Caregiving sucks. If it didn't, nursing wouldn't be such a growth field.
I was only under that anvil for about 1/3rd of the time for half a year. It took two months for my face to stop twitching and my drinking to drop back to normal.
I can understand it a tiny bit just because I have a toddler. But (a) a certain amount of exasperation with toddlers is expected by society, (b) I can realistically expect things to get better soon, or at least hard in different ways, unlike a lot of long-term caregiver situations, and (b) I have the impression that my kid is unusually easy-going and well-behaved. Hard to believe sometimes but overall I have to admit she's not that bad.
I'm never sure how to talk about this with people other than my immediate family or Unfogged, where we're all 95 percent like-minded about politics. There's one short paragraph in that article about gaps in the social safety net, and the rest of it is anecdotes about problems with caregiving. If I were to chat with a stranger about this article, I'd probably spend the first 10 minutes cautiously sounding them out for conservatism. If I found it, I wouldn't want to talk to them. If I didn't, there just wouldn't be anything to say. Democrats may be better than the Republicans on this stuff but are still very business-friendly. Some people here may remember that I found FMLA pretty crappy, and FMLA was apparently the best that a Democratic president and Congress could do.
The part about unpaid labor was huge.
There are a lot of aspects of it that will always suck, and aregiver support groups and therapy are probably helpful. But self-care isn't the problem, it's being overburdened.
This also happens in mental health services for the seriously mentally ill. There's a recovery orientation which is partly consumer/patient driven and about empowering them to get better and lead meaningful, independent lives and partly about being cheap and offloading things onto family. Relying on natural supports, I.e. Friends and family, means you're healthier than someone who sees a therapist frequently or lives in a 24-hr group home. The State saves money. The fact that there are economic costs to the unpaid caregivers is not accounted for.
Caregiving is absolutely a nightmare, and as boomers continue to age I feel like the US is on the precipice of a(mother) major crisis.
5: I'm super angry at Boomers. They said low tuition at public universities was unsustainable and burdened younger generations with lots of student debt but haven't mostly -either as individuals or collectively- prepared for the cost of their caregiving.
They, or at least the wealthier portion of the white ones in key states, also voted in Trump as a fuck you to those behind them.
(This is of course incredibly boring of me, but #NotAllBoomers. Lots of them have generally voted that way, but nothing like enough to blame them as a class. I'll punch myself in the face for being sanctimonious and be quiet now.)
Oh, yeah, I was sanctimoniousing at BG more than at you. You qualified, she didn't. And of course I'm sure she was mentally qualifying, I just get edgy about leaving that out there given that there are individual Boomers who read here who are on the side of truth, justice, and the social democratic way.
I did not have any trouble with my employer, but I very deliberately did not pull the FMLA trigger after it was explained to me. This meant using vacation time/holidays/work-from-home days to avoid taking more than three sick days in a row during two week absences. Avoiding FMLA is probably not something possible if your employer doesn't do things like give you four weeks of vacation a year and if you don't have the support of your immediate colleagues because you've been there for a decade. FMLA may not have been that bad, but, while I was very confident my situation met the requirements for it, I had no idea at all how I would manage to prove it because everything was all fucked up.
In California, the IHSS program allows you to be paid for providing home healthcare services to your elderly or disabled family member or spouse. Are there other states with similar programs? My understanding is that Medicaid Cash and Counseling does not permit payment to spouses.
10: I can safely rail at boomers because my ancestry skipped that generation.
And because deliberately trolling individual boomers who read here isn't entirely out of character for me.
10: I guess that I was being unclear. Of course there are a lot of great boomers. And I was trying not to blame people who couldn't save for the cost of elder care, because the cost is enormous, and I do believe that it's a societal, collective problem.
But, there are some people who have money and don't plan or save for the cost of their care, and I am angry at those individuals whose children will now have to plan for them. I mean, basically, I think that people should have plans for long term care in place just like they should have wills.
But, as I said, for so many people that's not financially feasible, and I can't say that those people are irresponsible as individuals.
I do think that there is a general aversion to acknowledging the fact that we age and die.
On the internet, no one can hear if you're a great boomer.
The other aspect of it is that no one has less time to organize and be political than caregivers.
Unless things have changed a lot since the last time I paid attention, long-term care insurance is so crazy expensive that it's hard for me to get mad at anyone for not buying it. Good caregiving is really hard, which means that it's really expensive to get other people to do it, and also that even high-quality paid care isn't as good as caring family can provide. One would think that public policy might recognize that and bend over backward to support and assist family caregiving, but apparently that would be socialist or something, so it's better to wait for the family to crash completely and then maybe fund the cheapest possible nursing home care.
and also that even high-quality paid care isn't as good as caring family can provide.
I very much doubt that for a great many conditions. There are skills involved, skills that take time and effort to acquire.
I still feel guilty about leaving my adult partner who was mentally and physically ill and wouldn't care for himself at all. Looking after my toddler was tiring, but not nearly in the same way, not that feeling of, "I'm doing this for no good reason".
Recently my long-distance partner and I have come to a bit of an impasse because he wants to move toward living together and I'm really not sure I want to do that. Reading this article made me realize that what's stopping me is that I'm not sure I'm ready to commit the rest of my life to potentially being his caregiver. I mean, I could get hit by a bus, but other than that it's not likely it would go the other way. And even with the guilt, I have so loved the last seven years of not having to care for an adult. Literally every day I wake up and feel like dancing around because I don't have to do it anymore.
This is of course incredibly boring of me, but #NotAllBoomers.
My children are being raised with a healthy, balanced, completely objective contempt for Boomers and men, even though when pressed, I am compelled to admit I am a representative of both groups. My 14-year-old son recently made me proud when he proclaimed (specifically as regards climate change) that we'll work this out once my generation is dead.
I mean, I'm not a racist or anything, but middle-aged white men are just the worst.
I'm thinking of dealing with dementia and I don't mean what people usually think of as medical skills. If you, for a hypothetical, watch a nurse who deals with lots of people with dementia and one who does not, you'll see one (usually) manage to calm down a potential episode before something goes wrong and the other get smacked in the head have to call for security and Mr. Haloperidol.
Reading what I just wrote - wow, the arrogance of the temporarily-abled. Now horrified.
even high-quality paid care isn't as good as caring family can provide.
This causes me to suspect that the folks you have known have benefited from the care of people who are not otherwise engaged in paid employment. It seems analogous to people who talk about how daycare is no substitute for a mother's attention.
It was insane that we relied on my sister for this labor during much of my father's decline -- and it only happened because she and he insisted on it.
20, 23: Fair point. My perspective was formed primarily with cancer, as well as a mental illness situation in which in-patient care was critical for a time. In the former case, we ran a hell of a lot better hospice than the hospice did, but even with an RN in the group, a friend handling the pharmaceuticals, and good doctors, it was incredibly draining for a number of people to keep it going.
25: No, not at all true, and it's pretty fucking offensive for you to make that assumption.
24: Seems to me you're being way too rough on yourself.
I think there's a difference between 'high-quality paid care' and 'seriously high-quality paid care' that's largely about the amount of hours devoted to each patient -- even unskilled family care is likelier to provide 24-7 coverage (at incredible hardship to the caregivers, of course), and if you're comparing to 'high quality' paid care that's around for a limited number of hours in the day, the paid care probably is inferior for a lot of patients.
But that's still a money issue.
29: That's a big part of it, but for people who are still mentally present, there's often also going to be a comfort factor in being cared for by people you know.
I am absolutely on board with much more public investment in caregiving. I just don't think it's realistic to expect that to replace family care completely.
In California, the IHSS program allows you to be paid for providing home healthcare services to your elderly or disabled family member or spouse. Are there other states with similar programs?
It's something Medicaid provides some match for, and 31 states have it in some regard, but states have a lot of leeway on who to cover and how much help to pay for, and CA is relatively generous, it looks like.
I am absolutely on board with much more public investment in caregiving. I just don't think it's realistic to expect that to replace family care completely.
It may be unrealistic to expect to replace family care, but there's got to be something out there for people who just don't have the family caregivers. And once that exists... isn't it cruel to demand that family step up and provide care at whatever exorbitant financial and personal cost? If there is family that feels that personally providing care is right for them, they should do that, of course, but it's inhumane playing chicken with the care of dying or incapacitate people on the assumption that family will do literally anything, no matter how costly, to keep them from suffering.
32: I agree completely. My point is just that there will continue to be a lot of families who will choose to personally participate. That choice should be supported by public policy that reduces the burdens (respite care, visiting nurses, etc).
It's been a rough year and I have no idea how I managed all we've been dealing with other than by not getting myself the care I needed. (I'm getting much better about that now and for instance TIL that there's a horrifying click sound when you get a breast biopsy and I'd like to think in any situation I'd have gotten it looked at promptly.) But with two surgeries for me and one for Selah plus after this week separate physical therapies for the older girls and psych and rheumatology periodically it's a lot even with patients who are still able to function in the world.
I do think that there is a general aversion to acknowledging the fact that we age and yet don't die for a shockingly long time. My parents are horrified by the idea that any family member would have to care for them, and I think both have this fantasy that they'll happily kill themselves or whatever to spare us the burden, which isn't really a plan... at all.
I know my sister will give 110%, because that is her way, and I will have difficulty being as generous because that is my way. It would be nice to figure out an equitable division of labor beforehand. Has anyone done this, made a family-wide elder care plan in advance for cost sharing and so on, correcting for differences in proximity and commitments? lourdes and I are each the distant sibling in our respective families, and we should probably be more diligent about sharing the obligations. But I wouldn't even know how to begin such an awkward conversation with the rest of the family. "Uh, so, we know we're the aloof, remote, entitled branch of the family, so we were thinking that maybe if you quantified the excess attachment you feel to our parents we could analyze the data and..."
"Can you please be the ones to do that to start out? We really don't know how. We'll just react defensively and critically to whatever you propose. Thanks, that's great, really helpful, I think this will make life easier for all of us."
35: Yes. Very few people just drop dead of a heart attack.
It does happen. Just ask my vice president.
Or a friend of mine who dropped dead at the beach with his family on Easter Sunday. Not a bad way to go, but 20+ years too soon.
Sorry for your loss, Dave.
(Just to be clear, I was actually kidding and not kidding on the square about being a horrible person, although I guess you can make a case that people feel bonds in different ways. I feel strong filial obligations, but those thousands of miles make a difference.)
Parental bonds are important.
39: Sure, and I'm very sorry. I occasionally hear of 85 year-olds who are healthy and then have an MI, but it doesn't seem that common. I know someone though whose father had a heart attack at a funeral and died about a day later.
That's like announcing your engagement at somebody's wedding reception.
40: No worries, it's just one of those shitty things that happen ever more frequently as we get older. And then one day it's us and it's someone else's problem.
I'm in a somewhat similar situation to yours with the prospect of my parents' care, as my extraordinarily kind and dutiful sister lives 2500 miles closer to them than I do. I'm not sure how all that is going to work out. I think my brother in law will help keep us honest, but we've never talked about it at any length, and honestly, waiting until we know what's needed and then winging it is probably as good a plan as we're likely to devise at this point.
You people are reminding me to call my mother. Can I suggest that while planning to the extent of asking how to coordinate among the kids or any kind of detailed plans might be a high bar to clear, not matter how good of an idea it is. Smaller thing can be a big help. Like signing a durable power of attorney for just-in-case or just making a list of bank accounts and bills that have to be paid.
45: Are you implying that it might be an utter clusterfuck if my father died in the midst of this massive construction project involving multiple contractors? Ha ha! All I can really do is laugh at that thought.
(And sorry, ick, but this clearly was the most appropriate pseud. My dad would be a much better president fwiw.)
As long as he leaves you the gas can and the matches....
My former neighbor's ex-husband tried to take that way out of a financial problem and wound up going to prison for a very long time plus having a court case go clear to the U.S. Supreme Court. Arson: If you don't want anyone dead, it pays to make sure nobody is home before you do it.
Her son would get mad at her because she was supposed to stay at their business during the day and wait from them to drive her home at night, but she would just to go the corner and ask for a ride and offer the driver $5.
I don't think she had dementia. I think she was just unwilling to spend that much time with her son and congenitally unable to give a fuck.
He's not that bad. I just wouldn't want to spend all day with him after he took my car away just because the police took her license away just because she drove into her house.
Re: caregiving, I was shocked at how well my father did taking care of my mother, but at some point, I think he realized that (1) he simply wasn't able to provide the calm, consistent, quiet environment needed and (2) he wasn't able to keep her safe. Say nothing of the grueling, 36 hour day nature of dementia, family caregiving was not tenable for him, with no other local family. The thing about paid caregivers is that it's a job. They get to go home. It's not watching someone you love decline. In some ways, the professional distance makes it easier. They can be kind and chipper and can often adjust better to what the person's current needs are than family can. (Example: One of my grandmother's caregivers brought her coloring books and crayons. She really enjoyed them. It would never have occured to any of her family.)
Lurid in 35, my father did this as contingency for my mother. If he dropped dead, she was to be moved local to my sister (in an appropriate facility), who is more geographically fixed than we are. However, I would be power of attorney and handle money and medical decisions remotely. At least one person must be local, so figure out if a move would need to happen. Usually finances/paperwork are easiest for a remote sibling. Another option is to hire a case manager, which can be helpful for monitoring care from far away.
My grandmother's and mother's care have both been totally excellent. Way better than I could do. And remember how crippling taking off a year or five would be to a mid-career professional. Spouses can go bankrupt without good legal advice on how to get their loved one on Medicaid. Repeating a comment from elsewhere, average time from Alzheimer's diagnosis to death is 8-12 years. In the inexpensive Midwest, dementia care is over $80K a year for private pay. Very few people have, say, $400,000 in cash for end of life care. My father is starting to worry mildly about finances. My mother just de-qualified from hospice and is back to walking (but falling frequently) again. It's anyone's guess how long this will last, but I'm not sure my father has an idea what the end game might look like.
It's definitely a good idea to figure out, at minimum, which sibling will get power of attorney, and what parents' (and partner's) end of life wishes look like.
Also, re: family care, it is often harder to patch together services like respite or daycare piecemeal. It is hard to know what is available, and of course, even harder in smaller towns. Out in nowhere where we live, there are a huge number of new memory care facilities being built, but upon Googling, there is maybe one adult daycare.
55.last: Absolutely true, but be aware that it won't really be a solid plan. Even basic directives can be ambiguous, especially with gradual declines. My grandmother would NEVER have wanted to live like she is, but you can't just smother the elderly with pillows, you know? I like sort of general questions - at what point should palliative care be the approach? Would they rather be more alert and frightened or anxious, or less of all three (eg psychotropic drugs)? Which infections should be treated (I just went over this with my father - told him to treat UTIs for comfort but not pneumonia)? Those are really fucking terrifying questions, though, for folks who are in relative good health.
you can't just smother the elderly with pillows, you know?
This is my plan. If I can't get anyone to do it, I might just have a boating accident of some sort.
My dad went about 8 months from starting to feel lousy to the end, and while chemo for the last 6 weeks wasn't exactly pleasant, it certainly could have been worse. It's amazing how little there is at the end of the line.
58: Potentially at your service.
Republicans aiming to fix the aging crisis creatively.
The demographic political apocalypse did seem to get here a bit early. I was thinking 2020-25 (it could just continue to deteriorate until then of course) when I thought the alliance of UMC white elderly with their net worth spreadsheets from hell had moved more erstwhile "liberals" into pure resentoids, fucked racist oldsters, evangelical-ish Christians, and just plain old Republicans coupled with even more systematic voter suppression would usher in this here government.
But here we are already.
A number of very-involving caregiver episodes in our family over the past 15 years, Gender roles not transcended.
We were both turned down for long-term care insurance, but not entirely sure of reasons*. Wasn't sure if we really wanted it either; so that decided it.
*They fairly outrageously cited a long list of reasons for each of us which consisted of basically every thing we had been seen for or even *asked* a doctor about in our adult lives that was recorded in an appointment write-up (we gave permissions just did not think they would be such *total* jerks about it). Very disturbing; and I fear all of that there stuff will be available for corporations and the government to use to their advantage before the robots wrench the reins of power away from Ivanka the III in 2071.
I believe the robots are our future. Hold them close and let them lead the way. Program them a sense of pride, to make it easier.....
At the risk of sounding all Tom Brokaw-y, I think the missing factor is that the WWII generation managed to age better than the Boomers.
(Did I mention my business plan for somebody younger than me to retire on? Buy up a bunch of Devo album covers, Bill and Ted's Excellent Adventure posters, still from Friends, and similar. Come 2045, a bunch of nursing homes are going to need them for decor.)
When my grandmother was in her final decline, we had some really annoying care issues. I was completely unprepared for the idea that once she was in a nursing home sort of place, that they could call us up and tell us we needed to additionally hire private 24/7 people to be with her, or they'd kick her out of the home and back to us. Stitching that extra care together from a roster of half-a-dozen people who I only knew by first name and telephone number was maddening. Also felt kind of like a scam, but I couldn't tell by whom.
(Similarly maddening was the lack of clarity about who had the medical power of attorney. I had it at one point, but my grandmother had issued a new document giving it to my uncle at some point without telling me, and of course it only came up when he was out of the country for a multi-week folk dance event and out of touch).
I am really stressed about this subject, because my MIL, who is in her mid 70s, is the full-time caretaker for my FIL, who needs 24-7 care. He had a debilitating stroke about 9 years ago, and an almost fatal heart attack about 2 years ago. He has uncontrolled diabetes, he chain smokes, and he refuses to drink water or do any PT. He's addicted to opioids, and to top it off he's a giant asshole. So far my MIL has held up reasonably well as the caretaker of an uncooperative, self-destructive, verbally abusive man, but I'm really worried about what's going to happen as they get older and he continues to get sicker.
65: Assisted Living places are often like that. I knew someone whose mother was in a for-profit continuing care community (the kind where you pay in, get an independent Apt, move to assisted living, then, if needed, a dementia unit or nursing home. They pulled that crap. Once hospice got involved it was much better.
My parents used to have team-based care for otherwise nursing-home eligible individuals that would provide services and work with the ALF.
66: Are you sure he isn't trying to die?
65: They usually expect less than 24-hours in the form of a private-duty nurse or aid. Not cheap. I highly. Recommend Jane Gross's "A bittersweet Season: Caring for our Agig parents and ourselves."
This article crystallizes something that has been hovering on the edges of my thoughts lately. Through some quirk of timing, I am in the gym locker room with ladies who seem to be in their 50s and 60s. I hear so much caregiving talk about husbands and parents. One lady took early retirement to arrange care for her father; one coordinates her husband's care. They are so polite in their discussions with each other, talking euphemistically about "difficult times." I . . . suspect the men's locker room chat is very different in topics. What a huge toll on a generation of women.
Probably all the generations before.
71: I'd say that shrinking family size, advances in healthcare to keep very ill people alive longer, and geographical distribution makes it increasingly difficult, but the truth is that you're right that it has always been pretty awful.
My God this is a depressing but valuable discussion. My wife and I are the ageing parents with one daughter 2500 miles away. No other family. She must not be forced into care giving for either of us but the time will come. Time to get some helium.
If there's one thing you can do that would help more than anything else, it's make a plan to move close sometime before you need help. Someone's going to end up uprooting themselves, and if it's not you, it's her.
Honestly, I think filling out legal documents and saving money is the best you can do. A determination to not need help can make things harder once it becomes clear that you do need help.
My mother often tells me, that when it's time, I just need to provide her with the means to kill herself. At some point I'll need to ask if she's kidding.
The elderly are too lazy to go to the store for themselves?
74 - Good suggestion. Would like to do that when and if she settles down.
75 - Legal documents in place. Saved as much as we could. I don't think coming out of retirement would be good. You are right about our determination possibly making it harder for her in some ways but determined we are. This is a tough one for a lot of people.
64: At the risk of sounding all Tom Brokaw-y, I think the missing factor is that the WWII generation managed to age better than the Boomers.
At the risk of telling you to go fuck yourself in the ass with a meathook, I will remind you that "Boomers"* are now aged ~late 50s to 70, and it is the "silents" (or whatever the fuck term our demented labelling discourse has settled on) who are most generally requiring the intense care-giving. (Not that it will matter, and of course demographics/cohort size matter, and it will undoubtedly suck with the Boomerangs as well.)
But per you comment above, troll on you crazy diamond.
*I do grant that "Boomer" seems to have become a catch-all term for the crazification/conservatism of aging and sins past such as California Prop 13.
70: I wonder how many of them are raising grandchildren too, which is taking sandwich-generation stuff to whole new levels.
I really know that it is the silents who need care now.
My point is that now that the WWII generation is mostly dead and with their passing the elderly are much more Republican they were before.
As recently as ten years ago, the elderly, as a whole, leaned toward the Democrats.
I'd say that shrinking family size, advances in healthcare to keep very ill people alive longer, and geographical distribution makes it increasingly difficult, but the truth is that you're right that it has always been pretty awful.
Also generation size. If you're in your eighties and your children are in their sixties, your grandchildren are in their forties, and your great grandchildren are in their twenties, there are a lot more people who aren't themselves raising children at the moment who might be able to help.
I'm thinking historically. Not at this moment in time. In 2017 if you're a great-great-great-grandma in your eighties, you're most likely part of a chain of intense poverty and the health consequences that come with it, so all bets are off.
78.last: Saved as much as we could.
An observation having last year completed the process for all 4 parent/parent-in laws. All of them having sufficient funds in the end was certainly a huge help and clearly reduced stress among the families. However, the lack of willingness to use those funds for their own needs was an ongoing (relatively minor)source of friction that I completely understood but was frustrated by. I will probably suck at it too...
The WWII generation didn't age better. They died uncomplainingly around the age of 70-75 apart from a few exceptions. They were not brought up to believe they were immortal, and if they had been WWII would have knocked that nonsense out of them tooty sweety.
In my family, they all lived past 80. They certainly complained less than some people.
I don't know what's happening in cable news, maybe this is a blip or an artifact, but apparently MSNBC outratingsed Fox News this past week. Related to the big die-off, or just FN being super-boring this year as they have to play down instead of play up the scandals?
87 - I call it being due to Liberal fascination with the Dumpster Fire. Probably not good for mental health tho...
82: Yes. At some point I put together various pieces of data on voting trends of the different cohorts through time. I am continually chagrined at the Boomer drift (who IIRC correctly were not as Dem-leaning as the Greatest but more so than the Silent, but who dis-proportionally fell for Trump* like total assholes**. And I fear whatever the Reaganoid bubble will bring, but maybe there will be a correction base don the current craziness (and if voting access doesn't totally erode.
* These are my peeps which is why I have such white hot rage for apologist fuckers like Arnande and JD Vance (who had the world's worst analogy about the US gov't role in healthcare in a NYT (aka the 666 Times) op ed:
Imagine a young father stepping into the street. He is alert and conscientious. Then, a government truck speeds around the corner. The man lunges out of the way, but it's too late: The truck runs him over, causing serious injury. Absent government misconduct, the man would have been just fine. While the primary effect of the government's conduct is an injured man, there are significant secondary consequences. His children will lose his emotional comfort and financial support. His neighborhood loses a valued contributor to its social fabric. His employer must find at least a temporary replacement for the man's labor.**I presumably should go back and find the data so I can see where I am talking out of my ass, and where I am semi-accidentally right.
88: I do think the entire country is now deranged. JRoth mentioned that several times here re: 9/11; the repeated viewings made us all literally a bit crazy. I think the same for shit like the Boy Scout speech.
89 - I read that J D Vance thing in context and couldn't for the life of me make it work out in my head. I thought we was a least supposed to be smart.
The Boy Scout speech made me sick to my stomach and I was kicked out of the Cub Scouts.
I just read Hillbilly Elegy and found myself completely puzzled by it. Yes, your family sounds as if it was terribly fucked up, but what's your point?
It seems a little unfair. The kid couldn't help feeling sick.
92 - They wanted us to take a loyalty pledge to God and country, I said screw you. My parents were pretty pissed but I felt pretty pleased with myself. My mother said I was an Aginner..
Did they specify a specific God and/or country?
91.2: On a more reassuring note the official Twitter account of NORAD and USNORTHCOM just tweeted out:
Yesterday, the @POTUS spoke to @boyscouts attending the #2017NationalJamboree about hard work, perseverance & believing in yourself.
So maybe we front-row kids are just misinterpreting.
We are not on path to pseudo-democratic authoritarianism.
We are not on path to pseudo-democratic authoritarianism.
We are not on path to pseudo-democratic authoritarianism.
Definitely don't have lunch with anyone from Venezuela right now and chat about parallels.
96 - If FSM had been a thing back then, that would have worked. But I really just wanted to see how pissed off everybody would be . Really hated authority from the start. Don't know why. I liked my parents well enough.
79: what's the name of the generation born in 1910 and then 1917 who came of age during the depression?
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Do Irish people sometimes play instruments while wearing huge wickerwork figurines over their heads? I've seen video but frankly don't believe it.
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73: If you're willing to have this discussion, this is also a good time to talk to your wife about what kind of caregiving expectations you have of one another--in particular, what if one of you has dementia?