Archive | March 2014

Bookmark This: A Big (Helpful) Medicare change

Bookmark This: A Big (Helpful) Medicare change

Short blurb on a change for Medicare reimbursing for services to maintain a patient’s level that would otherwise deteriorate.  So, if my father (for example) is receiving doctor-prescribed services to keep him ambulatory, those are now covered; before, you had to have to lost something you were trying to regain.  This is big and is going to save a ton of money in the long run since it’s going to keep people healthier, however you define that, longer, and therefore out of the hospital.  

If Medicare should have one overarching strategic initiative, it should be to keep the elderly out of hospitals no matter what.  Love it.

Plus, for the Sandwich Generation that is often the taxi of last resort, it’s going to give us additional months of time without the chauffeur’s hat.  I wear it well — but maybe this will help some of the rest of you.

No Time for Selfies

A quick note on what “the real world” is.

It’s been noticed and commented on by many that everyone is taller, faster, funnier and cooler on social media than in real life.  As the number of channels grows (Facebook, Twitter, Instagram, Google Plus, Pinterest for starters), it must be getting harder to build a #personalbrand.  But that doesn’t mean that people aren’t trying.

And if you think this seems silly on an average day, you can imagine how I react to it on days when I am locked in sandwich generation or caregiver mode.  Food porn selfies, videos of the great concert, car lust commentary, political rants to the echo chamber, absurd Top 10 lists, or nearly anything from the Huffington Post – it seems like another world entirely.  For some reason, it makes me feel  even more isolated than I do already.  On the bad days (and yes, there are bad days), it’s almost insulting that people are taking time out to advertise themselves.

Do I know that this is irrational and ridiculous?  Yes.  But it’s how I feel sometimes, and if you can’t recognize and honor your own feelings on occasion, you will not last long emotionally in the caregiver game.  Or the Sandwich Generation one.

I think this is especially true as a man, where you are often expected to advertise, publicly, that you are above feelings.

Not sure that’s going to make a worthy tweet.  #ohwell

Invite the Cow In

Image

Moo

As a sandwich generation man, I juggle competing priorities and events constantly.  Usually, I am cognizant that this is actually a sign of good fortune.  Sometimes it is easy to forget this, however.  Then you forget for a couple of weeks in a row and start to long for a simpler existence.  What if I could plan less?  What if I could just work as long as I wanted and finally conquer my to-do lists? What if I could go away for the weekend with my wife and not have one eye on my cellphone?

There is a story in Judaism of a man who lives in a small house with his wife and many children.  He is losing his mind with the noise and the crowded conditions.   He consults his Rabbi to ask what he should do, and is told to invite his cow into the house.  Not understanding why, he takes the advice anyway; such is the power of Rabbis in Jewish folklore.  He does so, and now, of course, it is worse.  Much worse (and don’t get him started on the smell).  So then the Rabbi advises him to banish the cow.  Suddenly, his previously unbearable cottage seems spacious, quiet, and more than enough home for everyone.

The emergency room is my cow.

Now that my father has emerged from his first Massachusetts hospital experience, I am looking forward to moving back into my cozy little cottage.  We’ll resume our usual Thursday frozen pizza dinners.  I’ll go back to being tech support on his iPad, and to reaching the light bulbs he can’t get to, and to expecting him late for everything.  I’ll have my next Saturday morning spent in front of our weekly-meal-planning-whiteboard with Nova, figuring out how to squeeze in one more meal with her and our kids.

True, I didn’t really invite the cow into my home; it sort of barged in.  But the same emotion applies: gratitude for the people I have inside the house and the hope I get to live here with them just a little while longer.

Sandwich Generation Irony alert – Part 2

You know how most blog posts from caregivers are about their elderly parents?  Well, right now, the list of my family members from healthiest to sickest looks something like:

1.  My daughter Sophie

2.  My dad

3.  Me (distant 3rd – I don’t recommend going for a weekend of skiiing and drinking with your friends when you actually have the flu, nor do I recommend flying home from said weekend on a red-eye into a flu-filled house.  I’m just saying.)

4.  My daughter Lily, who I took to the doctor earlier today fearing pneumonia.  She doesn’t have pneumonia, but when your kid is too flu-ridden to sleep, you have to get it checked out.)

5.  Nova.  She is out cold for the 3rd day in a row.

My dad just commented over email that he wishes he could help.  He better not offer that again, because I’ll find something.  In the sandwich generation, it usually works the other way.  But sometimes….

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Yes – It’s a Waiting Room Selfie with my daughter Lily

How To Get Your Parent to Move (or, Learn from the Universe)

People my age (44, thanks for asking) commonly look for ways to have their parents do something that they are simply not wired to do.  Move out of their home of 30+ years.  Hand over the keys to the checkbook.  Give up driving.  Eat less salt.  Luckily, the Sandwiched Man has been through many of these and has the magic antidote to get your elderly parent to do all of the above, and then thank you for the privilege.

The answer is: it’s not possible.

Here’s what I mean.  My father lived in his split-level in Lawrenceville for more than 2 years after my mother died.  He drove to the supermarket, to CVS, to the library, occasionally to the train station to pick me up, and even up to Boston.  He was determined to mow his own lawn, manage his own medication, pay his own bills and deal with the house’s aches and pains on his own.  At first, he let me assume my mother’s prior role managing the checkbook.  This lasted until my brother and I decided that keeping the house clean was a priority worth spending money on occasionally.  Then he suddenly decided to change his checking account online password, and move all of his assets out of Fidelity (where I had parked them) and instead invest them with a broker at Wells Fargo.  He also decided that not speaking to me for 2 months would be a good idea.

Now, of course, I manage almost all of this and he moved to be near me.  How did this happen?

Gradually.

First, the money.  He noticed that his investment account didn’t pay enough interest.  He’d had experience with my approach and results (index funds, boring stuff) and realized perhaps that he’d made a mistake.  I suggested that if he wanted to move things back, I’d be happy to help, but no pressure.  So about 6 months later, he reversed course and let me back in.  He even told me his banking online password.

Next, moving.  It is amazing to me that he lasted as long in that house as he did, because the margin for error was zero.  Once he got sick, he absolutely could not manage being there anymore.  But I started the conversation way before then, and not by asking for a date by which he was going to move.  Instead, I asked him that when he moved, where would he like to go?  Massachusetts (me) or California (my brother)?  We needed to make plans, I told him.  Then he told me that he was not moving.  “I know,” I said.  “But someday you probably will.  Those are just the odds.  Think about where you’d rather be.”  Using that line of conversation is some of the best advice I ever got.

Six months later, on a drive back from Legal Seafoods during one of his aforementioned visits to Boston, he again mentioned that he did not want to move right away, and that things were fine.  “Sure,” I replied.  “Until you get sick with something that puts you in the hospital.  Then we have a whole world of problems because there’s no one near you, and neither Rob nor I can move down there.”  The next day at the kitchen table he told me that after thinking about it, he’d want to come to Boston, and probably within a year.  I paused.  “OK.  No rush.”

Then he got sick.  And immediately, he declared that it was time to sell the house and move.  It was definitely not ideal, but realistically, it was the best we could have done.  He simply was not going to budge earlier.

Preserving his dignity is paramount for my brother and me, and not just because some day we hope our children remember our example and do the same for us.  If he’s not bought in, it is simply not going to work, whatever it is.  If he doesn’t have the will to make it work, it’s not going to work.

(Parenthetically, we didn’t just how little margin for error he had until he lived in the house for 2 weeks between my breaking him out of rehab and my brother moving him up to Boston.  The roof was falling apart.  The air conditioning had been broken all summer and, it turns out, the summer before.  He could no longer open childproof pill bottles or punch his lifesaving antibiotics through the plastic.  Every time he scaled the stairs, we risked disaster.  Then once we moved all of the furniture, the extent of the carpet’s mildew infestation became evident.  It was a horror show.)

My point is that in the end he moved “suddenly”, but the buildup took time.  I had to lay a foundation.  That takes time, patience, persistence, a sense of humor, and a respect for the dignity of the proud human being you are dealing with and whose pride is going to come in handy for you someday.  Trust me on this.

Think of it this way:  most meteors cross half the universe before they shoot across the sky for a few seconds.  Your job as a caregiver (and a parent, really) is to keep it moving across the universe so that you are ready for when it hits the atmosphere.

Top 10 tech tips for the Sandwich Generation

Let’s face it.  When you are helping manage an elderly parent’s life, you face the toxic combination of accountability without responsibility.  That is, you are sort of in charge, but not really, because this is your parent we are talking about.  As you remember from your childhood, this person has an opinion.

Anyway, I am here today to tell you the good news.  You live in an era which has technology that can make your parent’s life better, and your life a little easier.

Here are my top 10 devices/gadgets/tricks to help you accomplish a lot to take care of your elderly parent and save you a lot of worry and time.  This post is also cut-and-paste friendly so that you and your parent can look at it together and decide which of these make sense.  Here goes, in no particular order:

1.  Dropcam – do you wish you knew when your parents’ delivery or repair guy showed up (or didn’t)?  This $149 web camera is easy to install anywhere there’s a decent wireless signal, and then broadcasts the picture privately to an app on your smartphone.  Point it at the door to your parent’s place, sign up for the $10/month logging service and now you have a record of everything, including when (and IF) your parent came and left.  Many is the time my father has been late to meet me, but it’s not a big deal, because thanks to Dropcam, his departure time is easy to figure out.  And it’s not invasive because, trust me: you will not be watching this all the time.

2.  iPad – admit it: you are tech support for your parents and it makes you crazy.  Rather than recommending how to manage this bad situation, I instead advocate that you help your parents ditch their computer entirely.  Use a tablet instead.  Fewer viruses, fewer moving parts to break, easier to transport around their house/apartment, and the ideal platform for checking out pictures and videos of the grandkids.  Makes Skype accessible, and great for reading (Kindle app with big print = success).  Plus it has a camera.  Bonus tip: definitely get a Zagg keyboard with it too.

3.  Amazon – whether you know it or not, you are the shopper of last resort for your parents.  Why not make it easy to pick up the 1 or 2 things they never have time to go buy?  If you have an Amazon account, add your parent’s address and preferably their Visa or Amex card.  Then sign up for Amazon Prime if you haven’t already.  Now you can shop for them for just about anything in minutes.  Note: you will also need an Amazon account for your parent if they don’t have one already so that they can buy or borrow books on Kindle.

Now, for a word about telecommunications (a.k.a., the phone):

4.  Google Voice – old telephone technology makes it nearly impossible for you to serve as a backup for your parents.  Enter Google Voice, which gives you a virtual phone number that you can forward to any phone, or connect via a little adapter (we use OBI, but there are many others for this) to a regular telephone base.  This is a lifesaver.  His voicemails get sent to him as emailed voice recordings, so they are easy to listen to.  And, I forward a copy to myself.  Again, I don’t listen to these 99.9% of the time,  but I know when the calls came in, and if he misses anything, I am a pretty good backup.  Then on his cellphone (coming up next), I recorded a voicemail greeting that says “I don’t listen to this voicemail — call me on my home phone instead, which is 508-xxx-xxxx.”

5.  Panasonic KX-TG4745B home phone – big buttons, easy to program and add handsets and LOUD, LOUD, LOUD.  Which is great for him.  He has an 800 square foot apartment and 5 handsets because his mobility is terrible.  But now he is reachable.  My father’s hearing is so bad that he uses the speaker phone next to his ear to hear the phone.  I don’t judge – it means I can actually call him now.

6.  Snapfon, with ported home phone number – now that you have a new home number, keep the old home number by porting it to a mobile phone (your current provider won’t be happy,  but that’s life!).  We use Snapfon for my dad, a cheap big-buttoned cellphone that is not smart and is therefore very, very easy to use.  We moved his old home phone number to it when he moved.  He almost never remembers to have it on (not a big deal – remember the Google Voice trick above), and has forgotten how to use almost all of the features.  But he has a cellphone if he really needs one, and at $15/month, it’s a bargain.

And, now back into the apartment.

7. Apple TV – my dad is hooked on Apple TV, especially since he can stream YouTube to it from his iPad.  When you give your parent the gift of seeing any content they want on the television set they love, you will change his life.  I promise.  And, because the iPad talks to it, your parent  will soon be watching anything and everything on their TV set.

8.  Powered recliner – my sister-in-law suggested this, and I scoffed at first, but I was wrong.  My father’s chair will recline so that he can nap and read in extreme comfort, and also will electrically move him into nearly a standing position so that he can escape.  The La-Z-Boys will run you over $1500, but we bought a much less expensive one from Spinlife and it looks great.  Even a cheap one of these is about I went with the faux leather rather than cloth because it’s easier to keep clean (if your parent has incontinence problems, fabric… well, you know).  Another tip: although you can file for a Medicare reimbursement for part of the expense, don’t do it if you can forgo the money.  The process hurts, and can suck up a ton of time that will then delay your loved one falling asleep in comfort.

9.  TV headphones – rather than blast the TV, my dad has headphones with a remote wireless transmitter that plugs into the audio out jack of his TV.  I gave the link for the Sony headphones, which are $80, but really any pair will do if your parent, like mine, is nearly hard of hearing.

And last but not certainly least…

10.  Google Calendar / Gmail: your problem is this: you want to be able to micromanage things, but not do all of the work yourself.  And you can’t always call to remind your loved one about events.  It turns that you have kids who you are shuttling to dance/swim/soccer/Bar Mitzvah/football/violin practice.

So if you can possibly move to a model where email is the central communication channel, do it.

I remind my father about calendar appointments by putting them into Google Calendar and having a reminder email sent at least a few hours before to his gmail account.  My dad has recurring appointments that he now gets email reminders for and never forgets.  Once you get used to this system with email as the glue, you will never go back.

I subscribe to his Google Calendar.  Then I can add appointments on his calendar and mine at the same time and set up alerts for him.

I also know his gmail password — again, I NEVER read his email, but if for some reason he needs me to doublecheck things for him, I can do it.  He uses the native iPad mail program as his mail “client” (the program with which he reads email).  It’s not perfect but works well enough.

I realize that not everyone has parents who can handle email.  My advice is that if you can possibly make the up-front investment to make this work, find the time.  Travel down to your parents’ home if they live far away and implement as many of these as you can.  It is going to improve your life radically caring for a remote relative for whom, in the end, you are both accountable and responsible.

Irony Alert!

I organized a great support group for some fellow members of my Temple also taking care of elderly parents.  But… then I couldn’t attend because I actually was in the hospital with my father.

He has some severe hip pain, and the good news is that nothing is broken.  Probably a pulled muscle.  We were trying to figure out where he was going to end up tonight (the hospital, it turned out) and going forward (hopefully back in his same community, which part is TBD).

And in true sandwich generation fashion, my kids’ swim team annual postseason ‘banquet’ was also tonight.

So, now I am really glad I enjoyed the smooth days when I did.  And to my fellow support group members who were there tonight… I was thinking about you.  Ironic, right?

The Dishwasher Manifesto

Now for an introduction to another Sandwich topic: being stuck between career and responsibilities at home.  Or, as I think of it, the Dishwasher Manifesto.

Typically people use “Sandwich Generation” to refer to taking care of elderly parents and children, but to me, this seems limited.  As I noted when I started off, I (and people like me) are squeezed between 2 sides in a number of ways.

Even longer than I have been trying to juggle my responsibilities to my father and to my children, I have been trying to execute on the child-raising strategy on which my wife Nova and I long ago agreed.  It flows naturally from our basic philosophies and our aspirations about ourselves.

The main tenets are:

(1) We both want to work.  In particular, Nova wants to work both because she is educated and motivated, and because we want Sophie and Lily to see her do that.

(2) We are not going to outsource raising our children.

(3) We love our kids, and ourselves, enough to want to part of their lives as much as possible.

(4) We want to be active volunteers in the community and model this for our kids.

This is pretty close to the ideal that Sheryl Sandberg talks about in Lean In.  Or, the ideal she thinks she is talking about.  Since she lives in a rarefied world of hopping corporate jets when she travels, has an army of nannies and assistants, and a lack of elderly parents to take care of (I think), her model isn’t something we can copy.

So, to illustrate how this works in real life, I give you a rough transcript of a dialogue we had one morning emptying the dishwasher (my least favorite chore, by the way):

Me: “It’s not exactly fair.”

Nova: “What’s not fair?”

Me: “You expect me to have a satisfying career and earn enough to be able to live in Wellesley and take nice vacations, while helping take care of the kids, do a bunch of chores, and be on call if something goes wrong.”

Nova (without looking up from the dishwasher, after a short pause): “Yes.”

Me (nodding as a growing self-awareness rises inside me): “OK.”

Hence, The Dishwasher Manifesto.  Here’s how it, and the constraints it brings, translates into reality.

I am the primary breadwinner.  I want work that is fulfilling and challenging.  Who doesn’t?  But I cannot take a job that requires very frequent traveling, consistently long hours, or unavoidable regular evening dinners or other events.  I can do it for brief periods of time as needed, and as an entrepreneur and someone who works on deals I often do.  But it can’t the norm.

This means that I need a robust capability to work from home, or work in an environment where “family first” is not a social media slogan, but a reality.  I need a CEO who either has kids, or is caring for an elderly parent, or ideally, is a fellow Sandwich Generation Member.  Or I need to be an entrepreneur trading certainty for being able to set my own culture.

I also have my specific roles that I “own”. I cook more frequently than Nova does and manage food and meal planning.  I am also the CFO, manage the bill paying, and a lot of the administrative functions around the house.  We share a lot of the weekend, social, activities and vacation planning.  Nova has just about everything else.

When it’s necessary, which is often, we have to both figure out who’s going to be home to deal with the sick child/broken refrigerator/package delivery/carpool/whatever.  Because it’s not always going to be her.

If you are not COO of Facebook, it also requires certain financial choices.

Private school tuition breaks this model, so it’s out of the question.  Although if you live in Wellesley and are going to pay taxes to support my children’s schools anyway, I definitely think you should consider it.

We are fortunate to both have MBAs from Stanford, so our choices are not driven by financial need so much as constraints.  But many of our friends earn a lot more than we do.  It doesn’t matter though – we’re not optimizing for this.

So, having an impeccably decorated or landscaped house is not in the budget.  Significant philanthropy, the kind that gets you the notoriety that actually running a non-profit like Nova does not, is out.  (For more on this dichotomy, I recommend this excellent TED Talk on the subject.  People who give money to non-profits are heroes, but those who run them should be willing to work for less money.  Odd.).

Nova and I say all the time that we don’t believe in inherited wealth, so we aren’t concerned with building up a multi-million dollar fortune.  It’s true.  That’s the ONLY reason we aren’t doing it.

Weekends are filled with detailed meal planning, down to which dinners to cook early in the week so that there are leftovers the kids will consume for lunch.

Nova’s contention is the husband this requires is actually the person I am, so it’s not like asking me to live that way is forcing some kind of sacrifice.  I am living out my aspirations.  She is right, which as a man, I can tell you does not make it easy.

Frequently I remind myself of our organizing principles of getting the most out of the limited time we have with our 2 children.  It’s actually close to the minimum possible since we have twins who were born in June.  (Go ahead, take a second to do the math on why that is.  I’ll wait.)

This is the right thing for us and for them.  Being with my family is my passion.  I love being an involved father and as I begin to see glimmers of my kids as young adults, I have a weird sensation that our strategy is working.  “Yesterday Peter” did the hard work thinking this through, and as I have in past entries, I thank him today.

But I still feel caught in the middle, and sometimes envy people who are able to pour themselves completely into their careers and passions, kids or not.  I am just wired differently.  We all are.  Sometimes you need your spouse to issue a Dishwasher Manifesto to remember it and appreciate that this is why she loves you, and you love her.

Classical Music, and the Reason and Will to Live

Is “caregivee” a word?  Well, if not, it should be!

As I’ve mentioned before, my father presents a classical music demonstration in his community every other week.  He does so by creating a YouTube playlist of performances around a certain theme, then writing up a short blurb that is edited by my brother or me and printed/copied by the community’s Activities Director (the soon to be world-famous Andrea), and then streaming them over wireless to an AppleTV box attached to the flat screen in the common activities room.  Very 18th century meets 21st century.

Anyway, this is his favorite project and the thing that he lives for.  If you are a caregiver, you know how important it is that your loved one have an organizing principle in their lives beyond taking medication and watching old movies.  This is his.

The “reason to live” is the slightly younger twin brother of the “will to live”, which is something we all pray for regularly, whether consciously or not.  They are inseparable.  In Judaism, I believe that this is what “Refuah Shlema” refers to.

Below is an excerpt of my dad’s latest presentation, done Wednesday.  It is his 2nd pass at Mozart, whose Eine Kleine Nachtmusik was the soundtrack to many of my childhood family road trips in my dad’s faux-wood station wagon(s).  If you don’t like classical music, enjoy instead the depth of the curating effort of a man armed with an iPad, a YouTube search bar, and a reason to live.

The Classical Music Hour

with

Andrea and Steve

Wednesday, March 5, 2 PM

MOZART REVISITED

WOLFGANG AMADEUS MOZART is perhaps the most popular classical music composer. He produced over 600 works, including 6 major operas, 41 symphonies, 28 piano and 5 violin concertos, many of them acknowledged as masterpieces in their categories.

Although a few samples of his work were introduced during the past classical music hours, a more detailed, more comprehensive examination seems to be justified.

The next 45 minutes, you will watch a great variety of Mozart’s masterworks, such as:

OVERTURE of the ABDUCTION FROM THE SERAGLIO, Vienna Symphony Orch. – Fabio Luisi

http://www.youtube.com/watch?v=GrFbiw77_90

MADAMINA Arie from DON GIOVANNI, sang by F. Furlanetto

http://www.youtube.com/watch?v=INF9r5jju0A

CHAMPAGNE Arie from DON GIOVANNI, performed by I. Kovacs

http://www.youtube.com/watch?v=wW_L6Fo7Fjk

THE QUEEN OF THE NIGHT Arie from the MAGIC FLUTE performed by E. Miklosa

http://www.youtube.com/watch?v=H_xfC9RXicU

OZMIN’S Arie, THE ABDUCTION FROM THE SERAGLIO, sang  by  Jozsef Gregor

http://www.youtube.com/watch?v=rvDZ9Ikvc7U

THE FAMOUS PIANO PIECE, TURKISH MARCH, played by pianist R. Brautigam

http://www.youtube.com/watch?v=HMjQygwPI1c

PIANO CONCERTO #20 – Romanze, played and conducted by Mitsuko Uchida

http://www.youtube.com/watch?v=qhNITXBguSs

VIOLIN CONCERTO #4, performed by Julia Fischer

http://www.youtube.com/watch?v=9Hqyxy9u4W8

SYMPHONY #40, first movement, Berlin Philharmonic, conducted  by T. Pinnock

http://www.youtube.com/watch?v=pIsMmuf9Q3Y

SYMPHONY #41 “JUPITER” – Chamber Orchestra of Europe, conducted by T. Harmoncourt

http://www.youtube.com/watch?v=zK5295yEQMQ

TURKISH FINALE from the ABDUCTION FROM THE SERAGLIO

http://www.youtube.com/watch?v=Tw84smtNE1Q

Caregiving Success: It’s Not Entirely Luck

I consider myself pretty self-aware; given how much introspection it takes to keep myself on the rails, I better be.  Every once in a while, I allow myself to take some credit for my father’s improved situation and my kids turning into warm, emphathic, smart and kind people (credit shared with my brother and wife respectively, of course).  So many things are out of our control in both situations that when a chapter ends well, you take a small victory lap even if you know already that the book itself is going to be a tragedy.

Brief side note: I have a good friend down the street who convinced me to buy an outdoor gas grill that I could connect directly to the line in my house.  Best thing I’ve bought in ages.  His logic was simple: as a father of daughters, you control so little in life that you need something that you actually do control.

Anyway, I am also keenly aware that much success in life and caregiving stems from luck.