Coffee heat rising

Health care

Adventures in Medical Science…again…

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So this morning it’s out to the Mayo Clinic…again! Be there by 10 a.m. Along about 10 p.m. last night, I realized my car is low on gas. I’ll have to stop someplace to fill up on the way out there. That will add another ten or fifteen minutes to the trek, depending on how many people are in line.

Unless, of course, I get up off my duff and go buy gasoline right this instant.

This proposed test terrorizes me. Not because it sounds so horrible (well, yes. Yes, it does: not so much because it entails jabbing needles into your muscles and running electric jolts into them, by way of measuring how your nerves respond), but because when you look it up you realize that what they’re looking for is MS, Parkinson’s, or ALS (Lou Gehrig’s disease). All of those are truly terrifying.

My grandfather died of Hodgkin’s disease, in upstate New York during the 1920s. How exactly this disease is spread escapes me — apparently it’s caused by a genetic mutation. Or not: could have something to do with the Epstein-Barr virus, and yes, I have (supposedly…) had mono. WhatEVER: those represent two risk categories, both of which I happen to partake.

One of D-XH’s partner’s wives developed MS. One of her kids almost died when he got into her purse, found a vial of medication for it, and ate the stuff.

My college roommate died of Parkinson’s, after a lifetime blighted by suffering. A dear college friend’s fiancé came down with it, canceling their planned marriage and his planned career, for which he had just been accepted to medical school. One of my colleagues at the Great Desert University came down with it, too. He quit his job and went back to the Rez, whence he had escaped half a lifetime earlier. I, however, have no legal tribal affiliation, so I ain’t a-goin’ to some oasis of peace and quiet in the middle of nowhere. Besides, Oklahoma would not be my thing, anyway. Kayenta, maybe. The White Mountains: absolutely — great place to die! But Oklahoma? Not so much.

So we with dire cosmic worries to contemplate this morning…it’s…oh yeah…back to earth! I forgot to fill up with gas yesterday. It’s a 40-minute drive out to the Mayo — longer than that at this time of day. And I’ve got all of a quarter-tank of gas in the car. So another decision begs to be made?

a. Leave the house ten minutes early and get gas on the way; or
b. Get up off my duff right now, race out, stand in line stand in line stand in line stand in line, and get gas before setting out.

Neither of these appeals one helluva lot more than the proposed test appeals.

Nor does driving through the rush-hour traffic in a fog of exhaustion. Last time I looked at the clock during the night it was 1 in the morning. Finally got to sleep sometime after that. Slept in this morning until almost 6 a.m. So I’ve had about 5 hours of sleep. My eyes feel like they have dust in them — a phenomenon that must have given rise to the “Mr. Sandman” image, hm?

Ohhh well. The coffee’s gone. I’d better get up and start slamming around.

Machinating Toward Normalcy

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…Or toward whatever normalcy is around here. There’s a reason we call the the ol’ ranch The Funny Farm. 😉

Come the past couple of days, I’ve realized that I’ve got to get myself up off my duff and I’ve got to start acting a little bit more like myself and a little bit less like a 93-year-old woman who’s afraid to dodder across the the floor.

That literally is what I’ve been doing: doddering. Taking tiny little cautious steps and inching around the house lest I fall again and hurt myself worse. Or end up on the floor again and not be able to get up. Again.

Truly I don’t even have to sit down on the floor to be stuck. All I need to do is it squat down next to the dog, as I just did a few minutes ago to unbuckle her collar, and lo! I can’t get back up on my feet! This time I contrived to use the coffee table as a platform to climb up, saving me another butt-walk into the family room. But seriously: this stuff is scary. No wonder I’m mincing around the house, too cautious to take a normal stride.

First step — heh… as it were — is to get off my duff and get back to walking the dog a couple of times a day. I had kind of let the doggy-walks go even before this little fiasco happened, but once I was hurt, I felt like could not manage Ruby, who is not what you would call sterling obedience-trained. Indeed, a walk around the block with Ruby is actually a drag around the block behind Ruby. So, if I wasn’t already fully converted to Jell-O, the last three weeks of hunkering in the house have completed the process. Even Ruby has put on weight!

Instead of trying to make our usual 1 1/2- to 2-mile walk, I decided to take two shorter walks, one in the morning and one in the evening. Just got back from the second of those today. And it seems to be a pretty good idea. This should allow me to build up a little strength in the legs again, which seems to be in order. Over time, I can increase the length of the walks, which also should help some.

Next Wednesday, a friend is driving me to my first physical therapy session. Number-one order of business will be to ask them if they have any techniques for getting back on one’s feet after one ends up on the floor. Apparently I have habitually used both hands to press against the floor or some object in order to shove myself upright. One hand does not suffice for the job!

Even though Ruby did not drag me around the neighborhood tonight — I’ve learned a leashing technique that discourages that — the shoulder still hurts like hell. So exactly how this scheme is going to work remains to be seen…

 

Walloped, continued

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Well I’m still alive, believe it or not, and still more or less ambulatory. It’s hard to believe that it’s been almost 3 weeks since I fell out by the pool and and broke my shoulder. Since then my right arm has been in a sling 24 hours a day, except for a few minutes per day in the shower. That’s jolly fun. The pain has slowly gotten a little bit better, day by day in almost unnoticeable increments. This evening as a matter of fact it feels a lot better than it has over the past couple of weeks.

Yesterday — migod was only yesterday? — my son drove me out to the Mayo for more X-rays and consultation with the orthopedist. This soaked up half of his day and mine, too.

The young doc’ — who actually is a PA — ordered a vast round of X-rays to be done before we met with him.

Now, the problem with the Mayo’s X-ray department is that they operate at the speed of a galloping snail. They plunk you down in the lobby outside their four x-ray rooms and…you wait. And wait and wait and wait and wait and wait and wait and wait… I must have sat there 45 minutes waiting for them to get around to X-raying my shoulder, a job theoretically scheduled at 12:45. Only two other people were waiting to be x-rayed. So that was a bit stressful, if you find annoyance to be stressful.

On the other hand, the technician was awesome. She took photos of this damn thing from every angle you can imagine and then some. By the time we got in to see Young PA Kildare, we had a very detailed set of the images.

He said he thinks it will heal up completely in another 6 to 8 weeks. But in the meantime he wants me to start physical therapy.

The nearest physical therapy outfit is about three miles away. I’ve been in there before and was magnificently unimpressed. My long-ago physical therapist, who really was awesome, has moved into tonier realms, and I will be damned if I want to drive to Scottsdale to get to a PT.

Which brings us to the next problem: I can’t drive. And my son cannot keep on taking time off work to schlep me around the city. Yesterday soaked up his entire afternoon. He is supposed to be working. He manages a crew of underlings. He cannot be gone all day long. So how the hell I’m going to get to this place escapes me. In theory I could walk: three miles (one way) is not that far for me. But in the shape I’m in just now, really it’s too far. Plus it would require walking most of the way along major horrible thoroughfares, every one of them seven lanes full of Looney Tunes. Driving on those streets is difficult enough, but walking alongside one of them…Holy shit.

So one of my chores today was to try to get my coreligionists to volunteer to schlep me over there… Three times a week. Or to somehow get the Uber application downloaded into the iPhone and try to figure out how to use it. But I ended up so so engrossed in the client’s project that I never got around to either one of those proposed chores.

God only knows how much it’s going to cost to have Uber or taxicabs haul me to this place and back home. And the hassle factor is more than I can contemplate! So that is something I’m going to have to figure out in the next few days.

On Monday when Luz the Wonderful Cleaning Lady arrives, I’ll ask her if she has time to haul me around once in a while, and if so, can I pay her to drive me back and forth to this place maybe once a week. And today when I can work up the strength, I’ll ask around the church.

Meanwhile, the beloved new client is hot to trot... Off to the University of Washington Press! She wants to get a formal proposal organized and sent to the editor there. As a practical matter, she does need to get started now: selling a book entails creating a proposal (which is a very BFD indeed) and then shopping it around to publisher after publisher.

In theory you’re not supposed to send proposals out to more than one publishing house at a time. I personally consider that to be BS and in the past have sent my proposals to four to six publishers at once. It would be a cold day in an Arizona July for two publishers to happen to stumble across each other and oh, yes, of course chat about your brilliant proposal and discover that they both received the same magnum opus on the same day. I just don’t think that’s going happen, and I think publishers’ attempts to inflict that kind of embargo on their writers are exploitive. I hesitate to tell the kid that. But may discuss it with her dissertation adviser, and also with my favorite current spy in scholarly publishing.

Also meanwhile, trying to edit copy by using Apple’s dictation system, which is about as knowledgeable as my dog, is just flikkin’ torture!!! Every passage, every sentence, every phrase pops up with error after error after error after error after error after error after error. Each one of which has to be manually fixed with one-finger, one-hand point-delete-point-tap. Over and over and over and over and over and over again. To fix one item is endlessly time-consuming. And to do it for hundreds of pages simply defies belief. Dictating a few sentences gives you things like this:

This passage is probably more appropriate for the proposal, to be addressed to publishers acquisitions editor rather then placed in the books introduction. Consider using much of this material for your proposal focusing the introduction on the background of the events and in research in which you set the book’s facts and pieces

Here is what it is supposed to say.

This passage is probably more appropriate for the proposal, to be addressed to a publisher’s acquisitions editor, rather than placed in the book’s introduction. Consider using much of this material for your proposal, focusing the introduction on the background of the events and on the research in which you set the the book’s facts and thesis.

Intended:

Since then my right arm has been in a sling 24 hours a day.

Delivered:

Since then, the army has been wrestling 24 hours a day.

Intended:

It feels a lot better than it has.

Delivered:

it feels a lot better than cats.

LOL!! How do cats feel, anyway?

What this fiasco means — and it is an ongoing, unending fiasco — is that every single sentence, every single phrase, every single word has to be scrutinized with x-ray vision to get it correct. And even then some weird mistakes are going to slip through. It is excruciatingly time-consuming — probably absorbs about three times as much time and effort as ordinary editing requires. I do not know when I am ever going to be able to get through the client’s copy, and I’m certainly instilling as many errors as I’m correcting.

I do have my moments of wondering whether I can continue with this project… I may have to tell her she’s going to have to find someone else to edit her book.

And that is going to make this a very expensive little accident. The project is worth several thousand dollars, all of which are about to go right straight down the drain.

None of this is helped by the chronic insomnia. I was awake between two and four this morning — well, 4 a.m. was the last time I looked at the clock. The day was overcast, which delayed the usual dawn awakening for me and the dog, but we rolled out of the sack at about six. And I am presently bat-brained exhausted.

Isn’t that amusing. Apple thinks the word Dawn is a trade name, and capitalize it CAPITALIZES …sumbiche!  Five tries to get the damn thing to spell capitalizes correctly!!!!!!!!!!!

I give up. Gotta go to bed. Good night, Mrs. Calabash!

 

 

 

Hairsassination

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Well, clearly I’m going to have to find some way to “pay it forward” to the church and most specifically to the choir. My gosh! Choir members have risen in mass to help me out. Yesterday morning a fellow named Kerr came over to collect me and drive me all the way to hell and gone out to Scottsdale to get my hair done.

He’s the gent whose wife fell and busted her shoulder last fall. He said she’s back to normal now. Her fiasco was significantly worse than mine because instead of just inflicting a set of cracks in the bone, she actually snapped it into two pieces. Ouch!

So it’s reassuring to know that in spite of having a worse injury, she recovered: apparently with no long-term ill effect.

At any rate, once we got to beautiful downtown Scottsdale, we found that my old and much beloved hair stylist Shane is still there! As requested he cut off the Rapunzel-esque locks into a cute, curly style… Yes, to the tune of sixty-eight dollars. And so now I will have to budget something to visit him once every two months. {grump!}

The mop needed to have about four inches of split ends trimmed off. But I rather resent having to get it all cut off. As a practical matter, though, with a crippled arm I can’t even wash it, much less comb the tangles out of wet hair or keep it combed and brushed between launderings. So… it is what it is, to coin a phrase.

Today, the pillar of the choir, D., is going to pick me up and take me down to the dentist’s office.

I made this appointment when a little revelation struck me. As I was reviewing the test results that the Mayo has posted on its portal, I realized that none of them is outside the range of”normal” except for the A1C measurement, which is a grandiose .1 above normal. The vitamin B12 level, which Dr. Fields blamed for the crazy-making peripheral neuropathy, is smack in the middle of the normal range. The last I spoke with her, she remarked that she could not understand why, given these improved numbers, the PN hasn’t started to go away.

This led me to wonder if there might not be some other cause for the present ailment. And lo! Looking around the hypochondriac’s treasure chest that is the Internet, what do I discover but that a titanium dental implant can cause peripheral neuropathy! The site that has the most detail that I could find seems to indicate that by “peripheral neuropathy” they’re talking about tingling in the gums and lips. Mine started there but has spread to the hands, arms, feet, and legs. One would think that might suggest some more systemic problem than just a local reaction to a dental implant. However… now that I think about it, before all this started I had an episode of burning mouth syndrome. That seemed to come out of nowhere… But maybe it didn’t! Maybe it was a response to all the damned dental work.

At any rate when I called the dentist and mentioned peripheral neuropathy, you could hear his ears perk up over the phone line. This is a very smart guy. And so I think it will be worth raising the question of whether the metal they stuck in my gums could be causing this thing. Elsewhere I learned that a test exists that supposedly can tell you whether you have a titanium allergy. I’m going to ask him if we can get that test done somewhere here in town.

D. picked up a bunch of things for me at a Fry’s here in town, and tomorrow she’s going to drive me to the dentist’s office. A week from tomorrow, my son is driving me back to the Mayo for another x-ray and a repeat visit with the orthopedist.

The result of all this gallivanting is that I didn’t read one word of the client’s magnum opus. In fact the stuff has been such a distraction and I’m so effing tired that I didn’t even think of it until just this minute. Tried to sleep in the afternoon to no avail. Now at 9:30 in the evening, I can barely hold my eyes open.

Busted (literally) and Disgusted

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So yesterday M’jito and I visited the recommended orthopedist at the Mayo. Basically what he said was Yup! You broke your shoulder. Yup, the best course of treatment is to swallow a bunch of pain pills and keep the wounded paw in a sling.  He did give me a new sling to take the place of the one I got at the ER — the one whose support strap velcroes to a spot  around in the middle of your back, between your shoulders.

Actually he said he wanted me to do physical therapy starting in a couple of weeks, after meeting with me for a second time. Having done a course of physical therapy in the past, I wanted to be take myself to my guys, because they really are good and they’re only about a three-minute drive from my house. He also gave me a new arm sling. This one attaches either at the top of your shoulder or behind your neck, depending on how tight you wanted to be. [P.S.  OMG, did you spot that typo? 😀 Yes, as a matter of fact I wanted to be quite tight!!!)

So, referral in hand, I go to call my good old physical therapy dude. His office and number are listed in Google but when you call the phone number you get an annoying recorded phone company message saying “that number does not exist.” So now I have to get back to the Mayo and schedule physical therapy with them. That will mean I have to traipse halfway to Fountain Hills, God knows how many times a week for God knows how many weeks to cope with the aftermath of this fun adventure.

Paroxysms of hassle — painful hassle most of the time — occupied half of another day.

To get into this new sling or any similar one, you need to wear a shirt under it. That shirt needs to be easy to get into and out of. And when you have a busted shoulder, a shirt that pulls on and off over your head does not fit that description. I have three, count’em 3, shirts that button up the front. One of them is a pajama top.

So, it was off to Amazon for a shopping spree. Ultimately I ordered two shirts, which I hope will work for the current medical project and also will be usable in the future with blue jeans.

Meanwhile, my confidence in the Mayo’s crew of docs was mildly shaken, but exceptionally so regarding the handsome young doctor. He told me things that I happened to know — and have since confirmed — to be misinformed. First and foremost in the “wrong” department: he told me to quit taking ibuprofen because, said he, ibuprofen interferes with bone healing.

I remarked that acetaminophen, his drug of choice, does about as much for me as a caramel candy. Come to think of it a caramel candy would probably be better: at least it would taste good. Oh no, nothing would do but what I dare not take ibuprofen and must take acetaminophen.

Ohhhkaaayyyyy…

Being the skeptical old bat that I am, naturally the minute I caught my breath after that junket, I looked up the question of whether ibuprofen interferes with bone healing. Right out of the box, what should I come up with but this interesting 2020 comparison of ibuprofen and acetaminophen when used as painkillers for fractures. A “Colles’ fracture” is your basic broken forearm. But the type of fracture is irrelevant: the issue is that this 2020 study concluded that ibuprofen is a “bone-safe analgesic treatment in an acute fracture-phase.”  Moving on, we come across another report, also from 2020, in which researchers divided a group of patients whose average age was 65 into a set that used ibuprofen and a set that did not. They found that “There was no difference between treatment groups in bone mineral density, histomorphometric estimations, and changes in bone biomarkers. These findings may offer an indication of ibuprofen as a bone-safe analgesic treatment in an acute fracture-phase.”

So the orthopedist wants me to come back in two weeks, after which he proposes that I start physical therapy. That all seems fairly reasonable. The wounded paw is sore if I move it wrong, but by and large not too intolerable. It would help a whole lot if I didn’t have hair that came halfway down my butt. But next week I’ve got an appointment with my long-forsworn hairstylist. Between now and then I’ll have to decide whether just to trim off four inches of split ends or to go all the way and have him cut it off into a pixie. I really don’t want to get stuck on the hairstyle merry-go-round again. The trouble  with the cute short hair style is that to keep it cute you have to go back about every four to six weeks. Even if you stretch it out to once every two months, that adds up to a lot of hairstyling bills. On the other hand, there’s no way I can deal with long hair single-handedly… as it were.

Meanwhile, I’m having grand fun (heh!) learning what it’s like to live with a disability. It certainly enhances your respect for people who have to deal with pain or disability on a permanent basis. You have to adapt yourself to so many workarounds, extra considerations, do-withouts, and roadblocks that it pretty much defies belief. Yesterday a friend on the choir who is nearly blind called to commiserate. I can’t even imagine how she gets by. She’s now had…what?… three? four? surgeries on her eyes in attempts to save the vision she has left or to recover some vision. All of them have failed. So, when you consider what other people have to deal with, you realize your little dilemmas are as nothing

Yesterday, speaking of little dilemmas, I dropped my glasses,. Natcherly, they fell between the nightstand and the bed. Stupidly, I knelt down to fish them out and ended up on the floor.

Without both hands to push myself up, I cannot get off the floor once I’m down. Hot day-um.

Fortunately, though, I now have a strategy for getting myself upright. So I butt-walk up the hallway, across the kitchen, and into the dining room — this is a journey, in a 1900-square-foot shack, under the circumstances. Luckily, this house was built during the time of the rage for sunken rooms, and the family room happens to be one of those. Once in the dining room, I can dangle my feet over the ledge between the dining room and the family room. This gives me enough purchase to stand up.

The busted arm is sore on a low-key level, but it doesn’t actually HURT hurt unless I do something stupid. Alas, we know “do something stupid” is part of my stock in trade.

It’s interesting to consider how many of the various devices intended to assist people with permanent or temporary disabilities leave a whole lot to be desired. We could for example remark upon the shortcomings in Apple’s dictation function, with which I am clumsily writing this post. Sometimes it’s kind of hilarious, but most of the time having to correct phrase after phrase after phrase and word after word after word by hunting and pecking with your left index finger is just annoying. How exactly for example, does the word of sound like I’ll? How does I’ll sound like am?

We’ve already touched upon the ludicrous Velcro-decorated arm sling that attaches in the middle of your back — that’s handy and dandy.

My son has been picking things up at various grocery stores for me, but he cannot do that forever — he does after all have a full-time job. So one of these days, I’m going to have to send Instacart out to gather some serious provisions for the Funny Farm. While I’m very grateful for the existence of Instacart, all their employees suffer from the same shortcoming: being merely human. Ask for item a and invariably you will get item b — simply because a person who does things differently from the way you do things doesn’t understand what you’re saying when you ask for something that does not fit into their way of doing things.

I suppose if these antics continued very long, you would devise all sorts of workarounds, so that over time you would arrive at a point where you could get most things done the way you want them done.

Once, within living memory, it looked like this!

Several other small challenges remain to be figured out. For example, I have no clue how and when to get my hair washed. I don’t think it’s possible to wash a mane of hair that falls to your waist with one hand, to say nothing of picking the tangles out of the soaking wet mop. Literally, in the months since we were told we must not go into beauty salons, my hair has grown a good 4 inches; from shoulder length to waist length. I’m awfully afraid that I’m going to have to have it cut off into a pixie. I don’t want to have to run to the stylist every 4 to 6 weeks, but neither do I want to go around looking like an agèd Sheena, Queen of the Jungle.  Would that be Sheena, Grandmother of the Jungle?

Yesterday, though, I did decide to take a chance on the plumbing in the back bathroom and use Satan’s fancy travertine shower stall to bathe.

The thing you have to bear in mind about this spectacular happy handyman production is that, after all was said and done, the gorgeous stonework that he lined the shower stall with has to be stripped and resealed every six months. This he told me in the last five minutes of the final walk-through before clinching the sale of the house.

Seriously, dude? That bathroom is smaller than the closet in the master bedroom! And it has no — 0.00 — ventilation!!

Is that not brilliant, I ask you? It puts Satan smack in the same class with the designer of an arm sling that has to be attached  between your shoulderblades. The upshot: I never use that shower.

The middle bathroom has a regular bathtub with one of those showerheads on a hose that you can pull off and use to wash whatever you feel like washing — like, say, the dog. But it has the disadvantage, of course, that one must step over the side of the bathtub to get into it. And the other disadvantage: the plastic tub floor gets slippery when dampened with shampoo or conditioner. The shower pan that Satan installed is also plastic, but it’s textured, so one would be unlikely to slip in there. And you only have to step over a barrier about two or three inches high to get into the thing.

Of course it presents the enormous disadvantage, besides  the semi-annual refinishing chore, of having clear glass sliding doors, which means that somehow you have to get the hard water deposits off the glass every time you clean the flicking bathroom.

Fortunately, though, Luz the Wonder Cleaning Woman just came back this week — or rather, I just allowed her back, now that I have both the covid shots. So I can foist that job onto her. I think if I keep a roll of shop towels in there to wipe the glass dry and also to wipe down the stone walls every time I shower, it should be okay.

As okay as the ongoing horror show that we’re all living through ever gets. It seems as though the current depressing predicament goes on and on and on. Nor does there appear to be any realistic, believable end in sight. Even though I expect that this arm thing will heal up if I live long enough and I don’t fall again, I think it’s unlikely that the deadly virus presently threatening the future of the human race is going to go away anytime soon. Most certainly it will not go away, any more  than the flu ever goes away. Eventually it will pick off all the victims that it’s capable of killing, and those whose constitutions allow them to survive will survive and will reproduce, partially replacing themselves with offspring who are genetically resistant to the virus’s death-dealing skills.

Aging in Place: How to Pull It off

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As you know if you read Funny about Money off and on, one of my goals in life is to maintain my independence through my dotage. That is: to stay out of life-care communities.

Is there anything intrinsically wrong with a place where you fork over most of your life savings and cede your independence in exchange for shelter until the end of your life and a guaranteed place in a nursing home when you need it? Possibly not.

But from my point of view: yeah. Everything. The whole idea of a warehouse for old folks conflicts with my basic concept of a decent lifestyle. Understand: a life-care community is not a nursing home. It’s more like an age-restricted apartment complex with a built-in restaurant or two and a staff of keepers. And rules that constrict your behavior in much the same way that a dormitory’s rules do. In effect, it’s a dormitory for old people.

I hated living in the dorms during undergraduate school. And you may be sure I’m not going to spend the last few years of my life in another dorm!

But…as a practical matter, how can one avoid it? Or can one, in any safe and sane manner?

When you move into a life-care community, you fork over most of your life savings and cede your independence in exchange for shelter until the end of your life and for a guaranteed place in a nursing home when you need it. While you live there, you occupy a tiny apartment and are expected to take at least one meal a day in the institution’s “restaurant” (more like the chow line at the dorm), where you are treated to lots of processed, packaged, oversalted and oversugared foodoids. The reason you must show up for one meal a day is so that the proprietors can easily check to be sure you’re still alive and conscious.

There are some sterling benefits to moving into one of these places:

  • You don’t have to prepare your meals every day. In some cases, as in the place where my father stayed, you wouldn’t be able to do so in any practical manner.
  • You have lots of old people to make friends with.
  • Usually a nursing home is attached to the life-care home, and you get first dibs on entry to it. Sometimes getting into a decent nursing home when you need it is extremely difficult.
  • The level of security is very high.
  • Some housekeeping services are provided.
  • Various entertainments and amusements are provided: crafts rooms, a small library, musical performances, lectures, and the like
  • Some of these places have a swimming pool, a hot tub, and an exercise room.
  • Some also provide Alzheimer’s or other dementia care.
  • You could in theory live there without ever having to drive a car or go to another grocery store.
  • A doctor is usually on the staff or hired on contract.
  • If you fall, have a heart attack, or suffer a stroke, someone is on the premises to help you, 24/7.

All of those are good things. However…I would argue that alternatives exist, and those alternatives cost a whole lot less than a life-care community and do not lock you into a prison for old folks. You can get most or all of those services on your own — without forking over your life savings for the privilege.

First, let’s take a closer look at the benefits and the downsides of moving into one of these places.

We have two sets of friends here who have made two contrasting life decisions. One has determined that she’s not going into a life-care community, come Hell or high water. At 95, she still lives on her own, in a freestanding house with a large yard and an irrigated lawn here in the ‘Hood. Let’s call her Margarita. The others, a couple exactly the same age as Margarita, decided to sell their patio home and move into a two-bedroom apartment at the Beatitudes, one of the two most prominent life-care communities in the city of Phoenix. Let’s call them Dick and Jane. Knowing these folks well gives us a chance to think about their choices and how they work.

Bear in mind, as you’re perusing the first two lists below, that Dick strongly resisted moving into the Beatitudes. However, Jane owned the house where they lived, and so it was her decision whether to sell or not to sell; also, Dick had some serious health challenges that were making him infirm. Additionally, Dick and Jane lived next door to a crazy woman who was constantly doing battle with the homeowner’s association and who had taken to threatening to run down the neighbors in her car. Jane saw this madwoman as a serious threat, and she surely was right. So, at her behest, it was off to the Beatitudes!

How, then, has this worked out for our friends?

As you can see at a glance, both householders face similar challenges: advancing frailty, growing risk of injury from falls or health problems, the difficulties of obtaining and preparing food and other necessities. Dick and Jane faced an additional challenge: a neighbor who was batshit crazy. This woman took to threatening to run down other members of the small patio-home HOA with her car, and she in fact did aim her car at Dick a couple of times. She also harassed him every time he rolled the trash barrel out to the curb for pickup, and sued them in a misguided attempt to engross part of their backyard into her own (she lost).

Margarita does not have the crazy neighbor problem, but all the other issues are similar. Her solutions, however, did not entail consigning herself to a warehouse for old folks.

As we make this comparison, we do so with several assumptions in mind:

  • They all have enough money to handle whatever they need to handle.
  • They have access to medical help.
  • They retain all or most of their marbles.
  • No one is trying to cheat or rob them.
  • Dick and Jane’s kids are doing little to help them; Margarita’s husband and her only child are deceased.
  • They have no hired representatives (except for the Beatitudes) to handle various financial, health, and custodial matters.

These are not necessarily givens, but rather are assumptions based on what I’ve observed.

Okay. So what are the pro’s and the cons of their respective decisions: to stay at home or to move into a custodial setting?

HOME


LIFE CARE INSTITUTION

What seems like an advantage or a disadvantage would certainly depend on your own disposition and experience. To me, the disadvantages of the life care setting so outweigh the disadvantages of living at home that there’s really no choice. But on the other hand… That’s because I value my aloneness. I like privacy, I like independence, I like quiet, and I don’t much like people in my face. And I’m used to those things: I’ve lived that way for years.

Thus we have the question of just how important is a given advantage or disadvantage, when it comes to thinking about where you’ll spend the last few years of your life. How much do these things really matter?

To figure this out, let’s assign a value to each advantage and disadvantage, on a scale of 1 to 10, where 1 is least important and 10 is most important. What do we get then?

Here we see the advantages of aging in place at home are almost a wash when compared to the disadvantages. There’s a very slight tilt in favor of the advantages, but the disadvantages are very serious, and in fact when they’re weighted in terms of their importance, the advantages just barely outweigh them.

How does this way of looking at things work when we apply it to life in the Beatitudes?

Now we see a much more significant difference. Whereas the total point value of the stay-at-home advantages (the total advantage factor) was only one point more than the Beatitudes’ advantages, the total point value of the Beatitudes disadvantages outstrips its advantages by 23 points. This is because there are more disadvantages than advantages to living in the Beatitudes. That was not the case for the stay-at-home scenario, which presented an equal number of advantages and disadvantages.

Nevertheless, when you calculate an average, you come up with figures in the same ball park. Except…here the disadvantages on average outweigh the advantages by more than 3/4 of a point. whereas the advantages of living at home just barely outweigh the disadvantages.

Parsing it out, we can make these observations:

  1. There are more advantages to living at the Beatitudes than to living at home, but…
  2. Some of the advantages are rather low in value. This is reflected in the fact that…
  3. The average value of the advantages to home is higher than that of the Beatitudes.
  4. There are many fewer disadvantages to living at home, but…
  5. The overall weighted value of the disadvantages is about the same. That is, there are some major disadvantages to living at home, so that some advantages are outweighed by disadvantages.

Okay, so how did Margarita pull off the feat of living in an upscale home on the fringe of the tony North Central neighborhood, all the way into her dotage…all by her little self?

Well, in the first place, both her husband and her only child died some years ago. This means there’s no one that she feels bound and determined to leave her estate to. Thus that nine-point disadvantage posed by a reverse mortgage goes away.

That being a given, she had no impediment to taking out a reverse loan on her house. And if you believe Zillow, her house is currently worth $662,000. That puts a lot of cash in her pockets.

The house is in a fairly upscale section of the neighborhood, across the street from some mighty valuable horse property and nestled among well-maintained 1960s ranch houses on big lots. That suggests her husband made a good living and without a doubt left her a decent retirement fund. Plus of course as his widow she would be getting his full Social Security. The house is paid off. So all she has to do is pay the utility bills, pay the taxes on it, and hire people to maintain the place and assist her personally.

So: a major part of the plan could be to add the equity in your home to whatever you have in your life savings and to your Social Security income to support yourself in much the same style that you would enjoy at the Beatitudes. This would mean hiring housekeeping help, yard workers, and possibly a practical nurse to come in and help cope with your infirmities. It might include someone to chauffeur you around, if and when you reach the point when you ought not to be driving.

Given the value of Margarita’s home, she presumably would have plenty to cover those costs. If she added, say, $30,000/year to her Social Security income, which is probably around $16,000 or $17,000 a year, the cash in her savings and house equity would outlast her for many years,

My house’s value is nothing like hers — despite the influx of Californians and resulting inflation in real estate values, it’s presently worth about $461,000. But I have cash in savings. The result: there’s enough there to support me until I croak over, assuming I don’t live more than about another 20 years. That would put me at the end of the lifespan of my most long-lived relatives.

If you figure I spend, on average, around $30,000 a year on everything including taxes, insurance, medical care, house repair & maintenance, automobile costs, housekeeping help, yard guys, the pool guy: the equity in my house would support me for 12 years. The amount in savings would last for 22 years. Combine them, and they would keep me going for another 38 years in this house…and believe me, I ain’t a-gonna live for another 38 years! 😀

By “keep me going,” I mean provide most of the amenities one gets at a place like the Beatitudes: prepared meals, people coming in every day or two to check on you, transportation, home maintenance, medical & dental care, utilities, and whatnot. But you would get all that in the privacy in your own home, without having to give up much independence. Over time, you might become more dependent on certain kinds of helpers…but you would be the one who hired those people, not some institution’s management, which means you would be the boss.

So, what would be the drawbacks?

Assuming you weren’t incapacitated by a fall, the main things that would work against you would be cancer, stroke, or dementia. You could suffer cancer or stroke at any time of your life: my grandmother was in her 40s and my mother was 65 when they died of the Big C. If you evade cancer, a stroke or a heart attack are probably the likeliest wormholes into the other world. In that case, most of the cost for end-of-life care would supposedly be covered by Medicare plus my long-term care policy.

But dementia is the monster lurking behind the curtains… If you were demented, you truly could not take care of yourself and would die, slowly and expensively, in a nursing home — with, as far as I can tell, no way out. If on the other hand you suffered a disease that could be treated and staved off, you probably could return to independent living. This fact would be true, though, no matter where you lived: in a private home or in a warehouse for old folks.

Incidence of dementia in the US has fallen: at this time about  20-25% of over-65’s have “mild” cognitive decline. Furthermore, dementia rates in the US are continuing to drop as the population ages. Harvard University notes that dementia cases in this country are dropping at 15 percent per decade. The Alzheimer’s Association claims the numbers are growing…but then, it’s in their interest to do so. Additionally, the level of education a person attains is somehow associated with one’s likelihood of succumbing to dementia: the more education, the less likely you are to suffer senile dementia. I have a Ph.D. So presumably I’ll remain sharp as a tack no matter how superannuated I get!

The Alzheimer’s Association’s claim that the numbers are rising measures something different: their figures represent the fact that a huge bubble in the U.S. population — the baby boom — is advancing into old age, not that the percentage of people with Alzheimer’s in that population is increasing. In other words, if (let us say) 10% of people develop Alzheimer’s after age 65, and a city has a population of 100,000 people 65 and older in 2010 and 200,000 such people in 2020, obviously the city will see a lot more citizens with Alzheimer’s in 2020 than it did ten years earlier.

Gina Colata, writing in the November 21, 2016 issue of the New York Times, reported that “the dementia rate in Americans 65 and older fell by 24 percent over 12 years, to 8.8 percent in 2012 from 11.6 percent in 2000.” If this trend continues, then one’s likelihood of developing dementia drops accordingly.

It’s a crap shoot. If you can hang onto most of your marbles and you don’t develop a debilitating disease such as Parkinson’s or ALS, you should be able to maintain your freedom until close to the end of your life, if not until you’re all the way home. In my case, the peripheral neuritis surely could become debilitating. However, Margarita has it and says it’s not the reason for her crutches. It’s annoying, but apparently no more crippling for her than it is for me, which is…not at all.

Neither Jane nor Dick appears to suffer from dementia. Dick is ill because he has heart disease. Jane has suffered from hip pain, but a hip replacement seems to have resolved the problem.

The hip thing was one of Jane’s motivations…she was afraid she wouldn’t be able to continue caring for Dick much longer. But…she resisted having the surgery. After she went into the Beatitudes, someone finally persuaded her to do it. At 94, she came through it just fine and now is walking pain-free. Had they stayed in their home, she could have hired someone to come in and take care of Dick — or have rented a place for him at the Beatitudes for a month or three — until she recovered. After that, she probably would have been better able to cope, at least for awhile.

One powerful motivation for her decision to move them out of their perfectly manageable patio home was that a nut case lived next door, and this woman was threatening them with harm. So…let us say that you arrive at your dotage and find that you truly do need to move out of the home you’re living in, not so much because of infirmity but because of other issues.

Is there an alternative to the life-care community?

Well. Yes.

Check out this place.

This is an apartment in the high-rise where my friends and coreligionists Jack and Lou live. Personally, it’s not to my taste, mostly because I’m less than fond of apartment-house life. But…it’s one helluva lot better than the Beatitudes. $385,000 for 1261 modernistic square feet: that’s probably more than Dick and Jane paid to get in to the Beatitudes. But…

It’s not a prison. Also, Jack and Lou’s place is larger than Dick and Jane’s two-bedroom digs, I believe. Certainly the kitchen is vast, by comparison. The sitting areas are far more pleasant, and the master bedroom is large enough to accommodate…yes…a king-sized bed. One of those will not fit into Dick and Jane’s main bedroom.

Though it has no cafeteria in-house, it’s within walking distance of quite a few eateries. It’s also less than a mile from the beloved AJ’s gourmet grocery store. That shopping center has at least three restaurants.

It also has no monthly gouge, other than an HOA fee. At the Beatitudes, the monthly fee starts at just $2,815 with a one-time 90% refundable entrance fee starting at $144,800. The final pricing depends on the size of apartment you choose.  So they say. It’s impossible to get a straight story about their buy-ins and fees online — the only way you can get straight dope is to go down there and subject yourself to a ferocious sales pitch, and give them private information so they can keep hustling you til the end of time.

One site says the monthly fee starts at $2254 and is coy about the buy-in Another says the buy-in is $180,000, but that’s undoubtedly for a studio: Jane told me it took ALL of the proceeds from sale of their home to buy into the place…that would be around $350,000. Plus.

Here we have a more realistic claim of $350,000: “Residents in independent living pay a buyin fee. That price can range from two hundred and fifty to three hundred and fifty thousand dollars. They pay a monthly fee for services as well. We also have month to month rental units with no buy in requirement.” They claim 90% of this is reimbursed to family when the person dies — that has got to be BS. My understanding is it’s gone, once you move in. This article appeared in January 2017, over 4 years ago.

Dick and Jane’s place is supposedly 2 bedrooms, but it’s nothing like the size of Jack and Lou’s place. J&L’s kitchen is huge — probably bigger than mine. It’s three times the size of the Beatitudes’ kitchenette, which doesn’t even have room for a built-in microwave. It has a living & dining room, but so does the Beatitudes’ place, sorta: a large-ish room divided by a pony wall. It has a second bedroom — so does Jack and Lou’s. But the Beatitudes’ master bedroom isn’t large enough to accommodate a king-sized bed!

No kidding. Dick and Jane had to get rid of their marital bed and replace it with a queen-size bed, over Dick’s strenuous objections. Within a couple weeks, Dick fell out of the thing onto the floor! Only by sheer luck and the grace of God did he fail to break a hip.

Back at the Central Avenue high-rise, Jack and Lou’s place has a generously sized master bedroom and a normal-size second bedroom, both with astonishing views of the entire East Valley, the Superstitions, and the South Mountains. It has a dining room/living room suite that easily accommodates 15 or 20 guests for a party (I’ve been there!), and in addition it has another sitting area, a rather private alcove off the entry that could be used as an office or just a separate seating space. If you put a fold-out sofa there, you could use it for overnight guests. Or it could serve nicely as a small library.

The cost of a two-bedroom apartment at 1 Lexington (right on North Central — step out the front door and the light-rail will whisk you to AJ’s, to a Safeway, to any of half-a-jillion restaurants, the library, two nationally prominent museums, the baseball stadium, a live theatre, or your lawyer’s office downtown) is about the same as the buy-in for the Beatitudes, only without the exorbitant monthly fee and without the Big Mama constraints.

As for a chow line: it doesn’t cost anything like the Beatitudes’ monthly fee to order food from Instacart or meal delivery services. What’s to stop you from ordering seven meals from a restaurant at a time? Plus grocery stores sell rafts of prepared meals, which are the same damn thing you get at the Beatitudes’ dormitory-style eateries, only cheaper. But if you like real food, an in-the-wild apartment has no requirement to show up at the mess hall to be counted and assessed by your keepers while you eat institutional yuckum: you can cook your own meals.

We do have the fact that at the Orangewood institution, one of the office staff helped my father with his bank account bookkeeping when he no longer could cope. But again…for one helluva lot less than your entire life savings and a gigantic monthly fee, you could hire a bookkeeper to do that.

Obviously, a stylish high-rise apartment condo has no nursing or custodial care on site.

But it’s a five-minute drive (or less) by ambulance to not one but two major hospitals. And if necessary, you can hire people to come in and ride herd on you.

To my mind, the biggest drawback of this alternative is that it provides noplace for your dog. You’re allowed to keep a dog at the Beatitudes, but you have no yard space, so of course you have to take the dog out on a lead, meaning you have to stand there in the heat or the rain until the dog decides to do its business.

But we do have this thing coming up the pike: a plan to demolish a Paradise Valley ghost mall and replace it with an apartment/office/restaurant/retail complex.

Except for the dog problem, that could be ideal. And if you could get a unit on the ground floor, it would work: you could just step outside with the dog, rather than having to get it up and down an elevator and pray it doesn’t pee in there.

Other alternatives already exist.

For example, there are some older but very pleasant two-story garden condos down by the Phoenix Art Museum. These places also are close to Central Avenue — a short stroll to the light-rail line, minutes to the nearest hospital, across the street from a Safeway. They’re also within walking distance of the main city library, the Heard Museum, the Phoenix Little Theatre, and a variety of stylish restaurants.

Better yet: a patio home is your basic apartment…without anyone tromping around overhead.

The latter would give you some yard space for your dog.

Alternatively, you could re-home the dog and buy a suite on a cruise ship. Sail away into the sunset and never come back!

Or you could buy a room or a suite in a hotel. This would accomplish essentially the same objectives as moving yourself into an old-folkerie, only sans the age segregation, the bad food, and the officious supervision.

So…if there are better ways to get by without locking yourself in a prison for old folks — ways that cost no more and may cost less — why on earth do people do that? As I mentioned above, the sales tactics at these places are highly aggressive. I went in there one time with Jane, met a sales rep, and my mailbox still gets stuffed once a week with advertising junk for the Beatitudes. Too, I suspect peer pressure works its magic…my father was put on to lifecare communities by my great-aunt, who came into town looking at places when she wanted to move out of her (spectacular) place in Sausalito, California.  She ended up staying in the Bay Area, in a (very tony!) old-folkerie in the East Bay. But no matter how swell, the fact still remains: this is a prison to which the inmates deliberately sentence themselves.

Realistically, though, if you live as long as is theoretically possible, there’s going to be a point at which you will have to have help with daily living. How to get that remains a conundrum.