From: John De Armond
Newsgroups: misc.rural
Subject: Re: Benefits Of Rural Living
Date: Mon, 28 May 2007 13:31:23 -0400
Message-ID: <m22m53p33hlurh0pfui7k7jd8assc258b1@4ax.com>

On Sun, 27 May 2007 20:01:45 -0900, Jan Flora <snowshoe@xyz.net> wrote:

>Hi Jonquil Jan:
>
>The folks who want you to move into the old farts' housing
>must not know you very well. You'd either end up running the
>place or wither & die. In either case, you wouldn't be
>happy in town.
>
>You're better off at home, for as long as possible.
>Then you might be able to find a young, single mom, preferably
>with an adorable baby, to live with you and help you with daily
>chores, or something like that.

If I may add a gentle counter-point.  I'm on the other end of an elder dependent, my
mom.  Once one becomes dependent on others, then he or she must compromise a bit.  It
isn't fair to heavily burden one's volunteer caregivers just to have one's way.

My mom was in that situation.  My dad died a few years ago and mom could no longer
care for herself in her large (used to be) rural home.  She needed daily care and it
was all my brother and I and several friends could do to give that care, plus mom was
simply rotting away sitting alone in that big house.

After a 2+ year struggle, we finally got her to look at assisted care facilities. She
picked one out that has a section for actual assisted care and one for "pre
assistance".  This section is for those who are still mobile, can feed and clothe
themselves and pretty much go about the daily routine.  The staff check in on her
once a day to make sure she's taking her meds properly and there are call cords in
all the rooms ("help me I can't get up" wireless buttons optional).  They walk her
dog and deliver meals to her room when she's too tired to go to the white tablecloth
dining room.  They have so many activities for the residents that she never has to
sit and rot.

One of the things I noticed both with my grandparents and now with mom is that after
a certain age people become so resistant to any change that it's hard to get them to
do the things that they enjoy.  This place knows that and so the staff will come up
and gently encourage Mom to go play bingo or cards or go on a van tour somewhere.
Once over the reluctance of making the decision to do it, she has a ball.  She's
commented to me how much she appreciates them getting her up and out.

About a week after she moved in she was happy as a clam in sauce.  We were going to
hold on to her house for a year in case she didn't like the place.  Inside two weeks
she put the house up for sale.  Mom told me (again) just last night how thankful she
was to have such a nice and safe place to live.  The activities, meds supervision and
the good nutrition (how many elders eat properly at "home"?) has taken years off her
appearance and ability to function.

>The state will pay for in-home care for elders in lots of cases.
>It's far cheaper to keep elders in their own homes, if at all
>possible.

Actually it's not.  I have some hard numbers from our experience to prove that,
though out of respect for mom's privacy, I won't post them.  Mom and Dad were frugal
all their lives and saved for retirement instead of spending money on a new car every
year, etc., so with the aid of social security, she can afford this private facility.
The monthly "rent" is less than the sum of all of mom's expenses at home by a large
margin.  All she has to buy out of pocket is snack food, meds, a few clothes and dog
food.  Everything else is supplied.  Many of her friends are also residents so she
has much more of a sense of community than at home.

I think that this "keep 'em home at any cost" is a waste of taxpayer money.  It is
obvious that having a nurse on staff that walks from apartment to apartment every day
checking on residents is more economical than having one drive a route.  Patently
obvious.  It is also patently obvious that serving meals in an in-house restaurant is
cheaper than a "meals on wheels" approach.  And much better food.  Mom's facility has
a trained chef and there is a small but varied menu each day.  The dining room is
white tablecloth-elegant with nicely dressed and trained servers - far better than
any commercial restaurant in town.  That tax money could much better be spent
building similar facilities for those who can't afford to live in a private facility.

Most of this "I want to stay at home regardless of the cost" is simply the reluctance
to change that is easily overcome.  Between my folks and my friends' folks, I don't
know of a single one who wants to go back home after living a week or two on this
facility.  In fact, the experience has been identical in all cases I've witnessed.
Lots of resistance and some tears on "moving day".  By the second day, when all the
personal possessions are in place and the moving boxes removed, they're OK.  By the
end of the week they've planted root and are thrilled at being pampered and waited on
and having someone to talk to and not having to cook and....

To those who say "It's my right to stay home", well, respectfully, no, it isn't. Once
you become dependent on others for your care, unless you can pay for it all out of
pocket, then you have to respect the rights of others, including taxpayers.  Plus we
all know how age impairs thinking.  Especially considering the effects of low oxygen
sat from breathing problems, the meds and perhaps undetected mini-strokes.  At some
point elders simply cannot think clearly enough to make major decisions on their own.
We're all very fortunate that Mom has realized that and now relies on my brother and
me for the major decisions and we, in turn, do what we think is best for her.

Wrapping this up, Miss JonquilJan, I don't know your situation so of course I can't
offer hard advice but I can suggest this.  Look at the alternative arrangements
available to you and think about whether your quality of life would be better there
or at home.  Think about having most of the daily chores lifted from your back. Think
about not having to cook again unless you want to.  And think about what impact your
staying at home beyond the point where you're able has on your friends and family.
We all have an obligation to take care of our elders but IMO, that obligation should
not extend to near total disruption of our lives.

John

From: John De Armond
Newsgroups: misc.rural
Subject: Re: Benefits Of Rural Living
Date: Tue, 29 May 2007 21:53:46 -0400
Message-ID: <nglp53h5o30nr6nelfmd5dmvdegfn0ggn5@4ax.com>

Amen to all of that.  (can't believe we finally agreed on something :-)

Looking back on what it took to get Mom where she is now and knowing that I'm a
single guy without relatives who will probably remain single has made me do a lot of
thinking.  It has also made me take some concrete actions.  I'm either doing or have
done the following:

1. Making arrangements with my family lawyer (finding one that can be trusted is
another uniquely rural benefit!) about what I need to do to enable him or his
successors in the firm to do all the stuff that will be needed transition me from
independent living to assisted care.  That includes power of attorney to liquidate my
assets to pay for the facility and all the other myriad other things.  I want it set
up so that with one statement I can initiate the whole train of events.

2. Moving some extremely illiquid assets such as real estate into instruments that
are more easily liquidated by a third party.  Bonds, CDs, that kind of stuff.

3. I've made a video of me speaking to my future self about what we did for Mom and
how well off she is.  I'm hoping that I will be able to watch this video 15 or 20
years down the road without thinking "silly young whippersnapper" and have it knock
some sense into my no doubt stubborn head.

4. I've filed a note in my mental PDA to evaluate potential facilities as I travel
around, and to investigate making long term advanced reservations.  I'm still a bit
young to put down a deposit on a place, though recent health problems may accelerate
time a bit more than I'd like.  Nonetheless I want to be "up" on such things AND have
my attorney aware of my preferences.

A few years ago I was dreading my "dotage".  After seeing how comfortable, happy and
well cared-for Mom is, I'm kinda looking forward to it.

If I may restate Janet's central point - don't wait until it is too late to try to
choose your future path.

John

On Mon, 28 May 2007 19:24:25 +0100, Janet Baraclough <janet.and.john@zetnet.co.uk>
wrote:

>    We lived in a rural area which was too far from  homecarers' idea of
> "civilisation" for  them to be interested in living or working. We had
>three elderly, single neighbours living alone out of sight and earshot
>of anyone else.
>
>     What happened to each of them in turn, may be a warning to Jonquil.
>It certainly made us rethink  how we plan old age (especially, for the
>survivor when one of us dies).
>
>     What happened was that they hung on and hung on with occasional,
>and sometimes quite intensive support, from family or neighbours. The
>tipping point at which that became impossible, happened very sudenly
>indeed; a fall, an infection, a diagnosis, the sudden need for 24-hour
>care, or, the sudden, permanent removal of the means to independent
>travel. When the sudden tipping point came; they had all left it too
>late, and had no choices left. They had to accept whatever emergency
>residential care had a vacancy at zero notice. Unfortunately, this was
>never the residential place they would have chosen.
>
>    The lesson from their experience that we learned was; the last move
>you make is one of the most important in your life. You MUST make it
>while you are still physically strong  and mentally competent enough, to
>decide for yourself where YOU would like to spend the dependent time of
>your life, and get yourself there.
>
>     If you leave it to distant relatives, they are likely to choose a
>place far from your home, where they can more easily visit and supervise
>your care. This means a huge upheaval and you will perhaps never see
>your elderly social friends again. If you have no family, and are judged
>to be mentally incapable, the decision for your care will be made by
>strangers, professionals who have no idea of your personal tastes and
>preferences.
>
>    If you know exactly where you want to go, but leave the move until
>circumstances force you to leave your home, you may find your chosen
>place has no vacancy  available at that time. You will end up somewhere
>you did not want to be.
>
>     I intend to retain a degree of autonomy by selling my properties
>and  buying into  residential care at a time and  place of my choosing.
>The compromise I'm willing to accept to get what I want, is that I will
>have to make the move while I am still physically and mentally capable
>of independent living..
>
>      Janet.
>
>

From: John De Armond
Newsgroups: misc.rural
Subject: Re: Benefits Of Rural Living
Date: Wed, 30 May 2007 15:36:34 -0400
Message-ID: <0tjr53p2m49a95ihfq7smvdodqr9nt4cr2@4ax.com>

On Wed, 30 May 2007 13:19:54 +0100, Janet Baraclough <janet.and.john@zetnet.co.uk>
wrote:

>   BDDT. I think you've left a bad loophole; the benefit of Power of
>Attorney, is to have it set up in such a way that if you suddenly or
>gradually become so mentally impaired you CAN'T make the triggering
>statement, The POA will still roll into action. We have a  condition of
>" mental incapacity";  when (named, impecccably trustworthy and
>qualified) persons judge we are incapable of acting in our own best
>interests. (Either by sudden event, or gradual dementia). The POA will
>roll into place so that our assets, and care decisions, can be managed
>by third parties.

That's included, I just forgot to mention it in my post.

>    The only Terminal Arrangement we haven't yet done, but keep meaning
>to, is  something called here an "Advance medical directive", aka,
>"living will". An AMD is for when the patient is no longer able to
>communicate their wishes, and is legally binding on doctors and
>hospitals. There are certain circumstances (like my uncle's)  in which,
>neither of us intends to be resuscitated, or kept alive on a ventilator
>or by artificial feeding.

That's a problematic area here in the US where the "medicate 'em regardless" medical
lobby has kept living will laws weak.  Living wills are generally complied with
unless and until some moral high-horse of a doctor decides that "feeding the corpse"
is the "right thing to do".  All he has to do is get a court order (frequently by
phone via the hospital legal department's cozy arrangement with a judge) and both the
patient's and the family's wishes are overridden.

We ran into that with my grandmother.  We detected this doc's meddlesome nature in
time to fire him before the living will showdown happened but it was a close call.

Lacking a strong living will law, I've had to do everything I can to incent AGAINST
prolonging my life after it should be over.  No organ donation (don't "want to be
kept alive until recipients are found").  Strongly worded living will so that there
will be no question in some judge's mind about my intent.  Going to donate my body to
science, probably the Body Farm.  Trying to find a doc who quietly practices medical
euthanasia. Ideally, my last doc would be Dr Kervorkian but since he's otherwise
occupied...

My absolute worst fear is having to die like both my grandparents did - wasting away
in a nursing home and then hospital, any sense of life having long since departed.  I
want to go like my uncle did - sitting in his easy chair napping.  If that isn't
possible because of illness then some fine narcotics will be just peachy.

John

From: John De Armond
Newsgroups: misc.rural
Subject: Re: Benefits Of Rural Living
Date: Wed, 30 May 2007 20:12:20 -0400
Message-ID: <8b4s5394crbcvrb8ghp2bu058n6q6vee4q@4ax.com>

On Wed, 30 May 2007 17:51:50 -0600, AL <lithar@hamiltoncom.net> wrote:


>> Some people do all the paperwork correctly, but make the huge mistake of
>> not confirming with their doctor that he/she would be (or not) comfortable
>> with adhering to those guidelines.
>
>
>I suppose a few Drs would drag their feet but I think most would welcome
>the decision being made for them. In the types of situations where a
>living will is useful, the Dr already understands the futility of heroic
>measures, but absent the living will, they are bound by law, and I guess
>ethics, to pursue whatever means are at their disposal to keep the meat
>alive.

There's a relatively new problem that you need to be aware of.  This is, that many
GPs are giving up their hospital privileges and no longer administer care to their
patients when they have to be hospitalized.  The reasons are many - malpractice
rates, the hassles of daily rounds followed by a full day of managed care private
practice, the advent of hospital staff doctors who do not see private patients and so
on.  They have a fancy new title for this kind of doc.  I'm wanting to say
"hospitalist" but that doesn't sound right.

Unfortunately my doc is one of those.  We had a conversation about this and I fully
understand his perspective.  Nonetheless, this leaves me a the hands of total
strangers if I ever end up in the hospital.  A frightening thought.

John