Aging, Death and Dying, End-of-Life Care, End-of-Life Planning, Health & Wellness, Living Abroad, Mexico, Retirement

Death Café Ajijic, Mexico; Ex-Pats and Snowbirds Talk Gently about Mortality

A group of American, Canadian, and UK ex-pats and “snowbirds” recently gathered for the first Death Café Ajijic, Mexico. There were 18 persons present at Café El Grano including an anesthesiologist, a hospice nurse, a hospice social worker, a psychiatrist, teachers, and others. There were two facilitators who work with end-of-life planning and transitions.

If the term Death Café (excuse the brash wording, I prefer Sacred Conversation or The Conversation) is new to you, you may hear it more and more.  Death Cafes or Café Mortels began with Swiss sociologist Bernard Crettaz who held over 100 such meetings in his native country until recently. In 2011, Jon Underwood, inspired by Crettaz, created Death Cafes in England (see history at http://deathcafe.com/what/  ).

These all-volunteer social events to discuss death and dying respectfully and informally (no agenda) are now held in 52 countries including Australia, Europe, Canada, the U.S., and parts of Latin America where death has sometimes, but not always, been a foreboding and scary subject.  Buddhist, Hindu, or Muslim countries, and places with indigenous populations tend to consider death a natural part of life and honor it as such more easily. Most café organizers work with end-of-life, and tend to focus on alternative, kinder, spiritual ways of departing. Note: There is a Death Café in Singapore.

“At a Death Café… our aim is to increase awareness of death to help people make the most of their (finite) lives,” states the Café web site. Most of all, the Café encourages an exchange of stories and perspectives as a way to embrace death.

What prompted a Death Café in Ajijic?

First, a number of retired ex-pats and visitors die in Mexico unexpectedly, and, they die without a health care directive and/or an end-of-life plan. There is a need for continued conversation and education.

Second, Loretta Downs, MA, has been speaking to locals at a popular venue, Open Circle (as well as at In the Heart of Awareness, the Buddhist center), about end-of-life for several years.  She flies in from Chicago every January to deliver her talks. About 300 + persons show up to listen as she encourages her audiences to become friendly with the idea of mortality and to prepare for it – think about it, and express to others what you want.  See http://www.endoflifeinspirations.com.

DSCN2635
Wendy Jane Carrel and Loretta Downs, End-of-Life Guides, Planners, and Educators; Co-Hosts of Death Cafe Ajijic 2018

Third, yours truly, Wendy Jane Carrel, MA, has been speaking to ex-pats around Ecuador for three years and subsequently in Mexico with the same passionate message – make friends with your demise, please make a plan.

It seemed natural for Loretta and I to team up to host a Café for Lake Chapala.

My interests had been reinforced as a result of volunteering two years at Juntos Contra el Dolor, the only 24/7 palliative care hospital and hospice in the state of Jalisco, a model for Mexico. I was given the gift of observing how painful chronic and terminal illnesses are treated, the politics of medicine, the politics of opioids, cultural difficulties related to dying, family constellations, and the difficulties of running a non-profit in a rich country (yes, rich in many resources) with little tradition of philanthropy. Most of all, I learned the concept of a “good death” requires much education and outreach in Mexico as well as at home.

Loretta’s friend Nancy Gershman, who produces Death Café NYC, gave us welcome pointers before the Ajijic meeting. We followed Nancy’s advice – small tables of 3-4 for intimate conversation, one of us (Loretta) to circulate and ensure participant exchanges were flowing, see that anyone who was recently grieving the loss of a loved one was comfortable, followed-up by an evaluation to learn what we could do better the next time.  https://www.meetup.com/Death-Cafe-New-York-City/

Cafe El Grano, nice partitions for intimate conversation
Cafe El Grano, Ajijic, Mexico – nice partitions and small tables for intimate conversation – also a most accommodating owner 😉

Because Loretta and I travel often, she is based in Chicago, and I in LA, we may not be producing other cafes until January 2019 unless another healthcare worker can pick-up in our absence.

Note: If you have not heard of Ajijic, it’s a sleepy Lake Chapala village, with a population of around 10,000, an hour south of Guadalajara. It is a popular tourist destination. Lake Chapala is home to around 20,000 full-time retirees from north-of-the border.

The DeathCafe.com web site indicates there are 9 death cafes in Mexico. I could only find one. It is located in Mexico City. See http://deathcafe.com/deathcafe/1695/ .

I have so much more to learn. I am now eager to return home to attend hospice social worker and end-of-life guide Betsy Trapasso’s Death Café LA https://www.facebook.com/deathcafelosangeles/   or Maggie Yenoki’s gathering in Pasadena https://www.facebook.com/deathcafepasadena/

References

https://www.counterpunch.org/2018/01/12/what-happens-at-a-death-cafe/   excellent overview of a Death Café gathering in Sonoma, California by Shepherd Bliss

https://www.theguardian.com/healthcare-network/2017/mar/09/death-cafe-learn-talk-dying-patients

https://www.washingtonpost.com/news/acts-of-faith/wp/2017/07/10/the-founder-of-death-cafe-has-died-but-his-movement-to-accept-the-inevitable-end-of-life-will-live-on/

https://www.facebook.com/DEATH-Cafe-Singapore-402018853254286/  a unique look at what Death Café Singapore is paying attention to

https://www.prospectmagazine.co.uk/magazine/take-me-to-the-death-cafe

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Aging, Alzheimer's, Assisted Living, Expats, Health & Wellness, Mexico, Mexico Senior Living, Retirement, Senior Care Mexico, Senior Living

Senior Care/Senior Living Options at Lake Chapala, Mexico

Not long ago I addressed a group of Canadians and Americans at an Open Circle chat at the Lake Chapala Society in Ajijic, Mexico. Most of the attendees were full-time residents with the lay of the land, but curious newcomers attended as well.

The most meaningful part of the presentation?  Introducing American and Mexican senior living owners to the audience. After the chat they were able to become acquainted with one another.

In the photo below, four Mexican registered nurse owners are represented. I am the person holding the microphone.

FotoSeniorLivingProvidersLakeChapala
Senior Care Specialist Wendy Jane Carrel introduces owners of Senior Homes at Lake Chapala to Americans and Canadians

Senior Housing Forum posted my article based on the talk.. See http://tinyurl.com/zoz9zdf or https://www.seniorhousingforum.net/blog/2016/8/3/will-mexico-solve-senior-living-affordability-problem  to read the entire piece, or,  read below…

Will Mexico Solve the Senior Living Affordability Problem?

Published on Wed, 08/03/2016 – 4:55pm

By Wendy Jane Carrel, wellnessshepherd.com

If you cannot afford healthcare or retirement in Canada or the U.S., what are your options? Where do you look?

For the last five decades, and especially since the U.S. economic challenges that became apparent in 2007-2008, retirees have been choosing destinations in Asia, Europe, and Latin America.

Despite news about crime and drug cartels, Mexico reigns as the number one choice for most American and Canadians, primarily because of its lower costs, warmer weather, health care choices, and location so close to home.

According to U.S. Consulates in Mexico there is a current count of between 1.2 – 1.4 million Americans living in Baja California, Cancun, Lake Chapala, Mazatlan, Puerto Vallarta, San Miguel Allende, and other areas. (The number also includes Americans who are not retired). According to the Canadian Consulate in Guadalajara and the Canadians Abroad Registry, approximately 10,000 Canadians are registered in high season and 1,500 are registered as retired full time in Mexico. Not all Canadians register.

Choices for senior living in Mexico are not all that dissimilar to those in Canada and the U.S.:

  • Aging in Place – independent living in your own home or apartment

  • Aging in Community – co-housing

  • Assisted Living – if you require care and cannot afford full-time care at home

  • Nursing Care and Rehabilitation

Lake Chapala

Currently, at Lake Chapala, Mexico there are in the neighborhood of 20,000 retired Americans and Canadians.

North shore Lake Chapala, which includes the communities of Ajijic, Chapala, Jocotepec, San Antonio, and San Juan Cosala (40 minutes drive time from one end of north shore to the other), has several options for senior living with others being planned.

What is different from Canada and the U.S. is the cost of living, especially for health care, often up to two-thirds less.

What is also different is that there are no Life Planning (continuing care) models at Lake Chapala. A project was planned three years ago and has yet to be built. There is one, however, that will open in Mexico City sometime this fall.

Another difference is that in Canada and the U.S. Alzheimer’s and dementia patients are in separate areas on a campus. In most of Mexico, dementia patients are living and sharing the same space with older adults who have mobility issues, not dementia issues, and the care is rarely specialized.

Mexican senior homes are under the purview of the Ministry of Public Health and local fire departments. They are not tightly regulated and inspected as they are in Canada and the U.S.

What is available at Lake Chapala now?

  • Three co-housing/independent living options – one in Ajijic with three individual apartments and five casitas, a pool, lakeside views, and two meals a day; one in Riberas del Pilar on two levels where residents have their own apartment, are provided with two meals a day, and have access to a library, a gym, and a pool; and one in San Juan Cosala, focusing on health, green living, and sustainability.

    At the first two if you become immobile or develop serious health issues you would need to move. At the property in San Juan Cosala (in development) you can invite caregivers to your living quarters.

  • Three assisted living homes specializing in Alzheimer’s and dementia care – one is run by a geriatrician and a nurse, the other two by nurses with doctors on call. One of these homes plans to add a second home in the near future for a total of four dedicated Alzheimer’s care homes at the lake to meet the growing need.

  • Six homes combine assisted living, nursing and some rehabilitation.

    That number climbs to seven if you include two rooms above the offices of a physician in Ajijic (no rehab), and 9 if you include one owner who has three homes (no rehab).

    It climbs to 10 choices with an American-owned recovery care center for plastic surgery (more like a B & B) where you can also rent suites. The recovery center has been in existence for almost 20 years.

    The total number of choices reaches 11 if you include a low-income senior home in Chapala which also has Mexican residents.

  • Four properties have owners who live on site. These properties are either American- or Canadian-owned, or, owned by English-speaking Mexicans who focus on serving the expat community. There usually is one person who speaks English at the senior living options at Lake Chapala.

The above-mentioned places are private pay. Monthly costs for private pay assisted living at Lake Chapala range between $1,000 and $2,000 U.S. per month except for the home in Chapala. (The average U.S. private pay is $3200-$3500, and up to $12,000/month or more for Alzheimer’s care).

Most care homes at the lake have 12 or fewer residents. Service is considered personalized. In many instances there is the quality of “carino,” caregivers treating you like a lovable member of the family.

There are 125 senior living homes in the state of Jalisco, housing 1,723 elders. These numbers include only Mexican citizens. Not included are Americans and Canadians at Lake Chapala or in Puerto Vallarta. There are approximately 758,000 older adults in Jalisco state.

In Guadalajara, an hour from Lake Chapala, there are three models of senior care – private pay, non-profit care primarily with nuns (usually excellent quality), and government care (usually DIF, a social services entity that exists throughout Mexico). Prices range from gratis for the indigent to around $400-$800 U.S. for those with pensions, and up to $3500 U.S. for private pay.

Note: I have met Americans with incomes of $600 or less/month who are living comfortably and safely in Mexican assisted living homes throughout the country.

Resources:

Canadian retirees make new homes in Mexico

Instituto Nacional de Estadistica y Geografia National Institute of Statistics and Geography

US State Department – Relations with Mexico

* Cover photo of Lake Chapala courtesy of en.wikipedia.org
** Map of Lake Chapala region courtesy of mexico-insights.com

 

Aging, Health & Wellness, Mexico, Palliative Care Mexico, Retirement, Senior Care Mexico

Aging – Mexican Physician Advocates Eating Less, Walking More

Dr. Jose Gustavo Valladores, President of the Gerontological Society of Jalisco, addressed a group of older adults in a meeting room at Juntos Contra el Dolor Hospital in the parish of San Bernardo, Mezquitan Country, Guadalajara, a few days ago.

Valladores, a spry, humorous, and fit 75 year old advocated eating less, walking more, sleeping about seven hours, and learning to breath slowly and deeply for a more healthful life.

Dr. Valladores contends we do not need to eat as much as we continue to age. His comments remind me of a movement afloat in senior living in the U.S. called Grind Dining, serving small, elegant portions that are easy to see, easy to consume, and easy to manage, especially for those with arthritis, dementia, etc.  Studies show health outcomes with such meals are positive.

Harvard-trained physician and gerontologist Bill Thomas of the Green Project and Eden Alternative has a not to dissimilar approach for aging well that he calls MESH. Move, Eat, Sleep, Heal.

The conversation for wellness in aging continues with this notable consensus among two gerontologists from two different cultures. A return to basics. Wise.

Dr. Gustavo y Dra Susana 21 de mayo 2016
Dr. Jose Gustavo Valladores y Dra Susana Lua Nava

Dra Susana Lua Nava, the founder of the 24/7 palliative care hospital and hospice, was Dr. Valladores’ medical school student 20 years ago.

Aging, Assisted Living, Emergency Preparedness, Health & Wellness, Mental Health, Retirement, Senior Housing Security, Senior Living

Housing Security for Older Adults, Syria and the U.S., Three Stories

Below are two American tales, and one Syrian tale, each bringing up an important global issue for older adults – housing security.

This week the Washington Post published an article by Peter Holley about an elderly woman who has been asked to leave the only home she has known for decades, a rented cottage. Apparently, the owner has chosen not to honor the verbal agreement of the previous owner, whom he was related to. The situation could become a death sentence for the tenant in more ways than one, if indeed, she must leave.

Here’s a link to Story #1:

https://www.washingtonpost.com/news/morning-mix/wp/2016/02/24/its-a-death-sentence-facing-eviction-97-year-old-woman-could-wind-up-on-streets/

Here is a photo of 97-year-old Marie taken by her neighbor Lisa Kriger:

 

If you work your entire life to build what you have, and you cherish and are thankful for it, why should comfort and a sense of security be taken away if you are elderly, vulnerable, and not blessed with infinite financial resources?  What are the possible solutions? Moving and making major changes at an advanced age is not easy.

Furthermore, is it Marie’s fault society is crumbling down and things are drastically changing? Could she have known to prepare? No matter where she moves, if it turns out she has to move, it will be psychologically and physically traumatic. Since she may not be able to afford to move, it means she cannot afford to move to senior living, even though the article mentions she was asked about it. As a former senior living administrator I can comment that some seniors, not all, have a hard time adapting to senior living even if they can afford it, especially if they are mentally competent and independent minded.

I trust someone can help Marie and others in her situation create healthful ways to maintain independence, dignity, and sanity.The only saving grace seems to be that Marie has children. I hope they are in a position to come to the rescue.

Story #2  I recently witnessed a situation with an unhappy outcome, similar to Marie’s

A building on my block in West Hollywood was being torn down to build condos (each condo currently worth between $1-$2 million). Most of the tenants were elders under rent control who could not afford to move. Result? Almost every single elder died within the six months or year they were given to leave. No kidding. Heart-rending.

What are the lessons in this?  Could Marie or the seniors of West Hollywood have known to prepare for such an eventuality? Should we learn to be flexible, start paring down to basic clothing and furniture at age 50, give up all that makes us comfortable and content, and not enjoy what we worked to create?  If Marie were Buddhist, and attached to very little, it would still be a challenge to make a move because of one main factor, age.  Added stress as we age can be a contributing factor to a faster demise.

Story #3 takes the issue a step further.

Imagine being an 80 year old Syrian woman who has watched her loved ones killed, her home bombed, and has somehow managed to get to the Jordanian border for rescue. She is alone, has no clothing except what she is wearing, no funds of any kind, no way to make a living, and her home is a camp until a proper roof can be found, if one can be found. She is totally dependent on people she does not know. Quite frankly, at age 80, how would she have the energy to keep on despite the deep trauma and loss she must be feeling? What if she has a chronic health condition and needs meds?  What would it be like to live in exile? She is one of tens of thousands in this inhumane situation created by external circumstances.

For further reading on elder challenges around the world and in Syria, see the on-going rescue efforts being made by Help Age International, http://www.helpage.org . See also one of many stories posted on Syrian elders in exile at http://www.helpage.org/newsroom/press-room/press-releases/syria-three-years-on-older-refugees-in-exile-the-silent-casualties/.  Another telling story with facts about how disabled and elderly refugees are treated is at this link…  https://medium.com/@DFID_Inclusive/minimum-standards-for-age-and-disability-inclusion-in-humanitarian-action-e1932b32c141#.jd4061wxv .

Addendum:

At a recent conference on The Future of Housing for Grown-Ups: A National and Local Perspective, Dr. Anand Pareka, Senior Advisor at the Bipartisan Policy Center is quoted as saying

“I’m quickly realizing that housing is in many ways health. It’s a very important determinant of health.”

Addendum 2:

Liz Seegert of the Association of Health Journalists wrote an excellent piece about those who live with the stress of homelessness… they age faster than those who have a roof over their heads.

See http://healthjournalism.org/blog/2016/04/homeless-get-older-at-younger-ages-than-their-peers-research-says/#more-27689 

Aging, Ecuador, Ecuador Senior Living, Expats, Health & Wellness, Retirement, Senior Living

Guidelines for Choosing a Healthful Home or Apartment in Ecuador

Here below is a link to an article I posted on http://www.CuencaHighLife.com offering 12 key guidelines for selecting a healthful living environment in Ecuador or wherever else you choose to be.

See http://cuencahighlife.com/choosing-the-right-environments-for-healthful-living/

wide doors for easy access, glass panels for energy of light
wide doors for easy access, glass door panels for energy of light
concrete pavers instead of slippery tile or marble, safer when raining
concrete entry pavers instead of slippery tile or marble, safer to walk on when raining
round, soft furniture, no edges to hurt yourself
round, soft furniture, no edges to hurt yourself
Aging, Ecuador, End-of-Life Care, Expats, Living Abroad, Retirement, Senior Living

Why Creating an End-of-Life Plan When Living Abroad Is a Good Idea

Here below is a link to an article I wrote that was posted on CuencaHighLife.  It’s about the importance of creating an end-of-life plan if you live in Ecuador.  The bigger message is that it is wise to have such a plan in place where ever you chose to live.

Ecuador, is ruled by civil law. North America and England are ruled by common law. Different systems, different procedures.

Why creating an end-of-life plan in Ecuador is a good idea for expats | CuencaHighLife.

 

Camposanto Santa Ana, a    cemetery in Cuenca, Ecuador
Camposanto Santa Ana, a
cemetery in Cuenca, Ecuador
Aging, Ecuador, Ecuador Senior Living, Emergency Preparedness, Health & Wellness, Retirement

Senior Care Options in Ecuador, Overseas Radio Program

Hello dear friends and readers,

I was on the radio today.
http://overseasradio.com/ashley-rogers-and-michel-blanchard/   See the archives for January 5, 2015 for the download.

Big oops. My hostess was stellar. I was energetically flat for a subject I am so passionate about, and a bit off point. I know better. Am praying to redeem myself on another program later. 😉

Here below are a few observations I had intended to clarify:

I have lived or worked in over 40 countries and am truly blessed that I have maintained my health with the exception of being thrown from the back of a Vespa in Rome, Italy – Vespa hit by a truck – two cracked vertebrae. I fortunately healed and have no residual effects.

This experience, among others, led to one important point of our radio chat…

No matter where you choose to live, please give thought to your physical and mental well-being, especially if you are over 50. Self-care is everything for your future, though accidents are sometimes not in our control.

We are all subject to falls despite the place we choose to reside in or travel to. In Ecuador, where sidewalks are rarely flat, smooth, and wide, you can unwittingly fall into ditches, and the street. You can also trip on exposed rebar and protruding cement edges. When it rains, you can glide right across the marble and shiny tiles in front of buildings and splat. Do you want broken bones? Plan on looking down a lot and being mindful.

We are not all made the same when it comes to oxygen intake. The altitude in most Andean cities is between 6,000 and 9,500 feet. Some who are new to high altitude adjust well, others do not and do not know it. I recommend bringing a blood pressure cuff and reading your blood pressure each day. Also, as one ages, I am told we receive less oxygen into our bodies than when we are younger.  Options: bring liquid oxygen drops (haven’t found them here) drink coca de mate tea easily found in any store, go slowly, or, move to a lower elevation. The North American community has lost members who arrived with no chronic health conditions and a clean bill of health – they unwittingly succumbed because of the oxygen issue. These incidents remind me of the childhood story of Heidi and the fresh mountain air in Switzerland that healed her. I had always concluded that high elevation would be good for me or anyone else. Patrick Coady of http://www.southamericanhealth.com has written a fine article about living at high altitude and how to handle it:
http://cuenca-news.gringotree.com/living-at-elevation-cautions-advantages-for-your-health/

If you plan to live in Ecuador, make certain to create a Constancia or a Documentacion Juramentada for end-of-life arrangements. Your Advanced Health Care Directive or your Five Wishes are not valid in the country even if notarized, apostilled and translated into Spanish.  Again, your North American documents will not be recognized. If you wish to be cremated this is especially important. The number of days and bureaucracy required for your loved ones to negotiate the system is more than challenging, especially if they are grieving and far away. Different culture, different mentality.

Health Care Prevention and Emergencies in Cuenca in brief:

I had not intended to sound like an advertisement for people whose work I admire, but there is no getting around it. Trainers Ken Dobberpuhl of ZealCenter.com, Chelsea Gary at http://www.shaome.com, and Sky Rajewski will help you stay in shape if you have balance issues or injuries. They will also recommend physical therapists. They focus on keeping you well.

In 2014, the In Case of Emergency Cuenca volunteer team created lists of health-related emergency resources.  You can locate the information on a local church web site, http://www.internationalchristiancommunity.org/health-resources.html. The names include providers who speak English – but please beware, you are provided with lists, not recommendations. Do your due diligence as you would in your country of origin or elsewhere as to the person or persons whom you will feel comfortable with.  The church kindly provided space for the In Case of Emergency Cuenca team to deliver free seminars of interest to Europeans and North Americans residing in the city in 2014.  The next seminar will focus on End-of-Life and is planned for sometime in spring 2015.  Look for announcements on on-line newsletters Gringo Post and Gringo Tree.

Other holistic mentions for Cuenca:

Cuenca Holistic Network founded by psychologist Robert Higgins, a group of North American and Ecuadorian alternative healthcare workers    www.CuencaHolisticHealth.com

Patrick Coady and Silvana Spano of http://www.SouthAmericanHealth.com

Dr. Hugo Alvarez, MD and naturopath, a Cuencano who lived 25 years in Canada

Dr. Francisco Malo Tamariz, General Medicine and Ayurveda

Other MD’s are on the church web site link above.

When discussing senior health care in Latin America, the quality of care in Mexico was inadvertently omitted.  In many cities, medical care is truly excellent.  Assisted living in Mexico is often on a par with the U.S., depending what state and city of Mexico you are in, and as in the U.S., what funds you have.  The “carino” that was mentioned is also prevalent in Mexico.  Cuba, a leader is gerontology, has waiting lists at assisted living homes.  This is due to current economics.  Chile, also a leader in gerontology, has sophisticated senior care in Santiago.