Posts Tagged ‘attitudes’

How Old Am I?

May 5, 2019

Age is a funny thing. Yes, there is the chronological fact of the number of years a body has existed since its birth – but even that is not counted the same way in all cultures. For some a child is one at birth, for others (most?) one is only achieved after a year of existence. My reflections have little to do with chronological age, except as a baseline against which perceived age, experienced age, sensed age might be compared.

I remember a friend many years ago, a woman at that time in her early seventies, saying she got a shock each time she looked in the mirror and saw the old woman there looking back at her. She felt herself to be still young and energetic, looking forward to new experiences, as though she were still in her thirties – “or maybe early forties, certainly before my hair turned grey.”

In my own seventies now, I relate to her comments, not so much the mirror experience, but the definite discrepancy between the count of years lived and the way I feel from the inside looking out, at least most days. Yes there are some – yesterday was one – when a combination of fatigue, barometric instability, old injuries and some new pains cause me to feel my years. Fortunately so far they remain relatively rare. Or I can keep them relatively rare by getting enough sleep, eating right, using my herbal and topical pain treatments and not letting the time demands of my work overly dictate how I pass my days.

That last is the hard one. I still am not good at taking rest/activity breaks during the long and busy work days, though I know I am actually more productive if I do get out and walk a bit, or step away from the computer and the phone and give a few minutes of mindful attention to me. When the urgent deadlines pile up, work runs from 7:30 AM to 8:30 PM. That I can meet that schedule informs me that I am still young enough, with enough energy, to seem only in my fifties, if that. Stepping away from the work, when I do get an actual entire weekend off, I still feel young when I have energy to do fun things, like participate last weekend in Word Tai Chi Day, attend a Gay Pride event, the first ever in my community, and then an amazing concert by a visiting string quartet.

Yesterday, however, with all of my body aching with fatigue and hurtful reminders of every accident and injury experienced in my life, I felt every one of my years. Again, I am grateful those days are few and relatively far between.

The greatest discrepancies I perceive between “real” age and how I see myself are undoubtedly connected to my current life, married to a much younger man who is at quite a different stage of career and focus than my age mates, most of whom are busy with volunteer activities and the desirable pursuits common to engaged and energetic retirees. I do have in common with then an engagement with the raising of young children – in their case mostly grandchildren and some great grands, while in mine it is my husband’s youngsters, now mine by shared responsibility. Never having borne children myself, I still am getting adjusted to being Mama Niki to a seven year old!

From early childhood I have carried within me an awareness that, barring some accident, I would have a very long life. That expectation prepared me for working into later life, as I never had the kind of income to enable much in the way of retirement savings. When I read statistics about national saving rates, I feel rather proud of what I was able to put together, although when I look at articles dictating the amounts usually needed as retirement savings, I fall far short. In the former frame of mind, seeing what I have achieved and that I am still working and adding to that fund, I feel young. Comparing myself to the latter standard, I could lapse into a fearful awareness of being too old to get to the posited standard.

Fortunately, I don’t have to do so. I have begun to relax into the appreciation that financing my later years is no longer my sole responsibility. Indeed, I am very close to the point of being able to choose to work or to retire, an option I had not previously considered.

Enter an article I read this morning, about one aspect of a study being conducted in Cilento, Italy, and published in International Psychogeriatrics. The community has a very high proportion of very long-lived older citizens. Genetics and diet and lifestyle are all being reviewed, along with an analysis of psychological qualities which the article summarized into a list of values shared by all the residents aged over 80 who were being studied. Regardless of the state of their physical health, certain psychological traits were predominant among them.

Resilience was on the list, interpreted as a belief that one can withstand and overcome what living throws at one. Also optimism, and social engagement, and attachment to the land (the community is rural). What the researchers did not expect was the value that came up as number one – the expectation and intention to work throughout one’s entire life. This long lived populace (one in ten have reached 100 or more) have no concept of retirement. Types of work shift with physical changes of aging; fact of working does not.

It would seem that if I want to be present for the marriage of my young sons, and the birth of their children, I need to ignore the chronological years and instead keep a strong hold on my sense of youth and energy, as well as a continued engagement with my own career. My own experiences working with Hospice coincide with the research findings from Cilento. Over and over I have seen that the single most important component in determining length of life, especially near its end, is attitude.

There is a culture, I do not recall which one, where age is counted backwards. At birth a child is given the expected life span, and each year lived is one subtracted from that total. I don’t recall how the culture handles those who live more than the expected number of years. By the standards of that culture, I would place myself at about 35 years of age. Younger than my husband, appropriate to having young and early teen children, and definitely looking ahead to remaining years of employment and new challenges.

Resilience, optimism, engagement with the land (I have run away from city living for my entire life) – those are in place. I probably need to build in a bit more social interaction, although my work has me very engaged with people on a daily basis. So much so that, so far, I prefer quiet and solitary pursuits for relaxation. If my work changes from the current health care to what I project as a future of full time writing, I am alerted now to also add new social activities to my schedule. That will give me everything in place to join the residents of Cilento in an active older old age.

 

Foxes and Owls

September 23, 2018

I spent the past week in training to learn a new data/case management system being implemented by my employer. We were a mixed group of current employees and newly added imports from a former quasi-competitor, all of us working in care coordination as either first level case managers or second level supervisors. To simplify my referents here while maintaining a degree of anonymity for the companies I will refer to my employer group as the Owls and the newly integrating staff as the Foxes. Both groups previously provided services to Medicaid recipients under contracts with our state government. The Foxes contract was not renewed and its clients needed to change providers effective January 1 2019. In a negotiated arrangement, the entire caseload and some 300 employees were transferred into Owl as of September 1. The Fox staff thus has had to learn not only the case management system new to all of us, but also to adapt to the Owl corporate culture which is notably different from their own.

That difference in corporate cultures seems to me to be reflective of somewhat divisive differences in our wider society these days. It also seems linked to my observation of a worldwide and concerning repetition of a trend from the early 1930’s. Following the world wide repercussions of the 1929 stock market crash, economic differences between classes of societies in many countries became exaggerated. The relatively small number of economic “haves” were resented by the large number of economic “have not’s” in a fashion similar to the current anger of a large portion of U.S. society against the “1%” – or the 10% depending on which metric you prefer. Now, as then, reaction is taking the form of both scapegoating on some defined “other”, and a movement toward more authoritarian leaders. Recent election results in several countries suggest the phenomenon is not limited to the U.S. Resentment of immigrants, a rise in nationalism and parochial views, and growing intolerance of difference seems to mirror that experienced in the years before the outbreak of World War II.

The voices advocating “going high” are increasingly drowned out even on the so-called liberal side by strident demands for forceful counter measures. I do not have TV reception in my home by intent. Spending a week in a motel while at the training, I did turn on the set in my room one evening to watch the 6 PM news. I did not see the program through because I was so appalled by the viciousness of all the political ads peppered throughout the show. Not one presented a candidate’s platform, views, aims. Every single ad – all funded by political pacs, rather than individual campaigns – was an ugly, twisted and negative attack exaggeration of some opponent’s purported position. As little as I care to imitate anything in the conduct of our current president, I did find myself scolding the TV for “fake news” as I turned off the set.

Our instructor for my training week is now an upper level Owl manager with whom I have worked for five years. We started together and while I have chosen to remain a front line worker, she has advanced in well merited fashion to my supervisor, then my manager, and now up yet another level to program management. (I have 20 plus years of management in health care behind me and have less than no interest in ever again being responsible for anyone’s work product other than my own.) Holly did an outstanding job of both teaching the Fox staff the procedures we Owls follow to manage our cases, and teaching all of us how to get the work done in the new computer record system. Inevitably, usually in the question sessions, differences came out between how the Foxes had handled some of the work and the way they would now be expected to handle it as Owls. Many of the differences were minor tweaks to procedure (we were after all both subject to the same mandates in our State contracts) but some revealed a deeper difference in corporate culture which may well have contributed to the Owl’s State contract being renewed while the Fox contract was not.

The Owl company originated locally early in the last century. It has grown steadily and is now one of the largest employers in the state. Throughout, it has espoused and manifested a culture of open communication and of caring both for its clients and its staff. It is not perfect – no large business will ever be flawless – but it does consistently get high satisfaction ratings both from its customers and its staff. The Fox company is a regional branch of a major national corporation. It is continuing to do business in our state, just not any longer providing Medicaid managed care here. I have interacted with current and former Fox staff over several years, and learned much more about their operating culture during this past week of training.

What seems most salient to me as a difference between the two companies emerged in a lunchtime conversation I had with a Fox supervisor who was stressed by what seemed to him to be a conflict between what he had been told at the general orientation he had attended just two weeks prior to our training, and what Holly explained as a step in the Owl case assignment process. At issue was whether staff preferences for types of cases could/would be respected. In the general orientation, a presenter had stated that Owl management strive to enable employees to work in the areas for which they feel a passion and commitment. The supervisor heard this statement as supportive of Fox structure which allowed case managers to choose to handle only adult clients, or specialize in children; take on long term care cases or work only with clients needing links to physical health providers. Holly explained that Owl new case assignments are given on a round robin basis, and the case manager is expected to work with a variety of types of clients, with assistance from subject matter experts.

The supervisor could not reconcile what he heard as directly contradictory statements. Either case managers could specialize according to their preferences or they could not. Which was it to be?

I am aware of Owl company efforts to encourage staff to find their niche even as I work a caseload that includes members whose needs are quite far afield from my areas of expertise. I have not felt this to be a conflict because I know if I feel strongly enough that I am unsuited to managing a particular case I can discuss the issues with my supervisor, and either receive the necessary outside support or have the case transferred because it is in the best interests of the client to have a more knowledgeable coordinator to work with. I am also aware that an underlying expectation of Owl employees is that we will stretch and grow rather than stay locked in predetermined boxes doing only the same things over and over. And I have experienced the spirit of cooperation, interaction and helpfulness to one another that is a basic performance expectation in the Owl world.

Trying to explain to the Fox supervisor why I do not hear the two statements he cited as being in conflict, I suggested that he has been functioning in a “black and white” culture, with defined guidelines coming down from the national level and little if any room for discussion or interpretation. “Do it this way” because that is how it has been decided at corporate headquarters, where the responsibility for maintaining standards is held.  He agreed that was the essence of Fox corporate culture. I described Owl culture, by contrast, as a “rosy” culture where guidelines are more fluid. Our standards are clear and expectations communicated, but individuals are encouraged to take more responsibility for their own performance as they contribute to the group’s overall achievements. Flexibility, adaptation, change and growth are the norm for Owls. If those changes start to feel like they are coming too fast, we can speak up, be heard, and know that we will be offered support to adjust.

I suggested to the Fox supervisor that the challenge facing him was not to resolve a seeming contradiction in case assignment guidelines, but rather to shift from hearing things from a black and white mindset to hearing them in a rosy mentality. He thought for a few minutes and agreed that making that shift, and helping his supervisees to do so, would be a big part of his new responsibilities.

What does this employment environment discussion have to do with the near century old cycle of political movements with which I began? For me, Fox culture mirrors the have/have not, missing middle ground rigidity and authoritarian patterns that relieve individuals of personal responsibility but which almost inevitably lead to conflict and war. Owl culture seems to embody a more interactive and democratic model that demands flexibility and willingness to change, as well as taking personal responsibility for one’s actions, but offers a road to negotiated settlement of disputes.

Not everyone is comfortable within Owl culture. Employees resign because they need a more clearly structured environment, with very specific duties that they know they can complete. Or because they are unwilling to put in the overtime sometimes required, or to keep adapting to procedure changes implemented in an effort to further enhance customer experience. I can relate to their frustrations with Owl culture. I understand their need for more control as an extension of my own unwillingness to be promoted to a supervisor or manager role because I want to “only be responsible for my own work product.”

Despite that preference of mine, I know I would not last in a Fox corporate culture. I don’t take well to a highly structured, “my way or the highway” environment. I value the give and take, openness-to-suggestions approach that I have experienced as an Owl. Which is why I labeled the environment a rosy one, rather than the traditional gray  contrast with Fox black and white.

What I don’t know is how to bridge the divide between the two cultures.

The Fox supervisor was oriented to changing his own view. “I’m grateful to have a job instead of being out of one at my age.” He said he has been encouraging that attitude of gratitude in his peers, many of whom were finding it hard to accept their sudden transfer of employer coming after 9 months of uncertainty about Fox renewing its State contract. Over the next months, we will see who can adapt and who decides to leave and seek different employment. Those who remain will obviously be those who can accept, perhaps even welcome, the change of culture. Those who leave will seek the culture they prefer, and for their sake I hope they find it.

Can a third generation coal miner adapt to building solar panels? How do we help a worker on an auto assembly line feel comfortable living in a different state and manufacturing wind turbines? What steps have not been taken as/when they should have, to facilitate maintaining a middle between the 10% and the rest of us? As some of us continue to push for environmental protections, more equitable sharing of resources and social supports, and genuine equality of opportunity, how do we facilitate transitions for those who see themselves losing out in the change?

We are not all Owls. Our societies need Foxes, and need to include them in determining how there can be a place for them to feel productive and important., working alongside Owls. Otherwise, I see more and more countries torn by internal strife, and society as a whole repeating the century cycle ending, God forbid, in a World War III.

No Drama Please

December 28, 2017

Of the many adjustments required as we age, one I did not anticipate has emerged as a result of coworkers taking time off for the seasonal holidays. In particular, a behavioral health care coordinator (BHCC) with whom I work closely has been on vacation since before Christmas, and won’t return until after New Year’s Day. Meanwhile, one of the clients we coordinate to assist has been in crisis, suicidal and starting to misuse drugs. I have done what I can to support his immediate family members who are the ones actively intervening to divert his self harm. He seems to be headed for inpatient assistance, and I did find another contact person for his family to call if they need further help while I in my turn take the next few days off.

In years past I have had a counseling license, and supported myself at times with a private clientele about evenly divided between couples unable to communicate about their incompatibilities, and men with anger issues. From the feedback I received, I was an effective practitioner, and I found the work rewarding. I learned much that has been useful to me in my subsequent years working in home health, and now as a care coordinator for a managed care organization. I even thought about applying to work for the behavioral health component of the organization. Something held me back – and now I think I know what that something is.

Age.

Not that I’m too old to do the job, which is no more demanding than my own. In fact the  BHCCs have smaller caseloads, more paid vacation, and the same working hours as I do, so the capacity of my older body to see the work week through might well be less stressed by a BH caseload. That’s not the issue.

While I don’t agree that getting older means getting more conservative, I do see in myself a subtle shift in values that can perhaps best be described as less engaged with the drama of others’ lives. For those who seek help, I am ready to provide supports, encouragement, instruction, empowerment and accompaniment if that is needed. I don’t expect immediate success nor do I limit the number of repeats necessary or the amount of time allowed to achieve progress, however minimal, toward the client’s stated goals. What I used to also offer was intervention when misunderstandings escalated into high drama, persistent redirection when drug use became a burden, and a generally more receptive involvement with the ups and downs of my clients.

No more.

In one of several descriptions of the stages of life, the later years are said to be dominated by contemplation. Whether reviewing one’s own life, or reflecting on the state of society, older people are perceived to be thinkers more than doers. Pragmatically, we’ve learned the often negative consequences of impulsive, reactive behavior. We see benefit in giving reasoned responses and we know that few important decisions need to be made “right here, right now.” Which is not to say that we procrastinate (though some of us may do so), nor that we resist acting promptly, in a timely manner, to take advantage of unexpected opportunities. But we do so with forethought, and at least in my case, with a degree of detachment from the decision.

Perhaps what I’m trying to express is simply that few things that arise strike me as dire and in need of immediate action. Few things, equally, are apt to cause my world to collapse around me, if my decision turns out to be faulty. As a consequence, I apparently also prefer not to be unduly engaged , at this point in my life, with people for whom every decision is fraught with high drama. I care about, but do not fear, outcomes. I am confident that if things don’t work out as I hoped, I will not only survive but appreciate the different direction my life goes as a result of the unexpected outcome.

This preference definitely carries over into my work; I don’t wish to engage much with people in the midst of high drama, panicking over decisions that may seem, but seldom are, life threatening. Ergo, I would not do well with a caseload of clients with such mental instability that they need care coordination to get through the basics of their daily lives. My own clients need care coordination as well, but primarily to help them access supports for their physical shortcomings. I am occasionally called on for counseling on how to accept new physical limitations, plan for end of life, or adapt to new and frightening diagnoses. That is a type of mental/emotional support I still feel easily able to provide.

Without this past week’s experience, I might not have recognized my shift in perspective. I do know that I don’t want emotional tension in my life now. I used to live with a degree of dramatic stress which I would now find totally exhausting. Loss of energy with age? Loss of patience with false intensity of feeling? Or gain in understanding and perspective, with an accompanying gain in ability to express and manifest my preferences?

Whatever the underlying reason for my shift in preferences, I’m glad to recognize them and know that I have the capacity to implement them in both my personal and my work life.

Now, I wonder what previously unconscious inclinations, habits, tendencies and preferences will be revealed to me in the new year? I look forward to finding out.

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