I keep coming back to habit formation. I think this may be important. Good habits, formed now, might carry through into eldertime and perhaps prevent some of the issues that will not be addressed by the family that is not there. I know they cannot take care of every issue. A habit of not getting sick may not prevent you from getting sick. A habit of not having accidents may not prevent you from being rear-ended by another senile old fart. But a good habit can prevent some health-related issues from arising.
For Example: Yesterday I spoke with a massage therapist who described an elderly patient who had developed bad posture habits. She would slouch in her comfortable chair and look at TV. Because of the slouching posture, her head was tilted forward for long periods in order to see the TV. Now in her elder years, she has lost the ability to hold her head up, and has trouble swallowing which leads to drooling. She is appalled that she drools, but can do nothing about it. She cannot recover from this.
This is an extreme example of a self-induced medical issue. A bad habit, formed in facile times, carried over into elder times and caused problems. But there are smaller things that can have similar results. Tilting your head back to read something through your reading glasses or bifocals changes your spine alignment and balance, creating lower back problems that make you less mobile, thus allowing your leg muscles to weaken from lack of use, thus making it more difficult to climb those stairs, making it more difficult to do laundry, resulting in unsanitary conditions resulting in bladder infections resulting in ......
You get the idea.
Another gem of advice from the same source - If you exercise now, the conditioning will carry forward as you age. If you are in bad shape now, you will not get bretter as you age, no matter what. Weight training is as important as, maybe more important than, cardio training. Do both.
So, at the risk of sounding like your mother, STAND UP STRAIGHT! TURN THAT TV OFF! GO PLAY OUTSIDE!
Michael
Wednesday, June 27, 2012
Monday, June 11, 2012
Habits, Personality and Elder Abuse
A couple of things started me thinking about habits and personality this morning. First, an article in our local (state) paper on elder abuse: with a population of under 1 million, our little state had, in a twelve month period, 1,000 reports of elder abuse, and only 1 in 5 incidences are ever reported. That is 5,000 instances of abuse. Victims nationwide lose an estimated $2.6 billion from financial abuse and exploitation.
The second item was a discussion with Honey about the recent influx of scam emails we have been receiving purporting to be from a large prominent bank informing us that our account has been placed on hold and we must update our info in order to re-activate. A thoughtful link to thebank.com is provided. But if you put your cursor over the link, you are shown the actual url, which is to some obviously spurious location that is imitating thebank.com. Upon checking our account, it was, of course, just fine. I tried to forward one of these emails to the real bank site (they have an email address to which you can forward scams), but the email was somehow locked and unforwardable. Slick.
So, here is the link to habits and personality. I explained to Honey that when I receive a REAL email from thebank informing me that our bill is due, I never use the embeded link, even though I know this is the real deal. It is my HABIT. I go to the web site via what I know to be the real link to transact business. Habitually. Don't even have to think about it. Just do it. It is a feature of my personality to be skeptical, to never assume that what I see is what really is.
I believe that our personalities are, to a large extent, formed from a collection of habits (my psych friends may correct me on this). Habits are difficult to un-learn. And thus this aspect of my personality, these habits, will, I hope, carry over into my elderhoodedness and, perhaps, protect me from being susceptible to scams and elder abuse.
As I wrote earlier, I think that forming these kinds of habits now, while alert and facile, will enhance the experience of elding, and make for a more safe and secure eldertime. While no guarantee, at the least it will improve my chances of same safeness and security.
By the way, elder (age 62 and above) abuse comes in the form of: physical, emotional, financial, sexual, neglect, self-neglect, and the withholding of access to the good wine. Now, Honey, where did you put the key to the celler?
Michael
Signs and Symptoms of Elder Abuse - look for these in your friends:
The second item was a discussion with Honey about the recent influx of scam emails we have been receiving purporting to be from a large prominent bank informing us that our account has been placed on hold and we must update our info in order to re-activate. A thoughtful link to thebank.com is provided. But if you put your cursor over the link, you are shown the actual url, which is to some obviously spurious location that is imitating thebank.com. Upon checking our account, it was, of course, just fine. I tried to forward one of these emails to the real bank site (they have an email address to which you can forward scams), but the email was somehow locked and unforwardable. Slick.
So, here is the link to habits and personality. I explained to Honey that when I receive a REAL email from thebank informing me that our bill is due, I never use the embeded link, even though I know this is the real deal. It is my HABIT. I go to the web site via what I know to be the real link to transact business. Habitually. Don't even have to think about it. Just do it. It is a feature of my personality to be skeptical, to never assume that what I see is what really is.
I believe that our personalities are, to a large extent, formed from a collection of habits (my psych friends may correct me on this). Habits are difficult to un-learn. And thus this aspect of my personality, these habits, will, I hope, carry over into my elderhoodedness and, perhaps, protect me from being susceptible to scams and elder abuse.
As I wrote earlier, I think that forming these kinds of habits now, while alert and facile, will enhance the experience of elding, and make for a more safe and secure eldertime. While no guarantee, at the least it will improve my chances of same safeness and security.
By the way, elder (age 62 and above) abuse comes in the form of: physical, emotional, financial, sexual, neglect, self-neglect, and the withholding of access to the good wine. Now, Honey, where did you put the key to the celler?
Michael
Signs and Symptoms of Elder Abuse - look for these in your friends:
- Unexplained physical injury
- Agitation, trembling, confusion, disorientation (not to be confused with too much scotch)
- Emotional distress like crying, depression
- Withdrawn, shows no emotion
- Self-destructive behavior (not to be confused with too much scotch)
- Social and physical isolation
- Unexplained loss of financial independence and/or control
- Home is disarray, lacks basic necessities (no to be confused with too little scotch)
- Appears fearful of caregiver
- Appears reluctant to respond when questioned, or caregiver seeks to prevent elder from interacting privately with you
- Elder and caregiver give conflicting accounts of incidents
- Caregiver is indifferent or angry towards elder and refuses to provide necessary assistance
- Caregiver locks up the good wine and hides the key
Sunday, June 3, 2012
Sorry.....
..... to have been absent so long. We are not discontinuing the blog, just have been blogged down lately. Will resume shortly.
Michael
Michael
Monday, May 14, 2012
Long Term Care Insurance - is it worth buying?
Excerpt From NPR Family Matters series:
Long-Term-Care Insurance: Who Needs It?
Is it worth buying?
"Experts say the insurance can be a huge help, especially for people without children and relatively small retirement savings. But it's far from a perfect solution to all problems. For example, a policy typically covers three years of care, but many people live long beyond that cap. And the new policies are being written with more restrictions to limit insurers' risks.
Whether it makes sense to spend so much money on premiums, rather than focus on building up a retirement savings account, is a complicated equation that requires serious study."
Note: "...especially for people without children and relatively small retirement savings."
Insurance is, after all, a form of gambling. You are betting that you will get sick enough to need the policy. The House is betting you won't need more than you have paid in. But you can also look at it as a risk mitigation strategy. Ask yourself the following questions:
"If I do not have the coverage, and do need substantial long term care, will I have enough resources to cover the cost of the care and still be comfortable?" Answer: Yes. Action: Don't buy coverage. Answer: No. Action: Buy it. Answer: Maybe - Weeeeeeeelll, the decision becomes very personal, and relates to your comfort level with the probability of your remaining in long term care facilities longer than you can afford.
If, at the beginning of your long term care needs, you have sufficient resources to cover the likely costs, then LTC Insurance may only be worth it if you want to retain assets to pass on to someone. On the other hand, if at the beginning of your needs you will not, then LTC might keep you out of medicaid a bit longer. But, if you have no retirement kitty, Medicaid may be inevitable.
But if the probability of needing LTC for a long period at all is iffy, and you are comfortable with the gamble that you will not need it (in other words, you can live with the outcome if you are wrong), then why gamble?
Here is one "why": I am a male. I will not (likely) live as long as my spousie (we are not a same sex unit). So, If I think I will need LTC for a long time before passing on to that elder hostel in the sky (or wherever), and during my needs we will have spent our wad, then there will be less or little for my spousie to sustain her in elderhood. How's she gonna attract that second husband without some bait money?
Experts don't agree (see the WSJ 5/13 "Should you purchase long term care insurance). Friends will disagree. Hell, there are times when I disagree with myself. My advice would be, pick your strategy, periodically re-assess the ongoing costs (not the sunk costs you have already incurred - they are irrelevant), and then go have a glass of wine and relax. With my luck, I will live to 108 and then die suddenly while falling off a bar stool in the Candy Store as I check out the booty of that new hot server that Stephan just hired.
What a way to go!
Michael
PS, there will be one more post on this subject concerning a strategic decision that could result in a resounding "NO" to LTC Insurance. Research is pending. Then, enough already. We have other things to talk about.
Wednesday, May 2, 2012
A few words on fitness for the kid-less.
Staying fit as you eld seems to be a good strategy regardless of whether or not you have children. Under any circumstance, why would you want to become that immobile, vacant, dependent, Depends-dent person in front of the window watching the squirrels all day. There isn't much point in spending a lot of time on the subject of fitness in this blog as it has been well covered elsewhere.
However, since this is in part a manual for our personal adventure in elditude, we will make note of a couple of interesting things we heard the other day in a talk by Dr. Richard Besdine, Director of the Center for Gerontology & Healthcare Research at Brown University, speaking at the Redwood Library, titled "Fit at 50, Sexy at 70". Works for me.
- Behavior patterns are more important than genetics and the environment on maintaining good health as we age. Form healthy behavior habits.
-Blood pressure - eat right, exercise and treat when necessary.
-Exercise - make it fun. If it is fun you will develop a habit of doing it (remember "Habit"?). Also, the French Paradox has nothing to do with wine. It results from using public transportation, which results in more walking, which is good exercise.
-Smoking - STOP IT!
-Drive safely, or don't drive. Move to a place with good public transportation. Like Paris!
-Immunizations - get 'em. Flu, pneumonia, shingles, etc.
-Pills - don't overdo it. Make sure your Dr. knows what you are taking. Most dietary supplements don't do any harm, but don't do much if any good. Ginco can be bad for bleeding.
-Calcium - take it. Both men and women need it. With vitamin D. 50% of women in norther climates have vitamin D deficiency.
-Aspirin - not sure. Mixed benefits. Jury is still out.
-Environment - clean it up. remove toxins, get fire alarms.
-Guns - get rid of 'em. The odds of being shot by your own gun is 10x higher than the odds of you shooting someone else. Also, a common occurrence: wife dies, husband is depressed, drinks, shoots self. There is a reason why the NRA is opposed to DR's even asking if you have a gun (it is illegal in some states). They know it is a risk factor, and don't want you to know it.
-Screening - colonoscopy, mammograms. PSA is controversial. Test over age 70 does not improve survival.
-Booze - tolerance declines with age. Same amount drunk results in more alcohol in blood stream.
-Oral Health - not covered by Medicare. Brush.
-Osteoporosis - See calcium above. 1,500mg/day, plus 800u Vitamin D/day.
-Falls - Elder women have worse balance than elder men. Falls compound the osteo problem (fragile bones). Yoga, Tai Chi are great for improving balance. Falls cause anxiety, which carries over into all aspects of life. Wear good shoes, maintain strength (resistance training, not just cardio), watch vision closely.
-Emotional Health - you can train yourself to be happy (Habit!). Strive to reduce stress.
-Social networks - social people live longer. Friends count.
-Sex - Need I say more?
-Sleep - Treat discomfort factors. Limit caffeine, it stays in the blood stream longer as we age. Best treatment for insomnia is a warm drink, a dark room, soft music and a back rub. See Sex above.
-Dementia/Alzheimer's - limit risk by exercise, diet, use your brain (do puzzles, learn a language, keep working, interact with surroundings). Don't box or play football.
-Advanced Directives - you need these at the time of admission to a medical facility. Make sure someone, everyone, knows what you want to happen. Most elders are not afraid to talk about it, so listen to them/us. I plan to have mine tattoo'd on my chest.
-Sex - Did I mention this?
Any other ideas? I am especially interested in how to make your advanced directives heard. How does the ambulance EMT know that you do not want to be resuscitated? Do you even want an EMT to make that decision? Short of having them tattoo'd on your chest, how do you make your wishes know when you are alone, without family to represent you? Please let me know what you think.
Michael
However, since this is in part a manual for our personal adventure in elditude, we will make note of a couple of interesting things we heard the other day in a talk by Dr. Richard Besdine, Director of the Center for Gerontology & Healthcare Research at Brown University, speaking at the Redwood Library, titled "Fit at 50, Sexy at 70". Works for me.
- Behavior patterns are more important than genetics and the environment on maintaining good health as we age. Form healthy behavior habits.
-Blood pressure - eat right, exercise and treat when necessary.
-Exercise - make it fun. If it is fun you will develop a habit of doing it (remember "Habit"?). Also, the French Paradox has nothing to do with wine. It results from using public transportation, which results in more walking, which is good exercise.
-Smoking - STOP IT!
-Drive safely, or don't drive. Move to a place with good public transportation. Like Paris!
-Immunizations - get 'em. Flu, pneumonia, shingles, etc.
-Pills - don't overdo it. Make sure your Dr. knows what you are taking. Most dietary supplements don't do any harm, but don't do much if any good. Ginco can be bad for bleeding.
-Calcium - take it. Both men and women need it. With vitamin D. 50% of women in norther climates have vitamin D deficiency.
-Aspirin - not sure. Mixed benefits. Jury is still out.
-Environment - clean it up. remove toxins, get fire alarms.
-Guns - get rid of 'em. The odds of being shot by your own gun is 10x higher than the odds of you shooting someone else. Also, a common occurrence: wife dies, husband is depressed, drinks, shoots self. There is a reason why the NRA is opposed to DR's even asking if you have a gun (it is illegal in some states). They know it is a risk factor, and don't want you to know it.
-Screening - colonoscopy, mammograms. PSA is controversial. Test over age 70 does not improve survival.
-Booze - tolerance declines with age. Same amount drunk results in more alcohol in blood stream.
-Oral Health - not covered by Medicare. Brush.
-Osteoporosis - See calcium above. 1,500mg/day, plus 800u Vitamin D/day.
-Falls - Elder women have worse balance than elder men. Falls compound the osteo problem (fragile bones). Yoga, Tai Chi are great for improving balance. Falls cause anxiety, which carries over into all aspects of life. Wear good shoes, maintain strength (resistance training, not just cardio), watch vision closely.
-Emotional Health - you can train yourself to be happy (Habit!). Strive to reduce stress.
-Social networks - social people live longer. Friends count.
-Sex - Need I say more?
-Sleep - Treat discomfort factors. Limit caffeine, it stays in the blood stream longer as we age. Best treatment for insomnia is a warm drink, a dark room, soft music and a back rub. See Sex above.
-Dementia/Alzheimer's - limit risk by exercise, diet, use your brain (do puzzles, learn a language, keep working, interact with surroundings). Don't box or play football.
-Advanced Directives - you need these at the time of admission to a medical facility. Make sure someone, everyone, knows what you want to happen. Most elders are not afraid to talk about it, so listen to them/us. I plan to have mine tattoo'd on my chest.
-Sex - Did I mention this?
Any other ideas? I am especially interested in how to make your advanced directives heard. How does the ambulance EMT know that you do not want to be resuscitated? Do you even want an EMT to make that decision? Short of having them tattoo'd on your chest, how do you make your wishes know when you are alone, without family to represent you? Please let me know what you think.
Michael
Tuesday, May 1, 2012
Long Term Care Cost Update
Here is an update on the average costs of various elder services. This may be redundant with earlier posts.
These are, of course, averages. As you all know, total actual costs incurred are dependent on the intensity of use of these services. Fortunately, all of our friends of a certain age are ALL very fit, mentally active, and will no doubt not need these services much, if ever. Right.
The state by state comparison link is pretty interesting. Where do YOU want to retire? Or, where can you best AFORD to retire. Maybe matching up availability of services and life-style features with costs would be an interesting exercise.
Michael
These are, of course, averages. As you all know, total actual costs incurred are dependent on the intensity of use of these services. Fortunately, all of our friends of a certain age are ALL very fit, mentally active, and will no doubt not need these services much, if ever. Right.
The state by state comparison link is pretty interesting. Where do YOU want to retire? Or, where can you best AFORD to retire. Maybe matching up availability of services and life-style features with costs would be an interesting exercise.
Michael
The Cost Of Elder Care
Adults have been providing an increasing percentage of financial assistance to their parents in recent years. Below are the national average annual costs and daily rates paid for various types of adult care.
| Type | Average | Annual |
|---|---|---|
| Nursing home: semi-private room | $214/day | $78,110 |
| Nursing home: private room | $239/day | $87,235 |
| Assisted living | $3,477/month | $41,724 |
| Home care: home health aide | $21/hour | $21,840 |
| Home care: homemaker | $19/hour | $19,760 |
| Adult day services | $70/day | $18,200 |
| A state-by-state comparison | ||
Monday, April 9, 2012
A philosophical digression about the bearing of children
Why do we have children? In "Why Have Children?: The Ethical Debate," Christine Overall finds several reasons, and suggests that these reasons, when examined, are debatable. Here are three of them:
1. Having a child benefits the child. Without being "had", the child has nothing. But the supposed benefit is unknowable at the time of conception. The random nature of growing up could well, in fact, be a detriment to the child. Plus, if "becoming" is an intrinsic benefit to the child, then by implication "not becoming" must be a relative detriment. But nonexistent people have no standing in the argument, no skin in the game. Someone who does not exist has no argument for existing. Or not. Among the infinite number of non-existential individuals who have ever not existed, no one has ever complained about their lot in non-life (thanks, EK). Therefore, the argument for "having" is spurious.
2. Having a child perpetuates the family name and gene pool. Overall's counter-arguments here are a little weaker, but follow the line of "So what?" The greater mass of humanity does not care if your tiny pool of unique identifiers carries forward, and your providing for the continuation of the species, if carried to its extreme conclusion, would turn all women into "procreative serfs." Think of the breeding of horses and cattle.
3. There will be someone to care for us in our old age. A direct quote is the best refutation: "Anyone who has children for the sake of the supposed financial support they can provide is probably deluded." It just does not happen. A matter of opinion, as I have seen no research on this subject, but one I suspect is valid. (Same does not hold for godchildren with boats in the Bahamas, who are sure to be supportive.)
4. Parenthood will make us happy. Nope. In a 2004 study, one of the few activities that women found less enjoyable than caring for their children was doing housework.
The first two arguments propose a benefit to those who either do not exist or do not care. The last two indicate a certain level of selfishness. So, does having children come down to selfishness? Are we-who-have-none actually paragons of virtue for having not? Or are we the more selfish ones, denying the benefits of existence, however debatable, in order to pursue our own agenda of leading lives without the [hinderance, burdens, obligations, joys, anguish, ecstasy, insert preferred descriptor here] of having sons and daughters?
As a couple, we made a decision early in our married lives to forgo children. Permanently. Neither of us had a strong procreation urge, and peer/family pressure was light. Maybe the reason our families went easy on us was that they were quite surprised when, eight months after marrying at a very young age, we did not deliver. Who knew we married for love?
Our decision was not made lightly, but may have been made selfishly. There were places we wanted to go. Things we wanted to do. Worlds we wanted to conquer. We wanted to see what was beyond the horizon, free and unburdened. Children would have complicated things. Taken us down different paths. Maybe better, more rewarding paths. But they would have been paths not entirely our choice. So we made our choice, knowing that we would be missing some things while experiencing others. The choice was right for us, and we understand that it would not be right for others. We are OK with that.
Frankly, I reject the whole philosophical discussion above. Having children should not be an "ethical debate". The real reason we did not have children is that we did not desire them. No one should have children unless they desire them, want to love them, are prepared to care, nurture, coach and support them. Boiling it down to a rational decision removes the magic from life. It really is magical.
My apologies for the digression. This blog is intended to address the practical considerations of non-familied elders. But when I do see children lovingly caring for failing parents, I really admire them for their love, and their parents for inspiring such love.
Michael
[reference: The New Yorker, April 9, 2012, "The Case Against Kids", Elizabeth Kolbert]
1. Having a child benefits the child. Without being "had", the child has nothing. But the supposed benefit is unknowable at the time of conception. The random nature of growing up could well, in fact, be a detriment to the child. Plus, if "becoming" is an intrinsic benefit to the child, then by implication "not becoming" must be a relative detriment. But nonexistent people have no standing in the argument, no skin in the game. Someone who does not exist has no argument for existing. Or not. Among the infinite number of non-existential individuals who have ever not existed, no one has ever complained about their lot in non-life (thanks, EK). Therefore, the argument for "having" is spurious.
2. Having a child perpetuates the family name and gene pool. Overall's counter-arguments here are a little weaker, but follow the line of "So what?" The greater mass of humanity does not care if your tiny pool of unique identifiers carries forward, and your providing for the continuation of the species, if carried to its extreme conclusion, would turn all women into "procreative serfs." Think of the breeding of horses and cattle.
3. There will be someone to care for us in our old age. A direct quote is the best refutation: "Anyone who has children for the sake of the supposed financial support they can provide is probably deluded." It just does not happen. A matter of opinion, as I have seen no research on this subject, but one I suspect is valid. (Same does not hold for godchildren with boats in the Bahamas, who are sure to be supportive.)
4. Parenthood will make us happy. Nope. In a 2004 study, one of the few activities that women found less enjoyable than caring for their children was doing housework.
The first two arguments propose a benefit to those who either do not exist or do not care. The last two indicate a certain level of selfishness. So, does having children come down to selfishness? Are we-who-have-none actually paragons of virtue for having not? Or are we the more selfish ones, denying the benefits of existence, however debatable, in order to pursue our own agenda of leading lives without the [hinderance, burdens, obligations, joys, anguish, ecstasy, insert preferred descriptor here] of having sons and daughters?
As a couple, we made a decision early in our married lives to forgo children. Permanently. Neither of us had a strong procreation urge, and peer/family pressure was light. Maybe the reason our families went easy on us was that they were quite surprised when, eight months after marrying at a very young age, we did not deliver. Who knew we married for love?
Our decision was not made lightly, but may have been made selfishly. There were places we wanted to go. Things we wanted to do. Worlds we wanted to conquer. We wanted to see what was beyond the horizon, free and unburdened. Children would have complicated things. Taken us down different paths. Maybe better, more rewarding paths. But they would have been paths not entirely our choice. So we made our choice, knowing that we would be missing some things while experiencing others. The choice was right for us, and we understand that it would not be right for others. We are OK with that.
Frankly, I reject the whole philosophical discussion above. Having children should not be an "ethical debate". The real reason we did not have children is that we did not desire them. No one should have children unless they desire them, want to love them, are prepared to care, nurture, coach and support them. Boiling it down to a rational decision removes the magic from life. It really is magical.
My apologies for the digression. This blog is intended to address the practical considerations of non-familied elders. But when I do see children lovingly caring for failing parents, I really admire them for their love, and their parents for inspiring such love.
Michael
[reference: The New Yorker, April 9, 2012, "The Case Against Kids", Elizabeth Kolbert]
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