Menu

On the Efficacy of the Will

It is a commonplace in the movies, when a man is near death, for someone to say that his recovery depends on his will to live. For example, toward the end of the movie Hud (1963), Homer Bannon (Melvyn Douglas) is lying by the side of the road, dying from an injury, when he is discovered by his son Hud (Paul Newman) and his grandson Lonnie (Brandon de Wilde).  After the old man dies, Hud says, “Anyway, he couldn’t have made it another hour,” to which Lonnie replies, “He could if he wanted to.  You fixed it so he didn’t want to any more.”

In many cases, the assertion that a person’s life depends on his will to live is made by a doctor, giving it the authority of medical science.  I have only a limited experience with deathbed situations, so I cannot say how often this happens in real life, but it seems to me I have heard people say something to this effect when watching the nightly news.  An alternative way of expressing this idea is saying that someone is a “fighter.”

There is, of course, a trivial sense in which the will to live is important to one’s survival, and that is if one’s survival depends on one’s actions.  If the patient does not care enough about living to take his medicine, for instance, then he is less likely to survive than a comparable patient who does want to live and takes his medicine exactly as prescribed.  But what is intended by the assertion of a causal connection between the will to live and survival transcends such mere actions as ordinarily understood.  The idea, the metaphysics of it, if you like, is that the will can actually permeate the body and operate within it, causing beneficial physiological changes that make the difference between life and death.

If any of that is true, then I am in trouble, because I have never been a fighter, and my will to live is qualified.  I mean, before I go to a lot of trouble and effort to survive, I need to know, “What’s in it for me?”  If I am in danger of dying, say, of cancer, I can see myself opting for surgery, getting radiation treatment, or going through chemotherapy, but if I also have to exert my will to live, I just don’t know that I’ll be up to it.  Part of the problem is that I don’t believe in it.  The way I figure it, the will to live may be more of an effect than a cause.  It is not that a person dies because he lost his will to live; he lost his will to live because he was dying.

This belief that the will is effective, aside from merely being the cause of our actions, goes beyond its imagined role in making the difference between life and death.  In The Hot Spot(1990), Don Johnson, a used car salesman, tells Charles Martin Smith, a coworker, “I’m gonna sell one of these [cars] to the first sucker that walks in here today.”  When Smith asks him, “How do you reckon to accomplish that?” Johnson replies, “Sheer willpower.”

I suppose we could write this off as merely an expression of determination, which probably is a good attitude for a salesman to have.  But if we take this seriously for just a minute, we have to imagine that Johnson’s character in that movie supposes not merely that he will apply high-pressure salesman techniques to overcome the customer’s resistance, but that beyond what he does or says, his will, as a kind of psychic force, is going to shape events directly.

Once again, there is likely to be a confusion of cause and effect.  Don Johnson’s character is not a good salesman because of his sheer willpower; he believes in sheer willpower because he is a good salesman.  A lesser salesman, like the character portrayed by Charles Martin Smith, is probably more aware of his limitations and is more likely to believe that he just has to do his job and hope to make a sale.

We have a successful salesman running for president.  That would be Donald Trump, of course. And like Johnson’s character, Trump believes in sheer willpower.  Pointing out that Trump does not have specific plans to do the things he says he will do may be a perfectly legitimate criticism, but it might also be a failure to understand the psychology of the man being criticized. Trump does not believe he needs a plan.  He only needs the strength of his will.  And that is what a lot of Trump supporters believe as well.

In order for people believe in the will of Trump, it is not enough that he be rich, nor is it enough that most of his wealth be the result of his success in business.  He must brag!  A man who brags and then is able to back it up inspires awe.  For most of us, modesty is not merely a virtue.  It is a matter of prudence.  We are just not that good at anything we do.  Furthermore, bragging is obnoxious.  When someone brags about how good he is at this or that, we figure he is due a comeuppance.  And when people around you want to see you fail, you are likely to do just that.

But there comes a point at which bragging has the opposite effect, when it induces in the minds of others that one has special powers, and instead of wanting to see that person fail, there is a tendency to believe in that person, to want to follow him and be a part of whatever he is.  I am not a baseball fan, but I understand that Babe Ruth, while standing at the plate, once pointed to which part of the stadium he would hit his home run. And then he did it.  At that point he was no longer merely a great baseball player.  He became a god.

Cassius Clay took braggadocio to new heights in the world of boxing when he announced, “I am the greatest!” and then went on to win the heavyweight championship of the world.  Of course, he might have been knocked out in his next fight, and then he would have been thought a fool, one who got what he deserved.  And no one would remember him.  Alternatively, had he become a champion without any accompanying rodomontade, he would have been regarded as just another boxing champion. But he broke through that aversion most of us have for braggarts and came out on the other side with a mystique of greatness not seen since.

Friedrich Nietzsche, the philosopher of the will to power, understood this connection between will and arrogance.  For the title of his biography, he used the expression, Ecce Homo, used by Pontius Pilate to direct the crowd’s attention to Jesus, but which Nietzsche used to direct attention to himself. And as if that were not enough, some of the chapters of that autobiography are, “Why I Am So Wise,” “Why I Am So Clever,” “Why I Write Such Good Books,” and “Why I Am a Destiny.”  In that same book, Nietzsche says, “I know my fate. One day my name will be associated with the memory of something tremendous — a crisis without equal on earth, the most profound collision of conscience, a decision that was conjured up against everything that had been believed, demanded, hallowed so far. I am no man, I am dynamite.”

Whether one agrees with Nietzsche’s self-assessment or not is beside the point.  It is fitting that the philosopher of the superman would present himself the way a superman would, as a man of will, as a man whose greatness is so manifest that nothing short of bragging would seem appropriate.

Finally, part of what makes Donald Trump unique is the way arrogates to himself the privilege of doing what other politicians must not.  It is sometimes said of the Clintons that they believe the rules do not apply to them, that they think they are special. It is one of the reasons, some have speculated, that Hillary set up a private server while she was Secretary of State.  And the question now is whether this email business will hurt her in the upcoming election.  But when Trump breaks the rules, he not only gets away with it, but he benefits from it as well.  It is not that his politically incorrect remarks have failed to ruin his candidacy.  The fact that he says such things proves, in the eyes of his followers, that he is superior to the ordinary politician.

As we all know, incest taboos are universal.  And to be guilty of incest, even if it be between consenting adults, is to bring upon oneself the disgust of mankind.  And yet, as has often been observed, what is forbidden to man is permitted among the gods, Zeus and Hera, as brother and sister as well as husband and wife, are the most well-known example.  It is argued by some that incest is universally forbidden because it is a pleasure too great for man to enjoy, and thus only the gods are worthy enough to partake of it.

For most of us, violating a taboo, be it incest or anything else, is something best avoided, lest we suffer the obloquy of mankind. But under the right circumstances, violating a taboo can be a proof of superiority, the mark of godlike status.  Just as Trump would not be doing as well in the polls if he did not brag about how great he is, so too would his popularity be less if he did not take for himself the privilege of being outrageous and offensive. By establishing himself as someone who is superior, by pointing to his past success, by bragging about how smart he is, and by violating political taboos, Trump is able to make people believe that he will be able to overcome all obstacles in “making America great again” through sheer willpower.

In other places at other times, men like this have risen to power, but it will not happen here. Although it may not seem that way at times, Americans have too much common sense and practical reason for such a man even to win the nomination, let alone the election.  But he definitely has his true believers, and I suspect for years to come, long after someone else has become president, they will be talking about how great things would have been if only Donald Trump had been elected.

In Defense of Skepticism

Though it would be natural enough to infer from the title of this essay that it will be a polemic against religion, yet it is really not religion that concerns me, even if it is inevitable that the subject of religion will be a part of it. What I wish to defend is skepticism understood in its broadest sense, which arises from a general disinclination to believe.

One of the things that always bemused me when watching The X Files (1993-2002) was the sign over Mulder’s desk that read, “I want to believe.”  And as if to make sure we understood that this attitude was the quintessence of Mulder’s character, it was even included in the title of the 2008 movie based on this series:  The X Files:  I Want to Believe.  Now, this represents more than just being open-minded, in which one is willing to consider it at least possible that there is intelligent life elsewhere in the universe, and that some of it visits us from time to time.  No, this is much more than that.

Had Mulder’s sign read, “I hope it’s true,” that would have been perfectly understandable.  Alternatively, had his sign read, “I want to know,” that would have been understandable as well, and it would have been an attitude with which Scully would have been in complete agreement.  In that case, the difference would have been between Mulder, who hopes that there are aliens from other planets visiting us in flying saucers, and Scully, who thinks the whole business is just wishful thinking; but in either case, whatever the truth of the matter, they would both want to know it. But Mulder did not want know.  He wanted to believe. What does that mean?

I said this essay would not principally be about religion, but it is necessary for me to note that there is one sense in which I understand wanting to believe, and that is the case with religion. Of course, not all religions have the same attitude toward belief.  It is my understanding that Judaism is not about believing things; it is about doing things.  I have even read that one can be a Jew without believing in God, provided one observes the Sabbath, eats kosher food, wears a yarmulke, and so on.  That may be a rather extreme interpretation of Judaism, to which many may take exception, but the relative importance of doing over believing is probably correct.  At the other extreme are the religions of Christianity and Islam, in which belief is paramount.

Regarding Christianity, children are usually told that good people go to Heaven and bad people go to Hell, because getting children to behave is a difficult challenge, and parents are not averse to using a little superstition to fill in for them when they are not around.  But as one grows older, one learns that belief is the sine qua non of salvation.  Christians may debate whether faith alone is sufficient for salvation, or whether both faith and works are necessary; but in either case, without faith, there is no salvation.

There are two reasons for this.  First, by their very nature, religious beliefs are not acquired by observing the world around us.  The only reassurance people have that there is a God or an afterlife is that from the time they were five years old, they found themselves surrounded by other people who also believed those things.  Therefore, any encounter with disbelief is extremely disconcerting, because it undermines their faith.  Religious belief is a house of cards in which each person’s belief reinforces the beliefs of others. Disbelief is a puff of wind that with so little force can collapse the entire edifice.  It is for this reason that there is so much hostility to the atheist, the infidel, and the apostate.

Second, if the priest is to have power, it is essential that people believe. Whether they sin or not is a relatively minor consideration.  In fact, sin may even conduce to the power of the priest, provided people feel the need to turn to him for forgiveness.  To this end, the doctrine of original sin guarantees that everyone is so sinful from the moment of birth, or even while in the womb, according to St. Augustine, that only by believing that Jesus died for one’s sins can one be saved.  Therefore, the power of the priest is not weakened by sin, but strengthened by it. Disbelief, on the other hand, is a threat to his power, and cannot be tolerated.

So important is this need to have others believe, that those who do not are threatened with eternal damnation.  Unfortunately, since belief is largely involuntary, this can lead to a great deal of stress for those who find themselves unable to believe the teachings of childhood, but are unable to rid themselves of the superstitious fears instilled by such teachings.  They are persuaded by Pascal’s wager that there is not much to lose by believing in God, even if he does not exist; whereas there is a lot to lose by not believing in God when Hell yawns before you. When such a person says, “I want to believe,” that is something I completely understand.

But what does it mean when someone like Mulder wants to believe, even though there is no punishment for not believing?  For some people, like those who dabble in the occult or New Age philosophy, I suppose beliefs must be like delicious morsels, just waiting to be tasted.  As for me, I have never wanted to believe anything in my entire life.  Ultimately, I end up believing something only when the alternatives require more credulity on my part than that about which I might have some initial doubts.  For example, I believe there is an external, physical reality: by nature, because it is instinctive to do so; and philosophically, because I would otherwise have to believe something preposterous, such as Descartes’ evil genius, Berkeley’s God, or the solipsistic hallucinations of my own mind.

And now I arrive, finally, at my skepticism regarding science.  Let me begin with global warming.  I regard the issue of climate change as a complex subject, which, quite frankly, I have no interest in, have not studied, do not intend to, and am content to have no beliefs on the subject whatsoever.  I have a friend who adamantly denies that human beings cause global warming, and, as she has advanced degrees in science, she becomes exasperated with me when I refuse to accept her authority on this matter.  By the same token, there is an equally hostile attitude on the other side of this issue toward those who do not enthusiastically embrace the doctrine of climate change, calling them science-deniers, and comparing them with people who do not believe in evolution.

The point of this comparison is to make people ashamed to confess their doubts on the subject, lest they be lumped in with Christian fundamentalists.  Of course, there is a world of difference between the two, and it goes back to my point about physical objects, which I believe to exist as a kind of default position.  In other words, if it turns out that there is anthropogenic climate change, I will not be surprised, because that will mean that the scientific consensus was correct.  If it turns out that there is no anthropogenic climate change, I will not be surprised, because scientists have been wrong before.  My overall world view will not be affected one way or the other.  With evolution, on the other hand, the matter is quite different.  I would like to say that I believe that life evolved owing to the courses in biology I took in high school and college, along with the half-dozen or so books I have read on the subject since, but that would not be true.  I accepted evolution as true when I first heard about it at the age of eight, mostly for lack of any credible alternatives.  To reject evolution, one must either believe that there is spontaneous generation, in which, for instance, worms spontaneously arise out of the mud; or one must accept some cockamamie nonsense, like that found in the Book of Genesis.  So, unlike the case with global warming, if it turns out that I am wrong about evolution, and that in fact, the world is only six thousand years old, and Adam and Eve are my ancestors, then I might just as well quit thinking altogether, except, perhaps, for trying to figure out how to avoid going to Hell.

An important consideration in my skepticism here is that there is nothing I can do about global warming, even if I were interested in the subject enough to study it.  I could spend the next several years mastering all the mathematics and science needed to evaluate the papers that have been written on the subject, and it would have no practical consequence whatsoever. What the world does or does not do about climate change will not be affected by what I know or merely believe.  Hypothetically, if it were up to me, or if we were taking a vote on the subject, I would, in a manner similar to Pascal’s wager, vote to assume that there is man-made global warming, and institute things like cap-and-trade; for regardless of the truth of the matter, there is more to lose by not doing what needs to be done, than there is by doing something that turns out to be unnecessary.  Unlike Pascal’s wager, however, it would not be necessary that I believe, only that I act.  And whereas beliefs are largely involuntary, our actions are mostly under our control.

Another issue in which one is likely to be castigated for being a science-denier concerns genetically-modified organisms, in particular, the corn that has been modified by Monsanto in order to tolerate Roundup, which is a herbicide.  Here too I am skeptical, but in this case, there is something I can do about it, thus justifying some effort on my part to become knowledgeable on the subject, although not enough, unfortunately, for me to reach any definite conclusion. Nevertheless, I can buy organic corn.  And my ability to avoid this modified corn would be further enhanced were there mandatory labeling of such, but there is a lot of resistance to that, which only makes me suspicious.  At the present time, I will not buy corn unless it is organic, just to be sure.  This is not because I believe that the corn is bad for me, for it may well turn out to be harmless.  But neither do I believe the studies that conclude that this corn and its associated poison are safe, science notwithstanding. Once more this is like Pascal’s wager, only applied to actions rather than beliefs.  I have more to lose by eating Roundup-laced corn should it turn out to be dangerous, than I have to lose by eating organic corn only, even if Roundup turns out to be harmless.

In short, I am perfectly content to be skeptical about science, especially when corporate profits and political power are at stake, and will gladly endure the obloquy of those who find my skepticism in such matters intolerable.  And even when I am forced to act, and must choose to do one thing rather than another, I can remain skeptical while I do so.

Finally, there are certain propositions about which the expression of even a hint of doubt is absolutely forbidden.  Even to bring such subjects up, as something doubted by others, though not oneself, would incur the wrath of the mob.  On these matters, it is prudent to be silent. Fortunately, there is no Hell for having doubts, and one can always be skeptical in private. And this suits me fine, because I do not want to believe.

What Dreams May Come (1998)

A lot of people used to believe that marriages were made in Heaven.  Today, people speak of being soul mates.  Whatever expression one uses, that is the idea behind the marriage of Chris (Robin Williams) and Annie (Annabella Sciorra) in What Dreams May Come.  They have two children who die in a car crash, leading Annie to have a mental breakdown.  They almost get a divorce.  A year later, Chris also dies in a car accident.

He eventually makes it to Heaven, which is a wonderful place shaped by the imagination.  But since Heaven is created by the imagination, so too is Hell.  According to traditional Christianity, people who commit suicide go to Hell, and New Age philosophy is apparently in agreement on this point, if the movie What Dreams May Come is any indication. In this movie, people do not go to Hell because they are evil, but because they got confused and committed suicide. When Annie kills herself, she is trapped in Hell by her confusion. Her husband Chris manages to rescue her, but all the other suicides remain in Hell for eternity. Too bad for them.

Anyway, Chris and Annie make it to Heaven where they are safe. But Chris suggests that they be reincarnated so that they can meet each other again and experience another life together. Of course, that means taking a chance of becoming confused, committing suicide, and going to Hell, with little likelihood of there being another rescue. Who in his right mind would chance it? But the idea is that life is so wonderful that it is even better than Heaven, even worth the risk of committing suicide and being eternally damned.

Of course, that wonderful life involves such things as having your children die in a car accident, having the marriage deteriorate to the point of almost getting a divorce, and then having a husband die in an accident. Who wouldn’t want the chance to experience something like that again? Who wouldn’t forgo Heaven and risk Hell to experience such misery and suffering once more?

Why I Hate Quantum Mechanics

In the movie Duck Soup, Chico and Harpo are spies. As they confer with the ambassador of Sylvania about spying on Groucho, a secretary rushes in with an important telegram. Before she can hand it to the ambassador, Harpo grabs it from her. He looks at it, starts frowning, and then tears it up, throwing the pieces into the trash can. Chico turns to the ambassador and explains, “He gets mad because he can’t read.” That is exactly how I feel about quantum mechanics.

Seeing is believing, but there is very little of that in the world of the quantum. When I was in high school, the physics teacher evacuated a bell jar with an alarm clock in it, and we could hear the sound fade as the air was removed. I never doubted that there is no sound in a vacuum, but seeing it demonstrated had a powerful effect compared to which merely reading about waves of molecules simply lacked. Neither did I doubt that all objects fall at the same speed in a vacuum, but when I saw the feather drop like the lead weight right beside it in that same bell jar, I gasped. As for angular momentum, it was just a concept that I accepted, and regarding which I could perform calculations, but it was only when I tried to turn a gyroscope at right angles to the plane of rotation, and felt it push back against me, that this concept became truly real for me.

Some experiments I have never seen, but reading about them is a reasonable substitute. I have never seen a double-slit experiment, but I can imagine myself seeing it, and that is almost as good. A lot of experiments, however, are persuasive only if one already knows, or at least accepts, a great deal of physics. A physicist can look at a cloud-chamber photograph and say, “There goes an electron,” but to me it is just a line on a piece of paper. I am willing to take his word for it, but now there is an intermediary between me and the phenomenon. For the physicist, the photograph is evidence of the existence of electrons. For me, it is the photograph as interpreted by the physicist that constitutes evidence. It is the beginning of my estrangement. No longer is the observation enough. Somebody has to tell me what it means.

The Aspect experiment proves that the universe is non-local. At least, that’s what they tell me. I have never seen the experiment carried out, but even if I had been in the room at the time, it would not have made much difference. Where the physicists would be “observing” things like entanglement and polarization, I would be seeing a bunch of people attending to an apparatus, making calculations, and talking about Bell’s inequality. At this point, I am not merely estranged from the evidence. I am totally alienated.

Finally, there are the thought experiments, which have the drawback of not actually being carried out, but have the advantage of imagining observations that I can understand without an interpreter. The most famous thought experiment is the twin paradox of relativity theory. I can easily imagine waving my twin brother goodbye as he gets on a spaceship when we are young. Then, when I am seventy, he comes back and is not much older than when he left. That is pretty straightforward.

The most well-known thought experiment for quantum mechanics is Schrödinger’s cat, of course. But in this case, the observation is worthless, even though I would understand what I was seeing. I would see the cat being put in the box, containing an apparatus that might result in his death. Time would pass. I would look in the box and see the cat, alive or dead. So what? I am told that while the box was closed, the cat would be both alive and dead, or neither alive nor dead, depending on which law of logic you prefer to violate. In other words, I would get to see everything except the one thing that I would need to see to believe it. The theory makes claims about unobserved reality, which by its very nature cannot be observed.

Sometimes people point to technology as proof of a theory, but we have to be cautious. When James Watt was developing his steam engine in the eighteenth century, the theory of caloric probably entered into his reasoning. And if someone in the nineteenth century had doubted the luminiferous ether, he would very likely have been referred to the wireless telegraph as proof.

But even so, the wireless telegraph must have been pretty impressive when it was first invented, and so I am naturally curious about any technology that is supposedly dependent on quantum mechanics, since it might just provide me with something that satisfies my desire to see things for myself. I had heard about quantum tunneling and quantum computing, so when I came across an article plus a video discussing such, I decided to check it out. The video showed me a lot of gadgets and devices, and I heard a lot of people talking about how the computer can solve optimization problems, but to my untrained mind, it just sounded like some computers work better when they are really cold. I guess they suspected I might not be impressed, because they also showed a lot of eyeballs and pictures of the stars, while musing about intelligent life on other planets. And it was all accompanied by much hand waving, because the English language was proving to be inadequate. Needless to say, I was not impressed. You might just as well point to an eggbeater and tell me it works through the superposition of virtual particles.

There being no observation, real or imagined, that I find compelling, I am reduced to reading about quantum theory in books, and taking the word of physicists. Unfortunately, they talk about a lot of weird things that I find hard to believe, such as multi-verses and observer-created reality. Some of them even speculate about time travel, when they are not denying the existence of time altogether. Books I can put back on the shelf, but if the subject of quantum physics comes up in a conversation, I find myself in a box. I don’t want to agree with what is being said, but if I call any of it into question, I end up sounding like a science-denying ignoramus.

And this is where I get to the part about this theory that I deplore: the way it can turn an ordinary conversation into a New Age free-for-all. I have always noticed that there is a pent-up fascination for a lot of strange stuff that people ordinarily keep to themselves. They might carry on a discussion on a variety of topics, with a modicum of sanity and common sense. But if one person so much as mentions something the least bit odd, such as mental telepathy, immediately there will burst forth a whole raft of loosely connected subjects, not just other types of ESP, like clairvoyance, precognition, and psychokinesis, but also Tarot cards, astrology, the lost city of Atlantis, and ancient astronauts.

A good example of this sort of thing is the movie Close Encounters of the Third Kind, in which Steven Spielberg lumps together parapsychology, the pilots from Flight 19 who went missing in the 1940s, UFOs, Eastern religion, and a ship in the desert. He even manages to work in the parting of the Red Sea, not by connecting it logically with anything else, but simply through the association of ideas: we see The Ten Commandments on television while Richard Dreyfuss compulsively constructs a model of Devil’s Tower. The subliminal message is that it was not God, but ancient astronauts that helped the Hebrews escape. As an ominous precursor of how all this will be connected to modern physics, when the space-aliens produce the still young pilots, someone says, “It looks like Einstein was right.” In response, someone suggests that Einstein was actually one of the space-aliens. In other words, merely being intelligent would not have been sufficient for a mere human to come up with relativity theory. Einstein had to be a mystical space-alien with ESP.

As with Einstein and his theory of relativity, quantum physics also has the potential of unleashing paranormal fascination, as may be found in What the #$*! Do We (K)now!? I thought the movie might be worth a look, since the title seemed to represent my sentiments exactly. It is part documentary, part narrative, in which the protagonist is a female photographer who is deaf. I immediately became suspicious, since such things are only put into movies for a purpose. Her being a photographer is supposed to be a criticism of people like me, who need to see in order to believe. As for her being deaf, the idea is that though she cannot hear, yet by understanding quantum physics, she will perceive more deeply into reality than will the ordinary person possessed of all five senses.

She is also divorced and taking anti-depressants, so we are to assume that her life is a mess, especially since she seems to be irritable, frustrated, and unhappy. But it is quantum mechanics to the rescue. Not only will her understanding of this theory help turn her life around, allowing her to get off her meds, but it will improve her basketball game as well. Not that she plays basketball, of course, but the idea is that her understanding of quantum physics will allow her to control physical reality in a way that surpasses those of us who are limited to ordinary methods. So, she needs to go back to college and major in physics, right? Wrong. Just the most superficial acquaintance with the theory will suffice for her to commune with the cosmos, conveniently provided by the running commentary of the movie itself.

I should have lived in the nineteenth century, when a man could breathe the clean air of hard science. Back then, physics took no prisoners. It declared, without apology, that we live in a materialistic, mechanistic, deterministic universe, which was deliciously meaningless, and doomed to end in a cosmic heat death. There were, of course, people who believed in the occult, theosophy, mysticism, and the like. But they believed in such things in spite of science, not because of it. They knew their place, and pretty much kept out of the way. But now there is no living with them. Armed with what they believe to be the blessings of modern physics, they will take a conversation right through the looking glass at its first mention. And like Harpo, all I can do is sit there in silence.

Caveats for Caregivers (8)

This is my eighth essay on caregiving, first published on another website on February 3, 2013.

As may be inferred from the title to this diary entry, this is my eighth essay in this series about the problems I had to deal with when my mother went into a nursing home, along with some advice that I have to offer regarding those problems.  In general, this essay presupposes much of what has already been written; in particular, it is especially connected to my seventh essay recently published.  That diary entry covered my desire to keep my mother in a private-pay nursing home as long as possible, before transferring her to a Medicaid facility, which I knew I would have to do when she ran out of money.  My reason for doing so was that private-pay nursing homes are for rich people, while Medicaid nursing homes are for poor people, and, as is invariably the case, rich people are treated better than poor people.  That previous essay also discussed my efforts to protect my mother from noise, which meant finding her a roommate that was relatively quiet or paying extra for a private room. Although I touched on some of the financial aspects already, they will be the principal focus of this essay.

The monthly cost for a private room was $7,800; for a semi-private room, $6,500.  The rates were about the same at the private-pay facility as they were at the one that accepted Medicaid. Then there were the extras: telephone service; cable TV; beauty parlor; dentist; podiatrist; optometrist; the cost of an attendant to accompany us when she went to the doctor, in case she had to use the restroom; supplies not paid for by the nursing home; medicine not covered by insurance; and so forth, all of which averaged out at about $500 per month.

Given my mother’s income and assets, I knew she would be able to afford a private room for a year, or a semi-private room for eighteen months.  After her money was gone, there was always the possibility of my using my own money.  There would be no way I could pay all of her nursing home costs, but there was the possibility of my using my money to supplement Medicaid in order to keep her in a private room.  In other words, Medicaid will only pay for a semi-private room, but if I could kick in an extra $1,300, I could keep her in a private one.  That, plus the $500 worth of extras, would run me $1,800 per month.

If I had known for certain that my mother would live, say, one year after getting on Medicaid, I could have afforded to pay the difference, without too much of a dent in my net worth.  But there were no such guarantees.  I met a woman whose husband was a patient at the nursing home where my mother was staying.  She said that when her husband was first diagnosed with some kind of brain disease, the doctors told her he had three months to live.  “And that,” she said, “was seventeen years ago.”  With that kind of uncertainty, I knew that in order for me to start paying for a private room, I would have to go back to work to make sure I did not impoverish myself.  The daily visits to my mother, lasting four-and-a-half hours each, would then no longer be possible. My visits would have to be fewer and of shorter duration.  As my mother was extremely dependent on those visits, the option of my paying extra for a private room once she got on Medicaid was out of the question.

Because any extra money I could get for my mother would allow me to delay the day when I had to transfer her to the Medicaid facility, I applied for the Aid and Attendance benefit through the Department of Veterans Affairs, which I discussed in my fifth essay.  Unfortunately, it took the VA ten months to approve the application, and by that time I had already transferred my mother, since I was not sure she would get it.  In any event, after I had moved her to the Medicaid facility, the benefit was finally approved for $1,700 per month, which she started getting immediately. However, since it took them ten months to approve the benefit, they owed her for that period, which amounted to $17,000. For that, the VA said I would need to become my mother’s representative payee, which I also discussed in my fifth essay. They said that would take about forty-five days.  After a couple of months, I called them, but they said they were still processing the application.  A few weeks after that, my mother died.  I notified the VA, and they told me that as a result, the $17,000 was no longer payable.  If I had been a spouse or a dependent child, the accumulated benefit would have been paid. Or, if I had spent my own money taking care of my mother, and had the receipts to prove it, the money would have been paid. But none of this applied to my case.

Let me say at the outset that I really did not care.  The main reason I wanted the money was to keep my mother in the private-pay nursing home as long as possible, and once I had moved her to the Medicaid facility, it really did not matter anymore.  Although I would have inherited the $17,000, which ain’t hay, I humbly confess that I have enough money to last me for the rest my life regardless, and I have no real need of more. Besides, as far as I am concerned, the money never really belonged to me to begin with, so it is not as though they took something away from me that was mine.  However, I thought it might be important to relay this information, since others may not be as financially independent as I am, and they might find themselves counting heavily on something that may suddenly vanish.

Therefore, anyone who applies for the Aid and Attendance benefit should be aware of the situation regarding the accumulated amount.  If the VA had approved the application in the forty-five days they said it would take, the money would have been deposited in my mother’s bank account.  When she died, I would have inherited it.  But since they did not finish the application before my mother died, the money was no longer payable. Normally, this does not happen.  If Smith owes Jones money, and Jones dies, the debt does not die with him.  Smith still owes the money to Jones’s estate.  If Corporation XYZ is sued, and before the suit can be litigated, the plaintiff dies, his heirs may pursue the case.  With regard to the Aid and Attendance benefit, however, the government saves money by being inefficient.  I do not say that anyone intentionally used dilatory tactics to avoid having to pay the claim.  But the fact remains that the longer it takes the VA to process an application, the less likely they are to have to pay it.

When I reported my mother’s death to the VA, I was informed that I could apply for a $600 death benefit to help cover funeral expenses.  By that time, I was so tired of dealing with the VA that I decided it just was not worth it. However, the woman I spoke to on the phone assured me that it would be no problem, and so I filled out the form and sent it in.  I still have not heard from them. I doubt if I ever will.  I don’t care.

Because my mother died before she ran out of money, I never had to apply for Medicaid in her behalf.  Nevertheless, in anticipation of making that application, I did become aware of a few things that might be of interest.  In particular, there is the matter of qualifying.  In order for my mother to get Medicaid, I knew that she would have to run out of money, which means that her bank balance would have to drop below $2,000, and her income would have to be deposited in a qualified income trust, also known as a Miller trust.

In anticipation of this eventuality, a lot of people decide that it would be a shame to let grandma’s money go to waste.  Rather than allow the nursing home to deplete her assets, they decide to do it themselves.  With a little encouragement, grandma signs a few checks, reducing her substantial bank balance to the more modest amount of a few hundred dollars.  Then, they figure, when she does go into the nursing home, she will immediately qualify for Medicaid, inasmuch as her bank balance will be below the required ceiling. Needless to say, the government does not approve of such cleverness.

When the application for Medicaid is made on grandma’s behalf, an investigation is made of her finances, covering a look-back period of five years.  If there is any hint that she has given away her money, they want it back.  In other words, any large cash withdrawals that cannot be justified will be disallowed.  So, if grandma gave away, say, $100,000, then her children will have to pay for $100,000 worth of nursing home costs themselves before Medicaid will begin making the payments.  I read a story about a woman who applied for Medicaid on behalf of her mother.  When the civil servant handling the case looked over her mother’s bank statements, he found a $10,000 cash withdrawal.  The woman explained that her mother had had her roof repaired a couple of years ago, and she had paid cash.  But she did not have a receipt.  So, the $10,000 was disallowed, and the woman had to pay that amount of nursing home expenses before her mother could qualify for Medicaid.

Because neither my mother nor I have ever itemized expenses on our tax returns, the standard deduction always exceeding whatever could have been realized by itemizing, neither she nor I have ever worried about keeping track of expenses.  Income, yes; but expenses, no.  So while we each had records regarding such things as wages, interest, dividends, capital gains, and annuities, neither one of us really had any records regarding expenses. Since, like me, my mother preferred paying cash, and since, like me, my mother saw no need to hold on to receipts after the warranty period expired, there were almost no receipts for the five-year look-back period she would soon be facing. Fortunately, she had no really large cash withdrawals, like that of the woman whose mother had had her roof repaired, but only routine withdrawals that could easily be justified as money paid for groceries, sundries, gasoline, and the like.  At least, so I hoped.  Since I never had to find out, I cannot be for certain. Therefore, when it comes to nursing homes, keep in mind that justifying cash withdrawals is as important to Medicaid as reporting income is to the Internal Revenue Service.

Because of the importance of satisfying Medicaid that grandma has not given any of her money away, I advise you not to have any joint accounts with her. I know that it is tempting to do so, because it makes things easier.  A friend of mine had a joint checking account with his mother, with whom he lived. When she became incapacitated, he was able to pay her bills simply by writing checks.  As a result, there was no need for him to have power of attorney.  But if she had had to go into a nursing home and apply for Medicaid, distinguishing between his money and hers in that account could have proved messy.  I did not have a joint checking account with my mother, but we did have a joint safe deposit box.  We originally got the box for important papers, and there was no need for us to have two separate boxes. During the 1990s, I started buying gold coins, and as the average cost of those coins was only $350 each, I just stored them in a jar in my apartment. But as the price went up after the turn of the century, their increased value began to worry me, and so, without giving it a thought, I put the coins in the safe deposit box.  When I started anticipating the day I would have to apply for Medicaid, I looked at the application form, and naturally there was a question as to whether my mother had a safe deposit box, to which I would have to say, “Yes.”  Then they would want to know if she had anything of value in it.  They might even want to look inside, just to check.  If so, I wondered if I would be able to explain, to their satisfaction, that the gold was mine and not hers.  Now, I know what you are thinking.  Why didn’t I just take the gold out?  The answer is, they would probably ask me if anything of value had been removed from the box.  Maybe you could look them right in the eye and deny that you had removed the gold, and then sign a document testifying to such, under penalties of perjury, but I have been cursed with an inability to lie in such circumstances.  Oh, I can lie to be polite, or to protect a lady’s honor, but when it comes to lying to the Feds, forget about it.  I knew I would start channeling my inner George Washington:  “I cannot tell a lie.  I took gold out of the box.”  I consulted an eldercare attorney, and he told me just to be honest about it, tell them it was mine, and everything would be fine. Although I was glad to hear such reassurance, I was unable to be equally sanguine in the matter, and thus I continued to worry. As it turned out, I never had to find out if he was right.  But the moral of this tale should by now be clear:  do not have any joint accounts with grandma.

Even if all went well, I knew that from the time my mother qualified for Medicaid until the application was approved would be two or three months. The woman I talked to at the Medicaid office said it only took forty-five days, but every social worker I talked to said it would take two or three months. Now for the catch-22: During the application period, before Medicaid started paying, my mother would be responsible for the $6,500 per month it cost her to stay in the nursing home. But since her bank balance would have to be below $2,000, and since her income would not even come close to paying that amount, her being able to make those payments would be arithmetically impossible.  I asked the woman at Medicaid if I could get the application approved in advance, so that everything would be ready to go when my mother finally ran out of money.  Now, I know that you know that the answer to that silly question was “No,” but I was tired that day and not thinking clearly.

For someone like me, the obvious solution was that I would pay for the nursing home costs until Medicaid approved the application, at which point I would be reimbursed.  But it was my good fortune to have the financial resources to bridge that gap.  Many were the times that I asked myself along the way, “What do poor people do?”  In this case, I suppose that people who are really poor are already on Medicaid, and so there is no problem.  But there must be plenty of people who are not already on Medicaid, and who do not have children with enough money to make those payments, or possibly have no children at all, and thus are left in the lurch.  One woman, whom I got to know at the nursing home where her mother was also a patient, wondered about this problem as well.  “What if I were to just walk away?” she asked, theoretically speaking, of course.  I speculated that her mother might then become a ward of the state.  More ominously, there was the possibility of being sued by the state under filial-support laws, which can be used to compel children to pay for expenses incurred by their parents. These laws vary from state to state, the worst of which is Pennsylvania.  Although there do not appear to be such laws in Texas, where I live, this may change. When the politicians begin cutting Medicaid funding, more laws of this nature may be enacted. When they are, I can almost hear the politicians waxing nostalgic of the way things used to be, when family members took care of one another, and speaking glowingly of how these filial-support laws will help bring back those good old days.

In any event, one thing a poor person might do is avail himself of a nursing home that accepts Medicaid pending, in which the nursing home allows a patient to stay in a room until the application is approved, at which point it is reimbursed.  But none of the nursing homes I considered offered such.  It is my guess that the ones that offered Medicaid pending were either 150 miles from where I live, which would have made frequent visits impossible; or they were located in a part of town I would not have wanted to drive through in the daytime.

Some of these problems can be handled by eldercare attorneys. They can set up a Miller trust, help you apply for Medicaid, and arrange for allowable transfers of money that can then be used while waiting for the Medicaid application to be approved.  But all this costs money.  So once again, I ask myself, “What do poor people do?”  I hope I never have to find out the hard way.

Caveats for Caregivers (7)

This is my seventh essay on caregiving, first published on another website on February 1, 2013.

After my mother died last September, I wrote what I thought would be my final essay in this series, discussing palliative care and hospice.  I remember thinking at the time that there were one or two things that I wished I had covered in the earlier essays, but I dismissed them as not important enough to worry about.  At a time like that, not much else would seem important. But it keeps coming back to me that these remaining pieces of information would have been very useful to me at one time, and it was no fun having to learn them the hard way.  Having thus reconsidered, this will be the first of what I believe will be my last two remaining essays.

We have all seen those reports on the news or on some show like 60 Minutes that reveal how horrible conditions can be in nursing homes, with patients being neglected or physically abused. Fortunately, in my experience with nursing homes, I never saw any problems like that.   The situation reminds me of my father’s experience after World War II.  My father was in the navy, and in the early months of the war, his ship went down. He spent the next three-and-a-half years in a Japanese prisoner-of-war camp, where disease and starvation resulted in the death of all but just over a hundred men out of a crew of over a thousand (about half died when the ship went down). When he got back home, he had to listen to his family talk about how rough they had it during the war, what with Meatless Mondays and sugar rationing.  So, with apologies to anyone who has ever had real problems with nursing homes, I will now venture to discuss a relatively minor problem that I encountered.

When it became clear that my mother would have to go into a nursing home permanently, I had already had some experience with such facilities, and so I picked the nicest one of the bunch. It had only one disadvantage:  it did not accept Medicaid.  Except for the patients that were there for only a few weeks of therapy, which Medicare paid for, everyone else was private-pay.  My mother was not rich, but she had enough money and income to pay privately for about eighteen months. So, I decided to start at this private-pay facility, and use it as a base of operations, as it were, from which I could take my time investigating Medicaid facilities in the area.  Then, when she finally ran out of money, I would know where to transfer her.

I would have preferred to have her in a private room, but that would have cost about $7,800 per month, as opposed to just $6,500 for a semi-private room (plus about $500 worth of extras). Since the latter would allow me to stretch her money further, thereby keeping her at the private-pay nursing home as long as possible, I went with that option.  And this leads me to the problem that gave me the most stress, the one that used to keep me up at night:  the problem of noise. Imagine being in your living room, with a curtain down the middle.  On one side of the curtain, your half of the room, you are watching television.  On the other side of the curtain is your roommate, watching another television, but tuned to a different station. Since the sound coming from each television interferes with the other, there is a tendency to escalate, each set being turned up a little louder in order drown out the other.  And when you turn your set off, deciding to go to sleep, the other set remains on. That is what it is like to be in a semi-private room.

In the hospital, it had been different.  There she had a remote that allowed her to do everything: adjust the bed, call for assistance, control the television.  More importantly, the remote had the television speaker in it.  So she could turn the volume up loud enough for her to hear it, but without disturbing her roommate, and vice versa.  But not a single one of the nursing homes that I toured had that set up.  In every case, there were just two ordinary televisions, with regular speakers.  I suppose that the primary reason nursing homes do not have that kind of setup is that most nursing homes, to keep costs low, do not supply televisions.  You have to bring one in yourself. Headphones naturally suggest themselves as a solution, but they would have to be wireless, or else people would be tripping over the wire; and wireless headphones are a little too complicated for people in nursing homes.  By “complicated,” I mean, among other things, you have to turn them off to make sure the battery does not run down.  In any event, I never saw anyone in any of the nursing homes using them.

When I would go to visit my mother, she would tearfully plead with me to get her out of there. She said that her roommate’s television was driving her mad, because it was on all night long. Since my mother was suffering from dementia, I could never be sure of anything she told me.  At lunch, however, she used to sit at the same table as her roommate, who casually mentioned one day that she never got more than four hours of sleep at night, which meant that the television was probably on twenty hours per day.  After one long, miserable month, I moved my mother into a private room, which meant that her money would only last her about a year.  When she did run out of money, she would have to have a roommate, because Medicaid will not pay for a private room.  But at least this would postpone my mother’s nightmare a little longer.

In a way, it could have been worse.  At least my mother’s roommate did not have any hearing problems.  Being old, a lot of residents in nursing homes cannot hear, and the television is so loud that it is earsplitting.  I walked by one room where the television volume was up full blast.  Inside was a man, wearing a hearing aid, sitting right next to the TV in his wheelchair, and leaning slightly forward, presumably so he could hear better. Being in that room would be like being in Guantanamo, subjected to what some are pleased to call harsh interrogation techniques, but which I call torture.  I half expected to see a couple of CIA agents in there, demanding that the man’s roommate tell them where the weapons of mass destruction were.  In another room, with a television playing equally loud, the resident would often leave and wander down the hall, without bothering to turn the set off, while his roommate, who was confined to his bed, had to just lie there.

The second major source of noise was raving.  Some of the residents would cry out for help, and then scream to be left alone when the caregiver went in to see what they needed.  Others would beg forgiveness from God, sorry for whatever sin they had committed.  Others still would cry for their mothers. Unlike the problem with the televisions, raving only occurred occasionally. But when it did occur, it was unnerving.

And so, I said a little prayer to the politicians of Texas, to please have mercy on my poor mother and those like her, to change the Medicaid rules, and allow everyone to have a private room, for just a little peace and quiet at the end of their lives.  But I fear I prayed to a heartless pantheon, who are more likely to cut Medicaid than supply it with more funding, which will only make things worse.  As a harbinger of a grim future, one of the nursing homes I checked into had four patients to a room.  I did not even bother to tour that facility, and I shudder to think what four televisions must sound like.  As our politicians wax virtuous about the need to cut the entitlements, of which Medicaid is one, I fear that a Merciless Providence will eventually ordain a return to the wards: large rooms with twenty beds each, and a couple of minimum-wage caregivers running back and forth, trying to attend to the patients who occupy them.  Of course, each bed will have its own television.

Through a circuitous process that I covered in my fourth essay, my mother eventually ended up in a semi-private room with a roommate who slept all day.  As a result, she never played her television, and, equally important, my mother’s television did not seem to disturb her roommate. After all, my mother was not completely innocent in all this, for she liked to watch television too, and being hard of hearing, she tended to play it a bit loud herself.  So I had to worry about the noise problem both ways.

At any rate, the problem being temporarily solved, I began investigating the Medicaid facilities, for which purpose I found the website Medicare.gov extremely useful.  By typing in my zip code, it would tell me which nursing homes accepted Medicaid and which did not, and how many certified beds they had.  Unfortunately, no distinction is made on the website between beds that are certified for both Medicare and Medicaid, and those that are Medicare certified only.  That information needs to be obtained with a phone call.

Although a nursing home with a small number of beds may sound cozy, suggesting that the staff will find it easier to care for an equally small number of patients, I realized that there was a distinct disadvantage in selecting such a nursing home.  If my mother ended up with a noisy roommate, the option of moving her to another room would be limited. When I checked out a nursing home that had three hundred beds, however, the woman in charge of admissions mentioned, without my even having to ask, that they would work hard to find my mother a compatible roommate should that be necessary.

There is another reason why big is good.  When I said that my mother had enough money to pay privately for about eighteen months, that did not mean I could keep her at the private-pay nursing home for the full period. Most nursing homes have waiting lists, so I knew that I would have to put in an application to a Medicaid facility at least six months before she ran out of money, and even that might be pushing it.  I finally decided on nine months, just in case.  In any event, the larger the nursing home, the greater the turnover, resulting in a shorter waiting list.  If the number of certified Medicaid beds is small, however, getting one of those beds may not be possible.  One place I called, which only had six beds, told me not to even bother getting on the waiting list, for it might be years before one was available.

So, I went with the big nursing home when the time came for me to transfer my mother, and the good news is that the roommate my mother ended up with had good hearing, and thus played her television low.  And as my mother had reached the point where she no longer watched television, because she no longer understood what was going on, I did not have to worry about the noise problem on her end.

Running parallel to my effort to protect my mother from noise were problems concerning money: her money, my money, and the government’s money.  But that is for another essay, which I expect to publish soon.

Caveats for Caregivers (6)

This is my sixth essay on caregiving, first published on another website on September 21, 2012.

It had almost become routine.

My mother had frequent urinary tract infections, and they often resulted in her becoming even weaker than she already was, and more confused than usual.  So, when the nursing home where my mother resided called me early in the morning to tell me that my mother had become unresponsive, and that they were sending her to the hospital, I was not surprised.  I went straight to the emergency room, arriving there just before the ambulance did.

But then something happened that was not routine.

Shortly after my mother was brought into the emergency room, the nurse asked me if I had spoken with a social worker.  “Well, not today,” I replied. In all the previous times that I had been to the hospital with my mother, the social worker was someone who showed up the next day to discuss whether my mother lived alone, and what kind of care she would need, or whether I needed help selecting a skilled nursing facility.  I had never talked to one in the emergency room, especially before a doctor had even seen my mother. But five minutes later, a social worker showed up, and the first question out of her mouth was, “Have you considered palliative care?”  As the name would indicate, palliative care focuses on making the patient comfortable rather than on treating the illness.  It is like hospice, only you don’t have be diagnosed with a terminal disease with only six months to live to qualify for it.

Clearly, they had come to the conclusion that my mother’s health had declined to the point that ordinary treatment was no longer appropriate. They didn’t have to convince me.  I had come to the conclusion that hospice was the best thing for my mother almost a year earlier. However, my mother was not ready, psychologically speaking.  In her mind, hospice was a halfway house to euthanasia, and I was of the same opinion.  It is for people who want to die as quickly and as painlessly as possible, and if that is not your attitude, you are not ready for hospice.  Every social worker will deny this. “People in hospice often live for years,” they will tell me.  “It’s just a different approach to end of life care.”  But I knew better, and so did my mother.

She would sometimes tell me that she hated her life, that she wanted to commit suicide, but that she couldn’t figure out how to do it.  “Well, Mom,” I would say, “if you are really tired of this, I can put you in hospice.”  She would become silent, and then, after a couple of minutes, she would begin talking about something else.  Nevertheless, such thoughts persisted.  I usually was the one who gave my mother her medicine in the morning, explaining each pill to her as she took them.  “And this one is your stool softener,” I would say, while holding it in my hand. “Suicide pill?” she would ask.  “No, Mom.  Stool softener.”  This happened on at least three different occasions. So, clearly it was on her mind.  And yet, not surprisingly, she could not quite bring herself to go into hospice.  Once, when she was really sick, she just barely managed to get the words out, “I can’t take this anymore.”  “Do you want me to put you in hospice?” I asked. Without hesitation, she said, “No.”

But palliative care was different.  At least, it was a different term, one without the connotations of a death sentence.  Of course, my mother already knew that she was dying. But it is one thing to accept the fact that you are going to die, and it is quite another to give up.  Perhaps, with this concept of palliative care, I could get for my mother all the benefits of hospice without the disturbing connotations.  As it turned out, however, my mother declined to the point that I realized she probably would no longer know the difference.  So, notwithstanding my mother’s wishes, I decided hospice would be best for her.  I had already signed a do-not-resuscitate order on a previous occasion, but now I signed a do-not-hospitalize order as well.  I felt as though I was signing a death warrant.

Is there a term for the opposite of “control freak”?  Some would suggest “easy going” or “laid back,” but that is not what I have in mind.  It is not merely that “control freak” is a substantive, whereas “laid back” and “easy going” are modifiers that makes them inadequate. It is the fact that these latter terms fail to capture that strong aversion I have always had to deciding what is best for others or telling them what to do.  I once refused a promotion to manager for that reason.  Instead, I recommended a coworker who was younger than me by a generation.  He became manager, along with a raise, and I took my orders from him, which suited me just fine.  I never wanted to be responsible for anything but my own actions or for anyone but myself. Well, whatever the term for it might be, for the past year, I had been forced to make decisions for my mother, in some cases, contrary to her wishes.  For starters, I had put her in a nursing home.  On many occasions, at the end of a visit, she would ask me, “Can’t I go home with you?”  Saying “No” was a soul-crushing experience.  And now I had made a life and death decision for her.

Two weeks later, she became unresponsive again.  But this time she did not go to the hospital. For a day and a half, she received nothing but morphine. And then she died.  If I had let her go to the hospital, she would have received fluids intravenously. They could have intubated her to help her breathe.  And I could have had a feeding tube installed.  She might have recovered again, and then returned to the nursing home, after which she might have lived several more weeks, months, or even years.  But she received none of those things, because I denied them to her.

Now I have dreams that I forgot about my mother and left her somewhere—how frantic I am that she is lost, and how relieved I am when she manages to find her way back to me.

Caveats for Caregivers (5)

This is my fifth essay on caregiving, first published on another website on July 12, 2012.

In my first essay in this series, I wrote about my discovery that the federal government does not recognize power of attorney as having any legal standing, and that for each agency, office, or department from which my mother receives a check, it would be necessary for me to become her representative payee.  They each have their own set of conditions, but especially challenging was the Office of Personnel Management, who said that their preference was that I be my mother’s court appointed fiduciary. Their alternative conditions I was unable to meet, and so I called a lawyer and began the process of becoming my mother’s legal guardian.

My mother had direct deposit for each of her checks, and so there was no immediate need for me to become her representative payee.  There was, however, the problem of her mail.  Having shut down her apartment, I had the Post Office forward her mail to my apartment as a temporary measure. Then I called Social Security and had her mailing address changed, no questions asked.  The Office of Personnel Management, on the other hand, required a letter from my mother.  So, I typed one up and got her to sign it. Owing to her dementia, she did not know what she was signing, but I guess the federal government would rather have the genuine signature of an incompetent person than that of someone with power of attorney.  Moving right along, when I called the Department of Defense, the woman I spoke to asked if my mother was present, so that she could talk to her and get her approval for me to discuss her affairs.  I told her that she was not present, but that even if she were, she would not understand what was being asked of her.  As a result, the woman said I would have to become a representative payee before she could even talk to me about my mother’s mailing address. I learned long ago that if you call the federal government, and you do not like the answer you get, call back the next day.  There is a good chance that you may like the second answer better.  Consequently, the next day I called the Department of Defense again, and the man who answered changed my mother’s mailing address without further ado.

At this point, you may be wondering why I would need to do anything else. Her checks were being directly deposited in her bank account, and the bank recognized my power of attorney. Now that her mailing address had been successfully changed, it would seem that I could just coast.  However, it would be just a matter of time before my mother would run out of money and need Medicaid.  My mother’s three checks would not be enough to pay for her nursing home expenses, yet they give her an income above the limit allowed by Medicaid.  To bridge this gap, many states have qualified income trusts, often called Miller trusts.  Once I set up the Miller trust, I will have to direct her checks to this new account, and in order to do that, I will have to be her representative payee.  So, it had to be done.

Since I would have to become my mother’s legal guardian to satisfy the Office of Personnel Management, I decided to wait until I had that document before dealing with Social Security or the Department of Defense. The elder care attorney that I had talked to about the Miller trust did not do guardianships, but he recommended someone else.  The someone else was actually a divorce lawyer who had done guardianships in the past, but was reluctant to take my case. The fact that my mother had already given me power of attorney, coupled with the fact that I was an only child, precluding the possibility of there being a challenge to my case from one of my siblings, persuaded my attorney that a trial would not be necessary, and that my situation would present no difficulties.  So, she agreed to take my case, and I wrote her a check for $3,500 (damn that Office of Personnel Management anyway!).

My lawyer had a busy schedule, so nothing happened for the first two months.  Eventually, however, I signed some more forms, and the application was filed.  A few weeks later, while I was visiting my mother in the dining room of the nursing home, my mother was served papers, notifying her of my attempt to become her legal guardian, and advising her of her rights, should she have any objections.  Of course, my mother was not able to understand the papers, and I was the one who actually took possession of them, but otherwise, all was in order.  An old woman sitting at a nearby table looked at my mother, gave me the evil eye, and then looked back at my mother, and said, “Whatever you do, don’t sign anything!”  My mother was engrossed in her soup and did not hear her, but it sure made me feel as though I was doing something sneaky.

A couple more weeks passed by, and a court investigator showed up.   I guess I should mention that since I am retired, I am able to visit my mother between 10:00 A.M. and 2:30 P.M. every day, which accounts for how I happen to be there when these people show up unannounced. She talked to my mother about the legal guardianship, and my mother sort of understood and approved of it, so all went well.  But as can be seen from the dire warning of the old woman of the previous paragraph, some patients in nursing homes will vehemently resist the guardianship process, which can necessitate a trial by jury.  Three weeks later, my mother’s attorney ad litem showed up.  She is the attorney assigned by the court to represent my mother’s interests.  As with the court investigator, all went well.

Technically, I was my mother’s adversary.  Now, it only made sense that her attorney’s fees would be paid for by her.  But the $3,500 I paid my attorney was also paid for by my mother, thanks to my power of attorney.  In other words, my mother was forced to pay for the attorney of her adversary. Strange, but apparently legal.  Then I had to put up a bond of about $500, against the possibility of malversation on my part.  No problem, Mom paid for that too.

While all this was going on, however, the Department of Defense got wind of my mother’s situation.  My mother’s Navy annuity is based on my father’s service.  Every year, she receives a Certificate of Eligibility form, asking about her marital status. Apparently, if she were to remarry, she might no longer be eligible for the annuity.  If this seems like an intrusion into my mother’s private life, be reassured.  At the bottom of the page, it clearly states that “disclosure is voluntary.”  It also states, however, that “failure to provide information will result in suspension of annuity payments.”  At the time that my mother received this annual request for voluntary information about her marital status, she had recently fallen and broken her hand. Moreover, her dementia had progressed to the point that she would not have been able to sign even with a good hand.  Consequently, out of the expedience that comes with exhaustion, I just signed the dang thing with my power of attorney and sent it in.

Now they knew.  And now they wanted me to become her representative payee.  For this purpose, I had to send in a doctor’s letter stating my mother’s incompetence, and I had to sign an application.  I couldn’t believe it.  Unlike the conditions required by the Office of Personnel Management, these requirements by the Department of Defense were simplicity itself. Well, there was this one snag.  My signature had to be witnessed.  The employees at the nursing home could not witness my signature, but there were many patients there who were mentally sound, not to mention the visitors who were always about.  I asked a several different people if they would witness my signature, and they each looked at me as though I had asked them if I could sleep on their couch for the next two weeks.  So, I gave up on that and went to a notary who witnessed it for free.

In any event, the day of the hearing finally arrived, five months after I started the process, and I was made the legal guardian of my mother’s estate and person.  I sent a certified copy to the Office of Personnel Management, along with their forms, and hopefully that will do it.  I thought maybe I could do the same with Social Security, but they want a doctor’s statement anyway, and I have to go to their office in person for an interview.

In the meantime, the Aid and Attendance benefit that I had applied for my mother, based on her wartime service as a Navy nurse, was finally approved, after ten arduous months.  As part of the application for the benefit, I had sent in a doctor’s statement to the effect that my mother was totally incompetent. Therefore, the Department of Veterans Affairs wants me to become her representative payee.  For this purpose, my legal guardianship document was as worthless as my power of attorney.  The Office of Personnel Management might regard my status as a court appointed fiduciary as being of significance, but the Department of Veterans Affairs has higher standards than that, by George. What they require is my mother’s signature on a form appointing me as her representative payee.  In other words, they require that I be her representative payee, because they know she is incompetent; but her signature on a document, however incompetent she may be, is worth more than the court document that states that my mother is incapable of handling her affairs, which includes such things as signing documents.  My mother has since regained her ability to sign her name, but she has become uncooperative of late, so I am unable to get her to sign anything.  The VA says I can get her fingerprint on a document if she won’t sign, but it has to be witnessed.  I don’t want to go through the degrading process of having people rebuff me when I ask them to witness something, and I don’t want to drag my mother to the notary to have them witness it. I have heard there are mobile notaries that will come to the nursing home, but if my mother refuses to sign her name, she will probably fight any attempt to fingerprint her as well.

I don’t mean to end this essay with a cliffhanger, but I have gone on long enough, and how all this turns out will be revealed in my next essay, if I haven’t completely worn the reader out this time around.

Caveats for Caregivers (4)

This is my fourth essay on caregiving, first published on another website on May 4, 2012.

You know you are getting old when you hang a pendant around your neck with a button on it. Now, I know you have seen that commercial where the woman falls in the bathtub and lies there, unable to move, until her daughter shows up four hours later.  As horrible as that prospect sounds, there are two reassuring features about that commercial:  first, it was not her son that found her in that situation; and second, at least there was someone, daughter or otherwise, who had the key to her house and came over to see her that same day.  If I fell in the bathtub and broke my hip, no one would find me until the landlord decided to evict me for not paying the rent.  And so, around my neck the pendant hangs.

On the one hand, a medical alert system allows us to keep our independence, in the sense that it allows us to continue living alone instead of moving in with our children (if we have children, that is).  But on the other hand, it is an acknowledgement that we need some kind of assistance, even if it is only from the operators who are ready to help us should we fall, something that never crossed our minds when we were young.  By hanging that pendant around your neck, you are made aware of the fact that you are losing your independence in the very act of trying to preserve it.

But that we can joke about.  The real loss of independence begins when we give up the keys to the car, knowing we will never drive again.  Then what? Setting aside the question of cost, a not insignificant consideration, the next logical step in trying to preserve some degree of independence is having people come to our home to provide us with various goods and services, such as transportation to the store, help with bathing, and Meals on Wheels.  Or, we can move into an independent living community, which is essentially an apartment complex replete with all sorts of amenities for the elderly, such as a shuttle to take people to various stores, bathrooms that have grab bars, and a cafeteria on the premises.  When it is no longer safe for us to be around an oven, or when we cannot remember to take our medicine, we can move into an assisted living facility.  And finally, when our mental or physical limitations become severe, we give up the last vestige of independence and move into a nursing home.

I once imagined that my mother would proceed through each of these stages in just that sequence, in what might be thought of as a natural progression. However, because she had me to help her, she never needed to be in an independent living facility, and then, all of a sudden, she went to the hospital, and from there to the nursing home.  For the next two months, a nursing home was exactly what she needed.  But then she got better, at which point, putting her in assisted living became a genuine possibility.  Not only would the cost be less, but also she would have a private room.  And, inasmuch as my plan met with the approval of the nurse practitioner and other professionals in the nursing home, I decided this was the thing to do. What may be critical to what follows, however, is that this was the reverse of the natural progression.

I cannot, of course, speak for all assisted living facilities.  I can only relate my limited experience in this matter, which you may regard not as laying down a set of absolute truths about all such facilities, but as something to be aware of as a possibility.  First, there was a fee to “enter the community,” which was a thousand dollars at one place and two thousand dollars at another I considered. Second, they required thirty-days notice in case my mother should need to move out.  To put these two items in context, it must be borne in mind that at this stage of life, a lot can happen in thirty days.  In other words, I might have paid the fee and moved my mother in, only for her to undergo a sudden decline in health two days later, necessitating a move back to the skilled nursing section, forgoing the fee and a month’s rent in the process.

Then I found out that the rooms were not furnished.  Maybe I should have known better, but I thought the rooms would come with a hospital bed, a dresser, a chair, a lamp, and so forth, just like the rooms in a nursing home. They did not. Fortunately, the manager had a lot of donated furniture in storage that he let me borrow at no charge, or else I would have had to spend a lot of money setting it up.  The bed could have been a real problem.  My mother needed more than just a twin bed; she needed a hospital bed. Fortunately, again, the administrator was able to get Medicare to pay for a rental.

Then I had to buy sheets, towels, wash cloths, and the like.  In other words, stuff that was supplied automatically in the skilled nursing section would have to be supplied by the tenant in an assisted living unit.  At the department store, as I was about to buy three sets of sheets for my mother’s bed, I had the good fortune to be waited on by a woman with experience in such matters (she had been a caregiver for her father).  She informed me that a hospital bed needed extra long sheets, since hospital beds are slightly longer than twin beds.

As for the towels and wash cloths, you may be wondering why I didn’t just use the towels and wash cloths that my mother had had in her apartment. The answer is that I had already let go of her apartment, and had found it necessary to throw away a lot of good stuff that was simply impossible for me to stash in my own place.  So now I was going to have to replace much of what I had just thrown away.  One of the CNAs (certified nursing assistants) told me that I would need towels not only for my mother to dry with after bathing, but also for the CNA to wipe up the water on the floor that would inevitably be there when she used the handheld showerhead to wash my mother.  Without giving it a second thought, I bought a bunch of white towels.  When she saw them, the CNA announced, in a manner that would brook no exception, that I would have to buy colored towels, because white towels must never be put on the floor.  I was so awed by the gravity of her demeanor that I accepted this pronouncement without question.  As I had already put my mother’s name on the towels with a marking pen so that the laundress would know to whom they belonged, it was too late to return them.  So I bought a bunch of colored towels, and put them in the cabinet next to the white ones.  Three days later, I saw another CNA, who had just bathed my mother, wiping up the water on the floor with one of the white towels.

Then there is the toilet paper.  Even that had to be supplied by my mother, which is to say, by me.  Now, I was not worried about the cost of the toilet paper or other sundry items (facial tissues, soap, toothpaste, etc.).  The problem was that even with the availability of a shuttle to go to the drugstore, my mother was not really capable of handling money or remembering what to buy.  And while I visited her every day, and would normally be able to buy the items myself, I do get sick from time to time.  A mere cold can incapacitate me for a week.  What would happen if I got sick just when my mother needed more toilet paper?  In fact, I had surgery scheduled for myself the next month, and I could not be sure how long I would be convalescing.  In other words, when my mother was in the skilled nursing section, the room was furnished and supplied automatically, and even should I be sick for a month, I would know that she would be completely taken care of.  In the assisted living section, the situation was somewhat more precarious.

After about six weeks in assisted living, my mother fell twice, each time in the middle of the night.  Since the assisted living section is less staffed at night, I was told I would have to hire a sitter for her during the nighttime. This additional cost would have completely defeated the purpose of having my mother in assisted living, and so I moved her back to the skilled nursing unit, where, with hindsight, I guess she really belonged.

I hope that I will not be misunderstood.  Assisted living is perfect for many people, and the one where my mother briefly stayed was excellent.  I simply was not prepared for all that was involved in placing my mother in an assisted living facility, the result, no doubt, of backing into it from a nursing home, instead of following the natural progression.

Caveats for Caregivers (3)

This is my third essay on caregiving, first published on another website on April 25, 2012.

Having just put my mother in a nursing home the previous week, I was anxious to get over there to console her, since she was positively distraught. However, I had to make a deposit, so I was standing in line at the bank, thinking about all the things I needed to do.  I would have to empty out her apartment, which meant deciding what to keep, what to give away, and what to throw away.  I needed to drive across town to get help applying for the Aid and Attendance Benefit from the Veterans Administration. Unfortunately, I did not have much faith in the car I was driving, which the garage had lent me, because my old heap needed to be in the shop for extensive repairs (seven weeks worth, as it turned out).  Moreover, I had just discovered that I would have to become the representative payee (see “Caveats for Caretakers (1)”) for each of her three government checks, and I was wondering how involved that would be.  And, as the pièce de résistance, I had just found out I would need to go into the hospital for some minor surgery.

“What next?” I asked myself.

“Your driver’s license is about to expire,” the bank teller informed me, as she proceeded to record my deposit.

At this point, I guess I should mention that I live in Texas.  I don’t know how it is in other states, but from the time I arrived at the driver’s license office until the time I renewed the license and was heading out the door was three hours and forty-five minutes. Considering all the other problems I had to contend with, this was an inconvenience indeed.  “Oh well, at least that’s over with,” I said to myself as I got to my car.  And then it hit me. Since my mother has dementia, I carry her driver’s license around with me.  I looked at it, holding my breath.  Sure enough, her license would expire in four months.

Now, obviously, she would never drive again.  But she would need a photo ID, since that is one of the first things they want to see when you go the doctor, a hospital, or a nursing home.  I could see the ordeal unfolding before my eyes. I would have to get wheelchair transportation.  I would have to hire an attendant to help my mother go the restroom, which she would surely need to do during a four-hour wait.

“There must be some kind of exception made for people like my mother,” I thought.  And since this must happen all the time to people in nursing homes, I asked one of the administrators at the nursing home if she knew what usually happened in such situations.  She did not have the slightest idea.  The head nurse had no experience in such matters, and I even drew a blank with the social worker.

I went to the appropriate website, but my question was apparently one that is not frequently asked, and nothing seemed to fit my particular problem.  I looked at the contact number. You know you are in trouble when the contact number is not toll free.  It’s not the cost of the call that worried me, but the attitude that this phone number represented, that they were really not interested in hearing about my problem or helping me solve it. The woman I spoke with, however, was quite helpful, and she had some good news.  For people who are homebound or in a nursing home, Texas has a policy of sending someone out to photograph the person and do all the paperwork. Unfortunately, the woman informed me, I would have to go out to the driver’s license office in person to set it up.  “Don’t bother to try to get them on the phone,” she cautioned me.  “It’s impossible.”  I tried anyway.  It was impossible.  So, back I went to the driver’s license office.  For this situation, which could have easily been handled over the phone, I only had to stand in line for forty-five minutes (not to mention the commute, which was the better part of an hour).  I was told that someone visits homebound people or those in nursing homes once a month, and that I would be contacted sometime next month.  I asked for a contact number, just in case.  I did not get one.

All’s well that ends well, I suppose.  I was contacted, and a couple of state employees came to the nursing home. They took my mother’s information, took her photograph, and then tried to get her to sign the form. Unfortunately, my mother was too confused to sign her name or even to make a mark.  So, one of the state employees told me to sign for her.

“Do you want me to sign with my power of attorney?” I asked.

“We don’t accept power of attorney,” she replied. (There it was again, the government’s mantra.) “Just sign her name for her,” she said.

And so, I signed my mother’s name, and within a few weeks, my mother received her photo ID, with my version of her signature right there at the bottom. “If I need to forge my mother’s name on some document,” I thought to myself sardonically, “the signature will be a perfect match with the one on her photo ID.”

As noted above, none of the employees in the nursing home were aware of this service provided for people that are homebound.  For this reason, I have told this tale, to make the reader aware of a service that may be available, depending on the state in which one lives.  I would only add that one should not wait until the driver’s license is about to expire.  As soon as you are sure that your mother will never drive again, start making arrangements right away to get her a photo ID to take its place.

In the opening paragraph, I referred to the Aid and Attendance Benefit that is available to veterans who have served in wartime and their spouses.  The benefit may be as much as $1,700 per month.  If you think your mother may qualify, ask the social worker at the nursing home about it.  She will probably be able to give you a contact number of a government employee who can assist you with this.  My first effort was with someone at the VA, but the nursing home directed to me to a county employee, without whose assistance I would have long since given up. Unfortunately, it takes a long time for the claim to be processed. The odds are very good that you will have to put your mother on Medicaid before she ever receives anything, at which point she will no longer be eligible for the benefit (it will be reduced to $10).