Friday, October 28, 2016

Geriatric Care



What Geriatric Care Managers do
Assessment. When you first hire a geriatric care manager, he'll meet with your loved one (and family members, if appropriate) to evaluate the current situation. He'll assess your loved one's physical environment and mental, social, and emotional functioning and independence. Based on this assessment and conversations with family members, the GCM will identify your loved one's care needs.
Plan of care. Once the assessment is complete, the GCM will make recommendations about the types of care your loved one needs. He'll meet with you to review these recommendations in detail and get your feedback. He'll note recommendations in a written plan of care. As care progresses or as care needs change, the care manager will note progress in the plan of care and make updates as needed.
Coordination of services. A geriatric care manager can be as actively involved in the care of your loved one as you need him to be; be sure to clarify expectations at the outset. Most GCMs know all the senior care providers in your area and are well prepared to help you find the best match for your loved one. You can expect him to help you find agencies to provide in-home care, hospice, or skilled nursing care, as well as to coordinate the comings and goings of the caregivers. If your loved one needs residential care, the GCM will help you find the best assisted living or nursing home that meets your loved one's needs and fits within your budget. Some GCMs will also help with day-to-day care for your loved one -- picking up prescriptions, taking your loved one to doctor appointments, or visiting for regular check-ins.
Family support. GCMs also provide invaluable support to family members as they cope with a loved one's decline or illness. They can help smooth communication and mediate disagreements.
Ideas, products, and innovations. GCMs are always on the lookout for new types of services and tools to make caregiving easier and to help keep your loved one safe. Many will be able to tell you about new technologies, tools, or aids that help your loved one maintain independence and mobility for as long as possible.
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The 3 Principle Aspects of the Bodhisattva Path



There are said to be three principle aspects of the path to Buddhahood — renunciation, bodhicitta and wisdom. These are called “principle aspects” because of the crucial role they play in following the path. Most of the other aspects of the path can be understood as either steps necessary to attain renunciation, bodhicitta or wisdom, or as expressions of these three. In order to become a Buddha and achieve true and lasting happiness, one must cultivate renunciation, bodhicitta and wisdom. The practice of cultivating the belief that every living being has been one of your mothers, for example, is an optional element of the path, because it is part of a method, not the only method, of cultivating bodhicitta. So, one would not say that the belief that every living being has been your mother is a principle aspect of the path to Buddhahood.
Bodhicitta is a principle aspect of the path, because it is the aspiration to become a Buddha for the benefit of all. Obviously, if we do not have this aspiration, we are not going to become Buddhas; you cannot accidentally become a Buddha. The five perfections of effort, generosity, patience, moral discipline and concentration (as well as wisdom) are ways of expressing bodhicitta, because they are steps on the path to fulfilling our aspiration and because each virtuous act is chosen with bodhicitta motivation. It is not correct to say that bodhicitta is an expression of patience, but patience is an expression of bodhicitta. For this reason, bodhicitta is called a principle aspect of the path, but the first five perfections are not. By way of analogy, if we want to travel to Chicago, we would call this our goal, and we would say that we are traveling down a particular highway because we want to reach our goal. In this way, the goal is more central to what we are doing than the steps we need to get to our goal — the steps are chosen because of the goal, not vice versa.
Buddhahood is a state of mind; it is the mental activity of directly perceiving the way things truly exist, and it is the mental activity of always acting with the intention to benefit every living being. Buddhahood is also a capability — that of being maximally endowed with the ability to help all sentient beings. All of these elements of Buddhahood come from wisdom; a wise person always has these states of mind and this ability. For this reason, wisdom is a principle aspect of the path.
Renunciation may be the most misunderstood aspect of the path, because many people assume that Buddhists must totally withdraw from worldly activities and live the life of an isolated monk or nun in order to reach enlightenment. To people who believe this, renunciation is an extreme form of asceticism, but this is false. Buddhism is called “the middle way,” partly because it is the middle path between the extremes of trying to find happiness through indulgence in mundane, worldly activities on the one hand and, on the other hand, trying to find happiness by practicing extreme asceticism. Renunciation is actually an attitude about the value of mundane, worldly activities and things, not a total withdrawal from “normal” life activities. It is not necessary to abandon most of one’s material possessions in order either to become a Buddha or function as a Buddha. But Buddhas don’t need much of anything in order to be of great benefit to others. Shakyamuni Buddha’s teachings continue to be of immense benefit to all, but he possessed only the clothing he wore and the alms bowl he carried when he gave these teachings.
Renunciation is the conviction that true and lasting happiness cannot be found in the possession of material wealth, power or fame. These mundane things can, at best, only be instrumentally useful when skillfully used in the spiritual practices that do bring true and lasting happiness. A Buddha can possess wealth, power and fame, because they can be useful tools for helping others, but Buddhas find happiness in the mental states they have achieved, not from the things they possess. Achieving renunciation is the first crucial step on the path to Buddhahood, because as long as you believe that happiness can be found by possessing mundane things, you are not going to engage in the spiritual practices that do lead to true and lasting happiness. You, also, will not engage in effective and authentic spiritual practices as long as you think that happiness is found in a place of abode called “heaven.” Jesus and Buddha both taught this. Jesus communicated this when he said, “the kingdom of God is within you.” (Luke 17:21) Clearly, what Jesus meant by “within” is within your heart and mind. In order to achieve true and lasting happiness, you must train your mind until you reach Buddhahood or, in other words, find the kingdom of God that is within you.
In summary, renunciation, Bodhicitta and wisdom are the three principle aspects of the path, because these accomplishments, jointly, are the necessary and sufficient causes of true and lasting happiness. One must first develop the attitude of renunciation in order to begin to abandon dysfunctional, mundane goals; next, one must develop both aspiring and engaging bodhicitta in order to travel the authentic spiritual path; and, finally, one must acquire the wisdom that is the state of mind of someone experiencing the true and lasting happiness of a Buddha.

Tenzin Norbu Author, radio host and retired professor of philosophy
Terrence Moore is a retired associate professor of Philosophy who taught at the United States Air Force Academy and the University of Colorado at Colorado Springs, where he developed an interest in Buddhist philosophy. He earned his Ph.D. in Philosophy at the University of Pittsburgh and was a post-doctoral Fellow at the Edmond J Safra Center for Ethics at Harvard University. Tenzin Norbu, his pen name, means Bearer of the Jewel of the Teachings. Dr. Moore was given this name due to his clear understanding of and ability to articulate the Dharma. Currently, Dr. Moore devotes full time to writing about Dharma, spreading it to anyone who may benefit from it.
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Sunday, October 23, 2016

Nobel Economics Versus Social Democracy



OXFORD – Of the elites who manage modern society, only economists have a Nobel Prize, whose latest recipients, Oliver Hart and Bengt Holmström, have just been announced. Whatever the reason for economists’ unique status, the halo conferred by the prize can – and often has – lend credibility to policies that harm the public interest, for example by driving inequality and making financial crises more likely.
But economics does not have the field entirely to itself. A different view of the world guides the allocation of about 30% of GDP – for employment, health care, education, and pensions – in most developed countries. This view about how society should be managed – social democracy – is not only a political orientation; it is also a method of government.
Standard economics assumes that society is driven by self-seeking individuals trading in markets, whose choices scale up to an efficient state via the “invisible hand.” But this doctrine is not well founded in either theory or practice: its premises are unrealistic, the models it supports are inconsistent, and the predictions it produces are often wrong.
The Nobel Prize in economics was endowed by Sweden’s central bank, the Riksbank, in 1968. The timing was not an accident. The new prize arose from a longstanding conflict between the interests of the better off in stable prices and the interests of everybody else in reducing insecurity by means of taxation, social investment, and transfers. The Royal Swedish Academy of Sciences awarded the prize, but Sweden was also an advanced social democracy.
During the 1950s and 1960s, the Riksbank clashed with Sweden’s government over the management of credit. Governments gave priority to employment and housing; the Riksbank, led by an assertive governor, Per Ã…sbrink, worried about inflation. As recompense for restrictions on its authority, the Riksbank was eventually allowed to endow a Nobel Prize in economics as a vanity project for its tercentenary.
Within the Academy of Sciences, a group of center-right economists captured the process of selecting prizewinners. The laureates comprised a high-quality sample of economics scholarship. An analysis of their influence, inclinations, and biases indicates that the Nobel committee kept up an appearance of fairness through a rigid balance between right and left, formalists and empiricists, Chicago School and Keynesian. But our research indicates that professional economists, on the whole, are more broadly inclined toward the left.
The prize kingmaker was Stockholm University economist Assar Lindbeck, who had turned away from social democracy. During the 1970s and 1980s, Lindbeck intervened in Swedish elections, invoked microeconomic theory against social democracy, and warned that high taxation and full employment led to disaster. His interventions diverted attention from the grave policy error being made at the time: deregulation of credit, which led to a deep financial crisis in the 1990s and anticipated the global crisis that erupted in 2008.
Lindbeck’s concerns were similar to those of the International Monetary Fund, the World Bank, and the US Treasury. These actors’ insistence on privatization, deregulation, and liberalization of capital markets and trade – the so-called Washington Consensus – enriched business and financial elites, led to acute crises, and undermined emerging economies’ growth.
In the West, the priority accorded to the individualist self-regarding norms underlying the Washington Consensus created a nurturing environment for growth in corruption, inequality, and mistrust in governing elites – the unintended consequences of rational-choice, me-first premises. With the emergence in advanced economies of disorders previously associated with developing countries, Swedish political scientist Bo Rothstein has petitioned the Academy of Sciences (of which he is a member) to suspend the Nobel Prize in economics until such consequences are investigated.
Social democracy is not as deeply theorized as economics. It constitutes a pragmatic set of policies that has been enormously successful in keeping economic insecurity at bay. Despite coming under relentless attack for decades, it remains indispensable for providing the public goods that markets cannot supply efficiently, equitably, or in sufficient quantity. But the lack of formal intellectual support means that even nominally social-democratic parties do not entirely understand how well social democracy works
Unlike markets, which reward the wealthy and successful, social democracy is premised on the principle of civic equality. This creates a bias for “one-size-fits-all” entitlements; but there have long been ways to manage this constraint. Because economics appears to be compelling, and because social democracy is indispensable, the two doctrines have mutated to accommodate each other – which is not to say that their marriage is a happy one.
As with many unhappy marriages, divorce is not an option. Many economists have responded to the failure of their discipline’s core premises by retreating into empirical investigation. But the resulting validity comes at the cost of generality: randomized controlled trials in the form of local experiments cannot replace an overarching vision of the social good. A good way to begin acknowledging this would be to select Nobel Prize recipients accordingly.
OCT 10, 2016
Avner Offer, an emeritus professor of economic history at the University of Oxford, fellow of All Souls College, and member of the British Academy, is the co-author (with Gabriel Söderberg) of The Nobel Factor: The Prize in Economics, Social Democracy, and the Market Turn (Princeton University Press, 2016).
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https://www.project-syndicate.org/columnist/avner-offer