Long Term Care for The Aged: Hidden In Plain Sight
One of the most amazing things that happened to me while I was living in Doha was a conversation I had with a group of Qatteri and Palestinian women. We were talking about our summer plans, and when it was my turn, I told them I was going back to the US to take care of my Dad while my Mom had a knee replacement. They all looked at me in stunned silence, and I wondered what I had said wrong.
“You do this?” one of them finally asked me, “You take care of your parents?”
“Yes, of course,” I replied, not understanding her puzzlement.
There was a burst of excited chatter I couldn’t follow, and then one of the younger women said to me “but we NEVER see this on TV.”
Things have probably changed by now, with all the cable stations available, with Lifetime and a broader spectrum, but what they think of as America is Dynasty and – well, think of what your favorite programs are, and then imagine an alien culture watching and trying to figure out your culture from what you watch. If you are living with the aliens, they way we portray our own culture on television and in movies is appalling!
Long story short, most adults want to stay independent as long as possible. They never want to be a burden on their sons and daughters and grandchildren. I am willing to bet that this is almost universal. For one thing, from the point of view of the aging, if you live with someone else, you know you will increase their work load, and if you go to a facility, you lose a lot of options to choose. Being able to have someone to come into your own house allows you to remain independent as long as possible. If you live with one of your children, you still get to have home-care, which relieves a lot of the burden on those with whom you are living.
Here is an AOL Health News article on a ‘hidden’ provision of the new health care act which will make it possible to keep our elders at home longer. Believe me, this is a very good thing, if you have ever dealt with a rehab facility, or a residence for the aged.
Health Care Reform Will Impact Long-Term Care
From AOL News: HealthCare
Robert W. Stock
Contributor
(March 26) — As health care reform became the law of the land this week, a huge bloc of Americans with a unique interest in the outcome sat watching on the sidelines.
The 49 million people who care for older family members were hidden in plain sight, as usual, quietly shouldering a burden that so often takes a heavy toll on their finances and their physical and emotional well-being. Many of them — I know a few — are opposed to the new health care law, even though it includes one of the most important steps ever taken to improve caregivers’ lot, especially those of the middle-class persuasion. Of course, hardly any of them are aware of that.
The Community Living Assistance Services and Supports Act, otherwise known as CLASS, provides for a national insurance program to help cover the cost of long-term care — something 70 percent of people over 65 will need at some point along the way. The premiums will be much lower than those for private plans, and you won’t get screened out because you’ve already had some health problems. Once vested after five years, enrollees unable to care for themselves will be able to claim cash benefits for as long as needed.
Joe Raedle, Getty Images
A health aide helps a patient at his home in Miami. The new health care reform law could “transform long-term care” and make it possible for more patients to stay at home, said the chief of the National Council on Aging.
If you’re rich, you don’t require much financial help with long-term care. If you’re poor and can no longer fend for yourself, Medicaid pays the bills, often at a nursing home. For the rest of us, long-term care — at home or in an institution — now requires that we, or our caregivers, choose from among some unpleasant options.
We can spend down our retirement savings until we’re eligible for Medicaid funds. We can protect our savings by taking out expensive long-term care insurance — it costs my wife and me more than $5,000 a year. Or, depending on how dependent we are, we can throw ourselves, or be thrown, on the mercy of our families.
My friend — I’ll call him Frank — was a retired lawyer and in great shape until four years ago. He had just turned 90 when emergency surgery laid him low for months on end. Then his sight and hearing began to go. “I’m one of the lucky ones,” his wife, Helen, told me. “His mind is fine. But he can’t get around on his own — he falls, even with a walker. He can’t make a cup of tea or shower by himself.”
For now, Helen can afford to hire an aide for a few hours a day to help with Frank and allow her to get out of the apartment. “James gives me a life,” she said. The future looks darker.
Surveys show that 90 percent of Americans want to age at home. Frank is no exception, but he never signed up for long-term care insurance. “If I couldn’t keep taking care of him, I don’t what I’d do,” Helen said. “If he went into assisted living, it would use up all our money. It’s very scary.”
CLASS, one of the legacies of the late Ted Kennedy, offers caregivers and care recipients another option. “If it’s successful, if a large enough number of people sign up, it will transform long-term care,” says James Firman, president and CEO of the National Council on Aging. “It will create a market-based economy for keeping aging people at home.”
That’s an important “if,” since the program, by law, must be self-sustaining. Premiums will generally be collected as part of workers’ payroll deductions unless they opt out. The younger the worker, the smaller the premium.
There is a vicious circle built into the current arrangements. Many caregivers must hold down a job and maintain their own separate family household while also watching over an aging parent. That kind of pressure can have consequences.
In recent studies, workers 18 to 39 years of age who were caring for an older relative had significantly higher rates of hypertension, depression and heart disease than non-caregivers of the same age. Overall, caregivers cost their companies an extra 8 percent a year in health care charges and many more unplanned days off.
In other words, the strains of family caregiving can hasten the caregiver’s need to be the recipient of care.
CLASS bids to crack if not break that vicious circle. Its benefits would make it much simpler and less expensive for families to make sure Mom gets the support she needs to be able to spend life’s endgame where she wants — in her own home. Good news for Mom, and good news for the future health of her caregivers.
In the last few days, I’ve conducted a poll of a dozen friends who have been closely following the health care reform debate. I wanted to find out how much they knew about CLASS.
Not one among them had even heard of it. It somehow seemed fitting that this major program, just like the caregivers themselves, was hidden in plain sight.
Every Monkey Gets His Turn in The Barrel
AdventureMan and I have this phrase, and I cannot imagine where it came from (from where it came, for you grammar sticklers!) “Every Monkey gets his turn in the barrel.” It’s particularly true in the workplace, or at least almost every workplace where I have worked – it’s like the stock market, sometimes your stock is high, sometimes your stock can fall, and often, it is not so much your performance as the PERCEPTION of your performance.
Often, in the work place, stocks rise and fall based on little or nothing at all. In fact, if you are really really good at what you do, you are sometimes more at risk, because those who are less accomplished always need to focus the attention anywhere but on their own work, and if you are doing well, they will often find something to criticize to keep their own lackluster accomplishments from coming into focus.
But every monkey getting his/her turn in the barrel applies in almost all factors of life. Sometimes you’re up. Sometimes you’re down. Sometimes it has nothing to do with you, it’s just the way things are.
So my trip home was sort of my turn in the barrel. I was a little late getting to the airport, which was not crowded, but there was a long back-up going through passport control to get to the departure gates. They had plenty of staff, but for some reason, they were SO SLOW. When I got to the front, the woman ‘taking care’ of me was busy texting! I asked if the computers were slow today – honestly, she had already stamped my passport, she was just killing time – and she said “No, why?” as if she were unaware of all the people standing in line, waiting to get through.
When I got to Dubai, I had to do this 2 km run from the gate where Emirates comes in to the Delta check-in counter. I always think of it as good exercise, but the humidity in Dubai is particularly high, or else the air conditioning is going out, and at the end of the trek, I am almost soaked with sweat and thinking ‘OMG I need a shower.’ I went to the lounge, but there was a sign “opening at 2100 hours’ and it was 15 minutes after nine. I could see someone in there, but later she stuck her head out and said she couldn’t let anyone in until the ‘attendants’ came, which they did, about 15 minutes later – they had been shopping!
And then I discovered that I had to go to the Air France lounge, not nice at all, near the smoking station so even inside the Air France lounge it smells stale and smokey. I am spoiled. I love the Emirates lounge in Dubai, where they even have tiny small containers of Haggan Daaz ice cream for their clients. 😉 This lounge was filled with American contractors. Yes, we are also American contractors, but this was the other kind – great big fat loud-voiced men, bragging about their salaries and demeaning their wives. I couldn’t wait to get out of there, which I did quickly after checking my e-mails.
The flight from Dubai to Atlanta is just long – more than 15 hours – and started inauspiciously. As we took off, as the plane’s nose lifted, some cupboard fell open and we could hear china and cutlery falling and breaking, a lot of it. I felt so sorry for the flight attendants; they have a lot to do during those flights, and now it was complicated by a disaster at the beginning of the flight. I got through it, mostly by escaping into sleep.
As we arrived in Atlanta, everything had changed. I just did this trip six weeks ago, but there is a new traffic pattern, a longer trek, sterner instructions about how and where to get into line. My bags, marked “priority’, were, as often is the case, nearly the last off the plane, and I trundled them through customs, and then had to run (honestly, this is like a herd of cattle) to get into another long, snaking line to go through security again – this time in Atlanta, where you have to take off your shoes, take out computers, can only use a 1 quart zippering plastic bag, etc.
I had thought I had plenty of time, but a large troop flight came in from Afghanistan, and we all had to move aside to give them priority. That is the one inconvenience I did not mind at all – I am so proud everyone moved over with no grumbling and let our servicepeople through, to get them on their way for R&R.
Security found me very interesting, and this is my own fault. I have a little Waterford crystal sugar jar that I took with me. I’ve had it since the early years of our marriage, and I often hand carry it to the next post. It’s too bad that lead crystal goes opaque in the scanners, and that the shape was a little like that of a hand grenade. I also had my wireless router with me, and this led to a long, long, very long inspection of everything I was carrying.
As I griped later to my son, he said “And I am sure it never occurred to you that you were arriving from the Middle East on a one-way ticket.”
LLLLLOOOOLLLL @ me. Nope. It had never occurred to me. I guess I was thinking about other things – farewells, clearing out the house, packing, mortgage papers, insurance papers, TAXES (Oh aaaAAARRRGGHHH, yes we have an extension, but we still have to get them done!)
So this trip, I was the monkey. I rolled around in that barrel. Actually, because I had no real agenda, other than be in P’cola by Monday to close on a house, I could roll with it and figure that I have had so many breaks, so many times, that if I needed to take this roll in the barrel, so be it, God is good and needed to give the breaks to that old guy in the wheel chair and that family with two kids in strollers, and all those fine young people who serve our country in strange and alien lands . . .
And, at the end of my journey is my son, his wife, and our grandson, and a sweet, relaxed day with them, doing not much but catching up. 🙂 The real chaos starts this coming week, early on Monday morning. Think I’d better get to church, get some fortification for the demands of this coming week.
“Health Care Could be Fixed Overnight . . .”
Today, AOL ran commentaries on American health care and whether the new proposals will make a difference. The comment of one CEO who runs an enormous health provider, caught my eye. As I read it, I thought “he is talking about the USA, but the exact same thoughts apply to Qatar, to Kuwait, to Germany, where an epidemic of self-inflicted health problems is growing wildly.” And it also occurs to me that he is laying the accountability squarely where it belongs – on our shoulders.
David Feinberg, M.D., M.BA.
CEO, UCLA Hospital System
“The debate they’re having now in Washington is the wrong discussion,” says Feinberg. “They’re not talking about health-care reform. They’re talking about health insurance reform. The bill in Congress has nothing to do with health care.” He explains that health care could be fixed overnight if people would stop using alcohol and drugs, eat right and exercise.
“I have 800 patients in this hospital today, and I bet 50 percent of them have illnesses that could have been completely prevented,” Feinberg says. “That situation is not going to get better with a ‘public option.'”
He points out that even people without health insurance can receive care when they need it in the emergency room, and, while it’s not ideal, they’re not being denied care because they don’t have health insurance. “It’s impossible to give high quality, low cost care to everyone. What we need is to decrease demand for health care.”
According to Feinberg, some 75 percent of illnesses are treated at home, whether that’s a bad cold or a sprained ankle, and he says that health-care reform should be focused on home care. “When you compare us to other countries with similar Gross Domestic Products, they spend half what we do on health care because they have a different lifestyle,” he says. “We either need to change our lifestyle, or it’s going to be very expensive.”
“With all due respect,” he adds, “the surgeon general is obese. I don’t think the President of the United States should be solving this.” Rather, he says, each individual needs to come to terms with the fact that eating right, exercising, and avoiding smoking and alcohol will transform not only their own lives but the ever increasing cost of health care in this country.
You can read all the commentaries on AOL Health News. I know most of us in my age group need more exercise (not you, Big Diamond!) and are beginning to stave off the common age-related problems of high cholesterol, high blood pressure, obesity, diabetes, aches and pains, etc. We all KNOW we could be eating better and exercising more. We are smart educated people – but do we do what we know is best for ourselves? NNoooooooooooo!
I see the same epidemic striking in Germany, in Qatar and in Kuwait, people who have enough to eat are eating too much. Yes. Yes. I’m guilty. And I exercise a lot less than I need to. I was so happy to get back into a house, with stairs, so at least I would get the exercise of going up and down stairs a few times a day.
Japan has instituted a national policy of health, measuring citizens waists and penalizing them for carrying too much weight. I will be interested to see how it works out, if it pays off in health benefits and lowered costs down the road. It’s an inspired mandate.
Places I’ll Remember . . .
I’m not very good at being sad. Today is one of the saddest days of my life. I’ve been weeping all day, and I’m not one of those women whom the camera loves when they weep. My throat gets thick, so clogged with emotion that I can’t talk clearly, and my eyes get all red and swollen. My cheeks get all blotchy. I hate it, my eyes are leaking, and my nose is running. I think I’ve got it all stopped, and it all starts up again.
Most of the house is packed, the kitchen cupboards cleared out and all the goods not going with us distributed. I weep as I pack my bags. I weep as I take out the garbage. I weep as I load one last load of wash into the washer.
“What is it in particular?” AdventureMan asks me, as I weep, yet again, as I start to write this entry.
“It’s the end of an era,” I choke out, and the tears start rolling once again in spite of all my efforts not to succumb.
“We’ve lived our lives as nomads ever since we met,” I continue.
“It isn’t like we want to live in Doha forever, Doha is changing, too, old friends are leaving.”
“It isn’t like I love packing up and starting over in a new place.”
“I shouldn’t have scheduled to leave on a Friday after church,” I philosophized, but it’s too late now. The waterworks started in church and have turned on and off with ever fresh goodbye.
I steeled myself to smile cheerily at my oldest friends, knowing we’ll meet up again – a wedding, a retirement, a gathering of old hands. But small things defeated me. The friends who switched their normal place in church and sat beside us. The communion hymn “Lord of the Dance” sung as a duet. One of our friends provided our very very favorite meal for lunch. The priest blessing my travels and sending me on with the prayers of the people. The difficult ceremony of saying goodbye to the people we love in a place which has nurtured us, spiritually and socially.
And one young woman painted a watercolor for us of our new grandson.
It is a stunning watercolor, I can hardly wait to have it framed. There is something very special in it – I have a friend who knits, but is constantly telling us how badly she knits. She knit a blanket for the grandson, and it was COLD in Pensacola, and that blanket was used over and over again. The blanket is in the lower left corner of the watercolor. 🙂
It’s going to be a long trip to our new life. We are going to a happy place – sunshine, but not so much heat. Humidity and lightning, but also four seasons and seafood. Our son, his wife, our grandson. All these are happy things. Our new house, a new life, closer to our families. All good things.
I couldn’t leave without saying goodbye to my Palestinian friend, like my sister, and she shared all her children with me through these years of friendship. Saying goodbye to her was horrible. We know we may never see one another again. Her daughters assure me they will help us correspond; they will help her use modern technology to stay in touch. 🙂 I don’t know when I will ever see her again . . . and it breaks my heart. I guess I kind of thought she would come visit me. “No,” she said sadly, “no, I will never have the right papers to visit you.” Until that moment, I hadn’t realized how devastating are the restrictions on her life. And I’m just a friend. She hasn’t seen her own father, in Palestine, for years. Sometimes they can meet up in Egypt. . .
I’m not the first expat to leave here. One good friend left Doha last summer, she led the way. We all know that leaving the nomadic life is charting new territory. We’ve had a lot of fun, we’ve loved (most of) the expat experience. We know it’s time. It’s just the inner twenty-five year old is not ready.
AdventureMan’s company keeps saying “when you’ve had a break . . . ” and AdventureMan laughs and says “I’m not taking a break, I am RETIRING!” His company is savvy; they know that three months down the road the domestic life may get a bit old for these high testosterone kind of guys and they will invite him back for a special project or two. He promises me, if it is Doha or Kuwait, I can come with him. Even just a week or two, to see old friends . . . I’ll take it!
Thanks be to God, for creating us, and for giving us this wonderful life we were created to live. Thanks be to God for all these great adventures, for the exotic, the sights and smells and sounds, and for the eyes to see and the ears to hear. Thanks be to God for the generous spirited friends called to his life, who have shared the path with us. And thanks be to God for this outlet, this blog, where I can share the good, the bad and the ugly with friends from all countries who have ever lived as strangers in a strange land (even when that ‘strange’ land is the USA, LOL!) Thank YOU, friends.
Polite Reminder
Don’t you love this sign? It is so polite! Asking people not to smoke, even though it is outside, and – LOL – even though this restaurant encourages shisha smokers!
Early Morning Souk Al Waqif
One set of packers coming mid-morning, so AdventureMan is staying home, and offers to take me out to breakfast. I’m a cheap date – take me to the Beirut. I love this place.
As we get to the camel lot, we see they are being fed and dressed – a parade?
These guys look sharp. They have a lot of pride in what they are doing. And they have a dashing uniform. He told us they are a part of the Emiri Diwan.
On to the Beirut, and one of my reasons for loving these breakfasts – the souk cops, on their horses. The horses are beautiful, and well controlled. The cops are friendly and patient with all the tourists, and with us ‘locals’ too, when we ask them to pose with our Flat Stanleys. 🙂
It’s a real treat for AdventureMan to have a morning when he can sit outside with me and enjoy his favorite kind of breakfast:
We walked through the souks, and found that by 9:30, it is beginning to get HOT.
Tawash Restaurant
We didn’t end up at the Brussels. As we walked into the souks, we smelled a whiff of grilling meat and decided we wanted Arabic food while we could get it. We walked up and down and decided this was the night to eat at the Tawash.
The Tawash is gorgeous. Somebody put a lot of thought into it. You can eat outside, along the walkway, or outside on the balcony, or outside on the upstairs terrace. Or you can eat inside, in a private dining room, or in a large dining room that can be separated by tent-like hangings that drop down between tables. It is beautifully thought through.
We chose the balcony – we wanted to be outside, but I don’t like to eat right out on the street, with people walking by and oogling my food.
We started with hummus and baba ghannoush, served with hot hot bread:
And then we had two great dishes, a traditional Kepsa (mensaf in Jordan) which is rice cooked with delicious spices and, in this case, chicken:
And a shrimp dish, the shrimp marinated in yoghurt, then fried, accompanied by fried vegetables, sort of like tempura – the batter was very light:
And we finished with strong, grainy coffee:
If you have special guests in town for only one night, this would be a great place to take them. It is a beautiful building, it has character and charm, the food is very good, the service is attentive without being intrusive, and it has a kind of magic, a uniqueness that sets it apart from the chains of restaurants also in the souks. If the weather allows you to sit outside – do so. Part of the charm for us was the great parade of humanity passing by as we conversed and ate. It’s an altogether lovely restaurant.
Clean Carpets
If you are parking in the parking lot on the upside of the long restaurant street, near the Beirut, near Dhow roundabout, and you look at the souks, there is a whole area down on the left that is being developed. There is a large interior souk with abayas and scarves, for example, and a man with the model tents that they will make for you.
There was also, recently, a man cleaning a carpet. I was fascinated. We have carpets. They need cleaning. I have seen carpets cleaned at car washed, and hung on racks to dry. It does not seem to me that people wash these carpets with enormous care, they just wash the carpets.
I would rather like to wash some of our carpets. This man gave me an idea how to do it – gentle detergent in a bucket, a gentle brush, like a dishwashing brush – and the carpet is flat on the ground. I can do this!
No! No! Proposed Traffic Law Change is a Step Backwards!
You see it all the time, at the roundabouts. Those fellows – it’s always guys – in the hot cars, the Porche, the Cayenne, I don’t even know all the names. The light turns red; they don’t care. They see a gap, they go.
I would love a look at the statistics. I would love to see who is getting all the fines for jumping the red lights. I bet 90% are all the same nationality.
And now they want to LOWER the fine for running the red light???
Just when Qatar has proudly announced that traffic deaths are falling dramatically with the ENFORCEMENT of the new, stricter laws?
No! No! A moderation of this fine is a step backward! Please, please, don’t do it!
Lower fine proposed for running a red light
The Advisory Council seeks a review of the traffic law
By Nour Abuzant
Staff Reporter
The Advisory Council has proposed a review of the traffic law with a stress on reducing the current fine of QR6,000 for jumping the red signal, a member of the council said yesterday.
According to him, the draft proposal recommended a significant cut in the fine and suggested that the penalty be structured around a more practical model based on the circumstances of the violation and the number of times a motorist committed the same offence.
Senior officials of the Traffic Department had defended the stringent rules which came into force in October 2007, saying they had been issued to combat the mounting number of traffic accidents which claimed scores of lives on the country’s roads.
Advisory Council member Mohamed al-Hajery, who was one of the 20 citizens felicitated by the Traffic Department for their clean traffic record yesterday, told reporters on the sidelines of the ceremony that the House preferred a more pragmatic approach to the issue.
The awarding ceremony was part of Qatar’s celebration of the GCC Traffic Week, currently being held under the slogan “Beware of Other’s Faults”.
“The tendency of my fellow members is to take into consideration the number of previous traffic violations and the circumstances involving the jumping of the red-light,” al-Hajery said.
“You cannot treat someone who jumped the signal after a minute the light turned red and after a fraction of a second it turned red from orange,” he said.
“I think that the appropriate fine for a driver who jumped the red light without a criminal intention is QR1,500 – QR2,000.”
Al-Hajery stressed that his pleading for a more lenient treatment did not mean he was promoting traffic violations. “Anyone who deliberately jumps the signal should be treated like a potential killer and no mercy should be shown to him.”
He said he was in favour of treating each case of jumping the red light individually.
The Advisory Council members had on February 19, 2008, refused to ratify the 2007 law, arguing that “ it did not strike a balance between the crime and the punishment”.
In late July 2008, the Advisory Council members gave the law a “test period” that ended in October 2008, to check the effectiveness of the law.
The law had introduced for the first time a negative points system that might lead to the suspension or cancellation of driving licences.
The Advisory Council member said that he was personally against the system. He explained: “Sometimes, the (negative) points are registered in the driver’s account and sometimes against the owner of the vehicle. In some cases, your son drives the car and you sustain the points. It is an ineffective system and should be re-examined.”
However, Traffic Department director Brigadier Saad al-Kharji on Sunday said he was not aware of any intention to reduce, at least for the time being, the current fines.
“Anybody who respects the traffic regulations has nothing to fear,” he said arguing that after two and half years of its implementation, the law had “proved effective in reducing the number of casualties, if we take into consideration the increasing number of vehicles in the country”.
He said: “Our target is to save lives on Qatar’s roads and there is no fine that can equal the life of a human being. It is not true that our aim was just to collect money.”
Which Restaurant??? Which Hotel???
From Gulf Times
Restaurant at five-star hotel ordered to close
Municipal authorities have ordered the closure of a restaurant in a prominent five-star hotel in Doha for non-compliance of regulations, says a report published in a local daily.
The hotel authorities have been charged on the count of not obtaining health clearance certificate for the staff employed in the restaurant. A charge-sheet was framed by the prosecution after a full investigation and the matter has been referred to a court of law.
“It is the result of the periodic random inspection carried out by the authorities on all the eateries,” says the report.
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