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As of 2017, an estimated 1.5 million people are 65+ years old and identify as lesbian, gay or bisexual. This number is expected to double by 2030.  Unfortunately this data does not include transgender and nonbinary people, so the number is actually higher. Many of us, including myself, have experienced our sexual orientation as fluid at different times in our lives, and we deeply want to show our support to break down the walls of 'othering'. In addition to ensuring that LGBT older adults feel safe when receiving medical care, we must break down the walls of social isolation and victimization.  LGBT family structures are not necessarily based on blood ties. Families of choice and extended family systems are equally important.  As end of life doulas and caregivers,we need to support diverse familial systems and create a warm and loving environment for all of our clients, no matter their gender or sexual orientation.  Many LGBT people are solo agers. End of life doulas can provide loving, emotional support to ALL solo agers. No one should feel they must go this final journey alone. We care.

Something is happening in this world that has never happened before, and I am a part of it!   Within a decade, more than 1 billion people- or 1 in 6 people -all over the globe will be over 60 years of age. I am already one of them as I hit 60 a few years back. I get very tired of reading the condescending articles about aging: get used to loss, declining health, facing past regrets, physical limitations, less energy and the fear of loss of quality of life and ultimately death.  I get it. I am an end of life doula. I teach classes for the Elisabeth Kubler Ross Foundation on death and dying. I lead Death Cafes. I write on the topic. I contemplate it daily. Yes, we are of the nature to get sick and to die. I am not denying that. Nevertheless, my experience of aging is one of letting go and releasing old pains, patterns and hurt. I have a quieter mind, more self-acceptance, and a deeper sense of my own identity. As I get further along in my 'third act', I am meeting myself at a more soulful place. I know gratitude, pleasure, connection in an easy, open way. My spirituality and overall energy have been revitalized.  For me the key has been a significant reduction in stress as I retired from the workforce and work part time, my children are raised, and I left a very long and not too happy relationship. I know happiness and joy at a new level. I love the new people in my life and finally live in the right place. For me being older is all about arriving to a place I wasn't sure existed. My inner elder is blossoming and will help me along my way to the end of my days, whatever ups and downs they bring.  What are the gifts of aging that you have received?

I got so mad when Hospice called me a few months after my mom died for a 'grief check-in' call. My mom died 7 years ago and the call came 3 months later. The woman's voice on the phone was concerned; she asked how I was doing with my grief, her voice full of clawing inflections of sugary sympathy. I immediately was on the defensive. I said something like, "My 94 year old mom was ready to die. In fact she wanted to die. She gave me a gift with her readiness. So I am not in grief. I just feel love. I don't appreciate that you are assuming I am grieving and suffering and this is such a hard time. I have lost a lot of people and know grief. This is not that. Don't put that on me." I am not proud of what I am certain was a terse response, but I am proud of what my mom gave me. I never assume someone feels a certain way after the loss of a loved one. I am curious and inquire. I don't want to put any expectations on them about how to feel, nor do I assume they are 'grieving'. I want to open the space and find out what their journey after loss is like. What is your preference? How do you want people to ask you how you are doing after a deep loss? What words make you feel open? What makes you feel closed? What does grief mean to you?

The term "compressed morbidity" doesn't sound nearly as wonderful as it is. In Eastern philosophy, it refers to someone being in tune with the Tao or with nature, so they will live a long life and die fast.  Doesn't that sound wonderful? By extension, the philosophy also says that the last ten years of one's life should be the best ten years. Often in Western society, the last 10 years of someone’s life are the worst 10 years, marked by decline and loss. By another extension, if the last 10 years can be our best years, and if we are living well into our 70's, 80's, and 90's, then our 'third act,' after work and childrearing is done, when we settle into a quieter time, promises all sorts of wonderful riches, leading up to that last decade.  For me, my 60's have thus far been my best years, where I finally embrace, in my way, how to relish life and love with joy, curiosity, play and openness. Gratitude! Here's to your compressed morbidity!

Be a loud listener! A friend once remarked, "Wow. You really pay attention. I am not used to that. I don't usually listen to everything a person says. "We typically speak at the rate of about 120-150 words a minute, which is not enough data to fully occupy the brain of the person being spoken to, especially if said person is socially or otherwise anxious. Research shows that often we don't know what is going on in another person's mind. So, asking the sorts of questions that will allow a person to reveal their true selves is the key. The worst kind of questions evaluate, with the implication that you will be judged: Where did you go to college? What do you do? Were you close with X person who just died? Did you win? But were you there when Y happened? The best questions give the responder the freedom to go as deep or as shallow as they want: How is your mother? What is the best way to grow old? What was that like for you? Can you be yourself where you are and still fit in? What do you think? How did you adapt to that big change? What are you learning about in your life? So take a moment and consider: are you asking questions out of a need to evaluate and judge? do you want the other person to open up? Are your questions closed or open ended? Are you listening with your eyes, 100% engaged? Do you 'fake listen' waiting for the other person to take a breath so you can jump in with your own experience, hijacking the conversation? If you have a hard time listening, try SLANT: Sit up Lean forward Ask questions Nod your head Track the speaker. Listen loudly.

That is the eloquent sentence my dear friend and poet said to me the other night when talking about the death of his 65-year-old twin sister. He feels her absence. He feels her memory. He feels the part of him that is absent without her. He is incorporating into his being both the memory and absence of her, as well as allowing absence itself to be a space he holds. I find this terribly tender and honest, raw and true. We have holes in ourselves made by the loss of those we loved. In the holes, there is a wholeness that is the memory of them. In the memory of them, we feel the absence of them. Ultimately, we integrate the loss into our beings. There is no duality left. There is absence and memory. There is wholeness. There is love.

Today I am thinking about my dead people. The people I love that are no longer here. I am thinking about how little or much they suffered while they were dying.I I feel like most of them met suffering; knew suffering; suffered. So, I turned my attention to this amazing reflection that I use often in my classes and with clients. It's the Nine Contemplations of Death, a Buddhist writing attributed to Atisha, an 11th century Tibetan scholar. I hope you will find it as calming and meaningful as I do. The First Contemplation Death is inevitable, no one is exempt. Holding this thought in mind, I abide in the breath. The Second Contemplation Our life span is decreasing continuously, every breath brings us closer to death. Holding this thought in mind, I delve deeply into truth. The Third Contemplation Death will indeed come, whether or not we are prepared. Holding this thought in mind, I enter more fully into the body of life. The Fourth Contemplation Human life expectancy is uncertain, death can come at any time. Holding this thought in mind, I listen with utmost care to every sound. The Fifth Contemplation There are many causes of death— habits, desires, accidents can be precipitants. Holding this thought in mind, I consider the myriad possibilities. The Sixth Contemplation The human body is fragile and vulnerable, our life hangs by a breath. Holding this thought in mind, I attend to each inhalation-exhalation. The Seventh Contemplation At the time of death, our material resources are of no use to us. Holding this thought in mind, I invest wholeheartedly in the practice. The Eight Contemplation Our loved ones cannot keep us from death, there is no delaying its advent. Holding this thought in mind, I exercise non-grasping and clinging. The Ninth Contemplation Our body cannot help us at the time of death, it too will be lost at that moment. Holding this thought in mind, I strengthen my capacity for release.

In one of my recent Death Cafes, hosted by the Elisabeth Kubler Ross Foundation, a woman said something amazing. We were talking about listening and how equally powerful and beautiful the stillness is when you are heard by someone who is deeply listening to you. People were sharing what made them feel heard when their loved ones were dying. The woman offered that the discussion was reminding her that she didn't have to find the right words; all she had to do was be like her cat. He doesn't speak to her with words but she knows just what he is silently communicating! She feels his love. Be the cat!

As an end of life doula, I have had the opportunity to think about this a lot. My number one priority would be to make sure I could end my life on my own terms before my cognitive decline made that impossible. That's why I am really excited that California's advocacy group, A Better Exit, is working on proposed changes to the current law. SB 1196 would: Eliminate the requirement whereby a person must be within six months of death; Include the option of an intravenous method for self-administering the life-ending drugs; Make Medical Aid In Dying available to people with early to mid-stage dementia who have decision-making capacity. If you or your loved one had severe cognitive decline, would you want these options so you could end your life with dignity?

My mom died seven years ago and I feel no grief. I was talking with a friend the other day, who happens to be a rabbi and is extremely verbally persuasive, who insisted that if you love someone and they die, you experience grief. If you don't, then it means you didn't love them. I have a different take on it. I had people die before my mom died. I felt what I understand to be grief. I had a difficult time accepting that they had died; I felt sorrow and a tearing inside and despair. It hurt a lot. That was grief. But when my mom died I just felt love. And I have felt that way every day since. Sometimes I miss her. But that is as close as I have come to grief. I feel her close by. I feel her in my heart. I feel her love. I feel my love for her. She was ready to die. We said our goodbyes. We expressed our love. I knew all her wishes. She was at peace. She was reaching for death and so tenderly ready. After she died, I realized grief was optional. Is grief love with no place to go? I felt a deep love and it always had a place to go. Right to her, in spirit. I keep sending her love. I feel like she is okay out there somewhere. Maybe my friend and I are just having a semantical debate. I like to think we can transform the way we think about grief by the way we think about death. Love you, Mom!

The crazy thing I want for every U.S. resident: When you register to vote or get your driver's license or register for college or the military, you fill out your advance care directive. Sounds crazy, right? But it's one of the saner things you can do. As an end of life doula, I teach workshops on filling out your ACD- advance care directive. Most of the attendees have been avoiding it for years, inspired by fear and paralysis. If we normalized the ACD, as necessary paperwork for all citizens, who also have the legal right to the comfort care provided by hospice at the end of their lives, wouldn't that be a benefit to you and your family? An ACD states your wishes in the event you are not able to speak for yourself. Things like do you want your life to be prolonged under any circumstance? Do you want pain meds even if that would mean you would not be conscious? Most importantly an ACD gives you the opportunity to say who you want to entrust as your health care proxy. Who do you choose to advocate for your wishes? Here is a link to the form by state. Don't delay!

I don't want to die with regrets. Like you, I have no idea when death will come for me. But, I can say unequivocally, I am motivated by my heartfelt desire to die with no regrets weighing down my departure. This inspired me to talk with my ex-husband after 25 years. We ended up having a year-long email exchange where we worked through what happened to us in our spectacular demise. It was very healing, for both of us. All good! I have also forgiven my partner of 23 years and myself for that which was dysfunctional in our home. Very good! Some regrets I have involve former friends and colleagues. I was less than delicate or a misunderstanding became insurmountable. In some instances I have made amends. But that is not always possible. People move away; people die. I now have a practice of self-forgiveness so that when those memories flash before my mental screen, I pause and release myself through words of forgiveness. I wasn't fueled by anything but human foible. I can let it go. In my life now, I work hard to not incur new regrets and to make amends right away if I have trespassed. I also am a lot more intentional about who I am around and the quality of the connection between us. This has been a game changer. I am becoming regret-less. It is a process. I would love to hear how you see it.