 Aloha. I'm Larry Grimm, your host for the program. Don't just age, engage. What are the perils of aging at home, even unto the time and dying at home? It would seem like the most common and seem like the most natural thing to do. And quite frankly, 90% of Americans over 65 want to do this. That means only about 6% actually go into some sort of skilled nursing care. I'm Larry Grimm, your host for this program. Think Tech Hawaii works with the community and mostly looks at issues our island community faces throughout our state. I'm so grateful for Think Tech Hawaii and the work that they do. And they welcome me and my program is a little bit different in that it's not so much issue-oriented as it is looking at the internal dynamics of aging. I have my own online program and service for people in their elderhood called Personal Coaching for Life and Faith, that website there that you see. And I have devoted myself after working as a professional chaplain in long-term care and hospice care, devoting myself to taking care of people online to enable them to make that transition into elderhood. Well, in that transition, the most important preparation to be made is the decision of where you want to live. 90% of Americans over 65 are planning to live at home, but are they really effectively planning to live at home? Today, I want to take a look at six topics with you and encourage you to send your questions to that email address just flashed. I want to look at six topics that if we don't take them seriously and pursue them and answer them, these questions, then we, I think living in your own home, living in your own space can be a perilous experience. So I want to offer this to you today. It's a way of kind of priming the pump. It's a way of orienting you to what are the important things not to neglect in order to fulfill probably as your wish and desire as well, because you're probably one of the 90% who wants very much to live and die in the familiarity of your home. And why not? Surrounded by all the artifacts of your life, the stories of the past, the joys and the celebrations, the disappointments and the trials and the challenges and the successes. It's all there in the home, isn't it? That's full of all of our stories. But if we don't take seriously what we need to do and sincerely look at the ways of preparing for that very choice, living at home can be perilous. So let me begin these six topics with you. And I'll explore each one with you. And please, again, do send in your questions or comments that you have to questions at thinktechhawaii.com. Thanks, Eric. The first one then that comes across will be a concern for a home safety check. Now, it just seems like there's no, you know, there's no really big issue about this if you've lived in your home. On the other hand, if you're going to live at home, there may be a possibility that you're going to want to put, for instance, extra demand on the electrical system if you bring in medical equipment to help you breathe, especially when we're talking about COVID, to help you breathe, CPAP machines, to help you breathe oxygen, tanks, and oxygen developers, provider, those kinds of things can put extra tax on your home's electrical system. If you haven't had an upgrade into your home, you may even be out of compliance with a local code for electrical. So one aspect then is a home safety check is to have your electrical system checked out to see if it can handle any increase that may be necessitated in your care there in your home as you age. An extra demand on the electrical system hop a fire and can be very perilous. Same is true of the water system. Of your water system, oftentimes homes are built elegantly from the past and may have water system and pipes that have deteriorated over the years, both in terms of delivering water to you and also the sewage system. I had a sewage system at one time that in one home that was made of old, old, old iron cast pipe and it accumulated a huge amount of material in the pipe that really ended up blocking up the system and to replace the whole pipe to the street from the house to the street. That's one experience. But what might be the need for your own particular water system? So check the electric, check the water system, and check the flooring. What kind of floor covering are you going to want? One of the most difficult things for people who may have wheelchairs or walkers is carpeting. And it's frankly not safe for some people who are walking with the help of walkers. So what are the obstacles that if you need to have assistance in your walking and moving around motivation movement, what could be the obstacles that would make it not so safe for you to stay in that home and do what you need to do? So those are three areas in the safety check, electric, water of course, very common, and then surface. What's on the surface and how best can you accommodate your needs, whatever they may be, for surface safety. So those are just three things. Getting a safety check might open some others as well for you. Make sure your home is a safe place to age and live in and die in. What's the next topic and the next item on our six-point list is prioritize your health. As we get past the age of 65, our bodies take on a different agenda. It's kind of odd that many of our physicians in their training have a very limited amount of teaching and training in geriatrics. We are becoming geriatric folks in the medical definition of aging and we become unique in the ways our bodies process things. So prioritize your health by becoming educated about it. There's so much available online about what you can know better, about the way, what to expect from your physicality. Knowledge can also be obtained in several wonderful books that are available. There's excellent authors that have written, physician authors that have stepped outside of the box of not knowing and have increased their knowledge of the medical demands of the aging body and the uniqueness of the aging body. Atul Gawande is one of those and so is Dr. Louise Aronson, two remarkably great writers who have offered us tremendous insight. So yes, that helps you again to see your own physical dimensions and physical developments in new ways. We're not going to, our physicality is not going to proceed at home any better than it will anywhere else, but it will give you a chance to be aware of what's going on and to be in control to some extent, not control, but at least to be a good steward of your body and what the needs may be. So prioritize your health in terms of education and in terms of getting the best kind of care possible. Prioritize by having a physician in whom you have good confidence, knows what it is for the human body to age beyond 65 into the 70s, 80s and 90s. The third topic that I want to raise for you is make a plan for transportation. Can I just go ahead and drive? Well, what is it that many people talk about, young children of aging parents talked about? Well, we finally took the keys to the car away from mom or dad and it can be very, very, very challenging to you as an aging parent, as an aging human being. Our car, our motivation, our transportation is a tremendous symbol of independence and of course not only a symbol of independence, but truly a means for independence and a means for getting around to places we want to go, people we want to see. And so before you have to give up the keys for some reason and rightly so because dementia can be a harrowing experience out there on the interstate. So imagine what you will do for transportation. How will you utilize public transportation? What are the options that are available in your center, in your rural or urban center for transportation? What are the places and the people with whom you want to connect? One of the most difficult things for aging people is we get isolated. We get isolated and cut off from family and friends and when that happens, our health deteriorates. One of the, on the flip side of that, I would also say that when I was working in long-term care, we saw, I saw people come into long-term care from their homes where they had been in a nice place to live but were isolated and their health rebounded, because the physical health rebounded because they had community. So when you think in terms of transportation, think first of where are the places you want to go? Who are the people that you want to be with and connected with after COVID of course or wear a mask and make sure you're vaccinated and who are those people with whom you want to stay face to face, physically in touch and engaged with? Where are the places? Local pub, restaurants, churches, theater, movies, adult care center, adult daycare, senior citizens, programs that are so many of the good ones that are available. Where are the places and the people you want to stay connected with face to face? And what are they going to be the best ways that you can get there? That's car, great, use the car as long as you can and beyond that. What other transportation may you need to figure out, look into? So the next topic is number four, befriend technology. This may be a little bit about a place today because we're sure we've been and so many of us have been almost forced to befriend technology in order to communicate family and friends around the world and where we would have been without face to face video conferencing in this pandemic blows my mind because we were able to overcome the isolation of this pandemic in part because of the technology that we had access to. But look at some other things in the technology that's in this computer screen. We call it Windows. I know one product is called Windows and for me, I've always felt like that's Windows on the world. Through Windows, I can connect with friends around the world. I have friends in Palestine, I have friends in England, I have a friend in Finland, a friend in many friends in Houston. My daughters are in Denver, Colorado and my grandchildren. So befriend technology may be the key to not being isolated and cut off. The worst thing I think that can happen in staying where you are is that you would get cut off from the people you love. The relationships would suffer. Well, technology gives us a way in which we can stay connected in a very meaningful face to face way. Here's a question that came in. Isn't it best just to move closer to my adult children after age 65? Shouldn't I just sell the house and pick up stakes and move out close to my children, my adult children? That can be perilous too. Not that you shouldn't do it. I had one client, however, that always makes this question a huge question for me. She had gone through divorce. She was more in her later 50s. She had gone through divorce, was granted the house. She loved the house. She was in the home, in this suburban home, but it got to be too much for her and she had to sell it. Her plan was just to go ahead and move to the same area, the same suburban center where her oldest son lived with his spouse and two grandchildren. She was so excited about becoming a grandmother and being able to act that role every day in the life of her older son. What she didn't know was that her son's, her daughter-in-law did not want her involved, did not want her involved in the life of the children. So she went ahead and made the move and actually became more isolated than she would have been had she stayed in the same city and just moved maybe across the city. When she moved, she gave up her community, the people who knew and loved her and who supported her. She gave up, of course, the house that she loved. She gave up transportation, which she was familiar with. She gave up familiarity with everything that was there and so found herself in this place where her connection with her loved ones was really stymied in her opinion and so she had to rebuild the life, actually, as she did that, was able to do that in very meaningful ways through church connections, through educational process, through many things that she ventured into, which she'd not done before. So she did that, but it was pick up and move close and assume that things are going to be okay that your kids will just take care of you. It's pretty perilous. Or the other thing goes, other way goes as well, to stay in the home and say, I think all my adult children will just take care of me and they'll figure out all the needs that I have and how to make things happen. That, too, can be perilous because it would be based on an assumption that that's what they want to do. Children of aging parents have lives to live, have responsibilities, and my goodness, if they have children, they are tremendously engaged with their children and with their own lives and agendas, not to be mean to parents, aging parents, but that those do have a certain priority. So take into account relationships that you have with your adult children and what really is possible based on those relationships. And there's nothing wrong with asking and talking it out. That's the best thing, have the conversation, have the conversation. And you might even have that conversation in part around dying itself. There are many, there are several very helpful living will living will programs that you can turn to here in here in Hawaii. We have a cool amount that a tremendous group that that enables families and communities like churches and other communities to have the conversation about death and dying and to set the parameters for what you want in your medical care at the end of life stage. I am I think it's very important that we foster having a foster dying well and in foster dying, fostering dying well that we also are fostering living in elderhood well and having a wonderful elderhood, an elegant and extraordinary elderhood so that we live well and die well with each other. And having a conversation about that about death really can also lead into a conversation about living at home and who can be of help. Now, there are many, many opportunities, many, many resources I mean available for home care, food preparation, things that you think may you would want your children to do. And if we find that they don't want to do it, there are these other resources that are available so having the conversation gives you a chance to explore what the limits are from the family needs and then to find those resources that will fill the gap of what will enable you to stay, live at home where you love to be. The next topic is look into long-term care insurance. You can purchase long-term care insurance now as long as you're not in long-term care already. But long-term care will give you insurance would give you options if it comes if your body comes to the point that you need to have specialized care. The long-term care insurance means that you're able to, based on private pay, to have a range of options open to you. Medicare does not pay for room and board. Medicare pays for medical care. Medicaid pays for room and board. Medicaid has particular requirements that have to be met, financial requirements that have to be met. If you've heard your friends talk about spending down their assets, part of that may be motivated by it for positioning themselves for Medicaid. Look at what those options are. Look at what's available and what's needful. Consider a fairly low-cost long-term care insurance that will actually open up a wide range of possibilities if, in fact, you live at home to a point where you need to go into some other kind of care. And that can be the last few months of your life. Hospice care. You can enter hospice care when you have a physician who says you have approximately six months or less to live that gives Medicare coverage for hospice care. But long-term insurance would provide the place that you want to be. So look at the long-term, personal long-term care insurance for your aging in place successfully. Oddly enough, it could be one of the things that enables you to do it without peril. Now, the final and sixth and final topic is make a plan for your care. I have used I have used two different images of aging. One is that when I was living on the east coast, I lived in Richmond, Virginia, traveled from Richmond, Virginia to Raleigh, North Carolina, and we flew puddle jumper planes, smaller jets that could easily go in and out of the mountain airports along the Blue Ridge Mountains. This particular, I think it was 727, and this particular jet that I took was coming into Raleigh, North Carolina. And the pilot came on when we arrived over Raleigh airport and said, of course, it was sunny outside because we were above the clouds, and he said, the airports below us, but the cloud cover is a really terrible storm, and I can't go through it. I have to look for an opening to go through it. So bear with me while I cruise here and circle around until I find an opening. Well, eventually, about 15 minutes, I think we were circling, and he came back on and he said, I have an opening here, and I'm going to go down through the opening to the airport. Well, we have been cruising very comfortably above all the turmoil of the storm, and we got to this opening, and he just took a dive. It was like white knuckle time for everybody. It took a dive down through the storm, and of course, we got beneath the clouds, and it was windy and wet and all kinds of lightning and thundering and soap, but he took us down, got us into a safe landing at the airport. Now, that's one way that people live their elder hood. They seem to say, well, I'll do, I'll cruise along here until I need to make a dive into care, until I need to have an, until I have an emergency, and I'll meet the crisis when it comes. That's one way to do it. You can wait until the peril arises. You can wait until you, until you see the opening in the storm and make, and dive down into it. But another way to look at this is to think about coming into Honolulu airport, international airport, and you're really, because it's on the edge of the ocean, you start out, the pilot starts off miles out making a descent, and the descent is gradual and careful, and, and so easy that it feels so easy that you're on the ground before you even know it if you don't pay attention. In some ways, that's what I'm advocating by, by planning for your care. None of us can anticipate every possible problem that we're going to have physically, but if we start planning when we have our abilities and cognizance, and cognitive abilities, and our physical abilities, we start planning now way out over the ocean, so to speak. And we're going to make that descent much more gradually and much less perilously than if we don't wait for a trauma, or if we wait for a problem. So six items, if you want to know those six items for me, please send me an email and you go to my, if you go to my website, at personalcoachingforlifeandfaith.com, you'll find my contact information. I'd love to have further communication with you about it. This has been a wonderful time for me. Thank you so much for joining me. Don't Just Age and Gage is about empowering you to be creating an extraordinary elder hood in your life. So come back in two weeks and join me again and we'll have, we'll meet again over more people and more topics for discussion and interviews. Aloha and thanks to ThinkTik Hawaii. Make a donation today.