Coffee heat rising

Another Day, Another $250 Hit… And more to come?

Once again…not a single month has gone by since the first of the year without at least one unplanned financial hit! And I expect there’ll be more, what with this annoying medical thing. Lots more, no doubt.

Young fellow from Swimming Pool Service and Repair came by. He took the filter apart and discovered that Leslie’s had only replaced half of the DE filter’s eight white filter pad thingies. Their guy charged me $250 to replace all of them. Hm. Looks like I should’ve fired that outfit long before their recent effort to corral me into buying an expensive new pump!

You could tell which ones were fairly new and which were the old ones — the old, tired ones are kinda yellowed with age, mighty sickly-looking, while the newer ones look noticeably whiter. One of the old ones had several holes in it, which explains why the pool has been kinda hazy-looking: DE has been seeping out into the water.

Ducky. That’s going to be another $250, payable tomorrow when he shows up with eight new pads.

He said he’s about to take over his dad’s swimming pool service company — at the age of 57, Dad is recovering from a recent stroke. The kid said he’d provide weekly service for $90 a month. Sooo…if I have to have surgery that puts me out of commission in the heaving-around department, there’s going to be Sickness Expense the First. If I can’t lift things and my arms are effed-over by having the lymph nodes ripped out of them, I won’t be able to keep that pool clean on my own. At least not for quite some time.

Tomorrow morning I’m going out to the Mayo to see my old, OLD doctor, who practices out there. This morning I drove a CD with St. Joseph’s radiology images and the radiologist’s report out there, because I realized I couldn’t be here to wait for the pool guy and out there delivering the data at the same time this afternoon. Fortunately, the dog got up up at 3:30 again, so it was easy to get dressed, fed, and out the door by 7 a.m. A huge wreck closed the north- and eastbound lanes of the two freeways I would ordinarily drive to make this ridiculous jaunt, so I had to take surface streets all the way to the far side of East Scottsdale. However, traffic was light despite the dire warnings on the radio.

While plodding across the city, I reflected that Dr. Daley and I have known each other for almost 45 years! Holy mackerel! Who would think it? At any rate, he’s one of the Mayo’s grand old men now, and so if anyone can help me navigate through the hideous shoals of the medical establishment, he’s the one. Before I got off the phone from his underling, I had an appointment with him this week, like right now! He wanted to get his hands on said images/report early so that he could have a Mayo radiologist look at them. So, with any luck he should be able either to reassure me or scare the bedoodles out of me.

I’m taking the HealthGrades and Medicare.gov data to present to him, because of course the first decision I’ll have to make, should these things prove to be malignant, is whether to proceed with St. Joe’s or to go to the Mayo for surgery. The Mayo has the best safety record for patients — St. Joe’s is surprisingly wanting in that department. And I do want to ask him about St. Joe’s 16.5% mammogram follow-up rate, 2.5% above the level Medicare classifies as “unacceptable” and a pretty sure sign that they’re doing unnecessary procedures.

God! I’ve become such a skeptic in my old age! Take things with a grain of salt? Hell, I take everything with a pound of salt, thank you very much. I just don’t believe anything or anybody anymore, whether it’s a pool guy or a high-powered M.D.

Here are the issues that set off my bullshit alarm with the present cancer scare:

The radiology tech looked at the second mammogram images and said, of the alleged nodules, “Those aren’t cancer.” Admittedly she’s just a tech — i.e., likely a junior-college graduate — and she no doubt was shooting off her mouth when she shouldn’t have been. But there’s also a bachelor’s degree program for these technicians, and if she has a lot of experience, she may very well have a clue to what she’s looking at. Thirty or forty minutes later, I’m being told there’s a 50% chance the things are malignant. It plants a little doubt, albeit not much.

By way of trying to persuade me that I need more probing and possibly surgery and radiation, the radiologist asked if I’d ever taken hormone replacement therapy. When I said I had not, she said that was a bad sign — not doing HRT is a risk factor for breast cancer. Well, that is not altogether true. The American Cancer Society reports that HRT using estrogen and progestin raises your breast cancer risk, whereas plain estrogen therapy has a nil risk or even a slight protective effect.

Then there’s that 16.5% follow-up rate. It’s the highest of any of the area hospitals I looked at. Boswell, out in Sun City, has a 7.7% rate, below the state average of 8.9%. Good Sam’s is 13.7% and John C. Lincoln’s is 13.5%, dangerously close to that 14% figure Medicare considers “unacceptable.” IMHO, Medicare is a cash cow (heh…okay, pun intended). To the skeptic’s eye these diagnostic tools look a great deal like milking stools. We have a relatively simple procedure that Medicare covers; we have a public convinced it should be used routinely; and we have a dread disease that so terrifies women it can be used to herd them toward increasingly profitable extra procedures…from mammogram to new mammogram to sonogram to biopsy to…??? Hm.

That’s not to say I absolutely positively think it’s bullshit. Obviously, it’s best to assume the worst of any suspicious lesion, and then to be pleasantly surprised to find it’s harmless.

You know, that’s why it’s good to be a cynic: you’re always pleasantly surprised!

😆

Question Authority! Navigating the Medical Industry

Folks, I want you to bookmark and also write down the URLs for these two sites:

Medicare.gov’s Hospital Compare search engine (http://www.medicare.gov/HospitalCompare/search.html)
Health Grades (http://www.healthgrades.com/)
Health Grades’ Hospital Directory (http://www.healthgrades.com/hospital-directory)

Hang onto these. Sooner or later, you’ll need them, unless you drop dead out of the blue.

To get the mammogram that led to the speculation that I may have breast cancer, I went to St. Joseph’s, a vast medical center in downtown Phoenix — only because my gynecologist is on the teaching faculty there. It has a good enough reputation, other than the Church’s having fired and excommunicated an administrator and ethics board member because she approved an abortion to save the life of a patient who was had a 100% chance of dying if the pregnancy continued. And other than the fact that I almost died there some years ago, when I couldn’t even get triaged after showing up at their ER with acute appendicitis. But those, of course, are different stories.

Yesterday, after I finally began to calm down a bit, it re-entered my hot little mind that I won’t even have a dental procedure done without a second opinion. So why on earth would I let someone have at my boobs without a second opinion?

Emboldened by this thought, I called Young Dr. Kildare’s office and asked tentatively if he would be interested in chatting about this. His nurse basically said “uhhhh… I’ll ask him.”

Then St. Joe’s called to set up the biopsy. They only do these at 10:30 in the morning. I explained that I teach four days a week, and that my pay will be docked if I don’t show up. That  left only Fridays, and (fortunately, I suspect), this Friday was taken. So the thing is now scheduled for the 20th.

This buys some time.

Charley woke the Pup this morning as the sun’s first waves of electromagnetic radiation seeped over the eastern horizon, and they started to lobby to get up and play. That rolled me out of the sack at 4:30. More time purchased: I used it to do a little research.

Here’s what I found out:

First, I found this article, reporting on research that suggests mammography can lead to unnecessary procedures, and that some scientists believe women over 70 or 75 should skip the routine screening altogether. For women between 50 and 70, however, routine mammography may reduce the risk of death from breast cancer by 20 or 30 percent.

I’m not 70 yet, but I will be in less than a year.

Following a link in that article, I came upon a risk assessment tool at Cancer.gov that puts my chance, at age 69, of developing breast cancer within the next five years at 2.2%, exactly at the average risk of 2.2%. The site notes that this means my risk of NOT developing a breast cancer over the next five years is 97.8%. My risk of getting breast cancer between now and age 90 is 6.6%.

Hm. Kinda different from the 50-50 chance the St. Joe’s radiologist gave me, isn’t it? Interesting, too, that she qualified her statement with “that’s in my opinion.”

Healthgrades is a site that assesses the safety and quality of hospitals across the land. Out of curiosity, I checked on three hospitals where I might  have the threatened procedure done: John C. Lincoln, because that’s where Young Dr. Kildare practices; St. Joseph’s, because it’s a teaching hospital and it’s where my gynecologist practices; and the Mayo, because it’s the best of a generally mediocre lot here in Arizona.

In “Safety” (i.e., how likely are you to be harmed by some condition or error attributable to the hospital and its staff) Healthgrades ranks St. Joe’s below John C. Lincoln, which used to have a terrible reputation. St. Joe’s gets 7 “below average” dings, 4 “average” marks, and 2 “above average” credits, compared to JCL’s, with a mere 4 “below averages,” 3 “above averages,” and 6 “averages.” The Mayo is far superior, with 3 “below average” grades, 3 “average,” and 7 “above average.”

That’s interesting. Not to say “alarming.”

When you get into Medicare.gov…ah, that’s where it gets seriously interesting. The government has posted a lot of data about hospitals around here. One of the categories the statisticians track is “Use of Medical Imaging,” and they say that in Arizona the average rate among outpatients who have a follow-up mammogram, ultrasound, or breast MRI within 45 days of the initial screening is 8.9%. Now that may not be typical of the US overall, because there’s a lot of poverty here, and also because women who live on the Indian reservations might have a difficult time traveling back and forth for repeated exams and so might be asked less often to return. One never knows, with this place. However, on another page, the site states:

Medical evidence suggests that there may be a problem if a facility has either a very low or very high rate of follow-ups.

Although values for a very low follow-up rate have not been established, a follow-up rate near zero may indicate a facility that misses signs of cancer. Follow up rates around 9% are typical.

Research has established that a follow-up rate above 14% is not appropriate and may indicate a facility doing unnecessary follow-up.

And over at the page reporting on St. Joseph’s, we find the following:

Use of Medical Imaging:

Outpatients who had a follow-up mammogram, ultrasound, or MRI of the breast within 45 days after a screening mammogram: 16.5%. a rate higher than 14% may mean there is unnecessary follow up.

 Whoa! A return rate of 16.5 percent?? That’s almost twice the state’s average rate, and it’s 2.5 percentage points above the rate Medicare says is not appropriate. 

John C. Lincoln is better, though not great: 13.5%. It’s still very high — just a shade under the “inappropriate” level — but it’s 3 percentage points below St. Joe’s.

As for the Mayo, we’re told “Not Available; No cases met the criteria for this measure.” What on earth that means, I do not know. But I do know one may go to a local clinic of the Mayo for a mammogram, rather than having it done at the hospital per se. Maybe they’re able to claim the rate is not the Mayo Clinic’s by a little sleight of hand. In my experience, the Mayo tends to lean heavily on the panic button.

I feel like I’m on a railroad ride to Hell here…

So I’ve called Young Dr. Kildare’s office — got an appointment on the 16th. I’m going to print this stuff out and tell I want a second opinion about whether a biopsy is really necessary. IMHO it’s telling that the mammography technician stated, in no uncertain words, that the two tiny lumps were “definitely not cancer” and then all of a sudden we get a new story from someone with a vested interest in charging Medicare for an extra procedure. The tech may just have been shooting her mouth off. But…she’s in the business, too, and she must be trained to recognize, to some degree, what she’s looking at.

Unfair to the radiologist, of course.

But…in a culture where the profit motive drives delivery of medical care as well as production and delivery of pharmaceuticals, it’s hard not to be skeptical.

Doggy Tunes!

So this morning it’s off at 5:30 to M’jihito’s house. His luggage, his dog, and he are piled into my car, in that order. Thence, to the airport, where the son and the luggage were unloaded. And now Charley the Golden Retriever is here at my house for a week.

Charley and Pup are hilarious, because Pup brings out the two-year-old Charley’s lingering latent puppitude. Around Ruby, Charley is still, unmistakably, a puppy. A great deal of frolicking takes place, and much mischief is plotted.

One of their Looney Tunes schticks has to do with food. They both love it. They both desire it. They both require it. And neither one can stand to see the other get it.

Pup gets fed inside an X-pen so that Cassie can’t take her food away from  her, but a glance at Charley and a glance at the X-pen will tell you that the contraption is too feeble to keep him  out. Another scheme had to be contrived. As soon as I opened Ruby’s can of expensive urinary tract prescription dog food, Charley knew something was up. He was beside himself with excitement. No way a bowl of the stuff was going to get on the floor without him inhaling it

HUMAN: Come on this way, Charley!

HUMAN walks down the hall.

CHARLEY and RUBY follow human.

CASSIE flies up the hall and dodges into the bedroom.

HUMAN: You stay, Ruby.

RUBY ignores HUMAN but is muscled aside by CHARLEY, who strong-paws his way into the bedroom.

HUMAN dodges out the door and closes it before RUBY can squeeze in.

HUMAN: Dog food, Ruby!

RUBY races toward kitchen, a bundle of joy. CHARLEY slams self against door in despair.

Heeeee! He’s a nice dog. But not the brightest rhinestone on the fancy collar.

Speaking of Looney Tunes, I called the gynecologist’s office to be sure I understood correctly that the radiology department would call me to make an appointment for the pending torture sessions. After punching through two punchabutton nuisances, I get stuck on hold. And hold…and hold…and hold…and hold…and hold…and hold…and hold… This wouldn’t be so annoying if one could wait on the damn phone in SILENCE. But noooo…they have to subject you to vomitous muzak and endlessly annoying blather advertising the many services they would like to persuade you that you need. After a good ten minutes on hold — I’ve answered e-mail, posted an announcement on my class’s Canvas site, unloaded the dishwasher, and am reloading the washer with new dirty dishes — the phone rings through and someone answers and the first words out of her mouth are “WILL YOU HOLD, PLEASE?”

Well, no, thank you.

How much, again, are you folks charging Medicare for this?

 

Oh Goodie! Another Cancer Scare…

So it’s back from the extra trip to the mammography unit, where the radiologist says she and her ultrasound lady found two “nodules” which she believes to be dangerously suspicious. She explained all the reasons she thinks these things could be boob cancer, and she made good sense. So now they want to schedule a needle biopsy and, if that turns out positive, surgery.

Ducky. As if I didn’t have enough on my mind.

She said the chance that they’re benign fibroadenomas is about 50 percent. That, of course, means there’s a 50 percent chance that they’re cancer. Doesn’t sound like great odds to me. Because these are new growths, because of my age, and because I have never taken hormones, the likelihood that they’re malignant is elevated.

Look into this and you discover that benign fibroadenomas in old bats like me may (or may not) be precursors of actual breast cancer:

Women diagnosed with benign disease do appear to have an overall modest increase in risk for subsequent development of breast cancer, particularly for more hyperplastic or epithelial (the covering or lining) proliferative forms. However, the evidence regarding the risk of breast cancer for non-proliferative conditions is conflicting. Some research found that the risk of breast cancer for women with non-proliferative disease is about double that of women without benign disease (Bodian 1993b), while others find that lesions with no proliferative changes were not associated with an increased risk (Oza 1993; Henderson 1996; NBCC 1999). According to Hurley (1997), atypical hyperplasia is a risk factor, but is not with certainty followed by breast cancer; risk applies to both breasts, with greater risk on the affected side. There is no means to predict which women will go on to develop breast cancer and the effectiveness of current screening and management methods is unknown. Further complicating a physician’s ability to predict a woman’s risk for breast cancer is that most women do not have a history of biopsy for a benign lesion (Bodian 1993c; NBCC 1999).

Isn’t that informative!

Hm. Interestingly,  neurofibromas (a hereditary condition which I happen to enjoy) can also appear in one’s boobs, and they can be mistaken for fibroadenomas. And lo! These things are on the same side as the neurofibromas that infest my shoulder. Wish I’d known that…I would have pointed out the shoulder lumps to the radiologist. Oh well.

What a damn nuisance. You know, the truth is, I don’t really much care whether I live or die. My life is essentially over now, and I’m not at all afraid of dying. Nor do I imagine I have much of anything left to do on this earth: I fill my hours with frantic busywork mostly to pass the time. What does scare me is the prospect of suffering the way my mother did with her cancer…and with her incompetent quack doctors. Truly, I would cheerfully die right now, today, rather than suffer the way she did.

Because I’m all by myself and there is no one here to help me, the hassle factor is almost more than I can bear to contemplate. The biopsy is nothing, but if, as seems fairly likely, they decide these things are cancers, the upshot will be lumpectomy and radiation therapy, according to the radiologist.

That means an overnight stay in the hospital plus God only knows how long to recuperate enough to get back to a normal life. None of the sites I’ve looked at say how long it takes to recover, but I would assume it will be at least a couple of weeks… Evidently long-term pain and numbness of the arm, plus some other uncomfortable and weird manifestations, are possible. The radiologist seemed to be saying they would perform radiation therapy at the time of the surgery, but all of these sites talk about five or six weeks of radiation therapy.

So. At the outset, someone will have to take care of these dogs, since I will be unable to do so for at least several days and possibly longer than that. Someone will have to take care of the pool, which is merrily going green — I have to do battle every day to keep the algae blooms under control, because I was too damn lazy and cheap to drain the thing and refill with fresh water last winter. Probably someone will have to run to the grocery store at least a few times to get me some food. And of course all these little projects I’ve been doing, trying to get books published and the incoming giant index and the various other editorial projects are going to have to go away, to the loss of at least a couple thousand bucks. If I’m unable to function well enough to teach my classes next semester, that’ll be another $4800 out the door.

Ugh. Just what I need to make my day!

Life-Careifying My Home

A couple I know recently moved into a venerable life-care community here in Phoenix. They’re not that much older than I am… She has Alzheimer’s in her family and is beginning to show the earliest signs, and he is about ten years older than she. Their two-story house was getting hard for them to negotiate, so they figured now is the time. Another elderly couple — my current role models, come to think of it — are resisting being warehoused in a kennel for old folks, and getting by in their home pretty well, so far.

Within weeks after my mother died and was reduced to an urnful of ashes, my father moved himself out of their house in Sun City and into a Baptist-run old-folkerie called Orangewood. It was one of the early life-care “communities.” (Don’t you hate when the word “c0mmunity” is used to describe some development?) The idea with life-care is that you will move into an apartment in the joint, where, in exchange for a staggering amount of money, you will receive a variety of amenities, and, when the time comes, you will be guaranteed access to a halfway decent nursing home.

This expensive and, in my view, depressing arrangement turned out to be the biggest favor my father ever did for me. It relieved me of the responsibility of having to care for him as he declined into old age and death. He was only 69 when he moved himself in there, but he lived to be 84, and at the age of 80, he had a heart attack that reduced him to a cardiac invalid. Had he still been living in Sun City, I would either have had to get him into a nursing home at that point or would have had to move him in with me. Either scenario would have been a screaming nightmare.

So, occasionally I think I should do the same favor for my son.

But you know…I don’t want to live in one of those places.

For a dark little three-room apartment with an “efficiency” kitchen of the sort you see in motels (a hot-plate-like two-burner stovetop, a small sink, and an under-the-counter fridge), my father and his third wife forked over a $50,000 nonrefundable “endowment” and a monthly payment that was as much as my then-husband and I were paying for a 3,000-square-foot house on a third of an acre of the choicest real estate in North Central Phoenix, with a pool, five bedrooms, a huge country kitchen with breakfast nook, a vast family room, three bathrooms, fireplace, and pool. When I realized what he was paying for the little dump he and Helen were living in, I was just floored.

Now, they did get some amenities:

Access to the institution’s nursing home and, if a lesser level of care was needed, to a studio apartment adjacent to the nursing facility. This was roughly equivalent to long-term care insurance, for which I now pay $107 a month, a figure that can be expected to rise steadily from now into perpetuity.

A dining hall where they were required to take one meal a day and could also choose to take breakfast or a light supper.

The option to have these meals delivered to their apartment. This cost extra.

Semi-weekly light housekeeping.

Electric bills (including air conditioning) were covered. Of course, this meant the institute would decide when the AC would be turned on in the spring…

Access to an on-call doctor. Nevvermind that the guy was a dangerous, irresponsible quack who was enriching himself by defrauding Medicare. (Yes: my father caught him charging Medicare for visits after he (father) had told him and the institute that the guy was to stay away from him. Like all the other old folks there, he was afraid to report this abuse — getting into bad odor with the management would be counterproductive.)

Access to a hobby room. Whoop comma de-doo.

Access to a swimming pool that no one ever used.

Access to a beauty parlor/hair salon/barber shop that dispensed dumpy-looking haircuts.

“Free” shuttle-bus rides to doctors and a grocery store. Nevvermind that this meant once you were done seeing the doctor or dentist, you could sit in the waiting room for several hours until someone came to pick you up — it did defray some of the costs of transportation after one reached the point where one could no longer drive.

  Oh, and also please nevvermind that every time some kitchen worker came to work sick or failed to wash her hands after using the bathroom, a wave of dysentery would sweep through the entire population.

{sigh} Every time I think about the possibility of signing myself into one of those places, I recall not only the amenities but also the limits to the amenities. And I think how much I absolutely positively do NOT want to be warehoused into a kennel for old folks.

So, here’s the question:

Is it possible to stay in one’s paid-off home through one’s dotage by cloning those amenities, for no more than it cost my father to live in Orangewood?

Today, those inflation-adjusted fees are much higher. One newer outfit here in town charges an entry fee of $310,00 to $1.1 million, with monthly fees that range from $2,400 to $4,100 — for one person. The place where my father and his wife lived has been torn down and completely rebuilt, so it now commands an entry fee ranging from $279,900 to $389,900, with monthly fees from $3,040 to $8,130. Entry fees, however, now tend to be at least partly refundable, an improvement over the pay-it-and-lose-it arrangements of the early days.

Well, think about it: $2,400 to $4,100 for base living expenses for one person strikes me as passing exorbitant, especially considering that person likely will find herself in a cramped one-bedroom apartment, with walls through which she can listen to the hard-of-hearing neighbor’s TV blaring.

My base nondiscretionary budget is $620/month. That includes all utilities, phone, DSL, yard care, and long-term care insurance. Add another $167/month for property tax and another $79 for homeowner’s insurance, and about $52 for car insurance, and you get a total nondiscretionary cost of $918 a month. As a practical matter, these expenses come in lower during the fall, winter, and spring, because the budget is based on summer costs, when power and water bills are at their highest.

Everything else, I class as “discretionary.” This category includes clothing, gasoline, food, entertainment, dog care, hair care, personal care and cleaning products, house and pool maintenance, and whatnot. The discretionary budget presently is $1100/month, although sometimes I overspend. Ruby’s endless veterinary bills caused a $300 overrun this month, resulting in $1,400 in discretionary spending for the current budget cycle. So let’s figure that’s a typical range for discretionary spending: $1,100 to $1,400.

What that means is that for everything — all my routine costs, which include nursing home insurance — I’m spending $2,018 to $2,318. That is less than the lowest rate for a mid-range life-care community. And what do I get for the price?

A private pool that I can use any time of the day or night I please, that I can skinny-dip in; and I know who has been in it and what they’ve been doing in it.
A large, low-maintenance yard with fruit trees, climbing roses, and three private garden “outdoor rooms.”
The privilege of keeping pets.
A garage (not an open carport) in which to park my car.
No one on the other side of any of my walls.
Central location.
Brand-new light-rail going in within walking distance.
A large, bright kitchen with a gas stove.
My own propane grill.
More living space than Carter has oats.

Sooo… What do I not get that, say, my father had at his old-folkerie, and what would be entailed in acquiring those amenities?

Access to a nursing home.

The long-term care insurance I have plus Social Security and a 4% drawdown from savings should amply cover foreseeable nursing home costs. As for getting me into it? That’ll be my son’s problem, I suppose. As a practical matter, not all elderly Americans ever need nursing home, and often such care can be delivered in one’s own home (my insurance covers in-home nursing care). At age 60, your lifetime chance of needing nursing care is only 50%. If you have a policy with a 90-day elimination period, a typical 60-year-old’s chance of using that policy drops to 35% — meaning you have a 65% chance of dying or recovering within 90 days of admission.

A dining hall providing two meals a day.

It’s impossible to describe how dreadful those meals were! Since eating and drinking are the two major pleasures of my life, I would be suicidal if I had to live in a place that served up swill like that, especially given that about twice a year the stuff made everybody in the institution good and sick.

Option to have meals delivered, for an extra fee.

What part of Chinese order-out is hard to understand?

Okay, that’s flippant. But as a practical matter, many excellent meals can be delivered, for a reasonable price. On the low end, there’s a social service agency called Meals on Wheels, which provides healthy food for seniors in need. For those of us who can afford to buy groceries, grocery stores deliver these days! And most grocery stores stock various kinds of prepared meals, either in the frozen-food cases or at the deli. Here in Phoenix, both AJ’s Fine Foods and Whole Foods sell complete, fully cooked gourmet meals, and both stores deliver. 

Would having groceries and take-out meals delivered raise your food bills? Sure. But I’ll bet it wouldn’t add another $2000 a month to my existing bills. And the cost would be offset by lower gasoline bills.

Light housekeeping

The going rate for a cleaning lady here is $80/visit. So two house-cleanings a month, which is what my father got, would set you back all of $160. Like food prep, this obviously costs more than DIY cleaning, but it’s not prohibitive…and it would not increase costs much more than I’m spending.

Electric bills covered

For $4,000 a month? Seriously? Utility bills in these places are not free; they’re included in a staggering monthly fee.

Access to an on-call doctor.

I have access to an on-call doctor. Young Dr. Kildare’s office is within walking distance of my house. And he is not an incompetent, dishonest quack who hands out sedating, brain-dazing, addictive pills like candy. If I need help on a weekend, I call his office and get the doctor who is on call.

Access to a hobby room.

Be still, my heart! I have two spare rooms, one of which is now dedicated to my jewelry-making hobby. My office (which would not exist if I lived in an old-folkerie, because of course the presumption would be made that I do not need office space) is fully equipped, spacious, and dedicated fully to my writing and editing business. And I don’t have to share it with anyone.

Access to a swimming pool that no one ever used.

I use my pool several times a day during the summer. Cost is nominal, and the light jobs of cleaning and maintaining it amount to mild, healthy exercise. If and when I reach the point where I need someone to clean and dose it with chemicals, regular pool service runs about $100/month and includes the chemicals.

Access to a beauty parlor/hair salon/barber shop that dispensed dumpy-looking haircuts.

Granted, I can spend a startling amount on Shane: $70 for a haircut. However, my hair looks incredible, and as it gets longer, it has to be done less and less often. At this point I’m visiting him about once every six months. Here, too, this seeming “benefit” is not free to old-folkerie residents. You pay for it with your amazing monthly fee, and if you don’t care for dumpy-looking haircuts and drugstore coloring kits, you end up having to track down and pay the likes of Shane anyway.

“Free” shuttle-bus rides to doctors and a grocery store.

What cost a free ride? Is it really worth spending three, four, even five hours sitting in some doctor’s waiting room, just to save a few bucks? Another circumstance, I’d say, that would lead me to consider suicide.

With grocers, drugstores, and Amazon delivering for little or no cost, I think I could afford a taxicab for the few trips I’d need to take around town. The amount saved on car registration, auto insurance, gasoline, depreciation, maintenance, and repairs would probably cover most of the cab fare.

It looks very much to me as if I can turn my own home into a life-care facility, if need be, with surprisingly little effort and, compared to an expensive institution, not all that much more cost than I’m already paying to live in my home.

Let’s consider what those extra costs would be:

Lifecareifying the house
Item Cost Times/month Total
Light housecleaning 80 2 160
Extra yard care 75 2 150
Groceries, Whole Foods 6 4 24
Groceries, AJs 6 4 24
Groceries, Safeway 12.95 1 12.95
Pool care 100 weekly 100
Lightrail rides 32 monthly pass 32
Cab fare (senior citizen) $12/$40 ride 2 80
Less monthly gasoline $80+/month 2 refills/mo. -80
Total added cost: 502.95

So, the additional cost, above and beyond what it costs to live now, to approximate the added benefits of living in an old-folkerie, comes to about $503. Innaresting.

Let’s see how that translates when added to the existing cost of living here at the Funny Farm.

Discretionary 1100
Nondiscretionary 620
Added old-age costs 503
50% Murphy’s Law 251.5
Total old-age cost 2,474.50  / month
Total annual old-age cost 29,694
Percent of savings: 4.60%

This assumes a 50% “Murphy’s Law Tax” on the projected old-age costs. And it produces a figure to cover ALL costs, including whatever indulgences one pleases, that is comparable to the BASE costs on the low end. Total annual drawdown to cover this amount would in theory be 4.6%, but in fact it would be significantly less, because Social Security would cover more than half of it.

Suppose, though, that Murphy’s Law applied to the TOTAL projected costs of living after one can no longer drive. Then what?

Discretionary 1100
Nondiscretionary 620
Added old-age costs 503
Plus 50%, Murphy’s Law 1112
Total old-age cost 3,335  / month
Total annual old-age cost 40,020
Percent of savings: 6.20%

In this scenario, we end up with a cost comparable to the mid-range cost of living in a life-care community, totaling about 6.2% of total savings. But here, too, some $14,400 of the cost is covered by Social Security, meaning the drawdown from retirement savings would be significantly less than that: just under 4% per annum.

So, even in the worst-case scenario, aging in place ends up costing the same as or less than residing in a life-care community. And for the price, I get a house — not an apartment in a people warren — plus the cuisine of my choice, the doctor of my choice,  privacy, and independence.

Prescription Pills: Proceed with Caution

The past few weeks, what with a new pup to tend to, a bunch of paying work (and more incoming), the scheme to self-publish three books, and a busy Holy Week, I’ve hardly had any sleep at all. Pup regularly lobbies to go out at 4 in the morning, and once awakened, I rarely go back to sleep. And night after night, bed-time has come along about midnight. Nothing out of the ordinary…but then there’s also the slacking off in the exercise department. When I’ve had time to exercise or walk, I’ve been too tired to bother. Result: ta DAAA! Resurgent back pain.

Sunday night I hurt so much I could barely hobble up the hall. So, along about 10:00 p.m. I decided to try a muscle relaxant the doc prescribed last year. Tried one of these a week ago, and it worked pretty well…next morning, I was actually able to crawl from the bedroom to the refrigerator, a large improvement.

The Rx instructions say the stuff should clear out of your system in about eight hours. Had a vet appointment at 10:30 Monday ayem, meaning I’d have to get in the car at 10. Eight hours plus 10:00 p.m.?  Six a.m., right? So by 10 a.m. there should be no problem driving across the city and life should be good.

Actually slept seven hours, a record, but figured the haze of exhaustion was normal, since it usually takes two or three decent nights’ sleep to make up for ten days or two weeks of sleep deprivation.

Drive to the vet. Get last set of puppy shots. Bring pup back. Tuck her into her X-pen, turn around and race back out. Schlep to the credit union, deposit adjunct paycheck. Schlep to Costco; return ridiculous bathmats (purchased as dog mattresses) that can’t go into the washer(!) and make a few new purchases. Unload car, unload dog, let dog out, feed dog noon meal.

Fix my own meal. It’s now around 1:00 or 1:30 p.m.: fifteen hours after I’ve ingested 5 mg of cyclyobenzeprine. Midday feast: steak, potatoes, vegetable. I have a bourbon and water with this. Again, nothing out of the ordinary: I usually have a b&w or glass of wine with the big meal of the day.

I sit down to this little repast around 2:00 p.m. Shortly before three o’clock, I fall face-forward on the bed: seventeen hours after dropping the muscle relaxant pill. A friend expects me to show up at 4:00 p.m.; set the alarm to go off a little in advance. Conk completely out.

Alarm goes off. In a stupor, I can’t recall what I was supposed to do. Shut it off. Fall back to sleep. Phone rings at half-past four: where am I?

Good question…

Think of that! A small amount of booze — no more than usual and certainly not enough to inebriate…at least not normally — and I’m passed out in the sack!

Presumably while I was driving around in a haze of exhaustion earlier in the day, I must have been impaired. And mistaking impaired for tired. Apparently the stuff took a good 18 hours to wear off: more than twice as long as the bottle’s label implies is the drug’s period of effectiveness.

Five milligrams is half the amount of the original prescription a doctor gave me of this stuff. I asked for a smaller dose and got it. But apparently half a dose is not small enough.

So…watch out for drugs that knock you out. The effect may not wear off as advertised.