Invest in Social Connections

A retirement or nursing home is really just a form of communal housing, but with strangers.  People live longer and maintain their health longer when they have strong social connections - friends.  As we have posted before, there are several ways to structure communal or co-housing in order to keep your own lifestyle but still live with friends and support eachother.

Here is another piece on this subject, from NPR, oriented towards older single women.  This should apply to men as well (I suspect men are shy about living with other men in a communal setting thinking that they will be perceived as gay).  I DO feel vindicated, as I have been talking about this with my best friends for over 20 years now.  I'm so smart!

My concept is more of a co-housing arrangement, where each family unit (couple or single) has their own space, but common space is available for cooking, eating, cellering wine, humidoring cigars, whatever, with rooms for visiting grandchildren, godchildren, grand-godchildren, etc, and for a live-in caregiver when necessary.  Not quite so intense as living in a single house.

Anyway, here is the link to the NPR program.  I have also copied the transcript below, for posterity.

http://www.npr.org/blogs/health/2013/05/22/183903991/Boomer-Housemates-Have-More-Fun

Transcript (there are some typos):

May 22, 2013 3:00 AM
Copyright ©2013 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

DAVID GREENE, HOST:

Americans are living longer than ever before, and as seniors approach their golden years, most are cared for primarily by an immediate family member, a spouse or their children. Having children, in some ways, is a sort-of long-term insurance policy.

LINDA WERTHEIMER, HOST:

But as life expectancy continues to rise, more and more women are living and aging without spouses or children, and are likely to face an interesting situation: Who will care for them when the time comes?

GREENE: As part of our series on the Changing Lives of Women, NPR's Julie Rovner looks at the long-term care conundrum.

BONNIE MOORE: Welcome to our house. I'm Bonnie. Come on in.

JULIE ROVNER, BYLINE: Bonnie Moore is a pert, 60-something lawyer and accountable who lives in well-kept, five-bedroom house in a cozy suburb about a half-hour outside Washington, D.C. You can tell she's used to giving the grand tour.

MOORE: I'll show you my pride and joy - my kitchen. We bought an old house, and we've been remodeling it.

ROVNER: Lorene Solivan is one of her three housemates.

LORENE SOLIVAN: And I'm the youngest.

MOORE: She's the youngest, yeah. How do you like that?

ROVNER: She just turned 60. Lorene had been living on her own in an apartment in Northern Virginia, but she wanted to downsize.

SOLIVAN: And I saw the ad on Craigslist: Golden Girls House. I said oh, that sounds like fun.

ROVNER: Which is just what Bonnie had in mind when she started her little enterprise.

MOORE: It's a little bit like family, a little bit like roommates, a little bit like a sorority house. It just evolves.

ROVNER: The four roommates share expenses, some cooking, and they even throw parties together sometimes. They also look out for each other's medical needs. Bonnie said it was a huge help when she was hospitalized recently for her diabetes.

MOORE: When I was in the hospital, they were bringing me the stuff that I needed, and this and that.

ROVNER: The whole idea started after her divorce. Bonnie needed financial help to stay in the house where she'd put down roots, including out in her beloved garden. She has a grown son in Utah. He offered to build her a house out there, but she was adamant about staying in Maryland.

MOORE: He's just sort of saying, well, Mom, you're old now. We have to take care of you. And I'm saying, I'm not old. I've got 20 more years out there in my yard, thank you very much.

ROVNER: Now, Bonnie's got big plans to grow things other than plants and flowers. She's working on a guide to help other single boomer women set up group houses like hers.

MOORE: I think it'll be fun. And I'd like to be part of various seminars and workshops for women - you know, the whole idea of living communally and learning to get along in this kind of environment.

ROVNER: Which would be a good thing because even experts in aging are scratching their heads about what's going to happen to the huge generation of increasingly single childless women as they age. Sarah Rix, of the AARP Public Policy Institute, studies the economic prospects of women in the workforce. She's also a single boomer herself.

SARAH RIX: I think that's one of the scariest questions because I fall into that category. And I say oh, I've got wonderful nieces and nephews. Well, in fact, they've got their families. They've got their in-laws. They've got their parents, and I don't think it's reasonable to expect much out of them.

ROVNER: Across the country, in San Francisco, Kathleen Kelly says she's seeing the same sort of concern in her social circle.

KATHLEEN KELLY: I'm in my 50s, and my friends are all talking about, could we all move in together? Could we buy an apartment building, and all live together? There's all sorts of permutations on this conversation.

ROVNER: Kelly's executive director of the National Center on Caregiving. The numbers are, in a word, daunting.

KELLY: About a third of baby boomers are single, but we also know that there is a large percentage of those that are in their 50s and 60s that are getting divorced. And so we're going to have more single individuals, in the future. We just haven't seen this before.

ROVNER: And many boomers have had fewer or no children, compared to previous generations. There were nearly twice as many American women without children in 2008 as there were in 1976, according to a White House report on women.

KELLY: So there's less adult children to take the place of the caregiving cohort that currently is providing caregiving to their parents.

ROVNER: Family caregiving that currently provides an estimated $450 billion a year worth of care - meaning that the mostly women boomers now caring for their parents may be unprepared for their own future. Sarah Rix, of AARP, says a big problem for single boomer women is that they may lack the financial ability to hire the caregivers they might need if they don't have family members to provide it.

RIX: They are still likely to be concentrated in what we've traditionally called the pink-collar jobs: the lower-wage, low-benefit occupations. And so when they reach old age, they often reach old age without pension coverage.

ROVNER: They will, or at least should, have Social Security, she says. But for many older women, that will be all - or nearly all - they have to live on.

RIX: And it's not going to pay for a lot of care, formal care. So it's a frightening future.

ROVNER: But there are things women can do, says Kathleen Kelly of the National Center on Caregiving. Some of them are pretty obvious, like maintaining a healthy, active lifestyle. But another piece of her advice may not be so intuitive.

KELLY: And that is to invest in social relationships and networks - not the kind that are on the Internet, necessarily, but the kind that you build a community of individuals that may - you may be able to share tasks and responsibilities as you grow older.

ROVNER: Which brings us back to Bonnie Moore, of the Golden Girls house in Maryland. She says having people around was a financial necessity, but it's become a lot more than that.

MOORE: It's just the nature of women, you know. And to come home and have someone say, hi, how was your day? That's really nice sometimes.

ROVNER: Roommate Lorene Solivan agrees.

SOLIVAN: To have your own social group your own age, whether you're 20, 40, 60 - whatever the case may be - is a big plus, I think.

ROVNER: So if you're a boomer and you liked that group house you lived in, in college or just after? Good for you because the U.S. is one of the few developed nations that has no organized public policy for providing long-term care. So group living may be something in your future as well as your past.

Julie Rovner, NPR News, Washington.

WERTHEIMER: And there's more from our Changing Lives of Women series online, where we're asking NPR women about their careers and inviting you to join the conversation. Long-time congressional correspondent Cokie Roberts weighed in on how she found support in the workplace.

GREENE: She says her female friends always rallied behind her, and she had the advantage of having them right here with her at NPR.

COKIE ROBERTS, BYLINE: Let's start with the fact that Linda Wertheimer and Nina Totenberg lobbied -that's the polite term - the powers that were to get me hired in the first place. Later, when the three of us had desks together two NPR homes ago, one of our male colleagues dubbed our corner "The Fallopian Jungle." He is long gone. We are not.

GREENE: Linda, I'm speechless. The fallopian jungle - someone actually said that?

WERTHEIMER: A little bit of "Mad Men" at old-time NPR. But things have changed a lot since then, of course. You would never say anything like that, David.

GREENE: I would never say that, Linda. You can be assured. Well, you can read Cokie Roberts' full essay at our website, npr.org.

Copyright © 2013 NPR. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to NPR. This transcript is provided for personal, noncommercial use only, pursuant to our Terms of Use. Any other use requires NPR's prior permission. Visit our permissions page for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR's programming is the audio.

Michael

Look before you leap - or move.

Here is a piece on recently released health care cost data regarding hospital billing rates for various procedures.  It is a long slog of an article, but slide to the bottom and you will see an interactive tool to see comparisons by state (you select the state) to the national high, low and average costs.  While this pertains to what the hospital will bill Medicare for these procedures, it might be an indicator of relative costs for other healthcare services.  This is one more tool in selecting where you wish to eld, or at least being informed about the cost of elding in your chosen region.

Michael



One hospital charges $8,000 — another, $38,000
By: Sarah Kliff
Consumers on Wednesday will finally get some answers about one of modern life's most persistent mysteries: how much medical care actually costs. For the first time, the federal government will release the prices that hospitals charge for the 100 most … Continue reading →

Some Odd Thoughts on Medicaid and Procreation.

I suspect that if you are following this blog you are, if not financially secure, at least financially literate. But unforeseen medical issues can devastate the most cautious saver.  The prospect of being destitute and in need can be terrifying.

But lets do a what-if and think about this for a moment.  Lets say we come down with that debilitating desease that is going to cost a fortune, OUR fortune, and at the end of the day we will spend the rest of our days in a nursing home with no prospect of paying for it.  Thanks to the administration of Lyndon Johnson, there is a safety net that will not have us shivering under an overpass waiting for our kidneys to fail and the coyotes to carry our bones to their pups.  It is called Medicaid.  Just because you have some money now does not guarantee you will not need it some day.  Thank you, Lyndon, for this and so many other things.

Variations on this theme:  There are two of you, in a legally recognized marriage.  And, there is just one of you.  If there are two of you, in a legally recognized marriage, then the one not consuming assets for medical expenses is allowed to keep some assets, but not much - a house and a few dollars of financial assets.  Lots of complicated restrictions apply.  There are claw-back rules, so you can't just give away your assets to a caregiver and then collect medicaid.  The caregiver (family members, maybe) will have to give the money back.  Just doing the paperwork for applying for Medicaid is, I understand, "complicated".  And if you are not in a legally recognized marriage, then, well, what does that mean?

Bye the way, I have found a number of references to the subject of not just growing old alone without children, but growing old alone, period.  My perspective has always been as one who is a member of a stable couple who made a conscious decision to not have children very early in our relationship.

Listening to some of the Supreme Court arguments lately about the right to gay marriage, you might think that there are those who think WE have no moral claim on marriage, since we have shunned the prime rationale for ANY marriage - procreation.  But that is another topic.  This blog should be relevant to gay couples without children as well.

Update/Reminder on Long Term Care Insurance Features

Note number 6 below - this is something I believe we have not discussed before.  I am going to check our policies now to see if this is relevant.  I think we would have noticed if an exclusion was included, but best to check to make sure.

If you're interested in long-term-care insurance, you should look into the coverage before you need it -- perhaps when you are in your 40s, 50s or early 60s. If you wait too long the premium costs will be un-economical.  Choose a highly rated insurance company. Shop around and review the policies for the following features:

1. The benefit amount should be adequate. Most policies pay a specified amount per day, so you will have to pay the difference. 
2. Benefits should increase with inflation. You may not receive benefits for many years, so it's important to make sure that the amount increases with inflation. 
3. Covered services should include skilled care, intermediate care, custodial care, home health care, and adult day care. 
4. There should not be a requirement that you must first be hospitalized to receive benefits. There should also be no requirement that you must first receive skilled nursing home care to receive intermediate or custodial care, or that you must first receive nursing home care to receive home care. 
5. Benefits should be payable when you can't perform two or three activities of daily living such as bathing, dressing, eating, walking, transferring from a bed to a chair, using the bathroom, or remaining continent. Another condition that should qualify is cognitive impairment. 
6. Specific coverage should exist for Alzheimer's disease and other organic-based mental illness. Some policies exclude these conditions.
7. The policy should be guaranteed renewable, meaning the policy can't be canceled due to age or deterioration in health.
8. Select a reasonable waiting period and a benefit period you are comfortable with. The longer you wait before benefits begin, the lower your premiums.

Michael

Special Needs Emergency Registry

Here is a handy little tool for Elders with Needs.  This is great for us Child Free elders, whose non-children may be of non-help in an emergency.

Rhode Island has a state Special Needs Emergency Registry for people with disabilities.  Other states and communities may also have these, so check them out in any area where you intend to eld in place.  You sign up for the registry, and this puts first responders on notice of any special needs you might have, especially equipement that requires electricity such as respirators, dialysis machines, etc.

You can enroll in the Rhode Island Special Needs Emergency Registry online.  If you are unable to complete the online form, a paper form is available.  This may be inconvenient if you live in Phoenix.

Where we live, it is not uncommon to have power outages durring both winter and summer storms.  This past winter was particularly enlightening.  We own a small generator for hurricane preparedness, and have a plan for dealing with those kinds of summer storms.  But this winter caught us unprepared.  While the generator is fine for powering our refrigerator, we had no way to power our gas furnace when Winter Storm Nemo rolled into town and knocked out power to the entire island.  It started me thinking:  if I were aged and needy, and not able to operate the generator, how would I:

1. Keep my medicines cool in the fridge?
2. Preserve a little food for that nasty habit (remember habits?) I have of eating?
3. Generate a little heat without resorting to stuffing our sleeping quarters with Bed Cats (of which we only have one in stock).

So, the registry sounds like a good idea.  In theory.  But I have some questions.

Scenario 1:  Winter Storm Zydeco leaves 24 inches of snow in the street and knocks out the power.  I am lying in my (soiled) bed, my oxygen machine has stopped working, my phone is out (keep one of those old fashioned corded phones handy to plug into the socket - that power NEVER seems to go out - How do they DO that?) and my cat has frozen to death.  Will anyone look at the Special Needs Emergency Registry and think:  "The power is out, and we know that this coot needs oxygen.  Maybe someone should check on him."?

Scenario 2:  That skillet that I left on the burning stove after dinner last night has burst into flames (I eat lots of greasy foods), the flames spreading to the dried out flowers on the counter I have been meaning to throw out but just can't bear to part with because they were sent by our God Daughter after their last visit, which in turn set the cat on fire, which in turn set the rest of the house on fire, etc. etc. etc.  Does the fire crew know that there is an oxygen canister next to my (soiled) bed, having flagged my address as one included on the Special Needs Emergency Registry?  And when they pull me from the now-toasty house and see that I am no longer sentient, will they know that I have a Do Not Resuscitate Medical Directive in an envelop labeled "open me first" in my night stand?

There are a number of commercial services that can check up on you as well.  My mother-in-law has one tied to her phone line, and through speakers and microphones they can actually talk to her to make sure she is OK.  More on that later.

I have a call into the RI Department of Health, who administers the Registry, to find answers to these and other questions.  When I get a response I will post a comment to this blog entry with the answers.  Expect to hear from me in about 18 months.  In the mean time, stay away from winter storms.

Michael

Co-Housing - Why didn't I think of that?

Actually, I did think of that, or at least one variation of the concept.

Cohousing (in spite of my spell checker, there is no hyphen) is a concept that took root in Denmark quite some time ago, and has only more recently become popular in the US.  Cohousing is a type of collaborative housing in which residents actively participate in the design and operation of their own neighborhoods.  These neighborhoods can be in rural Kansas, an old New England mill building, or in the middle of a borough of NYC.  They can be new construction or re-construction of existing properties.  They can be family oriented (ie kids, playgrounds, schooling) or adult oriented ("Help, Lewie, I've fallen and I can't find my scotch!")  There are over 125 such communities in the US.  Actually, there are probably more, but they just don't identify with the name or enter into the statistics.

There are six defining characteristics of cohousing, per the Cohousing Association of the United States (www.cohousing.org).  They are:


1. Participatory process. Future residents participate in the design of the community so that it meets their needs. Some cohousing communities are initiated or driven by a developer. In those cases, if the developer brings the future resident group into the process late in the planning, the residents will have less input into the design. A well-designed, pedestrian-oriented community without significant resident participation in the planning may be “cohousing-inspired,” but it is not a cohousing community.

2. Neighborhood design. The physical layout and orientation of the buildings (the site plan) encourage a sense of community. For example, the private residences are clustered on the site, leaving more shared open space. The dwellings typically face each other across a pedestrian street or courtyard, with cars parked on the periphery. Often, the front doorway of every home affords a view of the common house. What far outweighs any specifics, however, is the intention to create a strong sense of community, with design as one of the facilitators.

3. Common facilities. Common facilities are designed for daily use, are an integral part of the community, and are always supplemental to the private residences. The common house typically includes a common kitchen, dining area, sitting area, children's playroom and laundry, and also may contain a workshop, library, exercise room, crafts room and/or one or two guest rooms. Except on very tight urban sites, cohousing communities often have playground equipment, lawns and gardens as well. Since the buildings are clustered, larger sites may retain several or many acres of undeveloped shared open space.  (And perhaps a dock and nearby moorings for us sailors.)

4. Resident management. Residents manage their own cohousing communities, and also perform much of the work required to maintain the property. They participate in the preparation of common meals, and meet regularly to solve problems and develop policies for the community.

5. Non-hierarchical structure and decision-making. Leadership roles naturally exist in cohousing communities, however no one person (or persons) has authority over others. Most groups start with one or two “burning souls.” As people join the group, each person takes on one or more roles consistent with his or her skills, abilities or interests. Most cohousing groups make all of their decisions by consensus, and, although many groups have a policy for voting if the group cannot reach consensus after a number of attempts, it is rarely or never necessary to resort to voting.

6. No shared community economy. The community is not a source of income for its members. Occasionally, a cohousing community will pay one of its residents to do a specific (usually time-limited) task, but more typically the work will be considered that member's contribution to the shared responsibilities.

There are a number of architectural firms and other organizations that can help a group interested in cohousing to pull their facility together, from site selection, to design, to organization, to construction, to  "lets move in".  There are also brokers that can help you find existing cohousing communities with units for sale (yes, as elders we must anticipate the inevitable turnover).

It sounds a lot like the communes of the 60's and 70's, but for adults.  As we know, there are a lot of adults who are getting older and want to remain independent as long as possible.  Cohousing can be a means of doing that.

My idea, discussed with friends for a decade or more and described briefly in this blog in April of 2012 ("Independent Living"), was, without my knowing it, a cohousing concept.

•  Get together with a bunch of really good friends.
• Jointly buy a property with enough room for a common house and individual living units.
• Have room for our stuff like boats and cars.
• Have room for gardens, workshops, studios, to be as self-reliant as we want.
• Watch over each other's stuff and feed each other's pets when someone wants to go on a cruise to the Bahamas or live in Paris for a year.
• Support each other for as long as we can stand each other.
• Have room for visitors in the common house.
• Have room for a live-in caregiver in the common house when that is necessary.  

Cohousing would not be for everyone.  It is tough to come up with a common vision, acceptable financing, personalities (seeing your good friends all the time is not the same as getting together once a year in Charleston to shop, eat and drink), living standards, outside interests, understanding of shared responsibilities.  And being pedestrian oriented, there could be less privacy than in traditional housing (as I look out my window at our back yard, I realize that I LIKE our back yard with its hedge that screens out the rest of the world).    It's complicated.  But for the right group of people, with the right design parameters, it could be, I suspect, very satisfying.

If structured properly, I think this could be a substitute for a Continuing Care Retirement Community, especially if there were a nursing home, rehab or other medical facilities nearby.  I have been thinking that a CCRC would likely be part of our aging strategy.  But, who knows, maybe some day we will actually pull together the Wooster's Retreat after all.

Who would have thought that I was such a visionary, a "burning soul".

Michael

An Example of why the habit of skepticism is so important

Received: A sophisticated looking response request card addressed to:  Me

HERE IS WHAT THEY SAID:

Content text:

PERSONAL Business Mail
2013 FORM AN99C

Social Security Taxes 2013 Update

Social Security legislation has been passed by Congress which changes your benefits.  There are now provisions to hlpe seniors from having to pay more.

Qualified seniors may potentially pay less on thier Social Secutiry Benefits.  Reutrn the attached postage paid card to learn:

• When should you apply for Social Security?
• What claiming strategies can you use?
• How are your benefits calculated?
• How can you apply for a tax credit?

For a FREE personalized Social Security Timing report, return the atatched card within 5 days or to go to www.freessreport.com to receive your report sooner.

Reply card addressed to:

Consumer Inquiry

PO Box 55o

Fall River, MA  02722-9910

Reply card requirements:

Signature

Spouse's

Date of Birth (for both)

Phone Number (NEEDED FOR DELIVERY

E-Mail (PLEASE PRINT CLEARLY)

I am currently receiving Social Security.  Please check YES or NO.

OUT OF HABIT, HOW DO I REACT:

Someone wants to know my date of birth or SS number or other personal data.

WHY?

WHO ARE THESE PEOPLE?  The address is pretty vague.  

There is a web site to visit.  I DON'T GO TO JUST ANY WEB SITE.

If I already receive my Social Security benefits, why do I need to know when I should apply for them?

I DON'T PAY ANYTHING FOR MY BENEFITS, DO I?

ACTION:

I AM SUSPICIOUS.
I NEVER GIVE MY PHONE NUMBER OR DATE OF BIRTH TO ANYONE I DON'T KNOW.

I THINK I'LL ASK SOMEONE BEFORE I DO ANYTHING.

AFTER LOOKING A LITTLE FURTHER:

As search of the Social Security web site (the real one) reveals no Form AN99C.

A general WWW search for Form AN99C reveals that this is the part number for an electronic component for a DC10 aircraft.  

The web site contains a picture of a cute couple, an official looking seal with the words "SOCIAL SECURITY SPECIALIST", and a disclaimer "c 2012 all rights reserved.  This site is not connected with, affiliated with or endorsed by the United States government or the Social Security Administration."  It is one page that requests the following information:

Name

Phone

Email

Zipcode

It also asks for a mailer code from the postcard.  The site will do nothing without all this data.

I DON'T THINK SO!

However, I do need to know something about social security.  For example, spousal benefits - how do they work?  There are alternate strategies for deciding when one spouse starts collecting benefits.  It's complicated.  After doing a little analysis, I will post here some guidance.  If you understand this subject, please post a comment.  Did I mention that it's complicated?

Michael