Steve in Sweden: Taking Care of the Kids

Torpa Preschool 2016

One of the highlights of this class for students, and for me, is learning about Swedish public policies concerning the family. We have seen our own kids struggle to balance the care of their children and work. Most of them got little time off after each child's birth.  They struggle to find good childcare and then the cost is as much as a second mortgage payment.  A child's sick days are always challenging, in fact, Judy is on-call to go to Pittsburgh for the grandchildren who are there.

The Swedes are practical people. When they see a problem, they get together to fix it, like how to help parents balance work and family. They have actually been working on it for a long time, since 1900 when Parliament passed a law providing a 4 week leave of absence after birth of a child. Since then, they have expanded benefits to create a comprehensive system of support that helps assure that infants and young children receive good care and helps prevent their parents from becoming overwhelmed.   What they do is really astonishing, especially when compared to the US.

In the US, mothers are guaranteed 4 weeks of leave after giving birth. Without pay. Swedish parents can take 13 months with full pay after the birth of a child and another 3 months at a flat rate, that is, not tied to their salary. They usually spread these days out, extending the leave to 2 years. Some of this time--at least 3 months is "Daddy time."  It must be taken by the father or the days are lost.  There are additional days that parents can take if a child is sick that extend through the school years. With pay.

At some point, usually around age 2, children start preschool.  There is an extensive network of high quality preschools, staffed mostly by teachers trained in early childhood education. Unlike here, the parents do not get socked by high costs. The maximum cost per child per month is $120. Less for a second child. That amount would cover a day's worth of care at some places in the US. The goal of the whole Swedish educational system, according to the lecturer in today's class, is to create opportunities for every child.

I can hear some of you saying, we can't do it here. It's too expensive.

It is expensive, but it's an investment in the quality of life of children and their parents.

We visited a pre-school in the afternoon.  It was a very nice program. The facility was old but serviceable. The teachers were engaged and creative, And the teachers had the freedom to be imaginative in creating activities for the children. There was music, art, running around, and a garden with fruit trees and vegetables planted by the kids.

While we might not be able to duplicate this kind of comprehensive program, maybe we could do some of it. And then, in time, we could expand it to meet more needs.  It's practical and solves a problem.

Steve: First Day of Class: Can nursing homes do more?

Jönköping University 2016

It was a marvelous day today in Jönköping, Sweden, with sun and a deep blue sky. After a morning of discussions of old age care in Sweden, we went on a visit to the first of 3 nursing homes we will see during the course.

The building was old, built on the model of a hospital, and not like more modern designs that are homelike and encourage activity and interactions among residents. On the plus side, residents had their own rooms with their own bathroom. None of the lunacy of roommates.  Really, if you are old and frail and maybe have a bit of difficulty remembering, would you want to share your room with a complete stranger? The rooms were filled with residents' own furniture.   Importantly, residents signed leases to their apartment, a small matter perhaps, but one that calls attention to the staff about how they should be treated. As the director told us, she wants the staff to see themselves as going into someone's home, and not thinking, "It's my workplace."

The director stressed the importance of giving care that "helps people keep living their life the way they were."  She talked about new initiatives in Sweden to learn residents' values and to plan care and activities around these values.  And not to do the expedient thing.  This can be hard when what the person wants to do involves safety and hygiene, for example, to refuse repeatedly to shower.  "We have ethical discussions and reflections" to find a way to solve these kinds of problems and give care that supports the person's values. When have you ever met a nursing home director who has ethical discussions with her staff?

American nursing homes are also emphasizing person-centered care that respects the person's own preferences and values. Some places like the Abramson Center outside of Philadelphia get it right. In many places, however, they’re just empty words. Here, it's the law and everyone is expected to find a way.

Steve: Retirement Becomes More Real

Lake Vättern  2011

This week I had a couple of milestones that moved me closer to full retirement .  My research lab held its last full meeting.  Three of my remaining students graduated, Erin McDermott, a talented undergraduate honors student, and two terrific doctoral students, Yin Liu and Courtney Polenick. There was a moment when I felt that retiring was like diving into a pool and not knowing if there was water in it or not. But that passed as I thought of all the plans Judy and I have for the next several months.

Another ending is that for the last time I am taking a class to Sweden. Beginning in 1995 I have taken classes there 8 previous times to learn about care of older people in Sweden as well as about other social and family policies. The class has been an eye-opening experience for everyone. They see that care does not have to be mediocre or worse, but instead people can live their lives with dignity, respect and good quality of care.   If you are interested, I thought I would provide updates during the next 2 weeks of the highlights of the class.

Although this is the last time I will be teaching the class, there are plans to continue it. Lesley Ross, a colleague of mine at Penn State, is co-teaching with me this time so she can offer it in the future. And we will be joined in Sweden by Beth Fauth, who is bringing a class from Utah State, where she teaches. She took the class from me in 2001 and subsequently did her dissertation using Swedish data. This is the second time we have done the class together and she also plans to continue it.

To see where we will be, look up Jönköping, Sweden. We travel to Stockholm next week.

Sensible Discussions of Aging and Alzheimer's Disease

Raspberry souffle 2007 at La Pichoun in France

We want to call your attention to three recent articles, all in The New York Times, which do a much better job than usual in getting things right about Aging and Alzheimer’s Disease.  Each article has information that we found useful.  We provide links to the article at the end of the blog.

The first article, A Life-Changing Diagnosis, follows one woman, Geri Taylor, from the moments in 2012 when she first noticed changes that could no longer be explained as normal memory problems through the journey she and her husband have made to understand and manage the symptoms of Alzheimer’s Disease.  What stands out about the article is that we hear Geri’s voice, what she sees and thinks. We see her struggles to still lead a meaningful life and her husband’s difficulties in accepting her illness. Like Geri, many people with Alzheimer’s Disease retain awareness of their cognitive problems and can tell us how they want to lead their lives.  As with other non-fiction accounts, this article has honesty and depth.  We see through Geri’s eyes and understand her struggles.

Along with the original publication of that article, the Times included a piece by Pam Belluck inauspiciously titled “What Is Alzheimer’s Disease.”  Most articles that we’ve read simply rehash the usual bland information and misinformation that abounds in the media.  But using clear, precise information, this article gets it right.  Among the topics covered are the difference between normal aging and Alzheimer’s, how Alzheimer’s is diagnosed, what causes Alzheimer’s and whether there are any medications for Alzheimer’s.    We were particularly struck with the succinct and accurate way Ms. Belluck addressed the question of whether Alzheimer’s is preventable.  In contrast to the usual exaggeration that envelopes this question in the media and the scientific literature, Ms. Belluck sticks with the facts.  She says that activities that “keep us healthy and engaged” have the possibility to delay the onset of dementia, at least for some time.  It’s a false hope and poor science to maintain that regimens of diet, physical exercise or cognitive exercise can actually prevent Alzheimer’s or the other forms of dementia, but by doing the things that promote brain health, we may be able, in Ms. Belluck’s words, to “keep dementia at bay.”

Ms. Belluck is a health and science writer at the Times, and shared a 2015 Pulitzer prize with colleagues for reporting on the Ebola epidemic.

The third piece, called “Better Aging Through Practice, Practice, Practice” picks up a similar theme.  The author, Gerald Marzorati, a former editor of the New York Times Magazine, gets past all the hype about staying forever young by staying active, and instead identifies an approach that makes a lot of sense and that reflects what the best research tells us.   Mr. Marzorati correctly identifies that it is not just staying active that is important but that how we stay active matters.  He proposes that we choose a demanding skill that we want to master and that takes considerable time and effort to get good at.  He took up playing tennis when he was in his mid-50s, learning the basic skills and working to improve through lessons and practice.  Unlike most of us who pick up a racket or golf club in a casual way, or start a hobby, Mr. Marzorati says we need to make “a disciplined effort at improvement.”  That means regularly working with coaches or experts in the skill we want to master and practicing that skill so that we work toward higher levels. This is what research tells us works best—expanding our physical and mental skills and staying engaged.  Earlier in life we might have hoped to rise to the pinnacle of our sport or avocation or to be able to compete at an elite level.  Now the focus is on the improvement itself rather than comparing oneself to others who excel at the activity we are working on.

We have been thinking in a similar way about the importance of building skills, but not with the crystal clear focus that Mr. Marzorati has.  The article has inspired us to examine our future choices more carefully and to think about our hobbies in a different way.   As some of you know, Judy is an excellent baker and cook, and she enjoys trying new and challenging recipes, and I am the resident grill-master.  We have taken some classes at Zingerman’s deli in Ann Arbor and in France, including one at Julia Child’s country home near Cannes.  We always enjoy learning new things, but the idea of challenging ourselves to improve was not the point.  Now we have a new perspective, so Judy found a class in knife skills at the CIA (Not that CIA, but the Culinary Institute of America, in Hyde Park), and Steve is going to take a grilling class at the same time.  While taking cooking classes is not really new and different, our focus on gaining skills and practicing until perfect, is a departure.

You’ll all benefit from this, too, if you come over for a meal.  Just don’t startle Judy when she has a knife in her hand.

A Life-Changing Diagnosis

http://www.nytimes.com/interactive/2016/05/01/nyregion/living-with-alzheimers.html?ref=health

What Is Alzheimer’s Disease?

http://www.nytimes.com/2016/05/02/science/what-is-alzheimers-disease.html?ref=health

Better Aging Through Practice, Practice, Practice

http://www.nytimes.com/2016/05/01/opinion/better-aging-through-practice-practice-practice.html?emc=eta1&_r=0

It’s Spring, sort of, and that means baseball

The baseball season just started, as usual two weeks before the weather turns warm in the Northeast and Midwest.  But it’s here.  It’s a time to feel the optimism of the season when we can dream that our favorite team might make it to the top this year, or at least get our hopes up with a nice run to the playoffs. 

The opening of baseball season is also a wonderful opportunity for all of us to lower our stress levels.  Instead of spending all that time reading about the primaries or watching the news, you can do what I plan to do—read the sports section and watch a game now and then.  I am sure there is some research somewhere that proves that watching baseball compared to the news extends life by lowering stress and also decreases the risk of Alzheimer’s.  It’s as likely as some of the other claims in the media, and I think we would all be better offer spending more time worrying about who is the starting first baseman on our favorite team and less time worrying about who is first in the polls.

Baseball plays a role in our retirement plans.  This summer, we start our quest—well, my quest with Judy supporting it—to visit all the major league ballparks I have not been to.  I have been to 13 current ballparks and so have 17 to go.  We will be seeing games in San Diego, San Francisco and Seattle this summer—all nice places to visit.  It is important to have goals.

The photo above is from game 2 of the 2005 American League championship season.  You may recognize the tall left hander in the photo—Barak Obama, then an Illinois State Senator and White Sox fan.  He threw out the first pitch that day and the Sox went on to win the next 8 games and the first World Series in Chicago since 1917.  It was a great moment for me, one I didn’t think would actually ever happen. 

This year there is considerable excitement about the Cubs’ chances.  I do hope for the sake of all my relatives and friends who are Cubs fans that their time will come soon, too.  Of course, I can’t help myself and hope that the Cubs and Sox might actually meet in the World Series, and the outcome will be the same as when they last met – that was 1906 for all of you who are history-impaired – where the team that was a heavy underdog managed to win it all.  So good luck to all you Cubs fans, and to everyone else, baseball trumps politics.