Thursday, February 25, 2010

Baby Boom Delusions and Solutions (Chap. 2, Part 2)

Today's post highlights the first three of five policy issues confronting and/or caused by the Baby Boom. These issues will significantly impact all 77 million Boomers, their children their grand children and the fiscal viability of the American Republic.

Chapter 2
(Part 2) See previous posts for background

In brief, here are the challenges:

1. Completely Re-Think Long-Term Care

Putting mom or dad in a “home” after they have lived a lifetime at home is a decision that usually causes immense family heartache, anger, guilt and division. Do you want to live in a nursing home? Deborah Chase certainly didn’t. Statistics indicate that you and Deborah probably will spend some time there at the end of your life—unless we begin changing policy and nursing homes now.

There is a reason that nursing homes are so universally feared; it’s because they are rarely good places to finish out a meaningful life. Nursing home owners and managers will likely take exception to this viewpoint. Many of these professionals are devoting their careers to making their nursing home(s) the exception to the rule. However, you know what is said about pigs and lipstick. You can gussy up an institution with flowers, homey furniture, sun rooms or allow pets and it’s still an institution. It is not and will not feel like home.

America’s institutional nursing homes develop rapidly in the mid-20th century in response to the fact that Americans were beginning, in large numbers, to live beyond their ability to live independently. Not only was advanced old age a new norm for America, it was new to mankind, thanks to better health care and new medicines. American politicians did their best to resolve this challenge and passed appropriate legislation to encourage (through financial incentives) the creation of beds to serve this growing infirm population. In the 1950’s this new industry borrowed the clinical hospital model as the template for building. There was no other model that seemed to fit.

Today there are better alternatives (many involving staying at home or moving into a truly home-like setting) and, here’s the promising part, these alternatives are budding just as the old institutional nursing home infrastructure is aging and crying out to be replaced. However, without the right incentives and public demand, the private sector will likely just tear down the old nursing home and put up a new, bigger institution. If so, one of those oxymoronically named “semi-private” rooms will be waiting for you and Deborah Chase, whether you want to live there or not.

Creating ways for people to age in-place--in their homes, or in a home-like setting--requires that we (1) provide more substantive support and tax relief for family caregivers, (2) re-direct public funds from institutional care to in-home care, (3) be creative and sensible in using the equity value of home mortgages so that the costs of in-home care do not translate into a higher tax burden for subsequent generations, (4) provide incentives for long term care facility providers to expand on a building model that mirrors a home environment and (5) insist that long term care insurance (including Medicaid) not be skewed toward institutionalization, as it is today.

2. Re-Design Social Security, Medicare and Medicaid

Any talk of trimming the big three entitlement programs makes politicians grow pale and wet themselves. They react thus because, once a benefit is established, it’s political suicide to suggest taking any of it away, even if the original benefit no longer makes any sense in a dramatically changed demographic and financial environment. As a result, we now have a Social Security system designed to serve the conditions of a 1935 America when there were 16 wage earners supporting one pensioner. Today, the ratio is about 3 to 1 and about to get worse.

Politics has generated a popular Medicare system that focuses on cure but shifts the cost of long-term care to the family. It is a program that is an unwilling and unhappy passenger on a run-a-way health care cost inflation bus. And, although it is arguably the nation's most efficient and fastest payer of claims, it is rife with fraud primarily because of this efficiency. No good deed goes unpunished.

Politics has also given us a Medicaid system that steers elders to nursing homes in many states (once beneficiaries can prove themselves penurious) and too often discourages care solutions that favor aging at home. Medicaid is another unhappy passenger on the health care cost inflation bus.

The conventional wisdom is that if law-makers tinker with the nature and intent of these entitlement programs, voters will relieve them of their power. Touch the entitlement “third rail” and you will be political toast. George W. Bush tried to tweak Social Security during his second term and was resoundingly booed off the stage. Although, he did manage to add an unfunded drug benefit to Medicare while big pharma cheered and waved pom-poms on the sidelines. Adding stuff is way more popular than subtracting stuff.

The consequences of maintaining the status quo of these programs makes for a grim financial picture. In fact, the status quo is unsustainable; period. No kidding. If the Baby Boom wants to make a reasoned and reasonable sacrifice for the common good of the country, amending these entitlement programs is the opportunity. If, however, the entire Baby Boom demands these entitlements in full, as currently constructed, the Boomers will eventually be hoist by their own petard. If Boomers fail to help adjust these programs now, their children and grandchildren will have less reason to remember “Grammie” fondly.

The fixes for these entitlement programs require political will, an attribute currently in short supply in Washington and State Houses around the country. Boomers must provide the backbone and leadership on these issues because the politicians have proven themselves unable to lead, time after inglorious time. We must insist that lawmakers grab the “third rail” and make sure that the entitlement train is headed in the right direction, not just in our direction. The fiscal viability of America depends on it.

3. Expose and Eliminate the Hidden Costs of Growing Old

Fraud.   Unless you have had first-hand experience or have made it your business to explore the ways in which the unscrupulous relieve the elderly of their money, you probably have but a cursory idea of the problem. The scamming of the elderly has become--thanks to sophisticated data base mining, improvements in telephone technology and the Internet--an international industry. The perpetrators are often beyond the reach of local law enforcement, highly mobile and relentless. Deborah Chase meant well, “Dr. Someone” did not.

Even more frequently than strangers, known caregivers financially abuse the elderly. These caregivers are often relatives but also include hired help such as aides or professional advisers. These financial losses often go undetected and/or unreported. It is a difficult problem because of privacy and autonomy issues. This hidden cost will significantly balloon with the aging of the Baby Boom, a generation that has more assets than any before it.
America needs to put a much higher priority on catching and meting out deterring punishment to those who take financial advantage of the vulnerable elderly.

Medication Mismanagement.   Another cause of unnecessary spending can be found in the medicine cabinets of the elderly: rows of medications, some current, many out of date and most of them potent. Without a reliable means of assessing the possible interactions or a foolproof way to manage their proper use, the aged too often end up in the emergency room because of over dose, under dose or drug interaction.

Beyond the problem of medication mismanagement, medication overload becomes problematic as the elderly expand their coterie of medical specialists, many of whom have neither the time nor inclination to conduct a thorough inventory of their patient’s medication regimen. In addition, few of these medical providers have even basic training in geriatrics. Boomers should take the lead in demanding that the health care industry find a workable solution to medication management, a problem that silently leeches away billions in private and public funds every year.

Corporate Inefficiency and Family Costs.   According to a 2006 MetLife study, the annual inefficiency cost to American businesses for the “under the radar” elder care responsibilities shouldered by employees was $33 billion. These corporate costs come from (a) unexpected turnover, (b) absenteeism, (c) workday interruptions and (d) diverted attention on the job because of the employee’s need to provide care for an elderly relative. It’s conservative to estimate that this inefficiency cost now exceeds $40 billion every year.

These figures do not include the out-of-pocket expenses incurred by employees, which, especially for the long distance caregiver, can easily be thousands of dollars per year. Deborah Chase’s children spent thousands for travel alone. Layered on to these dollar costs are the emotional and physical tolls that elder care can extract from family caregivers, most of whom have jobs and many with children still at home. American business leaders and government policy makers need to bring elder care out of the shadows, relieve it of its stigma in the workplace and help caregivers find affordable solutions. Not only is it the right thing to do, it is the economically sensible thing to do.



Observoid of the Day: 43.7% of all statistics are made up on the spot.

Monday, February 22, 2010

Baby Boom Delusions and Solutions (Chap. 2, Part 1)

With this post begins Chapter 2 of Baby Boom Delusions and Solutions. This chapter focuses on five demands that the Baby Boom must make on our policy and law-makers. If these demands are not realized, the negative experiences visited upon Deborah Anne Chase and her family--as recounted in Chapter 1--will be visited upon millions of Boomers and their families.


Chapter 2


Tom Brokaw’s 1998 book, The Greatest Generation, tributes his parent’s cohort, the one that mobilized, fought and helped the Allies win the Second World War. Millions of relevant examples can be recounted that illustrate the effort and sacrifice of the American generation born between 1910 and 1924. They rose to the challenge of a world threatened by the ideologies of fascism and militarism. Many did it enthusiastically. Others grumbled and groused but did it anyway. The overarching reality was a national effort and sacrifice in blood, money and deprivation. The Greatest Generation’s contribution from 1941 to 1945 was primarily as the military muscle. When blood was spilled, it was mostly theirs. They didn’t choose to play this role but they did it when history brought it to them.

Here are a few examples of that effort. Deborah Chase’s father piloted an Army Air Corps C-47 Skytrain and ferried airborne troops to North Africa, Sicily, Italy and France. He was wounded by flak fire on D-Day just after he had dropped paratroopers behind German lines. Deb’s grandparents, her mother and the others on the American home front endured shortages of critical raw materials, lived with rationed gasoline and foodstuffs, tended “victory gardens”, gathered scrap metal and bought War Bonds. It was a brief time of effort and sacrifice for the common good. Brokaw has a case.

When the war was over, the Greatest Generation then produced Deborah’s generation, the Baby Boom. Using Brokaw’s yardstick to compare the Baby Boom to the Greatest Generation, how do we Boomers measure up?

In terms of sheer numbers there is no doubt that the Baby Boom can claim the title of America’s biggest generation. Those of us born between January 1, 1946 and December 31, 1963 make up the largest generational cohort in American history: 77,000,000. Raised and educated in a prosperous post war society, the Baby Boom is the bull in America’s demographic China shop. Being big, however, doesn’t mean being respected and it certainly doesn’t mean general popularity.

Even a cursory review of things written and said about the Baby Boom will often include such descriptions as: “selfish, self-absorbed, entitlement mentality, navel gazing, irresponsible, immature, self-important, smug, frivolous….”, you get the drift and may agree. As a Baby Boomer, I squirm a bit considering that these descriptors could be more right than wrong. But are we as bad as our general reputation?

Very few voices have risen to defend us. One of those voices is sociologist Leonard Steinhorn whose 2006 book The Greater Generation, In Defense of the Baby Boom Legacy, suggests that the Baby Boom is generally getting an unfair evaluation. Steinhorn says that Boomers “created, reinvented, invigorated or sustained the great citizen movements that have advanced American values and freedoms” since the mid 20th century. Among these movements he includes environmentalism, consumerism, women’s rights, civil rights, gay and lesbian rights and openness in government. Well, maybe.

To be sure, Boomers took up many of these causes and provided the ground troops and some ballot muscle to change America for the better. However, in virtually all cases, the visionaries who first stepped out of line to challenge society on these seminal issues were from the generations that preceded the Baby Boom; Martin Luther King, Jr. (civil rights), Gloria Steinem and Betty Friedan (womens’ rights), Aldo Leopold, Rachel Carson, Bob Hunter (environmental awareness), Franklin Kameny and Barbara Gittings (gay rights) were all born before 1946. To claim that that the Boomers created these movements just doesn’t match the calendar.

The Baby Boom’s contribution to these social sea changes has more to do with lucky timing than with pioneering vision. The social movements of the 60’s and 70’s occurred when Boomers were very young adults, teens or adolescents, the perfect rebellious age for latching onto causes that parents and society were resisting. Unlike China’s Cultural Revolution, which harnessed the same age-related energy for destructive social upheaval, America’s turbulent 60’s and 70’s were fueled by the participation of Baby Boomers for the common good. But the leaders and visionaries behind these movements came from the ranks of the Boomers’ parents or older brothers and sisters.

Steinhorn also asserts that Boomers had an important influence on remaking the American workplace as soon as they began to enter the job market. “In the seventies,” he says, “at the precise moment that a critical mass of Boomers was entering the workforce, it became painfully clear to them that the economy was collapsing under the weight of shortsighted management decisions that protected the status quo at the expense of investments needed to keep our economy a step ahead. As Boomers saw it, the dinosaur organizations their parents embraced stifled not only creativity but fulfillment on the job.” (Italics, mine)

I was one of those early Boomers entering the workforce in 1972 and I can assure you that I was not thinking about any of those things and I doubt that very many of my contemporaries were either. We barely knew what an organizational chart was. We were just happy to have jobs. Granted, as our careers and business savvy matured and as younger Boomers entered the workplace behind us, we changed the American workplace, but then each new generation does, whatever its sensibilities. I don’t think that this makes the Baby Boom special, except for the sheer number of plum jobs that we now occupy. Deborah Chase attained one of those good jobs.

While Baby Boomers might want to take credit for most of the cultural good that has emerged in America since the 60’s, I think it's a stretch for Steinhorn to label it the “Greater Generation” in pointed comparison to the Greatest Generation. To quote Brokaw’s book, “In the World War II generation, ordinary people found common cause, made extraordinary sacrifices and never whined or whimpered.” To date, we Baby Boomers may have found several good common causes to rally around but the quantity of self-sacrifice has been measurably less than experienced by the Greatest Generation and we have not developed a comparable reputation for stoic acceptance of whatever burdens we have assumed. We tend to be a bit whiny.

Whether you agree or disagree that the Baby Boom has earned the appellation of “greater generation” based on its vision and sacrifice for the common good, I believe that there is one final chance for the cohort to truly earn (or burnish) such a reputation. This chance comes with the aging, decline and eventual death of the Baby Boom itself. It is an eventuality that is only now dawning on Boomers; a process and finality that most Boomers would rather not ponder. Many boomers are under the delusion that they will be spared.

The Baby Boom has prospered and the great majority of us will live long. History, therefore, has presented our generation with a monumental challenge based on our newly experienced longevity. Living long has some down sides.

America’s current social service policies, entitlement programs, health care systems, end-of-life care standards and support structures are ill-prepared for the onslaught of Boomers as they age beyond good health and independence. These shortcomings are plaguing the very old in America today, but the dependent elderly are, as they have been for many decades, not a powerful voice for change. Even now, millions of Baby Boomers are observing the challenges discussed in this book because they are grappling with the frustrations of care for their own parents. It’s amazing that this experience hasn’t already created a loud and long outcry for change.

If the Baby Boom wants better and more effective policies dealing with their own care, decline and death than are currently in place, the changes must begin now, not in 22 years when the oldest Boomers will be 85. Boomers should want to tackle these challenges for three reasons: (1) for their own good, (2) to save their children and grandchildren from a support system that, if not broken, is certainly dysfunctional, and (3) to allow America to regain budget sanity.

These systemic changes will impact how Americans are cared for as they decline and die for generations to come, not just the Baby Boom. And, some of the needed changes will ask for real but reasonable sacrifice from many Baby Boomers, lest the burden fall on their children and grandchildren. So, the changes are for the common good, many of them will require measurable self-sacrifice from Boomers and they need to be done with stoic awareness that they are necessary. Given these elements, it can be argued that if the Boomers take up the challenge and succeed, then the claim to be a great generation has traction.



Observoid of the Day: Anywhere is within walking distance if you have the time.

Wednesday, February 17, 2010

Baby Boom Delusions and Solutions (Chap. 1, Final)

Final Installment of Chapter 1, "A Baby Boomer's Life and Death". See previous posts for Parts 1 and 2.


One morning the other bed in Deborah’s room was empty and neatly made. She haltingly asked an aide where the other woman was; the aide said that Deborah “needn’t worry about it” and quickly left the room. Death was not spoken of in this place, although it occurred regularly. Two days later, another woman moved into the room with Deborah. The new roommate was ambulatory, talked incessantly about the same topics over and over and pawed through Deborah’s chest of drawers when she thought that no one was looking. She took clothing and small items. The aides recovered most of Deb’s stuff but it was a constant activity. Deb had never suffered fools gladly but here, she was forced to endure them; and, to endure this place along with them. They were all inmates.

Because Deb’s step-daughter made regular and unannounced visits, Deb was kept relatively clean and dry. When the daughter considered her mother’s care unacceptable, she made a fuss. The aides soon learned that Deb’s daughter could be a problem if they didn’t attend to her mother’s needs. Since there were too few aides for this 120 bed facility, taking good care of residents-- especially those who had regular visitors--meant that those residents with no one routinely stopping in for visits received less care. Often, when being wheeled past particular rooms along the long linoleum corridor, Deborah could smell the residents who were left to marinate in their own filth until the aides could find time to clean them up, sometimes hours later; too much work, too few workers.

In mid-September of 2035, Deborah developed an infection in an ankle wound suffered when an aide accidentally banged into her with the footrest of a wheelchair. The infection spread up her leg and proved resistant to the regime of antibiotics. After years of taking antibiotics for various infections, Deborah’s bacteria were well armed to resist eradication. The infection turned ugly and her leg gangrenous. Deborah was sent to the ICU at a large Atlanta teaching hospital. Her leg was amputated at the knee. The surgery site contracted another and different infection, a bug from within the hospital. The new infection spread to her lungs and they quickly declined in function. The medical team, none of whom her family had known prior to this hospitalization, recommended that Deborah be placed on a ventilator to “ease her breathing”. What they did not tell the family was that it was very unlikely that Deborah would ever breathe on her own again, ever.

Deborah’s kidneys began to fail. A young resident arranged for her to be gurneyed to the dialysis three times a week. Her daughter agreed.

The amputation site was painful and Deborah often teared silently and furrowed her brow when the doctors or nurses asked her how she was feeling. Pain medication was administered but never enough to do the job.

The wounded stump required another surgery to clean up additional gangrene. Deborah’s eyes were now sunken hollows, seeing little but still registering pain and misery. Her med-student grandson argued with one of the residents about failing to provide sufficient pain medication. The resident insisted that to give Deborah more drugs would make her dependent on the morphine; he said that she would become addicted. The grandson also argued with his own mother about her decision to allow Deborah to have dialysis. His argument was based on the medically obvious; Deborah was dying; doing anything to prolong that process was simply extending her suffering.

The daughter called Deborah’s doctor for his advice. He deferred to the hospital’s medical staff. It was clear, he felt that his role as a healer was over because Deb couldn’t be healed. Cure trumped care.

Deborah had never filled out an advance medical directive, although such forms were readily available. She had not discussed her end-of-life wishes with anyone, including her doctor. She had given her daughter a medical power of attorney but she never talked with her daughter about her wishes for care when her condition became terminal. Perhaps Deborah wanted every treatment available regardless of the expense, discomfort or likely outcome. Or, perhaps, she wanted the dying process to be comfortable, without intrusive and futile medical interventions. Her family was left to guess, because Deborah was no longer able to communicate.

As it was, Deborah experienced the first kind of dying; lingering, painful, undignified, fearful and lonely, in spite of the best intentions of the medical staff and family.

Dozens of friends, former employees, business associates and family members attended her memorial service. She was fondly remembered by these people. Most, except for the immediate family, were unaware of the details of Deborah’s life during those final few years.

No one from the hospital team attended nor did her family receive notes from any who had served her in the medical or care community.

Deborah’s rich and meaningful life spiraled into ignominy during her final four years. When she lost independence, she was swept into an elder care, health care and dependent living systems that were fragmented and awash in state and federal policies that frustrated proper and affordable care for the dependent elderly. In general, it was a dysfunctional, multi-layered system, ill-prepared for the tsunami of dependent elderly still known in 2035, ironically, as the Baby Boom.

Health care professionals, politicians, federal and state bureaucrats plus the voting public had seen the elderly tidal wave coming years before but, for various and not always altruistic reasons, had chosen to avoid big fixes. Instead, there was patching here and there hoping that it would somehow all work out. It didn’t. It was a delusion to think that it would work itself out.

The biggest delusion was that of the Baby Boom. They allowed themselves to believe that they would never grow old and dependent.

By 2064 there were but a mere handful of centenarian Baby Boomers left. The majority of the cohort had already experienced much the same kind of physical decline, sub-optimal care and poor dying process that Deborah had experienced. Their education, money and reputation didn’t alter the nature of the outcome. The Baby Boom failed to take control of its own inevitable future back when it still had political and financial clout. The generation’s lack of political will and action sealed its fate. It should have been different. It could have been different.


Coming next: Chapter 2 "A Greater Generation?"


Observoid of the Day: Growing old is an accumulation of small indignities.

Monday, February 15, 2010

Baby Boom Delusions and Solutions (Chap.1, Part 2)

See previous posts for background.

Deb’s daughter and stepdaughter arranged for a series of private duty in-home helpers. The first woman was good for the first few months and then began to skip days, show up late or leave early; but, she was always sweet to “Miz Chase” and Deborah liked her. The woman asked Deborah for a loan of $10,000, claiming that her husband “needed emergency surgery”. Deborah wrote her a check. The woman cashed the check but never returned.

The second woman lasted one week. The third, referred by an employment agency, turned out to be in the country illegally, had a drug habit--which she partially funded by fencing Deborah’s jewelry--and left the country before she could be arrested. Frustrated, the family hired bonded help through an in- home companion service agency. As Deborah’s confusion mounted and her memory slipped, the tag-team of companions had to be with her nearly 24/7 and the monthly bill exceeded $15,000. Because Deborah’s care needs were not directly related to medical treatment, Medicare paid not a penny. While well-to-do by most standards, Deborah’s nest egg could not stand a nearly $200,000 per year tab for trustworthy in-home assistance.

Her children might have pooled resources to keep her at home but they were already paying over 22% of their incomes to fund Social Security, Medicare and Medicaid. Their generation was financially struggling to fulfill the government’s entitlement program promises now that the entire living Baby Boom was over 65. It was rumored that FICA would increase another 2% in 2030.

After much rancorous family discussion, Deborah moved to an Atlanta assisted living facility. She left behind her spacious home with its beloved art collection, her craft studio, beautiful kitchen and peaceful screened deck. She gave her cat to her granddaughter because pets were not allowed at Heritage Gardens. She moved into her new small apartment an unhappy camper.

She hated the community dining room with its cliques of “ins” and “outs”, social butterflies and overly attentive gentlemen. She despised the cafeteria-style food. She wanted nothing to do with the group outings to local attractions, all of which she had seen before and several for which she had served on the boards or fund-raising committees. She only admitted it to herself, but the thought of returning to those local attractions as just another senior citizen shuffling off of the van was humiliating.

She made one or two friends, was attended to by the facility’s health and daily care staff and life for her scattered family returned to nearly normal. It wasn’t normal for Deborah and she developed clinical depression, a condition that went undiagnosed for over a year. Her doctor had no training in geriatrics. He mistook her symptoms as the natural state of the elderly. The woman that her children, grandchildren and friends visited and phoned during this time was a heart- breaking shadow of the vibrant woman Deb had been for nearly eight decades.

In March of 2030, Deborah’s daughter, by then living in Santa Fe, received a call from Deborah’s tax attorney. The attorney, a long-time friend was in the process of preparing Deborah’s 2029 return and had come across some banking transactions that were problematic and of no small consequence, nearly $80,000. She suggested that the daughter come to Atlanta right away.

Within the week it came to light that Deborah had been contacted via untraceable wireless phone by “Dr. Someone” (she just couldn’t remember his name) in Nigeria. He claimed to have gotten her name from the director of Deborah’s favorite charity, one that indeed did good work in Nigeria. The ”Dr.” indicated that there was a very large pool of money—Deborah thought it was $4 or $5 million, or maybe he said $45 million--available there, left over from an unfulfilled Nigerian government contract. If Deborah would just help free up this money he promised to give one quarter of the millions to the favorite charity.

Over the course of the next four months, Deborah wired $5,000, then $12,000, followed by $8,000, $35,000 and finally, $19,000. Each transfer was preceded by a call from the friendly “Dr. Someone” who assured Deborah that these additional payments were needed to take care of unforeseen bribes, a bureaucratic snafu or tax payment and that soon the charity would have its grand gift, thanks to her. He also assured her that she would soon get all of her money back with interest. Deb told her trust officer that these large checks were cash gifts for her grandchildren and children. Deborah had once been one of the most respected financial executives in Atlanta.

The money was never recovered; Deborah continued to insist that “Dr. Someone” was “such a nice man” and would never cheat her and she was livid when her daughter had Deborah’s phone number changed. For security reasons, the tax attorney was added to her checking account and did a daily on-line review of transactions. This trusted professional charged a pro-rated $250 hourly fee for this service. None of the government entitlement programs paid for this type of oversight or could provide someone who could do it cheaper.

The brain aneurysm did its damage late in 2030, just before the holidays. By this time, only one of her children remained in Atlanta. After the initial hospitalization, Deborah’s daughter and stepdaughter searched for a skilled nursing facility (nursing home). Deborah was now almost totally dependent. She could no longer communicate clearly, dress herself, go to the toilet on her own or transfer from wheelchair to bed. She was once a woman who ran 10Ks in support of local charities.

After a sobering tour of several facilities, the daughters selected the one that didn’t smell of disinfectant and urine. This “home” had the fewest residents aimlessly parked in front of common area TVs. The institution was pleasant looking from the street with well-maintained grounds and walking paths. Inside there were live plants in the sun rooms and common areas and the semi-private rooms had floor to ceiling windows that looked out onto small patios and gardens. Deborah’s roommate was bedridden and talked to unseen visitors while awake and even during her dreams. She had no idea who Deborah was day-to-day.

A nurse’s aide awakened Deborah each morning at 6:30. With nearly 100% of the nursing home’s aide staff turning over every year, the person who woke Deborah was often a new face with a new accent. Some aides were more patient with Deb’s physical deficits than others. All of them called her “Debbie” or “Darlin’” or “Honey” or “Suga”. None of them called her Ms. Chase and they spoke to her as if talking to a child. When they were angry, like when she soiled herself after they had just changed her into something clean, they spoke harshly. On these occasions, Deborah was frightened and cried. Some of the aides called her a “big baby”. During her career, Deborah had a reputation for speaking truth to power, it was one of the attributes that made her successful, but none of the aides knew of her personal history and they had all the power now.

In her one-piece shift with Velcro fasteners and her skid-grip socks, Deborah was wheeled to the dining room every morning at 7:00 a.m. She sat beside another woman in a wheelchair and both were fed oatmeal, always oatmeal, by one aide who spooned first to one and then the other. There were not enough aides to feed the residents who needed eating assistance one-on-one. Deborah hated the oatmeal. It was tasteless, always nearly cold and nothing like the delicious oatmeal that she used to make with a touch of brown sugar, wheat germ, fresh berries and a splash of half and half.

The aide who fed them talked to the aide at the next table and Deborah ate very little. Most of the gruel slid out the side of her mouth that drooped. Nevertheless, the aide was instructed to feed [them] “all of the oatmeal” and so the feeding charade continued until the bowl was empty. Much of the food slipped down the neck of Deborah’s shapeless dress. She had once been a superb cook and she still knew what good food was. What was shoveled at her three times a day in this fluorescent-lit, loud and confusing place was certainly not it.

On Tuesdays, Fridays and Sundays, Deb was wheeled to the shower room where someone would remove her skid grip socks, help her stand, strip off her dress and underwear and ease her onto a wet plastic bench where she steadied herself as the aide shampooed her snow white hair and washed her down. There was no dignity in this routine but it was efficient. Once, many years ago, Deb had redone her master bath with a large walk-in shower. She could still recall the pleasure of the slate tiles under her feet and the hot water coursing from two shower heads. In those years, showering efficiency was not a goal.


To be continued.


Observoid of the day: A nursing home bears little resemblance to your home.

Tuesday, February 9, 2010

Baby Boom Delusions and Solutions (Chap.1, Part 1)

With this post, I am making good on an earlier threat to use this blog to pre-publish the book that I have toiled over for more than three years: Baby Boom Delusions and Solution
s. Given its length, this will be accomplished via serialization. The end result will either be a ticker-tape parade in downtown Peoria--with me riding in the convertible--or a blog readership that shrinks to nada, as if it were the wet witch in the "Wizard of Oz". Either outcome could be good, depending on your vantage point. No guts, no ticker-tape.

Please take note: The person of "Deborah Anne Chase", featured in Chapter 1, is referenced throughout the remainder of the book. This is a literary device that allows me to provide examples of the topics covered in the subsequent chapters. Therefore, a reader who begins reading at some point after Chapter 1 would be confused by any "Ms. Chase" references. Therefore, in this blog version, I will parenthetically remind the reader to ("see Chapter 1") when these references occur. For those of you who start at the beginning it will be but a minor annoyance. Mea culpa.

Also, the subject matter is serious. Therefore, I try to respect the content appropriately


Chapter 1


This is a story for those Americans born between January 1, 1946 and December 31, 1963, the Great American Baby Boom. The narrative will be true with some details altered to avoid unnecessary angst for Deborah Anne Chase and her family in the future. The details of the story are based on the facts of a real life and the realities of growing old, dependent and dying in America in the 21st century. Barring significant changes to current policies, programs, health care systems, institutions, ethics and attitudes, this story mirrors how the great bulk of the Baby Boom Generation will decline and die when their independence wanes. While this happens, America will financially struggle to keep its promises to a generation who thought mostly of itself. Only the Baby Boom has the financial and political power to demand the necessary changes so that this story is not their fated future or that of the country. Only a truly great generation would have the will and capacity to demand and institute these changes.

May 4, 1950, Greensboro, North Carolina, 8:52 a.m.
Deborah Anne Chase gulped in her first air and cried.

December 14, 2035, Atlanta, Georgia, 3:35 p.m.
Deborah’s final breaths were raspy and labored on this cool late fall afternoon. A tear pooled in the corner of the one eye that remained open as she slowly grew still. This was as close to crying that her body would allow. Her eyes hadn’t seen much in that sterile hospital room, the final 90 days of her 85-year life. A respirator had softly and inexorably shuffled air in and out of her useless lungs. Nutrition, one recoils from calling the milky liquid “food”, had dripped directly into her small intestine through a surgically inserted abdominal tube. It had been nearly four years since she had eaten a pleasant meal, cooked in her own nicely appointed kitchen. She had once, and for a long time, been a creative cook. Now, in her desperate silence, her clouded mind conjured long forgotten favorite recipes in great detail. Strange how the failing mind can manage to recall the specifics of small things loved.

Her daughter had finally insisted on the removal of the respirator and nutrition support. She left the room in tears a few minutes before her mother’s labored breathing finally stopped. She was simply not prepared to observe her mother struggle to breathe. Remaining in the room were Deborah’s youngest grandson who was a third-year med student, the shift nurse who had removed the feeding tube, a hospital administrator and a young resident who had agreed to turn off the respirator. None of them thought to hold her hand in those final minutes.

Deborah’s pulmonary specialist had refused to assume the “withdrawing of treatment” task, citing ethical and legal concerns. This particular specialist had been assigned to her case several weeks ago but he had never really communicated with Deborah because, in her condition, only eye contact communication was possible. He avoided the family. Too many questions and he had no good answers.

This doctor had noted to one of his colleagues that Deborah often had tears in her eyes when his morning rounds included her room. Those visits became less and less frequent in the final days. The doctor had concluded that Deborah was aware of her environment even though she was unable to communicate. He was thinking of writing a paper about the issue of the “incomplete communications loop” and its impact on treatment decisions. Interesting article topic, he thought, when he had time to get to it. In the meantime, he had patients who might actually recover most of their functions. He didn’t know that Deborah had been a world-class communicator most of her years.

Until the 2030 brain aneurysm that, in a matter if minutes, permanently took away much of Deborah’s left-side muscle function, further clouded her memory and sentenced her to over four years in a nursing home and finally this hospital room, she had lived the American dream.
Born to educated middle class parents, Deborah earned a degree in French from Tulane University and then a Masters Degree in Business Administration from Georgia State University. Deb then did a two-year stint in the Peace Corps, an adventure that took her to Ecuador and fulfilled a self-made promise, following JFK’s assassination. Kennedy had been killed later the same autumn that Deb had screamed her thirteen-year-old-self hoarse at a concert in Jacksonville, Florida: The Beatles.

She married her college sweetheart in 1978 and they had a daughter in the spring of 1980. In spite of their subsequent divorce, the couple remained committed to raising the daughter as partners, remained on good terms and succeeded in raising a young woman who became a successful business owner and mother to two of Deborah’s grandchildren. Deborah’s remarriage in 1990 brought two stepchildren into her life and eventually three additional grandchildren. Over the 37 years that she was married to her second husband, she and his children grew very close and all the grandchildren simply adored “Dee”.

By 1981 Deb had begun what was to become a successful 30-year corporate career in financial services. A true believer but not a shrill voice in the pursuit of women’s rights, Deborah did not change her maiden name through the course of two marriages. She advanced in the corporate world with the Chase family name. An admired manager, skilled at recognizing and rewarding talent, she became a valued senior executive and was well known in the Atlanta business community because of her board participation with several large non-profit organizations. By the time she retired in December of 2011, Deb had earned a comfortable retirement nest egg. When her Social Security checks began arriving she diverted the money to her grandchildren’s education funds because her pension and investment income was more than sufficient for her needs.

She and her second husband used the freedom of their retirement to launch second careers, he as a free-lance copywriter and she as an American craft artist, turning a long time hobby into a small business. They also enjoyed hosting their children and grandchildren on trips to Europe, the American Southwest, South America and Africa to visit the places that they had come to cherish in their earlier travels together. Deb had a talent for languages and always charmed the locals by using their language with passing skill.

In the spring of 2027, Deborah’s husband died suddenly of a massive stroke while on an Arizona golf vacation with his son, sons-in-law and grandsons. Some would say that he was the lucky one.

Returning to Atlanta after scattering her husband’s ashes in a national park on the western slope of the Rockies, Deborah resumed creating art, reconnected with friends, hosted the children and grandchildren for holidays and adapted to life as it now confronted her. However, during the next two years it became evident to friends and family that her short-term memory was failing. This memory loss led to a series of prescription medication mistakes, three times sending her to the emergency room in 2029. With each crisis her level of confusion grew. The children suggested that she sell the house and move to an assisted living facility. Deborah was having none of that.

(To be continued)



Observoid of the Day: You can take the bumpkin out of the country but you can't always take the bumpkin out of the bumpkin.

Monday, February 1, 2010

Uh, About That Raise You Want...

I stumbled across the following post while doing my morning blog reviews. It's written in a style that leans toward the condescending, which, given the topic (health care reform) and the current mood in many quarters (populist anger), seems highly appropriate. I wanted to share it for three reasons: (1) I mostly agree, (2) I love well-deserved condescension and (3) the writer saved me a lot of work.


(posted on Craigslist, Chicago, January 28, 2010 by anonymous)

WHY you keep getting screwed--MR. (Tea Party Patriot):

Hey you. You there in the Glenn Beck T-shirt headed off to the Tea Party Patriot rally.

Stop shouting for a moment, please, I want to explain to you why you're so very angry.

You should be angry. You're getting screwed.

I think you know that. But you don't seem to know that it doesn't have to be that way. You can stop it. You can stop it easily because the system that's screwing you over can only keep screwing you over if you keep demanding that it do so.

So stop demanding that. Stop helping the system screw you over.

Look, you can go back to yelling at me in a minute, but just read this first.

1. Get out your pay stub.

Or, if you have direct deposit -- you really should get direct deposit, it saves a lot of time and money (I point this out because, honestly, I'm trying to help you here, even though you don't make that easy Mr. Angry Screamy Guy) -- then take out that little paper receipt they give you when your pay gets directly deposited.

2. Notice that your net pay is lower than your gross pay. This is because some of your wages are withheld every pay period.

3. Notice that only some of this money that was withheld went to pay taxes. (I know, I know -- yeearrrgh! me hates taxes! -- but just try to stick with me for just a second here.)

4. Notice that some of the money that was withheld didn't go to taxes, but to your health insurance company.

5. Now go get a pay stub from last year around this time, from January of 2009.

6. Notice that the amount of your pay withheld for taxes in your current paycheck is less than the amount that was withheld a year ago.

That's because of President Barack Obama's economic stimulus plan, which included more than $200 billion in tax cuts, including the one you're holding right there in your hand, the tax cut that's now staring you in the face. Republicans all voted against that tax cut. And then they told you to get angry about the stimulus plan. They didn't explain, however, why you were supposed to get angry about getting a tax cut. Why would you be? Wouldn't it make more sense to get angry at the people who voted against that Obama tax cut?

But taxes aren't the really important thing here. The really important thing starts with the next point.

7. Notice that the amount of your pay withheld to pay for your health insurance is more than it was last year.

8. Notice that the amount of your pay withheld to pay for your health insurance is a lot more than it was last year.

I won't ask you to dig up old paychecks from 2008 and 2007, but this has been going on for a long time. Every year, the amount of your paycheck withheld to pay for your health insurance goes up. A lot.

9. Notice the one figure there on your two pay stubs that hasn't changed: Your wage. The raise you didn't get this year went to pay for that big increase in the cost of your health insurance.

10. Here's where I need you to start doing a better job of putting two and two together. If you didn't get a raise last year because the cost of your health insurance went up by a lot, and the cost of your health insurance is going to go up by a lot again this year, what do you think that means for any chance you might have of getting a raise this year?

11. Did you figure it out? That's right. The increasing cost of health insurance means you won't get a raise this year. Or next year. Or the year after that. The increasing cost of health insurance means you will never get a raise again.

That's what I meant when I said you really should be angry. That's what I meant when I said you're getting screwed.

OK, we're almost done. Just a few more points, I promise.

12. The only hope you have of ever seeing another pay raise is if Congress passes health care reform. Without health care reform, the increasing cost of your health insurance will swallow this year's raise. And next year's raise. And pretty soon it won't stop with just your raise. Without health care reform, the increasing cost of your health insurance will start making your pay go down.

13. I wish I could tell you that this was just a worst-case scenario, that this was only something that might, maybe happen, but that wouldn't be true. Without health care reform, this is what will happen. We know this because this is what is happening now. It has been happening for the past 10 years. In 2008, employers spent on average 25 percent more per employee than they did in 2001, but wages on average did not increase during those years. The price of milk went up. The price of gas went up. But wages did not. All of the money that would have gone to higher wages went to pay the higher and higher and higher cost of health insurance. And unless Congress passes health care reform, that will not change.

Well, it will change in the sense that it will keep getting worse, but it won't get better. Unless the problem gets fixed, the problem won't be fixed. That's kind of what "problem" and "fixed" mean.

14. Sadly for any chance you have of ever seeing a raise again, it looks like Congress may not pass health care reform. It looks like they won't do that because they're scared of angry voters who are demanding that they oppose health care reform, angry voters who demand that Congress not do anything that would keep the cost of health insurance from going up and up and up. Angry voters like you.

15. Do you see the point here? You are angrily, loudly demanding that Congress make sure that you never, ever get another pay raise as long as you live. Because of you and because of your angry demands, you and your family and your kids are going to have to get by with less this year than last year. And next year you're going to have to get by with even less. And if you keep angrily demanding that no one must ever fix this problem, then, you're going to have to figure out how to get by on less and less every year for the rest of your life.

16. So please, for your own sake, for your family's sake and the sake of your children, stop. Stop demanding that problems not get fixed. Stop demanding that you keep getting screwed. Stay angry -- you should be angry -- but start directing that anger toward the system that's screwing you over and taking money out of your pocket. Start directing that anger toward fixing problems instead of toward making sure they never get fixed. Instead of demanding that Congress oppose health care reform so that you never, ever, get another pay raise, start demanding that they pass health care reform, as soon as possible. Because, until they do, you're just going to keep on getting screwed.

And it's going to be that much worse knowing that you brought this on yourself -- that you demanded it.

Thanks for your time.

P.S. -- I didn't mention this because I'm trying here to be as patient with you as I can, but you might also want to keep in mind that in addition to screwing over yourself and screwing over your family and screwing over your own children by demanding that Congress oppose health care reform so that you will never, ever see another pay raise, by doing that you're also demanding that I never, ever see another pay raise, which means that you're also screwing over me, and my family, and my children. Not to mention the millions of poor and uninsured and uninsureable (sic) people I didn't even mention above because they don't seem to matter at all to you. And for that, let me just say the only appropriate thing that can be said to someone so determined
to do direct, tangible harm to the welfare of my family: F*ck you, you f*cking moron.


Well now; clearly, there is a bit of anger on both sides of this issue as the final sentence indicates. However, the writer did patiently walk the reader through some basic financial facts about a very complex issue, facts that won't ledgibly fit on a T-shirt or homemade poster. And, as many wags have recently noted, while we are entitled to our own opinions, we are not entitled to our own facts.

Here's a fact: If you are upset about America's current and projected deficits--and we all should be greatly concerned--you will be apoplectic when you see the results of the Baby Boom aging into the waiting arms of Medicare, a system held captive by the mushrooming Leviathan known as health care cost inflation. Changing the insurance rules, as the current legislation attempts, is but a small step. America needs a lot more selfless thinking and a large dollop of intellectual courage.

Bruce (a.k.a. "Mr. Full of Elitist Crap")

Observoid of the Day: Every new administration has to clean up after the previous party's party.