A financial crisis is hanging over the heads of Americans, and many do not even know it is there. It’s not widely publicized and many people don’t want to think about it. It makes us squirm a little to think too closely about our possible frailty in old age. However, the cost of long term care for the elderly could bankrupt the current Medicaid system as the next generation of seniors begins to need it. And, since it is not widely discussed, the pressure for a solution is not terribly high outside of a few circles.
A recent study from the SCAN Foundation (Senior Care Action Network) found that 70% of Americans who reach the age of 65 will need an average of three years of long term care. Not everyone receiving long term care ends up going to a care community or nursing home, but for those that do the cost is about $75,000 per year. Will you have $225,000 available to cover those expenses when the time comes? Most people expect that Medicare or Medicaid will take care of them but the reality is Medicare does not cover long term care, nor does health insurance in most cases. Medicaid might, but not all communities accept it and you often need to pay on your own for a couple of years before they will accept it. You also have to have less than $2000 in assets (other than home and vehicle) to qualify.
It is estimated that long term care costs the country almost $725 billion each year. The majority of that expense comes from families supporting and caring for loved ones without pay. Of the remaining $275 billion, almost $200 billion come from federal programs. That is money coming out of an underfunded piggy bank, currently suffering cutbacks just when the senior population is about to boom. What will happen when there simply is not enough money to cover all the people who are qualified and in need of care? Additionally, there is the attitude that Medicaid, intended for the most poverty stricken Americans, will be there for middle and upper class seniors who spend down or protect most of their assets. While it is true that Medicaid will support them (as it stands now), the program is not intended to be a safety net for people who want to leave an inheritance to their children.
This is not a “far off” problem for some future generation to solve; it is right in front of us. In the next 30 years the number of people over the age of 65 will double. The oldest of the baby boomer generation are turning 65 now, at a rate of about 10,000 per day. In 2030, when the last of this generation turn 65, they will account for almost 20% of the US population (as opposed to 13% today). Medicare and Medicaid are already stressed; how will they continue to support the demand when less people are supporting the program and many more are taking out? According to SCAN, the country has about 5 years to find a proactive solution before it becomes a matter of simply reacting to emergency shortages.
In a follow up post, I will discuss what actions are being considered to address the upcoming crisis, but a clear plan has yet to be developed. The need for a solution is urgent and immediate. Policymakers and experts in senior care have yet to agree on exactly who should be responsible for long term care issues and what steps need to be taken for a resolution. What they do agree on is that the country is not currently prepared for the upcoming need and something has to be done to ensure that Americans have adequate care as they age.
A person born in the year 1900 could expect to live about 47 years. Now, just 113 years later, people are living much longer – about 77 years on average. Those extra thirty years offer wonderful opportunities for time with family, enriching ourselves, contributing to the world, and enjoying life. But they also have opened a new array of challenges for the medical field. Now that people are living longer, diseases that affected smaller percentages of the population 100 years ago are more widespread.
Heart Disease is the number one killer among diseases in the United States; it accounts for one in every four deaths. While it does not plague the elderly specifically, it is far more likely that a senior will die from a heart attack than a young person, and more seniors are living with heart disease than their younger counterparts. Some of the risk factors for heart disease are also more common in seniors: obesity, diabetes, and hypertension among them. The second highest cause of death in the country is cancer, and this is definitely a case where higher age groups are at higher risk. About 77% of new diagnoses are in people over the age of 55. One of the major causes of cancer is cell damage over time. The damage is usually repaired by our bodies, but as we age the damage can build and begin to spread. An extra thirty years of exposure to toxins and damaging environmental factors increases the risk of developing cancer greatly.
Diabetes is not restricted to the elderly, either, but it is definitely more commonly diagnosed in those over 65. When it is not properly treated, it is a major contributor to heart disease, kidney failure, and stroke. Stroke can occur at any age, but risk increases with time. Well over half of those hospitalized with stroke are above the age of 65.
Right now more than 5 million people are living with Alzheimer’s Disease; it is the sixth leading cause of death in the United States. Since the disease is most commonly found in adults over the age of 65, this is a relatively new health crisis for our aging population. Parkinson’s Disease is another case where longer life spans have drastically increased the prevalence of a disease. It most commonly affects adults over the age of 60, so a century ago the number of cases was much smaller.
Not so deadly, but definitely painful and limiting is arthritis. Osteoarthritis is the most common form in seniors and generally worsens over time. This means as people with arthritis age, their mobility and functionality lessens leading to more dependence and more pain. Also more common in the elderly are falls and related injuries, complications from the flu, pneumonia, blood pressure problems, hearing loss, and vision problems. While not all deadly, many of these contribute to reduced functionality and less enjoyment of life. The elderly are more susceptible to minor problems that can lead to serious medical issues and death if left untreated.
A longer life means we have to take better care of ourselves if we wish to enjoy those extra years. At 47 – extreme old age a century ago – we still have the potential for decades of fruitful living ahead of us. But these extended life spans mean we are open to a host of illnesses and health issues that were not as much of a concern before. The key to keeping those extra years healthy and productive is in how we take care of ourselves, no matter what age we are at now. A healthy lifestyle will not guarantee health in old age, but it will drastically improve our chances. And it is not too late if you are already in your silver years; changing unhealthy habits is beneficial at any stage in life. Exercise and diet changes affect how you feel and improve the functioning of your body even if irreversible conditions have already been found (just be sure to clear the changes with your doctor first).
Also vital are early screenings and prompt medical care for any issues that come up. In many cases, the earlier a problem is found, the more effective the treatment will be. Ignoring the warning signs of heart disease or pretending that it doesn’t mean anything when your cognitive function is slipping only allows the illness to progress and your chances of staving off a serious problem diminish.
The traditional term “nursing home” has come to have a variety of connotations and definitions. Medicare defines skilled nursing facilities as nursing homes. If you need medical attention while recovering from an injury or illness you may qualify for a period in one of these facilities. This is different from care for those who need help with everyday activities like bathing and dressing. This is called custodial care, typically provided in an assisted living community, and is not usually covered by health insurance. While the term nursing home is often used interchangeably with skilled nursing and assisted living, the two offer different services and generally have a very different lifestyle.
Skilled nursing facilities are focused on healthcare and may feel more like a hospital than a home. While the purpose is recovery from a particular illness or injury, custodial care takes place as part of the healing process. A person recovering from knee surgery is going to need a certain amount of help bathing and getting around. The patient will be released after healing from the injury – if continued help is still needed it is generally not given at a skilled nursing facility. At that point the patient and family will have to decide how the additional assistance will be administered and costs are their own responsibility.
Many people feel that nursing homes are places where very sick people go to die. There is often a negative connotation associated with the term and they are sometimes seen as scary places with poor quality of living. This is not true of all skilled nursing facilities. While there may be people receiving care in the final stages of life, stays are often short term and care can be good. They are not hospitals, but essentially the next highest level of care to what a hospital offers. As you would expect, quality varies from one facility to the next. Medicare’s Nursing Home Compare tool gives information about quality measures at all Medicare/Medicaid certified locations.
For those that need help with daily living but do not need the level of medical care offered in a skilled nursing facility, assisted living may be the right choice. Assisted Living communities have changed a lot in the past decade due to a much more abundant and competitive market. They strive to offer residents a comfortable, homey, and fun atmosphere in which to live out their golden years. These communities generally have many apartments built around activity rooms and social gathering spots. They provide meals, transportation, assistance with bathing, dressing, medication management, and other non-medical needs.
Many assisted living communities also have an independent living population. This is for people who do not need help with daily life, but prefer to live in a community of peers and enjoy the social and personal perks. Communities may provide cleaning, meals, laundry, entertainment, and other amenities to entice residents to their location. Another benefit is that if the need for assistance develops, it will not require a move at a stressful time in life, help will be there. Not all independent living communities have assisted living services while some contract them out, so it is a good question to ask before moving in.
More and more assisted living communities also have on-site memory care facilities. This is for people who do not need medical care to heal, but need supervision for safety and increasing levels of help with daily activities due to dementia. They are usually in a secure section of the community, though may participate in meals or activities with some extra assistance. In other communities, all activities and meals are separate.
Going to live in a “nursing home” or helping a family member to move into one does not automatically indicate a failure or lack of caring on the family’s part. It also does not mean you are going off to die alone. There are many valid and necessary reasons why a person would live in such a community, be it temporary or long term. There are also many communities with vibrant social aspects and very good care. It does not automatically signify the end of a life or a sad occasion, and need not be treated as such.
That being said, when selecting a community for a long term stay the right decision is essential. There are many factors that can affect the experience and since it is meant to be a permanent home, you want it to be the right one. Choosing a community that does not meet present and future needs or does not have the right blend of amenities and care can result in another stressful, expensive, and possibly health threatening move further on down the road. In a future post I will discuss some of the biggest factors involved in the decision and what to look for when making your choice.
It is quite commonplace to see young adults in public immersed in a game on their phones, looking up information online, or appearing to talk to thin air as they chat on a Bluetooth headset. But how often do you see Grandpa pull out his phone for a quick text? Would it surprise you to find Grandma checking in at dinner on her Facebook page? More and more seniors are finding their way into the modern technology market and companies are beginning to vie for their business. Products designed specifically to make technology more accessible and useful to senior citizens are undergoing a little boom of their own.
There are two markets opening up wide. One is remodeling modern devices to be more accessible to seniors. Phone companies are selling smartphones with larger buttons, simpler interfaces, customized grips, and less sensitive touchscreens to make them more appealing to a crowd that is not always nimble with the newest tech. Those who did not grow up in a pervasively technological environment can be intimidated by icons and functionality that the younger generations use intuitively. The new phones make it easier for anyone to take a quick snapshot, look up a phone number, or get a reminder of upcoming appointments on their calendar. Businesses are catching on that the market is open for senior-friendly technological devices and they are delivering.
Likewise, the market for new technology to assist seniors and caregivers is blossoming. As the American population becomes older and more senior heavy, demands on the healthcare and assistive living industries are increasing. People want to stay in their homes, be it for personal or financial reasons, but as Americans live longer independence becomes harder to maintain. Devices that allow older adults to live in their own homes, without nursing care, are becoming more and more popular.
Research has found that 20% (or more) of the people who end up in nursing homes do so because of difficulty managing medication. There are several devices on the market now that not only dispense medications at the right time, but also remind the patient to take their meds and can contact a caregiver if they are not taken within a preset timeframe. A new type of medicine cabinet is in the development stages now. It uses cameras and face recognition to greet people by name, checks to make sure they take the right pills at the right times, and even orders refills directly from the pharmacy!
Falls are a scary problem for some and can lead to hospitalization and then assisted living or a nursing home. New developments are taking fall monitoring well beyond the call button or pendant you may be familiar with. Systems now have sensors placed around the home that monitor for falls, use automatic alerts to call for help (rather than requiring a person to be responsive enough to push a button), and can tell the difference between a fall and just bending over to pick something up. More advanced systems will even call a caregiver if there is a significant change in daily routines, like not getting out of bed in the morning. Other fall prevention tech coming our way includes shoe inserts that stimulate the feet to improve balance, robotic nurses to help with lifting and basic tasks, and a walker that comes when called. Some walkers and canes will actually be able to help the user steer away from obstacles and monitor gait and pressure while walking to alert of a possible impending fall.
Not all of the latest devices are for health concerns, either. The market for tools that make daily life more enjoyable for seniors is wide open, as well. There are many computer programs and games coming out that are intended to engage the mind, preventing the loss of cognitive function as we age. Social media tools are becoming more simplified and accessible, too. There are computers whose sole purpose is to give users easy access to email, video chatting, and social media. Those uncomfortable with traditional computer interfaces now have a very simple way to keep in touch with their more “plugged in” family and friends. Even something as simple as a pair of headphones that allows everyone to enjoy the TV at a comfortable volume can keep seniors involved with the family and combat loneliness.
It is nice to see the market for technology coming around to be more inclusive of all users. Though the intention may be to market to seniors, many of these devices are appropriate for all age groups at different levels of need. Privacy concerns may turn a lot of people off to some devices, but when it comes down to a choice between moving into a caregiving situation or having someone monitor daily activities for safety, most people would probably choose a little invasion of privacy. Obviously, this is not for everyone, but advances in technology are opening up a lot of new options for people coming into their senior years.
It’s hardly fair. Thousands of people made deals with long term care insurance companies, agreed to a rate for the product, and signed a legal contract. They kept up their payments for years and retired feeling a little more secure in their finances. Now they are being notified that their premiums are going up – by a lot. Rising insurance costs is not a surprise, but the fact that a long term contract can be modified by the underwriting company is coming as a shock to many. The most recent case is CalPERS, California’s Public Employee Retirement System. Back in the 1990s they sold policies with inflation protection to policyholders who say they were promised premiums would not increase. Now that many of these employees are retired and living on a fixed income, they are finding that premiums are indeed rising, as much as 85% in some cases.
How can that be? Occasional increases may be unexpected and frustrating but at least somewhat understandable. But to nearly double the cost seems unconscionable. The fact is, it is legal. And the affected retirees have to make a difficult choice. Give up the policy altogether and lose the thousands already paid in premiums, continue at the same premium but with less coverage, or pay out a lot more money to keep their protection. All of these options put more of the financial risk on the insured.
“Fair” doesn’t enter into it. While insurance companies cannot raise premiums for one particular group or person, they can get government approval to raise rates for everyone. In the case of CalPERS, only a board decision was required. And due to their own errors in predicting future payouts for such policies, they’ve done it. I’ve written before about the mistakes policy writers made early on. Companies did not adequately account for cost increases in care, disproportionate health care inflation, or a poor market which made their investments much less valuable. Obviously it is not possible to predict the future, and insurance companies did not foresee the economic problems that put them into their current predicament. Frankly, if there was no risk involved there wouldn’t be a need for insurance in the first place. So why are customers the ones footing the bill?
While it may not be fair, the alternative is not good. If rates are not increased, there will come a point at which they simply cannot pay out on policies anymore. Not only is this illegal, it is worse than raising rates. A person who purchased coverage could simply find themselves out of luck at a time of need. The current solution at least approaches the problem proactively. It does, however, lead me to wonder how much of a loss the companies having these issues are suffering.
Dreams of retiring to a laid back lifestyle of relaxation and fun are going by the wayside. The word retirement used to be synonymous with leaving work, but not anymore. For a variety of reasons, more and more seniors are either skipping retirement altogether or continuing to work through their retirement years. Retirement has become more of a financial decision than a lifestyle.
More than half of the people working in their retirement years today are doing so out of pure financial necessity. The recent recession hit those about to retire harder than other age group. Just when they were ready to cash in their savings plans, the market crashed and the money available was too little. Even though the economy is recovering, home values are not back to where they were before the crash and people who lost jobs are in difficult financial situations. Retirement dreams may have receded like a puff of smoke. Even worse, elder workers have a harder time finding a new job once the market recovers and many of those that do may have to settle for less pay and benefits than they enjoyed before.
Recession aside, many people simply did not save enough to stop working at 65 (or 70). For some a few extra years on the job is all they need to make it by, but others need to keep earning for as long as they are able in order to stay financially independent. In fact, recent studies have found that 53% of Americans over the age of 30 will not have enough saved to retire without an extra income. Add to that the looming Social Security crisis (it is predicted that in 2040 the system will have depleted its trust fund), and working becomes less an option and more a retirement plan. One survey found that 75% of Americans over 50 expect to work in retirement. But finances are not the only reason for this shift in trends.
Lots of seniors choose to continue working for the personal satisfaction, learning opportunities, and social connections provided in the workplace. Others just don’t want to get bored. Many retirees switch to a job that is fewer hours, less stress, and more interesting than their careers were. Often seniors choose to take a job that allows them to pursue a hobby or area of personal interest. It can be much more about feeling useful and engaged than making money.
If you do decide that working past retirement age is in the cards, there are some financial pitfalls to avoid – extra taxes and a reduced pension are two big ones. Those who retire but continue to work are running the risk of raising their income into a higher tax bracket. If the point is to make some extra money, then make sure you will not be paying your earnings right back out in taxes! People who don’t retire but spend a few extra years on the job need to think carefully about what it will do to their pensions. Some plans base the payout on salary; if you reduce your hours or pay during those last few years you may end up receiving a smaller benefit. Other plans require you to start collecting by a certain age so waiting could cost you money.
Retirement planning is not an easy task. There are many rules, programs, and factors to consider to maximize your financial gain and maintain the lifestyle you prefer. Planning for personal satisfaction is also important. As we live longer lives the medical and financial risks get higher, but so does the risk of boredom and depression. It may well be worth some extra years of work to ensure that the following twenty or thirty years of retirement are enjoyable and comfortable!
I’ve written before about the helplessness of watching a family member slip away into dementia and some ways you can reach out to them. Communication attempts can have varying degrees of success, but more and more studies are supporting the power of music to activate parts of the brain otherwise inaccessible in many advanced cases. There has long been anecdotal evidence of the power of music for these patients, but scientific study is starting to find hard proof of its effectiveness.
Though the working of our brains still holds many mysteries, it has been found that music is processed and stored differently than language. Music can activate memories and brain function that is otherwise inaccessible. Have you ever heard a tune that swept you back to an old memory? It can do the same for Alzheimer’s patients. People who have forgotten their loved ones, their past, and themselves can hear a song and remember. That isn’t to say patients are cured, but for a family losing hope, it is a spark of life.
More than just memories are activated through music therapy. Patients actually become more engaged and communicative after listening to familiar songs. People who have spent months and years slumped in a chair, seemingly lost in their own minds seem to come alive. There are neurological connections between music and memory, movement, and emotion. Music therapy is being studied as a way to improve patients’ quality of life, not just for their enjoyment but for better health. Studies have shown its power to improve balance, decrease agitation, increase communication, and reduce depression.
More scientific study is needed to prove the effectiveness of music therapy for all patients, but it offers hope for those suffering right now. On the bright side, the risk is very low. It certainly doesn’t hurt to play songs that your loved one is familiar with and see if there is any reaction. Finding the right songs is important. The idea is to play things that are familiar and evoke positive memories and responses.
Trained music therapists can be very helpful, as well. Passive listening is one method and can lead to exciting results, but active participation in music making has benefits as well. Knowing what to try and how is important and therapists are prepared to help. The American Music Therapy Association has a lot of resources and can help you locate a therapist. In some cases, Medicare will cover the cost of music therapy, so it is worth checking into exactly what is covered before you pursue treatment.
Music is said to soothe the savage beast. It speaks to the soul (and the brain) like nothing else. For patients suffering from a disease that savages the mind, a familiar melody may be just the thing to soothe and comfort. Some patients undergoing music therapy say it is like a medicine. It calms agitation and allows them to cope with the confusion and fear that has become a part of daily life. While the search for a cure continues, music therapy can offer some patients relief and better health.
I recently came across a great program called Silver Sneakers. It gives seniors access to fitness facilities, online programs and trackers, and classes designed with senior health in mind. Many insurance programs (including Medicare) provide Silver Sneakers as a benefit, acknowledging the importance of fitness and good health to ward off illness.
The great thing about what Silver Sneakers does is not just the access to fitness centers (though that’s an awesome benefit). What’s really great is the supportive environment at those centers and on the website. Each location employs a Senior Program Advisor who will help you to learn how to use the equipment and select appropriate exercises for your needs. Of course, this does not replace a doctor’s advice, but it is helpful once you are there and ready to begin exercising. The Program Advisor also plans senior friendly exercise classes held on site regularly.
On the website, members will find personalized health trackers, demonstration videos, expert advice, articles, and recipes. Seniors without access to a participating fitness location or limited by travel restrictions can still access the website and use the Silver Sneakers Steps program to create a personalized exercise regimen and track their progress.
My favorite perk is that once you are a member, you can visit any participating location across the country. This means that if you are visiting family or traveling out of state, you still have access to nearby fitness facilities without extra costs. You can look on the website to find out if you qualify for free membership, but even those who don’t can still access the program by purchasing a membership at a participating location.
What a great tool for seniors needing a little support to reach and maintain their fitness goals!
Adult Day Care sometimes gets a bad rap from people without firsthand experience or an in depth understanding of caregiving. Granted, the name may give some a feeling of indignity, but the concept is much more valuable than the term implies.
Loneliness is a source of much suffering for humans of any age, though for the elderly and infirm, solutions may not be as easily found. When life no longer includes the collegiality of the workplace or lifestyle shifts and old friendships are lost, it can be very difficult to find and connect with people of common interests and backgrounds. For those who have to move in with a family member, the lifestyle shift is drastic and can be very difficult to handle. The loss of friendships can leave seniors feeling isolated, helpless, and very lonely. Having a place to find friends, or at minimum interact with others in a similar situation, is a valuable support. Not only will quality of life improve, but according to a Harvard University study, length of life can increase as well. Social interaction is not just a human desire, but an actual need.
The change in role from independent adult to care-receiver is a tough transition for anyone. The adjustment is difficult for the whole family, including the person in need of care. The feeling of being a burden, in the way, or a drain on resources can be very hard to get past and can make for a lot of tension at home. An opportunity to get out and give everyone some breathing space is good for the senior, too. Adult Day Care is relief for caregivers, yes. It provides a chance to get out of the house, run some errands, enjoy the kids, or just relax (don’t underestimate the importance of relaxation!). But it is also a break for the care receiver – a chance to be among peers and get away from feelings of guilt, helplessness, and stress.
Those with more advanced or complex support needs (such as dementia patients) can find comfort in the fact that many such programs are staffed by professionals in senior care. Programs may be held at an assisted living facility where the staff is prepared to handle a variety of medical conditions and trained for exactly the level of support needed. In some cases, participants have access to the community’s rehab, fitness, and recreational facilities as well. This opens up opportunities that are not easily accessible from home and would be an expense to access through other channels.
While adult day care will add an expense to the budget, it may not be as costly as other means of support. Options like length and frequency of visits, services provided, and care rendered can help mitigate the cost, depending on needs. Since you are often going to a community already structured for senior needs and not paying for each type of activity separately, costs can be mitigated. Some programs, often called Adult Day Health Care, also provide structured physical and medical support in addition to social and entertainment opportunities. Additionally, in some cases, insurance or public programs will help defray the costs.
It is a sad reality, but some seniors in home care situations may not be able to stay there for the rest of their lives. In some circumstances, needs may become too intense or complex for a home environment and assisted living may eventually become necessary. If an honest look at the situation reveals the potential for this need in the future, adult day care may be a good transitional tool for moving into a community. It offers the chance to get to know the staff, residents, and community. Such a move can be scary and depressing for some seniors, but if they have already had positive experiences in a community many of those feelings may be alleviated.
The realities of Adult Day Care programs are very positive. If tensions are running high at home or a senior you know seems lonely and in need of peer friendships, consider suggesting the option. Think of it as a supportive social gathering instead of daycare.
I found these recent articles interesting and worth sharing. Hopefully something will pique your interest, too!
Long Term Care Insurance Tax Deduction May Be Overlooked
Retirees, don’t forget about the tax deduction for long term care insurance premiums! Whether you qualify depends on income and medical expenses so even if you didn’t take the deduction before, you may qualify now.
Senior Fitness 101: She makes the grade
After 101 years, Eunice Green still maintains an active and outgoing lifestyle. She attends daily aerobic classes and walks regularly. She loves to be on the go and doing things, including entertaining at the piano!
Better Start Saving: U.S. Health Awesome — After Age 75
If you make it to 75, odds are good that you will live a lot longer, according to experts. While overall life expectancy in the US seems to be flagging compared to other countries, those of us that live to 75 are outpacing our counterparts in those countries. Better make sure your retirement account is ready!
All in the Family: Siblings, Caregiving and Money
When an aging parent requires help to get through daily activities, it takes more than one person to effectively provide care. While there tends to be a primary caregiver in the family, the effect is stronger if everyone works together for the person in need. It is, after all, a family concern and requires effective teamwork. Here are six tips to help smooth the process for everyone.