Aging in place 2020

Jennifer Barger has a useful article today in the Washington Post about aging in place. 

She discusses the idea of adding elevators to townhomes, and adding extra rooms to bungalows.

She also mentions the use of “volunteers” in many senior communities.  I’m not sure how this comports with seniors who still are very independent with their own activities and travel.

   

My own mother died in hospice at the end of 2010, four days after leaving her home since 1949.

Young woman living in Wuhan discusses the vulnerability of older people to Novelcoronavirus in video

“Asian Boss” interviews a young woman in Wuhan living in a typical highrise at some distance from downtown. She somehow got permission from the government in China to air the video.  But it sounds credible. The video was posted January 31. 

  

  

She says that life is not as “bad” as the media makes it look, but few people are in the streets.  She felt ill for two days around Jan. 25 and tested negative.  She got better.  But it is possible to have false negatives and false positives. Sometimes infection seems to take a while to seroconvert or produce symptoms. 

    

What’s more important is that she says most of the severe illness and death was in “middle aged and old people with other conditions”, especially elderly.  Her comments have drawn some anger on Twitter.

  

The comments suggested that elderly men might be at particular risk.

  

There have been earlier reports that men are more often symptomatic than women because of subtle physiology of the lungs and testosterone. But this latest video would suggest it is mainly older men. 

There isn’t anything to suggest that runners or swimmers or bikers were at more risk because they tend to have more lung tissue;  the extra capacity probably still helps them.

  

My own situation is some low hypertension and mild arrythmia (since 2000) and lower lung capacity than usual since childhood (in conjunction with dyspraxia).  I don’t’ have a particular tendency for heart infarctions because that has to do with plaque explosions inside coronary arteries (a somewhat different problem from pulmonary weakness and vulnerability to a virus like this). 

Short film "Being 97" as a philosopher faces the end of his own experience on Earth

I thought I would share the short “Being 97” (2018) by Andrew Hasse, depicting Herbert Fingarette, as “A 97-Year Old Philosopher Faces His Own Death”.  The director is his grandson, and the subject has just passed away, according to the end credits.

There is music from the slow movement of a Schubert String Quintet in the background. Later the Arioso of Beethoven’s last piano Sonata plays.

He has to face the loss of independence and self-expression, and the need for a caregiver.

My own mother died three weeks after her 97^th birthday, that was in December 2010.

He says, “when you die, there is nothing.  You are not going to be.”  But can you “be” as part of something else?

  

The Atlantic has an article by the director, Jan 14, 2020, here. 

He describes the absence of deceased spouse and family members as a “presence” (you remember Roger Ebert’s final “leave of presence.”)

   

I am 76.  It would be nice to have the body of a 20-year-old.  I  play backward many episodes in my own life, and how they connect up with moral ironies that are mine.  The smartest young adults today know a lot more than I did then.

Finland leads the way with "aging in place"?

Can remote health care keep seniors in their own homes, especially if living alone, rather than in assisted living?

   

In Finland, where over 20% of the population is over 65, there is a big experiment with remote care, described here in Laura Lovett, link. It gets more important with low birth rates. 

  

My own mother wasn’t computer literate (back before 2010) and I doubt really cold have been.

I could imagine how this idea could matter in my own situation.

   

When I visited a couple of cultural centers last summer, especially in Ohio (related to my book), I found the people rather clannish and emphasized togetherness.  And, yes, they are afraid of Putin in Russia.

Could many future inheritances be banned or current ones put in jeopardy by political polarization?

I do remember a night in December 1972 (before my “second coming”) in a drafty Newark, NH rowhouse hanging out with (or spying on) “The People’s Party of New Jersey” which at the time was associated with Dr. Benjamin Spock.  I was probably part of the enemy because I had a “good” “steady” decently paying job with Sperry-Univac.  I was the more privileged.  (These kids were all white.)

Oh, they whined about why we have to have capitalism, and they wanted to go after people that owned any inherited wealth, and confiscate it, vengefully, “for the people”.

  

The other day I ran across this article by Meg McArdle (who starts out by calling herself a “disagreeable person) in the Atlantic in June 2011.  It’s titled “Why do we allow inheritance at all?”

You can imagine all the schemes for a 100% inheritance tax. But the idea is bound to get traction with the far Left, especially with Warren or Sanders candidacies. 

   

It isn’t hard to think of the obvious flaws in an idea like this if you want to remain a social justice warrior. Suppose you were a childless relative or son or daughter who had given up personal independence and work and their own income in order to personally take care of you and that lasted a long time.  Caregiving is badly undercompensated by normal market properties.

Perhaps you could get around this by setting up trusts in advance to pay the caregivers properly.  But it is easy to imagine how this could be abused.

One idea that we should consider is allowing trusts to do more distribution to beneficiaries before the death of the grantor.  Typically “special needs” beneficiaries can claim something like 1% if the remaining value of a potential estate while the grantor is alive.  This could be increased as long as the funds were used only to provide services and not to promote political activity.

It used to be more common than it is today for distribution of inheritances to be predicated on conditions, such as raising a particular child in the family (the scenario for the movie "Raising Helen" or even getting married (heterosexually, as in the 1999 comedy "The Bachelor").

Inherited wealth could be penalized more than earned wealth in any wealth tax scheme.  Or it could count against Social Security benefits if we ever means test existing beneficiaries, which we could do some day (like if we have another debt ceiling crisis). 

       

Another concern is that self-published writers, bloggers, and vloggers who don’t need to make a living from the publishing itself could have an unhealthful outsized effect on policy.  This was actually an explicit controversy that came to a head in late 2005, as explained here (2014 post).  It gradually dissipated, as the comments note. But in a post-Charlottesville world where platforms and possibly paid hosts are concerned about “who” they do business with, they could well object to the injection of inherited wealth into speech that doesn’t pay its own way with normal visitor reaction (including analytics) or consumer support with purchases.  This might be very hard to enforce, but it seems at least tangential to the more recently increased concerns over the unhealthful dependence of the business models of Internet platforms on cookies and the selling of personal information.

With Medicare, required doctor visits for refills -- are they excessive and profit driven?

OK, I got the runaround getting a prescription refilled for arthritis medication.  I hadn’t kept up with their on-line app at the orthopedics specialist, and CVS told me refill was denied.

I call, get put on hold for 15 minutes, and I’m finally told I have to come in once a year now for refills.  Fortunately, they had a spot open for one of the assisting physicians.

So this is how Medicare works.  They want the appointments, the visits, the chance to charge $150 for fifteen minutes work. I try to be responsible, not overuse services, not go down the rabbit hole of doctors.

I have a feeling the same thing would happen with Medicare for All.  I suppose this is what happens in Canada’s single payer, too.

The warnings online for heart disease certainly set up cycles of visits.  Stress tests, catheritizations, maybe Holter monitors (maybe the Apple watch can do that now without the depilation). 

  

Seriously, especially in women, you can have advanced heart disease with relatively vague symptoms.  With a stent, you can usually be home and back to work pretty quickly.  But with a lower left coronary artery, or when there are many arteries compromised, or if they have become brittle, people can suddenly face “emergency coronary bypass surgery” (like David Letterman did in 2000).  That was pretty much happened with mother in 1999 at age 85 with severe angina.  There is usually a several week-long disruption including SNF care (the keyhole operation is possible).   As Regins Philbin said, they crack you open like a lobster (and that will please Jordan Peterson pr even Yorgos Lanthimos).  The Cleveland Clinic has a video noting at the end that patients didn’t realize how badly they felt before the radical surgery. But (except for mammary artery grafts) they don't last forever.

Princeton notes that the stress test only catches disease where plaque itself blocks most of the artery (where as many heart attacks occur when smaller blockages rupture suddenly). 

Can a web hosting forever be done from the grave? A "dead hand"?

Jeff Reitman has a detailed exploration on a site called Tutsplus on whether your website can be hosted automatically and forever after your death, according to directions in your will. 

  

The short answer is, probably not.  But people have tried to set up automatic long renewals.

  

The Internet Archive probably will hold a lot of your stuff indefinitely if left alone, but even there, a lot of stuff doesn’t get all picked up.

  

The ultimate problem is that it takes people to respond to problems.  No automated system is perfect (although if we master space travel and evacuate Earth to other planets, we’ll have to get pretty good at this.)   A completely unattended operation could probably become a security honey pot, too.

          

Culture is changing, too.  Yup, world famous classics authors will be around forever (although English departments in politically correct colleges are running those too).  But tech companies are starting to think about ephemeral content, that nothing needs to last forever.  Remember the right to be forgotten?