Supporting those organizations that provide support

When I was growing up, one of my family’s summer traditions was to watch the Jerry Lewis MDA Telethon every year. I don’t know if it was because my dad worked at the hotel where it was filmed, because we loved old Jerry Lewis movies, or just because my parents felt so blessed to have three healthy children, but we would all curl up in my parents’ bed and watch into the wee hours of the night. And every year, even when money was tight, my parents always made a pledge.

As an adult, I know that feeling of being blessed. My husband is a pediatrician who works in the intensive care unit and I work with many families struggling with serious illness and disabilities. Even though our son has special needs, we have never had to face the difficulties that many of the families we see live with every day.  We have also seen firsthand how charities and support groups can provide a lifeline for these families. Therefore, we try to give back as much as we can by volunteering and donating.

At WanderPolo Law our mission is to ease the burden on families facing challenging paths. We also know the importance of supporting organizations that provide services to seniors and individuals with disabilities, as well as support and outreach to caregivers and families. Mary and I are involved in several caregiver support groups and later this month I will join the Board of Jewish Family Service of North Jersey.

But this spring WanderPolo Law is also focusing on showing our support with our feet. In April, Mary ran the Caldwell College Autism 5K Run (and placed first in her age group!). And on Sunday, May 20th, the whole office is getting involved with the Walk Now for Autism Speaks.  Autism is the second most common developmental disability in the United States, and families struggling with this or other special needs rely on organizations like Autism Speaks for services, support and advocacy.  If you want to join our team or donate, follow this link.

Happy walking!

Shana Siegel, Esq. CELA

Moving forward–it is worth the effort

I spoke before a community group today and afterwards I was talking with a few parents. One mother of an adult child with developmental disabilities spoke about how she wrote a Letter of Intent for her son. Actually, what she described was far beyond the template that we provide clients; she prepared a full book about her son’s condition, daily life, her goals and wishes for him. She said it took her weeks to put together. But I was struck when she described the sense of relief she felt once it was completed. She said she felt that she could finally move forward with her life now.

I know that feeling all too well…that paralyzing fear that special needs parents feel about the future. Will my child be able to live alone and if not, who will be there for him? We are so used to being the only one who knows what will set our children off and what foods they will actually eat. A Letter of Intent can allow us to begin to let go just a little. It allows us to have a conversation with our child’s future caregivers and pass along everything we would want them to know.

Legal planning is the same really. It is difficult to make yourself do it. It isn’t unusual for my clients to let months go between our initial appointment and finally executing documents. However, when they are done – and have the health proxy, special needs trust, Will and whatever other documents they need – they always express that same sense of relief. It is so wonderful to see a client’s whole body relax as we develop a plan to prepare for the future.

I encourage you to take that first step…really you will be glad!

Shana Siegel, Esq. CELA

When should we talk about dying and death?

I’m throwing a dinner party in a few weeks.  8 people are coming.  We are going to watch parts of the documentary “Consider the Conversation” and talk about our own personal feelings about how we want our lives to end, what kinds of medical interventions we want, who we want to be with us, what we want done with our mortal remains, and we will all, hopefully, come out of it feeling a bit more comfortable talking about the one life journey that we will all take someday.  So, consider having the conversation, and having it again, and again!

It seems to me that we must all know that we are going to die.  Admittedly we can’t know for sure if we will get old, and we can’t predict which of us will even have the opportunity to refuse treatment or linger with a long term illness, but we will all die.  So why are we so reluctant to talk about it?  The New York Times published an op-ed piece on March 30, 2012 by Susan Jacoby.  She is the author of a new book called Never Say Die: The Myth and Marketing of the New Old Age, which I am currently reading.  In her op-ed piece she talks about the cost of care at the end of life, and what a drain on our medical system this is.  She also talks about how public opinion polls consistently show that the majority of Americans are worried about being kept alive longer than they want through medical intervention.  She quoted a Pew Research Center poll from 2006 in which only 22 percent of the respondents said that a doctor should always try to save a patient’s life, while 30 percent believed that patients should sometimes be allowed to die.  More than half of the respondents said they would tell their doctor to end treatment if they were in great pain with no hope of improvement!

However, only 69% of the respondents indicated that they had discussed end-of-life care with their spouse; only 175 (40% of those over 65) had done so with their children!

Statistics show that only one-third of Americans have a living will and even fewer have appointed an agent to make medical treatment decisions for them if they can’t make the decisions themselves!  Why is this?  Perhaps because we have trouble beginning the conversation about end of life, and so, like most things we find difficult, we put it off.  This may be the biggest frog we have ever avoided eating!

So, I offered this dinner party at a service auction at my Unitarian Universalist Congregation last fall.  My friend, Mike, told me no one would bid on it, and he is usually right about most things.  I admit that it wasn’t one of the hotly contested items, but it did sell all of the available seats and the people who purchased it have told me in the intervening months how excited they are about having the opportunity to have this conversation.  Several of the people who purchased the dinner are married couples, and at least one is a daughter/mother couple, where the daughter purchased the dinner party for her mother so that they could have this conversation in a comfortable setting. I hope I can provide that.

So, what will we discuss?  We will watch segments of the documentary, “Consider the Conversation,” broken up between appetizers and the main course.  The movie presents an inside view of the dying process in hospitals and nursing homes, hospices and at home, across the United States and provides thought provoking insight from people working in the field of Palliative Care and medicine.  Then we will have dessert and hopefully be actively talking about the end of life and what we each hope ours will be like.  Everyone will leave with an advance directive to work with, a health care proxy completed if they like, and hopefully an ongoing conversation with their loved ones about how they want to spend their final moments with their loved ones.

Light It Up Blue for Autism

This past week it was reported that autism rates have increased 80% in the past decade. New Jersey has one of the highest rates in the nation with one in 29 boys in the state having an autism spectrum disorder. Two of us at WanderPolo Law have close family members who breathe life into that statistic for us.

Monday April 2^nd is World Autism Awareness Day. Many advocates and businesses are commemorating the day with the Light It Up Blue Campaign featuring blue lights to “shine a bright light on autism”. The goal of the campaign is to increase knowledge about autism and education regarding the importance of early diagnosis and early intervention.

In New Jersey, we are lucky enough to have health insurance legislation requiring most private insurers to cover the costs of screening and diagnosing autism spectrum disorders, as well as therapies and behavioral interventions. This means that many more children can receive services that can literally change their lives. For more information on the law, go to http://www.autismvotes.org/atf/cf/%7B2A179B73-96E2-44C3-8816-1B1C0BE5334B%7D/NJ_FAQ.pdf 

Mary and I are running in the Caldwell College Autism Run April 21^st and next month WanderPolo Law will be participating as a team in the Bergen County Walk Now for Autism on May 20th. Look out for a link to donate on our website www.wanderpololaw.com coming soon.

Don’t forget the lights,

Shana Siegel, Esq.

A place called home

Riding the Bus with My Sister is the kind of book that you want to tell everyone you meet to read.  It is the story of the author’s deepening relationship and understanding of her sister who is developmentally disabled, as well as her own personal growth through sharing her sister’s favorite pastime of riding city buses.

There are so many wonderful insights in the book about how we perceive people, especially those with developmental disabilities, as well as thought provoking discussion of the balance between advocacy, protection and self-determination. However, one of the most poignant scenes is when the father desperately approaches his three adult children and asks them if they will share in the care of their sister by each taking her for one weekend a month. They each decline albeit with great emotion and guilt. While my initial reaction was one of anger and disappointment, I quickly turned to thoughts about how this event led to the place the author and her sister had come by the end of the book.  Both sisters lived happily independent and were there for each other without feeling burdened.

Parents of developmentally disabled adults often assume that living with family is the best option for their disabled child. And sometimes it is. For other families, this is not the best, or even a viable, option. Often this can be a source of great conflict in the family as parents expect siblings to take over the care of their disabled siblings. Other times parents are frozen with fear and indecision and so they fail to make any plans for the future.  

Riding highlights one possible solution – how a family member can be a caregiver without living with the disabled adult, thereby granting both siblings the independence they both needed.  Unfortunately it took this family a long time, and alot of anguish, to come to this place. Parents with a child with special needs can make this an easier road with proper planning.

Enrolling your child with the state agency for development disabilities is the first step. This should be done when your child is still a minor because it is not uncommon for agencies to have wait lists exceeding ten years. Your case manager and a special needs attorney can help advise you about residential options like group homes (informal or formal), supported housing, private homes and subsidized housing for individuals with disabilities. It is important to consider related public benefits issues as well. Knowledge is power and with the right planning every family can find the best solution for them.

-Shana

Aging children, I am one.

Ok, so I had an accident in the kitchen the other night. It was a skirmish between a paring knife, a stubborn avocado pit, and my left pinkie.  My pinkie lost.  Four stitches, several hours and a tetanus shot later, I am still bothered by how this little event dovetails with a societal issue that has been worrying me lately. 

I was home alone when I cut myself.  I called three friends before I found one who was answering her phone and able to jump in a car and run over to my house to confirm my fear that I needed stitches, and then to take me to the ER and wait around.  What if she hadn’t been available?  Would I have called 911?  It was just a bloody cut on my finger.  Probably not, and then what?

 We all underestimate how much we need the assistance of others, and this is going to be a big problem as my generation ages, and one that I think our society should be preparing for now.

I’m not so sure that it is a new problem, just one that we will be seeing on a grander scale because of the size of my generation.  One of my elderly neighbors died in January.  She was a single woman (I’m sure her contemporaries called her a “spinster lady”) who was always independent.  Even at her advanced age she still walked around the neighborhood daily picking up the trash people threw from their cars as they sped down our street.  Unfortunately, although the neighbors were all “nodding friendly” as my mother would say, and we checked up on her pretty regularly, shoveled her walk, raked her leaves and mowed her grass, this neighbor died alone in her house and none of us noticed for several days.  It was winter, after all, a mild one with no snow to shovel. We all work all day.  She didn’t like people bothering her or coming into her house. . . . There are so many other reasons that I can think of, but honestly, none of them is really a good enough reason, is it?  No one should die alone, and no one should remain in their home, alone, for days after they die.  But I am afraid that this will be happening more and more often as my generation passes from active adulthood to old age and on to death.

 Just today I read an article from the New York Times entitled “More Americans Reject Marriage in 50s and Beyond”  (http://www.nytimes.com/2012/03/02/us/more-americans-rejecting-marriage-in-50s-and-beyond.html?_r=1) which indicates that more and more of my generation are divorcing in their 50s and choosing not to marry but to live independently!  Who will be with them when they are ill or dying? 

 Then there was the Op Ed piece by David Brooks about the Talent Society (http://www.nytimes.com/2012/02/21/opinion/brooks-the-talent-society.html?scp=7&sq=talents&st=cse) in which he cites to statistics indicating that more than 50% of adults are choosing to be single and develop our talents!  We better hope some of those talents engage us with close friends who will be there when we are ill or passing on! 

 But then look at Jane Brody’s column from the Times this week, http://newoldage.blogs.nytimes.com/2012/03/02/when-i-needed-help/ discussing how it doesn’t really always work to ask friends to help you, and her own failure to realize when it was appropriate to arrange for professional personal care in the home!  

 A friend has been talking to me about her older friend who is living in his home in squalor, and not treating his diabetes.  It seems the only recourse in New Jersey is to call in Adult Protective Services.  They will most likely remove him from his home.  Are there alternatives?  Should there be?  What could have been done by his community to prevent this drastic turn of events? As a society, do we want to work towards developing community services that would avoid these terrible endings?

 So, what steps can we take?  Find out what your town is doing for the seniors now, and whether they have a long range plan in place to deal with issues of care, transportation, (see www.itnamerica.org  information about starting a shared transportation organization), dying alone (see http://www.supportivecarecoalition.org/LeadingPractices/noone_dies_alone.php and http://www.thetwilightbrigade.com for organizations that provide a human presence for those dying alone) simple home maintenance, all those things we don’t ever think we will need help with! 

 So, I’m worried, and when I worry I usually have to do something concrete about it.  Don’t you? 

Professional Geriatric Care Managers or How Wishes Can Come True

Anyone coping with a family health change, whether because of illness or disability, is in the midst of a potentially bewildering situation.  The illness or disability presents immense personal challenges in a family. At precisely the same time, as the family is coping with the actual illness, there is a huge set of important decisions to be made regarding health and nursing services, with deadlines, elimination periods, limitations based on time, medical needs, physical needs, financial resources, and overlapping benefits.  You will find yourself thinking, “I wish there was someone who specialized in this field!” This post is to let you know about Geriatric Care Managers, the professionals you can look to for help with the logistics of coordinating elder and disability care arrangements.

The Problem

Here is what is confusing: there ARE many social workers and benefit counselors in this field.  They are employed by hospitals, nursing homes, insurance agencies, Medicare and Medicaid to help you navigate through your loved one’s health or disability needs, and you will get to work with all of them. They are all “helpful”, but their loyalty is to the person or entity that signs their paycheck, and that is neither you nor your mom/dad/loved one, and they can each only “help” with the small part of the puzzle they control, and only during their limited work hours.  You will be juggling shift changes and have new workers to bring up to speed all the time.  Of course, you can always turn to a Certified Elder Law Attorney for assistance, but even they may not have the medical expertise you need when trying to determine the most appropriate placement option.

The Solution

But there is another resource: a Geriatric Care Manager (“GCM”).  If you have ever found yourself thinking, “I wish there was one single person who can answer my questions about home care, nursing homes, rehab and which benefits cover which types of care! Who can also explain how many days of Medicare coverage I have used! Who can also explain what happens when Medicare runs out!  Who understands the different Medicare coverage parts, and what other kinds of insurance my loved one has! Who can advise which institutions would be right for him, and can explain how I decide whether he can be cared for at home! I wish that someone would even help me make some of these calls, work through some of these papers, and give me advice on how to do this!” I am writing to say sometimes wishes do come true.  A GCM is a professional who can help with all of these issues. And GCMs exist not just in a worried caregiver’s dreams, but in real life.

What is a GCM? 

A Geriatric Care Manager is a specialist who helps families who are caring for older relatives.  A GCM can be from a number of professions—nurses, gerontologists, social workers, or psychologists.  A GCM has a specialized focus on issues related to aging and elder care.  Many GCMs are expert in assistance to younger disabled people and their families as well.

The best GCM is someone who you can trust to anticipate your needs and to steer your family through the maze of services and decisions as they unfold.  The National Association of Professional Geriatric Care Managers, (“NAPGCM”) began issuing certification to individuals based on a set of standards in 2008. Here’s their link: http://www.caremanager.org/ .  If you have the time, those standards are worth consulting. Here’s the link to their standards for certification: http://www.caremanager.org/about/standards-of-practice/ . Certification with this organization is a good rule of thumb in finding someone who can provide the kind of assistance you will need.

What should I look for in choosing a GCM?

All GCM’s are not alike.  There is no legal requirement for licensing or certification. There are differences between helpful GCMs and Care Managers, even those employed by a good geriatric service provider, who were of limited assistance or comfort to the family who had hired her organization.   Based on a review of the standards of the NAPGCM, certification with that organization should guarantee the GCM’s competence and effectiveness.  Other than certification, two things which will be good indicators of the likelihood that a GCM will be able to help you with managing the needs of your loved one are:

1.            Someone who has extensive experience in the many aspects of managing geriatric care in your geographical region or specific municipality. This may seem obvious, but while there are very kind and willing people who may have lower per-hour prices than a Certified GCM, in the long run they are not a bargain because they simply don’t have the vast base of knowledge necessary to guide a family through this difficult process. They should not be learning the field while trying to help you with your crisis. Their experience benefits you because, for example, they have seen many of the rehab facilities in your area, and they are familiar with their admissions policies.  Often hospital social workers have never seen the facilities where they send referrals.

GCM’s sometimes describe their expertise as being “professional daughters,” but as wonderful as that support sounds, an experienced GCM can provide so much more than that.  A good GCM saves time, saves confusion, and often lowers costs by helping a family get the full benefit of their insurance and government coverage.  GCM’s use the skills of a social worker, a nurse, and a benefits-counselor.  A good GCM will tell you what she knows and what she doesn’t know, and will be able to quickly research and answer any questions which are specific to your situation.

2.            Someone who is available and accessible when you need them.  Again, you say, “of course.” But I have seen families who played phone-tag for days, with the stress of uncertainty; not knowing when or if their paid Care Advisor would be able to answer their questions regarding available services.  In another instance, the weekend hospital social work staff threatened to discharge an elderly patient to a truly scary looking rehabilitation facility, but the family’s Care Manager was not accessible on weekends, or was away on vacation. A good GCM will have a strategy to work with a family throughout the crisis, and to have competent coverage for your case every day.  They will have a clear and easy plan to work with your schedule and your availability so that they give you the support you need, when you need it.

GCMs help families cope.

Elder care crises are overwhelming—both emotionally and logistically.  With all the difficulties and frustration during emotionally trying events, it is a relief to find professionals who can provide the specific help families need.  With a good GCM to guide you through the logistical hurdles, you and your family can have the room to focus on the personal challenges these situations present as your loved ones’ needs change.

 

Janet Chaplan Pew

Intelligent Debate on Public Benefit Reform

Recently, there has been an upsurge in public harassment of individuals with disabilities throughout the UK.  It seems a series of media articles on fraud and abuse in government benefits programs including one with the inaccurate headline, “Free BMWs for Pals of Disabled” spurred the attacks.  One woman reported that her car (not a BMW but with a disability placard) was vandalized the day after the “free car” article ran. Others tell of suffering verbal and physical assaults, including venomous accusations that they are faking disability to get aid.

As this year’s budget process begins, controlling government spending is on the minds of many in Congress and throughout America. It is essential to reign in the costs of public benefit programs such as Medicare and Medicaid. There are many common sense ways to do so, including expanding home and community based services to seniors and individuals with disabilities which will allow us to cut back on more costly institutional services.

Let us all avoid scapegoating and engage in an intelligent debate about Medicare, Medicaid and health reform as part of the larger budget discussion.  I recommend taking a look at a recent Kaiser Family Foundation report, Faces of Medicaid,  which introduces us to 16 Medicaid recipients and dispels many of the myths surrounding Medicaid beneficiaries.

-Shana

Planning? What for? I don’t want to think about that now, I’ll deal with it later!

Many of us spend a lot of time planning things.  Planning what to have for dinner, where to go on vacation, how to pay for our children’s education, what we will do after we retire from our working lives.  I suspect that the Baby Boom generation (those born between 1946 and 1964) is full of people who actually earn their livings “planning.”  Funny, then how most of us never plan for the one thing we know we will all go through, the dying process and our eventual deaths!

For some planning for death, illness and incapacitation is morbid and to be avoided.  For others, it is full of unknowns and unimaginable and so thinking about it is avoided.  However, coming to that stage in your life without a plan, is a mistake resulting in rather predictable complications for families and friends.

According to the Associated Press, it is estimated that roughly 64 percent of Baby Boomers do not have a living will (advance directive for health care) or health care proxy (power of attorney for health care)!  What’s up with that?  How can that be?  We (I am within that age group so I can say “we”) all grew up hearing about Karen Ann Quinlan and her family’s lengthy fight to give her a dignified death rather than a prolonged, painful life.  We couldn’t avoid hearing about Terri Schaivo and the battle between her husband and her parents over her right to a dignified death.  Shouldn’t we all know by now that planning for these eventualities is important?  Is it really that we all still think that we will somehow live forever?  That it will never happen to us?  I’m here to tell you that it will, we might be able to put it off longer than our parents, but it will happen to us someday and then we really should be prepared, if not for ourselves, for our families and friends.

What is a Living Will?

A Living Will also called an Advance Directive, is a document that allows you to outline the types of care you wish to receive if you are unable to speak for yourself because of an illness or incapacity in the future.   The document may also contain sections that spell out the details of your wishes regarding burial or cremation (maybe you want your cremains made into a diamond, which is my current plan, check it out at:  http://www.lifegem.com/) wishes, the names of your physicians and where you want to be cared for.

What is a Health Care Proxy?

Also known as a Health Care Power of Attorney this document simply appoints someone you trust to make your medical decisions for you should you be unconscious or unable to communicate your own wishes effectively.

Don’t think your exercise regime will prevent you from needing these documents – face it – we are all going to get old!  When we get old we are going to need help!  Hopefully you will have put down in writing who you trust to help you with these things and made that document known to your family and medical providers!

These documents are not just for the sick and elderly.  Life is unpredictable but it is not so unpredictable that you can say it is not clear whether you will ever come to the end of your lifetime!

Unfortunately, anyone, healthy or otherwise, can be struck with an unfortunate or unforeseeable illness, become a casualty in an auto accident, or sustain a life threatening injury, at any time.  And even if you are lucky enough that none of those things happen to you, you will, eventually, come to the end of your life!  Most likely, when you are near the end of your life, you will need to rely on others to help you make important decisions regarding your health care.  Be prepared and help them help you with the proper documents. Living wills that detail specific instructions can spare families a painful fight over what care is appropriate.

Highlighting the importance of drafting an end of life plan cannot be stressed enough. A simple document could save your family and friends years of drawn out fighting and court appearances.

Have a great weekend, but don’t forget to plan!

Mary!

Finding Connections – A Parent with Alzheimer’s

With a mother losing her memory to Alzheimer’s, recent reports of discoveries and research have been both exciting and frustrating.  While doctors are finding new information which will help in treatment and diagnosis, little of the research seems to help right now in coping with the daily questions that come up in trying to keep a relationship with someone whose memory is fading.  What is very helpful is the collective wisdom of caregivers, available on line and, for those of us working in Elder Law, available from colleagues and from people I speak with daily.

I remember the moment when I first noticed I was losing my Mom to Alzheimer’s.  She had always had some aphasia; we knew her recall was just not the best.  But the day she could not remember anything about her special cake recipe, I knew something had changed.  Mom had called to ask what she could do to help with preparing for my son’s bar mitzvah.  I asked her to bake his favorite cake.  A “Roulage,” we call it in our family: chocolate soufflé baked flat, rolled up with whipped cream like a jelly roll.  This had been Mom’s signature dessert for a half century, turned into everyone’s favorite birthday treat as we grew up, and the favorite birthday cake for our kids as well.

“Could you bake a Roulage?” I asked.   My idea was to bake five—like the five scrolls of the Torah, a new riff on an old favorite.  Mom hesitated.  “A what? If you give me a recipe, I’m sure I can make whatever you like,” my Mom volunteered gamely.  I was stunned.  50 years of her special dessert, gone from her memory.  In an instant, the connection I was trying to make, to bring to the coming of age ceremony Mom’s delicious way of making celebrations special, was lost.  I hung up the phone and I cried. Then I called my sisters, explained what had happened, and we all understood that something had changed.  Slowly we proceeded with the necessary evaluations, towards the ultimate diagnosis.  We put in place the needed powers of attorney, the health care proxy, and we discussed her wishes regarding end of life decisions.  We prepared for the Medicaid application.

Five years later, Mom is now moderately impaired, still living in her own apartment.  She has trouble assembling a meal from scratch, and that frustrates her.  She can do part, but insists she has no patience for green vegetables, or insists she prefers to go to her local sushi bar for dinner.  This from someone who prides herself on her ease as a chef.

If I cook a meal for her from one of her recipes now, Mom is delighted. “I have never tasted anything quite like this before, this is delicious!” she often exclaims. It is disconcerting to have her say she has never tasted the recipes she taught me to cook over my lifetime. At first I would say something like, “I’m glad you like it—it has always been your favorite,” hoping to trigger her memory.  But that connection is gone, and my pointing out what used to be only leaves us both feeling sad and a bit more alone.

Here’s where the collective wisdom of caregivers is so priceless.  Working in an Elder Law firm, I am surrounded by experts.  From Mary and Shana to each member of our staff, to many of our clients, the appreciation of the particular personal challenges of caring for family members with dementia is remarkable.  I consulted with many people in passing, and realized I had to change my goals.  Everyone said to relax.  Meet her where she is.  Don’t fight the disease, enjoy the person.  Now I joke with Mom, and say how nice it must be to taste her favorite things for the first time over and over again.  She understands that her memory is fading, and she gets the joke.  She is somewhat surprised that she has forgotten, but mostly pleased to enjoy a meal together.   We have begun to connect at this new place.

When I can relax and stop worrying about her memory, I can enjoy time with my mother.  The old conflicts are finally irrelevant.  Just last week she called me and thanked me for taking care of her, and told me she loved me.  I was elated.  Finally I am figuring out how to find her again.

Here are some links to great resources for caring for people with Alzheimer’s, pulled from the New York Times New Old Age blog.

The Alzheimer’s Reading Room:   http://www.alzheimersreadingroom.com,

A program at Johns Hopkins which gathers information from caregivers:  http://www.hopkinsmedicine.org/psychiatry/specialty_areas/memory_center/rabins_alzheimers/index.html

The Alzheimer’s Association:  http://www.alz.org/

And, of course, the New York Times New Old Age blog itself:  http://newoldage.blogs.nytimes.com/

Janet