Lift Every Voice: Listen to Women Veterans

During last week’s Veteran’s Day inspired concerts and tributes to veterans, a Hill-gathering of Disruptive Women (and our man of the month, Rep. Tim Walz, (MN-OI) spoke truth with power. Gathered to discuss challenges faced by women veterans, the group included veterans, members of Congress and their spouses, congressional staff, state leaders, and filmmakers. The group had had enough of platitudes and promises. We were ready for disruption, and Rep. Walz delivered just that, saying he was done with “incremental change” (Washington’s latest, favorite buzz-word) and prepared to lead “seismic change.”

Walz speaks from a place of experience, knowledge, and passion: He is a retired soldier, and the highest ranking enlisted man to serve in Congress. During a 24-year stint in the Army National Guard, including a tour of duty in Operation Enduring Freedom, he also taught high school. The latter tour provided him some insight into chaos and disruption. In the 113th Congress, he will serve in leadership roles that include the National Guard and Reserves Caucus, and the Congressional Veterans Jobs.

In his remarks, Walz noted that “it doesn’t take much to offer health care that people can’t access.” He added that although the VA has made some progress since the days when “the best thing the VA could say for what it had done for women was that the exam tables no longer face the door.” Later, he added that the VA system—staffed by dedicated people—still has far to go to really offer care for all, noting that, “it is much easier to put up a yellow ribbon than it is to step up care.”

As recent Veterans Health Administration scandals have revealed, its challenges go beyond exam room layout – and problems reflect deeper challenges within the system in particular and American culture in general.

The day’s two other panelists included Emmy award-winning filmmaker Patty Lee Stotter, whose award-winning documentary, Service: When Women Come Marching Home, uses women’s voices to tell their story. Director of Washington State Department of Veterans Affairs, Lourdes E. (Alfie) Alvarado-Ramos, detailed her state’s actions to address specific problems.

Stotter has crafted films to give women veterans a place to speak. Her presentation included quotes from several women veterans, and included poignant thoughts, such as these:

“Tell them how I had to file a congressional inquiry two years after my daughter was born because the VA was NOT paying my prenatal care bills, which impacted my credit score…Tell them that the stress of being billed throughout my pregnancy with no advocacy from the VA left me crippled with PTSD and physical pain.””

“Tell them I was told that I should leave my boots on while having a trans-vaginal ultrasound because the stirrups were so filthy.”

“Today, I am fighting for my life. I have an extreme case of PTSD that has rendered me housebound. I have been in the disability claims process for nearly 4 years…”

 “I was raped in Iraq and when I went to report it I was told I was lying and probably wanted it. I was denied the right to get medical help.”
Alvarado-Ramos, a veteran herself, offered models from the other Washington that reflected possibilities for change and improvement. Washington State, she said, has, 70,000 women veterans, and, by 2040, projections are that there will be a much higher percentage of women veterans, as well as on active duty, as the numbers of men decline. She listed a dozen programs underway, most brand-new and inspired by her own service. These include: establishment of a women’s veterans committee; development of a veterans registry to better tracking and inform veterans; hiring more women service officers to help veterans of claims; and creation of a statewide information campaign to educate the the public and raise awareness of veterans’ ongoing struggles.

All of these programs represent a step toward addressing shameful situations that our veterans encounter – including homelessness, food insecurity, incarceration, mental health problems, sexual assault and economic hard times.

DW on the Hill

In a follow-up interview with Disruptive Women, Stotter talked about gender stereotyping and discrimination, and its toll on women veterans. I told her about the work of MacArthur genius Ai-jen Poo to organize domestic workers in New York City: When Ai-jen talks about women work—particularly paid housekeeping and babysitting–she notes that  says simply do not value or compensate the people who do the work that allows the rest of us to do our work

“Exactly!” Patty said. “We don’t even value the work that allows the rest of us to be free.” She continued, “I am furious that hard-working people who are soldiers get so little. Going to war, we see the worst of what the universe has to offer.  In our response to women veterans, I fear that we are losing our soul.”

It was the first time in a decade of attending DC panel discussions that I went home and spent three hours writing a poem about what I had heard.  Earlier in the week I’d written an essay about Bruce Springsteen’s performance at The Concert for Valor, and my appalling realization that our veterans must rely on the national equivalent of bake sales to resume civilian life.

Musician Bruce Springsteen performs during The Concert for Valor on the National Mall on Veterans' Day in Washington

I am proud to join this movement to advocate for women veterans. Not a veteran myself, I cannot imagine what women veterans have endured. But as a midlife woman, I know too well what it means to have a voice that is silenced. A voice that gets shouted down or shamed or discounted. A voice that gets shoved against the wall with a knife. A voice that does not dominate the room.

As a Disruptive Woman, I know what it means to reclaim your voice, to use it for good, to launch seismic change that echoes for many, and that helps people build new and safer shelters within their own minds, bodies, and lives.

Each and every Disruptive Woman should join our sisters in this battle. We can all sing in this chorus. Perhaps not from the same page or even the same score, but in a song that raises our voices and lifts them for those who, just now, cannot do it for themselves.

key words: Disruptive Women in Health Care, Tim Walz, women veterans, military sexual trauma, rape, wounded warriors, Ai-jen Poo, Bruce Springsteen, Concert for Valor


This post originally ran on Disruptive Women in Health Care on Tuesday, November 18, 2014.

Race, memory, and the present: Washingtonian, October 2014

I grew up in a racially polarized time and place. I thought my Dad was Atticus Finch and Clarence Darrow. His first murder trial involved defending a black man accused of first-degree murder in the shooting death of a white police officer. This is my memory–and what it means in today’s racially polarized America.


Shattered House, Washingtonian, Oct 2014


Key words: race, Ferguson, murder, biracial

A Future So Bright: C4 Blogathon, Day 4

I’m great at lists, not so great at goal-setting. So goal-setting for my writing is a challenge,
but here goes.

1. Five goals to achieve w/in next ten years (personal or professional)

  • Find a regular, paying outlet for creative non-fiction essay
  • Write a few non-fiction books on extraordinary women, first Evelyn Wynn-Dixon, then Sofya Kovalevsky
  • Devote more time, in a more concentrated way, to reclaim the joy of being creative person
  • Get out of debt and get my kids through college
  • Visit some places that I love, and some that I daydream about

2. Now, five goals that need to be achieved in short-term to make these a reality

  • Engage more with writers in my virtual and real-time communities and attend readings and submit work to journals I admire
  • Investigate and understand the process of writing biography, develop book proposals, and pitch
  • Concentrate on centering happiness within myself, not seeking it from validation or support from Erik who cannot provide it
  • Save money, and establish and adhere to budget

3. Now, five goals, this year

  • Write the book proposal and participate in pitchfests I have registered for
  • Connect with people who are skilled in writing nonfiction and learn from them (especially an expert on this, Walter Isaacson)
  • Continue to follow steps to pay down debt, which I insituted this year
  • Continue to work on strategies to address chronic physical pain, and spiritual pain
  • Keep arranging small road trips, either solo or with family, that energize me

Writing these down makes me feel anxious–but I have a good friend who often tells me to put ideas into the universe, that this stating of intentions is the first step to making them a reality. As for a photo, I will insert one from today. This time last year, I thought I was on my last-ever ski trip, due to arthritis and finances. But I am on new meds that make the knees not so bad, and I found a great deal. In this photo, I am on top of a mountain, with the whole world spread out before me. I am not anxious, and nothing is holding me back.


Janice on the mountaintop


I Knew More Then Than I Know Now: C4Atlanta, Day 3

Just under the wire, responding to the question of my favorite work–my own piece of writing. This question reminds me of the hedging that sometimes occur when people ask about favorite children; as the mother of six, I have come to see that I love them all–but some days, am proudest of one’s accomplishments, or most anxious about another’s challenges. The love is constant, but the focus changes.

I write in a few genres: poetry, nonfiction essays, and journalism. Within each of these, I have favorite pieces. (And others which I would once have tossed in the trash, that are now immortalized somewhere on the web.) Among my favorites is a long poem I wrote when I was 18: “Sixty-four caprices for a long-distance swimmer.” At the time, I’d have been a likely candidate to major in English, but instead chose math, always a challenge for me.

I hated writing papers! And so to avoid having to write one for a psychology class, received persmission to write a narrative poem. I swam almost daily in the brand-new pool at Guilford College, and just loved the place: the view of the campus woods, the solitude, the occasional interactions with half-naked professors. The poem eventually appeared in an anthology of sports poetry–the only collection of verse ever reviewed by Sports Illustrated.

Some years later, the poem was anthologized in a collection of English literature: positioned on pages between Emily Dickinson and Walt Whitman! I was stunned by my arrival.

This spring, when Diana Nyad completed her historic swim, I googled the poem, and discovered a version online, courtesy of a Yale professor who was using it to teach an undergraduate class. As close as I’ll ever get to Yale!

Anymore, when I read that poem, I can hear the girl I was: She was so sure of herself. She was so confident in her vision. She was so certain in every thing she had to say, and so sure others would be delighted to hear.

That’s the point to which I would like to return as my creative journey continues: That confident center, that willingness to write without self-criticism preventing the first word from reaching the page. And then to release the work into a larger world, where others can make of it what they will. That connection is what I crave and enjoy most.


Key words: poetry, writing, swimming, sports, C4Atlanta

Boxing Lessons for Life



There is nothing like turning fifty, fat and unfit, to make a body feel old. It did mine. Combined with encroaching arthritis and an orthopedist who called me “dear”, before I knew it, I was hobbling down the road to my own old age, not quite sure how I got there.

Too young for knee replacement surgery, too wary of long-term NSAIDS, what, really, was my body to do? The last straw hit in February, when I took my 11-year old on our annual ski trip. Despite warnings from friends whose own artificial knees keep them upright, I hit the slopes. By the end of the week, I could barely move.

An MRI confirmed what my body knew: I’d damaged the knee, and badly. When I limped into the orthopedist’s office, he pulled up the images and asked me what on earth kind of spill I had taken, to have created the contusion he could see. I told him it was all physics: My overweight body, torqueing around a bend on that tiny pole and those little sticks.

He told me I needed to lay off it, wear a brace, walk with a cane, lose some weight. So every once in a while, I’d haul myself to the gym or walk a few blocks, but my aching knees and a bout with chronic nerve pain took my heart out of it.

I’d spent most of my life swimming and doing aerobics, bellydancing and, more recently, boxing. In fact, for a few years in my late 40s, boxing brought real joy to my experience, trimmed inches from my waist, and bolstered my confidence (it helped that the handsome trainer called me “baby,” somehow less patronizing than the doctor’s “dear”).

But chronic pain froze me. I put my gym membership on hold, and began to count the two-block walk to my office as exercise. Who was I kidding? Not my body. When I went to pull out my fall wardrobe, nothing fit.

You can acquire an amazing number of bad habits, just sitting around. Eat too much ice cream, for instance. Spend way too much time online. When even my fat pants proved to be too tight, I knew something had to give.

So I signed up for a yoga class at the gym, and slowly, slowly, moved my aching body enough that, literally, it stopped creaking when I stood up. Every beautiful summer day that came along, I’d email my friend and neighbor to join me for a long walk. Strengthened—but still hauling too much weight—I decided to hit a few Zumba classes, too, because there is nothing like fast music and lots of dancing women to make you feel exhilarated, if only for a moment.

For a few steps, I felt out-of-place and awkward, unable to jump. But a grapevine replaced that, and no one else cared.

In the midst of my sit-still-I’m-in-pain-summer, my college roommate cheered me on with links to old sketches by Justin Timberlake and Jimmy Fallon. I laughed so hard, I choked. When I saw that Justin was Jimmy’s guest recently, I watched a bit of his live-from-LA concert, then Googled his song, TKO.

Which is why Wednesday morning, I was back in the gym, this time for something called BodyCombat. An apt name, since the real battle is within and with myself, the struggle to get the upper-hand on pain, the relentless war on calories, fat and sugar.

It turns out that the class features mixed-martial arts moves, but mostly consists of boxing, made girly. Before I knew it, the two years I’d spent training with a boxer came back to me. It was like riding a bike, only better, because in the course of boxing, I’d also picked up lessons about living, too.

While I jabbed and snapped and crossed, my brain was remembering all the things my trainer had shown me, and all the metaphor hiding in the glove.

It reminded me, for instance, how vital it is to stay in the moment.  The present moment is always the last thing on my mind, which often strays to and regrets the past, or frets about the future. The physical challenge of boxing makes even my worried brain hush: The only way to get through difficult times is stay present.

Focus on the one moment: The feel of the body’s weight, for instance, or the strength of the thighs. The knowledge that any single moment can be endured—and even celebrated. The realization that moments build to minutes to hours to a lifetime.

I remembered to keep my guard up.  In the aerobics studio at the gym, you can’t escape your own image, surrounded on all sides by mirrors. There is no looking pretty when sweat is pouring from your eyebrows, and there is no chance to straighten your hair. You have to resist the urge to primp and care what others think: You need to keep your guard up.

No matter what is happening, no matter what you see, when you are boxing, you always keep your guard up. And as much as I like to embrace the world and open wide to things that come my way, it is a good idea, sometimes, to exercise caution. Reach out and reach in—see what’s coming, and be ready to respond. Guard up, and you won’t take it on the chin.

Learn to slip.  When challenges are coming fast and furious, slip by them. In boxing, you bend the knees, plant the feet, and slip under the punches headed your way. It is not always necessary to respond immediately, to fight back, to lash out. Better to slip a little, duck, and figure out some other response.

In the ring—as I never was or will be or want to be—boxers take the full measure of their opponents. As I understand it, sometimes their weary embrace is just a façade, a chance to test for weak spots and vulnerabilities. In life, too, it helps to see the full picture, to embrace the things that come our way, to know where and when and how it will move in relationship to us, and to know how to respond.

Boxers rely on their trainers to call combinations, series of punches and moves that they have rehearsed for hours in the gym. As someone who lives with chronic anxiety and depression, it has helped over the years to learn a few combinations to keep sadness at bay. To see the triggers before they hit, and to respond with strategies and tools that allow me to stay standing.

You are stronger than you know.  When my trainer first had me hitting the mitts, I held back. Having been a girl in the 1960s, I learned to keep my aggression to myself. Back when I was boxing with a group, I’d be paired with some twenty-year old guy on the other side of a punching bag. All my ladylike skills could not withstand that punching bag when he clobbered it, setting it swinging wildly in my direction.

The only thing to do—short of jumping out of the way—was to hit it back. It turned out I could do all kinds of unexpected things: Run across the floor with a 50 pound weight. Pump weights overhead for three minutes while jogging in place. I learned to snap a jab, and I learned to breathe. I learned that when I let go of fear and all the habits that came with it, my reserves were endless.

By the time Wednesday’s class ended, I was drenched and exhausted. But I felt better than I had in months. For hours, the neuropathic pain vanished. And my knees didn’t crack or creak till that night.

My clothes still don’t fit, of course, but my heart and mind feel better. I remember who I am. I know who I have been. And I know where I’m going.

Dear? Baby? I’m just Janice, ready for the world.


Reposted from, original posting 10-28-2013

Life Is a Discotheque: Dance, Whatever They Play

I had gone to bed early last Mother’s Day, exhausted by the energy I’d spent trying to cope with a recently acquired chronic pain syndrome. Sleep had become my friend and my remedy, a respite from the burning pain of a nerve injury.


I was halfway to sleep when my 11-year-old came in my room and laid down beside me, facedown in the pillows, head nestled against my elbow. I could tell from a shudder in his shoulders that he was crying.

When I asked what was wrong, he said, “Who would shoot people on Mother’s Day? Who?”  Via social media, he had seen news of a shooting rampage: 19 injured during a New Orleans Mother’s Day parade.

“I’m not going to go to Philadelphia on Friday,” he said. Philadelphia was the destination for his fifth-grade class trip, something for which they had prepared all spring. A coach bus! The Liberty Bell! Money for trinkets and lunch! A day with friends!

“You’ll be fine,” I said, slowly coming back to the world and the reality of his pain—the psychic pain to which all of our children are exposed these days, when violence erupts so constantly, so nearby.

“I’m not going,” he said. “I’m just not.”

I rifled through my maternal stash of platitudes and reassurance, and finally decided that the best advice of all has been circulating for months now, courtesy of Mr. Rogers and what his mother told him: When bad things happen, she said, look for the helpers. They will always be there.

I riffed on that, telling my son that the world is, in fact, more good than bad, and that we live among people who are more good than bad. Each day, we encounter them: teachers and day care workers, cafeteria ladies and crossing guards, hospital workers on the night shift and firefighters, paramedics, physicians and nurses, pharmacists.

We live among people who feed the hungry, shelter the homeless, comfort the sad, and care for the sick and the dying. Our lives are touched by the imagination and creativity of people who explore the universe and the earth, who look for cures for disease and disability, who build our schools and homes and hospitals, who protect our borders. We are enriched by people who create art, literature, music, film, theater, and culture.

It is true that, as my son puts it, some people have dark hearts. Indeed, their dark hearts can make the world dangerous and frightening place. They people our nightmares as they disrupt and destroy lives. Some days, it seems, they out-maneuver us—they implement any number of weapons aimed to destroy, cripple, and overpower others.

Yet no matter how much they try to defeat us, we mostly end up still standing. We emerge from the dust and the dark, the bullets and the chaos, and we fashion our lives and move forward.

The dark-hearted ones may take over the headlines on CNN—but they cannot take over our thoughts and how we choose to live each day.

I did not say all of this to him. Instead, I held him closer, and told him the short version—that the world is mostly a good place and, for most of us, life is a rich experience. We have good days, and not-so-good days.

In the midst of learning to live with my own pain, I have focused on keeping up with work. I thought about a recent cab trip across town. It was a rainy day, and I complained about that to the cabbie.

“Any day you wake up is a good day!” he said. As we drove down Washington’s Pennsylvania Avenue, he told me about his life: conscripted in the Eritrean military at the age of 15, the war-time deaths of both of his parents, the war in which he himself was badly injured.

Through it all, he said, he remembered his father’s advice: If you are alive, it is a good day. It may be a challenging day, but there is no such thing as a bad day. As the cabbie put it, “Life is like a discotheque. You need to dance, no matter what music you hear.”

So that’s what I told my son: How important it will be as he grows up to dance—with and despite the music, to find a place within and around it.

Living afraid is no life, and worry gets us nowhere.

Posted originally, October 9, 2013, by

Image credit: ancagray on Etsy

Go, Diana, Go!

I had not thought about Diana Nyad for years, until a few weeks ago, when I woke to a morning full of Tweets and Facebook statuses, full of joyful for support for her long-dreamt of swim from Cuba to Florida. At 64, Nyad is on the leading edge of the wave of boomers, about to crash against their own old age on the shores of a health care system ill-prepared to meet them. And at 64, she is a marvel of endurance, fitness, confidence, and dreaming. Those two elements are not in opposition, but in tension.

In any case, her age was not what I thought of as I joined the happy twittering crowd, wishing I were one of the spectators wading into the waters off Key West, cheering and encouraging her with my presence. I have had some remotely similar experiences, the years I walked marathons to raise funds for charity: the random people who lined the streets and shouted their good wishes also pushed me forward with their good will.

The onlookers could not swim for her, but they could be present for her. And the electronic world was far, far from the hand-slapping monotony of endless miles of freestyle  and jellyfish—but that energy, surely surged around her.

When the first newscasts began to broadcast happy headlines: She did it! I thought about how her whole generation has done it, too.  They dreamt what they wanted to become, and they did: they wanted to be lawyers and doctors, surgeons, CEOS, political leaders, and more. They wanted to be wives, mothers, friends, sisters, and the multitude of other people life fashions women to become.

Like Nyad, so many were met along the way with commentaries about the absurdity of their dreams and their ambitions, the unlikely world in which they might come true.  Her generation keeps fanning those dreams: the first woman president might yet emerge from its ranks.

Nyad herself said it best, when she told one interviewer, “You’re never too old to chase your dreams.” Or too crazy, or too young, too feminine, too other. My own failed attempts at childhood athleticism were met too often by the scornful comment: You swing like a girl (or run, hit, jump or field). I was too young to reply with the obvious, “Well, I AM a girl.” Instead, I stopped those ambitions cold, became a fan, and not a participant. A few years ago, I could not resist giving my own athletic daughter a shirt that said, “You think I run like a girl? Catch me if you can.”

In the midst of my Nyad happiness, I remembered a poem that I wrote  years ago, when I might still have been seen as a girl. I was 18, a college freshman, and not keen on some writing assignment or other. I persuaded the professor to let me write a long poem instead, and from it came something called “Sixty-four Caprices for  a Long-Distance Swimmer.”  In subsequent years, the poem meandered its way through many publications and anthologies, including one that was marketed as the only poetry anthology ever reviewed by Sports Illustrated. My own favorite version appears in a text book, at home between Emily Dickinson and Walt Whitman.

It has been years since I looked at the poem, but the number ‘64’ struck me, and I googled the poem, hoping to find an electronic version that would spare my arthritic knees a journey upstairs to my book collection.

It appeared! Apparently, a Yale professor has used it in anthropology course. I emailed him, and he replied that he finds the poem a way to illustrate for his students the ways poetry can encapsulate their experience of sports and athleticism. I was thrilled to find the poem—Yale! I thought, as close as I’ll ever get.

Still, I was not eager to read the poem. That 18 year old poet would hardly recognize herself at 51. Where she observed and daydreamed and dared-out-loud, her older self has been too often cowed by the vicissitudes of life. Where nothing could hold her young self down,  too many things cow the old one. That 18-year old, who balked at writing papers, wound up with a degree in mathematics and a career in writing. At the time, many people questioned the reality of the math degree, thinking I was crazy to do something so hard, so burdensome, so real. I never doubted that I could—and once I did, I never looked back.

So I skimmed the poem, and found pieces to commend it. Mostly, I like that the young woman I was admired the older women who swam with me in the college pool. I did not fear them—although I often averted my eyes. More often, I was curious to see where I was likely headed: baby fat, sagging breasts, wrinkles everywhere. Now that I am older, I am grateful that, despite all appearances, my body remains in working order. It gets me where I’m going, and then some:

5. Seventy-year old women stand naked in the locker room.
Some use walkers, others have artificial hips, scarred legs
and missing breasts; still, they love this morning swim
with the distant sun rising.

6. In these women, I witness how I too will age. I avert my
eyes, move to far lanes and other shadows.

7. I swim past men to prove my strength–after years of
”throwing like a girl”; I lap them twice.

63. I’ve been here before and am anxious to leave. I am
young enough to have learned that all things are composed
of change.

64. I shed water’s silk cocoon for the certain embrace of air;
my body emerges from the pool, form from cut crystal.

To honor Diana Nyad, that afternoon, I went back to the gym, which I have avoided in the wake of chronic pain and discomfort. I spit in my googles as I did when I was a teenager on a swim team, because that prevents them fogging. I stuffed into my suit. I walked into that water, and I swam as fast as I ever did.  Somethings the body never forgets, and some dreams stay with us, always. Go, Diana, go! Thanks for taking us along.


key words: Diana Nyad, extreme sports, athleticism, dreaming



Creative Minds Needed: Barriers and Opportunities to Better Care of Frail Elders

Posted originally by Disruptive Women In Health Care, June 14th, 2012


Janice Lynch SchusterBy Janice Lynch Schuster. When I was majoring in math, I was often stymied by theoretical problems that asked me to imagine things I could not conceptualize. I’d turn to my professor, JR Boyd, for advice, and it was invariably the same: Go home, lie in bed, daydream.

I thought of JR’s advice this week as I read Jonah Lehrer‘s bestseller, Imagine: How Creativity Works. Among the book’s many neurological, psychological, and sociological observations is that creative people daydream—a lot. They daydream not mindlessly or purposelessly, but with attention and intent.

Creative work, Lehrer suggests, also requires engaging outsiders, drawing in people for whom a problem is not old hat, and who can bring to it new ideas, visions, and possibilities. He suggests that creativity also requires a steady interaction with others and with the world, a willingness to see and make connections to which others are seemingly blind or indifferent.

Lehrer’s observations have some implication for work we do to make a better world for an aging population.  It may take all of us daydreaming to create a society in which we are able to see, understand, and respond to the needs of increasingly old and frail people.

As it is, the current health care system is anything but. For our elders who run into it—and run into it they do, with scores of doctors’ appointments and prescriptions and hospitalizations each year—the system is too often fragmented, failing to meet their needs for daily support and care.

Millions of Boomers will enjoy a longer old age than has any previous generation, most living into their late 70s and beyond. As they have with every other lifestage, Boomers are likely to want the current system to change, and change fast, to accommodate them. It’s what they’ve always done, only this time, they really will be charting new territory. No other generation has ever lived in such numbers for so long. But Boomers will be shocked to discover that the system they encounter  is in no position to care for them. Instead, in its current configuration, it will leave many people impoverished, isolated, and ill. We do not have the kind of comprehensive social and medical services that could enable aging people, and their caregivers, to thrive, or to live through to the end of life with meaning and dignity.

Some forward-thinking organizations are working to change the course, and have set sail in many directions, trying to find a way that will work best for most of us. Among the many innovations underway, the Community-based Care Transitions Program (CCTP) funded by the Center for Medicare and Medicaid Services, is injecting half-a-billion dollars into communities that are trying to improve what happens as people move from one care setting or provider to another. These innovative programs encourage the usual health care players to go beyond their walls and boundaries, and to work with untapped but essential partners, specifically community-based organizations. The first thirty of these awards have been made, with more to come. All are committed to breaking out of their usual medical model, working across agencies and programs to find ways to help people as they move across care settings. In the course of their work, CCTP communities are likely to find new ways to interact and engage with one another. They have the opportunity to apply some of what Lehrer suggests is essential to problem solving and creative work—the chance to work with outsiders, to welcome new players, to find more effective ways to communicate with one another, to brainstorm, to be critical, and to daydream.

With any luck, their daydreaming will become the foundation for real improvements not only in the selected communities, but in others around the country. More and more, local communities and organizations are finding that they have the ideas and the passion to overcome long-standing barriers, and to see opportunities to improve the care system. These local efforts have a long way to go—but they are a start in the journey now to secure a better future (and end) for us all.


Key words: aging, caregiving, frail elders, creativity, problem solving