Hurray for the New Year! What were the best books on aging and gerontology you read in 2011? Here’s the books I’d like to see be published in 2012.
1. How I learned to love Social Security and Medicare by John Boehner, Paul Ryan and The Republican Caucus of the House of Representatives. A change of attitude, a story of awakening and a growing heart, a tribute to a program that has kept our older citizens out of poverty and healthier than ever before.
2. Maggie Kuhn’s Legacy: The Return of the Gray Panthers. A biography of the activist and a description of the new, more militant advocacy arising among our elders.
3. Bismarck, Social Welfare and Capitalism: Lessons from the Iron Chancellor for the United States. Lessons in the importance of knowing that “those who are disabled from work by age and invalidity have a well-grounded claim to care from the state.”
4. Undaunted. Stories of how older persons made it through the Great Depression and how their lessons are helping their children survive the first Great Recession of the 21st century.
5. Through My Beard: A Biography of John Whittemore, the man who competed in athletic events up to his death at the age of 104. A tribute to those who strive forever.
6. Claude Pepper. An unabashedly fond tribute to a left-liberal.
7. The Emotional Intelligence of Aging. A discussion of how we live life more fully as we age due to our increasing ability to understand others’ emotions.
8. How Richard M. Nixon Saved Social Security by Raising Taxes and Increasing Benefits. A true story, often ignored. The title says it all, you Tea Party members.
9. Stopping Boomerang Kids: How to Make Your Children Independent Forever. A how-to book for elders who like their empty nest empty.
10. Mothers and Daughters, by E. Ayn Welleford. A gerontologist weighs in on the most important relationship in contemporary America.
It’s a great concept — that we will reduce our illness and our functional problems to a small period of time before death. We will live healthier lives and not live an old age of long years needing care or living in long-term care institutions. One of the more frightening aspects of older ages is the frailty and disability that we see in some older people. Having a stroke in your 70s and living until you are 85 is not our idea of the ‘golden years’ of retirement.
George Bernard Shaw lived to be 94 and died shortly after a fall that came while pruning an apple tree. It is the type of death we all aspire to – active into our later years and not debilitated.
We were hopeful for a while. It did seem to be that life expectancy increases were being matched by an increase in disease free years. A recent piece in the Journal of Gerontology: Social Sciences by Eileen Crimmins and Hiram Beltran-Sanchez suggests that, unfortunately, research indicates we are not experiencing fewer years free of disease and loss of function. They posit that “compression of morbidity may be as illusory as immortality.”
The good news is that we may be doing better handling the diseases we get than in previous years. We are identifying diseases sooner and thus initiating treatment sooner which is allowing us to live longer despite the presence of serious diseases. Diseases are ‘less lethal and less disabling.’ We have improved the ability of our environment to support our capacity to function. Most of us will take longer life if the diseases we have are manageable and we can function.
The bad news comes from two sides. The first is the increase in obesity at all ages and the potential effect of this on life expectancy and decrease in life functioning. This trend will compress mortality by shortening lives but may increase morbidity. The second source of bad news, at least for our wallets, is that those extra years we are enjoying with disease require more medical intervention than ever and disease care costs money. Witness the predictions about the ‘bankruptcy’ of Medicare and how the year that happens keeps getting closer.
The best action we can take? It’s the same old answer – exercise, eat right, stay connected with people. And maybe keep pruning those apple trees.
Last night I watched CSI Miami “How Could You”. It was a case of mistaken identity that went wrong. An older man, posing as a younger man, made a chat connection with a younger woman, who was really an older woman, posing as a younger woman. Are you still with me? Neither of the older persons was too happy when they finally met FTF, face-to-face, each presuming they would be hooking up with a younger person. Eventually, it led to murder.
But I was more struck by how, in age, the attentions of a younger suitor can be such a powerful force. Both of the older characters in the episode had attractive spouses, but they were carried away by the virtual thrill of ‘hooking up’ with a younger person. Those assignations in the chat room made them somehow believe that they were 18 again and the idea proved irresistible leading to doom for both of them. It brings to mind how often we do things, as we age, to recapture the thrill of youth. Part of that is due to how the society tends to view youth and old age. There is no doubt we are a youth-oriented culture. My students last semester, by a bare majority vote, did think the image of older people in the media overall was improving, but all agreed we are still youth-oriented. How sad that we have so few TV shows that offer us characters who are trying to act older than they are.
The other thought I had was how the Internet can mask our age. So if we are looking to combat some of the discrimination based on age, the ageism of our society, perhaps the Internet can be a tool to thwart that bias. In this case, it was not used to good effect, but I can see situations of consulting and contract employment where the anonymity that the Internet can provide could work in favor of older persons in this young society. The potential is there to judge proposals for work, and work itself, based on the outcomes and not on the person. I am not advocating that an older worker portray themselves as a younger worker when seeking jobs on the Internet. I do think the Internet may provide an ‘age-neutral’ environment which may limit age discrimination. Of course, that means that older people using it as such will have to master the tools of a younger generation and perhaps that does indeed make us younger.
I checked out the possibility of a long-term care insurance policy when I
turned 53. I had read so much about it and I was encouraging my students to check
out whether insurance worked for them. I decided I should do so myself. When I received a solicitation from one of the long-term companies, I asked them for a quote.
Long-term care begins when a person can¹t take care of themselves. We all go through periods when we need help taking care of ourselves, but most of these are short-term situations such as a flu, a broken bone, a temporary illness. Long-term care illnesses by definition, last a long time. They are chronic illnesses or disabilities that are expected to last more than three months. The Congressional Budget office defines long term care as “the medical, social, personal care, and supportive services needed by people who
have lost some capacity for self-care because of a chronic illness or condition.”
Long-term care can occur in a nursing facility, an assisted living, or in the home. Who receives long-term care? Researchers estimate that about 2% of those under 65 use long-term care (3.3 million people). About 17 percent, or about 5.6 million people, over the age of 65 use long-term care. About two-thirds of long-term health care is for older disabled persons and 1/3 for younger disabled persons.
Who pays for long-term care? It’s a mixed bag. Usually it¹s the person in need through their personal savings and the government health care program for the poor, Medicaid. Together these two sources cover most of the cost of long-term care services. About $43 billion from each source. Medicaid, however, only covers you when your poor, when you¹ve used up all your assets and income to pay for medical care and there¹s not enough left for anything else. Medicare will not cover your long-term care expenses. Read my lips: Medicare will not cover your long-term care expenses. Medicare covers acute care like hospitalizations and doctor¹s visits and some pharmaceutical drugs. Medicare covers your therapy after a hospitalization, even if that therapy occurs in
a long-term care facility like a nursing home. If you learn anything from this piece, learn this: Medicare will NOT cover your long-term care expenses.
Confusing? It sure is. Here¹s how it often works. Your Aunt Abby, who lives alone, has a severe stroke and can¹t look after herself anymore. For a while she may be able to get long-term care services in her community by paying for home care. But, eventually she needs a nursing home with a cost of $60,000+ per year. She can¹t afford that. She lives on a small pension and Social Security. Most of her wealth is in her home. So she sells her house for, say $240,000, and she can pay for the nursing home for four years. After the four years she still needs care and the nursing home social worker gets her on Medicaid because Aunt Abby can¹t pay her nursing home bill. (And neither can her family pay out $60,000 per year.) From then on, Medicaid pays the bill. But Medicaid doesn¹t pay the nursing facilities very much for the care so they really don¹t want Aunt Abby when she¹s on Medicaid. Most would continue to care for her, but some will reduce
the level of her care. She may have to move from a private room to a semi-private room. Some may not accept her back if she is hospitalized.
So, unless you expect to use Medicaid, the government program for the poor, you need to figure out how you will cover your long-term care expenses. First option is to save enough, on top of your retirement, to handle long-term care expenses. Second option is the growing choice of long-term care insurance policies. The policies are improving. It¹s hard to craft a policy that will hold up over the course of 30-plus years in terms of benefits and appropriate cost. And each person¹s circumstances are different. People with large supportive families may not need a formal long-term care insurance policy. But a single woman, given a long life expectancy, who does not anticipate having children
and who has no extended family, should consider some kind of insurance arrangement for formal long-term care.
The time to plan for these expenditures is now not later.
I never bought the long-term care policy, for a variety of reasons related to cost and risk. But each decision is individual. Check out your own need and how much a policy would cost.
The Center for Medicare and Medicaid Services (CMS) has an excellent site on
long-term care. See http://www.medicare.gov/longtermcare/static/home.asp
The US Department of Health and Human Services also has an informative site:
Another excellent source of information is the old standby, AARP:
The Kaiser Foundation has helpful information in an issue brief at:
Medicare is the most important way we cover the medical care needs of older people and people with severe disabilities.
Who does Medicare cover? People age 65 or older, people under age 65 with certain disabilities, and people of all ages with permanent kidney failure.
The basic parts of Medicare are: Part A is medical insurance, also called Hospital Insurance, or in-patient hospital care and some types of rehabilitation care.
Part B covers most doctors¹ services and outpatient care and some therapy and home care services and equipment.
The newest part, Part D, covers some prescription drug costs. A monthly premium is charged for Part B and Part D.
(Are you wondering what happened to Part C? It is the “Medicare Advantage” program and sets up optional managed care plans for people on Medicare.)
We pay for Medicare Part A through payroll taxes, similar to how we pay for Social Security. People pay into Medicare out of their payroll throughout their lives and current workers pay for current Medicare recipients. We pay for Part B out of regular taxes and the monthly premiums that each recipient pays.
Medicare is the second largest domestic program of the Federal Government (after Social Security). Medicare spends an average of almost $8000 per person per year on its 41 million beneficiaries, although 26% of all Medicare¹s funds are spent for the last year of life.
And there¹s not enough money. The deficit for 2005 is about $350 billion. That deficit is paid out of the trust fund Medicare has accumulated, but the trust fund reserves are estimated to run out in 20190. The deteriorating economy will only make this worse. So Medicare, like Social Security, needs some attention.
Watson Wyatt Worldwide, the premier financial management consulting firm states: “Retirees will have to assume greater responsibility in planning and paying for their medical costs in retirement, including saving more, delaying retirement or both.”
Out-of-pocket expenditures for persons on Medicare averaged $2223 per year. In the future, we can expect this proportion $8000/$2000 (4/1) to shift more towards the individual. As more costs are shifted to the individual during working years, Medicare will follow and a great share of the expenditures will be the responsibility of the individual. Furthermore, with annual growth in health care expenditures at 6-10% per year, we can expect substantially increased costs for health care as retirement approaches.
It remains to be seen how the Obama Stimulus Package and the President’s proposed budget will affect older persons. The plan to accumulate a reserve to address health care relies on Medicare savings to do so. Certainly, there are efficiencies that can be implemented to generate savings, but other actions such as reductions in reimbursement rates for physicians and other health care providers may result in a limitation on access to care by Medicare beneficiaries.
The basic message remains — there will be increased personal responsibility for health care costs. It’s down to you.
The Wall Street Journal reports today that more older persons are remaining in the job market and are seeking work in this recession than in previous ones. (WSJ, February 23, 2009.)
Keep in mind that retirement is a phenomenon of the second half of the twentieth century. Many older persons are finding out that there is no retirement in the 21st century. Their investments are down in value and those who retired with just enough money are finding that just enough is not enough for these times.
Employment until disability or death is the historical norm. For the next few years, work will be considered an important piece of retirement. Many older Americans choose to work beyond the traditional retirement age for reasons of finances, work/professional connections, and social links. As we struggle through this recession many older Americans will have to work beyond retirement age because they don’t have enough savings and retirement income to live on.
They are competing against younger workers and age discrimination is rampant. But in the coming years, we can expect the workplace to more multi-generational than in the past few decades. Although age bias will not disappear, the changing age structure of the American society means that there will be fewer younger workers available. So, in certain employment fields, older workers will be prized. Good news for those older persons seeking jobs now. They will benefit from a shortage of workers available to fill positions.
The recession also may generate more flexible options for older workers such as phased retirement, part-time work and seasonal work. Until the economy turns again, these more limited options may be more attractive to struggling firms and may be more suited to older workers. For maximum success in using the American workforce, companies will solicit and support older workers. With older workers in receipt of basic health care through Medicare, we may see increasing amounts of part-time opportunities so firms can save on health care costs.
Not all older persons will be able to work. Those with experience in physically and mentally demanding positions may not be able to continue. And in industries with extensive technological change, there may by a tendency on the part of older workers to retire rather than learn a new skill set. Jobs with substantial physical demands also may be perceived by older workers as too difficult. And, if the older worker develops a disability of any kind they may consider retirement as a preferable option to continued employment even with the reduced income. But the most important factor is money, or the availability of resources and income that can support the individual when they retire. As the stock market plunge eats into savings and rates of return, older person will once again, of necessity, forego retirement.
AARP has a section on its site for older workers and job seekers. http://www.aarp.org/bulletin/yourlife/0905_sidebar_2.html
Quintessential Careers is a site that offers much information for older job seekers: http://www.quintcareers.com/mature_jobseekers.html
I love secrets – especially when I’m one of the ones in the know. But this secret needs to be shared. There is a nationwide network of places to go to help you find services for your older friends and relatives. It’s called the Aging Network and it was set up under a law called the Older Americans Act, first passed in 1965. The Older Americans Act established an agency for older persons at each level of government in the U.S.
At the Federal level, the Administration on Aging’s role is to coordinate programs for older persons among the agencies in Washington and to lead the rest of the aging network in helping society assist older persons.
At the state level, each state has a State Unit on Aging. These agencies develop programs and advocate for older persons needs in state government and lead the Area Agencies on Aging in that state.
In localities around the nation there are Area Agencies on Aging who provide assistance and services directly to older persons in their communities. There are 655 Area Agencies on Aging. They have different names based on their history and community, but there is one that serves every locality in the U.S.
So you are or wherever your loved older friends and relatives live, there is an agency you can call to begin getting needed help. There is a website at the Administration on Aging that will direct you to the right Area Agency based on zipcode, city or county.
(See http://www.eldercare.gov/Eldercare/Public/Home.asp .)
Area Agencies provide a broad range of services:
• Information and referral (I&R)
• Outreach services
• Care management
• Employment services
• Senior centers
• Congregate meals programs
• Adult day services
• Volunteer programs
• Homemaker and Home Health services
• Home-delivered mealsr
• Telephone reassurance
• Friendly visiting
• Energy assistance
• Emergency response
• Personal care
• Respite care
Unfortunately, resources available to these agencies are limited. They can not serve all the elders who are in need. By law they do have to concentrate on those in greatest economic and social need.
But they provide information to everyone. So Area Agencies are a great place to start if you are seeking help for an older person. If they can not help, they can direct you to a geriatric case manager or another agency that may be able to provide the services your elder needs. This is especially true if for those out-of-town relatives and friends who are attempting to assist older loved ones through long-distance caregiving.
Website resources: The Administration on Aging
The National Association of State Units on Aging is an association of State Units on Aging that supports these agencies to achieve their mission. Here’s a site that lists all the State Units on Aging. http://www.nasua.org/SUAMembers.cfm#tx
The National Association of Area Agencies on Aging does the same for these local community organizations. http://www.mfaaa.org/AreaAging.aspx
Political issues to watch: The Aging Network is severely underfunded, yet they are a logical resource for a coordinated system of long-term care services. Watch how the Nursing Home Owners and other providers of long-term care and home and community-based care agencies struggle over meager resources and reimbursements for long-term health care.
Business Opportunities: Consulting opportunities at all three levels especially as the Area Agencies become more sophisticated and stretch into other health and social services arenas. They will need expert guidance. Service provision – check the list of services above. Although some Area Agencies provide their services using their staff, others contract for all services. If you provide one of these services, Area Agencies may be a source of a stable contract.
On this day after the Inauguration of the presidency of Barack Obama, it’s a good time to consider his words of hope and his words challenging us to “dust ourselves off and begin again the work of remaking America.” With the growth of the aging population, it’s a good time to consider this within the context of aging. This is the time to take charge of our own aging.
The safety net is shrinking. It was already full of holes and now, even with all the bail-outs and stimulus, neither government nor corporate America can do much more for us as we age.
Last century we gave more and more government benefits to older persons. Now the Feds argue about how to best fix Social Security and Medicare, let alone the budget cuts needed in other programs. The states, under similar fiscal stress have backed off too. Local communities do what they can, but it’s coming back to us to take more responsibility for our own aging.
We Americans have always emphasized both mutual support and self-sufficiency. We often debate what the public should do and what the individual should do.
It’s an American dichotomy. We have the strongest non-profit sector in the world. We will always rely on family and friends and volunteers and non-profit agencies to care for older people without adding much government money. As in the African proverb, we know “It takes a village to raise a child.” But Americans have always stressed the responsibility of the individual.
Now, the pendulum is swinging back to an individual focused society.
What this means is that more and more… it’s down to you. No question about it. You will do much more for yourself in the coming years – you must build and manage your finances, your health, your livelihood, your life.
So how do you want your aging life to look? It’s the chance to design the second part of your life. Not just the chance anymore, but the responsibility. How will you pay for 30 years of retirement and leisure? How will you pay for your health care? Where will you live? What can you do to stay healthy and fit? What kind of 90 year old will you be? How will you stay in charge of any care you’ll need?
If you don’t know what kind of life you want as you age, it’s time to find out. Complete this sentence: “After retirement, I, accomplished …. List ten of your most outrageous dreams.
So think about how you will continue to make or to remake yourself as an older person and how we want to remake the society to ennoble aging. We have duties to ourselves and to our own future and our community’s future.
Here are some resources to get you started on your own quest to remake your aging in the new America:
The International Coach Federation: http://www.coachfederation.org/ICF/
The American Association of Nurse Life Care Planners: http://www.aanlcp.org/
The 360-Degree Retirement http://www.retirement360.com/
Print Resources: Finding Your Own North Star: How to Claim the Life You Were Meant to Live, by Martha Beck.
The topic in our Social Gerontology class this week is retirement. There are many aspects to this 20th century phenomenon from a social gerontology viewpoint. One of the issues generating the most interest in the discussion was how one knows when to retire. Is it a question only of money. The decision is based on the four Ds – difficulties on the job, disability, desire, and denarii (money). Many older workers are under overt or subtle pressures to retire, to make way for the younger worker (who, coincidentally, is usually not paid as well). Discouragement and discrimination can make retirement look good. Disability begins to affect more people after age 55 when the rigors of a lifetime of work, sometimes heavy work indeed, begins to affect the body. An achy, breaky body can sure encourage retirement. Desire is the pull of activities away from the workforce. Older persons with strong hobbies, avocations or even new vocations that they want to pursue have stronger pull incentives to retire. Finally, the adequacy of their denarii (an old Roman term for money) will often end up being the deciding factor. Yet, not everyone feels fully prepared to have enough funds to last them for at least 20 years after retirement (about the life expectancy of a person at age 65 in the US today). Sometimes the first two reasons can force the issue before there’s adequate savings. Good thing Social Security provides the safety net it does.
I’m looking forward to next Monday’s show on PBS. Retirement Revolution – “Hazards and Vicissitudes”. Paula Zahn hosts this show on March 31, 10-11 p.m and I’m hoping it shows the diverse face of retirement in America today.
On Tuesday the Alzheimer’s Association released a report on the future impact of Alzheimer’s Disease on US health care. (See below.) Alzheimer’s Disease is the most common disorder causing dementia in older people. Dementia, with its significant deterioration in cognitive capacity, including symptoms such as loss of memory, judgment, reasoning, attention and orientation and a general deterioration in the ability to function, imparts a tremendous burden on the individual and their family and friends who support them. Alzheimer’s disease is not preventable and, except in early stages, is untreatable. The typical victim lives 7-9 years after onset although some can live much longer.
Studies have produced varying estimates of the number of people with some form of dementia. This Alzheimer’s Association study suggests that 10 million baby boomers will develop the disease. We don’t have firm estimates of the number with the disease mostly because of problems defining dementia and different ways to conduct the studies.
Only a few drugs are available for treatment of persons in early stages of Alzheimer’s disease including donepezil, rivastigmine, galantamine and memantine. However, after a certain point in the progression of the disease, all lose their effectiveness.
The care is extensive for a person with Alzheimer’s disease and leads often to severe caregiver burden. It can impair the health of the caregiver. The phrase “the 36 hour day” (from the book of the same name by Nancy Mace and Peter Rabins) best describes the overwhelming nature of the burden. In addition, the economic cost to the formal long-term care system is substantial but can be absolutely devastating for family financial resources.
This report is a great effort to continue to bring attention to a disease that has not received adequate support neither in terms of services and health care nor in research on how to control and ameliorate the effects of the disease.
For more information go to the key organization providing information on the disease — the Alzheimer’s Association: http://www.alz.org/ . The National Institute on Aging also has information about the disease and other dementias: http://www.nia.nih.gov/Alzheimers/Publications/adfact.htm
For an understanding of the disease start with this book: Mace, N.L. & Rabins, P.V. (1991). The 36-Hour Day. Baltimore: Johns Hopkins University, 1991. And I would encourage you to read
Alzheimer’s Association. (2008). The 2008 Alzheimer’s Disease Facts and Figures. Retrieved March 20, 2008 from http://www.alz.org/alzheimers_disease_facts_figures.asp
Political Issues to watch: One area to watch is the advocacy on the part of Alzheimer’s disease organizations and companies to encourage the Federal government to increase research dollars at the National Institutes of Health for this disease. However, given Federal budget limitations, Alzheimer’s disease is only one of a number of diseases calling for more resources. Another political issue connected to dementia and diseases such as Alzheimer’s is stem cell research. Expect continuing controversy with those who advocate for research to address incurable diseases aligned against those who oppose the use of stem cells.
For entrepreneurs in services related to this issue, there will be more demand for caregiver support services and products, better pharmaceuticals, and services to businesses to help them handle the effects of the demands of caregiving on their employees.