Study Shows Certain Personality Traits Help Seniors Reach 100

Want to live to the century mark? A growing number of seniors are doing just that, as advances in medicine and nutrition help more and more men and women reach the age of 100. A recent pair of articles sheds some light on some of the secrets of those people who not only age, but age well. However, their so-called secrets of staying strong and active through their 80s, 90s and beyond may not be exactly what you might expect. The shorthand version: how you eat may be less important than how you think.

The first article we want to spotlight is this one from the website of Time magazine. It claims to reveal the personality traits of men and women who remain alive and flourishing all the way to the century mark. “If you’re looking to live to 100,” says Time, “you may want to watch more than your diet. A study of people in remote Italian villages who lived past 90 found that they tended to have certain psychological traits in common, including stubbornness and resilience.” This study, published in a professional journal called International Psychogeriatrics, examined the mental and physical health of a group of Italian seniors in an area known for its abundance of active men and women 90 and older. Besides surveying the seniors, researchers also asked younger family members to describe the traits of their elders.

The results were quite revealing. “The younger adults tended to describe their older relatives as controlling, domineering and stubborn,” says the Time article. “But the 90- and 100-somethings also displayed qualities of resilience and adaptability to change.”  One extremely old Italian man stated, “I have fought all my life and I am always ready for changes. I think changes bring life and give chances to grow.” The researchers noted that these seniors, born into wars and the Great Depression, have experienced extreme hardship during their lives, and yet they have learned that  “in order to flourish, they have to be able to accept and recover from the things they can’t change, but also fight for the things they can.”

According to the Time report, the oldest adults in the survey shared other qualities people today might do well to emulate, “including positivity, a strong work ethic and close bonds with family, religion and the countryside.” In spite of their advanced age, these men and women weren’t just sitting back in their recliners: “Most of the older adults in the study were still active, working regularly in their homes and on their land. This gave them a purpose in life, wrote the study authors, even after they reached old age.”

Researchers uncovered an extremely interesting paradox when they compared both the physical health and the mental and emotional health of the older residents with a group of their younger family members, ages 51 to 75. As one would expect, the older adults were less healthy physically – however, they were in fact better off emotionally, displaying better mental well-being, greater self-confidence and stronger decision-making skills. Researchers referred to this as the paradox of aging: “Even as physical health deteriorated, mental health quality, at least for the people in the study, remained high. Things like happiness and satisfaction with life went up, and levels of depression and stress went down,” says the senior author of the survey. “It’s the opposite of what we might expect when we think about aging, but it shows that getting older is not all gloom and doom.” Here at AgingOptions we say a loud “Amen” to that.

Speaking of staying active while growing old, we found a second related article, this one from the website of the BBC, describing what the reporter called “the secrets of the superagers.”  These active seniors, says the BBC, are living independently, remaining “robust in body and mind,” and maintaining a wide and varied social circle. Unfortunately, as the article implies, even though more and more seniors will live longer and longer, not many will enjoy that type of healthy, active lifestyle, instead spending much of their longer lifespan battling various chronic health problems.

Helping people live better as they live longer is of critical global importance, says the BBC report, because the number of people worldwide aged 65 and older is expected to triple between now and 2050, to about 1.5 billion senior men and women. In the United Kingdom alone, of the total population of 65 million, as many as one in eight are expected to reach age 100. So are there really “secrets” that the rest of us can glean from observing the so-called superagers? In spite of the intriguing headline on the BBC article, there doesn’t seem to be a lot of substance.  These “secrets” sound pretty basic to us. To be a superager you’ll need to:

  • Maintain a positive attitude
  • Broaden your horizons as you grow older by learning new things and trying new experiences
  • Stay socially connected through community activities and volunteerism
  • Remember to exercise both the mind and the body.

Here at AgingOptions, no matter how long you expect to live, our advice to you is straightforward: have a plan in place for your future. Don’t make the tragic mistake of thinking the type of retirement life you’re hoping for will simply happen as if by magic. Yes, you need to maintain your physical and mental health, have a purpose in life, and stay connected to family and community, but you also need to ask yourself some profound questions. Do I have an adequate financial plan? Are my wishes going to be protected legally? Are my housing choices consistent with my health, my income, and my chosen lifestyle? Are my medical needs adequately covered? Is my family fully on board and supportive of my wishes? With a LifePlan from AgingOptions as your retirement blueprint, the answer to all these questions is a confident “yes.”

We invite you find out more by joining Rajiv Nagaich at a free LifePlanning Seminar early in the New Year. These information-packed sessions are extremely popular, and we assure you you’ll be very glad you came.  Remember, there’s no obligation whatsoever. For information and online registration, click here; or feel free to call us during the week for assistance. Retirement can be a time of security and great satisfaction, if you’re properly prepared – and that means a LifePlan from AgingOptions.

(originally reported at www.time.com and www.bbc.com)

Share this to your favorite network:

Nursing Home Rating System Plagued with Inaccuracies, Says Report

Since 2008, consumers searching for the best quality nursing care facilities have relied on a 5-star rating system on the “Nursing Home Compare” website maintained by the U.S. Government (that website is located here – it allows you to search and review nursing care facilities by zip code or locale). The site includes a rating system of between one and five stars (five being best) for the categories of Health Inspections, Staffing, Quality Measures and an Overall rating. Many seniors and their families rely on this service for information that is supposed to be objective and honest.

But it turns out that some of the ratings are bogus, or wildly exaggerated, based in part on nursing home self-evaluation, a practice that has been shown to be seriously inaccurate in several key areas. Two years ago the New York Times reported that nursing homes were manipulating the data (“gaming the system,” according to the Times) such that “even nursing homes with a history of poor care [had been rated] highly in the areas that rely on self-reported data.”  Last year a study done by the Centers for Medicare and Medicaid Services (CMS) revealed that little had changed. We found this disturbing report on the website of the Center for Medicare Advocacy, explaining how pervasive this practice is. Consumers need to beware.

The idea of a website to enable potential residents to search out and evaluate nursing homes goes back 20 years to the time of the Bill Clinton administration. The five-star rating system was launched in 2008. Recent studies have shown that a rating of five stars definitely increases occupancy while the lowest rating, one star, drives would-be residents away. But there’s a big difference in perception between a one-star facility and one that has a two or three-star grade, so it’s easy to see why nursing home operators would have a powerful incentive to boost their lowest ratings in order to attract move-ins. Sadly however, with the data appearing to be so flawed, it leaves many consumers in the lurch when it comes to evaluating care options.

In order to test whether nursing homes were complying with accurate rating standards, the CMS began by checking the ratings of nursing home facilities which had already been identified as sub-standard.  Every month CMS and state officials single out those nursing facilities that are providing the poorest care to residents, labeling them SFF’s or Special Focus Facilities. Each SFF is placed under more rigorous scrutiny by Medicare and Medicaid inspectors until discrepancies and shortcomings are corrected. As part of their evaluation of the rating system, the CMS selected 42 Special Focus Facilities – all of which should have had very low ratings (one star) on the Nursing Home Compare website – and checked to see how they had evaluated themselves. The results were eye-opening. Of the 42 suspect nursing homes, almost all had received a one-star rating on their Health Inspections, yet many had overall ratings of two or three stars, indicating they were giving themselves far better evaluations than they deserved in the areas of Staffing and Quality Measures, which are self-evaluated. Many of these facilities, considered operationally sub-par by the government, had given themselves ratings of four or five stars in their self-evaluations in order to avoid an overall one-star quality rating. They were still “gaming the system.”

The Center for Medicare Advocacy considers this troubling for two reasons. “First,” says the article, “it continues to demonstrate manipulation of the federal website.  Second, it moves facilities with one star in health surveys into a two-star overall rating.” The practice of facilities boosting their overall scores by reporting unrealistically high staffing and quality measures is being done solely to prevent “the stigma of being a one-star facility,” which drives away business.  The net result: evaluation scores that “seriously mislead the public.”  The sobering conclusion is that “composite scores do a disservice to the public when nursing facilities’ self-reported information boosts facilities’ ratings into higher levels.”

Getting objective information about retirement decisions is definitely a challenge. Here at AgingOptions, we want to be your objective guide as you make a whole host of retirement-related decisions, including choosing where you will live. If you need advice on how best to evaluate nursing facilities, assisted living options or any senior housing choices, contact us and we can help you by providing sources of information you can trust, not ratings systems manipulated by salespeople and marketing agencies! And for all your retirement planning considerations – finances, legal affairs, family communications and medical protection – we encourage you to explore the comprehensive process we call LifePlanning. Your LifePlan becomes your blueprint to help you build the secure and satisfying retirement of your dreams.

To learn more about LifePlanning, and about other vital facets of retirement preparation, we invite you join Rajiv Nagaich soon at a free, no-obligation LifePlanning Seminar, offered at locations throughout the area.  These fast-paced, highly informative events are extremely popular and tend to fill up quickly. For dates, times, locations and online registration, click here for our Upcoming Events page, or contact us during the week and let us assist you. It will be a pleasure helping you make smart choices as you plan for your retirement future.

(originally reported at www.medicareadvocacy.org)

Share this to your favorite network:

New Study Tells Seniors: “Get Out and Get Moving” to Stay Healthier

An interesting article we just encountered on the website of the authoritative publication Consumer Reports is a great read for seniors and for those who love them, because it reveals something most of us should find reassuring. When it comes to living longer and staying healthier, five simple words can make all the difference: “Get out and get moving!”

It’s not exactly news that exercise contributes to longevity. Study after study has demonstrated the benefits of physical activity, helping preserve not only physical fitness and stamina but cognitive fitness as well. What’s good to know, according to the Consumer Reports article, is that it’s not just rigorous exercise that helps. According to researchers, virtually any physical exercise, from walking to household chores, has benefit.  As the article puts it, “If you’re looking for ways to extend your life—and make those extra years healthier—heed this advice: Move at least a little and get out of the house as often as you can. That’s the takeaway from two new studies released Wednesday that look at how those who are 65-plus can live longer.”

Before we talk about the benefits of simply getting out of the house, let’s talk about physical activity. Part of the challenge for geriatricians trying to gauge the benefits of exercise on seniors, the article intimates, is that many of the exercise studies have focused entirely on adults under age 65. That’s what makes this new study, published in the European Journal of Preventive Cardiology, so helpful.  “Dutch researchers wanted to find out if being physically active (whether through work, exercise, household chores, or leisure activities) might reduce cardiovascular disease risk in older adults the way it does in those younger than 65,” Consumer Reports writes. The study included almost 25,000 men and women in three different age groups who reported their physical activity levels, and tracked these adults over a period of 18 years.

The encouraging results: “They found that physical activity was just as closely linked to a lower risk of heart disease in  adults over 65 as it was in those are younger.”  Study subjects who engaged in any form of daily physical activity reduced their cardiovascular risk by at least 14 percent. In the words of one geriatrician quoted in Consumer Reports, “This study shows that you don’t need a very vigorous workout regimen or to be walking six miles a day.  Every little bit you move is better than not moving at all.”  This data may help convince increasingly sedentary seniors to make more of an effort to be up and about every day.

The second study, this one done in Israel and reported in the Journal of the American Geriatrics Society, concentrated on the simple act of getting out of the house every day and how related it is to death from all types of disease.  Researchers, writes Consumer Reports, “tracked men and women between the ages of 70 to 95 who lived at home, asking how often each person left the house per week on average and then tracked how long they lived.” The results appeared incontrovertible: “Those who left home most frequently—whether on their own or with assistance—were significantly less likely to die during the 25-year follow-up period than those who tended to stay home, the researchers found.”

A few specific data points show just how significant these findings are. For example, among 78-year-olds who left their home for any reason almost daily, 71 percent survived to age 85; however, among people the same age who rarely went out, only 44 percent lived that long. The study made the same comparison among 85 year olds and found that about three-fourths of those who headed out every day lived to 90, but for their house-bound peers the number reaching age 90 was barely 40 percent. One lead author of the Israeli study explained the correlation.  “Getting out of the house is a proxy for a wider measure of being engaged with the world,” he stated. “Being active cognitively, reading, volunteering, and getting out of the house are all examples of a degree of activity and engagement with the world that seems to have some protective effect or that reflects an underlying attitude of resilience.”

In other words, if you’re a senior who stays at home most of the time, you could be adversely affecting your health. Similarly, if you are too content sitting around and not moving, you’re only making things worse.  The good news, as Consumer Reports states, is that there’s no downside to giving these strategies a try. “Getting out of the house and keeping moving will help you feel better and have a better quality of life for however many years you have left,” says one geriatrician in the article.  Start with something simple and work your way up to doing the things you used to enjoy such as gardening, cooking, or even just walking around the mall. Incorporate a social element if you can, walking with a friend or taking a gardening class. And as the article advises, “if there’s something keeping you inside, such as incontinence, depression, or pain, talk to your doctor to see if there’s a way to manage or treat the problem so you can improve your mobility—and get out the door more.” You’ll feel better and probably live longer if you do.

At AgingOptions we’re always surprised and a bit dismayed at the number of older adults who seem resigned to a sub-par lifestyle as they get older. We’re not talking merely about money – it’s simply not true that plenty of money guarantees a happy retirement. We’re thinking of those seniors who stop taking care of their health, stop being active, and assume that growing older means a downward spiral of decline and marginalization. It doesn’t have to be that way! Just as you can’t build a building without a blueprint or sail a ship without a chart, living well in retirement means having a solid plan, one that answers all your key questions and helps you approach aging with confidence and enthusiasm. A good plan helps you know that you won’t outlive your resources. It ensures that your wishes are legally protected. It guides you into the right housing choices and medical protection. Your plan even involves your family, because you don’t want to be a burden on your loved ones as you age. The only retirement plan we know of that does all that is an AgingOptions LifePlan.

Because this type of planning is so revolutionary, we offer free LifePlanning Seminars where people just like you come to meet Rajiv Nagaich and get their questions answered. Why not join us soon? You’ll find a complete listing of dates, times and locations here on our Upcoming Events page. Then simply register online or call us for help. If you want to follow the advice from the Consumer Reports article, here’s a great way to start: get out and get moving to an AgingOptions LifePlanning Seminar! Age on.

(originally reported at www.consumerreports.org)

Share this to your favorite network:

“Do Not Resuscitate” Tattoo Causes Ethical Confusion in a Miami ER

When is a tattoo a matter of life and death? Apparently when it contains the words “Do Not Resuscitate.” That’s what happened recently in the Emergency Room at a University of Miami hospital. (You can read about this unusual story here on the MSN website.) The story, as odd as it sounded to us, does bring up an issue that is vitally important to millions of Americans: how do you ensure that your end of life wishes, including your desire to avoid any extraordinary measures to resuscitate you in the event of a health crisis, are honored?

In the Miami story, originally reported  here in the New England Journal of Medicine, an unconscious 70-year-old patient was brought into the Emergency Room.  The man was diabetic, had an elevated blood alcohol level, and a history of pulmonary disease. He also had the words “Do Not Resuscitate” clearly tattooed across his chest.  Doctors “at first began lifesaving efforts,” reports MSN, because “tattooed ‘do not resuscitate’ requests are not considered valid by the Florida Department of Health.” Besides that, doctors and hospital officials could not locate the man’s family members or even identify him. They began giving the man intravenous fluids and antibiotics.

However, even as they worked to save the man’s life, the physicians sensed an ethical and medical dilemma. “This decision left us conflicted owing to the patient’s extraordinary effort to make his presumed advance directive known,” the doctors wrote in their report of the incident in the New England Journal of Medicine. To resolve the matter, they asked for an immediate ethics consultation. In the words of the MSN article, “Ethics consultants soon advised the doctors that the tattoo likely represented his wishes and should be honored.” MSN reports that, even though the decision to abide by the tattooed instructions was inconsistent with state law, it clearly was “in support patient-centered care and respect for patients’ best interest.”

In this case the patient passed away during the night with no further intervention on the part of physicians. Also, the situation was clarified significantly when a written copy of the man’s “Do Not Resuscitate” order from the Florida Department of Health was located. This, said the attending doctors, was a major relief: there had been an earlier case, uncovered during the ethics research, in which another patient had a “DNR” tattoo that apparently did not reflect this person’s changing wishes. It’s an important reminder – not to seem flippant – than your end-of-life wishes can change but a tattoo is forever.

So if a tattoo is not a good recommendation, what is the best way to ensure that doctors and family members honor your wishes should you find yourself in a similar situation? It might be helpful to consider what a “DNR” or “Do Not Resuscitate” order is and what it does.  We found this basic description on the LegalMatch website. “A Do Not Resuscitate (DNR) order is a written document instructing health care providers to forgo resuscitative measures. If a person with a DNR suffers a heart attack or stops breathing, it lets the medical personnel know not to try to revive them with CPR, defibrillators, or other life-saving procedures. The DNR order can be drafted by an attorney as part of a living will, or as a separate stand-alone document.”

(This 2014 article from the AgingOptions Blog also provides some helpful background information.)

Remember that a Do Not Resuscitate order will only apply if you are incapacitated in some way. That means key people in your life will need copies beforehand, including your physician, your close family members, a close friend if one is involved in your affairs, and officials at a retirement home or other senior residence if that is where you live.  You may also want to carry a card in your wallet stating that you have a DNR Order and include the phone number of someone who has a copy. This link to the Washington State Department of Health includes additional helpful information about how to document your end of life wishes, and describes the document which has been adopted by the Washington State Medical Association called a “Physicians Orders for Life Sustaining Treatment” (or POLST) form.

Do you need an attorney to draft your DNR form or can you do it yourself? Some websites will tell you that downloading a form and filling it out is all you have to do. However, we definitely advise you to consult an elder care attorney for this type of decision – not merely because the form requires certain legal language in order to be valid, but because making your end of life wishes known is part of a much larger picture in proper retirement planning. Your number one goal should be to plan comprehensively for your retirement years – not just on how you wish to die, but on how you choose to live. This means that medical decisions become part of a much larger picture that includes finances, legal affairs, and housing choices. In the case of a DNR or other similar medical directive, it is also vital that your family members are well informed about your desires. In order to accomplish this, we urge our clients to schedule a family conference, moderated by one of our attorneys, where a full range of retirement-related issues can be thoroughly reviewed. It’s the best way we know of to avoid the problem of families fracturing as mom and dad age and their care becomes more challenging and costly.

This comprehensive approach to retirement planning, blending health, finances, housing, legal and family matters into one seamless plan, is called LifePlanning, and it’s only offered by AgingOptions. If you’re ready for a fresh approach to retirement planning, come discover the power of a LifePlan by joining Rajiv Nagaich at an AgingOptions LifePlanning Seminar. These are held throughout the Puget Sound region, so for a complete listing of dates, times and locations, click here – then register online or call us during the week for assistance.

As we said, something as important as a Do Not Resuscitate order may tell those who love you how you want to die – but do they know how to want to live? Make sure they do, and protect your dreams, with an AgingOptions LifePlan.  Age on!

(originally reported at www.msn.com)

 

 

 

Share this to your favorite network:

Accountable Care Organizations: Better Coordination, Better Outcomes

Most people agree that in many ways the U.S. medical system is a convoluted and complex mess, with too much waste and too many gaps. So is there a way for this system to provide better care and at the same time keep costs under control? In theory, the answer is yes – but in practice it’s a bit more complicated.

One of the provisions in the Affordable Care Act was the creation of what are called Accountable Care Organizations, or ACO’s. These arrangements were based on a simple premise: the idea that patients get better care, and have better physical and emotional outcomes, when multiple doctors and hospitals actually coordinate their efforts and regimens. Not only that, but the health care system saves money at the same time. Millions of Medicare beneficiaries may already be covered under an ACO and not even know it.  But whether they know it or not, their ACO – when it’s working correctly – could be helping them get better care at lower cost. This is one reason why, even while the Affordable Care Act (a.k.a. Obamacare) is under attack in Washington, D.C., the continuation of the ACO seems likely because it’s one feature both sides seem to agree on.

To explain a bit about what Accountable Care Organizations are and why you should care, we offer two articles, including this one that just appeared on the website of USA Today. It spotlights a woman whose life was saved because of the coordinated care she received through her membership in Kaiser Permanente, which the article describes as “a more established form” of ACO. What makes this woman’s experience unique is that all the specialists she sees for her many ailments are actually employed by Kaiser, and Kaiser is the insurance company to which she pays her monthly premiums. “That means,” says USA Today, “[that] Kaiser loses money if her conditions aren’t managed correctly. This financial incentive is supposed to lower the cost and improve the quality of care.”

The concept of the ACO makes sense, and is designed to overcome the burdensome and leaky system in which the insurance company seeks only to lower costs of care while specialists who are disconnected from one another perform procedures and prescribe drugs with little communication with each other and insufficient regard for the patient. But the woman featured in the USA Today article, named Robin Gladden, “has nothing but good things to say about the quality of her Kaiser care. It’s her experiences outside of Kaiser that have turned her into a believer in both Kaiser and wellness.”  Before receiving treatment under the Kaiser ACO, “Gladden’s care depended on the often-contradictory advice of various doctors, which led her to develop diabetes, she said. She also experienced a very painful medication error in a non-Kaiser hospital when she went to have her thyroid removed because of her thyroid cancer.” However, because Kaiser treated Gladden’s health “holistically, not episodically,” her experience and her health have changed dramatically for the better.

To get a bit more background on the ACO concept, we turned to this explanatory article from a few years ago on the website of Kaiser Health News.  By creating the Accountable Care Organization structure, the Affordable Care Act “takes a carrot-and-stick approach,” says Kaiser. “Providers make more if they keep their patients healthy.” According to the Kaiser report, “An estimated 23.5 million Americans are now being served by an ACO. You may even be in one and not know it.”

Like an HMO, doctors and hospitals in an ACO will generally refer patients to hospitals and specialists within the ACO network. But unlike at HMO, “patients are usually still free to see doctors of their choice outside the network without paying more,” Kaiser explains.  Patients who don’t want to share data among ACO members can decline if they wish.  ACO members “can include hospitals, specialists, post-acute providers and even private companies like Walgreens. The only must-have element is primary care physicians, who serve as the linchpin of the program.”

So is there any downside? One worry among health care experts is that this level of consolidation will ultimately increase the rate of mergers and acquisitions, and decrease patient choice. Hospitals, says Kaiser, “are joining forces and purchasing physician practices, leaving fewer independent hospitals and doctors. Greater market share gives these health systems more leverage in negotiations with insurers, which can drive up health costs and limit patient choice.” But another health care analyst says this merger trend is already accelerating and he doubts whether the adoption of ACO-type structures will have much impact.  He calls health care mergers “a powerful and pervasive trend” and “a serious public policy issue” with or without the spread of the ACO.

Saving money is all well and good, but here at AgingOptions we’re more concerned that our clients and radio listeners get the care they need and deserve. For that reason, as we read the Kaiser Health News article, this quote from one health care researcher caught our eye. “One of the key challenges for hospitals and physicians is that the incentives in ACOs are to reduce hospital stays, emergency room visits and expensive specialist and testing services — all the ways that hospitals and physicians make money in the fee-for-service system.” In other words, reading between the lines, if your doctors and hospital are part of an ACO, they may be tempted to cut corners on your care in order to save costs. This is one reason why we strongly urge you – especially if you or a loved one is facing hospitalization – to consider using the services of a professional care manager. This professional will be your advocate and adviser during your stay and at the time of your discharge from the hospital, making sure you’re getting all the care you need during your stay and working on your behalf should you require a rehabilitative stay. We strongly encourage you to contact us here at AgingOptions and allow us to refer you to a care manager, to make certain your interests and those of your loved ones are protected.

At the same time, if retirement planning is on your horizon, we invite you to come join Rajiv Nagaich soon at one of our AgingOptions LifePlanning Seminars. Here you’ll discover how finances, medical care, housing choices, legal protection and family communication are all woven together into one seamless plan called a LifePlan. It truly is a breakthrough in retirement planning! Click here for details and online registration, or call us during the week and we will gladly answer your questions. We hope to see you soon!

(originally reported at www.usatoday.com and www.khn.org)

Share this to your favorite network:

Families Dealing with Dementia Need to Understand the Perils Ahead

If you are part of a family dealing with dementia, you know what a bewildering and painful journey it can often be. Part of the great and unanticipated tragedy of dementia is the emotional and relational damage it can wreak, not just on the one with the illness, but on loved ones as well.  In the words of geriatric psychiatrist Marc Agronin, writing in the Wall Street Journal, “When a family member suffers from dementia, we tend to view it as an individual tragedy. But too often this wrecking ball of a disease takes a toll on the entire family.”

Dr. Agronin is the author of this powerful and insightful article that appeared in the Journal a few weeks ago. We want to share it with our AgingOptions Blog readers and radio listeners because we know from our interaction with many of you that you have struggled with the unexpected pain that having a loved one with dementia causes for siblings trying to come to grips with this unpredictable disease. “Even under the best circumstances—with state-of-the-art care, well-intentioned caregivers, and sufficient social and financial resources—the trajectory of most forms of dementia is difficult to control,” Dr. Agronin writes in the Wall Street Journal. Dementia, he asserts, is usually chronic, with symptoms that will only get worse. On top of that, today’s health care system with its lack of geriatricians and its tendency to have medical specialists who don’t communicate with each other, working in their individual silos, makes the challenge for families even greater.

“In the face of these challenges, the families of individuals with dementia struggle to maintain emotional equilibrium along the way,” says Agronin, “especially when the spouse of the afflicted has already died, leaving decisions about care in the hands of the children. That’s when this disease of one damages the well-being of many, sometimes turning close and loving siblings into estranged and shattered combatants.”  But the doctor is quick to add that it doesn’t have to be this way. “If families understand the perils, they can navigate them without imploding,” he states.

We know one of the burdens, of course, is the often devastating economic toll that serving as a caregiver for someone with dementia can demand. “Families of persons with dementia spend billions of dollars—thousands a month per household—on health care, supplies and paid caregivers,” Dr. Agronin says.  According to the Alzheimer’s Association, the average unpaid caregiver, typically an adult daughter, works almost 22 hours a week on the loved one’s behalf.  Factor in lost wages, reduced productivity and resulting impact on retirement savings and the total adverse lifetime financial impact for a typical caregiver quickly tops $300,000. Yet, as ominous as that sounds, Dr. Agronin writing in the Journal says that “the economic toll often pales next to the emotional one.”  This emotional burden is especially hard on adult siblings who find themselves thrust by a parent’s illness into completely uncharted territory.

In a particularly poignant section of the Wall Street Journal report, Dr. Agronin lists some of the reactions he has witnessed among siblings to the pain of a parent with dementia. “I have seen people, for instance, who were simply not in a position to take care of a parent with dementia,” he writes. “So, perhaps after trying for a while, they send the parent to another sibling. They are relieved of the burden, but they are racked with guilt. Other children often relish the opportunity to organize a parent’s care, finding meaning in filial duties. But they can also find themselves increasingly frustrated and resentful when siblings critique their caregiving approach. Meanwhile, some children become enraged and depressed as they watch their parents go through changes that they struggle to believe are true. They might even reject the dementia diagnosis and medical interventions.”  Suddenly, Agronin suggests, siblings who have respected and admired one another from a reasonable distance are forced into painful interactions that can literally cause relationships to break apart.

There’s much more to this important article and we recommend you take the time to read it (once again, here’s the link.)  But before we leave this topic, we want to paraphrase Dr. Agronin’s recommendations for dealing with what he calls “a terrible disease that can wreak havoc on all those who must deal with it.”  The keys, he suggests, are assessment, communication and planning.

  • First, families must know precisely what they are dealing with. “This requires a comprehensive baseline assessment by an expert in dementia, and regular monitoring by both medical and behavioral specialists,” says Dr. Agronin. This puts everybody on the same page as far as knowing what exactly is going on.
  • “Second,” he says, “the caregiving family needs to meet early on and establish basic goals and ground rules.” How will they divide responsibilities?  What if someone can’t sustain their role?  How much financial outlay can they afford?  Caregivers need to coordinate a common plan for the type of care and the roles that each can play.
  • “A third and crucial step,” Agronin writes, “is to assign a point person for coordinating daily care and decision making.” This can be a third party such as a geriatric care manager or other professional if that’s best for family dynamics. This person can serve as a mediator for disputes and in extreme cases can be court-appointed.

Families need to understand, Dr. Agronin concludes, that caregiving for one with dementia can last an average of 8 to 10 years.  It’s “a long journey [that] requires constant learning, renewal and reinvention to survive.” But while dementia brings great heartbreak, it can also “bring families together in a common purpose, and to fulfill an endless debt to a parent that most children want to accomplish. The key is for families to understand that core emotional need and to realize that a win-win approach is possible, resulting in relationships that are closer, healthier and more resilient—not in spite of their parent’s illness, but because of it.”

Planning ahead for a devastating illness may be tough for most of us to contemplate, and we may hope to avoid illnesses such as dementia in our future. But one thing is certain: we can’t avoid growing older, and that means we must do a better job of planning for retirement. If your goal is a secure and fruitful future, with your assets protected and your wishes honored, you’ll never get there if you focus merely on any one aspect of retirement planning, such as finances or health insurance. At AgingOptions we advocate an approach we call LifePlanning, one in which all the essential elements of retirement mesh together: your financial plan, your medical coverage, your legal protection, your housing choices, and your family communication. A LifePlan becomes your blueprint allowing you to build the retirement you’ve always dreamed of. It’s easy to find out more, and there’s no cost or obligation: plan now to join AgingOption’s Rajiv Nagaich at an upcoming LifePlanning Seminar. Click here for details, and then register online or contact us by phone. It will be our pleasure to welcome you to an AgingOptions LifePlanning Seminar.

(originally reported at www.wsj.com)

 

Share this to your favorite network:

Three Tips for Helping Your Aging Parent Manage Medical Care

The woman sat with her aging mother-in-law across the desk from the oncologist. In front of the two women were 13 prescription bottles lined up in a row. Through tears of frustration the younger woman leaned forward, waved at the row of brown bottles with white prescription labels, and pointed her finger at the oncologist. “This can’t be right. My mother-in-law is feeling worse, not better – she’s confused and tired all the time. She shouldn’t be on this many drugs. Somebody isn’t paying attention!”

In this actual anecdote, the oncologist listened and agreed. He promptly took the older woman off several of her 13 overlapping prescriptions (some of which were counteracting the effects of others) and her quality of life rapidly improved. In this woman’s case, multiple medical providers had prescribed multiple prescriptions without carefully checking to see what else the patient was already taking. Had the daughter-in-law not intervened, a medical disaster could have ensued.

Here at AgingOptions we often hear variations on this story of adult children stepping in to assist aging parents (or other loved ones) with their medical care. This is especially important when your senior loved one is on Medicare.  To help our Blog readers and radio listeners with this issue, we found this fairly brief article that appeared last week on the website NextAvenue, entitled “Tips for Helping Aging Relatives with Their Health Care.” It offers three simple ways to help caregivers manage a loved one’s Medicare-related issues and to guide them as they make the most out of doctors’ visits. Taking an active role in your loved one’s care can dramatically help improve their quality of life, particularly as they become more frail and perhaps less able to handle complicated details and medical instructions on their own.

The article is written by a woman named Allison Renneke who works for a firm that helps clients manage Medicare and Medicaid issues. She writes in NextAvenue from her personal experience with her own parents. “If, like me, you help take care of a loved one on Medicare, you know it can be stressful,” says Renneke. “Whether you’re just starting to realize mom or dad may need some help managing their care or you’ve been doing it for a while, there are steps you can take to make the process easier on everyone — you, your loved one and their health care team.”

Before sharing her three tips, Renneke deals with the question of timing: if Mom or Dad seems to be doing fine with their medical care, should you try to step in now, or wait a while? Her advice is emphatic: don’t wait. “I recommend getting a head start now,” Renneke states. “If you wait until there’s an actual medical emergency, it can be difficult to get all the information you need in the heat of the moment. And it’s one less thing to worry about when emotions are running high.” From our experience dealing with hundreds of similar situations, we concur that early involvement is far better than procrastinating until a medical crisis strikes.

The three tips suggested by the NextAvenue article are fairly basic, yet we have found in our interactions with families that these relatively simple steps are too often overlooked. These are the very type of issues we address when we conduct a family conference for our clients, something we strongly recommend to deal with a wide range of retirement-related issues that can arise. Here are Renneke’s top three recommendations.

  • First, she writes, “become an authorized representative” for your loved one. Having this status in place allows the health insurance company to share information with you about your loved one’s health insurance plan, including the Explanations of Benefits. You can more easily gain access to details about bills and premiums.  Renneke says that every health insurance company has its own process for becoming an authorized representative, so you should contact the appropriate insurance provider to get the process started.
  • Renneke’s second tip is to research the details of your loved one’s health plan. Once you’re an authorized representative, the insurance company will provide everything you need to know about mom’s or dad’s insurance coverage. Take the time to ask questions or search the internet to clarify any terms you’re unsure about. You’ll also want to make a copy of your relative’s insurance member identification card so you’ll have access to important phone numbers and other relevant data.
  • Finally, Renneke recommends you make a list of all the doctors your loved one is consulting and the medicines they are taking, including names and dosages of all prescriptions and over-the-counter drugs. As an authorized representative you should be able to get relevant information from your loved one’s pharmacy or from Medicare if your loved one has Part D drug coverage. (Request what’s called a Part D Explanation of Benefits.) As a precaution you had also better double check the list against what’s actually in mom’s or dad’s medicine cabinet to make sure you didn’t overlook anything. Renneke includes a sample of a spreadsheet she uses for her own family member to help keep track of all this information.

We think the NextAvenue article contains some good and helpful information – but as is so frequently the case, it doesn’t really go far enough. Retirement planning that is really valuable and useful has to consider all the critical aspects of growing older. Medical care is clearly one of those aspects, but so is a solid financial plan, a well-crafted legal plan, a carefully thought-out housing plan, and even a family communication plan. Fortunately, there’s one type of over-arching plan that blends all these five together into one seamless strategy: an AgingOptions LifePlan. When it comes to retirement planning that is truly comprehensive, there’s nothing else like it.

We invite you to find out more by attending a free AgingOptions LifePlanning Seminar with Rajiv Nagaich. These popular events take place at locations throughout the area. For dates, times and online registration, click here for our Upcoming Events tab, or call us during the week. We’ll look forward to meeting you!

(originally reported at www.nextavenue.org)

Share this to your favorite network:

Report: Medicare Costs Can Consume 1/3 of Social Security Income

A new study just released by the Center for Retirement Research at Boston College provides some sobering news for many future retirees who will be relying entirely – or mostly – on Social Security for their retirement income.  If you are an average Social Security beneficiary, Medicare premiums for Parts B and D, plus average out-of-pocket medical spending, are going to eat up just over one-third of your benefits over the course of a year. That means a huge number of retirees may have a lot less money to live on than they anticipate.

We read about this study in this very recent article that appeared a few weeks ago on the website of USA Today. The title doesn’t really tell the whole story: the article is called “What retirees can do to reign in out-of-pocket spending.” At first we thought this was simply another article about the importance of proper budgeting, but the opening sentences changed our minds. “What percent of your Social Security benefit remains after spending whatever you spend out-of-pocket for health care, including premiums for Medicare Parts B and D?” asked USA Today author and Wall Street Journal contributor Robert Powell. His answer? “Not much.”

In their analysis, researchers from the Boston-based Center for Retirement Research looked at average out-of-pocket spending for Medicare beneficiaries who pay premiums for Part B (regular medical expenses other than hospitalization) and Part D (prescription drugs).  For the average senior on Medicare, the total out-of-pocket outlay was $4,274 annually (based on 2014 figures). About two-thirds of that total (just under $3,000) is spent on premiums. According to the study as quoted by the USA Today’s Powell, the average retiree had less than two-thirds of his or her Social Security benefits remaining after out-of-pocket costs were accounted for. Even worse, for the lowest-income seniors – almost one retiree in five – Medicare out-of-pocket spending devoured more than half of their Social Security income.

In raising the alarm about the difficulty many retirees find in making ends meet, the Boston College report doesn’t sound very optimistic about the future. “Things are likely to get worse rather than better for retirees,” writes the USA Today article. In the words of the report’s authors, “Medicare spending per beneficiary is expected to resume its decades-long rise by the end of the decade, which will put even more pressure on retirees’ budgets.” With this in mind, Robert Powell emphasizes, it’s imperative that seniors find ways to control their out-of-pocket medical spending. Writing in the USA Today article, he lists several ways this goal might be accomplished.

One excellent way to start is to make sure a senior is enrolled in every benefit program for which he or she might be eligible – including low-income seniors who can receive benefits from both Medicare and Medicaid. These individuals, according to the Centers for Medicare and Medicaid Services, are called “dual eligible beneficiaries.”  As the article in USA Today points out, for low-income, low-asset households who qualify as dual eligibility beneficiaries, the out-of-pocket costs for medical care can be reduced to almost zero, yet many eligible seniors fail to apply.  (Here’s a link to a CMS web page that describes this program in more detail. Note that benefits vary by state so you will definitely want to seek professional advice to get the full story. Contact us at AgingOptions and let us explore your benefits more thoroughly with you.)

The next piece of advice from USA Today, especially timely in these waning days of open enrollment, is to shop wisely for your Medicare coverage. But beware: often the plans with the lowest premium cost can leave you high and dry if your needs change. “You should weigh your own personal circumstances as best you can or with some help from a professional,” says the Robert Powell article. Once again, we invite you to attend one of our free AgingOptions LifePlanning Seminars where we can answer many of your questions. You will also find free help through statewide resources called State Health Insurance Assistance Programs, or SHIPs.   Here’s a link to the Health Insurance Assistance Program in Washington State.

We definitely agree with another of Powell’s recommendations for cutting your medical expenditures, and that involves becoming an empowered and informed patient. “The onus is now on patients for controlling spending,” he states. “Learn how to challenge all the unnecessary tests and care that is given.” Don’t just blindly agree to tests, scans and x-rays without insisting that your doctor explain exactly why they are needed, because it’s a virtual certainty that you will end up paying for a portion of these mounting and often unnecessary costs. The same goes for new or altered prescriptions: find out why the new meds are needed and for how long, and insist the doctor find the least expensive alternative. In many cases lifestyle changes can work just as well as a new prescription and the out-of-pocket cost for healthier living is typically zero.

Of course, as we at AgingOptions always advise those we counsel, none of this planning should take place in a vacuum. The USA Today article is talking about medical care, but that is only one facet of retirement: a truly comprehensive plan must also help you preserve your assets while avoiding becoming a burden to those you love. That means a fully developed financial plan, a carefully crafted legal strategy, and a well thought-out approach to your housing needs and desires belongs in your plan, combined with a means to involve your family members in the planning process. This is why our clients are so enthusiastic about a LifePlan from AgingOptions, the only plan that blends financial, medical, legal, housing and family strategies into one blueprint.

Please take a bit of time and accept our invitation to find out more at an upcoming AgingOptions LifePlanning Seminar with Rajiv Nagaich. We assure you, you’ll be very glad you did.  For a complete listing of currently scheduled LifePlanning Seminars, click here for our Upcoming Events page where you can register for the free seminar of your choice – or if you prefer you can contact us by phone during the week. No matter where you are in the retirement planning process, LifePlanning can benefit you. We’ll look forward to meeting you soon.

(originally reported at www.usatoday.com)

Share this to your favorite network:

Warning: Medicare Open Enrollment is Hunting Season for Scammers

We’re coming down to the wire on this year’s open enrollment period for Medicare, which runs through December 15th.  This is the season when millions of new and existing beneficiaries are sifting through mountains of direct mail brochures and a noisy gaggle of radio ads in an effort to make a prudent decision about health coverage for the year ahead. Unfortunately, according to this article that appeared last week on the national website Time.com/Money, this is also the season when scam artists are out in full force trying to rob seniors of their money by stealing their private information.

During this busy and confusing evaluation period, warns the Federal Trade Commission, “keep a careful eye out for scams.” In the words of the article, it’s precisely that high level of confusion surrounding Medicare rules that makes some seniors so susceptible to fraud. “Criminals will always use current events to confuse and victimize unsuspecting consumers, and this applies to the Medicare open enrollment period,” says Amy Nofziger of the AARP Foundation. “And,” the Time article adds, “being on guard for this type of fraud may be more important this year than in years past, as the number of scams is likely on the rise.”

Ironically, there’s actually some positive news that helps make this year such a ripe season for frauds and scams: according to the Centers for Medicare and Medicaid Services, the government is preparing to issue new Medicare cards, at long last dropping Social Security numbers in favor of “a unique, randomly assigned 11-character Medicare Beneficiary Identifier.” The new cards, which are meant to curb identity theft, will be shipped beginning in April 2018. According to the AARP, “savvy scammers may try to use this news as a tactic” by contacting beneficiaries and claiming that Medicare (or any other health provider) is requiring people to pay for the new cards. “There’s no cost for the new card and you don’t need to take any action to receive a new card,” says the Time article emphatically. “Additionally,” it adds, “Medicare says that it will never ask you to provide any personal or private information to get your new card.”

Apart from the “new card” scam, there are a few other tried and true frauds that keep popping up on the FTC’s radar. Make sure you watch out for these bogus claims, and if you are involved in the life of a senior loved one or friend, watch out for their sake, too.

  • What if someone contacts you claiming to be an “Official Medicare Agent”? This is a fraud, pure and simple, says the Federal Trade Commission, because there is no such thing. “Anyone who tries to sell you insurance while claiming to be an official rep is a fraudster, since the agency doesn’t employ any official sales reps,” Time
  • What if someone tells you that you have to buy Required Prescription Coverage? This is also a fraudulent claim, because Medicare Part D (prescription drug coverage) is voluntary. “It’s an automatic red flag if someone contacts you and requires you to join a prescription plan in order to keep your Medicare benefits,” says the Time
  • What if you get a personal call or visit from a Medicare official? “Medicare does not operate this way,” says the AARP’s Nofziger.  Adds the Time story, “Official correspondence is always mailed unless you initiate a phone call or send an email asking for a response,” adding that “no one is important enough to merit an unsolicited door-to-door service or even a phone call from Medicare or Medicaid regarding their insurance.” This means that, no matter who a caller claims to be, you should never give out personal information over the phone. “Medicare will never call you and ask for personal information such as Social Security number, bank account or routing information or credit card numbers.”
  • What if you get a call promising you a refund on your premiums? “Everyone likes a refund,” says the Time article, “but don’t fall for a scam in an attempt to claim your cash.” Scammers commonly claim that beneficiaries are entitled to refunds due to policy changes or enhancements, but all they really want is your personal information. “If you really are owed money, Medicare will send you a check directly—there’s no need to prove anything or provide any information like your Social Security number,” Time

So be wary of any caller claiming to represent Medicare, and never give out private, personal information by phone. Remember, if you need help making your insurance decisions we urge you to get some solid advice. (We at AgingOptions can answer many of your questions and we’ll gladly refer you to trusted experts who will spend time reviewing your individual circumstances.)  When it comes to planning for all aspects of retirement, solid advice is our specialty. You’ll find that the AgingOptions approach to retirement planning is completely unlike the disjointed strategy employed by so many others. Instead of treating finances, legal affairs, medical protection and housing choices as completely separate elements, our LifePlanning approach weaves all these together and even incorporates a plan to involve and engage your family so that your wishes will be honored and supported. For comprehensive retirement planning, there’s no plan like an AgingOptions LifePlan.

Why not join Rajiv Nagaich and discover this power for yourself? Come to a free LifePlanning Seminar at a location that’s convenient for you. For dates, times and locations, click here, and then register online, or call for assistance during the week. It will be our pleasure to meet you and to help you explore a dynamic new approach to retirement planning – an AgingOptions LifePlan. Age on!

(originally reported at www.time.com/money)

Share this to your favorite network:

Kiplinger: the Four Keys to a Happy and Prosperous Retirement

Here at AgingOptions we’re always just a little bit skeptical when we see an article with a title like “4 Keys to a Happy and Prosperous Retirement.” Still, this article with that very title just appeared on the authoritative financial website Kiplinger, and as we read it we found ourselves nodding in agreement – even though we do think the author missed a “fifth key” which we’ll talk about in a moment.

Financial Planner Wesley Price wrote the Kiplinger piece, but happily his advice is not all about money. Typically the only thing most financial planners focus on is – you guessed it – finances, and there’s no doubt that a reasonable source of income is essential to a secure retirement, but we know plenty of well-to-do retirees who are just plain miserable. In the Kiplinger piece, Price makes a good case that three of the four keys to retirement satisfaction have little to do with money and plenty to do with other, more fundamental things.  As Price writes, “Everyone knows that preparing for retirement is front and center these days in America,” adding that an average of 10,000 people “take the plunge” into retirement every day. “Commercials and print ads urge us to save more and get financially prepared for the big day. But are you prepared for those things that might be even more important than how much you accumulate toward retirement?” That’s an important question. Here’s an overview of the four keys to a happy, prosperous retirement as planner Wesley Price describes them.

The first key, writes Price, is to Visualize Your Ideal Retirement Lifestyle. This isn’t some New Age form of visualization but an attempt to think of retirement in a brand new way. “In our practice,” Price says, “the part I love most is the light in a retiree’s eyes when they discover they have enough resources to accomplish a life-long dream they had given up on long ago. Most people have been working hard their whole careers, raising a family and dealing with life as it comes. They often fail to think about their futures in a meaningful way.” Among the questions he suggests pre-retirees ask are these:

  • “What one or two things bring me the most energy and joy in life?”
  • “If money weren’t an issue, what would I probably be doing with my time?”
  • “What dreams or aspirations did I have when I was younger that I would really like to reconnect with now?”
  • “What does my ideal future life look like?”
  • “How do my spouse and loved ones fit into my plan?”

The second key from the Kiplinger article is to Stay Engaged and Have a Purpose. Price notes that “the happiest retirees stay busy with something meaningful in their lives.” In fact – and this is also something we have observed – “the happiest retirees are often busier in retirement than they were when they worked full time.” Here are a few ideas on engagement:

  • “Volunteer or get involved in your community.”
  • “Take a class, join a club or learn a new skill.”
  • “Pick up an old hobby from the past or try a new one.”
  • “Travel somewhere new or spend time in nature by camping, fishing or hiking.”
  • “Stay spiritually connected or close to a support group that can help when life gets difficult.”

Price’s third key is hard to argue with: Take Care of Yourself, he advises.  “The No. 1 concern of retirees is actually being healthy enough to enjoy their retirement years,” he writes. “After all, a large retirement nest egg means little if you don’t have the health to enjoy it.” We completely agree. His advice is pretty straightforward: get plenty of physical exercise, watch your diet, and join a health club or other group to help you stay motivated and active. He also suggested you stimulate your brain with challenging games, but from the research we’ve done this advice seems insufficient: the best kind of mental stimulation, we’ve read, comes from interpersonal interaction and conversation. Part of your program of mental stimulation needs to include staying socially active and engaged. (Here’s a link to an AgingOptions Blog article from July 2017 that talked about the positive impact of social interaction on cognitive health.)

Finally Price zeroes in on Getting Your Financial House in Order. His advice is familiar. Those preparing for retirement should develop a retirement income plan that provides secure, steady income not dependent on the stock market. Income sources such as pensions, annuities, and Social Security can provide this predictability. He also recommends retirees continue working part time doing something they truly enjoy, which provides fulfillment as well as a means to bridge an income gap if one exists. In the Kiplinger article, Price also recommends buying long-term care insurance if retirees can afford it.

So what’s the “fifth key” that we think Price leaves out? That’s easy: he says nothing about the importance of a comprehensive plan to tie all the various facets of retirement into one blueprint. At AgingOptions we call this a LifePlan, and it’s the only type of plan we know of that is truly comprehensive, ensuring that the critical elements – finances, housing, medical coverage, legal protection and family dynamics – all work together seamlessly. In our experience the real key to happiness and fulfillment in retirement is a LifePlan.

Why not take a bit of time and find out more? We invite you to join Rajiv Nagaich at one of our free AgingOptions LifePlanning Seminars, where in just a few hours you’ll gain powerful new insights into what retirement planning should be. These seminars take place at locations throughout the region, so you can click here for all the details, then register online for the seminar of your choice. Our recipe for a happy and fulfilling retirement: visualize your ideal future, stay engaged, guard your mental and physical health, prepare yourself financially – and above all, follow the right plan: an AgingOptions LifePlan. Age on!

(originally reported at www.kiplinger.com)

Share this to your favorite network: