Have you considered 'End of Life Care" for yourself, partner, your parents, other family member, or friend?

  • metta

    Posts: 39104

    Oct 16, 2013 6:02 AM GMT
    Have you considered end of life care for yourself, partner, your parents, other family member, or friend?

    I wont go into too much detail but I have recently had to discuss these issues with Doctors and health care providers because of a friend and family member. One Doctor told me that many of the elderly today can get into nursing homes and other similar type places. But that people that are younger who will be at that stage prior to 2040 (at the earliest) will not be able to because the nursing homes will be all too full to admit more: probably because of a combination of the baby boomers and the costs of such health care. He believes that the only option will be in home health care which can get very costly and it typically paid out of pocket. So he warned me to save a lot of money to plan for that. He has known some very wealthy people that spent every last dollar and more on end of life care.

    A little off-topic, but for myself, I wish that euthanasia was legal in California. If I get to that point, I would like it as an option.

    I think that this is an important topic. It is not one that people like to talk about but I think that it is important and that we should talk about it.

    Being gay, many of us do not have children. Many of us do not have partners/husbands. I think that makes it even more important that we try and plan ahead, if we can.


    Bill Gates: End-of-Life Care vs. Saving Teachers' Jobs
    http://www.realjock.com/gayforums/1137164#68686_1137164_name
  • metta

    Posts: 39104

    Oct 16, 2013 6:27 AM GMT
    Most people want to die at home but only 20-30% actually do

    http://www.reclaimtheend.org/fact_sheet.php
  • metta

    Posts: 39104

    Oct 16, 2013 6:31 AM GMT
    An article from 2009:
    The Cost of Dying: End-of-Life Care

    http://www.cbsnews.com/8301-18560_162-6747002.html
  • metta

    Posts: 39104

    Oct 16, 2013 3:33 PM GMT
    Amanda Bennett: We need a heroic narrative for death



    I don't totally agree with her. I think it is important to try and face reality. Hope is good but it also needs to be realistic. I have experienced what she has in regards to not wanting to let go. But it is important to realize when you have to. We already have programs for different scenarios. I'm not sure what changes she really wants. Hospice can be a good program for certain situations when it is known that the person is not going to live for more than 6 months.
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    Oct 16, 2013 8:16 PM GMT
    Yes, these places are extraordinarily expensive. I've been through shopping for assisted living, nursing homes, etc. with relatives. With rising demand from the boomers though, one would expect capacity to expand.

    And some of the expense seems unwarranted. A small apartment for my mother, with cafeteria meals and maid service costs more than my mortgage. Of course, that also gets her a panic button that can summon a nurse in five minutes. But one can imagine small group solutions that could do that with less money.

    And of course, the more assistance you need, the more it costs.

    BTW: I have done a "drive by" of the LGBT senior homes nearby and just judging from the exterior, in comparison with all of the other places I've shopped, the current ones seem to be in the shabby lower tier. But I didn't go inside.

    Also BTW, one thing we learned was that even if you can't afford a place for the long term, it is best to get in while you can still pay for a few years. Once "in," they have specialists to help you find assistance when your money runs out. But if you're already broke and on medicaid, they won't take you in the first place.


    I hardly see the point in a LGBT retirement home, unless they have go-go boys in the cafeteria...
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    Oct 16, 2013 10:51 PM GMT
    Just off the phone with my cuz who called to tell me about her kitchen renovs. During the conversation she brought up an old plan of ours I guess to see if I was still on board. I am. You might find it interesting.

    This is our alternative to home care as normally considered or to a nursing home. My mom was in a facility for her last four years. An extremely nice place but I found it depressing. So what I've been considering with a few friends and family is the idea of setting up a commune later in life so that we can take care of each other.

    I've already relocated to a property with two houses on it and we could build more here as I've the land for it and it is located near lots of medical facilities for older age. Or my brother might wind up on a large ranch out west and we could relocate there. The third alternative that a few of us really like, especially if Medicare goes belly up, is to head overseas, maybe Mexico or Thailand, pool our funds and have a comfy complex or a group of apartments nearby or attached. Then we could bring in live-in help for chores, shopping, taking us to doctors, etc.

    Even in a nursing home, even if I stayed stateside and had my nephew looking in on me, there's no way I'm going to get the same excellent care my mother received with me as her guardian. I've no children of my own. So even spending a shit ton of money here, you could still wind up getting abused, especially in Florida where the help is often from homophobic Caribbean countries. That scares me.

    I like my group's last idea best, especially in a place like Thailand where elder people are not as disrespected as they often are in the states and where sexuality is not such an issue. We could have live-in help and be there for each other to assure our safety. Then as we're aging, we'll just keep a bottle of cyanide handy for the sole survivor. /life
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    Oct 16, 2013 11:00 PM GMT
    Just FYI, a friend's relative was living the large life in Thailand. Country estate, staff, etc. But after he had a stroke, they decided to move back to the US for medical care, at least temporarily (I helped them move in). IIRC, he passed away shortly thereafter. Maybe they chose poorly.
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    Oct 17, 2013 12:17 AM GMT
    Valid, tricky part of the decision making. My brother has already informed me that he has no intention of going to Thailand and I'm sure he doesn't like the idea of dragging my corpse back.

    While the medical care there is supposed to be pretty good, they do not have infrastructure for aging as do we which is why I like the idea when coupled with going over as a group so we can look after each other.

    I sometimes consider going it alone, but I do have one line in my family with Alzheimer's and it's easy enough to get swindled being demented in this country, never mind a foreign one.

    Cost-wise is tricky too. Currently in order to get international insurance, you have to be of a certain age. After 65 or so, many companies lock you out, at least in SEA, not sure about Mexico. And even then, in the 70s and 80s I'd imagine that gets expensive, even overseas.

    At the same time, even though medical care is hugely cheaper overseas, our own Medicare does not currently cover expats but for in the 50 states, DC, and, I think, some territories (USVI, PR, Samoa, Guam). Maybe that will change as more boomers figure out how to survive this.

    Maybe while insurance is affordable a retiree could live overseas but also continue paying into Medicare and then for the big ticket items you'd fly back to the states for medical care after insurance overseas gets out of hand or denied. And all that's after paying into the system for your entire working life. It really highlights how fucked up we are.

    medicare.jpg
  • metta

    Posts: 39104

    Oct 17, 2013 12:19 AM GMT
    I have always liked the idea of communal living but I can't really see myself live outside of California. I really don't like cold weather or a lot of hot humidity. People as they get older feel the cold even more. And high humidity is just not comfortable.

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    Oct 17, 2013 12:39 AM GMT
    I love that video but where's the gay version? That to me is a wonderful life.

    Out of high school I wanted to join a kibbutz but my parents went nutz on my face to go to school which I did instead, one of my many mistakes.

    I've only been to the coast in Mexico and in the summer it was hotter than anything I've experienced. But I understand that in the mountains, where are expat communities, it can be cooler, not cold, and I think as it cools the humidity decreases.

    In Thailand, I understand that one of the main expat areas is Chiang Mai, which is in the mountains so the climate is not like at the beach. But they've some kind of fire burning season when farmers clear their fields and so then the expats head to the beach.

    I actually prefer some humidity to drier air. It's so much better for the skin. When I go up north in autumn or winter, I can't blow my nose without finding blood in the tissue. It's gross. That never happens in Florida.
  • metta

    Posts: 39104

    Oct 17, 2013 12:48 AM GMT
    ^
    I would be very concerned with the high crime in Mexico. Maybe if they legalized drugs in the US the mafia would calm down but until then, I don't think it is a very safe place for US citizens.

    I will say that I live the areas with ocean breezes. I would even prefer an ocean view or even ocean front. But the costs of that is normally ridiculous in most places. But the hot humidity, no thanks. That is why I would not want to live in Hawaii, even though I have family there.
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    Oct 17, 2013 1:39 AM GMT
    I'm not real familiar with Mexico living as I've been studying more about SEA, drawn by my interest in Buddhism, their food and culture. So I don't know but I would imagine the Mexican authorities try to keep the expat areas safer, generally, so as to keep the money there.

    Haven't been out to Calif in a while, not since my bud died, but I do recall seeing the ocean from the mountains. I'm not sure that really qualifies as an ocean view, however. What I did like very much about it there was I think Santa Barbara area, not sure, I was always on the back of his bike so he drove, but he loved this place for lunch on the water and I remember how beautiful it was to see the ocean from coming down off a hill which we don't have in Florida. I recall thinking, my first time seeing it, that your ocean looked bigger than ours. Because from that elevation as opposed to from our flat beachfront, you see more of it.

    But if you can afford a real ocean view and not peeking through the trees from Mount Wilson (I love it up there), then you can probably afford to invite friends to live with you there.

    If you've more than you need for overseas, but not enough for a commune in Dana Point, then you might also consider one of the US territories where you not only find affordable beachfront but also can enjoy Medicare benefits.

    In St. Croix, for instance, you can get a nice beachfront unit for under $200k, not far from the hospital and the humidity is not bad as USVI is right in the tradewinds. The weather there is gorgeous. Like Hawaii, food is more expensive but entertainment is merely walking out your front door and putting on a mask and snorkel. Rough life.

    For instance. here's lowest priced unit a few developments down from where I lost my virginity. haha.

    http://www.realtor.com/realestateandhomes-detail/119-Golden-Rock-Co_Christiansted_VI_00820_M37432-14750?row=1

    Here's the google map (its the mill harbor condo)
    https://maps.google.com/maps?hl=en&ll=17.755257,-64.72092&spn=0.002524,0.004823&t=h&z=18

    That puts even California to shame. That used to be my backyard. The water temp is perfect. No wet suit required.
  • musclmed

    Posts: 3279

    Oct 17, 2013 2:29 AM GMT
    you know in Palm Springs there are already facilities that are doing what you guys are talking about. They also do exist I believe in Honduras as well.


    http://boomforlife.tumblr.com/
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    Oct 17, 2013 5:20 AM GMT
    theantijock said So what I've been considering with a few friends and family is the idea of setting up a commune later in life so that we can take care of each other.

    pool our funds and have a comfy complex or a group of apartments nearby or attached. Then we could bring in live-in help for chores, shopping, taking us to doctors, etc.

    We could have live-in help and be there for each other to assure our safety. Then as we're aging, we'll just keep a bottle of cyanide handy for the sole survivor. /life


    I believe there is actually a term for this type of living (other than "commune"). Some friends and I have briefly discussed it... My only thought is that if you're the healthiest of the group of friends, you're stuck being main caretaker, with no one to look after you when you're in decline... Unless you're always recruiting new, younger and healthier housemates as your friends die off. LOL
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    Oct 17, 2013 5:38 AM GMT
    Hi kt, I was just looking over that post on Boom and was about to respond when I saw yours.

    A communette? It's not quite a commune in the farming sense but it is communal or congregate living.

    What you say could be a worrisome point--who does most of the work--depending on how you think of work, but the idea of communal living, as opposed to capitalist living, is that we do what we are capable of doing, regardless of the other person's capacities. We don't get extra credit for doing what we can do and we don't get demerits for not doing what we can't. Just like our parents took care of us when they were able and then we took care of them when we were able. So the whole mindset is noncompetitive, it's communal, familiar, supportive.

    For your idea on replacing those who help out, I presented our two-fold solution. Do it overseas where we could easily afford in-house help. Then we are all together to assure we are not abused by in-house help. And then when there's just one left of the group, well, that's what the bottle of cyanide is for. Hey, I never claimed a perfect solution. It still has some kinks in it, obviously. Perhaps your idea of replacements might work better than the bottle.

    But it's better than growing old alone, or going into a facility with no family to watch over you. We haven't signed any contracts; just something we've been discussing over the past few years, as we watched our parents deteriorate and realized we won't have that. We won't have us to take care of us like we took care of our parents; we only have us to take care each other.

    It's a very different scenario than what they had. Apparently they were much smarter about this than we are.
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    Oct 17, 2013 5:51 AM GMT
    musclmed saidyou know in Palm Springs there are already facilities that are doing what you guys are talking about. They also do exist I believe in Honduras as well.


    http://boomforlife.tumblr.com/


    Gaytopia seems a bit beyond an aclf. That's not just people needing assistance. That's older gay rich people isolating themselves. It's nothing more than the other end of the spectrum to being subjected to trashy homophobia, being dished by your neighbors.

    Can you just imagine all those 70 thru 90-year-old gay men and lesbians spending an evening in the community disco?

    Just look at how they try to present this
    boom-dsr.jpeg
    Two guys in a wheelchair and the rest of the characters probably average age 35 in a retirement community? Oh, wait, those are the doctors. And then there's the balcony and steps filled with 85 year olds cruising the 75 year old chicken. Yeah, right, like that's gonna happen. Some of the others show children running about. What's that, all our grandchildren visiting? What a crock.

    What we need are communes among friends and other compatible people supporting each other instead of everyone growing old alone. We need accepting facilities integrated into our communities. Inter-age active community centers and fabulous meals on wheels. Not some acreage of Golden Gay Ghettos where we bus our aging rich people.

    When I look at this
    tumblr_lspbkjjy7N1qff6uno1_500.jpg
    I see opportunity lost for people to volunteer to care for the aged and for the aged to continue contributing to their community.

    I understand how someone looks at that and sees utopia but I look at that and see fear.
  • metta

    Posts: 39104

    Oct 17, 2013 4:10 PM GMT
    I don't know about that one in Palm Springs but many of the retirement communities are so ridiculously expensive. A friend told me about one for LGBT people near San Francisco and only someone very wealthy could ever afford to live there. Yes, you can easily get a limo to take you wherever you want but not very many people can afford that on a regular basis. I don't really see myself having that kind of money.

    Commune living (or co-op housing) is a way to find a way to cut costs of living but still living a good quality of life.

    Anytime you have someone trying to make a profit on you (especially maximizing profit), it is going to get more expensive.

    http://www.coophousing.org

    http://directory.ic.org/records/coops.php


    http://www.cohousing.org/directory

    http://cccd.coop/publications/general_resources/housing_resources
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    Oct 19, 2013 6:39 AM GMT
    Hey metta, look what I just found...

    http://retire2thailand.com/retire2-assisted-living.php
    Assisted living communities for both expats and Thais, where one can live independently but at the same time have lots of the drudgery of everyday tasks like cooking and cleaning and laundry and shopping taken care of, will be the next step for many of us. Follow this link to see what one of the first of these communities has to offer. The McKean Hospital Senior Care Program is in the ancient city of Chiang Mai in the north, right on the banks of the Ping River, in a beautiful botanical garden-like setting. For less than $1,000 per month you are provided with room and board, activities, and nurse and doctor’s care right where you live.

    original-1354592067288.png

    http://www.mckeanhosp.com/796642/dok-kaew-gardens-comprehensive-retirement-living
    McKean Rehabilitation Center is establishing a multi-tiered aged care center where ageing in place is possible. This is a modern concept of providing for the varying degrees of care older people need within the same facility, where residents can maintain contact with friends and staff and doctors they know, even when they need to change from low to high-care. It is especially good for couples whose ageing processes may differ, but here they can receive the different levels of help they need in the same center.

    McKean established the lovely Dok Kaew Gardens retirement center in 2009. All residents eat together in the community living and dining room of Dok Kaew Wing, and, since residents represent many nationalities, a choice of western or Thai menus is available. There is an activities room filled with books and games, and a computer with wireless access. The center also has its own beauty parlour for hair dressing and foot massage.

    Lotus and Orchid Wings provide comfortable and convenient single units for semi independent elderly. Emergency call buttons by the bed and in the bathroom enable residents to summon nurse aides for assistance if needed. Bathroom facilities provide space for wheel chairs, and rails for support. All rooms have wireless internet access and TVs with cable channel access. A van takes folk on a weekly shopping trip to the superstore, and social interaction is encouraged with visiting ex-patriates

    Jasmine Wing is a secure facility for mobile elderly with dementia. Residents can move freely around the building, or relax in four different living areas, and care-givers are on 24 hour duty in this building. Staff take residents out for activities or daily walks round the tree-lines roads of the campus. Elders in need of palliative care for different diseases can be supported to enjoy quality of life in Dok Kaew. Residents can go to McKean Medical Center for physical or occupational therapy session, or arrange for a massage in their own rooms. Doctors at McKean are on call if residents need to visit Dok Kaew.

    We welcome visitors to our facility. Please call to arrange a mutually convenient time. From Thailand phone 053124430. McKean is situated on the banks of the Ping River, on Koh Klang Road, 8 kilometres south of Chiang Mai, between the second and third ring roads, just south of Wiang Khum Kan.


    And here's similar but pricier in Mexico, still no comparison to costs here.

    http://internationalliving.com/2010/06/assisted-living-in-mexico-slash-your-costs-improve-your-care
  • metta

    Posts: 39104

    Oct 20, 2013 6:49 AM GMT
    Out of all of the places that I could go in the World, Thailand has always appealed to me. The photos and videos I have seen of it have been just so beautiful. I love Thai food. And it would be fun to ride an elephant. icon_smile.gif
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    Oct 20, 2013 5:09 PM GMT
    Same here. Though regarding those who never forget, I understand they are often exploited, so if you go, research first to fund conservation.

    By the direction and speed of medical care here, overseas care might be our last & best hope. Besides that my big concern is not just affordability but quality and safety, having no children to protect me when I will become frail, being cared for in LOS might make enough sense to override being local enough for a nephew to check for signs of abuse once or twice a year.

    Even being checked on occasionally doesn't prevent abuse in the interim so it might make more sense to take that risk where the general environment is more conducive to caring.

    I was glad to find the facility I posted above and I'll bet that becomes a trend, setting up more such facilities as the world's population ages. It's good jobs for their economy and affords them opportunity to practice their compassion so it seems ideally suited.

    At $1,000 a month, it looks like they have matched the average social security disbursement which I believe is about $1200/month. Though someone would need additional savings to draw for much medical attention or have been in the international insurance system earlier to continue those benefits, it makes perfect sense, even without insurance or savings, for someone in the throws of dementia or a similar condition where you wouldn't want extreme medical measures anyway, but just a comfortable last few years with palliative care.

    For that, care there makes perfect sense.
  • metta

    Posts: 39104

    Oct 29, 2013 1:49 AM GMT
    Yesterday, I was talking to some friends about our aging parents, and it was surprising to hear how common it is for a leg to come out of its joint/socket because of wear and tear. However, it also shows how important it is to do squats and to continue to build muscle throughout our lives. I have some elderly friends that got too sedentary during their retirement and they are paying the price for it now. It is sad to see people deteriorate so quickly.

    One of my friends that is originally from India told us how he did not understand why he never saw really old frail people in this country. And then he went to visit a friend at a nursing home for the first time and was shocked to find out where we put them. In India, the family usually takes care of the parents so you see the frail elderly every place you go. Having to care for the elderly can be very difficult, especially if they have dementia or Alzheimer's.

    I will say that the assisted living place that one of my friends moved into last week is pretty nice.
  • metta

    Posts: 39104

    Oct 31, 2013 2:25 AM GMT
    Mentally Challenging Activities Improve Memory as Baby Boomers Age

    “It seems it is not enough just to get out and do something — it is important to get out and do something unfamiliar and mentally
    challenging.”


    http://www.utdallas.edu/news/2013/10/22-26961_Mentally-Challenging-Activities-Improve-Memory-as-_story-wide.html
  • metta

    Posts: 39104

    Nov 03, 2013 4:05 AM GMT
    LGBT Seniors Face Healthcare and Treatment Discrimination

    http://10thousandcouples.com/issue/november-2013/article/lgbt-seniors-face-healthcare-and-treatment-discrimination
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    Nov 04, 2013 12:03 AM GMT
    metta8 said...he did not understand why he never saw really old frail people in this country. And then he went to visit a friend at a nursing home for the first time and was shocked to find out where we put them. In India, the family usually takes care of the parents so you see the frail elderly every place you go. Having to care for the elderly can be very difficult, especially if they have dementia or Alzheimer's.


    Sorry, not buying it and a quick look at stats seems to back that...

    Chart1.jpg

    http://www.ncea.aoa.gov/Library/Data/index.aspx
    3.2 million Americans resided in nursing homes during 2008.

    So lets just throw another number and say 70 might be the earliest average age for a nursing home, likely the number is much older but let's just say for, say, Alzheimer's which can interfere with daily living skills in the 60s....

    https://www.census.gov/population/age/data/2011.html Here's is population in 1000s.

    .70 to 74 years 9,254
    .75 to 79 years 7,088
    .80 to 84 years 5,719
    .85 years and over 4,957

    So that's 3.2 out of 27 million or 12% in nursing home leaving 88% of that population still in society. Even if you just count the oldest old people, say from age 80 on, that's still only 1/3rd in nursing homes.

    I would think a more likely case why you might see more frail people on the streets of India and less here would be our community centers, day care centers, meals on wheels, our social security & food stamp programs allowing elder people to feed themselves in their own homes. etc., never mind out network of aging services and social work to get help to those in need. Plus, of course, our own families.

    My mother left specific instructions that we place her in a community of her peers. But my brother has taken in his father-in-law with Parkinson's, while raising his kids, and now has his mother-in-law, even buying for them a bigger house so she could have her own area to smoke in.

    It's not that we're throwing our elders away. You don't see them on the street here because we just put them in a cab to the mall for lunch.

    One of my issues with the idea of ageing overseas as an expat is the lack of support there for ageing, even with as much abuse as there can be here. Scares me either way.
  • metta

    Posts: 39104

    Nov 04, 2013 1:05 AM GMT
    ^
    Of course not everyone ends up in a nursing home. Many people die at home. Some are taken care of by family. Some people die in the hospital, etc. I don't think that my friend was talking about people that are just senior citizens. He was specifically talking about people that people that are at the "end of their life". And from what I have seen so far at the assisted living center, it is true that you don't see them very often in public.



    thebearerofbadnews saidfrom what i heard and know about nursing homes... if euthanasia was an option, i would chose that instead.


    There are very few places in the US where euthanasia is even an option. And where it is legal, I think you have to be terminally ill. I have heard that there are places in Europe that may allow it though. But if you are week and frail, what is the likelihood of taking a trip to Europe, even if it is legal.

    In regards to nursing homes, from what I have seen so far, the assisted living centers can be much nicer and cheaper. The larger facilities offer quite a few options: constant activities, physical therapy, doctor visits, etc. They do seem like places that people go to die though. The one my friend moved to last week is called Emeritus: https://www.emeritus.com. They have places all over the country but there are many other companies that do the same thing. Many of the nursing homes are around $8k/month. Assisted living seems like it is around $3k and up/month. Each facilities prices are different. Home health was costing my friend over $8k/month. She could not afford to continue that so the assisted living place was the next best option for her.

    There is a publication called New Lifestyles that is a directory of these places: http://www.newlifestyles.com/