I live across the street from L O V E.
The letters are 4' tall and adorn the brick facade of the American Visionary Art Museum in downtown Baltimore. The "L," "V" and "E" are fluorescent blue; the "O" is a red heart.
American Visionary Arts Museum in BaltimoreIn daylight, the letters fade into the building, causing me to forget that they are there. I look right past them to the activity on Federal Hill, the iconic park that surrounds the museum. Runners stretching their calves, dog owners clutching plastic bags as they wait for their pooches to sniff out the perfect spot. Children rolling down from the top of the hill to the sidewalk, shrieking with a fear that turns into laughter. On weekends, brides and grooms pose for pictures under the letters as if to label their feelings.
At night, as I sit in my rocking chair peering over the balcony, the hill recedes from view and the letters come to life. When the Realtor showed my husband and me this unit, she said, "Come out here and look. This is my favorite part — you can live in the light of love."
And most of the time I do.
Other times those letters mock me.
When I am present, in the moment, I bask in the love of my husband, children, grandchildren, extended family and friends. It fills me up — I am humbled and grateful.
My father almost said, "I love you," to me once. It was when I was a teenager and he was recovering from heart surgery. 
However, there are times that I drift to the past, jarred by jagged remnants of the long-ago pain of a fat, acne-faced child craving affirmation that she is lovable. In those instants, I feel like that heart-shaped "O" is missing.
My father almost said, "I love you," to me once. It was when I was a teenager and he was recovering from heart surgery. The doctors had told us, "The next twenty-four hours are critical. Go home and pray that he makes it through the night."
My overwrought mother took a sleeping pill to quell her anxiety. I paced. From the pink princess phone in my bedroom, I called the charge nurse every few hours for reassurance that my father was still alive.      
Devising Explanations About My Dad
When the sun finally rose, we hurried to the hospital and I tiptoed into my father's room. His eyes were closed, and he looked like a ghost encased in a web of tubing. I stood at his bedside and cried. He must have sensed I was there because he opened his eyes, looked into mine and whispered, "I should have showed you that I loved you."
Dad made a full recovery, but retreated to his pre-heart attack ways. I had hoped that, given a second chance, he'd treat me like my best friend's father who called her "my angel," like the TV fathers who snuggled with their daughters.
I yearned for a kiss on my cheek, on my forehead. A squeeze that was so tight, it crumbled my doubts of his love. 
When I tried to hug him, his arms hung by his side or rested awkwardly on my back. And he never used terms of tenderness except for an occasional, "Hi, dear." Nor did he offer the words to explain why he didn't.  
So, I devised my own explanations. He was from the tough-love generation. He was disappointed that I was overweight and not beautiful like my mother and sister. If he treasured me, the way I was, I'd have no incentive to change — and I'd never find a husband.
No Affection From My Mother  
My mother, on the other hand, was not one to control by withholding. The reason she never hugged or kissed me was because she was a germaphobe. And she never made up for her tactile deprivation with endearments because she couldn't give me what she'd never gotten. She'd had a rough childhood, an absent father, an anxious and overworked mother. Whatever nurturing she'd received, she hoarded for herself.
Even when she wilted into a shell after my father's death, when I tried to kiss her cheek, she'd turn her head away, bring her fingers to her lips and blow me air kisses.
When my mother lay dying in a senior living facility, there were no parting gifts of affection. A hospice nurse administered morphine, as I brushed stray hairs from her forehead. I took my mother's hand in mine and said, "It's okay. You can go. Go to Daddy." I waited a few seconds, summoned my courage, took a deep breath, and added, "I love you."
Silence. Not a nod, nor a squeeze of my hand.
Yet I was not ready to give up. I longed to climb into my mother's bed, lay her head in the crook of my arm, turn onto my side and cradle her until she was gone.
But I couldn't. I did not know how to give her that kind of love.
Instead, I stood at the side of her bed, my arms heavy with guilt, and watched as my mother took her final breath.
Wisdom Allowed Me to See Clearly 
My parents' lack of affection did not break me — but it did leave cracks. For a while, I scrounged about for remnants of love, and settled for attention. Whether from my diving partner at summer camp or a long-haired friend who lived across the hall in college, I hoarded any gestures that made me feel worthy.
I married, at 23, in an ill-fated effort to fill an emptiness that had metastasized. The marriage lasted 15 years, enough time to give birth to three children and an all-consuming, precious kind of love that I would never hesitate to express.
As the years between my childhood and adulthood mounted, wisdom worked like lidocaine — it numbed my pain and freed me to see clearly. I began to understand how my parents showed their love.
They showed their feelings in other ways, by deeds of kindness.
I thought back to when I was 16 years old. I had worked odd jobs to save enough money to buy my first car — a rusty jalopy. The engine died after only two weeks and I was heartbroken. A few days later when the bus dropped me off from school, a brand-new, midnight-blue Camaro waited for me in the driveway, along with an extended warranty.
I also remembered the time my parents threw me a surprise law school graduation party. My father beamed when he stood up for a toast, saying, "Every parent should feel the naches (Yiddish for pride) we feel today. We are so proud of our daughter." (My love for them kept me from disclosing that the party was not a surprise.)  
I recalled the times I was sick with minor colds or viruses. My parents would check in with me every few hours asking, "Are you feeling any better?"  Even as an adult, when I had a root canal and couldn't answer the phone, my new husband promised them, "I'll call you, if there's any cause for worry."
I spent my childhood and much of the ensuing years yearning for a love that made me feel safe, adored. For whatever reasons, my parents could not give me that intimate, demonstrative kind of affection. They showed their feelings in other ways, by deeds of kindness.
Like the sign on the museum in daylight, their love was always there, but I had looked past it. And although it was not all that I needed, it was all that they had to give.
Last night, when it stopped raining, my husband and I went out on our balcony. I pressed my palm to the cushions to see if they were wet. I nodded to indicate they were okay, and he reached for my hand.


The Missing Heart of My Childhood

Laura Black

I’ll skip right to the punchline: Check the expiration date on your passport. If you have six months or less remaining, renew it now. Really. Now.
Think your passport is valid?  Think again.Why do I feel compelled to give you advice you didn’t ask for? Because I want to spare you the nightmare I went through recently.
I’m not an inexperienced traveler. But five days shy of a long-planned trip to Croatia, I discovered that I was a blithely ignorant one, unaware of a recent change in U.S. passport rules that can render a seemingly valid passport annoyingly — and trip-defyingly — invalid.
Preparing Myself and My Passport for the Trip of a Lifetime
Back in January, my husband and I decided the time had come to realize our dream of sailing the scenic Dalmatian coast of Croatia. We researched our options online. Came up with a cruise that made us both salivate. Put down the not insubstantial fee. Purchased the pricey plane tickets. Checked our passports.
Then we kicked back and counted down the months.
Five days before our May 19 departure date, I trotted out my suitcase and a message began to nag at the back of my brain to check my passport. I ignored it and focused on packing. That night, though, the message grew so insistent that I got out my passport. The expiration date read 23 AUG 2017.
Given that my travel dates were May 19-29, I should have felt reassured. But for reasons unknown (probably something I’d read or heard on the radio without quite taking it in), my brain continued to flash a red alert. So, I logged on to the Internet and found this under “Quick Facts” on the Croatia page of the U.S. Department of State’s U.S. Passports & International Travel page — “Passport Validity: Three months past your planned date of departure.” For more information, I was offered the phone number of the U.S. Embassy — in Zagreb.
Seriously???
Panicked Actions Ensue
In a panic, I shared the information with my husband, who quickly scoured our travel documents and discovered that the State Department posting was inaccurate. According to the fine print buried in our cruise information, the expiration date on our passports had to extend six months (not three) beyond our return (not departure) date.
Suddenly, we were facing the prospect of being turned back at the airport security line. We also faced the prospect of losing every cent of the money we’d paid for the cruise and our plane tickets. Though we’d prudently purchased travel insurance, a frantic scouring of the reimbursement rules indicated that there was no allowance for a screw-up of this particular order.
In doing a little online research, search results displayed private services that, for $399 (plus a State Department fee of $170 for an expedited passport), promised to procure a new passport within days. But how could I be certain that these services were legitimate? For all I knew, I might be overnighting my valid passport into oblivion. The customer reviews ranged from ecstatic to scathing.
Not reassuring.
Eventually, I found a list of the State Department’s 27 regional passport agencies. Information on the site of the office closest to my home offered this: “If you are traveling internationally in less than 2 weeks or need to obtain a foreign visa within 4 weeks, you are eligible to schedule an appointment at this passport agency with proof of international travel.”
In addition to the usual paperwork required for a standard renewal (a DS-82 form, two new passport photos and a valid passport) the expedited application also required proof of travel plans. On the State Department's website, I downloaded the DS-82 form, and I printed a copy of my airline ticket itinerary to document my plans.
Stepping Back From the Ledge and Into the Line
At 7:58 a.m. the next morning, I began dialing the New York Passport Agency office, determined to be first in the queue. At precisely 8 a.m., I got a human being on the line who cheerfully told me that the first available appointment was for May 24 — five days after my scheduled departure date. “Oh, no!” I gasped.
The guy talked me off the cliff. (I’d read online that the Passport Agency folks are really friendly, and it was true. They don’t go all DMV on you). Calmly, he suggested that I come to the office today and stand in the line for people with no appointment. He warned that it would likely take many hours. But, he assured, getting a viable passport in time for my trip was doable.
Online, I’d learned that UPS stores do passport photos. I was outside the door of my local UPS store the moment it opened. Snap! “Like it?” the man asked, flashing the camera at me. I didn’t even bother to put on my glasses. “It’s great,” I said. (Certainly, it couldn’t be worse than my last one, which made me look like a strung-out meth addict.) Then I raced to the bus stop just in time to make the 9 a.m. bus to Manhattan.
Here's a tip: if you find yourself caught in this particular nightmare, wear sneakers. Passport Agency lines are l-o-o-o-ng. After I spent an hour clearing the ground floor entry line, I was directed to another floor, where I waited more than three hours for my number to be called. During those hours, I chatted up the staff and learned that depending on where you’re headed, your passport expiration date may need to extend anywhere from three to six months beyond your travel return date. “It’s a new thing,” a Passport Support Associate named Gilbert told me.
At the final window, I paid $170 for the expedited passport ($60 more than the usual renewal fee). The guy behind this window smiled sympathetically and told me, “A lot of the people are here for the same reason you are.” Then he delivered a final bit of bad news: Because I wasn’t leaving the country within the next 24 hours, my new passport would not be ready until the next day.
Grrr. I returned to Gilbert, who said that if I’d come the day before my departure date, I could have left with a passport in hand — provided I’d snaked through all the required lines. We agreed that seemed risky. At 3 p.m., the line for new applications closes. What if I hadn’t made it to the front of the queue by that witching hour?
A Little Charm Can Go a Long Way
As I left the Passport Agency, I chatted up Reggie, the worker at the door, flashing my best smile. Good move. He said that if I checked in with him the next morning, he’d let me go straight to the floor where my new passport would be waiting, thus averting the morning line (which begins to queue outside the agency as early at 6:45 am).
The next day, I returned to the city and greeted Reggie right at opening time, only to discover that the office was closed for a “shelter-in-place drill.” I stood. Then I stood some more. Eventually, I left with my new passport in hand, and, hey, it turned out the picture wasn’t totally terrible.
The tranquil turquoise waters of the Adriatic soon rendered this nightmare a distant memory. But it’s a lesson I won’t forget.
I know you didn’t ask for this advice, but truly, play it safe. If you have six months or less remaining on your passport, renew it now. Really.
Next Avenue Editors Also Recommend:
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Think Your Passport Is Valid? Maybe Not

Jill Smolowe

The mission of Death Over Dim Sum is to "provide space for AAPI-centric discussions about aging, caregiving, and end-of-life." "Death and dying are not topics normalized to openly talk about, especially among Asian families," says Chrislyn Choo, 29, of My China Roots, a genealogy startup. 
"There's often denial about getting older and end of life or flippant comments attached to shame [with] comments like, 'You'll wish you listened to me when once I'm gone.'" 
For these reasons, Holly Chan and Elizabeth Wong founded Death Over Dim Sum, a workshop series geared toward opening up intergenerational dialogues about life, death and beyond.  
Why Dim Sum?
Wong, 48, has been a labor and delivery nurse for over 20 years. Wong says, "My role as a nurse working with birth doulas who offer comfort and support at the beginning of life made me wonder why there wasn't a similar doula-type role in helping people as they get older and transition through the end-of-life."  
"There's often denial about getting older and end of life or flippant comments."
Wong did some research and discovered that there were, in fact, end-of-life-doulas," so she trained to become one, later co-founding Beacon Light Doulas. As a Doulagivers training partner, she set up a Facebook page to spread word about their programs, which is how she met Chan. 
Chan, 29, a user experience designer in Seattle, explains, "I have been passionate about design innovations in the funeral industry and end-of-life care since I was in high school. While I was living in San Francisco I stumbled onto Elizabeth's page and followed it. Elizabeth messaged me and we started chatting online." 
The two decided to meet over coffee. They found that despite their different upbringings, they still had much in common when it came to their experiences as second-generation Chinese American women. 
The two began brainstorming on how they could work together. Their conversations led to the creation of Death Over Dim Sum. The first workshop was held in 2019 at the End of Life Festival hosted by Reimagine in San Francisco.   
They gathered six local experts — Wong among them — on various topics including palliative care, funeral arrangements and financial planning. Frank Chui, the owner of Hang Ah restaurant in San Francisco, agreed to donate the food.  
While it may seem odd to talk about heavy topics while enjoying fried rice and dumplings, the two believe it is an ideal combination. "In my family, we often talk over food because it's easier to handle tough conversations when our bellies are warm and full," explains Chan. 
"From personal experience, I found dim sum is often a comfort food in Chinese American families, so what better way to bring people together to talk about a taboo subject than over a delicious meal?"  
Creating a Comfortable Environment
Both Wong and Chan wanted to ensure an open conversation where all participants would feel safe expressing themselves. Although not mandatory, Wong and Chan do prioritize inviting bilingual subject matter experts who identify as Asian or Pacific Islander. 
"I grew up in Chinatown, highly immersed in Chinese culture and surrounded by first-generation immigrants, many of whom spoke limited English. It's important that participants can relate to the experts, understand the information presented and be comfortable asking questions."  
Because it can be difficult just knowing how to start the conversation, Wong and Chan modeled the workshop's structure after a traditional dim sum service. "Typically, dim sum involves picking out what food you want to eat from carts being pushed around a busy restaurant," explains Chan.
"It's important that participants can relate to the experts, understand the information presented and be comfortable asking questions." 
"At the beginning of the workshop, participants pick up a 'menu' of frequently asked questions, divided by subject matter. They are encouraged to check off what questions they would like to ask the experts, but unlike at a restaurant they are also encouraged to order 'off menu' with their own questions." 
James Liu, a Healthcare startup founder in San Francisco, attended the second Death Over Dim Sum in March 2023. He returned for the third workshop, but this time as a volunteer. Liu was pleasantly surprised by the casual and approachable nature of the event. 
Liu says, "I appreciated the breadth of the speakers and the topics covered, mixing in both practical topics, such as planning a funeral and what legal documents are required, to the more emotional and spiritual, like the goals of care conversations and navigating family dynamics."  
Different Reasons to Attend  
Thanks to a grant from San Francisco Palliative Work Group, Wong and Chan have been able to hold three workshops since their inaugural event.  
Currently their workshops have only taken place in the San Francisco area but they hope to expand them to Seattle and beyond in the future.   
"They helped us face our fear, like 'Let's talk about death and dying so they no longer scare or paralyze us.'" 
Participants in the workshops have ranged in age, background and reasons for attending. Choo lives with her aunt who is in her 60s so they attended a workshop together in March 2023. "Holly and Elizabeth created a helpful, safe space for intergenerational conversation," says Choo. "The atmosphere was serious but not intimidating. They helped us face our fear, like 'Let's talk about death and dying so they no longer scare or paralyze us.'" 
Dyanna Volvek, 39, of San Francisco attended a workshop in March 2023. She explains, "My partner and I have decided not to have children. People often ask me, 'If you don't have children, what will you do when you get older? Who will take care of you and your husband?' I explain that just because you have children doesn't mean they will take care of you. But these questions got me thinking about what I would do when I am older and my parents age, so I decided to attend the workshop." 
Taking Care of Elders
In Chinese families, it is common practice for multiple generations to live together with the expectation that they ultimately become older relatives' caretakers. Wong explains, "My mother, like many in our community, immigrated to America for a better life. Our parents and grandparents made sacrifices for us, and when they age, we feel it is our responsibility to do the same for them." 
"Our parents and grandparents made sacrifices for us, and when they age, we feel it is our responsibility to do the same for them." 
This feeling of responsibility can be daunting. "I feel guilty that I might not be able to care for my parents or grandparents due to financial constraints," explains Volvek. "It was helpful to be surrounded by other people who understood my feelings due to our shared cultural upbringing." 
Anni Chung, President and CEO of Self Help for the Elderly was an expert at two Death Over Dim Sum workshops.  Chung says, "Many of the second-generation adults have moved out of the area due to high rents or new work opportunities since Covid. But their elderly relatives may be stuck here. They need to know how to help their loved ones from a distance such as how to choose a facility or how to find a local bilingual caretaker."
People Wait Too Long to Discuss
Throughout her life, Wong has had to find a balance between respecting and honoring her mother 's wishes and inserting herself into conversations that raise safety concerns as her mother ages. "Older adults don't want to lose control or be perceived as frail," explains Wong. "Suggesting they might need a cane or walker can be met with resistance and even anger." 
"It may take several conversations. You must start early, go slowly and pull back when necessary."
That is why it is essential to bring up these problematic topics before an acute issue arises. Wong says, "It may take several conversations. You must start early, go slowly and pull back when necessary, perhaps revisiting the topics in a few weeks, months or even years." 
Another reason to have these conversations sooner is cost. "People underestimate the expense of long-term care and how much is not covered by Medicare," says Chung. "At the workshop, several elderly Cantonese people spoke candidly what they need at this point in their lives and the costs." 
Shared Meal, Shared Experiences
Attending the event caused Choo to rethink some of her views on death and dying. "I realize that it is possible to integrate and honor my family traditions while exploring creative, sustainable ways of passing on in peace," reflects Choo.  
In addition to the practical guidance offered by experts, Choo's favorite part of the event were the personal stories people shared around the table. "I loved the candid exchange of perspectives," says Choo. "I learned about a grandmother who took the initiative to set aside funds for her own funeral. She didn't want her family to feel stressed or financially burdened while they were grieving. The fact that death is pricey is something I had never thought about before." 
The conversations didn't end when Choo left the event. She says, "I posted an Instagram story about the workshop, which sparked a lot of interest from peers. A group of us are talking about forming a support circle to work on our living wills together." 
The workshop was also a starting point for further discussions with her aunt and her parents. Choo says, "I told my parents about Death Over Dim Sum and it led to discussing what they might want when they die. Knowing my parents' wishes will make these decisions easier for me when the time comes." 
Not Just Sad
Discussions about the end of life are most often associated with emotions such as fear and sadness. While these are valid feelings, surprisingly, these conversations can also invoke more pleasant emotions such as gratitude, humor, understanding and empathy.  
"The most consistent and inspirational message I've heard is that the dying process contains so many profound lessons around living." 
"The most consistent and inspirational message I've heard is that the dying process contains so many profound lessons around living," says Liu. "So, I wish we could discuss them earlier and more frequently, especially as it relates to how these conversations can inspire reflection and action on how we want to live in the moment." 
Talking about death can help people live more full lives. "Rather than rushing to say goodbye at the end, it's possible to say a 'long goodbye'," explains Choo. "Don't wait until your loved one is old or ill to tell them what they mean to you or things you want them to know. Start right now." 
Death Over Dim Sum's next event will be held on February 18, 2024 from 12-3 pm at the International Hotel Manilatown Center in San Francisco.


Death Over Dim Sum

Randi Mazzella

With U.S. household debt at a record level and credit card debt topping $1 trillion, it's not surprising that paying off loans and credit cards is the most common New Year's resolution for boomers and Gen X in 2024, according to The Ascent personal finance site. The trick is actually doing it.
"If you're in the early stages of falling behind, there's still a way to work things out with your creditors to get back on track without going to the nuclear option,"Only 47% of credit card holders with balances have a plan to pay them off, a recent Bankrate survey found.
"If ever there was a year to avoid getting further into debt, this is that year."
"An increasing number of people, especially older Americans, are carrying debt from month to month. And the balances they're carrying are growing," Bruce McClary, senior vice president of the National Foundation for Credit Counseling said on the debt-reduction episode of the Friends Talk Money podcast I co-host.
Especially concerning: Interest rates on credit cards are about five percentage points higher than in spring 2022, on average, and rates on some department-store cards now exceed an eye-popping 34%. That has led to a rise in late payments.
Add Car Payments, Doctor Bills, Student Loans
Monthly car loan payments have been soaring, too, due to rising auto prices. So has medical debt, which is owed by one in three Americans.
Another problem: Student loan borrowers are facing long hold times trying to reach their loan servicers and getting inaccurate billing statements, according to a January 2024 report from the Consumer Financial Protection Bureau.
Debt has become so overwhelming that the number of people aged 55 and older filing for bankruptcy has doubled in the past 16 years, accounting for 20% of all bankruptcy filings these days, my podcast co-host Terry Savage noted.
Depend Less on Debt
"If ever there was a year to avoid getting further into debt, this is that year," said McClary. "If you become less dependent on debt and your credit-card balances are under control, 2024 is going to be a winning year for you."
Here are a few suggestions to reduce your debt load in 2024:
"It's an easy conversation to have, but you don't know what you can get unless you ask."
Call your credit card company and try to negotiate down your rate. A recent LendingTree survey found that 76% of people who asked their card issuers for a lower rate got one — often six percentage points below what they'd been paying.
"It bothers me that so few people actually think to call up their creditor and have that discussion," said McClary. "It's an easy conversation to have, but you don't know what you can get unless you ask."
Look into a 0% offer for a balance-transfer credit card. Many card issuers, eager to attract customers, dangle 0% interest rates for 18 months or so for people who transfer over their current credit card offers.
Swapping your high-rate credit card for one charging 0% might save you hundreds or thousands of dollars. You can find such offers on sites like NerdWallet and Bankrate.
Just be sure you know what the new card's regular interest rate is since you'll pay that when the 0% deal expires if you have a balance at that time. "This is not a long-term strategy; it's great in the short term," said McClary.
Find out, too, if there are fees to transfer your credit-card balance. Typically, the fee is 2% or 3% of the balance you're rolling over.
Ask About a 0% Balance-Transfer Card
Not everyone can qualify for a 0% balance-transfer card, though.
"To get one, you can't have had any late payments," said Friends Talk Money co-host Pam Krueger.
You generally also need a top credit score in the high 600s or above to get approved for a balance-transfer card. So, before applying, ask your bank for your credit score or go online and request a free credit report. You are entitled by law to one free report per year; if you need more than one, you will have to pay for the score from one of the three big credit bureaus: Experian, Equifax or TransUnion.
You Do Have Other Options
If you have a lot of medical debt, try negotiating with your doctor or hospital. You might get a reduction in the amount you'll owe by agreeing to pay the provider faster.Meet with a nonprofit credit counselor. The free session to create a debt action plan will likely take 30 minutes to an hour, either in person or by phone.The National Foundation for Credit Counseling, the nation's oldest nonprofit for improving financial well-being, never turns anyone away; its 1,215 certified credit counselors work in 250 locations around the country.A debt action plan can stop the debt collection calls and emails that heighten financial stress.If you have student loan debts, apply to enroll in the U.S. government's SAVE (Saving on a Valuable Education) plan. This income-driven repayment program, which replaced the REPAYE (Revised Pay as You Earn) plan, calculates your monthly payment based on your income and family size.SAVE lowers payments for many borrowers and it will become more generous in February. Then it will start forgiving debt in as few as 10 years if borrowers originally took out $12,000 or less in student loans, down from 20 to 25 years previously.Loans eligible for SAVE are direct subsidized and unsubsidized student loans, direct PLUS loans for grad students and Direct Consolidation Loans that didn't repay any PLUS loans made to parents. Loans that aren't eligible include Direct PLUS loans made to parents, Federal Perkins Loans and any loans currently in default.Debt Forgiveness Extended
Take advantage of the government's newly extended deadline for debt forgiveness. Originally, the program to consolidate loans for the forgiveness was scheduled to end Dec. 31, 2023. "It just got extended to April 30," said Savage.This debt forgiveness program is for Federal Family Education Loans (FFEL), school-held Perkins loans, Health Education Assistance Loans (HEAL) and Parent PLUS loans in repayment for at least 25 years.If you're not sure whether your loan qualifies, go to the Loan Breakdown part of the StudentAid.gov site."If you're in the early stages of falling behind, there's still a way to work things out with your creditors to get back on track."
If your debt load is crushing, investigate filing for bankruptcy. A nonprofit credit counselor can discuss the pros and cons and help you go this route if appropriate.In fact, nonprofit credit counseling is a required part of the process for filing a Chapter 7 liquidation bankruptcy or a Chapter 13 bankruptcy with a debt repayment plan."If you're in the early stages of falling behind, there's still a way to work things out with your creditors to get back on track without going to the nuclear option," said McClary. "But if you're facing potential legal action, that may be a more appropriate time to think about settling your debts and trying to get out of this with a pennies-on-the-dollar kind of approach."Sign up for a budgeting app to take control of your spending. The most popular one — Mint — was shut down by its owner Intuit late last year. But there are quite a few others that could be helpful.They include YNAB (formerly called You Need a Budget), Quicken Simplifi, Rocket Money, Tiller and PocketGuard. You'll typically pay $35 to $100 a year, but many of the apps have one- to three-month free trials."If you'll be using an app," said McClary, "just make sure your data is secure."


How to Get a Handle on Debt in 2024

Richard Eisenberg

Of all the latest books about retirement, you'd be hard pressed to find two more different than these: Teresa Ghilarducci's "Work, Retire, Repeat: The Uncertainty of Retirement in the New Economy" and Mark Walton's "Unretired: How Highly Effective People Live Happily Ever After."
Next Avenue thought it would be interesting to bring those authors together on Zoom and let them share their perspectives. So, we did.
"Successful unretired people not only love their work, they're fascinated with it. It naturally pulls them forward."Turns out, Ghilarducci, a progressive New School economics professor, and Walton, an award-winning journalist and leadership educator, agree on several aspects of retirement in America but have alternative takes on working in retirement.
Ghilarducci explained that her research shows that working in retirement is more difficult than many experts have insisted. She sees an ugly retirement crisis, particularly among older lower-income and minority adults. For his book, Walton interviewed chipper people working in retirement who he calls "knowledge executives and professionals."
Here are highlights from the conversation Next Avenue contributor Richard Eisenberg had with Ghilarducci, who was attending the recent American Society on Aging conference in San Francisco, and Walton, who spoke from his Palm Springs, California, home:
Defining Retirement Today
Next Avenue: What do you think the word 'retirement' means these days?
Teresa Ghilarducci: Retirement is a highly personal decision and varies by socioeconomic class, race, gender and luck. What I discovered is that most people who say they are retired were pushed out or laid off or had to leave because of their health, their sense of declining abilities or their spouse's care needs.
What did you and your research colleagues find about people working in retirement?
"Retirement is a highly personal decision and varies by socioeconomic class, race, gender and luck."
Ghilarducci: We found that when people said they were retired but also worked part-time, those jobs were often temporary and more likely to be lower paid than their career jobs, somewhat substantially.
We also found that 20% of people between 62 and 70 were working, but also collecting Social Security. So, it meant that instead of using work to delay and get a higher Social Security benefit, they were using Social Security to supplement their low wages.
You wrote that every time you congratulate someone on their retirement, you hear what you call 'shame, tinged explanations.' What's going on there?
Ghilarducci: I think that only happens in America, where the word 'retirement' denotes disuse and uselessness. There is this idea that if you can work, you have value. And there is a sense that if anybody has a pension, they're greedy geezers. So, there's shame about earned leisure.
A Unique American View
If you ask a 67-year-old woman if she's retired, she hangs her head in shame and says, 'Well, yeah, kind of, but I really am doing something.' And then she makes a list of all the productive things she does. Whereas a French woman at 67 puts on her red lipstick, her scarf and says, 'Yes, I'm retired and I'm going out to lunch.'
Mark, how do you define retirement and unretirement?
Walton: I tend to use the layman's definition that working is working, whether it's full-time or part-time, and being retired is not working.
Your book is called "Unretired." What does that word mean to you?
Walton: It means working. I would guess that perhaps 30% of the folks I interviewed are working part-time of their own choice; the rest are working full-time.
Teresa's research is primarily about folks who would like to retire at some point but cannot, and may not ever be able to, afford it. They need to work. Mine is about people who could afford to retire for the most part and have no interest in it.
Retirement and Personal Identity
Mark, you wrote, 'the more successful you've been in your career, especially financially, the more likely you are to feel like a failure in retirement.' Why is that?
Walton: It's a matter of loss. Losing your identity in a traditional retirement is extraordinarily painful.
Ghilarducci: Can I add to that? I was going to name this book 'In Praise of Retirement,' but it became more complicated than that ... If you retire, you have to decide who you are without a boss or the identity of your job. I think it's a very sensitive period.
That's the growth work we have to do. You don't need a boss to structure your day or to create personal interactions. It's self-knowing in the service of growth. When people do that, it doesn't really matter if they're employed or not.
Mark, what makes for a successful unretirement?
Walton: What I found is that there are three building blocks: fascination, flow and generativity.
Successful unretired people not only love their work, they're fascinated with it. It naturally pulls them forward.
Highest Form of Happiness
By putting the fascination to work, they experience flow — the highest form of human happiness, according to Greeks.
And then, there's paying it forward and being generative.
Ghilarducci: That's nice. What I want is for everyone to have a pension so they can sit down at a certain age and decide: 'What fascinates me? What gives me flow? What gives me generativity?'
If you don't have time to do that, you die in your boots or you die struggling.
Teresa, your book's subtitle is 'The uncertainty of retirement in the new economy.' What does that mean?
Ghilarducci: There's an uncertainty, a desperation that you'll never be able to retire. And the new uncertainty lifts up the growing reality-based anxiety that we cannot afford to grow old in America.
A Gigantic Experiment
The new economy is the product of the last 40 years of experiments providing economic security. One place we experimented is in pensions and retirement. We loaded in a lot of insecurity into those systems.
401(k)s?
Ghilarducci: Yes, and not helping pension plans flourish where they could. Congress was struggling to give more and more tax incentives to employers and employees to have a retirement plan. But the only people that respond to that are the very wealthy. So, you had this growing inequality.
The other part of the uncertainty of unretirement is the appalling difference in longevity by socioeconomic class.
When I read your two books, I felt they were polar opposite views about working longer and working in retirement. Mark was very optimistic and Teresa was pretty pessimistic. Would you characterize it that way or do you think I've got it all wrong?
Ghilarducci: It really is a tale of two retirements.
Walton: Absolutely. I would say my book is optimistic for people who can afford to seize the opportunity of continuing to work at things that fascinate them as long as they want to.
Teresa, you have this phrase in your book, 'the working longer consensus.' And I felt guilty as I was reading it because I feel like I'm part of that. The consensus is comprised of people who've said: 'We just need to work longer and that'll take care of retirement insecurity and solve retirement crisis.' But you're not buying it.
Ghilarducci: Yeah. My friend, the economist Alicia Munnell, wrote a book saying that if everybody just extended their work life one or two more years, they could make it. I've spent years refuting that assumption, asking: 'It works on the spreadsheet, but does it work in practice?' And I found that for most people it doesn't work.
Working Longer Doesn't Work
That's because of age discrimination and health issues for older workers?
Ghilarducci: Yes. Most will get pushed out. Even when people work longer, their wages are so low because wages have not kept up. They have to collect their Social Security. They've had to draw down their 401(k)s.
So, all the good things that come from working — delaying Social Security collecting and saving more — aren't happening for most of the people who are working.
"Everyone I've spoken to who is unretired tells me the same thing about themselves: They feel better."
Mark, you found that working in retirement was making unretired people happier and maybe healthier.
Walton: Everyone I've spoken to who is unretired tells me the same thing about themselves: They feel better. They consider themselves to be healthier and expect to be healthy for however long they continue to work.
But Teresa, studies you wrote about found that people working in retirement often run into worse physical and mental health issues than before. Can you talk about that?
Ghilarducci: If you're forced to work because of economic necessity past 62, you are more likely to hasten your morbidity and your mortality. There does seem to be a straight line to that.
It's especially true for women because they're often in physically difficult jobs — home health care, warehouse work. If you have had those kinds of jobs and that socioeconomic status, you're more likely to have some metabolic disorder. The class inequities just accumulate.
Proposing a Gray New Deal
Teresa, you've proposed The Gray New Deal to help people retire better or work in retirement if they want to. What is that?
Ghilarducci: The Gray New Deal requires worker training and Medicare being paid to people who are aged 60 or 65. But the most important thing to make work better is to make pensions better. We have to have universal access to a pension plan.
You want guaranteed retirement accounts where every employer would be required to offer a retirement plan that they and their employees would contribute to, right?
"Reflect on what fascinated you in your 20s and 30s ... that might be the basis of your future success."
Ghilarducci: I've updated that because that's hard. Democrats are for it; Republicans are against it. But Republicans are for a modification where everybody who doesn't have a plan will be in a government plan. We won't force the employers to do anything.
The Republicans changed my mind. That's actually a good idea. Just get the employers out of it and just have the government provide an account on top of Social Security.
Teresa and Mark: What's your advice for people in their 50s and 60s about retirement or working retirement?
Ghilarducci: Do a risk assessment of whether or not you can stay in the labor market in your 60s. Your Plan B should be very strong.
Walton: The advice I've heard from people who have continued to work is that somewhere around 60-something, it's helpful to reflect on what fascinated you in your 20s and 30s that you may have given up to do whatever it is you did to become a doctor or a lawyer or a stockbroker.
That might be the basis of your future success. Take it seriously.


A Spirited Exchange About Working in Retirement

In the fall of 2020, I was playing tennis with my pal Vini, just volleying casually without keeping score. Now and then, he would belt a shot well beyond my reach, and I would sprint after it. Only on this day, after three or four such tries in a row, I was gasping harder than usual.
"Let's take a break," I told Vini.
"I'd led a lucky life, luckier than most. If I died now, I'd have no right – none whatsoever – to feel cheated. I could, in effect, live with dying."Perhaps, at age 68, I had let myself get slightly out of shape and just needed to whip myself together.
Feeling winded in the middle of our hour-long sessions had never forced me to take a break. I had trained my whole adult life as a recreational athlete to keep going without letup, even if exhausted from my exertions, and was conditioned to catch my breath eventually. But this experience was different from anything I had ever known before.
So began the most significant health scare of my life. But I mentioned nothing about it to Elvira, my wife of 41 years.
I thought little of the incident at the time. Maybe, I reasoned, my stamina that day happened to be down a few quarts. Perhaps, at age 68, I had let myself get slightly out of shape and just needed to whip myself together. Then again, maybe, just maybe – though I never acknowledged it to myself – I had some kind of an issue with my heart.
A Persistent Problem 
Over the next few months, the problem persisted. In early 2021, I went for a jog around our neighborhood. Toward the end, I ran up an extremely steep hill, easily 100 yards long. I reached the top, panting loudly but also dizzy. I never got dizzy for any reason. I chalked the episode up as a fluke.
But then, a week later, it happened again, only worse. I ran up another hill, almost as steep, and had to stop in my tracks before getting to the top. I was dizzier than the previous time, so much so that for a second, I felt tempted to reach out to a parking meter to brace myself in case I blacked out and toppled over.
Clearly, something was wrong. But again, I set aside these inconvenient worries. I was just getting older. Stuff tended to happen. Maybe I would deal with it later. Again, nary a word to Elvira.
Then again, maybe, just maybe – though I never acknowledged it to myself – I had some kind of an issue with my heart.
Then came my final warning sign. I got into a three-on-three, half-court basketball game on a schoolyard playground nearby. About 20 minutes in, my lungs billowing away, I ran out of energy and grew dizzy. And, right then and there, in the middle of this competition, I stopped playing. Cold. I'd played hoops for 61 years, but this was a first for me. 
I should have quit the game on the spot. But pride – and the forces of denial and delusion – prevailed. So, I resumed playing. Indeed, I rationalized, I could finish the game before I keeled over dead. Still, I now knew, with a dawning sense of certainty, that I should see a doctor sooner rather than later.
Once more, I said nothing about any of this to Elvira. What if these symptoms turned out to be nothing serious? Why concern her unnecessarily? Whenever she asked me how I was doing, I would tell her I was doing okay.
Facing Serious Obstacles 
Besides, we faced another equally serious obstacle. Elvira was living in Italy while I lived in New York City, and I planned to move there as soon as possible. The coronavirus pandemic was hurtling along at full tilt, Italy its original epicenter, New York City its second. Elvira already had her hands full, keeping our family – our son and daughter, granddaughter and son-in-law – safe from the virus.
Hospitals worldwide were overrun with dying patients. Patients were delaying and canceling elective procedures and screenings left and right. How could I seek medical attention now? So, I opted, at least for the moment, to forgo a visit to my primary care doctor.
Meanwhile, I at least had the common sense to stop exerting myself as much. I avoided any activity that might leave me breathless and dizzy. I could have researched my symptoms online but decided against it. Whatever I learned would be less than definitive, mere diagnostic guesswork. Besides, did I want to know?
No. Not really.
A few weeks later, I came to my senses. I saw my physician and told him about my concerns. He referred me to my cardiologist, who subjected me to an electrocardiogram and detected an abnormal rhythm in my heart. He told me he needed to investigate further and strapped an electrocardiogram to my arm, connected to electrodes pasted across my chest, so that he could monitor my heart activity for 24 hours and evaluate the results.
Dealing With My Heart Issue 
The upshot was that I was suffering from atrial flutter, a cousin to atrial fibrillation, though less severe. My heart was beating arrhythmically, one minute fast, the next slowly, due to a defect in electrical conduction. It was unlikely to pose any immediate danger, but it was hardly nothing. Long-term, it represented a clear-cut threat. At some point, it could trigger a heart attack or stroke.
I was advised to undergo a procedure called catheter ablation. It would be minimally invasive, involving a small incision in my groin that would enable a wire to be threaded through to my heart to correct the arrhythmia. I was told the procedure was effective 95% of the time and was scheduled for surgery at Mount Sinai Hospital in New York City.
Again, I told Elvira about none of this – nothing about my breathlessness or my dizziness, nothing about seeing a cardiologist, nor his diagnosis and my upcoming procedure. I had good reason to hold off, I felt. I wanted to get all the facts nailed down first and leave nothing open to surmisal or speculation. As I've learned, sometimes, in marriage, we have to keep secrets and tell lies for the good of both parties. This happened to be one of those times.
I could die. I could suffer a stroke or sudden cardiac arrest on the operating table. And what then?
But now, in a video call, I told Elvira. And she took it, as she takes most news, more or less in stride. She accepted my reassurances that I would be okay at face value, just as I expected she would.
"I can come back to New York to be with you," Elvira said.
This was no small offer. Elvira hated to fly in airplanes. She dreaded every flight and stayed nervous from takeoff to landing. Flying to New York City to be with me also meant she would be leaving behind our daughter, granddaughter and son-in-law, all still quarantined in the strictest of lockdowns. Offering to fly across the Atlantic Ocean during a once-in-a-generation pandemic to be at my side touched me as profoundly as when she accepted my marriage proposal.
"No," I said. "No need."
The date for my surgery loomed large, and I tried my utmost to maintain a modicum of equanimity. These were reputable physicians at a world-class institution. The procedure was well-established as the gold standard. I was in otherwise excellent physical condition. What could possibly go wrong?
But, of course, anything could. The procedure could go awry. It had happened. I was scared. I could die. I could suffer a stroke or sudden cardiac arrest on the operating table. And what then?
Reflecting on Our Life Together 
I contemplated my mortality more gravely than I ever had done before. Everything would end for me. And why now? Round and round my head, this question went. Here I was on the cusp of starting a new life in Italy, reuniting with my family, only to be cut short. I would be gone, never to live in our new house, never again to be a husband, a father, a grandfather, much less a friend, colleague or neighbor.
With this new understanding of my life, a peace came over me, a peace such as I had never felt before, a peace that I now knew would see me through.
But I never said so to Elvira in any of our video calls. I was here and she was over there. Why complicate our complications? Instead, I told her I would leave the hospital all right. Again, I kept my secrets and told my lies. Specific stuff is, for the moment, best left unsaid.
But as I agonized, I reflected on my life, the whole of it. And I recognized, with a brilliant new and transcendent clarity, that I had led a good and more fulfilling life than I could ever have imagined or expected. 
Elvira and I had lived together since 1977 with no lapse in love, fidelity or faith in each other. We had raised a son and a daughter, both now decent, humane, intelligent, funny and beautiful adults. We had our miraculous granddaughter, Lucia Antonia. I had arrived at age 68 in otherwise above-average health. Even my career had proven to be a moderate success.
I'd led a lucky life, luckier than most. If I died now, I'd have no right – none whatsoever – to feel cheated. I could, in effect, live with dying. Besides, I had no control over any of it now. The anesthesiologist would knock me out, and the surgeon would do his stuff. It would be what it would be, and whatever was going to happen would happen, and I would just have to accept the outcome.
And just then, with this new understanding of my life, a peace came over me, a peace such as I had never felt before, a peace that I now knew would see me through.
The procedure went perfectly. I was in and out of the hospital within about 30 hours. The surgeon gave me a before-and-after presentation to demonstrate his success. He showed me one graph with spikes and dips showing my heart beating erratically and another with it beating smoothly.
My heart was fixed. I was good to go. Italy awaited. Three months later, my family met me at the airport in Rome.


Atrial Fibrillation: A Love Story

Bob Brody

For 15 years, Wendy Perry, 64, juggled her job as IT manager for a private K-12 school in San Juan Capistrano, California, while also caring for her mother, who passed away last year at age 101. Without a break, Perry is now stepping into her second tour of duty as a caregiver, this time for her mother-in-law.
"Over the last two decades, studies about caregiver support in the workplace have identified benefits that can be used for older parents and other dependents. But many of these studies did not consider the needs of hourly workers,"Perry is not alone. She is one of 23 million people caring for older loved ones while also working full or part-time. That is about one in every six employees, according to the National Alliance for Caregiving, a nonprofit coalition that advocates for workplace policies and practices that make life easier for unpaid caregivers.
While some employers offer in-office, remote or hybrid work options, reports show 59% of the entire labor force — approximately 90 million workers — are hourly workers who lack such options. Women and people of color comprise most of the workers without flexible schedules, and several reports found they were the largest groups leaving the workplace during the pandemic due to caregiving responsibilities at home.
Convening an Innovation Lab
The challenges for hourly employees who are also caregiving was the focus of the Rosalynn Carter Institute for Caregiving's (RCI) inaugural Innovation Lab, which focused on improving job flexibility at five small- to mid-sized employers in southeast Michigan. Outcomes and lessons learned have been published in a companion report, "Working While Caring." 
The Innovation Lab brought together small and mid-sized employers from for-profit and nonprofit sectors in southeast Michigan, each of which had many hourly workers in jobs requiring them to be on-site. The goal of the Innovation Lab was to collaborate on caregiving issues in the workforce and outline a plan of innovative solutions.
"If offering a senior care benefit helps just five employees who are caregiving stay on the job, it will save the company $200,000 related to the costs of replacing that employee."
Over the last two decades, studies about caregiver support in the workplace have identified benefits such as: paid family leave, flex time, support groups, remote work and health savings accounts that can be used for older parents and other dependents. But many of these studies did not consider the needs of hourly workers, such as helping to connect to local resources, that vary widely among urban, suburban and rural communities.
RCI  convened its Innovation Lab to consider solutions to these policy gaps. For instance, Employee Assistance Programs — services that offer employees professional help with personal problems — traditionally focused on behavioral programs (such as smoking cessation and weight management). They have provided little more than access to service representatives who can describe caregiving benefits and support services.
The Innovation Lab wants to go further, recommending specialized caregiving concierge services that include family care counseling, communication skills training and psychosocial cognitive behavioral therapy for caregivers. It also says companies need to focus on more employee education on how to manage caregiver stress, costs of care and how to navigate Medicare and Medicaid.
The Innovation Lab wants employers to ensure managers and supervisors are trained on the caregiving benefits their company offers and on communication skills to explain the benefits to employees. Most importantly, hourly workers should have access to a personalized assessment and care plan, especially for people with loved ones with dementia or mental illness.
More Laboratories Planned
The Rosalynn Carter Institute, which is based in Americus, Georgia, hopes to launch additional Innovation Labs in Atlanta and other cities.
"What is exciting about our first Innovation Lab is we are going to move the needle and not just check the box on what employers can do to help caregivers in the workplace," said Jennifer Olsen, CEO of RCI. "Over the next couple of years, the Michigan Innovation Lab will engage a Care Navigator service to help employees manage the costs, resources and programs available to help them balance work and caregiving."
Creating a care culture was the core aim of one of the Innovation Lab participants, the Michigan chapter of Volunteers of America, which provides affordable housing for low socioeconomic individuals, supports veterans with housing and other programs and runs retail thrift stores to raise funds for the programs.
"The first step was eliminating the stigma of not being able to talk about caregiving at work," said Aubrey Macfarlane, president and CEO of VOA, Michigan, who recently moved to Michigan to be closer to her older parents. "We erased all preconceived ideas of what would help our employees then we listened to them and took a bottoms-up and top-down approach so we could determine where to invest our support."
Benefits and the Bottom Line
The RCI report comes at a time when employers are realizing there is no-one-size-fits-all when it comes to benefits for caregiving employees but also that retaining these employees is crucial to the corporate bottom line. U.S. businesses lose an estimated $44 billion annually on recruiting, retaining and realizing employee productivity loss for those caring for older loved ones. In addition, the Urban Institute found individual caregivers who take a leave of absence from work can lose lifetime earnings on average of $237,000 in wages and other benefits such as Social Security and Medicare credits as well as health care coverage.
A recent Harvard Business School report conducted among employers that use Wellthy, a service that provides employees with personalized support to cope with logistical and administrative tasks of caregiving, found that companies offering caregiving support are likely to see a reduction in turnover of five to six percentage points.
"The first step was eliminating the stigma of not being able to talk about caregiving at work."
"Reducing employee turnover rates by just 1.7% is where a caregiving benefit like Wellthy starts to pay for itself," said Lindsay Jurist-Rosner, founder and CEO of Wellthy. "If offering a senior care benefit helps just five employees who are caregiving stay on the job, it will save the company $200,000 related to the costs of replacing that employee as well as win the loyalty of the caregiving employees."
An Ernst & Young survey found U.S. workplaces have four generations who are caregiving — including 42% of boomers, 48% of GenXers and 53% of millennials — while a Harvard report found 73% of U.S. workers are caregiving for a child, spouse, older parent or other loved one. Twenty-three percent of the workforce that is caregiving are caring for both older parents and younger children known as the "Sandwich Generation." 
The number of employees who are caregivers will only grow as the peak-65 group — the youngest boomers representing 4.1 million Americans who are poised to turn 65 this year and every year through 2027 — will join the fast-growing populations of 70-, 80-, 90- and 100-year-olds.
Workplace demographics are not the only thing employers can no longer afford to ignore. A study found the U.S. will lose about $290 billion a year in GDP in 2030 and beyond — more than the annual revenue of Alphabet (parent company to Google, YouTube, Nest), the second-biggest U.S. technology company — if it fails to address the care economy's two biggest issues: the workplace shortage of professional home care workers and the workplace departure of employees who are family caregivers.
Caregivers Needed
This was the dilemma for Karen Yingling, who was recently honored by Carewell as "Caregiver of the Year." Yingling, a millennial living in Duncansville, Pennsylvania, was a fulltime home health worker who was raising five children while also caring for a father with lung cancer and a mother with dementia.
"I was in a situation where caregiving was 24/7 for me — professionally with my home health clients and then with my parents and children when I got home," said Yingling. "After I lost my dad, I knew my only option was to leave my job, even though my clients were like family, to care full-time for my mom as her dementia progressed."
Senior Care Is a Key Benefit Today
A recent 2024 Care.com workplace benefits survey among 620 U.S.-based HR and business leaders, as well as 1,000 benefits-eligible employees, showed senior care support was a leading benefit request from employees. In the company's 2023 survey, the desire for senior care benefits outpaced childcare for the first time since the survey began in 2020.
"Our survey also found one in five employees have left a job because their employer didn't provide family care benefits."
That aligns with U.S. Census Bureau statistics showing that by 2034, for the first time in U.S. history, we will have more parents to care for than children. A recent workplace equity trends report says caregivers are the fastest growing employee group with many companies hosting internal employee resource group (ERG) focused on caregiving — whether for a child or for an older parent.
"Last year we had 43% of employers who prioritized senior care benefits, in this year's survey it increased to 50%," according to Ajith Segaram, head of global account management for Care.com's Care for Business division which provides a suite of caregiving services to employers including Best Buy, P&G and Trip Advisor.
Most Companies Don't Look
"Our survey also found one in five employees have left a job because their employer didn't provide family care benefits and 21% would leave one employer for another if they had access to senior care support."
One of Wellthy's clients, Hilton, who globally employs more than 168,000 "team members," many of them hourly and shift workers, was recently honored as No. 1 on the 2023 list of World's Best Workplaces. What contributed to Hilton's top ranking was its Care for All caregiving initiative that includes tools and resources to support the mental wellness and caregiving needs of team members launched in 2022.
Yet, despite the awareness, the need and the companies and organizations driving innovation, only 12% of employers currently track their caregiving employees' needs versus benefits and the 2019 Harvard study found more than half of companies do not track their organization's caregiving demographics nor conduct a yearly caregiving audit. In addition, a 2021 survey found almost half of caregivers said their workplace supervisors are not aware of their caregiving responsibilities outside of work.
Helping Employees in Need
Olsen shares that the RCI Innovationl Lab seeks to become a best practices case study to show how one group of employers, located in the same geographic region of the U.S. and sharing similar labor supply and ecosystem challenges, can make significant differences in the lives of employees who are caregiving.
She also feels another benefit of the Innovation Lab's collaborative efforts was a discussion about changing the language in the workplace so that employees see themselves at every phase along the caregiving journey, whether it is child care, spousal care, special needs care or elder care.
"We need to help caregivers struggling with caring for a loved one while maintaining their role at work," added Olsen. "We believe the Innovation Lab will help by giving us a roadmap to help caregivers and employers."


Workplace Caregiving: One Size Does Not Fit All

Sherri Snelling

She's almost 70 and has struggled to control high cholesterol levels and pre-diabetes for much of her adult life, resisting tempting treats like strawberry shortcake and French fries. But now her appetite is gone, and stage four ovarian cancer is gnawing away at her insides.
The goal of nutritional support for individuals in palliative care is to improve the remaining quality of life.She only wants ice cream, preferably chocolate with a cascade of caramel sauce. Her daughter is adamant she shouldn't have it. "Mom, you know it's bad for you," she says. But her mother is dying, and the doctor says it's essential for her to eat.
Chemotherapy and radiation treatments, particularly to the mouth and other areas involved in the digestive process, can cause tissue injury and irritation and affect eating ability.
The goal of nutritional support for individuals in palliative care (when potentially curative treatments have been deemed unsuccessful and have been stopped) is to improve the remaining quality of life. Proper nutrition impacts energy and stamina levels. 
According to Courtney Pelitera RD, a registered dietician with Top Nutrition Coaching, cachexia, wasting of the body and loss of muscle and fat are frequently seen towards the end of life. This can lead to impaired mobility, unplanned hospitalizations and increased symptoms.
Chemotherapy and radiation treatments, particularly to the mouth and other areas involved in the digestive process, can cause tissue injury and irritation and affect eating ability. Because the gut is not functioning normally and people may be less physically active, several symptoms are often seen in people undergoing cancer treatment, living with cancer or at the end of life, says Pelitera. 
These changes impact appetite and ability to tolerate certain types of foods or liquids and may include:
Appetite loss, anorexiaTaste and smell changesDiarrhea, constipation, nausea, indigestion and heartburnInflammation of oral mucosa and mouth sores, dry mouthDifficulty chewing or swallowing (dysphagia), choking episodesThe Emotional Aspects of Food Refusal and Appetite Loss
According to Pelitera, "Sharing a meal is one of the most common ways to socialize. In most cultures, people use food to celebrate milestones and special occasions. It is also sometimes used for comfort and to cheer people up. When someone is ill, visitors will often bring casseroles or sweets."
"Because hunger cues are gone, people at the end of life are not uncomfortable if they are not eating or drinking."
However, it can be very upsetting when someone you care about is uninterested in eating or refusing previously enjoyed foods. It is painful to see someone lose weight and become weaker, even though it is the disease process and not only the decreased food intake that is causing it.
The inclination to push food and prepare elaborate meals to try and entice the person to eat is counter-productive. The ill person may feel guilty, as if they are letting you down, and might try to eat even though it can cause them physical discomfort. As Pelitera explains, "Because hunger cues are gone, people at the end of life are not uncomfortable if they are not eating or drinking."
A Few Tips
End-of-life nutritional care is focused on managing a lack of appetite, minimizing food-related discomfort and maximizing food enjoyment. Family members and caregivers must listen to the individual's wishes and not be concerned with previous food restrictions to control conditions like hypertension or kidney disease (unless certain foods or drinks cause imminent or immediate danger).
Previously favorite foods may be poorly tolerated or, due to taste changes, may no longer be appealing. Foods that may cause difficulties include those with a strong odor, carbonated beverages, highly spiced foods, hot foods or drinks, and dry foods such as muffins. 
Sauces and gravies make meat dishes easier to swallow. Bland foods such as rice, mashed potatoes and bread (perhaps dunked in milk to soften) may be more acceptable.
When appetite is poor, eating smaller meals throughout the day, adhering to a strict eating or drinking schedule, and having snacks handy can be helpful strategies. Some people do better with cold foods, while others prefer room temperature or lukewarm.
Working with a dietician specializing in oncology or chronic illness can help patients and families deal with end-of-life challenges that impact nutritional status.
The American Cancer Society says frequent constipation can be worsened by dehydration, inactivity, chemotherapy or pain medications like opioids. Increasing fluid intake, especially prune or apple juice, and hot drinks such as tea and decaffeinated coffee are helpful. As recommended by a doctor, stool softeners, laxatives or fiber supplements may be needed.
High-fiber foods such as whole grains, fruits and vegetables can contribute to regularity. For dry mouth, helpful strategies include adding lemon or lime to water, using sugar-free gum or mints and avoiding alcohol and drinks with caffeine. If mouth sores are present, straws generally help decrease pain while drinking.
Pureed food, particularly meat or vegetables, is only generally enjoyed by some adults. Plant-based yogurts, ice cream, milkshakes, puddings and cream soups may be more palatable and are easy to swallow. 
For someone prone to choking episodes, thickening liquids or pureeing fruit in a blender may help. Tapioca, flour and cornstarch must be cooked and used as reducing agents or commercial thickeners may be used.
A Note on Supplements
As the disease progresses, people may be less interested in eating or unable to tolerate "normal" food and drink. "The best time to introduce liquid supplements are when people begin to skip meals or eat less. While we want them to maintain their chewing and swallowing abilities as long as possible, supplements can be helpful in insuring that the person takes in adequate calories and protein," Peltier says. 
As the disease progresses, people may be less interested in eating or unable to tolerate "normal" food and drink.
Supplements can be used in place of a meal or as an in-between snack. The two most used supplements are Boost and Ensure, which are lactose-free and generally taste better when cold. However, Pelitera says that some people enjoy them served warm, similar to a vanilla latte. They can also be used as the base for a milkshake with peanut butter or bananas blended in for additional flavor and calories.
Artificial Nutrition and Feeding Tubes
Utilizing artificial nutrition and hydration (ANH), administered via tube feedings through the nose, stomach or intestines can be controversial and wrenching as the end-of-life approaches. This is one reason a living will and health care proxy (end-of-life documents) are essential. 
These specify a person's wishes about treatment versus comfort care when they are actively dying and name a person to make decisions for them if they cannot do so. According to the Hospice Foundation of America, studies show that ANH does not prolong life in patients near death or whose disease is so advanced that they are unlikely to improve. 
In dementia patients, in particular, tube feedings may cause harm. Complications can include pain, bloating and aspiration pneumonia, and the patient might need to be physically restrained to prevent tube dislodging. In collaboration with the medical team, decisions need to be made with the best interests of the dying person in mind.
Working with a dietician specializing in oncology or chronic illness can help patients and families deal with end-of-life challenges that impact nutritional status; they can also be a source of emotional support. 
Depending upon the diagnosis, and sometimes requiring a physician referral, medical nutrition therapy services provided by a registered dietician are covered by most public and private health insurance, including Medicare and Medicaid.
The ancient Greek physician Hippocrates wrote, "Let food be thy medicine and medicine be thy food." When food or medicine can no longer heal the body, a loving presence will always be the most curative element in helping to heal the soul.


End-Of-Life Nutritional Support

Barbra Williams Cosentino

Bread, bagels, baguettes, cream puffs, eclairs, Danish, pretzels, cupcakes, croissants and pizza. You name a type of baking, and chances are Brooklynite Ira Polly, 60, has taken a class in it. "My wife and I are empty nesters, and I want a hobby that I can turn to in the future when I retire from my job as a technologist," he explains. (He writes computer code for a major national bank.)
During the pandemic, it seemed like everyone took up baking sourdough bread. For many, the desire to bake continued even after they had returned to normal life.Baking is a good fit: "I like figuring out the chemistry of baking and watching the dough rise, and it gives me something to do with my hands." 
"Our instructors can work with you if you don't have a particular piece of equipment, you realize your pan size isn't quite right or you've run out of an ingredient."
Ironically, he doesn't care to eat most of his creations, but rather prefers to give them away to others. "I bake for the satisfaction and enjoyment of making something that I hope will look like it's from a store," he says.
Online Baking Schools 
During the pandemic, it seemed like everyone took up baking sourdough bread (next on Polly's list of classes to take) as a way to pass the time. For many, the desire to bake continued even after they had returned to their regular lives and jobs. 
Enter online baking classes: Whether you are looking for live classes that are streamed into your home or on-demand classes that are pre-recorded so you can watch them at your convenience, it's now easy to find a virtual course that fits your interests and allows you to create fantastic confections without leaving your home kitchen.
King Arthur Baking Company. The largest and most prominent online baking instruction site, the King Arthur Baking Company attracts about 6,000 virtual students a year — including Polly. Their in-person classes are also hugely popular, with 15,000 students attending annually at their Vermont and Washington State campuses.
"We have had an online baking program since 2020," says Amber Eisler, director of the Baking School. "We've found that going online makes our classes much more accessible because people can bake from their home kitchens but have the same level of access to our instructors." A wide array of baking topics is covered, from sweet treats, pies and breads, to savory chicken pot pies, ramen noodles and falafel. 
You'll receive a list of suggested equipment, supplies and ingredients when you sign up for a class, but don't worry if you don't have everything. "Our instructors can work with you if you don't have a particular piece of equipment, you realize your pan size isn't quite right or you've run out of an ingredient," says Eisler.
The format for classes is a "bake-along" on Zoom with two teachers and two cameras — one focused on the instructors and the other on the baking surface, she explains. The instructors lead a group of up to 24 students through a recipe. Just as if you were there in person, you can ask questions of the instructors and share visual images of your progress and results. On-demand classes are also available, and there are lots of free recipes and baking advice posted on the King Arthur website.
A rolling pin, baking pans and parchment paper are de rigueur.
Masterclass. Starting at just $10 a month, you can take as many on-demand baking courses on Masterclass as you like, led by master bakers, pastry chefs and chocolatiers. You can also view about 200 courses on a variety of other topics. Skillshare ($13.99/month plus) and Udemy ($20/month) are similar course aggregator websites that offer access to on-demand baking classes.
Christina Tosi Baking Class, Studio.com: Taking this immersive on-demand class ($249) from the award-winning pastry chef behind New York City's Milk Bar Bakery will help you become a more confident and creative baker over the course of a month. Plus, you'll gain access to three of Milk Bar's recipes. 
Molly J. Wilk's Online Pastry School. For $28/month or $280/year, you can tap into a growing video library of French pastry recipes. Membership includes one new pastry recipe a month and one live Q&A with American ex-pat Molly J. Wilk, who attended Le Cordon Bleu and now teaches virtually from her home in Versailles, France.
Zingerman's Bakehouse. This Michigan-based company offers live pastry, bread and cake classes online, along with baking kits that provide everything you need to make their recipes.
Baking Hacks 
To get great results, take note of these tips: 
Buy essential baking equipment. A rolling pin, baking pans and parchment paper are de rigueur. You can use regular measuring cups for baking if you like, although for more professional and precise results you may want to consider purchasing a digital scale to weigh your ingredients. You may also want to purchase a thermometer to place in your oven, and a stand mixer. You don't need a bread-maker, says Eisler, although you may want one.
"The instructors will tell you how to do something, but you have to experiment with your own oven and equipment." 
For people with arthritis in the hands, a French rolling pin that is thicker in the middle and tapers to the ends on either side may be a better choice than a traditional handled rolling pin because you don't have to grip the handles. French-style rolling pins also allow you put more weight in the center of the pin rather than on the outer handles, which is really where you want to be applying pressure to your dough. 
If you can't find the ingredients or equipment you need locally, King Arthur has an online baking store that can help you get ready for class. They also sell gluten-free and keto-friendly product lines.
Get to know your oven. Baking times can differ between gas and electric ovens, and opening and closing the doors can change the temperature.
Keep a diary of what you make and how you make it. You'll likely bake something more than once. "The instructors will tell you how to do something, but you have to experiment with your own oven and equipment," says Polly.
Call the King Arthur Baker's Hotline if you need help. The company runs a baking hotline at (855) 371-2253 staffed by real-life bakers for emergency and non-emergency baking calls. You can ask them anything from "Why won't my dough rise?" to "I've run out of certain ingredient — what can I substitute in?" and "what do I need to do if I'm baking at high altitude?"


How to Go to Baking School Without Leaving Home

Nancy Monson

Author M.J. RyanM.J. Ryan, bestselling author of the recently updated book,  "How to Survive Change You Didn't Ask For; Bounce Back, Find Calm in Chaos and Reinvent Yourself" began her career in journalism as a writer, editor and then book publisher focusing on self-help topics related to sexuality, leadership and health, before leveraging her expertise to provide executive coaching services to thousands of professionals around the world. 
With bestselling titles such as "The Happiness Makeover," "Attitudes of Gratitude" and "The Power of Patience," Ryan has spent decades studying how people successfully move through change.  
Upon submitting her first manuscript on ways to make New Year's resolutions stick, Ryan realized the research she had just completed was helpful for people who had proactively decided to change but then wondered, "How do people handle change when it's something they didn't expect or ask for?"  
I spoke with Ryan via Zoom to hear her thoughts on using age to our advantage in dealing with the unexpected. The following interview was edited for clarity and length. 
Next Avenue: In your experience, where do you see older adults struggle the most with change they didn't ask for? 
M.J. Ryan: It's really easy for people to get caught up in regret. Regret around promises made and left unfulfilled. For instance, I've coached clients dealing with the death of a spouse. Widows often come in and say, 'But it wasn't supposed to be this way. We had our life planned.' Of course, it's terribly sad. Then there are other losses, from when a body changes to the world changing around us. Impermanence is true. It's why I am fundamentally Buddhist. The more we understand we're not in charge of much of what happens to us — and that we can't predict what will occur or when — the easier it is to accept and move forward. My friends and I are in our 70s, and suddenly, we can't walk like we used to. Combine all the personal things that come to us as we get older with being in a period over the last 20 years of such profound change, everything is just different.  
With so many life lessons the older we get, how would you recommend someone put any regrets into perspective, finding the positive rather than focusing on what could have been?  
"Combine all the personal things that come to us as we get older with being in a period over the last 20 years of such profound change, everything is just different. "
There's been a lot of research around the function of regret, and it turns out it's about helping us learn from and avoid it in the future. Regrets are useful to mine for any lessons you can glean. Allow yourself to ask, 'What can I be learning from this?' Sometimes, you may realize 'it's too late,' but maybe there is something you could do differently the next time around. Take your mind seriously and figure out what it's trying to tell you.  
Of course, as we age, we'll have more opportunities to experience unplanned and unfortunate events. In your book, you talk about stopping and noticing how one has moved through accepting change in the past. Can you share your idea around AdaptAbility and how your book can help those of us over 50?  
In my book and practice, I work with clients on AdaptAbility. One key component of becoming successful through change is being a lifelong learner. As we get older, more and more events will transpire we didn't ask for. I teach people to go through the process of dealing with the change. This means once someone has accepted their loss through the five stages of grief, the next step is to ask yourself, 'What can I do to deal with it?' 'And how do I get into action to deal with it?' It may sound easy, but it's hard because it's our feelings. 
If you've been downsized or outsourced, use your newfound time to discover (or rediscover) your passion. Contemplate something you loved when you were younger but haven't yet done due to other commitments. Ask, 'If I can do anything, what would I want to do?' Once you've successfully gone through all of these phases, you'll be better prepared to adapt in the future. 
Those are great suggestions to ask oneself. Yet, people are often afraid of the unknown. How would you recommend someone facing change deal with fear?  
This is a situation where age and experience can really help us. The best way to deal with fear is to remember what happened to you before. Reconnect with your experiences. How did you get through a challenging event in the past? What did you do? You may have written a letter, called a friend, or asked someone for support. The more we've lived, the more we know we can do. Fear makes us forget we already know how to accept and change. Also, don't listen to what others have done because that only creates interference; think about your experience. When we're stuck, we become disconnected from our reality. My advice is to replicate what's worked previously, rinse and repeat.  
Another thought, there's a wonderful practice that comes from Buddhism, which is to remember you are not alone. It helps to know millions of people are experiencing the exact same thing you are. And they, too, are scared, depressed or worried. When we connect to our common humanity, it doesn't feel as terrible; we don't feel as alone, and we can see the world is not singling us when tragedy strikes.  
"When we're stuck, we become disconnected from our reality. My advice is to replicate what's worked previously, rinse and repeat."
In your book, you discuss the brain's resiliency, and the fact humans can create new cells until their last breath. What suggestions would you offer to older adults regarding preparing for even expected changes? 
Practicing resilience is key. Studies show you can do things to help with resilience by focusing on positive emotions. Positive emotions help our body and minds come back into balance — because when we reduce our stress and increase our relaxation response, we can recover our mind, body, and spirits. Think of it as a teeter-totter. When you look at resilience, it's all about broadening the skills you already have and building upon them.  
For example, being optimistic about your circumstances and recognizing even though life is tough now, it won't be like this forever is one way to enhance resilience. Humor is another method of managing change and putting life into perspective. Consider, what could be funny about your situation? Next is to practice gratitude by noticing the good things in your life. Lastly, find meaning in what's going on. That's an advanced form of resilience — this isn't something you would want to do right away after a crisis. But soon afterwards. Eventually, you may say, 'That was the best thing that ever happened to me.'  However, don't say that same statement to anyone else. Doing so would deny how terrible someone else feels in the moment. Everyone needs to uncover lessons learned on their own. It's a process. It can take a while. Ultimately, remind yourself you have survived in the past. Doing so can provide the trust you will survive the next hard thing, too.  
Here are five tips from Ryan’s latest book:
Focus on the solution, not the problem. Because society rewards analytic thinking, we believe that identifying the cause is the answer: Why is this happening? That’s a starting point, but don’t spend too much time there. What are you going to do about where you are? What if you don’t believe you have the confidence or talent to find a solution? Pretend you do. Turns out that “fake it till you make it” has validity in brain science — the thoughts we hold and actions you take really do create new pathways in your brain. What really matters right now? That’s a question that will help you keep your eye on priorities. Celebrate success along the way, no matter how small: a new connection, a possible lead, a new idea. Give yourself credit for moving forward in a difficult situation. At the end of the day, look at what you’ve done and celebrate whatever accomplishment you can. Celebration creates positive energy and forward momentum. If you find yourself worrying all the time, set aside a 15-minute worry time, say 5 p.m. every day. Then when your mind starts worrying at other times, tell yourself it’s not worry time and distract yourself — read a good book, do a puzzle, something that occupies your mind.

Leveraging Age in Dealing With Unexpected Changes: A Q&A With M.J. Ryan 

Sheryl Stillman

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