Advanced Care Planning

Often, when I mention the topic of Advance Care Planning and health directives, the eyes of the person I’m speaking with glaze over and instant fortress walls are built. Most people think that advance directives are necessary only for the oldest of older adults and feel uncompelled to take any steps to prepare one for themselves. Yet, there are so many reasons to complete one, even as a young adult. I recall completing mine when my husband and I did our estate planning years ago when our children were born.   Yet then, even as a health care professional, I had very little understanding of the impact of not only completing the legal documentation, but in having these difficult conversations with the important people in my life.

Why is the topic of Advance Care Planning one that is largely avoided? Most people do not think that they need to worry about the future and they assume that they will be able to make their own decisions during a health crises. However this often is not the case. Most people will not be able to make their own decisions because they may be unconscious or confused.   Families are then left to make decisions for their loved ones during very stressful situations. Yet they enter this role with little preparation and less confidence that they are doing the right thing.   Everyone knows that they should have important conversations about their wishes for their goals for care whether in a health crises or at the end of life, but people simply do not. Another reason for avoiding the topic is that most people do not know how to have the conversations. Even if an older adult is motivated to open the discussion with their children, they may face resistance. “I don’t want to talk about this. You’re fine!” is a common response from adult children. Again, fortress walls are built. Unfortunately, those walls can not prevent the unexpected health event and when it comes, more peace of mind is achieved for entire families by being prepared.

In my care management practice, I work with each of my families to ensure that they not only have the appropriate documentation, but that families have rich and meaningful conversations about the values and wishes of their loved ones. We also discuss scenarios so that the designated spokesperson can be prepared when they are called to step in as decision maker.   There is no perfect way to prepare for every situation. But when the designated spokesperson and the family are “trained” in their role, everyone has peace of mind that they are honoring their loved at a time when it matters the most.

As a volunteer for the Orange County Aging Services Collaborative, I also provide community presentations on Advance Care Planning. “Advance Care Planning, Important Choices for Living and Dying” is a one hour presentation developed by the California Coalition for Compassionate Care and funded by the Alzheimer’s Association, St. Joseph Health, Orange County Aging Services Collaborative, SCAN Health Plan, and the California Healthcare Foundation. This free seminar teaches participants how to have these conversations and provides resources for preparing legal documentation of healthcare treatment wishes. I would be happy to speak on this topic for your church, men’s or women’s group, school or neighborhood.   Please feel free to contact me to arrange a seminar or to assess the advance care planning needs in your family.


The Power of a Good Broth

One of the best remedies for a cold has long been a good bowl of chicken soup comprised of wholesome home made broth and fresh veggies. It just feels good eating it. You take a spoonful, breathe in the warm steam and slurp up that comforting, nourishing goodness.   Books have been written about “Chicken Soup for the Soul” (by Jack Canfield) and how revitalizing it can be. But the process of regeneration does not start at the bowl and spoon stage. It starts long before that when preparing the broth.   Home made broth is well established as a healthy, nourishing foundation for many recipes. Broth making goes back generations and many of todays elders have their family recipe deeply ingrained in their memories. When my clients are sick, having a bad day, or just simply bored and unengaged, I often suggest that their caregivers make broth and encourage their elder to participate in the process.


The first point of engagement is conversation about the recipe. This conversation will go in many directions: the ingredients, the process, the times when broth was made and even how it was used in other recipes other than soup. Caregivers can share their recipes and make comparisons.


Next, there may be a need for a shopping trip to get ingredients. Whether or not the older adult is able join you, this in another opportunity for engagement. Picking out the perfect carrots, or celery; deciding between curly parsley or flat. These are all opportunities for the elder to engage their mind and contribute to the final product. Celebrating all the colors and textures of the fresh, raw ingredients is stimulating to the senses and provides a feeling of anticipation of what the broth will taste like.


For an older adult that may be home bound, it is the broth making that greatly enhances their day.   A good broth simmers on the stove for several hours. The fragrance drifts into the far corners of the house, carrying with it the familiar comfort of memories long ago. The smell of broth cooking on the stove is inviting, warm and stimulates the appetite. The elder should be encouraged to check on the broth throughout the day. Stirring a pot of simmering broth releases all the goodness of the fresh ingredients into the broth and engages the body and senses.   As the color and fragrance of the broth enriches, so too will the conversations about home cooking, family recipes and kitchen tips.


When the broth is done and strained, the fresh ingredients can be added to make your favorite soup recipe. This is another opportunity to engage the elder in food preparations such as chopping and measuring. While the soup is being prepared, they can taste test to engage their opinion on flavor and spicing. I often suggest that left over broth be frozen in 2 cup freezer bags or mason jars for use in recipes or just to sip like tea.   Sipping plain broth just feels good!


When the final product is done, you can finally sit down and enjoy the fruits of the day’s labor with a big bowl of warm goodness.   Enjoy the following recipes for broth and soup. Bon Appetite!


Taken from Nourishing Traditions by Sally Fallon, 1999



  • 1 whole pastured chicken or 2-3 pounds chicken bones with or without bits of meat, including feet if you have them
    • variation: turkey or duck
  • 4 quarts cold water
  • 2 T vinegar
  • 1 large onion, coarsely chopped (or your bag of collected frozen onion parts)
  • 2 carrots coarsely chopped (I omit this sometimes)
  • 3 celery sticks, coarsely chopped (I omit this if I don’t have celery)



  1. Throw all of your chicken parts (chopped up if possible) in a pot, add the water, vinegar and vegetables. Let sit for a half hour, then bring to a boil and remove the scum/foam that rises to the top with a spoon. No need to remove the floating fat. Reduce heat, cover and simmer for 6 to 24 hours. The longer you cook the stock, the more rich and flavorful it will be. You could also do this in a large crock pot / slow cooker.
  2. If you used a whole chicken, don’t leave the meat in there for more than about 2 hours. Remove the chicken, remove the meat and reserve, and put the bones back in the broth to cook.
  3. Remove the whole chicken pieces with a slotted spoon. Strain the stock into a large bowl, then ladle into mason jars. Let the jars sit until they are pretty cool, then freeze or refrigerate.
  4. If you want to defat: put the mason jars (or the large bowl) into the fridge until they’re completely cool then break off the fat. Freeze the fat for use in gravies.

Once you have your broth, here is a recipe for the Chicken Soup, by Kimi Harris, one of my favorite nourishing bloggers.



Bringing Out The Best In Your Caregiver

Often, older adults and their families hire caregivers while in a crises. The caregiver solves an immediate need for assistance and offers much needed relief. Because of the intimate nature of the caregiving job, older adults and their family members often forget that the caregiver is indeed an employee and they need to set clear expectations about their duties. Whether the caregiver is new or has been with your family for a long time, it is very important to check in with them, set expectations and hear from them what their challenges may be.

Agency employed caregivers likely have a “case manager” who can help define expectations and provide ongoing supervision to the caregiver. They act as a buffer between you and the caregiver so that you do not need to be responsible for having difficult performance related conversations. If the case manager is not checking in with you periodically, especially in the beginning, they should be. Call them and let them know how things are going. Share with them your perspective on the following:

Is the caregiver on time? Is the caregiver open to suggestions? Is the caregiver a compliment or a detriment to the rhythm of the household? Does the caregiver have a positive attitude and get along well with the client and other people in the household. Are things better when the caregiver is there? Is your loved one being cared for in a way that makes you feel at ease and peaceful? Do they seem to have a routine and know how to be helpful during down time? Does the caregiver respect your family’s privacy and give you space when you need it? Does the caregiver allow the family to help their loved one when they wish to? Does the caregiver allow the client to do as much for themselves as possible or do they “take over” to get it done faster. Does the caregiver respect that they are in your home or do they seem to “move in” whenever they arrive for their shift? Does the caregiver have sufficient skills to meet your needs?

All these questions also apply to caregiver that you may privately employ. In that event, the job falls on you to properly supervise the caregiver and ensure that they continue to be a good fit for your need. Since elder care is a dynamic season, it may be that the caregiver hired in the beginning is no longer suitable for your current need.   The older adult’s needs always take priority, even if you’ve had a caregiver for many years and feel close to them.

If you are not comfortable with this role or feel overwhelmed, I can be of service as your Geriatric Care Manager. Managing your caregiver’s performance does not need to be as formal as what occurs in the a corporate setting: no annual reviews or written performance appraisals. But there does need to be a process of checking in with the caregiver routinely about how they are doing. Ask them about their challenges. If there has been a recent change of condition with the older adult, ask them how they are coping and what new strategies they are using to provide care. Ask if they have any suggestions for equipment needs or other tools of the trade. You will learn so much from their responses and from their attitude when having this conversation. If the caregiver is open to the dialogue, it is clear that they feel part of the team. If you are getting resistance, there may be something else going on the requires your attention. You may need to dig deeper. In this event, as your Geriatric Care Manager, I can help you sort through strategies and options.

If you are struggling with a caregiver situation or want to stay on top of the caregiver program you have in place, I would love to hear your story. Please get in touch with me here.