 My name is Larry Graham. I'm your host for this Think Tech Hawaii program called Don't Just Age, Engage. I'm pleased to have you with me to look at some of the issues around aging in Hawaii and across the world. Frankly, we have a society, generally speaking, that really turns aging into a marketplace that I used to complain about our society made our children into marketing tools. Well, the aging process has also been fallen to be a marketing tool. And so if you go with the social understanding of aging, you are destined to become a victim because that's what marketing does. It turns you into a victim of the natural processes of aging. My program, this program Don't Just Age, Engage, as well as my book and my program as coaching is a counterculture experience. I want you to experience the empowerment of being able to make choices, of being able to make plans and of being able to prepare for adulthood in such a way that it will be wonderful and not just wonderful, but also a creative experience in your life. One of the most creative stages of your life as you prepare to live in it and live through it with all the resources that are available to you. I look at it as this way. There are a couple of ways to look at an aging process. When I was on the East Coast, I flew one day from Richmond, Virginia to, I think it was on the way to Raleigh, North Carolina in the Piedmont region, just in front of the, I'm to the east of the Blue Ridge Mountains, those gorgeous Blue Ridge Mountains. And as we got to the airport, the pilot came on the speakers and said, well, we're right above the airport, but we can't land because you'll see we're above clouds and those clouds are storm clouds. So I'm gonna circle around here around the airport until I find an opening through the clouds. So we circled around the air above the airport, above the clouds, beautiful sunshine all the way above the white and dark clouds. And then he came on and said, I found an opening, we're going in. Well, he found an opening and the plane went plunging down through those clouds into the rainstorm and all the buffeting by the wind and finally, of course, landing safely, no problem at all. But the point is that our lives are oftentimes like that. We wait until there's an opening, our crisis that comes and we have to plunge down into taking on the resources, plunge down into finding the resources that are available and needed. And that's one way of approaching aging. But on the other hand, if you're coming into the airport in Honolulu Airport, you're starting way out, miles away, you're starting that descent. And the pilot is making a gradual descent, which enables you to almost land before you become a, almost to become a car before you hit the land. And so that to me is the option that I offer to you in my program, which is to become a landing, an approach that is gradual, peaceful and competent. And today I'd like to look at the preparation for elderhood with that sort of framework in mind. I have a wonderful website here in Hawaii, Hawaii that is, I'm sorry about all this noise. I'm not sure how to, let me see if I can turn it off here. There we go. And it is called caregiverconnectionofhawaii.org. Would you flash that up there? Caregiverconnectionofhawaii.org. This is a wonderful resource. And I want to approach, open this resource up to you as an expression, as an experience of how you can make that approach to elderhood graceful and full of competence and planning. So we're gonna open up here in a minute. Yeah. And let's go to the resource library, Eric. And this is the resource library of this, terrific website. Now you may not be in Hawaii, but I suspect in your own context, your own city, your own state, there's something similar to this available to you. So, and going through this will give you an opportunity nonetheless to see the topics and the issues that will be at hand to prepare, to make good preparations for your elderhood. Now let's go down first of all to what is Medicare? You know Medicare, some of you are already on it. You have to be 65 or older. You may be younger than that with a disability, which has enabled you to get on Medicare or have particular end stage renal disease that also qualifies people for Medicare. There's part A, part B and part D. There's also a part C, which is an all in one alternative. But for instance, Medicare covers primarily physician, hospital, stays, care in a skilled nursing facility, hospice care and some home health care. Part B covers the doctor services, outpatient care, medical supplies and preventive services. And then part D, description drug coverage. If you're involved in this already, you understand what that's all about. And you've been using it effectively and no doubt. But if it's new to you, you've heard about these different parts and that's what those all involve. And if you're retired and on social security, then compensation or charges or fees for Medicare come out of your social security monthly. What it does not cover is just as important to be aware of. It does not cover long-term care, a long-term care facility, a room and board in long-term care. It doesn't cover most dental. It does not always cover eye exams. Some of them will, especially related to prescribing glasses, does not cover dentures or cosmetic surgery, acupuncture hearing aids and exams for fitting them or routine foot care. So Medicare has its limitations that are also such a grand and wonderful resource that we need to be aware of. And as you reach 65 and have reached 65, some of you already, you know the asset that it is. You've been paying into it all your life. It's yours to draw upon now. And Medicaid is similar. Let's go back, Eric, to the resource library and choose Medicaid. Medicaid comes through the state. And Medicaid has a different kind of coverage, as you can see, from Medicare. It is, first of all, determined what you get and how much, according to your household size and the maximum income level per year. It also takes into account assets that you have. And you may have heard people talk about having to spend down their assets. Well, there's an asset limit that you will find you have to make or a ceiling asset that you have to make. And it has to be spent down to that point. Your assets have to be given away or spent down to that point before you would use Medicaid. That's so that it's really available for people who definitely need it. If philosophy is, if you have enough assets that you can support yourself in your aging process, and that's what's preferred. Okay, let's back out of that and go to the resource library again, Eric. And at the bottom of the resource library list, you see SSI. What is SSI? SSI is Supplemental Security Insurance Income, I'm sorry. And it's a federally funded program. Gives aid to disabled adults and children who have limited income and assets. Again, once you make application and describe what your situation is, then you'll be able to, they will determine for you what you will be able to receive as a social security benefit. But very important and very helpful for some folks who have now built up a reservoir, a reserve of cash and a reserve to support them. And then suddenly have this need. Or if not so suddenly, you may know that you can count on it being there available for you. And the need does arise. And again, all this is a way of saying, while you are competent, while you were thinking well, become aware, become alert to the kinds of services available, the kinds of resources that are available, many resources available and how it might be important to one day incorporate into your thinking and planning for a wonderful elderhood. Back up to the top of our list, we see advanced healthcare directive and post. You may have already put together your advanced healthcare directive. It's a living will. It's a way of defining for your friends, your family or anybody who's involved in your care, your physicians, your people who will pick you up, the medical med techs will come if you have an emergency in your home. It will define the kind of thing that you want done with your body in response to any illness or sudden event, sudden incident. Now, Hawaii has an advanced healthcare directive form that you may fill out. Or there are others, one form that comes from a group called Aging with Dignity and that's called the Five Wishes document. Very good document, very thorough and comprehensive in its approach. Also, there is a post which is the Physicians Order for Life-Sustaining Treatment. Eric, let's pull that page up and take a look at the advanced healthcare directive. Click on that. This is a simple form, but take a look at what all it involves. Individual instructions for healthcare and that gives you several scenarios, possible scenarios. And essentially you choose what you would want to do in those particular scenarios. You choose what is the desire. If I have brain damage or brain disease that makes me permanently unable to make and communicate healthcare decisions about myself. And that's when these statements will apply. A choice to prolong or not to prolong life. Yes, I want to have my life prolonged as long as possible or no. I do not want to have my life prolonged. What about artificial nutrition and hydration? In other words, a feeding tube or in your stomach or in the vein. Yes, do you want that? No, I don't want that. Relief from pain, yes or no? All of this gives an opportunity for your family to say this is what our beloved wants. If you're not able to make your own decisions, this advanced healthcare directive form puts into place what you want done. Okay, Eric, let's go back and look at the post. Look, click on, yeah, thank you, consumer post. Usually you can get it in a green form and put it on your refrigerator with a magnet and that way anybody who comes in if you fall and are unconscious and someone at the house calls EMT then they will see this and follow your orders. The post is provider orders for life sustaining treatment. And it usually is for someone who has a long-term issue right now, it could be a COPD, a breathing problem, it could be a disease of the lungs, it could be a disease of the heart, something that's prolonged and might be actively involved right now. And it would give you a chance to make those same kinds of choices but directing more focused and directing towards the physician care. Akua Mao is a continuous care program that provides that pulse form and also provides some other wonderful resources. Okay, Eric, let's go back to the, yeah, the resources. And where do you wanna live? It seems like such a simple question. Where would you like to live for your elderhood? 95% of people over 65 in America want to live at home. They wanna live at home right up until the day of their death and so that's really surprising because for all the facilities that you see around your city and your community and maybe know that your friends have entered into but probably only about 5% or 6% of our aging population or elderhood population live in facilities. And you may see yourself one day having to do that or you may see yourself first and foremost to live in your home or to live in the home of your family member. Now, when I'm doing coaching I caution people of assuming that any family member would be willing or desirous of your home. You're entering their home for whatever reason. We often change locations and go into our family homes to be with children, adult children to be with the grandchildren. And we think that that's gonna be an easy change and it is, I guarantee you, not an easy change not an easy transition and needs to be talked out, talked over and talked out thoroughly before the move is made. Suppose you do decide to go into your own home stay in your own home and you find that you're going to find the debilitating illness of some sort comes on. What's available in home care? Just click on home care for us. There are all kinds of home care people who are available but services are often included in home care are personal care, assistance with dressing, feeding and personal hygiene, homemaker assistance, including housekeeping, shopping, meal planning, preparation, respite care and assistance and support provided to the family. If your family member is giving you a primary care then it's important that they get a chance to have days off and nights off and times off. And if you need to have the care ongoing for some reason then we need to provide for that. So this is one of the things when you think about living in the home which is just fine. You may want to explore what home care services are available, the costs and how they can be covered. Again, these are the costs in original Medicare, zero dollars for home health care if qualified. Oh, I'm sorry, that's your costs in Medicare, zero dollars if you qualify. 20% is your coverage for Medicare approved amount or durable medical equipment. So, but these are also requirements you can see in the list here. Bring that back up Eric. You can see in the writing here that there are qualifications that you have to fulfill in order to be eligible for home care coverage in Medicare. But home care is a wonderful option for you to stay in your home if you can afford to and have those resources to pay for for home care that is available. And there are many, many resources and people who do this or their own sense of calling and living that they do. So back to resource library. If you are going into home care staying in your own home care you may want to take a look at some adult daycare centers. And if you have a mother or father who wants to live with you you may want to also research availability of these daycare services so that several things can happen. For one thing, I know my my aging mother at one point wanted to move to California where my older brother lived and his two daughters and his wife. And so she moved there and she sort of shocked because she actually gave up her whole community a supportive community in her hometown of Kansas City in order to be there in San Diego close to her grandchildren which she loved very much. For her, her adult care or her adult community was in the church but there are these other adult community opportunities that could be looked into in order to make that social connection for a loved one and you can do it for yourself as an aging person. Be aware that there are those ways of connecting person to person and they're very important for your health and well-being. Let's go back to the Resource Library. Also, as we go down this list, we looked at advanced health care adult daycare centers. Case management agencies are very, very helpful. I reckon we don't have any listed here on this website, but I recommend that we look into case management agencies or case management persons when we need them. When things get critical and the family feels anxious about how they're going to manage everything and they're not certain what's available. Case management agencies or case management persons can be tremendously helpful and they can be social workers. They can be so well-trained and so much aware of the resources that are available that it will just relieve the anxiety of the whole family system. So, home care is a possibility. Now, in home care, of course, we have somebody there to take care of you that relieves family members of the intensity of care sometimes and provides you the opportunity to stay where you love to be surrounded by the artifacts of your life and the people of your life. If we don't go and stay with home care, we may find that we need to go into some other kind of housing. Click on the housing for me, Eric. There are several kinds of housing available. There are care homes and foster homes, assisted living and senior communities, nursing facilities and transitional emergency shelter. But the first three is what I'd like to look into. These sort of can be, in a way, graduated. You can go from independent living in a facility to assisted living and then to nursing facility. In other words, if some of the retirement, for instance, some of the retirement communities that you might be aware of already are senior communities, click on this, Eric. Assisted living and senior communities are for moderate to high income elders, 55 and older. And they provide sort of a safety net of all kinds. System of a system of care right there on on site. Assisted living facilities provide laundry and housekeeping services. Assisted living and provide apartment units and bathrooms. And they enable you to do what ADLs or activities of daily living that you're capable of doing. Sometimes for some of us, those ADLs diminish and we need assisted living to increase and take on more of what of what we need to be able to do and care for more of our self care. Some of the retirement and residence communities scroll down there a little bit, Eric. They are for moderate and high income elders and they provide housekeeping, transportation, recreation, meal services, on site medical care. These are actually sort of a condominium, almost condominium living. You don't rent if they're usually on a rent lease basis. Some of them can be purchased, but rent lease basis. But the point is that they provide, again, the whole community life support, transportation, some of the ADL activities of daily living that you may need some assistance with. And. But they provide that whole support system. And if they're and if there is a diminishment of your physical capability. Some of them have attached to their facility of a retirement community have attached assisted living care and also skilled nursing care. The skilled nursing care is the next. Is the next level of care. And when I was in a long term care facility in. Our Vanna, Colorado, just outside of Denver, I worked with patient and people who were in. Independent living. And then. In their independent living would then be introduced to assisted living without moving out. And then would be in then would move to the next level of nursing care when they got more severely ill. And that nursing skilled nursing care would be focused on their. On their particular needs. They had pharmaceutical support. They had. PT support. They had all kinds of care in the skilled nursing nursing facility, even to the point of memory care, then with. Dimension and all timers. So within that one facility, it went from independent living to all time assisted living to. Skilled nursing to Alzheimer's care. So you had the full range of care available within one facility. And that can be something you can think about. As you age, move into this aging, do you want to do you see yourself needing that kind of support system as you move. Through elderhood. And again, sometimes when some people like clients have moved to another place so they can be close to family members. Not living with family members, but close to family members and then are able to afford a retirement community that is that actually provides this ongoing support system. Let's back out of that again, you see some other there are also care home, foster homes. Care home, foster homes, if you click on that, Eric. Under housing. Your house. And sometimes. As I mentioned, our approach to aging with some family members, for instance, maybe an approach that is. Crisis oriented. Get into my family member has a crisis. And we've just got to do something. Care home and foster homes can provide opportunities for housing. Sometimes on an emergency basis like that, because they're small and they have the devoted most of them I've known have had devoted caregivers. Who take care of six or so. And are very well focused on the care that they give. So returning to housing, you can see we have. Listed here in this website, care home and foster homes, nursing facility assisted living. These are the general categories. And then down here below, there are some actual lists of available housing of that that. Remaining on the island, you could explore as being options. And one of the things I recommend is going to the facilities before you need to go to the facility. Go check it out. Go if you have friends or in them, visit with them. If you don't have friends. Or family members already in the facilities, go look at them. Check them out and see what they're like. And kind of get a feel for imagining yourself in that position to be ready to move in and to want to make a choice. Good, good, good detail here on on housing. Most important. It is the most I think the most important question that we face in our aging process. Beyond that, no, there are, of course, meal services, medical equipment, let's go back to the resource library. You see topics of meal services. Any meal services are provided medical equipment, palliative care, senior centers, support groups, family members of Alzheimer's, for instance, or Parkinson's disease. All their support groups that are very helpful for for family members of particular diseases. Oh, this is this is one website that provides a variety of resources. I do coaching on which is a program to engage you in the coaching process so that you move smoothly and gradually into this into this landing into elderhood. And we look at all the resources that are available, but also I work with you to create an action plan so that your action plan can be one that you use to make it the most wonderful landing opportunity it can be. Thank you very much for joining with me here today in this exploration of entering elderhood, preparing for elderhood. I want you to have an aging process that is wonderful, well, and then to die well as well. We don't provide much for that, but I am confident that we have all the resources needed and just need to make sure that you're in touch with them and that you're planning well and preparing well ahead. I want to say hello. Hi, this is my don't just age engage program every two weeks here at two o'clock on Tuesdays. I look forward to seeing you again in two weeks. Aloha.