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. 

RETHINKING THE “I’M OLD” MYTH

Now that I’m a senior advocate and activist, I find that many things that used to be funny are now insulting.  Recently, Julie Andrews did a performance to benefit AARP at Radio City Music Hall. It was her 79th birthday.  To be funny she rewrote the words to “My Favorite Things”, here is one of the four verses: “Cadillacs and cataracts, hearing aids and glasses, Polident and Fixodent and false teeth in glasses, Pacemakers, golf carts and porches with swings  . . . these are a few of my favorite things”

Is this funny?  Not to me.  Yet, she received a four minute standing ovation and several encore requests.  Apparently, I’m in the minority.  However, I think the truth lies in the difference between the Greatest Generation and the Baby Boomers.  Ms. Andrews is part of the Greatest Generation and I suspect her audience was, as well.

First, Cadillacs are no longer and “old peoples car”, secondly cataracts now mean that if you have them and remove them — there is a lens placed in your eye so you no longer need glasses!  Hearing aids?  I’m confident that one day I might need them and with any luck Bose will have them for $500 instead of $5000.  I don’t need Polident or Fixodent and neither did my Mother and she was 88 when she died.  If you go to my dentist, Dr. Friedman. you won’t need them either!

More importantly, let’s think of how lucky we are!  In today’s world of we know how to fix things – falling thighs, exercise!  Cataracts — Medicare pays to have them removed and new lens inserted which means no more glasses! (Or at a a minimum, only for reading tiny print.)  For our teeth, we have implants!  And, if you want to tuck in the chin, eyes, tummy, face —- well, there is my doctor, John Martin and Mike Kelly.  Both are Key Biscayne residents and Dr. Kelly has a column in this paper. 

Bottom line – yes, growing older takes its toll but in todays world we can fight against it.  We’re all aware of exercise and diet.  We know if we simply walk 3 or 4 times a week we live longer,  And, yes, fried foods are a guilty pleasure  . . . which, from time to time we should indulge!  But, for the most part, let’s celebrate those lines  . . . and, if you don’t like them — get rid of them.

GROW OLD OR PURSUE YOUR DREAM?

Gabriel García Márquez states it beautifully, “It is not true that people stop pursuing their dreams because they grow old, they grow old because they stop pursuing their dreams.”   When Dad turned 90 I realized 60 was young (and I wasn’t quite there yet).  Think about it, the first 30 years, you’re finding your way, the next 30 years you’re working your way and I say, use the last 30+ years to do it your way!   

The mindset of the Greatest Generation was to work until you’re 65, retire, receive medicare and social security.  I remember, Dad did that and within a year he was bored out of his mind and partnered with a good friend in a small exploration business.   That kept him busy until he was about 80.  Then he started volunteering at a church-run thrift shop weekly — he quit that when Mom got sick and she became his full time job.  

As I enter my 60s I’m launching a company,  working my consulting job and writing articles.  I love the deadlines and the intellectual stimulation.  I think we all do.  That makes me think it really is up to us to stimulate our minds in ways that make sense for each of us individually.  At the age of 77 Donna Shalala is running for Congress, at the age of 81 Madeline Albright is on tour for her latest book and at 93 Jimmy Carter is still relevant!  Yes, they’ve chosen a national platform but being relevant in a smaller community is no less satisfying.

With today’s technology and car-ride services there is no excuse to stay at home if you want to get out.  And, if you get out, you’re more relevant.  I know an octogenarian amateur playwright (soon we’ll be seeing one of his summer shorts!), and several septegenerian Starbucks employees.  All are happy and “pursuing their dreams.”   Let’s join them!

Medicare Supplement Insurance . . . It Can Be Tricky

George, an 85 year old, was surprised when he received a $4000 bill for his pacemaker replacement procedure, after he was told that it would cost him $250.   He’d called his Medicare Advantage plan before the procedure and was told that he would be responsible for a $250 inpatient hospital co-pay.  Unfortunately, the hospital and the doctor’s office did not tell him that his procedure would be done as an outpatient with an overnight stay.  He stayed overnight but since he was never an inpatient, the bill was applied to his $6500 deductible for outpatient services.  

It’s a constant refrain!  You’re a senior, on medicare, you do everything you’re told but somehow you still owe $4000.  Again – these insurance companies DO NOT WATCH OUT FOR SENIORS and make the simplest of “medical procedures” complicated on the non-medical side.  A simple medical procedure mixed with insurance is like a game with no rules.  It doesn’t matter what plan you choose, there is still many a “slip between cup and lip”.  No other industry in the U.S. is allowed to operate this way.  It’s illegal!

This is especially true if you have a Medicare Advantage plan. These plans are less expensive than regular Medicare with a supplement for a reason.  They may add extra benefits, but they are often more complicated to understand. So what do you need to do to avoid surprises or issues? Plan ahead, ask a lot of questions and advocate for yourself, your partner, your family members or call Parent Your parents.  We can do it for you. 

Parent Your Parents is pleased and proud to announce the advent of Ann McGuire, R.N. to our growing group of experts.  Besides being a RN she is also a certified case manager and knows the pitfalls of senior insurance issues.  Please go to our website, ParentYourParents.com to see her photo and biography.  She and I will be collaborating on more articles to assist you with getting through the insurance maze  . . . little things like what to do if you’re sent to the emergency room.

Bottom line:  remember – insurance when going to a clinic or hospital for any procedure can be very tricky.  It’s not because the doctor wants to charge you more, it’s because of the intricacies of how Medicare Advantage plans work.  

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!

FLORIDA ADDS MORE MONEY FOR SENIOR CARE

As we all now know, after Hurricane  Irma fourteen elderly souls died because the nursing home in which they resided did not have a electricity after the storm.  As a consequence, they “overheated” and died.  Well, there is good news – the Florida Legislature and Governor have placed $37.1 billion dollars in this year’s fiscal budget to be used across six health care and social service agencies.

Florida’s medicaid program is the largest recipient at $29.2 billion and Children & Family Services receive $1.7 billion.  Those living in nursing homes will receive a 25% raise, from $105/m to $130/m. Nursing homes are now required to have generators with enough fuel to cool buildings during elongated power outages. The above monies are all coming from Florida taxpayers but my favorite part of the legislation is not tax based.

Starting this fiscal year, nursing homes (that receive medicaid dollars) will be paid on a set formula.  These providers must meet certain “direct patient-care” requirements as well as “quality of care” requirements.  In other words, if a nursing home only meets a minimum standard, they will be paid a minimum amount and given a set amount of time in which to bring the ‘home’ up to the formulaic standard.  As the homes hire more qualified staff and add amenities to its building and programs – they will receive larger payments.  As one law maker put it, they have to spend money, to make money.

As a senior’s advocate I’m thrilled that our state government realized how badly these “homes” were treating their patients.  Yet, it took senseless deaths to have a focus placed on how our greatest generation and aging or ailing baby boomers are treated when they can no longer treat themselves.  That is where we must be more vigilant.

As I write this, I cannot help but remember the 17 people who died very prematurely at Parkland High School.  And, yes, because of the deaths and the student’s activism we’ve put in some stricter state gun regulations.  Also many large gun sellers are now refusing to sell to anyone under 21.  Still, much like our senior citizens, why must it takes death to examine our mores and ethics.

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!

SENIORS SHOULD NEVER SUFFER . . . BUT THEY DO

This is an editorial to the Miami Herald written by H. Frances Reaves, Esq., President of Parent Your Parents,  in October of 2017.  This was written after Hurricane Harvey and Irma and the mirror placed on Senior Services. As we suffer through a very cold winter these words are still prophetic.

IF YOU HAVEN’T SEEN the video of the residents of a nursing home in Houston, Texas sitting in waist high water simply search “video of seniors in waist high water” in your browser – the You Tube video comes right up.   School children were evacuated, families were evacuated and who was left behind  . . . seniors.  Two weeks later, in the aftermath of Irma, 14 seniors die from overheating in a Broward County Nursing Home.

If these seniors had been children the outcry would have been much louder and punishment swifter.  An excellent example is the most recent earthquake in Mexico.  The school caved in on top of 24 children and four adults.  The volunteer rescuers were there within minutes and the TV crews transmitted  the entire search and rescue for more than three days.  That would not be the case if this had been a senior citizens facility.

Fariola Santiago wrote in her September 24th column that “the elderly are like children, frail, unable to care for themselves, and vulnerable to abuse and negligence.  Those who don’t have money or advocates and require round-the-clock care end up in places with deplorable conditions  . . .”  I agree with Ms. Santiago regarding the elderly but disagree that all nursing homes have deplorable conditions.  We also need to remember that, with the exception of one “lonely soul,” everyone had a family  . . . and the family did not take them from the ‘deplorable home’ even after they knew about the power failure.

Baby Boomers, Gen Xers and Millennials beware — you, too will be a senior!  Seniors, are an older version of who we are today. We espouse the sentiment that, “I only want to live a long life if I have a quality of life” but legally we don’t have a choice once our mind collapses.

What we don’t discuss is that dementia does not take away your intellect, mental pain or physical pain.  Dementia takes away the ability to communicate effectively.  It also absconds with your memory – which allows we the children to believe that with memory loss there is a loss of all senses.  That is not the case.  The 14 elders who died felt pain and the first to die truly suffered because they did not have the benefit of hospice care.

No doubt, the staff at this nefarious nursing home was negligent, incompetent and uncaring and they were allowed to function as “caretakers” for years.  It took a hurricane and power outage to bring it to light. Had this been a daycare center the negligence would not have been allowed to continue.

As the President of a company who advocates for seniors, finds resources, counsels families and assists in medicaid preparations, my experience shows that most of us face living in a medicaid facility.  Unless you have a healthy pension or half a million dollars you will not have the money for dementia care in a private facility.  Today that runs between six to seven thousand dollars a month.  If you qualify for medicaid, nursing homes run about $700.00 and  medicaid picking up the balance.

We must look in the mirror!  let’s begin the process of treating our elderly loved ones as our children.  Treat them as you treat those around you.  Hold the Assisted Living Centers and Medicaid Facilities accountable and — START SAVING!!

 

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.