Is it possible to live emotionally well if you’re facing a serious illness? It may be counter-intuitive, but the answer is yes. Here’s my latest blog post for Sixty and Me on the subject.
A year before Isabella de la Houssaye reached the summit of a 22,840-foot-high mountain peak in the Andes with her daughter Bella, she had been diagnosed with stage 4 lung cancer.
The 55-year-old, an outdoors enthusiast, and her husband David Crane had five children, aged 16 to 25, all of whom had conquered outdoor adventures together with the family and as individuals. So after recovering sufficiently from grueling cancer treatment and feeling stronger, Isabella was determined to have other adventures with each of her children, individually, in large part to impart life lessons to them.
The climb to the top of Aconcagua in Argentina with college-junior Bella, with a team that included a New York Times reporter and photographer, is a remarkable story of almost unimaginable challenges, courage, grit and determination. It was featured in a lengthy article in the Times that you can read here.
One passage in the story that I found especially moving – and thankfully its lesson is not dependent on climbing a mountain to learn from – records Isabella’s attitude about illness:
“So much of who I was was defined by my physical strength,” she said. “It’s definitely hard being sick and saying goodbye to the person you were before. You have to redefine yourself, and you don’t want to define yourself as a sick person. I’m learning that you have to find acceptance with the decline.”
Facing Mortality Head-On
Her story is inspiring, to say the least. But I must admit that after I read it, I knew that if at some point I am diagnosed with a life-threatening illness, my first thought would not be: let me call my son and propose that we climb a 22,840-foot-high mountain together. As I kept thinking about Isabella’s ultimately successful ordeal, though, I wondered: what would I do (after emerging from a period of hiding and mourning my life under the covers)?
It’s an important question, one that many of us don’t think about much. How do I know that? For the past several months, I’ve been giving “Conversation of Your Life” talks to various groups. It’s all about advance care planning: having the conversation with loved ones about your treatment preferences if you cannot speak for yourself; choosing a health care proxy; preparing an advance directive; and communicating with your doctors about what you want and what you don’t want. Essential issues.
What I try to stress, though, is that the first and most important part of this process of communication is to communicate with yourself. That is, to confront your mortality head-on. So much flows from that. It isn’t all about medical treatments, just as serious illness itself isn’t just a medical issue. It’s about what you feel you want and need to do before you can no longer do it. It’s about how you want to live the rest of your life – honoring your sense of what gives your life meaning and purpose. It’s about the kind of legacy you want to leave. It’s about who you want to surround yourself with. And unfinished business to attend to.
When I talk about this fundamental part of communication, I sometimes ask my audience, who has given some thought to this? What are you envisioning? The response? Crickets, typically. Either no one has given this any thought, or people feel too shy or embarrassed to share.
Sharing Your Values
So I’ll share some of what I’d like. If I am gravely ill and still have my wits about me, I’d like a big good-bye party, with lots of food and lots to drink. I’d like to hear from family and friends about what I’ve meant to them, what they’ll remember, how I’ve affected them and funny stories they can tell. All the wonderful and moving things that people say at funerals that the deceased don’t get to hear. (At least we don’t have any evidence that they do.) I want to hear it before I go.
And, speaking of food: We’ve been hosting Thanksgiving and Passover for decades and in recent years our small family has happily grown to include seven grandchildren and cousins’ grandchildren, aged six and under. As you might imagine, these events are like organized chaos, but always seem too short. One reason I love to keep doing this is that I am hoping that all the younger-generation cousins and their children will continue to recognize how precious these times are and will keep the tradition going.
Clearly, Isabella had grander things in mind, but fundamentally she wanted to impart her values and wishes to her family. She succeeded in accomplishing what she set out to do. After reaching the summit, Isabella said, “It was so important to me that Bella and I have this experience together. I really wanted her to see that when things get hard, you can find a place inside yourself to keep going.”
An important lesson for all of us.
What’s your mountain?
(Note: This is a guest blog, from Teresa Greenhill, co-creator of MentalHealthForSeniors.com, a website dedicated to providing information on physical and mental fitness.)
Mental health is a serious issue among seniors. In fact, depression affects about 5% of people over 65 as well as up to 13.5% of older adults who require home healthcare. While depression is a common problem, it’s not a normal side effect of growing older. Depression should not be something we simply endure as part of the aging process. If you’re experiencing depression, keep reading to find out how Medicare can help you cover your treatment and support your mental health in the long run.
Mental Health Services Covered by Original Medicare
Original Medicare—also called Medicare Parts A and B—covers a variety of mental health services. Medicare Part A covers the costs of mental health care for hospital inpatients, including therapy and medications administered in a hospital setting. When it comes to outpatient mental health services, Medicare Part B covers one depression screening every year. In addition, it covers psychiatric evaluations, diagnostic tests, medication management, family counseling, and therapy with licensed mental health professionals such as psychiatrists, psychologists, and social workers. However, seniors using these services should be aware of deductibles and copays. After you reach the deductible for Medicare Part B, you will have to pay 20% of the cost for each mental health service.
Unfortunately, Original Medicare alone does not cover prescription drugs or other essential services that can support your mental health treatment. This is why many seniors opt for a Medicare Advantage plan. Medicare Advantage plans offer all the same benefits included in Original Medicare, plus coverage for services like vision, dental, hearing and prescription drugs to help improve your quality of life.
Finding the Right Medicare Plan
There are over 3,700 Medicare Advantage plans available across the United States, so how are you supposed to choose one? Start by making a list of services that you need covered. For example, you may need prescription drug coverage if you’re prescribed medications to treat your depression. If you have vision or hearing problems, make sure your plan covers these services as well—taking care of your physical health is crucial to good mental health. Untreated hearing loss, for instance, can lead to cognitive impairment! Additionally, many Medicare Advantage plans have in-home support services which can significantly improve quality of life for people facing mobility limitations.
Medicare Advantage plans that provide access to wellness programs may also be a good choice for people with depression. Research from McMaster University a public research university in Hamilton, Ontario, Canada, shows that staying active plays an important role in treating and preventing depression. Additionally, any senior with Medicare can also take advantage of a free annual wellness visit. During this visit, seniors can discuss prevention strategies with their doctor and develop a personalized plan for avoiding mental illness in the future.
Ensure Your Mental Health Provider Accepts Medicare
Since many psychiatrists opt out of Medicare, you may have trouble finding a mental health professional that accepts your health coverage. Fortunately, U.S. News recommends a few steps patients can take to find the mental health care they need. Start by talking to your primary care provider about your mental health concerns. Your doctor may be able to prescribe medication for your condition and refer you to professionals who they know accept Medicare. If you enroll in a Medicare Advantage plan, ask for a list of covered providers. For seniors who live in rural communities, telepsychiatry is a superior option to forgoing mental health care altogether. This service may be covered by Medicare, depending on where you live.
Is Your Mental Health Service Recognized?
On the other hand, you also need to ensure that your Medicare plan recognizes the mental health services you intend to use. CMS (the Centers for Medicaid and Medicare) recognizes mental health care provided by clinical psychologists, clinical social workers, clinical nurse specialists, psychiatrists, physicians assistants, nurse practitioners, and general practitioners. Non-medical doctors—like social workers and psychologists—must be Medicare-certified. Also, ensure your mental health care provider accepts Medicare’s approved amount for the services they’re providing to you.
Along the same lines, make sure that your Medicare plan will cover your prescription drugs. If you opt to stick with Original Medicare, you can add a prescription drug plan with Medicare Part D. Alternatively, you can choose a Medicare Advantage plan that includes drug coverage—most plans do. Either way, be sure to choose a drug plan that covers your prescriptions. If you cannot find a plan that covers all of your medication, consider choosing a plan that covers your most expensive drugs. It’s also important to check that your plan covers the pharmacy that you would like to get your medications from.
Depression is a serious problem that can accelerate aging and exacerbate age-related physical issues. Fortunately, seniors have several avenues for treatment. And, thanks to Medicare, you don’t have to spend a fortune to receive treatment for depression or any other mental health problems. Don’t hesitate to seek the treatment you need now.