Being, Doing, Becoming? Yes!

I read a number of e-newsletters, and a headline in one this week caught my eye.  “Are you a human being, doing or becoming?” This particular article was in a marketing newsletter that was aimed at self-employed small business owners, and not referencing retirement.  However, it struck a chord with me.

In some of our Route To Retirement materials we talk about doing versus being.  Once we retire, we don’t need to be doers all the time.  It’s OK just to be sometimes.  And as we move toward our senior years, we tend to be more than do.  This shift in mindset is not easy for some people, especially those who have been work oriented all their adult lives – those who took their identity from what they did in life – their work identity.

But there is more to that headline than being or doing. It is the becoming part. As the author pointed out, “in the plant kingdom, you have a choice – grow or die.  You simply cannot remain stagnant or you’ll wither and die.”  The same is true for humans.  We need to keep expanding our thinking and awareness in order to grow.   How do we do that at this stage of life?   For one thing, it means getting off the sofa and out of the house.  Try new things, different groups, places, activities, books.  This may take some effort to get going, but the rewards will be well worth it.

A woman came to my program on life style planning in retirement.  I wondered why she came to that program, because she was in her 80’s, and most attendees were 50-60ish.  She made some contributions to the group, and when the program was over, she said to the other people in the room  “I can tell you one thing for your plan: Say Yes!”  I have never forgotten that message – say Yes! to life, to new experiences.  That is how we keep growing.


Follow-up on Elder Orphans Article

Next Avenue has posted a very good article by Carol Marak headlined Choosing a Health Care Proxy When You’re An ‘Elder Orphan’. Carol runs the Elder Orphan Facebook page.  She points out that most of us don’t consider our long-term care needs until we see someone else struggling with the issues of decline and dependency.  Planning for retirement is not the same as planning for aging.

Also, health care proxies are not just for the end of life, or when we are incapacitated. This person is also your advocate ‘in the middle’, especially if you should develop a chronic condition.   Your proxy person should be someone you trust, someone who knows your values, your goals, your religious beliefs, your end of life decisions.  He or she should also have, in her words, ”the attitude of a pit bull — to not give up or give in because the person meets resistance” – your resistance to decisions that might be difficult to accept.

Additionally, having one health care proxy, while essential, is not enough.  You need a whole support network – people who can check in, do some driving, errands, provide companionship, provide personal help.  It is not too soon to start putting that network in place.  Also, it will need tending.  Friends do come and go – they move away, become involved with their own families and life issues. To have a friend is to be a friend to them and support them while you are able.

 

You can read the full article at http://www.nextavenue.org/choosing-health-proxy-elder-orphan/


More Life Long Learning Opportunities

I recently watched the Age Without Borders Virtual Summit. One of the sessions was about Life Long Learning and the diverse, worldwide opportunities for keeping an active state of mind as we age.

Several sessions dealt with the University for the Third Age. There are local U3A’s in countries all over the world, offering a wide range of local leader-led courses. There is also a website, offering online courses to anyone U3Aonline.org.au.  This is a membership organization.  For an annual membership of about $20 USD, you can take as many independent study courses as you want in that year.  (Since this is an Australian-based organization, the fees on the website are quoted AUS).  There is no equivalent in the US for leader-led courses, but Road Scholar has a page on its website listing Lifelong Learning Institutes in the US.  You can search by zip code for one near you.   http://www.lli.roadscholar.org/find-an-lli-near-you.

The March 2017 issue of AARP Bulletin has an article on online courses (Get Enrolled, page 37.)  They list several additional sites for online lifelong learning courses.

Big Think is defined on Wikipedia as a Web portal that features interviews, multimedia presentations, and roundtable discussions with speakers from a range of fields.  Big Think has also been described as a YouTube for ideas.  The Big Think website offers short articles and videos with a team of experts.  There is also a subscription channel called Edge for businesses.  I did a search for material on retirement, and Big Think listed 264 articles and 82 videos, although many of them had a very limited connection to retirement.  However, there was some very good material from experts such as Joseph Coughlin, director of MIT’s AgeLab, and the economist Paul Krugman. These are free.

The Great Courses.  These have been around since 1990, offering CD’s and DVD’s of college level course lectures.  Now, Great Courses have gone digital, with a subscription streaming service through their Great Courses Plus website.  You may find, however, a selection of Great Courses at your local library, either CD’s or DVD or streamed.  I am currently watching an online course on The History of the Ancient World on Hoopla, through my local library, however I am limited to five lectures a month. There are a few individual lectures on Youtube.com, plus previews of some courses.

Open Yale University.  These college level lecture courses are free, but no college credit is offered.  Actual Yale professors were taped in class and posted on youtube.  I did note one course that resides on Coursera.  These courses start at specified times, they don’t seem to be available on demand.

EdX  was mentioned in my first article.  It is a MOOC offering college level courses from schools and institutions around the world.  Some are self paced, others start at specific times.  They are free.

 

 


Brain Foods for Brain Health

The Age Without Borders Virtual Summit is running this week, and one of the presentations was by Dr. Nancy Emerson Lombardo, Professor of Neurology, Boston University School of Medicine and president of the Brain Health and Wellness Center. Dr. Lombardo’s subject was “Brain Foods to Help Save Our Brains and Our Bodies,” and she presented recent research on the subject in a very meaningful way.

Her key point was that nutrition and hydration is one of the eleven domains of brain health, and it is a domain that we can totally control.  We decide what we are going to eat or not eat, and how much.  And eating for brain health has the added bonus of preventing negative outcomes in other parts of the body, including heart and coronary artery disease and diabetes.

While many of the foods she listed as being brain healthy were no surprise – veggies, legumes, whole grains, nuts and seeds – several were surprising, spices and herbs, for one. Spices are strong antioxidants, reducing inflammation which leads to disease.  Cinnamon especially is an anti-inflammatory and anti-oxidant, and helps lower blood sugar and cholesterol.  Another surprise was eggs.  We have been told to limit egg consumption to one egg per week, because egg yolks are high in cholesterol.  Dr. Lombardo cited research which showed that consuming cholesterol in foods does not deposit it in our arteries.  Additionally, our bodies actually need a certain level of cholesterol for digestion and the control of blood sugar levels.

On the negative side was red meat – beef, pork and lamb.  In addition to its saturated fat content, red meat seems to be detrimental in other ways which are not well understood at present.    Limit consumption of red meat to once or twice a month.

Dr. Lombardo had her strongest words for sugar, not cholesterol.  Sugar, she said, is “The pathway to Alzheimer’s Disease.”  It is sugar that deposits the plaque in our arteries and leads to the tangles in the brain that cause memory loss and Alzheimer’s.  Excess sugar consumption shrinks the hippocampus, that part of the brain that is associated with memory and emotions.  This is true even in teenagers.

Sugar is in everything these days.  Read the labels on processed food packages to see how much sugar has been added.  Better yet, avoid processed foods altogether.  Soda is especially evil.  Even so-called ‘lite’ or low sugar foods made with artificial sweeteners are a risk to our health.  The only sweetener recommended is Stevia.

These are only a few of her recommendations.  Check her website for a Memory Preservation Nutrition Program plus resources, recipes and research supporting a healthy brain.  The Brain Health and Wellness Center’s website is  http://brainwellness.com/  It is a good source for brain healthy recipes,  information about brain health, and the research behind it. For specific recommendations, see the Consumer Nutrition Tips page:  http://brainwellness.com/nutrition/consumer-nutrition-tips-advice/


Elder Orphans

I have the makings of an elder orphan.  That is a term now used to describe older adults who have no support system – no families or friends left as they age, at least, none in the immediate area who can and are willing to be caregivers or provide support in other ways.   I have no family, but I do have a lot of friends.  I am not alone in this respect.  Almost half of all women over 75 lived alone in 2015, and that percentage increases as we age.   Nearly 23 percent of people over 65 are — or risk becoming — elder orphans, according to a study done by New York geriatrician Maria Torroella Carney.

Here is a story about one of them:  A woman of my acquaintance, an elder orphan, was living in her home with round-the-clock aides.  She had a fall, and was admitted to the hospital.  The hospital at discharge said she was no longer able to live in her home, and they discharged her to an assisted living facility.  She is extremely unhappy about this and resisting all efforts to help her adjust to the new environment.  While she has no family, she does have the support of some people from her church who are trying to help her.    There are other stories in the news of older people found dead or ailing in their homes, often full of clutter, and no one knew they were even there.  As a colleague of mine sighed about one of them “a social worker’s worst nightmare.”

What can we do to ensure that we will be able to live out our lives with dignity and as much independence as we can muster when no family is there to step in when we start to fall apart?    We need to create The Plan, and to do that, we must face the reality that we will age, and if we live long enough, we will need care.  These are not pleasant topics, but, as they say in business, “Failing to plan is planning to fail.”  Having a plan is no guarantee that things will work out as you projected, but at least, you will have a starting point.

That starting point is the paperwork.  As I have written before, we need to be sure our wants and desires are made know to those who would care for us.  And, we need to have people in place, including someone with Power of Attorney to handle our financial matters and a Health Care Proxy to make medical decisions when we cannot.  If you have not named a health care proxy and you become incapacitated, it may be a court-appointed guardian who determines your care, and you may not like the result.  In many states, there is little or no oversight of guardians, which can lead to disaster.

Having these two people in place isn’t enough, though.   We elder orphans need a whole social support network – people who can advocate for us on a day-to-day basis in the hospital or at doctors’ appointments, and help out with the daily stuff we can’t do.  (Be sure to sign HIPPA[1] forms for anyone who might be advocating for you, and give them to your doctors and hospital).  Building and maintaining a social support network is probably the most important thing we can do for ourselves.  That means getting out and getting involved with people in our communities.  The woman mentioned above has social support from her church.  Other avenues are neighbors, senior centers, local clubs and libraries.  But most of all, we need to face the hard questions and deal with them.  Wishful thinking is not a plan.

[1] Health Insurance Portability and Accountability Act of 1996


On Flunking Retirement

I recently ran across an article by Mark Walton on Why We’re Flunking Retirement.  Now, it has been my position that you cannot ‘flunk retirement’.  If one thing does not make you happy, providing meaning to your life, you can try something else – or two or three something elses.  You are not building a career here, and can take your time to find out what works for you.  And over time that can, and probably will, change. There are any number of opportunities out there waiting for you to discover them.

Mr. Walton’s article caught my eye, however, because he cited Peter Drucker, the Father of Modern Management.  Peter Drucker’s writings were required reading for us MBA students at New York University, and as a food service manager, I found much that resonated with what I saw in my own organization.

Drucker coined the term Knowledge Worker, one whose body did not wear out from physical labor, and who reached retirement age with a brain that was still working.  For the knowledge worker, a retirement of leisure, referred to as The Golden Years, was not satisfying.  These people need a new way of retiring, one that challenges the mind.

In Drucker’s 33rd major book, “Management Challenges of the 21st Century,” published in 1999, he proposed that the greatest management challenge of the 21st century will be managing oneself.  To do this, we need to know our strengths, identify our values, and know where we belong – the result of the first two points.  From that, we can approach the question of what is my contribution.  Where and how can I make a difference?  This leads many into new careers or volunteer activity in the nonprofit sector. Success is defined as making a difference in the world, or some corner of it, not achieving the top job or the highest salary.

What Drucker proposed has become the Encore movement, spearheaded by Encore.org, an organization dedicated to building a movement to tap the skills and experience of those in midlife and beyond to improve communities and the world.  Encore looks to harness the experience and skills of boomers to address the problems of the modern world and create a better future for generations to come.  You can read what others are doing in their encore careers at encore.org.

Dr. Drucker, by the way, remains a role model for aging.  He was writing, teaching and consulting up until his death at age 95.

Mark Walton is Chairman of the Second Half Institute which offers courses to people who are approaching the second half of their lives.


Busyness

Often one hears recently retired people say something like “Oh, I am so busy since I retired, I don’t know how I ever had time to work!”  When I hear that, I ask “But are you having fun?”  Most of the time they say “Oh yes, I’m having a great time.”  But once in a while, the response will be “well . . . now that you mention it . . .  “

This is busyness, not fulfillment.  A friend of mine is always busy – driving people to doctors, errands for home-bound friends, church committees, caring for neighbors’ pets, and occasionally caring for grandchildren who live several hours away. She says “I have no time for myself.”

Why do people fall into the busyness trap – activity that is not rewarding . . . now, when we have control over how we spend our time?

We have been busy all our adult life, and for most of us, that busyness has been in the structure of our work hours.   It is simply a habit that gets us out of bed early in the morning, and out of the house keeping busy with work and errands.

Another remnant of the job may be the sense that one must be productive – effective and efficient in order to be a valued employee and an important, needed employee.   For a workaholic, this is the most difficult mindset to change. All of a sudden, it is OK not to be busy all the time. It goes against the grain.

For some, the need to be busy is sensed as an obligation. “I should go and help them out, that organization needs people; she helped me or my family in the past.  Fear of boredom is sometimes given as a fear of retirement. Post-retirement time is seen as an empty void, with nothing to enhance our psychological needs to be useful, to achieve or accomplish, to be needed.  Sometimes an empty void is threatening.  It creates a space for something we have been trying to avoid or forget, something that work kept at bay.  Now we need to deal with it, and busyness is one technique to continue avoiding it.

Back in 1955, C. Northcote Parkinson, a naval historian, wrote an article in The Economist, satirizing the British Admiralty.  He announced a new scientific law, to be called Parkinson’s Law.  It stated: “work expands so as to fill the time available for its completion.”  I believe that the prevalence of busyness in retirement is evidence of this law in action.  If we have all morning to do grocery shopping, we take that time, even though before we retired, we could accomplish the same task in an hour after work.  Hence, more busyness.

” Socrates said “Beware the barrenness of a busy life.”

How does one break the busyness habit and move to a more fulfilling lifestyle?  Here are some suggestions:

  • First, start by keeping track of how you are spending your time – what is keeping you busy.
  • Then, rate each activity on two things
    • How important is it? What would happen if you quit doing it?
    • How fulfilling, rewarding, fun is it?
  • Decide which activities to stop doing,   and which to keep on doing, or to do in a different, less time-consuming way.
  • Think about why you have chosen to take on all these activities that keep you so busy – what are you trying to avoid? Are there psychological reasons – a need to be needed? To be seen as important? To achieve, to be accepted, loved?
  • Identify what is really important to you, and plan your time accordingly.
  • Learn how to say no. Set boundaries.   For example, I will babysit one day a week, or one week a month.
  • Are there activities you are not doing that you would like to do? Once you have got your schedule under control, then decide what new activities can go on the calendar.

Greg McKeon in his book Essentialism: The Disciplined Pursuit of Less  says “become an Essentialist” – identify what is essential in your life: the right thing in the right way at the right time.  Then channel your time and energy in pursuit of that essential thing.

Are we having fun yet?

Carol


Do you have a pill list?

A few posts back, I reported on Dr. James Firman’s keynote at the Positive Aging conference in August.  Dr. Firman is the President and CEO of the National Council on Aging (NCOA). In his talk, gave us Seven Keys To A Brighter Future.  One of them concerned letting others know what we want – taking responsibility for our own well-being, including managing chronic conditions.

A friend of mine, age 89, had a stroke a while ago.  By sheer luck, she was found in time by a neighbor who then called 911. (My friend lived alone, and has no family).  The EMS took my friend to a trauma center in the next town.  When I could not get her by phone for several days, I went over to her apartment.  I could see her walker standing in the living room, so I figured she must be in the hospital, and I started calling hospitals in the area. I eventually found out where she was.

The reason I am telling this story is this:  My friend had no experience with that health care system – no medical records there.  They did not know anything about her – past diagnoses, medications, even who her physicians were or who was her health proxy.  She was incapable of telling them anything.   Nevertheless, they did major surgery to remove a clot from her brain.

I started thinking: What if that were me. . . I have a health proxy and stated preferences concerning how I want to be treated.  I have carried a list of my medications and supplements with me for some time, mostly so I don’t have to be bothered remembering the assorted names and doses.  Given my friend’s experience, I took another look at my ‘pill list’, and I expanded it with everything I could think of that might be important in an emergency.  Recently I saw a new doctor. Instead of going through a lengthy medical history, and possibly getting something wrong or missing something important, I handed her my expanded pill list.  She was rather astounded, and very appreciative.  I am confident that she got correct and complete information. I now encourage all my friends to put together such a list and carry it with them.  Some are reluctant – Oh, that’s a lot of work and it isn’t necessary.  I say, you never know when you might need it. You could be hit tomorrow by a low flying elephant on Route One!  My friend did not expect to have a stroke.

Here is what I think should be on that list:

  • Name, address, birth date
  • Diagnosis of any current conditions
  • Blood type
  • Vaccinations with dates
  • History of surgeries
  • Medications, also any medications you are allergic to
  • Supplements
  • Diet including any food allergies
  • Primary doctor with contact information
  • Specialist doctors you see regularly with contact information
  • Your health proxy with contact information

One friend of mine doesn’t go to doctors, and doesn’t take any medications.  She is 81.  It seems to me that it would be helpful for her to have a paper in her purse saying so.  If she ever does have a medical emergency, at least the EMS crew would know they have nothing to go on.  Even if one has no information to put on a ‘pill list’, simply having one  that says so would be responsible behavior, as Dr. Firman advocates. At any rate, it is taking control of our medical conditions to the extent that we are able. The more we can keep on top of our own medical information and condition, the better the level of care the health professionals can provide for us.

I am interested in hearing what you think.  Is there other information that should be on the ‘pill list’?

Carol


What have you learned lately?

Today, I start a new class Introduction to Ancient Egypt and Its Civilization, offered online through Coursera by the University of Pennsylvania.  I am excited about it, since ancient near eastern history is an interest of mine. This will be my second online course. Last month I took a four week Coursera course on Graphic Design, offered by California Institute of the Arts.  It was the first of a four-course certificate program.  I was able to increase my knowledge of graphic design, but the biggest learning experience was having to actually draw something and have it critiqued by fellow students.  I hadn’t had to draw anything other than an organization chart or flow chart since I was in grade school!

One of the great things about being retired is having time to pursue interests we couldn’t fit in to our busy lives before.  Learning new things is a great way to fill our time with activities we enjoy, and it is also a way to keep the brain cells active and growing, as a defense against dementia.  I think I gained a few little gray cells with the Graphic Design course!

Many organizations now offer recreational learning opportunities for older adults, labeled Life Long Learning (as opposed to job or career training courses).  They offer courses in their communities, both academically based and individually. Colleges may offer non-credit continuing education courses or they may open auditing seats in their regular for-credit courses.  Community colleges may have special free tuition programs for older adults. The Osher Foundation for Life Long Learning funds courses through colleges and universities. You can find a list of them at http://www.osherfoundation.org/index.php?olli_list. Other places to look for courses are senior centers, arts organizations and recreation departments.  Road Scholar, formerly Elderhostel, was a pioneer in lifelong learning, offered in the context of travel. Some years ago, I took a course at Oxford on Norman Architecture. It was an incredible experience, studying in the halls of Kings College Oxford!  Don’t write off courses that are not taught by university professors.  Non-academics with an abiding interest in and enthusiasm for a particular topic can give you an in depth and enjoyable experience, and a perspective gained outside of the academic world.

If you don’t have lifelong learning options near you, there are online courses galore!  And if you think that you can’t manage an online course, well, that is your first learning opportunity. And it is one that will open many doors for you – beyond what you can imagine.

First, there are MOOCs – Massive Open Online Courses.  Initially, these were offered by major universities, and were online versions of for-credit courses that they already offered.  More recently, other nonprofit and for profit companies have gotten into the online education business, and the formats have become more varied.   Many of these courses are free.  If you want college credit or a certificate, there is a fee, and more stringent controls are in place to assure that the registered course taker is the person actually completing the assignments. Some of the companies facilitating courses are EdX, and Coursera. Udacity offers technical courses.  You can find listings of MOOC courses offered currently at https://www.mooc-list.com/.  Another site is https://www.ed2go.com/, which provides online courses offered by many local organizations and schools.  It is more weighted toward professional courses, but you might find something of interest there, perhaps less expensively than your local organization charges for the same course.

Other organizations also offer short courses on a wide variety of topics.  My favorite is Udemy, where my own course Your Lifestyle in Retirement: An Introduction resides.  Another one is Lynda.  These two sites offer a lot of technical, job-related courses, but there is a huge variety of topics offered, and a wide range of teaching styles. Some courses are free; others have a very small fee.  I learned a lot about video production and editing through the Udemy’s teacher training courses.  Another learning curve!

So! See you in class?

Carol

 

 

 

 

 

 


Deciding about Housing

The other day, a friend of mine said “My husband and I are talking about planning a move to assisted living.  I was quite surprised, as she did not appear to me to need any ‘assistance’ in her daily living activities.  However, I have heard this thought expressed frequently, and it seems to me that there is a big lack of understanding about different types of housing for older adults – what they are, and how one determines the level of care needed, if any.

Before we talk about care facilities, we should define ADL’s or the Activities of Daily Living.  It is how the older person scores on these various activities that determines what level of care he or she requires. There are two different screenings:  Activities of Daily Living and Instrumental Activities of Daily Living:

ADLs involve self-care and include the ability to:

Dress oneself

Use the toilet (not incontinent)

Feed oneself

Bathe/ maintain personal hygiene

Ambulate – walk independently or transfer into or out of a car, wheelchair, and bed

IADL’s are those that enable individuals function independently in the community:

Meal preparation

Housework

Shopping

Use transportation (car, public or arranged rides)

Manage medications

Handle money

Communicate – use the telephone

There are several screening instruments that professionals use to evaluate an older person’s needs.   A reduction of ability on one or two points may not indicate a need to move to a care facility if alternative support is available.  For instance, Meals on Wheels may be a substitute for inability to prepare meals.

Care facilities such as assisted living residences and nursing homes use ADL screenings to determine if a potential resident would benefit from their services, and what care level would be required, hence what the fee would be.  Since maintaining ADL levels does not require skilled nursing care, the costs of providing such care are not covered by Medicare.  Medicaid, which is state-based, uses ADL screenings to determine eligibility.  Medicaid has income level criteria.

Here are some examples of screening instruments for ADLs and IADLs

http://www.unmc.edu/media/intmed/geriatrics/reynolds/pearlcards/functionaldisability/IADLs_form.pdf

http://clas.uiowa.edu/socialwork/files/socialwork/NursingHomeResource/documents/Katz%20ADL_LawtonIADL.pdf

https://www.payingforseniorcare.com/longtermcare/activities-of-daily-living.html

Assisted Living

Assisted living is one form of care facility for people who need help with some of the ADLs or IADLs (often medication management).  Facilities can vary widely from a small board and care home with just a few beds to an elegant facility that looks more like a resort hotel.  The latter can offer a variety of floor plans, including some apartment sized units.  However, since three meals a day are provided, these units usually only have limited kitchen facilities, perhaps only a small refrigerator and a microwave. Residents can bring their own furnishings. Some units may be furnished and offered for temporary respite care or rehab care, and there may be a memory care unit. All housekeeping services are provided, along with a social activities program. Laundry services are available for a separate charge.  A nurse is available to manage medications.  Assisted living facilities fall under much less restrictive state or province licensing requirements than do nursing homes. Note that these regulations vary from state to state. There is no national standard.

Assisted living facilities follow a social model rather than a medical model.  They provide a secure environment with nonmedical services, including personal care, preventive health services, and planned social and recreational activities.

AARP has a checklist to help you evaluate an assisted living facility at http://assets.aarp.org/www.aarp.org_/promotions/text/life/AssistedLivingChecklist.pdf

55Plus Independent or Active Senior Living

Independent living is just that – no care services are offered.  The main distinction is that it is age restricted. The senior housing market uses a number of different terms for its offerings. They may be boarding houses, rental apartments, condominiums, townhouses or individual villas or homes.   Costs vary widely, as well as the structure of the fees – flat monthly or fee for service.  Some may offer subsidized housing for those who qualify.

The term Active Adult community may be used for a development that offers a wide range of activities and programs,  including amenities such as swimming pool, exercise facility and classes, tennis courts, and golf course.  There may also be social programs planned by program director or the residents themselves.

Continuing Care Communities CCRC’s or Life Care Communities

These include multiple levels of independent living and care facilities such as assisted living, nursing care and memory units. The amenities mentioned above are offered.  Residents pay an upfront fee which can be substantial, and a monthly service fee, a portion of which is applied if or when the resident must move from an independent living unit to a care facility.

Hope this clears things up.

Carol