These specialized programs have been designed to provide providing a comprehensive care program that encompasses the emotional, mental, and spiritual dimensions of aging.

They are:

• The Gerontological Wellness Program

• The Gero-psychology program

• The Expressive Arts Program

• The Forgetfulness -Dementia and Alzheimer’s Care program.

• The Spiritual Care Program and Hospice Services

The Gerontological Wellness Program

The elders we serve at our facilities deserve our complete attention as well as a quality of care that addresses the physical, emotional, mental, and spiritual aspects of their existence. Pacific Institute's Gerontological Wellness Program therefore, is a comprehensive care program emphasizing the holistic nature of aging. In our innovative work with the elderly, we call attention to the aging process as being a challenging yet rewarding period in the life of a human being.

Objectives

The Gerontological Wellness Program at Pacific Institute is open to all individuals from all walks of life. Once a person walks through the doors of the facilities, they are automatically integrated into the Gerontological Wellness Program. Licensed mental health professionals, psychology interns and trainees, as well as volunteers and nursing staff, work in concert with each other to provide a level of care to residents that is unmatched with any other residential facility in the Bay Area.

The Gerontological Wellness Program is rooted within a theoretical and practical framework that comprises of transpersonal and existential-humanistic philosophies. The program aims at supporting different activities of daily living at different levels of need. Besides offering physical care and services, psychotherapy interns and volunteers support the emotional and spiritual well being of residents through one-on-one contact and group activities and outings. This holistic emphasis is invaluable in furnishing our residents with well-rounded nurturing that goes above and beyond the standard aspects of care giving.

Some of the objectives of the Gerontological Wellness Program include the following:

• Provide our residents with diverse philosophies of care and support.

• Create a therapeutic environment where the residents feel safe and supported in living out the various dimensions of their existence.

• Provide a holistic approach to care that goes well beyond the thorough physical care we provide for our residents.

• Provide opportunities for our residents that are specific to the unfolding of the healing process that is innate in every individual.

The Gero-psychology Program

Geropsychology can be defined as the scientific field concerned with the multiple aspects of normal and abnormal changes in cognition, personality, well-being and mental health that occur with aging in the later years of life. At Pacific Institute, the At Pacific Institute, the Geropsychology program philosophy involves a conscious examination of how we transition from middle age to the stage of eldership. This enables each individual to address any challenges while simultaneously fulfilling missed opportunities in the later years. It is the hope of the program that from the vibrant community that we create will emerge an alternative vision of learning and being in adulthood that is transformative for individuals and for society at large. Importantly, this vision will be implemented in specific, practical ways as we develop models for mindful and soulful engagement in matters affecting the elderly.

One could imagine the Geropsychology Program as an experience oriented towards a holotropic sense of being. The name holotropic translates as "moving toward wholeness", from the Greek "holos" (meaning whole) and "trepein" (meaning moving in the direction of something). Because we understand that the human being is beautifully rich, complicated and diverse we try to remain open to all those facets and build a deep relationship with the person. Through their educational research, counseling, learning and continual focus on the emotional side of aging, the staff and psychology interns strive to set a new standard of care giving and to redefine the role of eldership.

The Geropsychology program is primarily concerned with understanding the “aging phenomenon,” what this implies on a personal and global scale, as well as its cultural and social implications. This program is catered to those individuals who are keen on acquiring an awareness of how they live their lives and how they age.

The Geropsychology Program is available to all residents who need emotional support and demonstrate through narrative or behavior a desire or movement toward wholeness. It is our intent to provide tools and support in their achieving this wholeness or completion. We do this by providing individual emotional support, and various programs and activities that allow the elder to express, explore, reflect and sometimes confront the issues that arise in their steps toward this place of completion. It is important to us that our Licensed mental health professionals, interns and trainees, volunteers and nursing staff are each trained to understand and support this philosophy and program.

Our objectives include the following:

• to provide space and permission for elders to explore their multi-dimensional experiences as they work towards wholeness

• to give our elders the opportunity to work through old issues that continue to challenge them and block them from the experience of feeling complete

• to provide various forms of counseling such as, grief counseling, family counseling, relationship counseling, and psychological testing when appropriate or needed

• to support the above effort with adequately trained staff, interns and mental health professionals

• to provide an environment that feels caring and supportive and gives the elders a sense of being part of a community

• to support not only the elder but also their extended family and friends

• to value the learning we receive as a community from each of the elders who inhabit our residence

The Expressive Arts Program

In our desire to honor the “whole” person at Pacific Institute, and knowing that all humans are gifted with an innate creative language, we believe that it is important to provide an opportunity for our residents to express themselves freely and creatively. Using all modalities, whether it is visual art, music, movement, poetry, sandplay and drama, we believe the arts provide another language for the elders to express themselves and the multiple issues that arise. We also believe that by providing and encouraging access to another creative language, our residents have more resources to continue to grow and learn, while also experiencing a better quality of life.

Objectives

Since creativity is an innate language that each of us holds, it is our intention to create a safe, accepting atmosphere, where the residents can use this language to express themselves openly and authentically in response to their inward experiences. Whether it is their sadness or anger about loss, frustration at challenges they face, or the gratitude they feel when they are greeted with a smile by another, the artistic expression offers another language that can be shared between the elders and others, even when their verbal abilities have declined.

Having another language is important and valuable to everyone, but especially to those who are challenged by “forgetfulness” or who are having difficulty communicating their emotional landscape to the outside world. Being able to share their experience through the arts provides the elders an opportunity to feel seen, understood and engaged with others. In so doing, they often feel less isolated and have the means to release pent up emotions that may be developing inside, that may ultimate create problems in their relationship to others. Given the recent research findings, and our knowledge and awareness of the benefits of creative expression, our goals and objectives in providing expressive arts to our residents are as follows:

• provide resources and creative ways to express their pent up emotions

• create a less isolated environment and develop a sense of community

• provide tools to the elders, to continue exploring, developing and growing

• enhance their quality of life

Elements and Description of Expressive Arts Therapies Program

Expressive arts therapies differs from the traditional view of the arts in that the focus is more on the process and personal statement, than on the product and needs of the audience. In other words, the facilitator’s goals are no longer necessarily creating a beautiful painting or song (although they may be) but rather allowing and permitting space for whatever comes forth from the artist or creator. By allowing this sacred space and honoring every stroke of paint, every guttural sound or beat on the drum, we are supporting the true inner experience of the elder to be expressed without critique, judgment or editing. This is vitally important in order for the resident to dip into a more “soul” level of experience. If we focus on the product, whereby, the viewer or audience holds more weight, the artist often moves away from their internal experience and/or may become distracted by the need to please others. Using the Person-Centered philosophy and being present as a witness, without judgment and with acceptance for what comes forth, combined with following the lead of the artist rather than leading the artist, will provide a space where authentic creative expression can spill forth.

Another key element of Expressive Arts Therapies is working multi-modally. By this we mean, combing multiple forms of creative expression. By starting with one modality and allowing an opportunity for the initial creative piece to move into another form of creativity, we can provide yet another means for the artist to continue exploring and expressing their experience. An example of this might be providing paper and paint or pastels to elders, with carefully selected music in the background and inviting them to paint the music on the paper. After lines and splashes of color have filled the paper, we could invite words that come to mind when they look at the color or ask them what the color reminds them of. This process gives them freedom to explore memories, stimulates their mind through movement and color, and can create a sense of community through sharing with others.

Another example might be simply dancing or moving to music and then asking people what it reminds them of, or asking if a memory comes forth with the music and offering them the opportunity to share it with others. Still another example would be facilitating a drum circle, allowing everyone in the circle an opportunity to start with their own rhythm and then invite members to create songs together that includes personal experience, again without critique.

Of course, some of the most successful expressive arts experiences happen spontaneously. A recent experience with one of our residents illustrates this very clearly. One of our female elders was dealing with dying and she had recently been exhibiting agitation and panic. One afternoon she suddenly began moving her body and arms slowly, as if she was pouring tea and visiting with another. The witness joined in with this experience and participated in the tea party with her, without cups, tea or a table. Through movement, imagination and following the resident’s lead the witness became aware of a new calm emanating from the resident. They continued with this process and the dramatic experience for some time. The witness reported that not only did this seem reassuring and comforting to the woman, but a new sense of connection developed between them. The resident for that time period was not alone with her fear but was instead clearly comforted. The impact of this process was evident the remainder of the day and reported by staff as well.

With each of these experiences, different modalities are combined. The expressive arts combine modalities that are creative, from poetry to singing, from gardening to dancing, storytelling to “dramaplay”. Each requires creative thinking and movement. Each requires a freedom of expression and elicits different forms of intelligent language. The drama includes imagination, movement, and sometimes voice. Visual art includes movement, imagination, color and sometimes story. Drumming requires movement, breath, listening and repetition. Each of these provides the elder a different resource, skill and mental activity.

The Forgetfulness - Dementia and Alzheimer’s Care Program

At Pacific Institute and its AgeSong Institute of Elder Wellness we elect to call what is traditionally called Alzheimer's or dementia with the term forgetfulness. Human beings are beautiful in all their expressions, as they love, as they cry, as they wonder, struggle, suffer. We, as human beings, judge what is good and bad, what is right and wrong, what should be and what shouldn’t. In many ways we create what is normal and not, what is health, what illness.

At Pacific Institute we hold different assumptions of the world and the human beings who inhabit it. We do not regard Alzheimer’s or dementia as a disease but as an opportunity of learning and growth, as an opportunity for deepening our understanding of who we are as human beings here and now.

We are entering into a new paradigm where we see life in its wonderful complexity and mystery aw, shed our prior simplistic and often reductionistic and causal way of seeing the world.

We emphasize that being in an atmosphere of non-judgment creates less anxiety in all of us, whether we are being cared for or are caregivers. We believe that people with forgetfulness are our teachers who continuously instruct us in a deeper meaning of being human and of caring, a community where aging means maturing, where growing old means growing into eldership and wisdom.

This specialized program based upon the book called Deeper Into The Soul; From forgetfulness into dementia and Alzheimer’s care, is an innovative approach based on the Coma Work of Arnold Mindell and the process work oriented psychology. The dominant assumption today about people with 'dementia’ is based on the bio-medical model stipulating that they require basically good physical care. Nonetheless, few techniques or approaches really work on the challenging behaviors people with dementia exhibit. The mainstream approach is to distract and/or dismiss but people with 'dementia’ are present and long for psychological as well as spiritual connection and guidance.

From this point of view, the well being of the body is only one important aspect of a person with 'dementia’. Another equally important aspect is the inner journey on which they find themselves and for which they need our help and relationship. It is our responsibility as helpers and therapists that we learn the way people diagnosed with dementia communicate with us. Their inner journey that we call 'dementia’ is meaningful and wants to be noticed and met. Sometimes this inner journey is as much about the individual him or herself as it is about working through current but also ancestral and parental as well as societal issues.

Typically, families work on the Consensus Reality level; from this point of view their primary process is to get “everything back to normal”. But the entire family becomes unbalanced by dementia; it is a change factor for everyone involved. Family therapy may be appropriate. It helps if they are open to change, to meeting the challenge of connecting in new ways.

Process Work, as developed by Dr. Mindell, and existential psychotherapy as developed by R.D. Laing, May, Bugental and others, are both approaches that share the basic assumption that problems, when explored with curiosity and awareness, contain their own solution and a key to personal, relationship and personal development. Both approaches bring methods into play that work in experiential ways. When we learn to listen to the many viewpoints and our deepest feelings and tendencies, renewed creativity emerges together with a sense of joy and aliveness.

The strengths of this approach are many. It helps to facilitate a 'different way" to process information. Since everything that can be noticed in a person with dementia is feedback, what the individual does is a statement for the whole family and society. People with dementia are present, they live in the moment. Every behavior, verbal and nonverbal is meaningful-an invitation to be met, noticed, related to. It is up to us to step into the moment and try to interpret their behavior, language, posture, and attitudes; to unfold the signals they are sending us. This may mean moving beyond the literal, guessing into the meaning on a symbolic level.

This advantage could also be a limitation for those who handle only the consensus reality as the sole reality. Moving beyond a mainstream paradigm can be a limitation.

The program start by teaching

• to facilitate the clinician's awareness to listen to the "language of dementia"

• Communication within the family.

• Interventions to care for the person with dementia.

• Interventions to care for the family of the person with dementia.

The Spiritual Care Program

The Spiritual Care Program provides spiritual support to patients, family members, friends, and staff at the assisted living facilities. Moreover, it attends to the often-neglected side of spirituality in the elderly. There is new research that links sense of well being and healing with spiritual practices and spiritual care. Long time mistaken with religion, spirituality needs to be seen as a deeper part of human beings.

Usually, spiritual care programs follow a particular philosophy or religion principles. What is most unique about the Spiritual Care Program at Pacific Institute is that it combines a myriad of faith rituals and traditions to address the issues of life, death, transcendence, and spirit. The Spiritual Care interns and volunteers seek to assist patients in obtaining comfort and support from within their own faith, thereby developing the resident’s own concept of spirituality.

The trainings are provided for the caregivers, volunteers and interns and include the following workshops and seminars:

• Assessing Spiritual Needs among the Elderly

• Spirituality and religion: Differences and Similarities

• Spirituality and health

• Breaking the Spiritual barriers

• Developing compassion for the aging and dying

• Coping with Crisis

• Working with spiritual Distress.

• Practices and Rituals for Living and Dying

Beyond the psychological aspects of the resident’s life, the program offers support to spiritual needs of the aged through spiritual consultation with interns, volunteers, or any religious representative. Some of the benefits include:

• Opening the Heart to Loss & Grief activities through celebration of loved ones and embracing grief as a personal growth tool and learning experience.

• Spiritual support during critical decisions in health care.

• Education and support when choosing end of life alternatives.

• Integrating Spirituality & Religion in daily life (group and tailor-made rituals and practices)

• Spiritual Preparation for Death and Transcendence Issues.

• Year-around celebration of most common religious and/or specific holidays and rituals.

• Open Space to exhibit symbols or representations of different beliefs and traditions.

Hospice Care:

One of the sub-programs of the Spiritual Care Program is Hospice Care. Pacific Institute believes in providing a model of aging, living and dying that will allow individuals to face their mortality with wisdom and grace, so that all beings may truly live and die at ease and in peace.

Hospice is a philosophy of care. Hospice is not a place, but a concept. Hospice is about life and the quality of living during a life-limiting illness. Hospice care is an interdisciplinary approach that includes state-of-the-art pain and symptom management, emotional and spiritual support, and bereavement services. Hospice is about bringing peace to the end of the journey we call life.

The Hospice Unit is a place of peace and comfort; a place where families and friends are cared for, as well as those who are dying. It is a place where hope and healing prevail. Hospice residents are cared for by the staff from an entirely holistic model. I addition, hospice residents receive care from a team of licensed Hospice professionals, as well as interns and volunteers of Pacific Institute, and volunteers from other religious organizations.

Services

The services provided for hospice include:

• Volunteer caregivers who are specially trained on Hospice care and end of life issues.

• Grief and loss supoport for family members and friends

• Emotional and spiritual support and counseling for residents and families

• Referrals to end-of-life care resources and support services

• A peaceful and home-like environment