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Make Decisions While You Still Can

August 17, 2017

Although 90 percent of people say that talking with their loved ones about end-of-life care is important, only about 27 percent have actually done so according to the Institute for Healthcare Improvement. Discussing topics like becoming incapacitated and dying can be difficult.

“Making decisions about end-of-life healthcare is important, and you need to do it before you get there,” said Mandy Slaubaugh, Social Services Manager for Complete Living Care at VMRC. “You don’t know what’s going to happen. You might get into an accident or become ill and not be able to make your own decisions. You don’t want your children or other relatives to fight about what to do with you. Making decisions ahead of time and communicating them to your loved ones is a gift to your family.”

Preparing an Advance Medical Directive (AMD) is one of the most important things you can do. It lets you state your wishes about what kind of medical treatment you would want if and when you are not able to make those decisions, such as when you develop a terminal condition or are in a permanent vegetative state. These directives typically address the following questions:

  • Should resuscitation be attempted?
  • Should life prolonging treatments such as nutrition, hydration and/or ventilation be given, continued or withdrawn?
  • Should treatment shift from the intention to cure to hospice or comfort care only?
  • Should a nursing home resident or someone ill at home be hospitalized?

Sometimes Advance Medical Directives will also address psychiatric issues and treatments.

In an Advance Medical Directive, you name one or more individuals to make those decisions on your behalf any time you are unable to do so - whether or not at the end of life.

“If you don’t name someone in advance, the law will decide who will make the decisions for you,” said Mandy. “In that case, that person may or may not make decisions in accordance with your wishes.”

Some people name a primary and secondary decision-maker - a good idea in case a primary decision maker is unavailable, unable or unwilling to fill that role. Others name two (or more) people to decide together, but that can lead to fighting between them if they disagree about what to do or not to do.

In the state of Virginia, two witnesses must sign an Advance Medical Directive (sometimes also called an Advance Directive for Healthcare) but notarization is not required. Requirements for such documents vary by state.

Another important document to prepare is a Power of Attorney (POA). It lets the person or organization you designate take care of legal, financial, insurance, business and/or medical matters on your behalf as you specify if you are unable to do so. For example, it can let a loved one take care of paying your bills for you while you are hospitalized.

POAs are legal documents which often but not necessarily prepared by lawyers and which must be notarized as required by state law.

“Once you’ve done your Advanced Medical Directive and Power of Attorney, make sure the person or people you have named in those documents know about them,” said Mandy. “Give copies to them as well as your family, friends, lawyer and doctor. If you know that you will be going in for treatment, give a copy to the hospital.”

For easier future reference, you can upload your Advance Medical Directive and declare your organ donor preferences on the following website: http://www.uslivingwillregistry.com/.

Advance Medical Directives and POAs remains in effect until you revoke them. You can change your mind any time and update your documents. You may have different wishes at different points in your life, or you may decide you would prefer a different person making decisions for you.

Mealtimes Matter More with Fresh Produce

August 2, 2017

At VMRC, residents routinely enjoy farm fresh produce from its very own Willow Run Farm. Last year, the farm grew more than 36,000 pounds of food, including tomatoes, sweet corn, assorted squashes, zucchini, bell and chili peppers, potatoes, beets, kale, chard, collards, lettuce, radishes, parsley, basil, watermelon, cantaloupe and muskmelon.

“Our four-acre market garden is now in its third season following an initial pilot program. It’s a modest, yet ambitious operation that gives us farm-to-table dining at VMRC,” said Tom Brenneman, Market Garden Coordinator at VMRC. “I’ve sat with residents and shared the joy and appreciation of eating our farm’s food together. Mealtimes matter. It’s something we could be more cognizant of at all ages because flavorful food and flavorful conversations are things that people of all generations have in common.”

The Farm at Willow Run grows food on quarter-acre plots totalling four acres. Much of its produce gets used by Dining Services to feed residents of Park Gables, Park Place, Oak Lea, Crestwood and Woodland Park.

“It’s nice to where our food comes from. I know that the produce from Willow Run was grown right and handled well, and it’s fresher than anything else I could get,” said Jeremiah Moyer, chef at VMRC. “I get an email with projections of what will be ready when, then I plan my menu around that and request what and how much I need and when I’d like it.”

Local produce is more diverse and affordable, giving Jeremiah more options for cooking. “I get more varieties of squash - including, for example, patty pan - which is usually more expensive. I also get more different kinds and colors of tomatoes and zucchini.”

Some of the produce goes to the Main Street Cafe, which includes a market stand that sells vegetables like squash, peppers, tomatoes, beets and chard to residents and staff. A portion is also sold to community buyers such as Bowl of Good and the Friendly City Food Coop.

With the goal of running a sustainable operation in the long term, Tom is always trying new techniques and different crops.

“This year we have been focusing on core food products that can deliver flavor, volume and a fiscal yield - crops that pay for themselves. Tomatoes are great example,” Tom said. “We opted to not grow green beans due to a combination of the labor required and heavy disease pressure from beetles.”

Farm workers utilize cover crops to protect and replenish soil nutrients in the winter, and while it’s not officially certified organic, it primarily follows organic farming practices. It does things like use polyester row cover until first blossom to let plants develop a viable foundation before they are exposed to pests. It also often uses crimping instead of tilling.

“We choose low to no spray - ‘no’ where we can and ‘low’ when we have to,” said Tom. “For example, we used neem oil to mitigate aphids - that’s approved on the organic spectrum of pest control. We always grow a little more than we think we’ll need assuming that we’ll get a little less considering likely losses due to the elements of nature and pest pressure.”

Going forward, Tom has a vision. “I want to amplify our farm-to-table footprint across all four seasons. I see potential for farm to table growth and viability. If we can be our own internal food hub, we’ll draw other local producers into our market for crops we don’t grow.”

There are just three staff members during the core summer growing season, so volunteers play an important role in the farm’s operations. Students in Eastern Mennonite University’s Sustainable Food Initiative Program participate in work study programs, and residents and community members come out to help anywhere from once a month to a few days per week. A local crop mob assists during crunch times like spring planting or fall harvesting.

Travel Tips for Older Adults

July 11, 2017

Who doesn’t love a vacation? Summer is a great time to travel to many destinations, but sometimes actually getting there is a big challenge. Sorting out all the necessary travel logistics can be intimidating. So we talked with four VMRC residents - all experienced travelers - to get their best travel advice for older adults.

Do Your Research

“Read about your destination ahead of time so that you know what you want to do, but be open to changing those ideas as you travel,” said Ann Sebrell. She and her husband Ralph like to take road trips to different destinations throughout the United States. “If you don’t get to where you thought you wanted to go, just find somewhere else to go!”

The Sebrells like to stay in one spot for several days so they have time to get to know the people and the area.

Consider Group Travel

Some older adults prefer to travel as part of groups. “There are advantages to group travel,” said David Eshleman, who leads group trips to places like Israel with his wife Joyce. “You get more for your money because everything is prearranged. When we coordinate our trips, we work with a local travel company in Harrisonburg and another one in the Middle East that places many groups there, so we get better negotiated rates. We simply tell them what we want to do, and they customize our trip.”

David also suggests making the time to go on longer group trips as it’s more worthwhile to travel far if you’re going to stay for awhile.

Pack Smart

Packing light and packing well means that you’ll spend less time managing your stuff and more time enjoying the sights, sounds and people on your trip.

“I pack a bag for each day, then I don’t have to root through my bag every day,” said David. “It makes it so much easier to live out of my suitcase.”

“We use two-gallon, clear plastic ziplock bags to pack our clothes,” said Joyce. “We started doing that after an airplane bathroom once leaked all over our luggage, but it’s also good because TSA can see into the bags, so they don’t open them all, and our clothes don’t get so wrinkly.”

Remember Key Personal Items

If you are taking prescription medications, be sure to take enough with you so that you don’t have to worry about sourcing refills en route.

“I take a cosmetic bag with Imodium, Pepto-Bismol, cold medicine, cough drops, allergy medicine and any prescription medicines,” said Joyce. “It’s best to leave them in their original containers, especially if you will be going through customs.”

“We always take our pillows - no matter what,” added Ann and Ralph. “It helps us sleep better.”

Take Care of Things at Home

Before you leave your home or apartment, don’t forget to hold the mail, stop the newspaper delivery, turn off the water and unplug major appliances. Let a neighbor or friend know that you’ll be gone so that they can check on things while you’re away. Those who live in retirement communities like VMRC can simply tell staff of their plans.

“Whenever we travel, we feel that our apartment is in safe hands with VMRC,” said Ralph and Ann, “We live in a great neighborhood, and security keeps an eye on things for us.”

Get Trip Insurance

Older adults are more likely to experience health issues that could them from travelling as planned. “We highly recommend travel insurance,” said David. “If you have to cancel out of the trip at the last minute after you’ve already paid, you can get your trip costs reimbursed. It also covers you if something happens while you’re there.”

“For example, one fellow traveler had a heart attack while abroad, and the insurance company and travel company took care of moving him to get him better care - in that case, going home. The age of the traveler(s) and cost of the trip are what determine your travel insurance premium.”

Switch Drivers

Older adults who drive should think about how much and when to drive each day. “We drive about six hours per day at most, and we switch drivers every 100 miles,” said Ralph. “It keeps us from getting too tired.”

“We stop a lot, so it takes some time, but we always plan our destination ahead of time and try to be there by 4:00 pm,” said Ann. Driving in the daylight works better for those with night vision issues.

Keep a Journal

Once you get underway, consider recording your experiences so you can reflect on them and enjoy them in the future.

“Keep a journal. You’d be surprised how much you each remember differently or don’t remember at all,” said Ann. “When Ralph and I first started travelling together 35 years ago, I wrote for a half hour each evening. Now we enjoy reading them together in the winter time.

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