Aging In Place

In a recent AARP study, nearly 75% of adults 45 and older said they strongly desire to stay in their current home as long as possible. To make sure that you can “age in place” you may have to make several updates to your home and your financial plan. Do not expect that your children or the government is going to step in and help you out. You need to create a plan to take care of yourself.

In addition to concerns about transportation and the availability and cost of help you need to take a serious look at your home. Don’t wait until there is a crisis to make needed improvements. Are your doorways wide enough to accommodate a wheelchair? A narrow wheelchair or walker needs clearance of at least 32 inches.

Do you have your master bedroom on the first floor? If not, are the steps to the second floor steep and is the stairway narrow? You may have to consider some sort of stairway elevator to get up and down at some point. Do you have a full bathroom on the first floor? If so does it  have a walk in shower? Converting a bathtub to a walk-in shower may cost somewhere between $3000-5000. This is most likely one of your most costly changes.

Look at your faucets and cabinet handles. Are they big enough to access with a closed fist? Check out your lighting. Older eyes need more light to see clearly. Check to see that the lighting is good in areas where tasks are performed. Consider the interior colors in your home. If your home has dark floors, keep the walls light. Change the color at potential tripping points, such as where the carpet on the stairs meets the floor. Are there other step ups or step downs in the home where it is possible to trip and fall?

You need to review access to the home itself. In addition to the entry way being wide enough for a wheelchair or walker, is there room to install a ramp for access if necessary?

Do not wait until someone is coming home from the hospital to consider these steps. Look around now and start planning to make the changes that will help you stay in your home.  Most of the suggestions listed above will not only make your home safe and accessible but they will probably increase its market value as well.

How to Find a Doctor for Your Mother

I have been reading Jane Gross’s wonderful book, “A Bittersweet Season”. It is about her efforts to care for her mother in her last few years. Jane writes a blog for the New York Times entitled, “The New Old Age. Not only is the book a very personal account of Jane’s experience with her mother but it is the source of a lot of valuable information on caring for an aging parent.

One of Jane’s problems was finding a family doctor for her mother when she moved from Florida back to the northeast to be close to Jane. She found it almost impossible to find someone that would take her mother.  Jane learned  a few facts about the medical profession that made things so difficult. First of all, fewer general practice physicians are coming out of medical school. These doctors just don’t make enough money. The average GP makes approximately $150,000 a year and their  loans from school are around $200,000. A typical anesthesiologist makes $400,000 a year. So medical  students are choosing to become much more highly compensated specialists.

Secondly, many doctors are choosing not to accept medicare.  They can legally opt out of the program. Reimbursement from medicare for various procedures is far less than what doctors often receive from insurance companies. In addition reimbursement is not for time spent with a patient but for procedures ordered. If a doctor convinces an older patient not to have her hip replaced he does not receive a dime. Often older patients take longer in an appointment than younger healthier patients which also ends up costing the doctor more.

Given these issues Jane was advised to take the following steps when seeking a new doctor for her mother:

First, get a referral from her existing doctor where Mom is now, before she moves. That doctor probably knows someone in the area she is moving to. That doctor will most likely be reluctant to turn down a referral from a peer.

Second, Get tightly crafted summaries from her existing doctor and any specialties that have been involved. Less is more. The new doctor is much more likely to read something that is clear and concise.

Third, If you can’t get a referral, scout the area for doctors in the area where mom is relocating, before she moves. Check with local councils on aging, senior centers, medical societies, and similar organizations.

Fourth, make it clear to the new doctor that one adult child will be the conduit for all communication. He won’t have to field calls from two or three siblings who all have questions. Prepare a plan within the family as to how communication will be disseminated from that key person. Show the doctor that you won’t waste his time.

Lastly, the same sibling should accompany Mom to medical appointments and communicate the results to the rest of the family. A family that manages itself internally is more likely to find, keep and get the best service from a doctor.