Sometimes I Feel Like a Piece of Bologna

Wednesday, January 31, 2007

Older Boomers Aren't Prepared for Medicare

More than 83 percent of 64-year-olds surveyed do not feel they have the information they need to make good choices about Medicare coverage. The Hacker Group, one of the largest direct marketing agencies in the West, today announced the results of a survey of 4,400 Pennsylvania residents who will turn 65 this year. Most of these are already retired or are planning to retire this year.

Private insurers are finding they need to step in to provide the information the government isn’t. This will be a market opportunity for them. But what of those seniors who aren’t part of the demographic targeted by private insurers?

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Tuesday, January 30, 2007

Caring For Your Aging Parents from Afar

I don’t know of many things that are harder than trying to stay on top of our parents’ needs when we live hours apart. I always feel that no matter how much I do, I’m missing something. I recently found a couple of resources to help.

CARING TIMES presented by Right At Home offers eight tips for caring for your aging parents from a distance. These are good reminders.

Another excellent and more comprehensive resource is So Far Away:
Twenty Questions for Long-Distance Caregivers
published online and in pdf by the National Institute on Aging.

In addition to the good information, it’s comforting to know that I’m not alone.

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Saturday, January 27, 2007

The Importance of Family

I’ve been thinking a lot lately about how important family is in providing for the elderly. There are four of us, plus spouses, who provide some level of care for my parents, and it often seems like there aren’t enough of us. Of course, each of us has our “specialty.” One brother calls to make sure Mom’s eating each day and invites her to visit for a few days of respite space when she’s willing to take it (which isn’t very often). The other brother handles a lot of the maintenance issues—keeping the yard in shape, helping to clean out a storage shed, doing minor fix-it jobs. And he visits once a month and just hangs out with Mom. My sister is the one who will steal Mom away for a day. Mom thinks she’s going to encourage Sis to get away, so it works for both of them. And I handle all of the medical, financial, and oversight issues for both Mom and Step-dad. No matter how much we do, we always feel there is too much left undone. Something will fall through the cracks—which are getting wider, it seems.

So what will we do when we get older? We have only one son. how many of our needs will he and his wife be able to meet? What do we need to do now to make sure their burden is less?

And what about those people who have no children, either by choice or default? Who will care for them? Patrick Watson at Driving Out the Snakes makes the point in a discussion of DINKs (dual income, no kids).

Like it or not, each generation needs the next. If we don't create another generation to follow us we will end up paying a terrible price. At the macro level, Social Security is going bankrupt because there are not enough younger workers paying into the system. Even if you are wealthy enough not to need a pension, you still need an economy where the rest of us are reasonably prosperous.

Individually, those who grow old without children will not be able to replace, for any amount of money, the love that adult children should show toward their aging parents. We all reach a point where we need someone we trust to take care of us and make important decisions for us. If you have no children, who will it be?

Yes, who will it be?

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Thursday, January 25, 2007

Care giver weariness

We were at Mom’s this weekend to celebrate Dad’s 91st birthday. He looks great, reflecting the wonderful attention he’s receiving at the care home. However, I saw subtle evidences of stress and loss of capacity in Mom. Nothing I can put my finger on, but just a vague sense that she’s less capable than when I saw her a month ago. She’s growing weary. Dad has been in care for eighteen months now, and she still feels she needs to visit every day. She doesn’t like it, but feels guilty if she misses a day. She won’t take a break more than once or twice a month. He’s increasingly dependent, and when she isn’t there, he calls over and over and over. He forgets that she said she wouldn’t be there, so panics. And yet, when she’s there, he doesn’t talk to her. He reads or listens to tapes, just wanting her nearby. Often he falls asleep. She feels frustrated. I feel helpless.

I worry that she’ll get sick or fall. She refuses to take care of herself. Just doesn’t see that as important. I wonder how long she’ll be able to live alone, to continue driving. And then what?

The past couple of trips, I’ve encouraged her to begin thinking about what she wants when she can no longer remain in the house or no longer drive. She says that will never happen. She isn’t going anywhere. But we both know it’s only a matter of time. I’d prefer for her to make the decision, but that may not happen. I may be put in the position of having to make the decision for her. That’s hard when I live so far away.

As our parents age, each day brings new challenges, new decisions. And a new sense of helplessness. Yes, I feel smooshed.

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Wednesday, January 24, 2007

Medicare in Trouble

As we Baby Boomers head toward Medicare eligibility, InsureBlog raises some interesting and frightening questions. While the "common wisdom" continues to press for more universal coverage, the reality is, we can't afford what we already have. Some difficult decisions are going to need to be made, but does our government have the guts to make them?

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Tuesday, January 23, 2007

Medicaid Asset Protection

I’ve been very confused about the Medicaid rules. They’ve changed recently, and everyone I talk to seems to be operating under a different set of rules.

Rocco Beatrice at Home Related Finance discusses the new rules, including look back waiting periods. It would appear that any loopholes that used to exist don’t anymore. We talked to consultants who want to charge $10,000 or more for the possibility of protecting my mom’s assets and qualifying my step dad for Medicaid. I’m not convinced it’s worthwhile, especially after reading this article.

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Monday, January 22, 2007

Changes in Grandparenting

Seniorscope has a fascinating article on grandparenting and the changes among boomers in this role. So much for "over the river and through the woods."

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Tuesday, January 16, 2007

How to Find a Good Nursing Home

The Norman Transcript today offers a useful list of ways to separate the good from the bad when you are looking for a nursing home. We like to think we won’t need one—for ourselves or our parents—but sometimes life doesn’t allow that luxury. So as Gen Sandwichers, it’s important to do our homework and find the best option in our locale.

Perhaps one of the hardest questions to answer if you (or the primary care-taking offspring) doesn’t live near the parents is whether to find a nursing home in their area or in yours. Of course it would be more convenient to have them nearby. In my case, my parents are a four-hour drive away. I’m getting old just visiting them!

But at this point, it’s better for them to remain in the town they know. Mom still lives at home, drives, and is active in her church. Friends still visit my step-dad in his care home. Furthermore, facilities in my urban area are far more expensive than those in their more rural area. For now, it’s a no-brainer.

Jim Comer talks about this in his book, When Roles Reverse: A Guide to Parenting Your Parents. He chose to keep his parents in their community and drove an hour to see them a couple times per week.

Down the road, who knows? If Mom reaches the point where she can no longer live at home or if they develop dementia to the point where they don’t know their visitors anyway, we’ll need to revisit the decision.

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Monday, January 15, 2007

Time to Discuss Estate Plans

Gwen Pacarro offers excellent suggestions for Gen Sandwichers to begin discussions with their parents about their estate plans.

It’s hard to do this without seeming to be snoopy or greedy, but it’s so important. And it’s important that we begin talking to our children just as soon as they’re old enough to begin understanding. When such discussions become normalized, they’re much easier to initiate and continue.

With both my parents and my husband’s parents, we have had to lead the way. We’ve had to encourage them to create living trusts and to keep them up to date. We’ve had to encourage them to think about what is important to them and how they want their estates managed, both while they are alive and after.

The reality is, we all need to take the responsibility to discuss estate plans and the reasons behind them. It’s important that we understand our parents’ choices and that our children and parents understand ours. The more we can talk about these things, the more likely we’ll be able to avoid hard feelings and misunderstandings.

If your parents aren’t willing to discuss their plans, one approach might to be begin talking to them about yours. As you develop your will, living trust, or other plans, tell them and ask what they’re doing in that area. Encourage them to talk to you. Usually, their reluctance is an unwillingness to face their own mortality.

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Friday, January 12, 2007

Medicare Part D Negoiated Prices will Hurt Elderly

The House of Representatives today passed H.R.4, which would require the Secretary of Health and Human Services to negotiate prices with drug companies. The negotiated prices would be standardized across the U.S. for Medicare Part D beneficiaries.

Republican opponents say the bill, which passed 255-170, would actually raise drug prices and retard pharmaceutical competition, putting a crimp in research on new drugs. Actuaries from the Centers for Medicare and Medicaid Services (CMS) agree.

In an OpEd for The Hill, Sally C. Pipes, president and CEO of the San Francisco-based Pacific Research Institute and author of “Miracle Cure: How to Solve America’s Health-Care Crisis and Why Canada Isn’t the Answer” challenges the wisdom of Nancy Pelosi’s “fix” for Medicare Part D. Her article is well worth the read as she points out that negotiating Part D will result in a restrictive formulary and lowered life expectancy.

U.S. Centers for Medicare and Medicaid Services (CMS) Acting Administrator, Leslie Norwalk agrees. She said that the only leverage in bargaining for discounts with drugmakers is to block some products from the list of covered drugs.

They're right. Government involvement in health care has done nothing but increase costs since its passage in 1965. Not because more people are covered, but because when you have such a huge purchaser of any good or service, that purchaser can dictate prices even to the detriment of the supplier.

In health care, Medicare and Medicaid have not covered their costs since their inception. The difference is shifted to private insurers and patients without insurance, resulting in more people without health insurance. And of course, those pockets are not endlessly deep, so we’ve seen providers go out of business as well as a significant increase in overall health care costs.

In the fifteen years following the passage of Medicare and Medicaid in 1965, expenditures for health care in dollars increased nearly sixfold, and health care costs rose from 6 percent to 9 percent of the country's gross domestic product (GDP). In the next 20 years, costs increased another fivefold, and more than doubled as a percent of GDP.

U.S. Health Care Costs
Dollars Percentage of GDP
1950 $12.7 billion 4.5 percent
1965 $40 billion (est.) 6 percent
1980 $230 billion 9 percent
2000 $1.2 trillion 14 percent

Anything the government does to require price negotiation will do more harm than good for both seniors and the rest of us. Medicare Part D is bad now; under the Democratic plan, it will only get worse.

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Wednesday, January 10, 2007

Tax Help in Caring for Your Aging Parent

If you provide a significant portion of support for your aging parents, you may be able to claim some of those expenses as deductions on your income taxes. Kay Bell at Bankrate.com offers detailed advice on what you can or can’t claim.

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Tuesday, January 09, 2007

When Roles Reverse: A Tender Look at Caring for Aging Parents

I’ve been enjoying a wonderful book called When Roles Reverse: A Guide to Parenting Your Parents by Jim Comer. Jim tells his story in a tender, matter-of-fact, and candid manner.

Following his father’s massive stroke and his mother’s Alzheimer's diagnosis, Jim found himself an overnight parent at the age of 51. He was a single professional enjoying life in Los Angeles when he received the call. Jim, an only child, jumped on a plane to Dallas and his world changed. While he was used to being the man who had all the answers, he soon learned that he didn’t even know the questions.

He tried to manage their care from a distance, but soon realized he needed to be closer, so he picked up his life and moved to Dallas. In When Roles Reverse, he shares the joys and sorrows over ten years of living the questions and learning the answers. He learned to deal with assisted living facilities, nursing homes, hospitals, rehab centers, and insurance companies, as well as his father’s deafness and his mother’s increasing dementia. Through it all, he managed to keep his sense of humor and develop a more intimate relationship with his parents.

I’ve been struck by the compassionate respect he shows, even when his life was obviously frustrating. In the process, he shares tips for dealing with aging parents, care facilities, and life. At the end of each chapter is a list of “Comer’s Commandments” that synthesize the main points. Although Jim isn’t a Gen Sandwicher, he has a lot to say to us about doing the right thing with panache.

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Monday, January 08, 2007

Poignant Reminders for the Sandwich Generation

I love to find other Gen Sandwichers who offer an optimistic, respectful look at being part of the Sandwich Generation, especially in honoring our parents. I’ve found two recently that I’ve learned from.

Stephen Orr of Tennessee at Christian and Scriptural Eldercase doesn’t post often, but is a health care professional who seems to work with the elderly. He offers poignant and humble insights into life in nursing homes. His posts gave me greater understanding of what my step dad faced when he was in the nursing home. He challenges us to find better solutions.

Emuna Braverman is a Messianic Jew in Los Angeles who addresses the “mitzvah of honoring our parents.” She talks about the opportunities of interacting with elderly parents for our children and oourselves.

She says,
“Yes, we have many responsibilities. We can cope with them, and even do more than cope by 1) taking care of ourselves, 2) recognizing our strengths and weaknesses, what we can do and what we can't (within the parameters of halacha) and ultimately 3) embracing our responsibilities.

If we feel imposed upon, if we expect more free time and undemanding, uncomplaining parents and children, we will be stuck in that sandwich generation. But, if we are grateful for our children and our parents, for the opportunities to give, for the strength and pleasure, then it will be a joy.”

When I feel smooshed by the demands of being a Gen Sandwicher, I appreciate the optimism and inspiration from bloggers like these.

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Sunday, January 07, 2007

More on Parenting Adult Children

Susan commented on my post of November 15 on Parenting Kidults
where I commented, “Boy, in my opinion, there’s nothing harder than parenting adult children!”

She says,
“Don't tell me that today! NOOOO! After a hard weekend with a preteen, a teen, and 84 yr old mom, this is not what I wanted to hear... we were just having fond fantasies of our empty nest.”
I explained a little more of my thoughts yesterday, but let me clarify. It’s true that teens and pre-teens can be exhausting and exasperating and even infuriating. Their demands seem to go on and on, and on… It’s easy to have fantasies of the empty nest. But we have 18 years to learn how to deal with our kids. It’s gradual. We grow as they grow and we change as they change.

Then one day, they’re grown up. The adult years come on much more quickly. If our kids go to college, we have four years max. Many want their independence even sooner. If they move into the job market, the transition comes even faster. That’s a steep learning curve, especially for moms who have devoted their lives to parenting. To meeting the needs and shaping the values of their offspring. And suddenly, her job is done.

The other difference is that when our children are young, we have some degree of control if we choose to exercise it. When they’re little, we can physically pick them up and move them. When they’re older we can ground them, assign extra tasks, or otherwise manage to persuade them to do what we think is important. I know. Many parents feel impotent and don’t exercise their authority. But they have it if they’ll exercise it consistently through the years.

However, when the kids become adults, we have only the power of relationship. If we haven’t built it in the prior 18 years, it’s unlikely we’ll be able to develop it now. And while our pre-adult years have been devoted to providing endless input that will help the kids become all God created them to be, the transition to adult influence comes rather suddenly.

That’s the hard part for me. Keeping my mouth shut. Going against my “mom” nature. Disciplining myself to not fix everything. Praying rather than talking. Allowing him to make his own decisions, whether it would be my choice or not. Whether I agree or not. Allowing him to reap the consequences of his decisions. Of course, a good parent will do some of that all along the way. But now, it’s essential to maintain “hands off.” The mom in me hates that. And loves the results.

So Susan, have faith. Enjoy the process. You’ll blink twice and the kids will be gone. The nest will be empty for a mighty long time—unless Mom moves in.

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Saturday, January 06, 2007

Family Time

Friends, I apologize for my long silence. At least it seems long to me. I’ve been hit with a combination of the “Christmas busys” and what has felt like far fewer brain cells. Everything I’ve thought about writing has seemed trite, and I truly want to avoid wasting your time and mine.

We were blessed with a nine-day visit from our DS and his wife. Although we all were sick for part of the time, we still managed to do everything we wanted to do and had lots of time for rest and reading, which is what DDIL really needed. It was a blessed, laid back time. But it was also busy. You know how it is when you have houseguests in a small house. Because we were all sick, I washed towels every day. And because we wanted all-together time, I cooked breakfast most mornings.

Breakfast, or perhaps I should say brunch, has become a tradition when they come home. We gather around the table about 11:00 and often sit there for hours. In the summer we eat on the patio and have been know to sit and talk until 4:00 in the afternoon—just in time to cook dinner.

These times are precious interludes for me. I’m usually a Type A personality, going, running, doing. I usually eat in the car or on the run. Even when DS was living at home, we usually had dinner together, but it wasn’t a four-hour affair. But because we home schooled, we had times throughout the day and week to talk. Often in the car driving to debate or other places. During those times, we developed a close relationship and the ability to talk about almost anything with one another. He learned to seek our advice, and we learned the best ways to give it so it would be heard.

When he went off to college, we would often spend an hour or more on the phone once or twice a week, just the three of us. He’d tell us all about what he was doing, thinking, feeling, and we’d share our lives with him. He’d often do this while walking around the campus—good exercise! In this way, we stayed close. Didn’t lose touch. And we were able to see him growing in his ability to make wise decisions and weather storms. We gradually let go, moving from being fairly directive in freshman year to just listening and sometimes reflecting or asking a question in senior year. The result is that he has continued talking to us, sharing his life. And his wife is learning to do the same.

Our task, of course, is to develop an adult relationship with them. As they move into adulthood, we can be their friends and their elders. Hopefully wise elders. It’s important to us that he no longer be our “boy,” but that he becomes a man, an adult, who is firmly grounded in his values, his faith, and his new family. A man who can make wise decisions; one who knows when to ask for help or input and when to do it on his own.

I’ve often said that parenting adult children is harder than parenting two’s or teens. It’s hard to make the shift from directive to reflective, but the rewards of doing it well are huge. I’m beginning to like this stage of life. We’re reaping the fruits of our labors.

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