Click Here To Register
On-Line For Free

Advance Directives Center

Play Video

Video: Susan explains Advance Directives
Get a Gerontologist's view on why everyone should have an Advance Directive.

Question Mark

Advance Directives FAQs
Have questions about Advance Directives or Estate Planning? See our Frequently Asked Questions or ask your own question!

Take Action Today Get an Advance Directive (Secured Form)
Talk to a Mom n' Pop Advance Directive expert now.

Death Panels

hospice

My husband had to put our dog to sleep this week. We have faced the gamut of responses ranging from disgust to deep love and sympathy. Naturally, the latter feels much better.

Our dog, Henry was beautiful and very loving, but could turn vicious at the drop of a dime.  He had already bitten my little boy in the face and caused him to get 17 stitches and cosmetic surgery.

Why didn’t we get rid of him then? We did not do that three years ago because I cannot even kill a spider in my home. Taking the life of a creature, let alone one that is so loved is not in my make-up. I believe that people and animals can change. I hoped that Henry would outgrow his lack of impulse control, but he did not and went on to terrorize other humans and animals in our neighborhood, attacking without provocation.

Of course there was a last straw. It came two nights ago when he took a little dog in his mouth and swung him around in the air as if it were a chew toy.

This is the same dog that I cuddled with that very afternoon.  My husband, who loved Henry as much as anyone, put his foot down and did something that required much bravery. He did something that would cause pain to all four of our children and anger.

Although I wanted to stop him, Henry was my baby, I did not. I could have talked my husband out of it, but I did not. I wanted to, but I did not.

Yesterday I met with a woman who told me that the nurse at the facility where her husband resides told her that her husband could not swallow his pills any longer.

They sought her permission to deliver his medication by liquid means. She told me that she wanted to say just let him choke on the medication and die.  He is in horrible facility, in diapers and very much demented.

Of course, she could not say that because our society covets life as if it is precious at all cost.  That would be extreme negligence at best and outright murder at worst.

Euthanasia is a very  complicated subject. It has been on our ballot in California . Many people who oppose it do not see the pain and suffering that I see on a daily basis. It is an objection based on theories usually religious in nature, for which I do respect.

Other’s object based on very real administrative concerns of abuse, such as who will deliver the dose and under what circumstances. Some think that it gives too much power to doctors who will become de-sensitized to death.

As a society we do condone taking the life of animals and humans under certain circumstances. All of these circumstances have nothing to do with the animal’s or human’s choice.

Years ago we had to put my Sheepdog to sleep because his stomach turned over on itself and he was in a great deal of pain. It was unlikely that a $5,000 emergency surgery would work especially because he had a platelet disorder. He was suffering.

We were allowed to take him out of his pain and misery. I wanted him to live forever. I wanted Henry to live forever. This great State of California has the death penalty for those who commit heinous acts upon others.

Although one could argue that by committing such acts these indivials implicty consent to the state taking their life, I would argue that they are as demented as some of my clients and like the dogs we are allowed to kill, cannot intellectually make that choice.

This is a good time to have this conversation. With the biggest growing demographic the 100+ years, and with the statics about Alzheimer’s (after the age of 85 you are at a 50% risk of getting it) we need to talk. This alone will bankrupt our country and cause pain to millions victims and their families. We need to talk.

Thank you for your kisses Henry and my love for you fills me with sadness at your death.

Share And Enjoy With Others:
  • E-mail this story to a friend!
  • Twitter
  • Facebook
  • Digg
  • Sphinn
  • del.icio.us
  • Google Bookmarks
  • Fark
  • HealthRanker

“Raising UP Your Parents” seminar update

Susan-Photo_final

Seminar Update:

The seminar at the Hotel Huntington Beach went very well. I am grateful for the panel and their expertise. For those of you who missed it or couldn’t find the Hotel Huntington Beach, this is what you missed.

First, in an effort to figure out whether or not it is safe to age in place, we explored some assistive technology. The CapTel phone was introduced. This device has streaming captions of the conversation a relatively big screen. There are some public benefits that enable you to get this for free. If you want to know more about his just click on the CapTel icon on my homepage. Jay’s Hearing is a fixture in Long Beach and Orange County. He has been in business for many years and he is truly an expert in assessing hearing loss and finding solutions to hearing deficits.

We had a doctor talking about fall prevention, in short, his advice get in shape and keep in shape.   NuVision also had some great technology for the vision impaired. I highly recommend checking them out if you know someone who has any type of vision loss and is looking for a solution.

Monica Bush from ResCare discussed what to look for when hiring an in home caregiver.  ResCare has some great technology available as well. They have a device that enables a family to watch what is going on in the home. You can just click on their icon to see more. HomeWatch Caregivers of Huntington Beach was also there. The owner of that facility used to be a fire fighter and is very dedicated to the health and safety of our citizens!

In the spirit of aging in place there was an in home dental company. How cool that they will go to your home or your parents home with before and after pictures to quell any suspicion that this service is too good to be true. They are called homecaredentists.com Google them!

Oxford Home Health discussed how one can qualify for in home health care under Medicare as well as how Oxford has been in business with the same owner since the 1960’s.   Oxford can be contacted by clicking on their icon. Greater Newport Physicians was also there. This medical group provides services to a wide range of people in Orange County.

Huntington Terrace Assisted Living was there. It is a beautiful, three-story community situated on three acres of meticulously landscaped grounds and gardens. I toured this facility and it is very nice especially with the renovation.

A representative from The Covington of Aliso Viejo shared information about this Continuing Care Retirement Community. A CCRC offers a broad spectrum of care and services to foster good health, fulfillment, and spiritual well-being in the lives of older adults. The Covington offers three levels of care: Independent Living, Assisted Living, and Skilled Nursing. In addition, The Covington also provides care for those with memory impairments in The Courtyard. A CCRC reduces the likelihood of relocation stress syndrome which can and does affect an older adult’s often delicate psyche.

This is a short list of items covered and experts involved in my last seminar. There will be an expert on dementia care at my next seminar on Saturday October 23, 2010 in Irvine at the Hilton as well as an expert on public benefits, MRS Specialists. It is a do not miss. I hope to see you there!

Share And Enjoy With Others:
  • E-mail this story to a friend!
  • Twitter
  • Facebook
  • Digg
  • Sphinn
  • del.icio.us
  • Google Bookmarks
  • Fark
  • HealthRanker

Part Three – The Magnificent Mrs. MB

How did I get Mrs. B to go to the hospital? I drew a chart of where she was when I first met her, where she was the previous Friday, where she wanted to be and where she was…. knocking at death’s door.  It went from the peak of a mountain to the valley.  I called 911 with her blessing.

One of my recommendations in my initial report was that she organize her paper work. It was scattered about her desk and should an emergency arise, it would be difficult to present the appropriate paper work without a frenzy which is exactly what I was thrust into when the paramedic asked me for her Medicare card.

Mrs. B had pneumonia.  She was placed on antibiotics. She spent three weeks in the hospital. Both of her daughters came in from various parts of the world. So many friends came that I had to put visitation restrictions on her door.  She is a fighter.

One day I came in and she was standing and sitting and standing and sitting. She was trying to work her muscles because she felt as if she would never walk again. Her whole body shook and no anti-depressant could stop it. She was scared.  She became nauseous. She vomited blood.  Instead of being transferred to the transitional care unit for rehabilitation, she was rushed to the intensive care unit. The diagnosis after two endoscopies? A massive pulsating ulcer—that could burst at anytime and end her life.

In the meantime, her husband was at home with in home care assistance and friends to ensure his safety.  She did not communicate to with him. He was scared and sad. I had to find a way to both enable her to release the guilt she was carrying around about his imminent placement in an assisted living facility without directly confronting her and find a way to for her communicate to him before he was taken from his home and moved to another…without his wife of 40 years.

I interviewed Mrs. B’s daughter and a close family friend, a Guatemalan man that they raised and who will be the conservator when things go very south. They told me of the nicknames that Mrs. B and her husband had for one another and memories that would evoke feelings of joy and nostalgia. I set out and wrote a love letter to him on her behalf. Bidding him fair well with love, signed “all my love twinkle.” Mrs. B approved of the content and Mr. B held onto it as if it were laced with sticky honey.  Not all lies are bad.

Share And Enjoy With Others:
  • E-mail this story to a friend!
  • Twitter
  • Facebook
  • Digg
  • Sphinn
  • del.icio.us
  • Google Bookmarks
  • Fark
  • HealthRanker

The Magnificent Mrs. MB, Part 2

Within 5 days of delivering the report, Mrs. B asked me to come to her home. She was shadowed by another woman who she sponsored at AA and who was there at our first meeting. We will call this woman, her shadow. At first I was suspicious. It is not just that I have an inherently distrustful nature, it is that I have seen these types linger around frail older adults with assets many times and THEY HAVE DONE BAD THINGS TO MY CLIENTS. In time, I came to not only trust the shadow, but because Mrs. B’s daughters were out of the country, I came to rely on her for doing the things that a daughter would do.

When I arrived, Mrs. B was sitting up in her bed upstairs eating a peanut butter and lettuce sandwich.  Because she had to sleep in an upright position, she developed stenosis. She complained of pain. Overall she seemed determined and strong. Mrs. B again reiterated her desire to move her husband elsewhere and the conflict she felt about “institutionalizing” him. The consensus was that she would tour a facility by her home that I recommended. I asked her to articulate her wish list, and certainly regaining her strength was primary. However, it was clear that her mental attitude was an impediment, so we discussed anti-depressants. Being the stoic person that she was, she had stopped taking them.

I spoke with Mr. B, he was bored. Every day that I spoke with him he said he was bored. He had very bad hygiene, could not make his own meals, pick his clothes out or do his own laundry. I came to feel that placing him was the right and kind thing to do. He sat and sat and sat all day without any social interaction.

We had a plan. Mrs. B. would tour the assisted living facility the following Monday. By the time I left, she was up and about and demonstrating her new lift. She looked happy and hopeful. The next Monday when I met her at the facility, she looked like she was knocking on death’s door.

What happened? I kept asking myself this question. Just two days before it seemed like you could swim in her eyes. When I saw her that Monday, she did not look spry and her lids were heavy over her big blues. She could barely get out of the car and I needed to get wheelchair assistance.  She had fallen the night before. There was no one there to help her.

The next morning I got phone call after phone call from one of her many friends “Mrs. B… keeps saying she is dying and she won’t let us take her to the hospital or the doctor.” I rushed back from my appointments and cancelled my day. Both she and her husband had fallen the night before and this time she was in terrible pain and scared. He was oblivious. She could barely breath.  She was gagging on her coughs.

I gave her two choices I would either bring her to the hospital or I bring a doctor to her. She told this doctor, (a geriatric concierge medical doctor who did her residency in geriatrics) was accused of being a quack while conducting a bedside examination and dismissed her. Now what?

Share And Enjoy With Others:
  • E-mail this story to a friend!
  • Twitter
  • Facebook
  • Digg
  • Sphinn
  • del.icio.us
  • Google Bookmarks
  • Fark
  • HealthRanker

The Magnificent Mrs. MB

elderly-woman-in-hospital-bed

This story begins 7 months ago when an attorney colleague asked me to call one of his clients who was frail. He knew that I was the person that had the skill set to ensure that she was getting her needs met and that she had a plan to stay healthy and safe. This person was the Magnificent Mrs. MB.  Her daughter came in from Canada to assist her after she had a minor heart attack in the hospital after being hospitalized for a bleeding ulcer. One year earlier, Mrs. MB had an extensive and highly invasive surgery because she had esophageal cancer. They used her stomach to re-construct her esophagus and now, for the rest of her life, she must sleep in an upright position. She had COPD and now emphysema and used oxygen.

Mrs. MB is 76 years old and for almost her entire adult life was the care taker for her husband who in the 1980’s was in an automobile accident and suffered minor brain damage. Now in his 80’s he has a rather well entrenched case of dementia.  I conducted a mini mental status examination and other standardized test on him that confirmed this diagnosis.

I did not meet with MB then. She did not want to hire me. Distrustful and afraid of change, she rejected her daughter’s pleas.

Exactly one month ago she called me. I went to meet with her. She had the biggest, bluest most alert eyes I have ever seen. They said I can size you up in a second and swallow you. I took her history. I found out that she was a retired psychiatric registered nurse. I found out that she wanted her husband out. She wanted her husband out. She had had enough. She was too frail to care for him and any suggestion of in home care for respite relief or getting him out of the house to an adult day health care center was not going to cut it. As time went on and as will be revealed later, I came to find out why I was being hired to be this seemingly affable man’s henchwoman.

As for her, she wanted her life back, she wanted to be social again and herself entertained moving into a nice assisted living facility.  She had been an alcoholic and for the last 20 years a valued mentor to many suffering from that disease. Her social life centered around those functions. In order for her to accomplish that,  it was clear that she needed major nutritional counseling. She was very thin.  She needed a lift put into her home to assist her with the 15 stairs to her room and grab bars installed. And, her legal affairs had to be put in order. Her estate plan was woefully outdated.

This seemed like a very easy case, one that my initial retainer could cover. I went back to my office, wrote a report with my recommendations and findings and summarily delivered it. One of my recommendations was that she re-consider moving her husband. I thought that she was underestimating the value of having a routine every day suddenly evaporate. It could be lonely and  isolating. Certainly she could get some relief through the adult day health care center or in home care. However, I would come to find out that there were people lining up to  be at this woman’s side, every day, all day.

Share And Enjoy With Others:
  • E-mail this story to a friend!
  • Twitter
  • Facebook
  • Digg
  • Sphinn
  • del.icio.us
  • Google Bookmarks
  • Fark
  • HealthRanker

Advance Directives And You

pict_submain_edu_011

I am always very surprised when I do a presentation and only 1 percent of the audience raises their hand when asked if they have an advance directive. It is, let me repeat, IT IS A CRITICAL DOCUMENT FOR ANYONE OVER THE AGE OF 18!!!

For those of you who have met me at one of my lectures, you know that I am not a soap boxy type of person except for two subjects:
  1. The need for advance directives and the value of long term care insurance.
  2. Long term care insurance is the subject of another blog.

An advance directive allows you to avoid a court, a doctor or board of directors of a hospital imposing their will and agenda that may be contrary to your formally unexpressed wishes.

Continue reading Advance Directives And You

Share And Enjoy With Others:
  • E-mail this story to a friend!
  • Twitter
  • Facebook
  • Digg
  • Sphinn
  • del.icio.us
  • Google Bookmarks
  • Fark
  • HealthRanker