Hannah and her sisters

This is one my favorite scenes from the movie, Hannah and her sisters. Kip I hope you see my blog because I know you are a Woody Allen fan. Woody's character has been having a crisis of faith throughout the entire movie and has tried all kinds of religions trying to find something that resonates with him when he finally reaches a moment when he feels he cannot go on with his life with the fear of death hanging over him.

It reminds me of something that I went through in my mid twenties. I went through a period of hypochondria and I became kind of convinced that I had lupus or a brain tumor. I began having panic attacks and couldn't even drive by a funeral home near my house without freaking out. I was sure that I was dying even though my doctor couldn't find anything wrong with me (and was getting really irritated with me) I was really racking up the doctor's bills. Eventually, I went to this woman's mental health clinic where they charged on a sliding scale. The therapist, who was probably a student doing her field placement, asked what the problem was and I told her that I was scared of dying and she said "don't you think everyone is scared of dying?" Well that had never occurred to me to be honest and just knowing that everybody felt that way made me feel a whole lot better. It is so important for us to know that we are not kooks but so often we think we are alone in what we feel. I saw in the paper that Heather Locklear was pulled over for suspicion of driving under the influence and the article mentioned that she had been in some kind of program for anxiety and depression recently. It seems that none of us are safe from anxiety, depression, fear of getting older and fear of death, no matter how beautiful or famous. If you have ever seen the movie Brian's Song, you know that in the opening scene the narrator says, "Ernest Hemmingway once wrote that all true stories end in death, this is a true story." Very sad movie! The fact is regardless of what comes next, our lives are true stories, rich, poor, famous, homeless, we all share the same ending (so there, Donald Trump get over yourself), at least to this life on earth, what comes next? That is a topic for another blog.

Some interesting statistics

First of all let me tell you about something that happened to me. The hospice nurse had come to my mother's house for the first visit to see my grandmother who was dying. We were sitting at the kitchen table talking and she told my mother how lucky she was to have daughters because they are the ones that usually will take care of you when you get older. The nurse said laughingly that she only had sons. I told her don't feel bad that I don't have any kids to take care of me when I get old and she looked at me and said quite seriously, "get long term care insurance." The problem with long term care insurance (basically nursing home insurance) is that how is someone who doesn't even feel comfortable buying wrapping paper the day after Christmas suppose to be optimistic enough to plan for nursing home care. It's the ultimate jinx! But on to the statistics:



Information from the Website Angelfire.com



For most of us, Medicaid will be our only option for financing nursing home care and then will do so only after taking everything we have. A 1996 law makes it illegal to shift assets to qualify for Medicaid and protect what you own like a house or any money that you have.



Most financial planners recommend that long term care be purchased in your late 50’s or early 60’s (I don't know about you but that is later than I thought). Premiums are based on your health, age and the plan you purchase. You must make three main decisions: how much do you want the insurance to pay per day towards nursing home care, how long can you afford to be there before the benefits kicks, and how long you wish the benefit period to be(the number of years the benefits would be paid keeping in mind the average stay in a nursing home is 2 ½ to three years)

That is something to think about.



Some interesting stats from Rubins.com



The cost of caring for a disabled older adult in the community has been estimated, according to an article in Gerontologist (Harrow et al 1995), as $9600 while institutional care was estimated by Spillman et al, 1995, at $30000. (another site that I looked at said $50,000) I guess it depends on the kind of care someone needs in the community because 24 hour a day care at $8.00 an hour would be close to $70,000. Which I guess explains why medicaid pays for nursing homes but not total in-home care.


"While only twelve percent of nursing home residents are between 65-74, 45% are over 85 years of age. It is estimated that anyone over 65 years of age will have a 43% chance of spending some time in a nursing home. About 24% of these individuals will spend less than a year in residence at a nursing home."


Interesting information for those of us don't live in the same area as our parents from the Rubins website:

"The costs continue to rise steeply for "long distance elder care". In a study done by the MetLife Mature Markets Institute, Westport, Ct. and the National Institute for Caregiving, a Bethesda, Md. nonprofit it was estimated that long-distance caregivers average about $392 a month, compared to $196 seven years ago."


"The expenses include travel, medicine, phone bills, medical supplies, meals and home maintenance. An estimated seven million Americans are long-distance caregivers. A long-distance caregiver is defined as someone who care from afar for a chronically ailing person. Among the 80% if the long-distance caregivers who are employed, 44% have rearranged their work schedules. Thirty-six % missed days of work, with an average of 20 work hours a month lost to caregiving duties."



Depressing stuff:

About 1.5 million Americans live in nursing homes. About 70% of people with dementia die in nursing homes. There are approximately 18,000 nursing homes in the US. 2/3rds are for profit and 55% are chains. 50% of nursing home residents have no close living relative and 60% have no visitors. (this makes me want to cry)


Consumer Reports says that non-profit nursing homes that are not part of large chains tend to provide the best level of nursing care.

Let me finish by saying that working with senior citizens I see that having children (daughters or sons) is no guarantee that there will be someone to look after you in your old age. It may not go along with our code of ethics but some of these adult children need to be grabbed by the shoulders and shaken briskly. "Wake up, this is your mother and she needs you, would a phone call every other day kill you"

Sara

Dead Poets Society

I was just thinking about a scene from Dead Poets Society where Robin Williams first meets the new students at the private boys academy he is teaching at. It is a very uptight academy where the students are taught dry subjects like Latin by rote but Robin is this rather eccentric character and the first thing that he does when they enter his class for the first time is take them out in the hall. He has them read from Wordsworth (I think), "Gather ye rosebuds while ye may" and asks them to look at the photos on the wall of past classes from like a hundred years ago and he tells them to look closely at the faces of the young men in the pictures and then he points out that now these young men in the pictures who are so filled with promise are all dead, fertilizer for daffodils. "Seize the day, make your lives extraordinary" he tells them. Actually I really never cared for that movie (or Robin Williams except for maybe The World According to Garp and certainly not Mork and Mindy or the god awful Patch Adams) but I went to a training class about five years ago and I hate trainings because they are usually boring and awful but this one was so good, and the trainer showed that portion of the video to illustrate how teaching can really inspire. I was working in training and development at the time (kind of ironic considering my previous comment about training being awful and boring) and I began showing that video snippet in a training class we did. I don't know that others were that moved by it but I always felt like running out and accomplishing something great after watching that. Damn it, I am going to seize the day! But then about four hours later I'd be at home watching Project Runway or shopping at Target, making my life rather ordinary. I think this ties into my topic in that people come to the end of their lives with regrets and how do we as social workers help them accept their life has had meaning and come to terms with their impending death and have some resolution. I took a class in Sociology called death and dying, and we talked about the five stages of dying according to Elizabeth Kubler Ross. I'm sure most of your remember that. Denial, anger, bargaining, acceptance (I forget the other stage) but how do people reach acceptance. How does a social worker with hospice help a patient accept that they have done the best they could and help them die in peace? I don't know but I guess we can start by "meeting them where they are at."

Why this topic?

In March of this year, my last living grandparent passed away at the age of 93. I was able to spend the last week of her life with her and though she was unconscious while I was with her, it was very meaningful to me to be there with her. Hospice made it possible for her to die in her bedroom at my parent's home where she had been living for the past three years. My grandparents were lucky in that none of them spent the last of their days in nursing homes. None of them had lengthy illnesses. It's sad that so many of us will say that we hope we die before the need arises to go into a nursing home. Not having any children, I have thought the same thing many times, "please let me die before I can no longer take care of myself!" Anyone who has visited a nursing home, especially a bad nursing home, has probably seen the vacant eyed old people sitting in their wheelchairs in the hallway because the nursing home is required to have them out of their room for some length of time, the weird smell of the place and the sterile environment. I know that there has to be a better way. I remember sitting with my grandmother when she was dying and looking at the picture she had hanging on the wall of her and my grandfather when they were in their twenties. It is so easy for people who work with the elderly to forget that they were once young. They were not always old and frail. I am starting a job this week working with persons who are elderly and low income so I think this topic will be meaningful to me for my job and for myself. Each post will discuss a different end of life topic like hospice care, nursing home care, alternatives to traditional nursing home care and living wills. This song that is playing, the Wabash Cannonball, was a song that my grandmother would sing to me when I was sitting on her lap as a little girl.
Sara