Peninsula Daily News Column 3-29-2012 "Consolidate, simplify to plan ahead"

            “Life on Earth” – We all know what we’re talking about, right? At this point, we’ve just begun to prepare for the unutterably inevitable.

            The main point from last week was to get in touch with how complicated our lives really are! A multitude of details, day-to-day, month-to-month, often year-to-year; sure, it doesn’t seem that complicated if you’re the one who’s handling it (or most of it), but if someone else came along and suddenly HAD to handle it, how would that go?

            Right, and Yes: I’ve walked that walk.

            I ended last week’s column with “Simplify, consolidate, organize and QUIT KEEPING SECRETS!” OK, one at a time:

            Simplify: Do you really need three checking accounts? Two savings accounts? How many of those credit cards have you actually used in the last two years?

            Do you really need to have three CD’s with three different institutions? And what about that acre in Eastern Washington? Really? And if you have no idea what that old coin collection is worth, probably nobody else does, either.

            Look: Genuine investments are genuine investments – So be it, but I’ll bet you know the difference.

            Or how about the old checking account in Fargo that has $1.12 left in it because you never bothered to close it back when your daughter was four? Or the life insurance policy that went out of effect when you quit that job? Or, for that matter, all that paperwork about your employer-provided health insurance back in ’86? Really?

            Wouldn’t it be easier to just pay Jack the $100 you owe him and forget about it? Or collect it? And if you’re ever going to actually sell those old “Farmer’s Almanacs” of your grandfather’s, just do it!

            You get it, right? Baggage! Baggage is for airports! If you don’t take care of or get rid of this stuff, someone else is going to have to, so I presume that “someone” will be someone you don’t like…

            Consolidate: This could mean the multiple accounts, as per the above, or it could just mean trying to get everything in one place; for instance, you keep the checkbook in the desk in the den, but the spare checks are in the closet in the spare bedroom, right next to the copies of your wills, etc. All of the insurance policies you’ve had since the Eisenhower administration are in a fireproof box in the basement – You know that to be true because you haven’t seen the key since Mugsy ran away. And NOBODY knows where the discharge papers are.

            You know where those old divorce papers are, but nobody else does, and there’s a reason for that…And let’s top right there, for a minute: If you have something – anything – tucked away that you wouldn’t want your partner of kids or family to find, get rid of it! – Because, it will be found. Think, “legacy.”

            You get it, right? If it’s irrelevant, GET RID OF IT! If it’s relevant, try to get it all in the same place – At least in the same room! Preferably, the same desk and/or filing cabinet and/or closet – Whatever! Nothing will make a grieving, tired, stressed-out loved one crazier quicker than finding bits-and-pieces of the puzzle all over the place – Unless, it’s NOT finding the bits-and-pieces.

            And as long as we’re talking about “consolidation,” consider this: If you can pay it off, pay it off – It’s smart financially and it’s smart from a planning perspective – Even if you don’t like those creditors, I presume you like your family.

            Back to “Where’s what:” Please remember that the fact that it all makes sense to you, or represents an efficient use of available space does not – In any way! – Suggest that it would make sense to anybody else, so here’s my piece of my story:

            My mother, who lived alone quite competently, thank-you-very-much, drove down to the corner store to get stamps – She planned on being gone 10 minutes. She did not plan on falling and breaking a hip, being taken to the hospital and having hip surgery the next morning. And she certainly didn’t plan on having a massive right-brain stroke in the recovery room – If she had, I’m sure she would have organized things a bit better (and probably have vacuumed and dusted), but she didn’t, so she didn’t.

            So I did – For weeks. And it was a small house; again, this isn’t about me or us, but put yourselves in that situation: How would it go for the one who was left behind?

            Too tired to take this on right now? Not enough time? I completely understand, as long as you’re not planning on going out for stamps.

             

Peninsula Daily News Column 3-22-2012 "'Life on Earth' business of preparation"

            OK, here’s our first problem: What are we going to call this thing?

            What we’ve set out to do is take a look at some things that we might want to do to prepare for death (our “passing,” “meeting our Maker,” the “other side” – Whatever euphemism you might prefer) and then, what to do when it happens, so what do you call that? “Dealing with Death?” “Preparing for Death?” “Dancing with Death?!” See the problem? Do you really want to start out your day reading any of those on the front end of a column?

            Right, neither do I, so we won’t. I think we’re going to call this, “Life on Earth” (because that’s what it is), and if somebody jumps in with us in a couple of weeks from now and doesn’t know what we’re talking about, it’ll be our dirty little secret.

            “Life on Earth.” The business of life on Earth, in this place, in this time, mature enough to look ahead and see what’s really there.

            Let’s start with the “getting ready” part, and I’m going to assume that we’ve all accomplished the staggeringly obvious, meaning that we’ve gotten wills, community property agreements, durable powers of attorney and durable powers of attorney for healthcare, advance directives and, if applicable, POLST forms drawn up and can actually find them.

            If you don’t know what any of those things are or why you care, scrounge up the last few months of newspapers and get caught up with the rest of us, because I am NOT going to put us all through that again!

            OK? Done? And you can actually find them? Yes, I know I just repeated myself about finding them, and the reason for that is that’s where we’re starting. And what’s even more annoying is that we’re going to start by thinking (I know, me, too – But sometimes it can’t be avoided):

            Most of us think our lives are pretty simple; I mean, we don’t need 3 accountants, 4 brokers and an entire law firm to manage our lives, right? Our income tax returns aren’t 250 pages long and we’re not depreciating the executive jet to an offshore conglomerate, so…pretty simple right?

            Now, close your eyes and think about your life: How many bank accounts do you have? How many credit cards? Where does your income come from? How many bills do you pay? When do they come? Own any land? – Any other land? Got any life insurance policies?

            How many health insurance policies do you have? (Medicare + Medicare supplement + Part D = 3, right there!) Got a car? More than one? Car insurance? House insurance? Renter’s insurance?

            Belong to any organizations? Pay any dues? Have any responsibilities?

            Married? Divorced? Widowed? Got any “ex’s” floating around? Kids? How many? Where?

            Stocks? Bonds? Pre-Civil War coins in a peanut butter jar?

            Who does your taxes? Does anybody owe you money? Do you owe anybody money?

            Did you just sign a 3-year contract for a new cell phone with the same phone number?

            …and on and on and on…See? (Oh, you can open your eyes now) It didn’t take long to get pretty complicated, did it? And we weren’t even trying! That’s a LOT of details! And who knows all that stuff besides you?

            And therein, my friends, lies the rub: Probably nobody.

            Even longtime couples who think they both know all the stuff, often don’t, and here’s why: It is very common for one person in the relationship to be the “business person,” the “detail guy,” the obsessive-compulsive “doer,” the Keeper of Lists (I know that to be true because I am one); while the other, well…isn’t. That’s not good/bad, right/wrong, and it usually works pretty well as long as there’s a genuine effort to share decisions and information – When it’s founded on love and trust, it’s probably fine.

            But it is very common. And if we’re trying to prepare for an eventual, inconveniently scheduled demise (“Life on Earth”), what does that tell us?

            Right: Simplify, consolidate, organize and QUIT KEEPING SECRETS!

            Well, I told you that this was about life on Earth, so we’re starting WAY upstream!

Peninsula Daily News Column 3-15-2012 "Death happens; details occur after"

            My mother died last October.

            To most of you, that isn’t “remarkable” – Oh, sure, some of you are saying to yourselves, “Oh, that’s too bad” or “I’m sorry” – Thank you for that.

            But for most of you – Most of us – It isn’t remarkable, because most of us are not unfamiliar with Death.

            …and Death, it seems, is not unfamiliar with us.

            Her death was not “unexpected,” but then, we could probably say that about anybody’s death, given the fact that most of us “expect” it will happen, eventually, so what that usually means is that it was “expected” sooner rather than later, which was the case.

            As an aside, the people who cared for her and helped me – Caregivers, aides, doctors, nurses, business people, etc ad infinitum - Were, without exception, wonderful. I say that by way of thanking folks who deserve to be thanked and to give you hope by reassuring you that we live in a very special place among very special people who, with rare exception, will “be there” when we need them to be.

            Thank you.

            But this isn’t about me and this isn’t really about my mother, who has moved on to better things – This is about death – Now, WAIT A MINUTE!

            I can well imagine that some of you, maybe a lot of you, just thought, “Oh, GREAT! That’s not exactly the subject I needed to cheer me up when the winter grayness is already beginning to get to me…!” No, it probably isn’t, so here’s my first thought worth sharing: Death happens when it happens…

            …not when it’s convenient or when the weather is good or when everything has gotten done or when we have the time…No, Death calls its own tune, and that’s what this is about.

            A short while back, I purposely did NOT conclude the “Boomer Primer” with “What to Do When a Death Occurs,” and I purposely didn’t do that because I wanted to conclude that whole “planning thing” with Life – Good for me.

            But the fact is, Death happens. It happens in its own way, in its own time and by its own rules, whether we like it or not – And we usually don’t.

            And since we put the “Primer” away, a number of you have asked about ideas, thoughts, lists, whatever on how to plan for this thing called Death, so we’ll go there. Interestingly, most of you who have asked for this kind of information are, by my reckoning, “Elders,” or at least not dancing on the daily threshold of puberty – No, you’re smarter than that.

            And braver than that.

            And more experienced than that.

            And have learned enough about love to understand it.

            Besides, courage is not the absence of fear, right? Right, so let’s do this – Adults only, please.

            By way of another aside, or a thinly veiled disclaimer, I am not a “Death Specialist” – What I am is someone who has spent a lot of years watching, listening and, I hope, learning. You’ll see soon enough that there are plenty of junctures where you’ll likely want to consult specialists – Attorneys, financial planners, funeral directors, insurance agents, etc – By all means, DO SO! My job here is to give you some things to consider – Your job is to translate them into the reality of your life in your way, and you may well want some serious “pro’s” to help you pull that off.

            I did.

            And here’s another…well, warning, I guess: An awful lot of what we’ll talk about relates to “business” – Money, paperwork, laws, regulations, procedures, bureaucracies, tra la – The “business of dying,” if you will. And the reason we’re going to do that is because that is reality – It’s how it really goes in this place, in this time, on this planet, so we’re not going to spend a lot of time (at least, right now) talking about dying or grieving or loss; besides, most of us already know way more than we ever wanted to know about that.

            No, this will be about business and planning, which means it will really be about love, so here’s the truth:

            My mother died last October, and I’m still cleaning up the details.

,

Peninsula Daily News Column 3-8-12 "Diabetes training covered by Medicare"

            Still got some of that Valentine’s Day chocolate lying around? Or cleverly stashed away where the others won’t find it? I thought so. PLEASE don’t tell me that you’ve still got Halloween leftovers leftover? Care to hazard a guess about how I knew that?

            Anyway, try answering a few questions (answer them silently, to yourself; otherwise, you’ll frighten the pets):

            Do you have diabetes?

            Do you think you might?

            Do you know and like anybody who does have diabetes?

            Are you on Medicare?

            Are you going to be on Medicare soon?

            Do you know and like anybody who has diabetes and is on Medicare?

            If you answered “No!” to all of the above, I can only say, “WOW!” and refer you back to the bio-bubble in which you, apparently, reside, because the rest of this is going to bore you out of your I-don’t-know-anybody-and-never-go-anywhere mind. The rest of us, who answered “Yes” to one or more of the above, might want to stick around.

            One could write a book about what Medicare does and doesn’t cover; in fact, a number of people have! In fact, the manuals that do exist on what Medicare covers (and how) generally need to be transported with farm equipment, which explains why I don’t usually get too deep into it – I don’t own a tractor. But given the demographics of our area and the fact that I know a lot of people who do have diabetes and are on Medicare (or soon will be), I want to give you a heads-up about something that you may not know.

            I’m not going to try to scare you into paying attention with all kinds of deadly and/or debilitating statistics – If you live in this world, you already know. And I’m not going to go on about how diabetes is a “chronic disease” that requires a lot of SELF-management and how chronic diseases account for 64-ish% of healthcare costs in the good ‘ole US of A and blah blah blah – You probably already know or very likely, don’t particularly care. What you do care about is your life and how much you do or don’t enjoy it and how much you can or can’t do and how long you might like it to go on. I get it – Me, too.

            And you likely already know that Medicare Part B (+ whatever Supplement plan you have, if you have one) covers things like blood glucose monitors and test strips and lancets and lancet devices and insulin and insulin pumps, depending. You may even know that Part B will cover custom-molded or depth-inlay shoes, and accompanying inserts and what-not, plus the services of a pro (and believe me, you want a “pro” for this, not just any old anybody who waves shoes at you) to fit them and make them work and monitor what’s happening, etc – Remember, your feet do a LOT more than just keep the ends of your legs from fraying!

            You may know a lot of stuff about what Medicare will cover for folks with diabetes, but did you know that it also covers diabetes self-management training? Yes! You can actually get training on how to get on top of this sucker so you can get on with your life! Your doctor (or somebody a lot like a doctor) has to prescribe it, of course, but a smart patient might ask about it if the doc doesn’t mention it – And, Yes: This training is available around here.

            Now, try this one, which it’s taken me this long to finally get to: Did you know that Medicare will also cover “medical nutrition therapy?” Yes! And what does that mean? Well, it means that you’ll be able to sit down with a registered dietician (or somebody a lot like one) and get an initial assessment plus 1-on-1 counseling (what to eat, what not to eat, how to follow an individualized meal plan, etc), help with managing “lifestyle factors” (you know what that means as well as I do), and follow-up visits and whatever else. Think “teacher” and think “coach.”

            You know what else tends to happen when you’re getting this teaching and coaching? You tend to find out about other services around to help you manage this diabetes thing – Services and resources and people that you likely wouldn’t know about unless somebody who cared took the time to tell you.

            That, friends and neighbors, is a “deal!”

            Well, OF COURSE you need a prescription! And if your doc doesn’t mention it, then you mention it! Why wouldn’t we take all the help we can get in order to handle this thing? Because we want to pretend that we don’t really have it and bad things won’t really happen, so we can go home and pull that candy-stash out of the nightstand drawer? Good luck with that.

            If you don’t particularly like healthcare or health insurance, then get a handle on handling this yourself, so you can use a lot less of both. And fine! DON’T take my word for it! Go to: https://www.cms.gov/MLNMattersArticles/downloads/SE0738.pdf and read it for yourself.

            Don’t know if you’ll remember all this and you don’t have a tractor, either? OK, then cut this out and take it with you to your physician or whoever you’re seeing about this diabetes thing – They’ll get it, because they’re on your side. The operative phrases are “nutrition therapy” and “self-management training.”

            Look: “Help” only helps if it helps – This will help.

           

Peninsula Daily News Column 3-1-12 "Study says a lot about 'golden years'"

            We’ve been pretty responsible for quite a while now, don’t you think? We’ve thought and studied and done stuff and registered for stuff and put stuff away in places where we will actually be able to find it again.

            We’ve made plans and talked them over with family, we’ve distributed copies of documents hither-and-yon, we’ve survived two Medicare “open enrollments” AND a rather significant winter storm.

            ENOUGH, already!

            Agreed. Try this:

            According to the U.S. Census Bureau, the 90-or-better crowd tripled in the last three decades, reaching 1.9 million in 2010! And that is expected to quadruple in the next four decades! In fact, 90-or-better will probably constitute 10% of our whole 65-or-better crowd by 2050! 10%!

            And what does the U.S. Census Bureau know about this gangbuster 90+ group? Well, they are overwhelmingly white (88.1%), considering the years in which they were born, they have an unexpectedly high rate of high school completion or beyond (61.3%) and women outnumber men by a ratio of almost 3 to 1.

            It gets even more interesting: 99.5% of people in the U.S. who are still alive at 90 are covered by health insurance (…hmm…); further, the median income for 90+ between 2006-2008 was $14, 760, 47.9% of which came from Social Security, but 14.5% of those folks lived in poverty.

            Half of men 90+ lived in a household with family members (or whomever) as opposed to only one-third of women, which must say something about…something. The report also says that the likelihood of living in a nursing home increases with age (no real surprise), so here are the odds: 1% of folks in their upper 60’s will reside in an institution, 3% in their upper 70’s, 20% for those in their lower 90’s, 30% for folks in their UPPER 90’s and 40% of folks 100 years of age or better live in a nursing home.

            Did you get that? If you’re 100 years old (or better!), the chances are 6 out of 10 that you will NOT live in a nursing home! WOW! We ought to find that a bit encouraging, because it says something about who we are and how tough we are, while it also says something about caregivers and caregiving – And it better say something about how we plan for the “golden years,” huh?

            One more: 80.8% of the 70-80% of the 90-or-better crowd that didn’t live in nursing homes had one or more “disabilities.” We don’t know what those “disabilities tend to be, but the report states that “…difficulty doing errands alone and performing general mobility-related activities of walking or climbing stairs were the most common…” things that folks needed help with.

            So, what I get from that is (a) ENCOURAGEMENT! and (b) some concern. The “concern” is that a lot of the “programs” I deal with all the time tend to prioritize very personal care (somebody’s hands on your body) and de-emphasize things like errands, housework, etc – Not completely, but more-or-less. And while there’s certainly basis for that, these numbers suggest what some of us in this business have been whining about for years: Help with housework, errands, etc – Chores! – Can help a lot of people stay right where they want to be, which is home.

            So, now, let’s take a detour regarding the very personal care, somebody’s-hands-on-your-body part (no pun intended):

            According to “the COPENHAGEN post” (What?? You don’t have any weird hobbies??), the use of robots in eldercare has “exploded” in recent years (I hope that’s metaphorical) and a new study seems to show that Danes are positive about these technologies; apparently, robotic vacuum cleaners and robot companions for folks with Alzheimer’s disease are “commonplace.”  

            Now, this “new study” says that a majority of respondents would prefer to receive technological assistance – Rather than human assistance – when (a) eating, or (b) going to the bathroom.

            I know, but that’s what it says.

            Of the Danes responding to said survey, 55% believe it is more dignified to be helped by a machine than by another human; in fact, a “bathing robot” is currently “on trial” (I presume that is metaphorical) at a nursing home whose name I can neither pronounce nor type, since this keyboard doesn’t seem to have the necessary letters. The bathing robot was produced in Japan.

            A group called “DaneAge,” which works for the interests and well-being of the nation’s “seniors”, warned that the study might be misleading because it came from an online poll so might have attracted more tech-savvy respondents.

            In conclusion, two things come to mind:

1. Have any of these respondents actually been assisted by the “going-to-the-bathroom robot?”
2. I think I know why the “bathing robot” was put on trial.