Specialist in Issues of Midlife & Older Adults

Monthly Archives: August 2012

“Navigating the Territory of Older Age” Discussion Series Begins Sept. 18

“Navigating the Territory of Older Age” Discussion Series Begins on Sept. 18


In ancient times, mapmakers fearfully labeled unknown areas of their world “Here Be Dragons”.  Less anxious mapmakers labeled those same unexplored areas “Terra Incognita”, i.e. “unknown land”.


For many of us, the territory of older age looms as “here be dragons”, probably largely due to our lives in an ageist, uninformed and thus fearful culture. Certainly we know there are many challenges in older life but there are also many opportunities, openings and blessings. As we walk through our older years, we can explore life with an acknowledgement that our journey is indeed through “terra incognita” and yet, at the same time, holding on to a vibrant spirit of adventure.


On September 18th, my friend and colleague Nan Heflin, MA, MFT and I will begin a 5 week seriesof “Tuesday Evening Discussions” focused on issues of interest to midlife and older individuals and families. Our discussions will be held in the lovely library at the Interfaith Counseling Center inSan Anselmo.


We will discuss “Navigating the Territory of Older Age” – topics may include subjects such as the following, depending upon the particular interests of the participants:


  • Adapting our living environments to meet a changing lifestyle – what are some traditional and newly evolving choices?
  • Becoming a passenger after years of driving – what are some options in Marin?
  • Learning about age-related memory change – how to support a healthy brain


Participants are encouraged to bring questions related to the ever-shifting terrain of older age, e.g. physical and emotional health, family relationships, societal roles, spirituality, and finding meaning and enjoyment in the second half of life.


The first evening discussion is FREE. The following 4 Tuesday evenings are $35/evening.Time is 6-7:30PM.


Space is limited. For enrollment or more information, please call Nancy at 415-378-6577 or send email to nancyrhine@aol.com  .



Nan Heflin, MA, LMFT has over 25 years experience specializing in issues of aging and mental health, working with older adults and their families. She is a coordinator of Marin County’s renowned Senior Peer Counseling Program, has conducted workshops in Aging and Mental Health throughout the Bay Area, facilitates support groups for the Alzheimer’s Association and maintains a private practice. Nancy Rhine, MS, LMFT has served older adults and their families for the past decade in Marin County as a hospice volunteer, care manager, educator and counselor. She is a former Commissioner on the Marin County Commission on Aging and sees clients in her office and in homes throughout southern Marin.



“Tuesday Evening Discussions” 

September 18, 6-7:30PM and the following 4 Tuesday Evenings

*Interfaith Counseling Center

15 Austin Avenue

San Anselmo, CA


*Wheelchair accessible. Plenty of street parking available. 

Medical Foster Homes – An Emerging Supportive Housing Choice for Older Veterans

Medical Foster Homes – An Emerging Supportive Housing Choice for Older Veterans


Housing Choices in Later Life


As our population ages, more and more living scenarios are surfacing for how to live out our lives safely with dignity, comfort and with as much control as we can maintain.  Increasing numbers of older people remain in their own homes as long as they can in order to preserve their independence. The number of people living out their whole lifespans in the comfort of their homes has increased by 50% over the last two decades.


When living alone is no longer an option, elders often opt to move closer to adult children who can provide assistance and advocacy. Often, additional hourly home caregivers are brought in; at times, live-in roommates exchange services for rent. Full-time, live-in caregivers are another, albeit expensive, option.


“Aging in place” member-driven, non-profit, community-based organizations such as Marin Villages strive to provide the kinds of support that older people are looking for in order to continue to live in their own homes, apartments or condo’s.


Independent living retirement communities serve as well-known housing alternatives for older adults. Assisted living and skilled nursing facilities come into the picture as health declines and care needs increase.


Smaller “board and care” homes are another alternative – with usually 2-6 residents. Board and care homes can be comfortable and safe environments, particularly for those older adults who do not need the full medical services available in assisted and skilled nursing facilities.


A Special Alternative for Veterans


Recently I found out about an interesting project that the Veteran’s Administration has been spearheading for several years called “Medical Foster Homes”.  These homes provide an alternative to nursing homes for veterans who are unable to live safely and independently at home or lack a strong family caregiver. The homes are open to vets of all ages but the average age is 70.


Initiated by VA social workers in Little Rock, Arkansas, the program currently serves about 600 veterans and has cared for 1,500 since it began. The program has grown to operation in 36 states and is scheduled to expand to 10 more states soon. Program administrators have reported that 30 percent of veterans who would qualify for VA-paid nursing homes choose instead to live in – and to pay out of pocket for – medical foster homes. This is evidence, they state, that the vets prefer a home setting.


Living in a medical foster home is paid for by veterans from their VA and social security benefits – the monthly costs range from about $1400 to $2500 depending on the applicant’s income and the level of care he/she needs. It should be noted that the VA rigorously screens and monitors the Medical Foster Care homes – only about 1 in 10-15 applicants is accepted.


For more information, read the full New York Times article For Veterans, an Alternative to the Nursing Home or go to the Department of Veterans Affairs Medical Foster Home website.  You can also call the Marin County Veterans Service Office at (415)473-6193 and speak with Marin County Veterans Service Officer Sean Stephens. Sean’s email address is  veterans@marincounty.org.


Won’t it be interesting if the VA’s valuable knowledge obtained as they continue to grow this popular housing solution can be translated for the general, non-veteran population of older adults?  Stay tuned!

Therapy and Integrative Care Contributes to Reducing Depression in Older People

Therapy and Integrative Care Contributes to Reducing Depression in Older People


I recently blogged about the potential benefits of geriatric counseling for older individuals and their families.


Then my husband sent me a link to this July 25 article from the wonderful New York Times blog“The New Old Age” called “More Older People Treated for Depression.” Click on the link to read the entire piece. Some relevant quotes are listed below.


  • “For years, mental health specialists lamented that depression was seriously under-diagnosed and under-treated in the elderly. Laypeople saw it not as a disease but as an inevitable part of aging. Doctors missed it because depression didn’t always look the way it did in younger patients– less sadness and weepiness, more physical symptoms and disengagement. Older people themselves often rejected help because mental illness carried a stigma.”


  • “Not anymore. Over the past decade, ‘we’ve seen a really big increase in the recognition of depression and the initiation of treatment,’ said Dr. Unützer, a geriatric psychiatrist now at the University of Washington. ‘The bad news is that a lot of these folks aren’t a lot better.'”

  • “One apparent explanation: the setting. A great majority of older people seek treatment through their primary care doctors, few of whom are able to offer much more than a prescription. One approach that has proved successful is to move more comprehensive care for late-life depression into existing offices and clinics.


  • “Among 1,800 depressed people over age 60, a group randomly assigned to collaborative care showed far greater improvement. After a year, 45 percent had at least a 50 percent reduction in depressive symptoms, compared with that dismal 19 percent in usual care. They reported less functional impairment, greater quality of life.”

  • “There’s an advocacy role for family members to play. Talking to a primary care doctor may be a good way to start treating depression, but in many cases that’s not where to stop.”


  • In one personal story cited in the blog article, a depressed elderly woman who has not found effective help begins to receive treatment in a comprehensive care center and from atherapist who visits her twice weekly in her assisted living apartment“It has turned back the clock 10 years,” states her adult daughter.

Why Is Counseling An Important Health Tool For Older Adults?

Why Is Counseling An Important Health Tool For Older Adults?


As we gather more years in our lives, we naturally encounter more and more experiences. Many of them are lovely, joyful and profound. Many of them also inevitably involve loss. Loss can refer to deaths in our families, amongst our loved ones, our pets and extended community. Loss can also be experienced in relationship to job changes, retirement, living situations, finances, physical capabilities, independence, hopes and dreams.


Learning how to deal with cumulative loss is paramount to good mental health and one’s sense of wellbeing. Coping skills commonly used by people to manage grief and loss include cognitive/behavioral techniques, mindfulness meditation, prayer, support groups, self-help literature, workshops, exercise, music, poetry, writing and individual, marital, and/or family counseling.


Older generation adults may or may not have experience with, or a belief in the valuable benefits of, counseling. Many are strong survivors who believe in the value of discipline, determination and will power to surmount challenges.


Counseling may have never been part of their family culture. There can come a time, however, when “white knuckling it” alone through emotional pain may not be the most effective strategy for health. Oftentimes, older people don’t want to burden their adult children with their worries and concerns. Where can they turn?


Traditionally, older people have sought comfort from their family doctors or spiritual leaders. Doctors nowadays do not have the time they used to have to spend counseling patients. Spiritual leaders’ time is usually limited as they often have large congregations to care for. A wise and experienced geriatric counselor who is genuinely caring, nonjudgmental and a good listener can be a powerful support team member for older people.


Why Is It Important for Older Clients to see a Geriatric Counselor?


All Licensed Marriage & Family Therapists receive a deep training in counseling-psychology, a variety of evidence-based treatment models and solid intervention techniques. Similar to geriatric MD’s, however, geriatric counselors also have extensive additional training and experience in addressing specific issues encountered in aging. With older people, many more pieces of the health “puzzle” come into play.


For instance, physical health status, medications, living conditions, safety, socialization vs. isolation, independence vs. dependence, spirituality, lifelong learned personality patterns, nutrition, shifting roles in families, impacts of ageism in society, a continuing sense of purpose and value, an ability to contribute to their communities – all of these and more contribute to the older individual’s sense of wellbeing.


A close attention to working collaboratively as part of a compassionate and competent support team is also often called for in serving older clients. With each client’s express written permission and where beneficial to each client, geriatric counselors can contribute greatly to the client’s wellbeing through effective communication and teambuilding with physicians, caregivers, facility social workers, nurses, psychiatrists, care managers, spiritual leaders and family members. “It takes a village” is often true in serving the wellbeing of older clients.


Thus, it is important that geriatric counselors are well-versed and up-to-date with the common physical challenges, safety issues, emotional challenges, relationship/role changes, societal influences, support teams and environmental concerns encountered by aging clients. In order to effectively advocate for, educate on behalf of and serve this population as a therapist, simply knowing the basics of counseling psychology is not enough.


In Marin County, geriatric counselors can be found through a local google search, through a search on Marin County’s online site for the Division of Aging and Adult Services, through the Find A Therapist tool on the Marin California Marriage & Family Therapists website, or through a referral from your spiritual advisor or physician.