 We're back, we're live at two o'clock, we have Larry Grim, G-R-I-M-M, and he's going to be a host of a show, and we're sort of initiating that show today, it's called Elderhood, okay, and he's a chaplain at the Bristol Hospice, so he has learned a lot about aging and dying for that matter, from his work. So we're calling this show, Does Life Begin at Elderhood, and the tagline is aging one day at a time, the whole thing is about aging, and aging in grace, so I call this a takeaway as aging is an art form, and aging in grace is the best way to go. Larry, do you agree with that? I totally agree with that. Excellent, Jay. Thank you so much, first of all, for having me on the show today, and for giving me this opportunity to engage people in their own life decisions. And to help coach a little bit what it's like to go through Elderhood, and each person is different. So, you're an Episcopal minister, and you come at this from, I guess, a religious point of view, but you don't seem to be a religious person to me, you seem to be more practical and philosophical and kind. I know those things are not necessarily consistent with religion. Over the many years of my service, I've been in the Presbyterian Church as minister in various congregations. Presbyterians, yeah. And I've enjoyed all the congregations, and they all have had elder people in them, of course, and more so now, because there are fewer and fewer young people that are entering into churches, and I'm going to join the church kind of fashion. So, I've been accustomed to elders, and now I am one. You're not only speaking for yourself, you know. That's right. So, for me, my faith tradition and my faith experience sensitizes me to other people. And as a professionally trained chaplain, I'm particularly interested and trained to listen to people where they're at, whatever their tradition is. Everyone lives in their own tradition and mythology, and whatever that mythology is for them, it helps them make sense of life, helps them to get in touch with that reality beyond this reality. It helps them to go through life, and I want to be a partner with them in that journey. Well, you know, the thing is you can go through your life and be on automatic. You can be on what your parents taught you and what your friends and teachers taught you, and you never really have to do anything introspective. You get a job, you stay with a job, you go through, you're automated. Okay, but when you face, you know, dramatic changes in your life, or dying, then you really have to start thinking about these things. As you said, you have to make sense of it for yourself. You have to come to grips, come to peace with, you know, your basic understanding of the world and yourself. And that requires more than the average for today, period. I agree, Jay, and so often, and I can speak as a professional church person, too. So often church people think, I mean, the professional church person will say, here, I have the answers for you. But that doesn't enable the person to struggle on their own and to find out what is, what do I claim myself? That works for me in terms of belief systems, in terms of making meaning of my life in my context. So for me, that's the big thing, enabling people to make meaning in their own context of their life. What I get out of that is so interesting is you speak about you helping them understand themselves, but in so doing, you also are helping us understand you, or helping yourself understand you. Because this is your chosen application. This is your chosen way to spend your time on the planet, no? Exactly. I get so much more. I get more than they do in some way. We can always say the teacher learns more. Yeah, it's a very rewarding experience, very rewarding. And working as a hospice chaplain, one of the things I've learned to do, or hope I am learning to do, is to walk in the room and say, with the attitude, you're teaching me what it's like to be you in this situation. Dying. In this bed. Dying. In this moment of dying. In this moment of letting go of this life or something else, whatever it may be. So I'm really wanting to go in, Jay, and I appreciate you picking that up. Open to what people can teach me. And how you spend your time. Yeah. I mean, it's one thing, maybe you suggest you can disagree. It's one thing to be a minister and a chaplain for that matter. It's another thing to be a chaplain in a hospice. Because you have to face this and you have to help other people face it. In so doing, you begin to understand the common threads about how people react at this point in life. Good point. And one of the things that I've heard said is that when the doctor says, we can do nothing else. That's where we come in. The hospice begins. The hospice begins by saying, we're here to help you die in a peaceful and comfortable manner. Help the family move through that as well. Alan Watts back in the 1990s said, philosopher said, we need more people that will help us die splendidly. Yeah. Well, you know, and the alternative is bleak. But before we get to the alternatives of dying splendidly, can we talk about the bell curve in Hawaii? Can we talk about the stats here? Okay. What do we have in terms of an aging population? You mentioned before the show that, you know, as a part of the pie, so to speak, of stats, we have more people in the aging process here than anywhere in the country. How does that work? That's what I've read. I don't have the stat in mind right now, exactly. But I've read that we here in Hawaii have the highest number of aging. And I'm going to assume that's over 55. Highest number of aging population in the United States. So it means that people are growing up here, dying here or moving here to die. But I will tell you, I'm amazed at the number of patients that we have in Bristol who have been born on the island and they're dying on the island. I mean, I've had people, I asked a patient the other day, when did you come to the island? And she said, I'm born here in her 90 degree. I mean, 90 year old, very sophisticated manner, very elegant manner. You know, very proud of it. So here are people who have, many people who have just made their place here years ago or were born here and they're dying here now as well. Some few, and I know one, have never left Oahu in their life. I'm serious about that. This is their home, they don't need to go anywhere else. But you know, one of the things that happens now in our changing times is it's harder to, you know, develop a retirement where you can feel comfortable. Because rents go up, you may not own any property. You know, there are more issues and there will be in the future more issues about health insurance, Medicare, Medicaid, all that. Social security, who knows where it's going to go. And some people who worked a hard middle class life, all their lives are in trouble in their retirements. The older they get, the more in trouble they get. And, you know, it's tragic, especially in Hawaii, that the old days in which they lived, you know, in Ohana housing and their families were around take care of them. In the nuclear Hawaii, everybody goes to the mainland, and maybe the kids aren't here anymore. And they got a problem in finding a soft place, the older people. They can go to the mainland and join their kids, but sometimes their friends are here. They don't want to leave. Absolutely. So what you have is some elderly people who are living longer because of modern medicine and because of many factors. But who are not living as well as they might have expected to live. And so they're unhappy. And that's got to be a big problem in Hawaii. I'm sure you've seen that. Absolutely is. We spend most of our medical money over the age of 65. So if you're over the age of 65, you need about $8,000 a year looking at that as medical costs. In a senior facility or just medical? Just medical costs in general, but the majority of those expenses are the facility. Facilities cost more for the 65 and older than anything else. We're talking about medical care and medicines and such, but it's the facilities that are so demanding. So I've seen, I know of three approaches, Jay, or three facility approaches. There's of course a dedicated facility that is dedicated to long-term care and licensed for long-term care. And then there's a facility called a care home, which is a smaller home that can take five to ten, perhaps five patients. And they're licensed by the state. And then there are foster care homes that are about three patients permitted and they do not need a license. So in that, you've got a whole range of quality of care that is represented. Now, of course, we as Bristol Hospice and along with the facilities and the care homes are all under the agency that does review and supervises and checks annually on our licenseeings. And so there's a good control factor there. And they really do a good job. They go into a facility and they'll make sure everything's in order. They look at the process of charting. They look at how people, medicines are taken care of, how they're distributed, how they're disposed of. You know, some of these things that are back office for facilities that we don't even know go on. But so those good control pieces in place and the care homes are subject to the same thing. One of the problems that I've seen this in friends of mine and friends of my wife and me is that they're not only expensive relative to what a middle class retirement will yield, but there aren't enough of them. And there aren't enough quality ones at a reasonable price so that a lot of people, you know, would be best advised to go to the mainland already. There's no point in staying around here banging your head on a wall looking and looking and looking and never finding. It strikes me that we have missed the boat on becoming a retirement community. You can say we have a lot of retired people here, as you said, you know, a good part of our population is retired. But the truth is, we could be a retirement major retirement industry, given our weather and our aloha and all that. True. True. But I don't understand is why developers cannot make a buck and do not therefore build senior homes. We don't have enough senior homes in Hawai'i next. Good point. There are a lot of folks who do stay at home and one thing that we do in terms of when you get to the hospice point is the hospice care goes into the home. So we do a lot of home care enabling families to take care of their beloved ones as they go through this end of life process. And Medicare funds that. Medicare funds hospice care, whether it's in a facility or in the home. Medicare does not fund the facility. That's Medicaid. Okay. That does enough. That's not enough to actually pay for it. Not all of them known by any means. But I think you've hit on a really good point and that is how do we shift, make a cultural shift that says we are devoted to a good retirement culture where people are, we recognize that people come here to live out the last years of their life. They're committed to it in a healthy way. And that's where I want to come in due as being supportive of people who want to really make this a glorious time of their life. And I have two ways of looking at this, Jay. One way I was on the east coast for a while and flying over the Appalachian Mountains. And at one point I flew to Asheville, North Carolina. What's a beautiful city? It's really pretty. And the mountains there are gorgeous, of course. And there's a lot of rain and we came in over a cloud cover and storm cover. And the pilot came on and said, folks, we got storms beneath us. We can't go in yet. I'm looking for an opening and then we'll go in for landing. So we we cruised around at the above this above the storm line, the storm area. And finally he came on and said, I see an opening. Let's go. And we went, wow, just went right through that cloud cover and onto the tarmac available. And it was just a vast and furious descent. Some people live their elderhood lives like that. I'm going to wait until the crisis comes. I'm going to lay around and cruise up here like I don't have any problems and just take it when it comes. I'll cross that bridge when I get there and then they get that disease or they get that crisis that you mentioned. And they know they've got to go zoom right down into the end of the last, sometimes the very last days of their life. But I don't mean to put it scary because it can be dealt with. And we do deal with people that way in hospice care. But I also see you can come into Honolulu. You can start out way out here on your approach, the approach to elderhood and way out over the ocean and get things planned. Look at things that are important in preparation and glide right in onto the onto the tarmac. Glide right down, you know, a careful landing. Yeah. And that actually reminds me of taking a break. We're going to glide into a very good little break here and we'll be right back in one minute. You'll see. Excellent. All right. Hello, everybody. My name is Walter Kauai. I'm your host for a monthly live streaming video entitled ukulele songs of Hawaii where I bring on guests. We enjoy talking story about the music industry here in Hawaii. Sometimes going back 50 decades if possible and always having some good fun talking with entertainers. We're here located at Think Tech Hawaii downtown Honolulu at the Pioneer Plaza building and in their studios. And so join me next month for ukulele songs of Hawaii. Hi, I'm Rusty Komori, host of Beyond the Lines. I was the head coach for the Punahou Boys varsity tennis team for 22 years and we're fortunate to win 22 consecutive state championship. This show is based on my book, which is also titled Beyond the Lines. And it's about leadership, creating a superior culture of excellence, achieving and sustaining success and finding greatness. If you're a student, parent, sports or business person and want to improve your life and the lives of people around you, tune in and join me on Mondays at 11 a.m. as we go Beyond the Lines on Think Tech Hawaii. Aloha. Back with Larry Grimm. He's the chaplain at Bristol Hospice. We're talking about aging, aging and grace. Does life begin at elderhood and how to age one day at a time? You mentioned before we took the break, Larry, that the idea was to have a graceful and good experience in your aging process. And sometimes your aging process is a degenerative process. You know, you don't get younger. Sorry to say. I wish there was a solution on that. Modern medicine may change that. You know, like the deacons chariot, they give you a pill that says, you know, you're going to last 100 years, and that's the 100th year of your 100th anniversary. Pingo, you're dead. That was the deacons. It was a poem in the 19th century. I missed it. But anyway, so what is aging and grace? Let's find different scenarios. That's great. When grace in a senior facility, what do you see as the ideal arrangement? Well, we talk, the implication is that we can get everything external is going to do everything we need to have done. And we really do pour a lot of good attention and resources as a society into doing what we can to provide an environment for elders. Some of them prefer to stay at home and die at home, and we'll get to that later. But part of what I want to look at, Jay, with people is the internal life. What goes on internally, and what can we do internally to help make this a glide path, start out here rather than start right at the crisis of moving into some other facility? So they're prepared. They know what's going to happen. Exactly. And things will not, you know, be as much of a cold shock as they might be. That's exactly what I'm thinking, Jay, and that's exactly what I mean. And I see that there are five basic tasks. You know, Eric Erickson, look out, did a lot of work with psychosocial development, and he identified tasks that were imperative to be done at different stages of life, eight stages. He got to elderhood too, and I think he was not there yet. He didn't really understand it thoroughly. But I take that stage approach, and I'm working with the stage of elderhood. We have childhood, we have adolescence, we have adulthood. I want us to have a wonderful elderhood, and it's a concept that's being launched on to since the 90s, the past couple of decades. So in elderhood, what I've observed is that the kinds of things that demand our attention internally in elderhood are five. The second one is grieving. Grieving, I'll come back to him. The second one is sorting out. Sorting out. Third one is forgiving. The fourth one is preparing, and the fifth one is letting go. Can I give you a description of each of those? Sure, but I'll tell you the truth. They all sound self-explanatory to me, but go ahead. Well, I'm happy to do that. Yeah, I think that well shows it. Grieving, of course, we get to this stage of life, and especially we baby boomers. I mean, we've been accustomed to having everything we wanted. We're not accustomed to having to give up things. And so grieving becomes suddenly a thing that we're involved with far more than we ever anticipated. And I think that grieving takes immunity. Somebody can help each of us and help us to move through this to get over the pain of loss. And some losses that are so great, and you've mentioned some of those already, but some losses that are so great that we think there's no way we can ever recover from those. We'll talk about that. Second thing is sorting out. I hear people sorting out their stuff. People have a lot of stuff. And when you go to sort out your stuff, every piece you pick up says, oh, I remember this. There's a story there. And you're sorting out stuff according to the story it represents. And so sorting out, I focus on what people's stories are. Who am I? How have I become the person that I am now? And there's probably a story that you like to tell about yourself way back when. And the story is different contexts, different tasks. But when you tell that story, your face brightens up, your body shape changes, you feel it right now. And we sort out those stories. What are the stories I want to keep and keep telling people about my life? Because every time I tell it, I experience it afresh. They find your life and they belong to you. They're special for you. They're your personal story. Beautiful. They belong to you. That's all right. That's right. So they're sorting out. So the third thing is forgiving. There seems to be, my mother called me one Sunday night. She was not healthy and I knew that. She was living in California. I was in Denver. Hi, Mom. Larry, she says, I'm so sorry when I get on the phone to get you on the phone. And I don't really see how you're doing it. Please, I just feel so bad about that. Mom, what are you talking about? She said, well, I just wanted to do forgiveness for that. And so I forgave her and hung up. She died Thursday. She had some desire to have that forgiveness. It meant nothing to me. I mean, it wasn't a thing that kept me angry. I'm sure it meant something to you. I mean, the fact that she started talking when she came online. So it was just something had to be cleared for her. I have another story about forgiveness that's really dramatic. So the fourth thing is preparing. And this is where I think getting a knowledge base about the externals is very important. We have a social worker at hospice. We have a liaison. We have a care, an RN care person who manages care. We have chaplains. I'm one of six chaplains there. We have nurses' aides. If you know what's available in a certain care system, then you can choose that and prepare to talk to yourself about getting into it eventually. What's it going to be like? So preparation is important. Legal matters, making sure everything externally is prepared. There's an internal preparation. And I think that is what is your belief about that life beyond life? There are four basic stories. No easy answer on that one. Well, there are four basic stories in human history. One is the lights go out, you turn out, you leave the building and that's it. The second one is you join your ancestors and you enter into wherever they are with them and you're reunited with ancestors. The third is that you live on in the legacy of people who remember you on earth. In Kenya there was a village that said, as long as somebody in our village remembers you, you're still alive. The fourthly is to join with the eternal or with the creator God and to live in harmony and oneness with that God. So those are the four basic stories. There's another story. The rainbow bridge. You know my meaning. Rejoined with your most precious beloved pet. Exactly. Exactly. More than ancestors. They were always nice to you. Absolutely. So I hope you unpack all these stories. And then the fifth thing is letting go. And the fifth thing is letting go because so often I've heard someone be outside in the hallway and the daughter comes out and says, you know, Mom just is not doing well. She needs to die. She just won't let go. Now you've thought. Just won't let go. Of course she won't let go. It's not easy to let go. Elizabeth Kubler Ross said, you know, when somebody dies that is our beloved, we're losing that person. The person who's dying is losing everything. Everything that ever means. To survive. It's primary will. Exactly. You have to give that up. Exactly. So those are the five elements. And I want to structure my program, the show here around those five elements. Those what I call spiritual, emotional tasks. And we'll be referring to those. And have visitors, people, guests that come on and share within the five elements something of their insights and knowledge. Yeah, I'd like to see you do that. I'd like to see you unpack each one of those things and connect them because none of them are in a silo. That's a good point. Yeah, that's a good point. So I mean, but some people are, you know, they're out of it. And it's very hard to have these conversations. And it's very, you know, even to the point of letting go, they have no idea where they are. They're out and beyond that. So what do you do as a hospice staffer? That's probably the most difficult piece for me. When we receive particularly Alzheimer's patients to for whom their brain is shutting the body down, gradually. They don't have any interaction at this point. They're not engaging. So I can't talk about meaning with them. But what I do is two things. One is presence. Just be a loving presence as best I can. And then the other thing that I do is sing. I'll sing for them. I'll sing songs from their past. I'll sing songs that I imagine they might enjoy. And we've learned that the part of the brain that is responsible for music and poetry remains unaffected by Alzheimer's. We also have particularly at our hospice a brighter moments program and we bring in an MP3 player that has earphones and we can load that with songs that the family, mom and dad used to love these songs. And then they put on the earphones. And also touching, I expect touching, the warmth of another human being. Exactly. We're out of time, actually, Larry. I'm sorry to say. There's so much more. And I hope that next time you also or in the times to come, you also discuss the problem of suicides, joint suicides, joint people couples, for example who can't live without each other or who have no money left and cannot envision the survivor surviving. And also I'd like you to cover if you don't mind at some point in the show the whole thing about the death with dignity and medical aid and dying. Where that fits? Yeah, where that fits. Because that's the law now. We haven't had a lot of examples of people actually doing that in the state. Where does it fit in your analysis and the needs people have at this point in their lives? I come at this, Jay, as a chaplain, hospice chaplain professionally trained. I also come to it as a coach, a life coach in elderhood. And so I have opportunity and ability to meet with people one-on-one either face-to-face or online and do some coaching in their particulars. It's great, sure. It's not just at the end of life. It's anybody who is thinking about that long glide in. Thank you very much, Larry. You're welcome, Jay. I feel younger. You look younger!