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. 

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?

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.

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.

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.

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: 

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:

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

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.