Saturday, June 27, 2009

Paula Span takes up eldercare in "When the Time Comes"

Author: Paula Span:
Title: "When the Time Comes: Families with Aging Parents Share their Struggles and Solutions".
Publication: Boston: Springboard, 2009. ISBN 978-0-446-58113-4. 276 pages, hardcover.

Paula Span writes columns on eldercare for The Washington Post, two of which I have recently discussed on my retirement blog. In this book, she explores most of the major options for caregiving and eldercare, with personal life histories, many of them in the Jewish communities around New York and Boston, and with some general advice, in bold italics bullet-points at the end of each chapter.

She covers five major opportunities: aging in place or at home; moving in with relatives, going to assisted living, going in to a nursing home, and hospice. She does cover what government will reimburse, such as the principle that Medicaid mostly deals with nursing homes, and that Medicare generally does not pay for “custodial” care -- hence the spasmodic development of a long term care insurance industry. She also correctly describes hospice as not a “place” but a change in aims of care (with more support from Medicare, usually). She points out that assisted living communities accept residents within a certain range of capacities, and many often progress to nursing homes and hospice. She discusses the value of professional geriatric care management.

She does not discuss the idea that an adult child might move in with a parent if the frail parent is fortunate enough to have an ample home and be financially stable. Nancy Polikoff had discussed the sensitive idea that a childless (often gay and without partner) person might, among siblings, be expected to do this in some families, especially among available siblings (Sept. 2008 reviews).

She also, as far as I can see, doesn’t mention state filial responsibility laws, or poor laws, which mandate that adult children provide for indigent parents, including their eldercare or nursing home bills. 28 states have these laws, and they are more likely to try to enforce them in the current recessionary environment.

That brings me to the “moral” or “social values” questions, which she does take up in her Introduction. On p 19 she writes “No one could characterize a patient’s intensifying illness, or the response it demands from children, as a positive development.” Soon she discusses the phenomenon called “caregiver gain” as concomitant to caregiver burden. She quotes gerontologist Kenneth Doka as having written “the self-sacrifice that caregiving entails offers a deep sense of personal fulfillment. It demonstrates a persistent ability to transcend self—to sacrifice for another without regard to one’s own needs.” Indeed, depending on circumstances, caregivers often do neglect their own health and can become impoverished or dependent themselves on others because of the experience. The general tone of family (outside of just spousal, which had already involved making a "choice" to say "I do" in the distant past) caregiving is "step up" and "I'm elected" (or "selected"). Caregivers who do "sacrifice" may well believe that others (especially outside the family) indirectly benefit from their "sacrifice" and resent the fact that others who haven't "walked the same walk" don't see their own hidden dependencies on the potential sacrifices of others; this is the age old karma problem.

All of this needs to be understood in terms of demographic shift: in certain populations, there are fewer children (the Christian right speaks of “demographic winter”) and an aging population with people living longer because of medical advances. Although medicine also delays some disability, on balance many adults live many more years, perhaps half a generation, than they did even fifteen years ago with significant disability in terms of frailty or dementia.

At the same time, our culture has tended to become more individualistic, with less emphasis on the common family experience governed by the stable marriage of parents, which used to own the “power” to allocate “sacrifice”. We tend to “measure people” in terms of individual performance, a trend that really became accelerated in the workplace in the 1980s until Congress had to act and recognize the need (and benefit) to allow for disability and family responsibility (and many will argue that we don’t do nearly enough with family leave, compared to European countries). An individualistic, global culture doesn't like to admit values that "encourage" individual decline, even if any integrated community knows that this must happen as part of a natural process where people share sacrifices over time. We tend to think of family responsibility as created by the choice to have sexual intercourse and procreate. Indeed, most adults will face family responsibility that they did not choose, and it’s appropriate to develop a sense of “right and wrong” and of expectations.

Span covers the wide range of strategies available for caregiving, but demographics and various social and political circumstances can only portend for a shortage of hired caregivers in the future. Some homes, she says, become almost like intensive care wards, with family members performing intimate tasks previously thought unthinkable. She notes, by the way, that there can be advantages, as well as risks, to hiring home aides directly and dealing with employer paperwork (EIN’s, green cards, and the like) oneself comparing to going through agencies, which charge more but which generally handle the legal risks. She notes that daughters do about 70% of the hands-on family caregiving, but that may be “just” because women tend to live longer and use (“consume”) caregiving services longer. But without managing the ability to hire others, the caregiver would be forced to redefine the whole intention or his or her own life, beyond what a “libertarian” society considers in a society based on “consent.” Pan notes one particular client who, at 96, said “I hate you. You’re no longer my son. Who ever heard of a child not taking care of his parents?” But that need has increased astronomically in the past two decades, and may have ambushed a whole generation grown accustomed to individualism and “meritocracy,” based on “choice” and “consequentialism”. We do need a “caregiver’s bill or rights” and “bill of responsibilities” both: we need new “rules of engagement.” The eldercare crisis, which still escapes the mouths or most politicians, will fit into debate on "generativity," and how we develop sustainable communities in the future.

Friday, June 26, 2009

Chris Anderson's "Free" raises some integrity issues with reviewers

I generally don’t write reviews of books I haven’t bought and read, but I have to note the furor of Wired editor Chris Anderson’s “Free: The Future of a Radical Price,” due July 7 from Hyperion (ISBN 1401322905). The Virginia Quarterly Review has a blog article by Waldo Jaquith “Chris Anderson’s ‘Free’ contains apparent plagiarism” here. shows a passage about “usury” that would appear to be a close paraphrase from definition in Wikipedia. The link is here. That observation raises another question: Should Wikipedia be used as a source for “establishment” published works? Many areas of academia don’t accept it, even for high school term papers.

Of course, the topic of the book is timely, in these days that music businesses, film companies, newspapers and traditional publishing are having to reinvent themselves to deal with "competition" from amateur free content on the Internet, from hyper-efficiency, and, in another direction, piracy. This was a big issue at the Digital Media Conference in northern Virginia June 25, which I reviewed yesterday on my main blog.

Update: Aug. 2

Fareed Zakaria (CNN/GPS) gives a link to a "free" audiocopy of the book here.

Sunday, June 21, 2009

New York textbook "word factory" leaves freelance writers in the red

The “About New York” column by Jim Dwyer in the New York Times, Sunday, June 21, 2009, p. 26, has a most disturbing story about the way freelance writers and book contributors get paid (or don’t get paid), “A Factory of Words in a Sea of Debt,” with the link here. The company at interest is Inkwell Publishing Solutions, which hired freelance writers, editors and illustrators to put together the components of textbooks. And some writers have not been paid, and some face severe financial hardship themselves. Inkwell works with Houghton Mifflin Harcourt.

The Inkwell story certainly sounds like its 180 degrees from the world of self-publishing and blogging for recognition and political discourse. But this is the real world where writers and authors make a living.

Curiously, the Inkwell contact page lists the National Writers Union as a resource. I wonder what NWU would say about this.

Friday, June 19, 2009

Fareed Zakaria: The Post American World (review)

Author: Fareed Zakaria.
Title: The Post-American World.
Publication: New York: Norton, 2009. ISBN 978-0-393-33480-7. Paper, 288 pages, revised from 2008, seven chapters, new Preface (first appeared in hardcover in 2008).

Fareed Zakaria is the host of a Sunday CNN program “Global Public Square” or GPS, and last Sunday he half-apologized for his own ego or vanity and recommended his own book, here, as a Father’s Day present. But I don’t know that international politics and economics is more dad-stuff than mommy-stuff today.

Zakaria’s thesis is somewhat optimistic: it’s not that America is in decline, it’s that it must change, and that the rest of the world is coming into its own. As in the PBS documentary “Guns, Germs and Steel” explaining why European civilization was dominant for half a millennium, Zakaria explains the historical and geographical circumstances that led to American dominance – and his explanations are bit from the conservative side (admitting that Chinese myopia really “worked” for a few hundred years), even if generally he writes and talks like a moderate-to-liberal Democrat, somewhere between Clinton and Obama. He draws and interesting distinction between totalitarianism and authoritarianism, the latter of which is on the famous Nolan Chart (“the World’s Smallest Political Quiz”). It’s possible for a country like China to maintain a somewhat benevolent, paternalistic authoritarianism and compete like capitalists – much as Ted Koppel showed in his documentary series for the Discovery Channel in 2008. And it’s possible that neo-regulation may really be necessary for America to maintain competitiveness. Zakaria puts the failure of the auto industry on the way the American health insurance system works – I think it’s more than that.

Zakaria provides some discussion of the “empty cradle” problem – that white populations in Europe and, to a lesser extent the United States, don’t replace themselves, partly because we have made it so difficult to carry out the responsibilities of parenthood in a hyper-individualistic society – a value system that can split open under the pressures of an aging population as well as international politics. But the United States has some advantages over Europe and certainly other societies in its ability to assimilate immigrant populations. The US economy is still the most flexible; it is the political system, once the envy of the world with its separation of powers and federalism – that seems to be locking up like a transmission that’s never had a fluid change.

Monday, June 15, 2009

New booklet on "The Science of Sexual Orientation" available from LCR; remember Chandler Burr's "A Separate Creation"

On Sunday, June 14, at Capital Pride in Washington DC, the Log Cabin Republicans were handing out a 24-page booklet “Is it a Choice? The Science of Sexual Orientation”, authored by the Liberty Education Forum. It appears that the LEF is actually part of LCR, and you can read the booklet free online here.

The paper is balanced as to the science, and there is a lot of discussion of brain structure (the INAH3), the work of LeVay, and the work with the Xq28 and other similar areas of the human genome. There is also discussion of birth order: it seems that younger brothers are more likely to be gay, suggesting uterine influences, and a number of subtle biological traits like smell and even finger length. I’ve personally seen somewhere a claim that gay men are slightly taller on average than men as a whole (I’ve noticed that on any gay disco floor there are always a couple of “very tall” men but I don’t know if this is statistically average or not.). But, there is no reasonable way to tell from “appearance” a man’s sexual orientation. There is no reliable connection to body build, strength, or other obvious factors.

There seem to be some subtle differences in the way gay vs. straight men process emotion relative to cognition. All human learning and behavior involve these two components (we really learn this from studies in aging). Gay men may actually have superior cognitive skills in some areas but these may interfere with the usual interest in responding to emotions related to procreation.

One of the most interesting observations comes from a study in Italy that explains why genetically-related homosexuality (in men) could persist even though it would seem to discourage reproduction. That is, the genetic trait in females tends to make them more fertile, and more receptive emotionally to men, and leads to females having more children. In a given population, it is desirable for women to have more children, whereas, from a biological viewpoint, it may not be as essential that all men pass on their genes (as many men will seek multiple partners anyway); so a “gay gene” could actually result in a net increase in a tribe’s population growth. (Along these lines, imagine the passionate character Sami in the soap "Days of our Lives" as a gay man instead!)

As for the moral implications, we are left with ethics and philosophy, but not science as such. Some people believe that all persons have a basic obligation to society to contribute to generativity or reproduction, regardless of genes.

The book refers the work of Chandler Burr, and I have read his monumental book “A Separate Creation”, published in 1996 by Hyperion (a Disney subsidiary), causing controversy then that led to calls for Disney boycotts from the religious right (but so did “gay days” at Disney parks). The original hardcover ran 288 pages and carried the ISBN ISBN: 0786860812. The book was written as a narrative, where Chandler Burr described his own adventures and road trips around the world (particularly the California coast) in investigating a scientific mystery. Burr had written “Homosexuality and Biology” in the Atlantic in 1993 about the time of the 1993 March on Washington, during the first Clinton term. The book would lend itself to an indie-film documentary.

The Liberty Forum had published an earlier paper in 2005, “The Only Question that Matters: Do People Change Their Sexual Orientation?”

A related post from April 2007 on my LGBT blog about an evangelical claim that it would be acceptable to treat the unborn in utero to prevent homosexual orientation, an idea that would offend mainstream western sensibilities, I hope. I thought we weren’t supposed to manipulate “nature” with some sort of “Brave New World” use of technology.

Sunday, June 14, 2009

Michael Lewis: "Home Game: An Accidental Guide to Fatherhood" (review)

Author: Michael Lewis:
Title: "Home Game: An Accidental Guide to Fatherhood".
Publication: New York: Norton, 2009. ISBN 978-0-593-06901-5. 188 pages, hardcover. Amazon link.

The author provides some insight into the experience of a heterosexual male intellectual nerd (and writer, that is) experiencing fatherhood, and dealing with all the psychological double standards. The book is in three parts, named after his three kids – Quinn, Dixie and Walker – with lots of whimsical anecdotes, the funniest of which may occur toward the end when he “takes one for the team” and has his tubes tied. His vasectomy sounds like a sacrifice that calls to mind Troy McClain’s gambit in Donald Trump’s “Apprentice.”

He notes that the emotional mores of fatherhood seem to be defined for men by women. It sounds like the old “women tame men” argument of George Will and George Gilder. (His exact word is that the American male got “fleeced”). He feels disinterest, a sense of burden at a new baby, which turns into love quickly as he realizes he is not a monster. (He also says that all kids look at grownups as monsters.) The demands of baby rearing (remember NBC’s “The Baby Borrowers”) become so great that he and his wife live “separately” in the house dividing responsibilities. Gradually, he comes to appreciate the awesome power that comes from being the head of family (and from the sexual intercourse that it countenances) when his son is born, the third child, and he says that he has to inform the two other kids about their “partial disinheritance.” Committed parents tell kids whom they must love and share their substance with – and sometimes that power continues to exercise upon adults. The power comes with trials, as he almost loses his son to a virus called RSV and spends agonizing days in the hospital.

There is an episode where he loses a major manuscript to theft – and one wonders why, as a savvy writer, he didn’t have the manuscript backed up. Why was the manuscript a target for theft?

Marriage and family for him become transformative. Not all of us want to go through that emotional remapping. But in the end he gains himself again.

Thursday, June 04, 2009

Donald J. Trump: "Think Like a Champion": Trump's own "literature anthology" of his own essays

Back in 2004, “The Donald” (that is, Donald J. Trump, in case anyone out there never saw “The Apprentice”) gave us the arrogant paperback “How to Get Rich”, and this time he offers an anthology of his short essays, “Think Like a Champion: An Informal Education in Business and Life”. The book has a foreword by Robert Kiyosaki, and was co-written by Meredith McIver. The publisher is Vanguard, with ISBN 978-1-59315-530-8, hardcover, 198 pages, indexed, with fifty essays.

No essay is more than three pages, and since they start on odd pages, there are many blank back pages.

Everything in the essays is high-level, and seems written with the tone of a 1980s motivational tape (I knew someone who was flown down “to Waco” to be considered as a salesman for these back then). Some people like these.

And the tone for every single one of them is upbeat. One has to follow his own personal calling in life. I buy that, except that sometimes externals and even calls for sacrifice can get in the way, for real people.

One of the early essays is called “Innovation”, and Trump certainly agrees that sometimes a single person’s idea can take off spectacularly (look at Facebook).

He does talk with some candor about the 2008 Financial Collapse, which he calls the Shock Market. He calls Bernard Madoff a sleaze bag and says that Madoff provides a lesson that everyone (including smart people) must do their due diligence. He speaks out for financial literacy, and seems to take the position that people should educate themselves rather than depend on financial planners and “experts” who call them for business. He says that it is important to organize one's own access to knowledge (I suspect he likes Wikipedia) and yet it's not cool to become a "know-it-all" (he mentions that at least twice). One has to be flexible and ready to learn and sometimes change mindset or mentality.

He does have a chapter “How to Get Rich” and this time he doesn’t mention, as he did in the 2004 book, that Apprentice candidate Troy McClain let his legs get waxed “for the good of the team” on a “Negotiation” assignment.

Another chapter is called “It’s Not Personal – It’s Business” when the boss says, “You’re Fired.” I recall a particular Apprentice episode where he fired “Bradford” for thumbing his nose at the “exemption from firing next week” rule, which he called “stupid” and “life-threatening” and something that could take a company down the tubes.

He has a chapter called “Reputation” which he talks about in terms of corporate brand. He doesn’t get into the subject of online reputation, which I would have loved to see him discuss; what are the policies in his own companies?

“Trump University” has an interesting blog, here.

Tuesday, June 02, 2009

Amazon's Kindle will have some stiff competition

Motoko Rich reports in the Business Day portion of The New York Times, p B1, that Google will compete with Amazon and others by offering e-books. It will let the publishers set the prices, rather than trying to set up a standard “Kindle” price. The new product will be separate from Google’s recent settlement over its Book Project, and its recent effort to make 1.5 million public domain works available on mobile phones. The new e-books will be readable on any appropriate device connected to the Internet, instead of the Kindle or some comparable reader like Barnes and Nobles’s a few years ago. The link for the story is this.