One of the most common hopes of retiring individuals is that they can move to the beach or go someplace abroad. A new study by the National Association of Real Estate Investment Trusts revealed that only a tiny percentage of seniors in their 60's, around one percent per year, move. Most retirees remain in their own homes, but for those that do retire abroad there are certain considerations that must be made before the move.
Financial Concerns Retiring Abroad
Some of the most common locations for retirees to move to oversees today include Ecuador, Thailand, and Portugal. However, many are unaware of the Financial Crimes Enforcement Network Report 114. Otherwise known as an F-Bar, this document is required for any retiree that has a bank account overseas that contains a balance above $10,000. Failure to submit an F-Bar results in severe penalties, such as fines up to $100,000 or fifty percent of the balance of the account.
Healthcare and Basic Amenities
Many seniors who retire abroad are also in for a shock when it comes to the level of healthcare and basic amenities. The level of difference from the United States and another country can be distressing to some, where the diversions, cultural attractions, sports, and basic necessities are all different. In order to avoid these problems, family members and other advisers for seniors need to make sure that they have as much information as possible before they make the move.
The largest issue for the elderly abroad is access to quality medical care. Country to country, even in the same geographical area, the quality of medical care can vary widely. Information about all other country's medical care can be found on the U.S. State Department website. Advisers highly recommend signing up for private insurance and medical care abroad, otherwise a person can wait weeks for a simple appointment.
In addition, getting the medication that seniors require is also an important issue to discuss. In countries like China and India, prescription medication counterfeiting is rampant and many people are not actually taking the drugs that they need. In other countries like Mexico and Ecuador a prescription is not even necessary for some medications, but it also means that a person could have a severe reaction and no medical professional to turn to.
What to Look For
The first step in any overseas retirement move is to choose the proper country. The best way to do this is to prioritize the most important aspects of your living situation and not compromise on a single one. In addition, remember the importance of communication and that you may be moving to a place where very few people speak English. Even going to the grocery store or the bank can become a stressful event.
You should also look into any potential safety concerns for seniors abroad. The risk of danger typically increases with the crime rate in that country or city. There are also a number of countries that are experiencing political unrest, violent protests, and acts of terrorism. The U.S. State Department also keeps an updated list of travel alerts, so seniors can review them before making a decision to move.
One of the most common hopes of retiring individuals is that they can move to the beach or go someplace abroad. A new study by the National Association of Real Estate Investment Trusts revealed that only a tiny percentage of seniors in their 60's, around one percent per year, move. Most retirees remain in their own homes, but for those that do retire abroad there are certain considerations that must be made before the move.
Medicaid is one of the most utilized government programs for elderly American citizens that are in need of medical assistance that they cannot afford. In order to qualify for the Medicaid program, an applicant must meet a number of criteria and an application can either be filled out online or in paper form. However, many applicants to the Medicaid program have run into issues of red tape and other problems when attempting to apply for benefits.
Online Medicaid Application
The online application for Medicaid can be found on the federal Medicaid program website. For seniors that are tech savvy, the online application can be filled out in about 45 minutes. The website contains all kinds of information like eligibility, benefits, and required documentation needed to be considered for the program. After an online application is submitted, there may be follow-up phone calls by the program to make sure that everything regarding their application is in order, but usually an accepted applicant can receive their benefits card within 45 days of submitting the online application.
Difficulties with Applying
One of the biggest issues regarding the online application for Medicaid is that many seniors are not comfortable enough with computers and technology to fill out the application online. This means that either errors are submitted on the online application, or elderly applicants face problems submitting a paper application to the program. One common complaint is that "a computer can't answer your questions, but a knowledgeable caseworker can." That is why some previous applicants to the Medicaid program encourage others to go in person to the Medicaid office to fill out their applications for coverage.
By filling out a Medicaid application in person at a local Medicaid office, the application can be completed with the help of a dedicated caseworker, the errors submitted are marginalized, and the delays on the application are greatly reduced. Unfortunately, some applicants have noted long wait times when many people go to the Medicaid office at the same time. It is important to plan accordingly if you wish to fill out an application in this manner. On average, a person waits about two hours before they are helped in person at a Medicaid office.
How to Get Help
There are many resources available to help Medicaid applicants with their issues on the application. Questions regarding the program can be answered at any local Medicaid office or Social Security office. You can also call in and ask a question about the application process, but typically callers are placed on hold before they can speak to someone about their problems.
Finally, you can get information regarding the Medicaid application process from a local hospital and hospital social worker. These employees will be able to offer access to the Medicaid application as well as answer any questions that an applicant may have about the process. Some hospitals outsource this job to specialized companies, and if your hospital does this then they can give you the information necessary to contact a specialist there.
The Florida House of Representatives rejected an expansion of the state's current Medicaid system that leaves hundreds of thousands of people caught in the state's coverage gap. This gap applies to people living in the state who make too much money to apply for coverage but too little to cover the costs of their medical care. It has the possibility of having a serious effect on elderly people who live down in Florida full-time or have made it their primary residence for Medicaid eligibility purposes.
Florida Medicaid Program
Florida currently has 1.3 million people enrolled in the federal exchange for healthcare insurance, more than any other state in the country. Most of these people qualify for subsidies, but if these subsidies were invalidated then they would lose their access to coverage. This is of particular concern now as the U.S. Supreme Court is currently ruling on the case of King v. Burwell, which will determine whether federal tax subsidies that allow for low and middle income people to purchase insurance through the marketplace will be unconstitutional.
Proposed Medicaid Expansion
The proposed Medicaid expansion would raise the income limits for eligibility, and one hundred percent of the cost of coverage would be covered by the federal government through 2016, with ninety percent coverage by the government after that. Without the expansion, around 700,000 people remain in Medicaid's coverage gap. Furthermore, it has driven many in Florida out of the marketplace altogether with 24% of its population completely uninsured, the second highest uninsured rate in the nation.
One advocate of the proposed Medicaid expansion in Florida said, "If the Medicaid dollars [were] accepted, in combination with the exchange, you'd pretty much have a path to coverage for everybody. People [would be] able to get primary preventative care and ultimately [wouldn't] have to bankrupt themselves to access coverage, as happens to many in Florida."
Effects on Florida Citizens
The downsides of rejecting the Medicaid expansion affect many in Florida, young and old. In regards to children, one researcher found that 28% of the population under consideration for Medicaid in Florida are parents, so their rejection affects their children, too. "When parents are covered, it improves the financial security of the family. It also improves the health of the parents, which reduces conditions like maternal depression."
Furthermore, it reduces the percentage of children that are uninsured across the state. "Florida has a very poor enrollment rate in the Medicaid and CHIP programs, and that's why Florida has the highest uninsured rate of kids in the South." Studies have found that when the entire family is covered by programs like Medicaid, enrollment has improved.
The lack of Medicaid expansion also affects the elderly in Florida. Many seniors across the state are living on a fixed income or may be close to outliving their funds. However, these seniors are still caught in the middle of the coverage gap and are unable to qualify for Medicaid. This means that they must spend down their assets and leave nothing for their loved ones or go without Medicaid coverage for their healthcare needs.
CVS Health Corp. CEO Larry Melo recently announced that the company is investing billions into the purchase of a nursing home pharmacy operator in an attempt to transform into a dominant healthcare player for senior needs. CVS purchased the company Omnicare, Inc. in its bid to outgrow CVS' drugstore chain persona into something more all-encompassing for healthcare needs and focus more on the growing population of aging seniors in this country.
Recent Changes to CVS
This is not the first major change that CVS has made to its healthcare focus in recent years. In 2011, the company announced that it will no longer be selling cigarettes in its mission to improve its consumers' health. It also changed its name from CVS Health to CVS Caremark and aggressively expanded the number of in-store health clinics. By 2017, CVS aims to have another 600 in-store health clinics for consumers and in 2013 the company purchased a drug-infusion company to expand its healthcare competencies.
Purchase of Omnicare, Inc.
The purchase of Omnicare, Inc. cost CVS $12.7 billion including debt. It is by far one of the largest and most aggressive moves that CVS has made into becoming a major healthcare provider. The company expects that the purchase of Omnicare will add adjusted earnings of twenty cents per share to its stock in the next year. The only other deal that is comparable to the purchase of Omnicare was CVS' purchase of Caremark Rx, Inc. in 2007 for $21.7 billion.
The purpose of these major changes is to "move away from being solely a pharmacy and PBM to becoming more of a vertical integrator of health care," focusing primarily on an aging population with greater care needs. Omnicare provides medications and helps nursing home facilities manage their residents' medications. CVS hopes to use this platform to move its care services towards more long-term care needs and assisted-living operations.
Growth of CVS Healthcare
The pharmacy unit for CVS is by far the company's largest driver of growth, with revenues increasing by 18.2% in that sector last year. The demand for pharmacy and medications continues to grow as more patients and medical professionals look to manage the costs of medications in a time of soaring drug prices. With the purchase of Omnicare and other vertical companies in the drug supply chain, CVS is poised to provide quality medications to seniors and other patients at a lower price.
Currently, CVS is the nation's largest provider of prescription drugs and the second largest pharmacy benefits manager in the United States. The company handles health plans for insurers and employers alike. In total, CVS operates 7,700 retail pharmacies, 900 walk-in clinics, and manages the pharmacy benefits of over 65 million people across the country. With the purchase of Omnicare, CVS hopes to increase the number of consumers cared for by millions as more seniors are in need of long-term care and medication.
The United Health Foundation, a nonprofit organization that is focused on improving healthcare and overall health, published its third annual report earlier this year that analyzes how well each state across the country is taking care of their seniors. Based on thirty-five different benchmarks, the study breaks down each individual state's strengths and weaknesses for various elder care needs in addition to comparing states as a whole.
Elder Care in the United States
Almost one in seven citizens in the United States is now 65 years old or older, and the need for quality checks on our nation's elder care system is increasing. By 2030, it is estimated that over one-fifth of the country's population will be elderly. By 2050, it is estimated that nearly 83.7 million people will be 65 years old or older, more than double the elderly population in 2012.
As a result, elder care needs threaten to swamp the existing healthcare system in America at both state and national levels. The massive increase in the number of elderly has the potential to impact Social Security, Medicare, Medicaid, and other state and federal elder care programs. Unfortunately, the states that are expected to see the greatest increase in senior population also have some of the worst levels of care for the elderly in the United Health Foundation report.
Elder Care Report Results
Some of the highlights of the foundation's report show that Vermont is now considered the healthiest state for seniors with a decrease in chronic alcoholism as well as increases in quality of hospice care, mental health days, and community support. Other top states for elder care include New Hampshire, Minnesota, Hawaii, Utah, Massachusetts, and Iowa. On the other side of the spectrum, Louisiana ranks as the state with the worst level of senior care in the country. Other states at the bottom of spectrum for senior care include Mississippi, Kentucky, Arizona, Oklahoma, and West Virginia.
New York was ranked 21st across the country for its quality of elder care by the United Health Foundation study. Among the strengths highlighted, New York has seen a decrease in the numbers of seniors smoking, high SNAP enrollment, and a ready availability of home healthcare providers. Unfortunately, the state is facing challenges with a high percentage of seniors in poverty, low volunteerism rates, and a higher percentage of hospital deaths.
In addition, New York saw an increase of seniors receiving a flu vaccination by thirteen percent to 62.2% last year, and smoking among the elderly in New York has decreased twenty percent from 8.1% to 6.5%. The average poor mental health days among seniors across the state also decreased 22% from 3.2 to 2.5 days per month. However, hospice care in New York increased last year by ten percent to 31.7% of decedents that were elderly and food insecurity for seniors also increased across the state by six percent to 15.7% of seniors over the age of sixty years old.
Millions of people across the country are currently part of the "sandwich generation" They are caring for their children and simultaneously caring for an elderly parent. Despite the fact that so many people are struggling to handle this responsibility, there are very few resources that caregivers can use for support. This article highlights six things that a caregiver can do to prepare for some of the most common stressful situations that occur with elder care.
Have a Talk with Your Parents
Before cognitive issues or even caregiving needs arise, you should sit down and have a conversation with your parents about everything regarding their care. You should discuss their wants and needs regarding caregiving as well as review their finances, estate plan, health issues, end-of-life decisions, and more.
In addition to having a talk, take that time to update any important documents necessary to your parents' care. This includes wills, trusts, powers of attorney, healthcare proxy forms, and living wills. This not only prepares you for caregiving but also updates all financial companies, government organizations, medical professionals, and more about your parents' care. Updating documents early is also important because if cognitive issues arise, such as Alzheimer's disease or dementia, then your parent may be deemed mentally incompetent to manage their affairs.
Complete a Medicine List
One of the most important things to know as a caregiver is what medications your parent is currently taking. In the case of an emergency where they cannot communicate to medical professionals what they are on, your parent could be misdiagnosed or given a medication that could cause complications. Even in a normal situation, elderly parents tend to have more than one doctor, and without a current list of medications one doctor could give a drug that counteracts another.
Ensure Access to Information
Make sure that as a caregiver you can get access to information and documentation when you need it. HIPAA laws, regulations, and company policies may forbid you from accessing your parents' information without their consent. Be sure to get authorization from all necessary parties regarding their information, and also remember to be added on as an authorized user to any bank safety deposit boxes if forms are being kept in there.
Review Parental Finances
As awkward as it is for some people to talk to their parents about money, it is important to review your parents' finances in order to plan for future care. By anticipating future costs and planning ahead, you can try to prevent your parents from outliving their money and being forced to live on public funds or your money.
Research Care Providers and Living Situations
Finally, put some time into researching care providers and different living situations that your parents would be comfortable with. Discuss how comfortable they would be with being admitted to a hospital, rehab center, nursing home, assisted living community, independent living community, or hospice care. This can save everyone time, money, and stress when an emergency arises. In addition, researching these things ahead of time allows your parents to give their input and makes them feel in charge of their own care.
The federal government has proposed new rules for private healthcare insurers that have Medicaid and children's health plans for the first time in over a decade. The proposed rules would cover healthcare plans for millions of people across the United States and calls for insurers to provide a report of what portion of money they're paid by the government is actually going towards health benefits and is recommending that states take that into account when setting their rates.
Medicaid and CHIP cover more than 70 million people in the United States, and 12.6 million people were added last year alone from the expansion of the Affordable Care Act. The Medicaid program is state-run, but it is overseen in part by the federal government and the Centers for Medicare and Medicaid Services. Private Medicaid plans operate in 39 states across the country and cover more than half of all Medicaid beneficiaries.
California has the largest number of members enrolled in the Medicaid program, followed by New York and Florida. In 2012, states were allowed to opt out of expanding their Medicaid program and 21 states decided not to increase their eligibility. The federal government is currently paying for the full cost of expansion through 2016 and ninety percent of the cost thereafter.
The last time that major changes were proposed for the Medicaid system was back in 2003, well before significant expansions were made to the program. Since then, the Medicaid program that covers the low income, the elderly, and the CHIP program for children has all expanded exponentially. The main reason for this expansion is the introduction of the Affordable Care Act, but managed-care firms have also expanded their care of beneficiaries.
Proposed Medicaid Rules
The proposed new rules for the Medicaid program call for managed Medicaid plans to report what is called a "medical loss ratio." Using this ratio, the state governments could set the rates that they pay plans. According to the new rules, insurers should be using about 85% of the premiums that they take on benefits. It is intended to cap the amount that insurers can spend on administrative costs.
Additional rules were proposed that include rules for private plans that provide long-term care for the elderly and disabled. This is also important given the large, and growing, number of elderly beneficiaries of the Medicaid system.
Blowback from the Industry
Not everyone is happy about the proposed rules for Medicaid plans and the medical loss ratio. One industry group leader criticized the new rules, saying that having one medical loss ratio for all states does not make sense because some states already have medical spending levels built into their contract plans.
Another trade group called the new rules "arbitrary" and claims that it could undermine other critical services that are not healthcare. The group named some critical services as transportation to and from appointments as well as social services for these Medicaid beneficiaries.
A new study has shown that a program that gives families with loved ones who suffer from dementia the tools necessary to help better care for them has lowered the use of nursing homes. This new program uses a telephone-based program where non-medical managers use assessments and evidence-based protocols to help educate and offer support to people treating family members with dementia and other cognitive impairments. This study highlights the need for new dementia care programs and proves that this type of system can be implemented on a large scale.
Results of the Study
According to one of the primary researchers of the study, almost fifteen percent of seniors over the age of seventy years old have some form of dementia. The study looked at around 250 caregivers that enlisted in the program and 250 caregivers in their normal routine that did not use the program. At the end of the study, the research showed that the caregivers enrolled in the new program were more satisfied with the level of care and had more confidence in their ability to care for their loved one.
In addition, the study found that nursing home use with the caregivers using the program was lower than the normal routine group. It found that many caregivers using the program called regarding care management strategies, and the researchers further surmised that the program is best suited for caregivers treating family members with moderate to severe dementia issues.
Furthermore, the telephone-based evidence system is easy to replicate with other providers and in other geographic areas. This model based itself on best practices and involved the entire care team in its implementation. It involved aspects of care that are not always a part of dementia treatment such as non-medication based approach to care, a method of safe return if a dementia patient wandered off, and the creation of advance directives for care.
More Dementia Care is Needed
Care for seniors with dementia is one of the most pressing needs for elder care. According to research, over fifteen percent of seniors over the age of seventy years old have some level of dementia or other cognitive impairment. The percentage quickly increases for seniors over the age of eighty years old. Nevertheless, this study showed that an evidence-based care model for caregivers treating family members with dementia is a system that can work.
However, there is still room for improvement and overall there is a greater need for quality dementia care. In many cases, when a senior with dementia requires a certain level of care their family members are forced to place them in a nursing home facility or other assisted living. One small issue in this study was that the new program does cost more than routine care overall, but the difference was not significant. As one doctor pointed out, "if it gave better care and did not cost significantly more, why wouldn't you want to implement a similar program?"
Senators are currently hosting a series of hearings that are focused on the need to improve Medicare for seniors that are suffering from chronic illness. Two senators, Mark Warner and Johnny Isakson, have been tasked with developing specific proposals for bills that would help this section of the elderly population pay for and treat their chronic illnesses under the Medicare system and have gotten others involved in actively suggesting reforms for the program.
Seniors with Chronic Illness
Seniors suffering from chronic illness is a serious problem in the Medicare system. Currently, about fourteen percent of Medicare recipients have at least six or more chronic conditions. This subgroup of consumers represents almost half of the Medicare program's costs. Another cost driver is that these seniors also often have other functional limitations or cognitive impairment that can also increase the cost of care that most of the other seniors in the program without chronic illness do not have.
According to a study done by the Urban Institute, Medicare spends on average about $16,000 per person suffering from chronic illnesses and other forms of impairments. This is nearly twice as much as the average elder enrolled in Medicare or enrollee that had chronic illness but did not have other impairments. The additional cost comes from hospital care, skilled nursing facilities, and other personal assistance needs.
Proposed Ideas for Reform
Thankfully, a number of medical professionals and others have been present at the hearings put on by the Senate and have proposed ideas for Medicare reform. One proposal involved the creation of Affordable Care Organizations. In this new system, doctors and hospitals would create financial arrangements to treat episodes of chronic illness for a fixed Medicare price.
Bundled payments, where medical service providers would combine services and payment in a less structured environment than the Affordable Care Organizations was also proposed as another option for chronic illness care. However, there are other ideas out there to reform the Medicare system that were not proposed at the Senate hearings.
Other Options for Reform
One idea to reform the Medicare program for patients suffering from chronic disease is called the Medicaring Accountable Care Model. This program would combine medical and social services into a single comprehensive care plan. Massachusetts has already enacted a Medicare Advantage plan similar to this model for seniors with special needs called "senior care options." It has successfully combined medical services with home supportive services.
It has become clear that the best options for treating Medicare patients suffering from chronic diseases would combine payments and treatments in addition to social services. These seniors need improved medical care, social support, and personal assistance at home or in a facility as well as better access to services. However, the current Senate hearings aimed at reforming this part of the Medicare system are a good start to helping this section of the elderly population.
Announced this month, Apple, Inc. and IBM are coming together on a new project that will bring iPads and custom apps to Japan's aging seniors. The companies are using Japan as the launch pad for their new system before possibly expanding the program to other countries. The country is a perfect place to test out the new system because by 2055, experts estimate that almost forty percent of Japan's population will be senior citizens and already over one-quarter of its residents are 65 years old or older.
New Technology for Japan's Elderly
The two American companies announced a partnership with Japan Post Group, the country's largest health and life insurance company, to bring specialized iPads and apps to the nation's elderly. The goal of the partnership is to connect millions of Japan's seniors with services and tools that they need to stay healthy and in their homes. The CEO of Japan Post Group admitted that "Among all the nations in the world, the issue of aging generations is most active in Japan. We need real solutions."
The system will run on an iPad and include all of the computer's regular apps in addition to specialized elder care apps designed specifically by the group. The system will have access to the healthcare data of the millions of seniors that are using the service; however, they will have the option to opt out of this if they do not wish to share that information. In addition, medical professionals and support will be available through Watson's cloud-based analytics, as well.
Purpose of the New System
Apple and IBM have gone on the record as saying that the purpose of this new system is to address elder care needs on a global scale. ""We will dramatically improve the lives of millions... sooner or later most every country on face of earth will encounter this issue," said the CEO of Apple Tim Cook. The goal of the new program is to "build a service that not only we can be proud of, but will leave a dent in the universe."
The rollout of the program in Japan will be slow, but given its large population of elderly citizens the country is the best option to test the program. It will begin by integrating in with Japan Post's exiting "Watch Over" service that provides in-person check ins for elderly citizens that live alone. The program will be integrated into the iPad program with a large, clear interface and simple buttons to choose options. These options include getting information on healthcare, keeping in touch with family, accessing friends and relatives, and a button that can immediately call for help.
In addition, features that already exist on an iPad can help seniors get more access to things that they need. Large type, closed captioning, dictation apps, and Siri can all help seniors with their everyday elder care needs. The group plans to add more customized elder care apps as the program progresses, but they have not revealed at this time what those apps or services might entail.
A recent PBS special focused on tending to older parents and other struggles faced by many with elder care needs. In a special program called "Caring for Mom and Dad," the station attempted to go deeper into the issues surrounding adult children as they attempt to care for their aging parents. It is one of the first times that a major television station has run a program that focuses on the difficult questions of cost, rights, and medical capabilities of elder care.
Caring for Mom and Dad
Narrated by acclaimed actress Meryl Streep, the program starts with a well-known fact, "America is facing a new reality. Soon the old will outnumber the young, and most will live longer than ever before." The program focuses on a few families and their unique struggles with elder care as well as the sacrifices that they have made in order to care for their aging parents. However, the program also looks at the costs for caring for ailing parents at home, both financially and emotionally.
One of the commentators on the special, Jane Gross, bluntly stated that "There are many scenarios in which by the time this is over, Mom and Dad are broke and so are you." However, the program also focused on what some communities are doing to address the current problems surrounding elder care, such as southwestern Ohio. "If we want in this country to not institutionalize everyone who's old or disabled, if we want to care for them in the community, that means the community has to step up."
The Council on Aging of Southwestern Ohio has taken great strides in addressing the needs of the elderly in their community. The initiative put forth in the area that was proposed by the Council on Aging taxes residents and uses the money to provide home health aides and pay for other necessary expenses for their elderly citizens.
This system implemented around the area prevents many seniors in the area from becoming institutionalized in a nursing home facility and cuts costs for them and their families for their elder care needs. In addition, the program in southwestern Ohio is providing jobs for home health care workers that might otherwise struggle to find work.
However, paying for some of the costs of care is only part of the solution, and "Caring for Mom and Dad" only just started to delve into the many issues surrounding elder care. Issues like addressing the number of elderly caretakers and how they should be trained were not addressed in the program, nor did it address the potential medical and ethical issues of sustaining life for seniors as long as possible with advances in technology. However, this special was a great start for conversations that need to be had at home as well as in society at large regarding the issues surrounding elder care needs across the country.
Most people consider elderly issues as problems with nursing homes, Medicaid, Medicare or Social Security. While these are important problems that need to be addressed with our nation's seniors, the number of elderly residents in cities is forcing them to rethink everything about their infrastructure.
Growing Number of Elderly in Cities
The Organization for Economic Cooperation and Development (OECD) has released a new report detailing the growing number of seniors in our country's largest cities. According to their report, between 2001 and 2011 the number of elderly ages 65 years and older living in well-developed cities has jumped by 24%. This is more than three times the rate of growth for these cities overall. By 2050, the report estimates that over one-quarter of these cities' populations will consist of elderly people, and the fastest growing population is seniors ages eighty years old and older.
Common Infrastructure Issues
The report by the OECD boiled down the issues facing large cities into three basic issues: increasing the supply of affordable housing that is accessible to seniors, making it easier for seniors to get around and stay active, and finding ways to provide more social services for less cost. While many people associate living in cities with a younger generation, city living actually works incredibly well for seniors if the proper infrastructure is in place.
Regardless of where they live, seniors typically move into smaller housing as they age, have more difficulty driving, need increased social interaction, and need proximity to medical and social services. Small apartments, public transportation, lots of people, and access to services are all available to seniors by living in a large city.
Examples of Senior Issues in Cities
In Philadelphia, one in seven citizens is already 65 years old or older. The city has been plagued in recent years by an aging population, poverty, and increasing housing costs. By 2020, the number of seniors expected to increase by another 24%, yet the budget for their services was cut by twelve percent last year. To combat the growing number of problems with their seniors, the city passed new zoning regulations in 2011 that would allow for the building of accessory dwelling units, such as a garage, basement, or backyard apartment for seniors to love into with their other family members.
These issues are not just within the confines of the United States. Other well-developed cities across the world are facing similar issues with their elderly populations. In Cologne, Germany, the city started a program where a senior can move in with college students in exchange for caregiving services. The city is also encouraging small businesses to relocate to residential areas so that it is easier for senior access.
In addition, Helsinki, Finland, developed floor sensor systems that allow for caregivers to monitor their patients remotely so that they can stay in their homes for as long as possible. In Lisbon, Portugal, the city has instructed that all sidewalks be at least five feet wide to accommodate their number of walking seniors and has enacted a public awareness campaign to watch out for the elderly on their public walkways.
Few people realize that nursing homes can file for guardianship over their elderly or disabled residents in order to collect on unpaid debts. Even fewer experts have done research on how often nursing homes initiate proceedings or track their progress through the courts. However, what research has been completed on nursing home guardianships show that not only does the practice happen often, but it seems to be increasing in use.
Nursing Home Guardianship Statistics
The Brookdale Center of Healthy Aging and Longevity has been researching how often these types of cases occur in the state of New York. While it has not released its full report, the Center has stated that its research found that between the years 2002 and 2012, nursing homes accounted for over twelve percent of all guardianship cases in Manhattan. Outside of the city, guardianship petitions by nursing homes over their residents are also a significant percentage of the court requests. Overall, estimates show that as many as two-thirds of all guardianship proceedings across the country are petitioned by an institution or government entity.
Why Guardianship is Important
The purpose of guardianship is to transfer an incapacitated person's right to make decisions for themselves to another person or party that is appointed by the court. Once appointed, the guardian makes all decisions regarding finances and personal affairs for the person. It is different than a durable power of attorney or healthcare proxy and actually supplants them both.
Reasons for Guardianship Petitions
Usually, a nursing home will file for guardianship of a resident if an issue is causing for unpaid debt to accumulate against the facility for long-term care. The most common reasons listed in nursing home guardianship petitions are family feuds, suspected embezzlement by loved ones, absence of family help, or for the purposes of Medicaid coverage. However, many believe that the actual cause of most guardianship petitions is to force family members of the resident to pay their unpaid bills or force a settlement of bill disputes.
In addition, a guardian is typically paid with the incapacitated person's money. This is especially important for a nursing home that is appointed guardian because it can directly take out the money that it is owed by the resident it holds guardianship over. As guardian, a nursing home also has the last say in their resident's care and can ensure that it continues to collect payment for their long-term care by keeping the resident in their facility.
How to Avoid Guardianship Traps
While a guardian does have access to all of the incapacitated person's readily accessible funds, such as a bank account, it does not supplant a trustee of a trust. The best way to protect your or your loved one's assets from an organizational guardianship proceeding is to place all of the assets into a trust before going into a nursing home or other care facility. Conversely, if only a will is used, a guardian has access to all of the assets in the will before the person dies.
The annual "Cost of Care" report by Genworth Financial was released last week that shows that the cost of care for elderly seniors in the United States continues to rise. According to the survey, the median bill for a private room in a nursing home is now $91,250 per year and the numbers are expected to continue to climb.
Cost of Care Report
Genworth Financial tracks the annual expenses for long-term care through its annual Cost of Care survey. Seniors, their families, government agencies, care facilities, and insurers all look to the annual report in order to know what to expect in elder care. The report looks at over 15,000 nursing homes, assisted living facilities, and other long-term care providers across the country.
Over the last five years, the survey has found that the cost of care for seniors has increased four percent every year. Just last year, the cost of care for an ailing senior was only $87,600, compared to the $91,250 this year.
The National Council on Aging released a statement, saying that "Most people don't realize how expensive this care can be until a parent or family member needs it . . . and then it's a real shock." The survey looks at a variety of long-term care services provided around the United States, including nursing home care, adult day care, and home health aides. The survey found that nursing home rates are increasing the fastest at twice the rate of inflation over the last five years. Now, one year in a nursing home costs three times the average cost of tuition for one year at a private university.
Paying for the Costs of Care
The main question that arises from the annual report is who will pay for the enormous nursing home bill? Many seniors believe that their Medicare coverage will cover the costs in a long-term care facility, but in actuality the program does not. Medicare only covers short-term care costs, like recovery after surgery, but not long-term stays in a nursing home or other community.
Medicaid is an option for seniors, but the program requires that an applicant have less than $2000 in assets before qualifying for the program. This means spending down almost all of your loved one's money before they can participate and handling complicated estate planning matters. One final option is the purchase of long-term care insurance, where the insurance company covers the costs of long-term care; however, most policies need to be purchased years or decades in advance in order to qualify with a decent premium rate.
Regardless of who is covering the costs of care, the annual Cost of Care report highlights the problems with the increasing cost of long-term care for seniors in the United States. With costs far outpacing the regular inflation rates, simply affording decent long-term care will be a significant issue for millions of seniors in the near future, affecting them and their loved ones seeking long-term care.
In cases of dementia, Alzheimer's disease, and other issues with cognition, studies have shown that the ability to perform simple math problems and handling financial matters are often the first skills that slip away. Equally important is the research that shows that as people age, even elders that do not have issues with cognition may reach the point where making financial decisions can become incredibly challenging.
Seniors and Financial Skills
The issue of seniors handling their own financial affairs is significant in this day and age. Currently, there are 44.7 million people in the United States that are 65 years old or older, and they account for fourteen percent of the overall population. In a mere ten years, that number will skyrocket to around 66 million people, and this age group has trillions of dollars in wealth. Unfortunately, many seniors are left to manage their financial affairs on their own, despite losing the ability to do so.
Around fifty percent of all adults over the age of eighty have some level of dementia or cognitive impairment. The director of the Alzheimer's Disease Center has said that "If you can detect emerging financial impairment early, you can also step in early and protect the person. It may be if you step in two months from now, they won't be in a position to make a poor decision or be exploited a year from now."
Warning Signs of Cognitive Decline
It can be difficult to determine when you should step in with your elderly loved one and take over the financial responsibilities. However, the National Endowment for Financial Education and the National Institute on Aging recently teamed up for a study to detect the early warning signs of cognitive and financial decline. The study looked at 138 adults over a period of time who were initially deemed cognitively normal when they joined and tracked their ability to handle financial tasks in addition to reevaluating the subjects for cognitive impairment.
The warning signs discovered by the study are subtle and can often be missed by a senior's family members. However, researchers behind the study say to look for the following when determining whether your elderly loved one may be showing signs of decline.
· Difficulty identifying the risks of an investment
· Focusing too much on the benefits of an investment
· Completing tasks on a financial to-do list take longer
· Everyday math becomes more difficult or full of errors
· Financial concepts become harder to grasp
Biology behind Cognitive Decline
Even seniors with healthy brains eventually experience some level of cognitive decline, and it can affect their ability to handle finances. One study found that a person's financial decision making abilities tend to peak at around 53 years old, or at some point in their fifties. Fluid intelligence, or the ability to solve new problems, can start to decline as early as in a person's twenties, but it is offset by crystallized intelligence of experiences and wisdom.
Brain researchers believe that crystallized intelligence tends to plateau in a person's seventies, and that combined with the decline in fluid intelligence might explain why seniors have more problems with cognition and financial decisions. "Our nation's wealth is disproportionately held by older adults, and they are exactly the group, particularly as they reach their 80s and 90s, that are most vulnerable. But our system has the fewest protections for those people."
Consider simplifying your loved one's financial decisions or adding yourself to their accounts. You can also set up an estate plan that helps with financial decision making or create a durable power of attorney form. You can also have financial institutions send you copies of statements to ensure that everything is running smoothly with your elderly loved one's finances.