Answer: No one likes to be judged as “less than.”  And most would rather have plans made with them rather than for them.

Given your situation, a few issues seem evident.  The first is the assumption your children are making about you, which may or may not be true.  They are questioning your ability and competency.

To determine your fitness and capabilities, an exam by your family physician or a geriatrician could provide the objective analysis of “how you are doing.”  That’s one way to determine if your self-assessment is valid.  Although most people are aware about how they are feeling and what they are able to do, a third party evaluation may eliminate doubts.

A second issue deals with assuming that residents of retirement communities or facilities are have nothing to offer. That’s not the case.  If you find a residence that initially appeals to you, check in as a guest for a week or two and sample the environment.   You may be surprised.

The third issue has to do with not wanting to be with “old people.”  We often hear comments about “those old people” as though they are aliens who have little to do with the rest of the world.Let’s think about what “old” actually means.

Formally, “old” is having lived or existed for a relatively long time.  Why should that be a problem?  Unfortunately, the term “old” in the U.S. has earned a negative connotation, except when referring to cheese, artifacts, antiques or vintage wines.

Sociologist Erdman B. Palmore in his classic book “Ageism: Negative and Positive,” originally published in 1990, presents several negative associations to the term “old” that frequently lead to stereotypes. These include older adults as sick, impotent, unattractive, suffering from mental decline, useless, isolated and depressed.

Palmore also describes some positive stereotypes such as being kind, wise, dependable, happy and affluent.

Note stereotypes are commonly held beliefs about specific social groups.  In this case, it’s older people.

If one has a relationship with several older adults who are stubborn and only discuss their ailments and doctor visits, one might be tempted to generalize that experience and judge all older people as rigid, complaining and self-centered.

What we need to do is to change the dialogue by omitting “old” as a descriptor and finding a substitute word that describes the person.  Instead of saying “I don’t want to be with those “old people,” one could say, “I don’t want to be with people who complain, are rigid and dull.”  Rather, “I want to be with people – regardless of their age – who are vital, interesting and curious about life.

Age stereotypes are bad for young persons who harbor them.  Based on four decades of data from the Baltimore Longitudinal Study, Becca Levy, an associate professor of epidemiology and psychology at the Yale School of Public Health, found that young healthy people, age 18-49 who stereotyped older adults were at risk for poor heart health later in life.

Results could not be explained by smoking, family history or cholesterol.  One explanation is that younger people internalize stereotypes of older age and may mature into the caricature of old age they are dreading. Perhaps what is operating is a self-fulfilling prophesy.

Thank you for your good question.  Consider that doctor evaluation, sleuth some of those retirement communities and rethink what you mean when you refer to “those old people.”

And by the way, the term “older” works better than “old.” Hopefully these few suggestions will be helpful in making your point with your children.   Best wishes to you.

Copyright 2010 Helen Dennis. All rights reserved.

The word “palliative” is derived from Latin, meaning “to cloak” or “to shield.”  The Oxford English Dictionary defines it as “alleviating symptoms without affecting a cure.”

Another definition is offered by the World Health Organization (WHO): “The active total care of patients whose disease is not responsive to curative treatment. … It (also) is applicable in the early course of illness, in conjunction with other therapies that are intended to prolong life such as chemotherapy and radiation.”

The goal is to achieve the best qualify of life for patients and their families.

Although palliative care is associated with end of life, that is not always the case. The following are characteristics of palliative care as described by WHO.

Palliative care:

• Provides relief from pain and other distressing symptoms.

• Regards dying as a normal process.

• Is not intended to hasten or postpone death.

• Offers support to help patients live as actively as possible before death.

• Provides a support system to help families cope during the illness and assists in family bereavement.

• Uses a team approach to address needs of the patient and family, offering counseling if indicated.

• Enhances the quality of life and sometimes may have a positive influence on the illness.

• Can be used in the early stages of an illness with other therapies that prolong life.

Palliative care is an area of research. Recently, the American Cancer Society and the National Palliative Care Research Center awarded $1.8 million in research grants to 12 institutions, to conduct studies that reduce the suffering of seriously ill patients and their family caregivers. UCLA is one of the recipients.

A new acronym has emerged: QOD, or quality of death. The Economist Intelligence Unit presented a paper commissioned by the Singapore-based Lien Foundation. It ranked the QOD of 40 countries. Here’s a quick summary:

The United Kingdom ranked highest in the QOD index. It was considered “far from perfect” but topped the quality of end-of-life category, which included “public awareness, training availability, access to painkillers and doctor-patient transparency.” It also was a leader in hospice care.

After the U.K. were Australia, New Zealand, Ireland, Belgium, Austria, the Netherlands, Germany, and then a tie between Canada and the U.S. The U.S. ranked seventh in quality of end-of-life care, eighth in availability of end-of-life care, ninth in basic end-of-life health care environment, and 31st in cost of end-of-life care.

Hippocrates, a Greek physician born in 460 B.C. and the founder of modern medicine, stated that physicians are “to do no harm.” There have been many interpretations of this phrase.

In general, palliative care is not considered “harmful.” Such care is central to the services of Hospice, which focus on caring, not curing.

In most cases, care is provided in the patient’s home. It also is offered in free-standing hospice centers, hospitals, nursing homes and other long-term-care facilities. The care team usually is composed of doctors, nurses, home health aides, spiritual counselors, social workers, volunteers and bereavement counselors.

Thank you for your important question. Hopefully, others will not have to go through the experience of interpreting the meaning of “do no harm” in dealing with end of life of a loved one.

Sending best wishes to you - with good memories of your father.

Copyright 2010 Helen Dennis. All rights reserved.

Answer: The challenge that you face has been given a name – long-distance caregiving. Here is a little background information:

The National Alliance for Caregiving and AARP report there are 5 to 7 million long- distance-caregivers in the U.S. who are caring for an older relative – a number that is expected to double over the next 15 years. They live on average 480 miles from the people for whom they care and spend an average of four hours in travel time per visit.

Employers are affected.  According to the Alzheimer’s Association’s Long Distance Caregiver Project, employers collectively lose 15 million hours a year of work time due to long-distance caregiving.

Given the responsibility and commitment, where does one begin?  The following tips may be helpful:

• Arrange for an evaluation of your sister’s physical and mental status.  This can be done by a geriatrician who is a physician specializing in the diseases of older age.    If possible, look for one who is board certified.  This may be difficult since there are only 7,000 board-certified geriatricians in the country.  For a referral, consider calling local hospitals or go to: wellness.com/find/geriatrician.

• Provide an assessment of the home environment.  One option is to contact a geriatric care manager.  This person is a professional – usually a social worker, nurse or trained gerontologist - specializing in assessing the needs of older adults and arranging for the appropriate services.

They assess the initial needs of the older person, suggest services to meet those needs, provide referrals and then arrange for the services to be implemented.  They provide a one-time service or ongoing assistance.  According to MetLife’s publication, “Since You Care:  Long Distance Caregiving,” assessments can range from $100 to $500; on-going care may cost $60 to $90 an hour. A geriatric care manager can be located through a local senior center, Area Agency on Aging, an elder law attorney or at caremanager.org.

Remember to check references, licenses, certifications and the billing procedure.   The assessment will serve as a guide in developing a care management plan – the keystone to effective care.

• Schedule some personal visits.  Consider arranging some respite time for yourself and visit your sister.  Here are some things to look for:   Determine if there is adequate food available, if she is taking her prescribed medications and if she is having social time with friends or family.  Finally, how does she look?  Does she appear well-nourished and well-kept?

• If you are not using a geriatric care manager, investigate community resources.  The Eldercare Locator at 1-800-677-1116 is federally funded by the Administration on Aging and provides information about local services by zip code.  Information also is available on the Internet at eldercare.gov. Local senior centers, hospitals, the library or your sister’s church or synagogue are additional resources.

• Keep a file of important documents.  Make copies of your sister’s birth certificate, Medicare and Social Security cards, and health insurance information.  If your sister wants you to discuss her concerns with her doctor, ask her to complete privacy release forms and have them filed with her doctor.  Keep a list of her current medications.  Finally make copies of her will, living will, trust and financial and health care power of attorney.

• Determine who will supervise the care.  This can be difficult yet is essential.  The care manager, your brother, a friend or neighbor – or you, long distance, may be the one who makes sure that “good and appropriate” care is being implemented.

Thank you for your question.  What is most important is to care for yourself.   Consider taking some time off.  It will be good for you, your wife and your sister.

Best wishes for a manageable and easy journey with some personal rewards.

Copyright 2010 Helen Dennis. All rights reserved.

Answer: The “toy syndrome” is a difficult one. A number of dynamics are likely at play. Let’s begin with the buying choices of a grandparent of the baby boom generation, a subject of commentary and research.

Some note that boomers want grandchildren to experience the same type of childhood they did, as a way to pass on their childhood legacy. They often buy traditional toys that encourage creativity, particularly in music and art, and purchase wooden puzzles and scrapbooks.

Others note that boomer grandparents are interested in toys that promote education, such as science and art, and purchase electronic gifts that encourage communication between the generations.

A study of “The Grandparent Economy” by Peter Francese, founder of American Demographics, commissioned by Grandparents.com, found that America’s grandparents are among the most powerful and underestimated drivers of the U.S. economy.

Currently, there are about 70 million grandparents in the U.S. The report indicates they buy $2 trillion worth of goods and services annually - about one-third of all consumer spending - and “have control of the majority of assets in the U.S. today.”

Here are some key findings that illustrate the demographic and economic force of grandparents:

• Three in 10 adults in the U.S. are grandparents.

• Grandparents today are younger than ever before. They first become grandparents at the median age of 50 for women and 54 for men.

• In 2010, more than half of the grandparent population consists of baby boomers born between 1946 and 1964.

• One of every three households is led by a grandparent.

• With recent economic events decreasing net worth, Americans ages 55 to 64, in general, are better off than the younger population.

• Of the $2 trillion spent annually by grandparents, about $52 billion is spent on goods and services for their grandchildren.

• Grandparents spend about $23 billion annually on toys for their grandchildren. It is estimated they spend $64 billion on all gifts.

• Grandparents not only spend on grandchildren, they make 45 percent of the nation’s cash contributions to nonprofit organizations and account for 42 percent of all consumer spending on gifts.

• They support and invest in their grandchildren’s education by spending $32 billion annually on tuition and other education-related expenses.

But what about the gift giving?

Depending on the age of the child and finances of the family, children get a lot of “stuff.” Think of the number of children attending birthday parties. Each child who attends brings a gift; that may total 25 to 30 gifts plus gifts from the family. Factor in Christmas, Hanukkah, Kwanzaa, and that may add another 10.

Of course, there are the McDonald’s toys and birthday party favors, too. A child could easily receive 50 to 75 gifts a year. One more gift may be just “one more gift for the moment.”

Here is a thought: Substitute some of your gift giving with “experience giving.” Do something with a grandchild that you both love and that builds memories.

For example, the Torrance Cultural Arts Foundation sponsors children’s programs; Torrance has the Western Museum of Flight; Lomita has the train museum. Then there is the Children’s Garden at the South Coast Botanical Garden on the Palos Verdes Peninsula.

Consider volunteering with your grandchild to feed the homeless or plant a garden. Think about taking a special trip - to the Los Angeles Zoo, maybe, or to San Diego by train.

View the world through the eyes of your grandchildren and cherish those moments. The toys are good but have momentary value. It’s the time we spend with our grandchildren that creates joy and lasting memories.

Thank you for your good question. And enjoy those grandkids.

Copyright 2010 Helen Dennis. All rights reserved.

Answer: You raise a very good question typically not discussed.  Let’s address it from a broader perspective.  Gay men often are grouped with a larger community consisting of lesbian, gay, bisexual and transgender individuals, often referred to as LGBT.

What is new is that your baby boomers neighbors are the first to live openly gay or transgender lives in large numbers.

In the 2010 report “Improving the Lives of LGBT Older Americans” – published by Services and Advocacy for Gay, Lesbian, Bisexual & Transgender Elders and a coalition of organizations – 4.1 percent of American adults identify themselves as lesbian, gay or bisexual.  This translates to 1.5 million older adults, a number expected to increase to nearly 3 million by 2030.

It was only four years ago that the first national LGBT elder survey was launched by the MetLife Mature Market Institute and the American Society on Aging.   The study revealed prejudice against older LGBT individuals in nursing homes and other long-term care facilities.

Nearly half of the senior centers and agencies on aging indicated that LGBT older adults would not feel welcome in their centers or agencies.  And almost three-quarters of LGBT older adults said they were tentative about using the services because they did not trust they would be treated well.

Some LGBT elders are denied housing in mainstream retirement communities.  In another study, one third of gay and lesbian respondents thought they would have to hide their identity if they moved into such a community.

To serve this growing market, a number of gay/lesbian retirement communities are open, being developed or have been proposed.  Retirement communities have been proposed for Los Angeles, San Francisco, Santa Rosa and Boston.

Here are just a few challenges these groups face:

• Resources are denied.  LGBT older adults often rely on friends and community members as their chosen family.  This is partly because many are estranged from their biological families.  The problem arises because policies, laws and institutional regulations generally recognize only legal and biological families.

• Financial security is a big problem.  They are poorer and less financially secure than older adults as a whole.  Discrimination, and safety nets that don’t equally include LGBT elders, compound the situation.

• Social isolation is an issue.  LGBT members are twice as likely to be single and about three times as likely to be childless than their heterosexual peers.  Despite strong friendship networks, more suffer from isolation than their heterosexual peers.

This year, MetLife Mature Market Institute and the American Society on Aging joined again to release a series of planning tips for the LGBT community.   Here are just a few:

• Pay attention to ownership of homes, bank accounts and investments.  Verify how the assets are titled between partners.

• If you are entitled to an employer-provided pension, determine if you can designate your partner as beneficiary.  If not, consider life insurance.

• In the event of hospitalization, have a Priority of Visitation that allows you to name the people you want to visit you.

• If you are expecting an inheritance, discuss the financial implications with an experienced professional.

• Investigate domestic partner benefits in your state.

Progress is being made.  In the recent MetLife study, two-thirds of lesbian respondents indicated their families were completely, or very, accepting of them.  That was similar for gay men.  For bisexuals, only about one-quarter of families were accepting; and almost half of families were accepting of transgender individuals.

The answer to your question is that some of the retirement concerns of LGBT elders are the same as those of heterosexuals - financial security.  Other concerns, however, are based on the fact that their relationships are not recognized by many institutions.  Loneliness, isolation, financial insecurity and health concerns of AIDS survivors are paramount.

The substitute word for diversity is inclusion; the substitute word for tolerance is acceptance.  Given similar circumstances, services for older adults need to  include and accept everyone equally.

Copyright 2010 Helen Dennis. All rights reserved.