Saturday, October 17, 2009

Long-Term Care Insurance and Other Reflections on Growing Older

This morning I reviewed information on long-term care insurance supplied to me by my insurance agent. Libba and I have to make a decision within two weeks about which policy to purchase in order to avoid a premium increase due to Libba's impending birthday for insurance purposes (her actual birthday is not until late May).  In addition to the cost of insuring that we can afford to be taken care of should we be unable to provide for our own ADLs (activities of daily living like feeding ourselves, bathing, turning over in bed, getting dressed, brushing our teeth, sitting on the commode, and cleaning ourselves after a bowel movement), it contained a page entitled "Exploring the Myths of Long-Term Care." It begins with, "Advances in medical and health care technology are enabling us to live longer.  While it is encouraging, an extended life brings with it the increased likelihood of experiencing a long-term illness.  To effectively preserve our dignity and freedom of choice tomorrow means carefully considering our options today."

Well, carefully considering the potential for becoming totally dependent on someone else for some of my most basic needs is not such a pleasant prospect and seems unlikely to hold much hope for preserving my dignity and freedom.  While I am currently strong and vigorous, I remember an uncle who could not walk down a short flight of steps without experiencing terror over a potential fall.  I also recall the agony expressed by my grandmother when a physical therapist was attempting to loosen her contracted joints following a stroke.  A younger friend with ALS (amyotrophic lateral sclerosis)* also comes to mind. He is locked inside a totally immobile body with absolutely no way to communicate with his caregivers.  He can feel an itch but has no way of communicating his desire to have the itch scratched.  I hope he has been able to find some way of turning off awareness of discomfort through some kind of profound meditation, but he may be more likely to be entirely insane but with no way to even scream or grimace.  There is no way of knowing his state of mind unless he can communicate through ESP, which I suppose may be possible. It is hard for me to think about my friend's tragic condition and usually don't as a result.

So, what do I think it will be like for me if I grow old enough to experience the almost inevitable ravages of age? Will my condition become horrifying in some way?  Will my friends have difficulty thinking about how bad it is and avoid me or pity me or talk to me in condescending ways, not out of lack of caring but out of their own discomfort with what seems all too possible for any of us to experience some day? Dignity and freedom, indeed! Is either truly possible in the face of severe debilitation?  I also think of some of my patients who are young enough and healthy enough but who are plagued by delusions which prevent them from living independently, much less from enjoying life.

Depressed yet?  I have to say that for me the prospects of losing my physical and mental agility could be very depressing if focused upon as a definite inevitability.  It seems to me that the only way to prevent a sense of despair over what may eventually be my plight is to validate the tragedy of these conditions and the fear associated with imaging having them, accept that some things about life cannot be changed, and live in the present moment as effectively as I possibly can.  I think effective, present-moment living includes being conscious, enjoying what there is to enjoy about each moment as it unfolds, accepting what is, and meditating often (BEAM for short).

I plan to keep in mind this BEAM prescription next week as I pay my first premium for long-term care insurance.  May the "golden years" of each of us be enriched by building upon our positive life experiences, and may we not be too burdened by our fears of the very real potential for experiences of pain and diminished capacities that may await us.


  1. Here's an example of the best of aging. I work in hospice and last week admitted a 95 year old who had been "slowly declining" over the past 6 months. She also had gotten ill suddenly and felt that she couldn't take care of herself in her independent living situation. Turns out she had a reaction to a flu shot [she diagnosed herself and correctly as it turned out] so within days she was back to herself and we are trying to get her to assisted living. She does acknowledge that she probably needs assisted rather than independent living at this point!!

    She does four crossword puzzles every day, her cognition and memory are astounding, she eats well, and she gets around without problem. But the thing that struck me most was that she has a "mission." The facility in which she lives does not contract with hospice. She is determined to change the minds of the Board of Directors and other management there, as she believes that many people in the facility who need hospice care, are not receiving it. She herself is the lone exception in the facility because she fought the administration to allow her to have hospice care and they finally made an exception for her. She describes herself as a mean, stingy Scotswoman, but she began to cry when describing that she was going to fight hard to accomplish her "mission." She believes this is God's plan for her.

    I like your BEAM and I'm going to add an M at the end for mission. Always good to have many things to inspire your passion and keep you feisty and engaged!

    Best, Mara

  2. Jim, I almost want to run when I start to think about the "Golden Years". My dad did not take out a long term care policy. I suspect many elder generation did not do so.
    I see the anguish and frustration in my dad and in myself. I see incontinence, compensation, denial,and his body shrinking from 5'8 to 5'4.
    I now will probably have to go to court to satisfy a new DEHC modality. My dad has 4 phychiatrists stating that he is not able to make health care and financial care decisions. My dad has been through the battery of tests to prove his incopacity. The experience almost destroyed our relationship. Now, because of SC new modiality, the assisted care facility can not recognize POA status. Now my dad can make his
    own health care decisions unless I go forth and claim him incompetent. If I do go to court, I take the last bit of dignity. If I don't go to court, I am not protecting his best interest.
    So I look at the golden years with anguish and with disolution. I do revere my moments in the here and now. Breast Cancer taught me to embrace the joy and yes, the pain of life. My life, not someone else's life.
    I think we begin as a rough stone that rolls, wobbles, and yes, at times is nicked. I also think in the water of life we eventually become a smooth and beautiful stone. It's the getting there.

  3. I find myself on the verge of tears after reading the thoughtful, obviously heart-felt comments of Mara and Sandy.

    Mara, your 95 year old friend is very fortunate, as I see it, to have a "mission." Adding mission as a meaning of M in BEAM seems more than appropriate. Having a mission or purpose does, in my experience, make such a difference in how life is experienced. Whether it's a destination on a mountain hike or working with severely mentally ill women at Dorothea Dix Hospital, I've found that a daily mission makes a big difference in my desire to get out of bed every morning.

    Sandy, my first reaction to your comment is an old Southern expression, "Bless your heart!" What an ordeal you are having as you find your way with your dad. May the smoothing water of life be as gentle as possible for you during this time. I can really feel your deep concern as you struggle to understand the best course of action in your efforts to support your dad in his declining years. Again, bless your heart!

  4. Sandy, I don't know who you are but I totally second Jim's comments. What a terribly difficult situation trying to balance your dad's dignity with protecting his interests. Blessings to you.


  5. In 1981 as a first year social work student I worked in a nursing home as a social work assistant/van driver. I came home from work one day and told my buddies to promise that they will never put me in a nursing home. I asked them to wheel me on to the Appalacian trail and let me be.

    Twenty eight years later I still have the same wish, but I now know that found on the trail in a wheelchair I will probably be pushed and fed all the way to Maine.

    It's great to live in America where many of us have the opportunity to extend our lives with amazing perscription drugs and high tech medical procedures. But spending 50% of our health care dollar on the last 30 days of a persons life, doesn't seem like a good policy to me. Quality not quanity would be my goal.


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