Retiring Abroad

by Ada

Here on the Totebag it seems that most people imagine retirement as getting closer to kids. Maybe it’s my phase of life (I love my kids and have SO much closeness with them) but a little space seems nice. I see my parents 4-5x per year; if I lived in Ecuador, I could make the trip to visit the grandbabies/museum openings/bail hearing at roughly the same frequency.

Also, due to my line of work, I see a lot of people who deeply regret the retirement choices they made – the 66 year old who find out he has a year to live, for example. Of course, they are statistical abnormalities, but their stories stick.

Retirement in America? Too Expensive.
A new book examines the lives of expats in Ecuador and their struggle to stay in the middle class.

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145 thoughts on “Retiring Abroad

  1. the 66 year old who find out he has a year to live… statistical abnormalities

    1 in 5 men don’t make it to 65 so it’s not all that anomalous.

  2. At this point I don’t plan to relocate when we retire – but if we do, I would want to relocate while I was still active enough to make friends and build community. And I’d only relocate if it was to be near one of the kids. My dad left San Francisco because he felt priced out. He first moved to Palm Springs – and then a year ago after his partner died, moved to Seattle. He’s 78, has some short-term memory issues (due to aging), and is finding it difficult to make friends (in part because of his short-term memory issues).

    My MIL has lived in Tacoma (mid-size city about an hour from Seattle) almost her entire life. As a result she has an incredible network of friends.

    Ada – if you moved somewhere out of the country, it might be easy for you to visit your kids 4 – 5 times a year. But when you reach the point of needing help, it might not be nearly so easy for your kids to visit you. At one point, my Mom moved to Arkansas in the Ozarks. Visiting her took two planes and then a 2 1/2 hour drive. She got sick and it was challenging to figure out the logistics. I think because of that, she relocated to outside Sacramento CA which made it much easier for us to visit her.

    I also think it’s much easier to age in cities where there’s good public transit and Lyft than in the country. And decent access to medical care. I’ve never understood the fantasy people have of retiring out to the country. Perhaps because I went to high school in Vermont – it’s impossible to get around without a car.

  3. “Adventure is often the story that expats tell about themselves to assuage the embarrassment of outsourcing their own retirement to a cheaper place. ”

    How negative. The tone of the whole article really irritated me. Why can’t it be both an adventure and a solid financial decision? Is there any evidence at all that the type of people who are moving to low cost countries to retire are “embarrassed”? I don’t think so.

  4. I have an aquaintance who has decided to retire in the Netherlands. But she had been dividing her time between the US, Great Britain and the Netherlands as part of her career for years. I could really see retirement in a place like Utrecht or Delft – so easy to get around, and so laid back. But I doubt I would do it. First of all, I doubt I would retire until I was well past the normal retirement age. Secondly, if I moved, it would be to be closer to a kid.

  5. I get my knowledge of the British retirees living in Spain from Netflix. They show people transferring almost every penny from Britain and investing in properties with some of dream business on the side. I really don’t know how that dream business works out but they sure spend a lot of retirement money on it.
    Some people have retired to the home country. These are mostly couples without kids and therefore have less ties to keep them here. They do have community in the home country but day to day life can be a hassle to get things done. Then, again they are retired, presumably have the time and are fully aware of home country hassles. They also face the problem of their relatives and friends passing away earlier than they expected and no assisted living facilities or the like in the home country.

  6. I think Finn’s idea of renting an apartment for 3 months in Paris or Amsterdam has a lot going for it. Especially if you end up retired relatively young and spry. None of these moves need to be permanent.

  7. Can a US citizen retire to Europe? My understanding was that with the exception of a few real-estate investment schemes (spend 300k Euro on a place in Portugal?) , there wasn’t an easy way to get a long term visa. Also, without access to the socialized health care system, how on earth could one afford health care and nursing/home care?

  8. Not exactly about retiring abroad, but a few weeks ago the WSJ Encore edition ran a long piece profiling one of their writers’ search for the perfect retirement spot. She and her husband spent 15 years and toured 21 cities before making their choice. What was striking — and made the whole piece virtually useless for most readers — was that they apparently have neither children nor aging parents to consider. And they are both healthy and relatively young.

    The 3-month apartment idea makes much more sense.

  9. For retirement you have to consider the early retirement phase as well as the late retirement phase. You have to pick a place that meets both needs. Travel in the early retirement phase can be done on a limited budget. It need not be overseas. Lots of people rent/buy an RV and travel around the country.

  10. Retirement can often be 20+ years and seems to have some distinct phases (hopefully). The travel or deeply engaged in the community period, the needs a bit of help period and the fully dependent period. It is likely hard to do step 2 and 3 in a different place than one does step one, but step 2 and 3 become lonely and isolated if you don’t have a partner and community. In my family, all of the older folks who were dependent for some period of time were in communities that they hated. The few family visits a week were insufficient to make the experience pleasant. (This was a variety of medicaid and private pay, adult family home to nursing home). I think all three would have been less miserable if they were in a warm-weather, higher staffed facility in Mexico.

  11. “You have to pick a place that meets both needs.”

    That’s a very good point.

    I like a one-month apartment idea, trying out different locations. But maybe longer would work depending on the location. I don’t have an interest in retiring abroad, but I enjoy the international house hunters/beach homes shows. I wish they would do follow up shows showing the disaster or success of these moves. For instance, does the 60-something couple plan to move back to US assisted living housing after spending 5-10+ “carefree” years living on a remote beach in a sh!thole country?

  12. I should have put quotes around “sh!thole”. Some people have that opinion, but obviously not everyone.

  13. Can a US citizen retire to Europe?

    Yes. You just need to show proof of income, proof of health insurance, proof you have someplace to live. Essentially you need to prove you won’t be a burden.

    To stay in France for longer than one year, you will need a carte de séjour, or residence permit. (You must obtain this document while still in the United States; you can’t head to France as a tourist and apply for residency while you’re there.) One of the biggest hurdles to obtaining residency is the paperwork – including your passport, numerous application forms, and extra passport photos, proof of financial self-sufficiency, proof of international medical insurance and proof of where you will live in France.

    You can apply at your nearest French consulate by mail but may need to report in person at some point. Expect to wait at least one to two months after applying to get your visa.

  14. Not exactly about retiring abroad, but a few weeks ago the WSJ Encore edition ran a long piece profiling one of their writers’ search for the perfect retirement spot. She and her husband spent 15 years and toured 21 cities before making their choice. What was striking — and made the whole piece virtually useless for most readers — was that they apparently have neither children nor aging parents to consider. And they are both healthy and relatively young

    I also read that article. I found it pretty interesting. I think the fact that they had no kids or aging parents to consider seemed to make their search harder. They were wide open.

  15. My/our retirement choices will depend mostly on our health. DH is likely to have heart issues but I will probably either die of cancer or live with health and independence until ~90, at which point the world will be so different from what it is now that there’s no point planning.

    I hope I’m healthy enough to interact with young grandchildren but considering how late I had my kids, and how I expect that they’ll have kids late, I’ll be an old grandma. I was taken aback when someone in Sunday School assumed that with an 11 year old, I could be 10 years from grandkids, so I should save my baby stuff.

    Global births peaked in the 1970’s, my birth decade, so people my age will be competing for caregivers.Retiring overseas will be different in 30-40 years than it is now.

    The article didn’t touch on declining life expectancies in the U.S. among the poor/working class. Without pensions to share longevity risk, I don’t think that poor/working class people can afford to have long lives. I expect that healthcare will become more socialized, in theory, and more difficult for nonwealthy people to access, in practice, as Meme described in her MRI example. I don’t see a solution to that problem.

  16. Our current plan is the “extensive travel” plan, but with a home base, probably here where we are now, unless a kid moves somewhere better. I am spoiled with reasonable cost of living, reasonable transportation, decent amenities for the size of town, and excellent airport access, so it will be hard to trade that away until the house becomes too unmanageable (or we keep getting so much $%!# rain — if I’m going to live in Seattle weather, I’m going to live in Seattle, dammit).

    OTOH, no matter how long a vacation we take, it’s never enough. We’re looking at Japan now for next summer, and we spent last night scrolling through google maps looking at villages and stuff, and I am seeing beautiful coastline and envisioning just moseying down from one bay to the next — but it’s not near a train line, and we don’t want to deal with international drivers’ licenses, so it’s just out of the question for now. I’d like nothing better than to have a couple of months where it really doesn’t matter if I take a wrong turn or want to stay an extra night somewhere.

    So I imagine that for the first @10 years of retirement. After that, I assume we will slowly cut back on the extensive travel and focus more time at home and with family. Assuming all goes well and as planned, of course; you never can tell.

    @Ivy: I agree, the tone rubbed me the wrong way. It seemed pretty presumptuous for the author to decide that the expats were just lying to themselves and their friends to make themselves feel better. I mean, really, don’t we all want a better life — however we define “better”? I sometimes dream of moving to Portugal and buying my way into the Golden Visa, living surrounded by vineyards and beaches and such — because that would enable me to retire now in a style I could not afford in the US, and might never be able to afford. But I don’t exactly think that demonstrates that I am a victim of capitalism (which would be laughable) — it’s more like I am a capitalism success story, where I was given the opportunity to live in a rich country and make a ton of money, and then use that money to buy my freedom through geographic arbitrage.

    I don’t want to belittle the economic issues that make people feel forced to leave the US to maintain a reasonable quality of life; y’all know my beliefs on how we treat/support the poor. But I also think the people who manage those challenges by moving abroad have energy and a spirit of adventure that should be celebrated, not pitied or portrayed as self-delusion. The reality is, for every poor American who moves to Equador, there are millions in the same circumstances who choose to stay home and scrape by as best they can. So I’m not sure those who choose to leave in search of better are the poster children for that argument.

  17. While I would like to stay where we are for as long as possible, I am well aware that where I live would not be possible/pleasant without DH or an adult child with a tolerant spouse living nearby. If one of the kids moves back in the area, I will likely stay here as long as feasible, but as G*D is my witness, I swear that I will move to town/assisted living/condo/granny flat when they tell me to. If none move back, I would like to live near them and if all goes well, become Meme to the grandkids.

  18. I think extensive travel sounds like hell on earth. I want my stuff. I don’t want to live out of a suitcase. I hate not knowing where things are. I hate counting how many pairs of underpants I have left before I have to hand-wash them in some foreign sink.

    I have no idea what’s going to happen to me. I expect I’ll die sooner than I would if I had had children, because there will be no one to advocate for me in the hospital. But maybe that’s okay. Maybe that’s what happens when you don’t have kids. Life is full of trade-offs.

    My friends who retired (well, they were forced out of the workforce) in their mid-fifties have moved to Nicaragua and love it. But then again there’s political unrest in Nicaragua that makes them uneasy. And it’s a four-hour drive to the vet for their pets! It’s a four-hour drive to any civilization, really, and the drive is on choppy roads. It wouldn’t suit me. Also the humidity would kill me, but they are from Houston so it’s no big deal to them.

  19. I doubt anyone on here would have difficulty proving, as Rhett says, that they wouldn’t be a burden to any European country they’d move to. Right now, and for many years, Americans can stay in most European countries up to three months without needing a visa or other paperwork. There are some differences. Austria makes it easier than most countries.

    Seattle, I agree with you about getting established somewhere while you are young enough to make friends. When my son was little and I was an assistant professor, I resented that my parents wouldn’t visit more than one weekend per year (and insisted on time with me, not on their own with grandchild). My mother told me then that they were making their own friends and I should be happy about that. Now that my dad’s memory is slipping, he still plays tennis 3x/week with the group he’s been in for years. He gets confused at times, and they help him out. I’m not sure they’d do that for a new guy his age/ability level.

    But my vision at this point is the kind of grandkid involvement Meme has, including calls in the wee hours asking for help, eventually shifting to me being the one receiving help. Whether that happens depends on my relationship with the DiL, among other things.

  20. “My friends who retired (well, they were forced out of the workforce) in their mid-fifties have moved to Nicaragua and love it.”

    Do they share with you what they plan to do when they cannot live independently? Do they plan to stay in Nicaragua.

    “In my family, all of the older folks who were dependent for some period of time were in communities that they hated.”

    Are you saying they moved to these communities once they became dependent and only because their family was nearby?

  21. July, I think they intend to stay in Nicaragua til the bitter end. I don’t know that for sure. But they moved there in part because their money would go further. I don’t know if they can really afford to move back to the states. Maybe when their SS kicks in? I am curious myself, but I don’t want to grill my friend.

  22. On the actual topic of retiring abroad: just last week people here were pointing out how cheap airfare is these days. Eventually travel is too hard on a body, but have you priced fares to Shipool, Milan, Barcelona,or other airports close to where people are talking about retiring? They are not prohibitive, and I don’t see that changing. 4 hours on a bumpy road to get to the vet or other services? Sounds to me like they’ve chosen to live out of the city. One factor people haven’t mentioned in considerations of moving to inexpensive places for retirement is that hiring people to help with whatever is much cheaper than in the US.

  23. My family (3/4 grandparents) moved to full-time care against their will because they could not care for themselves at home, and did not have capacity to create their own plans. My parents did the best they could in finding places that were quality and enabled the most contact with loved ones, but they all died angry and bitter about their living situations.

  24. If you don’t live near a major airport in the U.S., you may not want to travel in retirement. I’m heading to Florida for a conference and stopping in St Louis to see my brother next month. To fit with DH’s previous trip and Lego robotics obligation as well as corporate criteria, I end up having 6 separate flight legs. Portland isn’t on the way to anywhere.

    This will be my first business trip in~17 years. I’m nervous.

  25. I expect I’ll die sooner than I would if I had had children, because there will be no one to advocate for me in the hospital.

    I always enjoy how people here often believe that what is standing between them and certain death at the hands of uncaring medical professionals is one google-savvy friend. Certainly it is helpful to have a knowledgeable advocate when you are hospitalized (or going to Social Security, or the Dentist, or the Grocery store). However, we generally do our best to not kill people, even the childless and friendless. I don’t go to the hospital/doctor’s appointments with my parents (so far). Yes, careless medical professions kill a gazillion people every minute through fully preventable medical errors, but your smart-phone armed companion isn’t going to actually save you..

  26. The risk of hiring people in a distant country (talking from home country experience) is that with no supervision/oversight from family, the quality of care could vary significantly. Even with family nearby (but no active supervision) some extended family relatives who needed care and remained in their apartments were not well cared for even though they had multiple caregivers. The caregivers also helped themselves to things in the apartment that wouldn’t be missed. Very sad situations.

  27. “Yes, careless medical professions kill a gazillion people every minute through fully preventable medical errors, but your smart-phone armed companion isn’t going to actually save you..”

    I have spent the last ten years explaining to medical people that my mom is deaf. And, she has really good insurance and has been going to the same HMO for the last twenty years. I don’t know why they can’t put in her chart that she can’t hear, nor do I understand why the medical profession can’t seem to figure out that deaf people exist. I have showed I don’t know how many people how to use voice to text on their iphone, because mom can read, she just can’t hear.

    When DH was about to undergo surgery, they hooked him up to an antibiotic that he is allergic to. This was also at our regular medical group, who have all his records, including the part about him being allergic to that antibiotic. Fully preventable medical errors occur ALL.THE.TIME. In my experience, the patient’s advocate is the last, perhaps only, line of defense again medical errors.

  28. WCE, I bet you’d cut out a third of those flights if you were doing one thing on the trip, without all the extra stipulations on your departure and return. Granted, people with multiple kids who retire overseas may have to fly between kids when they come back to visit, but presumably, they will have more chance to rest up than a standard layover offers.

  29. I think the hospital advocate is more Cassandra’s first point about her mother being deaf than preventing errors. Yes, errors happen, but communications issues are much more common.

  30. Yes, errors happen, but communications issues are much more common.

    I wonder if things will be easier for us because if we didn’t quite hear or we forgot we could just log in and read the visit notes. Or whatever tech they have when we’re 80.

  31. Well, maybe, Ada, but for some reason I always had to tell the medical professionals to check Mom for urinary tract infections whenever she started to go extra ga-ga. They’d just go, Oh, I guess she’s completely demented now, too bad so sad. Uh huh, or you could check for a UTI, which is a well-known problem in geriatric care. I think I’ll write my DIL a note about that.

  32. “Yes, careless medical professions kill a gazillion people every minute through fully preventable medical errors, but your smart-phone armed companion isn’t going to actually save you.”

    Well, it’s not about having someone with a smart phone to find the right diagnosis because those stupid doctors don’t know what they’re doing — it’s about having someone with nothing else to do than pay attention just to you, vs. a bunch of people doing their best to get you everything as scheduled despite being understaffed and on hour 10 of a 12-hr shift and responsible for managing the care of 18 patients across 8 different hospital departments. Post-Whipple, my MIL was almost injected with an extra dose of insulin, because the morning guy forgot to write it down on her chart. My FIL caught it; my MIL was so out of it post-surgery that she’d easily have become a statistic without that second set of eyes.

    Basically, it’s acknowledging that everyone is human, and so when dealing with a big complex system staffed by humans, I’d like to have my own personal human just looking out for me.

  33. I appreciate that everyone has an anecdote of when they averted sudden disaster. However, of all the deaths/severe disabilities that I have seen caused by inappropriate medical care (it’s not a particularly long list), I can’t think of a single one that could have been averted by an attentive loved one.

    I’d love to hear DDs take on this. Based on his line of work, I assume he is sending people to the hospital frequently and also has patients that die routinely. I wonder if he thinks that his people would have longer lives if there was better advocacy.

  34. Rhett – We do the portal now. But that doesn’t solve the problem for the absent minded or non compliant patient without an advocate. DH has a full portal electronic communication system from his long time HMO. The Coumadin nurses (at least most of them) know that the telephone instructions will get garbled and his wife needs to have them so they post the twice a month instructions to the portal as well as call. The Endocrinology dept never posts visit summaries or updates to the current dosage, just tells him verbally how to change the number of pills. He (really me on the portal) has repeated requested full posting and secure email. My technique is to type up a report on his compliance with their existing instructions (or a summary of what he does if there is no documentation of their instructions), and he gives it to the primary or the specialist at the semi annual visit. If she (he always picks a she – in his experience he can get away with stuff because he is very congenial and has puppy dog eyes), has any questions, she calls me during the visit. His cardiologist just retired, so I may need to go with him next time to introduce myself to the new one. The psych pill doctor (he doesn’t do therapy) and I get along very well.

    So a patient like him needs an advocate (and medication manager, and chef) not because medical personnel are overworked or because he is going ga-ga but because he is not straight with the doctors and can’t/won’t follow instructions. And my AZ snowbird best friend waiting for the MRI has more money that I do and no children/grandchildren. It would never occur to her to pay for her own MRI. She was about to book an anniversary trip to Hawaii and realized that she couldn’t insure it since the stuff is already in the pipeline, and so she probably will never go now because she would worry about losing the money. Although having money is always useful, it is less useful if you are not willing to spend it or risk it.

  35. But you wouldn’t have seen these incidents, precisely because they were averted. Laura’s MIL didn’t die because her FIL stopped the second insulin dose. My mother made it back from dementia several times because I insisted on UTI tests. Etc. You have more anecdotes from work than we have from our families’ experiences, but that doesn’t make our anecdotes false or imaginary. They happened.

  36. Ada, how is your parents health? My dad was very well-liked and respected by hospital staff he worked with as well as by community—president of local AMA, on state AMA board, handmade Christmas gifts from nurses we’d never heard of, etc. Many of those same people are now who he sees for health care. When he’s had surgery, he’s always been happy to report that Patty or whoever was there. I expect they really want to take good care of him. Of course they want to treat every patient well, but maybe they feel a little extra with my dad. Still, no matter how much good will is there, he went along with my mom for her breast cancer appointments, and she now goes along to every one of his. It is simply prudent not to rely on them to catch every possible interaction of medicine, every other possible issue, and to write out instructions perfectly afterwards, etc.

  37. “I appreciate that everyone has an anecdote of when they averted sudden disaster. However, of all the deaths/severe disabilities that I have seen caused by inappropriate medical care (it’s not a particularly long list), I can’t think of a single one that could have been averted by an attentive loved one.”

    Wait, so your anecdotes trump our anecdotes? Meaning, what, that that kind of thing doesn’t actually happen? Because just now we’ve mentioned two life-threatening mistakes just now that were prevented by an advocate, and a third that certainly would affect the quality of life of the lady written off as suffering from dementia. And it’s not like we’re talking about a universe of a million people here; the blog isn’t that big.

    I am really not following this discussion. Medical errors happen — not because medical professionals are incompetent or bad, but because they are human. Some of those medical errors can have very bad consequences. Another human who is focused solely on the patient can help prevent those errors. Why is this controversial?

  38. RMS – but I have seen patients get antibiotics that they were allergic to, and extra doses of insulin/blood pressure medication/narcotics. I’ve seen people not get brought in promptly for UTI in elderly women because the symptoms appeared to be the same as progressive dementia. This is not ideal care, sometimes it is malpractics, sometimes it is malfiescence. . However, these are not usually medical disasters. The tragic, medical mistake disasters I have seen have been related to things that no advocate could have prevented. Since so many patients have no one to advocate for them, I should have some experience with the bad outcomes that people imply will most certainly befall all the unattended patients.

    For example: I was tangential to a case where HIT (heparin induced thrombocytopenia) went undiagnosed in an ICU. I consider that to be a medical mistake that led to death of a young person. It happened fairly quickly in a patient that had very good support. In another case (again, not mine), a critical potassium level was either mis-reported or mis-understoond and the incorrect treatment was given, causing death. No advocate could have helped with that.

  39. In Ada’s defense – In every profession the view of the customer who has experienced the error is different from the company professional. The company professional knows for sure that they have all these systems, processes and check points designed to avoid errors, so it just seems off, when customers are reporting problems. That’s where the highly paid consultants come in ;-).

  40. I take Ada’s point to be that 99.9% of medical errors don’t result in death or long term disability. Most result in no effect and some result in hours or days of discomfort/inconvenience.

    During my month in the hospital across from the nurse’s station, I learned that if integrated circuit fabs ran with the same error rate as hospitals, semiconductor chips would never yield. The human body is remarkably resilient and in the absence of medical care, usually heals itself. Semiconductor chips cannot heal themselves.

  41. DS’ fifth grade talked of his plans to retire to Ecuador, but after he had a chance to spend a few months there decided against it. He retired a couple years ago, and last I heard he still lives here.

  42. “One factor people haven’t mentioned in considerations of moving to inexpensive places for retirement is that hiring people to help with whatever is much cheaper than in the US.”

    I’ve known several people who grew up mostly in the Philippines, came to the US for most of their adult lives, then moved back to the Philippines for retirement. All of them cited the ability to hire servants within their budgets as one of their reasons for making that move.

  43. On the retirement topic and location choice

    As for the desired “Mémé” family relationship, there is a bunch of luck involved in our ending up in geographic proximity. And choices on both sides. DS and DIL MMM’d it up, paid off and added sweat equity to their Portland OR fixer upper before the kids were conceived (she felt she had to quit work because of chemicals in jewelry making), and so when DS got the chance for paid relo to Boston they had enough for a 50% down payment in a top school district. I worked like a dog while they were on the Left coast to fly out to visit even when not entirely welcome, and developed a cordial relationship with my saturnine and defensive DIL. I retired 3 mos before they announced the move, and had not even had time to investigate a move or seasonal residence. Then there was bad luck when DIL got cancer and good luck that I was free to be with the kids all the time, and the relationship with everyone turned the corner into what we have today.

    And her parents who are 1 1/2 hours drive away have an equally close relationship with the grandkids. Many weekends or summertime blocs. There is a MIL suite in my son’s house and they have a guest wing in theirs.

    Adventuresome people who move permanently to Ecuador for financial reasons don’t usually fly back to the States 5 times a year, and even if they do not to the same location or family group. People who are full time in Florida don’t even do that.

    And in the latest developments, the lice lady paid my grandkids a visit on Sat . (Outsourcing and the funds to support it are wonderful!!!) Nana was the one who said after observing the head scratching on Thursday, are you suuuuure she doesn’t have… DIL was panicked and mortified. DS rose to the occasion, googled and found the lice lady and made all the arrangements. Being more of a downtown guy than his uptown wife, he remembered head lice from his childhood and knew that it wasn’t such a big deal.

  44. “I was taken aback when someone in Sunday School assumed that with an 11 year old, I could be 10 years from grandkids, so I should save my baby stuff.”

    This gave me a chuckle.

    You’ve mentioned many times here the non-totebagginess of your local friends and acquaintances, especially those you know through church, so IMO you shouldn’t have been surprised by that sort of assumption.

  45. good luck to those that retire abroad and have no one to take them to the doctor. My step MIL has been going to a lot of doctors because she has cancer. She has to get to Sloan from a suburb. She is too sick to take public transit because of germs. Too frail to drive herself and my FIL is no longer able to drive. If we go pick them up, that could take 1 – 2 hours due to traffic from our burb to their burb. It is much easier for us to meet them at Sloan since Manhattan is in the middle of our two burbs. They’re frail and Uber isn’t always a great solution for the elderly/sick that have to get out of cars with walkers, wheelchairs etc and some how get into a doctor’s office.

    She is the person that primarily takes my FIL to most of his doctors unless my DH takes a day off from work to take him. I doubt that she will survive more than another year and we can’t figure out where his father should live after she passes away. He doesn’t want to move near us because ALL of his doctors are near his home and that is at least an hour from us by car. He sees a lot of doctors and he has several chronic diseases that require a lot of doctor visits. If we move him near us, all of his doctors will have to change. He is 90 and this would be a huge problem because he has not mental health issues. He is fully aware of what is going on, and he doesn’t want new doctors.

    This aging thing really sucks and I just think the whole retirement abroad sounds like a pipe dream when I think about how much time we spend with 6 elderly parents that are our parents or steps. Some of them started having issues around 70 so this isn’t just something that happens when you’re 80+.

  46. DS’ fifth grade talked of his plans to retire to Ecuador

    The entire class? Wow.

  47. Lice do not discriminate and she shouldn’t be embarrassed. It’s hard to avoid lice unless you never leave your house. Lice ladies are the best!

  48. “he remembered head lice from his childhood and knew that it wasn’t such a big deal.”

    I recall a few instances of it going around my kids’ school, and it wasn’t considered a big deal, not a reason for kids to stay home. I believe the local public schools also don’t consider it a reason for kids to miss school.

    Selfies were a much newer phenomenon then, and at the time it was believed that kids’ hair touching while taking selfies was contributing to the spread of pediculosis.

  49. “The entire class?”

    I believe his teacher did discuss it with the entire class.

    It’ll be a while before we see how much those discussions influenced his class.

  50. @Rocky: I am particularly impressed by the fact that the 5th grade class has all retired. Never thought of Finn Jr. as slow, but I guess that really is a helluva school.

  51. WCE, Alaskan Air flies direct Portland Orlando. https://www.google.com/flights?lite=0#flt=PDX./m/0ply0.2019-01-07.PDXMCO0AS782*/m/0ply0.PDX.2019-01-15.MCOPDX0AS727;c:EUR;e:1;a:AS*AS;sd:1;t:b;sp:2.EUR.29186*2.EUR.29186

    Louise, your comment sounds entirely on the mark, and reminds me of a disagreement my dad and I have about medicine, especially since I lived in Germany long enough to get familiar with their system. To him, something is “medically significant” if it is likely to cause death or long-term disability. That’s how his generation was trained and given the scarcity of doctors and nurses in many parts of the US, I expect that’s how medicine continues to be carried out–not enough to take care of “unimportant” things like pain. To me, considerable discomfort already crosses that threshhold. I was surprised to find how seriously German doctors took it when I said something hurt. They’d figure out the cause, I’d assume that since I wasn’t going to die, I’d just have to deal with it, and they’d be either aghast or puzzled.

  52. “Good catch Rocky”???? What she wrote is exactly what I understood the first couple times I read that sentence, until I figured out from the rest of the post that a word was missing.

    ” It’s hard to avoid lice unless you never leave your house. ” I’ve never had it. My son hasn’t either, but that could be because he doesn’t have the kind of hair that lice like to live in.

  53. Lauren,

    I think it’s very totebaggy to say that if you’re 70 and you get cancer you’re going to move next to Sloan and do everything possible. But someone could also chose to move to Ecuador and decide that if they get cancer they aren’t going to do anything about it. Just go the hospice root.

    A friend’s mom was 95 and diagnosed with cancer and they said you can do surgery, chemo, radiation etc. or you can do hospice. She decided on hospice. I think most of us agree that’s probably the best option. But what about at 90 or 85 or 80? I could see it both ways.

  54. Lice – schools put horrible fear into the parents. They would send these long letters on lice prevention (wash sheets, get rid of stuffed animals) and I think kids who had lice were not allowed at school. I think this rule has changed.
    In the home country, if no lice remedies including lice ladies worked, you had to get a short haircut. I was once forced to get my hair cut in spite of my Mom’s best efforts.

  55. S&M, I was just poking at Finn because he’s always such a stickler for precision.

  56. @Rhett – Yes. If people aren’t going to move to Naples, FL because of the horrific medical care available, then they sure aren’t going to move to Ecuador.

    What’s the problem if someone chooses to move to Belize for 10 years (from 60-70 say) and then moves back to the US when they get older & have different needs and daily routines? I bet people who voluntarily move to warm, tropical locations and relax in their retirement are, statistically speaking, healthier than those who obsessively continue to work high pressure jobs into their late 60’s worrying about the possibility that they’ll get some rare cancer.

    Living on a dirt road in Central America isn’t my dream, but I can certainly see the appeal.

  57. DD had lice 3 times. My guess is it spreads more among girls with long hair. The second and third times it was with her soccer carpool group. DS has only had lice once (which he got from DD). I think kids with short hair are much less likely to get it. The first time DD got lice was a nightmare – she has very long thick hair that would take 2+ hours to comb through. The second and third time we outsourced to the lice lady.

  58. Hello again. I wanted to say ‘hi,’ and, to be honest, to tap this valuable resource for some quick gift help, if anyone feels called to help.

    Simple Christmas gift that DW requested is a replacement throw blanket (or a couple) for the couch. We have a soft, cream/white one that she likes, but it’s gotten worn out.

    I’m looking for soft, not too heavy or hot, luxurious feeling but not scratchy. I should have taken a picture of the one I’d be replacing. Do you have any favorite or suggested brands?

  59. Ivy – my concern about moving to some place like Belize for the active healthy part of my retirement and then moving back to the US would be what kind of community ties and support I would be moving back to. It’s really hard to develop new relationships when you’re in poor health.

  60. “They’re frail and Uber isn’t always a great solution for the elderly/sick that have to get out of cars with walkers, wheelchairs etc and some how get into a doctor’s office.”

    I’ve observed that as well, and I wonder if Uber “ambulette” will become a thing, especially as aging baby boomers need this. The main addition would be assistance getting in and out of the vehicle as well as accompaniment to the doctor’s office.

    I’ve been reading more stories about lonely elders with no close relatives to care for them due to higher divorce rates and smaller families. The misery of old age is not always avoidable, so I will try not to worry about that possibility. Just plan as best I can.

    WCE — I expect you’ll enjoy your business trip, even with all those lousy extra flights.

  61. Speaking of that kind of thing, Rhett, my 86-year-old MIL had a hernia last week that was preventing her from voiding her bladder. They pushed it back where it belonged, but the next day it popped out again. So they told her she needed surgery. She has been recovering from a very bad cold and has said in the past that she doesn’t want any more surgery, period, because it took so long to recover from previous surgeries. So in the evening she was exhausted and telling my FIL and SIL that “sometimes people are just done.” The next morning they coaxed her into doing the hernia surgery, which was very minor, and she is now back in her assisted living apartment recovering well. But it can be a tough call. If her husband and eldest daughter hadn’t pushed her, she probably wouldn’t have done it, and might be gone by now. And I’m not even saying that’s a terrible outcome, because she’s 86 and exhausted. I’m just commenting that it’s a tough call.

  62. “I think it’s very totebaggy to say that if you’re 70 and you get cancer you’re going to move next to Sloan and do everything possible. But someone could also chose to move to Ecuador and decide that if they get cancer they aren’t going to do anything about it.”

    70 isn’t that old. Most people in that age group, totebaggy or not, are not going to forego cancer treatment unless the cancer is advanced and treatment wouldn’t help.

  63. It’s really hard to develop new relationships when you’re in poor health.

    What sort of scenario are you envisioning? Is the move going to be any worse than moving from your home in Seattle to an assisted living facility near your son in Sacramento?

  64. “This will be my first business trip in~17 years. I’m nervous.”

    A couple suggestions:

    -Noise cancelling headphones. Since I got a pair, I’ve found air travel to be much less tiring. I theorize that hours on the plane exposed to the constant drone is physically tiring, and that’s exactly the sort of noise that noise cancelling headphones excel at cancelling.

    -A bunch of reading material. I look forward to business trips as an opportunity to catch up on reading; all the waits and delays are just more time for reading.

  65. I don’t recall who it was, but someone recently asked about weighted blankets.

    I clicked on the Costco link RMS posted, and noticed on the bottom there was a link for a weighted blanket.

  66. “I bet people who voluntarily move to warm, tropical locations and relax in their retirement are, statistically speaking, healthier than those who obsessively continue to work high pressure jobs into their late 60’s worrying about the possibility that they’ll get some rare cancer.”

    Not to mention that, if you have any investment assets, keeping your expenses down for that first decade will significantly increase the likelihood you can afford to return.

  67. “70 isn’t that old.

    True but then what about 75 or 80? As RMS said it’s a tough call.”

    And what if one spouse is 70 but the other is 80?

  68. “I think extensive travel sounds like hell on earth. I want my stuff. I don’t want to live out of a suitcase. I hate not knowing where things are. I hate counting how many pairs of underpants I have left before I have to hand-wash them in some foreign sink.”

    So you seem to have purchased what works best for you. It seems like a lot of people share your preference for a home away from home.

    I’m thinking of something somewhere in between what you’ve chosen and what sounds like hell on earth to you in our retirement, spending a few weeks to a couple of months in a home somewhere. If we find we like someplace enough, I can see us returning to the same place multiple times in retirement. In particular, I can see us returning to a ski area multiple times.

  69. I guess I’m particularly argumentative today, but what on earth do you mean by this?

    If her husband and eldest daughter hadn’t pushed her, she probably wouldn’t have done it, and might be gone by now.

    People live with hernias for years. They can range from an occasional inconvenience to a painful daily burden. Rarely are they life-threatening. I suspect if they hadn’t pushed her, she would be living with her hernia this week. And maybe next week/month/year she would decide that she would prefer a small surgery instead of the burden of the hernia.

    If she had retired to England, she would have the right to start treatment for her hernia within 18 weeks of diagnosis! https://www.nhs.uk/conditions/inguinal-hernia-repair/what-happens/

  70. @Milo: DS won a hotly-contested Yankee swap at which a “Montauk” blanket was the #1 gift. Suuuuuper soft velvety top (in the “shiny-not-sticky” version of velvet), with a suuuuper-soft faux-sherpa-wool underside. I think it was something like this — https://www.ebay.com/itm/Blue-Super-Soft-VELVET-BERBER-THROW-BLANKET-by-Etoile-50-x60-NEW/253992212094?hash=item3b231d967e:g:KS8AAOSwxdtarxiD. He has literally worn it around the house like a cape every day since.

    I know it can’t have cost too much, because we do a $15 limit, and even the cheaters never go more than $25. ;-)

  71. “keeping your expenses down for that first decade will significantly increase the likelihood you can afford to return.”

    Not selling your abode in the US would also help ensure the affordability of the return.

    Rhett had suggested that I rent out our home while we spent time in other locations. Spending that time in less expensive locales is one type of geographic arbitrage that would similarly help stretch retirement assets, and is something I’ve read about numerous times in FIRE blogs.

  72. One of my coworkers is retiring in 2019 and plans to split his time between a barge on the Thames and a beach community near my city. He has UK & US citizenship. He’s been plotting the barge purchase for the last year. Apparently, being on the water means no property taxes and they can be quite nice. You can travel in them too.

    Living in a developing country in retirement sounds like a huge headache. I just think of all the logistics and language issues when travelling and don’t want to do that in old age. I do plan on relocating to a cheaper community, probably an ex-urb location of a big city (for the access to good healthcare yet slower pace)

  73. Sloan has a smart business model. They built offices in all of the burbs surrounding NYC. For certain cancers, it is easier to get routine chemo, radiation and scans at these nearby offices. You see the “big” specialists early in the process, and generally just have to go back once or twice a year to the mother ship. Her cancer is progressing and she’s entering a clinical trial. That has to be done in the city and it’s sort of her only option right now.

    Most of the kids that we know with cancer get treated at Sloan in the city. The suburban outposts are for the routine treatments. My friends commute, stay with friends or use Ronald McDonald house when they have kids at Sloan.

  74. RMS, coming home to chaos and grumpy DH when both of us are tired from Lego robotics and back-to-back business trips for DH and me is my main worry.

    I rather doubt that I will come home exhausted, dump my laundry in the laundry room, and magically find it all clean when I get ready for work on Monday morning. This is a practice for trip to SE Asia a couple weeks later, then no travel for awhile.

    I probably need to mentally separate the work stress from the home stress.

  75. I have a lot of retirement worries. In my perfect world, we have our beach house, and a bigger, main house in Chapel Hill. We go to a lot of UNC games and audit classes and enjoy the energy and vibe of a college town but have the excellent RDU airport for travel, a hatred of Dook to keep us feisty, and a beach house a mere 5 hours away. Kids would settle in Raleigh (after attending UNC), and we’ll be 30 minutes away – close enough to help out on a Meme type basis and to host Sunday supper but not so close that we’re all up in each other’s business.

    My real worry is that I’ll be stuck where we live now because of aging relatives of mine. Where we live is perfect for the stage of life we’re in, but it’s definitely not where I want to retire. And I worry the kids will move far away and seeing them regularly will be difficult.

  76. “Most of the kids that we know with cancer get treated at Sloan in the city. The suburban outposts are for the routine treatments. My friends commute, stay with friends or use Ronald McDonald house when they have kids at Sloan.”

    Yep, that is how it works. Because peds cancer is very different from adult cancer, and the treatment infrastructure is all in Manhattan. They have their own floor, specialized nurses, and pediatric oncology teams. They get kids from all over the world, and yes, they stay at the RMH.

  77. My father was diagnosed with cancer at 75 and high tailed it to Cleveland Clinic. He was not ready to throw in the towel and is currently in remission. Aside from the tumors in his colon, all his other organs are healthy and strong, and his mind is sharp enough that he isn’t living in misery or driving us all crazy (crazy is a relative term). He still thinks he has another twenty years left and although his mobility has decreased and their annual european vacations will probably not happen anymore, he tells me he feels too young to die.

    But, I also know plenty of people who think that 70 is old and that if they make it that long, they’ll be happy and content. If money or access to top medical care is an issue, then the cancer diagnosis at 75 is the end of the road.

  78. OK, so I bought Rocky’s Costco one, and LfB’s on eBay. I mean, for the price… And it’s an extra thing to open.

    The job is good. I think it’s a great fit, and work that I personally find a little more interesting. I was thinking to myself last night that I’m actually looking forward to getting in to work tomorrow (Monday) morning. It’s been a while since I felt that way. And I don’t work any Fridays at all, and the mindset that you develop when every weekend is a three-day weekend is really pleasant. Also, the work better sets me up for a transition into something more fun down the road.

    There’s still a ton of sh1t to learn, and emails are coming fast, and my admin is on vacation for the rest of the year (but, I actually HAVE an admin now, so that’s cool).

    I’ve never had a job that I’ve enjoyed as much as I enjoyed lifeguarding, but this one seems like the closest I’ll get for now.

  79. The big problem right now is that the RMH keeps filling up, which is very stressful for families from say Oklahoma or Israel

  80. We have a throw from Costco and it’s a year old. It’s great. We just bought a Velvet blanket that DD requested. Only $20 and it came out the wash looking like new. It’s hard to beat their quality and prices for the soft blankets unless you want a particular color/pattern.

  81. “I rather doubt that I will come home exhausted, dump my laundry in the laundry room, and magically find it all clean when I get ready for work on Monday morning. This is a practice for trip to SE Asia a couple weeks later, then no travel for awhile.”

    During my last business trip to Asia, my hotel room had a washer/dryer. You might want to look for that.

  82. thanks guys, and lark and hm for the additional suggestions.

    in other news, not exactly earth-shattering, but a little bit sobering for me, I had a basal cell carcinoma removed. 2018 has been the year for me to get more personally acquainted with the medical system, and as Scarlett summarized a while back, I’ve suddenly gone from “no history” to “hypertension and cancer” all in about four months’ (with an enormous asterisk on the second one, but still.)

    I’m glad I’m not pricing out new life insurance policies.

    BCC seems like the kind of minor thing that, as soon as you’ve had it, you learn that so many other people you know have had the same thing done and can all tell you about their surgeon.

    I start six-month skin checks in January. That will be fun.

  83. Milo! People have been wondering where you were, if everything’s ok.

    “that’s a hell of a lot cheaper than Soft Surroundings!”
    They have 5 on their outlet site right now. They don’t make a second line for the outlet–it’s the stuff that wasn’t sold on the main page. Sometimes it’s obvious why no one bought it, but other times there’s nice stuff there.

    https://www.pendleton-usa.com/national-parks/national-park-products/blankets-throws/

    If you were buying for me for an actual wintery winter, I’d say to get one with fleece on one side. Wayfair has a bunch, at various prices.

  84. Milo, good to hear from you, and I hope your health issues resolve themselves favorably.

    “And I don’t work any Fridays at all”

    Do you do the equivalent of a FT job in 4 days/ week, or are you taking your first step to a life of leisure?

    I can see where that would be a good intermediate step. Get your chores done on Fridays, and have the weekends for fun stuff with family and friends. I wish DW and I had that option.

  85. “a hatred of Dook”

    DD hasn’t really made a list yet, but that’s one school she’s mentioned investigating, influenced by a friend who’s a freshman there now.

  86. Finn – 4 x 10. But these people are serious about keeping it to that, and leaving on time. You could set your watch by it.

    In my old position, things had a way of bleeding past the designated hours, so you ended up working just as long regardless, but with more days.

  87. There’s just such a difference between “retired” and extreme old age with sickness, and we seem to be conflating the two in this thread. Most people end up doing things in stages. Better to decide now to practice flexibility in the future (Cassandra’s “as God is my witness” declaration) and adjust as circumstances change than to decide now that 1) the future is inevitably grim, feeble, and infirm or 2) one will always enjoy good heath, vigor, and prosperity. My mom’s CCRC was full of people who had spent 65 – 75 in New Zealand or Equador or on a boat and then at 75 were able to integrate just fine into a new community.

  88. “4 x 10”

    So are all your holidays worth 1.25x what they are worth to those working 5×8 schedules?

  89. yep. same with picking up floating holidays, or comp/incentive days.

    and now I’m going to note that it’s three minutes after five, so it’s past time to go home.

  90. WCE, I truly wish that gentle reasoning always worked with my husband, but it doesn’t. I have on occasion had to scream “Will you stop being a huge fucking baby?” to get him to change his behavior. Here’s hoping that gentle reasoning works with yours.

  91. I’d love to hear DDs take on this. Based on his line of work, I assume he is sending people to the hospital frequently and also has patients that die routinely. I wonder if he thinks that his people would have longer lives if there was better advocacy.

    I don’t think “advocacy” results in longer lives, but I definitely think it results in a better quality of care. When you patients who have dementia, they need someone to be able to explain what is normal for them and what is a change in condition. It’s also helpful for the patient to have someone to point out they need a water refill, didn’t get lunch, need to be changed, etc when the patient isn’t able to advocate well for themselves.

    I can speak more to nursing homes. When a resident has family/friends around frequently, the staff is going to give them some extra attention. It’s not right, but it’s reality because they are all under-staffed, so they give their extra time to residents that they know will have family coming in and are going to complain if things aren’t done.

  92. To Ada’s point, we recently lost a father in horrible manner where potassium reports were incorrectly interpreted by the doctor. Its still upsetting to think about the negligence part.

  93. My father was diagnosed with cancer at 75 and high tailed it to Cleveland Clinic. He was not ready to throw in the towel and is currently in remission.

    My mom was diagnosed at 63 with stage 4 lung cancer that had metastasized. She wasn’t ready to throw in the towel even though every Dr she saw told her they wouldn’t treat it. She finally got suckered in by someone willing to take her money (she had great health insurance). She did several months of chemo followed by radiation and died 6 months after she was diagnosed with a not-so-good quality of life.. She likely would have lived a couple of years with a much better quality of life if she threw in the towel and focused on spending time with her grandchildren instead of pursuing hopeless treatments.

  94. Isn’t the usual treatment for that Benadryl.

    Not for a severe allergy. If DW gets penicillin, her throat will close up and she’ll go into anaphylactic shock.

  95. @Anon 4:44- Very sorry to hear that. I don’t mean to be blase about the true costs of medical errors. I think that terrible things happen to people with vigilant family members at close to the rate that they happen to people without vigilant family members. The solution to these tragedies involves truly safety focused cultures, appropriate training, staffing, etc, not advocacy.

    Here is a heart-wrenching story of a dad who advocated for his daughter, unsuccessfully, in the middle of terrible unsafe environment. The dad is a practicing physician. He could not prevent the bad outcome – the system needed to be changed. https://projects.seattletimes.com/2017/quantity-of-care/talia/

  96. Thanks, guys. And so sorry to hear that, Anon. My closest friend from college has talked about the poor care his grandfather received in a VA hospital as probably contributing to an earlier death, and perhaps lower quality end-of-life than any of us would hope for. But he said his parents and the aunts and uncles all operated under the assumption that a “veterans home” would really take care of their patients.

    So, unrelated lighter topic, you may know how I like folksy idioms. I picked up the phrase “half tight,” meaning moderately drunk (more than buzzed, less than plastered) from the lyrics of Loretta Lynn (1) and Jean Sheppard (2).

    (1) Well you thought I’d be waitin’ up
    When you came home last night.
    You’d been out with all the boys,
    And you ended up half tight.

    (2) You’re goin’ out again tonight
    And you’ll end up gettin’ tight.
    Then when your money’s gone
    You’ll come crawlin’ home to me.

    But never in a real life, modern context. So imagine my delight the other day when I was talking with this woman at work — and she is FUN — and she said something like “You can believe we’re all going to get good and tight that day.”

    However, on the Internet I can’t find any good explanation on the origin of this phrase.

  97. Scarlett and Lark —

    I meant to ask earlier: Re. that couple in the WSJ that visited 21 cities in their quest for the perfect retirement location: Which one did they end up picking!

  98. Milo – he got tight is definitely a phrase used in the home country. People were too polite to say “he’s drunk”.

  99. DD – you’ve shared before the heartbreaking cancer treatment your mom underwent. She was young and can’t help think that I would try to do the same. But you provide a good reminder that treatment doesn’t always work. I’m sorry you and your loved ones didn’t get the result your mom was so hopeful for.

    Ada, that article is so sad.

  100. @ NoB – after all that, she didn’t specifically say! But I think to a planned community in the Greenville, SC area, based on other things she said. Also, this past week was a huge article on the “revival” of Greenville, and she’s an editor at WSJ, so…

  101. Thanks Lemon. Yes that’s the point – people need to be realistic in their expectations of the medical community.

    He could not prevent the bad outcome – the system needed to be changed.

    As much as I complain about all the BS work in both nursing and NP school, we covered a lot about errors, which was very interesting and useful. The main takeaway is that most errors can be caught/prevented with better systems.

  102. Ada,

    That’s a very interesting article. Any idea why they didn’t want to do the cricothyrotomy and/or didn’t have the kit available in the ICU?

    Is there any organization that investigates these things and makes recommendation? If a plane crashes the NTSB investigates. If an oil refinery explodes the NCSB investigates. Is there a team of investigators from the National Medical Safety Board? Admittedly it’s more complicated. If a plane crashes or an oil refinery explodes we know an investigation is warranted. Just because someone dies in a hospital doesn’t mean anything went wrong.

  103. It’s really horrifying – I thought I knew where it was going (patient with neck pain didn’t get results that she was promised) and was just floored by the outcome.

    Really, the state board of health should spearhead investigations into unsafe environments and practices. The tort system has some effect on this as well. It is hard to identify what an unexpected death is – but this situation clearly meets every definition. There have been significant consequences to this series by the Seattle Times – hopefully meaningful change has happened.

    Nobody (except perhaps naive residents and ENTs) wants to do a cric. They are bloody, rare procedures with significant risk of harm. On an inpatient unit, I would argue that a bedside cricothyrotomy represents a breakdown in management of the patient – it should never come to that. Most people have only done them on cadavers. I think everyone was far more comfortable believing that there was no way possible that an airway disaster could occur. Denial meant you didn’t need the kit or the expertise.

  104. Rhett, it would be great if there was an official investigative body to do that. But as Ada said, these are litigated through the tort system, and they almost always result in a settlement with a confidentiality agreement so the facts never come out.

  105. Ada, I’m curious what your thoughts are on the point Denver and I have made about quality of life/level of comfort.

  106. Milo, your new job sounds great!

    “My mom’s CCRC was full of people who had spent 65 – 75 in New Zealand or Equador or on a boat and then at 75 were able to integrate just fine into a new community.”

    Okay, this is encouraging. SSM’s anecdote about short-term memory issues presenting an obstacle to making friends made me stop and think. It seems that I should not overthink it but just enjoy today and make plans as best I can since life can take completely unexpected twists and turns, some good and some very bad.

    I’ve definitely heard “tight” IRL. Maybe it’s more of a southern thing? Apparently one explanation is “tight as a tick”. I also see that it’s used by Ernest Hemingway.
    https://www.google.com/search?q=%22getting+tight%22+etymology&cad=h

    Medical errors are the third leading cause of death.

    As Burrows dug into his mother’s case and the failure of the eICU to recognize her coma, he came across a staggering statistic. According to a study by researchers at Johns Hopkins University, the third leading cause of death in the United States is medical errors.

    But, as has been mentioned:

    The researchers caution that most of medical errors aren’t due to inherently bad doctors, and that reporting these errors shouldn’t be addressed by punishment or legal action. Rather, they say, most errors represent systemic problems, including poorly coordinated care, fragmented insurance networks, the absence or underuse of safety nets, and other protocols, in addition to unwarranted variation in physician practice patterns that lack accountability.

    https://www.npr.org/2018/12/16/677054343/bleed-out-shows-how-medical-errors-can-have-life-changing-consequences

  107. I’m reminded of one of my H’s favorite comments at the end of a horrible work day: “But at least I didn’t kill anyone today”.

  108. Okay, this is encouraging. SSM’s anecdote about short-term memory issues presenting an obstacle to making friends made me stop and think.

    Yeah, again, my in-laws moved into continuing care and are doing fine. My FIL even got them to build a woodworking shop that he and his new friends use. Sometimes I think older people had weird ideas about how their children would take care of everything and just sulk and get passive aggressive when that doesn’t happen. As best one can, I think a key is to try to stay emotionally flexible. But I know it’s not under our own control.

  109. I have a friend whose father is fading slowly. The couple moved into the local professor-heavy CCRC, his mom had already picked out her committee to run before they moved in and she is happy as a clam running the show while he has a few guys to talk to while he still can. The most successful moves are one of two – the widowed/single/divorced church or synagogue ladies move into a community full of their friends whenever they feel the urge, or the couples move in their 70s into a congenial CCRC (can be totally new location where they know no one) and the men and women both have social circles, plus being in the “young” and still driving cohort they have other pairs to socialize with.

    The sad situations are usually the single elder who enters when fairly sick or mentally gone, especially if they have been moved to a child’s city. Although I think Scarlett’s Father (?) has done pretty well, but he was just alone not failing IIRC. The social circle doesn’t want the decrepit old ones even if they still have some capacity to socialize. For the quirky among us, the committee and stuff do not appeal, the table hierarchy in the dining room takes us back to high school, so we are often the ones who don’t want to make an early move and only go when there is no alternative with not much chance for successful integration.

  110. these errors shouldn’t be addressed by punishment or legal action

    That’s very important in order to make progress. If you’re looking to blame or punish that’s not how you eliminate the problem. You need to get down to the essentials of what went wrong at the system level.

    Ada,

    IIRC irreparable brain damage occurs starting at about 5 min. If she was respiratory arrest due to a blocked airway, why did they keep trying to intubate her for 15 min? After 3 minutes of not having any luck shouldn’t they escalate to the cric? Is that a training failure?

  111. In addition to training there could be (what the aviation industry would call) poor Crew Resource Management. The nurse was frantically paging the PA, the Fellow, etc. but somehow when the surgeon arrived he came to the conclusion that she was fine. Did the staff feel comfortable confronting the surgeon and/or pushing back against his conclusion?

  112. It seems that I should not overthink it but just enjoy today and make plans as best I can since life can take completely unexpected twists and turns, some good and some very bad.

    This +1000.

  113. It seems that I should not overthink it but just enjoy today and make plans as best I can since life can take completely unexpected twists and turns, some good and some very bad

    To that end, we actually have a separate savings (investment account) for retirement, that is not intended to be our retirement income. We’ve separated it out and call it our retirement opportunity account. That means, if a perfect retirement house comes on the market and we want to make a move we can jump on it without having to sell our current house. Or, if the opportunity to take an amazing trip presents itself we can go for it without having to move around other $$. One thing we observed with both sets of our parents was there was some real financial juggling as they transitioned from working life to retirement life. The year up to retirement and the first couple years after retirement were probably the tightest financially they had had in years. I’m trying to avoid that with this account.

    And, given our current stock market dip, I’m trying to put as much money into that account this month as I feel like I can spare.

  114. Sometimes I think older people had weird ideas about how their children would take care of everything and just sulk and get passive aggressive when that doesn’t happen.

    My in laws have three kids and expected all to take equal care of them. They never expected to have to move to where their kids were, they thought their kids would be in visiting distance. They ended up in another country, with one of their three kids. So a total 360 from what they thought when their kids were young. The real change came after college as their kids moved for job opportunities.

  115. The year up to retirement and the first couple years after retirement were probably the tightest financially they had had in years.

    Why was that? Was it a Meme’s mom like scenario where they had the money but pulling the trigger to start selling was emotionally fraught after so many years of savings?

  116. Why was that?

    It was mostly around housing. Both sets were moving for retirement, and didn’t have the cash on hand to buy another house without selling the primary house. And, they didn’t want to pull out that large a chuck from their retirement bundles, which had been set up to provide solid/steady income but not huge outlays. And then once they each bought the new houses, there are so many expenses associated with renovations/new furniture, etc. and again they hadn’t really anticipated all of that in terms of cash flow.

    Don’t get me wrong – they’re both perfectly fine and well off. It was much more of a cash flow issue and how their money was structured than an actual money problems.

  117. I only have one child and my husband is older than me. I’m not sure what my life will look like in 20 years. I’d probably never retire overseas since I wouldn’t be near any family. My parents and my husband’s entire extended family all live in the area. I think it’s awesome. We see each other weekly and my child has a very close relationship with her grandparents. I expect that we will live where my child has settled, maybe to her disliking, lol. If there are grandchildren, there’s no way I won’t be close. I would want to babysit often.

    Ha- this might be one of the downfalls of being an only child!

  118. BTW, thanks for all the kind words and insight on the DS situation. Update: he was back on even keel yesterday; I think getting all that off his chest was a load lifted, and I hope that my support helped ease the anxiety that had caused him to keep it inside. He came home and told me the makeup work he’d gotten, sat right down and started working, explained to me the things that were causing him problems and his workarounds (apparently in English it was a tech glitch), and was humming and singing as he was working. It was funny: at one point he asked if he could help me cook; I told him to finish his homework first; he kept trying to negotiate so he could help first, I kept saying no (nicely/lauging!), and every time I said no, he was still smiling and laughing — I think he was relieved to see that we were setting the structure he felt he needed, and that that structure didn’t budge when he tested it. And then at bedtime, he came up to tell me that he would still keep it up even though I am leaving town today. :-)

    I still want to circle back with him and have a calmer discussion about expectations and grades and not getting stuff right away and all of that — I have a feeling he was so worked up the other night that my words didn’t register at all, and I want to make sure he knows, deep down, that he doesn’t have to come off as some perfect kid or be better than his sister or whatever to “earn” my love and approval. But that’s going to have to wait until I get back, alas.

  119. “Ha- this might be one of the downfalls of being an only child!”

    Cubs Fan – as an only child whose mom is practically a live-in nanny… if your daughter and you remain close and can make it work, it’s AWESOME. My mom is my savior in all ways possible. I don’t think DH and I could have the life we do without her. And it works for her – she has free room/board, so her retirement is stretching a lot further (she’s one of the many seniors in financial trouble due to medical expenses and chronic conditions). And I get to watch out for her. Win-win for us.

    LfB – that is an amazing resolution. I hope it continues and keeps him positive. You did great!

  120. Rhode- I knew a family like yours too. The mom lived in the in-law suite in the basement and watched the children after school. My own parents were wonderful when my DD was in daycare. I had quite a few nights where I couldn’t make the pickup deadline. I’d call them and they picked her up for me and took her to their house, fed her, etc., until I got off work (my husband usually worked evening hours then).

  121. “The social circle doesn’t want the decrepit old ones even if they still have some capacity to socialize.”

    I saw this at my Dad’s CCRC. The turnover of residents apparently led to a reticence in investing emotional resources in other residents, especially those perceived to be the most decrepit.

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