Long-Term Care Options. What is Your Plan?

I read this the other day in "Heart Insight" and thought it was worth passing on.

 

Peter Ross remembers the day when his organization received a call from a distressed woman who needed assistance placing her mother in a nursing home.

 

"Her mother had no medical problems," recalls Ross, CEO of Senior Helpers, a national in-home senior care agency based in Timonium, MD. "The daughter didn't want mom to (live) alone and thought a nursing home was her only option. The mother was beside herself. Instead, we provided a caregiver five days a week to help supplement her mom's care."

 

This scenario happens every day across the country. Many seniors can no longer care for themselves in their own home, or maybe their children can't manage their growing medical needs. Usually, they believe placing Mom or Grandpa in a nursing home is the only solution. However, families can now turn to other facilities and a wide variety of online or community resources that can help them plan ahead, find the most appropriate long-term care facility for their loved one and identify ways to pay for the care without going bankrupt.

 

What's Available?

 

Many families are simply unaware of their choices, adds Ross, and think that nursing homes are their only option. Most communities offer a variety of choices, such as:

 

HOME CARE. This full- or part-time service provides individuals with a home care worker who helps them perform daily living activities like bathing or dressing. Ross says the national average hourly rate is $19 per hour.

 

While 90 percent of people over the age of 65 prefer to live at home, according to a 2012 AARP survey, that's not always possible. Can Mom climb the stairs to her bedroom? What about Dad's health? Home care workers are not medically trained, so if Dad has health issues, other options like assisted living may be a better fit.

 

INDEPENDENT LIVING. Sometimes referred to as retirement communities, independent living facilities target people age 55 and older and offer housing ranging from senior apartments to free-standing houses that are friendlier to older adults (such as no second floors or stairs) and often more compact. Residents can drive their own cars and participate in group activities and meals. No medical support is provided.

 

GROUP HOMES or BOARD & CARE FACILITIES.  A small number of people live in these licensed homes--mostly in residential neighborhoods—when they cannot live on their own but don’t need nursing home services.  Line-in staff provides daily care, meals and activities.  Most facilities are wheelchair accessible.

 

ASSISTED LIVING.  These facilities are for seniors who have experienced a slight decline in their health and need assistance performing daily activities.  Residents are served three meals each day, can participate in various activities and trips and can often bring a pet if they can care for the animal.

NURSING HOMES.  Sometimes called skilled nursing facilities, this option offers the highest level of both custodial care, such as bathing and dressing, and medical care for older adults outside of a hospital.  Some also have special living areas designed for Alzheimer’s or dementia patients.  Doctors supervise each patient’s care.  Round-the-clock medical care is usually provided.

 

Some of these facilities may be covered under some private long-term care insurance or other assistance programs.  Check with your insurance company and Medicaid or Medicare to see what your policy covers.

 

To determine what type of facility your family member may need, call his or her physician, says Ross.  Then contact an elder care attorney, social worker or placement service for financial and other types of assistance.

 

“There are a lot of people out there who can help you,” Ross says.  “Narrow down your search once you understand where (your loved one) should be going.  Get information on how well-rated (each) facility is and make sure (you or ) someone you trust tours the facility.”  To find ratings on facilities in the United States, visit medicare.gov/NursingHomeCompare.

 

LETTING GO

 

The emotional impact ov moving family members from their home to another facility can be devastating for everyone involved, but there are ways to make it a bit easier.

 

“Nobody ever wants to move out of (his or her) house,” says Marion Somers, Ph.D., and elder care specialist in Gardenia, Calif. “But you have to face it realistically.  If you keep shoving the issue under the rug, all you’ll get is a lumpy rug that you’re going to trip over somewhere along the line.

 

She says family caregivers need to educate themselves about the disease their loved one has, so they can talk openly with them about it and be better prepared to manage the illness as it advances.

 

Somers suggests creating a list of key questions.  “Deal with things one sentence at a time because (your loved one) is dealing with a lot of emotional issues.” She says.  “Ask the question or state the facts, then wait for him or her to process the information and answer.  You may be on your third question and your loved one is still processing the first question.”

 

Above all, listen.  How is Grandma feeling about moving?  What is your father thinking?  “People need to be heard, understood and have their (lives) validated,? Says Somers.

 

Another strategy involves taking small steps, explains Barbara Ensor, Ph.D., a geriatric psychologist in Baltimore.  A good example is making a decision about the type of facility your loved one needs.  Bring up the idea, then wait a few days and approach the subject again, but this time, go one step further by narrowing your choices.  Use concrete examples like, “Mom, I’m concerned that the next time you fall, you could break your hip.  I want you to be safe.”

 

Often seniors are in complete denial about their health status or ability to care for themselves.  If this happens, respect their opinions and wait a bit before address the topic again.  Also ask yourself if they’re being reasonable or competent.  If so, accept their decision then present options like an in-home caregiver to help ensure their safety.

 

Ensor says a good way to overcome barriers is to use “I” statements, such as, “I can’t pick you up if you fall” or “I worry about you since you live alone.”  If they’re still resistant but need help caring for themselves, ask their physician to intervene.

 

When moving day arrives, involve them in decision-making.  Ask which drawer Grandma wants her sweaters in or which mementos your father wants to take with him.  Present options every step of the way so they still feel some control over their lives.

 

“The biggest thing I hea from seniors is that my children did this ‘for me’ or ‘to me’ and that they didn’t have a chance to say where they wanted the furniture or pictures to go,” says Ensor, adding that grandchildren should also be involved in the moving process.  Take them with you when touring facilities, encourage them to talk with Grandma about moving and make sure they visit her as often as possible to help smooth the transition.

 

Moving people out of their homes is a process that requires both time and patience.  “Try very hard to understand what it’s like for (them),” Ensor says.  “They’re giving up many years of independence, all they built up…It’s a very emotional decision.”

 

CAN YOU AFFORD IT?

 

Make no mistake—long-term care is expensive.  Nursing homes can cost at least $5,000 a month while the price of assisted living facilities can range between $45,000 and $80,000 a year, depending upon their location and amenities, says Harold L. Lustig, a financial advisor at Estate & Elder Planning Associates in San Rafael, Calif.

 

One underutilized source of income is the Veterans Health Administration.  He says veterans over the age of 65 may qualify for a tax-free benefit called Aid & Attendance Special Pension, which can help pay for care in the person’s home, a nursing home or assisted living facility.

 

This benefit is not dependent upon military-related injuries, says Lustig, author of Naked in the Nursing Home: The Women’s Guide to Paying for Long-term Care without Going Broke (2011, Blooming Twig)

 

To financially qualify, veterans must have less than $80,000 in assets, excluding their home and vehicles.  A veteran can receive up to $1,704 a month, while a surviving spouse may be given up to $1,094 each month.  Likewise, a veteran with a spouse is eligible for up to $2,020 per month and a veteran with a sick spouse can receive up to $1,338 each month.  For more information, visit veteranaid.org.

 

Other financial options include reverse mortgages, long-term care insurance or a tax qualified plan, which offers a tax-free benefit that’s calculated on a monthly basis.

 

Generally, the best time to buy an insurance policy is when your loved one is healthy “But in many states, there is life insurance where (to qualify), you answer four to five questions like, ‘Have you been recently hospitalized’, or ‘Have you ever had AIDS?” Lustig says.

 

He tells the story of a 72-year ols woman who was denied long-term care insurance because she had an assortment of medical problems.  But she was able to purchase a $100,000 life insurance policy with a $150,000 death benefit.  He says 90 percent of that $150,000 could be used for her long-term care.

 

Still, Lustig is always amazed at people’s reluctance to purchase any insurance.  Just compare a policy’s annual premium of $6,000 a year to a nursing home that costs $6,000 a month.

 

“When you say it’s too expensive, ask yourself, ‘Compared to what? Spending down all of your assets?” says Lustig.  “When you can’t afford it, get your kids to help pay because they’re going to end up paying anyway.”

 

Warning Signs of Financial Fraud

I saw this article from the Wall Street Journal and thought it would be appropriate.  We know of several elderly who have been cheated financially.


Older adults are frequent victims of financial fraud, but there often are telltale signs that can help family members recognize something is amiss.

These warnings can be as clear as a sudden inability to pay one's bills. But often the signals are more subtle: unopened statements from brokerage accounts you didn't know existed, mail boxes stuffed with sweepstakes offers or the sudden reliance on a "new best friend" for financial advice.

If you think there's a problem, it's crucial to persevere. Don't be surprised if the person at risk doesn't cooperate as you try to get to the bottom of a potential fraud.

It's embarrassing to be swindled at any age. Older adults already feeling ill at ease with their abilities, or feeling like their independence is threatened, may have a tough time admitting something has gone wrong and opening up about their finances.

Compounding the challenge is that often the perpetrator is someone the older victim knows and with whom he or she has built a trusting relationship—a member of the victim's church or veterans group, an accountant or even a family member.

"Seniors are going to be affected by every kind of fraud, because they tend to be the ones that have the savings and the cash," says Matt Kitzi, Missouri's securities commissioner.

Prevention starts with being vigilant, says Patty Struck, who heads up Wisconsin's securities division, which frequently is called upon to investigate fraud among older adults.

Just after Easter several years ago, Ms. Struck's office received a call from a man who was concerned about his father's financial adviser. While visiting his father over the holiday, the son learned that the adviser was helping the father take out a new loan on the house—the mortgage having previously been paid off. The adviser had even driven the father to the bank to help him fill out the paperwork, Ms. Struck says.

Seeing no financial need for the loan, the son called Wisconsin regulators. It turned out the adviser was looting clients' accounts. That included not just the caller's father, but also his grandmother's money, as well.

"It's all about reading between the lines and asking a lot of questions," says Ms. Struck.

To help ease the process, she suggests that younger family members talk about their own finances with older relatives to help them feel more comfortable opening up. Listen for offhand remarks, such as a comment that their broker isn't returning phone calls.

Don't feel guilty about doing some detective work. If there is an open bank statement, check to see if there's an unexpected name on the account. Other red flags: unusual transfers or big checks being cashed.

If you get the older adult's cooperation, order a free copy of the person's credit report. If anyone is opening up new accounts under the person's name or running up any big credit-card bills it will turn up in the credit report. The older adult may not even have realized he or she is being victimized.

Catherine Ann Seal, an elder-law attorney in Colorado Springs, Colo., says when she gets referrals from the local adult protective-services department for seniors who may have been victimized, one of the first steps she takes is to check public tax and real-estate filings—usually available for free online. She checks if new estate-planning documents or liens or deeds for a home have been filed.

If suspicion revolves around a financial adviser, go to BrokerCheck at the website of the Financial Industry Regulatory Authority (finra.org) to see if a broker has a track record of breaking the rules. Some states let you check online, for a small fee, whether an individual has a criminal record.

A common way older adults fall victim to fraud is what experts call the "new best friend" scam. "The senior all of a sudden has a very strong bond with somebody they have not known for a very long time," says Ms. Seal.

While those relationships can be on the up and up, con artists will often befriend lonely individuals, sometimes helping with errands or chores to gain their trust. "Very often the elderly people know that what they're getting into is probably too risky," Ms. Struck says. "But the person calling them to scam them is so friendly and they're lonely, so they're willing to take the time to talk to them."

More wrenching is when a relative is the one taking advantage of an older person. "Some of the worst exploitation happens among family members," says Ms. Seal.

Most often, she says, the theft is committed by a family member who is financially dependent on the senior. For example, a parent may be forced to sell a home and use the money to pay for a nursing home. A child, who was counting on the home for an inheritance, then dips into the parent's savings.

"Transparency is the key," Ms. Seal says. "Undue influence and exploitation only happens if no one else is aware of what's going on."

Survey Finds Theft By Family Members Most Common Form Of Financial Elder Abuse

I saw this while view the Assisted Living Federation of America site.  It brings to mind the need to watch our loved one's finances.  We not only need to protect them from outside thiefs but also from unscrupulous family members.

"A new poll examining financial exploitation of American seniors finds that 79 percent of experts surveyed identified theft or diversion of funds by family members as the most common form of financial abuse.

The poll asked state securities regulators, financial planners, health care professionals, social workers, adult protective services workers, law enforcement officials, elder law attorneys, and academics about their experiences with elder abuse. 77 percent of individuals surveyed thought that seniors are very vulnerable to financial abuse, and most cited financial abuse by family members as the most common form of financial abuse. Most respondents indicated that older veterans face the same deception risks as other seniors, but affinity fraud and VA Aid and Attendance fraud were also cited as important problems to address.

About 70 percent of those surveyed reported financial counseling and education programs administered by local professionals, such as caregivers, adult protective services workers, and law enforcement agencies as the most useful tool for helping seniors effectively manage their finances. Programs delivered through senior centers and other senior care organizations and programs delivered by senior oriented national and local organizations were also considered positively by respondents.

Learn more about the financial exploitation survey conducted by the Investor Protection Trust (IPT) and Investor Protection Institute (IPI) in response to questions posed by the Consumer Financial Protection Bureau (CFPB)."

SENATOR NELSON HONORED FOR EFFORTS TO PROTECT ELDERLY

August 6, 2012 -- AUSTIN -- Texas State Senator Jane Nelson-R, Flower Mound, has received distinctions from two organizations dedicated to supporting assisted living providers and residents in Texas.

The Assisted Living Federation of America (ALFA) gave Senator Nelson its Statesman Award, and the Texas Assisted Living Association (TALA) named her "2011 Senator of the Year." These recognitions honor Senator Nelson's efforts to promote the care of aging Texans, reduce injuries to the elderly, and improve long-term care services.

"These organizations have been tireless advocates on behalf of long-term care providers and clients," said Senator Nelson. "We have a responsibility to Texas' aging population, and it is a true honor to be recognized for our efforts to support them."

Senator Nelson has sponsored legislation creating a volunteer program to assist families in the care of their elderly. She supported a measure to increase awareness of fall prevention and to reduce the cost of fall-related injuries. Under her leadership, the Legislature has passed measures to improve long-term care services and to increase consumer access to related information.

"Each year the Assisted Living Federation of America honors a state legislator who has made an exceptional commitment to advocate on behalf of senior living residents. Senator Jane Nelson has been a true champion for seniors in Texas, and we are proud to present her with the 2012 ALFA Statesman Award," said Rick Grimes, President and CEO of ALFA. "Throughout her career, she has stood for improvements in care to the elderly," said Gail Harmon, Executive Director for TALA.

The Assisted Living Federation of America and its Texas affiliate, the Texas Assisted Living Association, advocate on behalf of assisted living facilities and residents to promote informed choice and quality health care.

SENATOR JANE NELSON represents District 12, including portions of Tarrant and Denton Counties. She is Chairman of the Senate Committee on Health & Human Services.

From www.tala.org

Binge drinking increases risk of cognitive decline

I saw this in the USA today and thought it was interesting.  We need to do all we can to keep whatever brain cells we have.  Enjoy.

By Janice Lloyd, USA TODAY

Moderate drinking and binge drinking among older people increase the risk for cognitive decline and memory loss, according to two studies presented today at the Alzheimer's Association International Conference 2012 in Vancouver, Canada.

Adults ages 65 and older who reported binge drinking at least twice a month were 2½ times more likely to suffer cognitive and memory declines than similar-aged adults who don't binge-drink. In this study, binge drinking is defined as four or more drinks on one occasion.

"It's not just how much you drink but the pattern of your drinking," says lead author Iain Lang of the University of Exeter in England. "Older people need to be aware, if they do binge-drink, of the risks and they should change their behaviors."

Binge drinking appears to be a big problem in the USA. The findings follow a study in January by the Centers for Disease Control and Prevention reporting that one in six adults in the USA are binge drinkers and those in the 65-plus age group binge-drink more often than any other age group. In that survey, binge drinking is defined as men having five or more drinks within a short period of time and women having four or more drinks.

Those most likely to binge-drink have incomes of more than $75,000 a year, according to the CDC.

The CDC recommends moderation, if you do drink. It describes moderate drinking as no more than one drink a day for women and no more than two drinks for day for men.

Lang's eight-year study on binge drinking followed 5,075 U.S. adults ages 65 and older and assessed cognitive function and memory in a telephone survey. Among the findings: 4.3% of men and 0.5% of women reported drinking heavily twice a month or more; another 8.3 % of men and 1.5% of women reported doing so once a month or more.

Earlier studies have noted drinking alcohol in moderation, especially red wine, might decrease the risk of cardiovascular disease, dementia and premature death.

"The many dangers of misuse of alcohol, and some of the possible benefits, have been widely reported, and there needs to be clarification by the scientific community," says Bill Thies, chief scientific and medical officer for the Alzheimer's Association. "Certainly no one should start drinking in order to reduce Alzheimer's risk."

In another study reported at the conference, researchers found moderate alcohol consumption had no protective properties in the mental functions of older women. The study followed 1,306 women ages 65 and older for 20 years. Among the highlights:

•Women who changed from not drinking to drinking over the course of the study had a 200% increased risk of cognitive impairment compared with non-drinkers.

•Women who reported drinking more in the past than at the beginning of the study were at a 30% increased risk of developing cognitive impairment compared with non-drinkers.

•Moderate drinkers in the late phrase of the study were roughly 60% more likely to develop cognitive impairment compared with nondrinkers.

"Alcohol use in late life many not be beneficial in older women," says lead author Tina Hoang of The Veterans Health Research Institute in San Francisco. "It may be that the brains of older individuals are more vulnerable to the effects of alcohol."

Counting on an Inheritance? (Part 3)

This is the final part of an interesting article from the Wall Street Journal.  Bottom line is that we all need to save and plan on getting no inheritance and then if we do, that's a bonus.  We also need to think of what will happen if our parents outlive their money and we need to pitch in.  Some definite interesting ideas to consider.  Read on and learn something.

By Anne Tergesen in the Wall Street Journal

Part 3

Measures to Take

If parents anticipate running short of money—and if they and adult children are able to start a dialogue—there are several steps families should consider, financial planners say.  Among them: Have parents recalibrate their budgets, downsize to a smaller residence, buy an annuity or longevity insurance to lock in a life-long income, or take out a reverse mortgage.

In situations where children have adequate financial resources, some advisers recommend the children pay a parent’s health-insurance premiums, purchase a long-term-care insurance policy for him or her, give a set amount of money each month or purchase the parent’s home to generate cash for living expenses.  (Before implementing a strategy, talk with your financial and tax advisers.)

The process can lead to conflict, although the tension typically remains beneath the surface, says Claudia Fine, and executive vice president at SeniorBridge, a New York-based company that provides care-management services.

Very often, she adds, she sees conflict arise over expenditures on caregiving.  “Because feelings about inheritance are not expressed, families have a hard time sorting out their differences.”

Siblings Sort It Out

Linda Fodrini-Johnson, 67, suspects inheritance calculations play a role in differences she and her three brothers have over managing the finances of their mother, Bernice Bidwell, 90.

Ms. Fodrini-Johnson says she and one brother, 60-year-old Craig Bidwell, “don’t need to inherit” from their mother, who recently had a stroke and suffers from congestive heart failure.  But disabilities have prevented the other brothers from working in recent years.

“There is tension,” says Ms. Fodrini-Johnson, who lives in Walnut Creek, Calif., and runs a company that provides care-management services.  “You hear it and feel it, but nobody articulates it because it would be disrespectful to Mom.”

She points to a recent disagreement over her mother’s hair.  She wanted to take her mother to a hairdresser instead of using the one at her mother’s assisted-living facility.  But other siblings resisted.

No one came out and said it was about the cost, Ms. Fodrini-Johnson says, but that seemed to her to be the motivation.  The siblings also debated whether to remodel and rent their mother’s San Francisco home—so it could bring in some money—or allow a grandchild to serve as temporary caretaker of the place.

To avoid conflict, Ms. Fodrini-Johnson says, she solicits her brothers’ opinions and explains the reasons for her decisions as well as the details of her mother’s finances.  But as her mother’s power of attorney, she has the final say.

Her three brothers declined to comment on the hairstylist incident, or said they didn’t know about it.  Tow brother, Craig and 63-year-old Gary Bidwell of San Francisco, say they discussed renting their mother’s house to bring in extra income to offset her expenses.

No Expectations

When it comes to the idea of inheritance, the three brothers are of similar minds.

Robin Bidwell, a 59-year-old in Colfax, Calif., says he sustained an injury at age 48 that has prevented him from working.  While he receives a pension and Social Security, “I wasn’t able to put money away.  I don’t live the life I want to live, but I don’t look to my mother’s inheritance to be on top of things,” he says.  “I believe my mother’s care is first and foremost.  That, to me, is more important than anything.”

“An inheritance would help, but I am not looking forward to it,” says his brother Gary, a 63-year-old who retired on a disability pension in 1998.  “I don’t want an inheritance if I have to lose someone I love.”

Like many adult children, the third brother, Craig, says he hopes to receive an inheritance—in his case to help pay for a new home he and his wife plan to build.  However, the retiree says he is grateful that his mother is able to afford the high-quality care she receives.

“Whatever my mother has is her,” he says.  “It’s not my inheritance.  I didn’t work for it.  My brothers didn’t work for it.  My parents worked for it.?

Counting on an Inheritance? (Part 2)

Here is part two of our continued saga of long term planning.

By Anne Tergesen in the Wall Street Journal

Scaling Back Bequests

Many parents, of course, won’t exhaust their savings.  The Center on Wealth and Philanthropy at Boston College estimates that baby boomers and their offspring could inherit as much as $27 trillion over the next four decades, with the progeny of the wealthiest pocketing much of the windfall.

But there are signs that expected bequests are under pressure.  According to Boston College’s Center for Retirement Research, from June 2006 to June 2010, falling asset values reduced projected inheritances for baby boomers and estimated 13%.  Stock prices have since recovered, although house prices in most markets have not.

Even the affluent are pulling back.  Among those with $250,000 or more in investible assets, only 41% said preserving inheritances was a top concern, down from 54% in 2009, according to a Merrill Lynch survey released earlier this year.  Due in large part to a 22% decline in projected future bequests of $500,000 or more, the amount individuals expect to transfer fell by 19% from 2008 to 2009, according to Michael Hurd, director of the Center for the Study of Aging at Rand Corp., a nonprofit research organization.

Just as telling is a recent study from Northwestern Mutual Life Insurance Co. in Milwaukee.  When asked how prepared they feel to live to various ages, one in three surveyed adults age 60-plus said they didn’t feel prepared financially to live to age 85; almost one in two said the same with regard to age 95.

Suffering in Silence

Not surprisingly, many families are loath to discuss these issues.

In addition to serving as a reminder of the older generation’s mortality, a conversation about inheritance of Mom and Dad running out of money can provoke anxiety in parents.  Many are uncomfortable disclosing the details of their finances in the first place, even more so when the’re worried about disappointing their children.

Adult children, in turn, aren’t eager to ask their parents about money for fear of coming across as greedy.  Some feel guilty for thinking about their own financial needs at a time when parents could be facing steep medical or long-term-care expenses.  “Due to the new realities of longevity, adult children—who have rightfully assumed they would inherit something substantial from their parents and have lived their lives accordingly—can no longer count on that,” says Lillian Rubin, a sociologist, psychologist and author.  Adult children, she adds, “often feel guilty for even thinking about” inheritance.

Nonetheless, financial advisers say, it is important for families to talk—if only to establish realistic expectations.

Peter Bell, 59, says he and his parents “have always been very open about talking about finances.”  That frankness has helped them through some tough choices in the past few years.

Mr. Bell, the president of the National Reverse Mortgage Lenders Association in Washington, D.C., “always assumed” his father, Jerry, 87, and mother, Florence, 88 would leave a substantial inheritance.

After his parents lent his brother money several years ago, Mr. Bell says, the “decided I would get the house and everything else would be split.

But when the elder Bells decided almost two years ago to move into a continuing-care retirement community, it became apparent they would need the proceeds from the sale of their home to finance the community’s $425,000 entry fee.  Worse, because the depressed Florida real-estate market hindered their efforts to sell their home in Delray Beach, the couple had to borrow the $425,000 entry fee from their son.

“We have always considered our money as family money,” says Jerry Bell, who anticipates repaying 85% of the loan from the proceeds of the home’s recent sale.  “When the kids needed help, we were there for them.  And when we needed help, they were there for us.”

Part 3 will finish this article tomorrow.

Counting on an Inheritance? (Part 1)

Here is an article my dad sent me from the Wall Street Journal.  I thought it was very insightful about our current working generation.  Plan and save for yourself is basically the gist of the article but please read on and I think everyone will glean something from it.  Here is part 1.

By Anne Tergesen in the Wall Street Journal

Baby boomers:  Get ready for a double whammy.

Four years now, there’s been a lot of talk about boomers getting tremendous windfalls as their parents pass on.  Many boomers, in fact, have been lagging behind in their savings, betting on – hoping for – big bequests, especially since many of them suffered big losses in 2008.

But for a growing number of boomers, things aren’t going according to plan.  The postwar generation is living longer—and many are spending their savings along the way.  And, of course, many of them also took a hit in 2008.

The result is that, as a group, boomers likely won’t be getting as much of an inheritance as they hoped.  Even worse, far from receiving a bequest, a growing number are tapping some of their own savings to help their cash-strapped parents make ends meet.

For families, the result is often a lot of scrambling, dashed dreams, and conflict and angst as parents and children try to come to grips with the lean new reality—and divide up a smaller pie.

“There are way too many adult children I see who are looking at Mom and Dad’s estate as their ticket to a secure retirement,” says M. Holly Isdale, and estate planner in Bryn Mawr, Pa.  “But with people living longer, much of the money is likely to be spent.”

How much longer?  Thanks to medical gains, a 65-year-old man has a 60% chance of living to age 80 and a 40% chance of reaching 85.  For women, the odds are 71% and 53%, respectively.  All of this has made the 85-and-over age bracket the fastest-growing segment of the population.  In an era of low interest rates, volatile financial markets, and rising costs for health and long-term care, finding money to cover those years isn’t always easy.

Consider the case of Nancy Becker, the co-owner of a small business in Waterbury, Conn.  Her parents, Morris and Dorothy Stein, were diligent savers, “But they didn’t imagine living well into their 90’s,” says Ms. Becker, whose father died in 2006 at 92 and whose mother died in 2011 at 97.

Ms. Becker and her two brothers inherited a house in Vermont from their father.  But they spent about $180,000 of their own money—an amount that exceeds the value of the Vermont property—to cover living expenses for their mother in the final three years of her long life.

Ms. Becker, now 63, says she certainly doesn’t begrudge her parents for outliving their savings.  The Steins built a thriving plumbing and heating business that now employs Ms. Becker and her husband, among other family members.  Still, as Ms. Becker’s in-laws enter their 90’s, she worries that “their money is running out, too.”

Financial losses can also put a dent in the older generation’s reserves.  Donald Hoeller, 86, of Glendale, Wis., says he and his wife, Bernadette, 85, had hoped to bequeath “several hundred thousand dollars” to each of their six children.  But an office complex in which the couple invested 60% of their retirement savings recently landed in foreclosure and litigation.

So, Mr. Hoeller says, “I don’t know if they will get anything.”

His daughter, Mary Hoeller, 58, says that while she never counted on an inheritance, “times are tough”—and she now has the added worry that her parents may run out of money.  A divorcee who is paying college-tuition bills for the youngest of her three children and wants to help another child with medical-school tuition, Ms. Hoeller says her income has declined substantially since 2008.

“I am very frugal,” says Ms. Hoeller, a mediator in Indianapolis.  But “who wouldn’t want an inheritance from their parents?  It would be a good thing.”

Come back and read the next part in my next blog.

Obama Care and Senior Housing Part 3: Senior Housing Wins Under ObamaCare

Here is the third and final part of an analysis of the ObamaCare decision.  I saw this on SeniorHousingForum.net and thought it provided some good points of view.  Only time will tell what the real pros and cons of the Supreme Court's decision will be.  Read on. 


If you take a look at the comments under part two, you will see I took some shots, for my article listing the losers.  It is clear this is an issue that generates a lot of heat and with good reason, it will in one way or another, impact each of us.  Even when I get taken to task (and sometimes I even deserve it) I really appreciate the dialog and will continue to allow the comments to stand.

Healthcare Delivery System Under ObamaCare

In my mind, the biggest question we need to ask is, What will the healthcare payment and delivery system look like 10 years from now?  It seems that we are headed toward one of two scenarios:

1. Health Plans for Everyone  -  I think this is the more likely of the two scenarios.  Direct payment by the government to providers will cease to be.  Rather the government will pay those dollars to health plans, who will then manage the care of the people they are responsible for.  This will mean an end to Medicare as we know it today.  Essentially what will happen is everyone will be forced into an HMO type plan,  some will function like true HMO’s and others will look more like preferred provider networks.  I also see the Medicaid system moving in the same direction.

2. Medicare For All –  There are a significant number people who would like to see the Medicare system expanded to include everyone and this would be true universal care.  There are many barriers to this, not the least of which, is a formidable insurance political lobby. Probably not in my lifetime, but it would likely lead to an even more uneven distribution of services, and delays in getting appointments, treatments and procedures as measures to control costs.

Senior Housing

I see opportunities in these areas:
1.  Skilled Nursing (SNF) Costs less than an Acute Hospital –  Under the old system, hospitals caring for patients with Medicare, received a specified lump sum payment for a particularly diagnosis.  The faster the hospital could get that patient discharged the more money they would make.  As a result, patients got discharged to skilled nursing or or other levels of care earlier than what was optimal.
This is being changed so that if a patient is readmitted within 30 days of discharge, the hospital will be penalized financially.  Hospitals will be looking to create tight relations with SNF’s that will take extraordinary steps to make sure those readmissions won’t happen.

2.  Assisted Living Costs less and Skilled and Acute Care –  Assisted living stands to be the biggest winner of all senior housing options.  Assisted living communities need to build tight relationships with hospitals.  In order to develop those relationships they will need to demonstrate they can accept these post acute patients and provide for their medical needs at a lower cost and in a much better environment.  And most importantly, keep those residents from going back to acute care in that 30 period.

Along this same line, those assisted living communities that develop relationships with senior HMO’s will tap into another source of post acute care opportunities.  The big win here is that in effect, these HMO’s are allowed to spend money that formerly could only be used for skilled nursing.  The HMO’s have a single goal, getting their members better at the lowest cost.  If your assisted living community can do that, you will win.  While many of these residents will be relatively short stay, some will convert to longer term residents.

3.  Independent Living costs less than Acute, Skilled and Assisted Living  -  The reason independent living needs to pay attention is that there will be residents who can successfully return to an independent living setting if appropriate resources are made available.  This is why the management needs to have a good rolodex of these resources and be willing to work with the residents and the resident families to access these services.

What other opportunities do you see?  What risks do you see?

10 warning signs of Alzheimer's

I joke with my wife about my having Alheimer's Disease every time I forget things.  While it's common for us to forget things as we age, how do we determine if we may be developing the early symptoms of Alzheimer's?  I saw these symptoms on the Alzheimer's Association website and thought they were something everyone should see.  Enjoy.

10 warning signs of Alzheimer's

1) Memory loss that disrupts daily life:  One of the most common signs of Alzheimer's is memory loss, especially forgetting recently learned information. Others include forgetting important dates or events; asking for the same information over and over; increasingly needing to rely on memory aides (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own.

What's a typical age-related change? Sometimes forgetting names or appointments, but remembering them later.

 

 

2) Challenges in planning or solving problem:  Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before.

What's a typical age-related change? Making occasional errors when balancing a checkbook.

 

 

3) Difficulty completing familiar tasks at home, at work or at leisure: 

People with Alzheimer's often find it hard to complete daily tasks. Sometimes, people may have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favorite game.

What's a typical age-related change? Occasionally needing help to use the settings on a microwave or to record a television show.

 

 

4) Confusion with time or place:  People with Alzheimer's can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there.

What's a typical age-related change? Getting confused about the day of the week but figuring it out later.

5) Trouble understanding visual images and spatial relationships: 

For some people, having vision problems is a sign of Alzheimer's. They may have difficulty reading, judging distance and determining color or contrast, which may cause problems with driving.

What's a typical age-related change? Vision changes related to cataracts.

 

 

6) New problems with words in speaking or writing: 

People with Alzheimer's may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a "watch" a "hand-clock").

What's a typical age-related change? Sometimes having trouble finding the right word.

7) Misplacing things and losing the ability to retrace steps: 

A person with Alzheimer's disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time.

What's a typical age-related change? Misplacing things from time to time and retracing steps to find them.

 

 

8) Decreased or poor judgment:  People with Alzheimer's may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean.

What's a typical age-related change? Making a bad decision once in a while.

 

 

9) Withdrawal from work or social activities:  A person with Alzheimer's may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced.

What's a typical age-related change? Sometimes feeling weary of work, family and social obligations.

 

 

10) Changes in mood and personality:  The mood and personalities of people with Alzheimer's can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone.

What's a typical age-related change? Developing very specific ways of doing things and becoming irritable when a routine is disrupted.

Obama Care and Senior Housing Part 2: The Losers

This is the second part of three on Obama Care.  I am using it from the Senior Housing Forum.  While I believe in a free market system and I am dessappointed that the law was upheld, I know there should be some changes.  Fraud is rampant and with the increased healthcare rolls, I see more targets for fraud.  There should also be some way that medicines are kept at an affordable price.  I am currently taking one pill that costs about $60 per pill.  That is about $1,800 per month.  Now the drug company can charge whatever it wants but it is easy to see how many people choose between medicine and food.  I truley hope Obama Care isn't as bad as I anticipate it will be.  Read below for some more info.



On Friday I talked about the winners, in light of the Supreme Court ruling.  Inevitably if there are winners, there are losers.  Thursday will close out the series talking about the specific implications for senior housing.

The Losers

1.  Taxpayers –  It has been said that, in effect, this is the single biggest tax increase ever implemented by the Federal government.  Hardest hit will clearly be the middle class.  Initially, it is clear the Affordable Care Act will add to the tax burden.  What is less clear is what savings, if any, will be achieved, when they will be realized and if they will save money for the middle class as promised.

2.  Drug Companies –  In the short term, the drug companies have created an agreement with the government that, in effect, protects their bloated profits.  The jury is still out on how long it will take for that agreement to crumble, but it will.  For consumers, this is a mixed bag.  Over time it will eliminate derivative drugs that are expensive but provide only marginal real benefits to patients.  On the other hand, it will likely dampen the innovation of new drugs that could radically improve life.

3.  Durable Medical Equipment Providers (DME’s) –  Several times each year a story on Medicare fraud splashes into the news.  Probably seven out of ten times, the fraud, involves DME providers.  One government study indicates more than 10% of all DME dollars paid out are for fraudulent claims. We can look forward to ObamaCare coming down hard on  DME.  If all they do is reduce fraud that is great, but look for real claims to also be denied and delayed.

4. Physicians –  There is ongoing pressure to reduce payments to physicians.  They are an easy target as the  general impression is that they are wealthy and by extension, overpaid.  There is no doubt that some specialities can still make practitioners wealthy, but in truth, being a physician generally means a very nice living but it is no longer a guaranteed path to wealth.

5.  Consumers –  A few weeks ago I had a significant allergy attack.  After a day of trying to push through it, I was nonfunctional.  First thing in the morning I called my primary physician and had an appointment for later that same day.  I got to my appointment on time and maybe 3 minutes after paying my co-pay I was ushered into the physician exam room and 3 minutes later the physician was there to see me.  This happens because there is competition and significant reimbursement.  I do not expect it to stay this good. There are already so many stories coming out of Canada and England of individuals having to wait weeks for a physician appointment for even serious (but not immediately life threatening)  problems and long waits when the appointment day finally arrives.

Too Early to Tell

1.  Skilled Nursing –  There is no doubt that skilled nursing communities must continue to fight to protect their funding.  Both Medicaid and Medicare dollars are at risk.  I predict that within 10 years every single recipient of government healthcare dollars will receive their benefits through an HMO like entity.  This will likely benefit top notch facilities and make life more difficult for the rest.
It is my view that, in reality, Skilled Nursing faces essentially the same problems with or without ObamaCare.

2.  Home Health –  This one is really difficult to predict.  It seems clear that Home Health actually provides the most bang for the buck and it feeds the instinctual desire people have to age in place.  The flip side is that, home is a pretty easy target.  Recipients do not speak as a single voice and providers are almost as equally fragmented.

3.  Hospice –  Ditto Home Health.

Obama Wins Big with Health Care: Does Senior Housing Win, Lose or Draw?

I saw a blog in Senior Housing Forum that I thought was interesting and on target.  While I personally think we do not have a healthcare crisis I do believe we have a health insurance crisis.  We need to put our heads together to find a way for those with no insurance and/or pre-existing conditions can purchase affordable, quality insurance.  If anyone figures this out, please let me know.  Enjoy.


This is part one of a three part series, that will be published today (Friday), then on Monday and Tuesday of next week.

First Things First:  No matter what the other side says, life will go on!

-  If you are a fan and see this as a victory, you will end up thinking it was not good enough and did not go far enough.

-  If you are depressed, believing that, in one fell swoop, the Supreme Court eviscerated the constitution (an opinion I am somewhat sympathetic to); This is a great country and a few bad decisions will not crush the nation.  Even the Supreme Court has reversed itself over time.  Life will go on and America will continue to be a great country and a great place to live.

It will, ultimately, take years to fully understand the impact on senior housing but here is my initial analysis for whatever it’s worth.

Winners

1.  Hospitals –  At least in the short-term, hospitals are the first or second biggest winners.  They will go from having many non paying patients to having very few indigents overnight.  No one seems to be suggesting that payment rates to hospitals should be modified to reflect this new standard.
That being said, over the long term, their prospects may not be so bright.  They consume lots of dollars and so will become a natural target for cuts.

2.  Many Uninsured –  In truth this is the one bright spot in the whole sorry mess.  There are a bunch of people who did not have insurance who will have coverage. No matter how you slice it, this is a good thing for them and for society. Clearly people with no access to basic health-care can end up becoming very ill and requiring hugely expensive indigent care.

3.  Government Workers – The plan will require more government workers; those who administer and regulate the system and the IRS who will enforce the plan.

4.  Fraudsters –  Today the government healthcare plans are a favorite playground for fraudsters.  This plan will increase the size of that playground. It will increase the opportunities to steal the people’s money.

5.  Some Employers –  It appears the health plan will in effect provide incentives for employers to eliminate private health plans in favor the government “healthcare exchanges”.

6.  Health Plans –  At least in the short term they will be big winners.  The current thinking seems to be that it is more efficient to hand big buckets of money to private health plans and make them responsible for the healthcare of corresponding groups of people.

Recapping the Winners

While there are, in my view, at least six groups that will see huge benefits from the health plan, this does not mean it is good for society as a whole. Still to come, the losers and how it will impact senior housing.

For Those with Alzheimer’s, Hospitalization Contributes to Mental Decline

In our small Assisted Living home, we have noticed some decline in our residents after a hospitalization.  I saw an article today confirming that has happened elsewhere.  Here is a copy of the article from the ALFA web page that I found interesting.


Harvard researchers have found that a hospital stay is related to a faster rate of mental decline and a heightened risk of dying or entering a nursing home for those who already have Alzheimer’s disease.

A study following nearly 800 individuals with mild Alzheimer’s disease found that those who had been hospitalized during the course of the research were nearly twice as likely to experience increased mental decline or death. Of those who were hospitalized, one in 16 passed away, one is seven had to move to an institutionalized setting, and one in five suffered mental decline within one year of getting out of the hospital.  If the individual experienced delirium during his hospital stay, he increased his risk for a poor outcome by about 12 percent.

"Delirium prevention may represent an important strategy for reducing adverse outcomes in this population," said Dr. Tamara Fong, an assistant professor of neurology at Harvard Medical School and lead author of the study. Delirium can be prevented through visits by a family member or other familiar person, supplying the individual with necessary eyeglasses and hearing aids, as well as encouraging the individual to get out of bed often for walks. Delirium can also be prevented by keeping older people out of the hospital and treating them in their homes, said Fong. Researchers emphasized that this study’s results highlight the importance of preventing hospitalizations and delirium, which is most likely to occur when individuals with Alzheimer’s disease experience a sudden change in routine.

Read more about this study, Adverse Outcomes After Hospitalization and Delirium in Persons With Alzheimer Disease, published in the June 19 online issue of Annals of Internal Medicine. Learn more about this study.

Assisted Living Options Grow, Nursing Home Occupancy Declines

I saw a great article today about the growth of Assisted Living and the effect it has on Nursing Facilities.  It seems that people have a mental picture of  Nursing Facilities of elderly people sitting on the front porch in their wheelchair, smoking cigarettes or just looking out of it.  In my opinion, there are people in Nursing Facilities who should not be there but should be in an Assisted Living Home.  If they just need help with activities of daily living, they don't belong in a Nursing Facility.  I believe pressure by families of the elderly will cause change in the thoughts of governing bodies.  It will just take time.

Many of the Assisted Living Homes will not accept Medicaid residents because the level of reimbursement is fairly low.  With the pressure of regulations and shareholders, it may be difficult for Medicaid facilities to keep their doors open.  Please keep reading below.


 By Katherine Kahn, Contributing Writer
Research Source: Health Services Research
Health Behavior News Service


Newswise — A new study finds an association between an increase in assisted living options, which provide older adults with an array of services such as help with everyday tasks in homelike settings, and a decline in nursing home occupancy. This shift in delivery of care has both positive and negative implications for seniors.

The study appears in the upcoming issue of Health Services Research.
Data on assisted living is patchy, primarily because the assisted living industry is not widely regulated and receives little government financing. Additionally, what constitutes assisted living is poorly defined and typically includes a broad range of housing options with varying levels of care.
“Assisted living has, in general, not been very well understood or studied in its role in the broader long-term care marketplace,” said the study’s lead researcher, David Grabowski, Ph.D., professor of health care policy at Harvard Medical School.

To collect data on assisted living, Grabowski and his colleagues contacted each state; however, only 13 states had long-term data available, from 1993 to 2007. Data for nursing homes was gathered from the Centers for Medicare and Medicaid Services, which represents over 95 percent of all nursing home facilities in the U.S., and from Brown University’s Minimum Data Set (MDS) on long term care.
“We found that a 10 percent increase in assisted living capacity led to a 1.4 percent decline in private-pay nursing home occupancy,” Grabowski said. “It’s not a huge effect and it’s not a one-to-one substitution, but I think this is a pretty sizable relationship.”

Since most individuals in assisted living are private-paying residents, researchers accurately predicted that assisted living expansion would have little impact on occupancy of Medicaid nursing home residents or Medicare-eligible patients who were in nursing homes for short-term care after a hospitalization.
Robert L. Kane, M.D., director of the Center on Aging and the Minnesota Area Geriatric Education Center at the University of Minnesota commented that growth in assisted living may not be the only reason for nursing home occupancy decline. “This phenomenon has been known for a long time…the problem is it’s not the only phenomenon in town. For example, there’s been a huge growth in home- and community-based services under Medicaid and it may well be that places that were growing in assisted living were also growing in these programs.”

Grabowski and researchers also found that as assisted living expanded, there was a small but significant increase in the level of care needed among nursing home residents. “This suggests that there is a healthier segment of the potential nursing home population that is being siphoned off and entering assisted living instead,” Grabowski said.

Since nursing homes generally prefer private-pay patients and Medicare patients over Medicaid patients, this trend could have negative financial effects for nursing homes, Grabowski speculated. “Assisted living may be a really attractive option for private paying individuals, but it has implications for Medicaid as well in that nursing homes can no longer depend on cross subsidies from private-paying residents since there’s maybe fewer of these individuals in that marketplace.” The result could be fewer resources for direct patient care of all nursing home residents.