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FRED FIRST: Entering The Continuum

Downtown Columbia MO |

We hope to be gently assimilated into the Elder-Borg

We will soon be moving to what we hope will be a good place and the right place for us.

Doing this right thing means working long and hard to totally disrupt our lives here, in a town and county we know and love. We will land in a place where we are strangers in a strange land, striving for weeks or months to create from scratch the story of our new lives.

Daily, I confront this agony that we bring on ourselves, demanding that I explain it to me one more time. This is why we must make this move: We are running out of runway, and liftoff happens now or not at all.

Now is the moment because time waits for no man (or his wife.) Our options for healthcare and augmented housing diminish day by day. As our physical and mental independence erode in our current and cherished location, it will become harder to transition in place to the next stage of care (from living independently today to needing assistance to needing skilled nursing).

It’s time to rev engines and pull the stick back. Buckle up.


I feel now that I can tell you about our new digs with a little bit of confidence, Our son (who moved back to Columbia MO two weeks ago) toured the facility this past week and has given it a thumbs-up. This was gratifying since the die is cast and the landing gear is coming down in two months. We had chosen Lenoir Woods (LW) in Columbia within the first 48 hours after we learned last November that the family was headed west.

As a CCRC (Continuum of Care Retirement Community) or Life Plan Community, Lenoir Woods is like Warm Hearth in Blacksburg, where some of our Floyd friends have moved, and my mother lived the last six years of her life and saw patients as a PT for more than a year.

Entry of Lenoir Woods assisted living in Columbia, MO, awarded Best Independent Living, Memory Care, and Continuing Care Retirement Community by US News.

Lenoir Woods: Independent and Assisted Living in Columbia, Missouri

This choice of placement at LW for our final residence takes meets our future need for the housing transition that will be required as age inevitably takes its toll. Incremental moves in that setting will be down the hall, not across the country or even across town. The survivor of the pair of us will be taken care of in a familiar place.

I hope to continue this travelogue as we become citizens of the New Space after we land, so stay tuned. What we learn might be useful if you see the end of your runway looming large and close – or even somewhat looming at all.


As several recent health situations among our age-peers and friends have clearly exposed, Floyd County is not a great place to be ill or injured. But having a physician a hour away is not such a good option either.  Columbia, Missouri, on the other hand, offers choices between good and better hospital systems, within 15 minutes of home.

Hospitals near Columbia, MO

I inquired from LW about obtaining a primary care physician, and was offered a list of docs used by residents. I was concerned that it may take weeks to become a new patient and get an appointment if we waited until after we got there.

To avoid that, after selecting a doctor, I called to enroll as new patients. The nurse handed the phone to the doctor (surprising, but read on) and we spoke for a bit. We now have September appointments on the calendar.

I chose the MD on the basis of his qualifications, but learned that in addition to his expertise and experience, this doc is part of a model of medicine I had not been aware of before. I think this is going to be a good fit.


Also called “retainer-based” or “boutique” medicine, this is a growing trend in health care that appeals to both patients and physicians (many of whom are burning out and looking for alternatives.)

Some express concerns that the upfront fee ($2k) is elitist and divides health care into a haves and have-nots tiered system. I see that, but also know the current model of high-quota patient loads is not good for docs or patients.

I have had a number of “minor” health issues I’ve never bothered to even mention in abbreviated visits, because the medical caregiver who just skidded into the room with the laptop need know only about the top two pains or other complaints before they whoosh out of one drab and somber patient containment cubes to the next.

Greet’em, treat’em and street’em as fast as you can, as I was told as a therapist-manager. Its all about volume and the bottom line.

The concierge structure helps avoid delayed treatment, long waits, unreachable doctors and unnecessary ER visits and hospitalization, while providing extended, unrushed MD visits and more thorough exams with an emphasis on well-care (vs sick care) and prevention.

The system that our new doc is part if is a large and growing network called MDVIP.

I offer a few resources if you are interested or know someone who might be. And again, I hope to continue to say more after we land and get our sea legs.


MDVIP – Wikipedia

6 Problems with Concierge Medicine (+ Overriding Benefits)

Why I chose concierge medicine | A physician’s experience

– Fred First is an author, naturalist, photographer watching Nature under siege since the first Earth Day. Cautiously hopeful. Writing to think it through. Thanks for joining me. Subscribe to My Substack HERE

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