Where to Start When The Doctor Says Its Dementia

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By CK Wilde for 3GenFamily Blog

It was during a phone call five years ago with my Dad’s primary care doctor that the “D” word first came up. Dad was in the hospital, again.

He had gastro-intestinal bleeding which the specialists had finally stopped — but not before a series of delirious outbursts about certain marital secrets that had his second wife shouting that she would have him committed to an institution!

As Dr. R explained, people who have lost a lot of blood can become very incoherent. The problem goes away once the patients’ blood levels are stabilized. “Oh, by the way, you know that your father has dementia, right?” the doctor asked.

Whoa! That stopped me in mid-sentence. Was my father’s second wife right? My father needed to be institutionalized?

“Are you going to commit him to a mental institution? I asked with considerable trepidation. The doctor laughed nervously. I took that to mean no.

Dr. R explained that she was seeing some signs of dementia but that they were mild. She rattled off a litany of symptoms. I had noticed many of those behavioral issues, too, but I didn’t know what to make of them.

The questions I should have asked the doctor were, “What is your recommendation for dealing with my father’s dementia?” and “What can I do to help him?”

The doctor’s diagnosis of dementia seemed like a cruel joke. To be truthful, it frightened me. I had terrible visions of my irascible father becoming a vegetable.

But no matter how frightening this seems, the most important thing NOT to do is pretend it will go away on its own. Taking the initiative to learn as much as you can about dementia can give you the knowledge to ask the right questions.

But, where do you start?

A great place to start is wth the basics: the 7 stages of dementia. Here is a link to the list of stages. Not everyone has all of the symptoms. Like my father, a person with mild dementia can continue to function in familiar surroundings. Denial is very common in the early stages of dementia. The person may become anxious, though.

This is the time for the family to plan for the next stages. My Dad was certain that the next day would be his last. As he envisioned it, he would go to sleep and just not wake up. It didn’t exactly happen that way.

Researchers have indicated that patients with dementia can live from 3 to 9 years after the initial onset of symptoms. Patients who develop symptoms at a younger age tend to live longer than those who are advanced in years when they develop symptoms.

Patients who continue to live in their community seem live longer than those in a nursing home or hospital, but this may be because patients who live in the community are in better health generally.

It is important to note that Alzheimers’ disease is only one cause of dementia. There are actually a number of causes including stroke, depression, or a major shock like loss of blood.

It is important to understand what is causing those symptoms for your loved one. By keeping an open mind and a positive attitude, you can help your elder and the doctor find the right combination of medical and nutritional therapies for the best possible outcome.

Other great resources include:

HealthCentral.com resource on Alzheimer’s,

The Dementia Caregiver’s Toolbox

HeartSpring’s section on Alzheimer’s

So what happened to my Dad?

His dementia seemed to be related to his vascular condition rather than Alzheimer’s. The doctor added Vitamins B6, B12, Folic Acid and E to his regimen of drug prescriptions. These nutrients are very helpful for cardio-vascular support as well as mental acuity. My father had a heart bypass operation a number of years ago and currently had a pacemaker. His dementia seemed to be related to these other medical issues.

His relationship with his second wife, however, was never the same. They eventually were divorced.

So, I became his caregiver for the last two years of his life.

Sending a Son to College - I Didn’t Know It Would Be Painful!

We stood for a long moment at the entrance to airport security. At eight thirty five p.m., the usual bustle of this busy airport had slowed to a trickle of passengers and flight crews tired and happy to be home.  There were also a few travelers preparing to take a “red eye”, one of those late evening flights of last resort when you absolutely need to be at your destination at a certain time.

My tall, curly haired 18 year old was preparing to board a late night flight alone to the East Coast to begin college.  He had traveled on his own last Spring on a decision making trip to choose between two great schools.  But, this felt so different from other times he has travelled.

“Try to get some sleep on the plane going to Chicago,” I reminded him for the third time.

“OK, Mom,” he said gently.

“We’re so proud of you. You’ll have a great time at school,” my husband beamed.

“Thanks, Dad, ” my son grinned.

As Number One Son walked through the airport security checkpoint with his new backpack stuffed to the top with necessary electronic gear, a bag of sandwiches and a pair of underwear and socks (in case his luggage got delayed), I felt a gargantuan lump in my throat.  I looked up at the so very familiar face of my husband. He was struggling with his emotions, too.

Wow, I was having “separation anxiety” and my son’s plane hadn’t even left the airport!  Even though my face was smiling, deep down my heart was crying. Will he be ok?Had I imparted every bit of knowledge and wisdom to him? Was he prepared?

Worse yet, was I prepared? As parents, we forged a  great relationship with our son by keeping lines of communication open, setting clear boundaries and, most important,  keeping a sense of humor. (My secret resource for parent/child humor was reruns of “The Cosby Show.)

Now, the situation that was so easy and comfortable was abruptly shifting – flying away on an airplane to the East Coast. My years of dedicated caregiving had paid off. My son had “made it” into one of his top choice colleges — he worked to get great grades and SAT scores. He polished his essays until they shined.  He was successful in his extracurriculars. But instead of a jackpot, I have sadness, questions and worries.

Did I do my job to prepare him to be competent in the adult world? What part do I play now in my son’s college life?

The “experts” have voluminous advice about letting go. The morning talk shows have been warning about the dire problems caused by “helicopter parents” who continue to control their college students lives even while they are away at school. Certainly, I don’t want to be like that!

The good news for us is Number One Son has been using his alarm clock on his own for quite a while. He knows how to cook a basic meal, clean a house, and do his own laundry.  He successfully managed his homework and outside activities schedule on his own. And yet, he would often solicit my husband’s and my opinions on various decisions before making them. Our son also had mentoring relationships with several of his high school teachers.

Suddenly, our son is away from home and his support system. How is this going to work? Where do we fit in his life now?

 My very astute husband pointed out, ” this isn’t so much about letting go as it is about redefining the relationship we have with our son.” How do we make that happen?

Luckily, I found this great book:

You’re On Your Own (But I’m Here if You Need Me) : Mentoring Your Child During the College Years

The author, Marjorie Savage, has been working with parents of college students for a number of years as the parent liaison at the University of Minnesota. Inside the 12 chapters of this easy to ready book, Savage offers understanding and insights that begin with the summer before college,  and include the culture shock of school (and the corresponding empty-nest upset for parents), the freshman 15, course loads, extracurricular activities,  and life after college. She gives parents an informed and common sense guide to establishing the right level of parental involvement.

I have found it to be a great resource in puzzling out the best way to forge our new relationship with our 18 year old. I urge you to check it out.

Thank You OurAlzheimers.com!

3GenFamily Blog has moved to a new location on the web.

Please come visit us at 3GenFamily.com

By CK Wilde for 3GenFamily Blog

When I launched 3GenFamily Blog on WordPress.com, it was with the intention of sharing a wide variety of issues and ideas about long distance caregiving to help others traveling the same road. I’ve tried to focus on substantive information rather than just telling stories of life caring for an elder with dementia.

When I first started searching for answers to my questions, I didn’t always find them. Sometimes I just didn’t know what search terms to use. To make things easier for others, I have tried to use phrases in my titles and content that I would have searched.

So, it was a very pleasant surprise to discover that HealthCentral.com’s website — OurAlzheimers.com — named 3GenFamily Blog a Top Alzheimer’s Site for 2007.

Thank You!

If you are a caregiver or family member of someone with dementia, Alzheimer’s being the most common form, please check out the resources available on all of the top sites in the link above. There is great information and commentary on the sites. Check them out!

Is It Time for an Estate Planning Checkup for Your Parents or You?

3GenFamily Blog has moved to a new location on the web.

Please come visit us at 3GenFamily.com

By CK Wilde for 3GenFamily Blog

Is your family like most others? Have your parents (or you) done some estate planning (see below for resources) and then filed the documents away to gather dust and cobwebs until they are needed?

Why do I ask? Because if an illness or accident suddenly happened, you just might discover that those documents are out of date and don’t do the job they were supposed to do!

In spite of the changes that my Dad made in recent years to his documents, he didn’t update all of them. Now as his executrix, I am discovering that some of the documents don’t do what he and my mom originally wanted.

As you may know from my previous posts, my father was frugal beyond belief. He never understood why attorneys got paid so much and tried to avoid using them whenever he could. But, he didn’t totally ignore estate planning.

Urged on by my mother, he got the requisite documents done. And, life events (my mom’s death, remarriage, divorce) forced him to update his will, financial power of attorney and medical power of attorney several times.

But, he never got help with the total picture. So now, I’m looking at estate taxes that wouldn’t have to be paid if Dad had just gotten someone to review his entire estate periodically.

No, not Federal Estate tax. Congress changed the law to increase the amount that is exempt from tax. I’m dealing with NJ Estate tax.

You see, when Congress changed the the federal tax, it threw the states into a tizzy at the prospect of losing desperately needed tax revenue. Every state has dealt with it differently. NJ did something unique — kept the tax rules that were in effect in 2001.

So what should my Dad have done?

Sit down every few years and double check that all of these estate planning documents still met his needs. And, he really should have had an attorney look at them.

What documents am I talking about?

1. Your will - Everyone should have one even if you think you don’t have many assets. The laws of Intestacy (dying without a will) in your state will dictate how your property should be distributed. But, it may not be the way you would want it. Why chance it?

2. Name beneficiaries for all bank accounts, IRAs and securities — The accounts will go to the person you name rather than into your estate and may save grief later. My father had several accounts that did not have beneficiary designations. Bank employees seem to be totally clueless about this.

3. Buy life insurance if people depend on you for support — Keeping small policies in force for elderly parents could help pay the funeral and other expenses if they are paid up policies. Accident policies are a waste of money for most seniors because the majority of our elders die from medical problems, not accidents. My father had 3 accident policies that were worthless.

4. Make out a Living Will or medical power of attorney — I discussed the importance of this in my previous post about getting a Living Will.

5. Make a financial power of attorney — When my father was rushed to the hospital and bounced in and out of rehab for 3 months, I was able to step in to pay his bills and handle his affairs because the power of attorney was in place. It’s a good idea to talk with your parent about bills and taxes before a crisis happens. Know what’s due when and where the banking records are.

6. Plan for children with special needs — Along with the will, you may need other arrangements to care for a special needs child. Don’t assume that the executor will know what you intended. Few of us read minds very well. Siblings don’t always get along. Spell it out.

7. Let your executor know where everything is located — Whether you use a specially designed estate planning organizer or just a spiral bound notebook, mark down where all of the documents are. Organize and label them. Write down the names and addresses of your attorney, accountant, banks and other key contacts. Document everything that is pertinent to your finances and life.

Here are a few resources to help

Wills and Estate Planning Information at NOLO.com

“Get Organized Now” on the Nolo Press website

Find an attorney who specializes in Elder Law

Estate Planning 101 from FindLaw.com

Don’t put off asking your parents about this. You aren’t prying. You are helping them achieve their final wishes.

Do be respectful if you are not designated to handle their affairs. Circumstances change. Your aging parents may need your help in the future if the other person can’t be there. You want to remain on good terms with your family.

Most important, toss away the urge to daydream happily about your future inheritance. If you are in charge of the estate, your elders come first. You may need to make decisions to spend that money for home health care, assisted living or a nursing home. Your focus must remain on doing your utmost to meet your parents’ needs.

After it’s all over, you’ll be very glad you did. (more about the tough decisions I faced in the next post)

Is Your Parent Afraid of Running Out of Money in Retirement (Part 2)

How much money does a 83 year old need to have in savings to avoid running out of money in retirement?

In a previous post (Is Your Parent Afraid of Running Out of Money in Retirement -Part 1), I described how my 83 year old father was living in abject terror of having his money run out before he died.  While doing research trying to understand what was bothering my Dad, I stumbled across an article about “Bag Lady” syndrome.

The fear of running out of money and being forced to live on the streets is not uncommon. But, it usually affects women who often depend on and defer to the men in their lives. They have a feeling of being powerless to prevent becoming a Bag Lady.  Men’s fears usually have to do with losing jobs, etc.

I tried to reassure Dad that he was comfortably set.  Running summaries of his savings accounts and graphing his frugal spending habits, with colorful charts and graphs showing almost horizontal lines extending ten years, did not diminish his fear.

In spite of all my logical arguments that his finances were in good shape, he continued to worry. My father understood, in the core of his being, that once you start spending principal it’s gone and so is the interest you could earn by investing that money.

Dad was managing to live within his modest budget except for certain hospital and medical bills. He had to use his savings to pay for them. The hospital is especially aggressive about collecting its money. If you don’t pay the bill within a certain period of time, the hospital sends it to a collection agency to hound you until you make arrangements to pay. A delinquency because of hip replacement surgery gets treated the same way as a car loan.

So, how much money does an 83 year old need to have in savings to avoid running out of money in retirement?

Like a zen riddle (What is the sound of one hand clapping?), I have turned this question over and over in my mind looking for an answer.  My extensive research on the Internet  turned up the same cryptic response again and again.

There is no single answer that fits all retirees. 

Because cost of living (New York vs. North Carolina) and spending habits (tuna vs. caviar) vary wildly, every major financial website offers a retirement savings calculator that allows each person to insert the dollar amounts for her unique situation. You can play with a variety of scenarios and come up with charts that provide peace of mind or many sleepless nights.

Even if the numbers are all positive, you don’t have an iron clad guarantee.

The cruel, ugly truth is that– even if all of the other calculations are accurate– no one can predict if you will have a prolonged medical crisis that will suck savings out of your accounts faster than . . . [insert your favorite phrase here].

(This is not intended to frighten you. It is time that someone said it. Now, we can look at the steps you can take to deal with it.)

Figure out your elderly parent’s regular monthly expenses and how to cover them without tapping into the principal. You may need the help of a fee based certified financial planner to decide how to invest the savings.

Here are some additional strategies that can help:

1 . Supplemental medical insurance - Medicare pays 80%. The supplemental coverage picks up some amount between 50-90% of the balance. What’s left is a very small co-pay that is so much easier to manage.

2. Prescription drugs - Ask the doctor to prescribe an older, low cost drug or a generic rather than the latest patent wonder drug. Use the mail order prescription service from your supplemental insurance if there’s one to get the lowest possible price.

3. Regular checkups - The doctor can identify problems early so that your parent does not need a trip to the emergency room. If you are the person named as medical power of attorney (see previous post), become familiar with your parent’s medication. Ask questions. Some doctors ignore a senior’s complaint as just “old age.” Don’t settle for that answer.

4. Exercise - Studies agree that daily exercise , just short walks of 10 to 20 minutes, contributes to better health and faster recovery after an illness. Even 80 year olds can benefit from basic strength training and balance exercises.

5. Sleep - Lack of sleep contributes to decreased immunity. Exercise often helps with sleep problems. If aging has changed your parent’s sleep cycles, encourage her to take a regular nap during the day. (40 and 50 year olds can benefit from power naps, too!)

4. Fruit, vegetables and water - Helping our elders have a regular supply of fresh and tasty produce and non-chlorinated water ready when they are hungry or thirsty is one of the lowest cost ways to boost health and vitality. (Check out Jack LaLanne’s website to see what good nutrition and exercise can do for a 90 year old if you don’t believe me.)

5. Supplements - I personally believe in vitamin and mineral supplements. Ask the doctor or pharmacist for advice. In a future post, I’ll discuss which common prescription drugs deplete certain nutrients from the body. The results can be disastrous but the solution costs just pennies in most instances.

6. Family, friends and fun - Ok, you knew this. Studies show that people live longer, healthier lives if they have regular social contact with family and friends. This is particularly important to remember if your parent is living alone in his own home. Oprah, CNN, even Larry King with his wide range of topics, are not substitutes for real, in person, human social interaction. Pets can help, too, if your parent can manage their care. Help your parent get out of the house on a regular basis. Even adult day care can be a spirit lifter for many seniors.

My father died recently. Yes, he made it to the finish line without running out of money.

The last three months of his life were grueling for both of us. His ultimate medical crisis arrived. 

More about those final months in the next posts.

When Should You Get a Living Will for Your Parent?

One of the Yahoo Groups I regularly read has had an ongoing discussion about health care in the USA. One of the posts talked about the need for a medical power of attorney or Living Will as it’s sometimes called.

K lives in New England. She told us what happened when her mother, who did not have a medical power of attorney, had a stroke and required hospitalization and then rehabilitation.  The hospital was willing to allow K to make the important medical decisions without any legal documents. But, when it came time to release K’s mother to the rehab facility, there was only one that would accept her. And, K was required to go to court to become her mother’s legal guardian for that one to accept her mom!

In my Dad’s case, each time he was sent to the hospital, the hospital would not share details of my father’s condition until I faxed them copies of his medical power of attorney. Then, I was issued a confidentiality code which the nurses would ask me for before telling about his current status.

Both rehab facilities my father stayed at, also required that I fax copies of all of these forms.  The nurses at these skilled nursing facilities didn’t require a secret code, but  my Dad’s chart had information on it about his medical power of attorney and who they were allowed to share information with about his condition.

The medical community takes these documents very seriously.

So, when should you get a Living Will or medical power of attorney drawn up for your parent? TODAY!

And, get one for yourself and spouse while you are at it. We can’t predict when a medical crisis will occur for any particular person.  Being prepared will make all the difference.

Here is a more complete explanation of medical powers of attorney. 

If your family has an attorney, s/he is the best resource for getting these documents drawn up. Some hospitals and senior centers also provide help in making a Living Will.  You can also purchase forms or software to help in getting one completed. The laws vary from state to state about the requirements for signatures and witnesses so it is a very good idea to work with someone knowledgeable of your state’s laws.

Start today.

I am so grateful that my father had one in place when he was sent to the hospital. It made all the difference.

Here’s additional information that can help:

Wills and Estate Planning Information at NOLO.com

Are Banks Encouraging Teens to Fall into Debt Trap?

My tall, quiet 18 year old is getting ready to fly across country to begin his four year undergraduate adventure. From the time he was a baby, my husband and I have tried to encourage positive financial habits — saving half of his gifts and earnings, comparison shopping, buying only items that he really needs, even selling used video games on eBay before buying a new one.

Number 1 Son has accumulated a small amount of savings, encouraged by the several banks with which we have had accounts. Children’s savings accounts are usually free of charges to get the child into the habit of thrift.

Until your son or daughter turns 18, that is. Then, they are fair game.

My son’s story began a few months ago when UBOC sent him a letter saying that they were automatically converting his student savings into a checking account with monthly fees. He is astute enough to know that those fees would relentlessly eat into his hard earned funds. He went down to the local branch of UBOC to ask if there was a better option. Nope.

So, he began the not so simple task of finding another bank. His original plan involved moving to a bank that also had a branch where he would be going to college. That limited the choices.

A few internet searches later, he found what semed to be the prime candidate, WaMu. The WaMu website was offering free checking and 5% on a savings account with a very minimal balance. Eureka!

He went down to the local branch to get more details. I tagged along to see what would happen. The New Accounts rep reassured my son that he could open the checking account at the branch and still get the high interest on his savings. (The website said the special rate only applied to accounts opened online.)

Being a person who likes to talk with people who take his money, he closed his account at UBOC and went back to WaMu the following Saturday to open the new accounts in person.  A different account rep opened the accounts. Being far too trusting, neither my son nor I questioned this account rep about the rates.

The first statement arrived — 0.25% on the savings account. With inflation running at 4%, this pitiful rate is just like having monthly fees erode the balance.

We went back to the branch. Both account reps insisted that no one ever told us that we would get the 5% by opening the accounts at their branch office. I asked to speak to the manager.  The assistant manager was available.

The assistant manager was friendly and polite. My son explained that he was college bound, needing a checking and savings with the best possible rates. The manager reiterated that the only way to get the best rate is to open the account online and gave instructions to my son on what to do. He would open new accounts online and transfer the money to them. It seemed simple enough . . . until he actually tried to do it.

Online, Number 1 Son discovered that the account rep had put in the wrong email address, accidentally dropping the final letter off of his name. He went into his account to change it.

But when he went to open the new account, it wouldn’t work. Even answering all of the security questions didn’t get it to work. He repeated his attempts several times until the bank computer turned off his active account for potential identity theft activity. Calls to the assistant manager didn’t provide any help. The solution — wait seven days and try again.

“Oh, also, you may want to check your credit report in case someone has tried to steal your identity, ” the assistant branch manager suggested.

Could that be possible? I showed my son how to order his free online credit report. Experian wouldn’t give him anything. Equifax wouldn’t give him anything. TransUnion had the good graces to say that they didn’t have anything on file for him.

Of course not! He hasn’t had any credit accounts or loans  in his name.  This was a clue.

Seven days later, my son tried again to open an online account. After his first attempt failed, I suggested he call WaMu’s online help center before the bank computer did another security lock down. A very pleasant person informed him that the computer wouldn’t open an online account unless it could verify his identity from drivers’ license records and credit verification.

A giant computer rules WaMu making all the decisions and the people just work for the computer.  No one can override the computer.

There was no way for my son to get the high interest account. Why didn’t they tell us that from the start? I don’t think the computer tells the workers at WaMu what the rules are–for security purposes.

Bank of America and Wells Fargo both have special college banking programs. A student can get a checking account with fees waived based on certain criteria. And, they’ll give your college student a credit card in addition to the debit card attached to the checking account. Oh, by the way, BofA and WF would love to consolidate your student loans, too.

Is there an equivalent savings account for college students? Certainly not.

What is the return on a regular savings account with fees? 0.1%

This seems so shortsighted! Who will have saved downpayments to buy homes (and take out home loans) if every college graduate only has loans and credit card debt? Saving money regularly is an important discipline that every person needs to develop. Otherwise, you can fall into the debt trap and not be able to get out.

For the banks, debt means profits. Banks are creating a new generation of debtors without a thought to the consequences. It brings to mind Michael Douglas’ s speech in “Wall Street” - “Greed is good . . .”

Update on Unexplained Anemia

What do you do when anemia keeps coming back?

In a previous post on Anemia, I talked about my 84 year old Dad’s recurring problem with fatigue and anemia. He (and I) thought the doctors had found the problem and taken care of it with medical procedures to stop the bleeding, most recently in his bladder,  and by making changes to his regimen of nine medications.

I was so relieved that the bleeding has stopped! Several units of blood later, my father was starting to look and feel a bit better. His kidneys were failing, though. He would need to start dialysis right away and he was willing to try it.

I believed that Dad could now start to recover some quality of life. For most of his over 40 life, he has been able to bounce back from serious illness with a determination that was ferocious at times. As nervous as I was about his current fragile condition, I felt confident that he would gradually get better like he had in the past.  

And, at first, it appeared that was happening.

Dialysis is an amazingly complex procedure for life support that involves the dialysis machine, doctors and nurses to monitor your blood and provide the right medications (such as Procrit for his anemia), and counselors and dieticians to help you adjust to a new lifestyle. And, Medicare pays for a substantial portion of the costs. It seems like a miraculous new lease on life when your kidneys are failing.

Day by day, Dad seemed to be getting better. He mostly slept through the four hour treatments three days a week. Our phone conversations centered around making the arrangements for my father to leave the skilled nursing home where he was staying. He was tired of being poked and prodded. He just wanted to go home.

But after a few weeks, his condition began sliding downward again. He wasn’t interested in talking on the phone. The confusion and delerium which had plagued him when his kidneys failed came back worse than before.

I spoke with the nurses at the dialysis center. Were his blood tests showing any imbalances? Not really. His electrolytes were within normal range. My father’s red blood cell count was low but seemed to be improving. They were watching it closely. He shouldn’t be having these symptoms but he was.

A few mornings later I got a phone call from one of the nurses at the nursing and rehab facility. They rushed Dad to the hospital. I got on the first available plane flight to be at his side.

In the ER, they doctors determined that my father had a massive urinary tract infection along with extremely low blood sugar (he is a diabetic) that made him unconscious.  He was admitted to the hospital, again.

Once admitted, the doctors ran through a series of tests including a routine chest xray. In his review of my father’s chest xray, the radiologist noted a pleural effusion, an accumulation of excess fluid in the space surrounding the lungs.

The lung specialist called in to consult with Dad’s regular doctor told me there were three main causes of this excess fluid: congestive heart failure, bacterial infection or a tumor. He would draw a sampling of the fluid to have it analyzed.

I spent an agonizing weekend waiting for the test results.

On Monday morning, the doctor reached me on my cell phone as I got to the second floor of the hospital. Test results showed the cells were abnormal - lung cancer.

So, we finally had the answer to the anemia that would not go away. Various tumors are hemolytic. They destroy red blood cells.

Now, Dad’s choices were limited and the outlook bleaker than ever.

I was grateful to have an answer that finally made sense because now I knew what I needed to do.

Is Your Parent Afraid of Running Out of Money in Retirement? Part 1

My Dad was a victim of Bag-Lady syndrome.

It took me a long time to understand what was going on. I finally found the name for my father’s terrible fear of losing his money in an article in MSN Money of all places!

Bag-Lady syndrome is the fear, often found in women at all economic levels, that financial security could vanish overnight. The spectre of being penniless and homeless haunts some women’s dreams.

Olivia Mellan, a Washington, D.C. therapist who specializes in money psychology, comments, “One of the ways that it impacts women’s lives is it makes them afraid to take risks with their money. That’s why a lot of women have lots of money sitting in a checking or savings account doing nothing. They’re afraid they might need it if they end up on the street.”

That’s it! But, how did my father end up with Bag-Lady syndrome?

According to Mellan, men don’t usually have this type of fear. “They have fears that are more rational and related to their provider burden: being injured, dying young, being laid off, things like that. Whereas bag-lady syndrome is more global, a magical, nameless thing like free-floating anxiety.”

At age 83, my father had already been retired for 18 years. His health had deteriorated so much that we joked about his quarterly “vacations” at the local hospital. Even with Medicare and supplemental insurance coverage picking up most of the bill, those vacations were shrinking his retirement savings.

If he needed to earn more money today, who would hire someone who was hard of hearing, walked haltingly with a cane and was flummoxed by high tech equipment?

All of my attempts to chart his retirement assets and show him graphs about how long his retirement money would last, were useless. It didn’t matter how much money he had. His fear had to do with not knowing how he could make more money if he needed it.

As his health and fear worsened, Dad just refused to spend any money. No geriatric care manager ( see previous post Is In Home Care The Answer?.) No in home care. No meals in the retirement community dining room.

In hindsight, I could have helped my father deal with his fear by dragging it out into the daylight and brainstorming ways for Dad to take action. Helping him find a job? Well maybe not a job, but some way to actively make even just small amounts of money.

Taking action, it turns out, is the key to licking Bag-Lady syndrome. (more in next post)

Is In Home Care The Answer?

In my last post Will An “Elder Monitor” Keep Mom At Home Longer?, I mentioned that my Dad chose to move to senior independent living rather than stay in the home he owned. Still mentally alert and generally capable of taking care of himself, he was having difficulty climbing the stairs to the second floor of the house.

But that was only part of the reason to move. It was the ongoing maintenance of a modest three bedroom Cape Cod that he wanted to eliminate. He had never been a supervisor in his career. Managing the gardener was not something he liked doing.

Those traits that made Dad outstanding as an aircraft quality control representative, paying attention to tiny details and holding fast to specific procedures to complete a job, made for immense frustration with a “mow and blow” gardener.  The gardener was trying to accomodate this 82 year old man while juggling the demands of other customers. There was only so much time allocated to each house.

The gardener understood very well that “Time is Money.” If my father didn’t get to the door rapidly (which was hard for him)  when the gardener ran the bell, the gardener would take off for the next house.

Dad and I discussed getting more help in the home for him. He just didn’t want to manage more people. ”They all try to cut corners,” he emphatically told me.

As a long distance caregiver, I was at a serious disadvantage.  Some people management issues can be resolved by phone, but most of the time, face to face talks are the best way to get things done. “Let me show you exactly which weeds didn’t get pulled.”

Dad was clear that he didn’t want to manage workers. I was too far away. We didn’t have a local family member who could act as “manager” of the service providers.  More service providers, like house cleaners and in home care providers, would make his life more complicated rather than easier. So, moving to retirement community where all of the maintenance was handled seemed like the perfect solution.

The concept of living in a secure, resort-like community with meals, house cleaning, and laundry services like a four star hotel had captured Dad’s imagination. Free local transportation, regular pinochle games, planned activities (Miko the Magician!) and weekly excursions added to the allure.

His cute little house, which had no sentimental value, was in a nice middle class suburban community where the overwhelming majority of residents worked during the day. His grey striped tabby and the newscasters on CNN  were his only companions.

Shops and senior services (lunch at the community center was just $1.25!) were only short drives from the house, but I could already see that his driving days were numbered. Diabetes had taken its toll on the circulation in his legs. He tried to compensate for his slower reaction time when he drove which was becoming less and less frequently. So when a a vacancy came up (after 3 months on the waiting list) in the lowest cost retirement community in the area, he made the move.

Other family members have made different choices. I have two aunts who chose to stay in the homes they have each lived in for half a century. In each case, one of their children moved in to manage care for the parent. One has daily in home care so that her son can work during the day.

My cousin tells me that he has fired more in home providers than anyone else he knows. He shrugs , “I’m tough to work for. She’s my mom and I want her treated right.” He has tried agencies; he has hired directly. One woman has cared for my aunt for seven years. Other have lasted just weeks or months. Because she need around the clock care, several providers are needed.

Still, in home care has been the right choice for my aunt. She had gotten very personalized care in familiar, comfortable surroundings. Nursing homes just can’t provide that. But in home care hasn’t been inexpensive. The largest cost has been my cousin’s time to hire and manage the care providers and take care of my aunt in the evenings.  He has put his own life on temporary hold.

For those families who can’t provide this type of caregiving, there are geriatric care managers who help elders and their families find the right solution and even manage providers. A geriatric care manager typically has a nursing or social work background and is very familiar with all of the services available in a local area. Some companies are even offering these services as part of employee benefits.

When I first became a long distance caregiver, I had the help of a free service provided by a local hospital where I lived. The care manager was a tremendous help in finding information I needed.

Unfortunately, the assistance the care manager could provide was limited by distance. She lived in California. My father lived in New Jersey. I tried to discuss the idea of hiring a local care manager to help him when I couldn’t be there. Dad rejected the idea of hiring anyone. Loudly!

Much later, I would discover the hidden reason why. (to be continued in next post)