Quarantined in the Geezer House

Clouds 3.21.20
West view from 7th floor

“Six die, 53 ill at nursing home,” reads the San Francisco Chronicle headline. It follows a similar, recent headline, “Coronavirus: 27 test positive at Orinda nursing home,” and seemingly endless others: “New cases in Alameda County facility,” “Another death at Gateway Manor”. . .  These are the sorts of headlines that the management of my particular senior housing community most fears, and that strike a little dread in the aging hearts of my neighbors and myself. I live in a 12-story assisted living building near downtown San Francisco. It includes some 90 apartments housing singles and a few couples with a median age of, say, 87. That is a random number, chosen only because it puts me in the younger half. I generally refer to our place as the Geezer House, but the marketing materials use slightly more refined wordage. Those materials do not lie: this is not the ritziest senior living place in town, but it would fall in the “upscale” category.

There are hundreds of senior living facilities in the San Francisco Bay Area, ranging from minimum-care to rehab to lifecare to nursing home; all of us are, to one degree or another, the scariest target populations for COVID-19’s quiver of poison arrows. At the center are the nursing homes, source of the horror stories that seem to increase daily; my community is somewhere around the second ring out from the bullseye. Though we are somewhat less vulnerable than nursing homes, if one COVID-19 virus particle managed to sneak into our building it would be Katie-bar-the-door. We’ve had practice runs, with flu or norovirus, but those moved in slowly, two or three new cases per day until the mini-epidemic retreated. With COVID-19 we’re staring down a mystery virus that, in neighboring senior facilities at least, seems to move in and take over in a blinding flash.Covid cluster

Extreme measures are underway to prevent that from happening in my building. Think San Quentin, but with better food. We began with Mayor London Breed’s shelter-in-place decree on March 16; this being San Francisco, Mayor Breed got a three-day jump on Governor Gavin Newsom’s March 19 statewide order. Life in geezer houses took a sharp turn toward confinement at that point. I encountered the new reality head-on when innocently heading out to drop some mail in the box across the street. “If you step out that door,” my friend the concierge remarked, “you must first sign this document.” He handed me a paper declaring that I “understand that by departing (the facility) I am violating Public Health Order No. C19-09, enforced by the San Francisco Police Department” and that I “may be excluded from (the facility) and not re-admitted.” I thought better of mailing my letters.

Birds in treesThere is a stillness here. Sometimes it’s eerily pleasant, the silence broken by birdsong in nearby trees. But often it is ominous. Having worked as a hospice volunteer and with other end-of-life organizations, I know the sudden stillness that is death, and others here have experienced it when losing a loved one. So here we are, in a place where most of us have come planning to stay until we die – and we’d just prefer not to be thinking about it in the middle of a pandemic. Listening to the stillness, watching the quiet streets no longer bustling with cars and people – manages to equate with death and become just a tiny bit stressful.

Life in confinement turns out to be something for which many of us were remarkably ill prepared, and there’s little comfort in knowing we share that woeful lack with millions of fellow citizens and certainly the Trump administration. Comfort is in short supply under social distance guidelines. Most of us here were children during World War II, memories of which have a certain nostalgia: there was shared sacrifice then too, but it felt noble rather than resentful. And there were Mr. Roosevelt’s fireside chats.

FDR 1936
FDR in 1936

I don’t remember the first of these, which was given a few months before I was born, but I well remember some of the last, during the war, when we’d gather around the big Philco radio to hear that deep, cultured voice. Grammatically perfect, unfailingly calm and reassuring. It’s hard not to yearn for such a voice when listening to our current president’s egotistical bombast and vulgar, vicious divisiveness. I think the memories of very different times accentuate the vague feeling among residents of senior living facilities that we are imprisoned against our will.

On the upside for my fellow inmates here and me, our fortress is pretty posh. Three good meals delivered daily in compostable containers, creature comforts like views of the San Bruno mountains to the south, or the San Francisco sunsets from our west windows. On the downside, it is possible to spend days at a time without seeing another human being, other than the masked person who shows up every day to take your temperature. For those of us still mobile there are decidedly other upsides: a small exercise room with treadmill, weights etc, and an outdoor terrace on the second floor (barred gate at the bottom of its stairs.) Walking from one end of the terrace to the other requires 180 steps. The exercise room being too small to accommodate more than one socially-distanced person, I get my best exercise walking from the 7th floor to the 3rd to see if anyone is on the treadmill. Eight or ten of us are also known to go walking at the same time, appropriately distanced, and thereafter to hang out for also distanced but at least human-to-human, conversation – though it does include frequent remarks in the “Did you see who that gurney came for?” category.Treadmill Some of us are more obsessive than others about checking the case/death numbers posted every morning at 9 by the San Francisco Department of Public Health; everyone talks less and less about when the country may “open up.” Or about politics at all, for that matter. Political discussions pretty much begin and end with “What about Trump saying . . .” This place is not a bastion of conservatism.

What’s not heard a lot? Complaints. If we chafe at confinement, we’re grateful to wake up without a fever. Most of us have friends or family in New York, Atlanta, New Orleans or Seattle and we worry about them far more than they need worry about us. All of us have friends or family who are doctors, nurses, first responders and others on the front lines. Somehow, gratitude seems to edge out the fear in our geezerly hearts.

Gratitude - sunrise

This essay also appears on Medium.com, a fine site committed to the exchange of ideas, knowledge and perspectives, on which I’ll be posting in the future. But I’ll still be holding forth right here on franjohns.net. So stick around!

Baby boomers & long-term care: innovation is the key

Baby boomers well into their final careers are increasingly discovering a new one: caregiver to elderly parents. And if current studies are to be believed, boomers themselves are more than likely to need long-term care. A new report out of Canada suggests that “baby boomers will have to develop non-traditional caregiver networks, or pay for long-term care facility care” in our neighbor to the north.

Today, up to 70% of the care provided to the elderly comes from an informal network of spouses, children and close family. But the baby-boom generation is unlike previous generations in that they have relatively few children, and stable couples are a rarity, according to researchers at the Université de Montréal. Baby boomers “risk finding themselves in difficult circumstances and might have to turn to the public system or pay their way,” says professor Jacques Légaré, who authored the study of aging boomers.

Friends, siblings or cousins could make up a new, non-traditional model of caregiving for seniors who can’t afford assisted living or skilled nursing care, Légaré suggests. The paper was presented this week at the 2010 Congress of the Humanities and Social Sciences at Concordia University in Montreal.

In the U.S., most surveys put the figure of “informal caregivers” — family members or friends — closer to 80%, and estimates of the number of boomers likely to need long-term care themselves go up with virtually every new study.

Choices in long-term care also are going up, though. The National Clearinghouse for Long-Term Care Information is a government-run (Department of Health and Human Services) site that offers information and resources for long-term care planning — along with some eye-opening information about costs and coverage.

Baby boomers can take heart in the fact that innovative models are being developed in many states, and possibilities are being pursued in both public and private sectors.  Non-traditional networks may be the new best thing for this looming fact of boomer futures.

Baby boomers may need to find new, innovative care networks, report finds – McKnight’s Long Term Care News.

Alzheimer's: old music, new songs

Think nursery rhyme. Sing the words. How long is it since you learned that ditty?

Years ago a friend of mine named Alice suffered a stroke that left her with the ability to say only two words: “one, two.” Or she may have been saying “want to.” In the months ahead she developed a skill for packing more meaning into that phrase than most of us can manage in several paragraphs. “ONE two!,” she would fairly shout at her husband, expressing displeasure (something she did with regularity before the stroke.) “OnetwoONEtwo?” she would ask, in a “Do you really like it?” voice. Still, it was tough on friends and family, and had to have been more than frustrating for her.

Eventually Alice and her husband moved into an assisted living facility. Though she was a woman of limited education and resources, she was able to resume a minimal degree of activity within that community. I saw her about once a week there, for a period of months.

At Christmas time, a group of us went caroling in Alice’s building. Midway through one old, familiar song, as we stood facing an assembled group of residents, someone noticed that Alice was singing merrily along, word for word. There was a lot of nudging and head-nodding, and by the end of the last verse not a dry eye. As we left, Alice smiled and said, “One two, one two.”

Now comes another interesting word about music and the mind, from a Science Daily article posted on the PositScience blog. It cites results from research by the Boston University School of Medicine showing that people with Alzheimer’s retain verbal information better when it comes within the context of music. The findings appear online in Neuropsychologia, an international journal to which I admittedly do not subscribe.

To determine whether music can enhance new learning of information, AD (Alzheimer’s Disease) patients and healthy controls were presented with either the words spoken, or the lyrics sung with full musical accompaniment along with the printed lyrics on a computer screen. The participants were presented visually with the lyrics to 40 songs. Twenty of the song lyrics were accompanied by their corresponding sung recording and 20 were accompanied by their spoken recording.

After each presentation, participants were asked to indicate whether or not they were previously familiar with the song they had just heard. The BUSM researchers found accuracy was greater in the sung condition than in the spoken condition for AD patients but not for healthy older controls.

The blog elicited responses ranging roughly from “that’s very interesting” to “so what else is new?” I come down on the “that’s very interesting” side of the issue, because it is.

And the more we know about connections of this sort, the more we begin to understand about the workings of the mind and the broader the possibilities of unlocking its secrets. Those pesky memorizations of yore, set to music, still manage to survive all manner of afflictions.

I still can’t figure out where I put the keys… but I can sing you every line of “Itsy Bitsy Spider.”

Moving Mom & Dad: 8 months later

“The best thing? Well, there are only three rooms to look for my glasses in.” Nearing the end of her first year after a final move, my sister reports a whole bunch of pluses and only a couple of minuses in her housing choice.

Like millions of other older Americans, my sister Helen and her husband Clare faced the multitude of questions that come with aging in this country: where to live, how to stay active and independent, how to get necessary health care, how to finance it all. After a lifetime in academics and music, they had good friends at home and around the globe, but were beginning to feel isolated in their 4th floor Boston condominium because of limited mobility (Clare has Parkinson’s; they had long since sold the car…) and knew that changes had to be made.

First issue: Housing. Staying in their home was not a good option; though it had plenty of spare room, no family member was available to move in and help. They were far from needing (or being able to afford, for that matter) regular in-home help. Their children were scattered across four states, with families of their own.

The answer for Helen and Clare was Kendal at Ithaca, one of a growing number of retirement communities offering “lifetime” or “continuing community care” in almost every part of the U.S. and many other countries. They chose a two-bedroom, two-bath “cottage” within an easy walking distance of the main facility and its dining room (they have one meal a day there), fitness room, crafts room, library (a large and very well-stocked area where Clare spends most of his disposable time), swimming pool and meeting rooms (where Helen quickly found ways to be useful on multiple committees.) They made the move eight months ago (as reported on this page along with a running bunch of posts on senior housing choices then and since then); I visited again this weekend to see how things are working out. Pretty well. The winter wasn’t all that bad, though April in Ithaca seemed about as cold and ominous as June in San Francisco to this San Franciscan, and they have had no second thoughts.

The bad point: they miss their Boston friends. The good? Not having to worry about home care or upkeep, having a regular cleaning/household helper whom they greatly like, door-to-door transportation to cultural events at nearby Cornell University, Ithaca College and elsewhere, plenty of activities and new good friends, good food (“the desserts are desperately attractive,” Helen says) and health care (mostly right there on the premises.) On this last point, Clare lists one great attraction he sees: “They can’t throw me out.” The crowning bonus, for this fairly happily aging couple, is the proximity of their physician daughter and her husband, who relocated from the west coast to be near their parents, and who are in daily communication and assistance.

Kendal communities are not cheap. Nor are most of the others that offer independent living, assisted living and nursing care in assorted facilities, along the can’t-throw-you-out principle. Helen and Clare paid a hefty lump sum (being able to sell a home you’ve had for decades is the way most people swing this) and their monthly fee, which covers meals, transportation, doctors visits, drugs, etc, etc and etc, is also substantial. They are, though, a good choice for many. One college friend now in such a spot refers to her South Carolina retirement home as “our little corner of paradise;” another very close friend is delighted with her Virginia apartment in a community where her husband now lives in a “memory unit” a few steps away.

If you Google “retirement communities” or “continuing care communities” or similar phrases, literally hundreds of choices pop up. The managers of those facilities can spell out the costs and the benefits; for the pitfalls, it’s a good idea to talk with those who live there or whose loved ones are/have been there.

My demo couple in Ithaca are in the right spot.

Moving Mom & Dad — into a Village

What about moms and dads who really don’t want to move?

The problem of where to go and what to do about housing in the sometimes not-so-golden years has an assortment of solutions for those who prefer (and can afford) the retirement community or any of the multitude of assisted living communities around. But for those who are bound and determined to stay put in the old house or the long-familiar apartment? A collection of obstacles begins to accumulate.

Enter the village.

Swiftly catching on around the country, aging-in-place “villages” are designed to help  members overcome those obstacles by providing a variety of programs and services – while the members stay put. The prototype was Boston’s Beacon Hill Village, founded in 2001, which offers “groceries to Tai Chi to cultural and social activities to home care.” Others have popped up in states ranging from Colorado to New York, Florida to Nebraska, Massachussetts to Hawaii.

San Francisco Village was the second, after Avenidas in Palo Alto, to get off the drawing boards and into action in California. Although each Village differs from others, SFV illustrates many of the attractions that are drawing in the stay-put crowd. The organization began with some local grants and individual donations, and is sustained now by annual membership fees.

Sarah Goldman agreed, after a good bit of arm-twisting, to be a poster girl for SFV in upcoming stories for the neighborhood’s New Fillmore newspaper. Sarah was among the first to join the organization, and in many ways typifies the village member-enthusiast: fit, active and fiercely independent at 80, she plans to stay that way as long as humanly possible. Her first move, as a Village member, was in support of someone older still and desperately in need of help: her landlady. Goldman could see that the landlady, who also lived alone, was becoming forgetful and increasingly unkempt – the distress signals that often propel seniors into care facilities. So she began by talking the landlady into joining also. This paved the way for calling in, with the landlady’s approval, a wide-ranging group of service providers: house cleaners, organizers, financial assistance people, personal care helpers. All had been vetted by SFV. Their help has now enabled both landlady and tenant to keep right on aging in place.

Goldman also quickly started a program patterned after one she had organized when working with an assisted living community. SFV’s play-reading group was an immediate hit among those seeking socialization and intellectual stimulation. Three necessities of life — social, physical and mental fitness — added to issues such as those dealt with by the landlady, add up to the heart of the Village. Members hope that by accessing things like this while staying on familiar turf their golden years may indeed stay shiny.

This one hopes that SFV membership will help keep the contributions of this space emanating from this laptop on this Sacramento Street kitchen counter for a very long time to come.

Fear (and the high cost) of falling

My husband was face down on the floor of the breakfast room, stretched below the table with one hand resting beside a chair he had pushed into the corner. As I came up from the garage, returning from a long opera just before midnight, he called out, hoping to spare me from alarm or a heart attack of my own. This is the sort of scene that tends to cause alarm at any age. According to an article in last Sunday’s New York Times, a similar scene occurs with alarming frequency: more than one-third of people ages 65 or older fall each year, writes Steve Lohr in an “Unboxed” feature, “Watch the Walk and Prevent a Fall.”

In our recent case, all was soon well. My husband had lost his balance while setting dinner on our not-too-sturdy table, and more or less slid to the floor. Still recovering from spinal fusion surgery 8 months earlier, he had done everything possible not to break anything — old bones or new rods and bolts that is; he wasn’t worried about the china — as he went down. But once down, getting back up was not an easy assingment. You know those awful “I’ve fallen, and I can’t get up” ads? Believe them. He tried shoving a chair into the corner to gain traction, but soon realized there was not enough strength in his lower legs to do the job, and decided just to wait. (Some people do carry cell phones… but that’s another story.) At 6’3″ and over 200 pounds, Bud outweighs me approximately two to one, so my getting him up was, we already knew, not an option. Happily we have a neighbor who seldom goes to bed early. Once he came over and the three of us strategized a while we were able to set my husband upright again. More specifically, John and Bud accomplished the deed; I supervised. Bud was tired and hungry, but otherwise fine.

Most of the falling elderly are not so lucky. About one fall in 10 results in serious injury such as a hip fracture, according to the Times story. Some 20 percent of older adult victims of hip fractures die within a year. If that weren’t enough to get one’s attention, reporter Lohr writes that “the estimated economic cost of falls ranges widely, up to $75 billion a year in the United States, if fall-related home care and assisted living costs are added to medical expenses.”

The last time I fractured my ankle, which I tend to do with dismaying frequency, I grumbled to a friend about “that dumb accident.” There are no smart accidents, she replied. (I was running late, and carrying a very large empty computer box down the stairs.) And this is a good thing to keep in mind. Somewhere not far past the age of 50 (I throw that in for all those weekend soccer-playing dads) bone breakage gets easier and healing begins to take longer. Somewhere a little farther along in the aging process, falling takes over from dumb accidents as #1 cause.

“Watch the Walk and Prevent a Fall” focuses on early research, backed by the National Institute on Aging, into the relationship between activity patterns and falls. “Fall prevention also promises to be part of an emerging — and potentially large — worldwide industry  of helping older people live independently in their homes longer,” Lohr writes. New technologies such as sensors that track behavioral and activity patterns will play growing roles in fall prevention, along with customized exercise programs and close attention to the role of medications.

Considering the risks and the cost, fall prevention may fast claim serious attention. But for now, especially if you’re over 65: get up slowly, watch your balance, and be careful setting your dinner plate down on a wobbly table.

Moving Mom and Dad

The folks are getting on in years, the old house needs work, the Stuff is piling up everywhere — it’s time to look at moving. But the big question is, where to? Urban condo? Assisted living? Retirement village? LifeCare facility? Co-housing? Maybe even the dreaded Nursing home or dementia facility?

Making the decision to move into what is likely the last residence on this side of the hereafter can be daunting, sometimes devastating. Whether it involves oneself or one’s older family members, the Final Move often exhausts patience, finances and family resources. But good choices are out there, and good help (sometimes free, more often adding to the growing costs of this life event) can be found. In previous posts this space has offered glimpses of these choices and experiences: Helping Mom Die (10/16); Hanging in the ‘Hood (9/29); Justice Souter’s Retirement Housing (8/10.) What follows is a look into the LifeCare option. I should first insert a grateful nod to the source of this headline, a great book by Sarah Morse and Donna Quinn Robbins.

I have just returned from a visit with my sister Helen and her husband, newly installed in a spacious two-bedroom cottage at Kendal at Ithaca (NY), a Continuing Care Retirement Community. To do this necessitated cleaning out and selling (of course, the sale fell through when everything was on the moving vans, but last-minute calamity is to be expected) the far more spacious four-bedroom plus roof deck 1920s condominium in Boston they have called home for nearly 40 years. It was not pretty. Despite my earlier Boston visits to whittle down the Stuff factor and later urgings to connect Helen with the National Study Group on Chronic Disorganization, the job tested the limits of patience and strength of their four extraordinarily loving children.

Nonetheless the deed did get done, and Kendal at Ithaca is perfect for Helen and Clare, thanks to a confluence of happy circumstances: their physician daughter has relocated from Seattle to Ithaca; Manhattan is a comfortable Cornell bus trip away; desired features are in place. KAI includes a community center with a dining room in which their monthly fees entitle them to one meal per day, a fitness center, a large library, a van to take residents to doctors’ appointments etc. Best of all, says Clare, who has Parkinson’s, “they can’t throw me out.” The major appeal of LifeCare, or Continuing Care communities, for many seniors, is the inclusion of facilities for different levels of care which one may require in the future. (Worst of all, Clare adds, is the fact that “we have a lot of Parkinson’s, so I see myself 3 years down the road… 6 years down the road.”)

Continuing Care communities do not come cheap. But for seniors who have a chunk of change from a home sale or other source and a comfortable retirement income, they fortunately exist in growing numbers across the country.

For my own part, and I am certainly very senior, I was suffering anxieties and depression after one day. I need regular infusions of 30-somethings and 40-somethings for basic survival. Again, from what I’ve heard about co-housing — the perfect choice for many others as they age — that arrangement would feel crowded and disorderly. But there is the growing aging-in-place “Village” movement, which many would not choose but seems perfect to me.

Thank heaven for choices. It is seldom too early for Boomers, or Beyonders, to start considering them — and while you’re at it, you may want to clean out the attic.

Helping Mom die

Flight #12 had not even left the gate in San Francisco yesterday before the conversation was underway. The man in seat #16F was talking to his new friend in #16E about his trip: another of many undertaken by himself and his siblings to their mother’s home in the long process of packing up, sorting through, tossing out, agonizing over. The scene is a familiar one to millions of Americans: aging, often isolated mom; far-flung, often cash-strapped, over-stressed children; a bewildering assortment of issues to be dealt with, ranging from health to housing to family dynamics.

I, of course, am the mom. Well, not #16F’s mom, and currently in good health and of relatively sane mind. But 76, with children across the continent and a dizzying amount of Stuff to be dealt with if my husband should have the crass inconsideration to die first and leave me to deal with it. (Actually, he’s been very good about making arrangements for disposition of his Stuff, but still, there are those piles and boxes and shelves of miscellany and cupboards of chipped dishes. And closets full of clothes from the 1950s and still perfectly wearable… but I digress.)

My sisters and I were fortunate that our dad looked after our mom as she slowly died, swearing they had a fine conversation the night before although dementia had long stolen her ability to converse; my father created his own realities. Twenty years later, the town of Ashland, VA, with the assistance of Randolph-Macon College, looked after our dad, because indeed it takes a village. But fewer and fewer of us have the traditional village, and more and more of us have the complications: dementia, physical issues, personal problems, too little financial and emotional resources, too much Stuff.

There is help. There are community centers and assisted living arrangements, there is the new Villages concept (more about that one in the next week or so) and an array of other anti-isolationist possibilities; there are nonprofits of every sort, from the Family Caregiver Alliance to multiple physical/emotional-needs groups to my alltime favorite, in name at least, the National Study Group on Chronic Disorganization. God willing, we may even get health care, but thanks to those earlier, similar battles we at least now have Medicare and Medicaid.

But too many of us still put it all off, and it falls to the children. We cling to the past in the form of too many boxes of old photos and letters and opera programs; we drive too long and invite fender-benders or worse; we think that old chair is worth too much for a garage sale; we forget to take the pills.

The issue, of course, is not about dying; it’s about living. Living as well as possible for as long as possible, as closely as possible to what we would choose for ourselves. But here’s what happens eventually: mom dies. It’s tough, but it’s probably okay.

I gave my card with the True/Slant website on it to the nice people in #16E and #16F; maybe they’ll check in. When I get back home, though, I think I’ll clean out some files.