Executive Summary:
Monday, September 30, 2013
POLST
One major concern about being childless is not having someone watching over your health care. Things can happen that we may not want to happen when we encounter a health care system with rigid guidelines on acceptable and unacceptable treatment. Advanced Directives are one way to maintain control. A POLST form extends that control one more level. See below for a description of POLST and the difference between POLST and Advanced Directives.
From POLST.org:
The National POLST Paradigm Program is an approach to end-of-life planning that emphasizes patients’ wishes about the care they receive. The POLST Paradigm – which stands for Physician Orders for Life Sustaining Treatment – is both a holistic method of planning for end-of-life care and a specific set of medical orders that ensure patients’ wishes are honored. The POLST Paradigm is built upon conversations between patients, loved ones, and health care professionals, during which patients can determine the extent of care they wish to receive. As a result of these conversations, patients may elect to create a POLST form, which translates their wishes into actionable medical orders. The POLST form assures patients that health care professionals will provide only the care that patients themselves wish to receive, and decreases the frequency of medical errors.
From POLST.org:
The National POLST Paradigm Program is an approach to end-of-life planning that emphasizes patients’ wishes about the care they receive. The POLST Paradigm – which stands for Physician Orders for Life Sustaining Treatment – is both a holistic method of planning for end-of-life care and a specific set of medical orders that ensure patients’ wishes are honored. The POLST Paradigm is built upon conversations between patients, loved ones, and health care professionals, during which patients can determine the extent of care they wish to receive. As a result of these conversations, patients may elect to create a POLST form, which translates their wishes into actionable medical orders. The POLST form assures patients that health care professionals will provide only the care that patients themselves wish to receive, and decreases the frequency of medical errors.
Does a POLST form replace the Advance Directive?
The POLST form complements the Advance Directive and is not intended to replace it. An Advance Directive is necessary to appoint a legal health care representative and provide instructions forfuture life-sustaining treatments. The Advance Directive is recommended for all adults, regardless of their health status.
A POLST form should accompany an Advance Directive when appropriate. For more information go to: www.caringinfo.org.
What are the primary differences between an Advance Directive and a POLST form?
ADVANCE DIRECTIVE
- For anyone 18 and older
- Provides instructions for future treatment
- Appoints a Health Care Representative
- Does not guide Emergency Medical Personnel
- Guides inpatient treatment decisions when made available
POLST
- For persons with serious illness — at any age
- Provides medical orders for current treatment
- Guides actions by Emergency Medical Personnel when made available
- Guides inpatient treatment decisions when made available
Friday, September 27, 2013
Our Stuff
(This is an update to this previous post in order to test e-mail notifications)
Why do we have the stuff we have? What does our stuff say about us? Does our stuff have any value, any character beyond its stuffy-ness, or does its existence have value only because of our own existence? Would Jack Handey or George Carlin have to say about this stuff?
We have a lot of stuff. Some day that stuff will have to move on. Our relationship with it will be severed, and some new relationships will be established. For some stuff it will be a relationship with friends and relatives. Charities may become involved. Some may find its way onto a barge or bale moving to a needy country. For some perhaps the curb, and the landfill for others.
Our exterior stuff is a reflection of our interior character. We dress the way we do because of the image we want to project. Our furniture also reflects this image. The couch is about comfort, yes, but also about style. It fits with the room that is painted in the color that frames the paintings that show how we appreciate abstract constructs that support the image that we are smart and sophisticated. Cars, houses, boats, they all say something about who we think are, who we want to be and what we believe is important.
Our stuff also gives us pleasure and comfort. Our things engender feelings of pride and satisfaction. They trigger introspection and memories. They help us do things we enjoy. They feel, smell and taste good. These are all attributes of a meaningful existence that we do not want to lose of as we age. The necessity of cutting back on our things is complicated.
We are beginning to assess the disposition of our stuff. Our stuff means something to us. We do not want to leave it to the guy with the pickup truck who comes to clean out the garbage in the house the day after we die so our executor can sell the house. Being childless, we do not have the option of letting them settle any stuff-related issues when we are gone. We want to identify proper homes for our stuff now, while we can.
Disposition of these items will require thought. As we age and our horizons move closer, it is important to not strip our lives of all their meaning. Here is one advantage we childless have - if we are careful, we can control our environment, rather than have it imposed by the will of others who will impose what stuff we can afford to carry with us and what must be left behind. We are starting to winnow down our stuff now, in an organized manner while in full control of our faculties. For example, I can anticipate now that the enlarged high school graduation picture of herself will stay with me to the end, but the effort of retaining the framed graph of Napoleon's March to Moscow by Charles Joseph Minard will at some point become too much to bear. I have reconciled myself to parting with it at some point. The framed CPA certificate will be worth nothing to anyone and will soon make nice kindling for the fireplace.
Our stuff is divided into distinct groups. Utility stuff is the stuff of everyday life. Cars. Window air conditioners. The band saw and other tools. Kitchen stuff. Yard stuff. Most of this stuff will have residual monetary value to others, and can be adjusted as our lifestyle changes. We can sell one car when we no longer need two. The lawn mower and hedge trimmers go when we hire the landscape guy to take care of the yard. The tools and furniture go when we move into the assisted living facility. The All-Clad pots go when we start eating in the dining room of the retirement home. The iron skillets and espresso maker, though, I am taking with me.
Much of the artful stuff will also likely find a home easily. Paintings and posters remain interesting. Rare restaurant plates, hand crafted glassware, figurines (why do we collect figurines?), hurricane lamps. We are not so unique that someone else will not have the same taste in decorative stuff (the disposition of the collection of animal-shaped creamers may be a little more problematic). We find all these things pleasant. Looking at them brings pleasure and fond memories. Some more than others, some more for her than for him. Some we keep because they were gifts and to dispose would be to offend.
And books. Oh, BOOKS! We have hundreds of them. Fiction, biography, history, instructional, referential and reverential. Humor. Plants. How to build a deck. How to install Windows 2.0. Some books we keep because we want to read them again. Some because they contain gems of wisdom to which we wish to have future access. And some we keep just because they were great, and it is comforting to give them a glance and remember the stories. When space no longer permits retention, call your local library. They are always looking for used books to sell at the annual Book Fair. They may even add one or two rare ones to their collections.
Historical stuff will be a little more tricky. Our histories are not our own. Our lives are linked with those of many others, and the documents of our lives may be of some interest to those others. While we have no children, we do have other family, friends, godchildren, organizational associations, geographical links, etc. So now is the time to start thinking about who might be interested in pieces of our historical stuff.
Historical stuff consists of:
Memorabilia and personal documents: same as pictures. No one will want them. Strategy: look at them once in a while, keep them as long as they give you pleasure and you have room, but at some point pitch them. Think of it this way: That stuff represents things we did in the past. We are in the NOW. We are creating NEW memories, and that is more important than dusty old past memories.
We have a lot of family historical documents. They include: a family geneology that goes back to the 1500's; old photos from when our parents were married, our siblings were young and our extensive family (Mennonite farmers from Kansas) was close-knit. Some of this might have value to a historical society somewhere, or some younger family members from another branch (my branch ends with me). We might box them up and send them to the church back home and let the cousins et al pick through them. We will keep it as long as we find it interesting and entertaining. But, again, we do not want all that history cluttering up what future we have left. "Scrape 'em off, Claire!" (-Bill Murray, Scroodged)
Business and financial documents: keep a list of recommended retention dates and every January go through them and shred (do not just pitch, but shred) the old ones. Make this one of the good habits you carry with you. Start now. Google Records Retention to find many links with helpful information. It is not complicated. Here are two such links:
http://www.shred-corp.com/guidlines.pdf
http://www.pncpa.com/Pdfs/RecordsRetentionSchIndividuals.pdf
Personal documents: Stash them in a safe deposit box for security. Your executor and whoever writes your obituary may need them. Let them worry about ultimate disposition.
Things of value: There are a couple of ways to handle this stuff, but both require you to figure out who you want to eventually have them. You can put them in a box, seal the box, and put a mailing label on it for the intended recipient. Or you can identify them in your will. I like the box route, because at some point this stuff will just get in the way. Get ready to distribute the treasure, and then do it while you can still control the process. Who knows, if the recipient is pleasantly surprised by your generosity, maybe they will visit and change your diaper each week.
As for the rest of the crap:
Michael
Why do we have the stuff we have? What does our stuff say about us? Does our stuff have any value, any character beyond its stuffy-ness, or does its existence have value only because of our own existence? Would Jack Handey or George Carlin have to say about this stuff?
We have a lot of stuff. Some day that stuff will have to move on. Our relationship with it will be severed, and some new relationships will be established. For some stuff it will be a relationship with friends and relatives. Charities may become involved. Some may find its way onto a barge or bale moving to a needy country. For some perhaps the curb, and the landfill for others.
Our exterior stuff is a reflection of our interior character. We dress the way we do because of the image we want to project. Our furniture also reflects this image. The couch is about comfort, yes, but also about style. It fits with the room that is painted in the color that frames the paintings that show how we appreciate abstract constructs that support the image that we are smart and sophisticated. Cars, houses, boats, they all say something about who we think are, who we want to be and what we believe is important.
Our stuff also gives us pleasure and comfort. Our things engender feelings of pride and satisfaction. They trigger introspection and memories. They help us do things we enjoy. They feel, smell and taste good. These are all attributes of a meaningful existence that we do not want to lose of as we age. The necessity of cutting back on our things is complicated.
We are beginning to assess the disposition of our stuff. Our stuff means something to us. We do not want to leave it to the guy with the pickup truck who comes to clean out the garbage in the house the day after we die so our executor can sell the house. Being childless, we do not have the option of letting them settle any stuff-related issues when we are gone. We want to identify proper homes for our stuff now, while we can.
Disposition of these items will require thought. As we age and our horizons move closer, it is important to not strip our lives of all their meaning. Here is one advantage we childless have - if we are careful, we can control our environment, rather than have it imposed by the will of others who will impose what stuff we can afford to carry with us and what must be left behind. We are starting to winnow down our stuff now, in an organized manner while in full control of our faculties. For example, I can anticipate now that the enlarged high school graduation picture of herself will stay with me to the end, but the effort of retaining the framed graph of Napoleon's March to Moscow by Charles Joseph Minard will at some point become too much to bear. I have reconciled myself to parting with it at some point. The framed CPA certificate will be worth nothing to anyone and will soon make nice kindling for the fireplace.
Utility Stuff Strategy: Be realistic about when you no longer need it, and get rid of it.
Much of the artful stuff will also likely find a home easily. Paintings and posters remain interesting. Rare restaurant plates, hand crafted glassware, figurines (why do we collect figurines?), hurricane lamps. We are not so unique that someone else will not have the same taste in decorative stuff (the disposition of the collection of animal-shaped creamers may be a little more problematic). We find all these things pleasant. Looking at them brings pleasure and fond memories. Some more than others, some more for her than for him. Some we keep because they were gifts and to dispose would be to offend.
And books. Oh, BOOKS! We have hundreds of them. Fiction, biography, history, instructional, referential and reverential. Humor. Plants. How to build a deck. How to install Windows 2.0. Some books we keep because we want to read them again. Some because they contain gems of wisdom to which we wish to have future access. And some we keep just because they were great, and it is comforting to give them a glance and remember the stories. When space no longer permits retention, call your local library. They are always looking for used books to sell at the annual Book Fair. They may even add one or two rare ones to their collections.
Artful Stuff Strategy: Keep it while it gives pleasure, but internalize the concept
of gradually letting go. Don't let it become junk.
Historical stuff consists of:
- Pictures of us, family, friends, places.
- Memorabilia of events. (programs, song lyrics, tchotchkes)
- Memorabilia of activities. (charts, maps, log books, journals)
- Personal historical documents. (expired passports, birth certificates, awards)
- Family historical documents. (parental records such as death certificates, photos, geneologies)
- Business and financial documents. (bank statements, tax returns)
- Personal documents. (birth certificates, etc.)
- Things of value (Redwood Library stock certificate, coin collections).
- Crap. (pretty much all of the above)
Memorabilia and personal documents: same as pictures. No one will want them. Strategy: look at them once in a while, keep them as long as they give you pleasure and you have room, but at some point pitch them. Think of it this way: That stuff represents things we did in the past. We are in the NOW. We are creating NEW memories, and that is more important than dusty old past memories.
We have a lot of family historical documents. They include: a family geneology that goes back to the 1500's; old photos from when our parents were married, our siblings were young and our extensive family (Mennonite farmers from Kansas) was close-knit. Some of this might have value to a historical society somewhere, or some younger family members from another branch (my branch ends with me). We might box them up and send them to the church back home and let the cousins et al pick through them. We will keep it as long as we find it interesting and entertaining. But, again, we do not want all that history cluttering up what future we have left. "Scrape 'em off, Claire!" (-Bill Murray, Scroodged)
Historical Stuff Strategy: Find homes for it early and let it go.
Business and financial documents: keep a list of recommended retention dates and every January go through them and shred (do not just pitch, but shred) the old ones. Make this one of the good habits you carry with you. Start now. Google Records Retention to find many links with helpful information. It is not complicated. Here are two such links:
http://www.shred-corp.com/guidlines.pdf
http://www.pncpa.com/Pdfs/RecordsRetentionSchIndividuals.pdf
Business and Financial Documents Strategy: Shred, don't dump.
Personal documents: Stash them in a safe deposit box for security. Your executor and whoever writes your obituary may need them. Let them worry about ultimate disposition.
Personal Documents Strategy: Keep 'em.
Things of value: There are a couple of ways to handle this stuff, but both require you to figure out who you want to eventually have them. You can put them in a box, seal the box, and put a mailing label on it for the intended recipient. Or you can identify them in your will. I like the box route, because at some point this stuff will just get in the way. Get ready to distribute the treasure, and then do it while you can still control the process. Who knows, if the recipient is pleasantly surprised by your generosity, maybe they will visit and change your diaper each week.
Things of Value Strategy: Controlled distribution.
As for the rest of the crap:
Crap Strategy: You Know!
Michael
Sunday, September 1, 2013
Summary of Strategies Thus Far
I think it is time to do a short summary of the trategies that we have discussed so far. Most of the 50-plus posts to this blog can be separated into the following strategies for elding without the support of a network of family and friends:
- Maintain your physical health
- Maintain your mental health
- Maintain your security
- Anticipate issues
- Develop habits that support the above strategies
- Develop plans well in advance of need
- Financial
- Operational
- End Game
A few other posts fall into the categories of "Weak Attempts at Snarky Humor to Try to Hold Your Attention," and "Trivia and Miscelanea." Do with them as you wish.
Below is a chart sorting the individual posts. If you are interested in one strategic category, you can find on this chart all the posts that pertain to that subject. Many of the posts touched on more than one category, and of course the snarky humor is pervasive.
( I hope this chart is readable on the final post. If not, I will try to find some way to reformat. And you can send me a reply or email and I will sent you the Excel file from which it was copied)
Below is a chart sorting the individual posts. If you are interested in one strategic category, you can find on this chart all the posts that pertain to that subject. Many of the posts touched on more than one category, and of course the snarky humor is pervasive.
( I hope this chart is readable on the final post. If not, I will try to find some way to reformat. And you can send me a reply or email and I will sent you the Excel file from which it was copied)
| Growing Old Alone | |||||||||||||
| Navigating Retirement and Aging Without the Support of Family | |||||||||||||
| Summary by Strategic Category | |||||||||||||
| Post | Post # | Date | Maintain Physical Health | Maintain Mental Health | Maintain Security | Anticipate Issues | Develop Habits | Develop Plans - Financial | Develop Plans - Operational | Develop Plans - End Game | Snarky Humor | Trivia and Miscelanea | |
| Growing Old - The Concept | 1 | 1/30/12 | N/A | ||||||||||
| Long Term Care | 2 | 2/4/12 | X | ||||||||||
| Done Got Old | 3 | 2/7/12 | X | ||||||||||
| A short description of Long Term Care Insurance | 4 | 2/9/12 | X | ||||||||||
| If you don't have a plan for where you are going… | 5 | 2/16/12 | X | X | |||||||||
| A few short thoughts | 6 | 2/23/12 | X | X | |||||||||
| Continuing Care Retirement Communities | 7 | 3/3/12 | X | X | |||||||||
| Getting Scammed | 8 | 3/4/12 | X | X | |||||||||
| Update on LTC Insurance | 9 | 3/8/12 | X | ||||||||||
| The Cruise Ship as Retirement Home | 10 | 3/10/12 | X | ||||||||||
| Memory and Habits | 11 | 3/28/12 | X | X | |||||||||
| "I don't want to get old" | 12 | 3/29/12 | X | ||||||||||
| Independent Living | 13 | 4/4/12 | X | ||||||||||
| Retirement Home Hint | 14 | 4/8/12 | X | ||||||||||
| A philosophical digression about the bearing of children | 15 | 4/9/12 | X | ||||||||||
| Long Term Care Cost Update | 16 | 5/1/12 | X | ||||||||||
| A few words on fitness for the kid-less | 17 | 5/2/12 | X | X | |||||||||
| Long Term Care Insruance - is it worth buying? | 18 | 5/14/12 | X | ||||||||||
| Sorry… | 19 | 6/3/12 | N/A | ||||||||||
| Habits, personality and elder abuse | 20 | 6/11/12 | X | X | |||||||||
| Not more on Habits? | 21 | 6/27/12 | X | X | |||||||||
| Attitudes (Gratitude in Particular) | 22 | 7/23/12 | X | ||||||||||
| Yummy! | 23 | 7/23/12 | X | ||||||||||
| Two Things You Need to Know | 24 | 7/26/12 | X | ||||||||||
| Rainy Day Money | 25 | 8/28/12 | X | ||||||||||
| Sex in the nursing home | 26 | 8/28/12 | X | ||||||||||
| Morningstar report | 27 | 8/30/12 | X | ||||||||||
| Morningstar - 40 must know statistics | 28 | 8/30/12 | X | ||||||||||
| Morningstar: do you have a viable plan for long term care | 29 | 8/30/12 | X | ||||||||||
| A Pasticcio | 30 | 10/3/12 | X | ||||||||||
| A Matter of Context | 31 | 10/9/12 | X | ||||||||||
| The Keys, Please | 32 | 10/15/12 | X | ||||||||||
| Guess we're not the only ones thinking about this | 33 | 10/18/12 | X | X | |||||||||
| Reverse mortgages | 34 | 10/18/12 | X | ||||||||||
| This has nothing to do with aging along, but | 35 | 10/19/12 | X | X | |||||||||
| Care by consensus | 36 | 10/22/12 | X | ||||||||||
| Exercise might beat puzzles for protecting the aging brain | 37 | 10/24/12 | X | ||||||||||
| A reflection on meditation | 38 | 12/16/12 | X | ||||||||||
| Downsizing | 39 | 12/18/12 | X | X | |||||||||
| Helpful publications | 40 | 12/27/12 | X | ||||||||||
| More on meditation from TED talks | 41 | 1/16/13 | X | ||||||||||
| It is really about self reliance | 42 | 1/29/13 | X | ||||||||||
| A sensitive subject | 43 | 2/25/13 | X | ||||||||||
| Involvement keeps the mind sharp | 44 | 2/25/13 | X | ||||||||||
| Confusion. Happens when you eld. | 45 | 2/27/13 | N/A | ||||||||||
| The Keys Please II | 46 | 3/13/13 | X | ||||||||||
| Some Statistics | 47 | 3/15/13 | X | ||||||||||
| An Example of why the habit of skepticism is so important | 48 | 3/15/13 | X | X | |||||||||
| Co-Housing - Shy didn't I think of that? | 49 | 3/25/13 | X | ||||||||||
| Special Needs Emergency Registry | 50 | 4/8/13 | X | ||||||||||
| Update/Reminder on Long Term Care Insurance | 51 | 5/8/13 | X | ||||||||||
| Some Odd Thoughts on Medicaid and Procreation. | 52 | 5/8/13 | X | ||||||||||
| Look Before You Leap - Or Move. | 53 | 5/13/13 | X | ||||||||||
| Invest in Social Connections | 54 | 5/23/13 | X | ||||||||||
| End-Of-Life Planning | 55 | 5/30/13 | X | ||||||||||
| A Technique for Aging Women to Remain Vital | 56 | 6/3/13 | X | ||||||||||
| Time Bandits | 57 | 7/21/13 | X | ||||||||||
| We Are Not Alone | 58 | 9/1/13 | X | ||||||||||
We Are Not Alone
A recent AARP study ("The Aging of the Baby Boom and the Growing Care Gap", http://www.aarp.org/home-family/caregiving/info-08-2013/the-aging-of-the-baby-boom-and-the-growing-care-gap-AARP-ppi-ltc.html) indicates a steep decline in the number of family health care givers per number of those requiring care that is facing the boomer generation. In 2010 there were more than seven potential care givers for every one boomer at age 80 (an age where we are likely to need some help). The study projects that by 2030 that ration will drop to four to one, and by 2050 it will drop further, to less than three to one.
Let me restate that more precisely: from >7:1 to 4:1, then to <3:1. The potential audience for this blog just grew exponentially.
So the discussion we are having here about strategies for becoming elders without the help of youngers may be useful for more than just the population of old people without children.
The reason for this decline may be a statistical anomaly. In the period from 1990 to to 2010 the boomers themselves were in the prime care-giving age group. Thus the ratio actually went up from 6.6 to 7.2. Before the boomer bulge the ration was likely lower. But now, as we eld, we potential care givers are leaving that category and entering the care needer category. Thus the steep decline in the ratio. As we boomers pass from Elders to Fond Memories in the years after 2050, the ration will likely once again change for the better.
But the numbers are a stark reminder that there are a lot of us, and not so many of them to take care of us. This, I would think, applies to paid as well as family care givers. Care availability may become a relatively scarce commodity.
Michael
Let me restate that more precisely: from >7:1 to 4:1, then to <3:1. The potential audience for this blog just grew exponentially.
So the discussion we are having here about strategies for becoming elders without the help of youngers may be useful for more than just the population of old people without children.
The reason for this decline may be a statistical anomaly. In the period from 1990 to to 2010 the boomers themselves were in the prime care-giving age group. Thus the ratio actually went up from 6.6 to 7.2. Before the boomer bulge the ration was likely lower. But now, as we eld, we potential care givers are leaving that category and entering the care needer category. Thus the steep decline in the ratio. As we boomers pass from Elders to Fond Memories in the years after 2050, the ration will likely once again change for the better.
But the numbers are a stark reminder that there are a lot of us, and not so many of them to take care of us. This, I would think, applies to paid as well as family care givers. Care availability may become a relatively scarce commodity.
Michael
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