Thursday, August 30, 2012

Morningstar - 40 must-know statistics


How to pay for long-term care is on your mind, judging from the valuable set of reader comments below last week's article about the limitations of Medicare and Medicaid coverage for long-term care. Readers shared their personal experiences as caregivers of elderly relatives and also discussed whether they had purchased long-term care insurance for themselves or were doing without.
Christine Benz is Morningstar's director of personal finance and author of 30-Minute Money Solutions: A Step-by-Step Guide to Managing Your Finances and the Morningstar Guide to Mutual Funds: 5-Star Strategies for Success. Follow Christine on Twitter: @christine_benz and on Facebook.
Making a sound decision about whether to opt for long-term care insurance involves weighing the probabilities. Is it worth it to pay the premiums for many years--and risk premium increases or benefit cutbacks along the way--in exchange for the peace of mind that your nest egg won't be wiped out to pay for your care at the end of your life? What if you never need long-term care, or only need it for a limited time?
Ultimately, the "right" decision will be evident only in hindsight. And in any case, the decision to buy long-term care insurance is a highly personal choice that will revolve around your health and your financial wherewithal, among other factors.
To make good judgments about whether to buy this type of coverage, it's important to arm yourself with the facts about what it's likely to cost, as well as to gauge how likely you are to need care in a long-term setting, and for how long. What follows are some statistics to aid in your decision-making. My aim was to seek the most current statistics available from objective sources. (Insurers and insurance associations crank out a staggering number of statistics about the likelihood you'll need long-term care and how much you'll pay, but it's hard to ignore that they have a horse in the race over whether to buy long-term care insurance.)
37 millionNumber of Americans age 65 or older in 2005.
81 millionExpected number of Americans age 65 or older in 2050.
9 millionThe number of Americans over age 65 who need long-term care in 2012.
12 millionThe number of Americans expected to need long-term care in 2020.
40%The percentage of the older population with long-term care needs who are poor or near-poor (income below 150% of the federal poverty level).
78%Percentage of the elderly in need of long-term care who receive that care from family members and friends.
34 millionNumber of caregivers who provide care to someone age 50 or over.
$113,640The maximum amount of assets a healthy spouse can retain for the other spouse to be eligible for long-term care benefits provided by Medicaid.
49%: Percentage of nursing home costs covered by Medicaid, 2002.
25%: Percentage of nursing home costs paid out of pocket, 2002.
7.5%: Percentage of nursing home costs covered by private insurance, 2002.
79Average age upon admittance to a nursing home.
40%The percentage of individuals who reach age 65 who will enter a nursing home during their lifetimes.
892 days (2.44 years)Average length of stay for current nursing-home residents, 1999.
272 days (8.94 months)Average length of stay for discharged nursing-home residents, 1999.
38%Percentage of nursing home patients who will eventually be discharged to go home or to another setting.
10%: The percentage of people who enter a nursing home who will stay there five or more years.
65%The percentage of people who entered a nursing home who died within one year of admission.
Five monthsThe typical length of nursing-home stay for patients who eventually died in the nursing home.
25%The percentage of deaths in the U.S. that occurred in nursing homes, 2010.
40%The expected percentage of deaths in the U.S. occurring in nursing homes by 2020.
68%The probability that an individual over age 65 will become cognitively impaired or unable to complete at least two "activities of daily living"--including dressing, bathing, or eating--over his or her lifetime.
42%The percentage of individuals in nursing homes who are experiencing some form of dementia.
33%: The percentage of individuals in nursing homes who are suffering from some form of depression.
71%Percentage of patients with advanced dementia who died within six months of admission to a nursing home.
$73,000Median annual rate, nursing-home care in U.S.
3.63%Increase in median annual nursing-home costs since 2011.
4.5%Annualized increase in median annual nursing home costs, 2008-2012.
$162,425Annual cost of nursing home care, Manhattan, N.Y.
$60,773Annual cost of nursing home care, Des Moines, Iowa.
$86,140Annual cost of nursing home care, Tampa, Fla.
$41,000Average annual base rate for residence in assisted living facility, 2012.
$20Average hourly rate for licensed, non-Medicare-certified home health aide.
7 to 9 millionEstimated number of U.S. residents who had private long-term care insurance, 2010.
59Age of typical purchaser of long-term care insurance, 2010.
79%Percentage of long-term care insurance purchasers with more than $100,000 in liquid assets.
44%Percentage of population age 50 or older with more than $100,000 in liquid assets.
$1,831Average annual premium for long-term care policy purchased by person age 55 or younger, at coverage start date. (Policy provides a daily benefit of $150, four to five years of coverage in home and institutional settings with a 90-day waiting period, and 5% automatic compound inflation protection.)
$3,421Average annual premium for same policy purchased by an individual age 70-74.
9%Percentage of long-term care insurance purchasers who let their policies lapse within the first year of purchase.

Morningstar Report


What You Need to Know About Long-Term Care
Forget gas prices, college costs, and cable bills. If you want an example of skyrocketing inflation, look no further than long-term care insurance premiums, which have jumped between 6% and 17% during the past year alone, reports Morningstar's Christine Benz. As insurance companies feel the pinch, existing policyholders have been confronted with the choice of swallowing higher premiums or accepting benefit cutbacks.

Given the current environment, many investors have decided to self-insure or depend on Medicare and Medicaid, which both have their own complications (Medicare only covers long-term care needs under a limited set of circumstances, and qualifying for Medicaid can be devilishly complicated).
In a series of popular articles in August, Morningstar's Chr istine Benz described why Medicare isn't much of a safety net for true long-term "custodial" care, explained what Medicaid will and won't provide, and discussed some practical takeaways. She also offered more than three dozen must-know statistics about long-term care to help investors frame their thinking, and she concluded the series with a set of top tips for self-insurers.

In the next post I will try to paste in the specifics from the Benz articles.

Michael

Tuesday, August 28, 2012

Sex in the nursing home

Had some trouble pasting this to the blog, so my apologies if this has been confusing.  I have deleted the earlier posts made in error.  I think.

So, SEX.  This article from MSNBC indicates that in Australia, at least, sex may not be allowed in the nursing home.  So, part of our planning must be to:

1.  Make sure that the nursing home we are likely to end up in (remember, we childless must make this decision ourselves at a time when we can still make decisions) will allow us to either a) stay together, or b) sneak into eachother's rooms when, you know, its time to, well, you know.

2.  Retain possession of a car with a wheel-chair accessible back seat.

3.  Give up on SEX.  Yeh, right, like THAT is gonna happen.

#2 could be problematic, #3 just ain't gonna happen, so lets concentrate on the first option.





By Arthur Caplan, Ph.D.
When it comes to the elderly, almost no one wants to talk about sex. This is especially true when nursing home and residential care are involved.
According to new report by a group in Australia in the Journal of Medical Ethics, the idea that adults should be able to engage in sexual relationships whenever, and with whomever, they choose becomes very complicated for residents in most nursing homes. For residents with dementia, romantic intimacy is especially discouraged.
Many older people, including those with early stage dementia, enjoy sex while living at home with their spouses. But this ends once they move into a nursing home, even for long-term couples, note the researchers from the Australian Centre for Evidence-Based Aged Care. Married or not, sex ends at the nursing home door.

Nursing homes are simply not set up to permit romance. Privacy is at a premium and few room doors lock. Most rooms are double-occupancy with single beds. And nursing home staff don’t typically encourage romance and sex. It's one less thing for nursing home owners and administrators to worry about.
We're so prudish about the elderly and intimate relationships that we don’t even broach the topic when a loved one is heading to a home. We consider freedom and autonomy when debating who will have the right to pull the feeding tube or turn off the dialysis machine if Mom or Dad can't communicate, but we do nothing to ensure their right to enjoy themselves in an area of life that matters a great deal to them.
Sex may not be for every nursing home resident, but it is surely for some. That's autonomy worth talking about.
A nursing home ought be at least as tolerant as a prison. Some prisons permit conjugal visits. Shouldn’t we expect the same of nursing homes? If you care about your parents' and grandparents' dignity, sex ought to be a topic of conversation regarding the nursing home if that's where they're headed or where they now live.
Bioethicist Art Caplan is the head of the Division of Medical Ethics, NYU Langone Medical Center.




Rainy Day Money




Many elders, especially from the depression and WWII era, have saved rainy day money for years.



Having that money available has provided reassurance and peace of mind for a long time. It is impossible to even think of it not being there. There is just one problem after all these years. They now can't recognize when that rainy day has arrived. And how could they even think about tapping into these savings that have become almost a part of them? Many excuses about why no changes are needed are offered, but often just to cover up the real reason, not wanting to spend the money.
How can we help an elder accept the idea that it is not only rainy, but there is hurricane howling with lightening, thunder, and that the rain is causing "the creek to rise". Ask your elder what reason they would consider worthy of spending the money. If it is an emergency fund, tell me what would be an emergency?

To get started I suggest using the Jeff Foxworthy approach. "You know it is time to use your rainy day funds when - - -"
  • Your diet is finally working as there is nothing to eat in the house because you can't get to the store.
  • Your expenses have dropped because the utilities were shut off for non-payment.
  • Your neighbor's child got lost in your yard because it is so overgrown.
  • You can't watch TV because your glasses have been lost in the clutter in the living room.
  • You take a sponge bath as the edge of the tub has grown too high to get in and out.
  • You stay in your underwear as the house is 90 degrees since the air conditioner stopped working.

You get the idea. If you help them to find one thing that is bad enough to actually spend some of that money you will have made a crack in the dam. The money is spendable if the reason is sufficient. Now you only need to agree on whether the present situation meets the level needed to loosen the purse strings.
P.S. If you are an heir do not get confused about whose money it is. NOT YOURS!

Thursday, July 26, 2012

Two Things You Need to Know

It seems likely that we will [experience][endure][incur][enjoy] much of our elding in and around Newport.  It is where we live, and where we intend to live for some time.  However, there is a chance that eventually we will seek [warmer][safer][cheaper] climes in which to complete the journey.

Should you be inclined to do your elding elsewhere than your current where, there are two very important things to learn about the new where before you move there:  A good general practitioner/gerontologist physician THAT IS ACCEPTING NEW PATIENTS, and the menu of available social and elder services of which you may need to avail.

The first may be the most difficult, as there is an acute shortage of GP's and Gerontologists.  Many are already overwhelmed, and with cuts in Medicare and Medicaid payments they can neither afford nor handle more work.  Lots of people are getting old.  Lots of med students are going into specialties that pay better.  The Affordable Care Act will not likely solve this dilema any time soon.  So, carefully survey the market and find a doc BEFORE you move.  Don't forget a dentist as well. 

Once you find the doc, s/he may be able to help with the other item.  There are lots of social services organizations around that help with elder issues.  For example, here is a description of our local Child and Family Services:


Our experienced elder care specialists will talk to you honestly and confidentially about your loved one’s situation. Whatever your need


home care services
respite care
adult day services
dealing with depression or neglect
home delivered meals
crime victim support
housing advice
We can provide or arrange for respectful, reliable care. You can count on our support.


Free in-home mental health care
Don’t let lack of transportation or inability to pay prevent your loved one from getting proper care for depression, anxiety, substance abuse, and other issues. Call (401) 848-4185 to see if you or your loved one qualifies.


Question about your health insurance?
Our trained volunteer State Health Insurance Program (SHIP) counselors can meet with Medicare beneficiaries and caregivers to answer any questions or concerns you have about health insurance or bills.


Living independently longer
We can help make staying home possible for your loved one. Our certified nursing assistants and homemakers, overseen by an experienced Nurse Supervisor, can assist with:


light housekeeping
shopping
personal care
meal preparation
errands
Friendly Visitors
Our volunteers visit the homebound elderly or those who are handicapped, to provide companionship and caring support. Volunteers will write a letter, play cards, chat or even drive you to a medical appointment.

Notice that they provide or help locate help with insurance questions, independent living, even snow removal.  It may be good to find these kinds of resources well before you need them.  One excellent way to get to know the providers is to volunteer.  Child & Family is a 501(c)(3), so they are dependent on grants, donations and volunteers.

Michael


Monday, July 23, 2012

Yummy!


So, at whatever elder hostel you may end up, ask to see the menu.  Lets don't settle for geezer food.

Thriving Gut Bacteria Linked To Good
Health
by ALLISON AUBREY
08:52 pm
July 15, 2012
There's no magic elixir for healthy
aging, but here's one more thing to add
to the list: good gut health.
A study published in the latest issue of
Nature finds diet may be key to
promoting diverse communities of
beneficial bacteria in the guts of older
people.
To evaluate this, researchers analyzed
the microbiota, or gut bacteria, of 178
older folks, mostly in their 70s and
80s.
Some of the people were living in their
own homes, and their diets were rich in fiber, fruits, vegetables, grains, poultry and
fish.
Others were living in long­term care facilities or nursing homes where the typical
diet was much less varied. "Mashed potato and porridge were the only staples in
this diet type that were consumed daily," explains Paul O'Toole of the Alimentary
Pharmabiotic Centre at University College Cork in Ireland. Meals were
supplemented with puddings, cookies and sugar­sweetened beverages such as tea.
O'Toole's team found that people living independently, who had the most diverse
diets, also had more varied gut bacteria. And they also scored better on clinical
tests measuring frailty and cognitive function. In other words, "they were healthier
older people," says O'Toole.
There may be many factors at play here, but O'Toole thinks diet is key. "We were
surprised that the correlations between microbiota and health came out so
strongly," O'Toole says.
There's an explosion of research into the gut microbiome as scientists fine­tune
methods to analyze bacteria in the gut, and with that comes an emerging body of
evidence that diversity of gut bacteria is important.
"What we're only now beginning to realize is that there's very close interaction
between the bacteria within GI tract and human health and disease," says Ilseung
Cho, a gastroenterologist at NYU School of Medicine.
Beneficial bacteria do a lot for us, says Cho. They help with digestion, help our
bodies make vitamins, and also likely help support a strong immune system.
But they also have to compete with the harmful bacteria. That's why we want a
variety of the good kind in our guts.
"If you have a lot of diversity and one bacteria that's doing something good is
iStockphoto.com
Eating plenty of fruits and vegetables is important for gut
health, especially in aging adults.7/23/12 Thriving Gut Bacteria Linked To Good Health : Shots ‑ Health Blog : NPR
www.npr.org/blogs/health/2012/07/16/156745291/thriving‑gut‑bacteria‑linked‑to‑good‑health?ft=3&f=11… 2/2
food and nutrition immune system bacteria aging
knocked out," explains Cho, "then you may have other bacteria that can compensate
for that loss."
These new findings are not proof that diverse microbiota lead to better health. But
experts say this paper is important because it establishes a link.
"Is it really that diet is altering the health of individuals through altering the gut
microbiota?" asks Gary Wu of the University of Pennsylvania. "Or is it that people
who are not as well tend to be housed in long­term care facilities?" It's possible that
the lack of bacterial diversity isn't the cause of illness, but a sign of sickness.
Wu says it will take additional studies to unravel cause and effect. Nonetheless, he
says, this new Nature paper is intriguing.
"I think there's growing evidence that diet is very important in regulating the
composition of the gut microbes," says Wu.

Attitudes (Gratitude in Particular)

Here is a quote from "True Secret to Success" in Inc. Magazine by Geoffrey James.  The context of the article is on how success in both business and life is related to fostering positive attitudes.

"I'm utterly convinced that the key to lifelong success is the regular exercise of a single emotional muscle: gratitude.  People who approach life with a sense of gratitude are constantly aware of what's wonderful in their life. Because they enjoy the fruits of their successes, they seek out more success. And when things don't go as planned, people who are grateful can put failure into perspective. "


He goes on to pose a way to reinforce a sense of gratitude by practicing, every night, to record in writing the day's events that fostered good feelings, either for you or for someone around you.  By making this practice habit (there it is again!), we become trained to have a positive outlook on life, an important aspect of both physical and mental health as we eld.  "The more regularly you practice this exercise, the stronger its effects."  In other words, make a positive outlook a habit.  


I know I am harping on this a lot, but the more I study the effects of aging, the more convinced I am that fostering good mental habits now will improve the quality of life later.  It won't solve every problem, but it will help deal with the unsolvable ones and perhaps protect us from the unexpected.  


So, while I look forward to being a curmudgeon, I am determined to remain a happy curmudgeon, surrounded by other happy old farts.  You know who you are.


Michael