Author: Fran Johns

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.

Money
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Who In The World Falls For These Scams?

by Fran Johns

I just received a fascinating e-mail from Mr. Michael Jones, who addressed me as his Dear Friend, and identified himself as director of his “bank here in the UK.” Mr. Jones was eager to share 30% of the nine million eight hundred pound windfall he had just uncovered… you can fill in the rest. What impressed me the most with Mr. Jones’ kind letter was the fact that there were at least one or two grammatical, spelling or otherwise glaring errors per sentence. I mean, don’t these guys know about Spellcheck?

The whole thing was ridiculous enough for me to want to RSVP, but I resisted that temptation. I simultaneously wanted to Do Something, but my husband assured me the old Nigerian e-mail scam is bigger than I am and it’s not likely I will be able to stop it.

Do people really fall for these things? It must happen. Somebody, I also presume, buys mortgages from telemarketers or they wouldn’t call me up 15 times a day. However, surfing around for more on Mr. Jones and his colleagues I was happy to discover a website that is way ahead of me:

Nigerian scam artists have wised up to the fact that many of us no longer get taken in by the Nigerian email scam from phony government or bank officials offering to split multi-million dollar fortunes or inheritances, or Nigerian scams involving forged overpayment checks that require us to send untraceable money-wires back to them.

So, they’ve developed new ways to try to convince us that their money-grubbing cons are really genuine.

New variations of the so-called Nigerian 419 scam (named for the section of the Nigerian constitution that deals with this crime) appear almost weekly.

Some of them are pretty clever. But with the right degree of healthy skepticism, you can still see through them.

We’ve got the low-down on three new tricks (or variations of existing Nigerian scams) to help you spot them.

1.

After bogus checks, prepare for forged cash.

Those checks that came with letters telling us we’d won a lottery or had been selected to become mystery shoppers are so yesterday.

Today’s Nigerian scammers try to convince us with the “real” thing — $100 bills.

In a new trick, seen for the first time in Kansas in April this year, a scammer sent $3,000 worth of forged bills to a man and asked him to use it to buy a Moneygram.

The victim had been corresponding by email supposedly with a woman in Nigeria. He received the “cash” from a person claiming to be the woman’s uncle, who asked him to send the Moneygram to her so she could come to the US.

He fell for it, but the forgery was spotted at the Moneygram office.

A few days later, a Nevada man tried the same thing, after receiving $3,000 of forged notes. He was told he could keep $500 and tried to buy a $2,500 Moneygram with the remainder.

Action: Watch out for more of these tricks in the coming months. Bluntly, never send Moneygrams on behalf of someone you don’t know, whether you receive cash or a check.

I’m glad to know there’s somebody out there watching. I think I’ll pass on Mr. Jones’ offer.

via 8 Cunning New Nigerian Scams Aim to Convince You They’re Real.

General interest
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Grassroots Healthcare Reform

by Fran Johns

If we get a health reform bill, it may be thanks in part to a push from the ground up. That belief is leading to a variety of grassroots support endeavors.

At a hospital-sponsored town hall meeting on the issue this week in San Francisco attendees were invited to take the microphone to tell their stories. Probably a bad idea at any meeting, since such an invitation guarantees off-point rambles and rages and this one certainly proved the point — but there were enough horror stories to assure everyone that our current non-system is a train wreck.

A cardboard cut-out of President Obama stood at the back of the room (there was a lot of photo-op going on before things got started) and the promise was that videos of the stories would go straight to Washington to help speed passage of the hoped-for health reform bill.

Participants told of needed care that couldn’t be found, needed drugs that couldn’t be bought and the widespread suffering of the un- or under-insured. A panel of local experts presented aspects of the hoped-for national plan and spoke of San Francisco’s own moderately successful effort to provide health coverage for all.

Speakers were asked to keep their remarks to under three minutes, another dictum doomed to failure, and a few did. My own plea (one minute, forty seconds) was for inclusion of some guarantee/protection of individual choice at the end of life. It stemmed from working for many years (as I still do) with terminally ill adults who seek options including hastening their dying. It was tempered in deference to the hosts, since St. Francis is a member of Catholic Healthcare West and the opposition of the Catholic Church was largely responsible for defeat of a widely popular physician aid-in-dying bill that narrowly failed in California two years ago. And the likelihood of such a controversial issue getting into the massively complex bill we may or may not get is somewhere between slim and none, but what the heck. With Mr. Obama standing there, I couldn’t resist.

At similar gatherings around the country, I suspect the message and the messengers are much the same. Health reform is a national need that translates in millions of heartbreaking individual stories.

My personal favorite message came from panel member Catherine Dodd, PhD, RN, District Chief of Staff for Nancy Pelosi in her pre-Speaker days. Dodd explained the current three-fold status (two in the Senate and one in the House) of the healthcare bill and defended its  probable cost. Then she threw out one new number: 19.7. After everyone had let 19.7 sink in, she told us that is the number of years it has taken this country, every time a health reform bill has been floated, to bring it up again. “We can’t afford another 19.7 years,” she said. I think she’s right.

General interest
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Sir Edward's Choice

by Fran Johns

It is ironic that while some of us were offering mostly light-hearted comments about how we might choose to die, news circulated  that  Great Britain’s reknowned conductor Sir Edward Downes and his wife had just made that very real decision for themselves.

Sir Edward and his wife Joan, a ballerina before she gave up her own career in support of his and of their family, flew to a Swiss clinic sponsored by the Dignitas organization with their two grown children to end their lives together. He was 85, almost blind and losing his hearing; she was in the final stages of terminal cancer.

I strongly support the right of terminally ill, mentally comptetent adults to hasten their own death. While there is a very distinct line between hastened dying for the terminally ill and “suicide,” it would seem almost cruel to criticize Sir Edward’s choice. And the key word is choice.

What most of us would choose is precisely what Sir Edward and his wife did indeed have: a swift, peaceful end with loved ones at the bedside. Few of us would choose what actually happens too often in the U.S.: prolonged pain and indignity, often a death that follows extended, expensive, frequently futile treatment, in circumstances we would never have chosen for ourselves.

Physician aid in dying, now legal in Oregon and Washington, is one good way to put rational choice back in the hands of mentally competent adults.  The Oregon law has been in effect for over a decade and has proven that such legislation works. It offers comfort and compassion and has not been abused. Efforts to extend this humane law into other states have been vigorously fought by religious groups, but end-of-life choice is just as much a right as is reproductive choice; like other individual rights, it will eventually come.

Given the enormous financial cost of the universal healthcare system most of us want, and the enormous human cost of futile end-of-life treatments and denial of physician aid to terminally ill adults, the time has come for serious dialogue about the right to die.

Sir Edward Downes left a remarkable legacy in his music. A very private man throughout his long life, he nonetheless left another admirable legacy in his poignant death. Maybe those of us over here in the colonies can learn something. Maybe we could at least honor him with a little civilized discourse.

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

by Fran Johns
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Image via Wikipedia

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.

General interest
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A Novel Idea for Healthcare Reform

by Fran Johns

Not long ago I attended an event at San Francisco’s Commonwealth Club, featuring a speech by the President’s Council of Economic Advisors Chair Christina Romer. Dr. Romer’s talk, “The Great Credit Freeze and the U.S. Economy,” was all about improving healthcare while slowing down the growth of its cost. We know we can’t reduce costs, she said; what we hope to do is reduce the rate of increase. And one way to contain healthcare costs might be to find out what the patient wants. Imagine.

This observation was not in direct response to a question, but could well have been. Dr. Romer was asked, by more than one audience member, about how to address excessive expenditures at the beginning and end of life. A grossly disproportionate share of costs, she conceded, “are spent on the last six months of life. And one thing we’re not doing enough of is letting patients express what they want.”

If the issue were not so grim and sorrowful it would call for a “Well, duh.”

It would be hard to find many people saying they’d like their last few days on this planet to be spent semi-conscious or in pain and distress, hooked up to a tangle of wires and tubes in a blue-lit hospital room (see Scott Bowen’s post 7/14.) But this is in fact the system we have created: we focus on prolongation of life without regard to quality, we aid and abet doctors who equate death with failure, we never talk about our own mortality as if in silence we can become immortal. Most of us would choose to die at home, properly medicated for pain and surrounded by our loved ones; most of us will die in an institution

Audience members had a wide assortment of questions, and Dr. Romer had plenty more to say. But finding out what the patient wants, and acting accordingly, is surely one excellent path towards better care – and even contained cost growth — and everyone in America could begin that process today.

It is an easy solution, even if only a small, partial solution, to this piece of the muddled medi-puzzle of our healthcare system: talk. Tell your doctors, caregivers, loved ones what you do or don’t want. Write it down. Use the forms universally available (Advance Directives, POLST, others.) You might even wind up with what you actually want in your final days. Christina Romer is on your side.

General interest
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On Getting Started, and Re-started…

by Fran Johns

Front pages of the two east coast newspapers that arrive on our west coast doorstep every morning featured references to a few of the primary issues this column proposes to address: staying active and upbeat while confronting one’s mortality; the multiplicity of housing shifts in late generations; and whether one’s life experiences lead to rigidity or understanding.

 

Even the front page of today’s True/Slant, in Scott Bowen’s innovative take on Boston Globe books and publishing writer David Mehegan’s Over and Out, takes up the end-of-life choices question which has consumed much of my time and energies over the past decade and which I tackled (albeit anecdotally) in a 1999 book, Dying Unafraid.

 

Now. If life experience can be applied to mastery of T/S’s technological tools – which are not, after all, quite so daunting as the above – it will be great joy for Boomers &Beyond to explore these through headline grabs, riffs and commentaries and perhaps some lively reader responses. Stay tuned.

 

 

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