Tuesday, January 27, 2009

It's Never Too Early to Plan

Back in the early '90's I went on a wonderful sailing vacation in the British Virgin Islands with a group of friends. We spent time researching charter companies, we researched the islands themselves, we planned menus and even took groceries with us. Once there, we shopped again for provisions, we read maps and charts, and we plotted the course for our two weeks in the islands. Before we ever got there, we knew we wanted to go to Foxy's on Jost Van Dyke, Cane Garden Bay, made famous by Jimmy Buffett, and the Baths on Virgin Gorda.

All in all, we probably spent more time planning for and anticipating this vacation than we actually spent on the vacation. I suspect many of you have had similar experiences, whether it's a vacation trip to Disney World or a camping trip to Big Bend.

I bring this up because I heard somewhere recently that many people spend more time planning a vacation than they spend either on planning for retirement, for later life health issues, or how to manage finances in later life.

This was something I had never thought of before, but as I have been thinking about it, I'm sure there is a lot of truth to the statement. One thing I have learned is that it is never too early to plan for anything, especially something as important as retirement, which has a huge impact on quality of life. Another thing I have learned is to plan for the worst, and hope for the best.

As part of a Life Care Planning Law Firm, this is what I help people do. The Life Care Planning concept is designed to help the older adult with a chronic disease process plan for the future. Traditionally, we have dealt with chronic illness as a series of reactions. We feel bad, the doctor prescribes medicine, we get worse, we go to the hospital, maybe we have surgery, maybe we go home; and the cycle starts over again. Too often the patient is a passive participant in this process, with little input or decision making capacity. My goal is to help people take responsibility for their health and health care needs, and to become a more active participant in the decision-making process.

In future posts I'll give some examples of how this new way of planning has been able to help people.

Tuesday, January 20, 2009

The American Way

There was an article in the New York Times today titled "A Front-Row Seat as a Health Care System Goes Awry" (http://tinyurl.com/7y8urf). The article is an interview with Dr. Robert L. Martensen, a former ER doctor. Dr. Martensen has written a book called “A Life Worth Living: A Doctor’s Reflections on Illness in a High-Tech Era.” I have not read the book yet, but I will be interested to see what his reflections are.

One thing he does talk about in this interview is the American way of dying. I have seen what he talks about far too many times, and I'm glad to see that at least one doctor recognizes the disservice that happens too often as patients and families face end of life issues. Dr. Martensen talks in the interview about doing ethics consults where there is no hope of recovery, and yet the doctors involved are reluctant to tell families this, in the name of keeping hope alive.

I will never forget the family I worked with some years ago. I don't even remember the initial problem that brought their mother to the hospital, but by the time she reached my unit she had several systems failing. This was shortly after HIPAA was enacted, and up to that point no one had talked to the family at all about what their mother's condition or prognosis was. When I took the intiative and talked to them about her condition, they were so relieved that someone was finally talking to them they didn't even care it was bad news.

A few days later, the physician agreed that a hospice referral was for the best, and I ended up having to talk to family about this over the telephone. While the way I had to deliver the information was less than ideal, the family was just glad that someone was finally telling them what to expect and what needed to happen next. I was able to get her transferred to an inpatient hospice unit, and as happens so often, she died just a few hours after getting there.

Dr. Martensen feels that doctors should be realistic, and I agree completely. I have seen 91 year old people put on dialysis, and people with end stage lung disease put on ventilators. I know that it is hard to tell people that there is nothing more than can be done, other than comfort measures; I've had to do it. I have also seen how hospice can be a tremendous support for patients and families, and how it can allow people to have the good death that Dr. Mortensen talks about.

It is my hope that as we start looking at ways to repair our broken health care system, we can work to make sure that more people have the option of a good death made available to them.

Sunday, January 18, 2009

There's No Place Like Home

One of the hardest things I do is help people make the decision to leave home and move to a nursing home, assisted living or retirement community. "Home" is obviously so much more than the roof over our heads. For some, home is where families were raised, with all the good and bad times that families go through. For others, home is where a husband or wife died, and the surviving spouse fears they will lose memories if they leave the house. Home is where all our stuff is; where we know which floor boards creak and how long the water has to run before it gets hot.

I've wondered before if this decision will be easier for people like me, who lived in a dorm, then went on to live in multiple apartments and living situations while in college and graduate school; but I guess deep down I don't really think it will be. I work with people who were career military and lived in barracks as well as all over the world, and they all struggle with the idea of leaving wherever home is now.

I do think that familiarity will make most changes a little easier. I and many of my colleagues are familiar with retirement and assisted living, so we may have a little easier time choosing that if and when the time comes. I was only half joking when I told my college roommate the next move was to assisted living!

I think the best thing we can do when we are helping an older adult with this decision is to try and help with the fear. Offer to take them to visit communities before they need to move. Most communities offer free lunch, and many will even let the prospective resident stay in a guest room for a few days to see what it's like. Encourage them to talk about the fears, and understand that they will experience grief at giving up their home and all that it represents. And always recognize that the decision is hard. It usually means a loss of independence or control, which is never easy. If possible, start the conversation before the move is even needed. It's a difficult conversation to start, but it will make the decision a bit easier when the time comes.

Friday, January 16, 2009

Greetings from Cowtown

To quote a friend of a friend, I never thought I'd be hip enough or cool enough to start my own blog. But here I am, starting my own blog. It seems that things have been guiding to me do this, so I finally decided to take the plunge and get started.

I am a social worker, and for almost two years I have worked for Katten & Benson, a law firm in Fort Worth specializing in elder issues. Now, a social worker in a law firm is a rare thing, indeed, but Steve Katten is a pretty rare lawyer. He is one of two Certified Elder Law Attorneys (CELA) in Tarrant County, and as he tells it, he realized some time ago that many of his clients needed more than the legal services he could provide, and that's where I come in.

While I have a title, Elder Care Coordinator, all you social workers out there know that titles in our business don't really mean anything. We do it all, or at least it feels that way many days! I have regular clients that I see through our Life Care Planning program, and I will talk more about that concept in the future. I also field questions from many other clients on issues like choosing nursing homes, or understanding their Medicare benefits.

One of my passions as long as I have worked with older adults is education, and helping people have the knowledge they need to make the best and most well-informed decisions possible, and that's why I decided to start blogging. I hope that as I run into situations and write about them, you will glean a little knowledge and understanding about growing older, caring for aging parents or loved ones, and navigating our crazy health care and public benefits systems. I don't know how often I'll post, but I hope that you'll check back often and see what's going on here in Cowtown.