I sometimes have people ask my opinion about reverse mortgages, and I have to tell you, I'm not a fan. I think the number of people for whom a reverse mortgage is a truly good idea is extremely small, and for too many people I think they are downright dangerous products.
Now, in the spirit of full disclosure, I got a great deal on my house because it had a reverse mortgage, and the heirs were desperate to sell quickly so they could pay the reverse mortgage off, so I guess I would have to say a reverse mortgage was good for me, it just wasn't MY reverse mortgage.
Anyway, I bring all this up because the AARP has sued HUD over a rule change that is putting a small number of reverse mortgage holders under the threat of foreclosure. The New York Times has an excellent article on the story, which includes some great links of it's own to other sources of information on reverse mortgages.
I encourage everyone to read this article, and follow some of the links included, to learn more about reverse mortgages.
Some of you may know that I've done some presentations on hoarding. I've recently been reading the book Stuff: Compulsive Hoarding and the Meaning of Things by Randy O. Frost and Gail Steketee. Frost and Steketee are the gurus of hoarding, and I think Randy Frost is a consultant on at least one of the popular hoarding shows on TV.
Any time I have done this presentation it seems that most people in the audience know someone they suspect is a hoarder, are related to someone who hoards, or they worry that they themselves are hoarders. Frost and Steketee report that between 2-5% of the population, or anywhere from 6-15 million people hoard. That's a lot of people with a lot of stuff.
I'm only part of the way through the book, but I'll share some tidbits:
Hoarding may not be as closely associated with Obsessive Compulsive Disorder (OCD) as once thought. Rather, it seems to be more characteristic of an Impulse Control Disorder (ICD), like kleptomania or compulsive gambling.
Hoarders often place high value on things that appear to be junk to the rest of us. They have difficulty distinguishing between things with true value and things that are trash.
Perfectionism appears to play a major role in hoarding.
Some studies have indicated a high correlation between compulsive gambling and hoarding.
There also seems to be a connection between possessions and a sense of security, with some people starting to hoard after suffering a severe trauma.
There's no doubt that this is a complex and difficult issue to deal with. I will keep you posted as I work my through this book.
Thanks to Robert Kraft (one of those facebook "friends" I don't actually know) for bringing this to my attention.
The New York Times has an excellent blog called the New Old Age.I don't get around to reading it often enough, but this recent entry is very thought provoking. The blogger writes about a recent study published in the Archives of Internal Medicine (the full article is only available by subscription). The study found that people with late dementia are frequently hospitalized too often, with medical symptoms and conditions that could have been treated in their nursing homes.
The study only looked at nursing home residents, and it found that over an 18 month period, 30% were hospitalized. Dr. Susan Mitchell, one of the researchers estimated that fully 75% of those hospitalizations could have been avoided.
So what's the problem? Dr. Susan Mitchell's comment: “Being in an emergency room where people are taking blood and putting in IVs in this crazy, noisy setting — it’s been described as an ‘assault,’ and I concur." If you don't know someone with late-stage dementia, allow me to describe someone I know.
This gentleman has been in an Alzheimer's care home for the last two years. He still recognizes me as someone he knows, but he has no idea how or why. He thinks he's known me for a very long time, but we have only known each other for a few years. He does not always remember his children's names. He is not able to carry on a conversation about anything, although he does still talk. It is reported that he eats a lot, but in the past year he has lost at least 30 pounds, and this over six foot tall man is wearing size small shirts.
Thankfully his family has him on hospice, so there won't be any unnecessary trips to the hospital, but how do you help someone in this state understand what is going on around them? How do you communicate to them what the IV is for? How do you keep this person calm without drugging them? And for what end? When we, as health care professionals or family members insist on sending someone like this to the ER to be treated for pneumonia, are we doing it for the patient, or are we doing it for us, whether it's to cover our backsides (in the case of a health care professional), or because we aren't ready to let a loved one go?
It does seem extreme in some ways to consider this kind of treatment assault, but once you have seen a frail, older adult, who doesn't know or understand what is going on, who only wants to be left in peace, being forced to stay in the hospital for aggressive treatment, you might agree that it is an assault. I happened to see a former colleague earlier this week, and when we worked together in a hospital he had one of these horrible situations. The patient was on a ventilator, he had multiple infections, he had pressure sores, he was on dialysis, and he was like this for MONTHS. His children would not let him go. It was so bad that there were nurses who refused to take care of him, because they felt it was assault. When his family finally agreed to take him off all the machines, he died before they got everything turned off.
We have to start talking about this. We are all going to die--that is one thing I am sure of.
According to a story in the New York Times, the FDA is getting closer to approving a scan that will help diagnose Alzheimer's disease. Right now, we can't definitively diagnose Alzheimer's disease until death, when an autopsy can be done. What a lot of people don't realize is that not only are there many types of dementia, but other treatable medical conditions mimic Alzheimer's.
Other types of dementia are related to vascular problems, such as having several small strokes, or Parkinson's disease. In these cases it might be possible to better treat the cause, especially with vascular dementia, to slow or stop the decline. Depression, which is very treatable, can also mimic the memory loss of Alzheimer's. Delirium is another condition that can look like Alzheimer's. Delirium is frequently caused by an infection, and infections are often successfully treated.
This is good news, because it gives doctors the potential to definitively rule Alzheimer's in or out, allowing them to properly focus their treatment. The article says full approval is still several months away, but it's certainly a great stride forward.
Thanks to Monica, one of the attorneys here at Katten & Benson, for sharing this great article about the oldest African American, Mississippi Winn. Miss Winn died recently at the young age of 113. Another amazing fact about her is that she was one of two known people left whose parents were likely born into slavery. Her niece said that even though she was 113, she thought she was young. Her family thinks one reason she lived as long as she did was because she just handled things as they came, of course, no husband or children might have been a factor as well.
I have my own Miss Winn story. Many years ago, when I still worked in the hospital, one of my patients was a nun, Sister Winifred. At the time that I knew her, she was 101. She was mostly deaf, and didn't see well, and she used to tell us that she figured God decided she had seen and heard enough.
She had been a teacher for many, many years, despite the fact that she did not really want to be a teacher. But she became a teacher anyway, because that is what the Church needed her to do, so she did it. Despite this, she had middle-aged, former students visit her in the hospital. I suspect teaching truly had been her calling, because she had clearly been beloved by many of her students.
The day I told her she was going to be discharged and would be able to return to her convent, she took my hand and said this to me: "I will pray for you every day for the rest of my life. I know that won't be long, but I will pray for you every day". She ended up living another three years. I never doubted that I was in her prayers.
Knowing her for even a short time was a gift I will always cherish. I hope all of you have the opportunity to be touched by a remarkable older adult.
I knew it had been a long time since I had posted anything, but I didn't realize how long. Clearly it's been a busy autumn, and now it's only four days until Christmas. The presents are bought and most are wrapped and under the tree, but I still have baking to do, and a house to clean up before my youngest brother and his family arrive from North Carolina. They'll be here for more than a week, and while I will love having them here, there will be no restful time during this holiday season. I've given myself a pass on Christmas cards this year, but somehow it's hard to let that go.
I did want to share this intriguing blog post I just read from the New York Times about parent-child relationships. A gerontologist at Cornell University did some research and found that parents will talk about having a favorite child, and how that sometimes influences who the chosen caregiver is. Kind of interesting reading, not sure what I think about it.
Anyway, I do hope everyone has a Merry Christmas, a Happy Hanukkah, a festive Kwanzaa, and a safe and Happy New Year!
I've been thinking a lot about end of life issues lately. Partly because we talked about it in class this week, partly because the 27th anniversary of my Dad's death was earlier this month, and partly because I'm going to 2 funerals in the next few days
The funerals are the worst part of middle age, as far as I'm concerned. Although I bet it gets worse when it's my friends who are dying, and not their parents.
During this week's lecture, and then with a facebook chat with a friend, I've had the opportunity to think and talk about the fact that we don't do grief and mourning well in this country.
We're lucky if we get 3 days off when someone in the immediate family dies, and if it's a cousin or an aunt or uncle, we're fortunate if we can take the few hours it might take to go to a local funeral. Once the funeral is over, well, that's all she wrote. We are expected to go back to work and get on with our lives like nothing happened. I read an article that popped up on Yahoo this week, and Michelle Williams (she was married to Heath Ledger) was talking about hard it was after he died. She made the comment that in Victorian times we got to wear black, then gray, then mauve, then pink, as we moved through the mourning period. Today there is no acceptable outward manifestation of our grief, and I think that's a shame.
The other thing that's gone the way of Victorian times is the vocabulary of grief. We don't know what to say to each other when we grieve. Platitudes like "He's in Heaven now with his Dad" (said to my mother when my 22 year old brother died) can cause more pain than comfort to some. My Dad was only 50 when he died, so Mom's response was that both of them were too young to be dead. As one friend pointed out, after his father's death, getting syrupy sympathy cards only made him dread more cards, and his father was still dead as a doornail.
I know that I struggle with knowing what to say, what to do, how to comfort those who are in pain. And looking back at the times I've been in mourning, it's hard to say what helped the most. Except I know my friends showing up at the funeral meant a lot, my friends making me go to baseball games I didn't care about meant a lot (during my Dad's illness--thanks, Roger), and my friends who pulled me forward and out of the daze of grief meant a lot. It wasn't so much what anyone said, but absolutely what they did.
