Life may offer you a guidebook, but the pages are blank -- you have to fill them out as you go. With that in mind, we are featuring stories this week about the challenges of caring for our aging parents and it's hitting closer to home than I ever imagined. I just returned to Washington, D.C., after a week in Redmond, Wash., a suburb of Seattle. I'd gone out there to help my 81-year-old Dad through a tough surgery and I only had a few days to get him home from the hospital and make sure he was safe and comfortable before I had to take the cross-country trip back. While at the hospital, in the grocery checkout, or in line at the pharmacy, I saw others just like me ?- adult children or other caretakers doing what they could to help out an aging parent. Assisting a frail parent walk, leaning in to hear a dry whisper of a voice, chuckling over some shared family memory -- these are scenes repeated hundreds if not thousands of times each day in this country.

We arrived in Oregon last Thursday to follow Bob around, capturing everything this extraordinarily active man does. The camera crew and I were hard pressed to keep up with him. Ann joined us on Saturday for our interview. We squeezed around the dining room table and settled in for a conversation. Ann and her father have the kind of relationship where it seems they've never stopped talking. They discussed everything: love, loss, learning, what it's like getting older, and how to keep one's zest for life.

If there's one thing I'd like to see people take away from this series of reports, it's this: Do what Ann did. Sit down with your parent or parents, set up a video camera and start talking. Don't do it around a holiday, when there are presents or other distractions. Do it for no other reason than to get them on the record - both the stories you've heard a thousand times, and the things they'll tell you that will surprise you. It might feel strange, but eventually you'll all forget the camera is there. And don't wait.

There is so much each home has to do to turn its systems around from the way they are institutionally geared to being individually geared. If homes are starting in that direction and know that they're not done, it seems like that's what they can say.

Ultimately, if people who live in a nursing home can live their lives as they would at home, but with the added benefit of caring support, then that home would be individualized in its care systems and practices.

OBRA actually gives pretty good language both in the Quality of Care section and in the Quality of Life section for the kinds of outcomes we should be seeing if homes are functioning in an individually-driven way.

I have a fear about moving too quickly to quantify and define something that is still developing and emerging because if we put parameters around it we may cut off the learning that is still underway.

It feels more useful now to capture experiences, practices, benefits and lessons from this development and spur on more. Windows of opportunity to innovate and change the norm are fragile and often short-lived. The rush to quantify could well lock things up and close off the innovation. And we still have so much to learn.

Sorry not to have something more definitive. A lot of state coalitions are grappling with this and I have a strong feeling about asking all of us to allow the unknowing the room it needs to take form rather than rushing to definition.

Take care,
Barbara

While Meadowlark did not go to a buffet style dining, we did convert to food prepared and served on site. What this has in common with buffet dining is that residents had the right returned to them to eat what they want when they want, which I assume would be components of your planned buffet dining lifestyle. Weight loss reduced by 92 percent in the first year and socialization dramatically improved during meals. Resident satisfaction with meals improved 67 percent.

Beyond that, it is difficult to gather data for something so elementary to our life satisfaction and quality. Its like wanting data to prove whether a dog is happier on a rope or free to roam. Somethings are just known and part of universal truth in the human condition.

Hope this helps.

Steve