This has nothing to do with aging alone, but.....

...its just to good to pass up.  It is a video of an invocation given at a conference of Home Instead Senior Care franchisees.

The Home Instead Senior Care family network of locally owned franchise offices is an in-home care agency, to help elders in their home as they grow older.

Watch it all.  Well done.

http://stg.do/9i0c

Michael

Reverse Mortgages

This is a link to a blog post (The New Old Age, NY Times) on reverse mortgages, with a link to the full article in the New York Times. I have saved the article to read when I am older.  As of this writing, a reverse mortgage is not part of our elding strategy.  I think we can do better than that.


http://newoldage.blogs.nytimes.com/2012/10/15/growing-concerns-about-reverse-mortgages/

Michael

Guess we're not the only ones thinking about this.

Here is a link to a piece in the NY Times written by Kelly Flynn titled "But Who Will Care for Me?"  Kelly writes about finding herself in a familiar situation;  Aging, and childless.

http://www.nytimes.com/2012/10/10/booming/10story-booming.html

It is a well written piece, and she seems to be worried about how to deal with the things we have been discussing here for a while.  But what I find really interesting about this piece is the tone of the comments written by others.  Some are critical of the decision (in those cases where it is a decision and not something that just happened) to not have children.  (See my earlier post concerning our decision to not have children.)   There were also comments such aas the following:

Sorry, but anatomy is destiny.
A woman was given a womb to hold a child.
A woman was given breasts to nurture that child.
A woman who makes a decision not to have any children becomes a study in tragedy and sorrow when she ages in an empty home.
So sad. So tragic. So selfish.

Are we talking about a woman, or a horse?

Others commented on the unreliability of children to provide happiness and security as their parents eld.  Some where happy to have husbands and families, some happy that they did not have to suffer the indignity of an ailing or un-faithful husband or ungrateful kids.

I guess my point is that in thinking about eldering without childering, there is a danger in getting hung up on decisions of the past, to foal or not to foal, circumstances that may have prevented or encouraged foaling, an involuntary act of conception that resulted in unanticipated or premature foaling.  Hey, snap out of it!  Looking back, looking for regrets, for missed opportunities, for things that might have been had not something else been instead, only promotes sadness.  And sadness does not get us where we want to go.

Here we are looking for strategies that will result in a happy elderhood.  I propose that an important aspect of an effective strategy is the ability to look forward, with enthusiasm and anticipation, not fear or regret.

• Yes, I will likely move into assisted living some day.
• I will meet new people there.
• Some will be incredibly annoying
• Some will not appreciate my humor or like my curried skittles.
• Some will become my best friends.
• I will cry when friends pass on.
• I will look back on our times together and smile, not with regret but with gratitude that we had a some great, interesting times.

Attitude is key.  Developing the habit (Oh, God, not with the HABITS again!) of a positive outlook is key.  If you must look at the movie of your past, think of it as a comedy.  Smile.  Laugh.  Then look forward.

"We did not have any kids.  I did have a foal once.  Named him Hargus.  Boy, what a stupid kid I was back then.  Hey, Kelly, want a beer?  Lets play some dominos!"

Michael

The Keys, Please.

Below is a link to an NPR piece (yes, I listen to NPR for news, but I do browse the "other medias" as well) on the pending surge in us older folks out on the streets driving our 20 year old Audi's.  The serious question (one I have touched on in these posts before) is, "when it comes time to give up the keys, who will tell us, the tellees, who have no tellers handy in the family, that time is up?"

Bunni Dybnis, a social worker at the Los Angeles-based geriatric care service LivHome, says this is typically how older drivers decide to give up the car keys: Their child or grandchild intervenes. "I could probably say it's 99.99 percent not the older adult saying, 'I want to stop driving; help me,' " says Dybnis, because giving up driving feels like giving up one's independence.

Here is what I plan to do.  I have already established the HABIT of getting an annual physical exam by my primary care physician.  My next exam is some time in March or April (it is iBuried somewhere in my iPhone iCalendar).  At that exam I intend to ask my PCP to incorporate the following steps into the exam program:  a)  discontinue doing a P.S.A. exam at age 65, and b) if possible, in this state, if he sees any signs of diminished capacity that could affect my ability to drive safely, to prescribe a driving test or class.  Since I also see a neurologist once a year, I will ask her to do b) as well (she has never offered to do a), much to my relief).

Actually, first I will ask them if it is wise to ask them to do this, as I don't want to screw up my medical records and insurance.  But I think this is the second most important thing to do about driving skills.  The first is to develop the HABIT of objectivity concerning driving.  Even now, in my prime, I can look into the rear view mirror and tell myself "That other driver was NOT an asshole.  I was the asshole in this situation.  DON'T DO THAT AGAIN!"

This habit is reinforced by SheWhoMustBeObeyed, who frequently says this, sometimes just the second sentence, even when I am not driving.

The link:

http://www.npr.org/blogs/health/2012/10/08/162392507/when-should-seniors-hang-up-the-car-keys?ft=3&f=111787346&sc=nl&cc=es-20121014

Michael

A Matter of Context

What is the difference between being observed, and being admitted?

Observation:  an activity of a living being, such as a human, consisting of receiving knowledge of the outside world (including knowledge of other humans) through the senses, or the recording of data using scientific instruments.

Admission:  the act of allowing to enter; entrance granted by permission, by provision or existence of pecuniary means, or by the removal of obstacles: the admission of aliens into a country.  Or, right or permission to enter: granting admission to the rare books room.

This is an important distinction when it comes to being precise about the written or spoken word.  It is even more important when these terms are applied by your local friendly hospital.

Note:  In a hospital context, it is possible to be observed after being admitted.  In fact, it is unavoidable.  When admitted to a hospital, ones every move is observed.  Movements are of particular import.  The absence of an expected movement can indicate a blockage (the state of being blocked;  an obstructed condition: the blockage of the streets by heavy snows.  The blockage of bowls by impacted.......stuff).

Note:  In a hospital context, it is possible to be observed without being admitted.  One may, in fact, be physically "in" the hospital, having one's blockages examined by all sorts of scientific instruments, passing knowledge to one's doctor, being "in" without being "admitted", without permission to say one is "here" more than momentarily, even thought a momentary observation might last days, even weeks.

In a hospital context, your doctor may allow you "in", without an admission that you have been admitted "in", that you do not belong "in" for anything other than to be "observed".  If you happen to be on Medicare, and you happen to have something wrong that will require further assistance or treatment, or "rehabilitation" (I'll not burden you with another definition), but the hospital is only "observing" you, not treating you, then Medicare MAY NOT PAY FOR YOUR REHABILITATION.  You will, like Arlo Guthrie, be doomed to answer, possibly forever, the question "Kid, have you been rehabilitated?" with a resounding "no, officer, I don't have the do-re-me."

Case in point:  Martha Leyanna, Newark, Delaware, fell.  Went to the ER.  Was placed in the hospital. Stayed for eight (8) days (I guess it took a few days to figure out that she could not walk).  Spent 40 days in a rehabilitation center (to which her doctor no doubt sent her after determining that mere observation was not helping her get back on her feet).  When the $11,000 bill for rehab arrived, her Medicare insurance would not pay it.  Why?  Because she had only been observed for 8 days.  She had not been admitted.

Under Medicare rules, they will pay for the first 20 days of rehab in a skilled nursing care facility, but only if the patient has spent at least three (3) full days in the hospital as an admitted patient. So for Martha, who was "in" the hospital for eight (8) days, receiving all the care that any "admitted" patient would receive, in fact the EXACT SAME CARE, the fact that none of those eight days of hospital care  were as an admitted person meant that she was not covered.

Now, there are those who would say that she should pay her own way lest she become one of those 47% of Americans who feel entitled to food stamps and health care, who do not take personal responsibility for their lives, who take advantage of the insurance they have already paid for to in order to somehow sponge off the rest of us.  As a politically agnostic blogger, I take no position on that.  But, given the rules as they are, if you are insured by Medicare, it is important you know the rules.

So here is what AARP says to do if you are "in" a hospital:

1. Ask about your status daily.  Your status can change at any time, without your knowledge.
2. If you are being "observed," ask the hospital doctor why.  Ask him to have the committee that decides this status to reconsider.
3. Ask you own doctor (if you can remember who he/she is) the same thing.
4. If you have been "observed" but need rehab care, ask your doctor if the rehab care can be done at your home so it costs less.
5. Worst cast scenario:  Rehab center needed, Medicare won't pay.  Then:
1. "Following the instructions given in your quarterly Medicare Summary Notice, formally appeal the ruling.  Explain that the basis for your appeal is that you should have been classified as an inpatient during your stay at the hospital."  Simple.
2. If denied, follow the instructions on your denial letter to appeal to a higher level.  Simple.
3. Yeah, right.  I've got macular degeneration and can't read, have no idea what pile of crap my Medicare Summary Notice is in, am not sure how to get back to my home to find it even if I COULD walk.  Yeah, right.

I guess it boils down to this:  If you are conscious when entering the ER, be sure to ask your doctor what your status is, why it is what it is, why he thinks why it is what it is is the right way to think should be, and if you are only being "observed", why you should not just go home to die instead of enduring the inconvenience of being "in" without belonging "in".  If you are conscious.  And aware.  Doesn't matter if you are 85 years old and believe that the women who says she is your daughter is some street walker that only wants to get in your underwear and steal you watch (that is where I always keep mine)(She IS in fact a street walker, because, now I remember, I DON'T HAVE ANY CHILDREN).  Just take some personal responsibility and fess up:  "Really, I can walk, I just don't CHOOSE to."
 
Or ask the daughter of the patient next to you (daughter, not son - you already know my feelings about sons and their worth when it comes to caring for elderly parents) to help, because frankly that fall and the concussion make you dizzy every time you even think about getting out of bed and walking to the bathroom.

Seriously, I wish there were better answers.  I wish the system included patient advocates that could protect old, confused, lonely people.  The American Medical Association has told Medicare that it supports the abolition of the three (3) day rule.  Others have lobbied to do away with the "observation" classification.  But when the AARP asked officials at the Centers for Mediare & Medicaid Services to comment for a recent article, they declined to be interviewed, citing ongoing lawsuits.

Lets hope the suits win.

A Pasticcio

Some interesting odds and ends that help put eldering in perspective:

¢ The average American aged 65 or older makes 8 visits per year to a doctor, a hospital and/or an emergency room, i.e., once every 1 ½ months (source: Center for Disease Control).

¢ 1% of the US population accounts for 21.8% of all health care expenditures.  5% of the population accounts for 49.5% of all health care expenditures.  15% of the population accounts for no health care expenditures (source: National Institute for Health Care Management).

¢ 50% of the US population accounts for just 2.9% of all health care expenditures (source: National Institute for Health Care Management).

¢ Americans born in 1946 or later will have to work at least until age 66 (to as much as age 67 for individuals born in 1960 or later) to achieve full retirement benefits from Social Security.  Once that retiree hits his/her unique full retirement age, postponing receipt of the retirement benefits will increase the payout by +8% per year (source: Social Security Administration).

¢ 62% of American adults believe the greatest risk to the success of their retirement years is living too long (source: MetLife Mature Market Institute).

¢ 70% of retirees surveyed in 2007 (i.e., 5 years ago) were "very" or "somewhat" confident that they would have a "comfortable" retirement.  Only 52% of retirees feel that way in 2012 (source: Employee Benefit Research Institute Retirement Survey).

¢ The life expectancy at birth of an average American was 62.9 years in 1940, 5 years after Social Security was created in 1935.  Life expectancy is 78.7 years today (source: Center for Disease Control).

¢ 25% of American families headed by a retired person do not pay off their outstanding credit card balance each month.  46% of families headed by an individual that works as an employee of a firm (i.e., not a business-owner) do not pay off their outstanding credit card balance each month (source: Federal Reserve).

¢ 51% of over 1,500 American households surveyed in May 2012 believe they are "behind" in their accumulation of retirement savings (source: Consumer Federal of America).

¢ 2 out of every 5 American males that live to age 65 will survive at least another 20 years to age 85 (source: Social Security).

¢ The average single-family home nationwide peaked in value on 6/30/07 but has dropped by 17% from that maximum value as of 6/30/12 (source: Office of Federal Housing Enterprise Oversight).

¢ An estimated 7,600 Americans will turn 65 years old each day this year (2012).  An estimated 11,400 Americans will turn 65 years old each day by the year 2029 (source: Government Accountability Office).

¢ A present value (PV) amount of $196,000 is required to fund a $1,000 per month payment for 20 years with a 3% annual increase for maintenance of purchasing power assuming a +5% annual rate of return is maintained into the future.  The PV amount is $269,000 if the required payment period is 30 years.  The calculations ignore the impact of taxes and are for illustrative purposes only and are not intended to reflect any specific investment alternative (source: BTN Research).

¢ If the fifth bullet is recalculated using a +6% assumed rate of return (+1% increase), only $179,000 is required to fund the 20-year payout and $237,000 is required for a 30-year payout (source: BTN Research).

¢ Social Security benefits were not subject to any federal income taxation until 1984.  Depending upon your adjusted gross income, as much as 85% of your social security benefits could be federally taxable today.  The first social security benefit checks were paid in 1937 (source: Social Security).

Morningstar: Do You Have a Viable Plan for 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, according to the American Association for Long-Term Care Insurance. Some existing policyholders have been confronted with the choice of swallowing higher premiums or accepting benefit cutbacks, and during the past few years major providers such as 

About the Author

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.

Contact Author | Meet other investing specialists

 Prudential Financial (PRU)and  MetLife (MET) have stopped writing new long-term care policies altogether. Not only are interest rates low, meaning the insurers can't earn much on the premiums and have to charge more to compensate, but insurers have had to cover larger claims for long-term care than they anticipated when they initiated the policies.

Given that inhospitable backdrop, many consumers are opting to go without long-term care insurance altogether. Wealthier individuals might decide to foot the bill from their own savings when and if they need long-term care. Less-affluent consumers, meanwhile, may conclude that forking over long-term care premiums simply isn't a good use of their assets if they're also behind on being able to meet basic needs during retirement, or they have missed the window to purchase long-term care at a reasonable price. (By the time a person hits his or her mid- to late 60s and might also be experiencing health issues, the policies can be exceptionally costly.) For such people, Medicare and Medicaid might be their only options should they need long-term care.

But Medicare only covers long-term care needs under a limited set of circumstances and for a short period of time. Qualifying for Medicaid, meanwhile, can be a devilishly complicated process, requiring an individual to exhaust most of his or her financial assets and also limiting the type of care that's available. If relying on these programs is your fallback plan, it's a good idea to understand the ins and outs of them well before you get close to needing them. Ditto if you help oversee your parents' finances and you expect they might have long-term care needs down the line.

Below are some of the key factors to bear in mind.

Medicare Not Much of a Safety NetMany individuals assume that Medicare will cover their long-term care, taking comfort in the fact that Medicare benefits are not needs-based, so people don't need to deplete their assets to qualify. But there are actually tight limits on what type of care the program will provide and when. Medicare covers the first 20 days in a skilled nursing facility following a three-day hospital stay, provided the person needs skilled care; for the next 80 days, Medicare picks up a portion of the bill. It may also provide short-term home health care for those recovering from an illness or injury as well as hospice care for individuals in the last stage of a terminal illness. Medicare doesn't cover extended, open-ended long-term care--what's called custodial care to help an individual carry out basic activities like bathing, eating, getting dressed, and so forth.

What Medicaid Will (and Won't) ProvideLong-term care benefits are available through Medicaid to low-income individuals who can demonstrate financial need. (More on that below.) Those benefits do cover long-term care for an indefinite period, but you'll be limited to certain facilities, which might not be as geographically well-situated or have the same amenities as others. One other important limitation to obtaining long-term care coverage via Medicaid: In-home care, which many people prefer over moving to an external facility, is typically not an option.

Punitive Lookback ProvisionFor many elderly people, the big nightmare of long-term care is that paying for it could gobble up the financial assets they had hoped to leave for their spouse, children, or grandchildren. And unfortunately, qualifying for Medicaid requires seniors to spend down nearly all of their assets first. Specific rules regarding Medicaid eligibility vary by state, but in many states, allowable assets top out at around $2,000; individuals are typically also allowed to retain some level of home equity, often up to $500,000.

At first blush, acting preemptively to shield those assets, either by transferring ownership to a spouse, gifting to loved ones, or setting up trusts might seem like a good workaround. But even if you can get comfortable with the idea of taking extraordinary measures to qualify for Medicaid (and some people cannot), there are some important caveats to bear in mind.

In order for the spouse in need of long-term care to be eligible for Medicaid, the healthy spouse is typically only able to retain a house, a car, and a modest level of assets equal to one half of the couple's assets, subject to minimum and maximum thresholds. (The maximum for 2012 is $113,640.) So putting assets in a spouse's name won't solve the problem, which becomes particularly acute if the spouse is much younger and will need assets for many more years.

Gifting assets to other loved ones also is not a viable solution if the elderly person expects to need long-term care anytime soon. If the assets are gifted five or fewer years before the individual applies for Medicaid, a penalty period applies, during which the individual is ineligible for government aid. The length of that penalty period is determined by dividing the assets that were gifted by the monthly cost of nursing home care in your state. So if you gift $100,000 to your son, and nursing care costs $5,000 per month, the penalty period would be 20 months. Moreover, the penalty period would only begin after you were already in a nursing home, had applied for Medicaid, and had spent down your assets to Medicaid-eligible levels. At that point, your only recourse would be to sell your home--which you'd otherwise be allowed to keep--or hope that one of your gift recipients would fit the bill for you until Medicaid kicked in. Needless to say, the laws are set up to deter such transfers.

The same five-year lookback provision applies to assets stashed in revocable trusts, as well--that is, trusts that can be changed after they were initially set up. It's possible to put the assets inside a revocable trust and avoid the lookback provision. You and your spouse would be entitled to any income from the trust, but the principal would pass to your heirs. Elder-law attorneys frequently set up such trusts as a means of helping families retain assets while also allowing for Medicaid eligibility, but the process can be costly. Also, you'd need to weigh whether setting aside money for your kids outweighs the added flexibility you'd have if you were to use that money for your own care. For example, you'd have greater latitude to opt for long-term care in your home or pick a facility near your spouse's or children's homes.

TakeawaysGiven the rising cost of long-term care, as well as long-term care insurance, the problem of paying for it is likely to be with us for the foreseeable future. That argues for investigating long-term care insurance while you're young enough for it to be affordable. Alternatively, if self-insuring is part of your plan, make sure you've calculated how much you could need in a worst-case scenario, and segregate that amount from the assets you'll use to fund your in-retirement living expenses. Finally, if you expect that you may need to rely on Medicaid to help cover the cost of long-term care, but you'd also like to pass assets to your children, the asset-transfer penalties outlined above should provide a strong incentive to gift to your loved ones preemptively, well before your need for long-term care arises. I'll be writing more about these and other issues related to long-term care in the future.