Consider this scenario:  You’ve gotten a frantic phone call from your elderly parent who, returning from a 10-day cruise, broke her hip and is in a distant hospital room recovering from surgery.  Her nurse just warned her that her health care insurance coverage expires tomorrow, and wants to know where mom wants to be transferred.  You’re completely unprepared for this and panic sets in.  What do you do?

This is hypothetical, of course, but the fact is that more than 80 percent of us will be in a similar situation at some point.  A parent, spouse, sibling or child will experience a fall, stroke, heart attack or some other traumatic episode and after a short hospital stay to stabilize their condition, hospital personnel (and/or the insurance provider) tell you to “make other arrangements.”  Returning home is often not an option because the physician has concluded that the patient needs some level of care to perform basic life functions.  Consequently, a rehabilitative, transitional or perhaps permanent care facility must be found.  The placement depends on availability, cost, needed therapies and geographic location. 

“Help!”  Assistance is available from both paid and unpaid advisers but you need to prepare and implement an action plan almost immediately—despite the fact that you know little or nothing about the health care system.  Adding to the crisis may be the resistance or confusion of the patient who wants desperately to go home. 

Here’s help.  I’ve prepared a short checklist of items to help you make an informed decision.  Take a deep breath and do some research.  Most hospitals offer lists of qualified facilities and employ nurses or social workers to advise you.  These individuals often do not impose their preferences but they may know current availability and their list will give you a starting point. 

Search our housing directory for alternatives using the criteria suggested by the hospital staff.  Most of the care that is necessary immediately after a hospital stay involves specific therapies (e.g., speech, physical, cognitive) and time to heal, and their availability is essential to a positive outcome. 

·       Actively involve the patient in the decision.  Their greatest fear is likely a loss of control.  They may also view a long-term health facility as a death sentence even if the facility has “rehabilitative” or “transitional” in its name.  Involvement will result in less resistance and a more positive result.

·       Ask lots of questions of the physician, the nursing and other hospital staff.   Don’t forget to ask the patient questions, too.  You need to get objective answers about what is needed to achieve the most positive outcome.  Change is difficult both physically and emotionally.  Moving a person from one facility to another can be devastating.  But frequent moves may be the result of poor selections made with little or incorrect information. 

·       Transitional and rehabilitative facilities require that the patient has certain physical and cognitive ability levels upon admission; improvement in those areas is charted at frequent intervals.  One of our dear friends has undergone two moves since being stricken with a massive stroke, because she failed to make the necessary progress in her recovery. 

·       Search with your senses.  Nothing takes the place of physically visiting a facility in advance of placement.  What do you see when you visit?  Is it clean and bright? It need not be new.  Frequently—unfortunately--décor is substituted for care.  Are members the staff visibly engaged in caring for the residents?  What do you hear?  Silence for me is a red flag in some facilities.  It certainly depends on the type of facility but it sometimes signals the overuse of antipsychotic drugs to quiet the population.  What do you smell?  Is it urine?  Stale food?  It should smell like home.  

·       Ask about food choices and taste something from that day’s menu.  One of the serious problems that patients encounter is a loss of strength because they fail (or refuse) to eat.  The problem may be that the quality of the food doesn’t satisfy a patient who is a good cook or has a particular love for good food.

·       Be visible.  Visit often for the sake of the patient.  Your visits are important for the companionship and love that they provide, but they have another purpose.  Most facilities are understaffed.  Staff ratios of seven or eight patients to one care provider make it difficult for that care provider to give sufficient attention to any one patient.  But humans tend to perform better when they know they are being observed.  I have no proof to support this statement, but I have observed that staff communicates with those patients whose family and friends are frequently present.  One of our friends found that bringing a box of candy or a bouquet of flowers as a thank you gift to the staff a good idea.  We don’t say “thank you” enough and most of us respond positively when we are told we’ve done a good job. 

·       Be positive and encouraging.  Illness often results in depression.  Prolonged rehabilitation can be very discouraging when positive results are in short supply. 

·       Review our Toolkit chapter for additional tips and specific questions you might use when searching for facilities by phone or in person.  

Now that you have experienced how difficult a task this is perhaps you could take a moment to make a list of what you have learned and what your wishes would be should you find yourself in the same situation.

Posted by: Kathy Harmon on 10/5/2010 | 0 Comments

In response to the travel blog from southern Europe and the Sahara the Deters gave us last week,  I have received e-mails from other friends about their favorite travel destinations.  Marsha and I have known each other since we were 13.  She is a dear friend and a real travel buff.  Marsha and her husband, Paul, are fearless adventurers and, I suspect, enjoy the planning beforehand and the reminiscing upon their return as much as the trip itself.  Here she tells us about a walking, sailing, touring combination they put together for a trip through South America. 


My husband and I love to travel.  It is expensive and time is precious so we plan carefully.  We order travel company brochures, browse the travel section at the library and surf the web.  We travel as frequently as our schedules allow.  One of my favorite excursions was to Argentina and Chile. We wanted to go to Buenos Aires, see the Patagonian landscape, and travel by small boat around Cape Horn.  We decided to spend some time in Buenos Aires on our own and spent time with a tour group

We loved South America.  Buenos Aires is extremely European in its architecture with lovely buildings and wide streets.  The city is divided into distinctive areas.  One is San Telmo with a huge flea market and antique sale every Sunday.  We spent an entire day watching couples doing the tango, mimes, men on stilts, and browsed hundreds of small booths filled with crafts, antiques and eating great food cooked in tiny stalls.

Then we were off to Patagonia which is the southern part of Argentina and Chile.  The landscape is breathtaking.  We saw the Perito Merino glacier, which is so huge that it holds one third of the world’s fresh water supply!  We hiked through the Torres del Paine mountain area in Chile.  The climate in this area of Chile is notoriously variable and the views of the mountains change continually.  Sometimes they are draped in clouds, sometimes bathed in sun or you might find yourself suddenly bracing against huge gusts of wind.    

In Chile we boarded a small ship that accommodates 120 passengers which sailed us around Cape Horn.  The water around Cape Horn is the roughest in the world with hundreds of ships having gone down in last few hundred years.  I can only imagine what it was like to be the first seamen to successfully navigate around the cape.  We found it thrilling. The ship stopped at Tucker Island where we were greeted by penguins, sea elephants, dolphins, South American flamingos, condors and an amazing collections of unusual birds.  In the photo below our ship is on the left.  It is one of the tiny specs a few hundred feet from the shoreline.   With only 120 passengers our little ship was able to sail much closer to the gkacier and gave us some unbelievable photo opportunities. 

We found South America to be quite inexpensive.  We had a wonderful hotel room in central Buenos Aires that came with a buffet breakfast for $112.00 (US dollars) per night.  Restaurant food was reasonable.  A person could eat a full meal for $10.00 to $15.00 (US dollars).  Wine enthusiasts know that Argentina and Chile have developed some very good wines.  Local wines are excellent and reasonably priced between five and six dollars a bottle.  South America was everything we had hoped it would be – amazing scenery, intriguing wild life and great food.  For your next adventure we highly recommend it!

Marsha Theis


“Marsha Very Wearable Art”

A clothing line that is both whimsical and beautiful

Posted by: Kathy Harmon on 9/28/2010 | 0 Comments

I've known Bill and Grace Deters for more than 30 years.  They are good friends, business partners and avid travelers.  When I learned of their plans for an unusual September adventure. I asked Grace to keep a periodic  travel log to share with our readers.   Here are some excepts and photos that I thought you might enjoy:


"We began our trip in Seville, Spain with two guides and seven couples on eight motorcycles.  A minivan tags along carrying our gear and a spare motorcycle.   Our tiny caravan consists of three couples from Rio de Janeiro, one from Canada, two from Sedona, Arizona, plus Bill and me. 


Our incredibly handsome guide is a newlywed from Portugal named Nuno and our driver is Malcolm, an Argentinean raspberry farmer who supplements the family income leading motorcycle tours four times a year.  We are riding BMW 1200 G.S. motorcycles and I would describe the trip as majestic, enlightening and damned difficult. 


The first day we traveled 200 miles to Menzeh, averaging between 75-80 mph in 106- degree heat.  Even with frequent stops and a two-hour lunch, it was a very full day.  The second day it was 310 miles to Marrakech.  The temperature dropped into the mid-90’s as we crossed the Atlas Mountains but the roads were winding and the terrain challenging. 


We crossed from Spain to Tangier, Morocco by ferry.  What a delightful surprise.  Color was everywhere--from the women attired in long dresses with matching head scarves to the men and younger women in colorful shirts, blouses and jeans.  I had expected a more traditional society but we encountered only a few older men in long white gandoras.  The traffic in Marrakech is something else--lots of traffic circles and streets filled with cars, trucks, motorbikes, bicycles, even horse-driven carriages.  The children loved to signal us to rev our engines which resulted in explosions of giggles and waves.  After our ride through the mountains, I found myself wishing I was 15 years younger.  We were shot.  The group took in a bit of nightlife and Bill and I could barely stay awake.


Thank goodness, the next day was a free day.  We slept, exercised, had massages,

and in the evening went to the Djemaa el Fna market which is the busiest and largest market square in the world.  There were snake charmers, story tellers, musicians and vendors selling everything from fresh fruit to live chickens. 


The next morning we rode through the Atlas foothills and into the Sahara Desert.  It is still in the 90’s but today we got a bit of rain which we are told is most unusual.  We will remain in Eroud and will leave at noon to begin our sojourn in tents, riding camels and experiencing, what we are told, are amazing sunsets.


It’s Saturday, September 18th and our seventh day of riding.  We’ve switched to 4x4 Land Cruisers to travel from the desert roads over the sand dunes on the way to our tents.  Our guides tell us that a previous tour had a tough time over the lava rock and fought to stay upright in the sand.   The trip took only 90 minutes but it included some interesting stops.  One was to the village of the “Black People.” The village founders were African slaves brought here in the early 1900s.  They keep themselves separate from the Moroccans, they’ve intermarried and survive primarily by performing for tourists.  There were no women visible on the streets or in the performances.  All the music, dance and even the mint tea was served by the village men.


We also stopped about 30 miles from the Algerian border where Moroccan solders are quartered to insure that no Algerians slip across.   Sound familiar?


Our four-wheel Land Cruiser took us over sand dunes, gravel pits, dry lakes, and by 5:00 p.m. we had arrived at our desert bivouac—tents.  We immediately mounted camels for a trek among the sand dunes to the top of the erg, which are dunes 22 kilometers long (north to south) and five kilometers wide.  The tallest dune is about 500 feet high.  As sunset approached we dismounted at the base of one of the tallest dunes, climbed to the top and were served champagne while we sat and watched the sunset.  I cannot tell you how magnificent and surreal I found this experience.  Then it was back to camp on our camels. 


That night in camp we were served a traditional Moroccan dinner, and were entertained with music

and dancing performed by the “Black People” villagers as we sat around a campfire.  After we retired to our tents, at 10:30 the generator was turned off and everything went dark as pitch, the only light coming from the half moon in the sky above.  What struck me most was the absolute silence:  Not a sound was heard.  I had trouble falling asleep.  It was mystifying.  I found the lack of sound almost deafening.   But in the morning sound returned with a fury at 6:00 a.m., when our Moroccan camp boss started banging on pans, signaling it was time for us to get up.   (More updates as time and internet are available)"


Graceann Deters is the author of Divine Betrayal, available from Amazon in the products directory on our site. 


We are constantly told that exercise is good for virtually everything:  weight control, reduction or elimination of  symtoms of most illnesses, vigor, attitude, flexibility, stamina, sex drive, concentration and productivity.  We hear it, we read it so why don't we do it?  It's not because we are lazy.

Here are my excuses.  I grew up a well-fed child.  Chunky would be a gentle term for my size at age 12.  I didn't play sports.  Activities that make you sweat were never "fun".  In my house feeding you was an expression of love and everything came to the table drowning in butter.  Meals were hearty and our kitchen was always filled with a variety of desserts. 

I work 14-20 hour days.  I love it but it makes it easy to put exercise on a back burner.  Every morning I am greeted by stacks of messages, hundreds of e-mails, a full cell phone mailbox and appointment calendar.  Sound familiar? I am a graduate of every diet program known to mankind.  I've never hit the optimum weight number on the medical charts and tend to hover in the 20-30 lb over range.  I love to cook and relish feeding family and friends.  I have a weakness for dark chocolate and a really good vodka. BUT I'd love to be thinner and, although I dread the first few minutes of a vigorous walk, the endorphines are a delicious treat.

I'm a fairly typical "A" personality Boomer who regularly sets and exceeds goals, loves hard work and challenges.  So, what's my problem?  My history of diet programs tells me that food is my fall-back position for anything negative like stress, fatigue and  technical breakdowns and that food is an addiction that requires a "rehab" program and constant vigilance.  I get it but sometimes chocolate just makes me feel better.   So, if I could just balance my food intake with enough exercise to burn the calories I take in (and a few more) the problem would be solved. 

I few years ago, one of my husband's colleagues told me how he stays on track.  He set as his goal walking  to all of the state capitals. I'm pretty sure we are talking lower 48 here.     With a wrist pedometer, a baggy of stick pins he walks outside in good weather, at the gyn or on his home treadmil.  He shopped AAA and a store called Latitudes to find a good size US mapwhich now hangs on his off wall.    He then plotted distances between the capital cities using an old Atlas and started his journey.  At three to five miles a day it took  him nearly two months to walk to the capital of an adjorning state and exactly a year to reach the east coast from his home in the midwest.  Last I heard he was about a third of the way to his goal and considering adding Hawaii and Alaska.  An interesting thing happened along the way.   His goal became the journey not the weight loss.  He found that on the days when he was "almost there" he would pick up the pace and put in an extra mile or two. 

Today I came across another element that could make this program more attractive.  Internet mapping sites have begun to add visuals to directional maps that let the viewer see what they would encounter on a road trip along the plotted route.  S0, now you can  take a virtual tour.  With a computer screen in site you can plot your journey.  Or, place a reading rack on your treadmill, with an I-PAD or any device with internet access and off you go.  Here's the Kathy challenge.  I've always done better at weight loss when I had to weight in.  I'll get the map and plot the first year's journey today and would be delighted if  you would join me.  I'm fairly competitive so let's make it a race.  I'll clock our progress on the blog page every Friday.  I'll list all participants in order of distance traveled.   I doubt I'll  leave anyone in the dust but I will keep up, stay consistent and may reap those wonderful benefits that medical research promises.  Guilt has always been one of my top three motivators!
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  • In the years has been online, we’ve received hundreds of e-mails from visitors asking questions about legal documents, how to start retirement planning in their 50's, as well as advice on traveling with grandpa and the kids and making everyone happy.   We’ve also received personal stories of triumph and tragedy including the creative, often humorous ways people cope with stress, relationships, balancing career and family, 70 hour work weeks, job loss and the "agony and defeat" they encountered starting a new company.   In our newsletter, I periodically share stories about my glorious 86 year old mother and have named a collection after her.  This is YOUR SPACE.  Ask for advice.  Share stories.  I love your e-mails. It's simple.  Just click here!