As Bill Mahr humorously, but perhaps, ineloquently stated as a “New Rule” last Friday night on his HBO show “Real Time,” the feds have been investigating the rising costs for durable medical equipment to see if certain types of equipment should be added to the competitive bidding list. Enter the swelling controversy surrounding the penis pump, more formally known as the “vacuum erection system.” Over the five-six year period between 2006-2011, Medicare paid an average of $451 per pump. That left a $90 co-pay per patient with Medicare picking up the remaining 80%. Comparatively, the VA paid only $186 for each device. And, is anyone surprised that any average shopper could find less expensive pumps online? Medicare purchased 473,000 pumps over the period investigated. Predictably, there is controversy underlying adding these devices to the competitive bidding program, as many conservative groups argue that these expenditures are wasteful and detract from true “health” related expenditures.
But, perhaps we shouldn’t jump past the “health” aspects of sex so cavalierly. Sure, in 2006 Congress barred medications like Viagra from being covered under Medicare Part D, the bill’s sponsor stating he didn’t want to have taxpayers subsidizing “grandpa’s recreational sex.” But, there is a larger bias here that is arguably being overlooked: the health aspects of sex in any adult human’s life. The clear bias exists that seniors are, or should be, asexual. Yet, how is that any different from the argument against younger, college age women who many on the left have argued should be insured for birth control pills. It seems at some base level, Americans are just prudish at worst or giggling adolescents in general when it comes to a healthy discussion about human sexuality. Is sex really just to procreate? Recent studies say no and that more than half of men and 40% of women over age 65 are sexually active.
So, at least one author urges that we just insist that Medicare not get ripped off by price-gouging device suppliers and continue to cover the devices, perhaps as well Viagra and then the discussion will shift to condoms and safe sex and STD control for seniors as well as the general population. This all in the name of health and to avoid “ageism.” At some point, we all must address the limits the system can bear and the “Pentagon-Contractor” nature of the abuse and over-charging that is a huge source of the problems. One thing is for sure, as millions of Baby-Boomers age into retirement, “No-Sex for Grandpa” rules probably are not going to work.
If your older relative has a long-term care policy, photocopy the page listing the company, policy number and claims contact information. Keep the insurance company updated on new addresses, yours (if you are the third-party designee) and your relative’s. It wouldn’t hurt, if the policyholder is becoming forgetful, to check bank statements or call the company to make sure premiums are current. One story reported by the NY Times shows the calamity that befell a Virginia family because paying the premiums slipped dad’s mind. State legislatures seem hesitant to correct the problem by mandating insurance companies give more formal notice to policy holders or their third-party designees.
A Boston College study conducted from 2003-2005 shows that the impact of abuse never fades. The study surveyed over 1,000 participants and ranked them into the following three categories: 1) those with no history of childhood abuse or neglect; 2) those who had been abused and were caring for their non-abusive parent; and 3) those who had been abused and were, to borrow the study’s memorable title, “caring for my abuser.” Researchers also compared caregivers neglected as children with those who were not neglected.
Unsurprisingly, adults who were abused by their parents as children were more likely to show signs of depression, like lack of appetite, insomnia, trouble concentrating, sadness and lethargy, when caring for those elderly parents as adults. But a stronger link arose for those category 3, caring for the abusive parent. Those abused children caring for their abusive parent were still affected by that abuse and suffered from more depression than those in the other categories.
So, a person falling into one of these categories, especially category 3, has to really ask themselves whether they wish to subject themselves to this kind of risk to their own health as adults. Worse, this finding raises the ugly specter of whether the abused child will succumb to the increased risk that they will abuse their charges, perpetuating a sorrowful cycle, if the care-giving becomes overwhelming. Clearly, the natural feelings of revenge could easily surmount any obligatory honor or other societal barriers that otherwise keep in check these more primitive urges.
Whether it is those that are forced to care for their elderly parents who were abusive to them when they were children because there is no alternative or if there are other factors which place the adult children in such a precarious position, those who must engage or who choose to engage in the caregiver role must steel themselves for the impact on their own health. They should be aware of the signs and symptoms of depression and methods of dealing with it such as therapy or support groups. What is clear is that more resources need to be made available to care for the aging other than reliance on unpaid family caregivers. For, as this article concludes, “Not only nice people get old.”
Expecting a continued battle over health care, the White House moved Wednesday to recruit volunteers for its campaign to defend and promote the law, which is likely to be a defining issue in many congressional races this year. A White House website invites supporters and beneficiaries of the law to provide their names, email addresses and personal experiences.
“Whether you have new coverage today or know someone who does, we want to hear your story,” David Simas, an aide to President Obama, said in an email to people who had expressed interest in the issue.
Jessica Santillo, a White House spokeswoman, said the invitation was part of a systematic new effort by the administration to “highlight stories of everyday Americans benefiting from the law.”
The administration hopes to encourage enrollment and reverse public opinion polls that show approval of the health care law lagging behind disapproval.
Following are five suggestions that may help elderly family members better enjoy the holiday festivities when all the younger family members are stirring up a ruckus celebration:
1. Prevent your elderly family members suffering from dementia from too much excitement or things like camera flashes, multiple blinking lights, over-exhuberant youngsters asking too many questions and generally just too many simultaneous visitors. Their own inability to process information at the same pace can lead to frustration and disruptive behavior on their part in response.
2. Try to help the elderly stay in a good frame of mind by playing softer music and familiar songs to soothe their mood(s). Perhaps predictably, those suffering from various forms of cognitive impairment, such as Alzheimer’s or other dementia, have shown positive reactions to hearing their favorite kind of music.
3. Protect your aging parent with dementia from loud noises, even loud talking and laughter that seem part of a normal day of celebration. A person with dementia can become upset by loud noises, even if they are happy sounds.
4. Like most of us, but especially those elderly suffering from cognitive impairment, need quiet time, for rest, reflection and repose. Too much conversation and holiday excitement among family members can agitate the elder. Subtle signs of fatigue or frustration are indicators that a break from the action is appropriate for them.
5. Stay on their current schedule. Keep the elderly family member(s) eating at that same times that they always do. Otherwise, disrupting their routine could create unnecessary stress or confusion.
Our thanks to Dr. Mikol Davis at http://agingparents.com for this information.
The Consumer Financial Protection Bureau has published new guideline booklets to help lay persons properly manage other people’s money when acting as a fiduciary. For example, if you are managing money for your elderly parent or anyone by virtue of that person naming you agent under a power of attorney, you are subject to fiduciary duties the breach of which may subject you to a lawsuit or other legal action. So, to help ensure you stay within the bounds of what the law allows you to do, it’s worth taking a look at these brochures and make sure anything you do stays within these bounds.
A study by the Veterans Affairs Medical Center in Durham, North Carolina, shows that the top concerns of terminally ill patients and their families are the following:
Prevention of pain is most important. People fear dying in pain more than they fear death. These folks need reassurance that pain management is available.
Patients want to be involved in decisions regarding their treatment. The study doesn’t report it, but it may well be that loss of control or the desire to maintain control are part and parcel of this driver.
Patients and their families want to know what to expect from the fatal condition and treatment. Again, although not specifically reported, it seems reasonable to infer that removal of a degree of uncertainty about what may help people better cope with their predicament.
Dying persons and their families search for meaning in their lives and relationships at the end of life. Practicing one’s faith, life review, and saying goodbye were listed as important activities.
Perhaps interrelated with the previous finding, altruism becomes more pronounced in people who are dying, as the study showed people want to contribute to the well-being of others. They find peace in helping loved ones come to grips with their impending death in order to let them go. They also like to leave behind means to care for the needs of their survivors.
Patients want to be seen as a whole person, not a disease.
Research from this study and others indicates that it is helpful to talk openly about death and to give your care receiver a chance to talk about death. Thus, doing away with the placebo of denial seems to work more fruitful results. If the patient allows an opening such as, “When I’m gone” or, “I need to get my finances in order,” take it. If the uncomfortable is not discussed, or the chance is missed and it doesn’t come up again, direct questions as to the reality of the situation are appropriate, such as asking, “Are you afraid of dying?” Alsl found to be appropriate are discussions about funeral plans and any advanced directives or other legal matters that have not been completed.
As in other phases of life, arguments with the patient about whether he or she can recover or to remain positive and believe he or she is not going to die are counter-productive. Denial is less than optimal. The study concluded that a care receiver will be more peaceful if their loved ones make it known that they have accepted his or her death and release him or her with love.
According to a NY Times article, two sociologists, one from Purdue and the other Cornell, have studied the family dynamics in America for almost 30 years. And, they’ve uncovered some handy tidbits besides proving that mothers have favorite children, despite taboos, and they thought that all sorts of personal history and relationship issues would factor into who wound up as caregivers for the elders. They figured it would be those children who were closest to their mothers emotionally, who had earlier received support from their mothers, and who had fewer competing demands on their time like work, spouses or children of their own. Not so: gender and proximity are the drivers. It turns out that women are 2 times more likely to be the family caregiver and the caregivers most likely to assume the role are those children who live within 2 hours of the elder–6 times more likely!
But, this is for the generation of Americans that had multiple children–a trend not carried forward predominantly in our current generation of Americans not yet in their later years. So, perhaps a light is shining on this new reality of aging: who will take care of this generation of Americans when they reach old age–they have only 1 or 2 children and many are childless. Clearly, the burden will fall on society at large, and this inevitably means the taxpayer. Now, it should be more apparent why the risk pool has to be increased, and thus, the vehicle most likely to succeed appears to be the Affordable Care Act.
When NPR Radio host Scott Simon tweeted from his mother’s deathbed, he opened a window into the usually-private process of dying.
Jody Schoger, another cancer survivor, thinks that “the more we talk and write about death, the easier dying becomes … if you know what’s going to happen, and how it can happen, you can make some plans, know what kind of questions to ask, make your wishes known so that your family and your doctor know what you want.”
2. 1 billion new family records publicly available
Thanks to FamilySearch.org and Ancestry.org teaming up.
3. How to close your online accounts
Just Delete Me is a huge-and-growing directory of links to account deletion pages. It’s probably worth spending an afternoon going through the directory and deleting any accounts you don’t regularly use.
4. ♫ I don’t want to live forever (online) ♫
It turns out most people don’t, but one-fifth of Britons surveyed haven’t even thought about what will happen to their online accounts after they die.