In early November, New York Times best-selling author (Knocking on Heaven’s Door) Katy Butler gave a talk focused on themes from her new 2019 book The Art of Dying Well at Sutter Health CPMC in San Francisco. Approximately 100 healthcare workers participated.
I was fortunate enough to attend and briefly meet Katy and her husband Brian, also active in humanitarian and senior care issues.
The event gave Butler a chance to share compelling, medically complicated personal stories relating to the passing of her parents and friends. She also spoke about her commitment to compassionate care and the human right to die with dignity and grace when possible.
I found what she had to say authentic, heartfelt, and practical… especially her reminders that a good many of us working in senior care and palliative care find imperative to share with others – make a plan for end-of-life if you haven’t already, find your tribe (who will be there for you, presuming your demise is not sudden), stay in charge (ask for what you want and need), and “bring in the sacred.”
Katy hosts a Facebook group entitled Slow Medicine, based on principles in the book of the same name by her Bay Area colleague and friend Dr. Victoria Sweet, calling for change in medical practices. Quality of life over invasive and perhaps unnecessary procedures, especially at end-of-life.
Notable aside: Butler, a Buddhist, was lay-ordained by Thich Nhat Hanh, Vietnamese monk and peace activist. She lived seven months at his Plum Village retreat in France, among other significant life experiences.
On November 2 the newspaper San Diego Union-Tribune hosted a free event that attracted a 50+ crowd interested in subjects related to aging. Main speakers were Patricia Schultz (author of 1000 Places to See Before You Die) and Captain Dale Dye, USMC retired (author, filmmaker) focused on veterans and others.
Most of the activity at the San Diego Convention Center was at booths. Among the participants offering information were AARP, Leading Age, healthcare service providers, a cancer awareness initiative group, estate planners, Medicare Advantage Plan insurers such as Humana and SCAN, retirement counselors, senior movers, senior living placement consultants, a sleep therapy advisor, and others.
The highlight for me, related to some of my work as a senior placement consultant for Mexico, was to meet up with Miguel Angel Torres and Marisa Molina of Serena Senior Care in Baja California. I toured their Rosarito assisted living home last year and am eager to return to see their latest developments. I appreciate their dedication, enthusiasm, and focus on quality care. See www.serenacare.net plus links to videos found on their web site.
As an aside, Serena offers residents and visitors to Baja a Full Assistance Card for $99/year ($198 per couple). The Full Assistance Card offers ambulance services, roadside assistance, a 24-hour bi-lingual call center, discounts, and access to online medical records. Have not seen this service in action so am not in a position to comment on it. Information on this is at the web site listed above.
Corey Avala of www.RetireBaja55.com was also present to encourage folks to retire early and “affordably” to one of three developments he is involved with. Have not seen them.
Jane Garcia, a realtor from Dream Home Mexico was also there to espouse the benefits of retiring to Mexico.
One of the advantages of Baja California for assisted living and retirement, aside from the lower cost of living, is its close proximity to San Diego for health care through the Veteran’s Administration, and U.S. healthcare for American ex-pats who wish to return in case of need.
Many thanks for the warm reception by the San Diego Union-Tribune sponsor team! Many thanks to the San Diego Union-Tribune for producing the San DiegoEldercare Directory 2020 available in print at the expo, and also available on-line at http://www.sandiegoeldercare.com. The directory includes listings of independent living and long-term care throughout San Diego County.
This is an exciting fall month for educational events.
Other than shepherding families to appropriate, compatible Mexican assisted living and ”nursing” care for their loved ones, pastoral care visits to sweet older adults at Lake Chapala (always a pleasure), and coordinating the production of health books (one a translation to Spanish), there are seminars to attend and blog about, plus informational talks I have prepared for ex-pats.
Here’s a partial calendar….
October 3 Future of Medical Cannabis conference on-line. Medical cannabis is not yet legal in Mexico, lots of challenges related to its release, but all is possible. Am keeping informed of movements in the U.S. and Canada. Some U.S. doctors are titrating down opioid prescriptions and other pain meds for their patients- slowly, by introducing medical cannabis at the same time.
Oct 16 Beautiful Dying in Mexico Power Point presentation at Lake Chapala Society. In honor of Mexico’s Day of the Dead, Dia de los Muertos, an overview of dying in Mexico – family and religious traditions, rituals, their origins and meaning, and why many Mexicans seem so comfortable with death. Told through stories I’ve been witness to volunteering at a palliative care hospital/hospice and/or as a friend on a village street in Ajijic, Mexico.
Oct 19 Medical Cannabis in Mexico Conference all day in Guadalajara
Oct 22 Preparing for Medical Emergencies at Lake Chapala Power Point presentation at Presbyterian Church
Oct 24-26 4th International Palliative Care Congress at UTEG in Guadalajara produced by www.JuntosContraelDolor.com, the palliative care hospital and service I volunteer with
Oct 30 Focus on Mexico Power Point presentation about Senior Care in Mexico, members only
One of the biggest pleasures for those of us dedicated to healthcare (for me senior care and palliative care from a social, spiritual, and administrative perspective) is to attend a conference where one can network and learn from thought leaders focused on a similar mission – best practices for quality care.
The 2nd PACE Pan American Forum for Emergency Care and Global Health held at Hotel Real de Minas in San Miguel de Allende, Mexico last month, was a gift for all attendees. (Below is a photo of Hotel Posada de las Monjas in SMA, a former monastery, where the PACEforum.org offices are located).
The three-day conferencefocused on innovative ways to offer medical training to communities in lower-resource, culturally challenging settings through technology (tele-mentoring, digital health monitoring), and one-on-one communication and care skills.
Public health leaders in Emergency Medicine shared years of accumulated knowledge from state, national, and international levels. Tracks included general emergency medicine, disaster management, obstetrics, pediatrics, the ECHO tele-mentoring program, rural and wilderness medicine, palliative care, and many more. Attendees received CME credits.
Each track was of the utmost importance.
The most meaningful tracks forme were physicians teaching palliative care to emergency resident physicians, a demonstration of a clinically proven mental health protocol for first responders and physicians to keep themselves and others calm through Breath-Body-Mind (trade-marked), and the presentation by internationally renowned social entrepreneur, university professor, and conference founder Dr. Haywood Hall who focused on the formidable impact the PACE program has had in Mexico, plus a current international concern, health and mental health issues at the US-Mexico border.
Thanks to the international work of Dr. Angel Braña-Lopez, and New York integrative psychiatrists Drs. Richard Brown and Patricia Gerbarg of www.Breath-Body-Mind.com who teach innovative programs to help people recover from trauma and mass disasters, I was able to travel to San Miguel de Allende. Many thanks also to Dr. Haywood Hall!! It was a privilege to attend.
Other attendees were medical school professors from Latin America (mostly Mexico) and the U.S., specialists, generalists, nurses, mid-wives, paramedics, community health workers and others.
More about PACE Global Health
PACE Global Health (aka Groupo PACE) is an off-shoot of the award-winning social impact program PACE MD, founded over 20 years ago “to improve emergency and general medical care in Latin America through community-based training in skills, knowledge and ability as well as to improve medical care in the US and Latino populations through MedSpanish’s language and cultural literacy training (offering CME and GME credits).”
PACE MD founder Haywood Hall is an Emergency Medicine Specialist, Telemedicine Physician, and Professor at the University of New Mexico and the University of North Carolina. He is an American fluent in Spanish language and culture, and is an Ashoka Change Maker Fellow who works with Duke University’s Innovations in Healthcare. His PACE program has trained and certified over 41,000 healthcare providers and 6,000 lay people in systems-based emergency care.
For his achievements in positively affecting the chain of survival through emergency care skills Dr. Hall has won the International Federation of Emergency Medicine Humanitarian Award as well as the College of Emergency Physician’s Hero of Emergency Medicine Award, LATAM’s Top 10 Social Impact Enterprise in Latin American and the Caribbean Award, the American Heart Association’s Silver Award, as well as 2nd place for Social Innovation from Mohammad Yunus Creative Labs.
“The future of emergency medicine is here and it’s up to us to pave the way,” states Dr. Hall. “As front line healthcare providers we are in a unique position to be agents of change. We know the exact problems that plague our societies.”
If you are interested in learning more about Latin culture and how you can use healthcare technology to reach low resource areas you may wish to attend the next Pan-American Forum for Emergency Care and Global Health (date not yet set), or contact PACE via the information below:
Another take away: What many people may not realize is the enormous effort and energy required to create innovative, sustainable public health programs, especially related to emergency medicine, which is often a 24/7 profession. Most participants, and PACE founder Dr. Hall, usually depend on their teaching income to fund their outreach passions and programs.
Note: PACE International is not to be confused with another PACE, a US federal Program of All Inclusive Care for the Elderly. The objectives are similar, however – to treat all with dignity, compassion, and quality care.
I always look forward to addressing folks from Canada, Europe and the U.S. at Focus on Mexico one-week seminars, currently held every two to three months at the Real de Chapala Hotel, Lake Chapala, Mexico.
Most attendees are considering a move to Mexico for a variety of reasons – adventure, climate, housing costs, more affordable healthcare, retirement, and more!
The newbies will see my Power Point presentation Thursday morning, August 8, outlining various models of senior living and senior care in Mexico – government, non-profit, and for profit independent living, assisted living, memory care, and Life Plan Communities/CCRC’s. My photos of senior living options are from various states in Mexico from Baja California to Merida in the Yucatan, all ex-pat havens.
To date, Lake Chapala attracts the fastest growing and largest community of ex-pats in Mexico.
I am a Spanish-speaking senior care specialist for Mexico, serving Americans, Canadians, and Europeans who are discovering they may not be in a position to retire, or, may outlive their savings. They are looking for more affordable aging options at home or abroad.
Where are these retirees choosing to move if going abroad?
Mexico … for the most part, because of its proximity to Canada and the U.S., milder weather, opportunities for new life adventures, and most of all, access to medical and senior care at one-third to one-half less than at home – a major concern, just in case, even for those who are super fit and who follow a healthy lifestyle.
This boom is no surprise to developers from Canada, Mexico, Spain, and the U.S. who have anticipated the rise in the number of retirees from Canada and the U.Sfor over 10 years – to Baja California, Mazatlan, Oaxaca, Puerto Vallarta, San Miguel Allende, and the Quintana Roo/Yucatan states where Merida and Cancun reign. Large numbers of ex-pats continue to arrive.
Many new retirees – boomers, boomers bringing parents, and some Gen-Xers – love technology, travel, and learning. They like to drive, to explore. Some will continue to work on-line. More than anything they enjoy their independence. They seek ways to live more economically, and, use Mexico as a home base for more travel.
They have unique interpretations of what independent living means. Generally, the vision is of a person 50 or older, usually but not always retired. The overriding lifestyle goal is AGING IN PLACE either within a community where one is self-sufficient, or in a community providing services such as meals, laundry, cleaning, and transportation.
Mexico is preparing to offer a variety of such choices in beach environments or the colonial highlands.
However, unlike the U.S., retirees must not expect choices as diverse as an all Hindu, laughing yoga, retired postal worker, artist, Japanese, or Presbyterian senior community, nor any development as large as a Sun City.
The most aggressive housing expansion has been at Lake Chapala, one hour south of Guadalajara, Mexico’s second largest city, which also boasts an international airport.
What kind of housing are retirees finding at the lake?
If not stand-alone private homes, most retirees are on the look-out for living akin to 55+ communities near golf courses, shopping, gyms, spas, and the company of other ex-pats.
What’s in the offing at Lake Chapala?
Three large construction projects – two Life Plan Communities with independent living (with moves to assisted living or nursing care as part of a long-term plan), and one “luxury” development of condos and casitas not unlike already existing communities known as El Dorado, El Parque, or The Raquet Club replete with tennis courts, pools, a club house, gym equipment, and gardens. The new projects may open by 2021.
The two newest additions for independent living at Lake Chapala are:
Namaste Lake Chapala Community tiny houses, a co-housing enclave in the village of Ajijic. Its founder is American James F. Twyman, a body/mind/spirit author and musician who travels the globe as a “peace troubadour.” The Namaste community opens its doors to the public for morning meetings to discuss or review A Course in Miracles.
Namaste offers 12 brightly painted homes providing 300 SF to 600 SF of living space, each with kitchen, bath, and living areas. The Namaste concept is to age in place affordably, bringing healthcare in should it be needed. Meals are communal, or taken to your residence if you wish silence.
As of this writing, all but one of the homes have been purchased and/or rented. For more information see www.NamasteLakeChapala.com or call Kerri Moon, Head of Sales, at (510)250-3002, a U.S. phone number.
Ohana Independent Living in San JuanCosala, 20 minutes west of Ajijic, is the other newbie. The owners are bi-lingual geriatric nurses. Even though there is no assisted living or nursing care at their two story independent living home on the lake, folks with walkers who can take care of themselves are welcome. An elevator is currently being installed.
Ohana Independent Living is located on a large lakefront estate with sprawling lawns, close to nature. There are 12 rooms. Each residence has mountain or lake views. There is a balcony on the second floor facing the lake. Rooms are partially furnished or decorated to one’s preferences. Dogs are welcome. Meals are included, as well as laundry, maid service, and parking. There is no web site. For more information call Alonzo Garcia at 52 331 495-6167.
There are currently three independent living residences with meals, laundry, maid service, and parking for your car at Lake Chapala. There is a fourth residence, owned by a physician, with no parking. If you became seriously infirm at any of these places, you would be required to move somewhere else. Monthly fees range from $1200 to $1800/month USD, the average cost of Mexican assisted living with no frills.
There are another four communities designed as individual apartments for older adults. Stretching the interpretation, there are about seven more that have a community feel but are exclusively rentals; the renters happen to be older adults. There are also four hotel apartments, some with kitchens, rented long-term by older adult ex-pats.
There are two intentional co-housing communities. Other than Namaste there is Rancho La Salud Village in West Ajijic. It consists of a group of larger homes created for aging in place and green, sustainable living. There are no communal meals, each resident is on his or her own. RLSV was founded in 2010 by Jaime Navarro and his wife Sara Villalobos, together with “green” architect Rick Cowlishaw. See www.ranchollasaludvillage.com
As of this writing, other “independent living” and/or senior living projects for ex-pat retirees are in the works throughout Mexico awaiting, for the most part, American and Canadian boomers.
Wendy Jane Carrel, MA, is a Spanish-speaking senior care specialist and consultant from California. Over a period of several years she has traveled state to state in Mexico researching health systems, senior care options, end-of-life care, and disposition of remains. She volunteers at the only 24/7 palliative care hospital/hospice in Jalisco that also has a community outreach service. http://www.WellnessShepherd.com or contact her at firstname.lastname@example.org.
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In February 2019, El Ojo del Lago (The Eye of the Lake), an English-language publication at Lake Chapala, Mexico catering to 20,000 high season retirees from north-of-the-border, dedicated a section of its magazine to articles on End-of-Life.
Each contributor has worked in Senior Care and End-of-Life care for over 20 years. A piece I wrote was included. See the link (looks good there) or, you may read the copy below the link on this page.
ODE TO LOVE AND CAREGIVING AT A CHAPALA, MEXICO ART INSTALLATION
It is a notable synchronicity that “Transcendence – A Celebration of Those with Perseverance”, a medical art installation created by LK Gubelman (Leslie Katherine aka Kate), is located in El Sacrificio (the Sacrifice), Jalisco, Mexico.
Gubelman, an architect by profession, was caregiver to her retired and ill parents (mom Canadian, dad American) over the course of eight years at Lake Chapala, Mexico. Her creation is based on what she witnessed as she put her life aside to assist and honor her father and mother. The installation is also, she might share with you, how she has been meeting her irrevocable losses and sadness. The art has been her therapy.
The Transcendence exhibit in El Sacrificio is located inside “Los Conos”, cone-shaped granaries that continue to serve as art studio. Once you enter the big cone you cannot help but notice what is before you – six large scale works that required several years to complete (2015-2018) with the assistance of six men.
What will you see?
Depending on your own interpretation, the exhibit offers a way to reflect on life and death, from the point of view of the caregiver and Kate’s parents.
The largest of the pieces – THRESHOLDS – UMBRALES – is what you notice first. From the entrance, it resembles a beautiful stained glass window. Up close you see a symbolic body surrounded and connected by IV bottles filled with bright-colored water through plastic tubing. According to the artist, this piece is about time passing; each frame telling a tale of care given and the will to persevere. Every bottle was actually used at home.
ENTANGLEMENT – ENREDO is a lattice work of medications, pills and pill boxes hung from the ceiling in suspended form, dazzling with crystal and beads linking one to another like Christmas decorations. Standing under it you cannot help but notice enormity of drugs consumed and what was required by caregiver Kate for medical management. All medication boxes and packets were used by Kate’s parents.
TRANSPARENCY – TRANSPARENCIA is a corridor of x-ray images, CT scans, MRIs mounted on translucent multi-colored panels described best by the publicist as “a tunnel of muted light and color…and a tale of medical machinery (cold steel) and the toll on all involved.” The names of Kate’s parents, Allison and Oscar, are on the panels.
Artist and caregiver Kate concludes, “there was no choice but to create the installation. It was a necessity, it helped my healing.”
Aside from honoring the wishes of her parents, and their lives, Gubelman bears witness to medical choices involved to keep her parents alive. Somehow, she felt compelled during the caregiving years, to collect and keep pill packages, intravenous bottles, medical records, x-rays, and other mementos.
Little did she know at the time they would become the basis of her installation.
What might you discover or experience?
You may instantly relate to Kate Gubelman’s art pieces, or not. According to Gubelman there are a variety of responses. Many visitors, both gringo and Mexican have felt either saddened or amazed. Many find deep meaning, especially recent widows and widowers who have been caregivers themselves.
Visitors have called the installation captivating, thought-provoking, emotional, and loving.
At minimum, you may feel sacrifice and perseverance were involved not only for Gubelman, but for her parents. An act of love? A comment on modern medicine? No matter your read, it is an immersive art experience.
Who might wish to see the exhibit Transcendence?
Caregivers, healthcare workers, perhaps those mourning the loss of loved ones, and, the general public
For more information or to schedule a private studio tour, please contact Bethany Anne Putnam
I am grateful to Focus on Mexico, where I address the ever-changing topics in Mexico (and elsewhere) of independent living, assisted living, nursing care, Life Plan Communities (CCRC’s – there is only one so far with others being developed).
The next talk to the Focus on Mexico attendees is March 21 at 11:15 a.m. at a hotel in Ajijic, Mexico. See https://www.focusonmexico.com/focus-6-day-program/ Focus on Mexico offers seminars to folks interested in how to move to and/or live in Mexico. All presenters at Focus on Mexico are volunteers.
On Friday, March 29, I will be speaking at a FREE community event (open to the public) at the Lake Chapala Society Sala in Ajijic at Lake Chapala, Mexico at 2:00 p.m. on Why End-of-Life Planning is a Good Idea for Ex-Pats in Mexico.
Here below are links to articles I have written on the above-referenced subjects:
Wendy Jane Carrel, M.A., a Spanish-speaking senior care specialist, has spent over seven years traveling province to province in Chile, Ecuador, and Mexico researching senior living options. She acts as an advisor or liaison for those who wish assistance negotiating health systems, senior care options, end-of-life care, and disposition of remains.
In January of 2018 Loretta Downs, M.A. gerontology, and I co-founded Death Café Ajijic aka Café Mortality Ajijic at Lake Chapala, Mexico.
The first café started the next month with the intention of encouraging the mostly retired community to talk about and prepare for end-of-life, not only to save loved ones and neighbors a lot of grief and time, but to provide a space to talk out feelings, hopefully leading to more well-being.
Because we travel a lot, we invited other health professionals in the community to join as volunteer hosts. We have been fortunate. There is now a rotating team to handle responsibilities for the all-volunteer events starting in 2019. We continue to do our best to improve the experience for attendees. One of the best ways for me to learn is to experience other Death Cafes.
For those of you unfamiliar with Death Cafes, they have been in existence since 2011 and are now in 63 countries of the world. See www.DeathCafe.com for a café near you.
I was recently in Santa Barbara, CA, originally a Spanish mission post, to attend the Santa Barbara Death Café.
It was a pleasure to enter the donated venue at 11 E. Carrillo Street, the Hill-Carrillo Adobe. Beautiful place built in 1825. It is on the National Registry of Historic Places.
There are three dedicated hostesses in Santa Barbara. One of them provides her grandmother’s tea cups and linen. Others bring cake or cookies. Attendees offer donations to defray expenses.
One of the surprises for me was that Santa Barbara Death Cafe provides a mobile library. They bring books in a large carton each month for participants to check out!! I love this idea!!
Participants in Santa Barbara are all adults, mostly older adults. In a group of about 20, there were two men, one a recent widower. We introduced ourselves to each other at a long, rectangular table, one by one, sharing briefly what brought us to the café.
We dispersed after the introductions to talk in groups of three, four, or more. It was organic, and attendees were encouraged to move to another group if they so desired. I see how attendees return over and over again. The hostesses and environment feel cozy and safe.
Thank you Death Café Santa Barbara and Center for Successful Aging for your hospitality!!!
I also attended an intimate Death Café in Santa Monica a few days prior to the Santa Barbara Café. It was hosted by a lovely woman at her office space. She is a psychologist, grief counselor. death doula, and drama therapist from Pasadena. There were five of us all together. The counselor led by asking why each came, and the other three participants, each in their 30’s, were off and running, lively and engaged from the start. Time went by quickly. This multi-talented lady also offers a Death Goes to the Movies night. Recently she screened a documentary about a psychiatrist/musician preparing for his green burial.
Both cafes in Santa Barbara and Santa Monica were unique, rewarding experiences. You may find the next dates for these Death Cafes or others near you at http://www.DeathCafe.com. If you do not find one, perhaps you may have a desire to start one.
Please see the following links for articles about two of the cafes in Ajijic if you are interested – how we organized, and how attendees shared experiences at the end.
For the last few years I have had the good fortune to visit palliative care and hospice entities in California as well as in six states of Mexico with the objective of learning more about what works, what’s missing, and what might work in Mexico for years to come. There are challenges based on cultural differences, but all is possible.
I am comparing various models – hospitals and facilities (medical), in-home community outreach (medical and/or volunteer), all volunteer, government, non-profit, and for profit.
Hospice of San Luis Obispo County (HSLO) has been on my radar for some time because it is a successful, locally based non-profit volunteer hospice that has sustained itself for 41 years!! For those of you who are familiar with the operations of non-profits, this is an extraordinary achievement.
Aside from serving the public, HSLO educates and trains locals and others as end-of-life doulas (companions). They host Death Cafes and much more.
The sustainability is based on more than dedication and love – mainly inventive ways to engage the public, an especially hard task in a difficult economy.
I am so pleased I was finally able to visit HSLO. I am indebted to the Executive Director and the Director of Volunteers, the few paid staff, for a warm, meaningful, memorable exchange.
HSLO is one of six hospice services in a county with a population of around 284,000. It is the only volunteer in-home hospice supported by the generous energy of over 200 volunteers. They serve approximately 5,000 persons per year.
Any county resident with life-limiting illness is served through “in-home respite care, emotional, spiritual, practical and non-medical support, and grief counseling support (group and individual).”
Other services are education about dying and death for professionals, caregivers and the community, doula programs, Death Cafes, Threshold Choirs, and Pet Peace of Mind groups.
From my perspective their outreach and activities place HSLO in the vanguard of the “death care and the death positive” movement that is sweeping North America and beyond. It is exhausting but rewarding work.
Additional treat: I was blessed to attend HSLO’s annual Light Up A Lifecandlelight vigil held at the San LuisObispo Mission on a nippy, rainy evening. Names of those who have passed were read out loud during the hour service that included a choir. Later we carried candles outside for readings and prayers.
Anyone may pay a fee (fundraising) to have the name or names of loved ones read at Light Up A Life. This lovely event is repeated during one week in December in different cities of the county.
HSLO was created in 1977 and has an excellent reputation through word-of-mouth.
Services are provided without charge; no insurance company is billed.
HSLO relies on community donations, fundraising events, grants, doula training fees, and the time of its over 200 volunteers.
Hospice of San Luis Obispo County is a remarkable operation. So much goodwill!! A great gift to the community.
The home which serves as office was bequeathed to HSLO by Dorothy D. Rupe; it bears her name.
1304 Pacific Street, San Luis Obispo,CA 93401 tel. (805)544-2266