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My family has been going through a difficult time lately.
My parents are both 65. His parents are in their late 80s, both still alive, but in rapidly declining health, and I think it's pretty likely that one, maybe both, won't make it through the summer. My mom's mother is doing fairly well for late 80s, but is clearly needing more assistance.
The last couple of years or so have been difficult with his parents. His mother had obvious dementia symptoms, but wasn't treated properly. His dad has been combative to the point of violence with family and healthcare staff, and had probably beaten his mom before she was moved into an assisted living facility late last summer. His dad has some level of cognitive impairment now, but it's hard to tell considering how combative he is.
The last six months or so have been absolute hell with a whirlwind of hospital stays, doctor's visits, working with attorneys, trying to find appropriate care facilities, dealing with his dad when he's raising hell, and careening from crisis to crisis.
My parents (and none of their parents or siblings, with the exception of one brother who is splitting time between and The Philippines) have lived outside of this area in decades, at least. They don't like change. They've lived in the same house for twenty-five years. It might have made sense when they bought the house, but it no longer does.
Both have been talking about moving recently. They've never really brought it up before during my previous moves.
Here are some things that have come up recently.
1) The area's healthcare system is awful. The area's flagship hospital was rated 1/5 stars by the Centers for Medicare and Medicaid.
Mom has autoimmune issues, and some issues with her hip that are limiting her mobility. The autoimmune issues are having to be treated in Knoxville due to a lack of specialists here. She has been cycling through ineffective treatments here for months. She's now going to a dedicated hip specialist in Knoxville for a consult in a couple of weeks. That specialist did a great job for my girlfriend's aunt.
His mom had a stroke at her nursing home a few weeks ago, and was sent to the main hospital in the town my mom and dad live in. No stroke code was called, and she sat in the ER on a gurney for hours. I used to work for this hospital system, and implemented the communication system used to page out medical codes and alerts at that particular hospital.
I did some calling around, and it turned out that no stroke code was sent because the hospital no longer has a team to handle stroke codes. There were several other specialities (neurology, urology) that are no longer supported at that hospital. Orthopedic treatment is also being discontinued. The trauma center was downgraded from level 1 to level 3. His dad has cardiac issues that have been referred to the flagship hospital because the hospital can no longer treatment them (this hospital used to be a "cardiac center of excellence").
I don't know if her getting treatment sooner would have made much of a difference in outcomes, due to her age and underlying medical issues, but she is now pretty much paralyzed on one side of her body. Between the profound dementia and stroke, she has absolutely no quality of life now.
This is a city of 55,000, not a tiny town. Any serious health issue is being referred to the 1/5 flagship hospital about forty minutes from them. Because the other area hospitals are basically triage centers and glorified urgent cares, this one hospital is having to treat basically anything serious for a geographic area about the size of New Jersey, with about 700,000 people in its service area, and they have a severe staffing shortage. Needless to say, you're not going to get effective treatment here.
My ex-girlfriend, who had extensive health issues and passed away last year, was always being sent from northeast TN to Vanderbilt in Nashville for pretty much anything.
They're both shocked at how badly his parents have been treated. I guess prior to all the issues with his parents, none of this was "real" to them. It was just me complaining from the perspective of an employee with a bird's eye view of the system due to my job.
2) Lack of/bad services. Mom is constantly complaining about the lack of anything in the area. They're fifteen to twenty minutes from a grocery store or Walmart. There's a McDonald's, one small pizza place, a diner, and a Dollar General in the area, but nothing else.
She's wanting to try Walmart+, but they won't deliver that far out. The power in that neighborhood seems to go out at least once a week - a minor storm can come through, and they'll be in the dark for the better part of a day.
The city they live closest to has lost a lot of retail and restaurants over the past five years or so. Anything more than Walmart, Target, and the regional grocer is a drive out of town.
3) Too much house. They have a very big yard on a steep hill - it's difficult for him to keep up - he's still working 30-35 hours a week on top of dealing with everything with his parents.
They really do not use the basement. She is having difficulty getting up and down the stairs. There's no way she could stay there if something happened to him.
4) Politics. They are Democrats. This area is 80%+ Republican, and is getting more extreme politically with each election cycle.
5) Family. He's not that close to three of his four siblings. The one brother he is fairly close to is overseas for at least half the year anymore. Once his parents die, he's been talking about wanting to move.
My mom's sister has been doing pretty much all the caregiving for her mom. I'm disappointed in how mom hasn't been there for her mom, but I don't think that's going to be a barrier to leaving.
Both mom and dad have been talking about leaving after his parents die for a few months now. They need to get out of the house they are in anyway. The healthcare system here is basically a death sentence if you have an emergency.
I'm probably leaving the area by the end of next summer as it is - almost certainly to upstate SC or western NC. They'll probably end up relatively close to where I do.
Did you realize the area you lived in for years wasn't viable as you age? What factors led you to that decision?
Location: East of Seattle since 1992, 615' Elevation, Zone 8b - originally from SF Bay Area
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At 70 and 71 we will be selling and moving in the next year, after 30 years in this house. We have outstanding healthcare, (have used it much in the last couple of years) and anything we need within about 6 miles in either direction. The problem for us is that the property tax is now at $12,000/year, insurance $2,300, and the house requires a lot of maintenance with 3,000 sf. Family is scattered about in other cities at 23 miles, 56 miles, 61 miles, and another state. Downsizing to a less expensive and less urban area will put us closer to some, further from others, and probably less local major health care facilities.
We knew what our have to and want to was, contacted several real estate agents by phone and disclosed that the one we put an offer in with we will sign with. Two weeks later we spent about six ours looking at 12 properties and signed on one which had a for sale sign in the yard. Smack across the street of one on our list so the agent got the signature.
Criteria: 15 minutes and two routes for SO to work, 30 minutes to an airport, enough shopping within 15 minutes to survive, medical of the finest, square footage, small yard, new house, no steps, wheel chair accessible, big garage not facing the street, top building materials/tech, extreme low maintenance, toothless HOA, including pre-move upgrades within funds of sale of previous house.
Master batch will undergo a tear out when we get to it within the next 2-3 years.
It may be time for you to start putting feelers out.
Did you realize the area you lived in for years wasn't viable as you age? What factors led you to that decision?
That's the thing, though. For us, it is viable.
Silicon Valley has excellent healthcare, particularly Stanford and UCSF. I'm spending the entire year at our place a few miles from Stanford so I can get the treatments and care I need...even if I feel like a test subject from time to time.
I'm sure opinions will vary but I've had mostly unfortunate experiences with clinics and hospitals in the Phoenix/Scottsdale area.
Honestly, I don't know how many people actually take the time to think about what kind of care they'll get 25 or 40 years from now. I think most people have more immediate concerns.
A city of 55,000 will still suffer from "small town doctor syndrome." It is an issue across the nation, particularly in rural counties. There are counties in the USA that do not have a single medical doctor, period, let alone an MD/PhD who is on the cutting edge of science.
Competent medical care, including higher quality specialists, is mostly going to be found in larger metropolitan areas with research universities. There are exceptions to the rule, of course. At the same time, in larger metropolitan areas such as San Francisco Bay Area, you'll find higher quality physicians, but my personal experience is less-than-average quality people in many of the other health care occupations such as nursing, PT, OT, RT, X-Ray techs and the like. Some of the issue is explained by the high cost of living: a physician can afford to live in good neighborhoods within commute distance of Stanford and UCSF, but RNs and other health care professionals farther down the pay scale struggle.
Said differently, if your hope is to support yourself and perhaps a child or two on an RN's compensation, your paycheck will go much farther if you live in smaller communities with a lower cost of living.
For certain things, a trip to a place such as the Mayo Clinic in Rochester, MN is definitely worthwhile to devise an appropriate treatment plan. The issue is paying for the travel, which of course Medicare or traditional health insurance does not cover.
Quote:
Originally Posted by Serious Conversation
Did you realize the area you lived in for years wasn't viable as you age? What factors led you to that decision?
In many places across the country, the joke is, "Where do I go for the best health care?" to which the answer is "The Airport." You need to be prepared to travel to get high quality health care.
The issue will get worse in the coming years as a result of the new Alzheimer's drugs coming on the market. The treatment protocol involves supervision of a Neurologist, and there are nowhere near enough neurologists to satisfy the demand, and there is no plan to generate more neurologists let alone MD/PhD neurologists. Indeed, part of the treatment protocol involves a PET scan, as I understand it, and there are many counties across the nation that do not have a single PET scanner and they are priced at over $1 Million each... then there is the training of staff... (Time to invest in companies that manufacture PET scanners?)
At the end of the day, more advanced health care will only be available in places near research universities.
***
Over the past 3 months, I know multiple people who have gone to NYC to the Hospital for Special Surgery https://www.hss.edu/index.htm for specific orthopedic surgery, and a few who have gone to the Mayo Clinic and the Cleveland Clinic for heart and kidney care.
Last edited by moguldreamer; 05-12-2023 at 11:46 AM..
Silicon Valley has excellent healthcare, particularly Stanford and UCSF. I'm spending the entire year at our place a few miles from Stanford so I can get the treatments and care I need...even if I feel like a test subject from time to time.
I'm sure opinions will vary but I've had mostly unfortunate experiences with clinics and hospitals in the Phoenix/Scottsdale area.
Honestly, I don't know how many people actually take the time to think about what kind of care they'll get 25 or 40 years from now. I think most people have more immediate concerns.
I never understood why they got the house they did.
Ostensibly it was to keep me in the same school district, but it wasn't like that school was that great. The city schools are better. It wouldn't have really mattered where I graduated from.
They were 40 when they bought it. It might have made sense then, but 65 with ailing parents and a near full-time job is way different than 40.
It is quite remarkable that OP's grandparents are still alive (3 of 4?) in that environment so his own parents might live into old age as well. Moving means uprooting people from friends and associates and what is familiar and accepted and facing new learning curves, finding new friends, new doctors, a new church, new shopping and banking arrangements, selling or buying/renting property, deciding what to keep or throw away. It is a big task and inertia is the main reason that people who need to move don't relocate.
I did my move at 65 and ten years later I still have a bit of a learning curve to master but I never looked back. I found the best doctor I ever had after I moved -- but he retires this month, so I'll have to adjust to a new one. I never found the church that was an exact replica of the one I liked and attended for 30+ years so there is another adjustment. We have to adjust to different things. If OP's parents are not able to cope with the changes and adjustments, moving might not be the best plan.
I've been fortunate to live 10 years+ after college in different cities--Memphis, Nashville, Atlanta and now North Alabama. Thankfully all of these were low cost of living places and we were able to live in large homes in nice communities.
We see that healthcare and the general society is an important factor in finding a great place to live in retirement. The home we moved to 2 years ago is too large for 2 people, but when you're used to lots of room it's hard to go down much.
My wife has had 9 operations in the last 4 years, and had as bad of a back operation as was possible 7/2022. She's been under pain management for 22 years, and continues to suffer with leg pains and an inability to walk very far. We have learned to live given her limitations, and continue to travel internationally.
But when a community starts a nosedive in society and in basic needs like healthcare, changes can be warranted. I'm sorry that's what's been happening to you. Time has a way of taking care of one's needs--with aging parents, etc.
A city of 55,000 will still suffer from "small town doctor syndrome." It is an issue across the nation, particularly in rural counties. Certain counties in the USA do not have a single medical doctor, period, let alone an MD/PhD who is on the cutting edge of science.
Competent medical care, including higher quality specialists, is mostly going to be found in larger metropolitan areas with research universities. There are exceptions to the rule, of course. At the same time, in larger metropolitan areas such as San Francisco Bay Area, you'll find higher quality physicians, but my personal experience is less-than-average quality people in many of the other health care occupations such as nursing, PT, OT, RT, X-Ray techs and the like. Some of the issue is explained by the high cost of living: a physician can afford to live in good neighborhoods within commute distance of Stanford and UCSF, but RNs and other health care professionals farther down the pay scale struggle.
Said differently, if your hope is to support yourself and perhaps a child or two on an RN's compensation, your paycheck will go much farther if you live in smaller communities with a lower cost of living.
For certain things, a trip to a place such as the Mayo Clinic in Rochester, MN is definitely worthwhile to devise an appropriate treatment plan. The issue is paying for the travel, which of course Medicare or traditional health insurance does not cover.
In many places across the country, the joke is, "Where do I go for the best health care?" to which the answer is "The Airport." You need to be prepared to travel to get high quality health care.
The issue will get worse in the coming years as a result of the new Alzheimer's drugs coming on the market. The treatment protocol involves supervision of a Neurologist, and there are nowhere near enough neurologists to satisfy the demand, and there is no plan to generate more neurologists let alone MD/PhD neurologists. Indeed, part of the treatment protocol involves a PET scan, as I understand it, and there are many counties across the nation that do not have a single PET scanner and they are priced at over $1 Million each... then there is the training of staff... (Time to invest in companies that manufacture PET scanners?)
At the end of the day, more advanced health care will only be available in places near research universities.
The local hospital system has gotten an extremely bad reputation. Two regional systems merged to form what is effective a state-sponsored medical monopoly. It's almost universally reviled in this area.
With no competition, pay has stagnated, specialists have left the area (why would a PhD/MD neurologist want to live in small town Tennessee?), and many former employee nurses have become travelers. The system is relying on contract labor, but is already $14M in the red so far this FY.
The path it is on is not sustainable. My guess is that the tertiary hospitals will be sold off to an HCA or Community, while most of the rural and community hospitals close, within five years or so.
The local hospital system has gotten an extremely bad reputation. Two regional systems merged to form what is effective a state-sponsored medical monopoly. It's almost universally reviled in this area.
With no competition, pay has stagnated, specialists have left the area (why would a PhD/MD neurologist want to live in small town Tennessee?), and many former employee nurses have become travelers. The system is relying on contract labor, but is already $14M in the red so far this FY.
The path it is on is not sustainable. My guess is that the tertiary hospitals will be sold off to an HCA or Community, while most of the rural and community hospitals close, within five years or so.
Someone very smart once said that anything that is not sustainable in the long run, won't be.
You describe what I call the appearance of health care. On paper, there is health care. In the real world, it is OK for simple things such as to cast a simple non-displaced broken arm, or perhaps to prescribe antibiotics for a case of Gonorrhea, or perhaps to prescribe a blood pressure pill, or a perhaps Lipitor for high cholesterol.
Patients who need more advanced care take their lives into their own hands for more complex medical needs.
The solution to lack of quality care in such areas is above my pay grade. Almost 50 years ago my cousin received an all-included fellowship to pay for all tuition/living expenses for medical school & internship/residency in exchange for agreeing to be a physician in a remote under-served area. That under-served area funded it. Because it is so long ago, I've forgotten the details; perhaps it was funded by a Native American Indian reservation; I just don't remember. Is that a possible model? Maybe that might be one piece of the solution.
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