THE COST OF AGING

Volunteering at nursing homes can be both rewarding and painful. I met Tiger about four years

ago when his wife entered the Pearl City Nursing Home. She had a stroke and is completely

immobilized, being unable to feed herself or take care of her bodily functions.

 At first, Medicare was paying a good part of his wife's care. Medicare pays when there is a need

for acute care. This is when trained medical or nursing care is needed.

 Jake entertains the patients. Mostly, he just lets them pet him. I had a talk with Tiger the other day

and asked how things were financially. He pays the entire cost of her care now, which is

$7,500 a month. This is just for custodial care. If she required nursing care, it would

be about $9,500 a month.

 Theresa, a nurse's aid, used to sing professionally and helps quite a bit when I'm there.

Tiger is there every morning at 10 and stays with his wife until 10 at night. He

doesn't know if she knows that he's with her. But, he says, he knows.

 Yvonne, also an aid, likes singing karaoke and she also helps in my show.

Tiger has run out of money and the reverse mortgage he took out on his home

doesn't provide enough for him to make his payments or, to support himself.

 Another resident who has since passed away, couldn't afford the fees. The V.A. paid about

$4,000 a month which is barely half of what was required. Tiger, who is 88, will be in that position

if he ever requires nursing or custodial care since he has already annuitized his house

with a reverse mortgage.

 Then, there's Ed, who kept asking for the song "Waikiki" and was so happy every week when I

sang it for him. When I finally got comfortable singing that song, he passed on.

 Or, Gunny Sarge, who sat through an hour every week just to hear the song, "Your

Cheating Heart". Another one who passed. And "No Money, No Honey" who

just enjoyed music... even my hacking. Also passed.

It's not that the nursing homes are charging so much. It's the dollar that keeps

going down. This summer, the Feds have announced that they'll be printing

$42 Billion a month just to keep the economy from going into a deep dive.

When you flood the economy with cash, then the dollar becomes cheaper, making the

price of goods and services appear to go up. Our kupunas have nowhere to go.

Music as Therapy

It has long been believed that music is an effective method of treating physical, emotional, social and mental problems that individuals have. One person goes a step further and uses music as a means to help to prevent such problems from occurring. Or, at least to delay the effects of aging.

Such a person is Aiko Sekiguchi, a renown singer from Japan.

Aiko has been in Hawaii for many years, having entertained at Oasis Nightclub during the 1960s to owning her own club called Koisan. About 1985, she decided that she should share her talents by teaching others the joy of singing and music. And thus, she opened her karaoke school.

She immediately attracted some notable and prominent citizens in the community who joined one of her five weekly classes.

Some were businessmen who joined grudgingly because their wives wanted to sing. And they themselves later became accomplished singers.

Some just enjoy performing in front of others. Others will never become singers. But they all look forward to going to classes once or twice a week to share in the camaraderie with other class members.

Others are very good and attend as many as three classes each week. Of course, some attend because they bring lots of food and the social interaction is as important or more important than the singing.

Most of Aiko's students are in their 60s, 70s and 80s. Their love of music and their singing keeps them young forever.

Aiko does not provide formal therapeutic sessions for her students. They are all self-motivated and use music to heal and keep themselves healthy. Music helps in the affliction of autism, Alzheimer's and Parkinson's diseases.

Once every two years or so, Aiko holds a recital so that her students can strut their stuff in front of family and friends. This year, it was held at Pearl City High School Performing Arts Center. The facility holds 800 people.

The planning, organizing and the preparations took a lot of effort by all the members. Some had never used a computer before but became very proficient at it after it was over.

Most were very nervous before the performance. Others looked upon it as an opportunity to perform and milked it for whatever they could.

 In most cases, music is the difference between withdrawal and awareness, between isolation and interaction, between chronic pain and comfort and between demoralization and dignity.

 Dale Senaga guided everyone in putting the show together. http://malamakupuna.blogspot.com/2010/05/dale-senaga.html

Aiko Sensei has five classes every week. Classes are located from downtown all the way to Wahiawa. Join the fun. And make some life-long friends.

Kanoe Andrade... an outstanding young person

I ran across a young lady at the V.A. Center for the Aging the other day. She caught my eye because she looked especially young compared to the other volunteers there. Her name is Kanoe Andrade and she is entering the 10th grade at Sacred Hearts Academy.

If she looks familiar, it's because we did a feature on her brother, Cheyne Andrade a year ago.

http://malamakupuna.blogspot.com/2011/07/cheyne-andrade-refreshing-to-see-some.html

The Spark Matsunaga Center for the Aging is located on the grounds of Tripler Army Medical Center. It services the entire Pacific Region for the Veteran's Administration.

Kanoe is limited in what she can do because of her inexperience, but, she does everything with her youthful enthusiasm. She visits with the veterans and keeps them mentally active through conversations and activities like arts and crafts. In fact, she's a big help to Heidi who is charged with getting the veterans involved with arts and crafts.

http://malamakupuna.blogspot.com/2011/09/heidi-shiozaki-arts-and-crafts-lady.html

Kanoe can also be seen in the gym where she cleans the rehabilitaion equipment, pick up linens and towels and anything else that the staff needs help with.

She decided to volunteer because her brother Cheyne did so last year and was curious to see what it's like. It'll also help her to determine whether she wants to pursue a career in nursing as her brother has done. Her mother was urging her to go into veterinary medicine but Kanoe isn't sure she can watch an animal die or worse yet, putting an animal to sleep.

A hat tip has to go out to her parents for encouraging the children to do volunteer work rather than wasting the summer hanging out at the beach. Her mother Holly is with the Veteran's Administration and works in the budget office. Kanoe volunteers Monday through Friday from 8 AM to 4 PM and rides in with her mother. Her father Wade works for the bus company. It's so refreshing to observe a family like this reach out to help make our community a better one.

In her spare time, Kanoe dances Ballet which she's been involved with since she was four years old. She also would like to get involved with paddling and soccer. Gosh. Her parents must be so proud. I know I would be.

V.A. CENTER FOR AGING MEMORIAL CELEBRATION APRIL 2012

I was honored to present thirty minutes of prelude music

to the Center's celebration on April 27, 2012

 The Veteran's Administration maintains the Center for Aging

under the Pacific Islands Health Care System.

 The facility is in a separate building on the

grounds of Tripler Army Medical Center.
The memorial celebration is to honor all those who have
received care from the Center and passed on in the previous twelve months.

 Staff members manned the reception table

 Other staff members made sure that the guests had bottled water to drink

We use the Doc's sound system each year. He makes

sure everyone sounds good. Even me.

 Dressed like a peacock. I've been told,

if you can't sing, at least look like you can.

 Ms. Marty Parmelee was the Mistress of Ceremonies

The Color Guard posted the colors

Ms. Devera Chun, LPN sang the National Anthem and Hawaii
Ponoi. She later did a chant of Island medley.

 Fr. William Kunisch, II gave the opening prayers.

 Dr. Michael Carethers, ACOS, GREC gave the first
welcoming remarks

Dr. James Hastings, PIHCS, Director gave
the other Welcome remarks

Mrs. Wanda Ulmer sang a song of Aloha. Her husband was a patient
here and passed away while a resident in the facility.
Some of the services by the facility:  http://www.hawaii.va.gov/services/ecrc.asp

 Roll Call was by Ms Janelle Ando, RN and Ms.

Gene Kama, NA

 Every time a name was called, Cecil Meadows rang the bell.

 As each name was called, the honor guard gave a solemn salute.
These soldiers stood at attention for almost an hour in their
dress blues.

When a name is called, a family member or a loved one presents
a flag at the altar. If no one is available, a staff member makes
the presentation.

 Dr. James Epure, Medical Director, CLC, gave the closing remarks

 The Marine Corp provided a trumpet player to play taps

The colors were retired.

FINANCIAL PUZZLES THE ELDERLY FACE

TWO TALES OF THE ELDERLY

The other day, I ran into two cases back-to-back which are typical examples of the financial and emotional decisions people face when taking care of the elderly.

Sue, (not her real name) had been a caregiver for her aunt until her passing and almost immediately had to care for her very ill father. Her father passed about five years ago but she’s now the fulltime caregiver for her mother, who has Alzheimer’s disease.

Sue is in her mid 60s and has to be available for her mother 24 hours a day, 7 days a week. She listed the long list of health challenges that she herself has, mostly due, I would guess, to the stress that fulltime caregivers undergo.

Sue is a tiny person and even though her mom is smaller than she is, cleaning, dressing, feeding and generally physically moving a person requires physical strength.

She has no income or assets and spends her time watching Korean dramas. She rarely leaves the house. She came into our VITA (Volunteer Income Tax Assistance) facility for free tax preparation because it would normally cost her $150 to get her taxes prepared just so that she can receive the $85 excise tax credits from the State of Hawaii. She was grateful for the $85 she would be receiving.

Soon after Sue left, Esther (not her real name) came in to get her taxes prepared. When I went through her paperwork, I saw that she had made a reverse mortgage on her home in July of 2011. I inquired as to why she decided to annuitize her home and her story broke my heart.

http://malamakupuna.blogspot.com/2010/10/reverse-mortgages-for-kupunas.html


Her sister was sick and they were spending down her sister’s assets for her care. Eventually, her sister would have to go on Medicaid (welfare) once the assets are spent. Her sister passed away in February 2011.

Esther was convinced by her advisors that since the paperwork was in the works, she should go ahead with the reverse mortgage. Part of the plan, as I understand it, was that Esther was to take the $200,000+ she received in proceeds and buy a single premium life insurance policy on her (Esther’s) life so that in the event that Esther passed, funds would still be available for her sister.

As a volunteer for VITA, I do not and cannot offer financial advice. I am there only to prepare income tax returns. In a previous life as a financial planner/enrolled agent, I have a habit of looking at tax returns from the other side.

Here’s what’s wrong with Esther’s situation.

1. Once Esther’s sister passed on, there was no need to close on the reverse mortgage loan. The sister passed in February and the reverse mortgage was made in July.

2. The life insurance situation was reversed. You normally cover the person needing the funds (in this case, Esther’s sister although she was likely uninsurable) so that you can make Esther whole for providing the money to care for her sister. When the sister passes, the insurance proceeds pays Esther for the funds provided.

She asked for advice and I suggested that she go to the bank who issued the reverse mortgage to see if the agreement can be backed out.

Here are some of the financial issues that our Kupunas are facing:

1. Most of the elderly do not anticipate the time when they would need to be cared for. Buying long term care insurance in adequate amounts (with inflation factors) is a start. Many live their lives believing that they will not be a burden to others, but, family members frequently make substantial personal, family, career and financial sacrifices to take care of elderly family members who cannot care for themselves.

Sue is an example of a person who has sacrificed her personal life for elderly family members. But she, too, will be left to fend for herself since she doesn’t have children. All because the kupuna didn’t provide for the situation.

2. Many Kupunas absolutely want to divide their assets equally to their children, regardless of which child does the care giving. The caregiver not only sacrifices his own career/family/finances, but risks health problems due to the stresses brought on by care giving.

3. Financial advisors sometimes put forth recommendations to line their own pockets rather than to improve the Kupuna’s financial situation. In the case of Esther, the person selling life insurance had the insured/beneficiary needs reversed and made five figures in commissions on the single premium policy. The mortgage broker made between $6,000 to $12,000 in fees for the reverse mortgage.

A reverse mortgage is to be used and considered only as the last resort. Once used, it usually cannot be undone. In Esther’s case, it should’ve been considered (if at all) only after her sister’s assets had been spent. And even then, it left Esther with nothing left to take care of her own care needs.

4. Frequently, family members who are also beneficiaries are not the best people to rely on. Family members often believe that the assets of their elderly family members are their rightful inheritances and would pressure the Kupuna to transfer the assets to them now so that they can get the government to pay for the care.

Some, who aren’t even the primary caregivers, who are the ones who suffer personal financial losses in the process, go so far as to resent having to spend their inheritance for the elderly person’s care.

When contemplating making changes like a reverse mortgage, consult an independent person who charges a fee. An attorney who specializes in estate planning, a knowledgeable CPA or a fee-based financial planner. Beware of financial planners who also sell a product where they also receive a commission such as insurance, stocks, real estate or reverse mortgages.

They have a conflict of interest and will have breached an ethical code of conduct by receiving both a commission and a fee.