Archive for May 2011
Medical Tests and Advance Directives
The May 25 post on the New Old Age blog, http://newoldage.blogs.nytimes.com/, discusses the distressing topic of unnecessary diagnostic medical procedures for seniors. This particular post is focused on the overuse of screening colonoscopies for elderly adults, but it includes links to other articles describing aggressive blood-sugar screening and the ordering of frightening and invasive mammograms for women with severe dementia.
If ordered by a physician, most of these tests are covered by Medicare, with little or no co-pay. This is not say that they are free, as the costs that are absorbed by Medicare, private insurance companies and/or health care providers are passed along to the rest of us one way or another.
For very elderly or demented seniors, there are other, more personal costs as well. These tests can be uncomfortable to downright painful. Some require sedation, which can further increase confusion for hours and days afterwards. The patient’s routine is disrupted, which can be further exacerbated by wait times and the requirement for fasting or other pre-test procedures. Finally, there is the assault on the patient’s dignity by a stranger who is requiring the patient to disrobe and endure unwanted touching.
I certainly recognize that these tests can be extremely valuable. I’m sure everyone knows at least 1 person whose life was literally saved because his cancer was discovered early through diagnostic screening. However, as noted in the articles that are linked to the New Old Age post, cancers that are detected through diagnostic screening only (in other words, there are no other symptoms) after age 80 tend to grow so slowly so that, most often, the cause of that person’s death is something other than the cancer.
These tests makes even less sense when an individual has made it clear in her Living Will or other Advance Directives that she would refuse treatment for the disease once it is discovered. When that’s the case, logic would suggest that the person would refuse an invasive test to find the disease in the first place.
Since health care providers have not, historically, drawn the conclusion, individuals may want to consider using specific language in these documents to make their wishes as clear as possible. For example, if you are expressing the desire that you not be subjected to surgery or any treatment that would only extend your life if you are suffering from dementia or are otherwise unable to express your wishes, you might consider specifically addiing that you also do not wish to be subjected to the diagnostic tests.
The best way to avoid such tests is to have frank discussions with the agent on your medical power of attorney and your primary care physician about your wishes in this regard. As is the case with all advance directives and end-of-life decisions, the more that you plan ahead, the greater control you will retain.
A Jewish Approach to Conscious Living and Conscious Dying
Earlier today, I had the privilege of participating in a workshop entitled “A Jewish Approach to Conscious Living and Conscious Dying,” sponsored by the Deutch Family Shalom Center of Temple Chai in Phoenix Arizona and the Jewish Community Foundation of Greater Phoenix. More than 130 people gave up a beautiful Sunday to come together and explore what it means to journey toward a meaningful elderhood in a Jewish context.
The Speakers included Rabbi Richard Address, who serves as the Union for Reform Judaism’s Specialist for Caring Community and Family Concerns, Dr. Lawrence Ettkin, a licensed psychologist who presently works as a life coach to help adults with the difficult transitions they are facing, and Dr. Howard Silverman, a Clinical Professor of Family and Community Medicine (among other things) at the University of Arizona School of Medicine.
After a day of considering such topics as Tools and Traditions for Meaningful Aging, and Seeking Guidance from Jewish Tradition in making sacred end-of-life decisions, I was honored to have the opportunity to speak to those who attending my breakout session on the practical foundations of life care planning. Once we have made our decisions about how we want to live the last chapter of our lives, it is important that we document it. For example, if we have made it clear in an ethical will that we want our children to work together after we are gone, we would not want to create the opportunity for family confusion and strife by not properly documenting how we want our property distributed. Similarly, we will not benefit from the thoughtful preparation of a Living Will that describes the end-of-life treatment we do – and do not – want, if we have not appointed someone as our Medical Power of Attorney to implement those intentions in a properly executed document.
Many of us are familiar with the joke about the man on his roof after a serious flood. He refuses the help of people coming by in a boat, and then a helicopter, because, he says, “God will provide.” When the man drowns, he agrily accuses God of abandoning him, to which God replies – “what do you mean? I sent the boat and the helicopter!” The moral of this story, of course, is that we work in partnership with God to implement his plan. Once we have done the hard work of thinking through how we want to live our last chapter and what sort of legacy we want to leave behind, it is just as important to do the human work of memorializing it in properly executed, legally enforceable documents.
A Lifetime to Remember
It seems like whenever I tell a friend or former colleague whom I haven’t seen in awhile what I’m doing, she also has a story about caring for elderly family members and how that has changed her life. One of those people, who used the experience to start her own transformative journey, is Shirley Cox Knipp.
Shirley has had a long, successful career as a commercial, interior designer, and she is still involved in that field. She is also responsible for caring for her mother, and she spends a lot of time with her and her neighbors in her assisted living facility. In addition to learning more about her mother’s story, she has heard many wonderful stories from her mother’s friends and neighbors. Sometimes, she learns things that their own family members never knew, or have long since forgotten. This got Shirley thinking about how these stories can be captured, both for the benefit of the elder, who loves the opportunity to reminisce, and for friends, current family members and those who will follow.
Shirley will conduct a series of interviews with your elderly family member, in which she will ask what they want their descendents to know about their life, times and family. What have they learned, and what advice would they give? Shirley will then compose the story and deliver it in a bound book that is destined to become an heirloom for generations to come.
About 10 years before my grandmother passed away, my mother had a friend conduct a series of interviews with her that were captured on cassette tape. I am fortunate to have these tapes, but I know that I need to have them digitized or transcribed, or they will be lost forever. If you are interested in the service Shirley provides as a way to keep these memories forever, please contact Shirley Cox Knipp at 480-993-9182.
May is Elder Americans Month
At the risk of duplicating many other blogs that provide information to seniors and those who care about them, I hope that we all celebrate Elder Americans Month with our businesses and families.
Americans are now living longer, healthier and richer lives than ever before. Many of my friends – the eldest of the baby boomers – are beginning to turn 65, without feeling the least bit “elderly.” At the same time, as many more people than ever before live into their 80s, 90s and even 100s, it is important to be aware that at some time, these people may need our help. We in the “young old” generation are in a perfect position to develp new ways for us to live, and care for one another, over the next 25+ years.
See the President’s Proclamation at the link below:
Pros and Cons of Annuities
Annuities: Are They Right For You?
As our population ages in what has been a declining interest environment, insurance companies over the last ten years have begun introducing very exotic and complicated annuity products to capture the wealth that baby boomers have accumulated for their retirement. Many of these new products are so intricate that even the brokers and financial planners selling them have difficulty explaining the subtleties of these investments to their clients. In addition, there are thousands of available products and even more agents selling them, many of whom may not have the necessary experience. Proper placement in a retirement strategy requires expert advice and analysis, so before you consider whether an Annuity is an appropriate investment for your financial plan, you should make sure you’re dealing with a trustworthy and seasoned investment professional with a high degree of ethics and integrity who can explain things to you in a way you can understand. Here’s a helpful website discussing some considerations to keep in mind when reviewing an Annuity product: http://www.annuitystraighttalk.com
