The Aging of Hawaii
Price of Paradise · Hawaii Public Radio · aired 1996-07-14
Guests: Max G. Botticelli (emeritus professor of medicine, University of Hawaii); Sam Shenkus (Director of Corporate Communications, Aloha Tower Marketplace); Eleanor C. Nordyke (retired research fellow, East-West Center Population Institute)
Duration: 1:06:48

[00:00:00] Randall Roth: informed public conversations about the issues that are shaping the future of Hawaii. Today's topic is the aging of Hawaii. Specifically to what extent is our population aging, and what are the implications, what challenges and opportunities will it present? With me in the studio to discuss these questions and respond to callers are Max Botticelli and Sam Shankus. Max Botticelli is emeritus professor of medicine at the University of Hawaii, John A. Burns School of Medicine. He was born in Michigan and received his MD degree from Wayne State University in Detroit. He was an intern at the Queen's Medical Center and was a resident in internal medicine at the Mayo Clinic. He practiced in Honolulu from 1963 to 1988. He was on the faculty at the University of Hawaii for a number of years, including Chairman of the Department of Medicine from 1991 until his retirement in 1995.

[00:00:55] Randall Roth: Sam Shankus is the Corporate Communications director for Aloha Tower Marketplace. Prior to her current position, she was director of marketing for Aloha Moana Center. She's been extremely active in community affairs, having served for example, as President of Aloha Festivals and Aloha Week, as well as the Rotary Club of Aloha Moana. Max and Sam, good morning.

[00:01:16] Max G. Botticelli: Hi. Thank you.

[00:01:17] Randall Roth: We also have on the phone Ellie Nordyke, and I'm going to tell you a little bit about Ellie in just a moment, but I thought we would begin Max by asking you just real briefly to sum up the main theme of your article that's in this morning's Honolulu advertiser, page one of the focus section. What were you trying to tell us?

[00:01:36] Max G. Botticelli: Basically that having a long life is not necessarily having a good life. And too often, the last portion of our lives is spent being treated for terminal illnesses at great cost to the society and and ourselves. And that this comes about because of our inability to deal with and accept dying.

[00:02:03] Randall Roth: Okay. Um and and I'm going to come back to that because it may seem to listeners at first as though we've got two guests talking about two completely different topics, but I think they really do tie together. Sam, you've got an article in this morning's paper, tell us about the main theme of it.

[00:02:18] Sam Shenkus: Well, the main theme of my article is based on quality of life, but as a consumer and as a baby boomer, and how you will not diminish or lower your quality of life as you age. You will keep working, although work in a different way than we know it now, to generate income, to generate the money that you need to maintain a lifestyle. As you age, as a baby boomer ages, they are not going to follow the traditional patterns of aging that we have known in the past.

[00:02:54] Randall Roth: They're going to shop till they drop?

[00:02:57] Sam Shenkus: Yes.

[00:02:59] Randall Roth: Well we have on the phone, Ellie Nordike and Eleanor Nordike was for many years a fellow in community population specialist at the East-West population institution or institute. Among her many publications is a fascinating book entitled The Peopling of Hawaii, it's put out by UH Press and I would recommend it to you. I think we just lost her. Is she on the line? Oh, okay we just lost her, but we're going to come back to Ellie in just a moment. Sam, I'm or Max I'm really curious, what did you think of of Sam's piece in the paper this morning because both are your piece and hers are directed at the question of the aging of Hawaii, but obviously she's approaching it very differently.

[00:03:43] Max G. Botticelli: Oh, [unintelligible — audio glitch] thought it was great. And I think Sam's attitude about growing older [unintelligible — audio glitch] wonderful. I I guess I I think there needs to be more concern about the end of it because you can't there is a period between the end of shopping and dropping that you have to that you have to sort of deal with and and also, I think there are some critical questions about how we're going to pay for the healthcare that's required for the elderly.

[00:04:21] Randall Roth: Okay. Sam, I'm curious, real quickly, what are your general thoughts about Max's piece this morning?

[00:04:26] Sam Shenkus: Well, I I really enjoyed Max's piece. I think that what you have to realize is that as baby boomers, you have a tremendous focus on your personal appearance, on your personal health, on your knowledge, on staying ahead of the times. As a boomer ages, they are not going to follow that traditional patterns of aging that we have known in the past. They are not going to plan of laying in a nursing home bed for a period of four to five years where they're not vital and they're not in control. So, I think there are many things in Max's article that are very complimentary, because as we're all in agreement on, there is a period of time where your health will fail. And so, what do you do to maintain dignity and control and be realistic?

[00:05:22] Randall Roth: You know I think that Sam is suggesting that we baby boomers, and Sam and I are baby boomers, that maybe we have a different attitude on life. I'm curious Max, what do you think of the baby boomer generation?

[00:05:36] Max G. Botticelli: Well, you're outnumbered. I have four. Okay. And and and I think they're great. I think baby boomers are are adding a great deal to our to to our lifestyles. I I think they're more concerned with their health than than we were. And hopefully that'll turn into a vigorous life right up until the time they die. If that happens, maybe we won't have the problems that I'm concerned about.

[00:06:06] Randall Roth: Okay. We're going to invite callers in just a minute, but we have Ellie Nordike back on the line, and as I mentioned, Ellie was at the East-West Center specifically the population institute for a number of years. She's the author of the Peopling of Hawaii, and also she wrote an article that appeared on page one of the focus section this morning. Ellie, good morning.

[00:06:26] Eleanor C. Nordyke: Hi Randy. Nice to talk to you.

[00:06:28] Randall Roth: Well, great. Appreciate you focusing on the subject. Well, you are well known for having focused on it for a long time. What are your thoughts about this topic of ours today, the aging of Hawaii?

[00:06:38] Eleanor C. Nordyke: Right. Well, I look at it in demographic terms, and the elderly in Hawaii are definitely a rapidly expanding part of our population. We now have low birth rates and low death rates and this pushes up the population so that we have fewer children and a higher proportion in the elderly. Now, I did want to say that an important factor is looking at life expectancy. And our residents of Hawaii enjoy a life expectancy that's among the highest in all the world. In 1930, a Hawaii resident could expect to live only about 53 years, and today a newborn baby can expect about 80 years of life. We've been adding about 3 years of life to the life expectancy table in every 10 years recently.

[00:07:25] Eleanor C. Nordyke: And this is very significant. So that I imagine the baby boomers today, maybe living to 85, 90, who knows, even more.

[00:07:32] Randall Roth: Ellie, what is the age group of of what we call the baby boomers?

[00:07:37] Eleanor C. Nordyke: Well, the um let's see, 25 to, oh, I should have that right at my fingertip.

[00:07:44] Randall Roth: I think the oldest are 50 because I'm I'm barely in the baby boomer group, but I don't know where the younger end of that is.

[00:07:50] Eleanor C. Nordyke: Well, I thought 25 to 46 but so I think we can stretch it up to 50.

[00:07:55] Randall Roth: Okay, well then then you've got me. I've heard the baby boomer generation described as the pig and the python.

[00:08:02] Eleanor C. Nordyke: Do you know what that refers to?

[00:08:06] Randall Roth: Well I'm told that when you look at the charts, you find that that there's this this big high percentage of people in the age group that the baby boomer generation is in and so right now there are a lot of people that are you know, 25 to 50 or whatever it is but some time down the road, they're going to be up there at the 65, 70, 75 age group.

[00:08:28] Eleanor C. Nordyke: Yes, that's right. But with um with all the nice things that we have, good nutrition, sanitation, communicable disease control, and new antibiotics and other med measures of health care, we can expect this group to go ahead and live full enriched lives in the future. And I guess I go along with you and Sam hoping that our lives will be valuable and rich, clear up to the end. And and only a small percent will need the important health care that is offered to the elderly.

[00:09:02] Randall Roth: Okay, well Ellie, thank you for joining us. If you'd like to stay on the line we can come back to you a little bit later. Thanks a lot, Max Botticelli.

[00:09:09] Max G. Botticelli: Well I have a question for Ellie, good morning, Ellie. The pig in the Python paradigm suggests that we're going to have a population boom that begins with the baby boomers and ends with the baby boomers. And and certainly they're less um they're less likely to have children. They're less fecund than than we were. But it seems to me that if we continue to expand our life expectancies that the end of that baby boom generation will not signal a drop in our population, that the population will continue to to grow. Is that fair?

[00:09:53] Eleanor C. Nordyke: Well I I definitely our population, for example, the projections show in 1993 a population of Hawaii have a million 179 by 2020 our population is projected at 1,815,000.

[00:09:59] Randall Roth: And and even when we get 20 years beyond that when the baby boomers are mostly gone, the population is still going to be way up there as opposed to coming back down.

[00:10:19] Eleanor C. Nordyke: Right, but our population growth isn't related to fertility, it's related to immigration and immigration relates to economics. So, it's a little complex.

[00:10:28] Randall Roth: Okay. All right, well thank you Ellie. I want to remind listeners that this is the Price of Paradise Radio Show. My name is Randy Roth. With me in the studio is Dr. Max Botticelli, who's an emeritus professor of medicine at the John A. Burns School of Medicine, University of Hawaii, and Sam Shankus and I Sam, I think your name is Helene, right? I didn't know that until I saw your resume.

[00:10:46] Sam Shenkus: Yeah.

[00:10:49] Randall Roth: Sam is director of Corporate Communications for Aloha Tower Marketplace. Also we have on the line Ellie Nordike, who is a demographer who for a number of years was at the East-West Center with the Population Institute. Our topic this morning is the aging of Hawaii. And I think in in many ways, it's a little bit like the the many blind people touching different parts of the elephant and maybe having different things that they're envisioning about this topic. If you have any questions or brief comments that you'd like to make about the aging of Hawaii, now would be a great time to call us up. Our number is 955-8821. If you're on a neighbor island, just add 1-800. So it would be 1-800-955-8821.

[00:11:34] Randall Roth: Well, we have a, let's see. Sam, won't you make another comment and then we'll go to our callers?

[00:11:38] Sam Shenkus: Just real quick regarding the pig and the Python, I used a number in my article today, and I would like to restress that number because it gives you an example. In January of this year, January of 96, $29 billion went into the stock market. That is equal to double the entire 1990 year of 14 billion. And the reason it's an example for the pig and the python, you have millions of baby boomers who are now realizing they better come up with college tuitions and they better start thinking about their their, their, you know, not retirement, but what they're going to do in 20 years. You have an incredible surge of 401k money's being pulled out and going into the stock market because they need to make more money faster.

[00:12:36] Randall Roth: So it's not necessarily that we save better than the generation before us, it's just that there's so many more of us that when we started saving, it was more than just a a blip on the screen.

[00:12:47] Sam Shenkus: There are so many of us that are now desperate.

[00:12:50] Randall Roth: Okay. Max.

[00:12:51] Max G. Botticelli: Yeah. [unintelligible — audio glitch] would say that they're uh that the baby boomers are uh are better savers than than we were. Uh I'd have to believe that uh my at least my experience with four baby boomers is that they're more concerned about certainly about educating their children and and are preparing for that because because they they don't see the help that we thought would be forthcoming to us. I think baby boomers seem to be less dependent on government. Uh mainly because we're telling them that there won't be much around when they get to be uh elderly, and I think that'll be a very valuable thing.

[00:13:29] Randall Roth: Interesting point. Well let's go to our callers. First, Bill in Weke Kiki. Good morning, Bill.

[00:13:33] Speaker 1: Well, Randy, thank you for the show. Uh Dr. Botticelli, don't stop with your good words of advice regarding that ending period of uh of our lives, everyone should pay attention to that. Uh Miss Shankus, you made some very good points about all these billions and billions of dollars going into uh tax free savings and investments. It's rather interesting that uh Hawaii is only one of seven other states that has a state tax that does not tax one penny of anyone's pension or retirement income. Uh it was projected on one show this year on the news that a billion dollars goes into the state or is paid to residents of the state in the form of some sort of retirement, and yet we don't tax that income not one penny's worth, and I'm not talking about the little old lady or the little old man who gets $400 a month, I'm talking about the people that get 50 and $60,000 and then hold another full-time job perhaps.

[00:14:24] Speaker 1: And regarding uh Miss Nordyke, uh you must admit that with the weather being as it is and more wealthy retirees we're going to see an influx here from people around the world that will bring their pensions here and then pay nothing to the state. Isn't this an important factor that should be looked into? Thank you.

[00:14:41] Randall Roth: Okay, Bill. Some real interesting comments. Uh I I think a lot of our listeners realize, but I'm sure not all of them realize, that the state of Hawaii is uh one of the few states that doesn't tax retirement income at all. Some people think that's really great because number one, people who are retired should have some sort of tax break like that. Number two, they think that maybe it attracts some retirees and that's a real clean industry that that helps out the economy generally. But number three, and this is something Bill mentioned, some people at least feel that with high income retirees, there really isn't a good reason not to tax their income. Uh, but it's an issue that I think needs to be talked about some more. Maybe we'll do a radio show on that one sometime.

[00:15:24] Sam Shenkus: That would be good. See, one of the one of the good things about this is that we're we're getting people to talk and think about 2011. So uh Bill made a wonderful point that can be followed up. There's going to be a major follow-up to the 2011 group in the fall.

[00:15:42] Randall Roth: You know why don't we take and I'm going to go to another caller in a moment, but just uh a minute to explain what this 2011 initiative is because uh to be honest, that's where I found you, too. I was told that the two of you by accident were uh one after the other and making presentations at a conference a few weeks ago and that uh as it was described to me, you stole the show, that people really got a kick out of uh your presentations, partly because each was excellent, but partly because the juxtaposition was fascinating. Uh Sam, tell us a little bit about that project.

[00:16:12] Sam Shenkus: Well, basically, the executive office on aging, uh in the governor's uh department, what they wanted to do was pull together a consortium of the health industry, business, community leaders to address the year 2011, and what it would mean to you as a citizen, to you as a doctor, as a business person. And so, basically what they want to do is over the next three-year period have dialogue, have meaningful conversations, panel discussions, presentations, and pull together a plan of action, so that we just don't wake up and there are all of these people that we don't know what to do with.

[00:17:03] Max G. Botticelli: Yeah, um, in that regard, I think it's important to to uh pay some attention to what John Griffith said today on the in the focus section and that was that uh we have talked about planning in the past, but haven't really been very good at doing it. And uh I I think um what we have to look forward to uh is serious enough that we really have to do some some adequate planning.

[00:17:34] Randall Roth: Okay. Well let's go to another caller. One one other thing if I could just point out is that um in in regards to taxes, uh we should all remember that Hawaii has a very stiff consumption tax, uh that um that that all uh pensioners like myself, uh pay to. So Well, we try to hide that from the consumer, but you you've evidently figured out that you're paying that tax nonetheless.

[00:18:01] Max G. Botticelli: Nonetheless.

[00:18:02] Randall Roth: Okay, let's go to Larry in Weke Kiki. Good morning, Larry.

[00:18:04] Caller: Good morning. I haven't heard the word used existing for senior citizens. A lot of them are just existing. All one has to do is visit a nursing home and see. You know, how can one say we are living longer when you are just existing, not knowing night from day.

[00:18:20] Randall Roth: Let me get Max Botticelli's reaction to that, Larry.

[00:18:23] Max G. Botticelli: Well, I think that's true and I I think uh that many of us uh uh according to the definition I read some place, um I I'm in the younger elderly uh being Oh, I'm not. And um but but all of us uh I think uh in our age group, um all of us above 65 have to think about uh how we're going to spend the last few years of our lives. And as Sam said, um uh none of us want to uh spend them in a in a nursing home just existing. And uh that's one one of the important messages I think that we should uh we should consider uh in this next three year period, how how can we, how can we deal with that reality.

[00:19:08] Sam Shenkus: Sam? I think another issue is that uh as as you said earlier and we've discussed, boomers aren't counting on anyone to take care of us as we age. And what we're thinking about is what am I going to do at 60, at 70, at 80 to generate income, to maintain a quality of life, to maintain my health. I think that there will be a more aggressive approach to aging rather than kind of accepting the fact that you're growing old, I think there will be more of a defiance and more of a sense of control that I am going to do the best that I can to control my life as I age.

[00:19:59] Max G. Botticelli: I want to come back to Larry in just a moment, but I'm really curious, Sam, if currently, let's say there's some age, and I don't know what it is, but let's say when I'm 80, if it were today, I would have the various problems of old age and in in Larry's words, I would begin just existing. Even if we're more aggressive and I take my hormones and I stay active, doesn't that just push it to 90 or to some other inevitable point in time when I'm going to be confronted with the exact same issues that I would have been confronted with even if I hadn't been as aggressive?

[00:20:30] Sam Shenkus: I would counter though, that if you are aggressive and proactive in your life, you will be proactive and aggressive as you deal with death. I think there is there will be more of a reality and more of an acceptance. That's why as I said earlier, there are many things that Max wrote about today that I think are absolutely right on because as you deal with the entire cycle of life and as you focus on quality of life, if you are uh an active, aggressive 80-year-old, you do not just suddenly turn into this victim at 83.

[00:21:12] Max G. Botticelli: Yeah, so if I understand you correctly, you're saying that just because boomers as a group might have a tendency to really hang on to youth and do everything they can to stay young, once the quality of life is gone and it becomes mere existing, then you think they're not going to hang on to life the way they were hanging on to youth or trying to hang on to youth.

[00:21:32] Sam Shenkus: Unless they're very, very wealthy.

[00:21:34] Max G. Botticelli: Max and Larry, I am going to come back, but Max Botticelli, you've really opened up something interesting, Larry. Max Botticelli. Well, um uh I was reading a little bit about uh Medicare um uh expenditures and uh it's clear that uh that people who die uh the people who die um expend more money in the last year of life than the people who don't die. And uh that's because they go to the hospital when they're ill. Uh the difference between decedents and the survivors uh in expenditures is something like uh $14,000 per uh decedent as opposed to maybe $2,000 per survivor. Um, that drops uh after 85 uh to $9,000. So there's there's some realization apparently after 85 that it really doesn't make sense to spend all that money trying to exist a little bit longer, and they um they therefore don't spend as much money on that last year of life. But it's still a lot of money. It's about 8,000 versus uh 2,000 something like that.

[00:22:48] Max G. Botticelli: And that was something in your article this morning that that had an impact on me that that we talk about saving lives, but when depending on who the patient is, oftentimes it's not saving a life, it's simply prolonging it. Yes. Okay. Larry, you're the one that started all of this. What what were you suggesting with your initial comment?

[00:23:07] Caller: Well, I'm just thinking that the baby boomers don't want to face reality. That they're go they're just thinking that tubes and pills and this and that. Sure, that might extend your life and age, but are you going to be enjoying it? You're just going to be existing again. You know, I like people to go on and enjoy life, not existing. My poor mother lived 11 years and didn't know today from yesterday.

[00:23:29] Max G. Botticelli: Well, Larry, you you've really raised a provocative aspect of this night. I appreciate your call. We are getting one more comment from Sam and then we have to move on, but thank you, Larry.

[00:23:37] Sam Shenkus: Larry, the only point I'd like to make to you is that in my column, I talk about master hormones and medications that aren't necessarily what you find today. Only the very, very wealthy can take them. But you have master hormones that over the next 20 years will prevent aging. We're not talking about taking something that'll make you feel a little better. We're talking about hormones that will literally prevent the aging process and that for a certain, not everybody Larry, but for a certain level of baby boomer with money and time and motivation, that's a whole new realm of aging that hasn't even been explored yet.

[00:24:21] Max G. Botticelli: Okay. Well, let's go to Anne in Hawaii Kai. Good morning, Anne.

[00:24:25] Speaker 1: Oh, hi. I'm just listening to that lady and wondering, she's so optimistic about what the baby boomers are going to be able to do in their old age, but I'm thinking about a program I listened to recently about Alzheimer's. I think 20 to 25% of us are going to end up with Alzheimer's and um surely a tremendous amount of money needs to be put into preventing diseases like this, you know, because otherwise those people are going to be um not only a misery to themselves, but a terrific drain on the economy.

[00:24:59] Max G. Botticelli: Mm, let's get Max Botticelli's thoughts to that. Well, I think that's right on. Uh Alzheimer's disease is one of those um disabling uh non-lethal diseases that uh that make people uh or result in people existing but not not really living and and I I think we should spend a good deal more dealing with that than we should in prolonging uh life expectancies. And I think that's a key point of your article as I understand it is that you're not so much saying let's spend less on on the elderly or or less in medical care as you're saying let's get a little bit smarter about how we allocate it. Yeah, absolutely. I I you know, and so much of that has become political, [unintelligible — audio glitch] uh let let me the power of older people who vote, is that? Well, not only that, but you'll notice that we have a women's health program that's uh uh dedicated to prolonging women's lives whereas they live five more years than men uh and and Of course, and it and it affects the demographics. Uh you look uh are uh the percentage of of people uh who will be uh women uh [unintelligible — audio glitch] the la in the middle part of uh the 20th century or the 21st century uh will increase uh just by virtue of the fact that women live longer.

[00:26:20] Sam Shenkus: Well, you know, an another aspect is that in looking at your planning and your preparation as you age, uh one of the comments that I made, the tremendous uh opportunities for living the living trust. One example, think over the next 10 to 15 years, all the different variations of legal issues where boomers and people in general can financially address if I do get Alzheimer's or if my medical expenses are too high, where you have you've thought it out financially. And there'll be plenty of people around to sell you the greatest living trust plan that ever was. Remember, there are whole new careers and advertising and marketing uh campaigns we can't even comprehend that we will be bombarded with as to all these people telling us how they're going to save us money and take care of us.

[00:27:22] Max G. Botticelli: Well, we talk about the aging of Hawaii. I shouldn't be surprised that our marketing expert sees a wonderful opportunity here. Uh and thank you for your call. I want to remind listeners that this is the Price of Paradise Radio Show. We're talking about the Aging of Hawaii. With me in the studio is Dr. Max Botticelli, who's an emeritus professor at the University of Hawaii John A. Burns School of Medicine, and Sam Shankus, who's the director of corporate communications for Aloha Tower Marketplace. If you'd like to ask a question or make a brief comment, we have some phone lines open and the number here on Oahu is 955-8821. If you tuned in a little bit late and you'd like to hear the show in its entirety, tonight on KIFO at 8:00, you can hear the entire show. You can find KIFO at 1380 AM. Again, if you'd like to ask a question or make a brief comment, just check us out at 955-8821. Well, we're going to take another caller or two, and then I want to check in with Ellie Nordik to see if she has some thoughts about what she's been listening to. Let's go to Jerry in Kailua. Good morning, Jerry.

[00:28:22] Speaker 2: Good morning, Ray. Um, [unintelligible — audio glitch] kind of feel you've got some somewhat naive people on your program in terms of knowing about aging in Hawaii. Uh, there's a lot of us out here who who have been working in the issue for many, many years with Kokua Council for Senior Citizens or AARP. Uh, and who are who um would like to to have some of the energy these people talk about channel through uh something that's going to do us some good. Um, many things have happened, you know, um that people who are getting older aren't older in the way their parents were older. You know, getting older does not you're there's a lot of focus on getting sick as you get older. Most people getting older now are not getting sick.

[00:29:23] Speaker 2: Uh, you do get sick when you're older, more than than when when you're younger. But um most people have to figure out what to do with their lives. Um, the accommodations have not been made for older people to continue working.

[00:31:00] Max G. Botticelli: Where do you think? um that would allow you to do something different with your life. So so Jerry, [unintelligible — audio glitch] I understand it, you're saying there are a lot of dimensions to this, and there are some organizations out there that are that are directly involved in addressing these issues, and you're suggesting that the issue is just far more complex than what we can address in in this one radio show. It seems that that yeah, there's a lot of truth to that. Yes. um you know, when you talk about the baby boomers, uh there was a time when the baby boomers would have been considered older people, but if you notice Ellie's charts, you'll notice that they aren't even mentioned yet. They're they're younger than that.

[00:34:47] Max G. Botticelli: I know, it's scary, isn't it? I'll tell you what, Jerry, I've got a bunch of people on the line, and and you've made some really good points, and I want to get some reactions from our guests to your points, but I am going to have to move on. One thing that I would mention, um I don't know about you, but I think it's a really good sign that the the Office on Aging in the governor's office has done this um 2011 program and is trying to focus on these issues that as you point out are out there. Okay, Randy, the problem with that is that they they've now disbanded the Office on Aging. The programs for work for helping older people, like all other human service programs, are being cut and they'll be cut further. That that we need more people to get active in the community to take care of themselves through the kind of programs I mentioned like Kokua Council for Senior Citizens and AARP.

[00:35:37] Max G. Botticelli: Okay. Because um the the Office on Aging doesn't exist any longer. It was a nice program that existed, but it didn't remain a priority with Governor Cayetano, and it's being pushed into the Department of Human Services where it won't have anywhere near the status it it has had. Okay. Jerry, thank you for call your call. I really appreciate it, and we get some quick thoughts on Jerry's thoughts, first from Max and then from Sam and then we'll move on. Max? Oh, I think he's right on. Uh I don't think there's any question about about the need uh to work on making um people live better. Uh [unintelligible — audio glitch] think um uh my point would be that that I I like Sam's approach. I I think this is an individual thing that really has to come from a group of individuals.

[00:36:27] Max G. Botticelli: Uh I think that um that the things that make uh the elderly's existence better uh should be um uh thought about by marketing people, and they should come up with uh with ways of of making uh the elderly um uh uh function better and and happier. And and one other thing I there was a talk uh at this conference uh about uh improving the the architectural aspects of of our communities, and I I think uh uh so [unintelligible — audio glitch] think the he he brings them up up some good points. But but the conference did deal with other things other than what Sam and I are talking about. Well, we've got a a red phone, a special phone that starts glowing whenever somebody calls in that we need to put at the top of the list. Uh Marilyn uh Marilyn Cely, who am I believe is the director of the Office on Aging, quickly called in. I'm sure in response to Jerry's comments, so we're going to put her at the top of the list and and let her respond to that. Marilyn, are you there?

[00:37:36] Caller: Yeah, good morning.

[00:37:37] Max G. Botticelli: I'll bet you've got a few things to share with us. Can you make it quick though?

[00:37:41] Caller: I've been listening with a great deal of interest and the reason our office sponsored this conference in this year-long project is exactly to do what you folks are doing, and that's to get the discussion going out in the community. So more people will be aware of what's happening and what's going to happen in the future. I yes, I would like to say the executive

[00:38:00] Speaker 1: office on aging is still alive and well.

[00:38:44] Randall Roth: Marilyn, if if somebody one of our listeners would like to to help out in some way with this year long project, uh, who would they call?

[00:38:53] Speaker 1: They would call me.

[00:38:54] Randall Roth: What's your number?

[00:38:54] Speaker 1: Our number is 586-0100.

[00:38:58] Randall Roth: 0100. Okay. Marilyn, our lines are are full and and I apologize to you because I know you could uh say a lot more about what you're doing and why, uh but we're going to have to move on but I I very much appreciate your calling and and um providing your side of of that question.

[00:39:16] Speaker 1: Thank you very much, Randy.

[00:39:17] Randall Roth: Thank you.

[00:39:24] Caller: So good heavens, that's me.

[00:39:26] Randall Roth: I know you've been waiting so long, you thought it would never come.

[00:39:30] Caller: Well, I've been having such fun listening to you on on two uh radio FM stereo and the phone. Good morning. I have a short comment for Dr. Botticelli. He referred to the Women's Health Initiative. Uh I believe he's mistaken in thinking that it's directed to prolonging women's lives. In fact, it's directed to disease prevention, specifically cancer, heart disease, and bone fracture. Okay. A bone fracture isn't lethal, but it can certainly lay you up and make you dependent for a long period of time.

[00:41:44] Randall Roth: Okay. Well, thank you. Thank you for clarifying that. I I know Max would be the first to say it's quality of life that we're after.

[00:41:50] Max G. Botticelli: Thank you. I stand corrected. Thank you.

[00:41:58] Speaker 2: Good morning, Zenata. Good morning. Um this is in response to a statement made earlier by one of your callers with regard to uh taxation in other states of uh in uh pension income and and saying how fortunate we are in Hawaii that that's not done. I'd like to call your attention and uh also the public's attention to the public law 104-95. Are you aware of that?

[00:42:24] Randall Roth: Uh the number doesn't ring any bells. Won't you tell us about it briefly?

[00:42:28] Speaker 2: Uh anyway, this new uh law uh was passed on January 10th, 1996 and I got a copy of it from Senator Inouye's office. And it says here, part of it says, no state may impose an income tax on any retirement income of an individual who is not a resident or domiciliary of such a state and then it goes on and on. But basically what it's saying is that this new law generally prohibits any state from taxing the retirement income of any non resident of that state.

[00:43:04] Randall Roth: Yeah, Zenata, what that was aimed at was that there were a number of states in California California was the first and and the most notorious, that when somebody uh worked in California during their their working life and then moved say to Hawaii, uh California said, well, even though you don't live in California anymore, we're going to tax your retirement income because you'd really earned it while you were living in California, you're just receiving it later when you're in Hawaii, and that's what that that new federal law is aimed at.

[00:43:34] Speaker 2: I see. Okay, but uh in any case, I just thought this would be helpful information for some who are uh planning to make a move to other states.

[00:43:44] Randall Roth: Absolutely. And it it makes a move from California to Hawaii that much more attractive. So we appreciate the federal government doing that for us.

[00:44:40] Speaker 3: Good morning. I just wanted you to know at 80, uh I am thrilled with the attitude and the help that I've been receiving and that I can see is happening right this minute. What I want to suggest to you is there a possibility that some of our legislators could address the pa [unintelligible — audio glitch] plan for the future where um the early baby boomers, the people that are still active, still have income, and still are capable of partial care, uh having some sort of tax break so that they would be encouraged to take someone, possibly not their own grandmother or or mother and or father into their home and give them care and love and attention, and still have a tax break to make it worthwhile for them.

[00:45:30] Randall Roth: Elizabeth, I think that's an excellent suggestion. I refuse to believe that you're 80 years old, but I'm going to get

[00:45:36] Speaker 3: Oh, I refuse to. I'm I'm 30 uh in imprisoned in this body.

[00:45:39] Randall Roth: I see what [unintelligible — audio glitch] vigor the vigor in that voice is an inspiration to all. Uh Elizabeth, your suggestion is a really good one. I'm going to get a reaction from Sam and Max and then I have to move on, but I really appreciate your call this morning.

[00:46:13] Max G. Botticelli: I I think there are uh foster care programs uh that deal with the elderly. Um, I don't know much about them though, and I don't think that there is a an age limit, but I think there are uh foster care programs uh whether or not they're state supported or private, I'm not sure.

[00:47:15] Speaker 4: Good morning. Um well I'm only 45 years old, but two years ago, I ended up in hospital and then nursing home and adult care facility and just now coming back out. And I think that it um the speakers on the show, uh speak of speak as if there's someone who doesn't have the experience and doesn't know because there if there is a point where you need help, you need it. And all of the bravado and um, I can do it which I had, I was an international employee and traveled the world and thought I could handle it all. And there's a time when you can't, and those systems need to be in place for people.

[00:47:53] Speaker 4: I also found that um what is available for the elderly they get to that point is very sad and and very, very inefficient and doesn't fit the needs. And I loved what the last woman said about who was 80 about bringing people into your home and having programs that are available for that. Um because there aren't and there's a lot of people out there that aren't getting the help they need and to say that that you can plan at um 40 or 30 or 60 to be able to take care of yourself your whole life, I think is very naive.

[00:48:29] Randall Roth: Okay. Leslie, we really appreciate your call. I might just comment.

[00:48:54] Sam Shenkus: Well, Leslie, the one point that I would love to make to you, if you could please call Marilyn Ceely at the executive office on aging because this whole process has been brought together because in 20 years, in 2011, we know that we're going to have a tremendous need and what you've gone through and experienced, you would be invaluable in helping this this office, the executive office on aging in helping to look at issues that need to be addressed.

[00:49:40] Max G. Botticelli: Well, just one quick comment. [unintelligible — audio glitch] don't think Sam nor I really wanted to give anybody the impression that we don't think nursing homes are are valuable and uh resources for our community, they certainly are. I think the point we were trying to make is that we didn't want to spend the last year or so of our lives uh just existing in one and we'd uh we'd both of us, I think, would rather die than than do that.

[00:50:08] Eleanor C. Nordyke: Well, fascinating. I just want to add a little positive factor compared to the United States, our elderly have a higher percent who are married. We have a higher sex ratio of males to females, and we also That won't matter in terms of marriage uh in a little bit Ellie, but but go ahead. That wellbeing We also have a higher percent of elderly who live in the family relationship and that means that they're cared for and nurtured at home and are also feeling important because they get involved in in helping to care for the family and I think this adds to a healthy elderly existence.

[00:57:00] Speaker 1: And also, uh, the patient autonomy is an important issue, uh, social issue, uh, that that uh, physicians support, uh, and uh, and rightly so. So, patients are given alternatives that are not really in their best interest. And uh occasionally I think that's done for economic reasons, but the vast majority of that is just done because, uh uh, we think that patients on to make the decision.

[00:57:34] Speaker 2: First of all, And some of it because they're afraid of being sued, I And because they're afraid of getting sued.

[00:57:39] Speaker 1: A reality in our litigious world.

[00:57:42] Speaker 2: Sam, what do you think of all of this that you've been listening to?

[00:57:44] Speaker 3: Well, I have a question. Um, in looking forward to say the next 10 to 20 years, uh, are there going to need to be in the medical community, I would assume as an example, master hormones. Already uh, with very limited distribution, it's a 10 billion dollar business. So you just think the millions of baby boomers that are going to want to either for vanity or for whatever, want to, you know, do their best to prevent aging and look their best. What happens as you have this incredible merchandising empire of hormones for lack of a better term, is the, is the medical community going to have to create some type of a watchdog or some type of a, a patient review process.

[00:58:45] Speaker 3: I mean, think about it. We can put this incredible stuff in our bodies, who's going to monitor that?

[00:58:52] Speaker 1: Well, uh, I I'm not sure. I think one way to to take care of that problem is to make sure that it's not uh, it's not funded by Medicare. So that if people want to spend $20 billion on uh, master hormones to to, to avoid aging. and and other things else, then then as long as it's not if they do it on their own pocket then that's perfectly okay. Um, I I think uh the federal uh, the FDA, uh, has uh has a lot of power to withhold uh, uh drugs from the market and over-the-counter market, and, uh, and they'll continue to do that as long as there isn't too much pressure on them. Political pressure.

[00:59:40] Speaker 2: The the last topic that I wanted to to address, and and Max, you mentioned, um, this briefly a little bit earlier, was kind of this this spiritual aspect of all of this, and Max, I know in your piece, you suggested that that, uh, generations before the baby boomers were maybe a little bit more focused on, uh, what lies uh, after life, uh, heaven or, or however that person's religious, uh, traditions defined it. And uh, and that maybe the baby boomers in particular are more focused on, uh, today and materialism and shop-till-you-drop type, uh, thinking. A couple of comments on that, and then we're going to have to wrap up the show.

[01:00:19] Speaker 1: Well, uh, the example I like to give is, is in my own family. Uh, my mother uh, was, uh, born in Italy, very very poor family. Uh, got to the United States, uh, and um had a had five children during the depression. So, uh, her life wasn't a very, a very easy one, although I think quite happy. Um, she uh, was able to to deal with this by, by offering this up to God and and felt strongly that this was uh, this, this would end up, her happiness would come in in heaven. Uh, her children, uh, me included, I don't think bought into that quite so, uh, fervently, and certainly my children, uh, don't even think about heaven, I don't think, although I may be mistaken.

[01:01:14] Speaker 2: Now, wait a minute, our red phone is glowing again. I think we've got a call from one of the Botticellis. Uh, Sam, what do you think about that, the spiritual aspect of this, and then we're we're just about out of time.

[01:01:26] Speaker 3: Uh, the short version is that I think you have a tremendous spirituality in baby boomers, but they, it's it's again, it's a different form. It's community service, it's chauffeuring their children around to soccer, 30 and 40 hours a week. I think it is different, but I think that as you get older, you get more spiritual, and I think maybe that's a generational shift that probably another new career, in 15 years, will be religion, because a lot of those pigs in that python are going to decide that maybe they need to think about issues more.

[01:02:08] Speaker 1: Yeah, that that's probably another show, but I think that's a problem, uh, you know, because, uh, I think the focus of this, uh, new age religion, uh, is, uh, on, uh, on the sanctity of life, uh, and that means you shouldn't die, uh, and on, uh, the possibility of miracles to keep you alive forever. Yeah, and I I think that's a very serious, uh, cultural problem that we're going to have to deal with eventually.

[01:02:35] Speaker 2: Okay. Well, I want to thank uh our guest Ellie Nordik, Dr. Max Botticelli and Sam Shankes. Uh, I think this has been a real interesting conversation. Again, that phone number for the uh executive office on aging is 586-0100. Our sponsor is the Hawaii Community Foundation, our technician is Philip Hutchinson and our producer is Susie Roth. Uh, last week, due to technical difficulties, many of you weren't able to hear our show. It was a particular particularly interesting conversation with Bank of Hawaii chief economist Paul Brewbaker and UH ethnic studies professor Knoll Kent. So we decided to go ahead and, uh, replay that show next week, and that's what you'll be hearing. I think you'll enjoy it.

[01:03:19] Speaker 2: You've been listening to the Price of Paradise radio show. I'm Randy Roth, Aloha.

[01:02:59] Randall Roth: Last week, due to technical difficulties, many of you weren't able to hear our show. It was a particular particularly interesting conversation with Bank of Hawaii Chief Economist Paul Brewbaker and UH Ethnic Studies Professor Noel Kent. So, we decided to go ahead and replay that show next week and that's what you'll be hearing. I think you'll enjoy it. You've been listening to the Price of Paradise Radio Show. I'm Randy Roth. Aloha.