Waterfront Condos: More on the housing dilemma
Waterfront esplanade, expansive views from a sunny terrace, walk to the ballpark — what’s not to love about this housing choice?
Downsizing from a large, Victorian house filled to overflowing with the accumulations of two very active lives, the Langleys of San Francisco decamped, a few months ago, to a new, easy-care, sun-filled two-bedroom condo in the city’s happening-place Mission Bay neighborhood. They love the convenience, the mix of ages and cultures, the freedom from old-house maintenance worries and some unexpected bonuses like new friends living on houseboats from another era who are within conversation range of their 4th floor deck. “We (the new condo development) block the view they used to have all those years,” Judy Langley says, “but there are a lot of trade-offs like getting the creek (which leads into San Francisco Bay) cleaned up, and the park over there…” For the newcomers, the young dog-walkers on the esplanade below, the middle-aged Chinese couple doing tai chi on the common lawn, it is an urban idyll.
Urban condos, even those without kayaks at the door and aged houseboats for neighbors, are an increasingly popular answer to the downsizing dilemma. But the dilemma remains huge and answers are seldom easy.
On the day the Langleys were hosting an Open House in their new digs, my sister was packing the last boxes from the high-ceilinged Boston condo that’s been her family’s home for decades. She and her husband are headed for a New York retirement community to which a physician daughter will also relocate from the west coast. Elsewhere this weekend a childhood friend was finalizing plans for a move from Northern Virginia to a coastal community where her husband will be able to live in a Memory Unit while she lives independently nearby.
These choices typify the variety of factors that go into contemporary downsizing decision-making: Is it affordable? Will I (or my parents) have the care that’s needed? Can life still be good (or even get better?)
And any of these families might also have considered co-housing. Yet another option for Boomers and Beyonders as well as for younger families and individuals, co-housing in some ways harkens back to a simpler, long-ago lifestyle and in other ways could only work in the 21st century. It was the topic of an OWL-sponsored panel discussion on Saturday, and will be tomorrow’s Boomers and Beyond topic.
Palliative Care: Rush Limbaugh vs the Grannies
The patient was in four-point restraint, which means his hands and feet were tied to the bed. He was shouting over and over, in Spanish, “Help me!” but no help came. Until Diane Meier happened upon the scene.
The back story, she learned, was that the man had end-stage cancer for which he had declined treatment. After he fell at home, his adult children had found him on the floor and called 911, landing him back in the hospital. There, among other interventions that were put into play, a feeding tube had been inserted through his nose. When he repeatedly pulled it out, his hands were tied. After he then pulled it out three times with his knees, his feet were tied. You could say these treatments were being performed over the patient’s not-quite-dead-body.
“Why,” Dr. Meier asked, “is it important to have the feeding tube?” The attending physicians answered, “Because if we don’t, he’ll die.”
It was at this point that Diane Meier, M.D., F.A.C.P., already honored for her work in geriatrics and for her personal and medical skills, became a crusader for palliative care. “A light bulb went off,” she told a group of physicians and other professionals in the field today in San Francisco. “I realized it was an educational problem, and thus a solvable problem.” She saw that the doctors and nurses were only doing as they had been taught, and the results were distressing also to many of them. “All I did was say ‘It’s all right to care about your patient.'”
Meier’s pioneering efforts to shift care of critically ill patients from aggressive, often futile treatment to comfort care focusing on the patient instead led to formation of the Center to Advance Palliative Care, which she currently serves as Director. They also resulted in a MacArthur Fellowship she was awarded in September, 2008.
“The MacArthur,” says the self-effacing physician, “was in recognition of the tens of thousands of people working in palliative care.” But those tens of thousands are not enough to have eliminated the tragedies of patients such as the unfortunate man cited above. Walk the halls of almost any hospital, nursing home or similar institution in the U.S. and you will hear the incessant “Help me!” cries of people being treated over their almost-dead bodies.
Helping them with comfort care rather than aggressive treatment, though, is referred to by the Rush Limbaughs of the world as “Killing off the grannies.” It is a handy sound bite, and it is tilting the balance against sanity in our lurch toward health reform. Unless Mr. Limbaugh can convince me I’d rather be 4-point-restrained with a tube inserted in my nose than gently treated with comfort care when I encounter my next critical illness, this particular grannie would appreciate his butting out of my rights. Palliative care should be a right.
It is, unfortunately, a campaign of the political right to keep palliative care out of health reform. They will prevail, Dr. Meier said, unless voices of sanity are raised, whether Democrat or Republican. She urged her audience, representative of a wide variety of compassionate groups, to help get the message out and get the calls, e-mails and letters in. Legislators behind the three bills working their way through Congress, she said, need to hear from the citizenry.
The citizenry is unquestionably in favor of comfort, and where palliative care can be understood it is welcomed. Hosting Dr. Meier’s informal talk were the California HealthCare Foundation, the California Coalition for Compassionate Care, Archstone Foundation and the University of California, San Francisco, four of many organizations committed to making palliative care understood, available and effective.
The question of whether they or Rush Limbaugh will prevail is as yet unanswered. Having Mr. Limbaugh forming our health policy, though, is almost as scary to this granny as 4-point restraint.
Health Reform 101 for Seniors
At an annual reunion gathering of California Senior Leaders today at the University of California, Berkeley, AARP California Executive Council member Bob Prath (himself a CA Senior Leader) made a valiant effort at outlining key segments of the proposed Health Reform bill which are of primary concern to over-50 generations.
Those segments include, in no specific order of significance or degree of complexity: guaranteed access to affordable coverage for Americans 50 to 64; closing the Medicare Part D coverage gap (known to insiders and more than a few others by now as the “doughnut hole”); approving generic versions of biologic drugs; preventing costly hospital readmissions by creating a follow-up care benefit in Medicare to help people transition to home; increasing funding for home-and-community-based services through Medicaid to help people stay in their homes and out of institutions; and improving programs that help low income Americans in Medicare afford needed drugs.
If that list of details seems daunting, it was not so to the Senior Leaders. Word had already circulated that Prath had read the entire 3,000+ pages of the bill, and no eye was going to glaze over. Covering it all, though, despite a carefully prepared power point presentation, was somewhat of a challenge in the after-lunch time whittled down to less than 30 minutes by the irrepressible tale-sharings of the reunion attendees.
Prath was asked, afterwards, for suggestions of where and how anyone over 50 might find concise and useful information, short of undertaking his own feat of studying 3000+ pages. Much, he says, can be learned through Health Action Now, and those worried about exorbitant drug bills can get some good, practical help from a nifty AARP brochure, “Don’t Dump Dollars into the Doughnut Hole.”
More enlightenment from the time-squeezed power point will appear in this space over the next few days.
Affordable Health Reform
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.
More on the Housing Choices Dilemma
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.
Who In The World Falls For These Scams?
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.
Grassroots Healthcare Reform
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.