Mom always was a worrier


Many psychologists write about the five stabile personality traits and one of them is neuroticism. Those who are anxious, depressed, self-conscious, impulsive, vulnerable and/or perhaps hostile may fall into this category. The bad news: this characteristic appears to remain stabile with age. If mom always was a worrier, she most likely still is. Is there good news? I don’t know, but in my opinion here are some good and bad ideas.

It may be that age logically exacerbates worrying. After all, if mom always feared that “something bad is going to happen”, guess what? As we near the end of life, many bad things aregoing to happen, ending eventually and inevitably with death.

My philosophy is to avoid unnecessary pain and suffering and to avoid premature death. That’s another article.

To mitigate mom’s worrying, there may be some solutions that mom and her family think might work.

For example, a Continuing Care Retirement Community may be thought to relieve the worry of “being a burden to the family.” A long-term care insurance policy might alleviate the worry of paying for home care or a nursing home. Safety improvements in the home can lessen the risk of falls and fractures. In my opinion the first two are not particularly good options for many people.

For one thing a Continuing Care Retirement Community (CCRC) will always be expensive and you are making a life-long commitment. What if you don’t like it? I’ve known people who paid an enormous entrance fee, only to discover that the age-segregated lifestyle was not to their liking. Or that wine was not allowed at dinner. Or almost everyone didhave wine with dinner. Moving out can entail sacrificing a large part of the entrance fee.

Review the contract thoroughly. It is a legal agreement. Does the community have the right to determine your needed “level of care”?

My beloved mother-in-law moved to a CCRC in order to not be a burden to her only child. When she broke her hip and it was not healing, she was moved from her lovely view apartment to a windowless assisted living unit. Then when she broke her otherhip, she ended up in the nursing home. Although this was a state-of-the-art, newly built long-term care facility, it was clearly a nursing hone and she hated it.

Every other month we flew from one end of the country to the other, round-trip, for over a year, to be with her. Many family members would view that as a burden.

Moving into a CCRC is not the answer for everyone.

Now, about long-term care (LTC) insurance. Every insurance salesman in the country will assure you that it saves money in the long run. No it doesn’t. Not for everyone.

Insurance is shared risk. You are sharing the risk of moving into a nursing home. This is a perfect risk to share, if like car insurance, everyone must buy into it. That lowers the cost. But at the present time only a small percentage of the population buys in, primarily those who can afford it and feel that they have a high risk of needing a nursing home.

Again, check the policy thoroughly. It is a legal contract. Does it cover home care? For many, that is a more desirable option. It can even be cost effective.

Are you at risk of needing long-term care? Who knows? But currently less than 5% of the population 65 and over are in a nursing home. Many of the oldest old, those most likely to need LTC, are in alternative settings such as assisted living, adult family homes, or at home with home care. Does the policy cover those?

Who determines your need? All LTC insurance policies have gatekeepers. Nurses or some type of professional who, based on your activities of daily living such as your ability to bathe, dress, eat and walk around, determine whether or not you are sufficiently disabled to trigger the use of your insurance. And typically it covers only part of the cost. And typically you must be quite disabled to qualify.

One change that can actually lessen the risk that “something bad might happen” is Universal Design. Universal Design is usually defined as the design of products and environments to be usable by all people, to the greatest extent. Wikipedia has a useful summary A trend today is Design for All (DfL), where the activity is facilitated, whether or not there is a disability. An example would be doors that open automatically when a person is present.

Back to mom being a worrier:

What about therapy? Great idea!! Years of research on people of all ages indicate that talk therapy and medication therapy for anxiety, depression, impulsivity, and hostility do both work. The combination of the two works the best. But be cautious with medications. As we age we become more sensitive to drugs, including Seattle’s drug of choice, caffeine. And of course our tolerance for alcohol decreases with age, making it more dangerous for older people to drive, even with alcohol intake below the legal limit. Now there’s something for mom to worry about!

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