THIS WEEK'S TOPIC: Families and aging
Gathering around the Thanksgiving table families often find themselves discussing tough issues around aging. Maybe the family's elders suddenly appear to be more frail, and in need of assistance. Or the aging parents feel like their kids are overbearing and trying to run their lives. How can families navigate issues such as independence, assistance, or sharing the care responsibilities among relatives? How do older adults envision their lives as they age, how do they stay connected, and what's important to them?

Join our conversation – tell us what has worked for you, your family, or what you are struggling with.

When: 12:00 noon Tues, November 24th.

Where: Right here. Click the blue button in the right sidebar to join the chat.

Moderator: Maiken Scott

This weeks guests:

Brian M. Duke, Brian M. Duke is Director of the Bucks County Area Agency on Aging. He has worked in the field of aging for many years, and also has personal experience as a caregiver; he cared for his mother during the last years of her life.

Dr. Dan Gottlieb is a therapist and psychologist, and the host of WHYY's weekly radio program "Voices in the Family".

Dr. Adam Davey Dr. Adam Davey is a Developmental Psychologist with a Research Interest in Aging. He is an Associate Professor in the Department of Public Health at Temple University.
 

Listen:

For some theater-goers, the play's deeply emotional plot comes as a surprise.

"I thought it was about rabbits"

Instead, Rabbit Hole is about a family coping with grief in the months after a 4 year old boy gets killed in a car accident. Playwright David Lindsay-Abaire received rave reviews from critics for his sensitive, quiet, and realistic portrayal of people torn apart by sadness.

The subject matter makes the play a challenge for both audiences and cast. For some, it stirs up hard memories. Here's the Arden theater's artistic director, Terry Nolan:

Nolan: I had a sister who died about 25 years ago, so she was younger, so when I read the play, I recognized it. I understood immediately what the family was grappling with.

For others, it's a topic that seems unbearable. Brian Russell plays the father in Rabbit Hole. While he fell in love with the play, his wife, who usually practices his roles with him couldn't stand it:

(l-r): Grace Gonglewski as Becca and Brian Russell as Howie in Arden Theatre Company's production of Rabbit Hole. Photo by Mark Garvin.

So – the play has been a bit of a tough sell for the Arden says Terry Nolan:

Nolan: As we have been marketing it, it's been a constant challenge to figure out how we are honest about the subject matter of the play, while letting the audience know that it's also a play that is filled with laughter and love.

After the performance on a Sunday afternoon – the feedback is positive:

Audience Member: it was beautifully done, and it was very engaging.

And theater goers are in conversation about grief:

(l-r): Julianna Zinkel as Izzy, Janis Dardaris as Nat, and Grace Gonglewski as Becca in Arden Theatre Company's production of Rabbit Hole. Photo by Mark Garvin.

That's what a play like this can do, says Philadelphia therapist Linda Welsh. It can start a conversation on a difficult topic, provide an outlet to deal with emotions, and teach important lessons along the way:

Welsh: What you can learn is how not to force your own way of dealing with loss and grief on someone, even someone who you think you know very well, and is very close to you, that everybody has to work these things out as their style allows.

Actress Grace Gonglewski who plays the mother in Rabbit Hole hopes for a simple take-away message – to be kind to one another:

Gonglewski: When my mother died I would be driving in the car, and I would lose myself in the grief, and I would not go right away when the green light changed. And I wanted to say to the person behind me, yo buddy just chill out, I'm grieving. But there is no way to have that in your life. So I hope that this play will remind people to just treat each other with a little tenderness, because there is a lot of grief.

Rabbit Hole is at The Arden Theater in Philadelphia through December 20th.

Listen:

Listen:

When people with autism become adults, many find themselves with nothing to do. That's because educational and employment programs often end at age 21.

22-year old Dan Abrahams has Aspergers, one of the autism spectrum disorders. He is living in a group home and says his inability to function under pressure caused him to lose his last job:

Abrahams: My manager didn't understand why I would have episodes at work when I got frustrated, I ended up walking off the job.

Nina Wall Cote directs Pennsylvania's bureau of autism services. She says employment is a big hurdle, and one challenge is finding employers who are willing to provide a good work environment for people with autism.

The day-long conference on Friday connected people at 15 different sites all over the country, who exchanged ideas and electronically voted on solutions.

Wall Cote says the conversation on adults is just beginning:

Wall-Cote: I think the whole focus has primarily been on children with autism, but now, the conversation is shifting. There are adults with autism out there who have been struggling for some time but the wave of children who are going to be hitting the adult service arena very soon is forcing these other discussions.

Artie Kempner is a board member of Autism Speaks and Autism Delaware. He says brain storming on a national level will lead to better solutions:

Kempner: We've got some really great programs, not just in the Philadelphia area and in Delaware, but also across the country. And if we bring all these people together, and bring employers in as well, and they can understand the needs, we can better serve the community of adults with autism.

Experts at the conference agreed that many adults with autism are able to work as long as they are in supportive environment and employers understand their special needs.

Listen:

Pennsylvania budget cuts mean fewer dollars for social services, though many providers say the cuts are not as bad as expected. Debbie Plotnick of the Mental Health Association of Southeastern Pennsylvania says in addition to facing a tighter budget, her agency is still hurting from the budget impasse – when state payments for services were held up:

Plotnick: We have to make interest payments on the loans that we're taking out for the many months when we had no cash flow, and of course we had danger to our reputation as a good payer, so our vendors of course had to wait.

Dr. Arthur Evans heads Philadelphia's Department for Behavioral Health and Mental Retardation Services. He says the budget cuts are not as big as initially feared, but agencies were de-stabilized during the budget stalemate when they were not receiving pay from Harrisburg:

Evans: Some of them had to lay off staff, many of them had to draw down on their credit lines, I think the other issue is that last year we had a cut, this year we have a cut, it means that those providers will not get a cost of living increase.

Evans says not getting a cost of living increase represents another challenge for providers as many of them face increased costs, especially for staff health care. He says his office has to examine many of its programs to see which ones are essential, and where cuts can be made. He says service providers also have to brace for a smaller Medicaid budget, which goes into effect in January.

The Philadelphia Alliance which represents service providers – is hoping to learn from this year's budget delay. It's surveying its members to see how the funding freeze hurt programs and how to be better prepared in case there's another budget impasse next year.

Listen:

A new survey claims that veterans still face many barriers when seeking mental health care – even though federal legislation mandated more services and better access a year ago. The survey by the National Council for Community Behavioral Health Care found that the majority of veterans face long waits for appointments.

Edward Lowry heads the Philadelphia Veterans Multi-Service and Education Center. He says his center is trying collaborate with the Veterans Administration to provide services, but the VA is struggling with staffing shortages.

Lowry: for the longest time we had two psychologists on site and a psychiatrist normally, three to five days a week, and over the last year, we lost a couple of the days that the psychiatrist was here, and we lost both of the psychologists

Lowry says not providing services to vets now will lead to more costly problems later:

Lowry: you know, the old saying pay me now or pay me later is in effect because we're seeing young, recently discharged veterans out of the military less than six months showing up in the homeless population that we serve.

Jeannie Campbell from the National Council for Community Behavioral Healthcare says the Veterans' Mental Health Act is falling short on its promise to offer reliable, timely care to veterans.

Campbell: there are so many folks who have indications for PTSD or some sort of a mental illness, that it's going to take all of us, and we can't continue to make the mistakes that we have made in previous wars such as the Vietnam War

Campbell says in addition to long waits for appointments, veterans also often face long drives to get to the closest VA – especially when living in rural areas.

Listen to the radio reports:

New Jersey National Guard Chaplain Joanne Martindale is just returning from a national conference for military chaplains – and says she and her colleagues are concerned about anxiety levels among military families following the shootings:

Martindale: They are wondering well, will Ft. Dix be the next base, or what will the next base be where somebody will do a copy cat shooting. So I think families are anxious.

Martindale plans to reach out to families, especially to children already in support groups, and encourage them to talk about their worries.

Michelle Sherman is a psychologist who works with military families. Sherman has written several books, among them "My Story, Four Blogs by Military Teens". She says in families that have a loved one in the service, parents should discuss the issues with their children, but they should limit exposure to media coverage of the shootings.

The shooting in Fort Hood has focused the attention of the nation on the state of mind of a single soldier. But mental health providers in the service say the shootings don't reflect on the military's increasingly pro-active approach to soldiers' mental health.

West Point psychologist Dr. Michael Matthews says the military has started to focus on resilience with its comprehensive soldier fitness program. Developed in collaboration with the Center for Positive Psychology at the University of Pennsylvania, it screens soldiers for potential mental health problems – and provides tools for improvement:

Matthews: If they come out a little low on any of the domains, there will be a series of recommended actions that they can get and resources they can tap into on their own to get better.

Matthews says focusing on what keeps soldiers mentally healthy reduces the stigma of seeking help for a mental health issue.

In terms of preventing future shootings – experts say there are often warning signs such as changes in behavior, or mood – but Temple University psychiatrist William Dubin says they easily go undetected because they tend to be isolated and random.

Listen:

Delaware's Division of Public Health reports that at the Brennen School in Newark, only 10 out of 320 students got the vaccine. This is a tough issue for parents of children with autism, says Theda Ellis, who directs Autism Delaware, a non-profit advocacy organization. She says worries about a connection between autism and vaccines still prevail:

Ellis: Many parents give anecdotal information that their children developed symptoms of autism following a vaccination so particularly for those parents, it's a big issue.

She says some parents think a preservative used in vaccines is related to autism. In addition, Ellis says there are other worries:

Ellis: For some people it's the impact on the auto-immune system, and so little being known about it, and then the third concern about the swine flu vaccine is that there's a sense that it hasn't really been adequately researched yet.

Dr. David Mandell of the Children's Hospital of Philadelphia says no research has shown a connection between autism and vaccines. He says parents should consider the health benefits of getting the vaccine when making their decision.

Mandell: Vaccines are extraordinarily safe, that is the risk from having any kind of problem associated with the vaccine is much lower than the risk of getting what could be a very serious infection.

School vaccines are also under way in Pennsylvania and New Jersey, but student participation rates are not available.

THIS WEEK'S TOPIC: Healthcare professionals and grief

Suffering and death are a regular part of the work day for many healthcare professionals. They struggle with their own grief, sense of loss and maybe failure, anger, and disappointment – all as they communicate with panicked or bereaved families, and try to care for other patients. Often, their hectic schedules don't allow time to rest for a moment, and deal with their emotions.

Several local hospitals are addressing this issue by encouraging open discussions among healthcare professionals; establishing monthly meetings, or "Grief Rounds".

We will be joined by three professionals who facilitate such discussions – and want to hear from healthcare professionals and consumers alike.

What helps healthcare professionals deal with grief – how do you cope? When your family was experiencing a medical crisis, what are some things the healthcare professionals did that were helpful? Or what do you wish they would have done?

Let's get a conversation started!

When: 12:00 noon Tues, Oct 27

Where: Right here. Click the button in the right sidebar review an archive of the chat.

Moderator: Maiken Scott

Our guests are:

Florence Gelo, D.MIN., NCPsyA, Associate Professor in the Department of Family, Community and Preventive Medicine at Drexel University. Dr. Florence Gelo has been a pastoral psychotherapist and psychoanalyst for over 25 years. She is the Behavioral Science Coordinator for the Family Medicine Residency Program, and the Director of the Humanities Scholar's Program, at Drexel University College of Medicine.

Horace DeLisser, MD, Pulmonary and Critical Care Specialist, University of Pennsylvania
Dr. Horace DeLisser has also been interested in medical ethics, end-of-life issues, cultural competency and religion and spirituality in medicine. He is currently the Assistant Dean for Spirituality and Cultural Competency in the U Penn School of Medicine and has been very active in medical education.

Linda B. Welsh, Ed.D., is a therapist and directs the Anxiety and Agoraphobia Treatment Center in Bala Cynwyd. She is the Co-Director of Professionalism Education at the University of Pennsylvania Medical Center, and facilitates discussions among healthcare professionals across our region.

Would you like a reminder? Enter your email address in the form in the right sidebar, choose a reminder time and click set.

If you miss the live discussion, an archive if it will be available on this page.

Note: Florence Gelo, Horace DeLisser, and Linda B. Welsh will take your questions and comments in an online discussion on healthcare professionals and grief Tuesday [11/03] at noon on Digest This. Click here to participate or read the archive.

Listen:

It's the death of younger patients that's often the most upsetting.

Resident A: Thirty year old lady, just had a baby six weeks prior, completely healthy, had just had a little infection, and no signs that this was going to go and progress the way it did.

Dr. DeLisser: House staff were having a difficult time processing and handling the death of patients in the medical intensive care unit here at the Hospital of the University of Pennsylvania.

Two years ago, Doctor Horace DeLisser started a monthly conversation about dealing with loss, the "Grief Rounds". This session brought together a group of residents – young doctors completing their training.

The conversation keeps returning to the young mother who died from a respiratory infection:

Resident B: I didn't know that she had passed away at that point, and I looked up and there was no one in the room, and the realization hit me then.

Resident C: This came out of the blue, could happen to anyone, it could have been one of our own friends, this could have been any of us in the same situation

Such feelings, says Philadelphia therapist Dr. Linda Welsh, are something health-care professionals take home:

Welsh: You see all of this fragility, vulnerability and loss in the hospital, you're bound to go home, feel anxious about whether your own family is safe, or how illness would be dealt with if you had to encounter it on a personal level.

Welsh hosts discussion groups for nurses, doctors and other staff in medical centers all over the region. These sessions often focus on the death of one patient and how it affected various staff members.

It's a prescription against burn-out, says Welsh – which can happen quickly. With the high death rates in the intensive care unit, University of Pennsylvania hospital Resident Kelly Vranas finds herself questioning the value of what she's doing:

Vranas: Being in the ICU you sort of start to lose hope that you are ever helping people because here, the end point is often death, and so you start to wonder whether any of your efforts are ever worthwhile…

Med students rarely get taught much about dealing with their emotions, says Florence Gelo. She teaches medical humanities at Drexel University.

Gelo: The idea is to be scientifically qualified, to be clinically savvy, but how to deal with one's emotions when constantly caring for patients where loss and grief are an unavoidable component is sort of rare.

Even seasoned physicians like DeLisser grapple with these issues

DeLisser: I have been a physician for close to 25 years, and I still struggle and have to deal with anger, grief, loss, disappointment, frustration, fear, the uncertainty of medicine

In addition, there never seems to be any time to deal with emotions, Vranas says:

Vranas: We have these pagers on us all the time that constantly go off…I found as an intern that stairwells were a very good place to go cry and let it out for a moment before you had to come back on the floor, or go into a patient's room.

Daily exposure to trauma, combined with work load and bottled up emotions, can lead to burn out, sleep loss, anxiety and depression.

A hospital setting, says Dr. DeLisser, should allow for space to process traumatic events:

DeLisser: You need to let it out now. It's not a question of bottling it up and then waiting til later. I has to come out now. Let's stop rounds for ten minutes and let's go to the conference room, and talk about what we have just experienced

Discussing emotions and grief used to be mostly taboo among hospital staff, but now conversations like the Grief Rounds are going on across the country, says Linda Welsh:

Welsh: They are expressing their feelings, which we know is healthier than repressing them, and they are reflecting on the experience, they are giving it some meaning, they are understanding how it impacts them personally and how it impacts them professionally.

That impact is what Resident Kelly Vranas worries about as she considers a career in Intensive Care:

Vranas: I find being in an ICU extremely rewarding. My only question is, can I sustain this life because the cost is so high, personally….

Linda Welsh says talking about emotions needs to become part of the hospital routine just like checking temperature and blood pressure.

Note: Florence Gelo, Horace DeLisser, and Linda B. Welsh will take your questions and comments in an online discussion on healthcare professionals and grief Tuesday [11/03] at noon on Digest This. Click here to participate or read the archive.

Thanks to Resonance Films and Seymour Levin for audio assistance.