PBS’ Powerful Assisted Living Exposé

Richard Eisenberg, Contributor
Next Avenue
WHERE GROWN-UPS KEEP GROWING

8/8/13

PBS’ Powerful AssistedLiving Exposé-

 

“Big, sophisticated national chains have the tools to provide the highest
quality care, the acumen and the infrastructure to minimize these tragic
incidents — that’s one reason we focused on Emeritus,” A.C. Thompson, the
show’s correspondent, co-producer and co-writer, told me.
Among the disturbing tales, all at Emeritus facilities:
Former pro football hall of famer George McAfee, who died after ingesting
industrial strength dishwashing liquid that the Georgia assisted living facility’s
staff failed to lock away. (The state fine: $601.)
Joan Boice, whose family was awarded $23 million after a jury determined her
assisted living facility was responsible for elder abuse and neglect. Boice, who had
advanced dementia, developed several deep wounds during her three-month stay
there. (Emeritus is appealing the jury award.)

Mabel Austin, who also suffered from dementia, wandered out of her assisted
living facility and froze to death.
Emeritus chief executive Granger Cobb wouldn’t talk to Frontline about those
particular incidents but did offer this response to the problems the program
found: “We are 27,000 human beings caring for 40,000 residents and human
beings make mistakes. We devote as much time and attention to training and
orienting and giving guidance and making sure that they feel comfortable in
the decisions that they make, but on occasion there will be mistakes.”

Pros and Cons of Assisted Living

Health care analysts and lawyers interviewed by Frontline had a different view
on what’s happening in the assisted living world.
(MORE: 8 Tips for Finding a Home for Your Elderly Parents)
“The head of a state licensing agency told me assisted living is the rock we
don’t want to look under,” Catherine Hawes, director of the Texas A&M
Program on Aging and Long-Term Care Policy, says in the show.
Assisted living isn’t a bad idea. Far from it. “Assisted living is a great option for
a lot of people and was created to fill a real need,” says Thompson, winner of
the 2011 I.F. Stone Medal for Journalistic Independence.
And these facilities, while hardly inexpensive, are much less pricey than
nursing homes. The median annual cost is $41,400 vs. a nursing home’s
$75,405, according to the Genworth 2013 Cost of Care Survey.
The trouble, as the program points out repeatedly, is the huge gulf between
the concept of assisted living and the reality. Specifically:
Understaffed facilities where residents aren’t well supervised By
law, assisted living buildings often need to have only “sufficient” staff to meet
the needs of residents, Thompson says. “That doesn’t really mean a lot,” he
adds.

Inadequate training for staffers and administrators Walking
Thompson through one of Emeritus’s “memory care neighborhoods” for
dementia patients during the program, executive Kelly Scott says its
employees there get eight hours of training.
“I could be a licensed administrator of an assisted living facility in California if
I pass a 40-hour class,” Thompson says. “And if I was running a small one, I
wouldn’t need a college education.”

A hard sell to fill the rooms One former head of an Emeritus memory
care unit told Frontlineshe felt pressure to get residents in “at any cost.”
Thompson says: “There’s incredible pressure on people working for the big
chains to move in as many people as possible. And that can lead to decisions
to move in seniors who shouldn’t be there. They may have psychiatric
problems or serious behavioral problems and should be in a nursing home or
a hospital.”

A lack of regulation Unlike nursing homes, assisted living facilities aren’t
overseen by the federal government and state regulation is spotty. California’s
7,500 assisted living facilities are inspected on a regular basis every five years,
for example, Thompson says.
“In many places, regulations are not sufficient to prevent seniors from being
hurt over and over and over again,” he adds.
A lack of comparable data for families trying to select a facility
“There’s an information vortex,” Thompson says. “The federal government
tracks, monitors and analyzes nursing homes with the Medicare
website’s Nursing Home Compare, but we have no clue what’s going on in the
assisted living industry.”
You may be wondering: Why does the federal government regulate nursing
homes but not their assisted living cousins?
One reason, Thompson says, is that the assisted living pioneers felt nursing
homes were overregulated, so they turned to the states. Another is that
nursing homes get money from Medicare and Medicaid, which means the
federal government has an obligation to monitor them; few assisted living
facilities get similar financing.

Assisted Living and Your Wallet

And that brings me back to the financial concerns for families deciding the
best place for their parents or grandparents to live.
Assisted living looks much less expensive than a nursing home, but Medicare
doesn’t reimburse any of its costs, unlike the way the federal health insurance
program does for up to 100 days of nursing home stays. And Medicaid – the
health insurance program primarily for the poor – covers some nursing home
residents’ costs, but typically pays for assisted living stays of only 90 days or
less.

So you or your parents may be on the hook for the substantial charges of an
assisted living facility. Here are a few tips to find one that’s worth the
money and will provide the proper care:
Start your research before you’re in emergency mode. “The best
scenario is to prepare ahead of time by investigating the options in the area
your parent wants to live,” says Sherri Snelling, a Next Avenue contributor
and founder and chief executive of the Caregiving Club. “Some facilities fill up
fast, so when your loved one needs a bed, there may be no room at the inn” if
he or she hasn’t been put on a waiting list.
Understand the basics of assisted living facilities and how to
compare them. The free online “Guide to Choosing an Assisted Living
Residence” from the industry trade group, the Assisted Living Federation of
America, is useful as is the Senior Housing Help Guide from the nonprofit8/8/13 PBS’

 

Also, the MetLife Mature Market Institute’s
guide, Choosing Assisted Living, has smart advice.
Next Avenue has also published three articles worth reading: “8 Tips for
Finding a Home for Your Elderly Parents,” “What Is an Assisted Living
Facility?” and “ How to Find the Best Residential Care.”
Look for reliable information about particular
facilities. The Alzheimer’s Association,Caring.com and LeadingAge.org have
state-by-state directories. Your local Area Agency on Aging can also tell you
about nearby choices.
Become your own investigative reporter. Do a Google search to see if
there have been any troublesome news reports about a facility you’re
considering.
Also, check the property’s regulatory history and complaint record for the past
five years. Generally your state’s health department or long-term care
ombudsman will have that data. You can find the appropriate agency at
the website of the Assisted Living Federation of America.
Ask the facility’s administrator key questions about how the place
is run. Don’t be taken in by the beautiful grounds or social activities, Snelling
says. You’ll want to get answers to such essential questions as:
What’s the ratio of caregivers to residents? (Thompson says that in a dementia
setting, you’ll want a ratio far below 1 caregiver to 20 residents.)
How many staffers are on duty overnight? Serious incidents, like falls, often
happen at night.
What type of nursing care is provided? Thompson says “24-hour nursing care”
sometimes means there’s a nurse on duty weekdays from 9 a.m. to 5 p.m. and the
facility will call a nurse if something happens during other hours. Also, he says,
nurses frequently spend little time caring for residents because they’re mostly
doing marketing, sales and administrative work.
How do costs vary depending on the level of service required? There’s generally a
base cost and then a variety of services offered a la carte. Medication management
runs $347 a month, on average, and dressing assistance costs $236, according to
the 2012 MetLife Market Survey of Long-Term Care Costs. Most facilities that
provide Alzheimer’s and dementia care also charge an extra fee.
Consider hiring a geriatric care manager to help you select the most appropriate facility.Member firms of the National Association of
Professional Geriatric Care Managers typically charge $80 to $150 an hour,
according to Next Avenue consumer blogger Caroline Mayer.
You might check to see if your employer offers the services of such a pro, as
companies like GE, Wells Fargo and Disney do, Snelling says.
Time for the Nation to Assess Assisted Living
I hope you’ll do these things, but I hope even more that
the Frontline/ProPublica work will lead the federal and state governments to
take a hard look at the way assisted living works (or doesn’t work) today.
As Thompson told me: “We’ve got three-quarters of a million people in this
type of facility and 5 million with dementia. We need to think of better ways to
care for them going forward and what we can do to ensure they live out their
lives with as much diginity as possible.”8/8/13 PBS’ Powerful AssistedLiving Exposé- 

At NorthStar Care & Guidance, we are available to talk with you and your family about all of your live-in home care needs. NorthStar Care & Guidance is an elder care agency providing assistance to seniors with elder care in New York City and New Jersey. Call 888-288-6152 for more information.

End-of-Life Care Improves But Costs Increase, Study Finds

June 1 2, 201 3 23:00
E.J. Mitchell / The Medicare NewsGroup
Improvements in end-of-life care have occurred rapidly for Medicare patients but costs have increased, according
to a new Dartmouth Institute brief that was released today. The study revealed that beneficiaries in their last six
months of life spent fewer days in the hospital and that more patients received hospice services in 201 0 compared
to 2007.
However, Medicare spending for chronically ill patients at the end of life increased more than 1 5 percent during
that time period, while the consumer price index rose only 5.3 percent.
The data from the brief, which is through the Dartmouth Atlas Project, also found that in 201 0 compared to
2007:
patients were less likely to die in the hospital;
patients were as likely to spend time in intensive care units (ICUs) during the last six months of life;
the variations in end-of-life care at some academic medical centers quickly changed;
patients spent more days in hospice care; and
patients were more likely to see more than 1 0 physicians during the last 6 months of life.
The Dartmouth Atlas brief found that across hospitals improvement was variable, with some experiencing rapid
change while others showed little improvement.
“The growing use of hospice care and decrease in hospital use at the end of life are promising trends that may
reflect attempts to provide care that aligns more closely with patients’ preferences,” said David C. Goodman, MD,
co-principal investigator for the Dartmouth Atlas Project. “However, improvements in care are not even across
regions and hospitals, and many are changing at a much slower pace, or not at all. We continue to see that where
patients live and receive care are some of the most significant factors in how they spend their last years.”
A recent Medicare NewsGroup (MNG) end-of-life series examined the most pressing issues facing the Medicare
program. Death and Medicare has become a much-politicized topic. The process of dying in the United States is
influenced by myriad cultural, religious, societal and health system factors. With an aging baby boom
population and end-of-life care consuming an increasing share of the Medicare budget, the issue has never been
more critical to U.S. health policy. The MNG special report explored how Americans die, the cost of death, the
politics surrounding the debate and potential solutions.
The Dartmouth Atlas brief shows rapid improvement in many places, although patients in some hospitals
continue to receive more aggressive and less palliative care than others. The reasons for the differences in the
pace of change are not well understood, the researchers said.
Medicare Spending
The Dartmouth Atlas brief found that overall, the average spending per chronically ill Medicare patient in the
last 2 years of life increased 1 5.2 percent: from $60,694 in 2007 to $69,947 in 201 0. Additionally, the brief
found that in 201 0 spending rates per Medicare beneficiary varied from a high of $11 2,263 in Los Angeles, Calif.,
to a low of $46,563 in Minot, N.D. Meanwhile, Bloomington, Ill., was the only region in the nation showing a
decrease in spending, from $57,802 in 2007 to $53,67 4 in 201 0 per Medicare patient.
Hospital and Hospice Care6/13/13 medicarenewsgroup.com/PrintView.aspx?Id=1bc1e4f4-26b7-41d7-95d7-8dc8b77d210c&ContentType=BlogPost
medicarenewsgroup.com/PrintView.aspx?Id=1bc1e4f4-26b7-41d7-95d7-8dc8b77d210c&ContentType=BlogPost 2/2
From 2007 to 201 0, the percentage of chronically ill patients dying in hospitals and the average number of days
they spent there before their deaths declined in most hospitals across all regions of the country. In 2007, 28.1
percent of beneficiaries died in a hospital; by 201 0, the rate had dropped to 25 percent.
In 201 0, the highest rates of death in hospitals remained in areas in and around New York City, including
Manhattan (43.7 percent), the Bronx (37.7 percent), East Long Island (37.4 percent), and White Plains (36
percent), though all these localities showed decreased rates from 2007. As compared to New York, chronically ill
patients were far less likely to die in a hospital in Dubuque, Iowa (1 5.2 percent), Cincinnati, Ohio (1 6.8 percent),
or Fort Lauderdale, Fla. (17 percent).
The number of days beneficiaries spent in intensive care units changed little (3.8 in 2007 to 3.9 days in 201 0),
but this reflects a leveling off of the rising ICU use seen prior to 2007, researchers said.
The variations in end-of-life care found in academic medical centers changed quickly in many centers, the study
found, though the increase in hospice use was uneven across academic medical centers.
The percentage of patients enrolled in hospice increased by 1 3.3 percent (from 41.9 percent to 47.5 percent) and
the average number of hospice days rose by 1 5 percent (from 1 8.3 to 21 days).
Doctor Visits Remain Stable But More Seen
The number of physician visits was stable (29.6 to 29.1 visits), but chronically ill patients were significantly
more likely to be treated by 1 0 or more doctors in the last 6 months of life in 201 0 than in 2007, with the
national rate increasing from 36.1 percent to 42 percent.
In 201 0, patients in East Long Island, N.Y., received the most intensive care by this measure, with 62.3 percent
of patients seeing 1 0 or more doctors in the last 6 months of life. Other regions with high rates included
Ridgewood, N.J. (62.1 percent) and Royal Oak, Mich. (60.2 percent). Regions with low rates included Idaho Falls,
Idaho (1 4.5 percent), Grand Junction, Colo. (17.7 percent), and Missoula, Mont. (1 8.2 percent).
Only seven regions decreased in this measure from 2007 to 201 0, including Neenah, Wis. (from 25.2 percent in
2007 to 21.4 percent in 201 0) and Santa Cruz, Calif. (from 31.8 percent in 2007 to 28.9 percent in 201 0).

New York State Gets $2.5 Million in Medicaid Fraud Case

By 

 

In life, Helen Sieger was the embattled owner of a Bronx nursing home.

Her employees at the Kingsbridge Heights Rehabilitation and Care Center went on strike in 2008 after she stopped paying their health insurance premiums, drawing attention from state lawmakers, labor leaders and even Barack Obama, then a senator from Illinois.

Ms. Sieger was arrested a year later on charges of bribing a hospital social worker to steer patients to her nursing home, and of improperly collecting payments from the state’s Medicaidprogram. She jumped bail, only to be caught in a Miami hotel and returned to New York, where she died in custody in 2011.

But now Ms. Sieger is making amends in death.

The state attorney general, Eric T. Schneiderman, said on Tuesday that his office had reached a settlement with the estate of Ms. Sieger to pay a total of $2.5 million to the state’s Medicaid program, which includes $1.2 million in reimbursements, and $1.3 million for damages.

“There are few programs as sacred and important to our most vulnerable citizens as Medicaid,” Mr. Schneiderman said in a statement. “So, when we have a case involving a criminal scheme that robs Medicaid, our prosecutors will do whatever it takes to restore those stolen funds — whether that criminal is alive or we’re forced to settle with their estate.”

Nicholas Gravante, Jr., a lawyer at Boies, Schiller & Flexner who represented Ms. Sieger’s estate, said that her family was “pleased to have this matter behind it.”

Ms. Sieger, who took over the nursing home in the mid-1990s, was removed in 2009 by the State Health Department because of an issue over the nursing home’s lease. The operation of the 400-bed nursing home, one of the largest in the Bronx, was eventually transferred to a state receiver, which still runs it today.

Also in 2009, Ms. Sieger was indicted, accused of paying Frank Rivera, a former social worker at NewYork-Presbyterian Hospital/Columbia University Medical Center, $300 for every patient that he referred who was subsequently admitted to her nursing home, plus a bonus of $1,000 for every 10 patients, according to the attorney general’s office. Beginning in 2005, he received more than $19,750 from Ms. Sieger.

Mr. Rivera pleaded guilty to felony and misdemeanor violations under a state law, and is awaiting sentencing, according to the attorney general’s office.

The attorney general’s office also said that the investigation had found that Ms. Sieger, who lived in Borough Park, Brooklyn, held several bank accounts, including one in Montana with $2 million.

Michael Benjamin, a former Bronx assemblyman, praised the settlement, calling it an appropriate way for “the state to recoup her ill-gotten gains.”

“It sends a signal that the state will not be cheated,” he said. “And that people who steal from the poor and from the elderly will be pursued whether they’re dead or alive.”

At NorthStar Care & Guidance, we are available to talk with you and your family about all of your live-in home care needs. NorthStar Care & Guidance is an elder care agency providing assistance to seniors with elder care in New York City and New Jersey. Call     888-288-6152 for more information.

June 9, 2013 Research Forgotten by Budget CutsBy ALBERT R.


June 9, 2013
 

Research Forgotten by Budget Cuts

By ALBERT R. HUNT | BLOOMBERG VIEW

WASHINGTON — Many Republicans, and Democrats, never thought the automatic across-the-board spending cuts known as sequestration would take effect. After all, they might produce dangerous, if unintended, consequences like potentially bankrupting the U.S. health care system, along with millions of families.

Typical Washington hyperbole, right? It actually is happening under the automatic cuts, which kicked in three months ago, a product of the political dysfunction in the United States.

Because the cuts only affect the margins of a wide array of defense and domestic discretionary programs, there mostly hasn’t been an immediate pinch; the public backlash has been minimal. But the long-term consequences, in more than a few cases, are ominous.

There is no better case study than Alzheimer’s disease. With the enforced cuts at the National Institutes of Health, research to find a cure or better treatment is slowing.

Alzheimer’s, the most common form of dementia, is the sixth leading cause of death in the United States. Five million Americans are afflicted by the disease. It costs about $200 billion a year, creating severe strain for public health care and many families. Then there is the emotional toll: The Alzheimer’s Association estimates that caregivers had an extra $9 billion of health care costs last year.

“As the population lives longer, Alzheimer’s is the defining disease of this generation,” said Senator Susan Collins, a Maine Republican who is trying to fight the budget cuts and sharply increase spending for research.

The latest annual report on health statistics from the Centers for Disease Control and Prevention underscores her point. There is a lot of progress, in large part because of earlier N.I.H. efforts: The number of deaths from strokes and heart disease is down more than 30 percent over the past decade, and cancer deaths have declined almost 15 percent. The reverse has occurred with Alzheimer’s. Over a decade, deaths have risen sharply, up 38 percent for men and 41 percent for women.

It is expected to get worse. A report this spring by the nonpartisan RAND Corp. estimates that by 2040, the number of Americans afflicted will have doubled, as will the costs. Other experts say that, as grave as those projections are, they may be underestimated. The Alzheimer’s Association says that under current trends the cost will exceed $1 trillion annually by 2050. That would either bankrupt Medicare and Medicaid, the insurance programs for the elderly and the poor, or force tax increases.

Much critical health research in the United States generally emanates from the N.I.H., which has compiled a record of success with most diseases that has been the envy of the world.

The supporters of the automatic cuts do not seem fazed. The N.I.H. funding is cut 5 percent, or $1.55 billion this year, across the board. That means 700 fewer research grants are approved and 750 fewer patients will be admitted to its clinical center. The longer the automatic cuts go on, the worse it will get; medical breakthroughs are rarely instant. They take years and build on previous studies and experiments.

Before the cuts went into effect, Alzheimer’s research was slated for a healthy increase this year. By moving a few discretionary funds, the N.I.H. has avoided cutbacks.

Still, the funding falls significantly short of the promise.

“In recent years, there have been some extraordinary advances, from genetics to molecular biology, that have given us insights into Alzheimer’s that we didn’t have before,” said Richard Hodes, a physician who heads the N.I.H.’s National Institute on Aging.

About five in six grant applications currently aren’t funded; Dr. Hodes said money for some of those grants and increasing some of the clinical trials, also being cut by the automatic cuts, would capitalize on these advances.

Ms. Collins said that aside from the human dimension, this is a simple cost-benefit analysis.

“We spend only $500 million annually on Alzheimer’s research, and it costs Medicare and Medicaid $142 billion,” she said. “It’s going to bankrupt our health care system and we’re spending only a pittance on prevention.”

She wants to double the Alzheimer’s research budget immediately and then double it again — to $2 billion annually — within five years. For most U.S. programs, huge increases in spending would cause reckless waste and inefficiency. N.I.H. is an exception. Fifteen years ago, its budget doubled in five years and the results were better than ever.

For N.I.H., there are other critical advances — in areas like Parkinson’s, diabetes and forms of cancer — that are slowed by the budget cuts. And the automatic cuts, which do not touch entitlement spending or the tax benefits enjoyed by the wealthy, forces reductions in programs like Head Start for low-income kids, the nutritional program for women, infants and children or the meals on wheels initiatives for lower-income senior citizens.

Congress did act once to reverse the damage wrought by the automatic cuts: It undid some cuts affecting aviation.

There was an emergency; members could not be inconvenienced by flight delays or cancellations when getting back to their districts. They do not seem as motivated to help prevent or slow the spread of a wrenching affliction that costs a fortune.

THE MAGAZINEYou Get OldBy PAT JORDAN   Sep 2009For any man

THE MAGAZINE

You Get Old

By PAT JORDAN   Sep 2009

For any man who has led a vibrant, robust life, the ­realities of aging can be humbling. But as the author has discovered, coming to terms with that is one of life’s great empowerments.

You get old, life gets small. Not meager, pinched, just small. You don’t buy groceries for a week anymore – two hours in the Publix, drenched with purpose, a grocery list that unrolls like the Dead Sea scrolls.

You get old, you shop every day, your list written on the inside cover of a matchbook. Two pork chops, a can of La Sueur peas, four corns (two for tomorrow), two rolls of toilet paper.

You never buy mangoes, avocados, grapefruits, or key limes. You just go into your backyard and pick them off your tree. When you were young, your Uncle Ben retired to Sarasota and immediately sent you oranges from his tree. You thought, How sad. Now that you’re old, you send mangoes, avocados, grapefruits, and key limes to your friends. You enclose a note, very serious, explaining that key limes are not ripe when they’re green. “You must wait until they turn yellow!” you write. You get old, you become an expert on fruit.

You get old, people don’t notice you. You sit at a bar, sipping your Jim Beam Black, neat now, no water, no ice, when a pretty woman in her 40s sits next to you. You smile at her, say hi. She looks at you and through you around the bar.

You get old, young guys don’t get pissed off anymore that you’re lifting heavier weight than they are on the preacher-curl bench. Now they say, “You sure that weight isn’t too heavy for you, sir?” They used to call you Mack. When you were younger you would have said, “Mind your own goddamned business!” Now you say, “Thanks, guy, I think I can handle it.”

You get old, you lose your anger. It takes too much energy to be angry when you’re old. You have more important things to do with your waning energy, so you hoard it like a dwindling resource.

You get old, it’s not always about you. You no longer wait for an opening in a conversation to talk about yourself, your dreams, your accomplishments. It becomes second nature to draw other people into talking about their lives. You’re no longer the life of the party, making people laugh. You no longer have that neurotic compulsion to be known. Why should you? You get old, you know yourself.

You get old, you need less. Less food, less booze, less sex, less sleep. One Jim Beam Black after dinner, savored, so that it lasts until you fall asleep.

You get old, you wake at 4 a.m. as if to catch every moment of your fading days. You struggle out of bed, let the dogs out, make coffee, light a cigar, then go out the front door for your newspapers. You sit on the front steps, sipping your coffee, smoking your cigar in the darkness until Jean Pierre, the Haitian paper deliverer, as black as a purple plum, pulls up in his Toyota. He sees you and gets out of the car. “Sorry, cher, da be late today,” he says, handing you the papers. “No problem, Jean Pierre.”

You get old, you eat dinner at 4 p.m., with your wife. You talk about the day, then save half of each of your pork chops, wrapped in Saran wrap, for tomorrow’s dinner. Your refrigerator is stocked with leftovers. Susie wants to throw them out in a day or two, but you stop her, turn the wilting asparagus, the sautéed mushrooms, a few grape tomatoes into a lovely frittata for dinner. You get old, you hate to waste things.

You get old, you see your wife in her tight T-shirt with the words IT’S NOT EASY BEING PRETTY scripted across her breasts, and you get an idea. But it’s only three o’clock in the afternoon, so you file it away for future reference. When you were young, you’d put that idea into action anytime, anyplace. Now you talk about it with her, make plans for sex. She puts on her silk negligee before she gets in bed. Then you both begin watching Ballykissangel, getting so caught up in it (will Father Peter leave the priesthood and marry Assumpta?) that the next thing you know you’re waking up at 4 a.m.

You get old, your dogs get old too. It never dawned on you, when you got them, all six, one year after another, that they’d all get old, one year after another, and then die. Now they’re between 10 and 16 years old. Their lives are bounded by food and sleep and all the pills they take, which are lined up on the kitchen counter with yours. Glucosamine and chondroitin for their arthritic joints. Carprofen for their dislocated knees. You see them limping and press their knees back into place. They glance back at you with gratitude. You give them phenobarbital to forestall their epileptic seizures. Ciproflaxacin for their rheumy coughs and sneezes. They wake in the morning with you and begin to wheeze, sneeze, cough, like old men, like you. They have their good days and bad days, like you. You just try to keep them alive for a few more months, then a few months after that. And when they begin to die before your eyes, you feed them water and baby food through a big plastic syringe at first, and then fluids subcutaneously with a needle before that final visit to the vet.

You get old, you set goals for yourself that seem meaningless to others. Not to you. They are proof that you’re not that old. Your wife asks you to “call the man” to break up the old sidewalk in the backyard so she can plant liriope. You tell her you’ll do it yourself. She says, “Don’t be foolish.” You get the sledgehammer and begin whacking at the sidewalk in the summer heat like Cool Hand Luke. Then you wheelbarrow the broken pieces of concrete out to the front swale for the garbageman. Two days later, you can’t get out of bed.

You get old, your strength and stamina go. You mow the lawn, then lie down. Your wife comes home with 10 40-pound bags of mulch. You carry them into the backyard, then lie down. You get old, you can’t do everything in one day – wash the car, mow the lawn, shop for groceries, go to the gym, get a haircut. So you plan out your day like Eisenhower planning D-day. Two things, maybe three, one day, then two more the next.

You get old, you become abstemious. You never buy clothes for yourself anymore. You wear your faded Hawaiian shirts until they’re so threadbare they’re like filmy curtains. You trim little threads with a scissors. One day your wife throws one out. You moan, “But that was my favorite shirt!” She says, “Hoarding is a sign of old age.” You sulk like a child the rest of the day.

You get old, you get your hair cut at Supercuts, $12 for seniors, and then let it grow for two months until it’s curling over your ears and you look like a French diplomat. You were young, you went to a fancy salon, where the pretty blonde massaged your shoulders while cutting your hair, for $65 and a $20 tip. You get old, your wife says, “You’re not going out like that!” You say, “What?” You are wearing a ripped and paint-splattered University of Miami Hurricanes T-shirt, baggy shorts, and flip-flops. You haven’t trimmed your beard in days. You look like Jeremiah Johnson, if he lived in South Florida.

You used to wear $200 Tommy Bahama island shirts and $2,000 ostrich-skin cowboy boots when you went out. Your wife wore spandex minidresses and six-inch pumps. You looked like a successful drug smuggler with a high-priced hooker. You get old, you sell your cowboy boots to a thrift shop for $50 and buy the dogs new collars. You get old, your looks go. You don’t care.

You were handsome once, like a Greek god, with curly black locks and luxuriant chest hair. You still are, in your mind’s eye, even if your hair is so white you look like a ghost in photographs. You look at that photograph of an old man, and say out loud, “Jeez, I look like an old man!” Your friends call back, “You are an old man.” A young friend of your wife’s, maybe 35, picks up a photograph of you when you were 38 off the fireplace mantel. “Wow,” she says. “You were hot once.” You resist the urge to tell her, “I still am.”

You get old, small things give you pleasure that were once an annoyance. Throwing out the garbage, you meet a neighbor walking his dog. You pet his dog, pass the time. The mailman stops at your mailbox. He talks to you about his Brazilian girlfriend, then hands you the mail. Bills, a check, and – eureka! – four movies from Netflix.

You get old, you realize order is freedom. You do your job more professionally, no longer on the fly. You get a magazine assignment – go down 1,500 feet into a coal mine in Virginia, climb a mountain in Haiti – and you prepare for it. You do heavier squats the days before you leave. You fly out the night before your interview so that you will have time to settle yourself, prepare. You get old, you check into a no-tell motel close to the thruway ramp so you have easy access to anyplace you have to go. When you were young you stayed at the best hotels, with pissing Cupid fountains in the lobby and businesswomen on the make in the bar. The first thing you did after you checked in was change your clothes and hit the bar with your barroom smile. Now you go to Denny’s for a snack. Then you go back to the hotel and put your clothes in the dresser drawers and lay out all your notes on the desk so you can review them the next morning before your interview.

You get old, you realize your job these past 40 years was God’s gift. When you were young, you thought you were God’s gift.

You get old, you forget things, not because your mind is going, but because your memory box is filled. A name comes up and you find yourself mentally flipping through all those thousands of slides, trying to place the name with a face or an event. You forget trivial things – where you put the car keys, your glasses – because your mind is filled with more important things. Is the gate in the backyard secured so the dogs won’t get out into the street and get hit by a car? You never forget that.

You get old, you scream at your wife. Not in anger, but because your hearing’s going. “What?” you scream. She looks exasperated. She says loudly, “I said….” You now see the world in a faint haze, like it’s covered with a gauzy film. “Pollen,” you say. Your wife says, “You need stronger glasses.” You refuse to admit that. So you call the Comcast TV repairman once a week. He arrives, a young black kid. “The picture’s blurry,” you say. “And the sound, I have to jack it way up to hear.” He fiddles with the remote, then says, “The picture’s fine. The sound, too. Maybe you need glasses.” You stop calling the Comcast repairman.

You get old, you sell your 1989 Taurus SHO with the five-speed, short-throw shifter, the Recaro racing seats, lowered suspension, rear spoiler, 19-inch mag wheels. You buy a Lincoln LS8, with leather, a wood-trimmed dash, automatic.

You get old, you read the obits. You call out to your wife, “Jeez, Isaac Hayes died! He was an old man, I guess.” Your wife calls back, “About the same age as you.”

You get old, your friends are old too. Old ladies, mostly. Why not? You’re an old man. Betsy, 59, Ina, 65, Julia, 76, Helen, 78. You drive Helen to work when her ride is late. You drive Betsy to the airport at 7 a.m. for a flight to visit her sister. Later, your friend John, 58, knocks on your door. He’s going to visit friends in Wisconsin. Will you feed his cats while he’s gone? Sure, why not?

You get old, your dreams constrict. You no longer expect fame and fortune, your face on the cover of Time. You no longer expect to write the Great American Novel, 859 pages. Your writing gets small. Fewer words. But cleaner, you hope. More nuance, less obvious. Subtle, you like to think. Like your life. Small essays about getting old. They please you just as much as if you wrote War and Peace.

You get old, you cry more. Not over your lost dreams, your sins, your old age, your impending death. You cry for others. You cry when Assumpta dies too young, at 30, in Ballykissangel. You cry at the sight of our soldiers in camouflage walking through airports on their way to Iraq. You cry at the sight of abused dogs and cats staring at you from the pages of newspapers. You cry when Betsy tells you she has inoperable cancer and she’ll never see 60.

You cry for everyone but yourself because you have lived a wonderful life, and you wish that every person, every pet, could live such a life too. When you were young, you cried only for yourself.

At NorthStar Care & Guidance, we are available to talk with you and your family about all of your live-in home care needs. NorthStar Care & Guidance is an elder care agency providing assistance to seniors with elder care in New York City and New Jersey. Call 1-888-288-6152 for more information

 

Surprising Finding: The Hardest Conversation To Have With Aging Parents

Carolyn Rosenblatt, Contributor

Here’s a new report that surprised me.

Advising adult children about how to tackle difficult subjects with aging parents makes up a good part of how I make a living.  I listen to their stories and struggles every day.  Most people seem to have the worst time talking to aging parents about finances and control over other life changing decisions. But a study done by Pfizer PFE +2.29%, in conjunction with Generations United, suggests that finances are not the hardest thing to discuss with aging parents.

Their study, part of their  Get Old wellness campaign was aimed at sparking a candid conversation about aging. Reporting on it, Pfizer relates that “Respondents said the hardest conversation to have with elderly parents is telling them to stop driving and hand over their car keys – more difficult (39%) than talking to parents about their final wishes or wills (both 24%).”

I wouldn’t have guessed it.  Although I have run into the problem of  aging parents who refuse to give up the keys many times, and I have written and spoken about it in many venues, I would not have put it at the top of the problem list  for adult children.

The explanation as to why respondents found it difficult, however, is quite understandable.  Driving is perhaps the ultimate symbol of independence and control.  An elder is likely going to feel trapped if he is required to give up driving when he is accustomed to that freedom.  Loss of control is a fear for anyone, especially for aging parents, who may be also feeling loss of control of their physical health.

From studies on the subject, we know that most people will relinquish the keys when asked to do so and when the time comes.  But there is still a sizable number of seniors who adamantly refuse to even consider it, in spite of accidents, and urgings of family.  I have encountered them and coached the adult children in how to address the  resistance.  In the worst cases, it takes legal action to get the elder to give up driving.

If you are facing the problem of an aging parent who should give up driving and don’t know how to begin, here are some tips:

1.  Get in the car with an aging parent whom you suspect is not safe behind the wheel.  Observe her driving. She should be able to follow all the rules of the road without prompting.  Keep notes.  Notice how your aging parent handles turning, changing lanes, maintaining safe speed and being alert for oncoming traffic.  Your observations can become part of the discussion about your parent’s driving and you can explain why you are afraid of their driving now.  Here is a checklist to help you. http://www.caregiverslibrary.org/Portals/0/ChecklistsandForms_DrivingAssessmentChecklist.pdf

2.  Acknowledge that this is difficult for your aging parent and approach the subject respectfully.  You can say, “Dad, I know this must be hard for you, but we need to talk about your driving”.  Then use whatever incidents you are aware of that led you to understand that Dad should not be driving.  Accidents, vision problems, dementia, small strokes, etc. can all be very good reasons to give up the keys.

3.  Figure out alternative transportation.  Whether it will involve hiring a driver, using community based senior transport services, or having family members pitch in, you do not want to leave your elder feeling or being trapped and deprived of participation in his normal outside activities.

4.  Request retesting for the driver’s license if your state allows you to do so.  Many people who should not be driving can’t pass the driving test, but have a license that is not going to expire for a long time.  Retesting will reveal that they should stop driving. In my state (CA CA +2.68%) the request  for retesting driving can be anonymous.  A physician can make the request as well.  Contact your department of motor vehicles website to find out what is needed in your state to request retesting.

5.  Have a family meeting about the subject of driving.  This should be done with advance planning by all concerned.  Respect and tact are essential.  If you are worried and others in the family will back you up, it may be enough to convince your aging parent to give up the keys.  Be politely insistent. The safety of every person on the road and every pedestrian in your parent’s path is at stake.

Most adult children do not realize that memory loss in an aging parent and driving problems are linked.  One may lose track of the task of driving in the same way she loses track of the conversation. Driving is a very complex task, requiring attentiveness to numerous stimuli at once.  There is a lot at risk with any parent who has memory loss and is still behind the wheel.

Even if the conversation about giving up the keys is difficult, it is important for adult children to initiate it.  Elders may not have the courage to self limit driving and may need a prompt from you to take that painful step.  Your kind help can keep your aging parent and others  a lot safer.

Until next time,

Carolyn Rosenblatt

 

Vitamins That Cost Pennies a Day Seen Delaying Dementia

By Andrea Gerlin on May 20, 2013

A cheap regimen of vitamins in use for decades is seen by scientists as a way to delay the start of Alzheimer’s disease and dementia, a goal that prescription drugs have failed to achieve.

Drugmakers including Bristol-Myers Squibb Co., Pfizer Inc. (PFE) and Eli Lilly & Co. (LLY) have spent billions of dollars on ineffective therapies in a so-far fruitless effort to come up with a treatment for dementia and Alzheimer’s.

Now, in the latest of a steady drumbeat of research that suggests diet, exercise and socializing remain patients’ best hope, a study published today in the Proceedings of the National Academy of Sciences shows that vitamins B6 and B12 combined with folic acid slowed atrophy of gray matter in brain areas affected by Alzheimer’s disease.

“You don’t have any other options for these patients, so why not try giving them this cocktail of B vitamins?” says Johan Lokk, a professor and head physician in the geriatric department at Karolinska University Hospital Huddinge in Sweden, who wasn’t involved in the study.

Alzheimer’s disease and dementia mostly affect older people. As people live longer, the number afflicted by the conditions is growing. Delaying dementia with an inexpensive vitamin regimen may help stem the surge in cases, which the World Health Organization predicted would more than triple from 36 million worldwide in 2010 to 115 million in 2050, as well as the cost, estimated at $604 billion in 2010 by Alzheimer’s Disease International.

Vitamin Market

Vitamin makers and retailers such as Pfizer’s consumer health-care unit and GNC Holdings Inc. (GNC) in the U.S. and Reckitt Benckiser Group Plc and Holland & Barrett Holding Ltd. in Europe stand to benefit. The Nutrition Business Journal estimates the global market for vitamins, minerals and supplements was $30 billion in 2012 and forecasts sales will grow 3.6 percent by 2017.

In the PNAS study, researchers tracked 156 people ages 70 and older who had mild memory loss and high levels of a protein previously linked to dementia. Among people with elevated homocysteine, the study found that the amount of gray matter declined 5.2 percent in those taking a placebo, compared with 0.6 percent in those who took the vitamin cocktail. The supplements cost about 30 cents a day in pharmacies and health-food stores.

First Look

“It’s the first and only disease-modifying treatment that’s worked,” said A. David Smith, professor emeritus of pharmacology at Oxford University in England and senior author of the study. “We have proved the concept that you can modify the disease.”

The U.S. Food and Drug Administration hasn’t cleared new drugs for memory loss conditions in a decade. Approved medicines such as Eisai Co.’s Aricept ease symptoms without slowing or curing dementia. A joint U.S.-European Union task force in 2011 found that all disease-modifying treatments for Alzheimer’s in the previous decade failed late-stage trials “despite enormous financial and scientific efforts.”

Since then, at least four more experimental treatments have failed. New York-based Bristol-Myers dropped development of avagacestat in December after data showed the therapy wasn’t effective enough to move into the final stage of testing. Solanezumab, from Indianapolis-based Lilly, failed to meet the main goal of two large studies last year, though the company plans to conduct further research.

Bapineuzumab from Pfizer, Johnson & Johnson and Elan Corp. failed to improve patients’ memory or thinking, according to test results released in August. This month, Baxter International Inc. said Gammagard, which is used to help patients with immune disorders, didn’t help Alzheimer’s patients in a late-stage study.

Meanwhile, scientists are exploring the use of experimental drugs to prevent Alzheimer’s. Independent trials will begin this year and run for three to five years.

Shrinking Brains

Older people’s brains shrink about 0.5 percent a year from the age of 60, and faster in people with vitamin B12 deficiency, mild cognitive impairment or Alzheimer’s disease, Smith said. If that pace can be significantly slowed before full-blown Alzheimer’s develops, it may delay the disease’s progression so that older people can enjoy better lives until they die from another cause.

“If you delay the onset by five years, you can halve the number of people dying from it,” says Jess Smith, a research communications officer at the Alzheimer’s Society, a U.K. charity. She isn’t related to A. David Smith.

The Oxford group studied people in the Oxford, England, area who had mild cognitive impairment, also known as MCI, or some memory loss. One in six people over 70 have MCI and about half of those develop dementia within five years, A. David Smith said. Alzheimer’s accounts for 50 percent to 80 percent of all dementias, according to the Alzheimer’s Association.

Vitamin Cocktail

Study volunteers were given either a placebo or 0.5 milligrams of vitamin B12, 20 milligrams of vitamin B6 and 0.8 milligrams of folic acid. Their brains were scanned using magnetic-resonance imaging and blood levels of the protein homocysteine were measured at the start of the trial and two years later. The MRI scans compared how much gray matter was lost in brain regions most affected by Alzheimer’s disease.

“It’s a big effect, much bigger than we would have dreamt of,” A. David Smith said. “I find the specificity of this staggering. We never dreamt it would be so specific.”

Brain Atrophy

The research reinforces previous findings that supplements slowed brain atrophy and cognitive decline in the group.

Smith and his colleagues at Oxford reported in 2010 that the atrophy rate in patients’ whole brains was reduced about 30 percent in those taking the vitamins and 53 percent in those on the vitamins who also had elevated homocysteine. They published study results in 2012 of memory tests that found people on the treatment who had high homocysteine were 69 percent likelier to correctly remember a list of 12 words.

The studies, known as Vitacog, were funded by seven charities and government agencies and vitamin maker Meda AB (MEDAA) of Solna, Sweden. Smith is an inventor on three patents held by Oxford University for B vitamin formulations to treat Alzheimer’s disease or MCI.

Vitamin B12 is found in liver, fish and milk and folic acid in fruit and vegetables. Deficiency of folate and B vitamins is already linked to dementia. Researchers such as Smith are studying whether less-than-optimal levels of B vitamins and folic acid contribute to its development.

Possible Benefit

“If you have somebody who has outright Alzheimer’s disease, this isn’t really going to help them much,” said Joshua Miller, a professor in the department of nutritional sciences at Rutgers University in New Brunswick, New Jersey. “If you can catch them at an earlier level, they may be able to benefit from it but only if you have elevated homocysteine.”

A U.S. study published in 2008 found that people who had moderate or severe Alzheimer’s didn’t benefit from the supplements. There’s no evidence that B vitamins enhance cognitive function in healthy people, A. David Smith said.

Doctors in Sweden began measuring homocysteine in people who report declining memory about two years ago, said Lokk at Karolinska. Swedish patients with high homocysteine are given folic acid and B vitamins, even if they aren’t deficient.

Taking Offensive

“We think the increased homocysteine level could be deleterious to the brain,” Lokk said. “We wanted to be on the offensive in diagnosing and treating patients. In our opinion, it is harmless and cheap.”

Vitamin B12 is probably the key to slowing the brain’s shrinkage and cognitive decline, Miller said. The FDA said in 1998 that folic acid had to be added to breads, cereals and other products that use enriched flour, to reduce neural tube defects such as spina bifida in newborns. A study by Miller and his colleagues in people of Mexican and South and Central American ancestry age 60 and older in Sacramento, California, the following year found their homocysteine was still high and that very few had low folate. Europe doesn’t require fortification of flour and breads.

Other studies have suggested that folic acid stimulates the growth of existing cancer cells. The data aren’t conclusive, so people at risk of cancer should avoid extra folic acid, Lokk said. This could include men older than 70 who may have undetected prostate cancer, A. David Smith said.

“We’re not suggesting everyone over 60 take this; we’re suggesting it should be targeted to people over 70 with high homocysteine and memory problems,” he said.

Too Early

It’s too early to put everyone on B vitamins, said Jess Smith of the Alzheimer’s Society.

“The evidence for supplementing is just not there yet,” she said. “We need bigger studies and more evidence that looks at what homocysteine is doing and what is actually going on in the brain.”

A. David Smith agrees. He plans a study of B vitamins in 1,200 people over 70 with MCI and elevated homocysteine. He needs 6 million pounds ($9.1 million) to pay for it. Miller plans another large study and wants to see if folic acid in flour in the U.S. leads to different results there. Meanwhile, the lack of blockbuster-drug potential presents funding hurdles.

“The pharmaceutical companies aren’t going to make any money on this and the supplement companies aren’t going to have enough money to do it,” Miller said. “This would have to be government-funded. I’m just not sure the climate is right for it now.”

To contact the reporter on this story: Andrea Gerlin in London at agerlin@bloomberg.net

To contact the editor responsible for this story: Phil Serafino at pserafino@bloomberg.net

Aside

Conscious Connections and Aging  As our roles shift in

 

As our roles shift in older age, so does our sense of community, and feelings of isolation often accompany elder life. When I spoke about this to Thich Nhat Hanh, a Vietnamese Zen Master, he said that in spite of the information age and advances in technology, which allow us to communicate with each other so rapidly, “one human being can’t be with another human being [through technology]. A father can’t be with a son, a mother with a daughter, a father with a daughter, a friend with a friend.” It’s harder and harder for human beings to be together, even though they can transmit information to more and more people all the time.

Although relationships change in all stages of life, it often seems harder to find new connections to replace the ones we lose as we age. This effort to stave off loneliness and to replace missing connections can sometimes take extreme forms, as in a case I read about in which a Japanese man hired a surrogate couple with a baby to visit his elderly parents because he didn’t have time. The old people spent the day pretending that these strangers were their actual family, talking about their “grandchild’s” health, how much the baby had grown, and so on. Before the surrogate couple left, kisses were exchanged and promises to visit again soon, and they were paid by the son an equivalent of $1,150 for their time and thespian abilities.

"Now and Then" photographed by Betina La Plante

“Now and Then” photographed byBetina La Plante

Caring for someone else is one way to combat loneliness. In response to this need, some older people have taken it upon themselves to be of service. Laura Huxley created Project Caress, a public space located in a shopping center where mothers and fathers can leave their babies while they shop. With a registered child-car professional in attendance, older people volunteer to come in to hold and cuddle the babies. The babies and the elders alike benefit from the contact. Although we may yearn to be quieter as we age, human beings have an inborn need for social contact that must be honored if we are not to suffer, and part of our conscious-aging curriculum must include finding ways to satisfy this yearning. We long to reassure ourselves that other hearts exist; to affirm our own existence through the presence of others. An older couple I know – he’s a psychiatrist, she’s a meditation teacher – have a big, beautiful home, where they raised a large family. After the children moved away and started families of their own, my friends were left rattling around in their big house, until one day they said, “This is a waste! Here we are in this wonderful house – why don’t we fix up the basement and move down there, and give one of our kids and his family the upper floor?” Their son and his family really benefitted by having the house, and my friends enjoyed the cross-generational companionship.

Through a strange set of circumstances, another friend of mine found herself  starting a family she never intended to have. At the age of 69, she became the sole caregiver for a six-year old child. Here was a woman traveling the world to give seminars, writing books, being an intellectual, who suddenly had her life “interrupted” by a child she could not turn away. For the first few years, she bemoaned her fate, but slowly this changed, and she and the child are doing fine. She even admits that her life is better for this unexpected change of plan.

Even though, as Thich Nhat Hanh reminded us, we can not betogether through technology, cyberspace can afford us a different way of maintaining connection in older age. No longer bounded by geography, we can meet in the brave new world of the Internet and spend time as companions in virtual reality. A woman speaking on National Public Radio recently reported how she’d used her computer and her internet contacts with people all around the country to get through her depression and loneliness after the death of her husband. A year later, she’s become the one who is counseling and supporting other recent widows in a chat group on the web. A friend of mine who is approaching seventy is teaching her still older next-door neighbor, a shut-in, how to surf the internet. My friend, who loves gardens, shares (among other things) a spirited international internet chat group on gardening. I foresee that computers will play an increasingly important role in engaging elders like me in educational and social participation, relieving us of the hassle of moving our arthritis-ridden, aging bodies around so much.

These sort of creative solutions to how we want to live as we get older are often more available than we think. Unfortunately, many of us are too caught up in the cult of independence to see these possibilities; either we don’t wish to be a burden on others, or we don’t wish to be burdened by others. Either way, we find ourselves more isolated than we need to be. In speaking with hundreds of elderly people, I’ve noticed a distant pattern of loneliness among those vaunting their own independence. We become Eleanor Rigbys, waiting at the windows of life. The “achievement” of living on one’s own is diminished by the sense of being ignored or left behind. This diminishment can become a barrier standing between our egos and the rest of the world, increasingly solid and hard to cross. Whether through shame over our own aging, or through fear of dependency, we should be vigilant about this tendency to isolate ourselves as we get older. To offset it, we might seek out community centers and other meeting places where peers congregate, or consider alternative living arrangements such as assisted-living centers, spiritual communities, and multiple-age communities set up specifically for bringing people of all generations together.

– Excerpt from Still Here by Ram Dass

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