December 21, 2009, 8:00 am New York Times
What a Big House You Have, Grandma
By PAULA SPAN
Ever since Laura Marsh moved in with Marjorie Marsh in Orange County, Calif., she has kept an eye on things. Ms. Marsh calls from work to be sure Mrs. Marsh is fine. When Ms. Marsh gets home — she works late hours as an emergency medical technician — she checks to see that the house is securely locked and that Mrs. Marsh is safely in bed.
Mrs. Marsh doesn’t need a lot of help; she is an independent, lucid 74-year-old who manages her household and still drives most places. But she doesn’t like to contend with the Southern California freeways, so sometimes Ms. Marsh takes the wheel — and helps lug the heavier items home from Costco.
And she reminds the older woman not to skip meals. “She can be a little wobbly on her feet,” Ms. Marsh explained. “If I hand her something before I leave, she’ll eat. Otherwise, she gets busy and forgets.”
Lots of daughters provide this kind of backstopping for their elders, and sometimes it is easier to do when they share a household. But Laura Marsh isn’t Marjorie Marsh’s child; she is her granddaughter. She was just 19 when they became housemates; now she’s 23. “It’s really been a blessing,” Marjorie Marsh said.
After her husband’s death four years ago, Marjorie Marsh was rattling around a bit in her four-bedroom house. Her family felt uneasy about her being alone. Ten minutes away, Laura Marsh had finished high school and was living with her parents and two brothers, who were stuffed into a single bedroom. Moving in with her grandmother and her two Pekingeses seemed a logical solution, one that everybody, including her parents, embraced.
Housing costs are high in Orange County. Laura Marsh couldn’t afford her own apartment without a couple of roommates. Paying rent — she offered; her grandmother declined — would also make it harder for her to continue taking courses at Saddleback College, where she is studying to become a paramedic. This arrangement seemed the perfect solution. “I’m out on my own, but not completely,” Laura Marsh said.
“And I’ve gotten extremely close to my grandma,” she added. “She’s so much fun.” They watch Dodgers games together and go shopping for clothes, and Marjorie Marsh welcomes Laura Marsh’s friends for birthday parties and other festivities.
“It makes me feel better to know there’s another human in the house, just for companionship,” Marjorie Marsh said. She likes knowing she is helping her granddaughter pursue an education, and she has enjoyed meeting Laura Marsh’s friends. “They all call me Grandma, and I love it,” she said. “It makes me feel younger, too.”
We know that millions of American children are being raised and nurtured by grandparents; we don’t know how often adult grandchildren return the favor. But Donna Butts, who heads the intergenerational advocacy group Generations United, told me, “We’ve become a lot more aware of it, particularly with the economy and the amount of time it takes young people to find a job after college.”
Sometimes, Ms. Butts points out, there is less friction in a grandparent-grandchild relationship than between parents and kids. (“The joke is that they share a common enemy.”) Such arrangements can help grandparents age in place, give young adults a sense of responsibility and allow elders to pass along family traditions. “We think it has a lot of value,” Ms. Butts said.
I wondered whether this sort of household might function well only as long the grandparent needs companionship, with perhaps a little reminding and driving and changing of light bulbs, leaving the grandchild largely free for work or school and a social life. But what happens when grandparents need more hands-on care, help with bathing or dressing? Are grandchildren willing or able to take on that role? “If it gets more serious, that’s a whole other conversation,” said Suzanne Mintz, director of the National Family Caregivers Association.
But some grandchildren do shoulder such responsibilities. Julie Lanoie, a nurse and counselor in Addison County, Vt., moved in with her ailing grandparents last spring. Ms. Lanoie cared for her 95-year-old grandmother as she died and now lives with her grandfather, who is 95 and has dementia.
“I wanted to make this commitment,” said Ms. Lanoie, 35, who has had to resign from her job. Her peers can be judgmental about her decision, she has found. But, she said, “I don’t feel like my life is on hold; I feel like this is how I’m spending this chapter.”
I imagine that for most grandparents and grandchildren, this is a more temporary arrangement: for the young, a way station on the road to independence; for the old, an opportunity to be both supportive and supported before real frailty sets in.
But maybe not. I asked Laura Marsh, who is about a year away from her degree, how long she planned to live with her grandmother. “Forever,” she said, only half kidding. “I’m never moving out.”
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”
• Copyright 2009 The New York Times Company
Thursday, December 31, 2009
Wednesday, December 30, 2009
Assisted Living: Back to the Future
December 28, 2009, 8:00 am New York Times
Assisted Living: Back to the Future
By PAULA SPAN
It’s right in my neighborhood, so I’ve probably driven past that gracious Victorian house, painted a dusty rose, a zillion times. But because it looks like many other houses in Montclair, N.J. — big old trees, nice landscaping, wraparound deck — I never realized that it was an assisted living facility.
Ever since a 1990’s building boom, the term “assisted living” has conjured up mental images of a three-story stucco building on a highway, with a brass chandelier in the lobby and a “concierge” desk. But long before those places began popping up, many owned by regional and national chains, lots of smaller, homier residences for seniors were tucked into ordinary neighborhoods.
Known by a variety of names (residential care homes, board and care homes, adult foster care, assisted living), sometimes operated by families who share the house with those they care for, they’re still around. In fact, of the one million seniors in assisted living, about a third live in small residences with fewer than 16 residents, estimates Karl Polzer, senior policy director of the National Council on Assisted Living.
Several of the nine current residents at the Victorian house, called Horizon Manor South, were just finishing lunch in the sunny dining room when I came by for a visit. Three women chatted amiably over their canned peaches; two others ate in silence. Administrator Keith Hach, whose family has owned this and another small senior residence for decades, showed off the stained glass windows and the spotless rooms of the residents.
(A brief digression: Are we permanently doomed to senior housing full of chintz and heavy draperies and pseudo-antique furniture? Designers, hear our call: When we boomers are past 80, we may prefer less formal interiors. But anyway. . . .)
Because few of these small homes can afford to do much marketing, and because they blend into neighborhoods, they’re often overlooked. “I’m like the charming independent bookstore — and Barnes & Noble is right down the street,” Mr. Hach lamented, referring to big competitors like ManorCare and Sunrise. But small-scale assisted living remains a reasonable option for seniors who need help with daily activities, particularly those with dementia.
Among other advantages, they often cost less. At about $4,000 a month, Horizon Manor is still cheaper, unbelievably enough, than most assisted living in this pricey precinct of northern New Jersey. At a nearby Sunrise facility with 98 beds, annual fees average $65,000. And Horizon Manor South doesn’t charge extra for medication reminders or use tiered pricing that raises monthly fees as residents need more care.
Nor can you beat the staff ratio. In this house, for example, three staff members (a manager and two certified nursing assistants) are caring for nine residents each day, with two staffers each on the evening and overnight shifts. “We know our people, we know their habits,” explained manager Sareen Reilly, an employee for 30 years. “If they’re not eating like usual, or they’re sleeping too much — we just know.”
I could see some disadvantages, too. There’s not a lot of organized activity, and most of the current residents have some degree of dementia; an alert older person who wants to play Scrabble or take field trips to the local museum would quickly grow bored. In some small residences, there’s a lot of TV watching.
But the house has been a good home for Joan Werner, 88, who has Parkinson’s disease and dementia. After an unhappy experience in a big assisted living in a neighboring town, she’s lived here for nearly 10 years in a private room filled with stuffed animals and mementos of Venice.
“When all the rooms look alike and the staff members are strangers, it’s mystifying to her,” said her son Jon Stout, who was visiting at lunchtime. His mother used to call him at work from her previous residence and say she didn’t know where she was or what she was supposed to do. “This works much better,” Mr. Stout said. “It’s homelike. She recognizes the people who work here. She’s had friends sometimes.
Someone’s always keeping an eye on her.”
Small-scale residences have fans among professionals as well. “Nobody, but especially older people, likes to be herded into large groups,” said Philip Sloane, the Goodwin Distinguished Professor of Family Medicine at the University of North Carolina. “As people get confused or demented, they get overstimulated by a large group environment. There are too many choices.”
Interestingly, the small group residence has become a cutting-edge development in senior care since the Green House movement undertook to de-institutionalize American nursing homes and attracted intense interest from those in the aging field.
Smaller is not always better, of course. In fact, without the standardization that national chains enforce, there’s probably greater variation between small assisted living homes, and thus greater need for vigilance and visiting by family members both before and after a relative moves in.
A homey-looking place can employ caring aides or indifferent ones, can provide quality care or lousy care. But that’s true of any assisted living, with a concierge or without.
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”
• Copyright 2009 The New York Times Company
Assisted Living: Back to the Future
By PAULA SPAN
It’s right in my neighborhood, so I’ve probably driven past that gracious Victorian house, painted a dusty rose, a zillion times. But because it looks like many other houses in Montclair, N.J. — big old trees, nice landscaping, wraparound deck — I never realized that it was an assisted living facility.
Ever since a 1990’s building boom, the term “assisted living” has conjured up mental images of a three-story stucco building on a highway, with a brass chandelier in the lobby and a “concierge” desk. But long before those places began popping up, many owned by regional and national chains, lots of smaller, homier residences for seniors were tucked into ordinary neighborhoods.
Known by a variety of names (residential care homes, board and care homes, adult foster care, assisted living), sometimes operated by families who share the house with those they care for, they’re still around. In fact, of the one million seniors in assisted living, about a third live in small residences with fewer than 16 residents, estimates Karl Polzer, senior policy director of the National Council on Assisted Living.
Several of the nine current residents at the Victorian house, called Horizon Manor South, were just finishing lunch in the sunny dining room when I came by for a visit. Three women chatted amiably over their canned peaches; two others ate in silence. Administrator Keith Hach, whose family has owned this and another small senior residence for decades, showed off the stained glass windows and the spotless rooms of the residents.
(A brief digression: Are we permanently doomed to senior housing full of chintz and heavy draperies and pseudo-antique furniture? Designers, hear our call: When we boomers are past 80, we may prefer less formal interiors. But anyway. . . .)
Because few of these small homes can afford to do much marketing, and because they blend into neighborhoods, they’re often overlooked. “I’m like the charming independent bookstore — and Barnes & Noble is right down the street,” Mr. Hach lamented, referring to big competitors like ManorCare and Sunrise. But small-scale assisted living remains a reasonable option for seniors who need help with daily activities, particularly those with dementia.
Among other advantages, they often cost less. At about $4,000 a month, Horizon Manor is still cheaper, unbelievably enough, than most assisted living in this pricey precinct of northern New Jersey. At a nearby Sunrise facility with 98 beds, annual fees average $65,000. And Horizon Manor South doesn’t charge extra for medication reminders or use tiered pricing that raises monthly fees as residents need more care.
Nor can you beat the staff ratio. In this house, for example, three staff members (a manager and two certified nursing assistants) are caring for nine residents each day, with two staffers each on the evening and overnight shifts. “We know our people, we know their habits,” explained manager Sareen Reilly, an employee for 30 years. “If they’re not eating like usual, or they’re sleeping too much — we just know.”
I could see some disadvantages, too. There’s not a lot of organized activity, and most of the current residents have some degree of dementia; an alert older person who wants to play Scrabble or take field trips to the local museum would quickly grow bored. In some small residences, there’s a lot of TV watching.
But the house has been a good home for Joan Werner, 88, who has Parkinson’s disease and dementia. After an unhappy experience in a big assisted living in a neighboring town, she’s lived here for nearly 10 years in a private room filled with stuffed animals and mementos of Venice.
“When all the rooms look alike and the staff members are strangers, it’s mystifying to her,” said her son Jon Stout, who was visiting at lunchtime. His mother used to call him at work from her previous residence and say she didn’t know where she was or what she was supposed to do. “This works much better,” Mr. Stout said. “It’s homelike. She recognizes the people who work here. She’s had friends sometimes.
Someone’s always keeping an eye on her.”
Small-scale residences have fans among professionals as well. “Nobody, but especially older people, likes to be herded into large groups,” said Philip Sloane, the Goodwin Distinguished Professor of Family Medicine at the University of North Carolina. “As people get confused or demented, they get overstimulated by a large group environment. There are too many choices.”
Interestingly, the small group residence has become a cutting-edge development in senior care since the Green House movement undertook to de-institutionalize American nursing homes and attracted intense interest from those in the aging field.
Smaller is not always better, of course. In fact, without the standardization that national chains enforce, there’s probably greater variation between small assisted living homes, and thus greater need for vigilance and visiting by family members both before and after a relative moves in.
A homey-looking place can employ caring aides or indifferent ones, can provide quality care or lousy care. But that’s true of any assisted living, with a concierge or without.
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”
• Copyright 2009 The New York Times Company
Tuesday, December 29, 2009
A Patient Dies, and Then the Anguish of Litigation
December 29, 2009
Cases
A Patient Dies, and Then the Anguish of Litigation
By JOAN SAVITSKY, M.D.
It was just an average busy, stressful day at work, in May 2004, when the deputy sheriff arrived with a summons. I sucked in my breath, signed the receipt and returned to my desk piled high with charts, messages, lab results and forms. I was being sued for medical malpractice.
That was how it started. Eventually I peeked at the text of the complaint, which was riddled with accusations. Apparently, my conduct was “malicious, willful, wanton or reckless,” and I had “negligently, carelessly and without regard” for my patient’s health treated her in such a manner that she had died the previous year.
At night I lay awake going over and over what happened. My patient was a relatively young woman who had developed an aggressive colon cancer; her illness was unexpected, and her course was tragic. I felt that I had treated her as I would wish to be treated.
But now her children, whom I barely knew, were coping with their own complex emotions, which I imagined to be grief, very likely anger and frustration, and perhaps misunderstanding. Filing a malpractice suit somehow addressed this. And now it would hang over all of us for years. It was as if a noxious subtle film had settled all around, making everything vaguely unfamiliar and unpleasant. I had become a little unfamiliar to myself.
The film settled on everything at home and at work. I loved my patients and my practice, but this made me wary and mistrustful of them — and of myself.
Medicine can be a minefield of uncertainties; no matter how thoughtful and careful we are, physiology is infinitely complex and fate is capricious, and occasionally something blows up in your face. If this happens, you have to integrate the experience, but for a while you lose your bearings. It is discombobulating. When this is followed by litigation, the effect can be paralyzing. And the lawsuit felt like an assault. Being sued, even with assurances that “it’s nothing personal” and that my insurance would most likely cover any settlement, was in fact deeply personal. The experience was devastating.
Still, I coped well enough. I was able to see patients and almost lose myself in their stories. One day I went in to see a delightful 95-year-old woman for a blood pressure check. In the middle of the visit, she gave me a piercing look. “You’ve got something on your mind,” she told me. “You take care of yourself.”
A few months later, my lawyer, Amy, arrived, a brisk, no-nonsense woman hauling a suitcase full of records. We spent an exhausting and inconclusive morning reviewing the case and the questions it raised. I couldn’t tell if she thought I might win or lose the suit. This was the first of many such marathons.
I had been cautioned not to discuss the details of the case with anyone except my defense team. At one point, I told Amy that I had decided to keep a journal of the experience. Apparently, this was a bad idea. A journal could be subpoenaed, and even if it contained no evidence of wrongdoing, the plaintiff’s lawyer could very likely find something that would be used against me. So talk only to Amy and my claims representative; other than that, suck it up.
After the initial flurry of activity, things subsided, and more than a year elapsed before I was deposed. For a grueling four hours, the plaintiff’s lawyer asked a lot of questions, but he did not hold my feet to the fire, and then that was that. It is often the case that these suits drag on for years, so I was taken by surprise when, in fall 2007, a trial date was scheduled for Oct. 27, 2008, in Middlesex Superior Court. In January 2008, I left my primary care practice after almost 30 years. I can’t say it was because of being sued, but I can’t say it was irrelevant either.
In September 2008, Amy and I resumed the process of reviewing records and discussing strategy. In early October, I was coached on how to testify: keep your feet on the floor, do not cross your legs or fold your arms. Don’t put your fingers together and pontificate. For heaven’s sake, don’t slump. Answers should be crisp and cogent, but do not hesitate more than three seconds before responding. Look at the jury. Don’t lose your cool during the cross-examination. And above all, relax and be yourself.
On Oct. 16, 11 days before trial, I got an urgent e-mail message from Amy. It turned out that the plaintiffs and their law firm had “irreconcilable differences.” These differences weren’t spelled out, but it appeared that the lawyers had decided they were not going to win the case. They couldn’t have figured this out four and a half years earlier? Before all this wasted time, the emotional anguish, and the more than $150,000 spent by my insurance company in the run-up to trial?
The plaintiffs, my patient’s children, refused to let their lawyers drop the case. I could imagine that they didn’t feel well served by this process. They met with their lawyers to resolve this, but neither side gave in. As this slowly unfolded, my mood turned from stoic resignation to a toxic muck of apathy and irritation.
On Oct. 23 everyone except me went in front of the judge. The plaintiffs’ lawyers asked to withdraw from the case, and the family requested a continuance, which would allow the case to be tried at a later time with a new set of lawyers. Amy opposed the continuance. The judge denied the continuance and ordered everyone to proceed with the trial as scheduled.
Just before Amy left, the children and their lawyers conferred again. The lawyers told them that they were unlikely to win and that they would have to pay for the expert witnesses if the case went forward. Finally, the family agreed to drop it, and they all went before the judge to seal the deal.
Amy called me. All in all, I thought I was pretty cool about the whole thing by now. The initial turbulent emotions had been squeezed out or tamped down, and I was ready for whatever happened. But when she told me the news, I started to cry.
Dr. Joan Savitsky is an internist in the Boston area.
Cases
A Patient Dies, and Then the Anguish of Litigation
By JOAN SAVITSKY, M.D.
It was just an average busy, stressful day at work, in May 2004, when the deputy sheriff arrived with a summons. I sucked in my breath, signed the receipt and returned to my desk piled high with charts, messages, lab results and forms. I was being sued for medical malpractice.
That was how it started. Eventually I peeked at the text of the complaint, which was riddled with accusations. Apparently, my conduct was “malicious, willful, wanton or reckless,” and I had “negligently, carelessly and without regard” for my patient’s health treated her in such a manner that she had died the previous year.
At night I lay awake going over and over what happened. My patient was a relatively young woman who had developed an aggressive colon cancer; her illness was unexpected, and her course was tragic. I felt that I had treated her as I would wish to be treated.
But now her children, whom I barely knew, were coping with their own complex emotions, which I imagined to be grief, very likely anger and frustration, and perhaps misunderstanding. Filing a malpractice suit somehow addressed this. And now it would hang over all of us for years. It was as if a noxious subtle film had settled all around, making everything vaguely unfamiliar and unpleasant. I had become a little unfamiliar to myself.
The film settled on everything at home and at work. I loved my patients and my practice, but this made me wary and mistrustful of them — and of myself.
Medicine can be a minefield of uncertainties; no matter how thoughtful and careful we are, physiology is infinitely complex and fate is capricious, and occasionally something blows up in your face. If this happens, you have to integrate the experience, but for a while you lose your bearings. It is discombobulating. When this is followed by litigation, the effect can be paralyzing. And the lawsuit felt like an assault. Being sued, even with assurances that “it’s nothing personal” and that my insurance would most likely cover any settlement, was in fact deeply personal. The experience was devastating.
Still, I coped well enough. I was able to see patients and almost lose myself in their stories. One day I went in to see a delightful 95-year-old woman for a blood pressure check. In the middle of the visit, she gave me a piercing look. “You’ve got something on your mind,” she told me. “You take care of yourself.”
A few months later, my lawyer, Amy, arrived, a brisk, no-nonsense woman hauling a suitcase full of records. We spent an exhausting and inconclusive morning reviewing the case and the questions it raised. I couldn’t tell if she thought I might win or lose the suit. This was the first of many such marathons.
I had been cautioned not to discuss the details of the case with anyone except my defense team. At one point, I told Amy that I had decided to keep a journal of the experience. Apparently, this was a bad idea. A journal could be subpoenaed, and even if it contained no evidence of wrongdoing, the plaintiff’s lawyer could very likely find something that would be used against me. So talk only to Amy and my claims representative; other than that, suck it up.
After the initial flurry of activity, things subsided, and more than a year elapsed before I was deposed. For a grueling four hours, the plaintiff’s lawyer asked a lot of questions, but he did not hold my feet to the fire, and then that was that. It is often the case that these suits drag on for years, so I was taken by surprise when, in fall 2007, a trial date was scheduled for Oct. 27, 2008, in Middlesex Superior Court. In January 2008, I left my primary care practice after almost 30 years. I can’t say it was because of being sued, but I can’t say it was irrelevant either.
In September 2008, Amy and I resumed the process of reviewing records and discussing strategy. In early October, I was coached on how to testify: keep your feet on the floor, do not cross your legs or fold your arms. Don’t put your fingers together and pontificate. For heaven’s sake, don’t slump. Answers should be crisp and cogent, but do not hesitate more than three seconds before responding. Look at the jury. Don’t lose your cool during the cross-examination. And above all, relax and be yourself.
On Oct. 16, 11 days before trial, I got an urgent e-mail message from Amy. It turned out that the plaintiffs and their law firm had “irreconcilable differences.” These differences weren’t spelled out, but it appeared that the lawyers had decided they were not going to win the case. They couldn’t have figured this out four and a half years earlier? Before all this wasted time, the emotional anguish, and the more than $150,000 spent by my insurance company in the run-up to trial?
The plaintiffs, my patient’s children, refused to let their lawyers drop the case. I could imagine that they didn’t feel well served by this process. They met with their lawyers to resolve this, but neither side gave in. As this slowly unfolded, my mood turned from stoic resignation to a toxic muck of apathy and irritation.
On Oct. 23 everyone except me went in front of the judge. The plaintiffs’ lawyers asked to withdraw from the case, and the family requested a continuance, which would allow the case to be tried at a later time with a new set of lawyers. Amy opposed the continuance. The judge denied the continuance and ordered everyone to proceed with the trial as scheduled.
Just before Amy left, the children and their lawyers conferred again. The lawyers told them that they were unlikely to win and that they would have to pay for the expert witnesses if the case went forward. Finally, the family agreed to drop it, and they all went before the judge to seal the deal.
Amy called me. All in all, I thought I was pretty cool about the whole thing by now. The initial turbulent emotions had been squeezed out or tamped down, and I was ready for whatever happened. But when she told me the news, I started to cry.
Dr. Joan Savitsky is an internist in the Boston area.
Carpe Diem? Maybe Tomorrow
December 29, 2009 New York Times
Findings
Carpe Diem? Maybe Tomorrow
By JOHN TIERNEY
For once, social scientists have discovered a flaw in the human psyche that will not be tedious to correct. You may not even need a support group. You could try on your own by starting with this simple New Year’s resolution: Have fun ... now!
Then you just need the strength to cash in your gift certificates, drink that special bottle of wine, redeem your frequent flier miles and take that vacation you always promised yourself. If your resolve weakens, do not succumb to guilt or shame.
Acknowledge what you are: a recovering procrastinator of pleasure.
It sounds odd, but this is actually a widespread form of procrastination — just ask the airlines and other marketers who save billions of dollars annually from gift certificates that expire unredeemed. Or the poets who have kept turning out exhortations to seize the day and gather rosebuds.
But it has taken awhile for psychologists and behavioral economists to analyze this condition. Now they have begun to explore the strange impulse to put off until tomorrow what could be enjoyed today.
Why, for instance, is it so hard to find time to visit landmarks in your own backyard? People who have moved to Chicago, Dallas and London get to fewer local landmarks during their entire first year than the typical tourist visits during a two-week stay, according to a study conducted by Suzanne B. Shu and Ayelet Gneezy, who are professors of marketing at the University of California, Los Angeles, and the University of California, San Diego, respectively. The Chicagoans in the study had visited more landmarks in other cities than in their own, and even their relatively small amount of local sightseeing was done mainly in the course of entertaining out-of-towners. Otherwise, the only time Chicagoans rushed to see the local landmarks was just before they were about to move to another city, when that deadline inspired sudden passions for taking architectural tours and going to the zoo.
When there is no immediate deadline, we’re liable to put off going to the zoo this weekend because we assume that we will be less busy next weekend — or the weekend after that, or next summer. This is the same sort of thinking that causes us to put the gift certificate in the drawer because we expect to have more time for shopping in the future.
We’re trying to do a cost-benefit analysis of the time lost versus the pleasure or money to be gained, but we’re not accurate in our estimates of “resource slack,” as it is termed by Gal Zauberman and John G. Lynch. These behavioral economists found that when people were asked to anticipate how much extra money and time they would have in the future, they realistically assumed that money would be tight, but they expected free time to magically materialize.
Hence you’re more likely to agree to a commitment next year, like giving a speech, that you would turn down if asked to find time for it in the next month. This produces what researchers call the “Yes ... Damn!” effect: when the speech comes due next year, you bitterly discover you’re still as busy as ever.
Dr. Shu and Dr. Gneezy demonstrated another effect of this fallacy by giving people gift certificates good for movie tickets and French pastries. Some got certificates that expired within two to three weeks; others got certificates good for six to eight weeks.
The people who received the long-term certificates were more confident than the others that they would redeem the gifts — a logical enough assumption, given all the extra time they had. But they just kept putting it off, and ultimately they were more likely to let the gift go unredeemed than the people who had received the short-term certificates.
Once you start procrastinating pleasure, it can become a self-perpetuating process if you fixate on some imagined nirvana. The longer you wait to open that prize bottle of wine, the more special the occasion has to be.
If you’re determined to get the absolute maximum out of those frequent flier miles, you can end up wasting them, as Dr. Shu found in an experiment offering people a chance to use discount coupons in the course of buying a series of plane tickets.
Once the subjects were told that they might have a chance at a free flight worth $1,000, they scorned lesser awards and hung on to their coupons so long that in the end they had to use them for much cheaper flights.
“People can become overly focused on an ideal,” Dr. Shu said. “Even if they know it’s unlikely, they get so focused on the perfect scenario that they block everything else. Or they anticipate that they’ll kick themselves later if they take second-best option and then see the best one is still available. But they don’t realize that regret can go the other way. They’ll end up with something worse and regret not taking the second-best one.”
But even if you know about all this research, how can you apply these lessons? How can you avoid the temptation to postpone pleasure? (You can offer suggestions at nytimes.com/tierneylab.) One immediate strategy, Dr. Shu said, is to cash in quickly any gift certificate you received this holiday season. “The biggest danger is that it will be forgotten and expire,” she said. “One of the best presents you can give back to the giver is to use it quickly and then tell them how much you enjoyed it.
The regret from not using it will be bigger than the regret from using it on a nonperfect occasion, for you and especially for the person who gave it.”
Another tactic is to give yourself deadlines. Cash in the miles by summer, even if you can’t get a round-the-world trip out of them. Instead of waiting for a special occasion to indulge yourself, create one. Dr. Shu approvingly cites the pioneering therapeutic work of Dorothy J. Gaiter and John Brecher, who for the past decade used their Wall Street Journal column on wine to proclaim the last Saturday of February to be “Open That Bottle Night.”
But you don’t even have to wait until Feb. 27. Remember the advice offered in the movie “Sideways” to Miles, who has been holding on to a ’61 Cheval Blanc so long that it is in danger of going bad. When Miles says he is waiting for a special occasion, his friend Maya puts matters in perspective:
“The day you open a ’61 Cheval Blanc, that’s the special occasion.”
Findings
Carpe Diem? Maybe Tomorrow
By JOHN TIERNEY
For once, social scientists have discovered a flaw in the human psyche that will not be tedious to correct. You may not even need a support group. You could try on your own by starting with this simple New Year’s resolution: Have fun ... now!
Then you just need the strength to cash in your gift certificates, drink that special bottle of wine, redeem your frequent flier miles and take that vacation you always promised yourself. If your resolve weakens, do not succumb to guilt or shame.
Acknowledge what you are: a recovering procrastinator of pleasure.
It sounds odd, but this is actually a widespread form of procrastination — just ask the airlines and other marketers who save billions of dollars annually from gift certificates that expire unredeemed. Or the poets who have kept turning out exhortations to seize the day and gather rosebuds.
But it has taken awhile for psychologists and behavioral economists to analyze this condition. Now they have begun to explore the strange impulse to put off until tomorrow what could be enjoyed today.
Why, for instance, is it so hard to find time to visit landmarks in your own backyard? People who have moved to Chicago, Dallas and London get to fewer local landmarks during their entire first year than the typical tourist visits during a two-week stay, according to a study conducted by Suzanne B. Shu and Ayelet Gneezy, who are professors of marketing at the University of California, Los Angeles, and the University of California, San Diego, respectively. The Chicagoans in the study had visited more landmarks in other cities than in their own, and even their relatively small amount of local sightseeing was done mainly in the course of entertaining out-of-towners. Otherwise, the only time Chicagoans rushed to see the local landmarks was just before they were about to move to another city, when that deadline inspired sudden passions for taking architectural tours and going to the zoo.
When there is no immediate deadline, we’re liable to put off going to the zoo this weekend because we assume that we will be less busy next weekend — or the weekend after that, or next summer. This is the same sort of thinking that causes us to put the gift certificate in the drawer because we expect to have more time for shopping in the future.
We’re trying to do a cost-benefit analysis of the time lost versus the pleasure or money to be gained, but we’re not accurate in our estimates of “resource slack,” as it is termed by Gal Zauberman and John G. Lynch. These behavioral economists found that when people were asked to anticipate how much extra money and time they would have in the future, they realistically assumed that money would be tight, but they expected free time to magically materialize.
Hence you’re more likely to agree to a commitment next year, like giving a speech, that you would turn down if asked to find time for it in the next month. This produces what researchers call the “Yes ... Damn!” effect: when the speech comes due next year, you bitterly discover you’re still as busy as ever.
Dr. Shu and Dr. Gneezy demonstrated another effect of this fallacy by giving people gift certificates good for movie tickets and French pastries. Some got certificates that expired within two to three weeks; others got certificates good for six to eight weeks.
The people who received the long-term certificates were more confident than the others that they would redeem the gifts — a logical enough assumption, given all the extra time they had. But they just kept putting it off, and ultimately they were more likely to let the gift go unredeemed than the people who had received the short-term certificates.
Once you start procrastinating pleasure, it can become a self-perpetuating process if you fixate on some imagined nirvana. The longer you wait to open that prize bottle of wine, the more special the occasion has to be.
If you’re determined to get the absolute maximum out of those frequent flier miles, you can end up wasting them, as Dr. Shu found in an experiment offering people a chance to use discount coupons in the course of buying a series of plane tickets.
Once the subjects were told that they might have a chance at a free flight worth $1,000, they scorned lesser awards and hung on to their coupons so long that in the end they had to use them for much cheaper flights.
“People can become overly focused on an ideal,” Dr. Shu said. “Even if they know it’s unlikely, they get so focused on the perfect scenario that they block everything else. Or they anticipate that they’ll kick themselves later if they take second-best option and then see the best one is still available. But they don’t realize that regret can go the other way. They’ll end up with something worse and regret not taking the second-best one.”
But even if you know about all this research, how can you apply these lessons? How can you avoid the temptation to postpone pleasure? (You can offer suggestions at nytimes.com/tierneylab.) One immediate strategy, Dr. Shu said, is to cash in quickly any gift certificate you received this holiday season. “The biggest danger is that it will be forgotten and expire,” she said. “One of the best presents you can give back to the giver is to use it quickly and then tell them how much you enjoyed it.
The regret from not using it will be bigger than the regret from using it on a nonperfect occasion, for you and especially for the person who gave it.”
Another tactic is to give yourself deadlines. Cash in the miles by summer, even if you can’t get a round-the-world trip out of them. Instead of waiting for a special occasion to indulge yourself, create one. Dr. Shu approvingly cites the pioneering therapeutic work of Dorothy J. Gaiter and John Brecher, who for the past decade used their Wall Street Journal column on wine to proclaim the last Saturday of February to be “Open That Bottle Night.”
But you don’t even have to wait until Feb. 27. Remember the advice offered in the movie “Sideways” to Miles, who has been holding on to a ’61 Cheval Blanc so long that it is in danger of going bad. When Miles says he is waiting for a special occasion, his friend Maya puts matters in perspective:
“The day you open a ’61 Cheval Blanc, that’s the special occasion.”
Sunday, December 20, 2009
Tiger Woods, Person of the Year
December 20, 2009
Op-Ed Columnist
By FRANK RICH
AS we say farewell to a dreadful year and decade, this much we can agree upon: The person of the year is not Ben Bernanke, no matter how insistently Time magazine tries to hype him into its pantheon. The Fed chairman was just as big a schnook as every other magical thinker in Washington and on Wall Street who believed that housing prices would go up in perpetuity to support an economy leveraged past the hilt. Unlike most of the others, it was Bernanke’s job to be ahead of the curve. Yet as recently as June of last year he could be found minimizing the possibility of a substantial economic downturn. And now we’re supposed to applaud him for putting his finger in the dike after disaster struck? This is defining American leadership down.
If there’s been a consistent narrative to this year and every other in this decade, it’s that most of us, Bernanke included, have been so easily bamboozled. The men who played us for suckers, whether at Citigroup or Fannie Mae, at the White House or Ted Haggard’s megachurch, are the real movers and shakers of this century’s history so far. That’s why the obvious person of the year is Tiger Woods. His sham beatific image, questioned by almost no one until it collapsed, is nothing if not the farcical reductio ad absurdum of the decade’s flimflams, from the cancerous (the subprime mortgage) to the inane (balloon boy).
As of Friday, the Tiger saga had appeared on 20 consecutive New York Post covers. For The Post, his calamity has become as big a story as 9/11. And the paper may well have it right. We’ve rarely questioned our assumption that 9/11, “the day that changed everything,” was the decade’s defining event. But in retrospect it may not have been. A con like Tiger’s may be more typical of our time than a one-off domestic terrorist attack, however devastating.
Indeed, if we go back to late 2001, the most revealing news story may have been unfolding not in New York but Houston — the site of the Enron scandal. That energy company convinced financial titans, the press and countless investors that it was a business deity. It did so even though very few of its worshipers knew what its business was. Enron is the template for the decade of successful ruses that followed, Tiger’s included.
What makes the golfing superstar’s tale compelling, after all, is not that he’s another celebrity in trouble or another fallen athletic “role model” in a decade lousy with them. His scandal has nothing to tell us about race, and nothing new to say about hypocrisy. The conflict between Tiger’s picture-perfect family life and his marathon womanizing is the oldest of morality tales.
What’s striking instead is the exceptional, Enron-sized gap between this golfer’s public image as a paragon of businesslike discipline and focus and the maniacally reckless life we now know he led. What’s equally striking, if not shocking, is that the American establishment and news media — all of it, not just golf writers or celebrity tabloids — fell for the Woods myth as hard as any fan and actively helped sustain and enhance it.
People wanted to believe what they wanted to believe. Tiger’s off-the-links elusiveness was no more questioned than Enron’s impenetrable balance sheets, with their “special-purpose entities” named after “Star Wars” characters. Fortune magazine named Enron as America’s “most innovative company” six years in a row. In the January issue of Golf Digest, still on the stands, some of the best and most hardheaded writers in America offer “tips Obama can take from Tiger,” who is typically characterized as so without human frailties that he “never does anything that would make him look ridiculous.”
Perhaps the most conspicuous player in the Tiger hagiography business has been a company called Accenture, one of his lustrous stable of corporate sponsors. In a hilarious Times article, Brian Stelter described the extreme efforts this outfit is now making to erase its six-year association with its prized spokesman. Alas, the many billboards with slogans like “Go On. Be a Tiger” are not so easily dismantled, and collectors’ items like “Accenture Match Play Tiger Woods Caddy Bib” are a growth commodity on eBay.
From what I can tell, Accenture is a solid company. But the Daily News columnist Mike Lupica raised a good point when I spoke with him last week: “If Tiger Woods was so important to Accenture, how come I didn’t know what Accenture did when they fired him?” According to its Web site, Accenture is “a global management consulting, technology services and outsourcing company,” but who cared about any fine print? It was Tiger, and Tiger was it, and no one was to worry about the details behind the mutually advantageous image-mongering. One would like to assume that Accenture’s failure to see or heed any warning signs about a man appearing in 83 percent of its advertising is an anomalous lapse. One would like to believe that business and government clients didn’t hire Accenture just because it had Tiger’s imprimatur. But in a culture where so many smart people have been taken so often, we can’t assume anything.
As cons go, Woods’s fraudulent image as an immaculate exemplar of superhuman steeliness is benign. His fall will damage his family, closest friends, Accenture and the golf industry much more than the rest of us. But the syndrome it epitomizes is not harmless. We keep being fooled by leaders in all sectors of American life, over and over. A decade that began with the “reality” television craze exemplified by “American Idol” and “Survivor” — both blissfully devoid of any reality whatsoever — spiraled into a wholesale flight from truth.
The most lethal example, of course, were the two illusions marketed to us on the way to Iraq — that Saddam Hussein had weapons of mass destruction and some link to Al Qaeda. That history has since been rewritten by Bush alumni, Democratic politicians who supported the Iraq invasion and some of the news media that purveyed the White House fictions (especially the television press, which rarely owned up to its failure as print journalists have). It was exclusively “bad intelligence,” we’re now told, that pushed us into the fiasco. But contradictions to that “bad intelligence” were in plain sight during the run-up to the war — even sometimes in the press. Yet we wanted to suspend disbelief. Much of the country, regardless of party, didn’t want to question its leaders, no matter how obviously they were hyping any misleading shred of intelligence that could fit their predetermined march to war.
It’s the same impulse that kept many from questioning how Mark McGwire’s and Barry Bonds’s outlandishly cartoonish physiques could possibly be steroid-free.
In the political realm, our bipartisan credulousness has also been on steroids in this decade, even by our national standards. Many Democrats didn’t want to see the snake-oil salesman in John Edwards, blatant as his “Two America” self-contradictions were if you cared merely to look at him on YouTube. Republicans incessantly fell for family values preacher politicians like David Vitter, John Ensign and Larry Craig. Fred Thompson was seen by many, in the press as well as his party, as the second coming of Ronald Reagan. Karl Rove was widely hailed as a mastermind who would assemble a permanent Republican majority. Bernie Kerik was considered a plausible secretary of homeland security. Eliot Spitzer was viewed as a crusader of uncompromising principle.
But these scam artists are pikers next to the financial hucksters. I’m not just talking about Bernie Madoff and Enron’s Ken Lay, but about those titans who legally created and sold the securities that gamed and then wrecked the system. You’d think after Enron’s collapse that financial leaders and government overseers would question the contents of “exotic” investments that could not be explained in plain English. But only a few years after Enron’s very public and extensively dissected crimes, the same bankers, federal regulatory agencies and securities-rating companies were giving toxic “assets” a pass. We were only too eager to go along for the lucrative ride until it crashed like Tiger’s Escalade.
After his “indefinite break” from golf, Woods will surely be back on the links once the next celebrity scandal drowns his out. But after a decade in which two true national catastrophes, a wasteful war and a near-ruinous financial collapse, were both in part byproducts of the ease with which our leaders bamboozled us, we can’t so easily move on.
This can be seen in the increasingly urgent political plight of Barack Obama. Though the American left and right don’t agree on much, they are both now coalescing around the suspicion that Obama’s brilliant presidential campaign was as hollow as Tiger’s public image — a marketing scam designed to camouflage either his covert anti-American radicalism (as the right sees it) or spineless timidity (as the left sees it). The truth may well be neither, but after a decade of being spun silly, Americans can’t be blamed for being cynical about any leader trying to sell anything. As we say goodbye to the year of Tiger Woods, it is the country, sad to say, that is left mired in a sand trap with no obvious way out.
Op-Ed Columnist
By FRANK RICH
AS we say farewell to a dreadful year and decade, this much we can agree upon: The person of the year is not Ben Bernanke, no matter how insistently Time magazine tries to hype him into its pantheon. The Fed chairman was just as big a schnook as every other magical thinker in Washington and on Wall Street who believed that housing prices would go up in perpetuity to support an economy leveraged past the hilt. Unlike most of the others, it was Bernanke’s job to be ahead of the curve. Yet as recently as June of last year he could be found minimizing the possibility of a substantial economic downturn. And now we’re supposed to applaud him for putting his finger in the dike after disaster struck? This is defining American leadership down.
If there’s been a consistent narrative to this year and every other in this decade, it’s that most of us, Bernanke included, have been so easily bamboozled. The men who played us for suckers, whether at Citigroup or Fannie Mae, at the White House or Ted Haggard’s megachurch, are the real movers and shakers of this century’s history so far. That’s why the obvious person of the year is Tiger Woods. His sham beatific image, questioned by almost no one until it collapsed, is nothing if not the farcical reductio ad absurdum of the decade’s flimflams, from the cancerous (the subprime mortgage) to the inane (balloon boy).
As of Friday, the Tiger saga had appeared on 20 consecutive New York Post covers. For The Post, his calamity has become as big a story as 9/11. And the paper may well have it right. We’ve rarely questioned our assumption that 9/11, “the day that changed everything,” was the decade’s defining event. But in retrospect it may not have been. A con like Tiger’s may be more typical of our time than a one-off domestic terrorist attack, however devastating.
Indeed, if we go back to late 2001, the most revealing news story may have been unfolding not in New York but Houston — the site of the Enron scandal. That energy company convinced financial titans, the press and countless investors that it was a business deity. It did so even though very few of its worshipers knew what its business was. Enron is the template for the decade of successful ruses that followed, Tiger’s included.
What makes the golfing superstar’s tale compelling, after all, is not that he’s another celebrity in trouble or another fallen athletic “role model” in a decade lousy with them. His scandal has nothing to tell us about race, and nothing new to say about hypocrisy. The conflict between Tiger’s picture-perfect family life and his marathon womanizing is the oldest of morality tales.
What’s striking instead is the exceptional, Enron-sized gap between this golfer’s public image as a paragon of businesslike discipline and focus and the maniacally reckless life we now know he led. What’s equally striking, if not shocking, is that the American establishment and news media — all of it, not just golf writers or celebrity tabloids — fell for the Woods myth as hard as any fan and actively helped sustain and enhance it.
People wanted to believe what they wanted to believe. Tiger’s off-the-links elusiveness was no more questioned than Enron’s impenetrable balance sheets, with their “special-purpose entities” named after “Star Wars” characters. Fortune magazine named Enron as America’s “most innovative company” six years in a row. In the January issue of Golf Digest, still on the stands, some of the best and most hardheaded writers in America offer “tips Obama can take from Tiger,” who is typically characterized as so without human frailties that he “never does anything that would make him look ridiculous.”
Perhaps the most conspicuous player in the Tiger hagiography business has been a company called Accenture, one of his lustrous stable of corporate sponsors. In a hilarious Times article, Brian Stelter described the extreme efforts this outfit is now making to erase its six-year association with its prized spokesman. Alas, the many billboards with slogans like “Go On. Be a Tiger” are not so easily dismantled, and collectors’ items like “Accenture Match Play Tiger Woods Caddy Bib” are a growth commodity on eBay.
From what I can tell, Accenture is a solid company. But the Daily News columnist Mike Lupica raised a good point when I spoke with him last week: “If Tiger Woods was so important to Accenture, how come I didn’t know what Accenture did when they fired him?” According to its Web site, Accenture is “a global management consulting, technology services and outsourcing company,” but who cared about any fine print? It was Tiger, and Tiger was it, and no one was to worry about the details behind the mutually advantageous image-mongering. One would like to assume that Accenture’s failure to see or heed any warning signs about a man appearing in 83 percent of its advertising is an anomalous lapse. One would like to believe that business and government clients didn’t hire Accenture just because it had Tiger’s imprimatur. But in a culture where so many smart people have been taken so often, we can’t assume anything.
As cons go, Woods’s fraudulent image as an immaculate exemplar of superhuman steeliness is benign. His fall will damage his family, closest friends, Accenture and the golf industry much more than the rest of us. But the syndrome it epitomizes is not harmless. We keep being fooled by leaders in all sectors of American life, over and over. A decade that began with the “reality” television craze exemplified by “American Idol” and “Survivor” — both blissfully devoid of any reality whatsoever — spiraled into a wholesale flight from truth.
The most lethal example, of course, were the two illusions marketed to us on the way to Iraq — that Saddam Hussein had weapons of mass destruction and some link to Al Qaeda. That history has since been rewritten by Bush alumni, Democratic politicians who supported the Iraq invasion and some of the news media that purveyed the White House fictions (especially the television press, which rarely owned up to its failure as print journalists have). It was exclusively “bad intelligence,” we’re now told, that pushed us into the fiasco. But contradictions to that “bad intelligence” were in plain sight during the run-up to the war — even sometimes in the press. Yet we wanted to suspend disbelief. Much of the country, regardless of party, didn’t want to question its leaders, no matter how obviously they were hyping any misleading shred of intelligence that could fit their predetermined march to war.
It’s the same impulse that kept many from questioning how Mark McGwire’s and Barry Bonds’s outlandishly cartoonish physiques could possibly be steroid-free.
In the political realm, our bipartisan credulousness has also been on steroids in this decade, even by our national standards. Many Democrats didn’t want to see the snake-oil salesman in John Edwards, blatant as his “Two America” self-contradictions were if you cared merely to look at him on YouTube. Republicans incessantly fell for family values preacher politicians like David Vitter, John Ensign and Larry Craig. Fred Thompson was seen by many, in the press as well as his party, as the second coming of Ronald Reagan. Karl Rove was widely hailed as a mastermind who would assemble a permanent Republican majority. Bernie Kerik was considered a plausible secretary of homeland security. Eliot Spitzer was viewed as a crusader of uncompromising principle.
But these scam artists are pikers next to the financial hucksters. I’m not just talking about Bernie Madoff and Enron’s Ken Lay, but about those titans who legally created and sold the securities that gamed and then wrecked the system. You’d think after Enron’s collapse that financial leaders and government overseers would question the contents of “exotic” investments that could not be explained in plain English. But only a few years after Enron’s very public and extensively dissected crimes, the same bankers, federal regulatory agencies and securities-rating companies were giving toxic “assets” a pass. We were only too eager to go along for the lucrative ride until it crashed like Tiger’s Escalade.
After his “indefinite break” from golf, Woods will surely be back on the links once the next celebrity scandal drowns his out. But after a decade in which two true national catastrophes, a wasteful war and a near-ruinous financial collapse, were both in part byproducts of the ease with which our leaders bamboozled us, we can’t so easily move on.
This can be seen in the increasingly urgent political plight of Barack Obama. Though the American left and right don’t agree on much, they are both now coalescing around the suspicion that Obama’s brilliant presidential campaign was as hollow as Tiger’s public image — a marketing scam designed to camouflage either his covert anti-American radicalism (as the right sees it) or spineless timidity (as the left sees it). The truth may well be neither, but after a decade of being spun silly, Americans can’t be blamed for being cynical about any leader trying to sell anything. As we say goodbye to the year of Tiger Woods, it is the country, sad to say, that is left mired in a sand trap with no obvious way out.
Friday, December 18, 2009
Alzheimer's World Two Circles Trying to Intersect
Alzheimer's Reading Room
Friday, December 18, 2009
Alzheimer's World Two Circles Trying to Intersect
Alzheimer's is difficult to understand and accept. Some caregivers get there, some don't.
It takes lots of thought, hard work, and the development of a new mental construct of behavior to get there. It takes time.
Take the relationship between my mother and me as an example.
I've known my mother my entire life. We have been communicating our entire lives. I would imagine that our communication is similar to most people. We engaged in all the human behaviors and emotions over the years. We established patterns on how to deal with the good and the bad.
Did I ever get angry with my mother -- of course. Frustrated, agitated -- of course. When we had a problem with each other we learned how to work it out. How to make up and reattach.
Over the course of 50 years we developed our own method of communication -- our own behavior.
Then Alzheimer's struck.
Our communication and the behavior changed. Abruptly, over night. It was if our ability to communicate effectively had been robbed from us.
I saw and understood these changes were being caused by Alzheimer's disease. On the other hand, my mother couldn't see the change. She couldn't understand what was happening.
When my mother would say something mean, or act out crazy behavior I experienced the same emotions I had my entire life. Anger, frustration, and agitation.
Why wouldn't I? I felt the same exact feelings and emotions that I had been experiencing for 50 years. I had 50 years of practice.
Looking in from the outside, most people would conclude its easy to come to an understanding that the meanness and craziness are a direct result of the disease -- Alzheimer's. That you simply adjust and come to an understanding that Alzheimer's is the cause, and as a result you can just shrug off the meanness and craziness.
This is so far from the truth and the reality of the situation it is almost impossible to explain to someone how difficult this adjustment can be. How difficult? It took me years. Years while I was trying to do it day after day after day. Every day.
I finally made it when I started to develop pictures of the behavior and finally came to some simple conclusions.
I had to change my mother couldn't.
I had to find a way to get into Alzheimer's world, instead of trying to drag her back into Real world. She wasn't coming back. Never.
Here is how our life looked before Alzheimer's.
My mother had her life. I had my life. Our lives clearly intersected and we had all of our shared experienced stored in that intersection.
We had an understanding and frame of reference that we developed over our lives. We knew each other very well. We knew how to deal with each other.
After Alzheimer's struck, this is what our life looked like.
It was like we were two new and different people. I guess you could say, we had to get to know each other again.
I thinks its obvious that when you first meet someone it takes time to get to know them. Over a long period of time you get to know and understand them -- better and better.
In this particular case you have to get to know a person and deal with a person that is often mean, and often does things that make you angry.
You really have two choices. The first choice is easy -- walk away. Or, you have a second choice -- to learn how to love and care for someone that does things that normally would make you do what you would do in choice one -- walk away.
You have to choose. You can choose change and understanding. Or, you can try what I call the hamster approach. Run around the hamster wheel faster and faster, and get no where fast.
If you choose the hamster approach you'll most likely end up bitter and angry, or worse --depressed.
You are the one that must decide.
I finally came to the conclusion that before I could make the leap into this new world, I needed a construct of the new world.
I was coming to an understanding of what I wanted to do and how I was going to do it. In order to organize my ideas I also decided I needed a picture of what this might look like.
The yellow section is the intersection of my mother's world (red), and my world (green).
I call this intersection (yellow) Alzheimer's world.
Friday, December 18, 2009
Alzheimer's World Two Circles Trying to Intersect
Alzheimer's is difficult to understand and accept. Some caregivers get there, some don't.
It takes lots of thought, hard work, and the development of a new mental construct of behavior to get there. It takes time.
Take the relationship between my mother and me as an example.
I've known my mother my entire life. We have been communicating our entire lives. I would imagine that our communication is similar to most people. We engaged in all the human behaviors and emotions over the years. We established patterns on how to deal with the good and the bad.
Did I ever get angry with my mother -- of course. Frustrated, agitated -- of course. When we had a problem with each other we learned how to work it out. How to make up and reattach.
Over the course of 50 years we developed our own method of communication -- our own behavior.
Then Alzheimer's struck.
Our communication and the behavior changed. Abruptly, over night. It was if our ability to communicate effectively had been robbed from us.
I saw and understood these changes were being caused by Alzheimer's disease. On the other hand, my mother couldn't see the change. She couldn't understand what was happening.
When my mother would say something mean, or act out crazy behavior I experienced the same emotions I had my entire life. Anger, frustration, and agitation.
Why wouldn't I? I felt the same exact feelings and emotions that I had been experiencing for 50 years. I had 50 years of practice.
Looking in from the outside, most people would conclude its easy to come to an understanding that the meanness and craziness are a direct result of the disease -- Alzheimer's. That you simply adjust and come to an understanding that Alzheimer's is the cause, and as a result you can just shrug off the meanness and craziness.
This is so far from the truth and the reality of the situation it is almost impossible to explain to someone how difficult this adjustment can be. How difficult? It took me years. Years while I was trying to do it day after day after day. Every day.
I finally made it when I started to develop pictures of the behavior and finally came to some simple conclusions.
I had to change my mother couldn't.
I had to find a way to get into Alzheimer's world, instead of trying to drag her back into Real world. She wasn't coming back. Never.
Here is how our life looked before Alzheimer's.
My mother had her life. I had my life. Our lives clearly intersected and we had all of our shared experienced stored in that intersection.
We had an understanding and frame of reference that we developed over our lives. We knew each other very well. We knew how to deal with each other.
After Alzheimer's struck, this is what our life looked like.
It was like we were two new and different people. I guess you could say, we had to get to know each other again.
I thinks its obvious that when you first meet someone it takes time to get to know them. Over a long period of time you get to know and understand them -- better and better.
In this particular case you have to get to know a person and deal with a person that is often mean, and often does things that make you angry.
You really have two choices. The first choice is easy -- walk away. Or, you have a second choice -- to learn how to love and care for someone that does things that normally would make you do what you would do in choice one -- walk away.
You have to choose. You can choose change and understanding. Or, you can try what I call the hamster approach. Run around the hamster wheel faster and faster, and get no where fast.
If you choose the hamster approach you'll most likely end up bitter and angry, or worse --depressed.
You are the one that must decide.
I finally came to the conclusion that before I could make the leap into this new world, I needed a construct of the new world.
I was coming to an understanding of what I wanted to do and how I was going to do it. In order to organize my ideas I also decided I needed a picture of what this might look like.
The yellow section is the intersection of my mother's world (red), and my world (green).
I call this intersection (yellow) Alzheimer's world.
Wednesday, December 16, 2009
Does Death Exist? New Theory Says 'No'
Robert Lanza, M.D.
"Robert Lanza was taken under the wing of scientific giants such as psychologist B.F. Skinner, i ...
Posted: December 8, 2009 04:06 PM
Many of us fear death. We believe in death because we have been told we will die. We associate ourselves with the body, and we know that bodies die. But a new scientific theory suggests that death is not the terminal event we think.
One well-known aspect of quantum physics is that certain observations cannot be predicted absolutely. Instead, there is a range of possible observations each with a different probability. One mainstream explanation, the "many-worlds" interpretation, states that each of these possible observations corresponds to a different universe (the 'multiverse'). A new scientific theory - called biocentrism - refines these ideas. There are an infinite number of universes, and everything that could possibly happen occurs in some universe. Death does not exist in any real sense in these scenarios. All possible universes exist simultaneously, regardless of what happens in any of them. Although individual bodies are destined to self-destruct, the alive feeling - the 'Who am I?'- is just a 20-watt fountain of energy operating in the brain. But this energy doesn't go away at death. One of the surest axioms of science is that energy never dies; it can neither be created nor destroyed. But does this energy transcend from one world to the other?
Consider an experiment that was recently published in the journal Science showing that scientists could retroactively change something that had happened in the past. Particles had to decide how to behave when they hit a beam splitter. Later on, the experimenter could turn a second switch on or off. It turns out that what the observer decided at that point, determined what the particle did in the past.
Regardless of the choice you, the observer, make, it is you who will experience the outcomes that will result. The linkages between these various histories and universes transcend our ordinary classical ideas of space and time. Think of the 20-watts of energy as simply holo-projecting either this or that result onto a screen. Whether you turn the second beam splitter on or off, it's still the same battery or agent responsible for the projection.
According to Biocentrism, space and time are not the hard objects we think. Wave your hand through the air - if you take everything away, what's left? Nothing. The same thing applies for time. You can't see anything through the bone that surrounds your brain. Everything you see and experience right now is a whirl of information occurring in your mind. Space and time are simply the tools for putting everything together.
Death does not exist in a timeless, spaceless world. In the end, even Einstein admitted, "Now Besso" (an old friend) "has departed from this strange world a little ahead of me. That means nothing. People like us...know that the distinction between past, present, and future is only a stubbornly persistent illusion." Immortality doesn't mean a perpetual existence in time without end, but rather resides outside of time altogether.
This was clear with the death of my sister Christine. After viewing her body at the hospital, I went out to speak with family members. Christine's husband - Ed - started to sob uncontrollably. For a few moments I felt like I was transcending the provincialism of time. I thought about the 20-watts of energy, and about experiments that show a single particle can pass through two holes at the same time. I could not dismiss the conclusion: Christine was both alive and dead, outside of time.
Christine had had a hard life. She had finally found a man that she loved very much. My younger sister couldn't make it to her wedding because she had a card game that had been scheduled for several weeks. My mother also couldn't make the wedding due to an important engagement she had at the Elks Club. The wedding was one of the most important days in Christine's life. Since no one else from our side of the family showed, Christine asked me to walk her down the aisle to give her away.
Soon after the wedding, Christine and Ed were driving to the dream house they had just bought when their car hit a patch of black ice. She was thrown from the car and landed in a banking of snow.
"Ed," she said "I can't feel my leg."
She never knew that her liver had been ripped in half and blood was rushing into her peritoneum.
After the death of his son, Emerson wrote "Our life is not so much threatened as our perception. I grieve that grief can teach me nothing, nor carry me one step into real nature."
Whether it's flipping the switch for the Science experiment, or turning the driving wheel ever so slightly this way or that way on black-ice, it's the 20-watts of energy that will experience the result. In some cases the car will swerve off the road, but in other cases the car will continue on its way to my sister's dream house.
Christine had recently lost 100 pounds, and Ed had bought her a surprise pair of diamond earrings. It's going to be hard to wait, but I know Christine is going to look fabulous in them the next time I see her.
Robert Lanza, MD is considered one of the leading scientists in the world. He is the author of "Biocentrism," a book that lays out his theory of everything.
"Robert Lanza was taken under the wing of scientific giants such as psychologist B.F. Skinner, i ...
Posted: December 8, 2009 04:06 PM
Many of us fear death. We believe in death because we have been told we will die. We associate ourselves with the body, and we know that bodies die. But a new scientific theory suggests that death is not the terminal event we think.
One well-known aspect of quantum physics is that certain observations cannot be predicted absolutely. Instead, there is a range of possible observations each with a different probability. One mainstream explanation, the "many-worlds" interpretation, states that each of these possible observations corresponds to a different universe (the 'multiverse'). A new scientific theory - called biocentrism - refines these ideas. There are an infinite number of universes, and everything that could possibly happen occurs in some universe. Death does not exist in any real sense in these scenarios. All possible universes exist simultaneously, regardless of what happens in any of them. Although individual bodies are destined to self-destruct, the alive feeling - the 'Who am I?'- is just a 20-watt fountain of energy operating in the brain. But this energy doesn't go away at death. One of the surest axioms of science is that energy never dies; it can neither be created nor destroyed. But does this energy transcend from one world to the other?
Consider an experiment that was recently published in the journal Science showing that scientists could retroactively change something that had happened in the past. Particles had to decide how to behave when they hit a beam splitter. Later on, the experimenter could turn a second switch on or off. It turns out that what the observer decided at that point, determined what the particle did in the past.
Regardless of the choice you, the observer, make, it is you who will experience the outcomes that will result. The linkages between these various histories and universes transcend our ordinary classical ideas of space and time. Think of the 20-watts of energy as simply holo-projecting either this or that result onto a screen. Whether you turn the second beam splitter on or off, it's still the same battery or agent responsible for the projection.
According to Biocentrism, space and time are not the hard objects we think. Wave your hand through the air - if you take everything away, what's left? Nothing. The same thing applies for time. You can't see anything through the bone that surrounds your brain. Everything you see and experience right now is a whirl of information occurring in your mind. Space and time are simply the tools for putting everything together.
Death does not exist in a timeless, spaceless world. In the end, even Einstein admitted, "Now Besso" (an old friend) "has departed from this strange world a little ahead of me. That means nothing. People like us...know that the distinction between past, present, and future is only a stubbornly persistent illusion." Immortality doesn't mean a perpetual existence in time without end, but rather resides outside of time altogether.
This was clear with the death of my sister Christine. After viewing her body at the hospital, I went out to speak with family members. Christine's husband - Ed - started to sob uncontrollably. For a few moments I felt like I was transcending the provincialism of time. I thought about the 20-watts of energy, and about experiments that show a single particle can pass through two holes at the same time. I could not dismiss the conclusion: Christine was both alive and dead, outside of time.
Christine had had a hard life. She had finally found a man that she loved very much. My younger sister couldn't make it to her wedding because she had a card game that had been scheduled for several weeks. My mother also couldn't make the wedding due to an important engagement she had at the Elks Club. The wedding was one of the most important days in Christine's life. Since no one else from our side of the family showed, Christine asked me to walk her down the aisle to give her away.
Soon after the wedding, Christine and Ed were driving to the dream house they had just bought when their car hit a patch of black ice. She was thrown from the car and landed in a banking of snow.
"Ed," she said "I can't feel my leg."
She never knew that her liver had been ripped in half and blood was rushing into her peritoneum.
After the death of his son, Emerson wrote "Our life is not so much threatened as our perception. I grieve that grief can teach me nothing, nor carry me one step into real nature."
Whether it's flipping the switch for the Science experiment, or turning the driving wheel ever so slightly this way or that way on black-ice, it's the 20-watts of energy that will experience the result. In some cases the car will swerve off the road, but in other cases the car will continue on its way to my sister's dream house.
Christine had recently lost 100 pounds, and Ed had bought her a surprise pair of diamond earrings. It's going to be hard to wait, but I know Christine is going to look fabulous in them the next time I see her.
Robert Lanza, MD is considered one of the leading scientists in the world. He is the author of "Biocentrism," a book that lays out his theory of everything.
Monday, December 14, 2009
Does Death Exist? New Theory Says 'No'
Robert Lanza, M.D.
Posted: December 8, 2009 04:06 PM
Many of us fear death. We believe in death because we have been told we will die. We associate ourselves with the body, and we know that bodies die. But a new scientific theory suggests that death is not the terminal event we think.
One well-known aspect of quantum physics is that certain observations cannot be predicted absolutely. Instead, there is a range of possible observations each with a different probability. One mainstream explanation, the "many-worlds" interpretation, states that each of these possible observations corresponds to a different universe (the 'multiverse'). A new scientific theory - called biocentrism - refines these ideas. There are an infinite number of universes, and everything that could possibly happen occurs in some universe. Death does not exist in any real sense in these scenarios. All possible universes exist simultaneously, regardless of what happens in any of them. Although individual bodies are destined to self-destruct, the alive feeling - the 'Who am I?'- is just a 20-watt fountain of energy operating in the brain. But this energy doesn't go away at death. One of the surest axioms of science is that energy never dies; it can neither be created nor destroyed. But does this energy transcend from one world to the other?
Consider an experiment that was recently published in the journal Science showing that scientists could retroactively change something that had happened in the past. Particles had to decide how to behave when they hit a beam splitter. Later on, the experimenter could turn a second switch on or off. It turns out that what the observer decided at that point, determined what the particle did in the past.
Regardless of the choice you, the observer, make, it is you who will experience the outcomes that will result. The linkages between these various histories and universes transcend our ordinary classical ideas of space and time. Think of the 20-watts of energy as simply holo-projecting either this or that result onto a screen. Whether you turn the second beam splitter on or off, it's still the same battery or agent responsible for the projection.
According to Biocentrism, space and time are not the hard objects we think. Wave your hand through the air - if you take everything away, what's left? Nothing. The same thing applies for time. You can't see anything through the bone that surrounds your brain. Everything you see and experience right now is a whirl of information occurring in your mind. Space and time are simply the tools for putting everything together.
Death does not exist in a timeless, spaceless world. In the end, even Einstein admitted, "Now Besso" (an old friend) "has departed from this strange world a little ahead of me. That means nothing. People like us...know that the distinction between past, present, and future is only a stubbornly persistent illusion." Immortality doesn't mean a perpetual existence in time without end, but rather resides outside of time altogether.
This was clear with the death of my sister Christine. After viewing her body at the hospital, I went out to speak with family members. Christine's husband - Ed - started to sob uncontrollably. For a few moments I felt like I was transcending the provincialism of time. I thought about the 20-watts of energy, and about experiments that show a single particle can pass through two holes at the same time. I could not dismiss the conclusion: Christine was both alive and dead, outside of time.
Christine had had a hard life. She had finally found a man that she loved very much. My younger sister couldn't make it to her wedding because she had a card game that had been scheduled for several weeks. My mother also couldn't make the wedding due to an important engagement she had at the Elks Club. The wedding was one of the most important days in Christine's life. Since no one else from our side of the family showed, Christine asked me to walk her down the aisle to give her away.
Soon after the wedding, Christine and Ed were driving to the dream house they had just bought when their car hit a patch of black ice. She was thrown from the car and landed in a banking of snow.
"Ed," she said "I can't feel my leg."
She never knew that her liver had been ripped in half and blood was rushing into her
peritoneum.
After the death of his son, Emerson wrote "Our life is not so much threatened as our perception. I grieve that grief can teach me nothing, nor carry me one step into real nature."
Whether it's flipping the switch for the Science experiment, or turning the driving wheel ever so slightly this way or that way on black-ice, it's the 20-watts of energy that will experience the result. In some cases the car will swerve off the road, but in other cases the car will continue on its way to my sister's dream house.
Christine had recently lost 100 pounds, and Ed had bought her a surprise pair of diamond earrings. It's going to be hard to wait, but I know Christine is going to look fabulous in them the next time I see her.
Robert Lanza, MD is considered one of the leading scientists in the world. He is the author of "Biocentrism," a book that lays out his theory of everything.
Posted: December 8, 2009 04:06 PM
Many of us fear death. We believe in death because we have been told we will die. We associate ourselves with the body, and we know that bodies die. But a new scientific theory suggests that death is not the terminal event we think.
One well-known aspect of quantum physics is that certain observations cannot be predicted absolutely. Instead, there is a range of possible observations each with a different probability. One mainstream explanation, the "many-worlds" interpretation, states that each of these possible observations corresponds to a different universe (the 'multiverse'). A new scientific theory - called biocentrism - refines these ideas. There are an infinite number of universes, and everything that could possibly happen occurs in some universe. Death does not exist in any real sense in these scenarios. All possible universes exist simultaneously, regardless of what happens in any of them. Although individual bodies are destined to self-destruct, the alive feeling - the 'Who am I?'- is just a 20-watt fountain of energy operating in the brain. But this energy doesn't go away at death. One of the surest axioms of science is that energy never dies; it can neither be created nor destroyed. But does this energy transcend from one world to the other?
Consider an experiment that was recently published in the journal Science showing that scientists could retroactively change something that had happened in the past. Particles had to decide how to behave when they hit a beam splitter. Later on, the experimenter could turn a second switch on or off. It turns out that what the observer decided at that point, determined what the particle did in the past.
Regardless of the choice you, the observer, make, it is you who will experience the outcomes that will result. The linkages between these various histories and universes transcend our ordinary classical ideas of space and time. Think of the 20-watts of energy as simply holo-projecting either this or that result onto a screen. Whether you turn the second beam splitter on or off, it's still the same battery or agent responsible for the projection.
According to Biocentrism, space and time are not the hard objects we think. Wave your hand through the air - if you take everything away, what's left? Nothing. The same thing applies for time. You can't see anything through the bone that surrounds your brain. Everything you see and experience right now is a whirl of information occurring in your mind. Space and time are simply the tools for putting everything together.
Death does not exist in a timeless, spaceless world. In the end, even Einstein admitted, "Now Besso" (an old friend) "has departed from this strange world a little ahead of me. That means nothing. People like us...know that the distinction between past, present, and future is only a stubbornly persistent illusion." Immortality doesn't mean a perpetual existence in time without end, but rather resides outside of time altogether.
This was clear with the death of my sister Christine. After viewing her body at the hospital, I went out to speak with family members. Christine's husband - Ed - started to sob uncontrollably. For a few moments I felt like I was transcending the provincialism of time. I thought about the 20-watts of energy, and about experiments that show a single particle can pass through two holes at the same time. I could not dismiss the conclusion: Christine was both alive and dead, outside of time.
Christine had had a hard life. She had finally found a man that she loved very much. My younger sister couldn't make it to her wedding because she had a card game that had been scheduled for several weeks. My mother also couldn't make the wedding due to an important engagement she had at the Elks Club. The wedding was one of the most important days in Christine's life. Since no one else from our side of the family showed, Christine asked me to walk her down the aisle to give her away.
Soon after the wedding, Christine and Ed were driving to the dream house they had just bought when their car hit a patch of black ice. She was thrown from the car and landed in a banking of snow.
"Ed," she said "I can't feel my leg."
She never knew that her liver had been ripped in half and blood was rushing into her
peritoneum.
After the death of his son, Emerson wrote "Our life is not so much threatened as our perception. I grieve that grief can teach me nothing, nor carry me one step into real nature."
Whether it's flipping the switch for the Science experiment, or turning the driving wheel ever so slightly this way or that way on black-ice, it's the 20-watts of energy that will experience the result. In some cases the car will swerve off the road, but in other cases the car will continue on its way to my sister's dream house.
Christine had recently lost 100 pounds, and Ed had bought her a surprise pair of diamond earrings. It's going to be hard to wait, but I know Christine is going to look fabulous in them the next time I see her.
Robert Lanza, MD is considered one of the leading scientists in the world. He is the author of "Biocentrism," a book that lays out his theory of everything.
Friday, December 11, 2009
The Class Act Survives, for Now
December 8, 2009, 12:14 pm
New York Times
By PAULA SPAN
With the insurance lobby hammering hard, and while scores of nonprofit and advocacy groups representing the elderly and the disabled held their collective breath, the Class Act last week narrowly survived a move to strip it from the Senate’s health care legislation. (The vote is here.)
At the moment the act, which would create a voluntary, government-run plan for long-term care insurance, survives in both the House and Senate health care bills.
Though disturbed that a number of Democrats had voted to remove the Class Act, Jim Firman, president of the National Coalition on Aging, sounded generally relieved in a recent interview. “We’ve come pretty far with this,” he said. “Six months ago, the conventional wisdom was there would be no action on long-term care in health care reform.”
The Class Act, which the late Sen. Ted Kennedy considered his legacy, would allow people to buy long-term care insurance through payroll deductions and to receive cash if they’re later disabled, regardless of their age or of a previous health condition. “This is the best chance the baby boomers have to protect themselves from impoverishment if they need long-term care,” Mr. Firman said.
The coalition and its allies, including AARP, are cautiously optimistic, Mr. Firman added – with emphasis on the “cautious” part. “The insurance companies will keep pressure on the Senate,” he said; many of them sell long-term care policies and don’t want increased competition.
“The Class Act could be stripped out in some last minute, behind-the-scenes deal,” Mr. Firman said. “We’re going to be very vigilant.”
Several other provisions that would make it easier for disabled people to receive care at home instead of in facilities are also part of the health care legislation.
Stay tuned.
New York Times
By PAULA SPAN
With the insurance lobby hammering hard, and while scores of nonprofit and advocacy groups representing the elderly and the disabled held their collective breath, the Class Act last week narrowly survived a move to strip it from the Senate’s health care legislation. (The vote is here.)
At the moment the act, which would create a voluntary, government-run plan for long-term care insurance, survives in both the House and Senate health care bills.
Though disturbed that a number of Democrats had voted to remove the Class Act, Jim Firman, president of the National Coalition on Aging, sounded generally relieved in a recent interview. “We’ve come pretty far with this,” he said. “Six months ago, the conventional wisdom was there would be no action on long-term care in health care reform.”
The Class Act, which the late Sen. Ted Kennedy considered his legacy, would allow people to buy long-term care insurance through payroll deductions and to receive cash if they’re later disabled, regardless of their age or of a previous health condition. “This is the best chance the baby boomers have to protect themselves from impoverishment if they need long-term care,” Mr. Firman said.
The coalition and its allies, including AARP, are cautiously optimistic, Mr. Firman added – with emphasis on the “cautious” part. “The insurance companies will keep pressure on the Senate,” he said; many of them sell long-term care policies and don’t want increased competition.
“The Class Act could be stripped out in some last minute, behind-the-scenes deal,” Mr. Firman said. “We’re going to be very vigilant.”
Several other provisions that would make it easier for disabled people to receive care at home instead of in facilities are also part of the health care legislation.
Stay tuned.
C.C.R.C. Fees: Prepare to Be Bewildered
December 3, 2009, 10:25 am
New York Times
By PAULA SPAN
With most varieties of senior housing, families looking for a rough idea of costs can turn to a number of sources.
The Metlife Mature Market Institute, for instance, publishes annual studies of nationwide and local averages for assisted living, nursing homes, home care and adult day services. So you can see that a one-bedroom assisted living apartment runs a relatively economical $2,595 a month in Phoenix and averages a daunting $4,034 in Boston.
Genworth Financial provides a similar array of data annually, including handy maps showing local costs.
But when it comes to the continuing care retirement communities (or C.C.R.C’s) I’ve been posting about lately, there is no comparable repository of current information.
C.C.R.C.’s, remember, allow residents to transfer from independent living apartments to assisted living to a nursing home, all on the same campus or in the same building, as their needs increase (though in the event, they seem as reluctant as other seniors to actually move ). “Yes, being able to take that burden off your kids is wonderful,” a reader, Alice Payne, commented. “But I suspect that the costs are going to prohibit most from taking advantage of such care.”
To which I can only reply, after many phone calls: That all depends. The reason it is hard to know what a C.C.R.C. costs is that price tags vary enormously, reflecting not only regional costs of living and amenity levels (communities range from modest to luxurious), but also contract types. Unlike assisted living facilities or nursing homes, C.C.R.C.’s around the country — there are about 1,900, after a period of growth largely squelched by the recession — offer fundamentally different products.
In what is called a Type A community, for instance, new residents pay an entrance or buy-in fee, plus a monthly fee; in exchange, they are guaranteed that same monthly rate, although adjusted for inflation, even when they move to higher levels of care.
In the classic early C.C.R.C. model, the appeal is that lifetime costs remain predictable. You’re essentially buying a form of long-term care insurance.
Then came Type B communities, where the monthly fees (also inflation-adjusted) rise as you move from independent living to the pricier units. Typically, you are entitled to free care in assisted living or the nursing home for a specified number of days, after which the higher fees kick in. Entrance and initial monthly fees, however, run somewhat lower.
Less common is Type C, where after the entrance fee, you pay as you go, at market prices, for whatever level of care you need.
To muddy the picture further, C.C.R.C.’s have different policies about refunding entrance fees to residents or their estates if they leave or die. And there can be hefty tax deductions, depending on the nature of the contract. And you can select independent living quarters ranging from studios in apartment buildings to freestanding three-bedroom “villas” with decks and gardens. The monthly fees typically include meal plans, utilities, housekeeping, maintenance, transportation and activities.
At the moment, moreover, since seniors are having trouble selling their houses to finance a move, some C.C.R.C.’s are reducing or deferring entrance fees, offering upgrades in their apartments, discounting monthly charges, or offering free appraisals and house-staging services.
Small wonder no one has tried to compile this welter of confusing information in a publication or chart. The best I can do for Ms. Payne and other readers wondering about prices is to give a few examples from C.C.R.C.’s around the country — and advise that if you are considering this option for your parents or yourself, you will want to visit several communities, amass a lot of information and then sit down with an accountant and a lawyer.
Like more than 80 percent of C.C.R.C.’s, these examples are all nonprofit operations. I’ve included just some of the variety of apartments and villas, and rounded off their prices. Note that these are prices for a single person; communities charge higher entrance fees, or monthly fees, or both for additional residents in an apartment.
(Mary’s Woods, by the way, is the community that Greg and Evelyn Hadley, featured in a recent post, happily call home.)
Granite Farms Estates; Media, Pa.
Type A contract
Independent Living
• Studio: Entrance fee, $97,000. Monthly fee, $1,800.
• One bedroom: Entrance fee, $153,000. Monthly fee, $2,000.
• Two bedrooms, one bath: Entrance fee, $204,000. Monthly fee, $2,300.
The prices for assisted living and skilled nursing will remain the same, adjusted for inflation.
Friendship Village West; Chesterfield, Mo.
Type A contract
Independent Living
• Studio: Entrance fee, $43,000. Monthly fee, $1,400.
• One bedroom: Entrance fee, $108,000. Monthly fee, $2,000.
• Two- or three-bedroom villa: Entrance fee, $262,000 to $306,000. Monthly fee, $2,600 to $2,900.
The prices for assisted living and skilled nursing will remain the same, adjusted for inflation.
Mary’s Woods; Lake Oswego, Ore.
Type B contract
Independent Living
• One bedroom: Entrance fee, $210,000. Monthly fee, $1,900.
• Two bedrooms, two baths: Entrance fee, $315,000. Monthly fee, $2,700
• Three-bedroom villa: Entrance fee, $496,000. Monthly fee, $4,700.
Assisted Living
• One-bedroom apartment: $160 to $248 a day, depending on care needed.
Skilled nursing or dementia care: $218 a day
Abbey Delray South; Delray Beach, Fla.
Type A contract
Independent Living
• Studio: Entrance fee, $88,000. Monthly fee, $1,800.
• One bedroom: Entrance fee, $136,000. Monthly fee, $2,200.
• Two bedrooms, two baths: Entrance fee: $168,000. Monthly fee, $2,395.
Prices for “assistance in living,” personal care provided in the resident’s apartment, and skilled nursing will remain the same, adjusted for inflation.
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions” (Grand Central).
New York Times
By PAULA SPAN
With most varieties of senior housing, families looking for a rough idea of costs can turn to a number of sources.
The Metlife Mature Market Institute, for instance, publishes annual studies of nationwide and local averages for assisted living, nursing homes, home care and adult day services. So you can see that a one-bedroom assisted living apartment runs a relatively economical $2,595 a month in Phoenix and averages a daunting $4,034 in Boston.
Genworth Financial provides a similar array of data annually, including handy maps showing local costs.
But when it comes to the continuing care retirement communities (or C.C.R.C’s) I’ve been posting about lately, there is no comparable repository of current information.
C.C.R.C.’s, remember, allow residents to transfer from independent living apartments to assisted living to a nursing home, all on the same campus or in the same building, as their needs increase (though in the event, they seem as reluctant as other seniors to actually move ). “Yes, being able to take that burden off your kids is wonderful,” a reader, Alice Payne, commented. “But I suspect that the costs are going to prohibit most from taking advantage of such care.”
To which I can only reply, after many phone calls: That all depends. The reason it is hard to know what a C.C.R.C. costs is that price tags vary enormously, reflecting not only regional costs of living and amenity levels (communities range from modest to luxurious), but also contract types. Unlike assisted living facilities or nursing homes, C.C.R.C.’s around the country — there are about 1,900, after a period of growth largely squelched by the recession — offer fundamentally different products.
In what is called a Type A community, for instance, new residents pay an entrance or buy-in fee, plus a monthly fee; in exchange, they are guaranteed that same monthly rate, although adjusted for inflation, even when they move to higher levels of care.
In the classic early C.C.R.C. model, the appeal is that lifetime costs remain predictable. You’re essentially buying a form of long-term care insurance.
Then came Type B communities, where the monthly fees (also inflation-adjusted) rise as you move from independent living to the pricier units. Typically, you are entitled to free care in assisted living or the nursing home for a specified number of days, after which the higher fees kick in. Entrance and initial monthly fees, however, run somewhat lower.
Less common is Type C, where after the entrance fee, you pay as you go, at market prices, for whatever level of care you need.
To muddy the picture further, C.C.R.C.’s have different policies about refunding entrance fees to residents or their estates if they leave or die. And there can be hefty tax deductions, depending on the nature of the contract. And you can select independent living quarters ranging from studios in apartment buildings to freestanding three-bedroom “villas” with decks and gardens. The monthly fees typically include meal plans, utilities, housekeeping, maintenance, transportation and activities.
At the moment, moreover, since seniors are having trouble selling their houses to finance a move, some C.C.R.C.’s are reducing or deferring entrance fees, offering upgrades in their apartments, discounting monthly charges, or offering free appraisals and house-staging services.
Small wonder no one has tried to compile this welter of confusing information in a publication or chart. The best I can do for Ms. Payne and other readers wondering about prices is to give a few examples from C.C.R.C.’s around the country — and advise that if you are considering this option for your parents or yourself, you will want to visit several communities, amass a lot of information and then sit down with an accountant and a lawyer.
Like more than 80 percent of C.C.R.C.’s, these examples are all nonprofit operations. I’ve included just some of the variety of apartments and villas, and rounded off their prices. Note that these are prices for a single person; communities charge higher entrance fees, or monthly fees, or both for additional residents in an apartment.
(Mary’s Woods, by the way, is the community that Greg and Evelyn Hadley, featured in a recent post, happily call home.)
Granite Farms Estates; Media, Pa.
Type A contract
Independent Living
• Studio: Entrance fee, $97,000. Monthly fee, $1,800.
• One bedroom: Entrance fee, $153,000. Monthly fee, $2,000.
• Two bedrooms, one bath: Entrance fee, $204,000. Monthly fee, $2,300.
The prices for assisted living and skilled nursing will remain the same, adjusted for inflation.
Friendship Village West; Chesterfield, Mo.
Type A contract
Independent Living
• Studio: Entrance fee, $43,000. Monthly fee, $1,400.
• One bedroom: Entrance fee, $108,000. Monthly fee, $2,000.
• Two- or three-bedroom villa: Entrance fee, $262,000 to $306,000. Monthly fee, $2,600 to $2,900.
The prices for assisted living and skilled nursing will remain the same, adjusted for inflation.
Mary’s Woods; Lake Oswego, Ore.
Type B contract
Independent Living
• One bedroom: Entrance fee, $210,000. Monthly fee, $1,900.
• Two bedrooms, two baths: Entrance fee, $315,000. Monthly fee, $2,700
• Three-bedroom villa: Entrance fee, $496,000. Monthly fee, $4,700.
Assisted Living
• One-bedroom apartment: $160 to $248 a day, depending on care needed.
Skilled nursing or dementia care: $218 a day
Abbey Delray South; Delray Beach, Fla.
Type A contract
Independent Living
• Studio: Entrance fee, $88,000. Monthly fee, $1,800.
• One bedroom: Entrance fee, $136,000. Monthly fee, $2,200.
• Two bedrooms, two baths: Entrance fee: $168,000. Monthly fee, $2,395.
Prices for “assistance in living,” personal care provided in the resident’s apartment, and skilled nursing will remain the same, adjusted for inflation.
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions” (Grand Central).
Monday, December 7, 2009
The Insurance Industry's Lethal Bottom Line -- and Sen. Al Franken's Solution
Wendell Potter
CMD's Senior Fellow on Health Care
Posted: December 6, 2009 07:33 PM
There was a time, in the early 1990s, when health insurance companies devoted more than 95 cents out of every premium dollar to paying doctors and hospitals for taking care of their members. No more. Since President Bill Clinton's health reform plan died 15 years ago, the health insurance industry has come to be dominated by a handful of insurance companies that answer to Wall Street investors, and they have changed that basic math. Today, insurers only pay about 81 cents of each premium dollar on actual medical care. The rest is consumed by rising profits, grotesque executive salaries, huge administrative expenses, the cost of weeding out people with pre-existing conditions and claims review designed to wear out patients with denials and disapprovals of the care they need the most.
This equation is known as the medical loss ratio (MLR), an aptly named figure that is widely seen by investors as the most important gauge of an insurance company's current and future profitability. In a private health insurance industry that collected $817 billion this year, a 14 percentage point difference in the MLR represents $112 billion a year! Over 10 years, that would be more than enough to pay for health reform.
Thanks to the efforts of several senators who pushed for a minimum MLR to be included in reform legislation, the current Senate bill requires insurers to provide an annual rebate to each enrollee if non-claims costs exceed 20% in the group market and 25% in the individual market.
Sen. Al Franken (D-Minn.) is now leading a group including Sens. Jay Rockefeller (D-W. Va.) and Blanche Lincoln (D-Ark.) to introduce an amendment that would go further by requiring that 90 percent of the money consumers spend on health insurance premiums go directly to health care costs.
The senators are proposing a reform that strikes at the heart of a health insurance system that puts profits first, and it would have a profound effect. When MLRs increase, that eats into profits, and Wall Street becomes very unhappy. A case in point is Aetna, the nation's third largest publicly-traded health insurance plan. Three years ago, the company reported that its quarterly MLR had inched up from 77.9 percent to 79.4 percent in 12 months. On the day this was disclosed, Aetna's share price plunged 20 percent as investors sold off their shares, reducing the company's market value by billions of dollars.
Wall Street investors expect insurers to pay as little as possible for medical claims. As a result, the nation's health insurance industry has evolved into a cartel of huge for-profit companies that together reap billions of dollars a year at the expense of their policyholders. The seven largest firms -- UnitedHealth Group, WellPoint, Aetna, Humana, CIGNA, Health Net, and Coventry Health Care -- enroll nearly one in three Americans in their health insurance plans. This year the industry will take about $25 billion in profits for getting between American patients and their doctors, according to the industry's trade group.
And they do this by finding every excuse in the book not to pay a claim, even if it means canceling individual policies when people get sick or ridding their rolls of unprofitable small business group policies if an employee or family member falls seriously ill. They issue confusing benefit statements to members so only highly motivated and persistent challengers of their denials stand a chance of reversing an unfair decision. And in the final analysis, when an insurance company has decided it no longer can make enough profit on a particular person or employer-sponsored group, it drives them away in a process known as "purging." In this unconscionable profit-protection maneuver, an insurer will hike premiums so high that the policyholder has no choice but to pay outlandish rates for what may be a reduced benefit package, find another insurer, or simply go without coverage. The consequences of such decisions can be deadly -- but Wall Street always has the last word when profits are the main consideration.
When Wall Street isn't calling the shots, the outcome is decidedly better for health care consumers. Government-operated plans, such as Medicare, and some organizations that provide coordinated care, consistently maintain higher medical loss ratios. Kaiser had a 90.6 percent MLR in 2007. Between 1993 and 2007, Medicare's MLR hasn't dropped below 97 percent.
The health care reform bill now being debated in the Senate must include a provision, such as that proposed by Sen. Franken, that sets a minimum medical loss ratio to keep insurers from gouging consumers and leaving patients without the care they need. Instead of being a formula to reward investors, a properly regulated medical loss ratio in combination with other cost containment measures in the legislation would be a reliable tool for keeping insurance company profits and administrative waste in check.
CMD's Senior Fellow on Health Care
Posted: December 6, 2009 07:33 PM
There was a time, in the early 1990s, when health insurance companies devoted more than 95 cents out of every premium dollar to paying doctors and hospitals for taking care of their members. No more. Since President Bill Clinton's health reform plan died 15 years ago, the health insurance industry has come to be dominated by a handful of insurance companies that answer to Wall Street investors, and they have changed that basic math. Today, insurers only pay about 81 cents of each premium dollar on actual medical care. The rest is consumed by rising profits, grotesque executive salaries, huge administrative expenses, the cost of weeding out people with pre-existing conditions and claims review designed to wear out patients with denials and disapprovals of the care they need the most.
This equation is known as the medical loss ratio (MLR), an aptly named figure that is widely seen by investors as the most important gauge of an insurance company's current and future profitability. In a private health insurance industry that collected $817 billion this year, a 14 percentage point difference in the MLR represents $112 billion a year! Over 10 years, that would be more than enough to pay for health reform.
Thanks to the efforts of several senators who pushed for a minimum MLR to be included in reform legislation, the current Senate bill requires insurers to provide an annual rebate to each enrollee if non-claims costs exceed 20% in the group market and 25% in the individual market.
Sen. Al Franken (D-Minn.) is now leading a group including Sens. Jay Rockefeller (D-W. Va.) and Blanche Lincoln (D-Ark.) to introduce an amendment that would go further by requiring that 90 percent of the money consumers spend on health insurance premiums go directly to health care costs.
The senators are proposing a reform that strikes at the heart of a health insurance system that puts profits first, and it would have a profound effect. When MLRs increase, that eats into profits, and Wall Street becomes very unhappy. A case in point is Aetna, the nation's third largest publicly-traded health insurance plan. Three years ago, the company reported that its quarterly MLR had inched up from 77.9 percent to 79.4 percent in 12 months. On the day this was disclosed, Aetna's share price plunged 20 percent as investors sold off their shares, reducing the company's market value by billions of dollars.
Wall Street investors expect insurers to pay as little as possible for medical claims. As a result, the nation's health insurance industry has evolved into a cartel of huge for-profit companies that together reap billions of dollars a year at the expense of their policyholders. The seven largest firms -- UnitedHealth Group, WellPoint, Aetna, Humana, CIGNA, Health Net, and Coventry Health Care -- enroll nearly one in three Americans in their health insurance plans. This year the industry will take about $25 billion in profits for getting between American patients and their doctors, according to the industry's trade group.
And they do this by finding every excuse in the book not to pay a claim, even if it means canceling individual policies when people get sick or ridding their rolls of unprofitable small business group policies if an employee or family member falls seriously ill. They issue confusing benefit statements to members so only highly motivated and persistent challengers of their denials stand a chance of reversing an unfair decision. And in the final analysis, when an insurance company has decided it no longer can make enough profit on a particular person or employer-sponsored group, it drives them away in a process known as "purging." In this unconscionable profit-protection maneuver, an insurer will hike premiums so high that the policyholder has no choice but to pay outlandish rates for what may be a reduced benefit package, find another insurer, or simply go without coverage. The consequences of such decisions can be deadly -- but Wall Street always has the last word when profits are the main consideration.
When Wall Street isn't calling the shots, the outcome is decidedly better for health care consumers. Government-operated plans, such as Medicare, and some organizations that provide coordinated care, consistently maintain higher medical loss ratios. Kaiser had a 90.6 percent MLR in 2007. Between 1993 and 2007, Medicare's MLR hasn't dropped below 97 percent.
The health care reform bill now being debated in the Senate must include a provision, such as that proposed by Sen. Franken, that sets a minimum medical loss ratio to keep insurers from gouging consumers and leaving patients without the care they need. Instead of being a formula to reward investors, a properly regulated medical loss ratio in combination with other cost containment measures in the legislation would be a reliable tool for keeping insurance company profits and administrative waste in check.
Sunday, December 6, 2009
Why welfare reform fails its recession test
By Peter Edelman and Barbara Ehrenreich
Sunday, December 6, 2009
We all like to imagine that there'll be something to stop our fall if we hit hard times. Mulugeta Yimer, for example, is a 56-year-old Alexandria cabdriver who escaped poverty and persecution in Ethiopia 20 years ago only to be clobbered by the recession. Business is way down, and he's facing possible foreclosure on his home.
He says he is averse to government handouts, but when he contemplates what might be in store for his wife, who works part-time at a convenience store, and their two young children, he muses wistfully, "There's always welfare, isn't there?"
Actually, no. When President Bill Clinton signed welfare reform into law, he didn't just end welfare as we knew it. For all practical purposes, it turned out, he brought an end to cash help of any kind for families with children in much of the country. While welfare reform was long ago declared a success in some quarters, it was deeply flawed from the beginning. The recession has shown how seriously unprepared it left us for hard times.
Conservatives had been attacking the old welfare system for decades, claiming that it fostered dependency. Many liberals found it unsatisfactory as well. Welfare checks weren't big enough to lift families out of poverty, and the system did little to help recipients get or keep jobs. When Republicans gained control of Congress and welfare rolls swelled in the early 1990s, these attacks gained momentum, and in 1996, Clinton ended the legal right to cash assistance and imposed a five-year limit on federally financed help to any given family.
Welfare reform also provided the states with nearly complete discretion over how to
administer benefits. Most states responded with gusto, reducing welfare rolls nationally by two-thirds in just a few years.
So when the Great Recession came along, the government safety net for families with children was in tatters. The United States was no more prepared for massive unemployment than New Orleans had been prepared for its levees to fail. Some important government programs, including unemployment insurance and food stamps, have started to rise to the challenge and have even begun to lose their stigma among former members of the middle class. Unemployment insurance now covers 57 percent of those who have lost their jobs, as opposed to less than 40 percent before the recession -- although their benefits amount to less half their former wages.
Reliance on food stamps has expanded even more dramatically. While the average benefit still isn't enough to meet people's basic nutritional needs, the program now serves 36 million people, double the number when Clinton left office and up by a quarter in the past year.
By contrast, the caseload for TANF (Temporary Assistance for Needy Families, the name we now give welfare) is about 5 million people. This number is up by about 1 million since the beginning of the recession, but it's still just a little over a third of what it was 15 years ago, before welfare reform.
Why the huge difference between unemployment insurance and food stamp usage and welfare caseloads? People have a legal right to food stamps if they meet the statutory requirements, but since 1996 there has been no legal right to cash assistance. And so welfare, generally speaking, has not cushioned the impact of the recession.
We can see the results: According to the National Law Center on Homelessness & Poverty, the number of homeless Americans is up by 61 percent since the recession began in December 2007. That figure will only continue to rise. The number of people living in poverty increased by 2.5 million during the first year of the recession, and it has surely risen further in 2009. The government reported recently that nearly 50 million Americans are experiencing what it delicately calls "food insecurity."
We are among the co-authors of a forthcoming report from the Institute for Policy Studies titled "Battered by the Storm," which documents the government's inadequate response to the human suffering caused by the recession and describes the excruciating choices people now face between feeding their families and paying the rent.
Both of us were critical of the new approach to welfare when it was enacted in 1996.
One of us resigned from the government in protest of the law; the other helped organize opposition to it from within the women's movement. We argued that the low-wage jobs available to former welfare recipients would not pay the bills. We warned that the legislation didn't provide adequate child care for single mothers thrown off welfare. And we cautioned that many welfare recipients faced serious barriers to success in the job market.
But some advocates of welfare reform seemed to consider poverty a voluntary condition, one curable with a quick kick in the pants and the opportunity to work for minimum wage. There were not enough jobs even then, but, blinded by the economic boom of the 1990s, the authors of TANF seemed to think that the business cycle had been abolished and that prosperity would take us only onward and upward.
In the rapidly expanding service economy of the 1990s, many former welfare recipients did find jobs, but most did not escape poverty, and a significant number were pushed off the rolls without finding work. Research showed that one in five former recipients ultimately became disconnected from any means of support: They no longer had welfare, but they didn't have jobs. They hadn't married or moved in with a partner or family, and they weren't getting disability benefits. And so, after a decline in the late 1990s, the number of people living in extreme poverty (with an income less than half the poverty line, or below about $9,100 for a family of three) shot up by more than a third, from 12.6 million in 2000 to 17.1 million in 2008.
In some states TANF virtually disappeared -- perhaps not surprisingly, given the states' new discretion and pressure from Washington to slash the rolls. Nationally, the fraction of poor children getting help plummeted from almost two-thirds to less than a third. A number of states reduced their welfare rolls by 90 percent.
Perversely, many observers welcomed these huge declines as proof that welfare reform was working. They didn't bother to follow these families as they moved into ever more crowded living situations, pieced together patchworks of part-time jobs or left their children alone while they went to work.
With the recession that began at the end of 2001, thousands of women who'd been removed from the rolls found themselves without jobs or welfare. Beverly Ransom, for example -- a Miami welfare reform "success story" -- had found well-paying work in the catering business, until the recession took her job away and left her without employment prospects and unable to pay rent for herself and her two children on the meager assistance available to her. She eventually found help from a community organization fighting for welfare rights.
If 2001 and the months thereafter revealed holes in the safety net, the current crisis shows even more vividly that TANF is essentially irrelevant in large parts of the country. If the real purpose of welfare reform was simply to reduce the rolls, it's been a smashing success. Some states have been more responsive to economic conditions, but they are the exception. Even now, in the face of high unemployment, caseloads in many states are tiny. At the end of last year, Wyoming had 281 families on its rolls -- about 550 people. Idaho had 1,600 families, Oklahoma had 8,639, and Arkansas had 8,664. The share of poor families receiving TANF was 4 percent in Wyoming, 5 percent in Idaho, 9 percent in Illinois, 9 percent in Louisiana and 9 percent in Texas. Caseloads fell in 20 states during 2008.
Benefits are tiny, too, with 30 states paying a maximum benefit that's less than 30 percent of the federal poverty line. Mississippi skimps by offering its TANF recipients $170 a month for a family of three, about 9 percent of the poverty line and barely enough to cover the utility bills.
Nationwide, there has been no increase in federal welfare funding since the 1996 law was enacted, so thanks to inflation, the value of that funding has eroded by about a third. There is an emergency fund for TANF in the stimulus package Congress passed in February, but little of it has been spent, primarily because it requires a match that fiscally strapped states are unable to put on the table.
Most states in effect adopted a welfare policy of ignoring the recession. Fourteen of 24 states that responded to an Urban Institute survey this fall said they had not changed any of their TANF policies or practices in response to higher unemployment.
There are two techniques that allowed states to radically reduce welfare rolls over the past decade, and they are being used to keep the rolls down now, even as need escalates. The first is to shut the front door almost completely through a process called "diversion" -- essentially telling someone: "You look able-bodied. Go out and look for a job." The Urban Institute's analysis showed that 42 states have rules that discourage enrollment, such as requiring an extensive job search, even when there are obviously no jobs to be found. For a person without a car or access to public transportation, a requirement to apply for dozens of jobs before an application for welfare will even be considered, as some states and counties mandate, can be a deal-breaker.
In some states, according to Kaaryn Gustafson of the University of Connecticut law school, "applying for welfare is a lot like being booked for a crime." There may be a mug shot, fingerprinting and lengthy interrogations as to the true paternity of one's children. Word gets around, and, even in the face of destitution, many people will not undergo such indignities.
The other technique for keeping the rolls down is to staff the back door with the equivalent of a nightclub bouncer. The practice is called "sanctioning" -- kicking people off the rolls because they were late to a work assignment (no excuses accepted, whether for sick children, late buses or car trouble) or didn't show up for an appointment at the welfare office (no dispensation for failure to receive notice of an appointment or inability to understand English). In some states multiple infractions of this sort can result in lifetime disqualification.
It's time to acknowledge that America's 1996 experiment with welfare reform was based on reckless assumptions about the economy, as well as a callous disregard for the realities of sustaining a family. We need a massive emergency relief package not only to fund new jobs but to repair the grievous holes in our national safety net.
Fifty million people need help now -- not in three months or six months, but today.
Peter Edelman is a professor at Georgetown Law Center and served as an assistant secretary of Health and Human Services in the Clinton administration. Barbara Ehrenreich's most recent book is "Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America." They are among the co-authors of "Battered by the Storm," a report to be released Monday by the Institute for Policy Studies.
Sunday, December 6, 2009
We all like to imagine that there'll be something to stop our fall if we hit hard times. Mulugeta Yimer, for example, is a 56-year-old Alexandria cabdriver who escaped poverty and persecution in Ethiopia 20 years ago only to be clobbered by the recession. Business is way down, and he's facing possible foreclosure on his home.
He says he is averse to government handouts, but when he contemplates what might be in store for his wife, who works part-time at a convenience store, and their two young children, he muses wistfully, "There's always welfare, isn't there?"
Actually, no. When President Bill Clinton signed welfare reform into law, he didn't just end welfare as we knew it. For all practical purposes, it turned out, he brought an end to cash help of any kind for families with children in much of the country. While welfare reform was long ago declared a success in some quarters, it was deeply flawed from the beginning. The recession has shown how seriously unprepared it left us for hard times.
Conservatives had been attacking the old welfare system for decades, claiming that it fostered dependency. Many liberals found it unsatisfactory as well. Welfare checks weren't big enough to lift families out of poverty, and the system did little to help recipients get or keep jobs. When Republicans gained control of Congress and welfare rolls swelled in the early 1990s, these attacks gained momentum, and in 1996, Clinton ended the legal right to cash assistance and imposed a five-year limit on federally financed help to any given family.
Welfare reform also provided the states with nearly complete discretion over how to
administer benefits. Most states responded with gusto, reducing welfare rolls nationally by two-thirds in just a few years.
So when the Great Recession came along, the government safety net for families with children was in tatters. The United States was no more prepared for massive unemployment than New Orleans had been prepared for its levees to fail. Some important government programs, including unemployment insurance and food stamps, have started to rise to the challenge and have even begun to lose their stigma among former members of the middle class. Unemployment insurance now covers 57 percent of those who have lost their jobs, as opposed to less than 40 percent before the recession -- although their benefits amount to less half their former wages.
Reliance on food stamps has expanded even more dramatically. While the average benefit still isn't enough to meet people's basic nutritional needs, the program now serves 36 million people, double the number when Clinton left office and up by a quarter in the past year.
By contrast, the caseload for TANF (Temporary Assistance for Needy Families, the name we now give welfare) is about 5 million people. This number is up by about 1 million since the beginning of the recession, but it's still just a little over a third of what it was 15 years ago, before welfare reform.
Why the huge difference between unemployment insurance and food stamp usage and welfare caseloads? People have a legal right to food stamps if they meet the statutory requirements, but since 1996 there has been no legal right to cash assistance. And so welfare, generally speaking, has not cushioned the impact of the recession.
We can see the results: According to the National Law Center on Homelessness & Poverty, the number of homeless Americans is up by 61 percent since the recession began in December 2007. That figure will only continue to rise. The number of people living in poverty increased by 2.5 million during the first year of the recession, and it has surely risen further in 2009. The government reported recently that nearly 50 million Americans are experiencing what it delicately calls "food insecurity."
We are among the co-authors of a forthcoming report from the Institute for Policy Studies titled "Battered by the Storm," which documents the government's inadequate response to the human suffering caused by the recession and describes the excruciating choices people now face between feeding their families and paying the rent.
Both of us were critical of the new approach to welfare when it was enacted in 1996.
One of us resigned from the government in protest of the law; the other helped organize opposition to it from within the women's movement. We argued that the low-wage jobs available to former welfare recipients would not pay the bills. We warned that the legislation didn't provide adequate child care for single mothers thrown off welfare. And we cautioned that many welfare recipients faced serious barriers to success in the job market.
But some advocates of welfare reform seemed to consider poverty a voluntary condition, one curable with a quick kick in the pants and the opportunity to work for minimum wage. There were not enough jobs even then, but, blinded by the economic boom of the 1990s, the authors of TANF seemed to think that the business cycle had been abolished and that prosperity would take us only onward and upward.
In the rapidly expanding service economy of the 1990s, many former welfare recipients did find jobs, but most did not escape poverty, and a significant number were pushed off the rolls without finding work. Research showed that one in five former recipients ultimately became disconnected from any means of support: They no longer had welfare, but they didn't have jobs. They hadn't married or moved in with a partner or family, and they weren't getting disability benefits. And so, after a decline in the late 1990s, the number of people living in extreme poverty (with an income less than half the poverty line, or below about $9,100 for a family of three) shot up by more than a third, from 12.6 million in 2000 to 17.1 million in 2008.
In some states TANF virtually disappeared -- perhaps not surprisingly, given the states' new discretion and pressure from Washington to slash the rolls. Nationally, the fraction of poor children getting help plummeted from almost two-thirds to less than a third. A number of states reduced their welfare rolls by 90 percent.
Perversely, many observers welcomed these huge declines as proof that welfare reform was working. They didn't bother to follow these families as they moved into ever more crowded living situations, pieced together patchworks of part-time jobs or left their children alone while they went to work.
With the recession that began at the end of 2001, thousands of women who'd been removed from the rolls found themselves without jobs or welfare. Beverly Ransom, for example -- a Miami welfare reform "success story" -- had found well-paying work in the catering business, until the recession took her job away and left her without employment prospects and unable to pay rent for herself and her two children on the meager assistance available to her. She eventually found help from a community organization fighting for welfare rights.
If 2001 and the months thereafter revealed holes in the safety net, the current crisis shows even more vividly that TANF is essentially irrelevant in large parts of the country. If the real purpose of welfare reform was simply to reduce the rolls, it's been a smashing success. Some states have been more responsive to economic conditions, but they are the exception. Even now, in the face of high unemployment, caseloads in many states are tiny. At the end of last year, Wyoming had 281 families on its rolls -- about 550 people. Idaho had 1,600 families, Oklahoma had 8,639, and Arkansas had 8,664. The share of poor families receiving TANF was 4 percent in Wyoming, 5 percent in Idaho, 9 percent in Illinois, 9 percent in Louisiana and 9 percent in Texas. Caseloads fell in 20 states during 2008.
Benefits are tiny, too, with 30 states paying a maximum benefit that's less than 30 percent of the federal poverty line. Mississippi skimps by offering its TANF recipients $170 a month for a family of three, about 9 percent of the poverty line and barely enough to cover the utility bills.
Nationwide, there has been no increase in federal welfare funding since the 1996 law was enacted, so thanks to inflation, the value of that funding has eroded by about a third. There is an emergency fund for TANF in the stimulus package Congress passed in February, but little of it has been spent, primarily because it requires a match that fiscally strapped states are unable to put on the table.
Most states in effect adopted a welfare policy of ignoring the recession. Fourteen of 24 states that responded to an Urban Institute survey this fall said they had not changed any of their TANF policies or practices in response to higher unemployment.
There are two techniques that allowed states to radically reduce welfare rolls over the past decade, and they are being used to keep the rolls down now, even as need escalates. The first is to shut the front door almost completely through a process called "diversion" -- essentially telling someone: "You look able-bodied. Go out and look for a job." The Urban Institute's analysis showed that 42 states have rules that discourage enrollment, such as requiring an extensive job search, even when there are obviously no jobs to be found. For a person without a car or access to public transportation, a requirement to apply for dozens of jobs before an application for welfare will even be considered, as some states and counties mandate, can be a deal-breaker.
In some states, according to Kaaryn Gustafson of the University of Connecticut law school, "applying for welfare is a lot like being booked for a crime." There may be a mug shot, fingerprinting and lengthy interrogations as to the true paternity of one's children. Word gets around, and, even in the face of destitution, many people will not undergo such indignities.
The other technique for keeping the rolls down is to staff the back door with the equivalent of a nightclub bouncer. The practice is called "sanctioning" -- kicking people off the rolls because they were late to a work assignment (no excuses accepted, whether for sick children, late buses or car trouble) or didn't show up for an appointment at the welfare office (no dispensation for failure to receive notice of an appointment or inability to understand English). In some states multiple infractions of this sort can result in lifetime disqualification.
It's time to acknowledge that America's 1996 experiment with welfare reform was based on reckless assumptions about the economy, as well as a callous disregard for the realities of sustaining a family. We need a massive emergency relief package not only to fund new jobs but to repair the grievous holes in our national safety net.
Fifty million people need help now -- not in three months or six months, but today.
Peter Edelman is a professor at Georgetown Law Center and served as an assistant secretary of Health and Human Services in the Clinton administration. Barbara Ehrenreich's most recent book is "Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America." They are among the co-authors of "Battered by the Storm," a report to be released Monday by the Institute for Policy Studies.
Thursday, December 3, 2009
America Without a Middle Class
Elizabeth Warren
Chair of the Congressional Oversight Panel created to oversee the banking bailouts
Posted: December 3, 2009 10:00 AM
America Without a Middle Class
Can you imagine an America without a strong middle class? If you can, would it still be America as we know it?
Today, one in five Americans is unemployed, underemployed or just plain out of work. One in nine families can't make the minimum payment on their credit cards. One in eight mortgages is in default or foreclosure. One in eight Americans is on food stamps. More than 120,000 families are filing for bankruptcy every month. The economic crisis has wiped more than $5 trillion from pensions and savings, has left family balance sheets upside down, and threatens to put ten million homeowners out on the street.
Families have survived the ups and downs of economic booms and busts for a long time, but the fall-behind during the busts has gotten worse while the surge-ahead during the booms has stalled out. In the boom of the 1960s, for example, median family income jumped by 33% (adjusted for inflation). But the boom of the 2000s resulted in an almost-imperceptible 1.6% increase for the typical family. While Wall Street executives and others who owned lots of stock celebrated how good the recovery was for them, middle class families were left empty-handed.
The crisis facing the middle class started more than a generation ago. Even as productivity rose, the wages of the average fully-employed male have been flat since the 1970s.
But core expenses kept going up. By the early 2000s, families were spending twice as much (adjusted for inflation) on mortgages than they did a generation ago -- for a house that was, on average, only ten percent bigger and 25 years older. They also had to pay twice as much to hang on to their health insurance.
To cope, millions of families put a second parent into the workforce. But higher housing and medical costs combined with new expenses for child care, the costs of a second car to get to work and higher taxes combined to squeeze families even harder . Even with two incomes, they tightened their belts. Families today spend less than they did a generation ago on food, clothing, furniture, appliances, and other flexible purchases -- but it hasn't been enough to save them. Today's families have spent all their income, have spent all their savings, and have gone into debt to pay for college, to cover serious medical problems, and just to stay afloat a little while longer.
Through it all, families never asked for a handout from anyone, especially Washington. They were left to go on their own, working harder, squeezing nickels, and taking care of themselves. But their economic boats have been taking on water for years, and now the crisis has swamped millions of middle class families.
The contrast with the big banks could not be sharper. While the middle class has been caught in an economic vise, the financial industry that was supposed to serve them has prospered at their expense. Consumer banking -- selling debt to middle class families -- has been a gold mine. Boring banking has given way to creative banking, and the industry has generated tens of billions of dollars annually in fees made possible by deceptive and dangerous terms buried in the fine print of opaque, incomprehensible, and largely unregulated contracts.
And when various forms of this creative banking triggered economic crisis, the banks went to Washington for a handout. All the while, top executives kept their jobs and retained their bonuses. Even though the tax dollars that supported the bailout came largely from middle class families -- from people already working hard to make ends meet -- the beneficiaries of those tax dollars are now lobbying Congress to preserve the rules that had let those huge banks feast off the middle class.
Pundits talk about "populist rage" as a way to trivialize the anger and fear coursing through the middle class. But they have it wrong. Families understand with crystalline clarity that the rules they have played by are not the same rules that govern Wall Street. They understand that no American family is "too big to fail."
They recognize that business models have shifted and that big banks are pulling out all the stops to squeeze families and boost revenues. They understand that their economic security is under assault and that leaving consumer debt effectively unregulated does not work.
Families are ready for change. According to polls, large majorities of Americans have welcomed the Obama Administration's proposal for a new Consumer Financial Protection Agency (CFPA). The CFPA would be answerable to consumers -- not to banks and not to Wall Street. The agency would have the power to end tricks-and-traps pricing and to start leveling the playing field so that consumers have the tools they need to compare prices and manage their money. The response of the big banks has been to swing into action against the Agency, fighting with all their lobbying might to keep business-as-usual. They are pulling out all the stops to kill the agency before it is born. And if those practices crush millions more families, who cares -- so long as the profits stay high and the bonuses keep coming.
America today has plenty of rich and super-rich. But it has far more families who did all the right things, but who still have no real security. Going to college and finding a good job no longer guarantee economic safety. Paying for a child's education and setting aside enough for a decent retirement have become distant dreams. Tens of millions of once-secure middle class families now live paycheck to paycheck, watching as their debts pile up and worrying about whether a pink slip or a bad diagnosis will send them hurtling over an economic cliff.
America without a strong middle class? Unthinkable, but the once-solid foundation is shaking.
Elizabeth Warren is the Leo Gottlieb Professor of Law at Harvard and is currently the Chair of th
Chair of the Congressional Oversight Panel created to oversee the banking bailouts
Posted: December 3, 2009 10:00 AM
America Without a Middle Class
Can you imagine an America without a strong middle class? If you can, would it still be America as we know it?
Today, one in five Americans is unemployed, underemployed or just plain out of work. One in nine families can't make the minimum payment on their credit cards. One in eight mortgages is in default or foreclosure. One in eight Americans is on food stamps. More than 120,000 families are filing for bankruptcy every month. The economic crisis has wiped more than $5 trillion from pensions and savings, has left family balance sheets upside down, and threatens to put ten million homeowners out on the street.
Families have survived the ups and downs of economic booms and busts for a long time, but the fall-behind during the busts has gotten worse while the surge-ahead during the booms has stalled out. In the boom of the 1960s, for example, median family income jumped by 33% (adjusted for inflation). But the boom of the 2000s resulted in an almost-imperceptible 1.6% increase for the typical family. While Wall Street executives and others who owned lots of stock celebrated how good the recovery was for them, middle class families were left empty-handed.
The crisis facing the middle class started more than a generation ago. Even as productivity rose, the wages of the average fully-employed male have been flat since the 1970s.
But core expenses kept going up. By the early 2000s, families were spending twice as much (adjusted for inflation) on mortgages than they did a generation ago -- for a house that was, on average, only ten percent bigger and 25 years older. They also had to pay twice as much to hang on to their health insurance.
To cope, millions of families put a second parent into the workforce. But higher housing and medical costs combined with new expenses for child care, the costs of a second car to get to work and higher taxes combined to squeeze families even harder . Even with two incomes, they tightened their belts. Families today spend less than they did a generation ago on food, clothing, furniture, appliances, and other flexible purchases -- but it hasn't been enough to save them. Today's families have spent all their income, have spent all their savings, and have gone into debt to pay for college, to cover serious medical problems, and just to stay afloat a little while longer.
Through it all, families never asked for a handout from anyone, especially Washington. They were left to go on their own, working harder, squeezing nickels, and taking care of themselves. But their economic boats have been taking on water for years, and now the crisis has swamped millions of middle class families.
The contrast with the big banks could not be sharper. While the middle class has been caught in an economic vise, the financial industry that was supposed to serve them has prospered at their expense. Consumer banking -- selling debt to middle class families -- has been a gold mine. Boring banking has given way to creative banking, and the industry has generated tens of billions of dollars annually in fees made possible by deceptive and dangerous terms buried in the fine print of opaque, incomprehensible, and largely unregulated contracts.
And when various forms of this creative banking triggered economic crisis, the banks went to Washington for a handout. All the while, top executives kept their jobs and retained their bonuses. Even though the tax dollars that supported the bailout came largely from middle class families -- from people already working hard to make ends meet -- the beneficiaries of those tax dollars are now lobbying Congress to preserve the rules that had let those huge banks feast off the middle class.
Pundits talk about "populist rage" as a way to trivialize the anger and fear coursing through the middle class. But they have it wrong. Families understand with crystalline clarity that the rules they have played by are not the same rules that govern Wall Street. They understand that no American family is "too big to fail."
They recognize that business models have shifted and that big banks are pulling out all the stops to squeeze families and boost revenues. They understand that their economic security is under assault and that leaving consumer debt effectively unregulated does not work.
Families are ready for change. According to polls, large majorities of Americans have welcomed the Obama Administration's proposal for a new Consumer Financial Protection Agency (CFPA). The CFPA would be answerable to consumers -- not to banks and not to Wall Street. The agency would have the power to end tricks-and-traps pricing and to start leveling the playing field so that consumers have the tools they need to compare prices and manage their money. The response of the big banks has been to swing into action against the Agency, fighting with all their lobbying might to keep business-as-usual. They are pulling out all the stops to kill the agency before it is born. And if those practices crush millions more families, who cares -- so long as the profits stay high and the bonuses keep coming.
America today has plenty of rich and super-rich. But it has far more families who did all the right things, but who still have no real security. Going to college and finding a good job no longer guarantee economic safety. Paying for a child's education and setting aside enough for a decent retirement have become distant dreams. Tens of millions of once-secure middle class families now live paycheck to paycheck, watching as their debts pile up and worrying about whether a pink slip or a bad diagnosis will send them hurtling over an economic cliff.
America without a strong middle class? Unthinkable, but the once-solid foundation is shaking.
Elizabeth Warren is the Leo Gottlieb Professor of Law at Harvard and is currently the Chair of th
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