Tuesday, March 17, 2020

It’s 1:00 in the afternoon, and this has been my day so far in The Age of Coronavirus.

7:00 A.M. Wake up, turn on CNN. Nothing but progress of COVID-19. Spreading exponentially. Testing now is actually occurring (after weeks of false reports). But not in Maryland where I live. We’ve received the testing kits and have a drive-thru site ready, but apparently there’s a snafu in the labs that read the tests. 

Jim at the Giant to pick up bananas and fresh tomatoes. We stocked up for possible quarantine, but he likes to get out while he still can. Early in the morning he expects few shoppers, so no problem social distancing. He calls to say the store is down to nine bananas. (“I left four. I’m not a hoarder”) and only cherry tomatoes. He’ll also gas up my car, covering the pump handle with a paper towel. Back in the car he’ll use a little of our waning supply of hand sanitizer.

My back hurts and I have a dry cough. No fear. The cough is chronic post nasal drip, and the pain is osteoporosis. I’m looking forward to my physical therapy session at 10:00 with Bonnie. Her massages test my pain tolerance–but they work. When she’s done I do feel better, and am usually able to get out of bed next morning without grimacing. We have a date every Tuesday and Friday.

8:00 A.M. I listen to more news, decide to cancel Bonnie, even though she’s Irish and it’s St. Patrick’s Day. All bars, restaurants, gyms, and schools are closed. No parades. I get emails from four doctors with the same basic message: STAY AWAY. Don’t worry, we have telemedicine! 

One email says if you have to come in, wait in your car (not in the waiting room). (I’m not making this up.)

9:00 A.M.  I eat a little yogurt for calcium. Read the Washington Post. San Francisco is locked down. There’s a run on GUNS, for God’s sake! People are preparing to shoot their neighbors, I guess, if they knock to borrow an egg. 

9:45 A.M. Check email. My millennial granddaughter Emily, passes along a message from a former colleague at Sloan Kettering Cancer Center. The hospital will run out of masks in one week. They come from China. (An hour later the President announces he has asked builders to donate painter’s masks to hospitals!) Gov. Cuomo says CDC predicts 40-60% of us will get hit, and 17% of those will have to be hospitalized. NY needs 7,000 more beds. Army engineers may put up field hospitals.

10:45 A.M. Sig (my co-author) calls with a little levity. He texts me a picture. Caption is “Experts recommend keeping your daily rituals even while working from home.” Shows a guy dressed for work, jacket, sunglasses, earbuds, standing in a bathroom — holding cellphone in one hand, the other grasping the shower bar.  

Gallows humor. 

11:00 A.M. Jim’s oral surgeon calls to cancel surgery scheduled for March 25. Why? It would be in his office, not in a hospital that needs space. An in-and-out procedure. Maybe his team just wants to stay ten feet away from everyone. Tough for a dentist.

On TV, Mayor De Blasio of NYC is warning residents to get ready for a possible “shelter in place” order. New Jersey already has a curfew from 8 P.M. to 5 A.M. 

The mayor’s speech interrupted by Trump predicting this may be like the Great Depression. But we can’t create jobs like the CCC because they worked in groups. Treasury Secretary Mnuchin announces we’re “signing paper” (Borrowing? Printing more money?) for a TRILLION DOLLARS. To send every adult $1,000. Sorry I laughed at Andrew Yang.

Stay safe, and look after each other!

After presenting a webinar on our book Love’s Way: Living Peacefully With Your Family As Your Parents Age, I realized that little of what I discussed about having “The Conversation,” or transparency, or naming a healthcare proxy applies to persons with no family connections.

What recourse has an older adult with no one to serve as her power of attorney or executor of his will or someone to call in case of illness or medical emergency?  Whom do these people (often referred to as “solo agers” or worse, “elder orphans”) rely on for these and countless other supports?

According to a 2016 study these issues confront an estimated 22 per cent of adults 65 years or older in the U.S.^* Many live in isolation although they may reside in populated areas. Even if they don’t experience a major accident or chronic illness, what about their emotional and psychological health? Imagine: No spouse. No kids. No one to turn to if their health deteriorates. 

Last month the National Academy of Science, Engineering, and Medicine (NASEM) released a study titled: “Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System.”

Among the study’s findings:  

• Nearly one quarter of Americans aged 65 and older who live in community settings are socially isolated, meaning they have few social relationships or infrequent social contact. 
• A significant proportion of adults in the United States (35 percent of adults 45 and older, and 43 percent of adults aged 60 or older) report feeling lonely.
• Older Americans who reported being lonely are twice as likely to die prematurely than those who aren’t.
• Conclusion? Social isolation and loneliness represent significant health concerns for older adults that put them at higher risk of developing serious medical conditions.

While the NASEM study doesn’t address solo agers, I believe there must be significant overlap. 

Where do these folks turn for support, companionship, for social survival? 

• I found an Elder Orphan Facebook group with more than 8,500 members.  
• Spread around the country are more than 240 villages in 41 states designed to help seniors age in place.** 
• More than 600 Area Agencies on Aging throughout the 50 states aim to help vulnerable adults aged 60 and older “live with dignity and independence in their homes and communities for as long as possible.”

Important as these resources are, they are too few to dent the growth in solo agers, increased isolation among older Americans, and an aging U.S. population.

These facts may not signal a crisis, but certainly a critical need for innovative approaches to a serious issue.

*“Elder Orphans Hiding in Plain Sight: A Growing Vulnerable Population.”  Maria T. Carney, et al. Oct. 2016. Current Gerontology and Geriatrics. Oct. 2016.
**vtvnetwork.org

I recently attended an End-of-Life Expo. Organized by Washington, DC-based IONA Senior Services, a highly respected nonprofit dedicated to improving the lives of aging persons, its notice about the expo tweaked my interest: “When you express how you want to die, you reveal how you want to live.”

The day-long expo offered 12 sessions from dementia planning and organ and body donations to writing your own obituary and DC’s Death With Dignity Act. (In 2016 the District of Columbia joined seven other jurisdictions* and enacted a Death with Dignity law that enables terminally ill DC residents to take their own lives with two doctors’ approvals and after meeting a host of other requirements.) More on this below.

The meeting spaces were filled to capacity and late registrants were wait-listed. Attendance at most sessions was standing room only. The speakers were well-prepared and engaging. 

My first session focused on writing one’s own obituary. What a great idea! Instead of having your relatives hurriedly piece together a summary of your life, why not do it yourself before you die? It takes a weight off your loved ones who may be absorbed with de-cluttering your home or coping with unanticipated financial complications. I didn’t know that (at least in Washington, DC) one has to pay a line-by-line charge for their obituary notice to appear in The Washington Post. By writing my own obit, it will contain what I want included.

Another session dealt with starting and talking about life and death matters. Drawing on “The Conversation Project,” a project of writer Ellen Goodman, the speaker offered suggestions for initiating and engaging loved ones in learning one’s end-of-life wishes: Do I want doctors to take heroic measures to extend my terminally ill life for a few weeks, or do I want to die without tubes and wires sprouting from my body — all working to add a few days or weeks to my diminishing time on earth?

The Death with Dignity session was the most attended. People need clarity on what the Act permits. For example, one has to be terminally ill and in the last six months of their lives to qualify for lawfully taking their own life. A person with dementia cannot take her own life. Only persons with “the ability to make and communicate health care decisions to health care providers” qualify for this program. Other provisions call for the terminally ill to submit a written and witnessed request to his attending physician before a “covered medication” can be prescribed; that the cause of death is the illness the patient suffered from NOT suicide; and the terminally ill person must ingest the lethal medication by him or herself without assistance from a medical professional.

Clearly many people are hungry for this information. They want to know how to die, not just when they’ll expire. Professionals in the aging arena should not underestimate people’s desire to learn more about what to expect as illness takes its toll and the need to prepare for death looms larger on the horizon.

Congratulations to IONA Senior Services for coming up with this remarkable program. It’s time comparable organizations and government agencies begin preparing us for the final season of our lives.

* Vermont, Colorado, California, New Jersey, Oregon, Hawaii, and Maine

I’ve given up resolving to lose ten pounds (now it should be fifteen) and exercise more. I still hope to do those things, but know I can’t count on enough self-discipline to accomplish either.

So this year I kept it simple. Two discrete goals, time-limited. And a continuation of my jagged trajectory in the bigger sphere of spiritual growth. 

A beloved baby grand piano takes up a quarter of my living room but sits unplayed. I love music. I want to play it. But something else always seems more urgent. One day Jim asked, “Could you just practice thirty minutes a day?” So I made a resolution to do that. I didn’t tell him, but I just sat down and played (badly) on New Year’s Day.

[Read more…]

When thinking about planning, I typically see a maze of legal twists and turns, forms to complete, conversations to conduct — an obstacle course with no finish line. But if I “de-construct” planning, it becomes more doable and less overwhelming. Here’s how I approach it:

Advance Care Planning

I start with my advance care directive comprising my living will and health care power of attorney (POA) or proxy.  These inform my loved ones and medical professionals how I wish to be treated if I have a life threatening illness or accident. The health care POA designates who should make health care decisions for me should I lack capacity to do so. Also included are a list of my doctors, prescription medicines, and other medical information.  

Of course, none of these documents are really operational without a conversation with those to whom I entrust my care. Advance care planning can extend to care-giving, whether provided by loved ones or hired aides. I also include a “dementia-directive”* which sets out my preferred levels of care should I lack capacity to make health care decisions for myself.

[Read more…]

Earlier I discussed how important medical advocacy is when a loved one or friend is hospitalized. As someone’s medical advocate, you want to ensure the hospital staff is serving her as well as possible. Especially at discharge. No one should ever be discharged from a hospital without an advocate, or at least a friend or caregiver, present to hear a discharge nurse’s instructions and review the paperwork that most discharged patients rarely have the capacity to absorb.

Following her hospital discharge your loved one (who has Medicare) may require skilled nursing care (SNC). She qualifies for SNC if: 

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When my husband Jim turned 82 recently (my age), one of our kids gave him a birthday card. It showed a back view of a naked white-haired guy running into the ocean. The word “Yippee!” in the shape of swim trunks was pasted across his buns. The card said, “Getting old is AWESOME!” 

But inside it read “ … said no one ever. Anyway, Happy Birthday!”

Not LOL. 

I for one do say old age is awesome! I’m not as spry as I used to be, but the freedom makes up for it. Here are some AWESOME things I couldn’t do when I was younger:

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Helicopter parents hover over their children, trying to protect them from every possible danger or scheduling every minute to insure a child succeeds
at whatever the parent holds dear, whether it’s sports or music or straight
A’s. Sometimes helicopter parents morph into “helicopter grownup children” as their own parents age. In their 50s or 60s, they may begin to parent their parents. What’s meant as caring can feel like control.

Signs You’re a Helicopter Kid

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A friend recently arranged to have his will prepared.  He told me he planned to bequeath his one piece of real property in three equal measures to his brother and his two sons.  In other words, three persons would become co-owners of one property. 

I asked whether he planned to discuss with them the terms (not the value) of his bequest.  He replied that they refused to discuss the matter. He said their unwillingness to discuss the bequest almost guaranteed a dispute over the distribution of the property after his death.  He acknowledged that from past experience he was powerless to avert this outcome. Discussions about death or money were out of the question. 

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Trust

Parents need to know their adult children will, to the best of their ability, ensure they receive appropriate care in a hospital, assisted living, or skilled nursing residence. They hope their kids will look out for their safety without diminishing their autonomy and independence, but enough to keep them safe.

Transparency

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