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Old 09-04-2016, 03:11 PM   #41
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Even with children it is difficult to insure that one has a health-care advocate who will be effective. By that, I mean someone who is willing and able to be present at virtually every doctor and hospital visit. I sat with my mom and dad and DW through all their doctor and hospital visits. Mom and dad lived longer because of it and I believe DW survived because of it. I found numerous mistakes - especially during hospitalizations. Communications Doctor to nursing staff, day shift to night shift, nurse to nurse aid, etc. etc. is virtually a clusterflop ready to happen.

Classic example - DW's doctor called and said her latest x-ray indicated a return of cancer. Going in for the biopsy, there seemed to be some confusion. First one doctor, then a nurse then another doctor left the room and came back into the treatment room as prep was being made (wired for sound, I call it.) Then, someone asked me if DW still had a gall bladder. "No" I said. More whispered discussions and leaving the room. Finally, the person "in charge" said there must have been a mix up in the x-rays and it probably wasn't DW needing a biopsy. They were pretty sure the x-ray had been mis-labled.

Insult to injury, they wanted to charge DW for all the needles and tubes and hospital "setting" she had soiled in her visit. When I suggested I would just add that into the law suit damages, the idea was quickly dropped. I didn't follow through on the law suit idea, but I'm guessing some malpractice insurance co. would have gladly slipped us a few grand had we pushed the issue. Imagine being told you have cancer, only to find out later that they had mixed up the x-rays. That ought to be worth something. I guess the good news is that it wasn't cancer - just a "harmless" mistake.

I did read recently that something like the third leading cause of deaths is mistakes in clinical settings. Whether I read that right or wether it is true, I don't know. Still, we all need to be our own advocate and hope that we have an advocate when we can not be our own.
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Old 09-04-2016, 03:32 PM   #42
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How about the other person whose X-ray was swapped with your DW?

Imagine being told while you are celebrating your erroneous good news: "Please come back in. Contrary to what we told you last week, you've got cancer".
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Old 09-04-2016, 03:47 PM   #43
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WE have kids that care about us but I would never live with any of them. However, I do expect them to do what we all did for our parents and that was help out as needed, manage finances if needed, visit for a few weeks after surgery to help out, etc. All that the 3 of us did kept my Mom out of a home. I helped my Mom care for my Dad and that kept him out of a home. Now if my Mom had gotten dementia instead of cancer 3x's then she would have had to go into a home. I think it really depends on the circumstances.
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Old 09-04-2016, 04:28 PM   #44
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While I love the idea of CCRC and have some family experience with them, they are not the answer to everything. My grandmother was a long time CCRC resident and finally moved to the daily nursing support section when she was in her mid 80s. The doctors told family that she had multiple organs failing, cancer and other problems and they had her under a heavy regimen of drugs to keep her comfortable and expect she had 6 months to a year left to live. Luckily her nephew (a doctor) came to visit and blew a gasket. She was being over-medicated and over-sedated. Once he got her off most of the meds she felt a lot better, returned to her lower level assisted care section and lived into her late 90s (more than 10 more years). CCRC was dutifully caring for her, but no one cares as much about a specific patient as family (or the patient themselves, if coherent). A real potential tragedy was averted.
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Old 09-04-2016, 05:45 PM   #45
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Let me share with you my weekend. I live in an apartment building. One of our residents is an elderly bachelor with only a brother (who he doesn't get along with) living on the east coast.

He called the front desk asking for a lift off the floor as he couldn't get up. Staff are prohibited from providing that service for liability reasons. He didn't want to call 911 for assistance. After several calls from him the front desk ignored his protests and called the non-emergency 911 number.

The fire department responded with EMTs. The put the guy in a chair and noticed rotten food around the apartment, told the front desk that they would be notifying county social services because they are concerned about his welfare.

After digging through old notes the front desk was able to contact the brother but he couldn't do much, let along influence the brother from 3,000 miles away.

Next day, phone call to the front desk again. Resident could not get out of the chair the EMTs but him in. No food, no water, no potty trips. Front desk guy went to his apartment and asked permission for the both of them to call his doctor. Reluctantly he agreed. His MD said he needs to be transported to the hospital for evaluation. In our town you call 911, out comes fire truck, in this case (because an MD had been consulted) also an ambulance. One of the EMTs also responded the day before so he clued the others into the resident's status and noted that he hadn't moved.

This resident has an "interesting personality" (no friends, just acquaintances) and judgement issues. Unless he has a miraculous recovery he can't live independently safely but there is no one who can guide his decisions.

If he had been left to his own devices he would be dead today.

There is no perfect solution for those with no one to oversee their healthcare but a CCRC would have been a better choice for him.
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Old 09-04-2016, 05:58 PM   #46
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a CCRC would have been a better choice for him.
And about what would that run, at the lowest rung , in your parts?

And what would be a good age to sort of "give up" and drop the hammer on a CCRC?

Not being a nudge. Seeking a qualified, even if it's just a "gut" opinion from someone with recent personal experience.
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Old 09-04-2016, 06:21 PM   #47
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Costs & services vary a lot, particularly urban vs small town settings. When we were looking one CCRC did not have nursing beds and had no options for residents with dementia. Crossed them off the list.

Some CCRCs are non-profits, their rates are generally lower - all things being equal. You want to take a hard look at the CCRC's financials particularly if they require a significant deposit. Use this link to screen those in your area: Accreditation Index, Why does accreditation matter? €“ benefits, fees, programs

I really think people should move while they have a social life. In that way they can make friends in the community.
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Old 09-05-2016, 06:10 AM   #48
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DW and I are in the same position. ChildFREE and relatives that we're not sure are that reliable. My brother would do anything for you, but don't let him near money, especially if he thinks his kids need it. Plus, he's very unreliable in stressful situations and I wouldn't trust him to make any medical decisions. I'd probably be on life-support for years. DW's brother's are distant (emotionally).

We're making/keeping friends and choosing to ignore some traits that would have lead us to walk away from them in our younger days. The plan is to keep ahead of it, the best we can. Move into some facility before we need/forced to. Have a financial guy that we (maybe) trust. As we already know, it's the hard medical decisions that are the real challenge.
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Old 09-05-2016, 07:40 AM   #49
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Childfree single here. Yes, CCRC is a great solution so I'm saving my money for that. And I agree that moving while one is young enough to enjoy the social aspect is the best approach. And too much later, one might not qualify for some of the care agreements or independent living. Meanwhile, a great support network of other singles of various ages is helpful. I've got one, but I'm the youngest so we are looking to include a few younger singles in our circle over time. Have made a hospital ER run with one friend and we mutually aid one another regularly.

It's impossible to guess if nieces and nephews will take an active part in my life as I age, and it's not fair or smart to expect them to take a major role. Maybe one of them will, but that cannot be Plan A. If any of them takes an active interest and wants to watch over me, I'll pick a CCRC close to them. One thing I've learned with my parents (and vicariously through friends with parent situations) is that if someone younger is going to help out, the elder needs to be willing to move close to them. Otherwise it is just too hard.


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Old 09-05-2016, 09:08 AM   #50
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<snip> The doctors told family that she had multiple organs failing, cancer and other problems and they had her under a heavy regimen of drugs to keep her comfortable and expect she had 6 months to a year left to live.<snip>

Once he got her off most of the meds she felt a lot better, returned to her lower level assisted care section and lived into her late 90s (more than 10 more years).
Wow- scary story. It was certainly more profitable for the CCRC to decide she was near death. I plan to find a CCRC near DS when I get to the point that I don't want to be on my own (I'm 3 hours away from him). He's frugal and sensible but there's a LOT he'll have to watch out for.

I know the thread was directed at childless people but I still had to weigh in on this! It sounds like you not only need to have someone lined up to handle your financial affairs but also have access to an independent medical opinion when needed.
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Old 09-05-2016, 09:33 AM   #51
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I had to spend some time in a nursing home myself when I had a medical condition that needed care. Ultimately I got better and was able to return home. But I left more determined than ever to make sure I had enough money to afford the best such facility in the area. There can be a big difference in the standards of care, and this is one purchase that I really really want the best available.
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Old 09-05-2016, 09:43 AM   #52
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You don't have to be old and fading and in a care facility. This is exactly how I lost most of my 40's. Drugs I didn't need for diseases I didn't have that the doctors were certain of and adverse reaction/side effects blithely dismissed as not happening or "It's not the drugs you just have some new diseases."

This is why this whole "old age" scenario gets scary. When you are old and have already "jumped the shark" it's real easy for anyone to assume yes, you probably DO have something and yes, you probably DO need the drugs. And unless you have very involved family, preferably sons and daughters who are doctors and lawyers themselves, the system (And that means the people IN the system) really don't care if they kill you. There's always more where YOU came from


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While I love the idea of CCRC and have some family experience with them, they are not the answer to everything. My grandmother was a long time CCRC resident and finally moved to the daily nursing support section when she was in her mid 80s. The doctors told family that she had multiple organs failing, cancer and other problems and they had her under a heavy regimen of drugs to keep her comfortable and expect she had 6 months to a year left to live. Luckily her nephew (a doctor) came to visit and blew a gasket. She was being over-medicated and over-sedated. Once he got her off most of the meds she felt a lot better, returned to her lower level assisted care section and lived into her late 90s (more than 10 more years). CCRC was dutifully caring for her, but no one cares as much about a specific patient as family (or the patient themselves, if coherent). A real potential tragedy was averted.
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Old 09-05-2016, 10:05 AM   #53
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You don't have to be old and fading and in a care facility. This is exactly how I lost most of my 40's. Drugs I didn't need for diseases I didn't have that the doctors were certain of and adverse reaction/side effects blithely dismissed as not happening or "It's not the drugs you just have some new diseases."
Or- "here's a new prescription for the side effect". DH got a prescription for an anti-nausea med after he noted that occasionally he had nausea. A week later he felt sick and I was afraid he wouldn't keep down the important meds he'd just taken, so I handed him one. Well, it worked, but that night at dinner he wasn't talking sense. It was scary as heck. I asked him to draw a picture of a clock face with numbers (a family member who's a psychiatrist told me that's one simple test for cognitive skill). After being asked 3 times, he drew a circle, drew lines dividing it into wedges like a pizza, and crammed a few numbers out of order onto the left side. Thank God it was only temporary, but I could see someone with a profit motive concluding he had developed dementia.

He's not taking that pill again.
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Old 09-05-2016, 10:28 AM   #54
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Often this is the result of a variety of physicians prescribing medications. Yes they ask what meds you are taking but few (IMHO) know how they are metabolized by the elderly. Find a physician who has geriatrics as a specialty.
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Old 09-05-2016, 11:33 AM   #55
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Often this is the result of a variety of physicians prescribing medications. Yes they ask what meds you are taking but few (IMHO) know how they are metabolized by the elderly. Find a physician who has geriatrics as a specialty.
I fail to see, how any doctor could know the interactions of the 1,000's of available drugs in various combinations on just an average human body, let alone a young vs old person.
It's just too much to ask them to know.

If the doctor uses a computer program to calculate possible interactions that would work, otherwise it seems impossible to me.
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Old 09-05-2016, 11:40 AM   #56
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It seems like many are assuming they will need care and not able to live independently. I have mostly seen the opposite where people age in place in an apartment or small home. Most did this until death or close to it. Only 25% of people ever end up in nursing homes.
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Old 09-05-2016, 11:49 AM   #57
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If the doctor uses a computer program to calculate possible interactions that would work, otherwise it seems impossible to me.
I found a good web site that allowed you to look up interactions but it seemed to be generic; the answer was the same for any antibiotic vs. any antihistamine, for example. I didn't find any red flags for the anti-nausea med and anything else DH was taking. But, as Sunset noted, we're all different. If DH were prone to frequent bouts of nausea, or it were a mission-critical drug like an antibiotic, I'd be on the phone to the doc's office. In this case, it's safe to say I'd be reluctant to have him take that one again.

DH actually tried to get referrals to a geriatrician; the one he could find wasn't taking new patients. Although it's a much-needed specialty, it's not popular because you're pretty much stuck with whatever Medicare pays.
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Old 09-05-2016, 11:56 AM   #58
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It seems like many are assuming they will need care and not able to live independently. I have mostly seen the opposite where people age in place in an apartment or small home. Most did this until death or close to it. Only 25% of people ever end up in nursing homes.
Absolutely true. In fact having run all these numbers and scenarios ad nauseam the upshot is the terrible ending/long ride into the final sunset is not likely to happen. We will perhaps need some help for a spell. Then perhaps The Big House (Hospital/Nursing Home) for a spell right at the end. But mostly we will just die fairly quickly and not after running on fumes for several years.

If you are really into playing the percentages, and we all are here, and that's more or less what investing/AA/ and ER are based on. You wouldn't spend much time on worrying about CCRC, Nursing homes, impoverished surviving spouses, which relative you can trust to stand up to the medical and/or insurance industries. Just keep an "In Case of Emergency Break This" plan around. And speaking of probabilities, you probably won't even need that. If you are on your way out ya'll won't be giving a carp about the details anyway.

On the other hand, what the hell is all this money for if not to handle the Black Swans? Or in this case, what I'll call Gray Swans. The Known Unknowns.

Of course we are all Planners so what else would we expect to do? And perhaps our workload (worry) is increasing to fill the available filing cabinet space? (Money)
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Old 09-05-2016, 12:01 PM   #59
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I am usually a big planner but not in this case. WE downsized to a small home with astro-turf so not much to maintain. If I get really old I may want to go into a condo.
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Old 09-05-2016, 12:39 PM   #60
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I am usually a big planner but not in this case. WE downsized to a small home with astro-turf so not much to maintain. If I get really old I may want to go into a condo.
That's pretty much the way I'm playing it. In fact I could stay here, hire someone to check on me 3 times a week, pay for cabs to take me shopping, get one of those I Fell Down and I can't Get up, alarms, pay someone to mow the grass and shovel the walkway and it would cost the same or less than moving into an apartment.

If I get really bad off I can fund a few yrs in The Big House at retail rates. If I last longer than that..... well, it won't be too much longer.

All the big money is in Transfer on death status. Any meager items like dispatching a house or apartment, or car, and disposing of the "burden of civilization" can be done fairly easily.

If I get some lead time call a lawyer, pay him to get rid of it. If I go suddenly without any lead time there is an office at the State or County level that does that in most places. The NYC one was the subject of a thread here about 2 yrs ago.
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