A good reference for safely getting over the hill

kw: book reviews, nonfiction, aging gracefully, elder care

My father, now in his nineties, says from time to time, "Don't get old." Only once have I replied, "It beats the alternative." And I notice he is not interested in the alternative, though he is hardheaded enough to plan well for his demise, whenever it may come. He lives in an "Independent Living Hotel", where he has a small suite and all meals and weekly housekeeping, for a set fee. In particular, he also has a Living Will and Advance Directive. I've heard from a few sources that these documents need to be revisited every few years. At age 70, someone might say, "Oh, I'd never want to live 'that way'", referring to some adverse condition of aging, particularly at a great age. At 75 or 80, they may have a different take on it, and at 90, it is surprising what someone will live with, just to keep on living.

I am not my father's primary caretaker, though I'm willing. He lives clear across the country, and the last time I went there, total travel time, door to door, was 14 hours. Not conducive to a pop-in visit to help him balance his checkbook or roust him out for a quick lunch together. Fortunately, he is a church-goer, and has a social network there (though they aren't much for the quick lunch), and he has occasional hired help for a few things; the list is expected to grow with time. Organizations such as Visiting Angels are a good first step for finding such help.

With these things in mind, I was eager to read a recent book by a couple who specialize in elder care matters: How to Age in Place: Planning for a Happy, Independent, and Financially Secure Retirement by Mary A. Languirand and Robert F. Bornstein (both append PhD). I was not disappointed. Drs. Languirand and Bornstein are about ten years younger than I, some 5-10 years short of retirement themselves, though if they are vigorous, they could follow many who delay retirement by a decade or so. They have sufficient experience that they cover literally all the bases. The book has two sections, "Making it Work" and "Making it Count", each of five chapters, though by page count, the second section is about 25% longer.

It all begins with "Money Matters", as it ought to. While it can be said that the three requirements for retiring successfully are money, money and money, the actual key is one's attitude towards money. Actor and comic Jackie Gleason is famous for saying, "Those who say money can't buy happiness don't know where to shop." Sadly, he didn't either, and you could describe his life as a long misery punctuated by brief pleasure binges. A more normal life is one of general contentment, with both happy and unhappy times, with the resilience to recover from the bad and savor the good. But this is nearly impossible if you're broke.

Here is my secret to having enough money in retirement: Knowing that a company pension plus Social Security usually total about half of one's earnings at career's end, my wife and I lived on half our income. After paying taxes, we saved the rest, mainly in 401k and IRA. Thus, the 50% drop in income after retirement was no shock, and when inflation eats into the buying power, we'll begin needing the deferred accounts, but they are likely to last…unless we both live to 120!

I realize that many folks are living on the edge already and cutting back to half their income is not feasible. All I can say is, save what you can. Maybe you only save "for a rainy day", or to afford "something special". Just consider this: once you retire, the rainy days have arrived, and you're now "special". Save what you can. Many larger companies have eliminated pension plans but the better ones have instituted an "enhanced 401k" to ease the pain. Take full advantage of that!

Well, money matters indeed, but the second chapter introduces the authors' framework of Access, Opportunities, and Services. Access: take a look at your home. If you were confined to a wheelchair or scooter, could you get out the door and to the driveway? If not, perhaps you've heard the old term "shut-in", referring to an oldster who can't get out. Now you'd be one of them. Opportunities refer to, if you can get out, what can you do, particularly after you quit driving? Suburban life is elder-unfriendly, once you lose your drivers' license. My father gave up driving about 6 years ago, in his late 80s. He misses driving more than anything else! Whenever I visit, we're out all the time; he has a lot of pent-up "out there" to satisfy. Services really come to this: if you can afford it, you can have full assisted living or even skilled nursing care in your home. If not, it is well to live in an area where such services are most affordable or are subsidized.

Thus we come to an interesting point: to "age in place" you may need a different place. It need not be an elder facility or nursing home, and in fact this book is about avoiding those. But your "place" needs to be somewhere with available and affordable opportunities and services. My father once analyzed hotel living. An independent living facility can cost from $60-$120/day ($1,800-$3,600/month), meals included, depending on location. A hotel with a good free breakfast—one like La Quinta with a short-order cook on hand in the morning—costs about $100/day, and a canny individual can take a bagel or two along to put in the mini-fridge for lunch, leaving only dinner to be bought. Further, a long-term resident can usually negotiate a lower daily rate, getting total costs down below $3,000/month.

The other three chapters in this section deal with home safety, transportation and health needs. The second section is equally practical, but deals with the elements of happiness. This begins with health, of mind, body and spirit. My mother and her father were afflicted with Alzheimer's Dementia, as were other ancestors including a great-great grandmother whose photo has the "Alzheimer's look". My mother took it badly, and was frequently depressed. Her younger sister chose a better way, saying, "If I'm going to go crazy, I may as well enjoy it!", and she did. There is a cleverness about even deeply demented people that allows them to mess with your mind if they like, and to get joy out of life, even if they have forgotten why this or that sibling or child is special to them.

The body's aging changes are equally variable. I've learned that most people, in America at least, in this age of antibiotics and other amazing medicines, have a "health span" that falls short of their life span by as much as a decade. Setting aside those who die untimely, physical ability can be maintained at quite a high level until one begins a declining period of a few years' length. Even more, our intellectual and mental health, in the absence of dementia, can continue to improve until nearly the end. There are a number of studies of IQ versus age. They all seem to show a decline after age 40 or 50. However, if the data are refigured for years until death rather than simple age, a different picture emerges: IQ usually increases up until the physical decline of one's last 3-10 years. It is best, then, to take steps ahead of time to push the health span out and minimize the length of the decline. Another book I read many years ago, Biomarkers by Evans et al, has useful advice in this regard.

Unlike contemporary and pop psychology, these authors recognize the reality of the human spirit, and the chapter "Healthy Spirit" addresses our need for faith. It is a simple fact that people of faith tend to have longer and happier lives. Whether you think it is simply the extra social dimension, or intervention by God, it lends weight to "statistical theology". I recall reading that in the U.S. Census of 1940 (maybe 1930), there was a "bump", an unusual number of men over age 80. Someone studied the data, and reported that the "extras" were retired Protestant evangelists who'd been active during a "Great Awakening" revival period of the late 19th Century. God takes care of those who take care of His interests. But for us more ordinary folk, churchgoing adds more good years to life than the time spent in church, making it a great investment.

The last two chapters are the most social in nature. As our abilities wane, it is important to increase our social network. Also, as long as we are able, helping others will improve our well-being, and if we are financially able, it is worthwhile to consider charities or causes to support. The Apostle Paul wrote that it is better to give than to receive. I can say from experience, it is definitely better to be in a position to give, and not need to receive. It can be embarrassing to receive! But near the very end, receiving with grace is a skill it is well to learn. We'll feel better about it if we feel the balance is strongly in our favor already.

The appendices include resources, worksheets and checklists. This is a good reference to have on hand.