REITS: The Truth about Your Elderly Parent's Montlhy Service Fees

Creative Commons License; Brett VA

You know that monthly service fee for the grandiose residents where your senior mom is living? Or how the monthly fee doubles when you or your elderly parent moves from independent living into assisted living - even though his or her bedroom/living room space is half the size? You may think that increase is going to increase services, which your elderly parents increasingly need. Then how come it doesn't? And how come you're so frustrated?

Where do you think the funds that your parents - or you, if you're supporting them - are paying are going to?

My mom lives in senior housing that began as senior housing run by Quakers and that is now one site owned by a national corporation. I used to think her service fee is split between her specific location, and the national corporation, each getting a piece. I thought I was so brilliant for figuring out that not all the money goes to getting her good care, but rather also to "the corporation."

Now even that turns out to be naive.

Have you ever heard of a REIT? You may not have but plenty of investors in it for the long haul have.  It stands for Real Estate Investment Trusts and this category of investment fund was created in 1960 by Congress. One type of REIT is Healthcare. We start with the fact that the land and physical facility on which you or your elderly parent live, or will live, is owned not by the senior services company but by the Real Estate Investment Trust.

Almost immediately after this type of stock portfolio was created, investors loved REITS. 

Read this from Forbes: 3 Recession-Proof REITs With Yields Up To 7.6%

or this from RealMoney:Top Healthcare REITs to Play an Aging Population

One reason why healthcare REITS are in demand is that they are required to distribute at least 90% of their income as shareholder dividends. In a normal company, profits would go back into the company in the form of better services, improved facilities, land maintenance and land improvement. Not so with REITS. 

AT LEAST 90% of their income is going to shareholder dividends!!!

Where my mom lives, the company advertises 74 acres that include 6-hole executive golf course,community garden plots, a greenhouse and hiking trails. But when you go there, the land is decrepit, the golf course overrun and uncared for. Bittersweet has overtaken acres and acres, shrouding out the tall trees that are probably hundreds of years old, squeezing the life out of them, now bare except for a few branches at the tippy top, and the REITS company does not cut the bittersweet down. Their way of dealing with it is to clear cut the trees and where they haven't clear cutted, the bittersweet just continues to overtake.

Once, I brought my golf clubs down. The land was soggy and pockmarked. The boundaries were overrun by bushes and invasive species that narrowed the fairways. To get from one green to the next hole, I had to wind my way through overgrown bamboo and bushes, often unsable to see to the next hole.  


This is not land stewardship. This is doing the least amount possible, to increase profits the most. There is no incentive to steward the land.

Every now and then an infrastructure improvement is made. But think about it: To get a physical structure improvement, the request has to go all the way from this individual facility to the REIT. 

I'll stop here for now, because I have a laundry list of improvements that could be made to the land and to the physical structure where my mom lives, and I have a laundry list of how services could be improved. But just start where it counts: 90% of the income of the assisted living facilities goes straight out to shareholder dividends.

the part of you that wants to sleep

When I called Mom's room at noon, I wasn't surprised that she was still in bed but I was surprised that none of the care aids had been in to get her up for lunch (or, in her case, the first meal of the day). Or at least that's what she said. If that's to be believed, given her current memory. But I said I'd call her back in 15 minutes, thinking that a care person would come in by then.

I was wrong.

I told her, "Mom, press the button on the thing around your neck." Sometimes I don't recall the name "pendant." It's no piece of jewelry, that I can tell you for sure.

Well, today she was able to press it and while it was blinking we had at least lots of time to talk. You know that having conversations with somebody with dementia can be challenging. 

"I'm tired," said she.

"I know," said I. 

"I just want to go back to sleep," said she.  

"Well, you can go back to sleep after lunch. It's not a very busy day. I don't have anything scheduled for you," said I. I know to say this, to promise her she can go back to sleep, which she can. I'd rather she do an activity, or sit outside in the sun, but I know to promise her the thing that will give her comfort. The thing she wants to hear. Then something surprising happened.

"I'm afraid," said she.  Now I start to think maybe I should have the facility psychiatrist come in and talk with her because she's talking about emotions! And she's in touch with them. This can be a good beginning.

"Afraid of what, Mom?"

"I just want to sleep." This is not such a stupid statement. This is a moment of self-awareness. For a person with dementia to be so self aware and to be able to share that, to bring me in to this thinking, is a moment I'm cherishing.  "I'm afraid that I"m going to be like this."

"Like what, Mom?"

"To be like this, and I'm not going to be more active." Suddenly we are in another zone of consciousness.  This word "active" is not a word I've heard her say in a long very long time.

"You me to be more active, and do things? Like what, Mom?" Am I pushing too much? Too fast? How far can I take this? Will I get another chance to have this conversation again?

She doesn't answer. The pendant is still blinking and the care person has not come in. I know that lunch will be over soon but I want this conversation to continue.

"So part of you wants to sleep and part of you wants to be active. Which one would you like to have right now?"

"I want to be active but the one that wants to sleep is stronger."

It is strong. And it's her biology at this moment. And while this moment is intimate, I think that after lunch the part of her that wants to sleep will win.

She may not remember this conversation but it made my day.

 

The Burden Interview: Of Mothers, Caregivers, Sons and Daughters

"You're better at it," wrote my brother in an email after I complained that he wasn't doing anything for our elderly mom while I was doing everything. 

His words still sting like a bumble bee.

Was that really supposed to appease me, or my primary care physician who was becoming extremely concerned as my blood pressure was rising higher and higher and higher and I was becoming pre-diabetic from lack of physical exercise? Or was it supposed to provoke?

Add to that the layer that he, my brother, lived only 20 minutes away from our mother, while I lived 300 miles away. 

A Boston-based 2012 study indicated that daughters, twice as often as sons, become the elderly mother's caretakers. But still, sons comprise up to 30% of those care giving for elderly parents.  In Canada up to 30% of those caring for elderly parents are sons, shows a Canadian study. The "elderly parents" are usually mothers, since women generally outlive men. 

While the men in the Canadian study indicated positives as well as negatives in caretaking, they still assumed that responsibility. Married men generally had the support of their wives, with whom they discussed decisions they were making. 

So how does it get to be the daughter living six hours away becomes the primary caretaker when the son, living 20-25 minutes away, does virtually nothing? And what repercussions does this have on my, the caretaker by default, health, finances, social life and emotional well-being?

After another email months later to my brother in which I outlined everything I'd been doing vis a vis my mom and the toll it was taking on me, his response was "Thanks."

Mine back was was "I don't want your thanks. I want your help."

While I could never anticipate my mother's declining cognitive, and physical, condition, I also could never anticipate that I would get absolutely no help or support from my "bro" or support from my sister-in-law, receiving instead just the meek justification for why it was that he was totally defaulting on the small things, including asking for information about her current health, and the very large and major things and decisions.

The word "burden" is used repeatedly in all studies about adult children as caretakers of elderly and frail parents.  And it completely amazed me that there is something actually called "The Burden Interview," which I discovered on an online search.

This discovery was a true relief, and I gladly read the questions and circled my answer, recognizing so many aspects of what the questions addressed. Twenty of the 22 questions on the Zarit Burden Interview begin "Do you feel....."  or "Do you feel that..." One question begins "Are you afraid about..." and the last and 22nd question begins, "Overall, how burdened to you feel..."  Answers ranged from Never (score of zero) to Nearly Always (score 5).  I wish that the question "Do you feel that your health has suffered because of your involvement with your relative?" should score a 5 and that my doctor's feelings about this should add in a bonus 5 points. Feelings are big in this test.

Test takers have 30 minutes for this test. Mine took much less, let's not say how much less. Then I added up my score. Yup! "Moderate to Severe Burden."

The one question that I'd like to see the questionnaire ask is: "Do you feel angry at other family members who are doing less than you are?" or "Do you feel that other family members should be doing a better job at caring for your relative?"

I do, and I do. I wish the Burden Interview asked these questions because the complete lack of participation in my mother's caregiving by the person geographically closest to her adds a lot of stress too.

When one family member is clearly dis-involved, and wants to dis-involved, there is no communication that is going to get you the understanding, and the help, that you want. There is no way to go but to accept that and let go. To do otherwise would be to increase ones emotional stress, and therefore burden and the consequences of that. 

"Anger deprives the sage of his wisdom, a prophet of his vision," says the Talmud.  More conversations, more attempts to get somebody to see your distress or point of view would end in just more frustration, and disappointment, and a self-destructive cycle of anger.

CARETAKERS of ELDERLY PARENTS: How many others like me are there out there? I would guess I'm not the only one. 

It's often repeated how commonly families break up over money, especially after the death of a parent and the distribution of the estate.

Or, in this case, they functionally and emotionally break up long before. And when that's the case, don't hang on and let it raise your BURDEN SCORE even more!!

There's Always Edible Arrangements for Mother's Day

I don't feel like sending flowers. I don't feel like it, and anyway, flowers just die.

Two weeks ago I arranged the Peapod order to include fresh pineapple single serving cups. My mom has never tried those and it was worth a go. Perfect serving sizes for seniors, easy to open and to dispose of (including to recycle). She loved them. So much so that one week later when I asked her to have one, there were none left. I had the aid look, thinking they had to be somewhere, then the other aid. "She ate the last one."

I guess the pineapple single serving cups were a success. Healthy food, healthy living.

So then what? Peapod has a $60. minimum order. With the $10 delivery charge, that's $70. A lot for just pineapple single serving cups.

So instead of flowers, I ordered her the Edible Arrangements.She'll get her fruit and flowers all in one.

And they come in a handy practical container that can be used anywhere for anything - much better than a glass vase that can break and be dangerous.

And if none of my relatives WHO LIVES LOCALLY, i.e. if none of her other two children show up to to the decent thing, at least she has a beautiful bouquet of edible fruit, that will last her well through the week.

The delivery guy showed up at 10:30 this morning, very early, very nice, for Mother's Day. Beautiful.

Caregiver? STRESS ALERT: Take care of your own health.

"One sixty nine over eighty," the nurse at the CVS Minute Clinic said as she unwrapped and removed the inflatable cuff from my arm. "That's high. Do you always have high blood pressure?"

Always? I never had high blood pressure. I'm the one who everybody points to as living a healthy lifestyle and getting plenty of exercise.I'm the one who does yoga. Back home, I put the numbers into the search bar on the internet. 169 over 80. Hypertension. I don't know what those numbers really measure, but I know it's not good.

My annual medical exam was scheduled for the following week. I would get my blood pressure remeasured by my primary care physician, and we would discuss this.

One week later, it was slightly lower but basically the same thing. It was as high as that of some long-time heavy smokers I know. 

THIS is stress. Stress caused by a full year of managing, or dealing with, my elderly mother's issues. Trying to save her from financial devastation and medical destruction. All the while I was trying to write, publish, and promote my book, and other creative and professional endeavors (not to mention time and energy for my husband). I knew that I wasn't getting much exercise, I wasn't sleeping well at night, I knew that my routine was so centered around her, but I never gave a moment's thought to that this might be affecting my own health in some major way. I knew I didn't have as much time for my work and writing and my book as I would have liked, and that created internal - I would call them philosophical but they play out in the real world and in real lives - debates about taking care of others vs taking care of self. I knew I was stressed but you should see the looks on people's faces when I tell them I have hypertension.

"You?"

At my annual medical exam, my doctor asked the usual questions: "Are you getting exercise?" My response was limp. Sometimes riding my bike, but no long distances any more. Sometimes but rarely getting to yoga. Sometimes but rarely running. Playing tennis with my husband, but only on Sundays in the spring and summer.  And my doctor told me to get more exercise and come back in three months and get retested.

This in combination with also being told I was borderline diabetic created some serious talks and evaluations regarding how I manage my own health, diet, life, and also my mother's.

This is what I learned:

• Walgreens is amazing for anybody with high or low blood pressure. They will take your blood pressure for free. When you go, write down the result, and date it. I keep mine on my "notes" on my iPhone. I went monthly. With Walgreen's, there is no excuse for not getting your BP checked. No Walgreens? There is surely some pharmacy nearby. Senior centers often have regular and free BP screening.


• The gym was amazing, especially given this awful winter. Even without the winter, it gave me a routine that I could stick with. I usually went late afternoon or early evening. I made sure I listened to music on my iPod that was relaxing, but kept me moving. For me this meant Neil Young, especially "Harvest Moon." I had a full workout, including 20 minutes running on the indoor track. Once a month I would use the steps machine, which would measure my average and high heart rate. THIS TOO I would write down and keep a record of. Because I don't have enough time to go to the gym and do yoga, I incorporate my yoga breathing and 'asanas' and relaxation techniques into my gym workout.


• Vulnerability. We know we are stressed but it's more difficult to acknowledge how that stress is affecting us physically, and the degree to which it is affecting us physically. While some physical conditions are beyond our control, high blood pressure is often well within our control.  As we age, we become more and more vulnerable to stresses on our system. We are faced with conflict - ourselves vs those we love. And some of us are in the "sandwich generation." There are things I couldn't not do: Help my mother with her divorce, help her move from her home to her apartment, help her move from her apartment to the senior community, and so on. But many things, such as maintaining her car and making sure those bills were paid monthly, were unnecessary and only added stress to my life and my body. oing off for the day or weekend or week with my husband became an big deal, because nobody else in my family was willing to share responsibility for our mother with me. Dealing with the continued blood-letting of my mother's finances in her codependent relationship was another that I ultimately had to take by the horns, be strong, and weather the harsh disapproval that I knew I'd be up against.


• Don't miss your annual medical exam. Schedule it. Put it in the system. Then make it to your appointment. If you're afraid of what the results will say, then face that and ask yourself honestly what you can do differently to make sure that your health is not irreparably damaged and that you haven't given yourself reason to avoid going to the doctor's. Have this discussion with your spouse or significant other, if one is in the picture. My doctor warned me, and I gave myself a goal of three months to get my emotional and physical house in order. Me, the healthy one.


• Do what you need to do to lighten your burden around your elderly parent. That will pit you against your parent but for your life you need to. For me, it meant selling her car, and other difficult actions I write about. We fought. Often the fights were about her desire to have her car, versus my need to reduce my stress level, which was, literally, killing me. The fights were horrible because they pit me and my needs, physical and emotional, against my mother, who couldn't "hear" me, and what she wanted to do. The fights brought up other feelings and long-term issues. But being dead is no picnic, either.

The next time I got my BP taken, just one month ago, it was 142/74. Lower but still hypertension. 

Today was my last visit before my three-month visit to my doctor for a retest. 

This morning I went before I had my morning cup of coffee. The pharmacist came out and took the reading. My BP was 120/79. I phoned my husband and reported the good news, as if I were 14 and had gotten straight A's on my report card. Then I came home, had my coffee, and made an appointment for my 3-month checkup.

And wrote this blog post.

Warm Hand and Foot Treatment - for Seniors

To the question, What Is the Largest Organ of the Human Body? You might think the lung (certainly lots of volume there), the heart (big heart, big hearted)... the large intestine (large and long)...

But the answer is the skin.  (I got that question wrong the first time I was asked so don't feel bad...). And touch is what, if it is missing, leaves children scarred for life.

Is touch any less important when people age, when people are "elderly"? 

No - but there may be fewer opportunities to get that hug or that handshake. 

Yesterday my mom had a PT appointment at her center and the therapist recommended, among other things, an appointment with a podiatrist. With her living in a center that has two podiatrists who have part time hours there, I made her an appointment. 

But that also got me thinking about none other than the beauty salon. 

She's been there for styling, for a cut, a shampoo.. but never for her feet! She's never had a pedicure or a manicure.

I looked at the flyer.  There I saw what I was hoping for. I saw Warm Hand and Foot Treatment. $15. This is clearly more than a hair salon. And that was really all I needed to know, but read on I did:  Key healing ingredients such as Keratin, Vitamin E and Copaiba Oil naturally strengthen nails, relieve dry skin, protect from... That was all I needed to know, but read on I did: ...harmful UV rays and help to prevent skin aging.

That's where I had to smile or laugh to myself. EVERYBODY who lived there was elderly. EVERYBODY was in their 70's 80's 90's. Maybe a few even in the 100s. Are we really talking about preventing skin aging?

I think the wording of the flyer is brilliant. No matter what age we are, we want to make sure we don't look even older. (Well, maybe teenagers want to look older so they aren't carded everywhere they go.... )  People in their 70s don't want to look 80. People in their 80s don't want to look like they're in their 90s. Right? When my mom looks in the mirror and complains about "that old woman there" she mimics my exact words when I look in the mirror and go running to my husband. "I look old."

So I'm going to ask her if she'd like a Warm Hand and Foot Treatment. $8 hands only, or $8 feet only. I'm hoping she'll splurge and go for the two full sets of appendages. I'm hoping that the thrill of being touched will ease her out of her depression and aloneness. There's a lot of surface area in those fingers and toes, and in between those fingers and toes... 

I call her. 

"Mom, there's a hand and foot treatment, you can get a massage and treatment. Would you like that?"

"I'll let you know next week."

When I talk to her the next day and ask again, she says, "I told you yes." This is Mom, who forgot she wanted to think about it? Or is this Mom who really wanted to say yes, but always has to disagree with everything first?

I hoping that tomorrow I'm going to make her (or I'm going to assist her in making) an appointment for a Warm Hand and Foot Treatment.  

(And by the way, what is copaiba oil?)