Archives: Aging, Disability, Death, Dying

“Look for the Helpers”

04.16.2013 12:43 PM

mister rogers helpers quote

 

In the wake of yesterday’s tragedy in Boston, Huffington Post Parents ran this article, which they had previously run following the Newtown School shootings, quoting the incomparable Fred Rogers on how best to engage children when horrific events unfold in the news.  Aside from the quote above, which I think is wonderful, the advise he gives is very sensible – limit a child’s exposure to television, internet, and radio news, model calm behavior in front of children, and go out of your way to affirm your love and care towards your child as they process the traumatic event.  The included link to his website leads to further advise for parents.

A good deal of research has taken place in the U.S. in the years following 9-11 about the psychological implications of large-scale natural and man-made disasters.  Parts of these studies have focused on the resilience of young people, and the factors that contribute in helping them process traumatic events.  A 2004 NYU Medical Center newsletter highlights the important link between children and the adults in their lives when it comes to positive outcomes:

In a study of post-traumatic stress in Israeli preschool children 30 months after SCUD attacks, the psychological well being of mothers and other family members was the best predictor of the child’s mental health.11  When families and mothers ‘did well,’ so did their children. Conversely, families and mothers who showed negative post traumatic reactions to the attacks had children who showed similar negative outcomes.

I highly recommend checking out both articles, as they are great resources for parents, teachers, and those who interact with Children regularly.


Surnames in the Digital Age

04.15.2013 11:31 AM

So, many of you know that I am a bit of a nut when it comes to following current practices in changing or not changing surnames in marriage.  I stumbled upon this collection of commenter anecdotes from The Dish.  One reader notes that our choices in terms of surnames is actually changing and will most likely challenge the art of geneology for future generations.  Coupling this name practice with my working thoughts on life and death in the digital age (catch up on your Google Death Manager reading here and here...), I continue to be struck with the ways that we find to unmoor ourselves from history and tactile existence.  Liberation may often be called for (spoken as a feminist who chose not to change her surname in marriage) but the existential philosopher in me wonders, what is real?  The digital age conflates form and content in ever new and challenging ways.  Our e-mail, social media, digital pictures not only communicate and share our thoughts and memories but they also hold them, or do they?  What does inheriting the stew of thousands of mundane, secret, time-sensitve, and time-limited e-mails of a loved one really mean?  Can you box them up and stick them in the attic for future generations to pour through?  Or does our digital existence and singular names actually speak to the intrinsic illusory nature of mortals?  The concept of legacy shifts beneath us in this modern age.  Literally, how will you be remembered?


Hope for Caregivers

04.10.2013 2:32 PM

Okay, as a hopeful follow-up to yesterday’s more dire future-of-caregiving post, here are some good things happening in the world of caregiving and how you and those you love can access resources.

This first link chronicles three women who are re-defining caregiving.  I especially like number two, Jenn Chan, who started “The Senior Shower” project after she attended a baby shower.  What a great idea to raise awareness of those caregiving in our midst and to do something both helpful and fun.  I am going to pitch this idea to our church!

The second link will shepherd you through how to access the new AARP caregiving app on your phone.  From what I can tell, it looks easy to navigate.

Some hope!

 


Are Family Caregivers Invisible?

04.09.2013 12:23 PM

Sheri Snelling writes an insightful piece on the current face of elder caregiving in the work place:

“Here is what we know today: 7 out of 10 caregivers work full or part-time and represent more than 15 percent of our entire U.S. labor force. We also know over the coming years our society faces a longevity silver tsunami where we are all living longer and more baby boomers are holding onto their jobs, putting off retirement while simultaneously caring for aging parents and spouses. And it isn’t just a boomer issue — Pew Researchrecently reported 42 percent of the younger Gen Xers are Sandwich Generation caregivers than their baby boomer counterparts (33%). All this has created an evolution at work — one where workers are more concerned about elder care than child care.

A challenging aspect for working caregivers and their employers is that caring for an older parent or ill spouse is not a joyful event; you don’t come to work with smiles and stories like you would if you were pregnant or just became a grandparent for the first time. In addition, in an era where the economy remains on life support, many employees are concerned about identifying themselves as caregivers, fearful for their job security. A report by the National Alliance for caregiving found 50 percent of working caregivers are reluctant to tell their supervisor about their caregiving responsibilities. In addition, the Shriver Report: A Woman’s Nation Takes on Alzheimer’s found 46 percent of female employees asked for time off for caregiving and could not get it forcing them to make a choice between elder care and employment.

There are two problems with this situation: 1) Caregiving employees are forced into the closet — mirroring the gay rights issues over the last few decades where lifestyle remained a secret out of fear of reprisal; 2) Employers who don’t hear or understand the personal lifestyle challenges facing their employees cannot be called upon to institute programs and work environments where these employees can get support to stay on the job, be productive and remain healthy, thus continuing to positively impact the company’s bottom line.” Read more…

She goes on to point out that the average elder caregiver is 50 years old, a population that will soon comprise one in four people in the workplace in the next seven years.  She also fails to mention that the sandwich generation, soon to be defined by 50-year-old Gen Xers will also be caring for an unprecedented number of divorced and/or remarried elders–thus TWO plus households to manage, TWO plus financial outlooks to tend, TWO plus people to shepherd through doctor’s visits etc.  Snelling points out that there are good awareness-raising initiatives happening but the prescriptive arm to that awareness is lagging.  It will be interesting to see who becomes the employers of choice in the age of long-term elder care.


Thoughts on the Fullness of Humanity

04.02.2013 3:26 PM

Access to marriage=Access to human dignity

The above equation is one thought I hope to explore during tomorrow night’s conversation with David Blankenhorn and Peter Steinfels.  How might we build on this belief that access to marriage is synonymous with access to full humanity.  Or, the converse, if we explicitly or implicitly believe that someone should not have access to marriage are we also saying that they do not have access to the fullness of human dignity?  As someone who has supported the access of gays and lesbians to marriage for some time, I hope that we can be inspired by the relatively rapid shift in public opinion towards this civil rights issue and begin to think about other populations whom we explicitly or implicitly deny full access to marriage.  For example, the elderly.  I do not think that our current policies and practices of providing long term care nor our societal support and honor for family care-giving in general begins in a place that honors the marriages of older Americans, in part because many of our current policies treat the vulnerable old as a burden, as less than fully human.

Another population that comes to mind is the incarcerate and/or previously incarcerated.  John Maki, of the John Howard Association, Illinois’ only prison watchdog agency, writes an insightful piece today at HuffPost on the current debates in Illinois on the current and future state of prison healthcare in a time when the prison population is and will be defined by long term chronic care conditions of inmates considered elderly at 50 plus years of age.  He is looking at Illinois, but New Jersey and California have also been struggling with prison over-crowding and attempts at consolidation as well as trying to meet the specialized needs of an often mentally ill, aging, and generally infirm prison population.

“Apart from overseeing the care of its general population, IDOC also struggles to treat the growing number of inmates with special needs. For instance, over the past decade, Illinois’ elderly prison population grew by more than 300 percent, far outstripping increases in other age groups. While exact estimates vary and there is no Illinois-specific data, it is widely accepted that U.S. prisons and jails house more mentally ill people than psychiatric hospitals. Additionally, a 2010 study by the National Center on Addiction and Substance Abuse at Columbia University found that 65 percent of the U.S. prison population meets the DSM IV medical criteria for substance abuse or addiction, though only 11 percent receive treatment.

These special populations and the costs associated with their care stem from decades of choices made by elected officials with the support of the public. Decisions to lengthen sentences, mandate harsher punishments for drug-based offenses, and close public mental health institutions have filled IDOC with inmates who are drug addicted, mentally ill, and growing older. As a consequence, state prisons have become de facto hospitals, asylums, drug treatments facilities, and retirement homes…

IDOC’s health care system is not just an issue for the state’s prisons. Every year, about 30,000 inmates leave IDOC to return to their communities. If the prison system is not able to meet its health care obligations, cities, counties, and the general public will inevitably pay a higher price when inmates are released, with increased transmissions of infectious diseases, emergency room visits, and higher recidivism rates…” Read more…

Now, granted, unlike with gays and lesbians we do not have outright laws against the elderly or the incarcerated or formerly incarcerated accessing marriage.  However, I am inspired by the current movement towards marriage equality for gays and lesbians to think not only of how we explicitly discriminate against others but also how we implicitly and structurally create second-class citizens of our neighbors.


Prodigal Stories, Forgiveness Stories

03.14.2013 4:51 PM

There once was a man with two sons….and they ALL lose…”

My sermon this last Sunday based on the Prodigal Son story in Luke 15 began on this note.  A story that shows what life looks like when we allow ourselves to defined by what we have lost.  It’s truly the story of all stories.  Where does a preacher even begin?  I consulted my friend, who is sharing preaching duties with me at this congregation, and I explained my temptation to preach one minute of each of the dozen sermons swimming in my brain.  She tactfully hemmed and hawed and said, “Well, they’ll be lost! And being lost is a theme but…”

To recap, the Prodigal (Lost) Son is a story of a father with two sons, the younger of whom requests his share of the inheritance long before its due, leaves home and loses all his money in dissolute living.  The older brother remains at home, earning his inheritance through daily work in the fields and by caring for his father as he ages, as is expected.  The father loses the story he might have told about his younger son, and even presumes he is dead.  The younger son eventually must lose the story he has told himself concerning what is of value in this world, including his pride.  And by the end, even the older brother is left contemplating what he must lose in order to remain in relationship with his family: will he lose the story of self-righteousness and fairness he has been telling?  Loss permeates every phrase.

I was tempted to share the insights from Marquardt’s Between Two Worlds data where adult children of divorce were asked to reflect on this story of loss.  They expanded our perspective of parental loss by sharing that they tend to relate to the father in the story and not the sons.  When children of divorce lose the story of living in one home and begin telling a story defined by moving between two worlds/two homes, they tell a story not of prodigal sons but of prodigal parents.  Like the father, they have spent much of their lives waiting, searching the horizon for the other parent who is lost at that moment.

My thoughts on loss continued as I listened to Krista Tippett’s recent On Being interview with Minnesota storyteller and poet, Kevin Kling.  He was born without the use of his left arm, withered, and in his forties he was in a motorcycle accident that left him without the use of his right arm.  He speaks most powerfully about the role that loss plays in life. He says:

“When you are born with loss you grow from it, and when you experience loss later in life, you must grow towards it.  After a loss, you are now a person you haven’t become yet and we use story to become the person we are.”

We may not all be born with distinguishable losses such as a withered arm, but our common mortal path, by definition, will include loss.  So, how do humans respond to loss?  He talks at length about the power of story to help us reframe and make sense of the losses we experience in life.  He shares that for him, storytelling is empowering:

“by telling a story, things don’t control me anymore, it’s in my vernacular, it’s how I see the world and I think that’s why our stories ask our questions, our big questions, like, where do we come from, before life and after life, what’s funny or what’s sacred, and even more importantly by the asking in front of people and with people, even if we don’t find the answers, by the asking, we know we’re not alone, and I have often found that that is even more important than the answering.”

He reflects on how loss can leave us defined by the word: disabled.  He wrestles with this word and reclaims it by defining disability not as un-ability, but as ability learned through shadow and reflection.  Through loss, all in the Prodigal Son become dis-abled and are faced with what they learn through shadow and reflection.  Some come to their senses, some learn to celebrate, and some remain faced with the eternal choice of finding a home in the world that lies before us.

These thoughts on loss reminded me of past conversations had here concerning forgiveness.  I recently read Dr. Fred Luskin’s Forgive for Good: A Proven Prescription for Health and Happiness.  He is the Co-director of the Stanford Forgiveness Project (part two of the book addresses the different studies conducted and their outcomes) and right away in the Introduction he lays out how forgiveness always begins with a grievance.  He explains that a grievance arises when an undesirable occurrence happens to us and then we think and talk about it in a certain way.  He defines a grievance as:

1)      the exaggerated taking of personal offense

2)      the blaming of the offender for how you feel

3)      the creation of a grievance story

As I’m sure you can imagine, he then defines the steps in forgiveness to be the reverse: learn to take reasonable offense at what has happened, take responsibility for your feelings, and create a forgiveness story.  The rest of the book talks about the interventions he uses to help train people in forgiveness (guided meditation and breathing play a large part), but I was especially drawn to the storytelling aspect.  He shows how the story we tell can have powerful implications not only for how we feel emotionally, but for long term cardiac health and overall well-being.  In other words, if we always tell a story of loss, eventually we will be lost.

I closed my sermon with this beautiful story from Kevin Kling’s collection, The Dog Says How:

“When Pots and Pans Could Talk”

There once was a man with two pots.  In order to have water, he had to walk down the hill, fill the two pots, and walk them home.  One day, it was discovered that one of the pots developed a crack.  As time wore on, the crack widened.  Finally, the pot turned to the man, “Every day you take me down to the river, and by the time you get home half the water has leaked out.  Please replace me with a better pot.”

The man said, “You don’t understand, as you spill, you water the wildflowers by the side of the path.”  Sure enough, by the side of the path where the cracked pot was carried beautiful flowers grew while the other side was barren.

“I think I’ll keep you,” said the man.

In life, we are all losers, but through story new life can grow from loss.


Gov. Cuomo should not heartlessly force sick or elderly couples into poverty or unwanted divorce in order to get Medicaid long term care

03.13.2013 12:09 AM

Apparently Gov. Cuomo has put the spousal refusal provision for Medicaid back on the list of possible cuts again in this year’s budget. The Staten Island Advance editorial says:

…The governor wants to eliminate the so-called “spousal refusal” provision that allows New Yorkers even at higher income levels to get Medicaid reimbursements for long-term care. The state Health Department says that doing so, would save taxpayers up to $100 million or more a year.

Spousal refusal allows the healthy spouse in a marriage to essentially divest the assets of a husband or wife in need of long-term care. In that way, the family need not spend the bulk of its own assets to pay for that care…

According to Republican Assemblywoman Nicole Malliotakis, who recently wrote a letter to the Advance opposing the governor’s plan, “Spousal refusal allows for a healthy spouse, known as the community spouse, to protect their entire life savings from being garnished by the government to supplement the massive expense related to assisted living and long-term care.”

She said that with it in place, the healthy spouse is allowed to keep the family home, a car and up to $113,640 in assets. Were the spousal refusal provision to be eliminated, the couple would have to live the rest of their lives with just $20,850 in assets.

As she notes, this would hit middle-class families particularly hard. Even younger families with children in which one spouse is stricken with a catastrophic illness would be wiped out.

Without the provision (which NY is fairly unique in having), couples have to spend down all their life savings or consider divorce in order to protect assets for the well spouse so they can get long term care through Medicaid for the ill spouse. (Keep in mind there is no long term care provision in Medicare, and private long term care insurance is prohibitively expensive for most.)

Here’s a piece I wrote at Huffington Post’s New York page one year ago, when he also tried this: “Gov. Cuomo Should Not Jettison the “Spousal Refusal” Allowance in State’s Medicaid Program“:

…Critics charge that New York’s spousal refusal allowance benefits wealthy New Yorkers who get to protect their assets while using Medicaid to care for their sick spouse. But let’s face it: people with resources want to pay for the best quality, most attractive and most home-like long-term care settings, which often don’t accept Medicaid. Those who will really suffer under the governor’s proposed change are elderly middle and low-income New Yorkers, people who worked hard all the years they were healthy and should not callously be forced into divorce by the state in order to get the health care they need.


Chavez, Cancer, & Cards

03.08.2013 12:22 PM

Do we need help talking about death?  Two stories from the last few weeks have convinced me yet again that the answer is yes and those stories put together Hugo Chavez and Hallmark cards.  A natural marriage, I know.

I’ll start with Chavez whose journey with cancer I’ve loosely followed paying close attention to what he says versus what he does.  Almost every article I’ve read acknowledges that the course of treatment he followed and so forth said clearly, I am dying of cancer, but his words never did.  He told a much different story about living with cancer, reasons for which would entail a level of political and personal analysis that is beyond me, but I continuously found the falsely optimistic story he told sad and empty.  As a public person of great influence, he could have modeled death so differently, but perhaps he just didn’t know how.  And that brings me to Hallmark.

Hallmark greetings for the Final Good-bye.

When I read this headline I assumed that Hallmark was announcing a new line of cards to serve those facing end of life, however, I quickly learned that is not the case.  The article traces the on-going campaign of Regina Holliday to urge Hallmark to create a line of “hospice” cards.   Her role as a caregiver for her husband during his journey in hospice care inspired and fuels her campaign.  She noticed that while her husband remained in treatment for cancer they received countless cards of encouragement, blessing and prayer, but when he entered hospice the cards stopped–right when they could have used words of comfort and encouragement the most.

Her experience echoes the isolation that I heard many patients and their family members express in hospice care.  Sometimes the physical isolation was necessary because of exposure to infection or because towards the end of life a person may choose to withdraw, but cards persisted as a welcome sign of love and support.  When I trained hospice volunteers (a core element of the hospice team of physicians, nurses, home health aides, social workers and chaplains includes community volunteers who receive at least 16 hours of training in order to provide short periods of respite, companionship, and support to dying patients and their loved ones), I often encouraged them to send cards to the patient and family to whom they were assigned.  Sending cards allowed a volunteer to introduce her or himself to a new family initially as well as maintain contact with a more private family.  Our role as volunteers entailed being the face of our community to this individual and his or her loved ones; to remind them that our community as a whole values the sacred time they are facing and that illness does not diminish their inherent dignity.  A thoughtful card can be a powerful emblem of that sentiment.

Beyond the comfort and dignity provided to the patient, the needs of a family caregiver at the end of life demand our attention as well.  Caregiving at life’s end often concludes many years of quiet, seemingly endless, day-to-day care.  The prevalence of informal, family caregiving can often astound those not currently caring for an elder.  The National Caregiving Association and AARP report that 44.4 million adults aged 18 above currently care for an elder.  Already in 1998, Health and Human Services reported that one in three Americans  serve as an informal caregiver, a number that will only rise as the Baby Boom generation become our next elders as the CDC reports that by 2030 adults aged 65 and older will double to about 71 million.  Granted, not all of those cared for meet the criteria for hospice care (a prognosis of six months or less) but many will become hospice eligible in time.  In 2011, NHPCO estimates that 1.65 million patients received hospice care, which includes at least 1.65 million additional people since admission to hospice requires a primary caregiver, often a family member.  From both a compassionate and a business perspective, a market for end life cards exists.

Now, I will admit, I am not actually a huge greeting card fan.  I like writing my own notes rather than relying on a produced poem.  So, when I read Linda Odell’s comments from Hallmark concerning why they have not developed a line of hospice cards, I initially resonated with her sentiments:

“…the company was not ruling out developing a line of greetings to address end of life but pointed out that many of the company’s current offerings, including blank and customizable greetings, could be used as a jumping-off point for starting tough conversations about virtually any situation or relationship in life.  In reality, this is a really sensitive subject and a delicate line to balance. Some feel the need for a card to express these difficult thoughts, while some feel it’s inappropriate to have such cards.”

If I am honest, I tend to gravitate to the blank cards if I purchase a card at all, but I am also a writer and someone who, after more than a decade in hospice care, is comfortable with death and dying.  Thus I fit the group that Odell describes, but I am an outlier.  When I have conducted talks about hospice in the community, like during United Way campaigns, the overriding response tends to be deep emotion, anxiety, and a fear of saying or doing something offensive.  How to best acknowledge the litany of vulnerable responsibilities in the caring relationship, such as bathing, managing medicines, assistance with walking, cooking, and dressing?  How best to talk about death and dying?  Blank stares.  And thus, most of us may be so afraid of saying the wrong thing, we say nothing.  What better time for hospice professionals, poets, and theologians to offer the general public compassionate and caring words to offer those dying individuals and caregivers we worry about?

A card can seem trivial but can be a lifeline.  For example, in our hospice’s bereavement program (hospice cares for a patient’s loved ones for thirteen months after the death), volunteers send handwritten cards and make phone calls every few months.  I smiled every time we received a survey back or heard from a family at a memorial service that they had read a card or listened to a voicemail right when they needed it most; seeing and hearing that someone remembered that they were grieving, that they were not alone, and that help was available 24/7 should they need it, was like a lifeline that kept them going one more day.

And so back to Chavez.  I hesitate to ask what kinds of cards we could have sent Chavez since I imagine that question taking us into non-dying-related fields, but I close with thinking about how the quality of our personal and professional lives often reflects the people with whom we surround ourselves.  Part of why I love the hospice model of care is because it acknowledges that we need a diversity of specialties to equip us to live life to the fullest and help us tell the story of our life and death where we are the best possible version of ourselves.  I imagine that there are countless reasons why Chavez was surrounded by who he was in life and in death, but maybe a thoughtful card from the outside could have helped.  Wow, I do have great optimism in the power of words.


Good reading from John Culhane

03.07.2013 10:49 AM

Later today I’ll be interviewing John Culhane, blogger here at FamilyScholars and co-author of the Same-Sex Legal Kit for Dummies.  Many of the questions submitted last week will be addressed–thank you!  As some background reading, I thought I would share some helpful links.

I first became acquainted with John through his writing at Slate Magazine on brain injuries and the NFL.  One of the Gen Xers we interviewed for our project on caregiving, grief and loss, cared for her dad, an ex-NFLer, who died in his early 60′s from what symptomatically looked like early-on-set dementia that progressed very rapidly.

I was totally ecstatic when John started blogging here at FamilyScholars, and since then I have simply e-mailed him all my law-related questions.  My most recent questions, which we may get to during the podcast, I considered to be more Law 101 questions.  I was reading some of the amicus briefs in support of the Proposition 8 respondents and DOMA respondent Edith Windsor–fascinating reads, and to keep the NFL theme going there is one from the NFL–when I realized I wasn’t 100% confident what the purpose of a brief is and how a brief might or might not influence the court.  So, I email John, my law Wikipedia, and lo and behold he had just written about it!  Check it out, if you too need a refresher on why briefs matter.

More to come, but I figured I’d share some good reading for your Thursday morning!


Thoughts on Haidt and Heathcare Costs

03.03.2013 9:32 PM

This weekend I dug into Jonathan Haidt’s The Righteous Mind: Why Good People are Divided by Politics and Religion and the recent issue of Time featuring Steven Brill’s “Why Medical Bills are Killing Us.”  I am definitely processing the Haidt book as a marathon—it’s packed with mind-musings—but here’s my first 50-yard dash of thought.

Both are must reads—even the Time article—it even comes recommended by Jon Stewart of The Daily Show!  To recap, Brill follows the medical bills of several Americans, tracing the inflated costs set by hospital “chargemasters” while we average Americans with insurance, or Medicare, or various flavors of Medicaid, or are uninsured, or more likely under-insured, learn after the fact that the costs connected to our procedures, doctor’s visits, lab tests, and drugs are all negotiable.  He concludes that we “are powerless buyers in a seller’s market where the only sure thing is the profit of the sellers.”

He does offer some solutions such as cutting prescription medications costs and basically de-coupling common incentive practices that tie diagnosis to outpatient clinics, medical device companies,  and laboratories owned by the same people diagnosing, but they underwhelm me.  Reading each of his healthcare billing case studies I see not only sob stories but individualism run amok where the incentive for individual practitioners and healthcare management lies solely in not getting sued and not making waves, and for some, making money.  Inspired by Haidt, who addresses “plausibility deniability,” (the experiment that showed that people are less likely to cheat if they have to lie directly to do so), I couldn’t help but think that one quick solution to try would be to require that at least two practitioners verbalize to each other answers to these questions: Is this bill fair?  Does this bill make sense to you?  To wax deontological, would we want to apply this bill to everyone we serve, including me?

We need some basic team accountability.

As I read the Brill article I realized that my experience in healthcare has been a bit warped—I’m a hospice junkie.  Instead of the traditional fee-for-service payment system, hospice is an outlier that is paid a per diem and must manage the costs related to the terminal diagnosis including medications, visits, emergency hospital visits, transportation, medical equipment, dying stuff and so on.  Our team of doctors, nurses, social workers, chaplains, nurse aides, and billing clerks, as well as the entire accounting department, talked about cost ALL THE TIME.  And our team talked about cost with families before they made any care decisions.  On page one of our “Welcome to hospice…” brochure we began: “Most families entering hospice have two main concerns: 1) I can’t believe I am going to die and  2) How am I going to pay for all this?

As our team worked with a family, countless team decisions would arise concerning the frequency of visits, the type of prescription medication to be ordered, the piece of equipment needed, the lab test required…In our team meetings, everyone became adept at figuring out how to make a case for what you believed was the best course of action.  Over time, you learned who was the most creative in a pinch, who had a sixth sense about families when a drug diversion was suspected, and that human beings on their own turf (in other words the patients and families we visited in their homes) are inherently tattlers who will rat you out in a heartbeat.  If you are cranky, complain about other team members, don’t follow protocol to a tee, are late, make promises you can’t keep, and so on…every patient and family will tattle on you…to EVERYONE.  Side effect: Your other team members will not like you and when you are inevitably called out at 2am with an emergency and need back-up, your back-up won’t trust nor like you.

Now, I know I probably sound naïve, as if hospice walks on water (it does not) and I must admit here, that as a pastor moving into healthcare management, I genuinely believed that individuals want to be just, loving, and good for the sake of being just, loving and good.  But working in healthcare management taught me the lesson that Haidt makes early on, drawing upon Plato’s Republic where Glaucon wonders if people really want to be just or simply appear just.  Haidt makes the case that

“people care a great deal more about appearance and reputation than about reality…Glaucon is the guy who got it right—the guy who realized that the most important principle for designing an ethical society is to make sure that everyone’s reputation is on the line all the time, so that bad behavior will always bring about bad consequences.”

Haidt reminded me of the rocky road I walked to learn that incentivizing individual morality (as a pastor) versus communal morality (as a COO) entailed different tasks.  Our CFO, who believed that the best form of trust was a good control, helped me realized that my job as a leader was tri-fold: 1) to make our ideals as transparent as possible, so that those who do NOT want to be excellent, honest, compassionate, aggressively charitable, and part of a team of diverse and highly accountable professionals can leave, 2) create policies and procedures that form an environment in which living the ideals will most likely occur, and 3) enforce systems of accountability where the money you make is directly tied to living the values.  We already had a mission (what we do) and a vision (what we hope to do in a perfect world) but what we needed were values, which we stressed were not defined by how you felt you were living them but defined by how people described you living them.  In other words, I don’t care if you say that you are loving or excellent, I care if your team members and the patients and families you serve say that you are.  We want a good reputation.

If we truly want to address healthcare costs, we need to begin asking whose reputation is on the line?  What values are we espousing and are we tying those values to the money made?  And if our fear of mortality and blind hope that nothing catastrophic will befall us is motivating us to deflect these types of macro questions, then we’re going to keep getting the bills we’re getting.  The good news is that almost all of the medical professionals I’ve known want to do what is best for patients and for society as a whole; they just need an environment that values that quality and calls them out when not espousing it.


A New Commission on Long-Term Care Meets after CLASS

02.22.2013 1:49 PM

Diane M. and I were discussing several days ago the on-going initiatives to provide affordable long-term care for the soon-to-be-crashing-on-our-shores “silver tsunami.”  Many folks had held out hope for 19 long months as the CLASS act deliberated on how to make access to affordable long term care for a greater percentage of Americans fiscally solvent only to learn that they learned that they cannot do it!

Well, despite the CLASS acting being officially dropped from the Affordable Care Act, a new commission has been called and appointed that has been charged with proposing legislation in 6 months related to affordable long term care.  Paula Span offers some insightful analysis and concludes, as I’m sure many of us do, “We’ll see.”

“But perhaps these appointments hardly matter. “I can’t imagine anything coming out of this commission that won’t be totally forgotten a year from now,” said Jesse Slome, executive director of the American Association for Long-Term Care Insurance. “How many commissions have there been?”

Yet one thing that he and the proponents at Advance Class can agree on — maybe the only thing — is that this issue demands attention.

Otherwise, Mr. Slome says, we are stuck with what we have when it comes to older people who might need expensive care for 30 years, and disabled people who might need care for even longer. And what we have, he said, amounts to “a little here, a little there, a little Medicare, a lot of Medicaid, a little long-term care insurance and a lot of unpaid family caregiving.” (I would say very little long-term care insurance, and a vast amount of unpaid family care.)”  Read more…


Death is Serious

02.21.2013 7:25 PM

Some Mirrored Merce
Death is serious,
or else all things are serious
except death.  A player who dies
automatically disqualifies
for the finals.  If there were no death
nothing could be taken seriously,
not truth, not beauty, but that is not
a situation which we need to face. 
–Harold Nemerov from The Blue Swallows

I read this poem as part of a reflection by Elizabeth Zimmer on the funerals for Merce Cunningham, Clive Barnes, and Francis Scarlett Mason, Jr. Her thoughts on the role of the arts in each of these funerals paint a lovely picture of how the rite of the funeral mirrors the life the one who died.  In the past few months I grieved that I couldn’t attend a dance tribute in memory of my ballet teacher and mentor, Moscelyne Larkin, and then grieved again when I learned that despite our communal wallowing in the technology of our digital age the memorial was not recorded. Zimmer’s reflections helped me re-frame those feeling of regret as she finds that each of these tributes, although each powerfully retrospective and indicative of the impact each of these giants had in their respective fields, she felt empty.  She attributes it to age—that somehow when people die at a certain age (meaning a non-tragic one, which I think she defines as over-30—yoinks!) then death happens and we trot out that person’s little wagonload of good works, nod, smile and then move on.

But as I read her words, I heard preacher Tom Long ring out loud and clear, “Well, of course you feel empty!  You went to a memorial when what you needed was a funeral!”  What he means, in my mind, is that when death happens we all long for a guiding narrative of redemption that gives our small “l” lives big “L” Life.  And let me be clear, I don’t necessarily say that one redemptive story trumps all others.  I’ve been to funerals of people of many different faiths, but when I hear their redemptive story proclaimed, I think, “Okay.  I get it.” And even though it may not be the communal story of redemption to which I ascribe, I know peace.  When death happens we want more than ourselves, we want meaning.   Long reminds me that funerals are not for the dead (that we even need to say this is funny, yes?) nor really even for the most directly grieved.  Those closely related are often in shock and as Elizabeth and I have been finding in our interviews, most memories of the funeral are snapshots, sounds underwater, who was sitting next to you, where you were sitting…And so Long says that funerals are for the concentric circles of community that gather for the funeral and the rite itself (the prayers, the scriptures, the music) which help those gathered have a funeral for the people they have lost to death when they are no longer acutely grieving them.  The funeral rite helps the community re-claim in words the overwhelming feelings of loss that have been experienced in life and hear them through a redemptive and loving lens.  We keep attending funerals because the task of making sense of loss through the lens of ultimate meaning is never complete.

A friend shared a poem with me that reminded me of both the mystery of hearing and temptation of words to capture our being, and the serious task of both.

“The smallest muscle in the human body is in the ear.

It is also the only muscle that does not have blood vessels;

It has fluid instead.  The reason for this is clear:

The ear is so sensitive that the body, if it heard its own pulse,

Would be devastated by the amplification of its own sound.

In this knowledge I sense a great metaphor,

But I do not want to be in haste in trying to capture or describe it.

Words are our weakest hold on the world.”

–Alberto Rios in “Some Extensions on the Sovereignty of Science”


Reciprocal Care in Stepfamilies

02.19.2013 11:47 AM

Paula Span at The New Old Age blog raises this important and timely issue about motivations for caring for a stepparent in need, especially when the remarriage happens long after the children from the first marriage are grown and on their own, and thus never raised by the new stepparent.

“Initially, many adult children whose divorced or widowed parents remarry seem delighted, Ms. Keller said when we spoke. “They’re thrilled that Mom or Dad isn’t alone,” she said. “It’s a wonderful thing — until somebody gets sick.”

Then, she has found, “it gets really blurry. Who’s going to do what?” Grown children don’t have much history with these new spouses; they often feel less responsibility to intervene or help out, and stepparents may be unwilling to ask. Perhaps it’s unclear whether children or new spouses have decision-making authority.

“Older couples in this situation fall through the cracks,” Ms. Keller said.

Research shows that the ties which lead adult children to become caregivers — depending on how much contact they have with parents, how nearby they live, how obligated they feel — are weaker in stepchildren, Dr. Silverstein said. Money sometimes enters the equation too, Ms. Keller added, if biological children resent a parent’s spending their presumed inheritance on care for an ailing stepparent.”  Read more…

The comments prove to be well worth the read; full of anecdotes and questions about how to balance financially, relationally, and emotionally the caregiving needs of biological parents and countless constellations of stepparents and ex-stepparents.  In the interviews that Elizabeth and I have conducted with Gen X caregivers, I think I was surprised, as someone who does not have stepparents, how basically all things boil down to simple dislike.  In intact families, you can dislike people but somehow still love them.  For example, I mother young children right now which means I say “NO” a LOT which means I also hear, “I hate you and you’re not my friend, Mommy!” a LOT.  But my response back is basically, “Well, I still love you and I’m not your friend, I’m your Mommy.”  But I’m beginning to see that in step families, where society often paints a stepparent as a “new friend,” this statement cannot be said back.  Stepparents may not love their stepkids of any age, and stepkids may not love their stepparents.  And thus, dislike is simply dislike.  Are there outliers?  Of course.  But read through the comments at New Old Age, and I see that various levels of simple dislike or indifference often marks the relationship between stepparents and stepchildren of any age, which does not bode well for the already thankless and exhausting task of elder caregiving.

What will motivate us to care for the vulnerable old in the next 10-20 years?  Hiring professional help is already out of reach for most Americans unless we decide to make Medicaid our de facto senior care system.  Having spent some time in Medicaid Room and Board facilities though, I just can’t imagine Baby Boomers in general accepting that solution.


The Legacy of High Conflict and the Family Caregiver

02.18.2013 4:40 PM

“Do you care for a parent in their vulnerable old age who did not care for you in your vulnerable youth?”  In other words, is the obligation to care rooted in a history of fair, reciprocal transactions?

Emily Yoffe AKA Dear Prudence asked several months ago and now expounds on an even dicier theme: Do you care for a parent in their vulnerable old age who not only did not care for you but also actively sought to harm you or deliberately ignored evidence of harm in your vulnerable youth?

I won’t rehash her article–it’s worth the read–although I will warn that the anecdotes crush the spirit much the way that I am haunted by one story of Judith Wallerstein’s in The Unexpected Legacy of Divorce that traces the life-long, debilitating reverberations felt in the life of a grown woman raised in a high-conflict family, one in which the parent’s did not divorce.  As Wallerstein notes, divorce is never great, but ending a high-conflict marriage almost always benefits the children, except for when they must spend time alone with with abusive parent.

Yoffe concludes with some thoughts on forgiveness and she echoes some themes that we’ve discussed here previously:

“In a 2008 essay in the journal In Character, history professor Wilfred McClay writes that as a society we have twisted the meaning of forgiveness into a therapeutic act for the victim: “[F]orgiveness is in danger of being debased into a kind of cheap grace, a waiving of standards of justice without which such transactions have no meaning.” Jean Bethke Elshtain, a professor at the University of Chicago Divinity School writes that, “There is a watered-down but widespread form of ‘forgiveness’ best tagged preemptory or exculpatory forgiveness. That is, without any indication of regret or remorse from perpetrators of even the most heinous crimes, we are enjoined by many not to harden our hearts but rather to ‘forgive.’ ”

I agree with these more bracing views about what forgiveness should entail. Choosing not to forgive does not doom someone to being mired in the past forever. Accepting what happened and moving on is a good general principle. But it can be comforting for those being browbeaten to absolve their parents to recognize that forgiveness works best as a mutual endeavor. After all, many adult children of abusers have never heard a word of regret from their parent or parents. People who have the capacity to ruthlessly maltreat their children tend toward self-justification, not shame.

Even apologies can have their limits, as illustrated by a Dear Prudence letter from a mother who called herself “Sadder but Wiser.” She verbally humiliated her son when he was a boy, realized the damage she had done, changed her ways, and apologized. But her son, who recently became a father, has only a coolly cordial relationship with her, and she complained that she wanted more warmth and caring. I suggested that she should be glad that he did see her, stop whining for more, and tell her son she admires that he is giving his little boy the childhood he deserves and that he didn’t get.”

While there are many trains of thought to follow in the piece (one of which being to muse on the commandment to honor your father and mother–a question Elizabeth and I have been asking Gen X caregivers all last year), I kept thinking about how to cultivate a general culture of care giving in response.  I know I often talk about hospice, but this model of care taught me about a culture of care-giving where the burden of care-giving is shared among a diverse group of professionals empowering a diverse group of concerned, non-professionals, ie. friends and family, of the person whose health is declining and leading to death.  Ask any hospice worker worth his or her salt and they will echo a point that I’ve heard Barry D. often make in comments, which I will paraphrase, “every family is a potential school in resilience.”  Each individual and requisite web of caregivers formed a unique stew of willingness and ability ensconced in pathologies of nature and nurture expressed in ceaseless scrapbooks and accompanying narratives–entertaining to observe but not so entertaining to live.  Time and again, we’d hear how the person you want to care for you may not be able to or won’t.  The person you wish would disappear is the only one who will bathe you.  And so on and so on…the relational gymnastics were infinite as our team worked with each family to make ensure that the care needed could be provided by the people willing and able.  But with a team approach, we often could discover serviceable, safe, and even sometimes grace-filled arrangements.  As I mentioned in a previous piece, forgiveness may be something that is communicated and lived by the whole community when forgiveness is not a transactional reality to be expected or even hoped for between the oppressed and the oppressor. We could often express dignity to someone based in our common humanity in ways that the those who had not been treated with dignity by this person could not.

Reading Yoffe’s piece I grieved not only the stories of suffering shared but the loneliness of their voices.  Where is their team?


A Dire Warning for the Future of Family Caregiving

02.17.2013 3:50 PM

Hospital

For the past few weeks my “Baby Boomer Google Alert” has been filled with one and only one story: The Health of Boomers is markedly worse than the previous generation.

“About 13 percent of baby boomers — the generation born in the two decades after World War II — reported being in “excellent” health in middle age. That compares with 32 percent of the previous generation who said the same thing at the same stage of life, researchers reported in JAMA Internal Medicine

Overall, about 39 percent of boomers were obese, compared with about 29 percent of the previous generation. Baby boomers were also less likely to get regular exercise.

About 16 percent of baby boomers had diabetes, compared with 12 percent of the previous generation. And baby boomers were more likely to have high cholesterol and high blood pressure.

King and his colleagues also found that baby boomers were more than twice as likely as people from the previous generation to use a cane or walker…”

The IOM already noted, our biggest health challenge in the next twenty years will be “living well with chronic illness.”  On the upside, advances in medical science and treatment enable many of us to survive illnesses and conditions that once were fatal.  However, there are long term chronic conditions that then come into play, ones that will entail not only a much higher level of sustained care but also will occur at a prevalence not yet experienced: conditions related to cancer survivorship, hearing and sight loss, chronic pain, arthritis, depression, schizophrenia, diabetes, dementia and obesity.  The trends pinpointed by JAMA in terms of the current snapshot of Boomer health do not bode well for living well with chronic illness.  The vista darkens when we combine that health snapshot with a care giving snapshot: that the generation of children who will one day be caring for them is the Divorce Generation.

The NYTimes yesterday featured a grim story about how changes in family dynamics are connected to an increasing rate of elder suicide in south Korea:

“Even with the explosive growth of suicides in South Korea, the case of the 78-year-old widow was shocking enough to merit attention in the recent presidential election and hand-wringing in the news media.

Rather than quietly taking her life at home as many South Koreans do, the woman staged her death as a final act of public protest against a society she said had abandoned her. She drank pesticide overnight in front of her city hall after officials stopped her welfare checks, saying they were no longer obligated to support her now that her son-in-law had found work.

“How can you do this to me?” read the suicide note that the police said they had found in a purse next to her body. “A law should serve the people, but it didn’t protect me.”

The woman’s death is part of one of South Korea’s grimmest statistics: the number of people 65 and older committing suicide, which has nearly quadrupled in recent years, making the country’s rate of such deaths among the highest in the developed world. The epidemic is the counterpoint to the nation’s runaway economic success, which has worn away at the Confucian social contract that formed the bedrock of Korean culture for centuries…

Kim Seok-jung, who started a company in the southern city of Pusan to care for their belongings, says he is haunted by the case of a 73-year-old whose body was found last February, months after her death.

“The calendar on her wall stopped at October,” Mr. Kim said. “When I see these old people, I see how my own generation will die.”

May this be a cautionary tale for us as a whole to be thinking of how to honor the extended family with economic incentives that enable family care giving and/or affordable, professional elder care at home.  In the US, we currently have neither, unless you count Medicaid spend-down, which depletes one’s nest egg for underwhelming institutional care or a care giving waiver program which in most states has a waiting list years long.


Thoughts on being a “Broken Leading Edge”

02.16.2013 5:22 PM

Writer and reporter, Kristina Cowan, writes at her blog on her responses to the recent Does the Shape of Families Shape Faith? report. As a Gen Xer she shares that she really didn’t think about the impact of her parent’s divorce until she got married:

“In a piece in The Atlantic, Amy Ziettlow, one of the report’s co-authors, raises other key points. Most children of divorce don’t understand what separated their parents. We might treat our friends like family. And we may grapple with how to build trust. “Scholars are finding that the legacy of divorce echoes throughout a child’s entire life story and, as my young daughter reminded me, for these children and for our culture, the story is sad.”

Most of the findings and statements above are true for me. I didn’t realize how deep my divorce wounds were until I was married. I’ve struggled to trust my husband. I trust my friends more than anyone–especially those from college, a time when I regained, through them, a sense of family. My close cadre of college friends became my domestic church, as the report suggests. As I mentioned in my last post, my parents’ shattered union is still a mystery.

I’ve long been challenged to find a church that feels like home. There are two exceptions. The tiny church in Arlington, Va., where I was married, and the massive Moody Church in Chicago. They’re markedly different places. But both offered me a sense of acceptance and unconditional love. I’m still hesitant to get involved, to trust and worship in these formal institutions. I suspect that part of this trouble stems from the fact that I didn’t spend much time in church with an intact family. The time I did spend was with my mom and her friends, mostly post-divorce….” Read More…

The previous post she writes concerning her mother’s death is also quite powerful.

She is currently working on a project exploring women who faced a difficult time transitioning into motherhood.  She is conducting a survey, it’s anonymous unless you would like for her to contact you, and here is the link.


Amour (2012): A Review

02.14.2013 7:00 PM

Georges and Anne are a Parisian couple in their early 80’s who have led rich, cultured lives. Retired music and piano teachers, the couple is introduced to us at a concert hall where they watch Anne’s former pupil as the featured soloist. Director Haneke is known for not using soundtracks or scores in his films, so the sparse opening chords of the soloist’s playing set a mood of rarified appreciation and beauty.

Those feelings of calm pleasure are interrupted when the couple returns home to find someone has tried to break into their apartment. “They used a screwdriver or something like that…it doesn’t look very professional…” comments Georges. He convinces Anne to wait until morning to call the superintendent. Anne retires to the bedroom without a nightcap, clearly still shaken but commenting with pride on how well her former prodigy had played.

Later that night, Georges awakens to Anne sitting up straight in bed, staring into space. Although she insists all is well, a similar incident the next morning at breakfast catapults the film into the shock, heartache and trials of caregiving for a spouse who has suddenly taken very ill.

Terrified by hospitals, Anne comes home in a wheelchair after her first “attack” still cognitively bright and full of pride. She makes Georges promise never to make her go back to a hospital again, a difficult discussion that for so many couples is often left until an emergency occurs.

As Anne’s condition deteriorates, the couple’s bonds become strained. Without the use of emotional theatrics, Haneke leads us through the icy shards of life’s winter with crushing reality: the awkwardness of friends and relatives visiting, the ups and downs of in home nurses, the humiliation of helplessness, incontinence and loss of cognition. It seems to be hinted that Georges himself is suffering from an early stage of dementia, although it’s never mentioned. Then again, distraction, memory lapses, terrifying dreams and even mild hallucinations could just as easily be attributed to his world crumbling around him.

Their grown daughter and her British husband are also professional musicians living abroad, constantly travelling with their music company. They have an estranged relationship with their grown son, a strained relationship with each other, and their visits feel stressful. It is difficult to sympathize with the daughter at times, but her flawed character too seems of a piece with Haneke’s brilliant use of understatement.

Amour won Haneke his second Palme d’Or in four years, and the film has won or been nominated for dozens of awards worldwide, including the 2013 Oscars for Best Achievement in Directing, Best Foreign Language Film of the Year (Austria), Best Motion Picture of the Year, Best Performance by an Actress in a Leading Role for Emmanuelle Riva (Anna), and Best Writing–Screenplay Written Directly for the Screen (Haneke). Riva, a career actress since 1957, is the first woman that Haneke has directed in a film to be nominated for an Oscar. Her performance, as well as that of Jean-Louis Trintignant, powerfully embodies a wide range of states, emotions, and flashbacks to healthier times.

Palliative care, a spouse slipping away, and other raw takes on aging are rarely the main focus of cinema. Indeed, Amour offers perhaps the most highbrow appearances of adult diapers and mobility aids ever to have taken center stage on the silver screen—refreshingly without flinching or masking with humor.

A resource that may have (retroactively) eased the experience of protagonist Georges, whose coping mechanisms went heart deep but lacked in preparedness, is aptly named PREPARE. This user-friendly website helps walk individuals and families through the steps to make sure their wishes are kept should they become too ill to speak for themselves.

These were my strongest impressions after having left the theater: life is both long and short, lovely and repulsive, lonely and shared and, above all, to be lived to its fullest: with amour.

Mary Otte is a staff writer for www.Parentgiving.com.


Digitial Estate Planning

01.29.2013 12:04 PM

This morning I chanced upon this article which is a treasure-trove of information concerning how to plan for your digital legacy.  Read it, print it out, follow the links.

Here are some things I learned:

There is actually a website devote to this topic called The Digital Beyond. Fascinating.  The creators of the website co-wrote a book called Your Digital Afterlife.  I will be checking out ad reviewing soon!

The sheer massiveness of digital data never ceases to amaze me:

“Today, there are more than 1 billion Facebook users worldwide, some 500 million people who play online, role-playing games, and more than 160 million members of LinkedIn. Moreover, some 5 billion images are shared on Flickr, more than 40 million blogs parcel out insights and advice, and 120 billion videos call YouTube home, impressive even if half of them are of cats doing tricks.

“Online, we generate a lot of assets, but we don’t think of them as assets,” says Eric Goldman, a professor of law and director of the High Tech Law Institute at Santa Clara University School of Law in California. “We don’t manage them as assets. We create content. We create data. We develop relationships. All of those things are valuable, but we don’t manage them as valuable assets.”

Law professor and recent responder in FamilyScholars Symposium, Naomi Cahn, opines in the piece about our reluctance to think about digital estate planning, let alone death:

“We tend to not write wills and plan for incapacity or death,” says Naomi R. Cahn, the Harold H. Greene Professor of Law at The George Washington University Law School. “But most people are not putting off creating a plan for their digital assets because they don’t want to think about it. They don’t know they actually have digital assets that have any value and are worth planning for.”

Cahn is teaching a class this semester on Elder Law and how I wish I could sit in!

What are your digital assets worth? For example, I’d love to know: what value you would give your commenting history on FamilyScholars?  PS-I would rate the general comment atmosphere pretty high!

“A 2011 survey by McAfee, Inc., the world’s largest dedicated security technology company, found that some Americans are not only aware of their digital assets, they can put a price on them. These individuals estimate the value of their digital effects—photo libraries, personal information, and entertainment files—at about $55,000, on average, compared to $37,438 for consumers from other countries.

Survey respondents said they had nearly 2,800 digital files stored on at least one electronic device, such as a smartphone, computer, or game console. The assets were varied and broad, including music and movie downloads; photographs and memorabilia; e–mails; health, financial, and insurance records; résumés and portfolios; and hobbies and other projects.

The survey found that individuals valued personal memories most highly because they are “impossible to restore” if lost. On average, they valued personal memories at $18,919, far higher than personal records ($6,956), career information ($3,798), hobbies and projects ($2,848), personal communications ($2,825), and entertainment files ($2,092).”

Now, this next piece of info didn’t surprise me but really made me think about all the music and e-books I’ve purchased…

“Apple owning all of your music in iTunes has sparked a number of posts and some rage, but then it always dies down,” says Tom Mighell, a national technology consultant and attorney. “It is not something that has reached a point of enraging people, but then not that many of us have been in a situation where someone we care about has died and we cannot inherit their music or e–books.”

The Terms of Use provided by Apple and Amazon make it clear that consumers are granted a “nontransferable” right to use the content, but users cannot give it away to friends or family members at any point in their lives, or even after they’ve died. While some enterprising attorneys are looking to challenge that provision, the language in the agreement is apparent, and the user has agreed to the terms, whether or not he or she has read them. Neither Apple nor Amazon responded to requests for comment.

“When we receive these items electronically, they are just leased,” says Jason Mazzone, the Lynn H. Murray Faculty Scholar in Law at the University of Illinois College of Law and an intellectual property law expert. “We have a right to see the words on the screen and hear the sound. There is nothing tangible. According to the providers, you violate the Terms of Use and access can be shut off. If you die, you can’t pass collections along to somebody else. If you don’t want something you bought, you can’t give it away. There is no ownership.”

My CD/cassette tape collection and ancient stereo are looking a lot more valuable!

The article goes on to address lawyer-ly type practical things to think about and concludes with sharing info about a new social media site for the terminally ill called My Last WishApp that connects people with similar dreams.

A lot to think about.  And hear I am blogging…adding to my digital legacy that someone will have to ignore, delete, or keep…someday.


The Gen X Caregiver Mini Movie Review: Quartet

01.27.2013 5:02 PM

File:Quartet-Poster.jpg

Last night we went to see Quartet, which represents Dustin Hoffman’s directorial debut and stars, among others, the illustrious Maggie Smith. The setting is a home for aging musicians somewhere in England, located on a Downtown Abbey-like estate staffed with Afro-Caribbean caregivers, a French tart of a waitress, and a Gen X generation actress who resembles Lindsay Lohan (if she were to get sufficient calories) as the doctor who runs the place. The plot centers on a forthcoming musical revue in which many residents will star and which, if pulled off properly, will restore the finances of the exquisite home.

It’s a little jewel of a film, starting out slow but unfolding, flower-like, to affirm the spiritual sustenance of the arts, the legacy of friendship, and the potential to grow at any point in one’s life, including the possibility of finding renewed love and the promise of marriage in one’s golden years. Yet, despite the attempts of various characters to bemoan the indignities of aging, the movie is a fantasy. In this home for the aged, there are virtually no signs of medical equipment; the elderly move through the day well dressed and, for the women, in immaculate make up; and the “doctor” (it’s never made clear if she is a medical doctor or some other variety) exists solely, it appears, to tend with calm compassion and fetching glamour to the emotional flare-ups of residents. For anyone who has actually provided care (for the aged, the sick, or the young), it is especially bizarre to see this doctor at work in fragile silk tops that are never mussed. In the world of Quartet, a brain-damaging stroke makes a Scottish cad all the more charming, and onset of dementia makes a great opera singer unfailingly kind.

One wonders, what about this particular story attracted Hoffman for his first time out as a director? Perhaps he, like the rest of us, would love to grow old in a world of rumpled beauty in which, even as short-term memory fades, artistic gifts and friendship never leave you. If it’s realism you’re after, go elsewhere. For a reverie, see Quartet.


Modern King Lear Dilemmas

01.24.2013 12:20 PM

When do you give your children an inheritance?  What does telling them that they will receive an inheritance do?  Is there an optimal time to do so?  A new estate tax rule has opened up new questions for parents planning on bequeathing millions to their heirs.  And although we may not be facing that dilemma ourselves, the questions about secrets, family dynamics, and motivation in general are interesting to ponder.  One option being explored is called a “quiet trust:”

“With a traditional trust, the trustee generally reports directly to beneficiaries, or their parents if the beneficiaries are children. With quiet trusts, the donor specifies who the trustee reports to and when.

That means someone who manages a quiet trust can’t get the heirs’ feedback about investment goals. And heirs might end up with mixed feelings after learning they went for years without knowing they someday would inherit a tidy sum.

“If I were going to set up a trust for my kids, I would tell them about it and why I don’t want them to rely on it,” Ms. Harrington says. “If I don’t feel comfortable doing that, then I should just keep my money.”

Alan Moore, a financial adviser in Milwaukee, says he generally recommends against parents and children keeping such secrets, and always asks why a client wants to hide inheritance plans. “This tells me there is something more going on psychologically that we need to address,” he says, such as anger or a need for control.

Mr. Moore recalls working with one set of siblings who didn’t learn until their 50s that their parents had left them millions—and, rather than being delighted, were disturbed their mom and dad had kept the secret from them.

Mr. Puzo, who says he has set up increasing numbers of quiet trusts in the past two years, notes that it is important not to leave heirs in the dark too long: The beneficiary needs to know his financial situation, and the family needs to make sure someone is keeping tabs on the trustee, he says.”  Read more…