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“Retirement Revolution: The New Reality,” Sept. 15th, PBS nationally airs -  focusing on the stories of seniors who are planning for their futures in the wake of the financial collapse of 2008. The broadcast also highlights living with Alzheimer's disease, featuring interviews with Alzheimer's Association staff members Bill Thies, Beth Kallmyer and two former Early Stage Advisors, Mimi Steffen and Gary Shelton, as well as Family Caregiver Alliance staff members Kathy Kelly & Caitlin Morgan.  Check local broadcast listings, or watch online:

http://www.pbs.org/wttw/retirementrevolution/watch/

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The International Longevity Center, with support from MetLife Foundation, has selected 15 community colleges to receive $20,000 grants for caregiver training programs. The grants are part of the Caregiving Project for Older Americans, a partnership focused on encouraging the expansion of caregiver training programs for family caregivers and in-home care workers.

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by Ariel Kleckner Ford

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A friend or family member is sick with a serious illness. We want to help. We want to express our sympathy. But we don't know how. We want to say the right thing. But what is the right thing to say? How do we effectively communicate our sympathy in a way that actually eases the burden of our loved one? Having recently been on the receiving end of alot of well-intended but poorly communicated sympathy, I can offer some tips.

Sympathy is a social affinity in which one person stands with another person, closely understanding his or her feelings. It also can mean being affected by feelings or emotions. Thus the essence of sympathy is that one has a strong concern for the other person. Sympathy exists when the feelings or emotions of one person are deeply understood and appreciated by another person.

Saying things like "Remember you have a husband and kids who love you" or "Don't feel that way, you have so many blessings in your life" is not sympathy. Rather, it is a highly ineffective and unwelcome form of communication to someone who is sick. Telling a person these things is in effect telling them to NOT feel the things they are feeling about their illness. It is also the quickest way to get them to stop sharing honestly with you.

It is important for a sick person to truly feel the emotions that go with their illness. Anger, frustration, resentment, sadness - these are all normal things for a sick person to experience when grappling with their illness. And the sooner they go through them, the sooner they are over them. Telling someone NOT to focus on those things - to instead count their blessings - is telling them it is not OK to feel their honest emotions about what they are going through. It is a form of telling them their honest emotions about their illness are somehow not valid.

A sick person with a wonderful husband no doubt knows she has a wonderful husband. But when you ask how she is feeling and she tells you honestly that she is angry and frustrated about her illness, she is not talking about her husband. She is talking about her health issues. Telling her to focus on something else is not sympathy. It is patronizing, and comes across as highly insensitive.

Effective sympathy comes in the form of sharing a person's burden. When a friend is sick, you can help her by asking how she is feeling and allowing her to explain. When she tells you how she truly feels, some examples of good responses are:

"Yes, I imagine that is very frustrating"
and
"I bet I would feel the same way if I was going through this"
and
"That must have really hurt"

All these responses are examples of validation - they are ways of letting the sick person know it is OK to feel the things they do, that you are somehow feeling the same things as they are by listening to them and understanding. And in validating their feelings, you are actually sharing the burden with them.

Believe it or not, these forms of sympathy actually lessen the emotional pain of the person experiencing these feelings. They come away feeling better because of the conversation. By validating their feelings, you are sharing their burden with them. And by sharing their burden, you have eased their load. This is the greatest form of sympathy, and offers true relief.

When 81-year-old Sally Darr needed nursing home care after injuring herself in a fall, her family turned to a new federal rating system for help.

The online tool uses movie-review-style ratings -- one to five stars -- to compare homes based on such measures as number of employees, state health inspection results and how many hours of licensed nursing care are provided each day.

"We had looked at nursing home Web sites, but they don't give you the whole picture," said Nancy Donaldson, one of Darr's daughters. Their choice, Inova Cameron Glen Care Center in Reston, "rated four stars pretty much across the board, and it is clean and the staff is very good."

Donaldson is one of millions of people who have visited the Nursing Home Compare site since it was overhauled and the nation's 15,600 homes were rated in December. But there's debate among industry and consumer groups about how well it's meeting the public's needs. The federal agency that runs the site plans to survey users later this year on exactly that question.

The industry, which had sought to delay the system's rollout, complained that the grading system was started much too quickly. Nursing homes say the information, gleaned from homes as well as from state inspection reports, misleads families and patients because it doesn't give an accurate picture of the amount and kind of care in each facility.

A leading consumer group wants the site to provide more details about inspection results and quality-of-care measures. Consumer advocates and industry representatives are calling for changes in the way the ratings assess staffing, which all sides agree is the best indicator of quality of care. Nursing homes say simple counting of workers does not reflect the care patients actually receive, while consumer advocates complain that employee information that comes from homes is unchecked and may contain errors.

'Out of Whack'

The Centers for Medicare and Medicaid Services (CMS) developed the rating system after criticism from Sen. Ron Wyden (D-Ore.), who said "something is out of whack in this country when it's easier to find out information about a washing machine than a nursing home." The repackaged site is more visually appealing and "takes a large amount of data and improves access to it substantially," said Thomas Hamilton, director of the agency's survey and certification group. Although CMS emphasizes that no one should choose a home without visiting it, he says the data can help narrow choices. But Hamilton conceded "there has been a fair amount of misunderstandings" with nursing home operators "about areas like quality measures and staffing."

CMS is talking to the industry, patient advocates and states about changes, including the way the system measures quality of care. For example, homes that specialize in managing pressure sores and pain have more patients with those problems, and that can skew the homes' ratings, the industry maintains.

In addition to an overall rating, the site provides star ratings for each nursing home in three categories: performance on health inspections in the past three years, ratios of staff to patients, and 10 quality-of-care measures. Consumers can also use the site to call up specific findings from inspections, other details on each home and consumer tips.

Ratings are updated as states complete inspections. Maryland's ratings mirror the overall national picture: About 20 percent of its nursing homes are listed as five-star and another 20 percent as one-star. Of the 33 facilities in Montgomery County, for example, six received the highest rating and five earned the lowest. Wendy Kronmiller, who oversees inspections of 235 homes as director of Maryland's Office of Health Care Quality, praised the system as "a great summary." Ratings generally are accurate, she says, particularly in the upper and lower ends of the range. As CMS weighs changes to the system, the first priority will probably be staffing information. Consumer advocates and industry representatives agree that the staffing numbers reflected in ratings don't capture the fluctuating employment picture at many nursing homes.

Larry Minnix, chief executive of the American Association of Homes and Services for the Aging, a trade group for nonprofit nursing homes, also contends that the current system does not count all categories of caregivers within a facility. As a result, homes may not get credit for the care they actually provide to residents.

Staffing is an important issue for consumers. Janet Chap of Chevy Chase, who consulted the site when her family needed to move her father from Florida to a nursing facility in Cincinnati, said she "gave a lot of weight to the ratio of staff to patients." Congress is considering one change: requiring homes to report their payroll data electronically every two weeks. CMS would use the data to help verify the accuracy of staff reporting.

Grading on a Curve

Other issues may not be so easily resolved. Some in the industry complain that the ratings operate like a grading curve, ensuring that similar percentages of homes will receive the highest and lowest designations. They say that makes it harder for an improving home to rise in the star system.

"Twenty percent of homes have to be one-star no matter what they are doing," said Steve Morrisette, president of the Virginia Health Care Association, which represents many of the state's 276 nursing homes. CMS maintains there's adequate opportunity for nursing homes to improve their ratings.

Inspections are another major point of contention among states, patient advocates and the industry. States have varying standards, Hamilton noted, citing as an example different practices concerning use of physical restraints, which are generally discouraged. (The CMS site cautions against comparing homes in one state with those of another.)

Minnix complains that inspection data generally are inconsistent, outdated and misleading. He urges that the process be revamped with better-trained inspectors and more funding. Colleen Ryan Mallon, marketing director for Northern Virginia's Goodwin nursing homes, says inspectors should be more objective and talk to residents more about the quality of care.

On the consumer side, the NCCNHR, formerly the National Citizens' Coalition for Nursing Home Reform, wants more state inspection information posted online. That includes specifics on deficiencies -- especially those that result in death -- and the penalties levied for infractions, said Janet Wells, a spokeswoman for the advocacy group. The coalition also wants verification of self-reported, unaudited information from the homes.

Six months after it launched, the rating system's impact is unclear. Even though CMS says the site attracts 50,000 daily visitors, both nursing homes and patient advocates suspect many families don't know about it. Gerald Kasunic, the long-term-care ombudsman for the District, who said he hears little mention of the five-star system, believes it "is a great tool for the next generation" -- people accustomed to using the Web.

Right now, he said, many people making decisions about homes "are in a crisis and pressed to make an immediate decision," and some simply "don't know that the ratings exist online."

This story was produced through a collaboration between The Post and Kaiser Health News. KHN is a service of the Kaiser Family Foundation, a nonpartisan health-care-policy research organization unaffiliated with Kaiser Permanente. Comments: health@washpost.com.

Are Baby Boomers Killing Facebook and Twitter?

It may seem like Facebook and Twitter widen the gaps between Boomers, Gen X-ers, and members of Generation Y, but online social networks may bring us all closer.

Robert Strohmeyer, PC World

The story is as old as the Web: A social network born among twenty-something college kids and young wired professionals sprouts up, apparently out of nowhere, and grows into a cultural phenomenon. Eventually, it reaches critical mass and explodes, its mushroom cloud drawing the attention of millions of Baby Boomers, leading to a huge influx of new users, which in turn triggers complaints from the youngsters who started it all. The invasion of the Boomers spurs some members of younger generations to flee the carnage (and the fallout) in search of fresher territory.

We've seen this scenario play out on MySpace and Facebook, and now it is starting to happen on Twitter. When the Baby Boomers--traditionally defined as anyone born in the United States between 1946 and 1964--arrive, they tend to do so en masse. And when they set up camp, they invariably change the dynamic of the social network itself. Whether due to their distinctive social habits or the sheer vastness of their demographic, a mass migration of 50-and-over folk brings in its train everything from increased political activity to a proliferation of spam.

That Boomers dramatically alter the social networks they adopt should come as no surprise, according to Lee Rainie, director of the Pew Internet & American Life Project, a think tank that studies Americans' online habits. "Boomers are the mainstream of the country now," says Rainie. "When you attract a mainstream audience, you're going to attract a lot more commercial interests. Boomers validate that this is a big market, and that this is a place where commercial interests can make money."

End of Innocence

The twin processes of mainstreaming and commercialization mark an end of innocence on a social network, as younger users lose what was once their private playground or--even worse--have to share it with their parents.

"Younger folks don't want their parents there," Rainie says. "But does that mean they'll all flock to different places?"

Not yet, according to data collected by Rainie and his colleagues at the Pew Research Center. Though a few early adopters may jump ship as a social network that was once on the electronic frontier gets swallowed up by digital suburbs, most stick around--at least until a major new network arrives to supplant the old one, as Facebook has done with MySpace.

Still, there's no shortage of anecdotal evidence that sharing the online world can be a source of intergenerational strife. Take Will Smith (no, not the actor), for example. When this 33-year-old tech professional received a Facebook friend request from his father in March, he was floored. Not because he didn't want to connect with his dad, but because doing so on the same network that he shared with so many peers and colleagues raised a host of complex concerns.

"My father, who I dearly love, has a tendency to forward e-mails that are off pretty off-color," says Smith. "It's probably nothing that would get me fired, but stuff that could earn me a trip to HR, if I ever opened them [at work]. My concern was that he would post that type of message on my Wall or in another public venue on Facebook without realizing it was a public venue. Since everyone from my immediate supervisor to the president of my company is in my friend list, there's potential for bad things to happen. I don't think anything actually would, but there was strong potential for embarrassment."

To reduce the likelihood of a career-damaging dust-up, Smith sent his dad an e-mail in which he laid out what he considered reasonable limits for their online father-son bonding. Off-limits: "Politics, sex, jokes, things you find funny but offend me, comments about family members, any combination of the aforementioned items, and pretty much every e-mail you've ever sent me."

Ultimately, Smith's worst-case scenario never came to pass and--perhaps because that e-mail--his father never logged back into Facebook. But according to data from the Pew Internet & American Life Project, people of the same age as Smith's father are logging onto Facebook in droves, and Baby Boomers are now the fastest growing population on the social network.