Couple Married 72 Years Dies Holding Hands - Libby Deege

This has been going around online I thought I had to share! Who wouldn't want a love like this!!

An Iowa couple who was married for 72 years died one hour apart last week in the hospital as they held hands

On the day she graduated from high school, Norma Stock promised to spend forever with Gordon Yeager. The couple got married on May 26, 1939 in State Center.
"They're very old-fashioned. They believed in marriage til death do you part," said son Dennis Yeager.
Dennis Yeager was the youngest of four children born to the couple. His sister Donna was first born.
"Staying together for 72 years is good, I'd say that's exceptional," said daughter Donna Sheets.

The way the kids tell it, dad was the life of the party while mom kept everything together.

"Anybody come over -- she was the hostess with the mostest. She just seriously -- the more she did -- the more she smiled," said Dennis Yeager. "Dad would be the center of attention, like, 'Weee look at me,' and mom was like 'get him away from me!' You know we even got a picture like that."
Norma didn't really want the distance, and family said she hardly left Gordon's side for 72 years.
"They just loved being together. Everybody argues once in awhile, but they still, he said 'I have to stick around. I can't go until she does because I have to stay here for her and she would say the same thing,'" said Dennis Yeager. Dennis Yeager said the couple left home last Wednesday to go into town, but they didn't make it.

At the intersection of Highway 30 and Jessup Avenue just west of Marshalltown, state troopers said Gordon pulled in front of an oncoming car. The Iowa State Patrol crash report said the other driver attempted to avoid the crash but was unable to stop in time.

"I rushed from Des Moines where I was working and saw them in the hospital," said Dennis Yeager.
In the intensive care unit of Marshalltown's hospital, nurses knew not to separate Gordon and Norma.
"They brought them in the same room in intensive care and put them together -- and they were holding hands in ICU. They were not really responsive," said Dennis Yeager.

Gordon died at 3:38 p.m. holding hands with his wife as the family they built surrounded them.
"It was really strange, they were holding hands, and dad stopped breathing but I couldn't figure out what was going on because the heart monitor was still going," said Dennis Yeager. "But we were like, he isn't breathing. How does he still have a heart beat? The nurse checked and said that's because they were holding hands and it's going through them. Her heart was beating through him and picking it up."

They were still getting her heartbeat through him," said Donna Sheets.

At 4:38 p.m., exactly one hour after Gordon died, Norma passed too

"Neither one of them would've wanted to be without each other. I couldn't figure out how it was going to work," said Donna Sheets. "We were very blessed, honestly, that they went this way."
"They just loved being together," said Dennis Yeager.

At their funeral on Monday, Norma and Gordon held hands in their casket. Family said they will be cremated and their ashes mixed together.

Read the Full article at http://www.kcci.com/

Fall Foods!! - Libby Deege

Fall Flavors!!
Apple Crisp!

Ingredients
10 cups all-purpose apples, peeled, cored and sliced
1 cup white sugar
1 tablespoon all-purpose flour
1 teaspoon ground cinnamon
1/2 cup water
1 cup quick-cooking oats
1 cup all-purpose flour
1 cup packed brown sugar
1/4 teaspoon baking powder
1/4 teaspoon baking soda
1/2 cup butter, melted
 
Directions


1.Preheat oven to 350 degrees F (175 degree C).

2.Place the sliced apples in a 9x13 inch pan. Mix the white sugar, 1 tablespoon flour and ground cinnamon together, and sprinkle over apples. Pour water evenly over all.

3.Combine the oats, 1 cup flour, brown sugar, baking powder, baking soda and melted butter together. Crumble evenly over the apple mixture.

4.Bake at 350 degrees F (175 degrees C) for about 45 minutes

Sometimes favorite foods have a great story that makes the dish all the more delicious. It’s that way with Betty’s corn pudding, which she entered in the Homemade Memories Recipe Contest. The corn pudding is a favorite because her mother-in-law and father-in-law always had a garden in the country and would grow the corn, shuck it and deliver plenty to freeze.
Please share your story that will passed along to the next generation.  Be it a memory, or a favorite recipe.  I know for me personally it will be my Gram's molasses cookie recipe.  I was fortunate enough to snag the beat up old round tin that she used to bring them over in when we were helping her downsize.  Memories that will forever be rooted in my heart.  Share your stories here on on the Homemade Memories Facebook page.  You can also visit the Craving CompanionshipSM website at www.mealsandcompanionship.com for more ways to keep those memories alive. "Now this recipe is special to my grandchildren as they always request that I make it when they come over for special occasions such as Thanksgiving and Christmas. I always think of my father-in-law, how he used to work so hard to provide fresh vegetables for all his children. He is greatly missed." 

You are NEVER to old to learn something new!! - Libby Deege

For those of you who haven't seen this couple attempting to use their new Web Cam software take a few minutes and watch! Priceless...what can be learned from Bruce and Esther Huffman?

1. You're never too old to learn something new
2. You're never too old to be childish
4. You're never too old to be in love

Click here to watch video

What is Elder Abuse? - Libby Deege

Each year hundreds of thousands of older persons are abused, neglected, and exploited. Many victims are people who are older, frail, and vulnerable and cannot help themselves and depend on others to meet their most basic needs. Abusers of older adults are both women and men, and may be family members, friends, or “trusted others.”

In general, elder abuse is a term referring to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult. Legislatures in all 50 states have passed some form of elder abuse prevention laws. Laws and definitions of terms vary considerably from one state to another, but broadly defined, abuse may be:

•Physical Abuse - inflicting physical pain or injury on a senior, e.g. slapping, bruising, or restraining by physical or chemical means.

•Sexual Abuse - non-consensual sexual contact of any kind.

•Neglect - the failure by those responsible to provide food, shelter, health care, or protection for a vulnerable elder.

•Exploitation - the illegal taking, misuse, or concealment of funds, property, or assets of a senior for someone else's benefit.

•Emotional Abuse - inflicting mental pain, anguish, or distress on an elder person through verbal or nonverbal acts, e.g. humiliating, intimidating, or threatening.

•Abandonment - desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person.

•Self-neglect – characterized as the failure of a person to perform essential, self-care tasks and that such failure threatens his/her own health or safety.

What are the warning signs of elder abuse?

While one sign does not necessarily indicate abuse, some tell-tale signs that there could be a problem are:

•Bruises, pressure marks, broken bones, abrasions, and burns may be an indication of physical abuse, neglect, or mistreatment.
•Unexplained withdrawal from normal activities, a sudden change in alertness, and unusual depression may be indicators of emotional abuse.
•Bruises around the breasts or genital area can occur from sexual abuse.
•Sudden changes in financial situations may be the result of exploitation.
•Bedsores, unattended medical needs, poor hygiene, and unusual weight loss are indicators of possible neglect.
•Behavior such as belittling, threats, and other uses of power and control by spouses are indicators of verbal or emotional abuse.
•Strained or tense relationships, frequent arguments between the caregiver and elderly person are also signs.

Most importantly, be alert. The suffering is often in silence. If you notice changes in a senior’s personality or behavior, you should start to question what is going on.

Remember, it is not your role to verify that abuse is occurring, only to alert others of your suspicions.

Simple Blog- Libby Deege

I attended a funeral yesterday of a beloved Caregiver for Home Instead Senior Care. After hearing all she had done with her life and all the people she had touched through her 80 years, I found this picture and thought she did all these things and was so happy every day!!

Mediation: Resolving Elder Care Conflicts Without a Battle - Libby Deege

Jerrod and Morgan Williams have been at odds for several years about their mother's care. Now a decision must be made and they are no closer to agreement. Gregory Jakes' children and his doctors all agree that he must stop driving. Even though his son has twice disabled the car, Gregory has twice had it repaired and continues to drive. Both of these families were referred to mediation as a last resort before turning to the courts to resolve their conflicts.

Elder care can be difficult under the best of circumstances. Mix in old family history and sincere differences of opinion and things can easily become unmanageable. As an older woman once said to me, "This would all be so easy if it weren't for the people!"

As an alternative to either throwing up their hands and walking away or ending up in court, many families are turning to Elder Mediation as a way to find a workable resolution.

A mediator is a professional who will help families open up communication in order to find the best solution to their particular situation. The mediator is neutral - not aligned with any particular "side" - and is part of the process only as a facilitator of the discussion. The goal is to give everyone a voluntary and confidential place to be heard, to share their concerns, and to explore options.

At the end of the process all the participants sign a document summarizing their aggreement. This document is not legally binding, as it would be if issued by a court of law. Family members are always free to seek legal advice before agreeing to any compromises.

Some families say that meeting with a mediator greatly reduced their stress and helped them accomplish far more than they had hoped. Others, while not able to resolve all their differences, were able to reach interim agreements and identify milestones that would indicate the need to revisit their options.

Elder mediators can assist families with resolving differences over caregiving responsibilities, residential alternatives, financial arrangements, guardianship decisions, individual roles and responsibilities in decision-making, and end of life decisions.

Mediators will not make decisions for the family, nor are they therapists. However, many families have found that meeting with a mediator can be therapeutic because the process helps diffuse tensions while allowing everyone to express themselves honestly and focus on the ultimate best interest of their senior.

How to Find a Mediator

Like Geriatric Care Management, there are no licenses required to be a mediator. However, there are ways to find experienced mediators who are highly regarded by professionals:

Check with your local family or probate court. They often maintain a list of mediators.

Bank Account of Memories

Bank Account of Memories


The 92-year-old, petite, well-poised and proud mother-in-law of my best friend, who is

fully dressed each morning by eight o'clock, with her hair fashionably coiffed and

makeup perfectly applied, even though she is legally blind, moved to a nursing home

today. Her husband of 70 years recently passed away, making the move necessary.

Maurine Jones is the most lovely, gracious, dignified woman that I have ever had the

pleasure of meeting. While I have never aspired to attain her depth of wisdom, I do

pray that I will learn from her vast experience.

After many hours of waiting patiently in the lobby of the nursing home, she smiled

sweetly when told her room was ready. As she maneuvered her walker to the elevator,

I provided a visual description of her tiny room, including the eyelet sheets that had

been hung on her window. "I love it," she stated with the enthusiasm of an eight-yearold

having just been presented with a new puppy.

"Mrs. Jones, you haven't seen the room ... just wait."

That doesn't have anything to do with it," she replied. "Happiness is something you

decide on ahead of time. Whether I like my room or not doesn't depend on how the

furniture is arranged ... it's how I arrange my mind. I already decided to love it...

"It's a decision I make every morning when I wake up. I have a choice; I can spend the

day in bed recounting the difficulty I have with the parts of my body that no longer work,

or get out of bed and be thankful for the ones that do. Each day is a gift, and as long as

my eyes open I'll focus on the new day and all the happy memories I've stored away ...

just for this time in my life.

Old age is like a bank account ... you withdraw from it what you've put in ...So, my

advice to you would be to deposit a lot of happiness in the bank account of memories."

Helping Seniors beat the Heat - Libby Deege

Older citizens are more vulnerable than younger individuals because they do not adjust as well to the heat, they perspire less, and they are more likely to have health problems that require medicines that work against the body's natural thermometer. A sudden or prolonged increase in temperatures can place a strain on the heart and blood vessels before the body can acclimate itself
When the temperatures begin to creep up, take immediate action. The following tips from Dr. Robert Luchi, Professor of Medicine-Geriatrics, can help you beat the heat:

Keep cool. Air conditioning can be a lifesaver, especially if you have heart disease. If you don't have air conditioning, head to a cool shopping center, senior center, library, movie theater, or place of worship.

Cool baths or showers can provide relief. Ice bags and wet towels are also helpful.
Beware of dehydration; drink plenty of water even if you are not thirsty.

Curtail physical activity during extremely hot weather. Activity adds to heart strain.

 Avoid heavy meals and alcohol. Alcohol acts as a diuretic, causing your body to lose water.

 Limit salt use.

 Wear loose fitting, lightweight clothing. Don't forget to wear a hat or carry an umbrella to protect your head and neck when you are outdoors.

 Take the heat seriously. Dizziness, rapid heartbeat, diarrhea, nausea, headache, chest pain, mental changes or breathing problems are warning signs that you should seek immediate medical attention

CAREGiver of the Month Shares her favorite caregiving story...

Angie Sieren has been selected for the CAREGiver of the month for the month of June. Angie was chosen because she has been doing an excellent job picking up fill-ins and going above and beyond for her clients. She has a genuine heart that desires to get to know her clients well, which results in trust and friendship.


"When I first met Willie, he was very protective of his home and the responsibilities he wanted me to take care of. PROUD would be the word to best describe this man of a 5 foot stature. But when I met him it seemed as if he were more like 6 foot tall. He would shuffle behind me pushing his walker everywhere I went while I was doing the chores he had asked of me, making sure I was doing it the RIGHT way....as in HIS WAY. Keep in mind he lived in a tiny little one bedroom trailer. As time went on, Willie began to share more about himself, his time in World War II, and memories of his beloved wife. In turn, he also began to ask more about my life and me. As the days grew into weeks and the weeks turned into months, Willie and I chatted like we were old time friends. He began making me breakfast every morning and this was a huge feat for him as he was partially blind in both eyes. So the task was a major undertaking, but one he was so very proud of. My most fond memory of my time with Willie was when we spent an hour going through old albums. The ones he and his wife would listen and dance to for hours. I will never forget the day he played his favorite on his old record player. We were sitting at his kitchen table. I was listening and laughing to so many of his old stories. He got up from the kitchen table and shuffled into his living room. He was smiling and laughing. He then turned and asked if I would join him on the dance floor. It was a fast one so I wasn't sure if I could keep up. But he waved one hand in the air while holding tightly onto his walker with the other. I popped out of my chair and waved my hands wildly in the air just trying to keep up. When the song was over. I hugged him and thanked him not only for the dance but sharing so many specials memories of his with me. I told him how honored I was that he shared such special memories with me. Our relationship as client and caregiver developed into one of being friends. From that day on Willie no longer shuffled after me to make sure I was doing what I needed to do. He now would sit at the kitchen table and chat w me as I moved about his house cleaning and doing laundry. Always wanting me to take a break and sit to chat or to drink a soda of his or eat a snickers candy bar that he had purchased because he knew that they were
my favorite. I had done it. I had earned this man's trust and was able to bring many smiles and laughter into a house that once was so very quiet and lonely. I will always remember how nervous I was my very first shift. But now all I can remember is how fortunate I was to be a part of Willie's life....to have been trusted....to have been loved by such an amazing human being. I am grateful to HISC for the experiences I have been given. My words of widsom to others would be: Remember you are ALWAYS a guest in your clients home. That what our clients are asking of us to come and do is scary for them.....it's also very brave...and so very humbling. That each senior is unique and special so go out of your way each and every shift to make your client feel that way. Be compassionate and kind. I have been blessed with the relationships I have developed in the last 4 and 1/2 years."

Angie found Home Instead Senior Care through a search on the internet. She was a stay-at-home mom for 10 years and decided it was time to do something for her. She wanted a part-time job that would offer her flexible hours. Working with seniors appealed to her because while she was growing up she would volunteer at a nursing home with her mom. Angie says, “It was time to do something for me.” What she didn’t expect was how much she received in return, from her clients. CAREGiving has been an excellent match for her because it has allowed her to maintain flexibility to continue to raise and be active in her children’s lives.


Working with and helping people have always been an active part of Angie’s life. Prior to CAREGiving Angie worked with children with special needs, she was a substance abuse counselor for teens and their parents, and as stated earlier she would volunteer with her mom at the nursing home. When she went into the nursing home she would read to the residents, bring them kittens to pet/play with, and sometimes her mom made her ride the horse to the nursing home so the residents could feed them apples and carrots. It was all of this that molded Angie into the successful CAREGiver she is today.

She grew up in Keota, Iowa (south eastern part of the state). She received her bachelor’s degree in psychology and sociology from Simpson college. Angie married her high school sweetheart in 1993, they now have 2 daughters who are 14 and 12. Kurt, Angie’s husband was relocated, for his job, to Minnesota but they relocated back 5 years ago and they currently live in Johnston. Here their girls are very active in school/sports. This keeps Kurt and Angie busy, but they love watching their girls grow and do what they love. When Angie isn’t busy at one of her girls’ sporting events she enjoys being outside, boating, grilling, shopping, reading, and just spending some down time as a family.

Pet Estate Planning - Libby Deege

Great Article!! Enjoy!

You don't have to be Leona Helmsley to want the best for your pet after you die. She'd left her dog Trouble $12 million when she passed away in 2007. A judge cut the award to $2 million and awarded some of the money to her grandchildren, but the Maltese still lived a life of luxury until his death in December. The dog's passing was just announced this month by the Helmsley trust.

Pet estate planning has grown since Helmsley's will made headlines. Today there are retirement homes for pets all across the country, and at least 45 states allow for pet trusts. A pet trust is an agreement that specifies how an owner wants a pet to be cared for, including details on who will be responsible for the animal and how the care will be paid for.

There are also attorneys who specialize in pet trusts, along with how-to books like "Who Will Care When You're Not There?" by tax attorneys Robert E. Kass and Elizabeth A. Carrie, "Fat Cats and Lucky Dogs" by law professor Gerry W. Beyer and estate planner Barry Seltzer, and "Petriarch: The Complete Guide to Financial and Legal Planning for a Pet's Continued Care" by animal attorney Rachel Hirschfeld.

Hirschfeld wrote a pet protection agreement that is legally binding and can be found online for as little as $39. Companies like Trusted Pet Partners, founded by attorney Chris Jones of Santa Barbara, offer a simple online pet trust for $289. Other online resources include a free planning guide from the Humane Society of the United States called "Providing for Your Pet's Future Without You" at http://www.humanesociety.org/petsinwills.

Exactly how many pets are abandoned after their owners die is unknown, says Richard Avanzino, former president of the San Francisco Society for the Prevention of Cruelty to Animals, but his best guess is 2 percent of surrendered animals, or 150,000 dogs and cats a year. A study from the late 1990s published in the Journal of Applied Animal Welfare Science found 1 percent of dogs and 1.5 percent of cats coming into 12 animal shelters had been surrendered because of owner death.

In 1979, Avanzino went to court to prevent the euthanization of a dog whose owner, Mary Murphy, had committed suicide. Murphy left a will instructing that her 11-year-old dog Sido be euthanized.

"She didn't think anybody else could take care of her in the same pampered, loving way," said Avanzino.
A judge ruled disposal of personal property does not extend to killing a living creature.

"People from the grave cannot dictate the demise of their beloved pets just because they are not around to take care of them," Avanzino said.

Murphy's case prompted the San Francisco SPCA to set up one of the nation's first sanctuaries for pets who outlive their owners.
A few veterinary schools offer estate planning options like lifetime care for pets and placement in a home. The Stevenson Companion Animal Life-Care Center, established by the Texas A&M College of Veterinary Medicine, offers a place for pets to live in addition to veterinary care. The Stevenson Center in College Station, Texas, currently houses 20 cats, 15 dogs and a llama, said Ellie Greenbaum, assistant to the director. They also have 377 animals from 20 states registered as potential residents. The fee for lifetime care is between $50,000 and $100,000 per pet, with any leftover funds donated to the center or the college.

But lifetime pet care arrangements don't always cost that much. Blue Bell Foundation For Cats in Laguna Beach, Calif., charges $6,500 for lifetime care for cats. The organization was founded by Bertha Gray Yergat, who wanted to ensure care after her death for the 200 cats she'd rescued. Yergat left about $1 million in assets, said Susan Hamil, chairwoman (and original member) of the foundation's board of directors. The organization now houses 50 cats.

One big problem is making sure trusts are written so that the pets and funds can be turned over quickly to the designated caregiver or facility. "The need when you pass away is immediate," Hamil said.
 
Most people will choose a friend or relative to take their pets.
 
"Much like an adoption, the goal is to make sure it will be a good match," said Kim Saunders, vice president of shelter outreach for Petfinder.com, an online pet adoption database. "You may love your best friend or family member, but they may not be a dog person." So some people designate an agency to find a new home for the pet.

Some owners leave money to whomever they're entrusting their pet to as a way of making sure the animal does not become a financial burden. Unfortunately, sometimes when large sums are involved, Avanzino said, "greed gets in the way."

In one case, Avanzino said, a cat was to be cared for by a maid and butler who were to get free room and board as long as the cat was alive. "The first time we saw the cat, we estimated it was 8 years old. Four years later, the cat was about 4 and the next time, the cat they brought in and said was the same cat, was estimated to be about 1 year old," he said.

In another case, the owner of a German shepherd left relatives the use of an entire estate as long as the dog lived. "They kept it alive almost two years on life support. The dog was totally incapable of moving," Avanzino said.

USA Today: Most Baby Boomers lack a plan to care for parents

A majority of Baby Boomers say they are likely to become caregivers for their parents, but only half can name any medications their parents take, a new survey shows

The survey of 600 adults ages 45 to 65, conducted for the Home Instead Senior Care network, also found:
•31% don't know how many medications their parents take.
•34% don't know whether their parents have a safe deposit box or where the key is.
•36% don't know where their parents' financial information is located.

"The majority of caregivers we work with have done no advance planning,'' says Jeff Huber, president of Home Instead Senior Care, a company that provides non-medical care services. "It is not important until it's urgent. So much stress and uncertainty down the road can be prevented."

Lack of planning can lead to serious complications when decisions need to be made quickly, says palliative care nurse practitioner Mimi Mahon, an associate professor at George Mason University in Virginia. "It's vitally important to plan ahead and have these conversations with parents, or families can act out of fear and make mistakes when emergencies arise."

Prescription drugs are of particular concern. In the survey, 49% couldn't name a single drug their parents took. Ask parents about their medications and, if necessary, do research, experts say. Find out the dose, what it's for, who prescribed it and why. People 65 and older account for about a third of all medications prescribed in the U.S., according to the National Institutes of Health, and older patients are more likely to have long-term and multiple prescriptions, which could lead to unintentional misuse.

"It's kind of a never-ending process for caregivers," says Sandy Markwood, head of the National Association of Area Agencies on Aging, part of the Department of Health and Human Services. "It gets further complicated when there is more than the family practitioner. A parent might have several specialists. It's a lot for a caretaker to keep up."

Markwood says the Administration on Aging, also under HHS, has been encouraging better record-keeping by seniors and stronger communication between seniors and caretakers since Hurricane Katrina. "Then you had a situation when seniors were evacuated without their medications and no one knew what medications they were on," Markwood says. "Doctors had to start from scratch."

One must-have answer for caretakers: What drugs can parents go without and which ones must be taken on schedule. For instance, blood pressure and anti-depressant medications cannot be missed, Mahon says.

The bottom line, she says, is being a staunch advocate for your parents' health care starts with "having conversations and putting plans in place."

Alzheimer's - Sundowning: Libby Deege

Sleeping problems experienced by individuals with Alzheimer’s and caregiver exhaustion are two of the most common reasons people with Alzheimer’s are eventually placed in nursing homes. Some studies indicate that as many as 20 percent of persons with Alzheimer’s will, at some point, experience periods of increased confusion, anxiety, agitation and disorientation beginning at dusk and continuing throughout the night.

While experts are not certain how or why these behaviors occur, many attribute them to late-day confusion, or “sundowning,” caused by the following factors:
•end-of-day exhaustion (mental and physical)
•an upset in the “internal body clock,” causing a biological mix-up between day and night
•reduced lighting and increased shadows
•disorientation due to the inability to separate dreams from reality when sleeping
•less need for sleep, which is common among older adults

Tips for reducing evening agitation and nighttime sleeplessness
•Plan more active days. A person who rests most of the day is likely to be awake at night. Discourage afternoon napping and plan activities, such as taking a walk, throughout the day.
•Monitor diet. Restrict sweets and caffeine consumption to the morning hours. Serve dinner early, and offer only a light meal before bedtime.
•Seek medical advice. Physical ailments, such as bladder or incontinence problems, could be making it difficult to sleep. Your doctor may also be able to prescribe medication to help the person relax at night.
•Change sleeping arrangements. Allow the person to sleep in a different bedroom, in a favorite chair or wherever it’s most comfortable. Also, keep the room partially lit to reduce agitation that occurs when surroundings are dark or unfamiliar.

Nighttime restlessness doesn’t last forever. It typically peaks in the middle stages, then diminishes as the disease progresses. In the meantime, caregivers should make sure their home is safe and secure, especially if the person with Alzheimer’s wanders. Restrict access to certain rooms or levels by closing and locking doors, and install tall safety gates between rooms. Door sensors and motion detectors can be used to alert family members when a person is wandering.

Once the person is awake and upset, experts suggest that caregivers:
•approach their loved one in a calm manner
•find out if there is something he or she needs
•gently remind him or her of the time
•avoid arguing or asking for explanations
•offer reassurance that everything is all right and everyone is safe

Wedding Rings and Engagement Rings - Libby Deege

As we are slowly creeping into Spring and Summer, it always reminds me that wedding season is starting to fire up! I started thinking about some of my older realitives and even my own parents who just opted for the wedding ring VS the whole engagement ring and then the wedding ring. How long ago did all of this start? The man goes out and buys a diamond then goes out to buy even more diamonds to present the day of the wedding. I often think of the act of telling your friends "Hey I am engaged!" the first response "Let me see the ring!!" What happened to congratulations? Has it become of symbol of how much you are loved by the size of the diamond?

Not just a mere object to adorn a finger, the ring has been a powerful symbol throughout history. Its circular shape and its banding to the body have given it meaning - from the magical to the practical. Rings have represented the cycle of life, the sun and moon and in the case of engagement rings, eternal love.

Although we now mostly associate the diamond, with its nearly indestructible properties, as the symbol of eternal love, it was first the plain ring that represented the promise of companionship. Today we still honor the plain ring as wedding bands, although the diamond engagement ring is seen as a more important or more powerful symbol of a man's love for his bride.

There is some evidence to suggest that the first wedding rings used by ancient peoples were actually ropes that held a woman as property and that is why the symbolic ring remained a part of our tradition. Rings may also have been used to signify ownership to men or tribes, and the exchange of rings signified the passing of the daughter of one clan to another.

Today, the diamond engagement ring is regarded by most as an essential part of the act of getting married. There are many styles, shapes and types of rings to choose from and diamonds to fit almost any budget. The modern wedding ring has spawned a global business of retailers, crafters, miners and importers. And to think it all began with a simple little bit of rope.

What really Is Fibromyalgia? - Libby Deege

You hear a lot about Fibromyalgia. My mom was diagnosed with it several years back but I was never really sure what the disease really was.

Fibromyalgia is the most common arthritis-related illness after osteoarthritis. Still, it is often misdiagnosed and misunderstood. Its characteristics include widespread muscle and joint pain and fatigue as well as other symptoms. Fibromyalgia can lead to depression and social isolation. More than 12 million Americans have fibromyalgia. Most of them are women ranging in age from 25 to 60. Women are 10 times more likely to get this disease than men

Fibromyalgia causes you to ache all over. You may have symptoms of crippling fatigue -- even on arising. Specific tender points on the body may be painful to touch. You may experience swelling, disturbances in deep-level or restful sleep, and mood disturbances or depression. Your muscles may feel like they have been overworked or pulled. They'll feel that way even without exercise or another cause. Sometimes, your muscles twitch, burn, or have deep stabbing pain. Some patients with fibromyalgia have pain and achiness around the joints in the neck, shoulder, back, and hips. This makes it difficult for them to sleep or exercise. Other fibromyalgia symptoms include:

• abdominal pain
• anxiety and depression
• chronic headaches
• difficulty maintaining sleep or light sleep
• dryness in mouth, nose, and eyes
• fatigue upon arising
• hypersensitivity to cold and/or heat
• inability to concentrate (called "fibro fog")
• incontinence
• irritable bowel syndrome
• numbness or tingling in the fingers and feet
• painful menstrual cramps
• stiffness

Fibromyalgia can cause signs and feelings similar to osteoarthritis, bursitis, and tendinitis. Some experts include it in this group of arthritis and related disorders. But the pain of bursitis or tendinitis is localized to a specific area. The feelings of pain and stiffness with fibromyalgia are widespread.
 
Currently there is no cure for the pain of Fibromyalgia, but it can be managed with medication and regular check ups.

A Poem for CAREGivers

Blessed In Aging


~Esther Mary Walker

Blessed are they who understand

My faltering step and shaking hand

Blessed, who know my ears today

Must strain to hear the things they say.

Blessed are those who seem to know

My eyes are dim and my mind is slow

Blessed are those who look away

When I spilled tea that weary day.

Blessed are they who, with cheery smile

Stopped to chat for a little while

Blessed are they who know the way

To bring back memories of yesterday.

Blessed are those who never say

“You’ve told that story twice today”

Blessed are they who make it known

That I am loved, respected and not alone.

And blessed are they who will ease the days

Of my journey home, in loving ways.

This poem, as read by Mary Maxwell in the video

“A Reminder That Laughter is the Best Medicine.”

View the video online at CaregiverStress.com

Seniors Often Do Not Drink Sufficient Amounts of Water - Libby Deege

As we age, we may feel less thirsty than in our younger years although our body still requires the same amount of water each and every day as it did during our younger years. As Spring and Summer are just around the corner (I hope) we need to make sure our elder loved ones are getting enough water in their daily routine to stay hydrated and healthy!!

The human body, which is made up of between 55 and 75 percent water (lean people have more water in their bodies because muscle holds more water than fat), is in need of constant water replenishment

Your lungs expel between two and four cups of water each day through normal breathing - even more on a cold day. If your feet sweat, there goes another cup of water. If you make half a dozen trips to the bathroom during the day, that's six cups of water. If you perspire, you expel about two cups of water (which doesn't include exercise-induced perspiration).

A person would have to lose 10 percent of her body weight in fluids to be considered dehydrated, but as little as two percent can affect athletic performance, cause tiredness and dull critical thinking abilities. Adequate water consumption can help lessen the chance of kidney stones, keep joints lubricated, prevent and lessen the severity of colds and flu and help prevent constipation.

Factors that influence water needs

You may need to modify total fluid intake from these recommended amounts depending on several factors, including how active you are, the climate, your health status, and if you're pregnant or breast-feeding.


Exercise. If you exercise or engage in any activity that makes you sweat, you'll need to drink extra water to compensate for that fluid loss. Drink 2 cups of water two hours before a long endurance event, for example, a marathon or half-marathon. One to 2 cups of water is also adequate for shorter bouts of exercise. During the activity, replenish fluids at regular intervals, and continue drinking water or other fluids after you're finished. During intense exercise involving significant sweating, for example, during a marathon, sodium is lost in sweat, and you may need a sports drink with sodium rather than just water.

Environment. You need to drink additional water in hot or humid weather to help lower your body temperature and to replace what you lose through sweating. You may also need extra water in cold weather if you sweat while wearing insulated clothing. Heated, indoor air can cause your skin to lose moisture, increasing your daily fluid requirements. And altitudes greater than 2,500 meters (8,200 feet) also can affect how much water your body needs. Higher altitudes may trigger increased urination and more rapid breathing, which uses up more of your fluid reserves.

 Illnesses or health conditions. Some signs and symptoms of illnesses, such as fever, vomiting and diarrhea, cause your body to lose extra fluids. To replace lost fluids, drink more water or oral rehydration solutions (Gatorade, Powerade, CeraLyte, others). When water loss can't be replaced orally, intravenous water and electrolytes may be necessary. Increased water intake is nearly always advised in people with urinary tract stones. On the other hand, you may need to limit the amount of water you drink if you have certain conditions that impair excretion of water - such as heart failure and some types of kidney, liver, adrenal and thyroid diseases.


Your body requires 8-10 cups (8 ounces) per day. To get an idea of how much water that adds up to, grab a measuring cup and fill a container. Throughout the day, pour your water from the container until it's all gone. Be sure to space your fluid intake out as too much water at once can prove fatal, creating an imbalance in the electrolytes.

If you enjoy a beverage throughout the day, such as juice or milk (which you should), then remove that amount of water from your daily water container. All beverages that are water-based count towards the daily intake.
Insufficient daily water intake can contribute to constipation and other digestive disruptions - yet one more reason to get in your healthy 8-10 each and every day.
 
Though uncommon, it's possible to drink too much water. Drinking excessive amounts can overwhelm your kidneys' ability to get rid of the water. This can lead to hyponatremia, a condition in which excess water intake dilutes the normal amount of sodium in the blood. People who are older, who have certain medical conditions such as congestive heart failure and cirrhosis, or who are taking certain diuretics are at higher risk of hyponatremia

Five Easy Ways To Create An Active And Healthier Lifestyle-Libby Deege



Outside of the economy, fitness and healthy eating are among the most critical issues facing Americans today. Only 31 percent of Americans are getting adequate exercise and 68 percent of men and 53 percent of women are overweight, according to the Centers for Disease Control and Prevention’s National Health Interview survey released in March.

The good news is that the tried-and-true approach of regular exercise and smart nutrition will go a long way toward managing weight loss and an overall healthy lifestyle. In fact, the benefits of being more active can be seen within a short time after starting a new routine and include more energy, less stress, lower blood pressure, improved digestive health and a reduction in cardiovascular disease risk.

A fitness program doesn’t have to take place in the gym. Beverly Abbs, an award-winning ultra-runner, recommends outdoor fun to get started on everyday fitness. “You don’t have to run long distances in order to reap the health benefits,” says Abbs, a member of Ultra-Running Team Sunsweet. “Short distance runs and even outdoor walks are a great way to stay fit and have fun. I got my start competing in athletic events with just 2- to 3-mile runs. That turned into a life-long love of ultra-running.”
When you add in smart nutritional choices to your exercise routine, the positives pile up further. “As a triathlete and a sports dietitian, I can tell you that plenty of healthy choices are convenient and taste delicious,” says registered dietician Dr. Katherine Beals.
So, whether you aspire to overhaul your diet and exercise program or are just thinking about taking a few first steps to a healthier life, smart choices can start with a few simple steps. Abbs and Dr. Beals offer these tips for getting started on achieving overall better health.

1.  Get and stay active: Adults should get 2.5 hours of aerobic physical activity per week and perform strengthening activities two days a week, according to the U.S. Health and Human Services department. Fortunately, it is easier than you might think to incorporate exercise into your routine. For example, take the stairs instead of the elevator and find the parking spot that is farthest away to get extra steps in between your car and your destination. Play tag with your kids, or consider signing up for a community fun run 5K. Not only do these runs usually provide an opportunity to race for a good cause, you can use it as training motivation.

2.  Use interval training: Experts say varying your cardio work with a combination of easy/hard intervals will result in faster fitness gains. It also mixes up your workouts and staves off boredom. Next time you go for a run, instead of keeping the same pace, try mixing in a few sprints. Start with 30 seconds on hard and 10 seconds on easy.

3.  Go for convenience: Abbs says dried fruits like Sunsweet Ones, individually wrapped prunes, are a convenient and nutritious snack whether you’re training for a marathon or just a busy person on the go. “These delicious snacks are portable, don’t spoil and deliver calories that count.” Plus, prunes are known to support digestive health.

4.  Fill up with fiber: High-fiber foods are critical to digestive health and any weight loss program because they fill you up and help keep the hunger pangs at bay. The typical American eats only about 11 grams of fiber a day, according to the American Dietetic Association, and health experts recommend a minimum of 20 to 30 grams of fiber a day for most people. Fruits (dried and fresh) and vegetables are great fiber sources including apples, pears, prunes, peas, broccoli and sweet corn.

5.  After an intense workout: Carbohydrate-rich foods that are energy dense, easy to digest and familiar and appetizing – like bagels, granola bars, crackers, dried plums and fruit juices – are good choices for post-workout fare to replenish any lost nutrients. Exercise also increases the loss of water from the body, primarily through sweat, so the harder and longer the workout, the more lost fluid that needs replacing.

“Drinking fluids like water, sports drinks, and fruit juices or eating water-containing foods can replace these lost fluids and, in the case of fruits, fruit juices and vegetables, replace much-needed potassium,” Dr. Beals says.

Regardless of your current level of activity and commitment to nutrition, it is never too late to make smart decisions. Make the commitment today and take these steps toward a more fit and healthy you.

Aprils Fools Day-Did you Fool Anyone?-Libby Deege

In honor of this blog falling on April's Fool Day I thought I would do a little internet research on the day. We have all tried to pull the occasional prank but I started to wonder, what are some of the "greatest" pranks ever pulled on this day of fun? Enjoy!! And Happy Pranking!!

The Swiss Spaghetti Harvest
1957: The respected BBC news show Panorama announced that thanks to a very mild winter and the virtual elimination of the dreaded spaghetti weevil, Swiss farmers were enjoying a bumper spaghetti crop. It accompanied this announcement with footage of Swiss peasants pulling strands of spaghetti down from trees. Huge numbers of viewers were taken in. Many called the BBC wanting to know how they could grow their own spaghetti tree. To this the BBC diplomatically replied, "place a sprig of spaghetti in a tin of tomato sauce and hope for the best."
 
Instant Color TV
1962: In 1962 there was only one tv channel in Sweden, and it broadcast in black and white. The station's technical expert, Kjell Stensson, appeared on the news to announce that, thanks to a new technology, viewers could convert their existing sets to display color reception. All they had to do was pull a nylon stocking over their tv screen. Stensson proceeded to demonstrate the process. Thousands of people were taken in. Regular color broadcasts only commenced in Sweden on April 1, 1970
 
The Taco Liberty Bell
1996: The Taco Bell Corporation announced it had bought the Liberty Bell and was renaming it the Taco Liberty Bell. Hundreds of outraged citizens called the National Historic Park in Philadelphia where the bell was housed to express their anger. Their nerves were only calmed when Taco Bell revealed, a few hours later, that it was all a practical joke. The best line of the day came when White House press secretary Mike McCurry was asked about the sale. Thinking on his feet, he responded that the Lincoln Memorial had also been sold. It would now be known, he said, as the Ford Lincoln Mercury Memorial
 
Nixon for President
1992: National Public Radio's Talk of the Nation program announced that Richard Nixon, in a surprise move, was running for President again. His new campaign slogan was, "I didn't do anything wrong, and I won't do it again." Accompanying this announcement were audio clips of Nixon delivering his candidacy speech. Listeners responded viscerally to the announcement, flooding the show with calls expressing shock and outrage. Only during the second half of the show did the host John Hockenberry reveal that the announcement was a practical joke. Nixon's voice was impersonated by comedian Rich Little.
 
The Left-Handed Whopper
1998: Burger King published a full page advertisement in USA Today announcing the introduction of a new item to their menu: a "Left-Handed Whopper" specially designed for the 32 million left-handed Americans. According to the advertisement, the new whopper included the same ingredients as the original Whopper (lettuce, tomato, hamburger patty, etc.), but all the condiments were rotated 180 degrees for the benefit of their left-handed customers. The following day Burger King issued a follow-up release revealing that although the Left-Handed Whopper was a hoax, thousands of customers had gone into restaurants to request the new sandwich. Simultaneously, according to the press release, "many others requested their own 'right handed' version."
 
Flying Penguins
2008: The BBC announced that camera crews filming near the Antarctic for its natural history series Miracles of Evolution had captured footage of Adélie penguins taking to the air. It even offered a video clip of these flying penguins, which became one of the most viewed videos on the internet. Presenter Terry Jones explained that, instead of huddling together to endure the Antarctic winter, these penguins took to the air and flew thousands of miles to the rainforests of South America where they "spend the winter basking in the tropical sun." A follow-up video explained how the BBC created the special effects of the flying penguins
 
The Body of Nessie Found
1972: On March 31 1972, a team of zoologists from Yorkshire's Flamingo Park Zoo, who were at Loch Ness searching for proof of Nessie's existence, found a mysterious carcass floating in the Loch. Initial reports claimed it weighed a ton and a half and was 15 ½ feet long. The zoologists placed the body in a van and began to transport it back to the zoo. However, the police chased down their truck and stopped it under a 1933 act of Parliament prohibiting the removal of "unidentified creatures" from Loch Ness. The body was then taken to nearby Dunfermline for examination. The discovery of the carcass received worldwide media attention. The British press dubbed it "Son of Nessie." But upon examination, Edinburgh scientists identified the creature as a bull elephant seal from the South Atlantic. The next day John Shields, Flamingo Park's education officer, confessed he had been responsible for the body. The bull elephant seal had died the week before at Dudley Zoo. He had shaved off its whiskers, padded its cheeks with stones, and kept it frozen for a week, before dumping it in the Loch and then phoning in a tip to make sure his colleagues found it. He had meant to play an April Fool's prank on his colleagues, but admitted the joke got out of hand when the police chased down their van

St. Patricks Day Fun Facts- Libby Deege

St. Patrick’s Day is observed on March 17 because that is the feast day of St. Patrick, the patron saint of Ireland. It is believed that he died on March 17 in the year 461 AD. It is also a worldwide celebration of Irish culture and history. St. Patrick’s Day is a national holiday in Ireland, and a provincial holiday in the Canadian province of Newfoundland and Labrador.

In Ireland on St. Patrick’s Day, people traditionally wear a small bunch of shamrocks on their jackets or caps. Children wear orange, white and green badges, and women and girls wear green ribbons in their hair.

Many cities have a St. Patrick’s Day parade. Dublin, the capital of Ireland, has a huge St. Patrick’s Day festival from March 15-19, that features a parade, family carnivals, treasure hunt, dance, theatre and more. In North American, parades are often held on the Sunday before March 17. Some paint the yellow street lines green for the day! In Chicago, the Chicago River is dyed green with a special dye that only lasts a few hours. There has been a St. Patrick’s Day parade in Boston, Massachusetts since 1737. Montreal is home to Canada’s longest running St. Patrick’s Day parade, which began in 1824.

34 million Americans have Irish ancestry, according to the 2003 US Census. That’s almost nine times the population of Ireland, which has 4.1 million people.

Some American towns have “Irish” names. You could visit: Mount Gay-Shamrock, West Virginia; Shamrock Lakes, Indiana; Shamrock, Oklahoma; Shamrock, Texas; Dublin, California and Dublin, Ohio.

The harp is the symbol of Ireland. The color green is also commonly associated with Ireland, also known as “the Emerald Isle.”

The Irish flag is green, white and orange. The green symbolizes the people of the south, and orange, the people of the north. White represents the peace that brings them together as a nation.

The name “lephrechaun” has several origins. It could be from the Irish Gaelic word “leipreachan,” which means “a kind of aqueous sprite.” Or, it could be from “leath bhrogan,” which means “shoemaker.”

According to the Guinness Book of World Records, the highest number of leaves found on a clover is 14!

One estimate suggests that there are about 10 000 regular three-leaf clovers for every lucky four-leaf clover.

Legend says that each leaf of the clover means something: the first is for hope, the second for faith, the third for love and the fourth for luck.

Small Scale Gardens-Libby Deege

A four foot square may still be too big for your yard if you live in a townhouse or an apartment but don’t give up. Even in a tiny space like a balcony or a patio, you can still grow your own vegetables.

The variety of vegetables that can be grown in a container is growing yearly. Some of the vegetables listed below you may have never eaten or you may have had the canned variety and not liked them. Fresh vegetables have a whole different taste than canned especially when you have grown them yourself. Keep an open mind and try a few new ones every year.

Vegetables for Containers

 Beets - I hated beets for years until a friend convinced me to try fresh ones last year. Fresh beets have a whole different taste than pickled ones. These can be grown in as little space as a cake pan and are better picked small and tender, about the size of a silver dollar.

Spinach – Fresh spinach is good both cooked and raw and it is another vegetable that can be grown in a small container. The leaves are best picked young and tender. One of the best things about spinach is that it doesn’t have to grow fruit so it doesn’t need a large container to support it. This is a cool weather plant and does not like hot summer days.

Leaf Lettuce - Like spinach, leaf lettuce can be grown in a small container and doesn’t need hot summer days to mature. Pick when leaves are young and tender. Start pots at different times so you have a continuous supply. There is also a variety of miniature head lettuce that can be container grown.

Patio Tomatoes – They are coming up with more and more types of tomatoes that are suited to container growing. Traditional tomatoes take a huge amount of dirt and grow to be 3 or 4 feet tall and wide if not supported. Patio tomatoes are more compact and were bred to retain a small size and be grown in a pot. Here is a variety of cherry tomatoes that can be grown in a container.

Radishes – Like beets, radishes don’t need a huge pot to grow and mature fairly quickly. These are fun to grow and make a great addition to any salad.

Green Peppers – These take a fairly good size pot and are definitely warm weather plants but they are not difficult to grow. They can be used in a variety of dishes and freeze well. If you are feeling a bit experimental, there is a new variety of mini peppers that you can buy. They are small and colorful.

Green Beans – While I would normally not recommend growing green beans in a container, they have come up with several varieties of dwarf green beans that are recommended and actually as you can plant 16 green bean plants in a square foot I would imagine these would do fairly well in a container.

Squash – Again, while squash is not something you would normally consider a container plant, new varieties are very compatible. This mild summer Patty Pan squash is only 2 ft high and 2 ft wide. It may be too big for an apartment but then maybe not.

Eggplant – Eggplant is a mainstay in Mediterranean cooking. It’s compact size makes it an ideal choice for container growing.

Garlic Chives – This is one of my favorites. It’s a beautiful flower and every part of the plant is edible.

Swiss Chard – This link is to a rainbow variety that will perk up any spot. Fresh Swiss Chard has a sweet buttery flavor that is delicious. The grocery store variety loses SO much of the flavor that it barely resembles the garden variety. Try it fresh and sauted in a bit of olive oil with a hint of garlic.

Herbs - You can mix and match herbs in a container. Basil, thyme, sage, tarragon, rosemary will all grow fine. My choices to put together would be basil, thyme and sage. Basil is an upright annual plant while sage is kind of sprawly. Thyme is a low grower so the three together make an interesting potted arrangement. All but basil are perennial.

Keep Your Brain Alive-Libby Deege

Switching things up can be fun and it can also be good for your brain. Here are a few suggestions to incorporate into your meal time routine!! Enjoy!

Try Musical Chairs!
Have everyone switch seats. In most families, everyone has his or her "own" seat. Switching seats changes whose "position" you occupy. who you relate to, and your view of the room! It even changes how you reach for the salt and pepper!

Plan a Democratic Meal.
Let each person in the family (even the youngest) decide one item on the menu. Peanut butter and steak may not sound appetizing, but is it not going to hurt you, and it may provide material for some bizarre associations.

Introduce Novelty.
Eat Waffles or cereal for dinner. The Norwegians eat their man meal for breakfast. You could try that too. Change the order in which you eat your food. Try starting with the dessert and ending with the chips. this may seem frivolous but your brain won't think so. it's primed to handle this unexpected strategy. Change where you eat your meal- a different room, outside, on the porch on the floor, BE creative.
Try eating your food using your "wrong" hand. Small changes like this makes even the most routine acts of eating challenging!!

Get Cooking!
Cook something from scratch. It doesn't have to be a five course gourmet meal. making a simple Italian pasta sauce give all your senses a good workout. As you chop and saute onions, herbs and spices, aromas permeate the kitchen and flood you with memories. You're engaging your tactile senses when chopping and peeling, and then in testing the consistency and texture of the sauce as it reduces. A good cook constantly tastes for flavor, adding and adjusting spices a little at a time.

Just remember changing things up and doing things a little differently is great for your brain and also your spirit. Try one tonight!!

Double Down - Libby Deege

Seniors are one of the fastest-growing groups of gamblers. Between 1974 and 1994, the percentage of seniors who “recently gambled” jumped from 20 to 50 percent. And a recent study found gambling to be the most frequently identified social activity among adults over 65, with casinos and bingo surpassing movies, lunch, shopping and golf as preferred social activities.

There are a number of reasons why seniors may be vulnerable to gambling problems. Senior citizens are often catered to by casinos, with bus transportation, free or discounted meals, special rewards and other prizes that attract older individuals. Gambling may provide a distraction to escape the loss of a spouse or a medical concern. Some may have financial problems they are seeking to overcome. The attention of casino staff may reduce feelings of loneliness. Cognitive impairment may prevent the recognition of a gambling problem.


Seniors may not understand addiction and be reluctant to seek help. Studies show that seniors are at risk for developing gambling problems. A 2006 New Jersey Study found that 23 percent of New Jersey residents over 55 had at least one symptom of a gambling problem. A 2005 Pennsylvania study found that 10 percent of those over 65 in a primary care facility were at risk for problem gambling.


Signs of seniors having a gambling problem include loss of interest and participation in normal activities with friends and families, blocks of time unaccounted for, missing possessions or assets, and changes in attitude and personality. Gambling problems may also be evidenced by neglect of personal needs (food, utilities and medical), secrecy and avoidance when discussing time and money, and depression. Seniors with a gambling problem and their loved ones need to know that help is available.


The National Council on Problem Gambling (NCPG) operates a 24-hour National Problem Gambling Helpline, a link for treatment, recovery groups and other resources for problem gamblers and their family members. Often, simply a kind and helpful listener can help a senior admit to a problem and seek help. To learn more or find help, call (800) 522-4700 or visit www.ncpgambling.org.

Bullying and Senior Adults- Libby Deege

Great Article by John McDonald

You’ve seen it on the news; you’ve heard the stories. Too many times, Senior Adults find themselves victimized by unscrupulous telemarketers, con artists, and taken advantage of by dishonest insurance agents.

Now, if that isn’t bad enough, many Senior Adults who are living in Nursing Home facilities find out that they are the subjects of bullying in these facilities as well.

Senior Adults are also the number one victim of investment scams. 1 In fact, telemarketing scams are so heavily geared towards Senior Adults, that the FBI2, the Federal Trade Commission, and the AARP have taken steps to protect Senior Adults from bullying telemarketers.

Laws have been put in place, and the creation of the National Do Not Call List has made its way nationwide to prevent telemarketers from targeting unsuspecting Senior Adults.

Senior Adults are targeted for many frauds including Medicare Fraud, Credit Card Fraud, Construction or Home Improvement Fraud, Insurance Fraud, Prescription Drug Plan Fraud, Door to Door Sales Fraud, Charitable Donations Fraud, Work at Home Fraud, Foreign Lotteries Fraud, Sweepstakes Fraud, Phishing Fraud, and Internet Auction Fraud.

There are many reasons why Senior Adults are targeted for fraud and telemarketing scams. A few of them are that many Senior Adults have established a “nest egg”, and con artists are well aware that these Seniors have money.

Many con artists are well aware that the majority of Seniors are trusting and good hearted people. They have mastered the art of smooth talking them with what appears to be genuine smiles and friendly conversation. Too often, Seniors aren’t even aware that they have been the victims of con artists until it is much too late, and the con artist have far left town.

These con artists work in many arenas to victimize Seniors. From construction, to telemarketing prize giveaways, insurance claims, and investment scams, it is imperative that Seniors learn how to say no to telemarketers, sales men, and potential con artists. They must learn to hang up the phone and close the door and protect their livelihoods.

Another sad fact that targets Senior Adults to bullying con artists is the fact that many Seniors have trouble with their memory. In fact, this is another reason that con artists choose to target Seniors. Con artists will “talk a good talk” relying on the fact that many of their Senior Adult victims will be unlikely to recall every detail that would be used against them in a court of law.
Too often, the Senior Adult is unaware that they have been the victim of a scam, fraud, or con until it is much later- usually a couple months of have passed since the initial contact with the con artist. This makes the Senior Adult a potentially poor witness and hinders the rendering of justice.

The best action any Senior Adult can take to prevent themselves from the schemes and plans of dishonest con artists is to be prepared.

A great resource for all Senior Adults is their local AARP. The AARP has spent countless hours of research, and money into finding the best methods and tools to help keep Senior Adults safe.

They have worked with many federal and state organizations and have many resources available to equip Senior Adults with knowledge that will prevent them from becoming the victims of ruthless, bullying con artists.

When it comes to Senior Adults and healthcare, no one would ever suspect that their physician might be bullying them out of Medicare dollars by billing them for services they never had.

Yet it is all too familiar and happens more often then you may believe. The number one person who can catch Medicare or Medicaid fraud is the Senior Adult himself. You can help prevent Medicare fraud by looking for multiple claims for the same service, checking to see if the service being billed was actually performed, and by seeing if you were charged a higher price for equipment that you received.

If you suspect Medicare fraud, you should first contact your physician to see if it was an honest billing mistake. If after further investigation, you still have the sense that something isn’t right, you can call the Medicare Fraud hotline at 1-800-447-8477. They will investigate the mater for you.

To reduce telemarketing scams and frauds, Senior Adults can elect to have their phone number placed upon the “No Call List”. You may access your local No Call directory by visiting the website, https://www.donotcall.gov/default.aspx. At this website, you can add your phone number to the National Do Not Call directory and receive further information regarding the No Call List.

Home Improvement fraud is another area where Senior Elders need to be careful. Due to the fact that many Seniors own homes and are home during the day they are targeted by con artists who plan to win them over with friendly smiles and small talk, only to bilk them out of thousands of dollars.
When contractors come to your door offering free estimates, you need to think twice before going into any business with these people. Though they may be legitimate, there is no way to know for sure, without checking their references, checking to make sure they have valid business licenses, and above all else, get other estimates by other known companies to affirm that what they have told you is indeed fact. Finally, never give a contractor large down payments of money before you have thoroughly checked out their credentials.

Many times, Senior Adults are advised by con artists not to include their family members in any of the details of the scams. This applies to home improvement scams, telemarketing scams, and sweepstake scams.

If you believe one of your Senior relatives may be the victims of a scam, you should get involved. Many times, if Seniors have been victimized, they may fear to tell anyone because they don’t want to appear incompetent.

Senior Adults should also take extra care in guarding their Medicare cards and Credit cards. Never give out your Medicare number to anyone asking for it for a “free” service.

You should always consult with your Medicare literature to find out what services are covered and which are not. If a service isn’t covered, and a provider asks for your number, they may be committing Medicaid fraud.

Also, you should never put your pin number on your credit card. If your card was ever stolen, someone could use your card and access an ATM machine. You must take care to keep all of your personal information safe. One way that you can keep your personal information safe is by tearing or shredding all personal and financial information before throwing it away.

Many unscrupulous con artists who are looking to steal your identity will comb through dumpsters and trash bins looking for information that contains bank account numbers, social security numbers, and other persona identifications.

When traveling or going out in public, limit the amount of credit cards and personal information related documents that you bring with you. These con artists are looking to steal purses and wallets to take as much of your personal identification as possible.

The best rule is to be wary of giving out credit card numbers and Medicaid numbers unless you verify that it is a bonifide business.

Case Scenario
Margaret Mills woke in the middle of the night with pains in her chest. She managed to call 911 before losing consciousness. She was suffering from a mild heart attack. She spent nearly three weeks in the hospital before being able to return home. When she checked her Medicaid Summary statement, she noticed several charges that she did not incur.
There were two charges for ambulatory services, when she knew she had only had one trip to the hospital in the ambulance. She also noticed several charges for home rehabilitation therapy that took place on the dates that she was still in the hospital. Margaret immediately contacted the billing department of the hospital and was told that the charge was to reimburse the physical therapy she received while in the hospital.

Margaret noticed that the charges clearly stated that they took place in her home and were for a substantial amount of money.

She decided to call the Medicare hotline, which assured her that they would investigate and told her that it sounded like a case of Medicare fraud

Senior and the Internet-Libby Deege

I found an interesting article the other day I thought I would share in regards to Older Americans and their use of the Internet by Jeremy Trogg! Have a great weekend everyone!!

Libby

Though people over 60 still lag behind their younger counterparts in Internet usage, the number of seniors online is expected to swell from 14 million in 2000 to more than 27 million in by 2003, according to Internet market research firm Jupiter Media Metrix.


The main reason seniors start using computers is because of e-mail. Next, they begin researching topics such as health, investing and entertainment. Then, they start shopping and join discussion groups.

Most Internet marketing experts agree that this usage pattern is the same as the general public's.

Older Americans also have financial clout, which should also attract marketer's attention. According to the American Banking Association, older adults own 77 percent of the country's financial assets. It is just a matter of mistaken assumption right now that seniors are not using the Internet.

It is truly amazing that corporate America has yet to wake up to the idea that seniors are online with many retirees spending hours online every day and learning to shop online as well.

The biggest mistake is that marketers fail to attract older adults to their Web sites when they use flashy and complex designs. Older eyes generally have to work harder to focus on text, but companies that are interested in attracting senior markets can easily make those modifications on their site.

Plenty of white space is critical along with keeping the text on each line relatively short. This is good marketing in general but especially important to older adults.

The National Institute on Aging and the National Library of Medicine have published a brochure on how to make Web sites senior friendly. The brochure emphasizes consistent design and clearly presented text and simple backgrounds to make reading easier for older eyes.

Another thing that can be extremely important to senior adults online is that page file size should be relatively small. Since many seniors have not yet moved to broadband services and therefore rely on dial-up modems, keeping that file size small lets the page load quicker and keeps the viewer happier longer. It is all about knowing your market.

Seniors are not adverse to learning technology. They're just unfamiliar with it, and once they have access to these new tools and the knowledge of how to use them, their lives are enriched.

What Broke My Father’s Heart by Katy Butler - Libby Deege

I was sent this article by one of our Clients Daughters...thought it was a moving piece and wanted to share.

One October afternoon three years ago while I was visiting my parents, my mother made a request I dreaded and longed to fulfill. She had just poured me a cup of Earl Grey from her Japanese iron teapot, shaped like a little pumpkin; outside, two cardinals splashed in the birdbath in the weak Connecticut sunlight. Her white hair was gathered at the nape of her neck, and her voice was low. “Please help me get Jeff’s pacemaker turned off,” she said, using my father’s first name. I nodded, and my heart knocked.

Upstairs, my 85-year-old father, Jeffrey, a retired Wesleyan University professor who suffered from dementia, lay napping in what was once their shared bedroom. Sewn into a hump of skin and muscle below his right clavicle was the pacemaker that helped his heart outlive his brain. The size of a pocket watch, it had kept his heart beating rhythmically for nearly five years. Its battery was expected to last five more.


After tea, I knew, my mother would help him from his narrow bed with its mattress encased in waterproof plastic. She would take him to the toilet, change his diaper and lead him tottering to the couch, where he would sit mutely for hours, pretending to read Joyce Carol Oates, the book falling in his lap as he stared out the window.


I don’t like describing what dementia did to my father — and indirectly to my mother — without telling you first that my parents loved each other, and I loved them. That my mother, Valerie, could stain a deck and sew an evening dress from a photo in Vogue and thought of my father as her best friend. That my father had never given up easily on anything.


Born in South Africa, he lost his left arm in World War II, but built floor-to-ceiling bookcases for our living room; earned a Ph.D. from Oxford; coached rugby; and with my two brothers as crew, sailed his beloved Rhodes 19 on Long Island Sound. When I was a child, he woke me, chortling, with his gloss on a verse from “The Rubaiyat of Omar Khayyam”: “Awake, my little one! Before life’s liquor in its cup be dry!” At bedtime he tucked me in, quoting “Hamlet” : “May flights of angels sing thee to thy rest!”


Now I would look at him and think of Anton Chekhov, who died of tuberculosis in 1904. “Whenever there is someone in a family who has long been ill, and hopelessly ill,” he wrote, “there come painful moments when all timidly, secretly, at the bottom of their hearts long for his death.” A century later, my mother and I had come to long for the machine in my father’s chest to fail.


Until 2001, my two brothers and I — all living in California — assumed that our parents would enjoy long, robust old ages capped by some brief, undefined final illness. Thanks to their own healthful habits and a panoply of medical advances — vaccines, antibiotics, airport defibrillators, 911 networks and the like — they weren’t likely to die prematurely of the pneumonias, influenzas and heart attacks that decimated previous generations. They walked every day. My mother practiced yoga. My father was writing a history of his birthplace, a small South African town.

In short, they were seemingly among the lucky ones for whom the American medical system, despite its fragmentation, inequity and waste, works quite well. Medicare and supplemental insurance paid for their specialists and their trusted Middletown internist, the lean, bespectacled Robert Fales, who, like them, was skeptical of medical overdoing. “I bonded with your parents, and you don’t bond with everybody,” he once told me. “It’s easier to understand someone if they just tell it like it is from their heart and their soul.”


They were also stoics and religious agnostics. They signed living wills and durable power-of-attorney documents for health care. My mother, who watched friends die slowly of cancer, had an underlined copy of the Hemlock Society’s “Final Exit” in her bookcase. Even so, I watched them lose control of their lives to a set of perverse financial incentives — for cardiologists, hospitals and especially the manufacturers of advanced medical devices — skewed to promote maximum treatment. At a point hard to precisely define, they stopped being beneficiaries of the war on sudden death and became its victims.


Things took their first unexpected turn on Nov. 13, 2001, when my father — then 79, pacemakerless and seemingly healthy — collapsed on my parents’ kitchen floor in Middletown, making burbling sounds. He had suffered a stroke.


He came home six weeks later permanently incapable of completing a sentence. But as I’ve said, he didn’t give up easily, and he doggedly learned again how to fasten his belt; to peck out sentences on his computer; to walk alone, one foot dragging, to the university pool for water aerobics. He never again put on a shirt without help or looked at the book he had been writing. One day he haltingly told my mother, “I don’t know who I am anymore.”


His stroke devastated two lives. The day before, my mother was an upper-middle-class housewife who practiced calligraphy in her spare time. Afterward, she was one of tens of millions of people in America, most of them women, who help care for an older family member.


Their numbers grow each day. Thanks to advanced medical technologies, elderly people now survive repeated health crises that once killed them, and so the “oldest old” have become the nation’s most rapidly growing age group. Nearly a third of Americans over 85 have dementia (a condition whose prevalence rises in direct relationship to longevity). Half need help with at least one practical, life-sustaining activity, like getting dressed or making breakfast. Even though a capable woman was hired to give my dad showers, my 77-year-old mother found herself on duty more than 80 hours a week. Her blood pressure rose and her weight fell. On a routine visit to Dr. Fales, she burst into tears. She was put on sleeping pills and antidepressants.


My father said he came to believe that she would have been better off if he had died. “She’d have weeped the weep of a widow,” he told me in his garbled, poststroke speech, on a walk we took together in the fall of 2002. “And then she would have been all right.” It was hard to tell which of them was suffering more.


As we shuffled through the fallen leaves that day, I thought of my father’s father, Ernest Butler. He was 79 when he died in 1965, before pacemakers, implanted cardiac defibrillators, stents and replacement heart valves routinely staved off death among the very old. After completing some long-unfinished chairs, he cleaned his woodshop, had a heart attack and died two days later in a plain hospital bed. As I held my dad’s soft, mottled hand, I vainly wished him a similar merciful death.


A few days before Christmas that year, after a vigorous session of water exercises, my father developed a painful inguinal (intestinal) hernia. My mother took him to Fales, who sent them to a local surgeon, who sent them to a cardiologist for a preoperative clearance. After an electrocardiogram recorded my father’s slow heartbeat — a longstanding and symptomless condition not uncommon in the very old — the cardiologist, John Rogan, refused to clear my dad for surgery unless he received a pacemaker.


Without the device, Dr. Rogan told me later, my father could have died from cardiac arrest during surgery or perhaps within a few months. It was the second time Rogan had seen my father. The first time, about a year before, he recommended the device for the same slow heartbeat. That time, my then-competent and prestroke father expressed extreme reluctance, on the advice of Fales, who considered it overtreatment.


My father’s medical conservatism, I have since learned, is not unusual. According to an analysis by the Dartmouth Atlas medical-research group, patients are far more likely than their doctors to reject aggressive treatments when fully informed of pros, cons and alternatives — information, one study suggests, that nearly half of patients say they don’t get. And although many doctors assume that people want to extend their lives, many do not. In a 1997 study in The Journal of the American Geriatrics Society, 30 percent of seriously ill people surveyed in a hospital said they would “rather die” than live permanently in a nursing home. In a 2008 study in The Journal of the American College of Cardiology, 28 percent of patients with advanced heart failure said they would trade one day of excellent health for another two years in their current state.


When Rogan suggested the pacemaker for the second time, my father was too stroke-damaged to discuss, and perhaps even to weigh, his trade­offs. The decision fell to my mother — anxious to relieve my father’s pain, exhausted with caregiving, deferential to doctors and no expert on high-tech medicine. She said yes. One of the most important medical decisions of my father’s life was over in minutes. Dr. Fales was notified by fax.


Fales loved my parents, knew their suffering close at hand, continued to oppose a pacemaker and wasn’t alarmed by death. If he had had the chance to sit down with my parents, he could have explained that the pacemaker’s battery would last 10 years and asked whether my father wanted to live to be 89 in his nearly mute and dependent state. He could have discussed the option of using a temporary external pacemaker that, I later learned, could have seen my dad safely through surgery. But my mother never consulted Fales. And the system would have effectively penalized him if she had. Medicare would have paid him a standard office-visit rate of $54 for what would undoubtedly have been a long meeting — and nothing for phone calls to work out a plan with Rogan and the surgeon.


Medicare has made minor improvements since then, and in the House version of the health care reform bill debated last year, much better payments for such conversations were included. But after the provision was distorted as reimbursement for “death panels,” it was dropped. In my father’s case, there was only a brief informed-consent process, covering the boilerplate risks of minor surgery, handled by the general surgeon.


I believe that my father’s doctors did their best within a compartmentalized and time-pressured medical system. But in the absence of any other guiding hand, there is no doubt that economics helped shape the wider context in which doctors made decisions. Had we been at the Mayo Clinic — where doctors are salaried, medical records are electronically organized and care is coordinated by a single doctor — things might have turned out differently. But Middletown is part of the fee-for-service medical economy. Doctors peddle their wares on a piecework basis; communication among them is haphazard; thinking is often short term; nobody makes money when medical interventions are declined; and nobody is in charge except the marketplace.


And so on Jan. 2, 2003, at Middlesex Hospital, the surgeon implanted my father’s pacemaker using local anesthetic. Medicare paid him $461 and the hospital a flat fee of about $12,000, of which an estimated $7,500 went to St. Jude Medical, the maker of the device. The hernia was fixed a few days later.


It was a case study in what primary-care doctors have long bemoaned: that Medicare rewards doctors far better for doing procedures than for assessing whether they should be done at all. The incentives for overtreatment continue, said Dr. Ted Epperly, the board chairman of the American Academy of Family Physicians, because those who profit from them — specialists, hospitals, drug companies and the medical-device manufacturers — spend money lobbying Congress and the public to keep it that way.


Last year, doctors, hospitals, drug companies, medical-equipment manufacturers and other medical professionals spent $545 million on lobbying, according to the Center for Responsive Politics. This may help explain why researchers estimate that 20 to 30 percent of Medicare’s $510 billion budget goes for unnecessary tests and treatment. Why cost-containment received short shrift in health care reform. Why physicians like Fales net an average of $173,000 a year, while noninvasive cardiologists like Rogan net about $419,000.


The system rewarded nobody for saying “no” or even “wait” — not even my frugal, intelligent, Consumer-Reports-reading mother. Medicare and supplemental insurance covered almost every penny of my father’s pacemaker. My mother was given more government-mandated consumer information when she bought a new Camry a year later.


And so my father’s electronically managed heart — now requiring frequent monitoring, paid by Medicare — became part of the $24 billion worldwide cardiac-device industry and an indirect subsidizer of the fiscal health of American hospitals. The profit margins that manufacturers earn on cardiac devices is close to 30 percent. Cardiac procedures and diagnostics generate about 20 percent of hospital revenues and 30 percent of profits.


Shortly after New Year’s 2003, my mother belatedly called and told me about the operations, which went off without a hitch. She didn’t call earlier, she said, because she didn’t want to worry me. My heart sank, but I said nothing. It is one thing to silently hope that your beloved father’s heart might fail. It is another to actively abet his death.


The pacemaker bought my parents two years of limbo, two of purgatory and two of hell. At first they soldiered on, with my father no better and no worse. My mother reread Jon Kabat-Zinn’s “Full Catastrophe Living,” bought a self-help book on patience and rose each morning to meditate.


In 2005, the age-related degeneration that had slowed my father’s heart attacked his eyes, lungs, bladder and bowels. Clots as narrow as a single human hair lodged in tiny blood vessels in his brain, killing clusters of neurons by depriving them of oxygen. Long partly deaf, he began losing his sight to wet macular degeneration, requiring ocular injections that cost nearly $2,000 each. A few months later, he forgot his way home from the university pool. He grew incontinent. He was collapsing physically, like an ancient, shored-up house.


In the summer of 2006, he fell in the driveway and suffered a brain hemorrhage. Not long afterward, he spent a full weekend compulsively brushing and rebrushing his teeth. “The Jeff I married . . . is no longer the same person,” my mother wrote in the journal a social worker had suggested she keep. “My life is in ruins. This is horrible, and I have lasted for five years.” His pacemaker kept on ticking.


When bioethicists debate life-extending technologies, the effects on people like my mother rarely enter the calculus. But a 2007 Ohio State University study of the DNA of family caregivers of people with Alzheimer’s disease showed that the ends of their chromosomes, called telomeres, had degraded enough to reflect a four-to-eight-year shortening of lifespan. By that reckoning, every year that the pacemaker gave my irreparably damaged father took from my then-vigorous mother an equal year.


When my mother was upset, she meditated or cleaned house. When I was upset, I Googled. In 2006, I discovered that pacemakers could be deactivated without surgery. Nurses, doctors and even device salesmen had done so, usually at deathbeds. A white ceramic device, like a TV remote and shaped like the wands that children use to blow bubbles, could be placed around the hump on my father’s chest. Press a few buttons and the electrical pulses that ran down the leads to his heart would slow until they were no longer effective. My father’s heart, I learned, would probably not stop. It would just return to its old, slow rhythm. If he was lucky, he might suffer cardiac arrest and die within weeks, perhaps in his sleep. If he was unlucky, he might linger painfully for months while his lagging heart failed to suffuse his vital organs with sufficient oxygenated blood.


If we did nothing, his pacemaker would not stop for years. Like the tireless charmed brooms in Disney’s “Fantasia,” it would prompt my father’s heart to beat after he became too demented to speak, sit up or eat. It would keep his heart pulsing after he drew his last breath. If he was buried, it would send signals to his dead heart in the coffin. If he was cremated, it would have to be cut from his chest first, to prevent it from exploding and damaging the walls or hurting an attendant.


On the Internet, I discovered that the pacemaker — somewhat like the ventilator, defibrillator and feeding tube — was first an exotic, stopgap device, used to carry a handful of patients through a brief medical crisis. Then it morphed into a battery-powered, implantable and routine treatment. When Medicare approved the pacemaker for reimbursement in 1966, the market exploded. Today pacemakers are implanted annually in more than 400,000 Americans, about 80 percent of whom are over 65. According to calculations by the Dartmouth Atlas research group using Medicare data, nearly a fifth of new recipients who receive pacemakers annually — 76,000 — are over 80. The typical patient with a cardiac device today is an elderly person suffering from at least one other severe chronic illness.


Over the years, as technology has improved, the battery life of these devices lengthened. The list of heart conditions for which they are recommended has grown. In 1984, the treatment guidelines from the American College of Cardiology declared that pacemakers were strongly recommended as “indicated” or mildly approved as “reasonable” for 56 heart conditions and “not indicated” for 31 more. By 2008, the list for which they were strongly or mildly recommended expanded to 88, with most of the increase in the lukewarm “reasonable” category.


The research backing the expansion of diagnoses was weak. Over all, only 5 percent of the positive recommendations were supported by research from multiple double-blind randomized studies, the gold standard of evidence-based medicine. And 58 percent were based on no studies at all, only a “consensus of expert opinion.” Of the 17 cardiologists who wrote the 2008 guidelines, 11 received financing from cardiac-device makers or worked at institutions receiving it. Seven, due to the extent of their financial connections, were recused from voting on the guidelines they helped write.


This pattern — a paucity of scientific support and a plethora of industry connections — holds across almost all cardiac treatments, according to the cardiologist Pierluigi Tricoci of Duke University’s Clinical Research Institute. Last year in The Journal of the American Medical Association, Tricoci and his co-authors wrote that only 11 percent of 2,700 widely used cardiac-treatment guidelines were based on that gold standard. Most were based only on expert opinion.


Experts are as vulnerable to conflicts of interest as researchers are, the authors warned, because “expert clinicians are also those who are likely to receive honoraria, speakers bureau [fees], consulting fees or research support from industry.” They called the current cardiac-research agenda “strongly influenced by industry’s natural desire to introduce new products.”


Perhaps it’s no surprise that I also discovered others puzzling over cardiologists who recommended pacemakers for relatives with advanced dementia. “78-year-old mother-in-law has dementia; severe short-term memory issues,” read an Internet post by “soninlaw” on Elderhope.com, a caregivers’ site, in 2007. “On a routine trip to her cardiologist, doctor decides she needs a pacemaker. . . . Anyone have a similar encounter?”


By the summer of 2007, my dad had forgotten the purpose of a dinner napkin and had to be coached to remove his slippers before he tried to put on his shoes. After a lifetime of promoting my father’s health, my mother reversed course. On a routine visit, she asked Rogan to deactivate the pacemaker. “It was hard,” she later told me. “I was doing for Jeff what I would have wanted Jeff to do for me.” Rogan soon made it clear he was morally opposed. “It would have been like putting a pillow over your father’s head,” he later told me.


Not long afterward, my mother declined additional medical tests and refused to put my father on a new anti-dementia drug and a blood thinner with troublesome side effects. “I take responsibility for whatever,” she wrote in her journal that summer. “Enough of all this overkill! It’s killing me! Talk about quality of life — what about mine?”


Then came the autumn day when she asked for my help, and I said yes. I told myself that we were simply trying to undo a terrible medical mistake. I reminded myself that my dad had rejected a pacemaker when his faculties were intact. I imagined, as a bioethicist had suggested, having a 15-minute conversation with my independent, predementia father in which I saw him shaking his head in horror over any further extension of what was not a “life,” but a prolonged and attenuated dying. None of it helped. I knew that once he died, I would dream of him and miss his mute, loving smiles. I wanted to melt into the arms of the father I once had and ask him to handle this. Instead, I felt as if I were signing on as his executioner and that I had no choice.


Over the next five months, my mother and I learned many things. We were told, by the Hemlock Society’s successor, Compassion and Choices, that as my father’s medical proxy, my mother had the legal right to ask for the withdrawal of any treatment and that the pacemaker was, in theory at least, a form of medical treatment. We learned that although my father’s living will requested no life support if he were comatose or dying, it said nothing about dementia and did not define a pacemaker as life support. We learned that if we called 911, emergency medical technicians would not honor my father’s do-not-resuscitate order unless he wore a state-issued orange hospital bracelet. We also learned that no cardiology association had given its members clear guidance on when, or whether, deactivating pacemakers was ethical.


(Last month that changed. The Heart Rhythm Society and the American Heart Association issued guidelines declaring that patients or their legal surrogates have the moral and legal right to request the withdrawal of any medical treatment, including an implanted cardiac device. It said that deactivating a pacemaker was neither euthanasia nor assisted suicide, and that a doctor could not be compelled to do so in violation of his moral values. In such cases, it continued, doctors “cannot abandon the patient but should involve a colleague who is willing to carry out the procedure.” This came, of course, too late for us.)


In the spring of 2008, things got even worse. My father took to roaring like a lion at his caregivers. At home in California, I searched the Internet for a sympathetic cardiologist and a caregiver to put my Dad to bed at night. My frayed mother began to shout at him, and their nighttime scenes were heartbreaking and frightening. An Alzheimer’s Association support-group leader suggested that my brothers and I fly out together and institutionalize my father. This leader did not know my mother’s formidable will and had never heard her speak about her wedding vows or her love.


Meanwhile my father drifted into what nurses call “the dwindles”: not sick enough to qualify for hospice care, but sick enough to never get better. He fell repeatedly at night and my mother could not pick him up. Finally, he was weak enough to qualify for palliative care, and a team of nurses and social workers visited the house. His chest grew wheezy. My mother did not request antibiotics. In mid-April 2008, he was taken by ambulance to Middlesex Hospital’s hospice wing, suffering from pneumonia.


Pneumonia was once called “the old man’s friend” for its promise of an easy death. That’s not what I saw when I flew in. On morphine, unreachable, his eyes shut, my beloved father was breathing as hard and regularly as a machine.


My mother sat holding his hand, weeping and begging for forgiveness for her impatience. She sat by him in agony. She beseeched his doctors and nurses to increase his morphine dose and to turn off the pacemaker. It was a weekend, and the doctor on call at Rogan’s cardiology practice refused authorization, saying that my father “might die immediately.” And so came five days of hard labor. My mother and I stayed by him in shifts, while his breathing became increasingly ragged and his feet slowly started to turn blue. I began drafting an appeal to the hospital ethics committee. My brothers flew in.
On a Tuesday afternoon, with my mother at his side, my father stopped breathing. A hospice nurse hung a blue light on the outside of his hospital door. Inside his chest, his pacemaker was still quietly pulsing.


After his memorial service in the Wesleyan University chapel, I carried a box from the crematory into the woods of an old convent where he and I often walked. It was late April, overcast and cold. By the side of a stream, I opened the box, scooped out a handful of ashes and threw them into the swirling water. There were some curious spiraled metal wires, perhaps the leads of his pacemaker, mixed with the white dust and pieces of bone.


A year later, I took my mother to meet a heart surgeon in a windowless treatment room at Brigham and Women’s Hospital in Boston. She was 84, with two leaking heart valves. Her cardiologist had recommended open-heart surgery, and I was hoping to find a less invasive approach. When the surgeon asked us why we were there, my mother said, “To ask questions.” She was no longer a trusting and deferential patient. Like me, she no longer saw doctors — perhaps with the exception of Fales — as healers or her fiduciaries. They were now skilled technicians with their own agendas. But I couldn’t help feeling that something precious — our old faith in a doctor’s calling, perhaps, or in a healing that is more than a financial transaction or a reflexive fixing of broken parts — had been lost.


The surgeon was forthright: without open-heart surgery, there was a 50-50 chance my mother would die within two years. If she survived the operation, she would probably live to be 90. And the risks? He shrugged. Months of recovery. A 5 percent chance of stroke. Some possibility, he acknowledged at my prompting, of postoperative cognitive decline. (More than half of heart-bypass patients suffer at least a 20 percent reduction in mental function.) My mother lifted her trouser leg to reveal an anklet of orange plastic: her do-not-resuscitate bracelet. The doctor recoiled. No, he would not operate with that bracelet in place. It would not be fair to his team. She would be revived if she collapsed. “If I have a stroke,” my mother said, nearly in tears, “I want you to let me go.” What about a minor stroke, he said — a little weakness on one side?


I kept my mouth shut. I was there to get her the information she needed and to support whatever decision she made. If she emerged from surgery intellectually damaged, I would bring her to a nursing home in California and try to care for her the way she had cared for my father at such cost to her own health. The thought terrified me.


The doctor sent her up a floor for an echocardiogram. A half-hour later, my mother came back to the waiting room and put on her black coat. “No,” she said brightly, with the clarity of purpose she had shown when she asked me to have the pacemaker deactivated. “I will not do it.”


She spent the spring and summer arranging house repairs, thinning out my father’s bookcases and throwing out the files he collected so lovingly for the book he never finished writing. She told someone that she didn’t want to leave a mess for her kids. Her chest pain worsened, and her breathlessness grew severe. “I’m aching to garden,” she wrote in her journal. “But so it goes. ACCEPT ACCEPT ACCEPT.”


Last August, she had a heart attack and returned home under hospice care. One evening a month later, another heart attack. One of my brothers followed her ambulance to the hospice wing where we had sat for days by my father’s bed. The next morning, she took off her silver earrings and told the nurses she wanted to stop eating and drinking, that she wanted to die and never go home. Death came to her an hour later, while my brother was on the phone to me in California — almost as mercifully as it had come to my paternal grandfather. She was continent and lucid to her end.


A week later, at the same crematory near Long Island Sound, my brothers and I watched through a plate-glass window as a cardboard box containing her body, dressed in a scarlet silk ao dai she had sewn herself, slid into the flames. The next day, the undertaker delivered a plastic box to the house where, for 45 of their 61 years together, my parents had loved and looked after each other, humanly and imperfectly. There were no bits of metal mixed with the fine white powder and the small pieces of her bones.




Katy Butler lives in Mill Valley, Calif., and teaches memoir writing at the Esalen Institute in Big Sur.