings.

Now I would like to describe a different situation. Mary, who lived in the advanced unit of a memory care center, could never fully understand where she was. Her mind ‘filled in the blanks’ with different delusions. On some days she believed she lived in a hospital, at other times she insisted she was in prison. Now, a certain caregiver met with Mary on a weekly basis. Each time, Mary insisted on phenomena that simply did not exist.

The caregiver responded with these three important steps.  First, she took Mary’s hands in her own - physical contact and affection are equally important at every stage of life. Second, the caregiver never contradicted or argued with Mary, but affirmed her. If Mary would demand, “I need to go home to my mother.” The caregiver gently repeated, “so, you want to go home to your mother.” People with dementia are used to being told “no” or “you can’t do that!” This caregiver, alternatively, simply affirmed Mary’s statements and desires. She respected Mary’s personhood. Third, in a calm voice, the caregiver responded to Mary’s emotional needs. “How does that make you feel?” She said, or: “That sounds so hard. Tell me about that.” At the end of these conversations, Mary usually relaxed because she felt heard and loved.

Miss Betty is another lady with advanced Alzheimer’s disease. Upon approaching her, she always begged me to take her home to her parents (who, I was aware, have long since passed away). In scenarios like this, the worst thing you can do is criticize her and try to explain that she is home and her parents are dead. Remember, these memories, this string, were permanently broken. But some strings were still intact. In the midst of Betty’s delusion, something was very real - her emotions and her need for sympathy, respect, and love. I usually responded to Betty by saying: “your parents must be very important to you, tell me about them.” By concentrating on what lasts, and not on what is gone, Betty and I developed a relationship that was meaningful and joy-giving.

Research continually links loneliness with physical pain, depression, poor psychological well-being, and “vegetation.”16 Tom Kitwood, a pioneer in person-centered care, observes that, “It is often the case that a dementia sufferer who is visibly withdrawing or becoming demoralized, is transformed by a little real attention and human contact.”17 Social relationships slowdown the progress of dementia drastically and improve the physical and psychological health of aging adults.18  It is crucial that we reach out to the elderly and spend genuine time with them.

Encountering God

One of our greatest gifts to the elderly, moreover, is to help them to experience God’s grace. When I meet with Christians, I often offer to say an ‘Our Father’ or a ‘Hail Mary.’ Most people learned these in their early infancy, and I am continually astounded to hear residents praying along with me, who could not otherwise tell you their own name. However brief, these moments can be like a drop of water on a parched throat, bringing peace and meaning to an elderly person.

One morning I sat by Rebecca’s bedside, and quietly read Psalm 148, “Praise ye the LORD. Praise ye the LORD from the heavens: praise him in the heights… Praise the LORD from the earth, ye dragons, and all deeps: Fire, and hail; snow, and vapour; stormy wind fulfilling his word.”19  Rebecca was in the most advanced stages of Alzheimer’s. Death was at her door, and she had long since grown silent and incoherent. But at these words in the psalms, she waved her hands in the air and cried, “Lord! I know they do that! I know they do that!” Who knows what the soul is working through, behind the vacant stares of so many like Rebecca. What we do know, most confidently, is that her heart pines for God.

The sacraments, of course, are the most potent gift available to a person like Rebecca. In For the Life of the World, Fr. Alexander Schmemann explains: “A sacrament…is always a passage, a transformation. Yet it is not a ‘passage’ into ‘supernature,’ but into the Kingdom of God, the world to come.”20 The sacraments are a passage into life itself.21 They unite broken humanity with God. They usher the weak and strong, the joyful and sorrowful, into the eschaton.22 Dementia robs so much from an individual, but it does not rob him or her of this blessed gift.

In one of his books, the eminent neurologist Oliver Sacks describes the impact of Church on a severely memory-impaired patient named Jim. He writes:

Seeing Jim in the chapel opened my eyes to other realms where the soul is called on, and held, and stilled, in attention and communion… he was held in emotional and spiritual attention – in the contemplation of nature or art, in listening to music, in taking part in the Mass in chapel – the attention, its ‘mood’, its quietude, would persist.23

Unknowingly, Oliver Sacks may have stumbled upon the nous - that indestructible medium for communing with God - that string on the instrument that will never break. Our memory-impaired elders are as equally in need of the Eucharist, confession, unction, holy water, sacred music and art, and all other physical manifestations of grace, as they are in need of food, water, and medicine.

Spirituality and aging

Spirituality has a strong influence on an aging person’s health. Harold G. Koenig, a leader in the geriatrics community, reports that “religiously committed older adults are healthier, abuse alcohol less often, have lower blood pressure, experience fewer strokes, and have longer survival rates than those older adults not committed to religion.”24Furthermore, evidence-based studies suggest that individuals with dementia who participate in meditation and prayer groups are less agitated, anxious, and depressed.25

Having said this, the purpose of the Church is not to provide coping mechanisms for mental health. The Church is life itself. It is God’s sacramental presence on earth.26 In Paul Meyendorff’s plain words, “Humanity is created to be in communion with God, and the eucharist is the realization of this communion.” True healing, he states, is “the restoration of the proper relationship between God and humanity.”27 Dementia and many age-related disorders are irreversible; however, a person can experience healing of a greater kind as he or she shares an authentic relationship with fellow brothers and sisters, and our Lord in heaven.

Our elder’s place in the Church

2015-0502-chair.jpg

We cannot address the needs of the elderly without discussing their place in the Church. “The body is one,” St. Paul tells us, “and hath many members, and all the members of that one body, being many, are one body.”28 Again and again, our scriptures and tradition emphasize the oneness of the Church. Meanwhile, we live in a society that is highly age-segregated and ageist. Life, as many of us see it, encompasses children and teenagers in school, adults in the work force, and then, well, what else is there? The old and the aging easily fall through the cracks - and just as easily in our parishes. When this happens, can we truly call ourselves one? The elderly are an inseparable part of the community.

The trials in old age are never isolated to an individual, but affect a continuum of people. The elderly usually rely on family members and friends for their most basic needs, a responsibility that can be physically, spiritually, and even financially crippling. One author points out, “As families deal with life, so do they deal with disease.” Alzheimer’s, she continues, “tends to bring about family crisis, even in the best organized and healthiest of families.”29 Paul Meyendorff once said something on a similar note, “The sickness of an individual, just like the sin of any member, affects the entire Church. The whole body suffers when one of its members falls ill or sins.”30 In the midst of so many changes and losses that are part of old age, people need an anchor to turn to. It is critical that the Church be present to the very end.

A Church that does not genuinely tend to the needs of the elderly fails to carry out its inherent mission. “We bear one another’s burdens,” St. Paul writes, “in order to fulfill the law of Christ.” To be Christian is to be eucharistic, and to be eucharistic is to be communal. Rosalie Hudson, a lay theologian and leader in the nursing community, suggests, “The Eucharist is a sacrament of remembrance…to unite us, in all our differences and personal alienations, into one body, a body in which the suffering of one is the suffering of all.”31  When we have ceased to incorporate the weak into our lives, we have ceased to be Christian.

Gifts of the elderly to the community

The elderly bring a distinct and all-important contribution to a community. In traditional Orthodox societies, older adults are looked at as beacons of wisdom and spiritual guides. Are we now so advanced and enlightened that we no longer need the elderly? I cannot emphasize enough how much I learn from residents at my assisted living home. Even those who are no longer able to remember their own names, often share truths that they have gleaned over a century. Are we able to listen? In a society that is constantly rushing, stressed, and anxious, the elderly give us an opportunity to slow down and contemplate. Are we able to be still? Christ promised us that when we serve the frail and broken, we serve Him directly. Can we see our savior in the aging person? And, which is perhaps most needed in our modern society, the elderly give us an opportunity to draw close to death.

Before studying at Holy Cross School of Theology, I spent four and a half years visiting monasteries on a weekly basis. My heart yearned for something, which I could not find in society. It drove me to northern Greece, where I joined a monastic community for fifteen months. The other day, a friend asked me how it was that, after all this, I ended up in healthcare. The answer I gave him is this: what I looked for in monasteries I have found in homes for the aging and the dying.

During so many hours by the side of dying patients - holding hands with Susan as she breathed her last breaths; gazing silently at the beautiful eyes of Mary, who was lost and confused; listening to the same stories over and over about Bob’s industrious parents - I have often encountered the transcendental. Something happens to a person in the twilight of life. The responsibilities, affairs, and preoccupations of young adulthood suddenly become less important. The noise of man’s world grows quiet, and is replaced by a melody of a very different kind. No wonder so many of us are uncomfortable in this setting. But this silence, this music, is our soul’s medicine.

The Church Fathers urge us to remember death on a daily basis.32 We refer to death in the liturgy and our evening prayers. The saints continually urge us to expect death “at every hour.”33 Remembrance of death is not the denial of life. It is life’s enhancement. This is because death, as Fr. Paul Evdokimov explains, “is not just momentary. It coexists and accompanies us all along the path of our lives. It is present in all things as their obvious limit.”34 The nearness of death is a great gift to us, for it helps us to see life as it truly is, and to discover our most innate purpose in this life. A community, therefore, that takes time to fully incorporate older adults into its daily life, will have the opportunity to share a divine and transformative encounter.

A few final reflections

We learn from the elderly a good deal about what it means to be human. At every stage of the aging process, whether someone is in ideal health, or is at the most advanced stage of dementia, we encounter a living, breathing person, wholly in the image of God, and fully able to share a relationship with God and man. By seeing the person beneath the disease, we can learn to nurture a relationship which brings joy and healing. Lastly, the elderly ought to have a true presence in our lives. It is only then, when every stage of human life is woven into the fabric of the Church, that we will truly be one. Ultimately, the old and aging give us an opportunity to learn to listen to the music.

Footnotes

1 Susan H. McFadden, Mandy Ingram, and Carla Baldauf, “Actions, Feelings, and Values: Foundations of Meaning and Personhood in Dementia,“ Journal of Religious Gerontology (2001), p.21.

2 Tom Kitwood,  “The Experience of Dementia, “ in Aging & Mental Health (1997), p. 23.

3 Tam Cummings, Untangling Alzheimer’s: The Guide for Families and Professionals (Dementia Association, 2008), p .41.

4 Ibid., p. 112.

5 Rene Descartes, Discourse on the Method, transl. John Veitch (New York: Cosimo, Inc. 2008) p.25.

6 John D. Zizioulas, Communion and Otherness: Further Studies in Personhood and the Church (Bloomsbury: T&T Clark, 2007), p.1.

7 Zizioulas, “Human Capacity and Human Incapacity: A Theological Exploration of Personhood,”  SIT 28 (1975), pp. 407-408.

8 Jean-Claude Larchet, Mental Disorders and Spiritual Healing, trans. Rama Coomaraswamy and John Champoux (Hillsdale, NY, : Sophia Perennis, 1995),  pp28-29.

9 Ibid. p.38.

10 Ibid. p. 30.

11 Hierotheos Vlachos, Orthodox Psychotherapy: The Science of the Fathers(Greece: Birth of Theotokos Monastery, 2005), p. 101.

12 Ibid.

13 Larchet, p.38.

14 Ibid.

15 Debbie Everett, “Forget Me Not:  The Spiritual Care of People with Alzheimer’s Disease,” in Larry Vande-Creek, Care for Persons with Dementia: Fundamentals for Pastoral Practice (New York: The Haworth Press, Inc., 1999), p.80.

16 Morley D. Glicken, Evidence-Based Counseling and Psychotherapy for an Aging Population (Practical Resources for the Mental Health Professional), (Waltham: Academic Press, 2009) p.2005.

17 Ibid., p.28.

18 Kitwood, “The Experience of Dementia,” p.18.

19 Psalm 148: 1-8.

20 Alexander Schmemann, For the Life of the World: Sacraments and Orthodoxy, (Crestwood, NY: St. Vladimir’s Seminary Press, 2003), p. 27.

21 Schmemann, The Eucharist, Sacrament of the Kingdom, (Crestwood, NY: St. Vladimir’s Seminary Press, 2003), p. 27.

22 Schmemann, For the Life of the World, pp. 102-103.

23 Oliver Sacks, The Man Who Mistook His Wife for a Hat: And Other Clinical Tales, (New York: Simon & Schuster, 1998), pp. 38-39.

24 Glicken, p. 270.

25 Elizabeth MacKinlay and Corinne Trevitt, Finding Meaning in the Experience of Dementia: The Place of Spiritual Reminiscence Work, (London: Jessica Kingsley Publishers, Ltd., 2004), p.137.

26 Schmemann, The Eucharist, p. 36.

27 Paul Meyendorff, The Anointing of the Sick, (Crestwood, NY: St. Vladimir’s Seminary Press, 2009), p. 24.

28 1 Corinthians 12:12

29 Frena Gray-Davidson, The Alzheimer’s Sourcebook for Caregivers: A Practical Guide for Getting Through the Day, third edition (Los Angeles: Lowell House, 1999), p.47.

30   Meyendorff, The Anointing of the Sick, p.86. 1 Cor 12:12.

31 Rosalie Hudson, “Aging and the Trinity: Holey, Wholly, Holy?” in Albert Jewell, ed., Aging, Spirituality, and Well-Being” (London: Jessica Kingsley Publishers Ltd., 2004), p. 137.

32 Paul Evdokimov, Ages of the Spiritual Life (Crestwood, NY: St. Vladimir’s Seminary Press, 1998), p.116.

33 Isaac the Syrian, Mystic Treatises, tr. A. J. Wensinck (Amsterdam, 1923)

34 Evdokimov, Ages of the Spiritual Life, p. 203.

Other Resource
G. Stokes, And Still the Music Plays (London: Hawker Publications, 2010).

This article was printed with permission from THE WORD, the Journal published by the Antiochian Orthodox Church where it was first published.

Peter Kavanaugh is the activities coordinator at Park Manor, a senior living community in Nashville, TN. He previously earned his Masters in Divinity at Holy Cross Greek Orthodox School of Theology, and is completing further graduate studies in healthcare administration. As a member of the OCAMPR Executive Board and a spokesperson on spirituality in elder care, Peter is an enthusiastic advocate for the rights and well-being of older adults.