Notes from a new widow

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 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.IMG_2861

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!

Next Weed Warrior Event is at a designated dementia care community, May 17, 1 to 3.

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 1stWednesday, 10 to noon: contact Sinclair at

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:



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 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😀

Free Oyster Tasting April 20

April is Earth Month!! Listen to my (almost) thrilling podcast 

Join Weed Warriors at a FREE Oyster Slurp on Friday, April 20, 5:30 at Seabold Hall. Although free, we must limit this event to 80, so please register at Brown Paper Tickets

This event is hosted by Weed Warriors andIMG_6770.jpgSustainable Bainbridge in partnership with the Puget Sound Restoration Fund. They are contributing the oysters, which will be harvested that morning at Pt. Madison.

Visit the Earth Month Calendar of events at

Earth Day itself is April 22 and Weed Warriors will be at Blakely Park on Bainbridge Island, 10 to noon. Bring tools and gloves if you have them, but we have extras if you do not. For more information:


I wear 2 hats

IMG_1477Most 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 is especially hard during the holidays

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.

Sleep is good for you

Sleep Patterns and Aging

Jeannette Franks, PhD


It will come as no surprise to anyone over 60 that sleep changes with age and it does not change for the better. There is a reason why some people can ‘sleep like a baby’. It’s because they are babies!

According to a recent article in The American Family Physician journal, “Up to 40 percent of older adults have insomnia, with trouble falling asleep, early awakening, or feeling tired on awakening (Feb. 14, 2013 Vol 87, No 4).”

While individual sleep needs vary, we know how we feel if we don’t get enough sleep. There’s a reason why intentional sleep deprivation is considered a form of torture. Insufficient sleep affects mood, ability to think, and possibly even the immune system.

One concept that can be useful is the notion of ‘sleep hygiene’. Here are some sleep tips from the US Center for Diseases Control (CDC) as well as a few of my own recommendations:

  • Go to bed at the same time each night and rise at the same time each morning.


  • Make sure your bedroom is a quiet, dark, and relaxing environment, which is neither too hot nor too cold.
  • Make sure your bed is comfortable and use it only for intimacy and sleeping, rather than other activities, such as reading, watching TV, or listening to music. Ban the laptop, TV, and smartphone from the bedroom.
  • Exercise may help promote sleep, but not within a few hours of bedtime.
  • Avoid large meals and alcohol before bedtime.
  • Avoid caffeine after mid-day.

Sleep disruptions can be associated with dementia in the elderly. Sometimes the sleep/wake cycle is completely out of whack and the person sleeps all day and wants to wander at night. In the right environment, this is fine. As long as it doesn’t disturb others, there’s no reason why someone can’t be awake all night and asleep all day.

A recent report at the annual regional Alzheimer’s Conference found that not getting sufficient sleep (7 to 8 hours) is a predictor of dementia. It may be a chicken/egg situation, but I’ll do almost anything to get the minimum of 7 hours sleep.

Another large study reported at the April 7 day-long conference was that those who performed cardio exercise for 30 to 40 minutes 5 times a week had a lower incidence of dementia compared to a control group who were told to stretch.

Sleep medications can be harmful, especially in older people. Consult your physician and limit their use to no more than once a week, otherwise there can be a rebound effect where without the drugs, insomnia worsens.

Sleep medications can have negative effects such as problems thinking, negative interactions with other medications, and increased risk of falls and fractures. If at all possible, a long walk in the great outdoors is one of the best possible remedies.

Work your brain to make it last

My father’s Alzheimer’s

Facing my father’s possible legacy of dementia

Jeannette Franks, PhD

When there is dementia in the family, it strikes fear into the adult children as they age. Every time a key is misplaced or the fridge is opened with the question, “what was I looking for?” it’s terrifying to think, “Has it started? Is it happening to me?”

Fortunately there are many factors that predict Alzheimer’s and genetic heritage is one of the least indicative. One of the strongest predictors of Alzheimer’s disease is low level of education Those with a low level of education also happen to be many of the people who voted for Trump.

The other major commonality of those diagnosed with dementia is age over 90.

First, to clarify, dementia is an umbrella term for any type of brain dysfunction. It could be Parkinson’s, it could be malnutrition, it could be alcoholism or a host of other maladies. It is now thought that everyone with Parkinson’s will ultimately get Lewy Bodies, a brain malfunction that manifests itself much like Alzheimer’s but appears differently in brain imaging.

Often brain dysfunction is directly correlated with cardio-vascular health. Indeed there are recent studies that indicate that vigorous exercise 5 times a week predicts a significantly lower incidence of Alzheimer’s. Now there’s a good reason to go to the gym! Or run! Or Zumba! Or whatever can get you working hard physically and you will do it consistently.

Healthy habits, such as good nutrition, moderate use of alcohol, and not smoking all are associated with a lower risk of Alzheimer’s. Adequate sleep and mental stimulation are also important.

Being bi-lingual, singing or playing a musical instrument seriously, and life-long learning are also predicative of a lower rate of Alzheimer’s. A recent study by Lisa Feldman Barrett of Northwestern University suggests that whether the effort is physical or mental, what helps the brain is “to work hard at something.”

Let’s all get to work in the new year. This planet needs it!

Guarding Grandma’s Gold


When I first started working professionally with older people (in the early 80s) I had few, if any preconceptions. Older people are just like anyone else; they’d just lived longer. For the most part this is true.

But, horrifyingly, there is a significantly higher percentage of older people who are victims of scams and scalawags. Why? For one thing there is the rising rate of dementia as we age. Long before clear symptoms emerge, judgment and decision-making falter. Ronald Reagan is often cited as an example.

Adult children of frail parents can be the worst culprits—they know where the gold is. Often the primary asset is the home. Keep a close eye on the executor of the will, usually an adult child. It may be prudent to have the will designate a professional fiduciary as executor, rather than a son or daughter.

While older people are actually less often subject to violent crime, those who are 65 and up may be more often targeted for financial crime. Indeed According to the Bureau of Justice Statistics (BJS), the National Crime Victim Statistics (NCVS) reveals that, from 1994 to 2005, violent crime rates declined, reaching the lowest levels ever recorded. Property crimes continue to decline as well.

But that email from Nigeria that no one takes seriously. Someone is believing it and it may be your mom. I’ve seen enough evidence firsthand that increased safeguards and watchdogs may be prudent as a person ages.

What specifically can you do? Grandma has right to spend her money however she likes. But she will not like being swindled. Have a serious difficult discussion with all family, grandma included.

One suggestion is a joint bank account. Especially since we all have easy access to statements via on-line banking, if your family member agrees, you can share any account, or even just get permission to use the login and password to keep an eye on things. But don’t forget crime happens within friends and family as well as from strangers.

I knew one man who had contributed a large amount to a joint account with his father, who was in financial need. One day it was all gone and he never got it back!

Another safeguard could be a trusted financial professional such as a CPA, tax accountant, banker, fiduciary, or advisor that has access to all information and participates in a mutual agreement to watch on a regular basis for any odd withdrawals. Again, this could backfire.

Banks are hesitant to interfere and there are some ethical and legal obligations not to question clients’ decisions. I knew a woman in her 90s who gave away tens of thousands of dollars to phone scams. When her nephews found out she had squandered over $50,000 in less than a year, they initiated guardianship and put her in a nursing home, where she subsisted for almost a year of a dreadful life.

Guardianship is an expensive and humiliating process and only to be used as an absolute last resort.

But really really bad things happen and it is prudent to ponder what can best be done to prevent disaster while still respecting autonomy and choice.