Articles
Financial Planning for Seniors and Their Adult Children
One of the many challenges facing adult children of seniors is the conversation regarding finances. In Kiplinger’s Retirement Report, research provided by Ameriprise Financial shows that no one, no matter their age, does well talking about money. Vice president of wealth strategies, Suzanna de Baca says that the conversation should begin sooner than later, so that needs are addressed as well as anything that might have been overlooked.
According to a Fidelity Investment study, 24% of children feel that they will need to provide financial assistance to their parents compared to 97% of parents who state that they will not need help. Yet, when conversations do actually take place, they, “can dramatically increase peace of mind, reduce anxiety and foster additional discussions.”
For those that worry a financial discussion will cause tension or for those that feel it is not their business to inquire, sitting down and discussing this important issue can put you and your loved ones on the same page.
The Fidelity study found that, “The top barrier noted by 30 percent of parents is they don’t want their adult children to overly rely on a potential inheritance. Additionally, parents who have had detailed conversations with their adult children feel significantly more at ease about their children’s financial future – 68 percent vs. only 30 percent – [than] those who have not had detailed conversations.
“When asked who they are comfortable with when talking about their financial situation, the study found that both parents (68 percent) and their adult children (60 percent) feel more comfortable discussing with a third-party financial professional than … each other.”
Ms. De Baca suggests using current events to help begin the conversation. By sharing such things as articles and the latest news reports, the conversation can begin with “What do you think?” or “How do you feel about…?”
Once the conversation starts, then ask if they would like for their finances to be reviewed. Maybe you can spot ways to cut back expenses or create income from an immediate annuity or a line of credit from a reverse mortgage. Or, hiring a fee only financial advisor could both help with a cash flow issue, and could protect you and your financial future by suggesting ways to assist your parents.
Some of those ways include paying bills directly, purchasing long term care insurance to cover expensive medical care, assistance with housing, or providing outright gifts of money. According to the IRS, you can give up to $14,000.00 to each parent without having to file a federal gift-tax return.
Another way to help parents is by looking into federal and state benefits that they could be eligible for. The National Council on Aging offers a free service that helps seniors identify the benefits that best fit their needs. Be aware that with some programs, seniors’ assets and income cannot be above a certain dollar amount. Please check with an accountant or elder-law attorney to ensure that your financial assistance won’t disqualify them.
In-Home Support Can Address Isolation and Loneliness in Seniors
Featured in a recent Los Angeles Times article, recently published research reports that social isolation can accelerate the aging process, thereby likely leading to an early death among the elderly.
According to the National Academy of Sciences, the seven yearlong British study, involving 6,500 participants, showed that when physical and mental health issues were taken out of the equation, a deficiency of social contact made a huge overall impact on the state of health.
According to the study’s author, epidemiologist Andrew Steptoe, people living alone in U.S. households make up a quarter of the entire population; increasing from 10% in 1985 to 25% in 2004. A comparable survey from 2010, showed that 25% of Europeans, over the age of 50, interacted with friends and family less than once a month.
The issues of feeling lonely vs. social isolation were both found to impact life span, but once health factors and demographics were accounted for, feelings of loneliness declined and the isolation became more of the focus; isolation being easier to determine due to the number of people the subject matters interacted with.
Last year, a similar study of retired Americans linked feelings of loneliness to many health ailments that include high blood pressure and illnesses of the heart.
That study’s author, John Cacioppo, director of the Center for Cognitive and Social Neuroscience at the University of Chicago, reports that isolation may encourage poor choices in lifestyle, such as lack of exercise, poor eating habits and smoking.
The National Institute on Aging, a division of the National Institutes of Health, Bethesda, Maryland, funded both of these studies. Richard Suzman, director of the division’s behavioral and social research, wonders if feelings of loneliness cause bad health or is it that when one is sick, one gets more lonely; not being able to get out or having fewer visitors. Suzman states that the awareness of isolation and loneliness should increase, much like joint and movement problems and smoking.
Clinical Depression, Obsessive Compulsive Disorder and Hoarding
Most hoarding engagements come about as a result of the hoarder being threatened with eviction. Homes that share a wall with another home can be put at risk when the neighbor is a hoarder. These risks include roach and rodent infestation, fire, and health hazards resulting from spoiled food, human and animal waste pathogens, and airborne contaminates. The hoarder will respond to the threat of eviction, but de-cluttering the home does not change the hoarding behavior. It will return.
Over the past 10 years we have de-cluttered many hoarded homes. Outcomes have ranged from the person moving to an assisted living facility, to remaining in their home and restarting the hoarding cycle, to ‘recovery’ with continued assistance. However, simply changing locations is not a final solution; hoarders exist in independent and assisted living facilities as well.
Yet, in two of our many cases the hoarder was not threatened with eviction. In one case, her coworkers recognized the person was clinically depressed, reclusive, and didn’t want others in her home. Her coworkers worked with her to get help. We were contacted and met with the resident in her North Bethesda home, accompanied by a trusted coworker. The resident reluctantly agreed to allow her home to be de-cluttered because she realized that her coworker friends sincerely cared about her health, both physical and mental. (It is important to note that hoarding does not favor sex, age or social status.)
Following the de-cluttering, heavy cleaning and structural repairs, the resident declined our proposal to have a companion visit on a regular basis. However, she agreed to a regular cleaning schedule and to periodic visits from a care coordinator. She has subsequently had our computer specialist purchase and install a computer system, conduct remote monitoring, and visit quarterly to answer questions, provide training and perform maintenance.
In another case, the Washington, D.C. home was so badly hoarded the toilets did not work and the water had been cut off for years. The resident frequented a local coffee shop for toileting and “sponge baths”. She has two dogs that she did not allow to go outside as her fence had openings where the dogs could escape. Because of the extent and duration of the hoarding, the home had deteriorated to the point of being seriously contaminated and unsafe. A contractor had to replace a rear deck before the de-hoarding crew could safely begin removing the accumulations.
Concerned neighbors had invited her to one of their homes. During the visit, the neighbors told her they knew she was a hoarder and turned on a television show about hoarding. She was horrified and embarrassed – she thought she’d kept it secret. They assured her that they liked her as a person but were concerned about her hoarding. She agreed to take steps to remedy the situation and called us. Throughout the process, the neighbors have continued their support and encouragement.
Most importantly, the woman has a new lease on life. She still suffers from depression, but has come to realize how much her environment influenced her moods and her entire outlook. The de-cluttering is finished and a new fence has been installed so the dogs can now go outside. Remodeling is not complete although significant progress has been made including installation of all new appliances.
An extensive body of literature exits on the subject of hoarding and obsessive compulsive disorder. Whether reporting on more precise diagnoses, medications or other interventions, the focus is exclusively on the person, not the person in their environment. As we are called on to change and improve the environment, we see the individual within that space. As these two engagements have demonstrated, the person in the middle of that hoarded environment may not always have OCD. “It [is] the light of course that is needed, but it is necessary that the place [have] a certain cleanness and order.”*
*Ernest Hemingway, “A Clean, Well-Lighted Place”
Innovations to Avoid Hospital Readmissions Among the Elderly
In an article featured in Health Day, cardiologist and Yale professor of medicine, Dr. Harlan Krumholz, points out how vulnerable patients are after a hospital stay. Dr. Krumholz compares it to being in a fog; almost like dealing with jet-lag. Even though the patient has been treated properly, there is still stress related to the many facets of the hospital stay including loss of sleep and the possible side effects of any drugs given. And sometimes, the problem is being discharged too soon.
With the lack of sleep or continued interruption of sleep, a patient can suffer from compromised mental ability, a lowered immune system and poor digestion. Once released from the hospital, if these issues are not dealt with accordingly, re-admittance can be required. Statistics are showing that one in five older Americans is re-admitted within the first month of their hospital discharge. Medicare has become concerned enough about this trend that, starting last October, the agency began withholding payment for patients readmitted to hospitals with higher-than-predicted readmission rates. These penalties apply in cases of patients readmitted after treatment for heart attack, congestive heart failure, or pneumonia.
Before a patient is released, it is wise also to monitor how they are sleeping as well as their physical ability – especially if an excessive amount of time was spent in bed with no physical exercise. Hospitals have left this responsibility up to the family in the past, but now more are being proactive thanks to organizations like STAAR (State Action on Avoidable Rehospitalizations) and tougher Medicare standards.
STAAR co-founder, Dr. Amy Boutwell, is also President of Collaborative Healthcare Strategies, Inc., which participates in creating programs to improve hospital care and prevent remittance. The programs are being conducted in states that last year began being penalized by Medicare for hospitals that had higher-than-expected readmissions within the first month of those patients’ primary stay.
Since hospitals differ in procedures to minimize readmission, the U.S. Department of Health and Human Services provides an excellent check list to assist someone when it is time to be discharged from the hospital. This guide will help in tracking all that needs to be done – from speaking with doctors and recording medicines to which exercises and what nutrition will be helpful in the recovery process.
Medicare Skilled Nursing and Therapy Services Expanded
Attorneys from the Center for Medicare Advocacy, Vermont Legal Aid and the Centers for Medicare & Medicaid Services (CMS) have agreed to settle the “Improvement Standard” case, Jimmo v. Sebelius. The proposed agreement was filed in federal District Court on October 16, 2012. When the judge approves the proposed agreement, CMS will revise its guidance to clearly state that skilled nursing and therapy services to maintain a person’s condition can be covered. Previous interpretations of the rule suggested that in order to continue receiving Medicare payments, the providers had to be able to demonstrate continued improvement.
Under prior interpretations of the rule, a person could receive therapy as long as continued improvement could be documented. But once the person reached a plateau and was no longer continuing to improve, facilities would stop the therapy out of concern the Medicare program would deny payment. As a result, patients would frequently regress once therapy was halted. Then therapy would be re-initiated and the cycle would repeat.
In an article in The New York Times, “Judith A. Stein, director of the nonprofit Center for Medicare Advocacy and a lawyer for the beneficiaries, said the proposed settlement could help people with chronic conditions like Alzheimer’s disease, multiple sclerosis, Parkinson’s disease, stroke, spinal cord injuries and traumatic brain injury. It could also provide relief for families and caregivers who often find themselves stretched financially and personally by the need to provide care.
“While the settlement is likely to generate additional costs for the government, it might save some money too. For example, physical therapy and home health care might allow some people to avoid more expensive care in hospitals and nursing homes.”
