Aging Parents: Is It Better To Have A Friend Be Your Doctor?

January 20th’s NY Times, Science Section’s “Hard Cases” column, Too Close to a Patient for Comfortmakes the case, based on AMA guidelines and other sources, that objectivity in medical care may be compromised by doctor-friends. “Medical care supplied by a relative — or an old friend, or a trusted employee — just seems so logical. After all, who could care for you more? But that is just the problem…”

The article triggered 2 thoughts and a dilemma:

1. When I was too young to know about medicine, I remember hearing that a doctor could not do surgery on a family member. Might have been true—or not. A playmate was having surgery. She was 9.

2. In graduate school, the professor in “Techniques of Counseling” gave us a practical list of counseling do’s and don’ts followed by his saying something like: “Be forewarned: if you’re trying to counsel a family member, your emotions will dictate and you may forget this.”

If the emotional ties of friendship can interfere with doctors’ objectivity, how does this impact our emotional needs? And how do we reconcile this when it comes to helping aging parents, the elders we care about, and ourselves?

Boomers and those older, remember doctors who knew your family, possibly made house calls, and definitely made hospital visits. It was more “warm and fuzzy” then. Today’s efficiencies, however, dictate something entirely different.

I hear people say “It’s not the doctor’s “bedside manner” that matters. Agree. Knowledge and expertise are most important. But it helps if we feel s/he cares about us, doesn’t it?

Three people immediately come to mind. They don’t have friends as their doctors; yet they’re confident in their doctor’s ability to is do what’s best for them and they feel a certain bond–perhaps a professional-type friendship. Another commonality: they make every effort to take care of themselves to the best of their ability. It appears doctors appreciate this.

1. Several weeks ago I reconnected with a dear friend, living in a large city in the west where excellent healthcare is available. I was unaware that she has a serious, unusual vision problem. Asking about her doctor, she related she did the research and now has the best doctor–adding she was concerned that, because of her age (she’s on Medicare), it would be a challenge finding a doctor who would take her. Then she said, laughingly, something like “When we met he told me he isn’t taking new patients, but I’m ‘vibrant’ so he’s making an exception.”

2. Sr. Advisor R, at 101, has had many doctors and replacement doctors due to retirements. This last year a new best ophthalmologist  (taking few new patients) has been doing his best to maintain her sight, which was rapidly worsening.

She was initially concerned that he thought “She’s old, I can’t do much.” R made him realize she takes very good care of herself (corroborated by the lab tests her primary care doctor sent), lives in her home by herself, and will do everything possible to maintain her independence. He, like her other doctors, respects that–and her. For several months there was no improvement. 12 weeks ago there was slight improvement in one eye. I drove her to her last appointment and there was even more improvement in that eye. The doctor was cautiously optimistic; said to be sure to call immediately if she noted any change–not to wait for her next appointment. He wasn’t a friend but he cared. R’s spirits lifted.

3. Next I check with my friend of decades, who had polio as a child. In her mid-70’s, she has seen countless doctors who were not friends. “Confidence in them,” she says, is a must or she finds a new doctor. She has made changes over the years, as allowed in her health plan.

And we learn a tip–

She writes thank you notes after each appointment. The notes aren’t a hidden agenda to make them like her, she says, but actually to let them know that she’s very appreciative of their help. In addition, reading her note must make them think about her again after her visit. “It puts you on a level that most patients aren’t on,” she says.

A tip for us?–And for us as caregivers for aging parents.


Related: New England Journal of Medicine‘s May 2014: Ethical Challenges in Treating Friends and Family..

VA Aid and Attendance Pension to Get New Eligibility Rules

Veterans’ Important Aid and Attendance Information
Reblogged from

Help! Aging Parents has presented information for–and about–Veteran’s since a June 2010 post. This reblogged post by John Roberts, Esq. offers new and important information, in hopes that as many Vets and their spouses as possible have this information in a timely manner, read the proposed regulations, and submit comments in the link provided at the end of the article– if they feel the need.
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February 12, 2015  |  16 Comments  |

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VA Aid & Attendance Gets New Eligibility Rules

Editor’s note: This is part one of an overview of some of the proposed changes that will impact veterans and their caregivers.

Have you or a family member benefitted from elder care reimbursed by an Aid & Attendance pension?

An Aid & Attendance pension can provide a wartime veteran with up to $21,466 this year ($1,788 per month) to cover care at home or in assisted living. The surviving spouse of a wartime veteran can get Aid & Attendance pension reimbursement for up to $14,353 per year or $1,196 per month.
Source for Veteran’s Pension Rates
Source for Surviving Spouse Pension Rates
The Department of Veterans Affairs gave notice on January 23, 2015 that it will be changing the rules for pension eligibility. You have an opportunity through March 23rd to comment on the proposed changes. (My addition, Susan)

The web address to connect with the VA and comment is posted at the end of this article.
Read HTML version of proposed rules (24 pages–my addition, Susan)
Read PDF version of proposed rules
Here’s part one of an overview of some of the proposed changes that will impact veterans and their caregivers:

Net worth will track Medicaid asset amounts; assets will include your annual income.

Across the country, VA claims processors have been inconsistent about the amount of assets that veterans and their spouses who’ve applied for Aid & Attendance are allowed to have.

$80,000 has been the most commonly mentioned asset amount, but there has never been a written rule. The new “proposed net worth limit” will be a nationwide number that tracks Medicaid’s maximum community spouse resource allowance. This amount is currently $119,220.

But unlike Medicaid, the VA’s calculations would add an applicant’s annual income and assets to see if a veteran or spouse is over the $119,220 limit. “The amount of a claimant’s net worth would be determined by adding the claimant’s annual income to his or her assets,” according to the new rules.

There will be no hardship exceptions. The VA has concluded: “we do not believe that a hardship provision is warranted” because the proposed income and asset limit is greater than the $2,000 SSI asset limit that Social Security allows for people who’ve been impoverished by disability.

The VA would calculate (or recalculate) a claimant’s net worth when it receives a new pension claim after a period of non-entitlement, gets a request to establish a new dependent, or finds information that net worth has increased or decreased. An example of a change in information would be the income tax reporting that is required whenever anyone sells real estate, such as a house.

Your home doesn’t count as an asset, but there is a two acre lot limit.

The VA net worth limit “would not consider a claimant’s primary residence, including a residential lot area not to exceed 2 acres, as an asset.”

So, if your home sits on a farm or a plot of land greater than two acres (87,120 square feet), the extra land would disqualify you, “unless the additional acreage is not marketable. The additional property might not be marketable if, for example, the property is only slightly more than two acres, the additional property is not accessible, or there are zoning limitations that prevent selling the additional property.”

It doesn’t matter that you are not living in the home, even if you are being cared for in another state. The VA “would exclude a claimant’s primary residence as an asset regardless of whether the claimant is residing in a nursing home, medical foster home, or an assisted living or similar residential facility that provides custodial care, or resides with a family member for custodial care,” according to the new rules.

But soon after you sell the home, the sale proceeds count as assets. “Proposed § 3.275 would also provide that if the residence is sold, proceeds from the sale are assets unless the proceeds are used to purchase another residence within the calendar year of the sale,” the VA says. For instance, if you sold your house in December, you would have only a few days to decide what to do with the sale proceeds.

If you rent the home, the rent counts as income. “Any rental income from the primary residence would be countable annual income under § 3.271(d) for pension entitlement purposes (and thus would be part of net worth under proposed § 3.274).”

Additionally, the VA “will not subtract from a claimant’s assets the amount of any mortgages or encumbrances on a claimant’s primary residence.” Conversely, you could take excess assets and pay down a primary residence mortgage without causing a transfer penalty.

A 3-year look-back on asset transfers can cause a 10-year penalty period.

Unlike Medicaid, which has a five-year look-back to catch any disqualifying asset transfers, the VA has never in the past imposed a transfer penalty on veterans who gave away money to qualify for the Aid & Attendance pension.

But now, the “new requirements pertaining to pre-application asset transfers and net worth evaluations” will “establish a 36 month look-back period and establish a penalty period not to exceed 10 years for those who dispose of assets to qualify for pension. The penalty period would be calculated based on the total assets transferred during the look-back period to the extent they would have made net worth excessive.”

The transfer of a ‘‘covered asset” would “mean an asset that was part of net worth, and was transferred for less than fair market value. Transfer of “a smaller covered asset amount” would incur a shorter penalty period.

If you make a transfer during the three-year look-back period, then you must have clear and convincing evidence that transferring the asset was not “for the purpose of reducing net worth to establish entitlement to pension.”

Otherwise, the VA will deny your Aid & Attendance benefits for months or years, based on how much you transferred. The amount you transferred will be divided by “the maximum annual pension rate at the aid and attendance level” and the result (quotient) is the number of months you will be disqualified.

In the example of “a surviving spouse with no Dependents” the applicable MAPR (Maximum Annual Pension Rate) is $13,563, and the monthly penalty rate is $1,130. So, the formula for the penalty period is $10,000 ÷ $1,130 per month = 8 months.

After the penalty period is imposed, there will be a very tight time frame to solve the problem.The VA will only recalculate the penalty if (a) they made a mistake or (b) “if all of the covered assets were returned to the claimant before the date of claim or within 30 days after the date of claim.”

The regulations don’t explain how a veteran would know they needed to get assets back if the VA doesn’t give notice of the penalty during the month after the claim is filed.”Return of covered assets after the 30-day period provided would not shorten the penalty period,” according to the new regulations.

The VA justifies their strict time frame by saying the “[n]umerous penalty period recalculations would detract from the primary mission of paying pension benefits to those in need.”

Also be aware that, “[e]vidence showing that all covered assets have been returned to the claimant” must be provided to the VA within 3 months of the penalty notice.”

Do you have a problem with any of these changes? Do you have an experience with the Aid & Attendance program that can help the VA reform its Aid & Attendance rules more fairly?

Read proposed regulations and submit comments.

In my next article, I’ll provide more in-depth information on how the proposed changes will impact the cost of caring for a loved one and the restrictions the VA plans to place on Annuities and Trusts.

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Entertainment for Elders– Lifting Spirits in Winter

PFS Garden in Spring ~Click to enlarge

Philadelphia Flower Show ~2013  Spring blooms inside                      (Click to enlarge)

Lifting Elders’ Spirits, Lessening Winter Woes

Entertaining elders and aging parents in winter can be problematical. Too many storms and chilling temperatures lead to winter doldrums, especially in parts of the US this year.

Understandably many older people hesitate to go out, except for necessities. Cabin fever. Grumpy dispositions. Inertia.

The antidote: Think spring and take elders to a flower show. Leave the cold and the reality of leafless trees and non-blooming plants and enter the sunshiny atmosphere and beauty of spring.

Flower shows abound in February and continue for months. Chances are there’s one that’s not far away. No matter the size of the show, it’s uplifting to experience spring in winter.

Mature tree~in forest exhibit PFS 2014

Mature tree~in forest exhibit PFS 2014                   Click to enlarge

Major shows, like the Philadelphia Flower Show, import mature trees, thousands of flowering plants, and tons of dirt to create gardens of our dreams and beyond.

Philadelphia Flower Show 2013There may be entertainment. There are always exhibits, usually tempting plants and gardening accessories for sale, lectures, and something to eat.

Many shows are handicap accessible and have wheel chairs (some noted below). It makes sense to plan ahead for the major shows*.  Money-saving packages for hotels, transit etc. often exist.

Feb. 19-22: Connecticut Garden and Flower Show Connecticut Convention Center, Hartford.

Feb. 19-22: Rhode Island Flower & Garden Show “Garden Adventure,” Rhode Island Convention Center in Providence. Handicap accessible; wheelchairs available.

Feb. 20-22: Arkansas Flower & Garden Show” Statehouse Convention Center, Little Rock

Feb. 20-22 and Feb 27-March 1: Southern Spring Home & Garden Show “Carolina Calling,”The Park Expo and Conference Center, Charlotte, NC.

Feb. 21-Feb. 22: 19th Annual Garden and Bonsai Festival Davie, Fla.

Feb. 27-March 1: Vermont Flower Show “Spring Reflections, Champlain Valley Exposition, Essex Junction, VT. Check out “History and Fun Facts.”

*Feb. 28-March 8: Philadelphia Flower Show “Lights, Camera, Bloom” is among the largest and most prestigious flowers show in the world. So timely for those experiencing the winter that parts of the US has endured. Handicap accessible; wheel chairs available. March 11-15:

March 11-15: Boston Flower & Garden Show “Season of Enchantment.” 100 years old, show will be held at the Seaport World Trade Center. Limited number of wheel chairs available “on loan.”

March 14-22: Chicago Flower & Garden Show at Navy Pier. Wheelchairs available at no charge, first-come, first-serve.

March 18-25: San Francisco Flower & Garden Show “Mother Nature Going Wild,” San Mateo Event Center, San Mateo (I love the design, photos and color that come with scrolling down this link to the show.)

April 15-19: Cincinnati Flower Show “Celebrate Cincinnati,” in downtown Cincinnati along the banks of the Ohio River at Yeatman’s Cove.

According to Web MD, 1 in 4 people experience winter woes which normally end in April. A flower show may be just what the doctor ordered to lift their spirits.Click to enlarge



Related: Calendar of 2015 Flower Shows in US

Also related: “Beating Winter’s Woes,” Web MD


Elderly love–Desire too


What is it that’s so endearing about seeing an old couple holding hands, walking arm in arm, smiling at each other in that certain way?

Is it what each one of us hopes for when we hit the old age mark?

I remember my birthday party some years ago. It was a small dinner party with close family and friends–a mix of ages from my infant niece to three elders–late 80’s-mid-90’s.

We sat around a large table in a hotel’s small private dining room. When the meal was winding down, I asked a question of the older guests. It was something like: “What would you tell us younger people that we should know, but might not be aware of?”

The oldest guest, my friend’s mother in her 90’s (the lady I took to lunch at a bar for her 100th birthday) shared: “I may be old, but Inside I feel like I did when I was an 18-year-old (pause) with all the same desires too.”

It’s so easy to forget that inside an old body can be a young-feeling heart.

With wishes that we can help aging parents and the elders we care about
find that young spot in their hearts this Valentine’s Day.
From Help! Aging Parents

Aging Parents, Caregivers, Heart Health, Heart Risk

Women’s Heart Attack Symptoms and Caregiver Stress

Caregivers help 1.6 million heart failure patients at home–did you know that? Many of us have–or have had–elderly family with heart issues, mine included.

If validation is needed about the importance of heart health and heart risk
–The Centers for Disease Control and Prevention call February “Heart Month:
–The National Institutes of Health recognize the month, featuring a February 2015  “tool kit” from the American Heart Assn.
–The American Assn. of Heart Failure Caregivers offers  information especially for caregivers.
–This week, February 7-14, is Congenital Heart Defects Awareness Week.
–February 6th was National Wear Red Day 

Are we all getting the message? Heart disease is the #1 cause of death for men and women. Yet many women are still not aware, evidently. In addition, more caregivers are women, and with caregiving comes stress

Women’s symptoms are listed in the American Heart Association’s “Heart Attack Symptoms in Women (updated 12/5/14). Women either aren’t keenly aware of the symptoms or don’t become as alarmed as they should– or are we simply accustomed to enduring more and/or putting our needs behind those of others?

Clearly caregiving requires putting others’ needs before our own–and we get good at it, don’t we! We can easily feel we’re indispensable. We also know if we get very sick we’re of no help to anyone—but somehow the logic escapes us when we push and overextend ourselves.

A 2013 post “Attention Busy Women Caregivers (Is that an oxymoron?)” is partially reposted here. It features a well-done, entertaining short video “Just A Little Heart Attack,” starring and directed by Emmy-nominated actress, Elizabeth Banks. Worth taking about 3 minutes out of a busy life to watch.

Not wanting to exclude men here, I wondered why I couldn’t find a similar dramatically entertaining video featuring men and heart attacks. These excerpts from the AHA/ASA article may explain the reason. In short,

Many women do not recognize the warning signs or symptoms of heart disease, which may be subtler than those exhibited by men. In addition, only 53% of women said the first thing they would do if they thought they were having a heart attack was to call 9-1-1.


Women age 45 and older are less likely than men of that age group − 74% vs. 81% − to survive a year after their first heart attack. In women, heart disease is too often a silent killer – nearly two-thirds of women who died suddenly had no previous symptoms.

Is it a male-thing to be more attuned to recognizing the symptoms of a heart attack and quickly acting on them?

“Place the mask over your face and mouth, before helping others…” Remembering fight attendants’ speeches preceding a commercial airplane’s take-off resonates here, especially when our goal is to help parents and the elders we care about age well.

Mayo Clinic: Heart Disease: Women–Symptoms and Risk Factors
   Center for Disease Control: Men and Heart Disease Fact Sheet
   American Heart Assn. Recommendation for Physical Activity in
 View:Just A Little Heart Attack 

 Check out “Newsworthy” (right sidebar). Links to timely information and research from top universities and respected professionals, plus practical information–to help parents age well.

Special Sweets are Valentine’s Treats for Seniors and Elders

 Three Scrumptious Treats: Middle Eastern, French, American
Mouthwatering Middle Eastern Pastries from Michigan

Mouth-watering Middle Eastern Pastries from Michigan

 Many older people, seniors and aging parents, appreciate smaller portions and small tasty bites–shunning the big meals and all-you-can-eat excesses of their younger years. Metabolisms change, dietary issues develop but let’s face it, a sweet treat now and then lifts spirits. If not on Valentine’s Day—-when?
1.  Shatila’s Middle Eastern Pastries. A thoughtful guest brought a tray of the smallest baklava all the way from Michigan to last Sunday’s Super Bowl party. The little beauties–the smallest baklava I’ve ever seen–walnut, pistachio and–I believe–almond were heavenly–a bite or two. Perfect. Assuming that eating nuts and honey isn’t a problem, I can’t think of an edible Valentine gift aging parents and elders we care about would enjoy more.
2. Laduree, famous for their macaroons, opened a small shop on Madison Ave. in NY 3+ years ago. Lines were around the block and the small space continues to be crowded every time I’ve gone by. They now have a branch in lower Manhattan (Soho).
     While pricey their fillings are incomparable. Phone #s and addresses in above link. I don’t know whether they ship, but if you’re in NY or Paris it’s worth a special stop.

3. Bissingir’s (St. Louis, Mo.) and Harbor Sweets (Salem, Mass) make delicious chocolates. Sr. Advisor R loves the Sweet Sloops (gold box w/small sail boats–sloops) at right.
     With time running out, I rush to add these small, dessert sweets and chocolates–a guaranteed win with the elders on Valentine’s Day,….or on any other occasion.

Check out “Newsworthy” (right sidebar). Links to timely information and research from top universities and respected professionals, plus practical information–to help parents age well. Continue reading

Entertaining Elders, Seniors and Aging Parents: Super Bowl 2015 Commercials

"Lost Dog" Courtesy Budweiser

“Lost Dog” Courtesy Budweiser

"Lost Dog"--can anyone resist? Best Ad--Courtesy Budweiser

“Lost Dog”–can anyone resist? Most popular  Ad–Courtesy Budweiser

What could be better entertainment for aging and elderly parents than watching some of these commercials, if they didn’t see the game?

Sunday, February 1, 2015. Super Bowl XLIX –and parties. My Seattle friend told me the shelves usually stocked with chips were empty at her supermarket. While Seahawks’ and Patriots’ fans (male and female) were no doubt glued to their TV’s, mostly men occupied the room with the large TV at the party we attended yesterday (far from Seattle and New England).

Again this year I thought about aging parents and elders in care centers who were/are football fans, or simply watched past Super Bowl games looking forward to the commercials. And again, I wondered how many still watched on TV or had fallen asleep or no longer cared.

If spirits need lifting, watching that little puppy in this year’s most popular “Lost Dog,” plus a few other Super Bowl 2015 ads, could be just what the doctor ordered. Last year’s simple message “Dog loves horse” is replaced with “Lost Dog” but could just as well be “Horse Loves Dog.”

Check out selected links below, then pay a visit to aging parents or old people you care about with your laptops/tablets/notebooks and share. The videos make excellent conversation starters…not the same old subject matter. (You’ll also find, below, links to last year’s best commercials. They again still put a smile on my face, so I’m again sharing them with you.

Entertainment. When we bring the world in–especially to those who can’t get out–we add stimulation and hopefully engagement with something outside themselves. Many of last year’s commercials had simple, nice messages–“Dad saves son,”  “America is good,” “Dog loves horse.” Of the 50+ commercials this year, the six selected below are, I believe, most likely to resonate with older people. They aren’t easily categorized. The commonality: They’re all spirit-lifting and generate good conversation as we try to help the parents and elders we care about age well.

Lost Dog
Pay With Lovin’
My Bold Dad
Beautiful Lands
Real Strength

Puppy Love
America the Beautiful
Dad’s Sixth Sense

Note: As most know, for full screen, click bottom far right icon on ad’s screen

Check out “Newsworthy” (right sidebar). Links to timely information and research from top universities and respected professionals, plus practical information–to help parents age well.