When Mom & Dad stay home — and need care

Years ago when my grandmother was dying — a process that seemed to consume her for a very long time — her children took turns having their semi-invalid mother live with them for a period of months. Grandmother was not an easy patient. She spent most of her days talking about how everyone she loved was dead — which used to make me wonder where my sisters, my long-suffering mother and I stood with her. But Grandmother’s decline was before technology complicated such events, and pretty much all that was needed was to put a borrowed bed somewhere, try to keep her comfortable and entertained and call the doctor if she needed anything. Most of her six children had at least one at-home family member who could handle Grandmother’s care for a few months without straining the family budget or everyone’s patience and good humor.

Caring for aging family members today is not so simple. Few families have a stay-at-home member able to juggle regular routine with patient care, such  care now often calls for high-tech equipment and/or high-cost drugs and interventions, and doctors don’t make house calls every other night.

In an informative and enlightening ‘Encore’ feature, Wall Street Journal writer Anne Tergesen follows the adventures of several families wherein siblings have become caregivers to aging parents.

Family cohesiveness is a tall order at any time of life. But as parents grow frail, brothers and sisters often encounter new obstacles to togetherness—at precisely the time they most need to rely on one another. Sibling rivalry can emerge or intensify as adult children vie, one last time, for a parent’s love or financial support. And even as parents grow dependent on children, the desire to cling to old, familiar roles can create a dysfunctional mess.

Today, with the economy and household finances in disrepair, such strains are more pronounced. According to a recent report by the National Alliance for Caregiving and AARP, about 43.5 million Americans look after someone 50 or older, 28% more than in 2004. In comparison with 2004, a smaller percentage—41% versus 46%—are hiring help. And more—70% versus 59%—are reaching out to unpaid help, such as family and friends.

Experts say it’s crucial that families figure out ways to work together, to work through their differences, for the common goal of caring for a parent. If they don’t, their parents will suffer—and so will they.

“Family caregivers are the backbone of the long-term-care system in this country,” says Francine Russo, author of a new book about how siblings can cope with aging parents, “They’re Your Parents, Too!” Siblings who work together, she adds, can help preserve not just one another’s health and sanity but also a “last link to their first family.”

There is, fortunately, a lot of support for family caregivers, through sources listed above, the Family Caregiver Alliance and other local or national groups. There are also helpful tips, many of which are outlined in Tergesen’s article: use new technologies, seek help, be flexible, keep lists, and laugh a lot.

The latter was what saved my family from collapse during Grandmother’s stays in our home. Grandmother would today be easily identified as clinically, chronically, severely depressed. My sister Mimi and I devised a game, after the first few days of jockeying for position as the one not to have to spend the afternoon with Grandmother. Whoever came up with the most hilarious joke to tell and see if we could make her laugh, or the most bizarre question (“Did Uncle James really go to jail, like we’ve heard?”) to prompt a family story, would win. I don’t know if this technique has real merit but it worked for us. We laughed a great deal, and Grandmother got to tell a LOT of previously untold family stories. Some of them were even true.

Siblings Overcome Conflicts to Care for Aging Parents – WSJ.com.

Moving Mom & Dad – but to where?

With the over-5o population expected to grow from 100 million this year to 130 million in 2030, the question of how and where to house these older adults is one that’s not going away. And it is not just a question of quantity and variety — enough houses, apartments, retirement communities — it’s how to ensure that needed services will be accessible to all.

A new report just released by AARP’s Public Policy Institute and authored by the Center for Housing Policy offers a comprehensive look at a complicated picture. Insight on the Issues: Strategies to Meet the Housing Needs of Older Adults and is designed to help state and local policy makers understand the needs of this growing population segment.

All of these Boomers, who are now beginning to swell the ranks of the Seriously Senior, have specific wish lists: independence, security, and above all avoidance of the N-word — the dreaded nursing home. The wish lists change almost by the day, but some things stay the same.

“With the population of older adults on the rise, this report helps to identify the essential housing policy strategies that can help them to balance their increasing needs with a desire to continue to stay closely connected to their families, communities and society,” said Center for Housing Policy Chair John K. McIlwain, senior resident fellow and the J. Ronald Terwilliger chair for housing at the Urban Land Institute.

According to Susan Reinhard, AARP Senior Vice President and Director of the AARP Public Policy Institute, “These resources will be invaluable for policymakers at the state and local levels as they adapt to the changing needs of an aging population.”

If you, or your parents or grandparents, are over 50, chances are you have already had The Talk. Where in the world will Mom and Dad go, and how in the world will they stay there? What’s going to be comfortable? How will we afford it?

Nine fact sheets accompanying the newly released report are divided into three sections. It all makes the task of plowing through the talk a little easier, especially if local and state policy makers are paying attention at the same time.

This space will be looking at the different points over the coming weeks. Your comments and personal stories are welcome.

Roadkill: geezers, texters at the wheel

His father-in-law, aged 91, got a new 5-year driver’s license from the State of California, with zero proof of intact driving skills. The family was worried, but without much power. According to an op ed piece by Santa Cruz, CA writer John Moir, the community was saved from potential disaster at the hands of an age-challenged driver only when a mild heart attack prompted his physician to order him away from the wheel.

Meanwhile, a nationwide population of licensed drivers young enough to be his great-great-grandchildren are navigating our roadways with one eye on the intersection and full attention on a text message in progress. Another op ed piece not long ago, this one by the Atlanta Journal-Constitution‘s Cynthia Tucker, told of accidents caused by phoning/texting drivers that are estimated at close to a quarter of a million per year. There is a growing movement to address this truly scary problem. And it is scary: if you walk in cities much you know how often only your own wits (Can’t make eye contact? Don’t trust that driver) keep you alive. In Nebraska, for example, activist teens, largely motivated by the horrific BBC YouTube video now gone viral, are pushing for a state ban on phoning/texting while driving. A national organization, FocusDriven, was started by a group of individuals who had lost loved ones to drivers on phones; they offer support for victims and tips for advocacy. FocusDriven is patterned after MADD (Mother’s Against Drunk Driving.)

But the issue of geezer drivers gets sticky. My own father was fond of pointing out, well into his 80s, that he had never had an accident. We bit our tongues not to comment on the disasters that probably followed in his wake. But the Commonwealth of Virginia continued to renew his license and none of his four out-of-state daughters was able to convince him that his driving was not in others’ best interest. It took a family friend, who pointed out how much money could be saved on gas, upkeep and insurance coverage, to get my father to sell his car.

The primary problem with aging drivers is the ease with which they are (in California, at least) re-issued a five-year license. Not long ago, at the ripe age of 75, I renewed my own. My eyes tested just fine — although prescription distance glasses make me way safer behind the wheel, especially at night. I studied for the written test (same test as anyone gets at any age) because it is full of trick questions, often concerning factoids that have little to do with public safety.  Presumably, if one is not mentally acute one would fail the written test — but you can retake it the next day. There was no road test of any sort, so if I were becoming prone to miss road signs, clip corners or misjudge parallel parking distances nobody would know. (I hope I’m not.)

Mandatory age limits for driving, such as commercial pilots have, probably aren’t going to happen, and probably shouldn’t. Many seniors must drive their own cars for endless reasons. Time and manpower required for road tests may put them beyond what states can afford these days. But why aren’t other answers possible?

Why couldn’t AARP put its considerable muscle and money behind a volunteer training program that would set in motion volunteer-led senior driving sessions? Why couldn’t states then require completion of such sessions before licenses were renewed after a certain age? Why couldn’t some insurance agency — AAA comes to mind — get behind a state-mandated program of this sort, offering the lower rates for graduates that are commonly offered graduates of safe-driving programs? Why couldn’t safe-driving seniors be offered a small compensation for running such programs, in return for the savings in lives and ER costs?

My license expires on my 81st birthday. I’ll happily sign up for a seniors class. Meanwhile I will remain on the alert for texting juniors.

New idea: patient-centered healthcare

American health care, with or without the reform so desperately needed, seems headed in the direction of comprehensive care. For us patients — those of us fortunate enough to have coverage allowing us to be patients — part of this is having one doctor who really knows and follows your general condition. A century ago, before costs went through the roof and access to care went out the window, American health care worked that way.

At the California Wellness Foundation‘s Healthy Aging Conference in Los Angeles earlier this week the talk was all about “medical home“. Unwilling to risk a blatant display of ignorance I spent much of the morning frantically searching the speaker’s handouts for a clue about what a medical home might be. The speaker, it being early on in the event when my bewilderment arose, was keynoter John Rother, Executive Vice President of Policy and Strategy for AARP.

Though it was not in the handouts — the audience consisted largely of health professionals who presumably knew all this — I will clarify the medical home business here. With a little help from Wikipedia: “an approach to providing comprehensive primary care… that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family.”

Rother’s power-point presentation, billed as “Moving Past Talk: the Challenge of Wellness” reviewed the state of U.S. health, health care and endangered health reform before getting to the medical home issue. When he did, he characterized the medical home as “more personalized delivery of services,” adding that the concept envisions that “someone’s in charge.” It enables hospitals and doctors to work more closely together, Rother said, and provides extra payments for primary care doctors.

Kaiser has this. Many of us enjoy this. Could we please find a way for the healthcare homeless of America also to find a medical home?

Cold Weather Won't Make You Sick

If trying to follow the progress of healthcare reform is giving you a migraine, and perhaps results of recent balloting have upset your stomach, here’s a little good news from Lindsey Hollenbaugh, writing in the November/December AARP Magazine. Not all of those sometimes-scary bits of advice you grew up with turn out to be true. New studies, Hollenbaugh reports, are busting a few  of those myths.

Myth
Most of your body heat is lost through your head.

Fact
Untrue. This myth likely originated from a 50-year-old military study; subjects enduring extreme cold lost the most heat from their heads. But the head was the only exposed body part, says Rachel Vreeman, M.D., coauthor of Don’t Swallow Your Gum!: Myths, Half-Truths, and Outright Lies About Your Body and Health. The real deal? “You lose heat from whatever is uncovered,” Vreeman says. “There is nothing special about the head.”


Myth
Taking vitamin C and zinc will help prevent or shorten a cold.

Fact
Taking vitamin C daily won’t prevent illness, and if you consume it after feeling sick, it won’t ease symptoms, studies show. As for zinc, three of four well-designed studies found it ineffective, while a fourth found that zinc nasal gel helped relieve symptoms. But in June the FDA recalled some zinc nasal products, since they’re linked to a loss of sense of smell. Bottom line: There’s no need for extra C, and zinc may actually harm you.


Drug-Free Pain Relief
Here’s one more reason to enjoy your cup of morning joe. In a University of Illinois study, 25 cyclists who consumed the equivalent of about three 8-ounce cups of coffee before working out had significantly less pain while training.

Myth
You should drink at least eight cups of water per day.

Fact
There’s no medical reason to follow this advice. In 1945 the Food and Nutrition Board of the National Research Council recommended that adults take in 2.5 liters of water per day (about 84.5 ounces), noting that most water comes from food. Many adherents, however, ignored the last part of that statement. Drink up if you’d like, but studies suggest that most people already get enough H2O from what they eat and drink: the average person takes in about 75 ounces of water daily, according to Department of Agriculture surveys.


Myth
Illnesses come from cold or wet weather.

Fact
Colds and flus come from viruses, not the climate, explains Aaron Carroll, M.D., Vreeman’s co-author. But because some viruses are more common in winter, more people may get sick then. Plus, chilly or rainy weather often results in more people staying inside—and then sharing their icky infections.

From San Francisco, in the balmy sunshine (November? That’s mid-summer) Boomers & Beyond wishes you well.

Cold Weather Won’t Make You Sick.

End-of-life counseling stays in health care bill

Here’s a piece of very good news just in from Associated Press reporter Ricardo Alonzo-Zaldivar:

It’s alive. The Medicare end-of-life planning provision that 2008 Republican vice presidential nominee Sarah Palin said was tantamount to “death panels” for seniors is staying in the latest Democratic health care bill unveiled Thursday. The provision allows Medicare to pay for voluntary counseling to help beneficiaries deal with the complex and painful decisions families face when a loved one is approaching death.

The business of thinking ahead toward end-of-life decisions and making  one’s own wishes known through legal documents such as advance directives has long been encouraged by federal policies. But when coverage for talking things over with one’s doctor was incorporated into health reform it was quickly distorted by Republicans.  Sen.Charles Grassley led the successful campaign to strike it from the Senate bills. But saner heads have prevailed in the House.

“There is nothing more basic than giving someone the option of speaking with their doctor about how they want to be treated in the case of an emergency,” said Rep. Earl Blumenauer, D-OR. “I think the outrageous and vindictive attacks may have backfired to help raise awareness about this problem, which is why it’s been kept in the bill.” The legislation would allow Medicare to pay for a counseling session with a doctor or clinical professional once every five years. The bill calls for such sessions to be “completely” voluntary, and prohibits the encouragement or promotion of suicide or assisted suicide.

The counseling provision is supported by doctors’ groups and AARP, the seniors’ lobby. It was not included in health care bills passed by two Senate committees.

It’s alive! End-of-life counseling in health bill.

Watching Idols and Icons Die

An article in yesterday’s New York Times chronicled the recent “funereal season” that has seen the passage of such players on the national stage as Walter Cronkite, Les Paul, Farrah Fawcett, Michael Jackson, Ted Kennedy and Patrick Swayze. Add to that the death this week of singer Mary (“Peter, Paul and Mary”) Travers. Although Times writer Sarah Kershaw noted that no more celebrities died this summer than in summers past, a couple of other elements are in play: the particular folks who departed the stage in recent months did so just as Baby Boomers are hitting retirement age, and they were the people who “defined (the Boomers) as a tribe, bequeathing through music, culture, news and politics as a kind of generational badge that has begun to fray.”

Generational badge-fraying is not necessarily a bad thing. As long as one wears the badge lightly on the pocket and occasionally notices which threads are coming loose, in fact, I maintain it is downright healthy. Contemplation of our terminal condition could do most of us a lot of good.

(Specifically, a few of those Boomers who have been putting off getting their advance directives done (OK, I see your eyes glazing over, but stick with me here) will start thinking about doing so. Or at the very least, have a little talk with their significant others about how long they’d like to be kept on life support if they have a stroke tomorrow. Getting this done today leaves tomorrow for enjoying everything else. Plus, it encourages calm; see below.)

Walter Cronkite wound up a long and happy life at 93. But Ted Kennedy was 77, one year older than yours truly. Farrah Fawcett was 62. Patrick Swayze, 57; Michael Jackson, 50. DJ AM Adam Goldstein was 36. The reality is that we’re all terminal; most of us terminate before we’re quite ready but it does happen. Acknowledging that fact can be ridiculously freeing.

The Boomers are reportedly worried not only about the finiteness of their lives, but also about their legacy. The Times article quoted a survey of 1,000 Americans age 44 to 79 conducted by AARP, which found that 55 percent believed they would leave the world worse off than they found it. That prospect can turn you gray in a hurry. But these near-retirees are not planning just to sit around getting gray.

Loss of their legends, according to Marc Freedman, author of “Prime Time: How Baby Boomers Will Revolutionize Retirement and Transform America, has created in this generation a sense of both the “expansion and compression of time,” and they are looking toward second careers doing good. “I think this is the first time so many have simultaneously had an awareness of death and the prospect of a whole new act,” Mr. Freedman says. Many of those new acts may turn the above expectation around, so the world might be left a little better off than they found it.

To which the post-Boomers say, Go Boomers.

Healthcare: Sorting Fact from Fiction

House legislation on health reform is a win-some-lose-some proposition for those over 65. Especially, as outlined in The New York Times yesterday, when it comes to Medicare drug benefits.

Medicare beneficiaries would often have to pay higher premiums for prescription drug coverage, but many would see their total drug spending decline, so they would save money as a result of health legislation moving through the House, the Congressional Budget Office said in a recent report.

Premiums for drug coverage would rise an average of 5 percent in 2011, beyond the level expected under current law, and the increase would grow to 20 percent in 2019, the budget office said.

“However,” it said, “beneficiaries’ spending on prescription drugs apart from those premiums would fall, on average, as would their overall prescription drug spending (including both premiums and cost-sharing).”

The Congressional Budget Office report set off an immediate battle between Republicans and Democrats, each side eager to convince seniors — those vocal voters — that the other was representing the devil incarnate. Republicans swear the House bill will threaten Medicare beneficiaries in order to cover the uninsured, Democrats say the bill will help them by eliminating a gap in Medicare drug coverage.

On this particular segment of the impossibly complex bill, maybe seniors would do well to listen to their own purported champion:

Nancy LeaMond, an executive vice president of AARP, the lobby for older Americans, welcomed the report as evidence that “health care reform will lower drug spending.”

“Opponents of reform may use today’s projections to try to stall reform,” Ms. LeaMond said, “but we hope they will look at all the facts before jumping to a false conclusion.”

And there, some would suggest, is the problem. The facts have been virtually obscured by misstatements, misrepresentations and outright lies. Death panels? A lie that served its scary purpose. Rationing? It’s already here, folks; it’s done by insurance companies that deny coverage in sometimes arbitrary ways. Socialized medicine? Hello? Does anyone over 65 remember those screams before Medicare was signed into law in ’65? When half the population over 65 had no insurance coverage at all?

Set aside the fact that providing healthcare for all is simply the right thing to do. Millions of American seniors (whether you begin that definition at 65, 60 or — to their horror as it sometimes happens — 55) were motivated to support President Obama by not only their hearts but also their brains. If those brains can be called into play to sort fact from fear-mongering, we may yet get the health reform common decency requires of this otherwise civilized nation.

Health Bill Would Cut Drug Spending for Many on Medicare, Budget Office Says – NYTimes.com

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