ERE or Semi-ERE past Age 65

[ffj]

I would really like to hear more of what candide has to say if they feel like it.

And Jenny too. Hoping for a fast recovery.

[dustBowl]

There was an emphasis on nobody becoming "overfactored". A team will often be in a situation where one person knows more and can do the job better than just about any one of the rest of the team. The danger here is that the rest of the team comes to rely on that one person.

In my work life, we called this the Bus Factor AKA the hit-by-a-bus factor. On good teams, there was a continuous effort to spread knowledge around so that no person could become a potential single point of failure.

It seems like a harder problem to solve in a personal context, because instead of having 5-10 people of roughly equal competency who you can spread knowledge between, your whole 'team' might be just you + spouse, or even just you, depending on life circumstances.

You can try to expand your 'team' to include other family members or hire 'team members' from the market in the form of advisors etc. but this thread is replete with examples of the limitations of that approach.

@jp Wishing you a quick recovery

[AxelHeyst]

How nice would it be to live in a location where there are 6-12+ people within walking/biking distance who you know to be approximately as competent as you and familiar with your systems should they be called upon to help out in a pinch...

Heal quick jp!!

(ETA: I now feel obligated to add that I don't think that having helpful competent neighbors will cover the kinds of circumstances that Candide and others are talking about. I'm not sure who does think that, maybe people are talking about two different things and not realizing it. It's one thing to be able to push the line of "I need professional help" a bit further into the future, it's another to assume that you'll be able to delete that line for good no matter what.)

[candide]

I had a bad accident last month.

I am so sorry. Here's to a quick recovery. I meant it when I wrote that if anyone could make these situations work in an ERE way, it was you. Here's wishing you the best of recoveries, and add me to the chorus of people who would love to know more about your experiences with this when you are able to gather your thoughts.

Speaking of...

I would really like to hear more of what candide has to say if they feel like it.

I'll try to keep that in mind. No promises, though.

But I imagine I have time today to write one out: I think there has been a real overestimation of informal arrangements as opposed to ones that are formal, professionalized, predictable, and, yes, have to be set up with money in our society.

Example: MIL's Parkinson's medication. Though I can make the devil's advocacy case that if someone is going to refuse pills it doesn't matter what system you use, I guarantee that where we put MIL will create a situation where she does better on her meds than the current situation. For a while she was experimenting with a half dose, essentially just 'cuz. She has also had days where she is manic after feeling well for part of the day (usually because she actually took her meds at the correct dosage) and then says "I'm not going to take them today!" only to crash when the meds wear off. I've seen the exact opposite, with her panicked because while she didn't mark the sheet, she thought she took them, but doesn't feel it, so now is afraid she can't take it... (That last one was actually when I was staying with her while her husband was in surgery, the one whose complications he died of. It was those two days of hanging with her that let me inform the family how bad off she really was; a lot of masking was going on with her and my father-in-law).

Once your cognition is impaired -- even if it only intermittently -- what you need are systems, not occasional check-ins from friends and neighbors.

Family is a bad solution, as you are now putting a continual, every day burden on them, or it gets put in the portfolio of family members too disorganized to do their own shit routinely.

... I think it is this insistence that no matter what it just has to be the case that "a little help every now and then" will be all that is required that kinda tips the hand that someone doesn't understand the part of life I am talking about.

[Ego]

@JP, I hope you recover quickly. Please keep us up to date on your progress.

Once you're cognition is impaired -- even if it only intermittently -- what you need are systems, not occasional check-ins from friends and neighbors.

Family is a bad solution, as you are now putting a continual, every day burden on them, or it gets put in the portfolio of family members too disorganized to do their own shit routinely.

... I think it is this insistence that no matter what it just has to be the case that "a little help every now and then" will be all that is required that kinda tips the hand that someone doesn't understand the part of life I am talking about.

I have argued both sides of this.

-While managing the senior apartment complex Soylent Towers we came to the conclusion that our handful of poor Section-8 seniors got about the same level of care as those with deep pockets. More than one tenant had serious cognitive issues and one with full blown dementia. We also had one tenant in our last place who was in home hospice when we left. His care was excellent. He had no income other than social security and help from social service agencies. His life was pretty good, all things considered.

-My friend who moved from an incredible community that they both loved to the retirement community did so because his wife was a hospice nurse and she knew the system well. She wanted to lock in good end-of-life care for them because she knew how bad it could be. We have since learned that they have made some highly questionable financial decisions which makes me question this decision.


Ultimately, my question is whether it is worth the effort to save a large nest egg to prepare for those weeks/months/years of incapacitation. Do the years of extra work do more harm than the benefits or will I regret not having a massive nest egg?

Is the poor person's experience that much different from the wealthy person's? Is it possible that spend-down requirements make the large nest egg a liability?

This is most certainly location dependent and requires guessing what will happen in the future after the Boomer wave subsides.

[Sclass]

You bring up a good point. When I’d speak to my mom’s care givers some would tell me about their other clients. Some of the ladies worked at Silverado which is a big chain of nursing homes. Family members would hire them as supplemental help to fill in.

They would talk to the other caregivers to try to figure out which patients were Medicare and which were self pay. The same beds side by side - some had to pay and others were free ride compliments of Medicare. The idea was you spent down all your funds then the government would step in and pay. In both cases the Silverado facility would care for you but family would hire the extra contract help to make sure you had frequent diaper changes and ensure drinks when the Silverado staff was too busy. Bottom line is both patients had the same care broke or not. It was kind of a game for the nurses to try to figure out who was paying and who was not. It’s a really boring job waiting around between changes so I guess they had to entertain themselves.

The care givers would ask me why not move my mom out of the house and take her to Silverado. They said I’d have to sell the house or Medicare would want to do some kind of clawback later. And I’d need to spend my mom’s nest egg. Or optionally I could have drained off her funds prior to her hospitalization - apparently there are strategies to do this to outmaneuver the government so you can get the free care and keep the money. A friend advised me to do this early in my mom’s disease but it just seemed freaking wrong and my father wouldn’t cede control on top of that. It would mean losing control of his socal home that he evidently wanted to secure till the last possible moment.

At the end of the day it may have been possible for mom and dad to go out on the government deal. Their deep pockets didn’t seem to buy much as they withered away in hospital beds with only a diaper and a disposable blanket draped over them. Medicated on morphine and sedated. Maybe the extra diaper changes and dry bedding took the edge off? Free lorazepam seemed to do that too.

Like a lot of government stuff it seemed to be about how well you knew your way around the system. When I’d stress about potentially running out of money the caregivers would say “sclass you are not good at getting help. You don’t have to pay for all this.” It was complex and I didn’t want to change course at that point. But it made me realize there are other ways if you understand the system.

Once I got my mom on hospice we’d get these huge bills in the thousands a month but they’d magically get nulled out by Medicare. There was this industry of hospice providers that appear to be milking the government to get this cash. Both parents got this at the very end. I wasn’t terribly good at asking for all I could get.

ETA - this is a thing.

Family is a bad solution, as you are now putting a continual, every day burden on them, or it gets put in the portfolio of family members too disorganized to do their own shit routinely.

It really is a bad solution. Social capital paid by the socially indebted.

My dad thought it would be appropriate for me to care for my mom because I didn’t have to work. I also didn’t have the family responsibilities that my brother and sister had. ERE was a blessing to him…he didn’t have to pay me to prop up his second household.

After mom passed he tried to get me to start “checking up” on his sister who lives in West Hollywood. I had to bow out saying she wasn’t my mom. She kept calling me asking me over for “lunch”. I refused to pick up the phone. Eventually he sent my brother over. All the way from Silicon Valley…to move her furniture around her livingroom, fix a fence that fell down and put up a shower curtain. My brother is visiting her regularly now. She has daughters but they live on the east coast and cannot “check up” on their mom. At my dad’s funeral her daughters just scowled at me. Like I wasn’t helpful or something because I “only live an hour away.” My aunt said “ooh my Sclass I must have the wrong number or an old email because I don’t hear back from you. My daughter says it’s the right one but I’m so confused.”

Right Auntie. “I don’t pick up for you. You’re not my mom”. The room went silent as my cousins glared at me. I just kept on eating deviled eggs and fruit punch. I mean WTH. You’re 88, you cannot maintain your life (four bedroom suburban home) alone and your kids live on the east coast so you want me to pay your freaking “infrastructure debt”? No way. And cousins you better stop staring at me like I’m supposed to be taking care of YOUR mom just because she doesn’t want to move out of her giant home in Los Angeles.

Some kids or grandkids do this stuff for free rent. They can smoke weed in grandma’s back yard and mooch her wifi. But it’s a dead end and it ruins their lives when they are kicked out of their home ten years later by the family during the estate fight. When I hear somebody has their grandchildren helping it makes me barf.

One of my buddy’s brothers is a step from homelessness because mom died and my buddy evicted him. They had to sell the house. It doesn’t help that the little brother is morbidly obese and suffering from chronic depression after living with an Alzheimer’s patient for ten years. He’s on the street. Luckily another relative took him in.

My BIL is doing the same thing. While my brother and sister ignored me while I cared for my mom my wife has been ignoring her brother who lives with their incapacitated mom. He’s obese. Hooked on free broadband. My FIL lives in another house because he (and his mistress) doesn’t want to deal with the shitshow. FIL sends Amazon fresh and pays bills. And my DW just ignores them and says “Sclass stay out of my family business.” My disorganized BIL seems to think it was better than working so he quit his job and moved home in 2014. He has destroyed himself.

Yeah agreed. It’s a bad solution .

[7Wannabe5]

I'm currently reading these weird old mid-20th century writings on the application of systems theory to psychological therapy. Murray Bowen, one of the pioneers of family therapy, clearly noted that his approach with psychology was only one perspective among many others such as genetics or psychiatry. Bowen posed the question or created the notion of "What if we regard the entire extended family system as suffering from schizophrenia rather than the patient upon whom the diagnosis has become centered?" On one level this seems entirely nuts, but on another level it makes pretty good sense.

It's actually somewaht happenstance that I started reading down this tunnel as I am intermittently helping my sisters with my bi-polar, physically decrepit aging mother, but it's proving quite enlightening. So, I pose the question for the members of this highly towards the individualistic forum, "What if the physical and cognitive decline associated with the aging of a family member or members is seen as the cognitive and physical decline of the extended family rather than a condition centered on the aging individual(s?) " A core tenet of family systems therapy would be that you can't simply offload the emotional impact/responsibility through the sort of distancing/cut-off made available through simply throwing money at the problem. Although, it could be the case that as a healthy psychologically "differentiated" yet still emotionally engaged individual member of an extended family you could respond/make an appropriate decision in alignment with spending more money. IOW, it's a matter of the difference between "emotional cut-off" which will almost certainly eventually boomerang back on you vs. "emotional differentiation." For example, if you throw Granny in the Medicaid nursing home and then never or rarely visit her (likely in avoidance of your background guilt) then that would be an example of "emotional cut-off." If you can verbalize, move from "emotion" to "feeling" (activate the part of the brain that rationally considers emotions, as opposed to the other part of the brain that rationally deals with other rational thoughts), "I feel guilty about throwing Granny in the Medicaid nursing home", perhaps on a forum such as this one, then that is towards emotional "differentiation."

[Sclass]

"What if the physical and cognitive decline associated with the aging of a family member or members is seen as the cognitive and physical decline of the extended family rather than a condition centered on the aging individual(s?) "

As silly as this sounds at first glance I think there is some element of truth in it. Running home to live rent free with an incapacitated parent and living off half of their social security is kind of a sketchy move. It tells a lot about the state of the younger family member.

[7Wannabe5]

As silly as this sounds at first glance I think there is some element of truth in it. Running home to live rent free with an incapacitated parent and living off half of their social security is kind of a sketchy move. It tells a lot about the state of the younger family member.

Yes, but this perspective is highly dependent on framework which equates financial independence with emotional differentiation, when it is often more the case that financial independence simply allows for emotional distancing*. If you, like Bowen, believe that we evolved to experience mammalian social emotions as background noise we can no more completely excise from our function than simpler reflexes, then "Yes" simply physically removing yourself from a stressful social situation will reduce your own anxiety to some extent. However, your general behavioral patterns for dealing with an anxiety producing social situation, such as the declining cognitive functioning of a member of the group, will likely have already been formed in your family of origin, and will likely to continue to be reflected or "triangulated" into any other social setting in which you find yourself to the extent to which you haven't gained functional "differentiation."

Bowen also did work on expanding the notion of family therapy to consider social relationships in the workplace. It often happens that when humans feel helpless or shut-out of a role in the family group, they will overcompensate, form more of their more functional identity, in the workplace social setting. Thus, they will also experience more anxiety and a greater sense of loss when they retire. In our society, it is more often the case that individuals are more emotionally "differentiated" in workplace setting than extended family setting, but this may vary.

Anyways, I bring this up, because I was struck by this statement by candide:

Family is a bad solution, as you are now putting a continual, every day burden on them, or it gets put in the portfolio of family members too disorganized to do their own shit routinely.

From the perspective of family systems therapy, the problem itself inextricably lies within the family unit, rather than the unit of the individual, so it makes little sense to suggest that "family," whether in the form of more or less functional members, is a "bad solution." It's like saying "Near dune forest eco-system" is a bad solution for "disease observed in Jack Pine population." You can't just do one thing in a system. The choice (or, really, the many other family systems factors contributing to this choice) of whether or not to put Granny in the Medicaid nursing home can even have emotional reverberations on generations yet to be born, and this choice when made is also very likely based on family systems factors brought into play in past generations long dead. For example, whether or not Granny's own paternal grandfather was his mother's overly favored youngest child may have an impact.

Fascinating stuff! (to be taken with large grain of salt.)

*For example, if you tend to hold the "charge" or role of "caretaker" in a situation with increasing anxiety, then distancing yourself from the situation won't alter the extent to which you tend to hold that "charge" except in the simplistic sense of "I am not dysfunctionally taking on the role of caretaker, because I have removed myself from any situation in which that might occur." IOW, a magnet in a box far away from the other magnets is still a magnet, even if you never observe it moving towards or away.

[jacob]

Yes, but this perspective is highly dependent on framework which equates financial independence with emotional differentiation, when it is often more the case that financial independence simply allows for emotional distancing*.

In a given family, there will likely be people who are Kegan2 and others who are Kegan3 or 5. These will be connected in different ways. For example, Kegan3 typically lacks an independent sense of self and so if someone they're tightly connected with starts failing, they're in deep doodoo... likely to undergo an amount of denial, bargaining, ... grief over the loss of not just the other person(s) but technically also their "socialized self".

Whereas Kegan2 would be capable of leaving as soon as they don't get anything out of the transactive relationship anymore. No hard feelings, because their sense of self is purely egotistical.

Whereas Kegan4 would be capable of relying on one of their other group identities, like e.g. leaning away from the family identity and finding solace (identity) in work, hobbies, ... And so they would have an easier time dealing with a failing person because they can deliberately strengthen or weaken bonds as necessary.

Kegan3 is kinda screwed though.

(To complicate it a bit further but not losing generality, it really depends on where/what people find their sense of self. If someone identifies as "mom" or "familyman", then a divorce or the loss of a child is far more significant than if they primarily identify as "engineer" or "athlete". In summary, it sort of depends on what is lost as who is losing it and how those things connect with others in the "network". It's not really that different than snipping connections in a WOG.)

[Ego]

They would talk to the other caregivers to try to figure out which patients were Medicare and which were self pay. The same beds side by side - some had to pay and others were free ride compliments of Medicare. The idea was you spent down all your funds then the government would step in and pay.

@sclass, thank you again for being so open about your experiences. I hope others here read them carefully and begin to think early about how to handle these challenging situations. I also hope that others who have experience with family or friends who reached old age with little money tell their experiences. This is where a forum like this really shines.

The choice (or, really, the many other family systems factors contributing to this choice) of whether or not to put Granny in the Medicaid nursing home can even have emotional reverberations on generations yet to be born, and this choice when made is also very likely based on family systems factors brought into play in past generations long dead.

Do you have any information that suggests that a "Medicaid nursing home" is different from a regular nursing home, like @sclass's example above? Calling it a Medicaid nursing home implies that it is somehow terrible and the alternative is better. It also implies that home care is better than round the clock skilled nursing care.

To your broader point, we had two members of the family express a similar opinion when a particular parent, with whom we had cut ties a decade before, was nearing their end. Ironically, these siblings had both cut ties for very good reasons with the same parent earlier in their lives, but had decided to rekindle the relationship when they themselves had children. It took a while to get to the heart of their argument, but it came streaming out one day when they were telling an absurdly hilarious story about something the parent had done to a caregiver. They were not appalled by the cut ties. They were appalled by the example we set for their children. Both are divorced, live alone, hope their children will be involved in their old age and are terrified by the prospect that they could be abandoned.

Different people approach these known-unknowns in different ways. I like to learn what I can about the systems and get to know the worst case scenarios. That way, I can try my best to avoid them. If the worst case is not much worse than the best case, then I probably should not spend much energy trying to earn money to buy the best case.

And because we have no children, the fact that we will have to fend for ourselves is something we already know. I believe that gives us something of an advantage. Without the fallback of "the kids will have to figure it out", we are forced to plan for ourselves.

[7Wannabe5]

Whereas Kegan4 would be capable of relying on one of their other group identities, like e.g. leaning away from the family identity and finding solace (identity) in work, hobbies, ... And so they would have an easier time dealing with a failing person because they can deliberately strengthen or weaken bonds as necessary.

Kegan3 is kinda screwed though.

Yes, and as Kegan noted, the median college educated adult in our society is most likely to have achieved Kegan 4 "the professional" functioning
of a "differentiated" individual in his work environment while still exhibiting Kegan 3 more "emotionally-fused" functioning in his family environment. Still, we can see in phrases such as "FU money" that there is some emotional-fusion also held there, likely proportional to perceived ability to negotiate on adult-to-adult level. Another example would be how the median middle-class female has so thoroughly transferred her identity and security needs from "husband" to "employer" over the last 60 years (2/3 generations) that being a homemaker theseadays seems like a radically risky endeavor.

IOW, if you can only find solace in other spheres, then you likely also "only" have an illusion of Kegan 4 in those spheres, and you are simply distancing from the other sphere. It's very much akin to having an affair to triangulate the dysfunction in your marriage. In theory, the truly "differentiated" individual can "hold on to themself" while in the midst of the any sort of social anxiety producing situation. They can keep the relationship bonds strong while still engaging in practice of self-aware, well-boundaried, self-care. Often this comes out as , "I love you, and..." For example, "I love you, and that is why I am going to help place you in a very good, appropriate facility where I will feel happy to visit you every Tuesday evening for our game of checkers." In the other context (dealing with sex-dead marriage) in which I originally learned a sub-set of this theory, it might come out more like "I love you, and I would love to be having an active sex life with you. I do not wish to continue in a sexless existence, so I will be going out to the bar at the Uptown Hilton on Saturday night. I hope to see you there." Maintaining your functionally "differentiated" posture through whatever reactivity such a statement might produce in other is also not always easy. For example, a sign that you are "emotionally fused" with your professional identity or job would be if you feared that your boss would insult your essential competence if/when you attempted to negotiate a raise or a new role. It might be worth questioning what is going on elsewhere if/when your job is making you cry or your relationship with your work-spouse is more intimate than your relationship with your marital spouse, etc. etc.

That said, Bowen stated that he observed very few humans who were consistently very well "differentiated." I would also note that IME, there can be a very fine line between "differentiated" and "dominant."

[7Wannabe5]

Do you have any information that suggests that a "Medicaid nursing home" is different from a regular nursing home, like @sclass's example above? Calling it a Medicaid nursing home implies that it is somehow terrible and the alternative is better. It also implies that home care is better than round the clock skilled nursing care.

No. My bad, I was just using the phrase to convey sort of thing somebody might feel avoidant guilty about. My take on the practical question would be that it is an inefficient market, so you can increase your "luck" with some research and planning.

To your broader point, we had two members of the family express a similar opinion when a particular parent, with whom we had cut ties a decade before, was nearing their end. Ironically, these siblings had both cut ties for very good reasons with the same parent earlier in their lives, but had decided to rekindle the relationship when they themselves had children. It took a while to get to the heart of their argument, but it came streaming out one day when they were telling an absurdly hilarious story about something the parent had done to a caregiver. They were not appalled by the cut ties. They were appalled by the example we set for their children. Both are divorced, live alone, hope their children will be involved in their old age and are terrified by the prospect that they could be abandoned.

Well, I definitely believe in the concept of the "good divorce", even when it comes to family of origin. I just think that "differentiation" points the way to the difference between "cutting ties" and "parting ways." Also, I have known individuals who completely cut themselves off with a line in the sand from their dysfunctional family of origin and decades later it snapped back on them in their new relationships. From a perspective of 100% self-interest, I believe it is usually better to work forward from whatever was good or reasonably functional rather than throwing out the baby with the bathwater. For example, constantly saying to yourself "I had a fucked up childhood." is a worse predictor for your future than self-aware reflecting on the scant three things that were good about your childhood. Another example would be that I'm as likely as the next person to weakly grouse about the faults of my exes, but when I split with my first husband, I told him that I really appreciated how he had provided enough financial support that I could stay home with our kids when they were young, and then we both had a bit of a cry together, and then we continued on with the process of our moderately-"good"-not-the-worst-possible-sort-of-divorce. I will be attending the memorial service for my ex-MIL in a couple of weeks, and I will for sure be giving my ex a strong, sincere hug.

[candide]

@sclass and @ego

The examples you have both given are eye-opening, and will help me when dealing with my mother when her time for this stuff comes, as she is the most financially foolish of all the elders that I will be left holding the bag for (all are dead other than her and MIL anyway). Still, this is an example of ERE merging back with FIRE, if not just straight-up normie living. (Which is fine -- ERE is a home economics theory, not a religion that replaces the realities of aging and death). And the idea of the results merging was how I answered Scott2's original point:

viewtopic.php?p=285584#p285584

My problem was with those that acted like they would still be using charm and accumulated social capital to deal with the end-game of life. In this society, the one we actually live in, if you don't use any money to set up any structures, you are just dumping a bunch of shit on your loved ones that is perfectly avoidable.


Key take-away. Use professional services to automate the routine and tedious so you can focus on providing visits that are caring and loving. The context of my comment was that family is a bad solution for making sure medicine is given correctly every day. If it is stuck to one person, this is now their prayer to Mecca until the other person dies. If it is spread across family members, then I promise you the ball will get dropped somewhere... Just get it folded into a professional system, and focus on love and memories with the time left.

Anyways, I bring this up, because I was struck by this statement by candide:
[...]

It would appear that at the performative level you see benefit in family not being the only solution:

My sisters and I are currently engaged in an experiment with converting my decrepit bi-polar 84 year old mother's fairly small 2 bedroom centrally located senior apartment into a more useful extended family WFH hub. In fact, I am typing this from the mini-office space created in one of the bedrooms. Since my mother can only sleep in a mechanical chair in the living room, a second office space was created in the 2nd bedroom, along with sleeping spaces still retained in both bedrooms. The services of a paid caretaker/aide for around 10 hours/week were also included in this design.

It's probably for the best that the set-up isn't a granny-pod in the middle of a food forest on one of the properties-- because after all, our ideals are supposed to serve our families, rather than our families twisted to serve our ideals (Bed of Procustes), but you are using the market, and should reserve the right to use it more as the situation gets worse. Your practice isn't all that different than ours.

Okay, on to this framework, I think my biggest problem with it, at least as presented, is that "family" and who has what obligation is pretty amorphous in these situations, and highly prone to defection. Sclass's example is really representative.

viewtopic.php?p=290523#p290523

Are his obligations really more because he lives an hour a way (when traffic conditions are perfect) than those who were given daily care by the person for 18 years, and almost certainly financial support beyond that? They have their plausible deniability in their minds about whose job it is, and that will help them defect for longer... Also, the elderly person who refuses to relocate closer to family is defecting from family to individual values... what does this framework have to say about what you are supposed to do it?

[7Wannabe5]

@candide:

I am not promoting the "should"s of conventional family values or even those of ERE. I am sharing a seemingly outlandish relic of perspective/theory from the archives of the mid-20th century origin of systems theory and wondering if it just might be useful here. In purely practical terms, I have already de facto installed my own semi-aging self in a Medicaid nursing home in the form of the advanced biological infusion center I visit every 8 weeks due to Crohn's disease. As I have noted elsewhere, if I was just one tree in one of my permaculture projects, I'd be in the ash heap already.

Key take-away. Use professional services to automate the routine and tedious so you can focus on providing visits that are caring and loving. The context of my comment was that family is a bad solution for making sure medicine is given correctly every day. If it is stuck to one person, this is now their prayer to Mecca until the other person dies. If it is spread across family members, then I promise you the ball will get dropped somewhere... Just get it folded into a professional system, and focus on love and memories with the time left.

I don't disagree, but I wonder if the outlandish notion/perspective that the treatment unit of disease is the system of the family rather than the system of the individual might help with answering a question such as "Why is making sure an elder takes their medication as prescribed (etc.etc.etc.)in many ways a more difficult problem than, for instance, running a small family business growing pot in your basement?"

It is actually semi-ironically the case that our recently designed family system as I described above failed to ensure that my mother took her medication as prescribed a couple days ago, and she is still cognitively pretty sharp beyond her tendencies towards bi-polar disease. She was hospitalized (again) due to severe back pain and edema in her legs, and the medical staff noted that her behavior seemed to be manic, so they called my sister who is currently her medical contact, inquired whether she had been taking her psych meds, and that is when we realized that the super-organized pill dispenser system we had just set up (versus her former basket of cluttered medicationsand miscellaneous) wasn't good enough. However, it did allow us to give the medical staff more informed information, because at least we could see that "Nope, she skipped two days." The fact that I am still willing to go back to the drawing board on fixing the system likely has a good deal to do with the fact that two of my sisters with whom I work pretty well are also engaged.

Anyways, since I am obviously currently right in the mix myself with my family, and I happenstanced across this outlandish perspective/theory in my reading, what I am thinking is that maybe the expectations and emotions often found within our family systems contribute to making it a more difficult dependency need problem than running a pot farm in the basement. For example, the fact that our mother was towards cold, neglectful, and intermittently raging as a parent is a complication in our elder care system, which might actually be perversely more functional in terms of sharing the burden than most, because our sibling bonds are stronger than usual in part due to our shared experience of weathering the trauma of growing up with a parent with active bi-polar disease. Dunno.

[ertyu]

This thread really validates the hemlock solution if you're single. As someone with family history of Alzheimers/dementia but hopefully 30 years from that point, I wonder what stage you'd recommend taking it at. Having observed your ageing parents, when would you yourself check out, assuming no family to care for you and no state support system one can rely on? What signs would you watch out for so you don't miss the moment when you're still sane enough to follow through? I do wonder if I'll be strong enough, or if I'll end up going, "just another day, just another day..."

I'm particularly curious to hear from those who've seen the bad and the ugly -- @Sclass, I'd really appreciate your perspective here, but also anyone else with first hand experience.

[jacob]

This thread really validates the hemlock solution if you're single.

To me it illustrates how deep cultural expectations are. You would not have a thread like this in Scandinavia, for example. Whereas, here the health care plan is something like.
1) Don't get sick/old.
2) ????
3) Die.

There are essentially three solutions to having others take care of you.
1) Family.
2) Charity (basically others volunteering to help)
3) Institutions.

The US leans heavily towards 1 because 3 is corrupt (arbitrary/secret/ridiculous pricing) to the point of being broken or perhaps more accurately: it is believed that it is broken as many believe that institutions (medicaid) are really bad or even immoral to use. Whereas, the Scandinavian cultural belief has zero expectation that one would rely on family. I for one keep learning just how much elder care in the US happens "at home (with a relative playing medical manager/aid)" whereas in Denmark, people would just be shipped off to the same style retirement home(*) once they can no longer take care of themselves.

(*) Roughly on par with what a student would get. A nice but boring 120sqft studio apartment in a multi-story building. I'm not aware of any options that are more or less luxurious than that.

[zbigi]

(*) Roughly on par with what a student would get. A nice but boring 120sqft studio apartment in a multi-story building. I'm not aware of any options that are more or less luxurious than that.

Is that a studio apartment or just a room? It's a bit hard to imagine studio apartment (which includes toilet, shower and kitchen/cooking area) on just a 120 sqft.

Also, Scandi countries may be a sole exception in the world regarding family expectations, given it seems that (from what you're saying) Scandi public instutions provide decent living conditions and care for elderly/infirm. Whereas pretty much everywhere else it's substandard and "not something I'd want to put my parents thorugh" or good, but very expensive.

[urgud]

You would not have a thread like this in Scandinavia, for example.

Agree. It's quite alien, to be honest. Sure, people spend a bit of time attending to their elderly parents at the very end, but I have never heard anyone here describing it with anything near the level of catastrophizing on display here. My guess is it's the demographic (strong sense of control) coupled with American perspective (every man for himself).

For what it's worth, both of my living grandparents are still in their own residences at 87 years old. One lives alone, the other with a partner. Generally speaking, retirement homes/end-of-life facilities are not available before they become truly necessary.

Regarding the hemlock solution? I actually consider that for myself in old age. Same notion of control, I guess.

[AxelHeyst]

...but I have never heard anyone here describing it with anything near the level of catastrophizing on display here. My guess is it's the demographic (strong sense of control) coupled with American perspective (every man for himself).

Have you been inside an elder care facility in the states? I haven't been inside one in Scandinavian countries, but I have a strong suspicion there's more to the difference in perspective than just American individualism.