Ch. 23. Suburbs Are Ripe For Change

HOPE: A Primer for Care Of Alzheimers and Other Dementias

I have been slow on blog posts being heavily involved in re-writing my book HOPE. I am nearing completion and publication. In the meantime I will be more than slow on posting. I will however post each Chapter or part as it becomes done.

What follows is Ch 22, as rewritten: 

23. Suburbs Are Ripe For Change

I have posted a three part document in my archive entitled: A proposal for local initiative in the suburbs to provide senior services. The WebSite Address of this post is:

http://ic-mike.blogspot.com/2011/05/proposal-for-local-initiative-to.html.

One of these articles appeared in the Minneapolis Star and Tribune entitled: Suburbs Are Showing Their Age. The second and third articles are comments posted by me on my Blog. They are entitled: A Bold but Sensible Proposal! Parts 1 and 2. Part 1 is found at the WebSite Address:

 http://im-mike.blogspot.com/2011/05/suburbs-are-ripe-for-change-part-1.html

and Part 2 at:

http://im-mike.blogspot.com/2011/05/suburbs-are-ripe-for-change-part-2.html

These comprise material on the first of a number of proposals. They propose acting at the local level, grass roots if you will, to rejuvenate service for treatment of AD and similar dementia.

This first article deals with the capability of local government to remedy many of the faults in the manner and form Care has taken. It deserves serious attention.

As you read be mindful of this: Local government is as broke as all other levels of government. In a perfect world it is in no position to take this remedial action on. The trouble observing this admonition is that every other level of government is in the same condition. If we choose not to act our economy cannot survive what is soon to come. The Silver Tsunami will engulf us killing all economies now in existence.

Local Government has the power and the authority to act. It can’t afford to do it, but, with the power it has, it can find ways of doing it that don’t drain their economies. We need to take the initiative out of Washington and Wall street.

We need to do this for two reasons.

1.    Washington is gridlocked; anything it does has to protect the vested interests or face gridlock.

2.    Washington’s decision making capability has been kidnapped by Money.

Corporations rule the day in Washington receiving more and more favorable legislation enhancing their ability to turn a profit. Parts of the profits are returned to the legislators voting in favor through the thriving lobby industry.

Together Corporations and Washington politicians have become a separate, self-actualizing segment of our society serving only itself.

WHAT TO DO?

Consider the following:

Part 1:

A municipal bond written on the security of the revenue coming from a public improvement in a municipality is readily negotiable on the bond market. What I describe is called a revenue bond. It is written by a unit of local Government and sold for money. It is a promissory note with oomph.

As a bond it makes a pledge by the maker of the bond to the holder of the bond, namely the person who owns the bond. It states it will repay the holder the amount of money paid for it at a specified time or in specified installments. It also promises to pay an amount as interest for the use of the sum paid to buy the bond, paid in installments or all at once at the time of repayment of the principal.

To assure the holder that this money will be paid the bond states and the maker promises it will commit the revenue from the improvement for which it is written to the principal repayments and the accrued interest before any other use is made of the funds coming in by reason of the improvement.

The revenue can come from anything, most often revenue from whatever improvement the bond was written for is pledged. Often earnings of the improvement are committed. These are written in smaller amounts so the everyday investor can buy one or more

What is called a tax increment bond can be written that will assure the additional real estate tax paid because of the improvement to the real estate. It pledges the additional tax will be paid in repayment of the bond by the unit of government receiving the increased payment of real estate tax.

There is any number of ways to fund.

The unit of government making the bond can also write a General Obligation Bond. This pledges payment of interest and retirement of the debt with all of the assets of the unit of government and the power of its taxing authority.

Most levels of local government and groups of government working together can do the same thing with bonding

The interest paid for these bonds are tax free as interest income to the holder unit federally and in the domicile state of the holder if they are issued in that state. This is of course subject to a variety of laws treating with it. The tax free part can make investment in such bonds quite favorable.

The foregoing was a major Urban Renewal tools used in the ‘60’s and ‘70’s.

That was a period in which the Federal Government enticed local government to create Housing and Urban Renewal Commissions and through them spend money to make money earmarked to renewing dilapidated real estate in their respective communities.

The pitch was to save downtowns, revitalize industrial and commercial areas, build what is now called Section 8 housing and many other projects of improvement. Some of the projects were quite successful, others questionably so.

In spite of the success of any one project the sum of all the projects created financial, construction and myriad other activities and jobs for the people in the locality of the improvements. This in turn gave the regional and national economy a needed infusion of economic growth.

This all occurred in those heady days of post new-deal politics which came to a screeching halt in 1980 with the ascendency of the conservatives in the government in our country.

It is the time now, 30 years later, we find ourselves looking for ways of doing some type of infusion into the economy of our country. We are seeing a start of it with the public improvement programs that are working their way out of Washington and into our communities.

The needs of a large segment of our people can generate actions to satisfy these needs. One such need is that of seniors for affordable services in the areas in which they live. They are living in the suburbs many having been the young families with children who moved there to raise their children. The young families and children have moved from the suburbs. The demography has changed many suburbs dramatically.  Their makeup is mostly older families.  

This change has resulted in population decline. Without the children less people are living in the suburbs. They are moving back to the core of the city where services are more conveniently accessed and they are not so alone.

For those who remain, who have not moved back to the core, mostly older people, there is so little convenience for them in decentralized shopping areas, lack of organized public transit, everything is distant and requires a car to get there. Many don’t drive.

Schools, recreational parks, ball parks, ice arenas and the many other facilities that have been built in these areas to serve the children are deteriorating having no use any longer.

Congregations in Churches and Synagogues are waning as are the use of many different facilities for active young adults. There is just too much infrastructure designed for younger people’s use and little of it amenable to the use by seniors.

 

Part 2:

  

As the populations of the suburbs are getting older they need different kinds of public service than are currently available to them.   

The infrastructure that was built to attract young families with children remains, as do the governments that designed and built it. With the needs of the community changed, having no use for the infrastructure in place, the government responsible for it is put at risk.

Because of this we will see these governments folding unless we act to shore them up. The infrastructure that was built by these governments will be left to dilapidate to that point that it all becomes blight and of no use to anyone.

At this time the atrophy of these areas is building but the corresponding dilapidation has not irreversibly occurred. The units of government remain in place with the power and authority to act to provide service for the population that makes them up. That population desperately needs the services that can be provided.

Just as we built schools and playgrounds, joined suburb and exurb to central cores in Cities throughout our country by the subterfuge of the Eisenhower years, namely its construction of the gargantuan Interstate Highway System, we must look again at these tools of the 50’s 60’s and 70’s and put them to work.

This is not an option for us. It is a critical necessity that we do this. We must use any number of ways to provide services and do it at an affordable cost. Washington will not and has not done it via its overwhelming support of the free market competition model that has been undertaken to fulfill that need disingenuously.

The free market approach has all but destroyed us as we lift our heads out of the foxholes of the strife of the last 30 years and see all the damage wrought in the name of free competition. Our economy is in a shambles.

Between the deficits left by the boundlessly free market, attributable in large measure by tax breaks for the uber rich, two wars and profligate spending on Homeland Security, not where it’s needed but every other where, the Federal Government has become paralyzed. It is paralyzed by the damage of this friendly fire it has sustained.

The shrill contrarians in Washington who through deficit spending created the beast we now face demand that we pay it the tribute it demands. “Bring the deficit down” they say. They offer no alternative. As a result this evident paralysis is occurring in Washington and throughout the states. This has complicated the fiscal integrity not only of the federal government but that of local government as well.

This is put into plain sight as we see local government losing the help of the feds. The federal government’s paralysis has become contagious. The funding of local government by the feds has been cut. It had been depended on by local government.

In turn the financial crash that accompanied the paralysis has caused further chaos. Cuts in the grants flowing from the federal to local government are occurring across the board. Loss of income to local government is accompanying this on all its fronts.

Local governments rely heavily on the income generated by their real estate tax authority. This tax is based on value of the real estate paying it. The real estate has lost its value.

The economy crash has further caused loss to local government by the downslide of the economy that pays the sales tax, the income tax and all other forms of support for local government. This is bankrupting many units of government from the states down to the villages and all units in between.

We need the heroic fortitude of those leaders who put in place all the bold fiscal initiatives of the ‘50’s, ‘60’s and ‘70’s. There is no other way. If we fail to act we will then atrophy and die as an economy.

We will die with no action because of the current catastrophe in the making. The so called “Silver Tsunami” is on us. There is no way we can afford the health care needed to answer the call of those needing help because of the exponentially burgeoning numbers of people with needs that is calamity of AD and similar dementia. There is no way the Federal Government can step in to help; it has its hands full just making it day to day.

The Silver Tsunami is the end product of the perfect storm that will come from the Baby Boomers entering their senior years and the high risk of getting AD and similar dementia by reason of their aging. The dearth of services to keep them out of institutional care together with the prohibitive cost of care should they go into institutional care is a paradox that will  financially doom us all. In turn government of the kind now existing will not have the wherewithal to step in and pick up the cost. It no longer has the economic resources to do it.

This predicament we are in will not go away. It needs our attention.

AD and similar dementia is but the canary in the coal mine, put there for early warning to the miners of toxic air. The air that kills the canary is toxic and will build up sufficiently to kill the miners unless they take notice of the canary.

We must turn to units of local governments throughout the suburb and exurbs that have the wherewithal to handle the problem. They are positioned by time and circumstance having it in their interest and need to survive to act to deal with the calamity coming. They need to shift gears and work as effectively as they did with their respective populations years ago when these populations were young.

There is no reason school districts can’t be changed to districts empowered to provide senior services. There is no reason all units of local government can’t be redesigned to do the same and add to that the building or renovation of existing vacant real estate to Care facilities for seniors particularly those impaired with AD and other like Dementias.

This can be done and needs to be done. Bonds with an attractive interest rate, more than the 1% to 2% available for fixed return income securities, will sell as quickly for care facilities as they did for schools. The money spent can generate money paid back by the improvements. If this is not done the canary will die as will the rest of us.

As it is today, at the high rates charged by the system of care, by the inability of the federal government to step in and pay it, after our personal payment has bankrupted us, we will all be homeless out in the street.

Ch, 22. Criteria and Recommendations for Change in the Care of Dementia

HOPE: A Primer for Care Of Alzheimers and Other Dementias

I have been slow on blog posts being heavily involved in re-writing my book HOPE. I am nearing completion and publication. In the meantime I will be more than slow on posting. I will however post each Chapter or part as it becomes done.

What follows is Ch 22, as rewritten: 

22. Criteria and Recommendations for Change in the Care of Dementia

In the preceding chapters I have been concentrating on the need for change in the way we provide care for Dementia. This was generally discussed in two previous chapters the first entitled: Ch. 19. It is Time for a Radical Paradigm Shift Seeking Economy in Care. The second entitled: Ch. 21. The New Moral Frontier: WE DO FOR ONE ANOTHER! 

These chapters discussed the reasons for changing. Now comes the hard part. This chapter is about “WhatToDo!”

I thought the simplest way to provide recommendations was to provide links for posts of articles and comments covering criteria and recommendations for change. I prepared the list and you will find it at the end of this chapter entitled: 

Previous Posts Relating To Criteria And Recommendations For Change In The Care Of Alzheimer’s Disease. 

My purpose is to avoid swamping you the reader with too much. I will be more than happy to edit and publish the material if there is a desire for it.

This list comprises posts I have made to my blog Dementia Endured which has the following WebSite address: http://im-mike.blogspot.com/ or my Archive My Alzheimer’s Archive of Articles and Memoranda which has the following WebSite address http://ic-mike.blogspot.com/

Each post in the list has its specific WebSite address within either the blog or the archive

I was floored by how much I had written. The volume of material makes it difficult for one with Dementia to cut through it all and give a lucid review. I will try nonetheless.

The issue left needing more specification and detail is finding Economy in Care.

What now exists is entirely insufficient. The Government, the Community, those of us affected by AD or similar dementia, when required to personally pay the cost, simply cannot do it.

We face an insurmountable wall that is impossible to get over, get under, or get through. Under the system as it is now it will be impossible to pay for the costs for the deluge of numbers of people needing assisted care. We simply do not have the resources.

If we try to pay for it, trying will fall short. It will break us all financially; it will break government; it will break community resources and it will break those of us affected by AD or similar dementia. This leaves all of us with no way to get care. It is truly a Lose/Lose proposition.

“WhereToGo-WhatToDo?”

We should look to Community resources now while we are not yet financially overwhelmed.

The first requirement needing attention is cost. Next is adequacy of service. Then source of service needs to be considered. The criteria for this is to do it at the lowest possible level, seeking the lowest denominator of cost, without sacrificing quality of care.

The country seems to be currently leaning towards more levels of home care rather than institutional care. This is a good the place to start.

The worst part of home care now is cost.

Compared to Nursing Home Care, costly in its own way, the equivalent Home Health Care is more costly. At current costs this makes Institutionalization the more economical choice.

There are many ways to find economy in Home Health Care. These choices can make Home Health Care an economical alternative to institutional care.

A first measure to consider is the use of volunteers and the encouragement of folks to volunteer.

When greater professional qualifications are needed we should devise ways of pooling resources. There are many ways to accomplish this.

The first of these is to form neighborhood groups acting together in retaining qualified people jointly and/or mutually to provide both service and management of the non-qualified providing service.

The neighborhood can be just that or it can be Apartment, Condo or Co-op buildings having a common geographical location.

Co-ops for Care can be formed. This can involve folks establishing the equivalent of assisted living facilities by each of them setting up residence adjacent to one another and then forming a service arm to provide services when needed and as needed by the members.

The attrition in these ventures always acts against their establishment. A neighborhood group or a coop established for this is complicated each time a person must leave for more intensive care or by reason of death.

To cover this eventuality the establishment of a supervising authority would be most helpful.

This would be an important undertaking for any Religious Group willing to provide a necessary community service or any Social Service or AD Support Group so willing. Such a group could track available resources, groups needing help and able to supply replacement or additional members for any group in need.

I have cherry picked some of the posts from my blog discussing ways and means of making necessary changes. Each post offers ideas and there are many ideas contained in the posts listed.

Again, I am not carrying them as text for fear of getting more redundant than I already am.

Posts Relating To Criteria And Recommendations For Change In The Care Of AD or similar dementia.

1. Elder Cohousing http://ic-mike.blogspot.com/2011/04/elder-cohousing.html

2. Boomers Redefine Retirement Living  http://ic-mike.blogspot.com/2011/04/bulletin-boomers-redefine-retirement.html

3. Broke Town, U.S.A. http://ic-mike.blogspot.com/2011/03/broke-town-usa.html

4. Researchers Conclude Nonprofit Hospices Care for Most Costly Patients http://ic-mike.blogspot.com/2011/02/researchers-conclude-nonprofit-hospices.html

5. Strains for Hispanic Caregivers  http://ic-mike.blogspot.com/2011/01/strains-for-hispanic-caregivers.html

6. COMMUNITY OF CARE http://ic-mike.blogspot.com/2011/01/community-of-care.html

7. New Lives for ‘Dead’ Suburban Malls http://ic-mike.blogspot.com/2011/01/new-lives-for-dead-suburban-malls.html

8. Wanted: A National Respite System  http://ic-mike.blogspot.com/2011/01/wanted-national-respite-system.html

9. Some Retirees Opting for Campus Life http://ic-mike.blogspot.com/2010/12/some-retirees-opting-for-campus-life.html

10. The Bright Side of C.C.R.C.’s (Continuing Care Retirement Communities)  http://ic-mike.blogspot.com/2010/12/bright-side-of-ccrcs.html

11. Where will seniors live?  http://ic-mike.blogspot.com/2010/12/where-will-seniors-live.html

13. Suburbs are showing their age pt 2  http://ic-mike.blogspot.com/2010/11/suburbs-are-showing-their-age.html

14. Suburbs are showing their age pt 1 http://im-mike.blogspot.com/2010/11/bold-but-sensible-proposal-part-1-of-2_17.html

15. Living Together, Aging Together pt 2 http://im-mike.blogspot.com/2010/11/bold-but-sensible-proposal-part-1-of-2.html

16.Living Together, Aging Together pt 1 http://ic-mike.blogspot.com/2010/09/living-together-aging-together.html

17. Coordinating Help for a Neighbor in Need

http://ic-mike.blogspot.com/2010/09/food-for-thought-then-some-more-thought.html

18. The Caregiver Next Door  http://ic-mike.blogspot.com/2010/08/caregiver-next-door.html 

19. Helping seniors stay at home  http://ic-mike.blogspot.com/2010/08/helping-seniors-stay-at-home_03.html 

20. A Fast Paced City Tries to Be a Gentler Place to Grow Old  http://ic-mike.blogspot.com/2010/07/fast-paced-city-tries-to-be-gentler.html

21. Can Community Involvement Prevent Memory Loss?   http://ic-mike.blogspot.com/2010/05/can-community-involvement-prevent.html

22. We Can Make a Difference   http://ic-mike.blogspot.com/2010/05/we-can-make-difference_20.html

23. Quality of Life IS Possible After a Diagnosis of Dementia   http://ic-mike.blogspot.com/2010/05/quality-of-life-is-possible-after_17.html

24. New Funding Proposed for Adult Day Centers   http://ic-mike.blogspot.com/2010/05/new-funding-proposed-for-adult-day_15.html

25. What a Big House You Have, Grandma

 http://ic-mike.blogspot.com/2009/12/what-big-house-you-have-grandma.html

Ch. 21. The New Moral Frontier: We Do For One Another!

HOPE: A Primer for Care Of Alzheimers and Other Dementias

I have been slow on blog posts being heavily involved in re-writing my book HOPE. I am nearing completion and publication. In the meantime I will be more than slow on posting. I will however post each Chapter or part as it becomes done.

What follows is Ch 21, as rewritten: 

21. The New Moral Frontier:

We Do For One Another! 

In Chapter 19. we discussed the proposition: It is Time for a Radical Paradigm Shift Seeking Economy in Care. This chapter is a continuation of my thoughts and premises about the direction the shift has to take.

We have experienced a slow but certain drift in our culture and economy to a polarization between those having the assets and those who have not. At one time there was more of a balance in our society. That led from the Great Depression, WWII, and the recovery that followed that war. There was a great deal of equalization in the ownership of assets; there were fewer “have nots.” Owning your home with a car in your garage coupled with disposable income with which to use the car and otherwise seek the good life became an achievable goal. There was more of this then a chicken in every pot which was the endeavor of Hoover before the great depression

Then it shifted again just like a pendulum. We went back to what was. We are there now. It is slowly becoming painfully obvious.

Those of us affected by AD and similar dementia face our future with significant difficulty because of this drift. Seen from our eyes we must deal with the following challenges:

·       The cost of care exceeds reason making it impossible for way too many of us when professional care becomes an absolute need and personal assets are not sufficient to absorb the cost. Too many of us are faced with paying this confiscatory cost until our estates are paid down to the poverty level. When we reach that poverty level we then will qualify for aid from the government.

·       This factor, complicated by runaway cost, is a new equalizer. It doesn’t equalize between the “have” and the “have nots;” it equalizes the middle class and the poverty class, reducing all of them to poverty class.

·      This equalization doesn’t touch the rich. Their assets are secure; their assets are able to absorb the cost and are made even more by the tax advantages accorded the rich.

·       If the cacophony issuing from Washington is to be believed all levels of Government are nearing insolvency.

·       We hear “pay down the deficit”, “starve the beast”, “cut-back” from the same politicians who gave us deregulation of the financial markets, who brought us War in Iraq, sans, conscription and tax increase to pay the fare. In 2000 one president stepped out of office leaving a surplus only to have that surplus turned into an alarming deficit in eight years. This deficit was then capped in 2008, the eighth year of the deficit, with the bust of the bubble of the false economy that came to be in the absence of deregulation.

·      This left the new administration in Washington faced with two wars to wind down and out of, the economy in the emergency room needing critical care and re-regulation of the de-regulation.

·       It is this same absurdity coupled with a tax cut for the uber rich, the decrease in local tax payment resulting from the economy stripped of its worth that has in turn de-funded all of the grant-in-aid and similar programs of federal support for the operation of local government. This leaves local government unable to do what the Federal Government won’t do and the local governments can’t as they are inching up to insolvency.

·       Medicaid is the federally funded program given the states to provide Health Care to that group it defines as below the poverty level of our society. This level is ownership of no more assets between a husband and wife than approximately $107,000, a homestead, one car and a few other not particularly significant assets.

·       Medicaid is subject to the local control of the states administering it. The current cut back cry is producing an almost unanimous trend of reduction of benefits in many states, some states severely doing so.

·       Between the cut back trend, the near insolvency of state and local government, and all the opposition to anything characterized as welfare, it is doubtful Medicaid will survive.

·       The space between the rock and a hard place is swiftly narrowing as it relates to help for the necessary care of Dementia. The entrepreneurial fever that has captured institutional care is pushing cost higher and higher to secure profit and capital gains. 

·       65% of Nursing Homes are owned by private for profit owners.

(http://www.instabriefs.com/healthcare-facilities/nursing-homes/nursing-homes-fast-facts.php)

They tend towards the Big Box style of operation the funding of which frontloads the development cost in a profligate sort of way.

We Need To Re-Invent This Wheel:

The re-invention needs to come from the bottom up. It needs this because there is no other source able to provide this. By bottom up I mean local, us, me and you, viz, the rest of us. It comes to us to help one another. 

Competing no longer works. After 500 years the “Survival of the Fittest” has changed to the “Survival of the Special.”

Ch. 20. The Brain's Amazing Potential for Recovery

HOPE: A Primer for Care Of Alzheimers and Other Dementias

I have been slow on blog posts being heavily involved in re-writing my book HOPE. I am nearing completion and publication. In the meantime I will be more than slow on posting. I will however post each Chapter or part as it becomes done.

What follows is Ch 20, as rewritten: 

20. The Brain's Amazing Potential for Recovery

On May 5, 2011, CNN carried an excellent analysis of the power of plasticity of the brain. It is worth the read. Entitled The brain's amazing potential for recovery It can be found in my Archive by googling the title to goto my Archive to read it.

It discusses US Congressman Gabriel Gifford’s amazing recovery from brain trauma caused by a gunshot wound to the brain; it discusses the plasticity of the brain making that recovery.

As a person with dementia I read it with particular interest. I was diagnosed 7 years ago with dementia while I was in the very Early Stage of the disease. I have benefited from my Early Diagnosis by asserting my brain’s plasticity. I firmly believe I have stemmed the slide of the intellectual deterioration that is part of the disease.

My interest in the article has to do with this: The article reports on the progress of Gabriel Gifford’s amazing recovery from a bullet shot into her brain. The article attributed much of the recovery to the innate plasticity of the brain. About it Dr. Sanjay Gupta, neurosurgeon and CNN chief medical correspondent said:

Her case shows off the brain's capability to restore some functions after substantial injury, a phenomenon called "plasticity" that is helped by rehabilitation.

It's still a relatively new concept… The brain was once thought to be completely immutable or not capable of change, after childhood.

If it is possible with traumatic brain injury as we already know it to be possible with stroke it seems it must also be possible with damage the result of vascular insufficiency and AD.

I have seen recovery of lost function in myself and in many others. Following the “Best Practices” is one of the ways it can be done. I am convinced that many of us have prolonged our stay in the Early Stage of AD by working the “Best Practices” hard!

This aphorism if followed is effective. The reason is in part the amazing plasticity of the brain. It works with AD and similar dementia as it does with stroke and with brain injury!

The collateral benefit of working your brain’s plasticity is the quality of life it produces. On diagnosis of AD we are stereotyped as that person standing in the corner drooling, captured by the two sides of the corner, unable to find our way out.

Particularly in the Early Stage we remain quite functional, come off normal, and suffer the indignity of the response “You can’t have it, you are just too normal!”

We have all heard this too often. It was Richard Taylor in his book Alzheimer’s From the Inside Out who said “If I got a dollar for every time I was told ‘you can’t have it…’  I would be a multi-millionaire.”

AD and similar dementia professionals have been slow in coming to the plate on prolonging the Early Stage. It is so important to the quality of life of all of us affected by AD and similar dementia, namely we who are impaired and our loved ones, particularly our Caretakers. It is equally important to us and everyone else because of the savings it causes in the Cost of Care. The longer we are functional the longer we can avoid the cost of institutionalization.

If Plasticity works with Traumatic Brain Injury and with Stroke Therapy, it works with AD and similar dementia too. The only difference is the need to keep our efforts ahead of our deterioration when working out of Dementia‘s portal.