In Citrus County, Florida, more than one-third of the residents are senior citizens which is one of the highest rates in the country. However, in just fifteen years over one-quarter of the state will be 65 years old or older. Seeing how Citrus County operates now is giving policy makers and researchers a glimpse into the future of how the entire country will look in just a couple of decades.
A Look at Citrus County
Billboards across the county advertise home health care services, and health care is the dominating labor force for people still working. In addition, lawyers and doctors make house calls, and elderly citizens that can still get around use the county minivan system to be transported to and from the store.
Other services provided by the county also differ from the norm. The library offers free seminars on Medicaid planning, and voters are very active even though the majority participates through the absentee system. With these services provided by the county, the senior citizens are much more engaged and active within the community, but the trade-off is that the economy is supported mainly through low-skill jobs.
Research in Citrus County and other areas with high populations of elderly citizens show that these voters are not typically excited to vote for school funding or other initiatives that benefit younger generations. For example, Citrus County voted to reject a referendum to raise property taxes in order to better fund schools. Having an older population also makes it difficult to attract younger families to fill the service jobs that are required for an older population, and health care jobs make up more than one-third of the jobs in the county.
It is not just the economy that has issues retaining younger people. Churches in the county have struggled to maintain congregations as older members move to be near family or pass away. At the same time, any changes suggested to attract younger church goers is often met with resistance.
The Growing Gray Belt
Citrus County is only one of eight counties in Florida around Orlando and Tampa Bay that is considered the "Gray Belt" of the south. It has the oldest populations in Florida and one of the oldest across the nation. This area looks to be the most elderly area in the country for decades to come, and by 2030 these counties will have senior populations that make up one-third to one-half of their residents. Other states like North Dakota, Michigan, and Texas have their own growing gray belts, but those are attributed more to younger residents leaving and not older residents moving in.
The key issue for states facing a shift in the average age of the population will be balancing the voting concerns of the younger and older generations. With such high participation rates in the elderly population, researchers and policy makers expect to see states with growing gray belts to become less invested in education or transportation and more invested in issues of healthcare and insurance.
In Citrus County, Florida, more than one-third of the residents are senior citizens which is one of the highest rates in the country. However, in just fifteen years over one-quarter of the state will be 65 years old or older. Seeing how Citrus County operates now is giving policy makers and researchers a glimpse into the future of how the entire country will look in just a couple of decades.
In late February, the New York State Department of Financial Services (DFS) issued guidelines to financial institutions located within the state regarding prevention of elder financial exploitation. The guidelines were issued to remind banks and other lending institutions that they are allowed to report possible instances of elder financial exploitation to New York's Adult Protective Services (APS) in addition to outlining the best practices used to identify, investigate, and report instances of elder financial abuse to the authorities.
Federal and State Reporting Law
While not mandated, DFS strongly recommended that financial institutions report any suspected elder financial abuse to APS. A joint task force of the federal OCC and FDIC released their own report in 2013 that clarified that it is not a violation of state or federal law to report suspected elder financial abuse to the relevant authorities.
The report specifically stated that any notification would not violate the Gramm-Leach-Bliley Act's (GLBA) privacy provisions or related regulations. In fact, the joint federal report went so far as to point out that the GBLA and regulations explicitly permit the sharing of nonpublic personal information when elder financial abuse is suspected without complying with notice or opt-out requirements.
In addition, Section 473-b of the New York Social Services Law allows financial institutions operating within the state to report suspected elder financial abuse to APS or other authorities and gives civil immunity to any person who makes the report in good faith. This immunity extends to the employees of a financial institution and the institution itself.
Best Practices to Avoid Exploitation
The report released by DFS stresses the importance that financial institutions play in deterring and preventing elder financial abuse. Bank employees are usually the first people to notice the "red flags" of elder financial exploitation, especially if they are working directly with an elderly client. In order to deter elder financial exploitation, DFS recommends the following best practices for financial institutions:
· Develop a plan and "red flag" procedures for detecting and reporting suspected elder financial abuse
· Hold regular trainings for employees regarding the institution's policies to prevent future exploitation
· Appoint or hire staff specifically to investigate suspected elder financial abuse and report their findings to APS or other authorities
For guidance regarding potential red flags of elder financial abuse, lending institutions are encouraged to review the Financial Crimes Enforcement Network's 2011 advisory report. It describes the most common red flags of exploitation but also encourages financial institutions to immediately investigate whenever any uncharacteristic behavior of an elderly client is noticed.
How to File a Report
When elder financial abuse is suspected, the lending institution should file a Suspicious Activity Report (SAR) with the code of "elder financial exploitation. The bank can make the SAR without fear of civil liability as long as it is made in good faith and should notify either APS or local law enforcement about the SAR filing. Because there is no specificity as to what type of information should be included in an SAR, financial institutions should provide enough information to a reasonable degree explaining the basis of the report.
In January, the Department of Veterans Affairs proposed new regulations regarding when and how a veteran is entitled to the VA pension. The proposed regulations have sparked considerable controversy and outrage over the potential penalties involved with making gifts and eligibility for the pension program.
VA Pension Program
The Department of Veterans Affairs established the VA pension as a way to help veterans and their families once a person has retired from the military. It provides tax-free, supplemental income through the pension program. Additional benefits through the pension program called "Aid and Attendance Benefits" are also offered to veterans who are unable to perform daily living activities, such as bathing, eating, dressing, and so forth. One of the main purposes of the Aid and Attendance benefits is to help veterans offset the high costs of nursing home care.
The Aid and Attendance benefits are part of a needs-based program, but currently the Department of Veterans Affairs does not have any penalties for veterans who divest their current assets in order to apply for these benefits. The proposed regulations would make a change to this particular area.
New Proposed Regulations
The proposed regulations would establish requirement income limits based on pre-application net worth of the veterans in addition to look at any asset transfers or gifts of assets used to qualify for Aid and Attendance benefits in the VA pension program. Right now, there is no net worth limit on these additional benefits, but the proposed legislation would place a clear net worth limit at $119,220.
This is the current maximum community spouse resource allowance for Medicaid in 2015, and it includes annual income as well as assets. The limit would increase with inflation at the same rate as cost-of-living increases for Social Security beneficiaries. The new regulations would also define how the VA pension plan defines and calculates an asset. Under the new rules, the VA would exempt the primary residence as an asset but only property up to two acres.
Gifts and Transfers
Finally, the new regulations would impose a look back period on gifts or asset transfers before application for Aid and Attendance benefits. The look back period proposed would be three years, or 36 months, and a penalty period of ten years for veterans who dispose of their assets below fair market value in an attempt to qualify for benefits. In addition, transferring assets to a trust or converting the assets into a single annuity would fall under the umbrella of transferring below market value. Gifts of money or assets to family members would also be a punishable offense if it is proven that a veteran did so in order to qualify for additional benefits.
The new rules presuppose that any transfers made within the three year look back period are done to quality for pension benefits, unless clear and convincing evidence proves otherwise. The penalty would be calculated based on the value of the assets transferred during the look back window in the amount over the net worth limit.
Some of the country's tech elite are coming together to use their companies' technology, entrepreneurial spirit, and tech savvy to improve home care for the elderly across America. Big names such as Apple's Ron Johnson, former Senator Bob Kerrey, Yelp CEO Jeremy Stoppleman, Facebook CTO Mike Schroepfer, Paypal founder Max Levchin, actress Jessica Alba and many others are working together to create Honor, a modernized home care program for seniors.
Current Elder Care Issues
The goal of the Honor system is to keep parents in their homes and safe for as long as possible. With the number of Baby Boomers in America reaching retirement age and beyond expected to reach 84 million people by 2050, elder care is quickly becoming a concern for families everywhere. Other options like nursing homes facilities can be costly and unpleasant for everyone involved.
Currently, there are 1.5 million people employed as home care workers. These people help seniors with daily living tasks around the home like getting out of bed, making meals, ensuring that medication is taken, and other daily tasks. They either work as independent contractors or employees for around 50,000 home care companies in the United States. Unfortunately, these workers typically earn minimum wage, work part time, and rely heavily on government assistance. As a result, the turnover for home care workers is high and the quality of care for seniors can be poor.
Implementing the Honor System
One of Honor's directors has come out and said that "it is a really big problem on both sides . . . There is a fundamental challenge of how do we care for a much larger percentage of older people in a way that is as respectful and humane and positive as possible. The other side is the workers. Today, this is not a job where they feel respected . . . There is an opportunity to have it become a more professional job, and a better paying job, a job where people have a lot more respect."
The Honor program is set up as an online marketplace for home care workers and seekers. The workers will be able to list their qualifications, skills, experience, and distances able to travel for work. The seniors or their family members will be able to list the type of services that they require, the hours needed to work, and any specific qualifications that come with the job. The Honor system will then match home care workers and seniors, with the final approval given to the seniors and their families.
In addition, the Honor program will give each senior client a simple, touchscreen pad to use so that they can update their families and care givers about any changes in their needs or condition. That way their loved ones stay informed and their care givers can be prepared when they walk in the door. The device also records what services were provided to the senior and for how long in addition to allowing the senior to rate the quality of care.
The results of Biogen's new experimental drug for Alzheimer's disease has provided the best evidence so far that the memory-robbing condition is caused by a protein in the brain that, if stopped from acting erratically, could lead to an effective treatment for the disease. While German psychiatrist Alois Alzheimer was the first to connect dementia to an abnormal protein deposit in the brain, it has taken until now for scientists to understand where the protein, known as beta amyloid, was made and to see it as a potential target in treating Alzheimer's disease.
Clinical Trials of the New Drug
Prior to the testing of this new drug, no clinical trials had been run that had previously reduced beta amyloid in subjects' brains while also slowing the deterioration in their cognition. Now, the findings on BIIB037, Biogen's medication, show that it's possible. In an early stage trial, 166 participants who took BIIB037 showed reduced beta amyloid in the brain and reduced cognitive decline.
Furthermore, with higher doses and longer treatment, patients in the trial saw even more improvements. Based on the Clinical Dementia Rating, BIIB037 showed a 71% reduction in cognitive decline among patients who took the highest dose, compared with those on placebo. The results of this trial show that "it's a major advance in confirming amyloid beta is the right target."
Other Alzheimer's Drug Testing
Researchers have said that BIIB037 is "a chance that this could be the first registered disease-modifying drug for Alzheimer's disease." As Biogen prepares the drug for late=stage trials of BIIB037 later this year, other drug companies have tried and failed to have success with their own Alzheimer's medications.
Two medications, solanezumab, from Eli Lilly & Co., and bapineuzumab, developed by Pfizer Inc., Johnson & Johnson and Elan Corp., both failed to show a significant effect on the disease in their own trials. Eli Lilly is now retesting their drug in earlier-stage Alzheimer's patients, while bapineuzumab has been scrapped by their group. In addition, Roche Holding AG is sponsoring a drug trial of its own amyloid-targeting drug in Alzheimer's patients with mild dementia. However, in December it abandoned their drug study of people with early stages of the disease because of poor results.
Possible Side Effects of the Drug
Although BIIB037 shows some serious promise in terms of fighting Alzheimer's disease, there is also the potential for serious side effects. Most concerning is brain swelling known as amyloid-related imaging abnormalities, or ARIA. "Among patients carrying the ApoE4 gene, which is strongly linked with Alzheimer's, 55% of patients on the highest dose reported ARIA. That resulted in 35% of the ApoE4 carriers on the highest dose discontinuing treatment." Finally, 22% of patients in the trial who took the drug had headaches, versus only five percent on a placebo.
Researchers have also admitted that even with the promising results of Biogen's drug, Alzheimer's disease should still be approached from multiple angles. "It's not an either/or," said the director of global science initiatives at the Alzheimer's Association. "There needs to be as many of those as possible so we can have a fuller understanding of Alzheimer's."
Two weeks after major surgeries, medical treatments, and life-saving procedures a doctor found his patient's advance directive in his medical chart. Suffering from dementia and unable to communicate, the patient was unable to tell his doctors about the document that stated "he wanted comfort care only, no heroics." This story illustrates one of a number of growing problems that medical professionals have with advance directives.
Advance Directives and Living Wills
Advance directives, which commonly include living wills and advance healthcare proxies, dictate the wishes of a person's future care. A living will is used to communicate which treatments and procedures you would like performed in the case that you are unable to communicate them yourself. It is most commonly known for dictating whether a person wishes to be resuscitated in life threatening situations.
A healthcare proxy is used to appoint a person to make healthcare decisions for you if you become incapacitated. However, if a living will also exists then the healthcare proxy is bound by those terms when making healthcare decisions.
A final form commonly associated with advance directives is a "Physician Orders for Life Sustaining Treatment," or Polst form. This document is filled out by health care professionals alongside their patients and can stipulate that only comfort measures be applied, to perform full life-prolonging intervention, or various options in between.
Increase in Advance Directive Popularity
When Congress passed the Patient Self-Determination Act in 1990, healthcare professionals urged their older patients to fill out advance directives and pass them out to their family members. As a result, the number of Americans over the age of sixty rose by 72% between 2000 and 2010. However, since the introduction of this legislation there have also been issues that have arisen with carrying out a proper advance directive.
Problems with Advance Directives
There are many stories of advance directive documents that have been misplaced, lost, stashed in safe deposit boxes, or filed away in a forgotten drawer. One doctor remembered having a patient who's advance directive was found tucked inside of a Bible. Unfortunately, when the hopes of a patient are not backed up by an advance directive, their wishes are overridden by medical necessity.
Advance directives also fail because they are not medical orders. Vague language and outdated vocabulary do not always give medical professionals enough to know how to proceed. Emergency medical personnel operate under standing orders to attempt resuscitation, whatever an advance directive says. Only a state "do-not-resuscitate" or Polst form can prevent that measure from being taken. "You may already be on a breathing machine before you pull into the E.R."
Finally, patients that use a Polst form instead of other advance directives also come across issues. Implementing this type of document requires a coordinated statewide system involving hospitals, nursing homes and hospices. However, some states like Oregon and West Virginia have instituted developed systems for tracking a Polst form, and forty out of fifty states are well along in their implementation of the system.
While it is important for everyone to plan for their future, it is especially important for a person that has been diagnosed with Alzheimer's or other forms of dementia. The sooner that the planning begins after a diagnosis, the more likely that the person can contribute to the conversation and it becomes the less likely that problems will arise in the future. The Alzheimer's Association has many resources available for seniors that have Alzheimer's or other forms of dementia as well as for their loved ones, including steps to take regarding legal plans for the future.
In most cases, a person who is suffering from dementia is able to understand the meaning and importance of a legal document. As such, they possess the legal capacity to execute the document. So long as the person suffering from Alzheimer's possesses the legal capacity to make decisions regarding their care, they should take part in legal planning.
However, before you have someone suffering from dementia sign a legal document, there are some steps that you should take. First, talk with the person to make sure that they understand the document along with the consequences of signing. Second, ask for medical advice and examination regarding their mental capacity and ability to comprehend the legal proceedings. Finally, take an inventory of existing documents that the person possessed before being diagnosed. It is important to review and update any of those legal documents as necessary.
There are a few basic legal documents that a person suffering from dementia or Alzheimer's needs to have before they lose the ability to make decisions on their own. Again, be sure to check for existing documents that need review, or prepare to create these documents with an attorney.
A living will dictates what medical decisions, treatments, medications, and the like a person would like to receive or deny if they become unable to communicate those choices when the time comes. The living will is carried out by the person named as the healthcare proxy, and it can even include wishes regarding artificial life support.
Power of Attorney
The person named as the power of attorney for someone suffering from dementia makes all financial and legal decisions that are not related to medical care. Typically, this is a spouse, family member, close friend, or attorney. It is important to update this document as life changes occur. This document should be drafted as "durable," which means that they are valid even after a person loses legal capacity.
The healthcare proxy form names a person to make all relevant medical decisions for a person who can no longer make decisions on their own. If a living will exists, the healthcare proxy must make decisions based on what is in that document. These decisions can include choices about a person's physicians, care facilities, types of treatments, and whether or not to resuscitate.
A will is a document that names an executor for an estate and beneficiaries or heirs to the estate for a person suffering from Alzheimer's. This document only takes effect after the person has died and it dictates who will inherit what from the estate.
A guardian or conservator can be appointed from the court to make choices regarding a person's care and property if one has not been decided before the person suffering from dementia loses capacity. This comes into play if the person has no family or if the family cannot agree on the proper course of care. A guardian also ensures that the person's day to day care and needs are met.
At the American Academy of Hospice and Palliative Medicine conference earlier this month, Dr. Perla Macip spoke at a talk entitled "The 30-Day Mortality Rule in Surgery: Does This Number Prolong Unnecessary Suffering in Vulnerable Elderly Patients?" In recent years, a number of doctors and other medical professionals have questioned the thirty day mortality standard as a measure of success, particularly when it comes to elderly patients. Some go as far as argue that the standard of thirty days alive after surgery may undermine appropriate care for seniors.
Example of the Thirty Day Standard
One of Dr. Macip's patients, "Mrs. S." was a 94 year old patient who prior to surgery was fit and still lived in her own home. She consented to a valve replacement surgery and told physicians that her main goal was to return home. During the surgery, Mrs. S. sustained cardiopulmonary arrest and needed resuscitation. A series of complications followed, including an irregular heartbeat, fluid in her lungs, kidney damage, and pneumonia. Then, Mrs. S. had a stroke and was moved in and out of the intensive care unit, off and on a ventilator.
After two weeks in the hospital, Mrs. S. become depressed and stopped eating. Her geriatricians recommended discussing "goals of care" in order to determine whether she wanted to continue such aggressive treatment, but surgeons were optimistic that she would recover. As a result, Mrs. S. was not consulted about palliative care until Day 30, when she was septic and had multiple organ failure. She died the next day, 31 days after surgery.
Thirty Day Mortality Standard
For most surgeons, Mrs. S.'s case would be seen as a success because thirty day mortality is considered the normal standard for surgical quality. Several states require public reporting of thirty day mortality rates after certain surgeries, and even Medicare uses risk-adjusted thirty day mortality measures. However, some experts believe pressures for better thirty day statistics can cause more harm than good, discouraging surgery for patients who could benefit in addition to sentencing others to long stays in hospitals and nursing homes.
At other conferences, doctors have admitted that they could not operate on a person because it would hurt their thirty day mortality statistics. The debate is particularly urgent for seniors and elderly patients who are more likely to undergo surgery and to have complications. Surgeons may decline to operate on high-risk patients because of fears that their deaths could hurt the thirty day results.
Effects on Elderly Patients
Not only may surgeons decline to operate on elderly patients, even if the patient understands the risks, but the thirty day rule has other potential ramifications for seniors. When things go wrong in surgery, surgical teams are more concerned about their thirty day metrics than things like palliative care, hospice, or even try to override advance directives. One doctor admitted that ""Surgeons are reluctant to withdraw life support before 30 days, and less reluctant after 30 days." However, many older patients and their families have different ideas about what is worth sustaining and would rather appreciate an honest discussion before the month passes.
As the elderly population in Tokyo booms, waitlists for nursing homes are becoming exceedingly long. There has been a scramble for free beds in these facilities, and yet the nursing homes in the city are starting to cut back. The problem is an extreme shortage of workers for these homes and impending cuts in government aid.
Growing Problem in Tokyo
In the city's northern Adachi ward, as many as 4,000 elderly residents are on a waitlist to get into a nursing home. There is a nursing home in the ward with thirty percent of their beds available, but no one is allowed to use them because the facility is too short staffed. This problem is not restricted simply to a couple of wards in Tokyo.
Right now, over one quarter of Japan's total population is older than 65, and Tokyo is expected to have the biggest rise in elderly residents of any city in the nation. However, two decades of deflation in the country's economy and rising debt is forcing Japan's legislators to cut budgeting for its nation's nursing homes.
The nursing homes in Tokyo were started by land owners and are run as family businesses. Japan has unique care coverage for its elderly; long-term care is only paid about ten percent out of pocket with the rest subsidized by the government. Unfortunately, facilities that are eligible for aid from the government have prices that cannot be raised. These nursing homes also cannot close down without government approval, even if the facility is losing money.
Less Aid for Homes
The Japanese government is set to reduce reimbursements for long-term care by a little over two percent in April. Japan's cost to care for the elderly is expected to more than double to 19.8 trillion yen ($167 billion) in 2025 from 2012, with the government covering around half. In an effort to retain staff for its homes, the Japan health ministry has said that it will pay an extra 12,000 yen per month per worker for wages and will pay an even higher premium to facilities that hire workers with additional qualifications.
However, the shortage of spots in nursing homes has also put additional pressure on working children to care for their ailing parents. "Many families in cities don't have the capacity to care for the elderly at home," said Masahide Tanaka, chairman of general affairs at the Tokyo Council of Social Welfare. "It will add burden to family members and may lead to a rise in people exiting from the workforce to care for the elderly at home, elderly abuse and neglect."
Studies have shown that about 490,000 Japanese workers quit or changed jobs in order to care for older relatives between 2007 and 2012. By the year 2025, Japan will need 2.5 million caregivers for its elderly and the country's health ministry forecasts that it will be short 300,000 workers by then. Some government officials are hoping that the cuts will force smaller nursing homes to merge and operate more efficiently, and eventually raise salaries to attract workers.
Last year, medical identity theft increased 22% as more U.S. patient health data becomes electronic. While it is easier for doctors and other medical professionals to readily access patient data, the process is also making it easier for cyber criminals to hack into doctors' offices, hospitals, and insurance companies for personal information.
Medical Identity Theft
In 2014, more than 500,000 people were victimized by medical identity theft frauds and hacks. Those who gained access to the data then proceeded to use it for insurance fraud, free medical care, and other health-related illegal activities. According to the Ponemon Institute, resolving each incident of fraud costs around $13,500 in expenses. In almost twenty percent of the cases, the victims found additional or erroneous medical information added to their records by an imposter. Things like positive drug tests and other damaging information cost some victims job opportunities and caused other significant issues.
As healthcare hacking continues, the number of victims of medical identity theft are expected to rise. Already this year, insurance company Anthem, Inc. had their systems hacked and as many as 80 million clients had their medical information stolen. Medical data has become an incredibly popular target for cyber criminals because it will sell ten times as fast on the black market.
Electronic Medical Files
The Ponemon Institute saw an increase in the number of medical identity theft cases after the use of electronic medical records became more commonplace in 2012. In many cases of medical identity theft, a person's medical history and records can be purchased for around $50 to $100. This is usually purchased by a person who does not have medical insurance and needs care. The records almost always include the name, social security number, birthdate, and other important medical information that is needed to get treated by a medical professional.
The bill from the fraudulent care is then sent to the victim's insurance company, and the victim is on the hook for any unpaid expenses, deductibles, or services that were not covered by the insurance. In other cases, the criminals set up a fraudulent company and bill the insurance companies for services that were never provided to the person with the stolen identity.
Cost of Medical Identity Theft
Not only does it cost thousands of dollars per case to settle issues of medical identity theft, but on average it takes around 200 hours to resolve each case. Another issue is that the healthcare industry is less savvy about how to deal with cyber criminals, unlike the financial industry that has been fighting identity thieves for years. "The industry is aware of cyber threats and vulnerabilities but it is a little bit newer to them compared to retail or financial services." As a result, researchers agree that medical identity theft will continue to increase in frequency as well as severity as more companies and medical care facilities place their clients' and patients' medical records in digital form.
According to the Long Term Care Consumer Price Index, the overall costs for long-term care insurance coverage increased 8.6% compared to the costs last year. Researchers found that these costs affected both men and women at varying age levels that are currently paying for or are interested in purchasing long-term care insurance for possibly future needs.
Increased Costs for Long-Term Care Insurance
The American Association for Long-Term Care Insurance group has estimated that a healthy 55 year old man can expect to pay $1,060 per year for $164,000 in long-term care insurance benefits. This amount is fifteen percent higher than the 2014 cost of $925. However, the 2014 figure was a fifteen percent decline from 2013, which means that for healthy middle age men the annual premium has stayed steady between 2013 and 2015.
Women began seeing an increase in their long-term care coverage in 2013 after reports were released that showed that women are more at risk of needing some type of long-term care. For a healthy 55 year old woman, the annual cost of a long-term care policy is $1,390 for the same amount of coverage ($164,000). This is a thirteen percent increase over the 2014 figure of $1,225 per year and has resulted in lawsuits against insurance companies for gender discriminating policies.
Consumers Buying Less Policies
These prices are for new policies that are being issued to seniors or people nearing retirement for long-term care insurance. However, some insurance companies have been increasing the rates on existing policies for years. This is because the companies have been hit particularly hard by low interest rates and higher than expected future claims. One glaring examples of this is the insurer Genworth Financial, that raised its premiums on some policies by as much as fifty percent in 2012.
The higher premiums on long-term care insurance policies mean that seniors are purchasing fewer policies for long-term care coverage and those that do buy policies are paying for less protection. This was backed by an industry-wide survey in July 2014 that found that sales of three year policies increased from 23.6% in 2007 to 35.3% in 2013. For the same time period, sales of five year policies dropped from 18.9% to 13.5%. In addition, the sales of more expensive policies that offer lifetime coverage for long-term care decreased from 5.7% to just 3.6%.
Glaring Price Disparities
For a new policy this year, a married couple that were both sixty years old would pay $2,170 annually for a total of $328,000 in long-term care coverage. Just last year, that number was only $1,980. By adding on inflation to their policy that would garner them $730,000 in coverage by the time that the couple was eighty years old, the couple would pay an additional $1,760 for a total of $3,930.
The price disparity for inflation protection is particularly glaring. Right now, a typical sixty year old man could buy a $200,000 long-term care insurance policy with no inflation protection for about $1,300 a year, but the same policy with five percent inflation protection would cost him almost three times as much, nearly $3,700.
The 2014 MacArthur "Genius Grant" recipient, Ai-Jen Poo, is the co-director of the Caring across Generations Campaign and author of the book, "The Age of Dignity: Preparing for the Elder Boom in a Changing America." While it is common to hear of our aging population as a retirement crisis or the "silver tsunami," Ms. Poo writes that getting older is not a crisis - it is a blessing.
Elder Care Imbalance
Caring across Generations is a nonprofit organization working to transform elder care throughout the country with a mix of nationwide policy advocacy, social media, and other channels. It is spreading the word about the looming crisis in elder care and ways that our country can avoid it.
There are currently 79 million seniors living in America today, and although the Bureau of Labor Statistics has claimed that personal care aides and home health aides are some of the fastest growing professions if the rate of growth does not by 2050, there will be about three times more families in need of elder care providers than workers prepared to do the work. Ms. Poo's suggestion is to create millions of jobs that will support elder care needs. She claims that this can be done by making elder care professional, highly valued, and trained.
Training Care Workers
Ms. Poo claims that training elder care workers can save families and society an enormous amount of time and money. "As people live longer, there are issues about managing chronic illnesses and hospital admissions. Training family and paid caregivers can reduce the costly aspects of our medical delivery system. What better prevention than quality health care? At the front end, training is an investment that creates cost savings and efficiencies in the long term."
One of the biggest problems is that Medicare does not currently pay for custodial care at home or in nursing home facilities. However, seventy percent of seniors over the age of 65 years will need some kind of help with daily living activities before they die. Ms. Poo has stated that Medicare reimbursement structures are not aligned with the current needs of elders today. The program is not thinking about the quality of life, which will affect Medicare in the long run.
In her book, Ms. Poo stated that families have their own responsibility to prepare for their members' future care needs. She encouraged family members to sit down and discuss two major questions: First, what is our family's plan for meeting our future caregiving needs? This includes whether we can afford the care we want. Second, what joys could getting older and caring for one another bring? However, at the same time, it is important to remember that it is unrealistic to expect a family to fully absorb the responsibility of caring for an aging loved one.
For one thing, some families there may be a physical distance issue. Another issue for families dealing with care is the sandwich generation of working-aged adults caring for children and aging parents at the same time. There is also a lot to manage when it comes to care, which is why the profession of geriatric care managers is growing. "In the 21st century reality, it's untenable for many families to go it alone."
In a report released last week by the National Institute on Retirement Security (NIRI), fewer Americans are concerned that they will not have enough money to live on in their retirement. While 86% of Americans agree that the country is in the midst of a retirement crisis, a number that increases to 92% for millennials, more people are taking control of their retirement savings and feeling better about their living expenses once they stop working.
Results of the Report
Every two years, NIRI polls thousands of Americans to see how they feel about their financial security for retirement. They also poll people about their views on government policies and legislation that could help those reaching retirement age. Compared to the results in 2013, the overall percentage of people concerned about their retirement outlook fell from 85% down to 74%. In addition, more people polled expect the money in their pension plans to be there when they retire at 84%, up from 79% in 2013.
The report also showed that Americans view the best option for retirement security to be defined benefit pension plans, even though the option is quickly disappearing from the employment scene. A total of 78% of people polled believe that a loss of pensions makes it harder to be financially secure in retirement, and more than half of those polled now strongly agreed that "those with pensions are more likely to have a secure retirement than those who do not."
Retirement Saving Concerns
One of the biggest worries of those polled for the NIRI report was healthcare costs in retirement. In total, 86% of Baby Boomers cited the rising costs of long-term care as a major factor in making preparation for retirement harder. Coming in second place were salaries not keeping up with wages, with 80% of those polled citing it as a cause of concern. Fewer pensions and longevity were also concerns for the Baby Boomer generation; however, the millennials polled did not cite longevity as a concern.
Policymaking and Retirement Savings
Americans polled also did not see legislators or policymakers helping anytime soon. According to 87% of people polled, the nation's leadership does not understand how difficult it is to prepare for retirement. A significant number of people also feel that policymakers need to do more to help Americans achieve secure retirement savings. However, the report also showed that people are open to alternative ideas. For example, state-sponsored low-risk automatic enrollment retirement plans for those without retirement plans at work was judged a good idea by 71% of those polled, and 75% said that they would consider joining such a plan if it was offered.
One interesting note from the survey comes from the questions on Social Security. When asked, only 42% of respondents replied that it was a good idea to delay taking Social Security, even if it meant tapping savings, in order to get greater benefits from the program. Many people do not seem to understand the massive difference in cash flow that delaying Social Security retirement benefits can make during retirement.
The cost of prescription drugs is one of the biggest issues for seniors in America today. Not only are the prices of these necessary medications skyrocketing, but many insurers try to get out of paying for most or all of the cost. One of the most common excuses given by insurance companies is that the drug is not being used for its prescribed purpose, even if it is treating some other condition. However, for seniors that are stuck paying for expensive prescription drugs on their own, there are some tips that can help lower the cost of your necessary medications.
Buy generic brands
Whenever possible, try to purchase the generic brand of your prescription drugs. Even if your doctor is prescribing the brand name, ask if a generic is available. The generic brands of drugs work just as well as the name brand types, but they cost a mere fraction of the price. In addition, the co-pays on generic medications are typically smaller than for the brand name drugs.
Ask for free samples
Most of your doctors will have samples of the brand name drugs that they prescribe in their office. These samples come from the pharmaceutical companies, and while they may not cover your entire need it can help reduce the amount that you pay for.
Buy larger doses in tablet form
One way to save money on prescription drugs is to ask for a larger dosage in tablet form. If the drug does come in this way, you can pay less for a reduced number of high dosage pills. Then, you can cut the pills into the size that reflects your accurate dosage for each medication. Most drug stores sell inexpensive pill cutters for this very purpose. However, you should check with your doctor beforehand that your particular drugs can be cut.
You can go onto Google or another search engine and type in the name of your drug with "coupon" to see if discounts are available. Discounts can be as high as seventy percent on websites like internetdrugcoupons.com.
Big box stores compete to fill your prescriptions, so you can save money by shopping around for the best price. This is particularly useful if you need an over-the-counter or nonprescription medication.
Consider mail-order pharmacies
The prices from mail-order pharmacies are typically cheaper than filling them the normal way. However, you should thoroughly check out reputation of the company before getting any prescriptions filled. Canadian mail-order pharmacies have been usually very good about filling prescriptions, but mail-order companies from other countries have had issues with sending what is needed.
Call customer service at the pharmaceutical company
Many pharmaceutical companies will send out free samples or offer discounts if you call their customer service. This applies especially for low-income or fixed income individuals who might not have the money to pay for the full cost. Some customer service departments will even appeal to an insurance company on your behalf to cover the cost of the drug.
While some say that it takes a village to raise a child, others are now saying that it takes a crowd to pay for rising medical costs. As more caregivers are expected to pay for their loved one's medical costs out of pocket, they are turning to the internet and crowdfunding websites for help. Certain crowdfunding websites are now dedicated portions of their sites specifically for health care expenses or specific diseases that need treatment.
Crowdfunding, also known as crowdsourcing, uses a page on the internet to talk about the issue at hand and raise money for costs. It relies on friends, family, and strangers alike to donate money to the particular cause. Websites like YouCaring.com, GiveForward.com, GoFundMe.com, and Fundly.com are all examples of websites where people can go online and ask for help.
For example, GiveForward.com has raised over $149 million since its inception in 2008. Most of the money raised on the site has gone towards unexpected medical expenses. Donations have been asked for medical expenses, the cost of funerals, out-of-pocket expenses, and even nursing home care. The organization's co-founder said that "No one should have to go through a difficult illness alone, and giving someone the opportunity to help is a big gift."
How to Ask for Help
The operators of crowdfunding websites have noted that some types of requests garner more response than others. For example, unusual expenses or illnesses tend to get more of a response than generic medical care. Crowdfunding is usually more successful with extraordinary circumstances, and the infinite dragging on of expenses is not something that typically gathers support.
Experts say that building a large network is critical in raising money for senior health care costs through crowdsourcing. Try using emails and other social media websites like Facebook and Twitter to gather support. Having friends and family spread the word helps a lot, too. "Usually, 80 percent of the people who contribute are people you know rather than strangers. The key is getting people with big, active networks involved."
In addition, people do not always donate the first time that you ask. It can take three or four times of asking, and persistence is vital. Having a three or four percent return on your "asks" is considered a good rate for these types of websites. Asking for smaller donations is also a better tactic than asking for large sums of money, and most crowdfunding websites will allow donations to start at as little as one dollar.
Why Crowdfunding Works
High out-of-pocket expenses can quickly deplete a caretaker's financial resources. According to a survey done by the Commonwealth Fund, 87% of people ages 65 and older have at least one chronic illness. In addition, seniors in the United States have much more difficulty paying for their medical expenses than the elderly in other countries.
In a society that is so closely tied to the internet, crowdfunding websites can cast a wide virtual net for help. As Americans shift from communities where everyone helped take care of a sick elder, technology can pull from all areas of the country. As one expert put it, "Technology is breaking down solid walls with virtual windows, and it can virtually recreate the family."