Tag: Assisted living

General interest
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What to do about Mom?

by Fran Johns

My friend Joan is distressed about her mother.   Joan – that’s an alias, we both value her privacy – lives quite near her parents, visits regularly, helps out with finances, health issues and everyday needs. They are in their late eighties. Other siblings live in other states. Until recently everything was fine; now the parents are in separate areas of their assisted living residence, Joan’s mother is in frequent despair and need. What’s a daughter to do?

This story is being repeated thousands of times every day across the country. Only this story has a peculiar twist: Joan’s parents did everything right. They lived frugally, planned ahead, raised their children to be successful and independent, moved early into a retirement community which offers care through illnesses minor and terminal. With Joan’s help they kept their affairs in order, including updated advance directives. (You don’t have your advance directives done? Horrors. Let me know and I will be at your door, cyberspacially speaking, to walk you through them immediately.) Joan’s parents were among early advocates for advance planning and end-of-life choice.

Joan comments: “Frankly, Mother is tired of being alive.  She’s not depressed, just ‘finished’, especially as she sees these slow declines in her quality of life as a steady and inevitable progression.  Her greatest desire would be to have a massive stroke and not survive.  But then her greatest nightmare would be to have a stroke and live . . . Even with the best advanced directives reflecting her choices, that’s a fine line to navigate.”

The moral of this story is that no amount of planning and preparation can guarantee the kinds of last months and years we might want. My own mother died peacefully at home, followed 20 years later by my father, same story. But that was in 1967 and 1987, in the small town of Ashland, Virginia where they had lived since 1939. The town looked after them; their out-of-state daughters merely visited and counted their blessings. Towns and neighborhoods like Ashland are in diminishing supply.

But all is not gloom and doom; this writer is constitutionally unable to write doom and gloom. Joan is at least clear about her parents’ wishes, and her parents have good care plus all allowable precautions: DNR orders, POLST forms, understandings with their medical professionals. Most of these are possible for today’s Boomers and their Beyonder parents; if you can’t find them I’ll happily tell you how. Joan’s parents are also in housing of their choice. And those choices are many: co-housing, retirement communities, assisted living facilities, many of them available to middle and low income Americans. Anyone over 50 who thinks he or she should postpone considering all of these issues, documents and choices until next year is delusional. Essays re housing choices have appeared in earlier Boomers and Beyond posts; others will follow. The secondary moral of this story is that without planning, late years can quickly turn into hell for elderly parents and adult children alike.

What we don’t have, of course, is health care such as Joan’s parents still enjoy for others who need it. The thing is, we can.

General interest
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Brain Fitness: The New Best Thing

by Fran Johns

At a program on Assistive Technology for Seniors sponsored by the Commonwealth Club of California yesterday, four panelists at least one generation away from 50 themselves discussed the technological wonders being perfected by their contemporaries for the likes of boomers and beyonders. (Devices that tell your children across the country how many times you open the refrigerator; nifty machines to compute and address your every need…) But for some of us, the handsome twenty-something geek talking about brain fitness made the most newly-revealed sense. OK, maybe he’s 30-something, but not very something if so.

“Exercising your brain in very specific ways,” said Eric Mann, Vice President of Marketing for Posit Science, ” will be recognized within the years ahead as just as important as cardiovascular exercise.” The brain is not an organ condemned to progressive deterioration, he explained, but something evolving every day. Pointing out that mind and body are the two assets with which everyone comes equipped, Mann urged his largely gray-haired audience to understand that both need to be maximized through ongoing exercise.

To that end, his company has thus far created programs titled Brain Fitness, DriveSharp (brain/foot/hand fitness?) and InSight.

The program went back and forth between those sorts of brain-governed assists for our rapidly aging population — the percentage of Americans over 65 increases every day — to the computer-assisted living which is coming, ready-or-not, onto the scene. In what would surely have been proclaimed la-la land a decade or two ago, assistive technologies at one’s fingertips already include personal emergency response systems (esthetically improved over the “Help! I’ve fallen and I can’t get up!” necklace, cell phones with a button that alerts your five first choices), medication management systems (electronic pillboxes that do everything but pop the right dosage into your mouth) and senior-friendly e-mail options for the internet-averse.

The thought of all that technological wonder was enough to induce brain-weariness in some audience members who occasionally wish they had the “Number, please” telephone lady back. But because such an attitude might fall into a category Mr. Mann referenced in passing as  “maladaptive compensatory behavior,” most went home willing to hear it all as good news. And to ramp up the exercising of their brains.

More on those technological wonders in a following blog.

General interest/Health/Money
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Affordable Health Reform

by Fran Johns

It was actually spoken out loud on NewsHour Friday night: we could have a workable, affordable healthcare system if we would address the excessive costs that go into the last six months of life, particularly the last few days. The remark was immediately followed by the standard caveat: of course, no one is going to suggest doing this.

Good grief, why not? Everybody knows it, a few others have even said it out loud. Sure, it’s political suicide, but if someone were ever brave enough to fall on that particular sword there would be a lot of people around to pull out the sword, cleanse the wound and stand him or her back upright.

It could be done. If individual choice were encouraged and enabled. If physicians had to be honest about the quality of life (if any, usually for a few days or weeks) being bought with aggressive treatment at life’s end. If futile treatment were avoided. If protections were put in place for physicians and hospitals complying with the above, since fear of lawsuit is behind most of the mess. If all of us began to look at — and make clear — what extreme measures we would or would not want.

Big ifs. But the reward would be a workable, affordable system.

General interest
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More on the Housing Choices Dilemma

by Fran Johns

This week’s earlier post about the multiplicity of housing choices for the post-Boomers (and often Boomers ready to downsize or make other shifts) touched on just a few of the possibilities out there. The staying put option is one that many, including my friend Berta whose current consideration of home changes was cited, would choose. The question is addressed at some good length in today’s New York Times:

Stay put or sell?

That’s the question many older people ponder as they move into their 70s and beyond.

Most older people settle on staying put, according to a recent survey by the Home Safety Council, a nonprofit organization dedicated to preventing home-related injuries. (From the source of the survey, you can see where this column is heading, right?)

Staying put makes economic sense. It is not only more comfortable to live out your life in your own home, it’s much more affordable.

Those posh retirement condos and assisted-living facilities might seem easy-living and attractive, but crunching their numbers can take the shine off their attraction fast.

The average annual fee at an assisted-living facility — a place where older people live independently but also receive a host of services like medication monitoring and meals — is $34,000. And in the nation’s most expensive metropolitan areas, including New York, the costs may be closer to $70,000.

The Times article goes on to cite the case of octogenarian Catherine Fisher, who chose to adapt her New Jersey home to her own needs rather than take those needs elsewhere. Sooner or later, countless Americans will face similar choices.  Guidelines to what is becoming “an entire service industry… taking shape around the goal of letting people age in place” are worth a quick study now, for whenever “later” comes.

via Patient Money – Cost-Effective Ways to Make Homes Safer for Older People – NYTimes.com.

Health/Money
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The Joys (and Angst) of Housing Choices

by Fran Johns
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What is it about the term “adult living” that seems so, well, one-foot-in-the-grave to me? Being surely one foot in the grave myself, if one chooses to look at actuarial tables which I do not, you’d think my opinionated mind might be pried slightly more open.

It’s a dilemma. Not whether one is polite and knowledgeable about adult living communities urban or suburban, but how to differentiate — and ultimately make choices among — the often bewildering assortment of housing communities and choices targeting everyone over 50 (and increasingly even below.)

I gave a talk at Rossmoor earlier today, a serene and bucolic adult living/retirement community about 25 miles and 40 degrees from San Francisco. This is no lie; it was 58 in the fog when I left home, 98 in the sun when I arrived. Rossmoor is full of recreational amenities: golf and tennis, choirs and bridge clubs and book groups. You cannot live there unless you are (or are formally attached to someone who is) 55 or older, and if you’re 18 or under you can’t hang around for more than 3 weeks. Rossmoor has its own mildly bewildering housing choices: congregate living, condos, co-ops and big houses on lush lots. It is ranked among the top such senior adult communities in the country and they are everywhere.

Add to these the growing varieties of aging-in-place groups (think Beacon Hill Village in Boston) and the truly bewildering assortment of assisted living facilities. The latter include simple rentals, detached cottages and elegant high rises; you can pay fixed or varying fees, or you can turn over your total estate (if it’s a large one) in return for a promise that you’ll be cared for in style throughout whatever infirmity or affliction arises and unto the grave.

Our friend Berta, widowed not many years ago, made the (possible) mistake of mentioning to her children that the responsibilities of maintaining her tidy, comfortable home were becoming onerous at times. This set off a frenzy of activity among her very active progeny, 3/4 of whom live in far-flung states. In addition to tackling the task of clearing out (“I had to grab a few things I wanted that were about to get thrown away…”) they came up with an assortment of possibilities for the mother whose comfort and well being they value above all else: condos and co-ops and a variety of retirement homes near their own homes, most at price tags more than daunting to someone who grew up in the Depression. Berta hopes to stay put. Most of us do, many of us can’t, and there’s the rub.

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