What’s all this I hear about “death panels”, forced abortions, and mandatory sex change operations? Has the country I used to know gone AWOL? Come on, folks, get real. No one wants to kill Grandma, and no one wants to abandon disabled children. As a matter of fact, the current situation is causing both the elderly and the disabled to suffer needlessly. In California, Governor Schwarzenegger eliminated $6.3 million from services for the elderly, because the current financial set-up doesn’t work.

We’re all on this sinking ship together, so enough already with the “I’ve got mine, screw you!” attitude that so many Americans are voicing lately toward their less fortunate compatriots. There are plenty of reasons to disagree with each other, but let’s not become abusive about it.

We have before us an immense dilemma and an extraordinary opportunity.

The dilemma is that our current healthcare system is ailing and getting sicker by the day. According to the National Coalition on Healthcare, the cost of health insurance premiums is chewing up both household and business budgets. Having health insurance coverage does not guarantee access to healthcare when you need it, and even if you are lucky enough to have health insurance, you may or may not be approved by your insurer for the care that your doctor prescribes. That’s part of the healthcare rationing that the Washington Post reports is currently practiced by the health insurance industry. Even if your treatment is approved, its out-of-your-pocket cost may put you in the poorhouse.

If you get sick and need a significant amount of medical care, or ongoing medical care, your health insurer is now free to drop you from their rolls. Then just try getting a new policy on your own with a pre-existing condition.

I tried, and was put into a high risk (read “high cost”) category by Anthem/Blue Cross, because I take a daily 10mg dose of a generic statin drug for borderline high cholesterol. It works like a charm, and my cholesterol level is under excellent control. Other than controlled high cholesterol, I am in superb health. Wouldn’t you think the insurance company would want me to be on a low cost, successful treatment for a chronic condition that could spiral out of control if not managed?

Now I only have insurance because my spouse’s job offers me coverage…at our cost.

Take a look at your health insurance premium rates for the past ten years or so. You’ll see a precipitous rise in premiums, and there’s no telling how much higher they’re likely to soar as America ages and needs more healthcare for acute and chronic illnesses. Even if your employer pays your premiums, find out what the cost has been over the course of the past ten years. If the boss is paying through the nose for health insurance, he’s not likely to add to your take-home pay. My premiums over ten years rose from about $120 a month to over $600, and my deductible went from $50 to $5,000! Prescriptions fell off the covered wagon, as did many routine tests and procedures.

Are you or a loved one counting on Medicare or your VA benefits for healthcare? Just remember, that both of those programs are government provided coverage. By the way, they are also the most cost effective and well appreciated healthcare coverage systems in the country. Whom do you know who has ever given up Medicare or VA coverage?

Okay, that’s the health insurance and healthcare crisis in a nutshell.

We now have an opportunity to turn healthcare in this country around. The US spends more per capita on healthcare than any other country, but we rank below 41 other nations in life expectancy. Surely we can do better than this.

The current administration is ready and willing to do the heavy lifting necessary to reach a national consensus on how to meet the healthcare needs of ALL Americans without breaking the bank. That’s right, without breaking the bank…while doing nothing will cost us a fortune! Find out the real story of the Obama administration healthcare proposals. Listen with an open mind and heart to people who see things differently from you. Ask them to listen respectfully to you. Maybe we can all learn something new and useful from each other’s experiences.

If you want to ensure that your elderly loved ones…and eventually you…have affordable healthcare when it’s needed, join the debate in a productive way. No one has all the answers, but each of us has something of value to add to the conversation. Listen, share, learn.

TAG, YOU’RE IT!

“Why isn’t there a handbook on taking care of parents when they get old?” someone recently lamented to me. You know, like the handbook parents don’t get when a baby is born, there should be a handbook on caring for aging, ailing parents, and for helping us and them as they go through the dying process.

An aging, ailing, and dying parents handbook could certainly provide some useful information so that baby boomer “children” don’t have to re-invent the wheel on taking care of parents who once took such good care of us, right? Afterall, we’re a generation not known for wanting to extend any extra effort on our own behalf. Okay, I’m being cynical here, but still.

As it turns out, there are many books on taking care of elderly parents. One I particularly like, and one that is endorsed by AARP no less, is “How to Care for Aging Parents” by Virginia Morris. Published by Workman Publishing, New York, it’s available through Barnes and Noble. It is a full range handbook that covers a wide array of topics including: healing old relationship wounds, finding healthcare providers, healthy aging, physical body changes, mental and emotional changes, nursing homes, spiritual needs, finances, elder law, and even dying what to do next.

As the cover says, it’s chock full of answers to “questions you hoped you’d never have to ask”. So if you’re wishing you had a great handbook on how to care for your elderly parents, check this one out.

This meditation on dying came from a friend whose beloved mother just died. When we become aware that a parent is about to die, thoughts such as these can be most comforting:

I am standing upon the seashore. A ship at my side spreads her white sails to the morning breeze and starts for the blue ocean. She is an object of beauty and strength. I stand and watch her until at length she hangs like a speck of white cloud just where the sea and sky come to mingle with each other.

-Henry Van Dyke

Dad died on April 12 of this year. He and Mom were at home with friends enjoying conversation along with coffee and macaroons at their dining room table…one of Dad’s favorite activities ever. All four were having a lively chat about the state of the world, another of Dad’s favorite activities, although now compromised by his aphasia. I’m told that he became quiet for a handful of minutes before one of his guests noticed that his eyes had closed. As Mom and the other guest became aware of his stillness, Dad put his head back, “coughed”, and was gone. I can only wish such a peaceful transition for the rest of us. Dad squeezed every last ounce of living out of his life, which came to a close with the sweetness of companionship, conversation, and cake on his lips. Namaste, Dad. I love you always and forever.

Now we enter Mom’s transition. She did not expect to grieve, believing that she had already dealt with her loss when “the husband [she] wanted left” at the time of Dad’s stroke. Unfortunately, her lack of emotional preparation is making this passage into early widowhood an extreme challenge for her. She has chosen to cling to one of her children but to cut off other ones. It will take time and careful treading to help her regain her equalibrium and to assist her in making her own transition without lashing out for the abandonment that she is now feeling at her life-long partner’s departure.

The duality of the peaceful death of one parent and the severe, nearly debilitating grief of the other is hard. While Dad’s death was expected and the gentleness surrounding it is a blessing, Mom’s extreme pain and vulnerability came on without warning. Or may I say, without her anticipating it. Now the challenge is to help her to open up her wounded heart to allow in the love and support that are waiting only for her nod of acceptance.

It’s been a year since Dad returned home from the stroke rehab hospital.  He’s still dealing with 12 hours a week of dyalisis which leaves him fatiqued and often depressed, but he and Mom continue to enjoy life’s gifts.  They spend time with friends and family, go to parties, entertain in their home, frequently dine out, and especially enjoy visiting the local park. and river front.  Dad is confined to a wheelchair these days due to stroke related spasticity, so getting around takes more time and effort, but he’s really good at maneuvering!  He and Mom are now supported by two amazing and compassionate home-care aides, Adair and Carmen.  Together they provide 24 hour care for Dad and give Mom the time she deserves to take care of her own needs.  Mom and Dad recently downsized their home, and although my sibs and I helped with the move, it was Mom, at 80, who joyously did most of the unpacking and organizing once they arrived at the new house.  They are now happily nearer friends and more centrally located to community services.  Dad’s most challenging deficit is his severe aphasia which has significantly limited his speech and language abilites.  We’ve all become used to giving him more time to attempt to communicate his thoughts.  He is clear in his head about what he wants to say, but the words just aren’t there to share.  It’s quite frustrating, but, as Dad can and does say, “What can you do?”  He’s eager to change what can be changed but willing to accept what can’t.  Speech therapy has had only limited effect.  Singing sometimes helps…and if it doesn’t help the words flow, at least it’s a way to cheer him up.  For an insightful treatment of what it’s like to live with/love someone with severe aphasia, visit cartoonist extraordinaire Lynn Johnston’s (“For Better of for Worse”) website http://www.fborfw.com/char_pgs/grandpa/index.php?page=letters and read the letters that character Grandpa Jim’s wife Iris has written about her life with Jim.  Also see Lynn’s page about the research she did for the Grandpa Jim storyline http://www.fborfw.com/features/research/index.php?page=stroke.  KUDOs to Lynn for her marvelous work!

I’ve been “missing in action” for a while.  Everything’s okay…even great in some ways.  It’s been a busy few months, and my head has been  elsewhere.

I visited Mom and Dad in December, and it was a wonderful reunion.  Dad has lost a lot of weight (that’s a good thing), but he does look old to me now.  His aphasia still makes his speech hard to understand, so it takes some time and effort to catch what he’s trying to say.  The payoff is generally terrific…the mind is still sharp, that’s for sure.

This was the first time I visited since Dad came home from rehab and the nursing home.  He and Mom have their routine all worked out.  There are now wheelchair ramps at all the relevant doors, and several rugs had to be removed to allow Dad to get around in the house in his chair or on his walker.  The man is tough…and strong of body, mind, and spirit!  What a treat to go to the theatre with them and out to eat.  Life is different, but they’re living it to the fullest.  Reminder to self: Don’t worry so much.  They’re on top of things.

I took a few minutes this afternoon to call Mom and Dad to see how they were doing.  The in-home healthcare aide had just gone home, and Mom was fixing dinner.  Mom put Dad on the phone, and he sounded GREAT! 

It’s been over six months now since Dad’s stoke, and he’s still doing daily physical therapy, occupational therapy, and speech therapy.  But now both of my parents are encouraged by Dad’s progress.  “He’s walking more.” Mom told me.  “We’re dressing himself.” Dad said.  His pronouns are still a mess, but his thoughts seem to be clear, and he feels much more confident in expressing them.

Dad and I talked about the gift that his stroke is.  You see, along with all of the suffering that he and those of us who love him are experiencing, there is also a wonderful lesson in gratitude.  No longer can I take for granted my ability to hop out of bed in the morning, to dress myself, to throw open the curtains to another sunny day.  Each of these acts is a miracle. 

“That’s lovely!” Dad told me when I shared this thought with him.

We signed off with a big “Shabbat shalom (Peaceful Sabbath)” as we do most Fridays.

With the Jewish High Holy Days and the Muslim month of Ramadan overlapping for the second time in two years, this year seems particularly auspicious for reflecting on the question of Baby Boomers’ responsibility to provide health and other care for our aging or ailing parents.  

Why should we care for our parents or other elders?  Didn’t they raise us so that we could go out into the world as independent adults to fend for ourselves and to raise the next generation?  Isn’t Elder Care a process of looking back rather than of moving forward? 

Oh, no, no, no…from every fiber of my Jewish soul, I must say, “NO”.  I know that many (perhaps most) of you are not Jewish, so let me just say briefly, that many of my spiritual and philosophical views do emerge from my Jewish heritage and upbringing.  I hope that my heart-songs (thank you Mattie Stepanek for this wonderful word!) can help you to strengthen yours. 

Caring for, or arranging care for, our parents, aunts, uncles, and other aging loved ones is our duty.  The fifth commandment says, “Honor your father and your mother.”  There is no codicil that emends the commandment with stipulations such as “if you feel like it” or “if you love them”, or “if it suits your needs”.  No, the commandment is quite simple and direct. 

What does that imply?  The implications range from the obvious to the obscure.   

Obvious: Our parents cared for us when we needed care.  Now it’s our turn. 

Obvious: (As Mom and Dad often explained to me about all sorts of orders) Do it, because I said so. 

Obvious: What goes around, comes around.  Do you want someone to care for you when you are elderly or ailing?  Put some credit in that bank. 

Obscure: Human nature is not as benevolent as we might wish to think.  We all need a “kick in the pants” from time to time, and the ancients recognized this.  So “Honor your father and your mother.” made it into the Top Ten list of Thou Shalts. 

So whether or not this is your time of year for soul reflections, I hope that you’ll take a moment to think about what honoring your parents means to you…and to them. 

Now that Dad is home from stroke rehab again, I’ve had the luxury of reflecting on the early days following his stroke, when my siblings, my mom, and I had to decide where he would go when he no longer needed to be hospitalized.  For the time being, that chapter in our lives is past, and thankfully so, but there were family moments and healthcare decisions that I would like to share.

As Dad recovered from his initial stroke, the hospital charge nurse gave us a list of local nursing homes.  Where Dad would go would be largely a matter of which facility had a bed available when he was ready to be moved.  But we wanted at least to have veto power so that he wouldn’t end up in the “badlands” of the healthcare system.

Dad’s stroke left him with a physical disablity, aphasia, and what is probably a mild dementia.  It was clear that, at least initially, he would need more than in-home nursing care or assisted living could provide.  He would need nursing home care and concentrated rehabilitation.

Mom and I visited a handful of local nursing homes.  The first decision we made was that Dad would stay within their small town so that Mom would be able to visit him regularly and easily.  It was easy from there to rule out the first two places we saw.  They smelled bad, we were ignored when we walked in, and the staff seemed too busy to attend to the droolinig, agitated, and vacant-eyed residents whose wheelchairs lined the halls.

Two places made our “not awful” list.  The staff smiled and talked with the residents.  The facilities were clean.  The meals in the dining room looked tasty.  Residents were allowed to move about.  The residents’ rooms and rehab facilities were cheerful.  We were greeted warmly, and our questions were fully answered without making us feel as if we were getting a sales pitch.

With Dad’s aphasia, his communication needs were important to us.  The nursing home we finally selected had a therapist who spoke German, Dad’s native language.  Although Dad’s aphasia affected his ability to speak in ANY language, he clearly enjoyed hearing Julian speak to him in his childhood tongue. 

That small, serendipitous “find” made Dad’s first nursing home placement choice clear, and we all felt that he was in good hands for his next step towards stroke recovery.

I have to say that watching Dad age in the past year has had its ups and downs.  Dads are supposed to be there always, to be the strong ones, to take care of you no matter what.  So when Dad had his stroke, it took some adjusting to the role reversal.   Now I get to give him the care and love that he has always shown to me, and the really neat part of the whole shebang is that our relationship is definitely deepening as a result.

 Mom is having her own struggles with “aging Dad”.  She is about to put another candle on her cake too.  Although she is not personally slowing down much yet, Dad’s illness has certainly changed her life.  She needs to be taken care of also…but in a very different way. 

Dad has become the focus of everyone’s attention, yet it is Mom whose needs may be greater, if not emergent.  Mom needs more TLC than before Dad became ill, and she needs us to help her to give him care so that she can continue to spend time each day persuing the activities that bring joy to her heart…music, writing, and time with friends.

I speak with a lot of Baby Boomers who, like me, are travelling this transitional road from being the care-receivers to becoming the caregivers for their aging dads and aging moms.  It seems critical to me that we stay mindful of the “other” parent, if we are lucky enough still to have two to care about. 

* How are you doing at giving attention to the “other” parent?

* What opportunities can you see in becoming your parents’ caregiver?

* When was the last time you said “I love you” to an ailing, aging parent?