What White House Conference on Aging? This December 2005 gathering, much ballyhooed in advance by some of America’s involved elder citizens and by many professionals in the field of aging, drew almost a complete blank in the media, so far as I could tell. Not a single story appeared in any of the mainline journals that I read.

The official host, George Bush, did not see fit to visit the assembly of some 1200 elders and their advocates. This marked the first time that a president had absented himself from this every-ten-years assembly.

Instead, Bush left town, traveling to a retirement residence in suburban Washington, reportedly a gated community, there to praise the perceived virtues of the new Medicare prescription drug program. Perhaps he sensed the possible specter of delegates reacting to that program with something less than enthusiasm.

Lack of enthusiasm would be too mild a term to describe the delegates’ sentiments about changes in Social Security. Overwhelmingly the delegates voted to keep this program the way it is, expressing little sympathy for Bush’s privatization proposals.  

Though he was not present, the conference was scripted by the planners to reflect Bush’s values. Thus “personal responsibility, healthy lifestyle, technological innovations, and entrepreneurial solutions,” all found emphasis in presentations by administration representatives, according to Washington journalist Abigail Trafford.

The three-day meeting itself was not exactly a model of democratic process. In fact, the agenda stirred protest among some groups of delegates, notably the New Yorkers who issued a formal complaint. Instead of setting their own agenda, participants found themselves confronted with a list of prefabricated issues which they were required to rank in order of importance.

Unfortunately, this belated report of the event must rely on secondhand experience because my own plans to attend were torpedoed by unexpected health problems. I would have enjoyed sharing with you some of what I heard on-site from my age-peer delegates and professionals.

However, tapping my contacts in the latter group, I find topics that deserve ongoing attention. The top issue is long-term care. Calling for change, delegates voted for widespread action in the areas of “financing, choice, quality, service delivery, and the paid and unpaid workforce.”

Across the country, advocates of older Americans continue to worry because the health care system is just not delivering what we need. Until you yourself or members of your family get hit with a serious chronic health problem, it is hard to appreciate how inflexible our system is.

People are suddenly faced with a maze of regulations that confound their efforts to cope. Not unreasonably, those needing care and their loved ones are often reduced to tears by the limits on their freedom to choose what is best.

Altogether too many people of modest means are forced into institutions that no one would freely choose. As Dr. Robert Butler, founding director of the National Institute on Aging, stated at the conference, only one out of every ten nursing homes across the country meets standards established by the federal government, a fact that ought to cause shock.

As he has done for decades, Butler also decried the nation’s failure to provide doctors specializing in medical services for older people. Of some 600,000 physicians in the country, only one percent has been trained in geriatrics. By way of vindicating Butler’s lament, Congress, at almost the same time he was speaking, eliminated the budget for geriatric education.

At least one local delegate, Michael Smyer, graduate dean at Boston College, found specific value in the conference. Though he says it is too early to tell about particular outcomes, he hopes for important proposals to gain traction when the final report is presented to Congress in June.

Among the topics receiving attention, he is particularly interested in mental health  and workplace issues. Both areas were ranked near the top from the list of 73 voted on by delegates. Also, the caliber of the discussions was high, a factor that encourages him to think the proposals have a future.

Another local delegate, Andrea Cohen, director of Houseworks in Newton, went to the conference with low expectations. However, she found it “verified for me some of the things that need to be changed.” Like Smyer, she was pleased at the level of interest in mental health services, and she took note of actual and proposed technology that may better the chances of tomorrow’s elders to live on their own.

With a third-place finish in the voting, another issue that scored surprisingly high among the concerns of delegates was transportation. Concern for the mobility and independence of older people moved them to stress the need for more options than we have now. Many Americans live in places, especially suburbs and rural areas where public transportation is quite inadequate or nonexistent, and private businesses have not made up for that lack.

Results of voting on resolutions, names of delegates, and much other information about the conference is available at www.whcoa.gov.

Richard Griffin

Whoever invented aunts did us all a fine favor. Having your mother’s sister or your father’s available to coddle you can count for a lot when you are growing up and, perhaps, later.

Your uncle’s wife, an aunt by marriage, can and often does, fill the same kin-keeping role. I remember with affection my aunts Grace, Katherine, and Rose, all of whom helped me feel strong ties of kinship.

My aunt Grace, a charming hospitable Southern lady, was married to my uncle Bill for more than 60 years, and lived to see (and delight) four generations of descendants.

The other two aunts by marriage, Katherine and Rose, I knew less well, though I cherished their obvious affection for me. Each of them had one son, cousins whom I liked but lost close contact with in later years.

My father had two sisters. The elder of the two, Margaret, was a nun stationed in western Massachusetts. Her visits were infrequent but welcome to us children. She always came dressed in full habit with another nun as companion, the common practice for religious of her order.  Since she was tall, we called her “Big Auntie,” a descriptive name but also an affectionate one.

My father’s other sister, Mary, was a social worker in New York City. After her death, we found out that, during the years when she visited clients in the tough sections of the city, she had packed a gun in her purse. We had always admired her independence, but this news added a special aura to our memory of her.

But my favorite aunt was another Mary, my mother’s sister who lived with her mother in Peabody. In the days when Sunday automobile rides were a family tradition in middle-class America, our most frequent destination was my grandmother’s house.

Aunt Mary and our grandmother Hannah Barry would make much of us children, shaping our visits into the stuff of family legend. It was this aunt who introduced us to finger bowls for use at the end of dinner. Sometimes, in order to tease her, we would affect to drink out of them rather than use them properly.

As this custom may indicate, Mary lived in the backwash of the Victorian era. Her style of life, as a single lady of fastidious manners, suggested a bygone time. We loved her but could not resist making gentle fun of her even in our young years.

As the eldest, I enjoyed special privileges: being taken to Boston for plays, movies, lunches at Schrafft’s or the Hi-da-way.

Among the shows we went to, I recall the Student Prince, an operetta by Sigmund Romberg, full of sentimental songs. We also went to see Walt Disney’s film Fantasia. Few were then aware of the film’s particular appeal for pot-smokers─something that, in any case, Aunt Mary would not have noticed.

According to family lore, Mary had been disappointed in love and turned down an offer of marriage, an event that I still find poignant. She reportedly spurned an eligible man with a name famous in the city.

Be that as it may, Aunt Mary always enjoyed a wedding─or a funeral, for that matter. Wakes also were for her, as for many of her contemporaries, an important part of the social round.

As I recall, when coming home after a wake she would often talk about the fine appearance of the corpse, often better, she would observe, than he or she had looked when still alive.

My aunt’s room was a place of mystery for me and my brothers and sisters. Mary kept the door closed; only rarely did we catch a glimpse of its contents. These sightings revealed boxes galore pushed under her bed, and other spaces filled with old newspapers and other relics of the past.

After her death, a niece and nephew helped clear out the contents of our aunt’s room: old letters, balls of string, hat boxes, and books from some of which fluttered long-forgotten 20 dollar bills.

Mary enriched my life, as did my grandmother with whom she lived almost her whole life. In many different ways, this aunt made me feel important and gifted, qualities that contributed to my development. In spite of─indeed, perhaps because of─her abundant eccentricities, she was dear to me and enhanced my childhood.

In the light of this tradition, I greatly value seeing the ways in which my two sisters now fulfill the role of aunts. The affection they show our nieces and nephews increases my appreciation of having an extended family.

Their feeling for younger family members younger extends beyond the generation immediately after themselves. My sisters also cherish grandnieces and grandnephews, the beginnings of yet another generation. It gladdens me to see how they reach out to these children and share with them some of our family traditions of love and support.

Yes, aunts count for something. That holds now as it did for me when growing up.

Richard Griffin

My old friend, whom I will call Sarah, has reached age 87. She, I have discovered, is more reliable at predicting the weather than are meteorologists. When we met one recent afternoon, the sky was perfectly blue and the day had become warm and spring-like. It looked for all the world as if the next day would be sunny also.

But no, Sarah told me that rain was on the way.  This she knew, not because of hearing a radio forecast or seeing one on television, but because her bones hurt so much. She knew from the pain in her legs that the next day would be rainy and cold.

When we encountered one another that afternoon, Sarah was walking to the bank. But she had no intention of walking the three blocks home after finishing her business. Her legs hurt too much for that and she would take the bus even for such a short ride.  

Sarah, like almost one-half of Americans over age 65, suffers from arthritis. So do many younger people. Almost twice as many of those with this chronic disease are women rather than men. For the population at large, this disease qualifies as “the nation’s leading cause of disability,” according to the Centers for Disease Control.

Strangely enough, Americans who have lower incomes and less education are more likely to have some form of arthritis. At least, this is what the authoritative National Academy on an Aging Society reports. This source provides no explanation for this phenomenon and I have not found an answer either.

According to this same source, more than twice as many people over age 70 with arthritis need help with the activities of daily living as do those who are free of the disease. They are also much more likely to have spent five or more days in bed in the course of a year.

The name “arthritis” is something of a catch-all term for more than 100 different conditions that affect the joints or muscles and other tissues. The two main types are 1) osteoarthritis, an ailment caused by the breakdown of the issue between joints and 2) rheumatoid arthritis that comes from swelling in the joints.

It may be of dubious benefit to pass on the National Academy’s statements about how arthritis sufferers look at life. According to surveys, the latter experience much less satisfaction with life and those over 70 feel pessimistic about their chances of living 10 or 15 more years.

These gloomy research results suggest the importance of managing arthritis better. And for that Marian Hannan, a researcher at Hebrew Rehabilitation Center for Aged’s Research and Training Institute has some tips to offer:

1. Exercise can help to increase joint range of motion, strength and flexibility.
2. Rest, along with relaxation techniques, stress reduction, and biofeedback may ease pain.
3. Weight control looking to reduce pressure on joints can make a difference in symptoms.
4. Acupuncture and other non-traditional remedies may prove important elements in treatment.

Dr. Hannan also advises shifting your focus away from disabilities to abilities and looking for support systems within your extended family, circles of friends, and others.

The editors of the Harvard Health Letter also offer advice based on both research and practice. They offer much valuable information and provide the following upbeat appraisal of what can be done for those who suffer from this disease, with special attention to prevention:

“Specialized exercises and lifestyle changes can help anyone with arthritis live a more active and pain-free life. In terms of prevention, no sure-fire program advice exists. But you and your physician can slow the progression with a timely diagnosis and by beginning treatment right away. You can improve your day-to-day life through a combination of sensible exercise and work routines, physical therapy, weight reduction, and by making some minor modifications in your home.”

The Harvard editors summarize their hopeful approach: “Millions of people live with arthritis. Medical research, new drugs, improvements in surgical treatment, and an active role in the control and treatment of your condition can help you be one of the growing number of arthritis patients who live well.”

As a person thus far spared the pains of arthritis, I do not speak with much authority on the subject. However, I do sympathize with Sarah and other friends who must cope with it all the time. This friend lives alone and it must be hard for her to deal with the pain and general discomfort. I like to think that she can rely on support from her family and friends.

Being able to predict tomorrow’s weather is a skill better acquired in a science course than through the pain in one’s bones. I hope Sarah and others like her find relief with the passing of a rainy April.

Richard Griffin

Ronald Reagan was not my favorite president, to say the least, but even I was touched by the letter that he wrote ten years ago. In that letter, addressed to the American people, he explained that he had Alzheimer’s disease and had decided to make the fact public.

He did so because good effects had already been produced when he had disclosed news of his own cancer surgeries and his wife Nancy’s breast cancer. Doing so had raised public awareness and moved others to arrange for testing.

Similarly he hoped to promote public awareness of Alzheimer’s and to increase understanding of this disease on the part of those individuals and families affected by it.

With characteristic optimism the former president then indicated his plans for the future – sharing his life with Nancy and other family members, enjoying  the outdoors, and staying in contact with friends and supporters.

However, he also acknowledged that Alzheimer’s would impose a heavy burden on his family. He especially regretted the effect it would have on his wife. “I only wish there was some way I could spare Nancy from this painful experience,” he wrote in his most moving sentence.

Toward the end of his letter Ronald Reagan indicated both a faith in God and great love for his country along with “eternal optimism for its future.”

The next ten years leading up to his death this month were largely hidden from the public. His wife shielded him from all but family members and their closest friends. Of course, she supervised his care, a program that in the latter stage included confinement to bed and around-the-clock nursing.

Patti Davis, the former president’s daughter, has written a brief article for Time Magazine in which she gives a few more details of her father’s life as of a few months before his death.

Most of the time he was asleep. By that stage, he no longer recognized anyone. To disguise this fact, says Davis, would be to do a disservice to the public. Seeing someone in this situation “rearranges your universe,” she writes, and “it strips away everything but the most important truth: that the soul is alive, even if the mind is faltering.”

The house was peopled largely by women then, the caregivers and Reagan’s wife and daughter. When his sons came to visit, their father seems to have become aware of their presence, but even that is uncertain.

Davis characterizes Alzheimer’s as a long series of “I-don’t-knows.” For her, the time after her father dies will bring many silences and some emptiness. But she believes that the most important things in which her father believed will remain – “echoes, whispers, all those things don’t vanish when a person dies.”

My own reflections on the experience begin with the fact that, as a former president, Ronald Reagan was assured good health care. Unlike so many other Americans, he did not have to worry about what would happen to him in the face of crippling disease. Would that Americans of all ages and conditions shared that security!

Another reflection is inspired by Nancy Reagan, who said, at one point “Ronnie’s long journey has taken him to a distant place.” These poignant words express well the experience of those who come to know the fading of a loved one as the disease progresses to its final stages.

Mrs. Reagan must have gone through what a religious sister who works with Alzheimer sufferers has described: “You want to sit and cry. You know where it’s going and there’s nothing you can do to stop it.”

But her experience has enabled her to become an advocate for research that will lead someday to a solution. She has pressed for more money devoted to this effort and has argued for the controversial use of stem cells from human embryos for this purpose.

However painful the Alzheimer’s diagnosis may have been, the letter bears witness to Ronald Reagan having been told the truth about his disease early on. His family did not yield to the temptation of shielding him from the facts. That speaks well for them in a situation of growing anguish.

The love with which members of the family treated Reagan is thoroughly admirable. I would add an old fashioned word to describe their devotion to him – reverence. Though they saw his growing deterioration in body and mind, they kept in focus that he remained a human person, deserving of respect and honor.

Both the letter from the father and the article written by the daughter give testimony to a spirituality that impresses me as an indispensable response to Alzheimer’s disease. Though I myself find Davis’s spirituality too vague for comfort, and I take issue with her father’s optimism, I feel glad that they could find some deeper meaning in the trial that the disease brought.

Richard Griffin

A 71 year-old man and his wife come to see an elder-law attorney. The client was recently diagnosed with Parkinson's disease.  As a result, he is retiring at the end of this year.  His wife is 13 years younger and still working. They have a house and modest savings.

Fortunately, he has a long-term care insurance policy, but it is limited to five years of coverage.  As of now, the husband needs no assistance.  He and his wife are considering selling their house and moving to a condominium more suited to him once the Parkinson’s becomes more disabling.

The attorney advises him to transfer the house and all of their savings (other than the husband's IRA) into his wife's name.  She will revise her estate plan, which currently gives everything to her husband, to leave their assets in trust for him in the event she dies first.  

The trust will be under her will, which is a safe harbor in the Medicaid rules.  He can qualify for Medicaid once his insurance runs out and be a beneficiary of the trust, but the trust funds would not have to be spent down. The lawyer also advises the clients to execute durable powers of attorney and health care proxies.

This slightly edited case study comes from Harry Margolis, one of the premier attorneys specializing in elder-law. Recently I visited his Copley Square offices in order to discover new developments in the practice of law on behalf of older people.

Margolis is one of some 5,000 attorneys across the United States who specialize in elder-law. Massachusetts alone has 600 of them.

Not every elder-law attorney can offer the view from Margolis’ office. As we talked about his work, I looked out on the beautiful cityscape below. Trinity Church, the Boston Public Library, the Sheraton Hotel, all shone in the afternoon sun, some of the scene mirrored in the soaring John Hancock Building.

The brief case study of the man with Parkinson’s and his much younger wife calls attention to the complexities of health-care planning. The advice given by this lawyer takes into special account an important change in federal law that took effect last year. As of 2006, it has become harder to qualify for Medicaid.

Previously, if you had children you were allowed to give them half of your assets and then spend down the other half by paying for care. Now, however, you can’t give anything away until five years after applying for Medicaid.

The effect of this law is to encourage people to give away their assets earlier. These days, Margolis encourages parents to give their children money well before the time when the older generation might need nursing home care. That, he observes, is contrary to the advice that he used to give

Nowadays he also frequently advises people to buy long-term care insurance. This he does with greater confidence than formerly, for two reasons. First, the policies are better than they used to be and, second, as noted, it is more difficult to qualify for Medicaid.

Fortunately for  planners, there is now a greater variety of ways to pay for care. For those with low incomes, the adult foster care program may prove a valuable resource. In one model, if you are eligible for Medicaid, you can move into someone’s house and the state will pay your caretaker.

In other instances, family members can be paid to take care of you. If an adult child, for instance, were to care for both parents, he or she would receive two levels of tax-free pay.

How best to benefit from home ownership is another area for legal counsel. Reverse mortgages, says Margolis, are sometimes appropriate. However, compared to some other possibilities, “it’s an expensive way to borrow money.”

Frequently, a home equity loan makes more sense. This lawyer judges it a good idea at least to open up a line of credit, even if you don’t actually draw on it.

One variety of the latter approach is a home equity loan that remains private, perhaps among family members. In this arrangement, an affluent grandson, for example, might lend the money. With careful documentation, this choice might prove beneficial for both parties.

A new instrument favored by Margolis is the family protection trust. Rather than giving money outright to your children, you put it in a trust for their benefit. This device can protect them from their creditors. It can also guard the money if they get divorced and, if the child dies, the funds stay in trust for the grandchildren rather than a spouse.

For those older people who worry about adult children or grandchildren with disabilities, family protection trusts can prove especially helpful.

If you seek more information about elder-law, I recommend the electronic newsletter that Harry Margolis sends out. One can sign up for it without charge at Margolis.com. You can also find a nation-wide list of elder-law lawyers by consulting NAELA.com.

Richard Griffin