THE PLEASURES OF OLD AGE

“Old age has its pleasures, which, though different, are not less than the pleasures of youth.” W. Somerset Maugham.   

With maturity comes an ‘ease of being.’   It’s true, we don’t stay up until the wee hours of the morning (often) but we can still have a fabulous time and be in bed by midnight.  Recently, I went to Philadelphia for my cousin’s 80th birthday celebration.  It was three full days of partying — everyone had a blast!  Yes, bed time was earlier but the enjoyment the same.

Most Assisted Living Centers happy hour starts at 3:00pm!  Personally, I loved going to Dad’s Happy Hour . . . let the party begin!  Dad and his fellow residents also loved Happy Hour and still had time for a nap before 6:00pm supper!  

Another pleasure of old age is being able to play 18 holes of golf instead of a “quick 9”.  I remember when we were kids, Dad had Saturday golf every week — and he didn’t get home until after lunch.  That did not go over well with the Mother of his children.  After the children left, it was 9 holes with Mom once a week and 2 rounds of 18 holes weekly  . . . ahhh . .  the decadence!

Now, it’s the little things that give us much more pleasure; taking a grandchild to their first ballet or play, hearing the newest member of your family call you “Grandma” or “Nona”.  The family getting  together to celebrate a wedding or birthday  . . . all give us a chance to luxuriate in the foundation we have created for the generations to come.

And to those baby boomers reading this — remember, how you treat your loved ones is how you’ll be treated.  Paul said it best in his Epistle to the Galatians:  for whatsoever a man soweth, that shall he also reap.”

AGING ALONE? PREPLAN!

Teddy Roosevelt once said, “Old age is  like everything else.  To make a success of it you’ve got to start young.”   That is especially true if you plan to age alone, without the benefit of children or close family.    I am most likely going to age alone and I am preplanning for that.  You should too.

Today’s 80 is the new 70 and 70 the new 60.  Most of us don’t plan on giving up work, volunteering or travel until we’re well into our 70s or 80s.  I have friends who were volunteers at the Key Biscayne Tennis Tournament for over 20 years — the only reason they didn’t volunteer this year was because he became sick and couldn’t.  

As we grow older those of us aging alone have to make plans while we’re fully functional.  We have to discern what resources are available to us in whichever community we choose as our ‘last home’.  With today’s service industry and technology there is a huge advantage . . . there are healthy meal services (both for profit and non-profit), ride share and in many neighborhoods free ride services.  We also have medical care right here on the Island.  

But, as I state over and over again, it’s about preplanning.  You need to have a trusted friends or advisors who can be named as your Power of Attorney for Finance and Health. You need to decide now how to disperse your jewelry, money and tangible goods and write it down.  You should also plan to stay out of probate court.   

You also need to give your passwords for your bank, phone, computer and any other technological device you have, to trusted friends.  Sometimes the best thing to do is find a disinterested third party, such as elder care lawyer, and give it all to him or her.  Yes, you have to pay them but it’s a simple business transaction devoid of emotion.  You should also think of who is going to manage your health care from an insurance point of view so you’re not selling your tangible goods to pay for unwanted or unneeded health care.   You will need an advocate and that takes preplanning.

To review:  If you live alone now or believe that you will age alone without the benefit of family, now is the time to decide where to live, who to trust, who to choose as your beneficiaries and who to have as your Power of Attorney.  I strongly advise you consult with an elder care attorney for all the correct documentation and to have an advocate for you when you can no longer advocate for yourself. 

VIVE LA VIDA BUENA (LIVE THE GOOD LIFE)

From March 6 to April 8 of this year, I experienced five deaths of people I consider part of my life.  Two were wonderful  with whom who I had the pleasure of sharing some time and three were dear friends.  All were under the age of 75.  Only one of these deaths was from cancer — the other four were unexpected and left families and friends reeling.

There is, in my humble opinion, only one way to conquer death — live a good life. Perhaps my previous columns have been too obtuse  . . . so let me make it clear — you must preplan to age gracefully and comfortably.  We all have different needs and it is YOUR needs that must be met.  It seems that as we age we view ourselves as less relevant but are we really?

When people talk about living a good life they discuss “paying it forward”, or being kind to your neighbors, or creating world peace in your environment.  I’m pragmatic, therefore I view living a good life as being relevant and keeping my and body healthy.  How do we do that?  Easily, we plan.  Once we begin using medicare I suggest we begin to plan for our last years — which in today’s world is 80 to 100.  The longer you live, the longer you will live.  But, and its a big but, we want to live it well . . . and that means having to deal with the senior care/elder care bureaucracy.

I have a plethora of columns discussing how ‘institutions’ are obstacles not cheerleaders — why – because “seniors” are not valued and easy targets. The exact opposite is the real truth – we vote, we pay taxes, our children are the current workforce and we have experience.

To that end, how do we stay relevant?  It’s easy, preplan!   Whether you have parents or a partner who is older you have to discuss how to stay healthy, both mentally and physically.  Some of the mental health is dependent on financial health. What insurance policies are available?  How many financial accounts are there?   Does the home and financial accounts transfer without going through probate?   These are DIFFICULT! conversations but once done provide true peace of mind.

So, I urge you to look at the non-medical side of your life and begin to ask yourself, your partner or your parents the tough questions then find the solutions so that we can all “Vive La Vida Loca.”

To recap:

  • Are the financial instruments in order
  • Are the legal documents in order
  • Is your house “too much”, does it need de-cluttering or should you move
  • Are you, your partner/spouse or parents healthy

ARE YOU HAVING FUN?!?

LET’S DO THIS!

Elder Rage: How to Survive Caring for Aging Parents

We at Parent Your Parents think this is a terrific “true experience” article authored by Jacqueline Marcell.  Jacqueline is also the Author of Elder Rage @www.ElderRage.com.  Check it out!

 

Jacqueline Marcell, Author, Elder Rage www.ElderRage.com

For eleven years I pleaded with my challenging elderly father to allow a caregiver to help him with my ailing mother, but he always insisted on taking care of her himself. Every caregiver I hired soon sighed in exasperation, “Jacqueline, I just can’t work with your father. His temper is impossible to handle and he’s not going to accept help until he’s on his knees himself.”

When my father’s inability to continue to care for my mother nearly resulted in her death, I stepped in despite his loud protests. It was so heart-wrenching to have my once-adoring father be so loving one minute and then some trivial little thing would set him off and he’d call me nasty names and throw me out of the house. I took him to several doctors and even a psychiatrist, only to be flabbergasted that he could act charming and sane when he needed to.

Finally, I stumbled upon a thorough neurologist, specialized in dementia, who put my parents through a battery of blood, neurological, memory tests and PET scans. After ruling out numerous reversible forms of dementia such as B-12 and thyroid deficiency, and evaluating their many medications, he shocked me with a diagnosis of Stage One Alzheimer’s in both of my parents – something all their other doctors missed entirely.

What I’d been coping with was the beginning of Alzheimer’s, which begins intermittently and appears to come and go. I didn’t understand that my father was addicted and trapped in his own bad behavior of a lifetime of screaming and yelling to get his way, which was coming out now in intermittent over-the-top irrationality. I also didn’t understand that “demented does not mean dumb” (a concept not widely appreciated) and that he was still socially adjusted never to show his Mr. Hyde side to anyone outside the family. Conversely, my mother was as sweet and lovely as she’d always been.

Alzheimer’s makes up 60-80% of all dementias and there’s no stopping the progression nor is there yet a cure. However, if identified earlythere are some FDA approved medications (more in clinical trials) that in most patients can mask dementia symptoms and keep patients in the early independent stage longer.

Once my parents were treated for the Alzheimer’s, as well as the often-present depression in dementia patients, and then my father’s volatile aggression, I was able to optimize nutrition and fluids with much less resistance. I was also able to manage the constant rollercoaster of challenging behaviors. Instead of logic and reason, I learned to use distraction and redirection. I capitalized on their long-term memories and instead of arguing the facts, I lived in their realities of the moment. I learned to just go-with-the-flow and let the hurtful comments roll off while distracting with a topic of interest from a prepared list.

And most importantly, I was finally able to get my father to accept two wonderful live-in caregivers and not drive them crazy and to quit. Then with the tremendous benefit of Adult Day Health Care five days a week for my parents and a support group for me, everything finally started to fall into place.

Alzheimer’s disease afflicts more than 5.4 million Americans, but millions go undiagnosed for many years because early warning signs are chalked up to stress and a “normal” part of aging. Since 1 in 6 women and 1 in 11 men are afflicted by age 65, and nearly half by age 85, healthcare professionals of every specialty should know the 10 Warning Signs of Alzheimer’s and educate their patients so everyone can save time, pain, money, heartache… and a fortune in Kleenex!

NOT ALL HOSPICE IS CREATED EQUAL

What is Hospice?  First, it is a type of care and philosophy that focuses on the palliation of a chronically ill, terminally ill or seriously ill patient’s pain and symptoms, as well as attending to their emotional and spiritual needs.   OK – so what is palliation?  Palliation is a service that makes you feel better even though it can’t cure you.

Hospice is a positive addition to our medicare system because the focus is the patient.  The goal is to keep each patient as comfortable as possible.  This means additional care over what your loved one is already receiving. Between nurses, social workers and priests, there is someone there two to three times a week to make certain there is no pain or discomfort.

The other side of this service is that it is run by medicare.  That means that Hospice is free if you’re in Medicare as most of our seniors are.   This also means not all Hospice providers are the same.  There are thousands of Hospice providers and you have to be certain that they are doing their job (much like those Medicare doctors I’ve described in earlier articles).

I’ve had two different patients in different facilities with different providers and the difference was night and day.  One provider is in a nursing home that accepts medicaid patients, we’ll call it A for purposes of this article. The other provider was for a client who lived in an assisted living facility – one that cost $4500/month.  This Provider is called F.

A little background – once a patient has been admitted to Hospice, its doctors, nurses and aides “rule” the care.  If the patient is a diabetic he or she will still stay on diabetes medicine but perhaps be taken off non-essential medication depending on the comfort level. Yes, the facility still feeds and provides a clean environment  but Hospice is in charge of the patients comfort.

In most nursing homes the patients are in full blown dementia but not necessarily at the end of their life physically.  Therefore, it is much more difficult to qualify for Hospice in a nursing home.  However, once the patient is accepted the care for my nursing home client was beyond great.  Her nurse was Mark and I could call anytime to check on her (once the children had given their permission)

The other client was in an Assisted Living Facility and qualified for Hospice before the children asked.  They had no indication he was in his last days, weeks or months.  Once their loved one  become uncomfortable and disoriented they started receiving a “run around.”  Parent Your Parents was asked to intervene.  Here’s what we found, the Assisted Living Center blamed it on Hospice and Hospice blamed it on the Assisted Living Center.  We started calling the Hospice office daily to ask for more help. Hospice told the children that babysitters were needed (at $20/hour).  That is when we went into advocate mode.  I reminded the Hospice company that their job was comfort and they had to start providing real comfort, not advice to the children and Assisted Living Center’s employees!  Remember these companies make money and paying people to babysit takes away from their bottom line.  The end result, this Hospice company did what they advertised and found a bed in an extremely lovely location where the client passed away comfortably and peacefully.

Bottom line – not all Hospice is created equal.

NURSING HOMES – HOW TO FIND A GOOD ONE

I am confident most of you heard the news about the  fourteen seniors who died from overheating.  They were all in a licensed “nursing home” in Hollywood Hills.   ‘Nursing Home’ is a euphemism for a home for seniors who are at the poverty level and qualify for medicaid.

Nursing homes are like every other industry — they have to make money to survive.  In the case of nursing homes they’re paid by the state medicaid fund and it’s per patient.  This fund is made up of state and federal dollars.  Obama Care expanded medicaid in the states who took the federal dollars but Florida is not one of them.

Bottom line, these are not the luxurious environments for either staff or residents.  In my parents case, Mom had been in a lovely residential facility where she was one of three or four people.  Her Long Term Care Insurance paid for it.  She outlived her two year policy and we had to place her in a Nursing Home.  It was our only realistic option as Mom’s care in an Alzheimer’s facility would be close to $7000,00 a month.  Mom and Dad couldn’t afford it and neither could the children.

In pursuit of the best we could find, I  went to several nursing homes and learned more than I needed to know.  All these homes are very austere and it’s a shock!  Bare floors, usually  a formica, and waiting rooms with plastic chairs.  Almost all the receptionists were behind a barrier — some better designed than others.

The patient population is made up of mostly Alzheimers and Dementia sufferers.  All the residents are in a wheel chair, a portable bed or never moved from their beds.

Another surprise, the aides often use pulleys attached to patients to change their clothes, move them to the shower or simply change their diapers.  Depending on the home, these medical aides must change and clean about 19 patients each.  Some work in tandem others work solo — it all depends on the chore.

Further, most patients are only bathed twice a week, maximum three times a week.  During one of these showers their hair is washed.  Bottom line, it’s not how we envision our last days, weeks, months or years of life.

On the good side, the ‘better nursing homes’ have excellent care.  They hire a team of Geriatric Doctors that include Psychiatrists.  These Geriatric groups come to the Nursing Home through a PPO and the doctors physically visit once a month.  There is usually a Podiatrist group that also visits once a month (Medicare pays for podiatry services) and a dentist who comes once a quarter. The day to day care is with the Registered Nurses (RNs), Licensed Professional Nurses (LPNs), physical therapists and medical technicians.  They also have a contracted Hospice service.

Here are some tips when you need to look for a nursing home:

What is the turn-over rate of its employees

Needless to say, the less turnover the better the place.  If the staff is not leaving then something is going well — usually their paid above average wages

Is there a hair salon

If there is a hair salon then there’s a market for it.  This means the residents take pride in how they look.  People who take pride in themselves care about their environment.

Is it clean

As we all know, cleanliness is godliness

Is there a smell

Again, if it smells that means it’s really not clean – no matter how good it looks

Is there a smile on the faces of the staff

A smiling staff means a happy staff

Again, hopefully it doesn’t come to this but if it does, know how to choose the best one.

The Expected is Still Unexpected

On July 28th, at 1:00 am in the morning my phone rang, it was the hospice nurse informing me that Mom had died at 12:28 a

Mom and her skydiving team – Frances, Jeff and Elizabeth

And yes, our hospice nurse had prepared us for this  . . . he said as nicely as he could that she was “leaving”, that “it was time”  . . . using gentle words to describe death.  Still, when the call came early Friday morning I wasn’t’t “prepared.”  Why?  Because no one ever is.

As you know if you’ve been reading my columns, the family had done all we could to prepare for death.  So the lesson learned was PREPLAN.  My brother and I had  hired a funeral home which allowed us to make our father the focus of our lives in the the immediate days after his partner of 63 years died. He insisted on seeing her one last time, my brother called the funeral home and they prepared her for Dad’s visit.  My father insisted on a small, familial memorial service — not a problem, we focused on the service and the reception after.  Caterers were hired, programs were printed and music abounded.

And yes, all this costs money but there was no “guilt money”.  We knew what we could spend and had done all the budgeting when hiring our funeral home.  In fact, we told the director that when Dad dies he wants his ashes placed in a military cemetery in Ft. Worth, TX – next to one of his best friends, our cousin General Akin,  “so they can pal around.”  The funeral home takes care of that, as well.

So, yes it all worked to our benefit.  Mom was cremated, some of her ashes placed in the ground at the nearby churchyard and the rest to be mixed with Dad’s when we take them to their final resting place.  What doesn’t go away, nor should it, is the grief.  it comes in waves.  At the service when I spoke I didn’t shed a tear.  Two days later, telling a ‘stranger’ the story, my eyes welled with tears.

Grief counselors tell you this is what happens.  I was shocked at myself, I knew Mom was close to death but when the finality happens it hits hard!  We even had time for last rites, last songs, last moments  . . . but death is final and no amount of preparation prepares you for it.

Revel in the memories, think of the good times and admire your loved ones for all they accomplished  . . . including you!  Yes, they do live on in our hearts.

Nursing Homes – Often the End Game

I am confident most of you heard the news about the eight seniors who died from overheating.  They were all in a licensed “nursing home” in Hollywood Hills.   ‘Nursing Home’ is a euphemism for a home for seniors who are at the poverty level and qualify for medicaid.

Nursing homes are like every other industry — they have to make money to survive.  In the case of nursing homes they’re paid by the state medicaid fund and it’s per pa

The nursing home visit

tient.  This fund is made up of state and federal dollars.  Obama Care expanded medicaid in the states who took the federal dollars but Florida is not one of them.

Bottom line, these are not the luxurious environments for either staff or residents.  In my parents case, Mom had been in a lovely residential facility where she was one of three or four people.  Her Long Term Care Insurance paid for it.  She outlived her two year policy and we had to place her in a Nursing Home.  It was our only realistic option as Mom’s care in an Alzheimer’s facility would be close to $7000,00 a month.  Mom and Dad couldn’t afford it and neither could the children.

In pursuit of the best we could find, I  went to several nursing homes and learned more than I needed to know.  All these homes are very austere and it’s a shock!  Bare floors, usually

formica, and waiting rooms with plastic chairs.  Almost all the receptionists were behind a barrier — some better designed than others.

The patient population is made up of mostly Alzheimers and Dementia sufferers.  All the residents are in a wheel chair, a portable bed or never moved from their beds.

Another surprise, the aides often use pulleys attached to patients to change their clothes, move them to the shower or simply change their diapers.  Depending on the home, these medical aides must change and clean about 19 patients each.  Some work in tandem others work solo — it all depends on the chore.

Further, most patients are only bathed twice a week, maximum three times a week.  During one of these showers their hair is washed.  Bottom line, it’s not how we envision our last days, weeks, months or years of life.

On the good side, the ‘better nursing homes’ have excellent care.  They hire a team of Geriatric Doctors that include Psychiatrists.  These Geriatric groups come to the Nursing Home through a PPO and the doctors physically visit once a month.  There is usually a Podiatrist group that also visits once a month (Medicare pays for podiatry services) and a dentist who comes once a quarter. The day to day care is with the Registered Nurses (RNs), Licensed Professional Nurses (LPNs), physical therapists and medical technicians.  They also have a contracted Hospice service.

Here are some tips when you need to look for a nursing home:

What is the turn-over rate of its employees

Needless to say, the less turnover the better the place.  If the staff is not leaving then something is going well — usually their paid above average wages

Is there a hair salon

If there is a hair salon then there’s a market for it.  This means the residents take pride in how they look.  People who take pride in themselves care about their environment.

Is it clean

As we all know, cleanliness is godliness

Is there a smell

Again, if it smells that means it’s really not clean – no matter how good it looks

Is there a smile on the faces of the staff

A smiling staff means a happy staff

Again, hopefully it doesn’t come to this but if it does, know how to choose the best one.

LAST RITES OR LAST RIGHTS?

My nephew was getting married — everyone in our family was thrilled — we love his wife, love him and love that they found each other.  The wedding was in Texas — Mom and Dad live in Atlanta.  Mom is extremely ill and cannot travel.  Dad had just gotten out of the hospital and we could not travel.  Our big fear — what if one died the weekend of the wedding? 

My brother and I called several funeral homes to discuss options.  We also consulted friends and my brother’s priest. During the course of this journey we discovered that family owned, multi generational funeral homes tend to be more gentle and understanding.  They listen to what you want and explain what you need.  There are several here in Miami — the oldest is Van Orsdel who took care of Eddie Rickenbacher and Marjorie Stoneman Douglas.

Most of us hate the idea of ‘visiting the funeral home.’  The idea of death and its finality brings discomfort.  In this particular case Mom and Dad are both alive and we were there for selfish reasons – not wanting a wedding interrupted by death.  Yet, as I write this, it was the smartest decision we ever made (more on that later).

There is nothing INEXPENSIVE  about the simplest of funerals.  The entire “funeral experience” has changed.  It used to be 30% of the deceased were cremated and 70% buried.  Today it’s the opposite, The average cremation costs in Miami are $2000.  Then you need an ash container (beginning at $100.).  Caskets range from $3000 up and add to that the burial plot, the actual burial and the memorial service  . . . bare bones cost is about $6000.00.   And then there’s the celebration of life . . . shiva  . . . wake . . . which, arguably is the most important part of this process.

The first decision is the manner of ‘the goodbye’ – cremation or a burial?  This brings me to insurance policies for burials.  There are policies that cost from $50.00 to $100.00 a month which will pay out enough to cover the cost of  the funeral and burial.  It’s all a question of how much you want to pay.  I know many of us on Key Biscayne think we have the money to bury a loved one but do you really have $7,000 to $15,000 sitting around for a burial?

Once that decision is made, it’s time for the legalities.  Each state is different but all require notarized signatures.  An example – although I am my Mother’s Power of Attorney (POA) for everything, my father had to sign the document allowing her cremation.  However, Dad is not the person who signs for his own cremation — that was my brother and me as mother is non compos mentis (not of right mind).

Lastly, the choice of the receptacle or casket – another big financial hit – or not, depending on what you choose.   Today, many funeral homes offer rental caskets (a variety of pricing) for the memorial/viewing or church service of the family member who will be cremated.  A new trend is  “cremation viewing”  . . . in other words you can watch your loved one enter the cremator. 

My brother and I went through this entire experience together.  My advice — do not do this alone — no matter how lovely the people at the home there is an emotional toll.  Having another person with you is calming. 

We now have everything in place so when “it” happens we will not be making decisions with heavy hearts or guilty minds.  And,  the icing on the cake – my Father asked me what arrangements we had made. I  asked him if he wanted to hear what we had in mind and he said yes.  I told him that he and Mom will be cremated and after both have died (and I used that word) we were flying their ashes to Ft. Worth, Texas (Dad’s a Texas boy).  There we will do a memorial service at their church and a party at Riviera Country Club.  Dad loved the idea!   Rites and Rights – done! 

THE BEGINNING OF THE END, HOSPICE CARE

Well, the call finally came, “Ms. Reaves, we’d like to re-evaluate your Mother.  She has lost more of her core function and we think she might be a candidate for Hospice care.”

Here’s the thing, dear reader,  I thought Mom was already a candidate for hospice but she wasn’t’ approved the first time she was evaluated.  Now, she is approved and I realize — this could be the end.  My emotions are mixed.  I’m sad one minute then remember her non-existent quality of life and I know it’s appropriate and its time.

The wonderful thing about Hospice care is that the focus is the patient.  The goal is to keep her or him as comfortable as possible.  This means that besides the care Mom is already receiving there will be someone there two to three times a week to make certain she has no pain and is comfortable.

What is Hospice?  I had to ask myself that question and found several definitions.  First, it is a type of care and philosophy that focuses on the palliation of a chronically ill, terminally ill or seriously ill patient’s pain and symptoms, as well as attending to their emotional and spiritual needs.   OK – so what is palliation?  Palliation is a service that makes you feel better even though it can’t cure you.

The term “Hospice” comes from the 11th century where hospitals had an area that  was “hospitality for the sick, wounded or dying”.  In today’s medical and insurance world, it is palliative care for the incurably ill, either in a medical facility, nursing home or at home.  Medicare covers it therefore if you’re a US Citizen or Green Card holder you are eligible.

To qualify for Hospice the patient is evaluated by a doctor or nurse practitioner and he prognosis must be that the person is terminally ill and has less than six months to live.  The truth is many hospice patients live longer than six months at which time they are re-evaluated.  If placed in Hospice again, the six months starts over.

In today’s medical world, (and we know I’m a bit cynical) there is both Hospice care and Palliative care.  Hospice is covered by Medicare, Palliative care is not.  It is often covered by insurance (if you have a PPO) or you can pay out of pocket.  In both cases, the patient is going to die in the “short term” — but it might be more than six months.

This is VERY IMPORTANT:  once your family member goes into Hospice or Palliative Care it means that there are NO MORE CURES. The caretakers want the patient pain free, and supported both emotionally and mentally.

If your parent or grandparent is in an Assisted Living Facility and begins a decline, the Facility prefers them to be in Hospice or Palliative Care.  This means your family member will be receiving more attention but that also means their regular doctor is not in charge anymore.  It’s also a signal that death is not far away – a sobering moment for you and your loved one.