Old Age, From Youth’s Narrow Prism by Dr. Marc E. Agronin

The old woman had drawn down the shade in her room — hoping, I imagined, to stop the midday Miami sun from penetrating her grief. But the sun still hit the window full force and illuminated the shade like a Chinese lantern.

She sat silently in a wheelchair, her 93-year-old silhouette stooped in the bathing light. I entered, held her hand for a moment and introduced myself. “Sit down, doctor,” she said politely.

I asked her why she had come to the nursing home, and she described the recent passing of her husband after 73 years of marriage. I was overwhelmed by the thought of her loss, and wanted to offer some words of comfort. I leaned in close and spoke.

“I’m so sorry,” I told her. “What has it been like for you losing your husband after so many years of marriage?”

She paused for a moment and then replied: “Heaven.”

Seeing my bewilderment, she smiled and went on to describe how she had endured decades in an unhappy marriage with a gruff, verbally abusive man.

As she spoke, I realized why my instincts were so completely off. In my misguided empathy I had committed what William James called the psychologist’s fallacy, assuming incorrectly that one knows what someone else is experiencing. With this newly widowed patient I imagined that only a life of sadness and decrepitude remained, and I felt bad about it.

But I was wrong. She had not fallen into the abyss. She was glad to have finally won a measure of freedom and was determined to make the best of it. As her life unfolded at the nursing home over the next year, she threw herself into new activities and relationships in a way that was quite unexpected.

All of us lapse into such mistaken impressions of old age from time to time. It stems in part from an age-centered perspective, in which we view our own age as the most normal of times, the way all life should be. At 18 the 50-year-olds may seem ancient, but at 50 we are apt to say the same about the 80-year-olds.

“So what’s it really like to be old?” I often ask my patients, who are mostly in their late 80s and 90s, and the responses are unexpected.

“I forgot I was so old,” a 100-year-old patient recently told me, and then excused herself to make it to bingo on time.

This age-centrism is particularly pervasive in people’s attitudes toward nursing homes. All too often we imagine that life seems to end at the nursing home door — that it is loveless and lonely, with death hovering close by.

We make this mistake when we refuse to see the needs for intimacy even in the most debilitated elderly. Our youth-centered culture equates love with sex; in contrast, I have seen with my older patients that love can be an endlessly blossoming flower, felt and expressed in hundreds of ways. A friend’s mother who suffers from Alzheimer’s disease has fallen in love with another resident on her floor, and they walk around holding hands and snuggling with a newfound innocence that perhaps only their memory loss restored.

We also project our terror of death onto the aged, assuming that fear and depression must stalk the final years of life. And yet in my 15 years of working in nursing homes, I have never heard a patient say that he or she was afraid of death. Sometimes there is acceptance, other times anticipation, but most often it is not a great concern. Life goes on in its shadows.

In the end, there is a cost to our myopic view of aging. We imagine the pains of late-life ailments but not the joys of new pursuits; we recoil at the losses and loneliness and fail to embrace the wisdom and meaning that only age can bring. Henry Wadsworth Longfellow captured the sentiment well:

For age is opportunity no less

Than youth itself, though in another dress,

And as the evening twilight fades away

The sky is filled with stars, invisible by day.

When I first viewed this, I knew I would post it on our blog. What I also knew was I would share a brief synopsis of my own journey of grief. The one thing I discovered about grief is, it takes it own course and it is best to let it run the course it needs to go. When I lost mom, all that appeared to come forth was strength as I wanted to help dad through grieving his wife of 64 years. I was numb. And I could hardly believe it when dad died 3 months later and I found myself sitting back in that damn cemetery. Up to that point I had always viewed cemeteries with reverence for the deceased but seeing a headstone with both my parents names on it was horrifying. I learned we all grieve differently and we all grieve over different periods of time.

I was not able to control my grief and thankfully had the sense to go into therapy to help me understand why I could not get out of bed and why I was having severe memory loss. It took me 1 1/2 years to finally “come back to life”. I remember my hair stylist looking at me and saying, “you’re finally back”.

Grieving and allowing the grief to come out in whatever way it manifests itself is to be human. Today I can say that mom and dad are with me all the time and I know and am happy they are together. What I did not understand before they each passed was how grief would consume me. This short video, though based only only Christianity, depicts the very real emotions we all have to go through on the grief journey. 

Digital Publishing for Seniors - find digital editions of senior resource guides, magazines, brochures and newspapers at the the web’s only interactive library for aging adults at www.after55.com

Wonderful short video packed with helpful tips on, “Making the Golden Years Golden”, by Dr. Eva Mor. She discusses 7 steps to help take some of the anxiety out of growing older. Get your pen and paper out as it’s worth taking notes!

Digital Publishing for Seniors - find digital editions of senior resource guides, magazines, brochures and newspapers at the the web’s only interactive library for aging adults at www.after55.com

 photo - courtesy of flickr and roadsidepictures

Here’s an informative article from the New York Times. The New York Times has a great blog called, “The New Old Age”, which addresses many subjects relating to growing older. I found this particular article to be immensely valuable. Enjoy!

May 13, 2009, 7:00 am
 
When the Hospital Says ‘So Long’
By Maggie Jones

Last December, a hospital discharge coordinator called my husband to detail plans for the release of my 84-year-old father-in-law. After a few days in the hospital — his dementia and several other ailments had reached a tipping point — he was leaving for a nursing home. Given the limited availability of nursing home beds, the discharge coordinator said she could offer him one option near my mother-in-law: a facility in which (this seemed to be a good sign) the coordinator said she gladly would place her own family members.
My husband got on an airplane to be with his father during the transition. I went onto the Internet. Within several minutes I found multiple Web sites rating local facilities, and with each click I pulled up another abysmal review of my father-in-law’s proposed nursing home.
A federal Medicare Web site gave the facility two out of five stars overall, and just one star — “much below average” — for its care of patients. But my father-in-law was 24 hours away from discharge — what options did we have? With trepidation, we settled him into the nursing home recommended by the discharge coordinator, while my mother-in-law scouted for an opening in a better, more reputable place. (Eventually she found one and moved my father-in-law there a few weeks later.)
Since then, I have wondered what we could have done better. So recently I asked several experts for their tips on creating smoother hospital discharges.

Who’s in Charge?
As soon as a family member has been stabilized in the hospital, I was told, your next priority should be to find out who will handle the discharge. There may be an actual “discharge coordinator.” Or it may be the patient’s primary nurse. Whoever it is, start a conversation and start it early.
“You don’t have to accept it if they say [the patient] has to leave the hospital in the next hour,” said Susan Reinhard, senior vice president for public policy at AARP. (Indeed, hospitals are required to give Medicare patients at least 24 hour notice before discharge.) “Families have a right to say, `I need more information. I don’t know what I’m doing,’” Ms. Reinhard added. Doing so early in the process gives the discharge planner more leeway to set up services or find alternative plans.
Early communication also allows families more room to appeal discharge plans if they don’t feel the plans are safe or adequate, noted Ariella Peist, senior program manager of the families and health care project at the United Hospital Fund in New York. She and other experts urge families to make informal appeals first. A formal appeal over a discharge plan can be a complicated and potentially expensive proposition, since families may be responsible for hospital charges if the appeal is denied. If families do formally appeal a discharge plan, they have to go to their state’s Quality Improvement Organization — a private agency appointed by the federal government to handle Medicare and Medicaid complaints about quality of care, including hospital discharge. Patients with private insurance, meanwhile, usually must turn to their insurers to file complaints about discharge plans.

Do Your Own Research
The Medicare Web site I used during my father-in-law’s discharge is a good place to start researching nursing homes. It provides checklists for evaluating nursing homes and allows consumers to view results from state inspection reports of facilities. You can find other Web sites with relevant information on housing and services on The New Old Age’s Resources page.
Go see nursing homes in person. Are they clean? How does the staff interact with the patients? Nursing homes are required to make their state inspection reports available to the public. If the staff resists your request, take it as a warning sign.
There are other Web-based resources for discharge planning, and one of the best is United Hospital Fund’s Next Step in Care. The resource provides, in both English and Spanish, checklists for discharge, including questions to ask the hospital staff and questions for family caregivers to ask themselves to prepare for the transition.

What’s Expected of You
The days after discharge can be overwhelming, particularly if your family member is coming home with you. “You move from 24-hour monitoring at the hospital and the next day you’re becoming a nurse and doctor yourself,” said Mary Naylor, a professor of gerontology at the University of Pennsylvania’s School of Nursing.
Ask the discharge planner, as well as nurses and doctors, what you should expect as a caregiver. What will the first day be like for the patient? The first week? What are the medications, and how should they be administered? What services and training are available for you and your family?
“Lots of people who are eligible for a home care referral don’t get it,” Ms. Naylor said, in part because hospital staff do not always realize that insurance would cover the visits for particular patients. “It’s worth asking, and saying you need a visiting nurse to get you started.” The work may be enormous, and the toll both physical and emotional.
As Ms. Reinhard of AARP put it: “We ask caregivers to do things that make student nurses tremble.”

Don’t Expect Them to Get It Right
Discharge plans are notorious for being illegible. (It’s one reason AARP and other organizations have pushed for more widespread use of electronic records). And medications, many of which may have changed since the patient entered the hospital, are often botched in the “hand-off,” as the patient transfers are known. Patients may arrive at a nursing home without pain medications, for instance, or they may have been taken off their cholesterol medication and never put back on.
One defense against such errors is getting copies of the medical records, including lists of medications and the discharge plan itself. And if the hospital tells you a visiting nurse is scheduled to come to your home the next day, make sure you have the phone number yourself in case no one shows up.
Finally, experts advise never leaving the hospital without a follow-up appointment for the patient. That appointment can be the difference between a patient’s steady recovery at home and being readmitted to the hospital and having to start the healing process all over again.
What’s your experience during and after a hospital discharge? Do you have advice or tips on what helped your family? What do you wish you’d done differently?

Digital Publishing for Seniors - find digital editions of senior resource guides, magazines, brochures and newspapers at the the web’s only interactive library for aging adults at www.after55.com

Alzheimer’s is a disease which affects most families. In my own family, every woman, with the exception of one aunt, has had Alzheimer’s or Dementia. I make a point of reading everything I can on Alzheimer’s. When I saw this video on YouTube I was so touched as it is from a young man whose grandmother has Alzheimer’s. He is sharing what he has found out about the disease and the symptoms he witnessed in his grandmother.

Anyone needing more information on alzheimer’s can go to www.alz.org . The Alzheimer’s Association is the leading voluntary health organization in Alzheimer’s care, support and research.

Digital Publishing for Seniors - find digital editions of senior resource guides, magazines, brochures and newspapers at the the web’s only interactive library for aging adults at www.after55.com

The National Academy of Elder Law Attorneys, Inc. released this video on Guardianship. It’s a subject I personally need to know more about. It’s short, yet informative. Happy learning.

Any family looking for a reputable and knowledgeable attorney who specializes in elder law should visit the website for the National Academy of Elder Law Attorneys at www.naela.com . 

Digital Publishing for Seniors - find digital editions of senior resource guides, magazines, brochures and newspapers at the the web’s only interactive library for aging adults at www.after55.com

photo - courtesy of my camera…Arizona sunsets are unbelievable

This e-mail is provided as a courtesy of the Governor’s Advisory Council on Aging. It is our intent to offer the Legislative Update weekly during the 2009 session of the Arizona State Legislature. The purpose of this service is to keep Arizona’s seniors and advocates for aging services informed about bills and action taking place at the Legislature. The information provided is intended to help you form your own opinion about an issue and to give you the necessary resources and contacts to help ensure your perspective and voice are heard. Please note the Legislative Update is non-partisan in nature. We thank you for your interest!
GENERAL OVERVIEW: 
2010 Budget:
On Monday, Governor Brewer released her FY 2010 budget proposal. The plan has been widely viewed as a better scenario for human services and vulnerable populations than legislative alternatives. The proposal addresses the increased caseloads state agencies have faced during this economic downturn. The 5-point Long Term Recovery Plan includes those ideas presented to the Legislature in March of this year.
Documents outlining details of the proposal can be found at:
http://www.azgovernor.gov/Budget2010.asp
In response, the Senate and the House have been working to reach agreement on proposed budget bills. Both reconvened this afternoon. Senate budget bills include S1027; S1028; S1029; S1031; S1035; S1036; S1145; S1187; S1188; and S1258. The House package includes: H2633, H2634, H2635, H2636, H2637, H2638, H2639, H2640, H2641, H2642.
Note: The Council’s FULL LIST includes all of the Senate and House budget bills and you can access information on the bills through the link provided in this newsletter. Live proceedings can be viewed through the Arizona State Legislature website at http://azleg.granicus.com/Mediaplayer.php?publish_id=5 or through Arizona Capitol Television available through Cox Cable Channel 123.
The JLBC summary of the House and Senate budget plan can be found at:
http://www.azleg.gov/jlbc/HouseSenate6-3.pdf
At day 144 of the Regular 2009 Arizona Legislative Session, 1,111 bills posted, six (6) passed, six (6) signed; 96 memorials and resolutions posted and one (1) passed. Please be advised that the presence of a bill on the Council’s web page does not represent support or opposition by the Council to that bill. It does mean that the bill topic is something that is likely to be of interest to or have an impact on Arizona seniors so the Council is tracking the bill’s progress.
STATE LEGISLATION:
Visit the link below to view the Council’s web page and the list of bills the Council is tracking.
FULL LIST:
http://www.azcapitolreports.com/webreport.cfm?webreport=364&listid=13720&print=true
Scheduled Hearings on bills the Council is tracking include:
S1049: Fingerprint Clearance Cards; Hearing: House Health & Human Services; 6/9/09, 10:30 am House Rm. 4.
Reminder: Be sure to check the Arizona State Legislature website for updated Senate, House and Joint Legislative Budget committee agendas at:
http://www.azleg.gov/CommitteeAgendas.asp?Body=H&ShowAll=OFF
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The website FULL List link provides you with the current status and upcoming hearing information about the bills being tracked by the Council and is available and updated on an ongoing basis, 24 hours a day, 7 days a week. Information about bill status, hearing, etc. is a purchased service provided by the Arizona Capitol Times.
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Reminder: You can contact your policymaker. If you have a particular perspective about budget bills or anything in a piece of legislation that is being considered, you may voice your thoughts by contacting the:
Governor’s Office of Constituent Services at 602-542-4331 or toll-free at 800-253-0883
Or you may contact the legislator from your area. If you do not know how to reach your local legislator, start at the homepage under How do I find My Legislators or follow the instructions provided at both the Senate and House Member links at the website.
Arizona State Legislature website: http://www.azleg.gov/
FEDERAL LEGISLATION:
S.906
Senior Investment Protection Act of 2009
S.906 was introduced on April 28, 2009, by Senator Herb Kohl (D-WI) with the one co-sponsor on this bill, Senator Claire McCaskill (D-MO).
The purpose of this bill is to protect older Americans from misleading and fraudulent marketing practices with the goal of increasing retirement security.
S.906 directs the Attorney General to establish a program of grants to states to:
(1) Investigate and prosecute misleading and fraudulent marketing practices; or
(2) Develop educational materials and training aimed at reducing misleading and fraudulent marketing of financial products toward seniors.
On April 28, 2009, the bill was referred to Senate committee; it was read twice then referred to the Committee on the Judiciary.
For more information, go to the Thomas website http://thomas.loc.gov/ and enter the bill number under Search Bill Summary & Status.
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Today, the U.S. Department of Health and Human Services and the U.S. Department of Veterans Affairs announced plans to develop a nationwide program to help older Americans and disabled Veterans with disabilities remain independent in the community.
Read the press release at:
http://www.hhs.gov/news/press/2009pres/06/20090604a.html
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Contact Your Congressional Member: If you are interested in Congressional bills or wish to share your thoughts or concerns with your federal representatives, find out how to contact your congressional representatives by visiting: http://www.house.gov/ for members of the House or http://www.senate.gov/ for members of the Senate.
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INFORMATION & RESOURCES:
Area Agency on Aging, Region One (Maricopa County) can assist
adults over 60 or an adult with disabilities in getting and/or installing a Converter Box. For more information, call the 24-hour Senior HELP LINE at 602-264-HELP (4357).
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If you would like to submit an educational or public service event for consideration, you can do so by sending an email with the description to: gaca@az.gov.
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Thank you and have a great week!
~Governor’s Advisory Council on Aging

photo courtesy of flickr and robert huffstutter

The Assisted Living Federation of America reported that parting with “stuff” is keeping some seniors from moving into assisted living communities. The Household Moves Project has been launched which will look at how a seniors stuff can hinder a senior from living independently, safely, and as healthy as possible. This three-year project will follow 100 individuals and 65 couples in and around Kansas City and Detroit from the time they decide to move into smaller spaces until after the move. This is a subject near and dear to my

heart. When the time came to move my parents into an assisted living community, my parents grieved having to leave “stuff” behind. Going from a big home into a small, one bedroom apartment meant taking a very small amount of their belongings. It was a painful time for my mother and father, yet their safety was paramount and therefore the move was necessary. I am not sure there is an easy way but beginning to downsize in anticipation of growing older and needing help is a reality. It’s a lot easier to downsize when we are doing so willingly than to do so when it is forced upon us. I had neighbors in Scottsdale who were way ahead of the curve. Right after retirement they bought a small condo and decided to downsize, clean out and make a life with less “stuff” so they would not have to do it later. They also stated it really freed them up not to have the responsibility of a large home. Wise and yet they are the minority.

I recently downsized and am planning to downsize even more. I find that the less attached I am to “stuff” the more freedom I have. Life is about letting go, not holding on. Stay tuned for the results of the Household Moves Project…

Digital Publishing for Seniors - find digital editions of senior resource guides, magazines, brochures and newspapers at the the web’s only interactive library for aging adults at www.after55.com

photo courtesy of flickr and grant neufeld

This article was wriiten by Julie Connelly in the April 2, 2009 edition of The New York Times -

DOCTORS ARE OPTING OUT OF MEDICARE

EARLY this year, Barbara Plumb, a freelance editor and writer in New York who is on Medicare, received a disturbing letter. Her gynecologist informed her that she was opting out of Medicare. When Ms. Plumb asked her primary-care doctor to recommend another gynecologist who took Medicare, the doctor responded that she didn’t know any — and that if Ms. Plumb found one she liked, could she call and tell her the name?

Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them. Some doctors — often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists — are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle.

When shopping for a doctor, ask if he or she is enrolled with Medicare. If the answer is no, that doctor has opted out of the system. Those who are enrolled fall into two categories, participating and nonparticipating. The latter receive a lower reimbursement from Medicare, and the patient has to pick up more of the bill.

Doctors who have opted out of Medicare can charge whatever they want, but they cannot bill Medicare for reimbursement, nor may their patients. Medigap, or supplemental insurance, policies usually do not provide coverage when Medicare doesn’t, so the entire bill is the patient’s responsibility.

The solution to this problem is to find doctors who accept Medicare insurance — and to do it well before reaching age 65. But that is not always easy, especially if you are looking for an internist, a primary care doctor who deals with adults. Of the 93 internists affiliated with New York-Presbyterian Hospital, for example, only 37 accept Medicare, according to the hospital’s Web site.

Two trends are converging: there is a shortage of internists nationally — the American College of Physicians, the organization for internists, estimates that by 2025 there will be 35,000 to 45,000 fewer than the population needs — and internists are increasingly unwilling to accept new Medicare patients.

In a June 2008 report, the Medicare Payment Advisory Commission, an independent federal panel that advises Congress on Medicare, said that 29 percent of the Medicare beneficiaries it surveyed who were looking for a primary care doctor had a problem finding one to treat them, up from 24 percent the year before. And a 2008 survey by the Texas Medical Association found that while 58 percent of the state’s doctors took new Medicare patients, only 38 percent of primary care doctors did.

Currently, about 40 million Americans have Medicare insurance, according to medicare.gov. Coverage is provided to those 65 or older, some younger disabled people and people of all ages with end-stage renal disease.

Those approaching Medicare eligibility should talk to their doctors. Even doctors who won’t take new Medicare patients may be willing to allow their existing ones to remain in their care. If they are not, it’s advisable to start looking around. But the search will be easier for people who start early.

“If you have just moved into town and are 64,” said Dr. Jeffrey P. Harris, an internist and the president of the American College of Physicians, “it is easier for you to see a doctor than if you had just moved into town and are 65.”

Before giving up on a doctor who will not accept Medicare, a patient should ask about signing a private contract that stipulates the patient will be responsible for paying the doctor’s fees and lists exactly what those fees are and what they cover. Some doctors may be willing to negotiate and tailor prices to what patients can afford.

For example, a doctor who charges younger patients with employer health coverage $250 for an office visit might be willing to accept $175 from an older patient who pays cash and requires no insurance claims.

“I have a lady of 93 who pays me $5 a visit, and for her that’s real money,” said Dr. Steven D. Knope, an internist and private contract doctor in Tucson. “I charge her because then she listens to what I say.”

How do you find a doctor who accepts Medicare? The Web site www.medicare.gov provides a list of enrolled doctors. Other sources are state medical societies and local hospitals, most of which have online directories of doctors. But that’s no guarantee they will see new patients.

Other options are also available. Roughly 18,000 walk-in, stand-alone urgent care centers in the United States are staffed with doctors who set simple fractures, take X-rays, do minor surgery, diagnose ailments and write prescriptions. By far the majority of these centers take Medicare.

Although they were never intended to provide continuing care, “our primary care practice is growing more than anything else,” said Dr. Franz Ritucci, who is medical director of the American Academy of Urgent Care Medicine and practices at America’s Urgent Care in Orlando, Fla., a chain of walk-in centers that also has clinics in Columbus, Ohio.

The centers are open 12 to 18 hours a day and patients do not need an appointment, though they may have to wait. Some centers allow appointments to see a specific doctor for follow-up.

“If you can hook up with a primary care provider in an urgent care center who is willing” to provide continuing care, said Dr. J. James Rohack, a cardiologist who is president-elect of the American Medical Association, “then yes, it’s an option.”

Type “urgent care centers” into a search engine and thousands come up. In June, the Academy of Urgent Care Medicine plans to add a list of centers it has accredited to its Web site, www.aaucm.org.

Another, more expensive option is concierge or “boutique” care, which comes in two forms. In the most popular kind, doctors accept Medicare and other insurance, but charge patients an annual retainer of $1,600 to $1,800 to get in the door and receive services not covered by Medicare, like annual physicals. Before signing up and paying the retainer, patients should get a written agreement spelling out which services the doctor will bill Medicare for and which the retainer covers. And always check carefully for double-billing.

The other form of concierge medicine — doctors who have opted out of Medicare — is more expensive still. Fees range as high as $15,000 a year and cover office visits, access to the doctor when care is needed, referrals to specialists and thorough annual physicals.

Dr. Knope, the author of “Concierge Medicine: A New System to Get the Best Healthcare,” has this kind of practice in Tucson. His patients sign a contract agreeing to pay $6,000 a year for individuals and $10,000 a year for couples. The fee covers office visits, physical exams and phone consultations, and Dr. Knope will meet patients in the emergency room, see them in the hospital and occasionally make house calls.

A list of about 500 concierge doctors throughout the country is available on Dr. Knope’s Web site, www.conciergemedicinemd.com.

Is the care worth the money? Harold and Margret Thomas, who are in their mid-70s and live in Cincinnati, spend the winter in Tucson. After many phone calls, the couple were unable to find an internist in Tucson who took new Medicare patients, so they signed with Dr. Knope in 1996. Five years ago, when Mrs. Thomas developed a blinding headache, her husband called the doctor at 8 o’clock one night, and he, suspecting an aneurysm, insisted they get to the emergency room immediately.

The doctor met them and ordered an M.R.I. and a CT scan. The tests revealed an aneurysm, and Dr. Knope found a surgeon who quickly operated. Medicare paid for the emergency room, the surgery and the hospital stay.

“If there were a concierge practice in Cincinnati, I’d be part of it there, too,” Harold Thomas said.

Digital Publishing for Seniors - find digital editions of senior resource guides, magazines, brochures and newspapers at the the web’s only interactive library for aging adults at www.after55.com

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Another great and yet brief video by The National Academy of Elder Law Attorneys, Inc. on Medicaid.  Any family looking for a reputable and knowledgeable attorney who specializes in elder law should visit the website for the National Academy of Elder Law Attorneys at www.naela.com . You will find a list of Elder Law attorneys in your state.

Digital Publishing for Seniors - find digital editions of senior resource guides, magazines, brochures and newspapers at the the web’s only interactive library for aging adults at www.after55.com

The National Academy of Elder Law Attorneys, Inc. released this video on Medicare.  I always look for short videos which provide good food for thought. It is easy to get overwhelmed when faced with the complexities of medicare. Broken down into smaller parts it doesn’t seem quite as daunting. Take a little bite and chew on the rest when you have a chance. Mentioned in the video is the government site which is packed with a lot of information. There are 2 more videos in this series; Medicaid and Guardianship. Any family looking for a reputable and knowledgeable attorney who specializes in elder law should visit the website for the National Academy of Elder Law Attorneys at www.naela.com . 

Digital Publishing for Seniors - find digital editions of senior resource guides, magazines, brochures and newspapers at the the web’s only interactive library for aging adults at www.after55.com

National Academy of Elder Law Attorneys, Inc. has released a few videos which are short but full of good information. This video on health care decision making is excellent. Over the next few days I will share more videos by the National Academy of Elder Law Attorneys. There are 3 more videos in this series; Medicare, Medicaid and Guardianship. Any family looking for a reputable and knowledgeable attorney who specializes in elder law should visit the website for the National Academy of Elder Law Attorneys at www.naela.com . I’ve had first hand experience with attorneys from this group and have nothing but deep respect for their dedication to serving all aging adults. Enjoy the video…

photo courtesy of flickr and onkel wart

I found this article in the New York Times. My mother died of COPD, better known as emphysema. Upon reading this article I naturally wondered if my mother would have stopped smoking had she been told earlier in her life that smoking was aging her lungs prematurely. Having my mother die of COPD caused me to be an advocate in support of any assistance which helps an individual stop smoking. As we get older, our lungs are aging normally and the cigarette smoking speeds up the aging of the lungs. Why cut our lives short? No one deserves to die of COPD and certainly no family deserves to watch their loved one die of any type of lung disease.

New York Times

Reminder to Smokers: Your Lungs Are Aging
By NICHOLAS BAKALAR

A simple discussion of lung capacity appears to double the rate patients follow a doctor’s advice to quit smoking.

A study published online March 7 in the British journal BMJ suggests that if a doctor tells smokers their “lung age” — the age of the average healthy nonsmoker who would match them in breathing strength — they are more likely to stop smoking.

Using a spirometer, a device that measures how fast and how much air a person can breathe, British doctors tested 561 smokers, men and women with an average age of 53.

Half were randomly assigned to receive their results as lung age, explained with a chart showing lung capacity as it normally decreases with age. The other half were told the amount of air in liters they could force out in one second and were to return in a year “to see if there has been any change in lung function.”

The subjects with readings that suggested a medical problem were referred to their physicians.

Regardless of the results, all participants were advised to quit smoking, informed about government programs to stop smoking and told that the test of lung function did not show anything about other serious diseases that smoking causes.

Twelve months later, the scientists tested participants for carbon monoxide in their breath and cotinine in their saliva, reliable indicators of smoking. Of those who were not told their lung age 6.4 percent were no longer smoking, and 13.6 percent of those who knew their lung age had quit.

Dr. Gary Parkes, the lead author and a general practitioner in Hertfordshire, said that at first the smokers were not highly motivated to quit. More than 60 percent had made no plans to do so.

According to background information in the report, a physician’s simple advice results in a 4 to 6 percent rate of quitting.

“All smokers should have a lung function test,” Dr. Parkes said. “Sixteen percent of our sample had lung damage they didn’t know about. And communicating lung function as lung age is a good psychological tool for helping people make decisions about their own health.”

There was no evidence that subjects with poorer lung function were more likely to quit. A 45-year-old who was told her lung age was normal was as likely to stop as one told her lung age was 65. Although the study could not prove it, merely being presented with the facts of lung function in a vivid and understandable way was apparently enough to encourage people to stop smoking.

The authors speculate that when told lung function is normal, a smoker feels encouraged to quit before it is too late, and when shown that it is abnormal is motivated to stop by the fear of further deterioration. The precise psychological forces remain unclear, but the scientists cite previous research that suggested that information presented as a prospect for gain is more persuasive than negative messages about costs or disadvantages.

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Dr. Marion Somers always shares brief but highly informative information. When I first heard this short video I was struck by the simplicity of her wise words. Preparing every aspect of a trip to help insure a smooth “ride” for a traveling senior is the right way to go. My mother-in-law wants to take the train to come visit us however she gets overwhelmed that she might get mixed up on the train. We are going to visit her and ride back on the train with her so we can make sure we arrange every detail so that when she does travel alone, she will know exactly what to expect. Don’t let our aging family members stay at home. Help them prepare for a trip so they feel safe when they venture out of their secure environment.

Increasingly, many older people who live alone are not truly alone. They are being watched by a flurry of new technologies designed to enable them to live independently and avoid expensive trips to the emergency room or nursing homes.

Bertha Branch, 78, discovered the power of a system called eNeighbor when she fell to the floor of her Philadelphia apartment late one night without her emergency alert pendant and could not phone for help.

A wireless sensor under Ms. Branch’s bed detected that she had gotten up. Motion detectors in her bedroom and bathroom registered that she had not left the area in her usual pattern and relayed that information to a central monitoring system, prompting a call to her telephone to ask if she was all right. When she did not answer, that incited more calls — to a neighbor, to the building manager and finally to 911, which dispatched firefighters to break through her door. She had been on the floor less than an hour when they arrived.Technologies like eNeighbor come with great promise of improved care at lower cost and the backing of large companies like Intel and General Electric.

But the devices, which can be expensive, remain largely unproven and are not usually covered by the government or private insurance plans. Doctors are not trained to treat patients using remote data and have no mechanism to be paid for doing so. And like all technologies, the devices — including motion sensors, pill compliance detectors and wireless devices that transmit data on blood pressure, weight, oxygen and glucose levels — may have unintended consequences, substituting electronic measurements for face-to-face contact with doctors, nurses and family members.

Ms. Branch, who has severe diabetes and heart disease, said she could not live on her own without the system, built by a Minnesota company called Healthsense.

“I lost a very close friend recently,” she said. “She was also diabetic and she fell during the night. She didn’t have the sensors. She went into a coma.”

Without the sensors, Ms. Branch said, “I would probably be dead.”

Stories like Ms. Branch’s show the potential of relatively simple devices to provide comfort and independence to an aging population that is quickly outgrowing the resources of doctors, nurses, hospitals and health care dollars available to it.

The cost for Ms. Branch’s basic system, supplied by a health care provider called New Courtland as part of a publicly financed program, is about $100 a month, far less than a nursing home, where the costs to taxpayers can exceed $200 a day. In the two years Mrs. Branch has had the system, she has fallen three times and been stuck once in the bathtub, each time unable to call for help without it.

“On an individual basis, we’ve demonstrated that they can be very effective,” said Brent Ridge, an assistant professor of geriatrics at Mount Sinai School of Medicine in New York. “But until they’re launched on a wide-scale basis, you just don’t know. Physicians might say, ‘I’m already overstretched, I don’t have time for all this data.’ ”

At a white ranch-style house in Middletown, N.J., Joseph Hayduk, 86, a retired Air Force lieutenant colonel, is greeted by a voice from a small box: “Good morning. It is now time to record your vital signs.” Mr. Hayduk has been using the device since 2006, after his second heart attack, through a program run by Meridian Health.

He stepped on a scale. “Are you experiencing more difficulty breathing today, compared to a usual day?” the voice asked. Mr. Hayduk pressed yes.

“That’s normal for me,” he said.

“Are your ankles more swollen than usual?” the machine asked. In patients with chronic heart failure, swelling or weight gain can indicate that they are retaining fluid. Mr. Hayduk pressed no. After a blood pressure reading, the device signaled that it had relayed the information to Meridian Health.

There, a nurse calls all 18 patients in the program daily, starting with the ones whose data call for urgent attention. One morning, Mr. Hayduk left the house before the nurse’s call. As he sat on his neighbor’s porch, he watched a police car pull up to his house to check on him.

Mr. Hayduk chuckled at the memory, but said that the system had allowed him to stay in his home of 37 years.

“This system’s invaluable to me, not only physically, but psychologically,” he said. “I don’t want to be in assisted living. That’s for people in wheelchairs and walkers.”

Philip Marshall, 85, another Meridian Health patient, uses a system tied to his cellphone to help him remember his medications. Mr. Marshall has high blood pressure and macular degeneration, and takes 10 pills a day. He cannot see a clock or work the buttons on most phones, so he uses a Jitterbug, a phone with big buttons and limited functions.

Drug compliance is one of the biggest problems for the elderly, especially those with memory loss. Until Mr. Marshall got Meridian’s Jitterbug system, his daughter Melanie, 55, said she had to leave work several times a month to help him with his drugs. “I’m answering the phone in meetings,” she said. “He’d forget whether he took a pill or whether he was supposed to take a pill.”

The system, which costs $20 a month, calls him after he is scheduled to take a pill and asks if he has taken it; if not, it asks him why not and sends automated alerts to his daughters.

“I worry a lot,” Mr. Marshall said. “All my life. So this gives me peace of mind.”

He added that knowing that a call was coming had helped him remember to take his medications before the phone rang.

This is the ultimate goal of personal health monitoring — that people who know they are being watched may modify their behavior to better their health. Jeffrey Kaye, director of the aging and Alzheimer’s and memory assessment clinics at Oregon Health and Science University, said one of the most useful health technologies was a cheap pedometer, because carrying one motivated people to walk more.

But Stuti Dang, who directs dementia care for the Miami Veterans Affairs Healthcare System and uses monitoring systems to track the vital signs of 400 patients, said one unforeseen consequence of the system was that “it somehow absolves their kin of the responsibility.”

“The daughter doesn’t have to call every day because she knows if something was wrong with her father, she would receive an alert,” Dr. Dang said, adding: “It’s good for the patient, but there needs to be personal responsibility. As a provider, I don’t want to be responsible for my patient 24 hours a day.”

Raymond Carroll, 59, a retired school administrator, said he went online every day to check on his mother, Viola Carroll, 85, who lives in a building in Queens run by Selfhelp, a nonprofit organization that assists Holocaust survivors. Mr. Carroll checks the temperature of her apartment and calls if it is too hot. Since a system of motion detectors called Quiet Care was installed three years ago, on a grant from Selfhelp, he said he probably called more often but visited less.

Marvin Joss, whose mother, Ray, 89, is also in a Selfhelp building, said the system had helped improve their conversations. “In the past, I tried to spend more time on, ‘How are you feeling?’ ” Mr. Joss said. “I still ask those questions, but now it’s more to an idea of having a conversation, not trying to listen for clues about whether she’s O.K. ”

The future of these technologies, and the terabytes they gather, can involve unprecedented information about the whereabouts and well-being of older people. In a program with Intel, Dr. Kaye is combing motion data for patterns that indicate the onset of dementia, years before the decline shows up on cognitive tests.

But until there is more research — and reimbursement — the technologies’ ultimate impact remains unknown.

“It’s not that we need new technologies,” Dr. Kaye said. “We need to use what we have more creatively. It’s all cool — but is it going to be helpful?”

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photo courtesy of flickr and tero maaniemi

I am on a roll as here I go with another cute joke I received last night. Hope it brings a chuckle.

Three women, two younger and one senior citizen were sitting naked in a sauna. Suddenly there was a beeping sound. The young woman pressed her forearm and the beeping stopped. The others looked at her questioningly. ‘That was my pager,’ she said. ‘I have a microchip under the skin of my arm’.

A few minutes later, a phone rang. The second young woman lifted her palm to her ear. When she finished, she explained, ‘That was my mobile phone. I have a microchip in my hand’.

The older woman felt very low-tech. Not to be out done, she decided she had to do something just as impressive. She stepped out of the sauna and went to the bathroom. She returned with a piece of toilet paper hanging from her rear end.

The others raised their eyebrows and stared at her. The older woman finally said….Well, will you look at that…I’m getting a fax!!

Digital Publishing for Seniors - find digital editions of senior resource guides, magazines, brochures and newspapers at the the web’s only interactive library for aging adults at www.after55.com

when an old grandpa walked by.

And one of the old grandmas yelled out saying, ‘We bet we can tell exactly how old you are.’ The old man said, ‘There is no way you can guess it, you old fools.’

One of the old grandmas said, ‘Sure we can! Just drop your pants and under shorts and we can tell your exact age.’ Embarrassed just a little but anxious to prove they couldn’t do it, he dropped his drawers.

The grandmas asked him to first turn around a couple of times and to jump up and down several times. Then they all piped up and said, ‘You’re 87 years old!’ Standing with his pants down around his ankles, the old gent asked, ‘How in the world did you guess?’

Slapping their knees and grinning from ear to ear, the three old ladies happily yelled in unison — ‘We were at your birthday party yesterday!’

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I received this “touch”ing article about what massage does to help the loneliness in a seniors life and wanted to share it with all of you. An astounding 75% of all seniors who reside in assisted living or nursing homes never get visitors much less get touched. I hope this wonderfully written article will inspire someone to visit their loved ones and touch them. I know in my own life what a gentle touch does for me and although this article is wrtiten about massage easing the elderly’s loneliness, a gentle touch can also bring joy to a senior who needs to know they are still loved and cared about.

Using Massage to Ease the Elderly’s Loneliness
Lifespan: Hands to Hold
By Karrie Osborn
Originally published in Massage & Bodywork magazine, August/September 2004.
Copyright 2004. Associated Bodywork and Massage Professionals. All rights reserved.

Loneliness Can Find Us All
It’s not that she was neglected or abandoned by her family. She hadn’t been cheated out of a full life, and she wasn’t bitter about the cards she’d been dealt. On the contrary, she was a happy, well-loved woman who was full of faith, even after being widowed for more than 20 years. But no amount of faith could keep this elderly woman from being struck with loneliness after sitting alone, day after day, in her new home — a 12-by-12 room in a full-care nursing facility. She would rarely let on to her family that the isolation could be overwhelming, but visits started to end with extra-long, extra-tight hugs, and phone calls were a welcome lifeline to the world.This woman was my grandmother, and it wasn’t until she one day shared with me her joy of massage that I understood how much the comfort of touch had come to mean to her and how much it put loneliness at bay.

My grandmother is the perfect example of someone who learned a lot about touch near life’s end.

She had to move into a nursing home in her early 80s when she could no longer care for herself. Her son brought as many of her worldly possessions into the room as he could, trying to create an environment of comfort for her after living most of her life in the family home my grandfather had built.

She admitted early on how many changes she’d had to make to survive in this new setting. The first, and the biggest, was the relinquishing of modesty. Having had only her husband and the occasional doctor touch her body before, she now had to accept the many hands that came to her aid on a daily basis, including the young man who helped bathe her. Still, she was initially more accepting of this act of touch than that of simple foot massage. In her mind, massage involved very personal interactions she was not ready to accept.

It took time, but eventually my grandmother began looking forward to seeing the massage volunteer who brought oils and strong hands to nurse her feet and ankles. She told me how good the massage made her feel, and while I knew that the therapy certainly helped her arthritic body, I also knew that her greatest comfort came in simply being touched by another human being.

I regret that I couldn’t have been geographically closer to my grandmother to offer her my own hands for comfort, but I do take solace in knowing that she had the courage to let a stranger bring massage into her life and, with that, found the power of touch.

Walk into any nursing home today, and you’ll see them: The aging lonely. They are easily recognizable. Look for the sadness on their faces, the pain in their eyes. With a television on for company, these men and women sit alone in their rooms. Their shelves are bare, their bulletin boards void of pictures, cards, or any memento denoting love from the outside. Those sad eyes may even hold a twinge of bitterness, asking, “Why am I still here with no one to love me?”

So many elders face their final years alone, in a nursing home, with few of the daily comforts they once knew so well. With friends gone or fighting their own battles against the ravages of time, and with families consumed with daily strifes, the last stages of life can often be spent in isolation — both physically and emotionally. Even the best nursing facilities and the best staffs can be too overwhelmed with standard care needs to offer much time to their residents for conversation, laughter, or especially touch.

While massage is not a replacement for all that family and friends can do to fill the aching heart, or what a grandchild’s gentle touch to the cheek can mean, when given with the compassion with which it is intended, massage can, quite simply, do miracles for the spirit.

Trying to Reclaim Our Touch Instincts
After decades of mechanization, we are now understanding (or rather remembering) the great significance human touch has on us — from birth to death. The “new world” offerings that automation once promised in the 1950s are slowly being replaced in the new millennium with more hands-on approaches.

So now, for example, instead of outright shunning the act of breastfeeding, as was the rage 50 years ago when 96 percent of new mothers bottle-fed their infants,1 we’re once again embracing the importance of putting a child to the breast not only for its nutritional benefits, but because of the importance of that early touch experience.

We’re also reclaiming our instinct to nurture the ill and dying, both in an attempt to revive health and/or offer transitional compassion. Yet, we haven’t embraced this population as openly with our touch as we have the young child. Something still holds us back from easily touching the elderly with their fragile, wrinkled skin.

“Touch is a natural and therapeutic way of being with the elderly. It is relaxing and healing, and at the same time pleasurable and sacred,” writes Mary Ann Finch in her book Care Through Touch. Yet, she says, “Touch and its life-enhancing benefits are too frequently denied the elderly in our culture.”

Is it that the elderly remind us too much of our own mortality? Ashley Montagu, author of the groundbreaking work Touching, says indeed it is our “unwillingness to face the fact of aging” that allows us to pretend it doesn’t exist. He says it is this blinder mentality that is the principal reason for our inability to truly understand the needs of the elderly. “The most important and neglected of these needs is the need for tactile stimulation,” he writes. “One has only to observe the responses of older people to a caress, an embrace, a handpat, or clasp, to appreciate how vitally necessary such experiences are for their well-being.”2

Massage is one way to bring touch firmly back into the lives of the forgotten, the abandoned, and those who are alone in this new stage of life. Whether it be a family member, a nurse, or a trained practitioner, offering massage to this segment of society can be a key to its lasting happiness.

Touch Benefits
Just as with any other age group, massage has proven to be physically beneficial for the elderly, too. Massage has shown to improve circulation of both blood and lymph, stimulate the nervous system, soften tight muscles, and enhance function of the digestive and respiratory processes.3 Administering touch to the elderly can also increase appetites, decrease the need for pain medications, calm agitated states, promote restful sleep, and decrease post-surgical recovery.4

But beyond the physical, massage has a more emotional benefit for the elderly client — to sweep loneliness away.

“Touch becomes increasingly important for those in extended care homes who receive few visitors from the outside world,” says Dawn Nelson, author of From the Heart, Through the Hands, and founder of the Compassionate Touch program. “Though their basic needs are met, these men and women can remain starved for the nourishment that comes through one-on-one attention and skin-to-skin human contact.”5

Nelson’s work in a variety of care facilities has afforded her the opportunity to see many examples of this touch deprivation. “I have encountered residents in the hallways and doorways of nursing homes reaching out their arms and, quite literally, crying to be touched, longing for contact and for acknowledgment of the continued worth of their existence.”6

It is with the elderly that touch can have the greatest significance, Montagu says. “It is especially in the aging that we see touching at its best, as an act of spiritual grace and a continuing human sacrament.”7 Having someone take their hand, stroke their arm, or rub their feet can open the world back up to one of hope and love. Isolation can be swept away with a single stroke of the hand. “Tactile needs do not seem to change with aging,” Montagu writes. “If anything, they seem to increase.”8

Sharon Puszko, director of the DayBreak Geriatric Massage Program, says the act of offering touch to the elderly for emotional benefits is profound. “I think it’s as important as the physical benefits,” she says. “Sometimes the physical conditions are manifested because of the person’s loneliness and stress of being alone.” Giving that client an opportunity to interact with you can mean so much for their well-being, Puszko says.

With nurses, aides, and doctors having only minutes to offer, perhaps touch therapists are the only real visitors coming to see these elderly clients and interact with them. “And, even when they don’t feel like massage, just hold their hand and talk,” Puszko adds. “Let them talk about anything — their new hairdo, what they had for breakfast, their new doctor. When they have someone really listening to them, it stimulates their happiness and well-being.”

Nelson says in addition to fighting off loneliness, caring touch helps address other quality of life issues for the elderly, such as depression, feelings of isolation, lack of self-esteem, and anxiety.9 Touch sessions offer an opportunity for sensory, tactile, and mental stimulation and a context for social interaction, she says. They provide companionship, nurturing, and a certain type of “nourishment” that is sometimes lacking in nursing care.

Good News
The good news is that newly-built care facilities are starting to add wellness centers to their sites, and nursing homes are gradually finding the dollars to hire on-site massage therapists for their residents. An increasing number of younger massage therapists are looking to the geriatric field as a means of specialization and as a viable option for avoiding burnout and professional injury.

Puszko says while the majority of elderly clients she personally works with are still paying for massage out-of-pocket, more and more families are understanding there’s such a thing as geriatric massage and finding ways to give it to their loved ones. “They used to think, ‘I can’t have anyone beating on my mother like that,’ but now they understand what geriatric massage really is … and that it’s not sports massage,” Puszko says. “I think they understand that Mom would much rather have a massage than another nightgown.”

Remembering
For those outside the massage profession, touch is an age-old gift many forget they have. It’s given freely to our children and our spouses, but we often overlook its power on our elders, especially as an emotional salve. The role of the massage therapist is to remind us of that gift and all it can offer to the world.

In her book, Untouched, Mariana Caplan sums it up nicely: “Though we cannot heal the soul-wound by an affectionate pat on the back, for those who have felt unloved all of their lives, a small act of kindness can shake their whole perspective about who they are in the world. Touch, when done with heart, is always healing — period.”

Karrie Osborn is contributing editor to Massage & Bodywork magazine.

References
1 Montagu, Ashley. Touching, New York, NY: Harper & Row, 1986:71-72.
2 Ibid., 395.
3 Finch, Mary Ann. Care Through Touch, New York, NY: Continuum, 1999:16.
4 Nelson, Dawn. From the Heart, Through the Hands, Scotland: Findhorn Press, 2001:20.
5 Ibid., 42.
6 Ibid., 44.
7 Montagu, 396.
8 Ibid., 395.
9 Nelson, Dawn. From the Heart, Through the Hands, Scotland: Findhorn Press, 2001,43.
10 Caplan, Mariana. Untouched. Prescott, AZ: Hohm Press, 1998:xxiii.

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Photo courtesy of Flickr and bfraz

I was sent the story I am about to share and I always give credit to the author but I have no idea who wrote this beautiful piece. It brought tears to my eyes which is not why I am sharing but rather that I hope it helps each of us to reach out to others. As you read this story remember that people may not remember exactly what you did, or what you said, but they will always remember how you made them feel.

“I arrived at the address where someone had requested a taxi. I honked but no one came out. I honked again, nothing. So I walked to the door and knocked. ‘Just a minute’, answered a frail, elderly voice. I could hear something being dragged across the floor. After a long pause, the door opened. A small woman in her 90’s stood before me. She was wearing a print dress and a pillbox hat with a veil pinned on it, like somebody out of a 1940’s movie.

By her side was a small nylon suitcase. The apartment looked as if no one had lived in it for years. All the furniture was covered with sheets. There were no clocks on the walls, no knick-knacks or utensils on the counters. In the corner was a cardboard box filled with photos and glassware. ‘Would you carry my bag out to the car’ she said. I took the suitcase to the cab, and then returned to assist the woman.

She took my arm and we walked slowly toward the curb. She kept thanking me for my kindness. ‘It’s nothing’, I told her. ‘I just try to treat my passengers the way I would want my mother treated’. ‘Oh, you’re such a good boy’, she said. When we got in the cab, she gave me an address and then asked, ‘Could you drive through downtown?’ ‘It’s not the shortest way,’ I answered quickly. ‘Oh, I don’t mind,’ she said. ‘I’m in no hurry. I’m on my way to a hospice’.

I looked in the rear-view mirror. Her eyes were glistening. ‘I don’t have any family left,’ she continued. ‘The doctor says I don’t have very long.’ I quietly reached over and shut off the meter. ‘What route would you like me to take?’ I asked. For the next 2 hours we drove through the city. She showed me the building where she had once worked as an elevator operator. We drove through the neighborhood where she and her husband had lived when they were newlyweds. She had me pull up in front of a furniture warehouse that had once been a ballroom where she had gone dancing as a girl.

Sometimes she’d ask me to slow in front of a particular building or corner and would sit staring into the darkness, saying nothing. As the first hint of sun was creasing the horizon, she suddenly said, ‘I’m tired. Let’s go now’. We drove in silence to the address she had given me. It was a low building, like a small convalescent home, with a driveway that passed under a portico. Two orderlies came out to the cab as soon as we pulled up. They were solicitous and intent, watching her every move. They must have been expecting her.

I opened the trunk and took the small suitcase to the door. The woman was already seated in a wheelchair. ‘How much do I owe you?’ she asked, reaching into her purse. ‘Nothing,’ I said. ‘You have to make a living,’ she answered. ‘There are other passengers,’ I responded. Almost without thinking, I bent and gave her a hug. She held onto me tightly. ‘You gave an old woman a little moment of joy,’ she said. ‘Thank you.’

I did not pick up anymore passengers that shift. I drove aimlessly lost in thought. For the rest of that day, I could hardly talk. What if that woman had gotten an angry driver, or one who was impatient to end his shift? What if I had refused to take the run, or had honked once, then driven away? On a quick review, I don’t think I have done anything more important in my life. We are conditioned to think that our lives revolve around great moments. But great moments often catch us unaware - beautifully wrapped in what others may consider a small one”.

Let’s end by saying that life may not be the party we hoped for but while we are here we might as well dance. The world can get very lonely as one gets older and getting out becomes more difficult. Remember to visit your loved ones or anyone who is getting on in their years.

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