If you decide to make your home or apartment friendlier for aging in place, how much will it cost and who will help you do to do the work? Additionally, if you choose to move, there are typically a large number of major and minor upgrades required to prepare a house for the market.

Even the most capable do-it-yourselfer slows down with age. Protect your back by not doing it all yourself, and protect your budget by being extremely selective.  Happily there are many resources via your keyboard. If you are not a fan of computers, your local library can help you conduct an electronic search.

I recommend trying to find an “Aging in Place Specialist”.  In my small community, when I went to the Certified Aging in Place Specialistsite of the National Association of Homebuilders, more then 30 popped up, mostly architects and contractors.

Of course some were not what I was looking for, such as a reverse mortgage advocate. At the present time, reverse mortgages need to be considered very carefully. Also listed were some individuals with a poor reputation in my community. Others listed had no information at all.

Select three contractors and obtain at least three references for each. This means a minimum of 9 phone calls, but that’s cheaper than a botched job or an overpriced remodel.

I would also look up the Northwest Universal Design Council website for ideas https://www.environmentsforall.org/home-checklist/. Their home checklist is particularly useful. Other urban centers probably also have similar organizations.

I suggest that any person you hire be licensed, insured, and bonded. While we have had some luck with sub rosa (under the table) handypersons, those who operate without credentials, we have also had some bad luck. Caveat emptor—buyer beware!

The same goes for plumbers and electricians, although you may not have the leisure in a time of need to get numerous referrals and recommendations. Learn a bit about plumbing yourself. Anyone can plunge a toilet if he or she knows how.

I recommend having a housecleaner well in advance of when it becomes a necessity if you can possibly afford it. When I had unexpected hip replacement, I was so relieved to have a trusted, competent, and even beloved person to do the essential cleaning. Many women think it self-indulgent to have a cleaner or are convinced that someone else wouldn’t do nearly as good a job as they do themselves.  First of all, I consider it an equity issue. Some men, it appears to me, have never scrubbed a bathroom. Why should I be the only one cleans the commode? But more important, as we age, there will be certain tasks that are too difficult or too risky for a frail older person. Hiring a helper in advance of necessity precludes hiring a person you don’t know in a time of great stress and great need, such as when you are in the hospital about to be discharged. It also precludes dusting that top shelf, falling, and ending up in the hospital. Admit it in advance that there willbe a time when you will be hospitalized and then discharged and will need help at home.

Prilosec killed my husband  (not taking it can also be perilous)

Jeannette Franks, PHD January 2019

Recent studies suggest that if my beloved husband had not taken Prilosec, a PPI, he would be alive today. PPIs are a class of drugs called proton-pump inhibitors. These medicines block production of stomach acid. Long-time use of PPIs also interferes with the body’s ability to absorb calcium, which can lead to osteopenia, especially in women and older people. Osteopenia is a precursor of osteoporosis, devastating thinning of bones.

Osteoporosis is difficult to treat and irreversible. Although there are medications that slow the process, those medications have negative side effects and do not produce the quality of bone one would want.

Thinning of the bones after age 70 is a risk factor for fractures, hospitalization, and premature death. Yet if you read the precautions on a Prilosec label,  it says nothing about thinning of the bones. And how many people actually read the fine print? It does admonish users to take only one a day for 14 days, and not to repeat until 40 days have passed, but it does not even hint why. I think it should say DANGER BONE THINNING in huge red letters.

When my late husband learned about the serious negative side effects and his low bone density, he tried to quit the PPI. However, the rebound effect was very painful, so he upped his weight-bearing exercise, calcium and vitamin D. Yet when he had what for many of us would have been a minor fall, so many bones broke that he was in ICU at Harborview for 10 days before he died. The pain was enormous and with the addition of pain medications, intubation, dialysis, and feeding tube, his condition consistently worsened.

While this is by no means a scientific treatise, I just want more people to know the risks of PPIs. Perhaps you or someone you love can avoid a painful and premature death. But you may also need to take a PPI for certain forms of cancer and other diseases. There are always tradeoffs for taking or not taking drugs.

You will never be prepared enough. Although I taught a continuing education course on Grief and Loss for over 15 years for the UW School of Social Work, there were unexpected issues after the devastating loss of my beloved husband.

When I called my lawyer, a respected colleague, I was surprised when she said, “Don’t tell the bank yet.” Indeed she was correct. My husband and I always had three expenditure accounts: his, hers, and ours. One of the credit cards was in his name only. It had been used for an expensive trip that had to be cancelled. It will now be more complicated to receive the numerous refunds from hotels, airlines, and rental car. Put everything in both your names.

You must of course promptly notify Social Security, 800-772-1213. You can speak to a Social Security representative between 7 a.m. and 7 p.m. Monday through Friday. Generally, you’ll have a shorter wait time if you call during the week after Tuesday. They notify Medicare.

Keep in mind that you must then also notify any other health care programs such as the Medicare supplement and drug insurance. I called the prescription provider promptly. Nevertheless they mailed out a $500 prescription after they had been notified of his death. They were kind enough to refund the money but it was an added pain.

Make absolutely certain that the hospital understands your documented end-of-life preferences. These are obviously painful and complicated issues. For example, my husband had a pacemaker/defibrillator. Therefore he was DNR. That literally means do not use cardiopulmonary resuscitation. CPR would not work with a pacemaker. It does not mean comfort care only.

We still wanted broken bones to be mended, fluids and medications maintained, and more. However, when his situation slowly worsened over 10 days, the hospital kept adding interventions such as dialysis, intubation on a ventilator, a feeding tube. His potential for recovery became dimmer and dimmer. Even though I had durable power of attorney for health care and wanted to involve hospice, they refused. “We don’t do hospice here.”

I finally had to bring in a “Values Worksheet” our lawyer had given us. It clearly stated that he did not want extraordinary interventions such as permanent intubation, continuing dialysis, tube feeding.

My heart is breaking writing all this. My last piece of advice in this article is sign up for People’s Memorial. The web site for Washington State is https://peoplesmemorial.org. They can refer you other organizations in your area. They were wonderful. It is a non-profit co-operative, providing education and affordable cremations, burials, and green funerals. There is a one-time $50 fee and we were long-time members. One of the most difficult aspects of saying goodbye was made smooth and easy and cost less than $1000. My husband was always thrifty, and I respect that. Death is not cheap. Or easy.

Can We Wear 2 Hats?

Most of us wear 2 or more hats. Join Weed Warrior/Gerontologist Jeannette as we battle ivy at Madrona House, 8800 Madison Ave NE (or as most of us say, right by the Baptist Church), Thursday, May 17 from 1 to 3.

Revered dementia specialist Teepa Snow recently led staff training at Madrona House. A respectful, interactive approach helps residents function more fully and with greater joy.

A more harmonious environment of native plants helps us all enjoy the outdoors more fully. Contact: jfranks1@comcast.net206-755-8461.

Other upcoming invasive plant removal events:

BI Land Trust 1^stWednesday, 10 to noon: contact Sinclair at Sinclair@bi-landtrust.org  https://www.bi-landtrust.org/get-involved/

BI Parks & Rec: Waypoint Park just north of the ferry ticket Kiosk, 2:00-4:00pm, 3rd Tuesday of each month. The garden at Waypoint Park is one of the first sites for visitors to Bainbridge Island. Help us maintain its beauty as a symbol for the rest of our island. Contact: emilyh@biaprks.org  https://biparks.org/volunteers/

Our Oyster event was a marvelous party—you should have been there! Betsy Peabody of the Puget Sound Restoration Fund went on to the Hama Hama Oyster Rama. That same week she appeared on 60 Minutes https://www.cbsnews.com/news/seaweed-farming-and-its-surprising-benefits/and in the Seattle Times magazine. Thank you Betsy for your generosity, hard work, and fame for an important cause! Let’s do it again next spring😀

Most of you know that I am your friendly neighborhood gerontologist, specializing in aging in place, independent living, and accessibility.

I also have coordinated Weed Warriors for more than 16 years. We do environmental restoration by pulling invasive weeds and planting natives. To help save trees and forests is to help save the planet.

Weed Warriors are a volunteer coalition of amateur and professional gardeners and environmental activists serving various organizations including but not limited to (in no particular order) IslandWood, Sustainable Bainbridge, BI Land Trust, City of Bainbridge Island, BI Parks Foundation, BI Parks & Rec, BI Watershed Council, Association of Bainbridge Communities, schools, service groups, and Kitsap Weed Board. Weed Warriors’ goal is to participate in at least one action and/or educational event a month focused on removal of noxious weeds and restoration of native plants. Weed Warriors is a 501c3 through Sustainable Bainbridge.

OUR NEXT EVENT is Sat. Dec. 16, from 1 to 3 at Way Point Woods on Bainbridge Island. This is an easy walk from the ferry or from T&C. Just take the very first left turn off the ferry and turn left, if by ferry. Or from Winslow, take the left from the Waterfront Trail just past the bridge.

Hospice During the Holidays

Many of the huge and multiple challenges facing friends and family when someone is in hospice become larger during the holidays. Whether it’s Christmas or Passover, or a host of other gatherings intended to be celebratory, being with family and friends is even more difficult when someone is dying during special times. Thinking and planning in advance can help.

Humans are flawed and families are collections of humans, often with much more in common than just shared genes. Family gatherings can ignite conflict; the larger the gathering the greater the potential for flare-ups.

I come from a long line of bossy women. Get two of us in the same room at the same time and sometimes sparks will fly!

But understanding this in advance is a wonderful prevention. By this I mean if you recognize the possibility of a flare-up, you can minimize the flames.

The mix of old age, dementia, past history and a person at the end of life make family gatherings terribly difficult. Many issues are, at core, control issues. Relinquish control as often as possible. Even folks with Alzheimer’s are entitled to choices—even bad choices.

Especially during times that are supposed to be festive and harmonious, let grandpa have pie, even with his diabetes. (Perhaps bring a sugarless one!) Hide the alcohol and make everyone go without, if one person is at risk of a making major scene if unlimited alcohol is available. Refrain from forcing grandma to wear what you think are appropriate clothes; after all, it really doesn’t matter.

Check in with yourself as to what is important and what is not. For an old person near the end of life, the pleasures from dessert or wine or a summer gown on a winter night offset any risks. This is true regardless of age.

I remember a man in hospice who wanted one last beer (or probably a sip) before he died. The hospice nurse denied him “because he’s on morphine.” There is no reason in the world why a dying person on morphine cannot have a beer. Or snuggle in bed with a loved person. Or smoke a cigarette.

Keep the conversation pleasant. It is easy to switch the tone of a conversation, especially if the person has dementia. When grandma wants to know where her husband who died last year is, ask her “how did you meet granddad?”

If a person is disagreeing with you, accept it gracefully. If dad brings up that awful car wreck that was your brother’s fault, change the subject to an enjoyable one. “What was your favorite car?” This is not the time to disagree or drag up old disasters. Indeed there are very few times when it is actually productive to do so.

It is axiomatic in schools of social work that all families are dysfunctional—it’s just a matter of degree and coping skills. At first I was unwilling to agree with this pessimistic assessment, but over the years I have come to concur.

At my family reunions we explicitly do not discuss politics, religion, or home schooling. Everything else is fair game to talk about—including sex and drugs! The important topics are love, history, and shared lives.

“7 Actions You Can Take to Avoid Ending Up in a Nursing Home.” Tuesday, Sept. 19 at 11 to 1, Multicare Hospice, 10356 Silverdale Way NE. The first 3 answers are easy! The other 4 you need to know and no one gets all 7. But you will after this talk!