Caring for Aging Parents - The New Old Age Blog

October 15, 2012, 2:40 pm

Growing Concerns About Reverse Mortgages

In The Times today, a cautionary tale about an increasingly popular income alternative for older people: reverse mortgages.

Jessica Silver-Greenberg reports that the very loans that are supposed to help the elderly stay in their homes are instead pushing some out.

Reverse mortgages, which allow homeowners 62 and older to borrow money against the value of their homes and not pay it back until they move out or die, have long been fraught with problems. But federal and state regulators are documenting new instances of abuse as smaller mortgage brokers, including former subprime lenders, flood the market after the recent exit of big banks and as defaults on the loans hit record rates.
Some lenders are aggressively pitching loans to seniors who cannot afford the fees associated with them, not to mention the property taxes and maintenance. Others are wooing seniors with promises that the loans are free money that can be used to finance long-coveted cruises, without clearly explaining the risks. Some widows are facing eviction after they say they were pressured to keep their name off the deed without being told that they could be left facing foreclosure after their husbands died.

The Times reports that more reverse mortgages are ending in foreclosure.

Although the numbers of reverse mortgages have declined in recent years, the rate of default is at a record high — roughly 9.4 percent of loans, according to the consumer protection bureau, up from around 2 percent a decade earlier. And borrowers are putting their nest eggs at risk by increasingly taking out the loans at younger ages and in lump sums, federal data and a recent bureau report show.

Read the full article, “A Risky Lifeline for the Elderly Is Costing Some Their Homes.”

October 12, 2012, 6:40 pm

A Blogger’s Caregiving Chapter Closes

By PAULA SPAN

For several years, I’ve been a fan of Chuck Ross’s “Life With Father” blog. In 2008 Mr. Ross, a journalist and consultant who had recently moved to Cape Cod, took in his father, Charles Ross Sr., and has been chronicling his caregiving experiences almost ever since.

Lots of compassionate but stressed-out sons and daughters have taken to the Internet to tell similar stories, but few tell them as beautifully. As his father aged and faltered, as Mr. Ross developed unwanted expertise in juggling multiple medications and specialists and dressing pressure sores, he remained clear-eyed and unfailingly honest about the task. (And, no, families have not always shouldered all these responsibilities year after year — that’s one reason we call the blog The New Old Age.)

Chuck Ross rejected all nominations for sainthood. He knew this role could become messy in every sense. Sometimes, when you are taking care of a former Marine who craves independence but has become dangerous behind the wheel, you have to arrange for the state to revoke his driver’s license and he hates your guts. Sometimes you grow impatient, angry, resentful.

Sometimes the blog goes quiet for weeks as you cope with your parent’s health crises, your own work crises, the fact that the rest of your life stubbornly refuses to stop spinning while you care for a frail old man. Sometimes, you need a nursing home.

Chuck reported in the latest installment of “Life With Father ” that Charles Ross Sr. died Wednesday at 90. Death came quickly and peacefully — “a blessing,” he wrote.

I wish his father godspeed, and I wish Chuck peace and some quiet Indian summer days on the Cape, throwing tennis balls for his golden retriever.

October 11, 2012, 11:29 am

Reaching 90 With Only Three Prescriptions

By PAULA SPAN

Murray Span

My father, Murray Span, turned 90 a few days ago.

We kept the celebration pleasant but low-key, as he requested: lunch at his independent living community with my sister and me, her son and his girlfriend. Flowers and balloons. A round of “Happy Birthday” from everyone in the dining room. And two cakes to pass around, one sugar-free for diabetics. My dad, a k a Mr. Rationality, opted for the sugar-free.

Our family has never made much fuss about birthdays, one reason we opted for modest festivities. But it’s also true that while a 90th marks a significant personal milestone, in the broader demographic scheme of things it’s become almost commonplace.

October 10, 2012, 6:54 am

How in the World Will We Care for All the Elderly?

By JUDITH GRAHAM

All over the world, people are living longer than ever before and posing caregiving challenges that span the globe.

We think of this phenomenon as particularly true of wealthy “first world” countries like the United States. But it’s not.

Consider these facts, drawn from a fascinating new portrait of global aging published by the United Nations Population Fund:

Developing countries in Africa, Asia and other regions are experiencing the most rapid aging of their populations, not developed countries like those in Europe or North America. “Today, almost two in three people aged 60 or over live in developing countries, and by 2050, nearly four in five will live in the developing world,” the report says. (While 60 isn’t considered an entry point into older age here, it’s the cutoff used by the United Nations.)

Developing countries are also seeing the fastest growth in the ranks of the “oldest old” — in this report, those 80 years old and above. By 2050, an estimated 280 million people in developing countries – most of them women, who tend to live longer than men – will be in this category, compared with 122 million in developed regions. Of course, this is the population group most likely to become frail by virtue of age and illness and to require the greatest assistance.

Here are some other facts that made my head spin: Almost 58 million people worldwide will turn 60 this year. By 2050, there will be more old people than children under the age of 15 for the first time in history.

It’s hard to wrap one’s mind around a demographic change of this magnitude and the caregiving challenges that it entails.

The true nightmare prospect is this: People live longer, with more chronic illnesses like high blood pressure or diabetes, in poorer health, requiring more attention from family members and costly medical care.

Should the globalization of aging follow that path, the strains on governments and families will be extraordinary and potentially devastating.

The best picture is this: People live longer, in good health, remaining productive, valued members of society who contribute in workplaces, communities and families through their later years, and are treated respectfully and supported economically and socially as they become frail.

The authors of the United Nations report argue that those goals are achievable, with well-thought-out policies and a firm commitment to care for the elderly while taking advantage of their wisdom, skills and experience.

But data in the report speaks to the enormous scope of this challenge. Witness this nugget: “Worldwide, more than 46 percent of people aged 60 years and over have disabilities and more than 250 million older people experience moderate to severe disability.”

Which conditions top the list in developing countries? Visual impairments like cataracts, glaucoma, refractive errors and macular degeneration, which currently affect 94.2 million people, hearing loss (43.9 million people), osteoarthritis (19.4 million) and ischemic heart disease (11.9 million).

Who will take care of older adults with these problems? Once it was a given that families would do so in the developing world, where nearly three-quarters of adults live in intergenerational households rather than on their own, which is the norm in the United States and Europe.

But as middle-aged adults leave rural areas for economic opportunities in the city – this is happening in Africa, large parts of China and other regions — older adults are left behind to tend to grandchildren and take care of themselves as best they can, without the aid of adult children.

“Informal support systems for older persons are increasingly coming under stress as a consequence, among others, of lower fertility, out-migration of the young, and women working outside the home,” the United Nations report observes.

What this means is that the old are taking care of the old in many instances.

Japan is currently the oldest country in the world, the only one where elders represent more than 30 percent of the total population. There, about 60 percent of so-called informal caregivers (friends or relatives who care for older people voluntarily, without being paid) are 50 or older.

“This percentage can be expected to increase steeply over the coming decades as a consequence of population aging,” the United Nations report says.

Thirty-eight years from now, 64 countries will stand alongside Japan with seniors exceeding 30 percent of their total populations.

It’s no surprise that the United Nations Population Fund reiterates the need for greater support for caregivers of the elderly. Progress is being made, it notes, with some countries (the Russian Federation, the Slovak Republic, Turkey, the United Kingdom and Canada) introducing paid “allowances” for caregivers, others passing laws supporting caregivers (Japan, Finland and Sweden) and still others developing national strategies relating to caregiving (Australia, New Zealand and Britain) But the needs outstrip resources being made available, in those nations, as well as here.

Countries around the world a decade ago developed a framework, known as the Madrid International Plan of Action on Aging, to respond to these trends and others, and a meeting is being held on Wednesday in New York to discuss the progress they’re making.

No one suggests enough is being done. But increasingly, there’s an awareness that the aging of the globe doesn’t lie off on the horizon: It’s a reality, here and now, and unfolding at breathtaking speed.

Enlightened policies, including those dealing with caregiving, may make a great difference in the experience of older adults in the years to come. Stasis and a failure to envision new ways of responding to these demographic shifts, both here in the United States and in the world that surrounds us, no longer seem an option, but the way ahead remains unclear.

October 9, 2012, 5:02 pm

Caregiver, Plus M.D. or R.N.

By PAULA SPAN

Josh Haner/The New York Times Family caregiving these days often means providing medical care, not just support and companionship.

Let’s briefly consider this phrase: “family caregiver.”

“The public perception is what you see in ads — people sitting by the bedside, holding hands, making lunch, smiling at one another,” said Carol Levine of the United Hospital Fund, a longtime researcher and caregiver herself. “It has that glossy look. That’s not the whole story.”

In fact, a substantial proportion of people caring for family members — elderly and otherwise — are shouldering medical and nursing tasks that professionals used to handle, once upon a time. They give injections, manage complicated drug regimens and use feeding tubes and dialysis equipment, usually with scant training and little backup. And while they feel they’re doing something worthwhile, keeping their loved ones out of nursing homes, they pay a price in their own mental and physical health. Read more…

Arts & Culture October 5, 2012, 1:55 pm

Books to Teach Children About Alzheimer’s

By PAULA SPAN

I stopped at a children’s bookshop in Manhattan last week and asked to see books on Alzheimer’s disease. The store stocked at least half a dozen, with titles like “What’s Wrong with Grandma?” and “What’s Happening to Grandpa?”

That was only a small sample. Three doctoral students at Washington University, analyzing the way storybooks describe the disease, found 33 of them published for 4- to 12-year-olds from 1988 to 2009.

It’s a growing market, since the number of people with Alzheimer’s keeps rising along with the number of older Americans. I wonder, given that most of those people are in their 70s and 80s, whether storybook readers are likely to be not grandchildren but great-grandchildren.

Nonetheless, “storybooks about a difficult disease like Alzheimer’s can be a gentle way to introduce it to young children,” said Erin Y. Sakai, lead author of the study, which was just published in the American Journal of Alzheimer’s Disease and Other Dementias. “It’s a recognized technique.” Not only can books give children insight, she added, but also, “they can also guide parents with their discussions.”

Ms. Sakai and her co-authors were disappointed, however, by many of the 33 books they examined. “There are areas that are important to address that some books aren’t capturing,” she told me in an interview.

Like, for example? “The books did a generally good job of portraying the cognitive aspects — memory problems, poor judgment,” Ms. Sakai said. “But other elements were less well-represented.”

They include symptoms like wandering, agitation, sleep disturbances and depression. Only about a third of the books depicted anger or irritability, and very few showed functional limitations — the inability to drive, feed oneself, walk.

The researchers, arguing for more comprehensive portraits, noted that only a quarter of the books discussed the diagnostic process, and only 12 percent reassured kids that Alzheimer’s wasn’t catching and that they wouldn’t come down with it. Acknowledgments that people with the disease will get worse were rare, and references to incurability and eventual death even rarer.

October 3, 2012, 12:51 pm

‘Old’ Myself, and None Too Pleased

By JANE GROSS

The first thing I learned about my new Medicare card is that it’s hard to fit in my wallet. Made of paper, not laminated, it’s a tad bigger than the slots perfectly sized for a credit card, a drivers license or my Blue Cross-Blue Shield card, which until Sept. 1, the start of the month of my 65th birthday, had been my ticket to health care.

My mother’s card, in her wallet for 23 years, still looked starched and clean at her death at 88. I was too busy asking existential questions at the end of her life to inquire about how she managed more mundane things (ditto her recipe for stuffed cabbage and pot roast). By the end of the first day I used it, my card was wrinkled, smudged and almost torn.

I dropped my new Medicare card near the receptionist’s desk on its maiden outing, didn’t notice it had gone missing, went to the ladies’ room, looked for it and freaked when it wasn’t where it belonged. The receptionist saw it fall to the ground and retrieved it. But if all of our blunders are expressions of the unconscious, as Freud would have it, this one was laughably simple to decode: my fear of turning 65.

I hadn’t blinked at 30, back when all good girls were supposed to be married and I wasn’t. At 40, I heard the faint ticking of the biological clock. I considered having a child alone and decided, without terrible angst, that I could not. Fifty, to my surprise, just wasn’t a biggie. And 60 was actually fun: I celebrated a don’t-look-half-bad-for-my-age birthday.

Then came 65, a punch to the gut. This is the beginning of the period the Census Bureau defines as “old.” Sixty-five to 84 is one big demographic clump — a dated notion, pun intended. Still, describing myself as middle-aged now is lying.

October 2, 2012, 11:33 am

The Deadly Threat of Silent Heart Attacks

By JUDITH GRAHAM

For more than six months, Harriett Cooke had been uncommonly tired, panting when she walked her sixth grade science class to the cafeteria and struggling to keep her eyes open when she drove home at night.

One day, during a class trip outside the school, she just couldn’t go on. “I sat there on the side, I put my head down on the table, and I knew I shouldn’t be feeling like this,” said Ms. Cooke, 67, who lives in Durham, N.C.

Making excuses, she left and stopped at her doctor’s office, where staff ordered an electrocardiogram (EKG). The test showed that Ms. Cooke had suffered a so-called “silent heart attack” at some indeterminate point, perhaps months earlier.

Few people know about this type of heart attack, characterized by a lack of recognizable symptoms. Yet silent heart attacks are even more common in older adults than heart attacks that immediately come to the attention of doctors and patients, according to a recent study in The Journal of the American Medical Association.

What’s more, they’re equally deadly.

The research underscores the importance of paying attention to lingering, hard-to-pin-down symptoms in older adults, experts say. Many elderly men and women tend to dismiss these; caregivers shouldn’t let that happen.
Read more…

October 1, 2012, 6:27 am

Advice for Dealing With Multiple Ailments

By PAULA SPAN

Philippe Huguen/Agence France-Presse — Getty Images A new brochure offers tips for managing medical care of multiple chronic conditions.

Here’s the problem: A majority of older adults, the medical literature shows, are coping with at least three chronic conditions. Diabetes, heart disease, arthritis, osteoporosis, hypertension, kidney failure — the list goes on and on.

Medical groups have developed separate clinical guidelines for most of these diseases, but when doctors simply follow those recommendations, treating one disease can worsen another. Drugs interact in unpredictable ways. Side effects make patients miserable, even if their lab results look better.

The drugs an endocrinologist might prescribe to strictly control a diabetic patient’s blood sugar (and very low blood sugar doesn’t benefit the older patient) can cause problems for people who also have kidney disease, for example. Opioids to control arthritis pain can impair cognition. The examples are probably infinite.

“There’s not a good understanding of how to manage all these problems simultaneously,” said Dr. Matthew McNabney, a Johns Hopkins geriatrician and the American Geriatrics Society’s chairman of clinical practice. “Not only is it difficult and complicated, but it’s often harmful.”

Dr. McNabney led a panel of 11 geriatrics experts — including an ethicist, a nurse practitioner and a pharmacologist — who began meeting more than a year ago to come up with a better approach to treating “multimorbidity” (medspeak for having several chronic illnesses) in older adults.

September 28, 2012, 6:35 am

Listening Carefully to Voice Changes

By JUDITH GRAHAM

A study of the speeches of Gordon B. Hinckley, former president of the Church of Jesus Christ of Latter-day Saints, revealed some clues about how voices change with aging.

George Frey/Getty Images A study of the speeches of Gordon B. Hinckley, former president of the Church of Jesus Christ of Latter-day Saints, revealed some clues about how voices change with aging.

As is the case with so many bodily functions, our voices change with aging.

The pitch of women’s voices becomes lower, while the pitch of men’s, oddly enough, drifts higher. Speech slows, with fewer words uttered between breaths. The voice gets weaker, harder to project, less consistent and more tremulous.

Underlying these changes are a gradual loss of muscle mass in the voice box, a stiffening of the cartilage that surrounds it and atrophy in the vocal cords. Mechanisms controlling the jaw, tongue, lips and soft palate begin to deteriorate, and fine muscle coordination involved with producing speech becomes more difficult.

All of this has been known for some time. What hasn’t been as clear is when these changes occur.

September 25, 2012, 12:58 pm

A Form of Dementia That Is Often Misdiagnosed

By PAULA SPAN

Courtesy of Paul Smith Paul Smith and his father, Jim, at a family wedding in 2011.

Lori Roberts’s father, who used to deliver the mail in Mitchell, S.D., has undergone startling personality changes. “He used to be very easygoing,” Ms. Roberts said. “Now he’s gotten kind of physical with my mom and my brother, pushing and shoving.” The other day, when her exhausted mother visited him in the nursing home he had recently entered — by sad coincidence, it was their 53rd wedding anniversary – he loudly insisted that she take him to Mexico, immediately.

Paul Smith’s father hallucinates. “He commonly sees a dog lying by the wall. Or a little girl,” said Mr. Smith, a sales manager in Port Byron, Ill. “He’ll see half-humans, half-animals. Or little stick men running around on the floor.” With hindsight, Mr. Smith sees how wrong he was, as his father deteriorated, to keep saying,“It can’t possibly get any worse than this.”

Neither Ms. Roberts nor Mr. Smith had heard of Lewy body dementia before their fathers were found to have it, a process that in each case took several years because even many health care professionals remain unfamiliar with the disorder.

Yet, “this is not an uncommon disease,” said Dr. James Galvin, a neurologist at NYU Langone Medical Center who has published extensively on the subject. He and other researchers helped the Lewy Body Dementia Association extrapolate from epidemiological surveys and come up with an estimate: About 1.3 million people — considerably more men than women — have Lewy body dementia, named for the scientist who identified these protein deposits in the brain.

September 24, 2012, 3:26 pm

The Drama of Aging and Caregiving, on YouTube

By PAULA SPAN

Maura Tierney and Lois Smith, as Erica and Ruth, discuss care of Erica’s father, Harry, played by Philip Baker Hall in “Ruth & Erica,” a series on the YouTube channel WIGS.

“I don’t want to take care of them,” Erica confesses in Episode 12 to the man she’s just slept with, speaking about her elderly parents.

“Who does?” The man is the real estate broker who has just sold her parents’ home in San Francisco so that, after a year’s resentful debate, they can downsize.

“People do. Children do,” Erica replies. “They think of it as payback for all the sacrifices their parents made for them. They think it’s a privilege.”

“I don’t know those kinds of people,” he says.

Amy Lippman invented those characters, told them what to say, then directed all 13 episodes of “Ruth & Erica,” a YouTube drama about aging and caregiving. You can find the first one today on the female-centric channel called WIGS, which stands for Where It Gets Interesting.

“I decided to write about something I was experiencing, and all my friends were experiencing — parents who’d been independent and self-sufficient, but were beginning to need more support and guidance,” said Ms. Lippman, who’s in her late 40s. “It seems to have come as a shock to all of us.” Read more…

September 21, 2012, 6:53 am

The High Cost of Out-of-Pocket Expenses

By JUDITH GRAHAM

Joyce Dopkeen/The New York Times The elderly and their families are often shocked by what Medicare does not cover.

It comes as a shock: how much people have to spend on medical care for a frail older relative in the last several years of life.

A common assumption is that Medicare will pay for almost everything. But that’s mistaken.

As a new study by researchers at the Mount Sinai School of Medicine in Manhattan documents, out-of-pocket costs for older adults at the close of life often place a significant financial burden on individuals and families.

The report, published in The Journal of General Internal Medicine, analyzed data about 3,209 people who participated in the national Health and Retirement Study and who died between 2002 and 2008. The survey, sponsored by the National Institute on Aging, collects information about medical out-of-pocket spending every two years.

Key findings are eye-opening:

On average, people with Medicare coverage paid $38,688 for medical care in the last five years of life.
There was enormous variation, with 25 percent of participants spending an average $101,791 out-of-pocket for medical services and 25 percent spending an average $5,163 during this period.
One-quarter of older adults incurred out-of-pocket medical expenses that exceeded the total value of their assets during this five-year period. Forty-three percent of older adults incurred expenses that exceeded their assets, excluding the value of their homes.
People with Alzheimer’s disease spent more than those with any other type of illness — an average $66,155 during the last five years of life, compared with average spending of $32,129 for cancer, $37,996 for cardiovascular disease and $38,517 for diabetes.
Long-term care expenses (nursing home, assisted living), which aren’t covered by Medicare, much to many families’ deep surprise, were the No. 1 category of out-of-pocket spending, followed by home health care.

September 19, 2012, 6:42 am

A Little-Known Benefit for Aging Veterans

By SUSAN SELIGER

As veterans age, many are unfamiliar with a benefit that can help pay for care at home or in assisted living or a nursing home.

Ricardo Arduengo/Associated Press As veterans age, many are unfamiliar with a benefit that can help pay for care at home or in assisted living or a nursing home.

Here’s a riddle: When is a government benefit that pays for caregivers, assisted living and a nursing home not a benefit? When hardly any people know they’re entitled to it.

That seems to be the story with a Department of Veterans Affairs benefit called the Aid and Attendance and Housebound Improved Pension benefit, known as A&A, which can cover the costs of caregivers in the home (including sons and daughters who are paid to be caregivers, though not spouses) or be used for assisted living or a nursing home.

The benefit is not insignificant: up to $2,019 monthly for a veteran and spouse, and up to $1,094 for the widow of a veteran.

Surprised that you’ve never heard of it? You’re not alone.

September 17, 2012, 5:46 am

A Choice of Community Care, in Your Own Home

By JUDITH GRAHAM

For 51 years, Catherine Mack has lived in a four-bedroom house in Haddon Township, N.J. Even at age 96, she has no intention of leaving.

Joining other older adults at a nearby retirement community doesn’t appeal to her, although the facility is attractive and has a great reputation.

“I think in a place like that, life is restricted,” Ms. Mack explained. “You eat at a certain time, and you’re always around other people. I am more on the side that I like to do what I want to do when I want to do it.”

So this independent woman instead selected to get services at home from the retirement community’s “C.C.R.C. without walls” program.

Only a dozen continuing care retirement community — C.C.R.C. — programs like this exist across the country, mostly east of the Mississippi. But several more are under development, and experts believe the concept may be poised to expand more broadly in the years ahead.

How does it work?

In traditional continuing care communities, members pay a substantial entry fee ($250,000 and up) and monthly fees (typically $2,000 to $4,000 a month) for housing, with a lot of on-site amenities and a guarantee that assisted living and nursing home care will be available, if needed. The model is “come to us and you’ll get what you need — all in one place.”

In a continuing care program without walls, members also pay an entry fee ($20,000 to $70,000) and monthly fees ($250 to $800) and receive a similar guarantee of lifelong care, with a twist. The main focus of these programs is helping people stay healthy and independent in their homes for as long as possible. This model can be summed up as “let us bring what you need to you — or find a way to make it easy for you to get it.”