November 13-15, 2020 represented three full days of listening to and interacting with “conversations on the bench” via the new Hopin.com platform at the second annual Beautiful Dying Expo, produced by author and certified end-of-life midwife Michele Little of San Diego and San Francisco, CA.
Little, with co-host Kimberly C. Paul (filmmaker, creator Death by Design, and former hospice caregiver), guided an eclectic and worthy gathering of evolved, connected and compassionate folks dedicated to End-of-Life work. They shared best practices for advance health care planning, financial and estate planning, preparing for long-term illness or sudden illness, ancient traditions and rituals for end-of-life care, green burials, grief, and more.
Screen shot of Beautiful Dying Expo 2020 on-line with Kimberly Paul co-host and Expo Founder Michelle Litle
The expo goal according to Little? “To help you see more clearly about what’s involved in this journey and to provide you with new perspectives, resources, and connections… All of us are devoted to this sacred space.”
Participating thought leaders were from Australia, Argentina, Brazil, Canada, Costa Rica, Mexico, New Zealand, Puerto Rico, The Netherlands, South Africa, and the U.S. According to Little, there were attendees from 35 countries from outside the U.S.
In addition to the seminars, Little created a public space for one-on-one video chats and personalized advice with physicians, nurses, ombudsmen, social workers, lawyers, scientists, psychologists, music thanatologists, end-of-life doulas, and others.
This historic period with COVID at the forefront, and great numbers of people dying not only alone, but unprepared and without their wishes known, has brought more awareness, reflection, and discussions about dying.
Several folks working with those who are ill, near end-of-life, or working through the aftermath have been collaborating with colleagues in an accelerated way. This expo is one of many gatherings and events on-line since the onset of the virus.
One common theme among presenters and care panels was love – “love in the time of COVID” to borrow from Gabriel Garcia Marquez – providing support in a compassionate, collaborative, gentle, holistic way plus approaches to accomplish this.
Because some presentations overlapped, many worthy presenters and their subjects were not covered. Here a few highlights:
Of note was palliative care physician and gerontologist Karl Steinberg (a speaker at the 2019 expo) whose valuable talk focused on the importance of a relationship with your physician to state emergency, long-term care, and end-of-life wishes ahead of time. Steinberg is the current Vice President of the National POLST (Physician’s Order for Life Sustaining Treatment – known as a MOLST on the east coast). His expertise also extends to bioethics.
Screen shot of Dr. Karl Steinberg at Beautiful Dying Expo 2020 on-line
Another highlight was the session with Ken Ross, son of Elizabeth-Kubler Ross, the Swiss-American psychiatrist who normalized grief through many books, the most well-known of which is On Death and Dying. That particular book offers a model known as the five stages of grief. Ken Ross, a natural storyteller, was his mother’s caregiver the last 10 years of her life. He is carrying on his mother’s legacy through her worldwide foundation and foreign publication of her books. Ross regaled listeners with stories of travels to 20 countries with his mother. He clarified that his mother thought grief happened in cycles, and continues – it is not a cut and dry five stages.
The Elizabeth Kubler-Ross Foundation of Mexico, headed up by psychologist and end-of-life doula Wilka Roig, a Puerto Rican by birth, gathered a group of colleagues from other Elizabeth Kubler-Ross chapters around the world – Rodrigo Luz, a psychologist and thanatologist from Brazil, Else Groot-Alberts originally from The Netherlands but residing in New Zealand, Dr. Laura Aresca from Argentina and Uruguay, Wendy Pineda of Guatamala, and Cynthia Frahne a German psychotherapist devoted to palliative care in Argentina.
Screen shot of slide show from Ken Ross of Elizabeth Kubler-Ross Foundation, see Ken in upper left corner under the street sign bearing his motther’s name
Verna Fisher, a social worker, gave an endearing and sensitive talk about how to discover what is unsaid with both patients and families, how to show up for others, and how to listen.
Keith Bradley of Final Exit Network gave a valuable talk about Advanced Health Care Directives for Dementia, and John Tastad, a thought leader in end-of-life ethics, shared about truth-telling in a gentle way.
The closing hour with Brad Wolfe, creator of Reimagine, was especially heart-felt. Wolfe spoke about the death of his cherished grandmother and what it means to love someone all the way to the end of their life. An especially poignant moment was when his father Jim Wolfe joined the talk about this delicate subject. Reimagine is a platform to reimagine death. It has gathered over 65,000 attendees since its inception to discuss how to embrace life by facing death. See https://www.letsreimagine.org/about
Screen shot of Reimagine Founder Brad Wolfe with his father Jim Wolfe discussing delicate subject; Brad sings a song about beautiful dying
I was honored to attend and present at the first Beautiful Dying Expo last year in San Diego which you may read about here:
In January 2020 Los Angeles-based nurse and case manager Elena Lopez realized the first part of a 20+ year vision – to return to Mexico to open a hospice, the first in her native state of Michoacan.
HOLA Hospice of the Angels/Hospicio de los Angeles Founder Elena Lopez with Charge Nurse Claudia
There have been previous efforts since the 1970’s to create hospice homes in Mexico following models in Canada, the UK, and the U.S. For financial reasons, as well as the predominant family cultural value of caring for the ill at home through end-of-life, the hospice home model with others doing the caring has yet to be accepted or sustainable. There have been hospice homes but none have survived.
How will Lopez create a sustainable model?
Lopez’ residence Hospice of the Angels has married assisted living care with rooms for hospice. Assisted living is a concept prevalent in every state of Mexico.
Lopez has attracted not only local Michoacanos but Mexican-Americans with life-limiting illnesses who wish to live their last months in their native land. Note: It costs families in the U.S. up to $20,000 or more for remains to be shipped from the U.S. for traditional Catholic burial. Choosing Mexico for end-of-life helps defray these expenses for Mexicans living in Canada or the U.S. and allows local family to be present.
Lopez continues to train staff – nurses, caregivers, and volunteers, despite the pandemic -based on her professional experience in California at VITAS, Kaiser Permanente, and in private service. In 2020 her staff also received End-of-Life doula training (psycho-social practical and ritual support) with psychologist and doula Wilka Roig of the Elisabeth Kubler-Ross Foundation of central Mexico. Roig is headquartered in San Miguel de Allende. (See www.ekrmexico.org ).
Hospice of the Angels currently has 10 assisted living residents. The home hosted five hospice patients this year. There are 15 staffers including Luisa Fernanda Ruiz Montiel psychologist/tanatologist who holds a PhD (former professor), the accountant, and an attorney.
Despite COVID, Lopez and team have managed to keep the virus out of the home, and, host fundraisers. Residents are busy with small therapy dogs, arts and crafts, visits by priests, and music performances. Recently, American hospice nurse Ian McCartor, known for creating inspirational Legacy Songs for his patients in English and Spanish, played and sang at the home.
Priest visits residents and staff at HOLA Hospice of the Angels/Hospicio de los Angeles in Morelia, Michoacan, Mexico
An out-patient hospice service in Morelia and neighboring areas has not been deemed practical. It is considered unsafe to send doctors, nurses, and caregivers out at night due to heavy cartel activity.
At Hola Hospice of the Angels, each room offers a bed for the patient and a bed for a family member, a model first instituted in Mexico by Dra Susana Lua Nava at Juntos Contra el Dolor, the first and only level one 24/7 palliative care hospital in the neighboring state of Jalisco. See www.JuntosContraelDolor.com
Mexican end-of-life care is provided through out-patient or in-home services in most states. Since the Mexican Palliative Care Law of 2009, there is now a broader view for care of the ill that includes those with life-limiting, painful illnesses that may last many years.
How to find Hospice of the Angels:
Fundación Hospicio de los Ángeles
Miguel Silva 149 Morelia, Michoacan de Ocampo, 58260, Mexico
Tel. 52 443 275-0279 office; 52 443 331-6647 cell; and USA cell 213 706-1111
Additional hospice project for Uruapan, Michoacan, Mexico:
Lopez is collaborating simultaneously with a Michoacano whose life dream has been to open a home for older adults. The gentleman donated land in a tranquil forest area. Part of the home will be dedicated to assisted living and nursing care, the other part to hospice which will be headed up by Lopez. Architect Ivan Marin of Morelia will fuse old Michoacano style (lots of wood) with Japanese Zen-style structure – healing light, views to nature from all sides, and tranquility (a hard-to-find concept in Mexico). Two years ago Lopez and Marin travelled to Japan to study hospice and architectural concepts they could incorporate. Lopez says she envisions a quiet, meditative, sacred place. They plan to break ground within two years.
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist, consultant, and Mexico senior living writer from California. She has travelled Mexico for several years researching health systems, senior care, and end-of-life care in order to connect Americans, Canadians, and Europeans with options for loved ones. She has investigated hundreds of senior housing choices in 16 Mexican states. Her web site is http://www.WellnessShepherd.com.
COVID has brought about loss of lives, economies, and untold devastation around the world.
It has also brought with it dedicated palliative care and end of life practitioners gathering for discussions about how to improve healthcare inequities and offer psycho-social-spiritual support to patients, families, medical teams, and first responders for now and the future.
New alliances and friendships have been formed via Facebook, Webinar, and Zoom chats that may not have been forged otherwise.
In August 2020, I attended several gatherings. Below are highlights. Each exchange was a gift.
The Chaplaincy Innovation Lab lead by Wendy Cadge and Michael Skaggs at Brandeis University continues to host a remarkable gathering of chaplains and others. The Trauma and Spiritual Care meeting in August emphasized the value of chaplaincy during COVID. We listened to moving stories about trauma created by the current medical model, especially for minorities, and the statement “racism is a public health crisis.” Also of note were observations by Dr. Ayo Yetunde, a professor at United Theological Center of the Twin Cities, who focused her remarks on the trauma and stigmatization of growing up black in America. She spoke about moral injury and how “politicians traumatize us.” Her newest book, to be released this fall is Black and Buddhist. See https://www.unitedseminary.edu/academics/faculty/pamela-ayo-yetunde/ and http://chaplaincyinnovation.org/
The Elizabeth Kubler-Ross Foundation of Central Mexico. Psychologist and end-of-life educator Wilka Roig in San Miguel de Allende produces monthly seminars related to death, dying, and grief. The August gathering was uncommonly interesting with Ken Ross, son of Dr. Elizabeth Kubler-Ross, as the guest. It was fascinating to learn about his mother, the Swiss doctor who spent her adult life in the U.S. devoted to continuing the hospice movement started by her friend and colleague Dame Cicely Saunders of St. Christopher’s Hospice, London. I have visited the Elizabeth Kubler-Ross library in Torrance, California at Dr. Ira Byock’s Institute of Human Caring but had no idea of the trials and tribulations of this remarkable woman’s life. Dr. Kubler-Ross was a Jungian, and a prolific author best known for Death and Dying, 1969. Ken was her caregiver for almost 10 years. He gave a loving, tender report that included amusing stories about how stubborn she could be. A revealing part of his talk was how most people interpret the five stages of dying or the five stages of grief literally, as fixed stages. He showed us circular graphs his mother created showing all phases are connected and that we go in and out of phases arbitrarily. There is no end.
Dr. Marcos Gomez Sancho, the pre-eminent thought leader for palliative care in the Latin world spoke on Facebook to over 700 physicians, nurses, social workers, psychologists, educators, and volunteers in North and South America from his home in Palma de Majorca, Spain. As anticipated his talk was well-planned and included music, paintings, and photos to illustrate his points. His presentation was “El Duelo Normal al Duelo Imposible”, normal grief to impossible grief, emphasizing “the cruelty” of dying alone without traditional support and the suffering of the patient, the family, and the medical team. Dr. Gomez’ website is: http://www.mgomezsancho.com/esp/index.php
I was honored to spend time with Dr. Gomez at the 2nd International Palliative Care Conference in Guadalajara in 2015 and last year when he was again the headliner at the 4th conference: https://wellnessshepherd.com/tag/dr-marcos-gomez-sancho/
Dr. Marcos Gomez Sancho, 2 August 2020
The National Association of Hindu Chaplains (NAHCA) A unique gathering of mostly Hindu Americans (14) with special guest Sanjay Mathur of the Hindu Temple of Rochester, NY. Moving stories by this tender-hearted man with compassionate presence. I could see why anyone would feel comfortable receiving his pastoral care. http://www.hindutempleofrochester.com/
Let’s Reimagine End of Life, based in San Francisco, has put a tremendous amount of energy into producing 700 “spaces” around the world, and 125 workshops. Congratulations to programmer Dara Kosberg. One of my favorite discussions included a small group of first generation Americans of Chinese, East Indian, Korean, and Thai descent discussing how to talk to their parents about planning end of life, a culturally taboo subject. On August 31, founder Brad Wolfe, a Stanford educated entrepreneur and artist hosted a chat with palliative care physician Jessica Zitter (also author and filmmaker), Pastor Corey Kennard, and grief author Hope Edelman. I loved the breakout sessions where a marvelous synchronicity introduced me to Jessica’s lovely mother Rhoda, and two colleagues whom I hope to stay in touch with – international end-of-life doulas Glynis German of Mallorca, Spain and Merilynne Rush, RN of Michigan. They both also host Death Cafes. Small, meaningful world. https://letsreimagine.org/
Heartfelt thanks to all those mentioned above who dedicate their lives to the well-being of others, and who are so willing to share what they’ve learned. And heartfelt thanks to all others engaged in these activities and are not mentioned.
The worldwide “death positive” movement of the last 10 years has encouraged many persons to prepare for their earthly demise – emotionally, physically, spiritually, and legally (addressing healthcare wishes, wills, and more).
The arrival of COVID has accelerated these discussions.
Many gatherings and programs focus on a return to “slow medicine”, person-centered care, traditional ways of honoring departures, the creation or continuation of rituals and all things “natural”.
Who is leading the conversations?
Here below is a random short list (many missing) of conferences and educational resources (mostly in the U.S.) about healthcare, death, dying, and transitions in 2020-2021. Consider it a starter list.
Not included are hundreds of insightful books by caregivers, chaplains, doulas, journalists, nurses, physicians, and lay folks, as well as numerous end-of-life doula programs, local civic community programs, and offerings from hospices, and faith-based organizations.
1001 thanks to all persons near and far who openly share information about mortality and ways to create a thoughtful, peaceful end-of-life for all (when possible) as part of their love mission.
Afterlife Conference The 10th annual conference, produced by Dr. Terri Daniels, a clinical chaplain, certified trauma professional, and end-of-life educator took place on-line in June. The 2021 conference is scheduled for next June. https://afterlifeconference.com/
Art of DyingInstitute at the New York Open Center. On-going seminars plus certificate trainings all year for end-of-life doulas, and dying consciously teachers. https://www.artofdying.org/
Association for Death Education and Counseling based in Minneapolis, MN cancelled its 42nd annual meeting for 2020. The next conference is scheduled for April 6-10 in Houston, TX. The conference offers continuing education credits and thanatology certifications. See www.adec.org
Authentic Presence On-going contemplative end-of-life care trainings and meditations led by interdisciplinary palliative care practitioners Kirsten de Leo, and Dr. Anne Allegre. Currently being held on-line. Notable professional education team https://www.authentic-presence.org/our-team
Café Mortality, Death Cafes, and Death Over Dinner. Groups around the world started gathering to discuss death over tea and cake in Switzerland in 2002 with sociologist Bernard Crettaz. In September 2011, American Jon Underwood, based in England, carried on the tradition by creating Death Café. Jon died not long ago but his wife, mother, sister, and other volunteers keep the organization going. There are Death Cafes in 79 countries!!! Find one near you or far from you (as most are on-line at this time of COVID) at www.deathcafe.com. Death Over Dinner continues in the same vein with night-time conversations about how we wish to die. See www.deathoverdinner.org. These are all volunteer efforts.
End of Life University. Dr. Karen Wyatt, an award-winning spiritual care author and hospice physician, started on-line podcast interviews (over 250) with end-of-life professionals in 2013 to offer a resource for family caregivers, healthcare workers, and the public. Dr. Wyatt also creates a book list every year, one book per month, known as The Year of Reading Dangerously. See http://www.eoluniversity.com and
Reimagine A non-profit organization based in San Francisco that “explores death and celebrates living.” On-going on-line conversations with a diverse group of participants – for example, an interview with palliative care physician Ira Byock, and a group of young Asian-American professionals focusing on how to address the subject of advance healthcare directives with their immigrant parents. For more info see www.letsreimagine.org
The Conversation Project. Boston-based non-profit, co-founded by Ellen Goodman, dedicated to helping folks talk about their wishes for end-of-life care at home and in community settings. Excellent materials (starter kits) to download and work with plus guidance for how to have your end-of-life wishes respected. They have a new COVID-19 specific guide which you may download for free as well as other resources. www.theconversationproject.org
University of Bath, UK The Centre for Death and Society, according to Director John Troyer, “is the only research centre that looks at death.” They held their 14th prestigious international conference in the fall of 2019. Their 2020 conference was cancelled but there are some continuing events including “Big Death Talks” https://www.bath.ac.uk/research-centres/centre-for-death-society/
University of Wisconsin International Death, Grief, and Bereavement Conference sponsored by the University of Wisconsin La Cross Center for Death Education, Bioethics, and Extended Learning. June 6-9, 2021 Call for proposals is open for the subject Ambiguous Loss and Grief.https://www.uwlax.edu/ex/dgb/
World Hospice and Palliative Care Alliance Last but not least, the most meaningful COVID healthcare conversations for me professionally were organized by WHPCA Executive Director Stephen R. Connor, PhD. Connor gathered palliative care professionals from Africa, Asia, Europe, Latin America, and the U.S. to review challenges related to caring, pain management, policy, resources, and serving during COVID. The series was on-line for 12 weeks and included collaboration with the International Association of Hospice and Palliative Care (IAHPC), International Children’s Palliative Care Network (ICPCN), and PALCHASE offering Palliative Care in Humanitarian Aid Situations and Emergencies. WHPCA has over 200 affiliate organizations and members in 79 countries. See https://www.thewhpca.org/covid-19/ for briefing notes and information on participants.
This month I had the honor of participating in an on-going Zoom conversation about A Thoughtful Death with the Unitarian Universalist Fellowship of San Miguel de Allende, Mexico.
Care team member Lydia Jane Failing was the lively and engaged producer and host. Many thanks to her and team members Wilka Roig (co-host), Francoise Yohalem, Joan Wolf, and Rev Tom Rosiello.
Articulate and engaging producer/host Lydia Jane Failing of UUF SMA
They are dedicated to discussing why and how it may be wise for non-Mexican residents (full or part-time) to prepare for their demise legally, psychologically, and spiritually in Mexico.
I adore informal chats but for whatever reason when it was announced the conversation would be recorded just as we began, my energy froze and I omitted helpful information. I sounded like a newbie instead of someone comfortable and experienced. Yikes!!!
Some clarifications for the listeners:
Palliative Care
Freedom from pain is a humanitarian right. Few countries are able to provide it in part or fully. When it exists, it is provided by a trained and empathetic team of doctors, nurses, psychologists, social workers, chaplains, nutritionists and volunteers creating palliar (Latin) – comfort, support, and protection. This support extends to patient’s families and other loved ones.
Mexico has had a palliative care law since 2009 (modified in 2014). It states everyone is entitled to relief from pain, especially in the last six months of life. Few places in Mexico are able to provide or sustain such an important and needed service. Few people know the law exists, let alone where to go and how to access needed services.
Juntos Contra el Dolor, A. C. in Guadalajara is the first and only 24/7 palliative care hospital in the state of Jalisco. Its founder is nun physician Dra Susana Lua Nava, a palliative care thought leader. Every person, physicians included, is a volunteer except for two civilian palliative care nurses (day and night shift), and the cleaning lady. My social service for Juntos coordinating patient care, “companioning”at the bedside, community outreach, and raising funds has been and continues to be as a volunteer. All donations go directly to http://www.JuntosContraelDolor.com .
Lydia Jane asked: How do you bring a level of spiritual acceptance to the people you encounter when their transition is imminent?
I do my best to live by one motto: “The secret of the care of the patient is caring for the patient” – Dr. Francis W. Peabody at the Harvard Medical School, 1925.
When I am invited in, I recognize that someone is willing to share exceptionally sacred, tender, even mystical moments. It is an honor to companion.
Human engagement is about feelings. Each experience is different, intangible.
I do my best to bring authentic presence and friendship.
I say a prayer or meditate before I enter that I will bring my best in honor of this sentient being.
After introducing myself, I ask permission. Would you like me to accompany you?
If accepted, so far no one has said no, I learn what environment this person wishes for and imagines.
Windows and curtains open? Flowers or no flowers? Candles or no candles? Perhaps anointment with frankincense? Music or quiet? More pillows, a change of dressing gown? Bathing each day? Linen changes each day? Photos nearby?. Practical considerations. Then, sit quietly with full attention to needs of water, nourishment, and more.
“Companioning” seems to involve spontaneous creativity, trusting intuition about the care of the soul before you.
For those who are anxious, I guide breathing exercises which seem to help.
Each person teaches me, not the other way around. There are no rules. I feel any of us may be present by sitting quietly, hand holding (if wished for), and being open to whatever arrives. The journey is always theirs, not ours.
In my experience, most folks have answers inside as long as the person at the bedside is there as support.We are listening posts, and on occasion guides. I listen until something appears, perhaps a clue or a cue. Invariably feelings are expressed. The process is usually slow.
In my experience people who are fading surprise themselves intoacceptance, but not all. Some folks see someone waiting for them. Most folks seem to wish a witness alongside, someone honoring their existence in order to lapse into peace. Others may prefer to make their transition alone and will do so when everyone has left the room.
Invariably, the process follows divine timing.
Note: my service as a companion to the ill and their families in Mexico is as a volunteer.
No burials of bodies on your property in California. Ashes of loved ones have been known, however, to be buried not just at sea but under trees, rose bushes, and more.
More thank yous:
My appreciation for our conversation extends to talented designer and technology wiz Diana Amaya for making certain we were appropriately situated. Thanks also to Wilka Roig psychologist, death doula, Director of Elizabeth Kubler Ross Foundation SMA, and first speaker.
Dr. Pepe Valencia, San Miguel de Allende, Mexico
On June 10 San Miguel de Allende gerontologist and thanatologist Dr. Pepe Valencia talked candidly about how he has overcome government and church challenges as they relate to serving patients in pain at end-of-life in Mexico. He has been serving older adult residents, expats in particular, for over 40 years. Here is the link to his talk:
On June 17 Carlos F Chancellor, Jungian-Archetypal Psychotherapist, Somatic Movement Educator, Integration Therapist, Dream Worker, Mythologist and Storyteller joined the program. His sensitive and healing talk can be listened to at: https://www.youtube.com/watch?v=0iFcrgQadZc&t=107s
On June 20, Felicitas Rusch-Lango, a life coach and yoga instructor offered breathing exercises to calm anxiety, poetry, Buddhist wisdom, and more. https://www.youtube.com/watch?v=l7yTnvhQyes
Wilka Roig is continuing the A Thoughtful Death dialogues through the Elizabeth Kubler-Ross Foundation Central Mexico. Please write info@ekrmexico.org or Wilka at info@wilkaroig.com for more information on how to participate. The June 30 talk was by a member of the Green Burial Council in the U.S.
May this find you, your loved ones and all beings well and healthy.
Deep bows
Wellness Shepherd Wendy
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist and consultant from California. She has travelled Mexico for several years researching and building relationships with health systems, senior care, and end-of-life care in order to connect Americans, Canadians, and Europeans with options for loved ones. She has investigated hundreds of senior housing choices in 16 Mexican states. Her web site is http://www.WellnessShepherd.com.
Taking care of frail or gently infirm older adults, even in “good” times, is a challenging job. For many of us in senior care it is also a satisfying way to serve, and offers rewarding engagement.
But how does one rally to protect and defend older adults living in senior communities from COVID-19, the newest corona respiratory virus with multiple symptoms and possibly an unmerciful death, perhaps alone?
Precious American senior at a Lake Chapala assisted living home offering love to a little crab
Medical experts and tragic statistics share that older adults are more vulnerable than others to this borderless virus. A recent New York Times article reports an estimated one-fifth of U.S. deaths are linked to nursing facilities often due to inadequate protection and/or compensation for staff who sometimes work in more than one building to financially survive.
COVID-19 is now in Mexico. It flowed from Asia to Europe and the U.S. first. As of April 18, 958 Mexicans over age 60 have been hospitalized and 160 have required intensive care, representing 37% of the population. (No number is known from senior homes if any, but most patients had underlying health conditions).
Inspired by the response of healthcare workers around the world and despite distressing international and local news, all hands are on deck at approximately 25 assisted living/”nursing” homes at Lake Chapala, Mexico, one hour south of Mexico’s second largest city Guadalajara. Residents are ex-pat and Mexican retirees and do not represent typical populations in other parts of the country.
Garden area, assisted living, Riberas del Pilar, Lake Chapala, Mexico
Important note: In Mexico, there are no nursing homes as they are defined north of the border. Acute care is in hospitals only. Assisted living homes offer some nursing care and rehab. There is more or less a one size fits all approach to senior care in Jalisco state and the rest of Mexico, with exceptions.
Shelter-in-place began March 19, the date of the first confirmed case in Guadalajara. Since then I’ve been engaged by phone and e-mail with home owners and staff where I have found appropriate care for “gringos”. I am also in touch with precious residents via phone, e-mail, and sometimes Skype.
The virus has probably been present at Lake Chapala far longer than April 22, the date of the first reported but yet to be confirmed COVID-19 case locally. Why? Because the lake is a major destination for American, Canadian, and European retirees and/or residents who travel extensively.
What protocols have been in place at assisting living/”nursing homes” since mid-March?
First, no visitors allowed, until further notice.
Each lakeside home (4 to 20 residents, owned by Mexicans or ex-pats) is doing what it can to adhere to guidelines from Jalisco Governor Enrique Alfaro and his Ministry of Health, as well as to those of the World Health Organization (WHO). In a land not known for high health standards and cleanliness, and where compliance for the greater good is not the norm, it is impressive what this virus has prompted at assisted living/”nursing homes”.
Restful Assisted Living grounds in San Juan Cosala overlooking Lake Chapala
Hand washing for all, several times. Hand sanitizers at all entry ways.
Hand sanitizer on mini-tables outside every room for doctors, nurses, caregivers, and residents.
Personal Protective Equipment (PPE) such as masks and gloves are provided for staff and residents, including masks for sitting in outside garden areas. These items are in regular supply. This is unusual as hospitals countrywide do not have enough PPE. Outside China, Mexico is the largest manufacturer of PPE. Mexico, ironically, sent a majority of its supplies to help China months ago. There is a cottage industry in every lakeside village making cotton double fabric washable masks at reasonable cost. Not the same as N-95 masks which are intended to be disposed after each use in clinical settings and are a challenge to clean. Home-made masks are, however, a helpful alternative.
Staff has stopped wearing scrubs on their way to work.
Rooms for staff to change from street clothes to scrubs have been created. Some places had these areas before with private lockers included.
Washing machines are going all day with resident clothing and staff clothing.
Staff stopped wearing scrubs to work based on hospital doctors and nurses being assaulted with bleach, hot coffee, eggs, or beatings because scrubs identify them with the virus. From Guadalajara to Merida healthcare worker abuse incidents have been markedly on the rise. Some essential workers have been prevented from entering their apartments or evicted by landlords who fear contagion. In one city, hospital workers now live in a hotel. See The Guardian article at end for more details.
Daily disinfection multiple times of door handles, railings, ground walkways
Double the work keeping dementia care residents safe
Food for kitchens now delivered to entry gates, fewer trips out
Meals served in rooms. Disposable utensils instead of flatware.
So far, no staff shortages and no cases as of this writing. Staff is showing up, fear or not. This could change if the infection takes hold. The majority of healthcare workers are young and have families.
One building picks up all staff for work so they do not travel by bus. The ideal situation, though not possible in most places, is having staff live on campus for the duration of the outbreak. Hogar Miguel Leon, a senior home housing 30 residents in Cuenca, Ecuador, for example, has outside staff living with the nurse nuns who are in charge.
Most homes, despite the added work load for prevention and preparation, are addressing isolation and possible loneliness issues of their residents. Volunteer visitors, outside entertainment, and chair yoga teachers on campus are no longer present. There is instead accelerated collaboration with faith communities, the Lake Chapala Society, other service groups, and individuals providing phone trees and Zoom chats. Adopt-a-Senior is happening. Facebook provides various resource guides for COVID-19 and delivery services on lakeside group pages. Example: one home orders to-go lunches which are delivered by a restaurant every Friday.
Assisted living for abandoned Mexican women near Jocotopec, Lake Chapala. An extraordinary volunteer service is offered by ex-pats.
Technology. There is a sudden rise in Facetime and Skype use. Zoom conferencing has been implemented and used for daily or weekly news and events. For those who are cogent, this technology is happily received. For the most part, there are not so many innovations for dementia residents. No one has mentioned the use of telemedicine which is on the rise in the U.S.
Culture. In Mexico, life works depending on who you know. Owners and staff network for support with family, friends, and colleagues for solutions – Facebook reigns.
As mentioned, the majority of homes at Lake Chapala implemented public health advice promptly and with uncommon vigor.
But will the rest of the community outside these homes rally for COVID-19 and honor quarantine and face mask measures?
Is there a way to prevent unprecedented loss of life in assisted living at Lake Chapala?
Senior living homes may not be able to prevent outbreaks, but they are working on delaying them. They are taking known measures to protect vulnerable populations and staff. But the variables are many and luck is required. As in the U.S., testing is slow to arrive.
And, the virus is invisible, so prevention may be an impossible task. Staff could unwittingly be silent carriers. Local quarantines are suggested and are not enforced. Mexicans enjoy gathering in large groups, no matter what, even when they’ve been asked not to.
The song Ay Yay, Yay Yay… Canta, No Llores comes to mind for Mexico in the time of COVID-19. Sing, Don’t Cry, continue on. The words represent a mindset for suffering and profoundly sad situations which the majority of the population has endured for five centuries. The country is rich in resources. Few are well-to-do. The rest struggle to put food on the table. Singing is a way to continue every day.
In closing, gratitude to all Mexican healthcare and essential workers, unsung heroes and heroines. Thank you for your presence. You demonstrate tremendous strength and courage. May you and those you care for be protected in the days ahead.
Final note: The majority of older adults in Mexico cannot afford healthcare, let alone assisted living or in-home care. The majority of assisted living/”nursing home” residents at Lake Chapala are ex-pats, even though there are a number of Mexican residents. Each home has private rooms and baths, few have shared rooms, What’s available at the lake is not typical of the rest of Mexico where almost 900 senior homes are generally more crowded and contagion more likely.
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist and consultant from California. She has travelled Mexico for several years researching health systems, senior care, and end-of-life care in order to connect Americans, Canadians, and Europeans with options for loved ones. She has investigated hundreds of senior housing choices in 16 Mexican states. Her web site is http://www.WellnessShepherd.com.
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Corona Virus Mental Health – Healthflix.Onine Launches FREE Online Classes March 31, 2020 GMT with 100 World Thought Leaders Sharing Knowledge
My distinguished award-winning book clients, integrative psychiatrists Richard P. Brown, MD and PatriciaGerbarg, MD, join colleagues on-line to support the public during the current public health and mental health crisis.
Drs. Brown and Gerbarg, New York-based medical school professors known for their continuing trauma relief work at Ground Zero NYC, and with Syrian, Sudanese, Rwandan, and Rohingya refugees, have written innumerable articles and six noteworthy books.
See The Healing Power of the Breath from Shambhala Publications as welcome reading for these times.
Their participation in the Corona Virus Mental Health discussion begins March 31, 2020 Greenwich Time (London, UK) and continues for the next two weeks.
Details may be found in the press release I posted on the Internet at the following links:
Corona Virus is changing where we might be, what we are choosing to do, or what we are restricted from following through with in order to protect the health of others.
This is not a complaint. But it has come to signify postponing meaningful work or gatherings in person, especially with the vulnerable who depend on the presence of family and others who support them.
Circumstances have already created loss and a sense of abandonment for our elders worldwide. You may recall the sad circumstances of elders alone in ICU’s in Italy, as well as in assisted living homes in Georgia and Washington State in recent days where family members may not enter to hold their loved ones as they make their transitions.
Note: This post is being written from Jalisco, Mexico where I have been attending to older adults.
The state of Jalisco (second largest state with Guadalajara as its capital), lead by Governor Alfaro and public health officials, is doing its best to tame the rise of Corona virus. There are several cases throughout the state, reportedly brought in by a group of wealthy Mexicans who traveled to Colorado to ski in mid-March or by travelers (foreign and Mexican) returning from Germany, Italy, and Spain. All persons except those in necessary services have been asked to stay inside through March 29 except for buying provisions or medicine. No travel unless necessary is another request. It is likely the date will be extended. Borders are still open but flights to other nations have diminished. So far, not a single assisted living home in Jalisco has reported a case of the Corona virus.
I had plans to see colleagues in the Mexican highlands and then return home to California. Plans have changed.
I wish to thank several colleagues whom I was going to meet with or revisit in March and early April – folks dedicated to the well-being of older adults. May we meet again soon.
1001 thanks to Lydia Jane Failing, Francoise Yohalem, and Rev. Tom Roseillo of the Unitarian Universalist Fellowship outreach in San Miguel de Allende, Mexico. Warmest greetings and blessings to each of you, your fellowship, and your community-at-large.
I so appreciated your kind invitation to participate in the seminar “Thoughtful Dying in Mexico” with other colleagues March 20, even though it was necessary to postpone as a form of protection for all. My topic was to have been spiritual aspects of dying in Mexico based on psycho-social-spiritual support of older adults at Lake Chapala, plus my involvement with a palliative care mission in Guadalajara.
My thanks also to the owners of assisted living homes in San Miguel de Allende and Cuernavaca who were waiting for me, as well as to hospice nurse Elena Lopez of Hola Hospice and Luz Serena, an assisted living home in central Morelia with two rooms offering American standard hospice. I look forward to visiting all of you and writing about your dedication to quality of life for older adults on other dates.
Many thanks to Café Mortality colleagues Debi Buckland, Jane Castleman, Loretta Downs, and Darryl Painter for their dedication at Lake Chapala. We cancelled gatherings for March and April for public health reasons.
Discussions of our wishes and mortality, especially at this time of crisis, may have been meaningful for attendees, not to mention this co-host. We will find other ways to reach out through Facebook posts and more.
And, last but not least, a big shout out to my care liaison colleague in San Miguel de Allende, Deborah Bickel of www.BeWellSanMiguel.com who is deluged with requests for assistance at this time. Deborah’s colleague, nurse practitioner Sue Leonard, was to have been on the UU Fellowship morning panel on March 20.
Where ever you are and whomever you are I pray you are safe, comfortable, and remembering to breathe. As we reflect on the health of those around us, our own health, and new ways to reach out, let us remember the greater dangers for those less fortunate – the elderly, the homeless, and immigrants on the road, in camps, or in cages.
Please remember our healthcare workers, first responders, drivers, and food purveyors.
Please consider volunteering by sending money to a cause dear to your heart and/or healing thoughts for everyone on your path and on the planet.
And, remember to keep reading inspiring stories if you choose about nail salons converting to sewing centers to make masks, the Chinese manufacturer who sent medical masks in crates to healthcare workers in Italy with a poem by Seneca, the Italians who sing on their balconies to each other, the Spaniards who stand on their balconies applauding healthcare workers as they go off shift at a nearby hospital, the small businesses and their drivers offering take-out throughout the world, and thousands of other folks who make sacrifices as they continue to show up for others.
Wendy Jane Carrel will address a group of American retirees about senior care and senior living options in Mexico at Focus on Mexico, Thursday, February 27 in Ajijic, Mexico. (Ajijic is a village with a population of around 10,000 at Lake Chapala, one hour south of Guadalajara, the country’s second largest city).
Her talk will cover Mexican senior care models (including those owned by Americans, Canadians, and other foreigners), and senior care options in expat retirement havens around a country often better known for its tequila, tamales, and mariachi.
Carrel recently wrote an article about corporate senior living developments in Mexico that was posted on SeniorLiving Foresight, a popular senior housing news site in the U.S. The link to the article is below.
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist and consultant from California. She has travelled Mexico for several years researching health systems, senior care, and end-of-life care in order to connect Americans, Canadians, and Europeans with options for loved ones. She has investigated hundreds of senior housing choices in 16 Mexican states. Her web site is http://www.WellnessShepherd.com.
Senior care specialist and palliative care liaison Wendy Jane Carrel will speak at the Lakeside Presbyterian Church in Riberas del Pilar, Lake Chapala, on Wednesday January 29, 2020 from 2-3 p.m. about “Palliative Care and Hospice in Jalisco.”
The free public talk will cover Carrel’s years on a palliative care mission in Guadalajara, and introduce what is currently available in Jalisco for pain management, especially at end-of-life.
On January 22, same time, same place, Dr. Sam Thelin, who has a general medical practice in Chapala serving ex-pats, will review “NewHealthcare Options at Lakeside.” Thelin, an American, studied medicine at the highly-regarded private medical school UAG (Universidad Autonoma de Guadalajara). See http://www.drthelin.com
Wendy Jane Carrel, MA, is a Spanish-speaking senior care consultant from California. She has travelled Mexico for several years researching health systems, senior care, and end-of-life care in order to connect Americans, Canadians, and Europeans with options for loved ones. She has investigated hundreds of senior housing choices in 16 Mexican states. You may read more of her history at https://wellnessshepherd.com/about/ .
Wellness Shepherd 