Fading from Memory

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Wednesday 20 February 2008

Money matters

Yesterday Greg, Rachel and I met with a financial adviser to go over mum and dad's financial position in detail.

This exercise involved identifying assets and income which the government deems relevant to calculating both the up-front costs and on-going costs of their care. We were able to do rough calculations around the table, and what we concluded is based on the following goals:
  1. getting mum into care as a concessionary patient, which means she will not have to pay a bond
  2. getting dad into care without having the house counted as an asset
  3. minimising the on-going daily care charges for the two of them.
We can achieve 1 by reducing their assets by $65,000 - so we are doing this right now, as mum is already in care and we therefore have a deadline. We are making the maximum permitted amount of gifts ($10,000) to the four children. We are going to prepay mum and dad's cremations (about $15,000) and we are finally going to get some necessary repairs done to the house (about $40,000). To pay for this we have to sell the few shares they own, cash in a matured life insurance policy and some bonds, and dig into their bank accounts.

We will keep the house and rent it to tenants. For some reason, if we do not pay the full bond of $250,000 for dad, and pay interest on an outstanding part of it, the house is not considered an asset, and this position can be extended indefinitely. The rent is not considered income either. This seems too good to be true.

The result of all this is that while mum and dad are in care, if we are successful in keeping the house tenanted, they will have a net income of about $20,000 per annum, after paying the costs of their care. This seems very comfortable, especially as it can continue indefinitely.

Monday 19 February 2007

Blog innards

Here is a quick reference page on this blog, for anyone interested in how I use it. I use different software to post, view and analyse the blog. Items in red are those that I have continued to use beyond the initial period of novelty fascination.

Blog software
: DotClear (the Gandiblog version, which is in very limited release)

Statistics: Sitemeter, Google Analytics, DotClear, StatCounter, Histats, Performancing

Editor and XML-RPC front end: Performancing, Deepest Sender

Browser: Firefox 2

RSS feeds: Firefox 2 (via Live Bookmarks) and Thunderbird (via RSS Accounts)

Networking: Technorati, Del.icio.us, and practically every other such service under the sun. Boring, boring, boring. Too much trouble to look after, nothing much in the way of additional traffic. Not interested in using any of these any more.

Milestones

17 July 2006: first post
27 July 2006: first comment
16 August 2006: plugged the blog on Alzheimer's Association Caregiver's Forum
22 August 2006: plugged the blog on Alzheimer's Association Caregiver's Forum
8 November 2006: 5,000th page viewed ("Telephone tag" by Gail Rae Hudson at 18:49)
20 November 2006: plugged the blog on Dementianet.com.au
21 January 2007: 10,000th page viewed
19 February 2007 (today): 13,422nd page viewed

Explanations of my software selections:

Dotclear: came free with the 'fadingfrommemory.info' domain, required no downloading of software, looked a little different, worked fine from the beginning, has introduced nice new features every few weeks. Developed by a good bunch of French guys.

Sitemeter: simple and straightforward, real time, sends out email reports, loads quickly, allows browser and IP address blocking. Seems unable to display a counter in some browsers.

Google Analytics: by far the most comprehensive and profession of the free statistics services I've come across. Nice graphics, long logs, huge range of options, agrees with Sitemeter, but not quite real-time. Requires Flash.

StatCounter: very similar to Sitemeter except that the graphics are a little more sophisticated. Differences: shows return visitors and can display a counter on all my browsers. No longer consulted; Google Analytics is making StatCounter redundant. Left a suspicious cookies on my machine.

Histats: beautiful graphics from Italy, does not allow blocking, requires Flash, does not email results. On-site counters also require Flash.

Performancing - for stats: no need to download a page to see stats, but they are limited and inaccurate. So inaccurate as to be useless, in fact. I have removed Performancing for stats, but see next.

Performancing - for editing: a great little front end to any number of blogs, cannot yet set tags remotely but wil allow selection of categories, accepts most formatting, allows remote deleting and replacement of posts, and local storage of drafts.

Deepest Sender: never worked very well with DotClear as it is not fully compatible with Movable Type blog software.

Firefox 2: seems to be always ahead of Internet Explorer, does not have as many security holes, and doesn't attempt to take over your computer. Using RSS feeds is a piece of cake - and saves a lot of time when looking for updated blogs. Has many useful add-ons (one of which is Performancing. I use others for VoIP, a British dictionary, translations, constant update of Google AdSense data and advertisement blocking.)

Thunderbird: stores email files in transportable, human-readable formats. Seems to be ahead of Outlook in filtering, junk mail controls, RSS feeds (which automatically download comments from my blog).

Comments on my statistics:

I do not count my own visits or page views. I think if a visit extends beyond 30 minutes it counts as two. Counters are oddly inaccurate. StatCounter and Sitemeter, for example, only approximately agree. All statistics are therefore only approximate, though reasonably close to the truth. My blog site also gives statistics based on server logs, which show about twice as many visits as the counters - including Google Analytics - that are based on small scripts.

Thursday 1 February 2007

The big question (part 4)

I must admit I was a little puzzled not to have heard from my brother Derek in response to the 'big question' posts. Then, on second thoughts, I calculated that he was unlikely to say anything until he knew what he wanted to say - and on this particular subject that doesn't happen instantaneously. Sure enough, yesterday I got a rather good email from him, which I reproduce here:

Mike,

I have been watching you blog for the past few days but wanted to chew things over before replying.

Looking at your four goals, it occurs to me that goal two is probably the key.

It is easy for me to say that the main criterion for deciding the timing of placing Mum and Dad in a home has to be the well being of you, Rachel and Greg, because I won’t have to physically move them. I will not have to sell the house and contents, take Mum and Dad to the home, leave them there and then carry the departure image with me. I will not have to live with the knowledge that I physically placed my parents in a home. I will not have to endure the inevitable pleas to take them away from the ‘hateful place’ and back to a home which no longer exists. I,therefore, see this decision as being a balance between the stress which you suffer as a result of their remaining at home (together with any potential guilt which may arise if they injure themselves) and the feelings which may well arise if they go into an institution.

Clearly, the fact of having this discussion means that the wellbeing of Mum and Dad is an issue which needs to be considered but I think that the context given above is important, not to say crucial. Having said this, I am unsure how one measures ‘wellbeing’ for AD sufferers unless it is the absence of stress as the disease progresses. In this situation maybe death is the ultimate state of low stress and thus of wellbeing!

When Janet and I were leaving the UK to live in Tokyo I took Rebecca, then aged 15, to stay with friends as a paying guest for about 12 months. I shall never forget how lost she looked sitting in her room, surrounded by her belongings and among people whom she knew but who, in this context, were strangers. I still feel guilty after 18 years and I have had the advantage of being able to talk to Rebecca, subsequently, and express my regret.

Any distress being suffered by Mum and Dad will be over in a few years, but any guilt which you, Rachel or Greg carry may go on for much longer.

I was interested to read your analysis of your feelings for Mum and Dad as well as your more general musing on the nature of love. It was as though I was listening to my own thoughts.

Regards

Derek

Well, I took everything he said very seriously. In fact, many of the comments that have been left over the last few days have also struck very resonant notes. It has been so far a very worthwhile exercise trying to think aloud in public.

Wednesday 31 January 2007

The big question (part 3)

A couple of days ago I received an email from Patty Doherty. I'd just thanked her for the thought-provoking comment she left recently. Patty's email was also thought-provoking, and it seemed a waste that only I got to read it. Here, with Patty's permission, is what she said:

Mike,

Please understand by leaving that comment, I in no way am implying you need to live up to anything. With this disease, there is such a battering of one's ideals, it's hard to even recognize oneself in what remains.

The fact is Alzheimer's is completely destructive. If our life is a construct of all we have done and failed to do in our lives, Alzheimer's is its deconstruction. And we, the witnesses of our parents dismantling, are left to cobble together, as best we can, a constantly failing system of care. The care and treatment of Alzheimer's patients is severely neglected by society, because it's hidden. When you mention that you are unable to find adequate services for your parents at home, you will be very surprised to find its just as tough to get adequate services in a nursing home. If you feel a pain in your stomach, it may be indigestion, or it may be the feeling one gets when over a barrel. Can't get decent care at home, can't get decent care in a nursing home. All of it, ever last bit of my experience was heart shredding. And what you probably already know, a nursing home's location/cost/experience does not confer quality of care. I am afraid if you were to set up your hidden granny cam in any nursing home - pick one - you would have more information than you could bear.

Are there any opportunities for live-in care at your parents' home? Where a person might be able to move in, care for your parents and earn a living wage doing so? Are there other families attached to the elders at the day care who could pool resources and live together with the help of live-in caregivers? In my experience, one experienced caregiver could provide care for 3-4 Alzheimer's patients, but not more than that. When I hear numbers like one caregiver for eight patients, I laugh out loud at the ludicrousness of the proposition. It is impossible. Unthinkable.

I am no expert, but I have a hunch we will find no "official" help that will be acceptable to us. I think quality care will only be found by organizing dedicated family members, friends and hired caregivers to help and pooling resources with others in the same boat. By combining other families, and setting up systems of care, sharing the load, there may be some truth to the strength to handle this disease being found in our numbers.

The question is, who would do the organizing? Who would put the systems in place? Who would start the process? Who would see that it works?

Then I have this question. If one family/group can make it work, can it be duplicated? Can it be offered as a guide to other families? Can we start putting together success stories, where families pull together instead of apart because they've found a way that can work?

And then, is this idea impossible or are we just led to believe that it's impossible? You are a system's person. Does it seem that impossible to you? I believe we are built/designed to love and care for our parents. I believe it is a natural part of our innate structure to care for the very young and the very old. I believe it is very doable, but we haven't figured it out quite right in this day and age. But I think we can. Especially with the technology available to us. Web cams, instant messaging, the power of blogging to connect one person in sunny Florida with another person in frigid Colorado with another clear across the world in New Zealand. If we can do that surely we can keep our parents safe and sound, even in their addled, demented final years.

And then my last question, why can't it work? Why can't we make it work? Why can't this be done? Not by government, not by social services, not by countries, but by children who happen to love their parents? You know how many families are going through this?

Nursing homes have made a fortune off of our stupidity and lack of organization. We can change that. We can ignore them and build a better way to care for family members when they're old. If we don't do this, who will? Who should do this, if not us?

Just some thoughts, based on my own constant "what if"-ing.

Patty - stepping down off her shaky, wobbly, soapbox...

My answer to all of these questions is that I know families could look after the elderly, infirm and demented - it is just that we have organised our society, and our comcomitant lifelong goals, desires and plans, around an image of life that doesn't have these problems. When they do arise, quite naturally, generation after generation, we go into shock and surprise and mouth the words, 'This wasn't meant to happen to me! I've been pretending all my life that this wasn't going to happen!'

I get the impression that for close family to take the full burden of care for the demented would require such tectonic shifts in society that it would be of a scale with our coming, tortured, decades-long, attempts to kick the oil habit.

I wrote back to Patty:

I think you are right that the community, with a little bit of  reorganisation, could probably provide superior care to its elderly. I envisage a village of about 15 huts. Little children who are too young to work in the fields play with their grandparents and great-grandparents, and come running to their parents sometimes: 'Come quickly! Granddad's gone oft into the woods!' Older children lead them back. If grandma wanders into the wrong house, someone just shoos her out the door and points out the right one.

Instead, we've made our neighbourhoods so dangerous by mixing traffic with housing, We lock kids away, either at home or in school, and none of us gets introduced to dementia until we have to, so many of us grow up thinking of it as something rather distasteful and shameful. We move away from home as adults, and then add great distances to all the other problems.

When we were younger, my mother looked after her father as well as her own children. It added to the work considerably, but if she had been paid what we now contemplate paying a nursing home for similar services - she would have thought she'd found heaven!

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