Today Trustees for the Medicare program announced that Medicare would be bust by 2019, 11 years from now.  And, this year, for the first time, Medicare will begin distributing more funds than it takes in.

This is staggering in it's implications.  But what is more staggering is that our top news today is Hillary's fictional account of snipers in Bosnia, Obama's poor taste in pastors, and McCain's deficiencies as an economist. 

We are truly all, fiddling while Rome burns.  We must persuade our politicians to take on this issue now.  It will soon become the major factor in American prosperity, or lack thereof.  And, as with all big challenges, the longer we avoid dealing with the issue, the larger and uglier it will get.

Please, learn more about this issue.  Tell everyone you know about what you learn.  We must start this conversation.  We must start it TODAY.

Normally I'm a big advocate of free market capitalism and the idea that the markets will work out the true value of assets; stocks, bonds, houses, oil, gold, the dollar...everything.  In the long run, we have ample evidence that this is true.  So this economic shock we're experiencing right now will work itself out without government intervention.

 BUT, our elderly cannot rely on 'the long run'.  They cannot simply 'weather the storm'.  Severe inflation, a sharp decline in the value of the dollar, the dramatic reduction of the Fed funds rate all have immediate, drastic impact on our nation's elderly - the majority of whom live on fixed income.

When your income is fixed, but the price of food and heating oil is increasing, and the value of your home, your primary asset which you've paid for over 30 years or more, is decreasing right at the time you need to sell it to pay for non-optional elder care...well the long run just isn't any consolation.

While there are urgent economic issues in the US that will require tough choices, we MUST remember that our senior population does not have the option of 'working more hours' to compensate for higher prices.  Our seniors cannot 'hold out for the long run'.  Thier economy is NOW. 

We must find a way to protect our seniors, our parents, from the healthy but sometime destructive forces of free market capitalism.

There was an interesting article in last Tuesday's New York Times reviewing a book called "Swimming in a Sea of Death".  The book was written by the son of author Susan Sontag about her long agonizing battle with cancer.  Ms. Sontag 'beat' two types of cancer before finally succumbing to a third after a long, painful battle.  Throughout her struggle, Ms. Sontag mainatined that she would beat this third cancer.  Her son's role was head cheerleader. "His job was to enthusiastically endorse her struggle, always to be optimistic and supportive and never, ever to talk about death." In spite of her being "...covered in sores, incontinent, and half delirious" his role was to tell her she looked better than the day before, that she was improving.

The point that struck me most was this: the son "wound up entangled in the single biggest dilemma in medicine: how to calculate the dose of hope, that most powerful of all medications, to be dispensed in hopeless cases.  The professionals stumble here all the time.  No child could or should be asked to get it right for a parent"

When my mother's father was in hospice with lymphoma about 10 years ago, I can recall visiting him and struggling with the same question. I stayed always optimistic, and some extent in denial, about the prospects of recovery.  And yet it felt disingenuous.  And that's a lousy way to feel in the final weeks or days of a relationship with a loved one.

I've often heard the idea that rather than go into retirement or assisted living, seniors will just get on a cruise ship and stay on board.  Well I just got back from a 5 day cruise in Caribbean. (I know, lucky me ;) and I have to say I'm not sure I'd mind spending another month on board.  After all what's not to like?  Sunshine, a new port of call every couple of days.  Free food available anytime you want.  Housekeeping services every day...Ok, there's probably a few too many drunk people running around to put up with it for too long but it's an intersting idea.

On the positive side, there's the cost.  Two people, 8 days, Western Caribbean, with an ocean view cabin on Carnival Cruise Lines = $439 each.  That's $1,756 per month including food and housekeeping.  Not bad!

The downsides are primarily medical: There's really no 'assistance' available for any activities of daily living.  The high seas are no place to have an urgent medical need.  While food is included, it's a long walk to the dinning room.  And those tiny bathrooms are not exactly 'senior-friendly'. Also, it would be a bit tough to visit family members regularly.  But then again, Cozumel isn't such a bad place to fly into for a visit!

So it's not the most realistic idea in the world but wouldn't it be nice if an assisted living company included a month-long cruise twice a year as part of your stay?  If they brought along an appropriate number of caregivers and medical staff (for whom it would be a nice perk) it seems like it could be done for around $3,300...roughly what one month costs in assisted living.  Travel to and from the port would be an incremental cost but perhaps that could be covered by the family?

Why isn't this possible?  Certainly if you're running an assisted living community it's easier not to try to move half your residents onto a cruise ship twice a year.  And it's safer for your residents as well, and caregivers prioritize safety in a big way.  But not everyone wants easy and safe.  Some love travel and adventure.

What do you think?

Recently my parents moved my Grandmother into an assisted living community. I'm certain that is was one of the hardest things they've ever done. I know that it was one of the most stressful experiences my father has gone through.

My grandmother has early stage dementia. Not bad enough to create big problems, but certainly enough to make day to day life a challenge. She's had a collection of health issues as is not uncommon for someone in their late 80's. She had a hip replacement, had a number of procedures done to help correct her macular degeneration (loss of vision in one eye) and glaucoma. She hasn't driven in at least 5 years which is a very good thing, and was recently living alone in the house she and her late husband shared for about 35 years. Her husband, my grandfather, died in the late 1990's.

Our family has been trying to convince her to move into assisted living for at least 5 years. Her house was too much to care for, she wasn't eating properly, and local 'kids' were telling her they had mowed her lawn and done her gardening and demanding $200...which she paid them. No gardening or lawn mowing was being done however. A kind woman from her local senior center would take her shopping for groceries (and gambling - video poker is legal in her state) once a week. The highlight of her day was watching Jeopardy and doing the crossword. With the gradual loss of her vision, even the large-print crosswords were becoming too hard to see.

My folks, (who live 1500 miles away) had hired home care agencies to help her out. She consistently fired all of them.

My father told her it was time for her to move to an assisted living. She absolutely refused. Her perspective was that if she left that house it would be feet-first. When my father told her that she must move for her own safety, her response was "If you do move me, I'll do something drastic." My grandmother is a very tough, determined woman. Everyone understood what she meant.

About 3 weeks ago, my parents decided there was no other option than to move her. She was clearly no longer safe alone (she had stumbled and fallen, giving herself a huge bruise on her head recently. She had also let this 'kid' and his friend into her house again despite previously understanding they were stealing from her.)

My father had a terrible time coming to this decision. He knew that she would always blame him for the move. He also knew there was a very good chance that she might make good on her threat to "do something drastic". My father spent over 25 years as a partner in one of the top management consulting firms in the US. I've seen him stressed before. This decision was a completely different level of stress for him. Torn between following your mother's wishes, doing what's best for her well being in spite of them, and knowing that doing the right thing could result in losing her or minimally losing his relationship with her. I wouldn't wish this on anyone.

As it happens, my cousin's wife works for A Place for Mom in my grandmother's city. She had lined everything up for my parents. A great assisted living community with an excellent reputation, an experienced geriatric care manager, and a top gero-psych doctor for her dementia. The care manager recommended that she take my grandmother to the doctor's office for her regular check-up. Then afterward, she would take my grandmother to the assisted living community and explain that this was her home now. She recommended this to soften the family dynamic of such a move. Meanwhile my parents and my cousins moved her things from her house to the assisted living community so when she got there her apartment was already 'home'.

Her comment after all of this was "I don't remember agreeing to this". My Dad, being the steadfastly honest guy he is, told her "No Mom you didn't agree to this. But this is the best thing for you and I, Bruce (her other son) and the kids (me, Pam and my cousins) all know this is the right place for you."

It's been nearly 3 weeks now. Nothing dramatic has happened. She's eating far better than she did before though she's still not socializing as much as we'd like. Reluctantly she's settling in. When my parents take her out for lunch or dinner she gets tired and and asks to go 'home' to her assisted living community. And in 3 weeks she hasn't yet mentioned her old home.

I don't know how this is going to turn out. I know that my Dad did the right thing. I know my grandmother is healthier and safer than she was. But I also know that my Dad is a deep believer in personal freedom and everyone's right to make their own decisions about their own lives, regardless of the outcome. I would suggest that dementia is an extenuating circumstance and personal freedom may not extend to endangering oneself due to mental illness.

But this is family. Personal philosophy is about ideas in the abstract. Where those ideas apply to family...well that's a whole different story.

Thanks for reading,

John

(original post date: August 2007)

The best book available on the age wave: The Coming Generational Storm by Laurence J. Kotlikoff, Scott Burns.

"Like it or not, ready or not, everyone reading this book will experience the greatest demographic change in human history"

other stunning facts:

"You get a visceral idea of what we are facing by considering an extreme; the rising population of people at least 100 years old. By mid-century the US centarian population will exceed 600,000. That's ten times the number of centarians around today."

If you ever doubted that a book on US demographics could be a "keep you up all night page-turner" this book will change your mind! After all - how will we pay for their care? How will we pay for their retirement? Once social security goes broke, how will our parents and ourselves survive? This is an outstanding book - balanced, well researched, and frankly very, very scary.

(originally posted 9/2005) 

I was talking recently to someone who runs an assisted living property in New Orleans. She was telling me about the difficulties they were having around finding alternative housing and eldercare for all the folks they evacuated.

Today I pulled the list of all the eldercare properties within 50 miles of NewOrleans - these are places where people have clearly been impacted by the storm - there were over 200 properties. Most properties have about 100 residents. That's 20,000 seniors directly and immediately impacted by this storm. Many of them had to evacuate. I hope most were able to. I can't imagine where they went to. Where do 20,000 seniors who need daily assistance and care go when they have to move with almost no notice?

This storm will have many many ramificatiuons and we will realize those ramifications more clearly as time goes on. But one of the major issues will be taking care of our frail elderly who were in harm's way. These are the most vulnerable people. They are our parents and loved ones. They will need extra help.

My company has listed all the eldercare facilities within 150 miles of New Orleans on our website. that list is at: http://www.aplaceformom.com/katrina.htm It is our hope that this list will help the people who are helping those seniors find alternative housing options in that area. We want to help more. If you have ideas or suggestions about ways we might help, please add a comment, let us know your thoughts.

Giving residents with mild mental impairment a 10-item smell test may help determine whether they are more likely to develop Alzheimer's disease, researchers say.

"Problems with identifying common smells can be an effective early marker of the diseases," said Dr. Matthias H. Tabert of Columbia University College of Physicians and Surgeons, New York.

Tabert and colleagues tested more than 300 people to narrow down identifiers from the 40-item University of Pennsylvania Smell Identification Test (UPSIT). They wound up with a 10-item test that was just as effective and could be completed in less than five minutes. A report on their findings was published in the Annals of Neurology.

The shorter test featured scents of: strawberry, lilac, menthol, leather, pineapple, soap, natural gas, clove, lemon and smoke. Further checks showed that poor identification of the 10 odors was consistently associated with a higher risk of Alzheimer's disease, researchers said

My grandmother Jean Taylor passed away last week. She was 85 and died of a sudden heart attack. She was still living in her own home, alone. It was such a shock since she was so vibrant and mentally strong. The day before she died she hosted a dinner party for a few friends who told me that she had talked that night about finally moving into a nearby retirement community that she liked. She had a heart attack in her bathroom sometime on Monday night. Friends found her on Wednesday.

In some respects I know that this is how she wanted to go; quickly and in her own home. She was very afraid of ending up in a hospital bed for her final months or years. But I do wonder if she'd been able to get help that night if she'd still be here, for a little while longer. I'll never know.

(originally written in August 2005)

One of the most striking things about eldercare in the media is all the terrible stories people hear about. One would think that all the 2M seniors in the US in living in senior housing are being neglected of abused. It's truly amazing that no one hears the good stories.

But it's also easy to explain. Drama sells newspapers. Trauma sells newspapers. Sweet stories about seniors who have recovered from isolation and depression while living alone at home, seniors who are now thriving in an assisted living setting with friends and good food, our parents who have become themselves again, who've regained their 'spunk' - all these stories do not sell newspapers.

I see so many of these positive stories - stories about people being rescued from truly dangerous situations at home alone; situations of isolation, malnutrition, neglecting to take medications, safety hazards...it's incredible that we don't hear more about this side of the story.

So the goal of this blog is to discuss current and future trends in eldercare.

Who am I? I'm one of the founders of A Place for Mom, Inc. We're the nation's largest eldercare referral service and we do it for free. We've got nearly 300 eldercare advisors across the US that provide free, personal, professional assistance to families looking for care for their aging loved ones. Check us out at http://www.aplaceformom.com

So my goal here is to start an online forum about eldercare. The service, the process of finding it, and people's experiences with it. Maybe some of these discussions will also help us provide a better experience for folks who visit our web site and use our sevice: A Place for Mom.

Welcome!

John