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

Time Bandits

There are those for whom time weighs heavily, like thick, humid air on a hot day, nothing of interest filling a void of boredom.  If you have ever been a child in Kansas, where summers can be so hot and slow, where the tempo of the cicadas' song noticeably extends with each hour spent on the river bank as you seek to capture the catfish that will never bite, then you know what I mean.

For others, time flashes by.  In our mid-life years, there is so much to do, so many tasks and chores, that the day is a vortex of activity leaving us exhausted at the end of the day, wondering "What happened? How could I be so busy and get nothing done?"

Then we become old.  Then so many aspects of our lives have a tendency to revert to the simpler and more dependent days when we were young.  We have less to do.  Time accelerates even more as we realize that every day becomes a larger proportion of the time we have left.  It has been posed that the reason time seems to accelerate as we get old is that we do not have the anticipation of the future that we had when we were younger.

We can change that perception, or not.  We can:

• let go of the hectic pace of our mid-life years and revert to what we thought were those boring days of youth, with nothing substantial to do, no pressing agenda, no drive;  
• or we can realize that what we remember as the lazy summer days of childhood were in fact filled with adventure, new experiences, new places to go and things to learn.  Before we sat on the river bank for what seemed like hours but were in fact only moments, we had ridden our bikes for two miles, cutting donuts on the sand-covered sidewalk in front of the library as we passed, then wading in Emma Creek to catch some crawdads to use as bait, and then building a small fire to roast the fish we knew we were about to catch, and open the hot can of beer that we found in the ditch across the road from Uncle Henry's farm, but pouring it on the fire when we realized that how hot beer, any beer, at age 10 tastes awful.  And all that and more in one gloriously long summer day.

My point is this:  As children, there was so much NEW to experience.  Life moved slowly because we were always looking forward to something new.  Tomorrow lets collect cans and bottles from the ditch and maybe we will find something else amazing.  Will Christmas never come?  Will I ever be old enough to drive?  When I am 18, boy, then, ..............  Just WAIT until I am 21.  Looking to the future slowed time.  This is an immutable but as-yet inadequately documented law of physics (it also changes brain activity patterns). Why would we not want to follow that model?

The old joke is that boredom does not make you live longer, but makes it seem longer.  Boredom might make NOW seem to last forever, thus extending life.  But waiting for something NEW, some pleasurable and exciting FUTURE, will slow life to crawl.  Looking forward - next week, next month, next year - forces NOW and THEN out of our minds.  In looking back, an extended series of boring NOW's will seem to have gone in a flash, because there was nothing THEN to remember.  But waiting for exciting FUTURES's, with all the attendant anticipation, will take forever, because there is always something THERE that is not yet NOW.  And looking back at past FUTURE's will be so full of activity and interest, that it will seem like we are still THERE.

I have often said that I enjoy what I do for a living, and that if I ever retire, why would I want to stop doing something I like, in order to do nothing, which I do not like.  My challenge will be to find new things that I enjoy to anticipate.  After all, the attributes of work that I enjoy are action, learning, thinking, talking.  It is not the WORK that I enjoy, it is LIFE that I enjoy.  I can easily find new things to do.

Michael

A technique for aging women to remain vital

The other night I was talking with a friend who has done extensive research on a specific technique to assist older single women in remaining physically active and mentally alert into their elder years.  Variations on this technique may well also have positive results for men, but since the friend is a woman she has not extended her study to men.  The technique is based on admittedly unscientific research practices, but the results have been so stunning as to warrant further study with control groups.

It is well established that living in a group setting in close contact with friends or people with similar interests keeps older people active and engaged in life (see several previous posts on this blog).  It is also well established that exercise is a key component of a program to maintain mental alertness.  And staying mentally alert is the single most important factor affecting one's well being and physical health as one ages.

Co-housing is of particular interest to this author, having promoted this concept for a number of years with close friends (See "Invest in Social Connections", May 23, 2013).  There was also a recent piece on NPR about group housing for older single women (same post as above).  Perhaps a variation on this concept is the ideal test bed for my friend's technique.  Lets hope that someone picks this up as a research project.

The technique is this:

• Several compatible older women live in a group house.  An older Victorian with a garden in a pleasant setting.
• Staying physically fit is important, so the house includes an exercise room, a pool, and a good kitchen (cooking is a good social as well as physical activity).
• Since single women living together are not usually knowledgeable in maintaining facilities, outside resources are brought in to keep things working properly.
• A good handy man is essential to keep the building pleasant and attractive.
• A good gardener to augment the efforts of the ladies and do the more physical work on the grounds.
• A good pool maintenance man to keep the water clear and appealing.
• Someone who, in California, for instance, would be called a pool boy.
• A good pool boy.
• A good HOT pool boy!

So that is the key component:  A HOT pool boy.  Good cardio stimulation.  Happy mental state.  Social interaction.  A perfect catalyst for a healthy life style for older single women in a group setting.  What could be better.

Well, being a man, I can think of one or two variations that might be better.

Michael

End-of-Life Planning

Is it really possible to step out of our lives for a moment and objectively assess our selves, our resources, and plan for the end?  Having long been involved in stepping away from the heat of transaction negotiations and developing objective business plans, I suspect I find this a little easier than most.  But still, this is an emotional subject.  Can anyone really answer, objectively, such loaded questions as:

• Do I really want someone to pull the plug?
• Do I want to have the option of pulling the plug myself?
• Am I prepared to have things happen to me that are outside of my control?
• Is what I want now what I will still want when faced with reality?
• How can I have done what I want done when I have lost control?

Here is a thoughtful TED Talk about that last question.  Judy MacDonald Johnson offers five practices for planning the end.

1. Make a plan.  "Saying we would like to die at home is not a plan."  "'Just shoot me' is not a plan, it is illegal."
2. Recruit advocates.  You will need help.  Your physician, your neighbor, your accountant.  Don't count on friends and family alone.
3. Be hospital ready.  Put all the relevant information and documents in a brightly colored envelope and tape it to your fridge.  Give your advocates a copy. 
4. Choose caregivers.  Consider personality, resources, needs.
5. Discuss last words.  What will you need to hear to be ready to let go.

Here is the link to the talk.  It is short, but meaningful for those of us who do not have a large community of family to rely on for care.

http://www.ted.com/talks/judy_macdonald_johnston_prepare_for_a_good_end_of_life.html

Michael

Invest in Social Connections

A retirement or nursing home is really just a form of communal housing, but with strangers.  People live longer and maintain their health longer when they have strong social connections - friends.  As we have posted before, there are several ways to structure communal or co-housing in order to keep your own lifestyle but still live with friends and support eachother.

Here is another piece on this subject, from NPR, oriented towards older single women.  This should apply to men as well (I suspect men are shy about living with other men in a communal setting thinking that they will be perceived as gay).  I DO feel vindicated, as I have been talking about this with my best friends for over 20 years now.  I'm so smart!

My concept is more of a co-housing arrangement, where each family unit (couple or single) has their own space, but common space is available for cooking, eating, cellering wine, humidoring cigars, whatever, with rooms for visiting grandchildren, godchildren, grand-godchildren, etc, and for a live-in caregiver when necessary.  Not quite so intense as living in a single house.

Anyway, here is the link to the NPR program.  I have also copied the transcript below, for posterity.

http://www.npr.org/blogs/health/2013/05/22/183903991/Boomer-Housemates-Have-More-Fun

Transcript (there are some typos):

May 22, 2013 3:00 AM
Copyright ©2013 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

DAVID GREENE, HOST:

Americans are living longer than ever before, and as seniors approach their golden years, most are cared for primarily by an immediate family member, a spouse or their children. Having children, in some ways, is a sort-of long-term insurance policy.

LINDA WERTHEIMER, HOST:

But as life expectancy continues to rise, more and more women are living and aging without spouses or children, and are likely to face an interesting situation: Who will care for them when the time comes?

GREENE: As part of our series on the Changing Lives of Women, NPR's Julie Rovner looks at the long-term care conundrum.

BONNIE MOORE: Welcome to our house. I'm Bonnie. Come on in.

JULIE ROVNER, BYLINE: Bonnie Moore is a pert, 60-something lawyer and accountable who lives in well-kept, five-bedroom house in a cozy suburb about a half-hour outside Washington, D.C. You can tell she's used to giving the grand tour.

MOORE: I'll show you my pride and joy - my kitchen. We bought an old house, and we've been remodeling it.

ROVNER: Lorene Solivan is one of her three housemates.

LORENE SOLIVAN: And I'm the youngest.

MOORE: She's the youngest, yeah. How do you like that?

ROVNER: She just turned 60. Lorene had been living on her own in an apartment in Northern Virginia, but she wanted to downsize.

SOLIVAN: And I saw the ad on Craigslist: Golden Girls House. I said oh, that sounds like fun.

ROVNER: Which is just what Bonnie had in mind when she started her little enterprise.

MOORE: It's a little bit like family, a little bit like roommates, a little bit like a sorority house. It just evolves.

ROVNER: The four roommates share expenses, some cooking, and they even throw parties together sometimes. They also look out for each other's medical needs. Bonnie said it was a huge help when she was hospitalized recently for her diabetes.

MOORE: When I was in the hospital, they were bringing me the stuff that I needed, and this and that.

ROVNER: The whole idea started after her divorce. Bonnie needed financial help to stay in the house where she'd put down roots, including out in her beloved garden. She has a grown son in Utah. He offered to build her a house out there, but she was adamant about staying in Maryland.

MOORE: He's just sort of saying, well, Mom, you're old now. We have to take care of you. And I'm saying, I'm not old. I've got 20 more years out there in my yard, thank you very much.

ROVNER: Now, Bonnie's got big plans to grow things other than plants and flowers. She's working on a guide to help other single boomer women set up group houses like hers.

MOORE: I think it'll be fun. And I'd like to be part of various seminars and workshops for women - you know, the whole idea of living communally and learning to get along in this kind of environment.

ROVNER: Which would be a good thing because even experts in aging are scratching their heads about what's going to happen to the huge generation of increasingly single childless women as they age. Sarah Rix, of the AARP Public Policy Institute, studies the economic prospects of women in the workforce. She's also a single boomer herself.

SARAH RIX: I think that's one of the scariest questions because I fall into that category. And I say oh, I've got wonderful nieces and nephews. Well, in fact, they've got their families. They've got their in-laws. They've got their parents, and I don't think it's reasonable to expect much out of them.

ROVNER: Across the country, in San Francisco, Kathleen Kelly says she's seeing the same sort of concern in her social circle.

KATHLEEN KELLY: I'm in my 50s, and my friends are all talking about, could we all move in together? Could we buy an apartment building, and all live together? There's all sorts of permutations on this conversation.

ROVNER: Kelly's executive director of the National Center on Caregiving. The numbers are, in a word, daunting.

KELLY: About a third of baby boomers are single, but we also know that there is a large percentage of those that are in their 50s and 60s that are getting divorced. And so we're going to have more single individuals, in the future. We just haven't seen this before.

ROVNER: And many boomers have had fewer or no children, compared to previous generations. There were nearly twice as many American women without children in 2008 as there were in 1976, according to a White House report on women.

KELLY: So there's less adult children to take the place of the caregiving cohort that currently is providing caregiving to their parents.

ROVNER: Family caregiving that currently provides an estimated $450 billion a year worth of care - meaning that the mostly women boomers now caring for their parents may be unprepared for their own future. Sarah Rix, of AARP, says a big problem for single boomer women is that they may lack the financial ability to hire the caregivers they might need if they don't have family members to provide it.

RIX: They are still likely to be concentrated in what we've traditionally called the pink-collar jobs: the lower-wage, low-benefit occupations. And so when they reach old age, they often reach old age without pension coverage.

ROVNER: They will, or at least should, have Social Security, she says. But for many older women, that will be all - or nearly all - they have to live on.

RIX: And it's not going to pay for a lot of care, formal care. So it's a frightening future.

ROVNER: But there are things women can do, says Kathleen Kelly of the National Center on Caregiving. Some of them are pretty obvious, like maintaining a healthy, active lifestyle. But another piece of her advice may not be so intuitive.

KELLY: And that is to invest in social relationships and networks - not the kind that are on the Internet, necessarily, but the kind that you build a community of individuals that may - you may be able to share tasks and responsibilities as you grow older.

ROVNER: Which brings us back to Bonnie Moore, of the Golden Girls house in Maryland. She says having people around was a financial necessity, but it's become a lot more than that.

MOORE: It's just the nature of women, you know. And to come home and have someone say, hi, how was your day? That's really nice sometimes.

ROVNER: Roommate Lorene Solivan agrees.

SOLIVAN: To have your own social group your own age, whether you're 20, 40, 60 - whatever the case may be - is a big plus, I think.

ROVNER: So if you're a boomer and you liked that group house you lived in, in college or just after? Good for you because the U.S. is one of the few developed nations that has no organized public policy for providing long-term care. So group living may be something in your future as well as your past.

Julie Rovner, NPR News, Washington.

WERTHEIMER: And there's more from our Changing Lives of Women series online, where we're asking NPR women about their careers and inviting you to join the conversation. Long-time congressional correspondent Cokie Roberts weighed in on how she found support in the workplace.

GREENE: She says her female friends always rallied behind her, and she had the advantage of having them right here with her at NPR.

COKIE ROBERTS, BYLINE: Let's start with the fact that Linda Wertheimer and Nina Totenberg lobbied -that's the polite term - the powers that were to get me hired in the first place. Later, when the three of us had desks together two NPR homes ago, one of our male colleagues dubbed our corner "The Fallopian Jungle." He is long gone. We are not.

GREENE: Linda, I'm speechless. The fallopian jungle - someone actually said that?

WERTHEIMER: A little bit of "Mad Men" at old-time NPR. But things have changed a lot since then, of course. You would never say anything like that, David.

GREENE: I would never say that, Linda. You can be assured. Well, you can read Cokie Roberts' full essay at our website, npr.org.

Copyright © 2013 NPR. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to NPR. This transcript is provided for personal, noncommercial use only, pursuant to our Terms of Use. Any other use requires NPR's prior permission. Visit our permissions page for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR's programming is the audio.

Michael

Look before you leap - or move.

Here is a piece on recently released health care cost data regarding hospital billing rates for various procedures.  It is a long slog of an article, but slide to the bottom and you will see an interactive tool to see comparisons by state (you select the state) to the national high, low and average costs.  While this pertains to what the hospital will bill Medicare for these procedures, it might be an indicator of relative costs for other healthcare services.  This is one more tool in selecting where you wish to eld, or at least being informed about the cost of elding in your chosen region.

Michael



One hospital charges $8,000 — another, $38,000
By: Sarah Kliff
Consumers on Wednesday will finally get some answers about one of modern life's most persistent mysteries: how much medical care actually costs. For the first time, the federal government will release the prices that hospitals charge for the 100 most … Continue reading →

Some Odd Thoughts on Medicaid and Procreation.

I suspect that if you are following this blog you are, if not financially secure, at least financially literate. But unforeseen medical issues can devastate the most cautious saver.  The prospect of being destitute and in need can be terrifying.

But lets do a what-if and think about this for a moment.  Lets say we come down with that debilitating desease that is going to cost a fortune, OUR fortune, and at the end of the day we will spend the rest of our days in a nursing home with no prospect of paying for it.  Thanks to the administration of Lyndon Johnson, there is a safety net that will not have us shivering under an overpass waiting for our kidneys to fail and the coyotes to carry our bones to their pups.  It is called Medicaid.  Just because you have some money now does not guarantee you will not need it some day.  Thank you, Lyndon, for this and so many other things.

Variations on this theme:  There are two of you, in a legally recognized marriage.  And, there is just one of you.  If there are two of you, in a legally recognized marriage, then the one not consuming assets for medical expenses is allowed to keep some assets, but not much - a house and a few dollars of financial assets.  Lots of complicated restrictions apply.  There are claw-back rules, so you can't just give away your assets to a caregiver and then collect medicaid.  The caregiver (family members, maybe) will have to give the money back.  Just doing the paperwork for applying for Medicaid is, I understand, "complicated".  And if you are not in a legally recognized marriage, then, well, what does that mean?

Bye the way, I have found a number of references to the subject of not just growing old alone without children, but growing old alone, period.  My perspective has always been as one who is a member of a stable couple who made a conscious decision to not have children very early in our relationship.

Listening to some of the Supreme Court arguments lately about the right to gay marriage, you might think that there are those who think WE have no moral claim on marriage, since we have shunned the prime rationale for ANY marriage - procreation.  But that is another topic.  This blog should be relevant to gay couples without children as well.