Roy Laird just shot his wife in a nursing home here in Southern California. It was all over the newspapers. They were married for 70 years. He loved her. She had dementia.

My husband, who is 50 years old, has made it very clear that if he gets advanced stage Alzheimer’s disease and there is no hope for him to be cured, he wants to die, instead of languish and make his family suffer. He is not making a veiled request. He is quite serious. We have had many a philosophical discussion about this topic. This recent shooting has re-opened the debate. I love him. I hope that I have the great pleasure of being married to him for 70 years. If he develops advanced stage Alzheimer’s I will still love him. He posts these blogs for me and if there is anything inaccurate he will surely know. I WILL NEITHER DO THIS NOR RECOMMEND THIS FOR ANYONE ELSE.

What my husband has requested is his right-to-die. If I were to assist in his death, it might be a mercy killing and it might be the result of an intimate pact between him and me, but he would not be the one pulling the trigger, it would be me. If I carried it out, I would be forced to figure out at what stage in the disease to pull the trigger. Because Alzheimer’s takes away one’s ability to communicate, he would not be able to tell me that he changed his mind.  This is why we will continue to discuss our personal wishes with one another for years to come. If I develop Alzheimer’s I want God to take me when it is my time. I do not want my husband or anyone else to kill me. I do not want to be on life support if it means I will be in a permanent vegetative state with no hope of living a meaningful life.

There is no doubt that Roy Laird loved his wife. The facts reveal that after his wife got sick and started showing signs of dementia, he insisted on helping dress and feed her. He refused to hire nursing aides to help care for her. He insisted on doing everything himself — from washing her laundry to cooking her meals. When it became too much to handle, he reluctantly agreed to check his wife into the nursing facility. At that point she was no longer able to walk, sit up in a wheelchair, feed herself or recognize those around her. From witness accounts, after her admission, Roy would visit her three times a day, spoon-feeding her at each meal. He would deliver a goodbye kiss while holding her hand.

Should we allow people to choose how and under what circumstances they should leave this beautiful earth? This is a question that has only been answered in the affirmative in one state, Oregon.

Many people cite unbearable pain as a reason for euthanasia. There are many pain treatments available and hospice providers who work with pain management doctors are an excellent source for providing this relief. Certainly, education initiatives should involve informing patients about their rights as consumers. Everyone – whether it be a person with a life-threatening illness or a chronic condition – has the right to pain relief.

Remember people cannot be forced to stay alive? Neither the law nor medical ethics requires that “everything be done” to keep a person alive. Insistence, against the patient’s wishes, that death be postponed by every means available is contrary to law and practice. That is why everyone should have an advanced health care directive.

Recently an investigative reporter for the Times Sacramento Bureau Chief Evan Halper uncovered that violent felons have been permitted to enter the homes of the frail and sick to perform healthcare services. Is this an incendiary story with little statistical significance designed to give the Governor an excuse to cut the In Home Supportive Services Program (“IHSS”)? Or is it a horrifying reality of an industry fraught with problems such as high stress, relatively low wage positions?

IHSS, is intended to provide an alternative to nursing homes for low-income residents. Here in California, one must qualify for Medi-Cal in order to receive this benefit which is 283 hours a month.

According to Halper, individuals convicted of crimes such as rape, elder abuse and assault with a deadly weapon are permitted to care for some of California’s most vulnerable residents as part of the government’s home health aide program. The facts:

1. Data provided by state officials show that at least 210 workers and applicants flagged by investigators as unsuitable to work in the program are nonetheless scheduled to resume or begin employment. Current rules allow California to hire convicts, and privacy laws often keep patients in the dark about their caregiver’s past. Simply stated, thousands of current workers have had no background checks.
2. A court ruling earlier this year that said only specific types of child or elder abuse or fraud disqualify a person from being a caregiver in the state’s In Home Supportive Services. As a result, people convicted of crimes such as rape and assault with a deadly weapon have been permitted to provide care.
3. The 210 providers alleged to be dangerous felons with convictions represent 0.00005 percent of the 380,000 homecare providers in IHSS.
4. Many homecare providers are family members or friends.
5. If this program is cut, many older poor frail adults will have no assistance with daily tasks critical to thriving such as eating, bathing, walking, toileting, etc.
6. The budget was initially passed by the state assembly and senate last week and was approved by Governor Arnold Schwarzenegger the same day. Schwarzenegger implemented nearly $1 billion in additional spending cuts by exercising his line item veto power. He cut $300 million cut from In-Home Care.

I don’t usually believe in conspiracy theories, but here’s a question. If our legislature truly cared for the sick and disabled, wouldn’t he keep the program alive and put in place systems to ensure that this population can safely age in place instead of killing it?

Seminar Update:

The seminar at the Hotel Huntington Beach went very well. I am grateful for the panel and their expertise. For those of you who missed it or couldn’t find the Hotel Huntington Beach, this is what you missed.

First, in an effort to figure out whether or not it is safe to age in place, we explored some assistive technology. The CapTel phone was introduced. This device has streaming captions of the conversation a relatively big screen. There are some public benefits that enable you to get this for free. If you want to know more about his just click on the CapTel icon on my homepage. Jay’s Hearing is a fixture in Long Beach and Orange County. He has been in business for many years and he is truly an expert in assessing hearing loss and finding solutions to hearing deficits.

We had a doctor talking about fall prevention, in short, his advice get in shape and keep in shape.   NuVision also had some great technology for the vision impaired. I highly recommend checking them out if you know someone who has any type of vision loss and is looking for a solution.

Monica Bush from ResCare discussed what to look for when hiring an in home caregiver.  ResCare has some great technology available as well. They have a device that enables a family to watch what is going on in the home. You can just click on their icon to see more. HomeWatch Caregivers of Huntington Beach was also there. The owner of that facility used to be a fire fighter and is very dedicated to the health and safety of our citizens!

In the spirit of aging in place there was an in home dental company. How cool that they will go to your home or your parents home with before and after pictures to quell any suspicion that this service is too good to be true. They are called homecaredentists.com Google them!

Oxford Home Health discussed how one can qualify for in home health care under Medicare as well as how Oxford has been in business with the same owner since the 1960’s.   Oxford can be contacted by clicking on their icon. Greater Newport Physicians was also there. This medical group provides services to a wide range of people in Orange County.

Huntington Terrace Assisted Living was there. It is a beautiful, three-story community situated on three acres of meticulously landscaped grounds and gardens. I toured this facility and it is very nice especially with the renovation.

A representative from The Covington of Aliso Viejo shared information about this Continuing Care Retirement Community. A CCRC offers a broad spectrum of care and services to foster good health, fulfillment, and spiritual well-being in the lives of older adults. The Covington offers three levels of care: Independent Living, Assisted Living, and Skilled Nursing. In addition, The Covington also provides care for those with memory impairments in The Courtyard. A CCRC reduces the likelihood of relocation stress syndrome which can and does affect an older adult’s often delicate psyche.

This is a short list of items covered and experts involved in my last seminar. There will be an expert on dementia care at my next seminar on Saturday October 23, 2010 in Irvine at the Hilton as well as an expert on public benefits, MRS Specialists. It is a do not miss. I hope to see you there!

Everyone needs an advocate.

On Wednesday my little girl had a major seizure in her 5^th grade class. She was taken by ambulance to the emergency room. You could have decorated the wall with all of the people waiting on stretchers for a room.

She was released without an EEG and any significant tests. Our pediatrician referred us to an pediatric neurologist. We took her to the neurologist who hurried us out with a diagnosis of Autism (I know huh?) and gave a scrip for some heavy duty piousness drug for epilepsy. We had one hour for $400.00. She did not answer any of my questions about why that is her diagnoses, why she had not ordered an MRI or an EEG, or what kind of epilepsy my daughter allegedly has. When my husband Joel went to go fill the prescription, it was for a different child.

This doctor’s specialty is autism, and she told us that we could make another appointment for a consultation about that. MY DAUGHTER IS NOT AUTISTIC AND I KNOW THAT THERE IS A RIVER IN EGYPT CALLED DENIAL.

Our pediatrician complained to my husband he was “in it for three hours, he hadn’t made a dime, and professionals need to get paid.”

I guess one hour was for what I thought was his kind visit to the emergency room and my conversation with him the next day about how we were rushed through a life changing appointment about my baby.

Well, you can’t make an appointment for a workup without a doctor calling. He has been her pediatrician for 8 years. We need to converse with him about the status of our appointments. Maybe part of the $800.00 we pay a month for insurance should be directed back to him for making calls on our behalf. Or, maybe the system should change.

Why I can’t call a pediatric neurologist myself and get in for an appointment is mind boggling.

Here is what I know as my daughter’s mom. It was very  hot for the previous two days. My daughter had a terrible cough and she is very athletic. I have not put her on medication yet (it causes a deadly skin rash). I got her a lot of b6 b12 DHEA and Magnesium, Zinc and Calcium and a great all natural powder for electrolytes. I drop a bit of holy basil leaf into her warm tea and honey and release her to God.

I just have no faith in the medical community anymore. Tomorrow upward and onward. I will not let this rest until I am satisfied that all causes have been considered and ruled in our out.

It is sad to say, but EVERYONE needs an advocate-When I help a family, I leave no stone unturned. I leave my cell phone on at night, I hold hands and give hugs and research until I am satisfied that I have done all that I can to help them. I make sure that doctors answer their calls and their questions. I will do no less for my child.

Your collective prayers are appreciated.

How many of you have a favorite month? Two nights ago I was thinking about how I can’t wait until October because it is my favorite month. Then I had a thought that is consistent with many thoughts that I have had as a by-product of working with older adults and their families every day.  Every day I see people in the throes of Alzheimer’s or dementia. I wondered, based on mortality charts and my genetic make-up and controlling for the fact that my little ones have taken several years off my life, how many Octobers do I have left? Twenty? Thirty? Will I, on every September 19^th count this down?

Last night my favorite client passed away. I will miss her. Her death saddens me on many levels. What makes me most sad is that the night before she passed away I held her hand and asked her if she still had the will to live. She did. In fact, it was clear from spending so much time with her that she had big plans that she saved her whole life for and, like most of us, deferred.

How many of your favorite months do you have left.  This October, I will act like it is both my first and last. The fresh autumn air will smell better, the Halloween candy taste better and the world with all of its flaws will look better.  In fact, I resolve today, publicly that I will wake up every day and see my life as a the miracle that is it. And tonight when I go to sleep I will not make plans, I will resolve to do them.

Peace be with you Mrs. B you are loved……….

One of my recommendations in my initial report was that she organize her paper work. It was scattered about her desk and should an emergency arise, it would be difficult to present the appropriate paper work without a frenzy which is exactly what I was thrust into when the paramedic asked me for her Medicare card.

Mrs. B had pneumonia.  She was placed on antibiotics. She spent three weeks in the hospital. Both of her daughters came in from various parts of the world. So many friends came that I had to put visitation restrictions on her door.  She is a fighter.

One day I came in and she was standing and sitting and standing and sitting. She was trying to work her muscles because she felt as if she would never walk again. Her whole body shook and no anti-depressant could stop it. She was scared.  She became nauseous. She vomited blood.  Instead of being transferred to the transitional care unit for rehabilitation, she was rushed to the intensive care unit. The diagnosis after two endoscopies? A massive pulsating ulcer—that could burst at anytime and end her life.

In the meantime, her husband was at home with in home care assistance and friends to ensure his safety.  She did not communicate to with him. He was scared and sad. I had to find a way to both enable her to release the guilt she was carrying around about his imminent placement in an assisted living facility without directly confronting her and find a way to for her communicate to him before he was taken from his home and moved to another…without his wife of 40 years.

I interviewed Mrs. B’s daughter and a close family friend, a Guatemalan man that they raised and who will be the conservator when things go very south. They told me of the nicknames that Mrs. B and her husband had for one another and memories that would evoke feelings of joy and nostalgia. I set out and wrote a love letter to him on her behalf. Bidding him fair well with love, signed “all my love twinkle.” Mrs. B approved of the content and Mr. B held onto it as if it were laced with sticky honey.  Not all lies are bad.

Many older adults have asked me questions about shingles, a common viral illness, also known as herpes zoster or zoster. When I tell them that it is a form of herpes, they look at me the way I suppose I looked at a woman when she ordered sweetbreads when I waitress at a deli in Chicago. How could you eat cow brains to a college kid looks like how could I have herpes to a clean cut older adult.

The truth is that while people of any age can get a shingles infection once they have had a chicken pox infection; it is most common in people over the age of 60 (accounting for over ½ of all cases). It also strikes those who have altered immunity due to certain medications or treatments, such as chemotherapy, radiation therapy or steroid treatments or certain chronic conditions.

Shingles usually appears as a blistering rash along one side of the trunk, chest, back or face. There is a test for shingles in case you are not sure what to make of a new rash. It consists of a laboratory examination of cells taken from the skin.

There is also vaccine to prevent shingles, and it has been available for more than two years, but only a small percentage of my clients have reported being vaccinated. Many are distrustful of the vaccine and some think it is too expensive. Because the condition is particularly dangerous on the face (it can affect the eye and lead to temporary or permanent blindness), I urge everyone to get vaccinated.

There is also a risk of developing post herpetic neuralgia (pain, headaches, and nerve problems that occur as a complication of shingles). Post herpetic neuralgia lasts for at least 30 days and can continue for months to years. It most commonly occurs on the forehead or chest. The pain associated with post herpetic neuralgia may make it difficult to eat, sleep, and perform daily activities. It may also increase the risk for depression.

To address the first concern, I will cite to The Shingles Prevention Study, a large government-funded study, found that the vaccine prevented about 50 to 60 percent of shingles episodes in older adults. It also prevented about 70 percent of post herpetic neuralgia cases. Additionally, in the in the May 4, 2010 issue of Annals of Internal Medicine, scientists reported that the herpes zoster vaccine is safe and well-tolerated for most older adults. Finally, the vaccine has been recommended by CDC’s Advisory Committee on Immunization Practices, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American College of Physicians.

Please talk to your doctor about this because the vaccine is not appropriate for adults with weakened immune systems and those with allergies to gelatin, the antibiotic neomycin or any component of the shingles vaccine.

The vaccine costs can range from $150 to $300. Private insurance coverage varies. The vaccine is covered under the Medicare Part D drug benefit.

I never had the chicken pox and I never ate cow’s brains so where does that leave me?  Can I catch shingles from an infected person? Or can you, my non vaccinated client pass it on to me? It appears only if I come in direct contact with the rash. The upshot? You can sneeze on me, cough on me but you cannot order or eat sweetbreads in front of me.

I just assisted an older adult with a slip and fall. This gentleman is 80 years old and tripped in a local grocery store. This had nothing to do with any balance issues, it everything to do with a mat that was protruding from the floor. This significance to the aging world is this: now due to the growing Medicare shortfall in Washington liability insurers (which include carriers who write CGL policies, auto policies, homeowners’ policies and those defendants who are self-insured such as supermarkets) are required to determine and report whether a claimant is covered and is entitled to Medicare benefits. If the claimant received Medicare benefits during their treatment for the injury, Medicare is and will be relentless in its pursuit of a 100% reimbursement.

This new law will pose new challenges for plaintiff’s attorney and the plaintiff. If the attorney or insurance carrier does not comply, they risk being sued by the Government for reimbursement up to five years post-closure and monetary fines. If there is a settlement and Medicare does not know about it and mistakenly pays for services it has a right to recover, it can go after the attorneys whose fees are paid out of the settlement.

Also the Medicare recipient can lose his or her benefits. Lawyers could be exposed to malpractice claims for not handling a client’s benefits properly. Insurers can be liable for monetary fines for failure to report. If a plaintiff loses his Medicare benefits, the plaintiff may bring a legal malpractice claim against the attorney and a bad faith claim against the insurer for not making sure Medicare benefits were protected.

This is bad for older adults because there is and will be less of an incentive to assist older adults with their legitimate personal injury claims. A settlement amount will have to cover Medicare charges up to 100%, attorney fees and provide money for the plaintiff.  If that type of recovery does not seem likely, most attorneys will strongly consider rejecting the case.

Finally, negotiations with the liability insurance carrier will become more difficult. They will demand information about your client, such as social security number, so that they can comply with the requirements and avoid fines. Once the claim is settled, it can take up to four months before Medicare signs off on the settlement.

The Senior Medicare Patrol is a trained group of individuals, mostly retired professionals and other senior citizens, who can, as a result of their training, recognize and report instances or patterns of health care fraud. They also are educated as to how threats to financial independence and health status may occur when citizens are victimized by fraudulent schemes.

The SMP program empowers seniors through increased awareness and understanding of healthcare programs. This knowledge helps seniors to protect themselves from the economic and health-related consequences of Medicare and Medicaid fraud, error and abuse. The activities of the SMP program also serve to enhance the financial, emotional, physical and mental well-being of older adults — thereby increasing their capacity to maintain security and independence in retirement, and to make better financial and healthcare choices.

The result of training the almost 2.6 million beneficiaries, counseling over 1.0 million beneficiaries and 97,000 media outreach events?  Over $105.7 million in savings, including Medicare and Medicaid funds recovered.

How can you protect yourself from healthcare fraud?

1) Only go to your personal doctor, hospital or clinic for medical help. Only they should make referrals for special equipment, services, or medicine.

2.) Never show anyone your medical or prescription records without first talking to your doctor or pharmacist.

3) If someone calls and tries to threaten or pressure you into something simply hang up the phone.

4.) If someone comes to your door and says they are from Medicare or some other health care company, SHUT THE DOOR! ….. It’s shrewd to be rude!

5.) Do your homework and talk to your healthcare provider before buying or investing in internet “cure-all” or “miracle” products or services.

6.) Don’t keep mail in your mailbox for more than one day. People can and will steal

personal information right out of your mailbox!

7.) Rip up, shred or otherwise destroy your Medicare or other healthcare papers and other important documents instead of just throwing them away, but remember to record your doctor’s visits, prescriptions, etc., in a healthcare journal Crooks will go through the trash!

8. Treat your Medicare and Social Security numbers like credit cards. If someone offers to buy your Medicare or Social Security number, DON’T DO IT…It’s simply not worth it.

9. Remember that Medicare doesn’t SELL ANYTHING.

10. Follow your instincts – if it seems too good to be true, IT USUALLY IS!

11.  ALWAYS READ your Medicare Summary Notice (MSN) or health care billing statement (Explanation of Benefits). Your MSN & other Explanation of Benefits forms are generally stamped “This is Not a Bill” and come in AFTER you receive medical care. Look for three (3) things on your billing statement(s):• Charges for something you didn’t receive • Billing for the same thing twice• Services that were not ordered by the Doctor.

12. Every State has a SMP look up the number on Google and call!

I feel the season changing.

The subtle smell of new growth. The sun refusing to go easy into the night. The moon less eager to rush into the day. I just had my 47^th birthday. I too feel less eager to close my eyes at night. I spent my birthday skiing in powder up to my knees. The day before it was bleak, grey, windy, cold and wet. On my birthday, the sun shined and the powder forced me to just lay back and enjoy. For those of you who don’t ski, it can be effortless if you just relax into it. When I decided to sit back and glide down the slope I began to notice the lakes in the distance, the hawks in the sky, the music in my head.

There are many challenges we as Americans young and old currently face. Most of us spend our days trying to put out one fire after another and then go through the rote tasks before we go back to sleep and do it all again like pre-programmed zombies. I know that it can feel like you are a salmon swimming upstream, trying to get to places that we need to be, but having to face serious challenges along the way.   However, this is it. THIS IS IT.

If you have children and have to get them off to school and yourself off to work, take two minutes to  watch their faces as they chew their toast with two missing teeth. They are cute. If you have a long drive in traffic, turn off the news and turn on some funny morning guys and laugh or put on pretty music and find something pleasing about the sky. If you’re really lucky you will pass someone picking their nose or arguing with themselves behind the wheel. Who knows maybe you will get a glimpse of a wildly cute dog tonguing the air from the back seat of a sedan. Like Julie Andrews sang, these are a few of my favorite things.

If you have money problems trust that it is temporary and that you will be o.k.. Give yourself three minutes to fret about it and understand that while today is cold and bleak, the seasons are changing. I promise that tomorrow the sun will shine, it inevitably does (even in Seattle). So, just relax and enjoy the glide.

LOVE SUSAN

I thought that mixing old blood with young blood was a metaphor for multigenerational encounters—like Larry King and his wife. Now, it seems that science has found a way to be scientific about it and go literal. I never use the word goolish, but there it is. Taking blood from young adults and mixing it with octogenarian blood is kinda creepy.

The experiment, led by Harvard Stem Cell Institute in Boston, showed that mixing blood from young people with the one from elderly might help reverse effects of ageing. Apparently, the blood of the young animals seemed to rejuvenate ageing blood stem cells in the bone marrows of the older mice.

Old mice also make too many myeloid blood cells, which contribute to inflammation and the development of cancer, and too few lymphoid blood cells, which orchestrate tissue repair. In this study however such age-related changes were reversed.

I’m no scientist, but I think that this will cause vampirism. I imagine a world where packs of older adults stalk young people, forcing themselves upon them until they’ve reached a state of homeostasis. It will be a dark place.

On the other hand, from a public policy standpoint, maybe we won’t have to solve the problem of how we are going to afford to house and care for elderly frail adults, because there will be none. Everyone will have super youth powers and no one will need assistance with their care.

In case you have not heard, caring for our aging population is a huge problem that we, the public, have been zombies about (ya know walking around in a mindless stupor thinking the government will care for us). So on balance, I guess if it is a choice between being a zombie and a vampire, I will choose the latter. But of course I will have to have a little “work done” so that my outer appearance is consistent with my blood, also known as the vital life force.

Work and kids and work and kids and my husband and my kids and work. When I had a chance to fly away on business I was almost salivating. I had been thinking for days I have to get away.  Yes, they are my life, what I live for. But, I had to get away.

And there starts my journey. I had a two hour lunch meeting in San Francisco. With round trip it should have taken me four hours, total. Oh what I would have accomplished in four hours. A flight, a business lunch and a deal! But that four hours turned into 24 hours, and by the time I was on the plane home, the sound of my kids fighting with my husband and themselves before school was like a sweet symphony. My little angels. I couldn’t wait to see the source of so much joy and terror.

Has anyone heard of a ground stop? Well, apparently, the ground at the San Francisco Airport Stopped on my way up. By the time I got to my lunch appointment at the hotel, two hours late, my mascara was smudged all over my face and the restaurant had just closed. I pleaded with the waitress to feed me and shoved food in my mouth as I tried to impress a founding partner in a rather large important to my business firm. Was that charming or disturbing? Only time will tell.

Just as I was about to take him up on offer to drive me to the airport I received a call from the airline that my flight had been delayed until 9:00 p.m.  But, I just wanted to come for lunch. I guess the ground stopped in Los Angeles too. So as we said out goodbyes, without shaking hands of course, you know the swine flu way, I contemplated my options. I was curiously desirous of getting home to my family.

“How about a spa treatment” my husband suggested.  Nope, no spa, it was an airport property and I guess that people who stay at airport hotels and have gone through their own various travel nightmares don’t need massages.  After I go through security I need a massage. Oh well.

Five hours to kill, hummmmmmmmmmmmmmm. After speaking with a lovely young woman who used my triple A discount to lure me, I stayed over- night—without pajamas, or anything else, including a plug for my laptop or cell phone. Now, all I wanted was my annoying children, demanding, yet handsome husband who doubles as a masseuse and my bed.

The next morning after I boarded my on time flight home, I called home. My 9 year old and 6 year old in the background shouting names at each other, my husband shhhhsing them, the dog peeing somewhere in the house, I took a deep breath, sipped my carry on Starbucks, and smiled.  Whether I struck a deal with my intended target or not, which is what I want, I had what I needed and no ground stop would keep me from that.

Many people ask me if they will lose their social security benefits if they stay on the job or go back to work. With the economy being as it is, many older adults have put off retirement and are working past the time planned. If you have reached full retirement age you will not lose your benefits. This is the result of legislation passed in 2000.

Only those under full retirement age and already receiving Social Security Retirement Benefits are affected by the following (2008) limits. For that group of individuals the formula is as follows:

If you are under full retirement age you can earn up to $13,560 without penalty. For every $2.00 over the limit your benefits will be reduced by one dollar. If you are reaching full retirement age this year, you can earn up to $36,120 without penalty. Your benefits are reduced by $1 for every $3 earned over the limit. For example, if you earn $40,000 a year and your Social Security payout is $13,000 a year, that payout would fall by $1,293 (about 10%) to $11,707.

Again, if you have reached full retirement age, there is no penalty for earned income.

If you can make do without Social Security benefits until age 70, you will receive a larger monthly benefit. When they begin, monthly benefits will be increased substantially above the base full retirement age, increasing at about 7 to 8% for each year of delay beyond full retirement age. Conversely, if you begin before reaching your full retirement age, the monthly benefits are paid at a permanently reduced amount (up to 20 to 25% less) to reflect receiving benefits for more years.

Another question is whether an individual will continue to receive Social Security benefits as a widow (or widower) if that person remarries. The answer is yes, if you are at least 60 when you remarry. (A widow or widower isn’t actually eligible for benefits until age 60 or, if disabled, until 50.) Or you could apply to receive benefits based on your new spouse’s work record instead if those benefits would be higher. If you remarry before turning 60, however, you will be ineligible for widow’s benefits throughout your marriage.

In honor of National Memory Week I feel compelled to write about what I have witnessed first-hand. I could sum it up in a one liner, (but I like to write so I won’t)!

The older individuals that I have met don’t remember that they felt anxious or stressed to the point of making themselves sick about the economy or their stock portfolios or the burst real estate bubble. Many can’t remember their children’s names. If they could, I bet that they would kick themselves for the energy they put in that direction instead of pursuing joy.

It is hard to avoid the pain that life can bring, but the next time you worry about how you are going to be able to pay a bill or send your children to college, try to take a moment and recognize that those are just thoughts that you can control by making new thoughts. This is a luxury that people who have a cognitive impairment lack.

So, use your brain wisely and think about good things, because life is good.

In order to understand the permutations of Medicare Part D, you must have a Lewis Carroll like sense of the absurd and a gift for games of logic and language.Hopefully this blog will give you the keys to unlock the mysterious door to this provision and help you determine when you will go into the hole and when you will come out of the hole.

What is Medicare Part D?

Medicare offers prescription drug coverage for everyone with Medicare. This is called “Part D.” This coverage may help lower prescription drug costs and help protect against higher costs in the future. It can give you greater access to drugs that you can use to prevent complications of diseases and stay well.

If you join a Medicare prescription drug plan, you pay a monthly premium. Part D is optional. If you decide not to enroll in a Medicare drug plan when you are first eligible, you may have to pay a penalty if you choose to join later.

There are two ways to get Medicare prescription drug coverage. You can either join a Medicare prescription drug plan that adds coverage to the original Medicare plan, or join a Medicare Advantage Health Plan (like an HMO or PPO) that includes prescription drug coverage. You get all of your Medicare health care including prescription drug coverage through these plans.

Medicare Advantage Plans (like HMOs and PPOs) that include prescription drug coverage as part of the plan are health plan options that are approved by Medicare but run by private companies. They are part of the Medicare Program. If you join a Medicare Advantage Plan you are still in Medicare.

What is the donut hole?

The standard Medicare Part D benefit includes an initial $295 deductible. After meeting the deductible the beneficiaries pay 25% of the cost of covered Part D prescription drugs, up to an initial coverage limit of $2,700. Once the initial coverage limit is reached, beneficiaries are subject to another deductible, known as the “Donut Hole,” in which they must pay the full costs of drugs.

When total out-of-pocket expenses on formulary drugs reach $4,350 – including the costs of the deductible and coinsurance, beneficiaries reach the “Catastrophic Coverage” benefit.  Beneficiaries entitled to Catastrophic Coverage pay $2.40 for a generic or preferred drug and $6.00 for other drugs, or a flat 5% coinsurance, whichever is greater. This out-of-pocket amount is calculated annually. Beneficiaries who reach the out-of-pocket threshold in one year have to begin to meet it again on January 1st of the next year.

Only certain costs, such as money spent on formulary drugs (or non-formulary drugs that have been granted an exception by the plan), costs paid by the beneficiary’s family, a charity, or a State Pharmaceutical Assistance Program such as ConnPACE, count toward the true out-of-pocket spending requirement.

Costs paid for non-formulary drugs, cost of drugs purchased outside the United States, costs paid for by other insurance, including ADAP plans (CADAP in Connecticut), and Premiums paid to the Part D plan, do not count towards the requirement.

Do Medicare Prescription Drug Plans have Doughnut holes?

Each state offers at least one plan with some type of coverage during the coverage gap or donut hole. However, plans with gap coverage may charge a higher monthly premium so as to provide more coverage during the gap which occurs in many plans. Some plans may only offer generic drug coverage during the gap.

Tip: On your monthly statements from your Medicare Part D provider, follow the cost of your prescription, amount paid by your plan, amount paid by you.

Resources:  http://www.medicareadvocacy.org/PartD_DoughnutHole.htm

“Find & Compare Plans that Cover Drugs” [Medicare]

Have you ever heard of a double negative? That is what it is like to have role models that represent everything that you do not want to be and who conduct themselves in a ways that you find inappropriate and offensive.

I call them the anti-models.

It takes a great deal of strength and maturity to find something positive when confronted by these people.  To someone who holds onto grudges, I say “thanks for showing me what I do not want to be like.” And I act accordingly. When at the mercy of someone who reacts instead of seeks to understand, I say “thanks for showing me what I would look like if I didn’t take a minute to think before I hit the send button or leave an angry message.” And I act accordingly.

When I have to deal with someone whose emotional quotient is low, whose maturity level stagnated, I say “I will act like an adult because my success in life and business depends on it.”  When I am being judged by one who is in no position to judge, I tell myself that “being judgmental is not attractive.” When gossip gets the better of people, I say “I will not republish falsehoods.”

My parents were great anti-role models on many fronts. For years I never understood what a gift they gave me. I complained that I was not given chances, that I was robbed of happiness as a child. While it is all true, and if Iwas not a forgiving, non-grudge bearing person, I might have let those technicalities ruin my life. But, as an adult, I recognize their anti-role model value, and am a better mother and spouse because of their conduct.

So as we get older let others be our teachers, even if their messages are repugnant because role models come in all forms..

A positive attitude enhances our immune system and can turn a challenge into a positive experience

Gordon discusses how balancing nutrition with a boost of fiber, a multi-vitamin and fish oil for DHA is a great formula for healthy aging.

Gordon explains how he is able to continue breaking his own world weight lifting records despite the fact that he is in his 60’s.

The answer is, perhaps.  Under the law, if you have been taking care of your parent or have promised to take care of your parent you are legally required to continue giving your best effort.

Under the California Family Code you cannot leave a helpless, indigent parent home alone. Specifically, the code states that: “Except as otherwise provided by law, an adult child shall, to the extent of his or her ability, support a parent who is in need and unable to maintain himself or herself by work.” Family Code, Section 4400.

Family Code Section 4403 enables the parent or the county to bring an action to enforce the duty of support and recover attorneys’ fees for pursing that action.

Additionally, a criminal action could ensue. California Penal Code, states that it is a misdemeanor to fail to provide necessary food, clothing, shelter, or medical attendance for an indigent parent. (Section 270c).

There are exceptions to these rules. First, if your parent abandoned you for at least two years when you were a child, you may not be required to care for that parent now. Nor would you be liable for supporting your parent if he/she is receiving certain governmental aid. (WIC § 12350)

Episode #020 – A veteran talks about his guilt and how just days before being deployed overseas, got reassigned and avoided getting shot down.

Episode #021 – A Veteran talks about the extreme differences between his war experience and his little brother’s, and how it has affected their lives today.

Episode #022 – Marvin Donsker, a Jewish Veteran talks about what it was like to liberate Dachau during the war.

Episode #023 – At the 5th of July BBQ, Marvin and Betty Donsker talk about Marvin’s Book ‘Under The Rainbow” and why Marvin now wants to talk about his war stories.

Yes.

How could this be? How could our government ask that people become more self reliant, yet take away opportunities to pay for their own care?

The government is scheduled to decrease the amount of money one can borrow under a HECM (Home Equity Conversion Mortgage, i.e., reverse mortgages insured by the federal government) by 10% effective for all loans on which applications are taken on or after October 1, 2009. It is still unclear as to whether loans currently be processed will be grandfathered into the current HECM program.

Are you facing challenges with aging family members? Are you having trouble getting clear, practical and useful answers? Steve interviews elder issues expert and gerontologist Susan Geffen about everything from elder abuse to reverse mortgages, from long-term care to Alzheimer’s.

Also, are you frustrated with your financial situation? Do you wonder where your money went at the end of the month and why others are getting ahead when you are not? Steve talks about the basics of getting out of debt, getting the most out of your money and how to set yourself up for personal financial success.

My kids went back to grammar school today and I am arguably old enough to be a grandmother if I was a naughty or careless twenty year-old.  But, I wasn’t, careless, that is! I chose education and freedom to travel around the world instead of a life of family servitude.

Last night at Target during my last minute rush to get school supplies, it was as if I was at Harrods fighting over the last remaining magenta cashmere sweater. If only I had an umbrella to ward off the woman who thought she could wrestle the last box of number two pencils from my grip. I swear!

What does this have to do with aging? Everything.  Getting older is about passages strung together with pearls of wisdom.  It is like methodically stepping from one paver in a garden to another.   Getting school supplies leads to college applications, which leads to graduations, which results in tears of joy and then comes weddings and children in laws and grandchildren and then, the need for my services.

Maybe some people meander and their path goes around and about, but it always ends in getting older, day by day and year by year. You can’t fight  that off with an umbrella. But, you can be prepared and takes steps to ensure that  you live a carefree, not careless, future.

I just finished my new book, “The 7 Triggers of Mental Health Decline in the Elderly and How to Disarm Them Forever.” In the course of writing, I had many opportunities to reflect upon my own feelings and heed my own advice. But I must admit that I am a hypocrite (and apparently a poet as well).

In particular, the notion of what we choose to pay attention to has challenged me a lot. Lost in the discussion of what can trigger a decline in mental health is nostalgic reminiscence.  For me, that practice does not work as I inevitably experience a feeling of loss and the palpable sensation of emptiness.

For example, when I think about my college years, arguably one of the best periods of my life, I feel like I have lost something that I cannot regain, like a broken branch of a tree. When I think about how much my children have grown, I feel like I have lost an opportunity to get parenting exactly right. When I think about my deceased mother, I think about how I lost a chance to get being a child and sibling right. When I think about my father, I think about how I am losing a trusted confidant as I take on more responsibility for his well being.

I give a lot of power to the notion of being in a state of “loss” and a lot of lip service to being in a state of “possibility.” The former causes pain and longing, the latter, I am sure, will create a sense of excitement. Deciding to alter the way we perceive things is like exercising a new muscle; it is a conscious effort that takes energy. The pay off for changing this process will be better mental health.

So I make this pledge:

Starting today I am going to concentrate on the delightful future that is in store for me.  I will adhere to the cliché that the present is a gift. I will go on a thought process diet and only digest words of wisdom that inspire me to do great things and find beauty in my reflection. How about you? Are you ready to change?

#1 Not wanting to be a burden to our children, our spouse, or relatives.
Love is shown in many ways. One of the best ways to show it is by making sure that the financial and physical burden of being cared for does not fall on our loved ones.

#2 Access to Quality Care
The cost of being cared for is extremely expensive. Unless you have huge cash reserves, long term care insurance is the only realistic way of paying for care without going broke and ending up in a nursing home.

Remember. After the age of 60, there is a 70% likelihood that you will need long term care.

#3 Aversion to Welfare
Most of us have worked hard all of our lives and expect to remain in our homes when we get older. Unfortunately, for millions of Americans, the government is now their caretaker because the high cost of health care has depleted their assets.

#4 Asset Protection
It is sad how many people lose everything they have worked for when they get older and need long term care. Many people still think the government will take care of them, but they don’t realize that it will probably be in a nursing home and they will have had to spend their entire life savings to get to a place they don’t want to be.

#5 Control and Independence
There are many important decisions that have to be made about our living space and healthcare as we grow older. If you are like me, you want to remain in your own home. Long term care insurance can help insure that you have many favorable options available to you, including assisted living and in home care.

#6 Peace of Mind
For those who have already purchased a long term care policy from a reputable company, they would tell you that it is a huge relief to know that they have this important coverage.

You can bring a horse to water but you can’t make it drink

Here’s one for you.  She fell, and then she fell again. She has fallen so many times that it would be more efficient to list the times when she didn’t. But she doesn’t need help. She’s not, as she has said, “an idiot.”  Wait a minute. Now I am not a judgmental person, but I will play the role of devil’s advocate, yes, aunt of a client whose name shall remain safe with me, YOU are an idiot.

Why? Because you have at your disposal many nieces and nephews ready willing and able to help you find the care that you need, and you can afford it, but you are not one of those old people. Yet, you lay on your floor for 7 hours with a towel over your head until someone, I mean some people—plural, picked your 300 pound body off of the floor. You have cracked your head open twice from falling and you are bound to break your hip and die.  That’s what often happens to 76 year old women who break their hips.

I know that this sounds a bit ungerontologist like, but I adopt this demeanor to make a point, as ineloquent as it might sound….You can take a horse to water, but you cannot make it drink. She may be an idiot, but she is not delusional. Or is she?

Where is that line? It is the same question I have when I ponder the criminal defense not guilty by reason of insanity. Isn’t everyone who kills another person insane? Isn’t every person who chooses to live life on their terms when those terms mean self neglect insane? O.K., maybe it is a bad analogy, but we as a society and our legal system are going to have to seriously start thinking about this right to self determination.

Is it her right to break her hip and die on her floor? Is it the right of a person suffering from Alzheimer’s to be euthanized if that is a wish communicated when that person was as lucid as Albert Einstein, who as I might remind you, was the genius among geniuses who discovered, merely by thinking about it, that the universe was not as it seemed?

Is it the right of an older adult to slam the door on me when I come to see how they are doing upon being hired by an adult child? Is it my right to call those people idiots (even though it was in my non-judgmental role as devil’s advocate)?

I say, yes, yes and yes again. I believe in the right to self determination, period. HOW ABOUT YOU?

Episode #018 – Millie distinguishes between dating and having a relationship. According to Millie “a little hug, a little kiss, you go your way and I’ll go mine,” is enough. She is lonely now that both of her most recent boyfriends are in nursing homes.

To see the complete Millie series, click here.

Episode #018 – At 63, Laurel is still searching for her soul mate. Although she does use internet dating services, she would prefer to have her eyes meet with another’s across a crowded room.

To see the complete Laurel series, click here.

Episode #017 – Laurel reflects on the Beatles tune, “When I’m 64″ and talks about how she tore up her AARP card when she first received it.

To see the complete Laurel series, click here.

Episode #016 – This was one of the few times that Gordon has spoken about his experiences in the Battle of the Buldge and Omaha Beach during World War 2. He shares his remorse about the casualties and explains why so many men from that war do not speak about what they encountered.

To see the complete Gordon and Ginny series, click here.

Long Term Care Insurance is not a luxury or for the rich. It is a necessity that you should not ignore.

For years, Americans have believed that Medicare would take care of them when they get older, but that just isn’t true. Nursing homes are home to over 8,000,000 Americans, and that number is going to double in the next 10 years!

If you have been wondering whether of not Long Term Care Insurance is right for you or a loved one, then I will do my best to convince you that this is the very best investment you can make in yourself or a loved one. Yes, it has a monthly price tag higher than a gym membership, but benefits far outweigh the costs.

Hello, my name is Susan B Geffen, and for more than 20 years I have been an attorney and taught as an elder law professor at Loyola Law School. About 8 years ago, I decided to concentrate on helping the elderly and their adult children make good decisions about this precious time in their lives.

Early on as a Gerontologist, I discovered that Long Term care Insurance is one of the most important insurance policies a person could own in this country. I have seen wonderful, successful people end up in nursing homes because they couldn’t afford the high cost of in-home care. These proud people had very sad twilight years, but it didn’t have to happen to them.

How do you know if you are going to need long term care? You don’t know, and you won’t know, until it happens. Truth be told, you are much more likely to need Long Term Care than get into a car accident. If you are age 40 or older, there is a 50% likelihood you will need Long Term Care, and when you hit 60 years of age, there is a 70% likelihood you will need it, 70%!

And the problem is only getting worse for Americans. With the attempt to balance the budget in the United States, Medicare is no longer going to pay for in-home care, forcing thousands of elderly adults who need help with ADL’s (Activities of Daily Living) to move into nursing homes. These folks have no choice. They simply cannot afford to pay for in-home care themselves, yet they cannot survive without help.

It’s sad, it seems very wrong, and often unnecessary. If people in this country would wake up and smell the coffee, things could be much different. With better planning, and less denial about getting older, they could age in place, in their home, comfortably. Instead, millions of Americans are being uprooted at the most fragile time since their birth.

No one, including me, wants to be a burden to our children.

If you don’t have Long Term Care Insurance, you are 50% to 100% more likely to move in with your children when you need care. Of course if you have adult children, they will want to help, but is it fair to them or their children to be such a burden?

And moving in with your children is not the end of your problems. Eventually they will become exhausted, physically and emotionally, financially drained, and sooner than later you will probably need to move into a nursing home. This is called caregiver burnout, and it is happening everyday to families everyday.

Each of us hopes, including me, that we stay healthy for our lifetime and never need any long term care. But, that just isn’t realistic. And it is gambling. If you happen to get sick and need long term care, you won’t qualify for insurance.

Just because you need help with Activities of Daily Living, doesn’t mean you should lose your control and independence

I have worked with many clients who have become depressed because they have lost their ability to make decisions about where they live and who helps them. They need help with things like getting dressed and taking a bath, but now have no choice but to move into a nursing home. This could have been avoided if they had planned ahead and purchased a good Long Term Care Insurance policy.

What is peace of mind worth to you?

Let’s look at the break-even point. Lets say you are paying $2,500 per year for Long Term Care Insurance, and skilled nursing costs $7,000 per month. With just 3 months of care, all of your premiums you’ve paid over 3 months would have been eaten up. How else would you be able to afford the care you need without having Long Term Care Insurance?

One of the best things I can say about Long Term Care Insurance is that people who have it have a greater peace of mind than those who are still thinking about it. I think having a greater peace of mind is what insurance is all about, don’t you?

It’s about giving you a sense that “if something goes wrong (and for most of us, it will), then I will be taken care of and my family will be off the hook for the expenses”.

Episode #015 – Gordon found a new side to himself when he was thrust into retirement from an industry that he loved. Gordon shares his volunteer efforts at the Braille Institute and the Getty Center Museum.

To see the complete Gordon and Ginny series, click here.

Episode #014 – One look at this 85 year old man and you will want to take up gardening too. He is physically fit and looks like he is in his 60’s.

To see the complete Gordon and Ginny series, click here.

Episode #013 – Ginny keeps a busy social calendar and in so doing thwarts Alzheimer’s Disease, the only ailment she truly fears.

To see the complete Gordon and Ginny series, click here.

Aid and Attendance is a special pension benefit offered by the Department of Veterans Affairs (VA) created to help veterans pay for in home care, an assisted living facility or nursing home.  As a prerequisite, the veteran must generally meet certain requirements:

Service Requirements – must have served at least 90 days of active military service, one day of which was during a period of war, and must not have been dishonorably discharged.

Disability Requirements – must require the regular assistance of another person to perform everyday functions and activities that people usually do without help; be bedridden or need help to adjust to special prosthetic or orthopedic devices; or have a physical or mental injury or illness that requires regular assistance to protect them from hazards or dangers in their daily living environment.

Income and Asset Limitations – must show that, excluding the value of the family home, the household furnishings, and one motor vehicle, total assets are valued at $80,000, or less, and monthly income is less than unreimbursed medical expenses.

In 2009, a single veteran who is eligible is entitled to a maximum monthly benefit of $1,645, a married veteran is entitled to $1,950, and a surviving spouse of a veteran is entitled to $1,057.  (Additional details about the Aid and Attendance program, as well as other veteran’s benefits, can be found on the VA Benefits website at http://www.vba.va.gov/VBA/.)

If you are considering availing yourself of these benefits, please consider consulting a professional who is familiar with how these benefits work, especially if you are contemplating transferring assets into a Veteran’s Benefit Trust, annuity or any other tool to affect eligibility for Aid and Attendance.  Naturally, you should consider other tools for planning your long term care needs, including private long term care insurance.

Episode #012 – Ginny uses trends in hair as a metaphor about life. “If you fail to keep up with the times, time will pass you by.” she says. Whose hair style do you think Ginny likes the best? Dorothy Hamil, Farrah Faucet or Jennifer Aniston?

To see the complete Gordon and Ginny series, click here.

Episode #011 – Ginny could write a book about all of the stars she has worked with, but won’t because she is a lady.

To see the complete Gordon and Ginny series, click here.

“Everyday, elderly people are forced to move out of their homes and into crowded nursing facilities because they can’t afford the care they need to live alone.”

If you are at least 62 years old, it doesn’t have to be this way if you own your own home. You just have to understand some of your options.

It’s hard enough getting older having to cope with all of the daily physical challenges that come along with aging. Most of us expect things will get more difficult. But having to move out of our homes into a crowded, sterile smelling nursing home isn’t something any of us desire, nor are we prepared for it in our later years.

Unfortunately, over 8 million elderly are living in nursing homes today, but some wouldn’t have to if they were aware of their important options.

Years ago, Reverse Mortgages had a bad name, but that is no longer the case. Today, thousands of seniors are using the equity in their homes to afford the care they need while remaining in their homes.
“I’ll shoot myself before I move into a nursing home!” And most of them mean it!

I think remaining in their own home is probably the biggest concern of my geriatric clients. A reverse mortgage is a great option, especially if you don’t have long term care insurance. In fact, many of my clients are financing their Long Term Care insurance with their Reverse Mortgage funds.

• Reverse mortgage lets you cash-out the equity in your home without having to sell out.
• It’s a loan that all seniors and couples above 62 can obtain against their homes. You don’t need certain income or medical criteria to qualify for a reverse mortgage. But you do need to possess a home of your own with enough equity in it.
• This loan requires no repayment whatsoever as long as you live in your house and don’t leave it due to a sale out, death, or permanent shift.

If you’re like me, you’ve worked hard to pay for your home, and create a place of comfort for yourself. What you probably didn’t plan on (most of us don’t) is needing someone to come in and help you everyday with things like getting dressed, taking a shower, grocery shopping, cooking dinner, etc.

But this is reality for many elderly, isn’t it? And it is super expensive! Having part time help is about $125 per day, and full-time care is about $250 per day, about $7,500 per month. What financial options do you have left, if you don’t want to move out of your home?

It has often been said that money is security in our society. This is definitely more prophetic as we get older and more of our money gets spent on taking care of our health and other personal needs.
With a Reverse Mortgage, you can get cash in a lump sum, monthly installments, line of credit (whenever you require the money), or any chosen combination these.

While a large number of my clients have used the funds from their reverse mortgages to remain in their homes and afford care, you can use the funds for other things as well, including:

• pay off your current mortgage or debt
• home improvements
• medical bills
• prevent foreclosure

You may have been reticent about reverse mortgage products available in the market, but the industry and regulations have made them much more mainstream and practical.

Years ago, reverse mortgages were recourse loans. That means that if the bank was going to lose money on the loan after the homeowner moved out or died, they could go after the estate to make up for their losses.

Well that is no longer true. These loans are non-recourse. If the bank loses, they are Federally insured loans, and the government makes up the difference.

Another good thing to keep in mind is if there is still equity in your home your heirs get the proceeds from whatever is left over after the debts are paid.

So What Should You Do?

Find out if a reverse mortgage would be right for your financial situation.

To begin, click here to go to our secured page.

Episode #010 – Ginny has always been independent. She was forced to raise three children on her own at a time when that was not the norm. She was a women’s libber before that term was in vogue.

To see the complete Gordon and Ginny series, click here.

Episode #009 – Does keeping busy and having purpose keep you young? After viewing this segment, you should have no doubt!

To see the complete Gordon and Ginny series, click here.

1. The need for advance directives and the value of long term care insurance.
2. Long term care insurance is the subject of another blog.

Episode #008 – This segment depicts two people in their 80’s, in love and dedicated to living life on their terms.

To see the complete Gordon and Ginny series, click here.

Part (1/2)

Part (2/2)

Episode #005 – This segment demonstrates how a reverse mortgage can create a flow of money so that and elderly person can remain in their home instead of moving into a nursing home.

For the complete Mike Rose Series, click here.

Episode#003 – Professor Rose talks about how some female neighbors have manipulated his stepfather into parting with assets and how he fell victim to a late night television land sales scheme.

For the complete Mike Rose Series, click here.

Episode #004 – It is useful in gaining an understanding of how the loss of a loved one can result in social isolation and depression.

For the complete Mike Rose Series, click here.

Episode #002 – In-home care is a great solution for those who want to age in place.  Professor Rose’s stepfather did not want to go to an assisted living facility.

For the complete Mike Rose Series, click here.

I was in a car accident a couple of years ago and injured, among other parts of my body, my lower back. I can’t talk about the case in any more detail, but I can say that the defense attorney who told me that my injuries were not injuries at all. He said they were natural age related changes to my infrastructure, but he was a j— , (I need to be kind here) and severely misguided. One thing that I learned in my grad school physiology class is that there are few age related diseases. Many less than imagined.

First, many of the ailments that we encounter as we age are not as much age related as they are lifestyle related. For example, take Type 2 Diabetes. Yes, that is more prevalent in the older adults, in fact it is often referred to as “adult onset diabetes,” but it is not a necessary evil.

In fact, Type 2 Diabetes is also increasing dramatically among children, adolescents and younger adults. That’s probably because with older adults, there is a tendency to exercise less, lose muscle mass and gain weight. Many kids today are corn syrup and Nintendo DS junkies (but of course, not mine.)

In a nut shell, people with Type 2 Diabetes can’t make or respond to insulin properly. Insulin works like a key that opens the doors to cells and allows the glucose in. Without insulin, glucose can’t get into the cells and so it stays in the bloodstream. As a result, the level of sugar in the blood remains higher than normal.

With Type 2 Diabetes, insulin is still produced but the body doesn’t respond to the insulin normally. Glucose is less able to enter the cells and do its job of supplying energy. This in turn, causes the blood sugar level to rise, making the pancreas produce even more insulin. Eventually, the pancreas can wear out from working overtime to produce extra insulin. Then, the pancreas may no longer be able to produce enough insulin to keep a person’s blood sugar levels within a normal range.

What does a healthy lifestyle have to do with this process? Being overweight raises your insulin resistance and the kind of food that you eat can affect your blood glucose levels. It stands to reason that if you exercise the resulting decrease in body fat will result in improved insulin sensitivity.

So, dad (if you are reading this blog) please stop eating hot dogs and ribs and cherry pie because I love you. And, while you are at it go take a swim or something. On the other hand, you are almost 80 so go ahead and feast upon your fatty favorites and enjoy your day sitting at the race track. I love you and I want you to be happy and live life on your terms, but please don’t forget to take your Vytorin after!

Episode #001 – Professor Rose, relays the struggle he had with balancing work and the obligation he felt to care for his step father.

For the complete Mike Rose Series, click here.

What a grumpy man….I just met with an 88 year old man who used profanity that even I, the queen of naughty language, never heard. Maybe he was making some of  the words up. Or, maybe they were bad words at the turn of the 20^th century. If I sound rough, it is only because I had to smile as he berated me to a pulp. Actually, I understand why he was a grouch; once fiercely independent he was now being told that his right to drive was being rescinded.

They say that your personality gets magnified when you get older. So, if you are a very pleasant and reserved person in your youth and adult years, you will be extremely reserved and perhaps even an outright recluse as an older adult.

It stands to reason than the opposite is true. If you were prone to angry outbursts and lacked the ability to hold your tongue, when you get old the people around you should either take cover or grow a thick skin in a Darwinesque “Survival of the Species” way.

Failure to do so will result in withdrawal from your loved one’s life at a time when they most need you or when you have a limited opportunity to find joy in between the lines. It will never get better than it is in the present;  your parent no longer has the ability to adapt to your emotional needs, and maybe they never did.

When I was at an American Society on Aging Conference, there was a session entitled “How to take care of a parent who didn’t care for you.” If I tell you the room was packed that would be an understatement.

I knew why I was there, but it just could not be possible that all of those professionals had the same struggles as me. Actually, they did and more…there were tales of not just verbal abuse (the type that I endured) but physical and sexual abuse as well.

There was a story of how one police department called a daughter who was sexually abused by her mother and stepfather as a child and told her that if she did not come and take care of her mother, she would be arrested for neglect and abuse.

That was a lie, you have no legal obligation to care for a sick parent. Any obligation that we have is self imposed by religious beliefs, our culture,  or pure love.

Maybe you are just a good person. And what does that mean? When you get old your attributes will be enhanced and you will be a truly GREAT PERSON!

Don’t shoot the messenger. Laughing is good for the soul, even if it’s about getting older!

Two old women are sitting in a convalescent home and a lady went by flashing. One woman said to the other, “Did you see what she is wearing.” The other replied, “No, but whatever it is she needs to get it ironed!”

Not to discriminate against old women, here’s a joke about old men!

Two old men are talking. One said, “I am having a lot of trouble, I can’t remember anything anymore.”The other replied, “Why don’t you do what I did? I went to a memory school.” “Oh,” said the other man, “What is it’s name?” In response, the man asked him a question, “What is the name of flower that has thorns on it?” “A rose,” the other replied.   “Rose,” screamed the man to his wife, “What was the name of that memory school?”

Now, let’s stick it to the government…..

The Senate is investigating deceptive sweepstakes practices. These companies target the elderly and make them think they will receive a bunch of money, but in reality they never see any of it.

The most popular of these scams is called… Social Security.

How do you do it? What do you say? What are the consequences of not stripping them of this last vestige of independence?

I will now answer the latter of those questions; the former will be addressed in my second newsletter which, when done reading this infinitely interesting blog, you can click on!

Last week I met with a family to discuss how to care for their 87 year old father and husband, a former charismatic public relations guy. He was slipping away slowly, but nonetheless, slipping away.

Although the doctor told him that he could no longer drive, he said that he did not hear that. He wore hearing aides in both ears. So, to clarify I asked him what he meant by the word “hear.” Did he not literally hear him or was he going to a happy place when his doctor was uttering those life altering words?

The next day he got into a fight with the taxi cab driver, found the keys to the car and drive from Santa Monica to an imaginary appointment in downtown Los Angeles. What was going through his head as he plowed into a one parked car after another?

The answer is nothing. There was nothing going through his head. The classical music provided a background to the delusional, life threatening excursion. All I got from him was the relief he felt at not having a memory of anything and that he was glad because it would have been very scary.

There was no connection with his conduct and the real possibility that many innocent people could have been killed. We don’t have to worry about him driving again. The LAPD who surrounded him when his vehicle finally came to a halt took away his license and Buck’s Towing took away his totaled vehicle forever from his reach.

Raise your hand if you think that you should buy a worthless piece of property for $50,000 off an infomercial. Well if you are 85 years old, live alone and forget to take critical medication than the answer is, I guess.

That is precisely what a client’s father did this year. That was just a couple of days before he went into the hospital because of severe dehydration. Thereafter, he ended up in a nursing home to rehabilitate for three weeks.

When he got home and learned of his shopping spree, he was outraged and in complete denial. There was just no way that this fiscally responsible man would have done that.

Ahhh, those pesky IADLs (Instrumental Activities of Daily Living)—medication management, what a drag. This gentleman is on seven medications all of which have to be taken at different times throughout the day.

How could this have been avoided? Unfortunately, for most people, it takes just one incident to realize that the senior needs assistance. This gentleman now has a In-Home Care professional living with him at his home who reminds him to take his medicine and feeds him three squares a day.

To see a personal interview with this man’s son, go to our video archive and click on “Not taking MEDS can be expensive…”

Once upon a time lived a very bad girl. She took and took from her kind hearted mother even when her mother, wife of a once very prominent dentist, was well into her 90’s and had very little left to give.

Now I use that term “give” lightly as most of the time it was less give than outright petty theft.

Everyone knew that this daughter stole this woman’s check book and depleted her life’s savings, forged her signature on loan documents, destroyed her home with dozen of urine spewing cats, but no one did anything.

Why? Would it further surprise you to know that this 95 year old woman is my wonderful and funny and brilliant aunt? That this girl is my 53 year old adopted cousin?

I am after all an attorney, a gerontologist and former elder law professor. Why have I done nothing?

The answer is easy. Although this appears to be elder abuse, my aunt does not want anything done. She may complain and complain, but she has her wits about her, knows what and who her daughter is and will not take any action. In fact, she continues to welcome her into her home to and to financially violate her.

There is something that my aunt gets out of this dysfunctional dynamic. Without this she would surely die. I want her alive, all of us do. She may be poor as a church mouse now (I hope that is not politically incorrect, I just don’t know anymore), but she has something less tangible, and that is the need to be needed.

Most often, there is something that that the older adult is getting in return for what we see as financial abuse. Who of us is to say that what they are “paying” for does not have value?

The other day something unusual happened. I received a call from an 88 year old woman who needed my advice about her daughter in law’s pushy (for lack of a better word) behavior.

Fearing that she would be institutionalized against her will, she wanted to know what her rights were. When I got to the woman’s house, she and her middle aged care-giver, greeted me with a warm smile and a welcoming gesture.

As she spoke of her daughter barging in, her eyes began to tear. The daughter, the wife of a son who passed away in his twenties, had begun a campaign to rid the home of the caretaker and the cat that the caretaker brought in and to place my client into some form of assisted living.

The daughter had even gone to a doctor’s visit where she made not so subtle illusions to the house being in a state of filth and disarray and run over by pets.

Concerned, the doctor had a social worker come to the home. The social worker reported that the house and living conditions were in perfect order.

Later that day, the grandson barged into the home and removed the cat that my client had come to love, insisting that my client had allergies and that she simply forgot about them.

My client was afraid that she would be snatched and institutionalized when she went to put her garbage out. Was this a paranoid delusion? Was the care giver up to no good?

Or, was this a case of elder abuse?

My findings were that my client’s mental capacity was very much in tact. Furthermore, she was very happy with her caretaker and wanted a pet. I spoke with my client’s doctor who agreed.

To this day, I do not know what her daughter in law’s motive was. Although she was in the will, placement of my client into an institutionalized setting would deplete her inheritance. My suggestion was two fold.

First, I could have the family participate in a family mediation to have everybody’s concerns aired and my client could assert her right to independence and autonomy, she could make her 80 year old sister a proxy under a durable power of attorney for health care or she could voluntarily submit to a conservatorship over herself. Short of that, she could get a restraining order.

That seemed a bit extreme. When I followed up with her she told me that she suggested to her daughter in law a cooling off time. They will meet in a couple of weeks to smooth things over with or without my mediation.

Empowered by two professionals assessment that she is not incompetent, I suspect that my client will now be in a position to assert her boundaries that she created over 88 years on this planet.

Every day I speak with families across America who are being forced to make decisions that affect the lives of their parents and grand parents.  Most are ill equipped to make these calls on their own (which is why the call me) often requiring an understanding of complex issues like dementia, depression and loss of independent living.

With my new the Elder Life Series, I am going to give you a birds eye view into the lives of adult sons and daughters, elderly moms and dads, who have been gracious enough to share their stories with the public.

Why am I producing this series?

The answer is, we are all in this aging process together. Eventually, if we live long enough, each of us will be in a position where we have to depend on others because we can’t do everything for ourselves.

I want this on-going video series to show you what the future may look like for you or your loved ones so you develop an understanding about what some of the initial symptoms are of dementia; what it feels like to lose the privilege to drive and the  independence that goes along with it.  On a broader scale, I am hopeful that this will create greater feelings of empathy and respect for elders in this country of ours.

I also want educate the public on the many options available for caring for the elderly, from assisted living facilities to in-home care. The vital importance of purchasing long term care insurance as protection from ending up in a nursing home instead of remaining in your own home.

Be forewarned, this series can be emotionally difficult to watch. Seeing and hearing others stories can be quite sad and distressing, even as a viewer.

Seeing other families being thrust into unfamiliar territory and suddenly working side by side other family members to come up with workable, loving solutions for their elderly can instantly turn good intentions into a powder keg!

If you are taking care of your kids and your parents, you are a proud (or maybe not proud) member of the sandwich generation, so good luck!

We didn’t grow up thinking it would be this way. We figured we’d have kids and our parents would fend for themselves. At least that is the way it was always presented to us on TV and other forms of the media.

Today, everyday, Sandwich Generationers are being struck with the harsh decisions that face them when their parents start to have serious problems, from dementia to a broken hip. Things get even more complicated when one of the spouses is unable to care for the other or one has passed away.

Are you ready to step in with the time and financial commitment it will take to take care of them?