Throughout 2018, I have been invited to address Focus on Mexico participants, a lively and engaged group of mostly retirees from Canada and the U.S. curious about Mexico, curious enough to perhaps make a move.
I talk about senior living options, including possibilities at Lake Chapala.
I share a power point presentation with a few statistics and show photographs based on several years of due diligence and relationship building in 16 states of the country. I review independent living, assisted living, and nursing care – what’s here, what the differences are from home, what’s missing, and what is being created for the next generation that may be in need – boomers.
My VOLUNTEER talk shares an insider’s view for those who wish to consider living south-of-the-border. Other speakers focus on real estate, banking, buying cars, health insurance, medical care, bringing pets, etc.
My next talk is the week of October 29, 2018.
If you are interested to learn about Focus seminars and activities, please see their web site at http://www.FocusonMexico.com. The popular education group is celebrating its 20th year.
Note: My articles are posted on http://www.WellnessShepherd.com. Sometimes they are re-posted on other web sites. If an article does not have my by-line, it is not by me. And, I do not post lists.
Some folks with good intentions, but without senior care experience and/or education, write articles and create lists with recommendations. Unless they are health care professionals, they may not be conversant with possible challenges of moving older adults from one nation to another, where the staff turnover is high, how the staff is trained, how med management is handled, what the activities are, and other subjects related to quality of life.
In the course of one week of August 2018 a fellowship, a Death Cafe, and a talk group at Lake Chapala, Mexico hosted events related to considerations for end-of-life.
These events, intentionally or not, are part of the growing Death Positive movement around the world – places to share, plan, or think about what we want; to consider how we foresee our own passing; and to learn from others who openly share their experiences.
Wikipedia’s explanation of Death Positive:
“The death positive movement is a social and philosophical movement that encourages people to speak openly about death, dying, and corpses. The movement seeks to eliminate silence around death-related topics, decrease anxiety surrounding death, and encourages more diversity in end-of-life care options available to the public.”
Retiree ex-pats ages 50+ from Canada, Germany, the U.S., and the UK gathered at three different venues to hear or participate in interesting, lively, or poignant discussions about mortality.
Lake Chapala Unitarian Universalist Fellowship
On a sunny lakeside morning, the fellowship hosted an inspirational, memorable service devoted to End-of-Life.
Sandy Wallin was the service leader. The sermon, “What I Learned from Charlie,” was delivered by Lew Crippen. Hymns related to transitions – I’ll Fly Away ( performed on a recording by the Humbard family), plus One More Step, and Spirit of Life. The postlude was Handel’s The Trumpet Shall Sound.
Crippen’s sharing was an endearing, sometimes funny, but definitely moving tale about how witnessing the dying of his beloved rescue cat taught him more about love and life.
Service poetry included Mending Walls by Robert Frost, and the surprisingly amusing Let Me Die a Young Man’s Death (Roger McGough), beautifully read by Wallin.
Note: The tenets of the Universalist Unitarians have much in common with palliative care and hospice – “to honor the inherent worth and dignity of every person,” plus “justice, equity, and compassion in human relations.”
A group of American, Canadian, and German retirees and others recently gathered for the third Café Mortality Ajijic in Mexico August 2018. Thirty persons sat in an engaged way at six round tables and one rectangle table (added at the last minute) at Min Wah Restaurant. Conversation was uncommonly lively. Participants included a hospice chaplain (a new café volunteer), a hospice nurse, a hospice volunteer (a new café volunteer), three psychologists, a psychiatrist, one professor, one journalist, and others.
Currently, there are three co-hosts sharing the duties – Debi Buckland, Wendy Jane Carrel, and Loretta Downs, each with 20+ years devoted to some or all aspects of end-of-life care, planning, and transitions. Each Cafe Mortality is introduced by one of the hosts. The August café was heralded by Loretta Downs who flew in from Chicago to lead.
In the last few minutes, a representative from each table stood up to share with attendees interests and concerns discussed – how to die peacefully at home in Mexico, how to take one’s life legally in Mexico, how to die on your own terms in Mexico (have your wishes honored), and what happens in the afterlife.
These all-volunteer social gatherings which discuss death and dying respectfully and informally (no agenda) are now held in 52 countries. See http://deathcafe.com/
A review of the first Death Café Ajijic, held in February 2018, may be found at the following link:
The next Cafe Mortality is scheduled for October 9, 2018. Please RSVP to firstname.lastname@example.org if you wish to attend. Note: the venue may change.
Open Circle Ajijic
David Acuff, PhD, talk show host, and author of 15 books, spoke to over 300 attendees at Open Circle Ajijic on Creation of the Afterlife: Perspectives of Different Cultures. He brought forth views from Native Americans, Australian aborigines, Judeo-Christians, Buddhists, and Hindus about what happens when we die. He interspersed his presentation with audience breaks asking those present to find a partner to ask questions with such as…Where are we going after our demise? As at Café Mortality, the audience was fully engaged with the subject, voices were animated and lively.
In closing, Acuff offered a new view of afterlife suggested from findings at tombs of the Nazca mummies in Peru. Perhaps, he shared, there is evidence we are not alone in the world. According to DNA research in the spring of this year, mummies from 300 A.D. and 1400 A.D. had three fingers on each hand and were not homo sapiens.
Maybe we do go somewhere else, time travel, or reincarnate… all food for thought.
Award-winning author, podcast host, and hospice physician Karen Wyatt connects healthcare professionals and the public with information about healing options for the dying through End of Life University, which she founded in 2013.
For three years+ I have been dedicated to a palliative care/hospice mission for Mexico. Even though I am back and forth to California, I am continually on the look-out for how care and support for patients and families is being provided on a national and global basis.
What interests me are differences place to place as they relate to education for providers, physicians, patients, and families – what’s missing, what’s working, what options and perceptions about dying are offered.
This is where Colorado-based hospice physician and thought leader Karen Wyatt comes in. She brings my quest to my computer in an open and engaging way through her END OF LIFE UNIVERSITY web site podcasts. Colleagues share experiences, feelings, information and wisdom about how they are advancing best practices for end-of-life.
Dr. Wyatt’s approach to death and dying is holistic, with a special emphasis on sacred and spiritual aspects of our transitions.
The goal of her effort is a national dialogue for “creative healing… opening the heart of Western medicine.” The podcasts, connections, and resources are a welcome gift not only for healthcare professionals but the public as well. See www.EOLUniversity.com.
In conjunction with the university, Dr. Wyatt launched an on-line book club in January 2018, The Year of Reading Dangerously, where she introduces one book per month about an aspect of end-of-life, and, interviews the book’s authors live on-line. Participants type in questions on-line or ask via the phone line they are listening on.
Interview with Dr. Wyatt
Please share with us about your personal history, and, what led to your work in end-of-life care.
I trained to be a family doctor. I had no knowledge of death and dying or hospice.
Three years after my residency, my father died by suicide. His sudden death upended my world. I felt guilty. I had training in psychiatry and couldn’t save my dad. I floundered for a long, long time trying to get through the grief. Three years after his death, I still felt very lost. I was wondering if I would ever smile or feel joy again. Suddenly a voice said, “call hospice.” It was my voice, and I have no idea where the message came from.
I didn’t even know if there was a hospice in the Utah community I lived in. I searched “hospice” and found one. I called and asked if they needed a volunteer. When they discovered I am a doctor they enthusiastically exclaimed “oh my goodness!” The Hospice Director, stunned, continued to ask “what made you call us now?” I just had an inspiration, I replied. The Director continued, “Our medical director resigned 30 minutes ago and now you’ve called us.” Just like that I became a hospice medical director. I was guided to this place, and I knew it for sure when I met the team.
What inspired the creation of End-of-Life University? What led you to gather fellow end-of-life colleagues to share what they know with each other and the public?
Years in hospice have brought me profound spiritual experiences. I have learned many lessons about how to live my own life. Hospice has helped me live a life of appreciation and that brought me to the decision to write a book. Many patients had asked if I could tell their stories one day. I made a promise to do so.
Writing a book was a long process and is what probably inspired the eventual creation of EOL University. I began the book in 1999 and finished in 2010. I felt I must live the lessons of the book in order for it to be complete. The book was published in 2012 and it was then I realized for the first time that the population, in general, was resistant to talking about death and dying. It seemed people were not ready or open; it was the last thing they wanted to talk about. It was then I knew I wished to do something to change this, something different needed to happen.
Brainstorming led to the question, what else may I be involved with other than a blog or writing? (At the time, Wyatt was posting occasional articles on Huffington Post and in local newspapers). The year was 2013 and I began listening to on-line interviews on other subjects and realized no one was doing this on-line for death and dying. I started the research to find people to interview. It was fun, I loved it (and still do). I was learning so much and wished to keep it going. That was five years ago. I am grateful to the Internet and social media as networks for good.
What response did you receive when you first began End-of-Life University?
End-of-Life University is always a work-in-progress, unfolding. In the beginning I felt no one was listening to the interviews, and that no one cared. The interest grew slowly over time. I learned consistency is important, showing up regularly. I followed the top web sites in Google search. I recognized ranking makes a difference. Over the years EOL University has gone from 200 to 4,000 subscribers. There is a lot of patience on my part.
I knew I was in it for the long haul, and it was the right thing to do whether I received validation for it or not. In the last couple years, whenever I’ve been at a conference, I kept meeting people who have been listening to the podcasts. Some would say, “every week, your interviews got me through two terrible years when my mother died, or “I’m interested in working in end of life because of your podcasts.” One of most important things I learned is that your heart tells you to continue, even if there are signs showing otherwise. You don’t know the impact you are making, but someday you may find out. Always trust your heart.
How did the concept of creating the book club with its engaging title, the Year of Reading Dangerously, take hold?
I felt it would be important. There are so many books, and books are another wonderful way people can learn about death and dying. The goal is to reach people. The concept of reading and discussing a different book each month had been with me for a while. So late one night I posted the book club on Facebook to see if there might be any interest. I was imagining maybe 20 persons might respond, and if so, that would be great. Well 150 had signed up! Now over 1,000 have signed up. It’s never too late to join. The response has been so positive I am thinking about continuing the book club in 2019.
What I like most about the club are diverse points of view, completely different voices with unique perspectives discussing end-of-life. I owned some of the books and hadn’t read them yet. Some of the authors I had invited to talk about their books suggested others. Katy Butler, author of Knocking on Heaven’s Door: The Path to a Better Way of Death, suggested Megory Anderson’s book Sacred Dying: Creating Rituals for Embracing the End of Life. Ken Wilbur is a friend and I felt his story Grace and Grit would be compelling.
I find a lot of our listeners are going through their own personal struggles related to death and dying. It seems energetically powerful and perhaps healing if people around the world are reading the same books. There is something enormously attractive about bringing people a shared body of useful knowledge.
Dr. Wyatt has retired from her medical practice. Her focus is end-of-life education. She enjoys speaking to audiences across the U.S. and has discovered that “threads” connecting those who do this work remain strong. “Death has called us in and somehow we end up sharing our experiences with others,” she says.
The “death positive” movement has taken off in recent years. Dr. Wyatt’s End-of-Life University and her podcasts seem to be at the right place at the right time.
It was almost 20 years ago when Bill Moyers’ PBS series ON OUR OWN TERMS showed that those of us who tend to the dying wish “to assure patients they can have a ‘good death’ one that fits them, their families, and their culture.” This is Dr. Wyatt’s mission as well. More people are now receiving the message.
Thought: What do you wish for your end-of-life?
Links where you can learn more or support the non-profit, all volunteer End-of-Life University:
Thank you fine women of the Order of the Good Death, Undertaking LA, Going with Grace, and Death Doula LA for all that went into producing an educational death positive seminar for colleagues and the public at Atwater Playhouse in northeast Los Angeles, June 2.
For those of us who have been attending the ill since childhood, witnessing both sudden and prolonged deaths, and advocating in our own quiet ways for natural, holistic, spiritual energy for end-of-life care (honoring the wishes of the person whose life it is before/during/after), your fresh, energetic voices are welcome!!
It was encouraging to witness Gen X-ers moving forth with generosity, and a sense of community spirit, and a pleasure to listen to your presentations conveying authenticity and dedication.
What transpired at the unusual gathering?
The engaged audience of 50 colleagues and others got to listen, meet, greet, and ask questions, based on experiences as family caregivers, hospice companions, end-of-life planners, and coordinators of arrangements for families. A few were contemplating a career devoted to end-of-life. Each person who participated has been drawn to end-of-life work through past circumstances (common among most of us).
We met author and natural death mortician Caitlin Doughty of the Order of the Good Death and UndertakingLA; Caitlin’s associate mortician Amber Carvaly; end of life doula, end-of-life planner, and attorney Alua Arthur; and end-of-life doula Jill Schock who is also a hospice chaplain. These ladies, age 40 or under, are passionate and powerful and demonstrate strong skills related to their work. Their goal: educate the public about green/natural alternatives and choices available at death, and, share why planning ahead can save energy, time, $$, and grief.
What pleased me most is discovering that even though the ladies make their living this way, they do not seem to be commercial. Their focus is on giving back, and being present for the ill and their families. I also admire their ability to get the word out effectively.
They offered up-to-date information about California state laws and regulations, medical forms, home funerals, death duties, their experiences as morticians or alongside the dying, and, various options for burial, etc.
A worthwhile event and recommended for anyone interested when they host another seminar.
The photo above demonstrates Caitlin’s marvelous sense of fun. Her best-selling books, which I recommend, reveal her unique humor (find When Smoke Gets in Your Eyes, and, From Here to Eternity). Even though she sat in the audience during the presentation, she actively participated with the three main presenters (her colleagues), as well as the attendees.
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 direct wording, I prefer Sacred 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.
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/
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.
According to realtors at Lake Chapala, Mexico, and the information desk at the Lake Chapala Society in Ajijic, the popular ex-pat retirement destination has received more than double the no. of potential renters, buyers, and information hungry folks from Canada and the U.S. than in years before. (Other popular retirement destinations are also seeing an increase in activity – see no. 3 below).
Among visitors intent on moving are travel aficionados looking for a unique cultural experience, the prospect of meeting stimulating people from all parts of the world, but more importantly, an opportunity to stretch their dollars.
And then there is senior living and healthcare, a subject of interest for most. For “sandwich-generation” boomers who lost savings and/or homes during the American recession of 2007-8, or spent savings for the education of millennial children or grandchildren, many are finding there may be little left for themselves or parents if assisted living or nursing care are ever required.
An added concern is that funding for Medicare and Medicaid in the U.S. are currently being challenged.
If the cost of assisted and continuing care in Canada (Canada takes care of its disabled, ill, and older adults through universal care programs but there is also private pay care) or the U.S. is not an option, there are more affordable options in other countries. The closest place to look is Mexico.
Here are guidelines for looking at assisted living and continuing care in Mexico, costing between $600 USD to $3500 USD/month, depending on the value of the American dollar and the Canadian dollar vs. the peso, the location, and the residence you choose:
Take note – in Mexico the terms assisted living and “nursing home”are often one and the same, with exceptions. Care facilities are not known as they are north of the border – assisted living, rehabilitation, nursing home, and hospice. It is often an all-in-one approach. Also, with some exceptions, homes mix physically disabled residents with memory care residents.
Select cities or areas you wish to be in for climate – coastal, desert, mountains. (Coastal tropical places cost a little more because A/C is expensive).
If the future resident does not speak Spanish, seek places with ex-pat communities and English-speaking locals who are often a source of volunteers – Baja California Norte (Ensenada, Rosarito Beach, Tijuana), Cancun, Lake Chapala, Mazatlan, Mexico City, Puerto Vallarta. Or, choose smaller places such as Merida, and San Miguel Allende. Some care homes have all foreigners as residents, others locals and foreigners together. Usually one person on staff speaks English, sometimes more than one.
Do the due diligence. Research places and determine costs. Most assisted living and “nursing homes” catering to foreigners have web sites in English easily found on Google Search.
Consider private pay homes and non-profits, as well as residences run by nuns whether you are Catholic or not. Nuns often (but not always) provide quality care as most are nurses with a mission to serve, plus costs tend to be what Mexicans would pay if price is a consideration. Another level of care is found in government homes, some pleasant others not; some accept foreigners with residency cards. There are differences in every region of the country, and there are no rules.
Note: no two places will be alike – financially, environmentally, socially, and in terms of care. Homes are not regulated with the strict standards one is accustomed to in Canada and the U.S. However, there are places with quality care and high standards.
Conduct site visits. Assess for yourself what might be an acceptable match in terms of environment and people. Would you or your loved one feel comfortable and safe? Do you like the space, the staff? How are you welcomed? Do residents seem cared for or are they alone in “God’s waiting room” without attention and activities? Ask residents what they like best and what they don’t like. How clean is the home? Standards differ from place to place. Arrive at meal time… is there enough assistance for each resident? Is food fresh, nutritious, and nicely presented? Is it food you would or could eat? Does the home prepare meals compatible with health challenges? What about care plans and medication management? What about emergencies? How are these matters handled?
There are no simple answers for selection.
Ideally, we would all have perfect health to our last days and an abundance of funds which would allow us to receive the best possible care wherever we choose to live.
Note: CCRC’s (Continuing Care Retirement Communities, from independent living to demise), now referred to as Life Plan Communities, have not arrived in Mexico, with one exception. There are plans in the works for Life Plan Communities in Baja California, Cancun, and at Lake Chapala from American, Canadian, Mexican, and Spanish developers.
Throughout Mexico, children and grandchildren make a point of spending time with their elders on August 28. They also bring gifts. This year, because the official day is Monday, most festivities and visits were held over the weekend.
Note: The tradition of celebrating Grandparents Day was instituted in 1983 under the presidency of Lazaro Cardenas. During the 1990’s, announcer Edgar Gaytan promoted the special day on a radio program dedicated to older adults. It has become an important event for families.
This year, Ohana Assisted Living in San Juan Cosala at Lake Chapala in the state of Jalisco honored its residents with a grand party that included relatives and friends, staff, folkloric dancers, an extraordinary jazz band with musical choices remembered by the generation of residents, and a beautifully prepared buffet. The residents at Ohana are from Canada, Mexico, and the U.S.
Hosts Ana and Alonzo, both geriatric nurses who live on the lovely campus, warmly greeted all. They produced a memorable event.
The dancers changed costumes three times and by the end of their performances they had gone from pastels to bright and colorful red, white, and black!! Loved the zapadiada dancing. Fun for all.