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."
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.
Families of China's political elite and senior Communist Party leaders are now fighting for a more unusual cause: the right for their seniors to die with dignity. Failure to take every measure possible to keep these people alive is considered shameful and is often confused with euthanasia in China. As a result, the elite are given every possible treatment to prolong their lives, despite it not being their final wishes.
New Group Efforts
Children and grandchildren of some of China's highest ranking officials have come together to discuss the issue of dying with dignity. Many recall family members that spent their final days strapped to machines and tubes instead of living out that time peacefully at home. The group's goal is to help patients in China say no to certain types of medical interventions and instead seek palliative care.
For the last nine years the group has promoted the use of living wills in China, and recently the group has provided the funds to train medical professionals on how to give end-of-life support to the terminally ill. The group is supported by medical experts, social celebrities, and from the family members of the political elite.
China and Issues with Death
According to an article published by the Asia Pacific Journal of Health Management in 2013, patients in China are encouraged to believe that scientific medicine can cure all diseases. "Some Chinese people do not like saying words like death or dying as they believe it will then happen." Across China, end-of-life discussions are becoming more crucial because over 200 million citizens are currently over the age of sixty. In addition, more than three million new cases of cancer are purported every year.
Ordinary Chinese citizens face a very different issue then the political elite: hospital bills quickly surpass their life savings, forcing them to go home and die in discomfort without professional care. "What we do now is, if you have money we resuscitate and torment you until you die, and if you don't have money you simply wait to die," said the president of the Beijing Living Will Promotion Association. "Neither is right. Both are inhumane, and they can't reflect your dignity."
Developing Death with Dignity
Natural death has not been a choice for many of the country's top political leaders. One leader's child recounted that ""It's a political issue, because my father was a political figure . . . so his life and death were decided by the party." Unfortunately, many Chinese health professionals lack the training to provide pain control and palliative care. The World Health Organization defines palliative care as an approach meant to improve the quality of life for terminally ill patients by treating the pain and using other psychosocial methods; however, it is not meant to either hasten or postpone death.
In China, the Communist Party may pick up the hospital bill after a senior official dies as part of their job benefits. Palliative care has the ability to redistribute resources in the Chinese overburdened healthcare system because spending millions of yuan on one official is money that ordinary people do not have access to.
The federal government announced on Thursday that it was changing the way that it rates nursing homes, adjusting the curve that it uses to measure the quality of the communities to make it more difficult to earn four and five star ratings. Using the new guidelines, officials said that many nursing homes' ratings will likely fall, but the information will not be made public until February 20.
Current Ratings System
Currently, nursing homes are rated on a one to five star scale on the website, Nursing Home Compare a widely used federal website that evaluates more than 15,000 facilities across the country. Unfortunately, the system relies heavily upon unverified information that resulted in notoriously poor nursing homes receiving top marks. Two of the three major criteria used in the current ratings system, staffing levels and quality measure statistics, were self-reported by the nursing homes and not audited by the federal government.
Last October, the government announced that nursing homes would be required to start submitting their staffing levels quarterly through a system that could verify its claims through payroll data. It also announced that it would initiate a nationwide auditing program geared towards checking quality measure statistics.
Changes to the System
Under the new system, the Centers for Medicaid and Medicare Services (CMS) expanded and strengthened its NHC-5 Star Quality Rating System. It did so by reevaluating and introducing the following revisions to the program:
Adding Two Quality Measures
These measures refer to the use of antipsychotic medication in nursing homes. One quality measure focuses on the use of these medications for short-stay residents without diagnoses of schizophrenia, Huntington's disease, or Tourette syndrome. The second quality measure looks at the continued use of these medications for long-term nursing home residents that do not have these conditions.
Raising Performance Expectations
This change broadly raised the standards for nursing homes to achieve a high rating on all publicly reported measures in the Quality Measures category.
Adjusting Staffing Algorithms
This change is focused on more accurately reflecting the staffing levels at the nursing homes. Under the new changes, nursing homes must earn four stars on either the individual registered nurse or the staffing categories to receive four stars in the Overall staffing rating. In addition, a facility cannot have less than a three star rating on any of those criteria.
Expanding Target Surveys
The final change institutes specialized, on-site surveys of nursing homes by the State Survey Agencies. They assess the adequacy of the resident assessments and the accuracy of the information reported to CMS that is used in the quality measures for the ratings system. A pilot study was done in five states in 2014 that will be available to the public on February 23.
Response to the Changes
Federal officials have stated that the purpose for the revisions is to rebalance the ratings by raising the bar for nursing homes to achieve a high score in the quality measures areas. Representatives for the nursing homes have responded that they are worried that the changes will send the wrong message to the consumers. However, officials have contended that the changes would be explained fully on the website and that the public would be cautioned not to draw conclusions just because a nursing home's star rating declined.
An 89 year old man who was charged in the killing of his 86 year old roommate at a Buffalo, New York nursing home facility has died. Chester Rusek, 89, passed away in the Erie County Medical Center, where he was being treated for multiple medical issues. He was charged with manslaughter in the November 2012 killing of his roommate in the assisted care facility, Salvatore Trusello, 86.
The authorities stated that Mr. Rusek used a two pound magnet to beat Mr. Trusello to death as he laid in his bed at the senior living community in Tonawanda. Mr. Trusello survived the initial attack but died one month later due to his injuries. Mr. Rusek told police at the time of the attack that he believed that Mr. Trusello was stealing from him. Mr. Rusek's attorney has stated that once a death certificate is filed, the prosecutors plan to dismiss the charges.
Violence in Nursing Homes
Mr. Rusek and Trusello's incident is not an isolated case of senior violence in nursing homes. In October 2013, two men in the Beacon Rehabilitation and Nursing Center in the Rockaways shared a room and had a disagreement about the curtain divider. It exploded into violence where one resident, Thomas Yarnavick, 66, took a piece of his wheelchair and severely beat his 71 year old roommate. The roommate died a short time later at the hospital.
In another case, a Houston nursing home resident is facing capital murder charges for killing two people in his room at a nursing home. Guillermo Correa, 56, did not get along with his roommates: Antonio Acosta, 77, and Primitivo Lopez, 51. In April 2014, an argument escalated to violence, and Mr. Correa beat his two roommates to death.
Examples go on and on of increasing levels of senior violence in nursing homes. While most nursing home abuse and neglect is focused on the caregivers, oftentimes the residents are the most violent.
Resident to Resident Mistreatment
Studies have been done that focus on the causes, effects, and rates of resident to resident violence in nursing homes. In a presentation by the New York Presbyterian Health Care System, "negative and aggressive physical, sexual, or verbal interactions between long term care residents that would likely be construed as unwelcome by the recipient in a community setting, and that have high potential to cause physical or psychological distress."
One major issue in studying and fixing resident on resident violence is that the information is difficult to gather. Some of the major issues are that the events happen constantly, the rates of cognitive impairment are substantial, and dementia produces false positives and negatives.
Another study of resident to resident violence focused on various triggers that seniors in nursing homes have. The study found that two categories of triggers emerged from the work: active triggers and passive triggers. Active triggers included the actions of other residents that were intrusive, like wandering into another resident's room, taking a resident's belongings, etc. Passive triggers included the internal and external environment of the residents. For example, factors such as boredom, competition for attention and communication difficulties all contributed to passive triggers. The study found that there is still a lot of work to be done in examining and minimizing resident on resident violence in nursing homes.
A number of elderly people create an advance directive that states that they do not wish to have life-saving measures performed in the case of a medical emergency. But now, more seniors are adding a new provision to their advance directives that state that if they develop a certain level or form of dementia or Alzheimer's disease they do not want any type of nutrition or hydration. It has started a quiet debate among medical professionals over whether seniors who develop dementia can use this method to hasten the end of their lives in an advance directive.
Use of an Advance Directive for Dementia
The measure at issue is called "voluntarily stopping eating or drinking," otherwise known as VSED, and it is a common end-of-life strategy for elders dying of a terminal illness. However, only a handful of people have incorporated the strategy into their advance directive as it pertains to dementia and Alzheimer's disease.
The number of elderly suffering from dementia has seen a fairly significant increase in recent years with the Baby Boomer generation reaching the age where dementia can affect them and their parents. As of now, over thirty percent of seniors over the age of 85 are affected by Alzheimer's or another form of dementia. "People in their 50s and 60s frequently say: 'I don't want to be in that situation. I don't want to put my family in that situation and people will increasingly voice those views to others, sometimes in a formal way through advance directives."
Even in states that allow physicians to prescribe lethal amounts of drugs to someone with a terminal disease, the law requires that the patient be mentally competent and able to ingest the drugs themselves. This means that patients with dementia are unable to die with dignity, even though multiple studies have shown that VSED is a comfortable way to die.
Issues with Dementia and Advance Directives
Although experts agree that dementia is a terminal disease, it presents unique obstacles for seniors who wish to choose how they wish to die. Generally, dementia kills slowly over years, and there is no specific point where there is "the plug" to pull. With dementia, there is no life-sustaining treatment that can be withheld.
The main issue with using VSED for patients with dementia is whether it should be allowed for seniors who later do not remember or understand why they wanted to exit in this way. Even medical professionals in support of the method admit that the patients, their families, and their doctors will face a lot of controversy if they try to cut off food and water to a person with dementia.
Moreover, the issue of using VSED with a patient that is suffering from dementia has been untested in court. The Hastings Center Report recently wrote an article where two advocates of the procedure argued that food and water should not be withdrawn until severe dementia has eroded the patient's quality of life and "the self has withered." In addition, several states have strict laws that make it difficult to withdraw food and water, even if it is in an advance directive.
According to a new article published by Financial Planning, "How to Fix LTC Insurance" claims that the best way to make long-term care insurance accessible to more seniors, as well as affordable, is to integrate the use of short-term elimination periods. The Director of Research at the Pinnacle Advisory Group is claiming that the use of this often avoided measure may be the key for more seniors to be able to use long-term care insurance for their medical needs.
Purpose of LTC Insurance
Originally, the purpose of long-term care insurance was to guard against the "high-impact but lower-probability risk of needing long-term care assistance at an advanced age." When this insurance was introduced, the thought was that a small number of seniors would need long-term care, but those who did would face incredibly high medical costs.
However, due to advances in medicine and medical technology, the life expectancy of the elderly has increased dramatically and the chances of needing long-term healthcare are also higher. Researchers estimate that the risk of a person at age sixty needing long-term care in their lifetime is as high as fifty percent, and the chances of a fifty year old woman needing this level of care is as high as 65%.
That being said, research has also suggested that the costs of long-term care may be less than what was originally anticipated. According to the American Association of Long-Term Care Insurance, around 75% of nursing home stays last no longer than three years. What this means is that instead of long-term care being a "high-impact but lower-probability risk" it is actually a "low-impact but higher-probability risk."
Proposed Solution for LTC Insurance
The solution proposed by Financial Planning is to dramatically lengthen the elimination period for long-term care insurance. Right now, around ninety percent of long-term care insurance policies are sold with a 90-day elimination period. This means that the senior pays for the first ninety days of care on his own, and the insurance covers the rest. However, ninety days does not achieve the intended purpose, which is to carve out high-frequency small claims because insurance companies still consider a year or two is a "small" claim whereas a large claim might be five years of care or more.
By lengthening the elimination periods to as much as two or three years, with benefits covering up to five to ten years of care afterward, would make long-term care insurance a much more effective policy. "With an elimination period that high, even the average stay in a nursing home will fall within the deductible period; the actual probability of ever having a material claim against the long-term-care insurance would fall dramatically. That's good, as it means the cost of coverage could fall significantly, while policies could simultaneously have richer benefits (after the elimination period) and do a better job of insuring against extreme events when they occur."
The article admits that it would also force consumers and insurers to rethink other parts of the long-term care equation. For example, policies with a longer elimination period attached would need financial underwriting or "some other process that will reduce the risk that consumers might buy untenably long elimination periods."
Most of the questions surrounding elder care revolve around who will take care of that senior or determining where that senior will reside. However, a more important question that the elderly should be asking is how can they take care of themselves for as long as possible without becoming dependent on the assistance of someone else. The Centers for Disease Control (CDC) and other organizations have put together a list of tips for keeping seniors active and independent longer as they age.
Improve Your Fitness Level
According to the CDC, falls are the leading cause of injury among seniors ages 65 and older. Consequently, falls are also one of the biggest threats to independent living for the elderly. In fact, in 2013 over 2.5 million seniors were treated in emergency rooms for injuries related to falls and 20,000 people died as a result.
Increasing your fitness level as a senior can help to prevent falls and lowers the chances of injury if you do happen to trip. In addition, increasing you level of exercise has other benefits like preventing certain chronic illnesses that could jeopardize your independence, such as diabetes, congestive heart failure, certain cancers, and even Alzheimer's. In fact, some experts have gone as far as saying that regular exercise is the single best thing, physically and emotionally, that an elderly person can do for themselves in their twilight years.
Expand Your Social Connections
A strong social network can also aid in keeping seniors independent longer. It keeps the elderly engaged physically and mentally with others, making them happier overall. Thankfully, with the advent of certain technology and social media websites, expanding your social connections as a senior is easier than ever.
Research has found that elderly people in social isolation is as bad for you as smoking up to fifteen cigarettes per day and can even be worse for a person than being sedentary or obese. In order to stay independent, tend to your current friendships and try to cultivate new ones. Signing up for classes, meeting with neighbors, or joining a club can all help expand social connections.
Arrange for Extra Help
Staying independent longer does not necessarily mean that you have to do everything on your own. If you need some help around the house, yard work completed, or some meals delivered to your home it can all be easily arranged through your children or on the internet. Companies such as TaskRabbit have been created solely to provide seniors with extra help for things like running errands, cleaning the gutters, or shoveling a driveway.
Rethink Your Living Situation
Downsizing your living situation can be one of the best things that a senior can do to stay independent longer. Moving to a place like a condominium where you do not need to take care of yard work and have certain amenities provided for you can help you stay out on your own. Hosted independent living, assisted living communities, or a retirement village are all other options that can still give you a sense of living independently. If you do not want to move from your current home, consider making modifications that will make it easier to get around.
Few people are aware that a nursing home has the power to file for guardianship over its residents. Because guardianship cases are difficult to gain access to or track through the court system the rate at which this occurs is difficult to ascertain. However, research is emerging that shows that this practice is becoming routine for nursing home facilities that have issues with financing the care of their long-term residents.
Nursing Home Guardianship Research
Researchers at Hunter College completed a review of New York state guardianship court data and conducted interviews with seniors that have shown that nursing homes are commonly filing for guardianship over their patients when long-term care costs become an issue. This practice is underscoring the increased power that nursing home facilities have over their residents and their families in regards to the financing of long-term care.
In a random sample of 700 guardianship cases filed in Manhattan alone over the last decade, more than twelve percent were brought by nursing homes to take guardianship over their residents. While some of these cases may have had legitimate purposes such as family feuds, suspected embezzlement, or absence of help to obtain Medicaid coverage, those who know about the guardianship process agree that the majority of these cases were probably used as a means of bill collection.
Why Nursing Homes File for Guardianship
Nursing home facilities primarily use guardianship petitions as a way to collect on unpaid bills or to force the settlement of bill disputes with residents. It is universally agreed upon that this was not the intent of the state legislature when the guardianship statute was enacted in 1993, known as Article 81 of the Mental Hygiene Law, and at least one judge has ruled that the process is an abuse of the law because the nursing homes had brought the petitions solely for the purpose of being paid.
Even if the petition is ultimately unsuccessful, filing for guardianship can force the families of nursing home patients into costly court battles. It is meant as a strategic move to intimidate the families, and as a result most families agree to settle any bill disputes that they have with the facilities in exchange for dropping the guardianship lawsuit.
Purpose of Guardianship
The purpose of a guardianship proceeding is to transfer a person's legal right to make decisions for themselves to another person appointed by the court. The guardianship act is aimed at helping people who are unable to manage their affairs on their own because of incapacity and need the court to intervene on their behalf. In legal terms, a guardian supplants both a power of attorney and a healthcare proxy.
Typically, the guardian is an attorney appointed by the court who is paid with the ward's money. However, nursing homes have made the argument that a representative of their facility should act as guardian because using guardianship to secure payment for long-term care is better than suing their own incapacitated resident who cannot respond to the lawsuit.
The first part of this article explained that there are many programs and benefits available to seniors that live in New York. The second part of the article continues to explain various services that are available to the state's elderly population.
This program provides cash benefits for senior citizens with limited income for essential food, clothing, and shelter items. You can be any age to apply, but people over the age of sixty do not have to meet the program's work requirements. The resource limit for an individual is $2,000 and $3,000 if any household member is ages sixty or older. Employed applicants may be able to disregard some of their earnings and still qualify for the program. There is a sixty month limit on this program, and it applies for the lifetime of the applicant.
Elder Pharmaceutical Insurance Coverage Program (EPIC)
This program is available specifically for New York residents 65 years old or older and covers more than one-half of the cost of most prescription drugs after the Medicare Part D deductible. There is no limit on resources, but the limit on income is $35,000 for an individual ($50,000 for a couple) including Social Security benefits. This program can only be used at EPIC approved pharmacies but it does cover insulin and syringes.
Supplemental Nutrition Assistance Program (SNAP)
This service applies to seniors at any age and provides food stamps that can be used like cash at certain retail food stores. There is no limit on resources for an applicant, but there is a $1,915 limit on income for an individual ($2,585 for a household of two) for a household that has an elderly or disabled member.
Weatherization Assistance Program (WAP)
This service provides eligible families and seniors help by reducing their heating and cooling costs as well as improve their home's safety through energy efficient measures. You can apply at any age, and there is no limit on resources. In terms of income, any household that is at sixty percent or below of the state median income is eligible for the service. Priority is given to senior citizens, families with children, and people with disabilities.
Senior Citizen Rent Increase Exemption (SCRIE)
This program exempts rent-controlled or rent-stabilized housing and hotel tenants from certain rent increases. It is available for seniors ages 62 and older, and there is no limit on resources. For seniors living in New York City, the income limit is $29,000 per year and outside of the city you must check to see if your community has adopted the program. SCRIE covers increases for renewals on leases, maximum base rent increases, fuel, landlord hardship, and major capital improvements.
New York State School Tax Relief Program (STAR)
This program provides an exemption from the school portion of property taxes for owner-occupied primary residences. It applies to all New York residents who own their one, two, or three family homes, condominiums or cooperative apartments, mobile homes, or farms in the state. You can apply at any age, and there is no limit on resources. The annual household income must be less than $500,000 and for senior citizens STAR exempts the first $30,000 of the primary home from school property taxes.
As an elderly resident of New York state, age sixty years or older, you have access to many programs, benefits, and community services that you might not be aware of. Different benefits throughout the state have varying requirements regarding age, finances, and other rules regarding eligibility. This article, and the local chapter of the state's Office for Aging, is here to provide you with the information that you need to take advantage of the services that are available in the state for you.
It is important to remember that when discussing these programs, the term "resources" refers to the assets or property that you own. This includes cash, bank accounts, investments, and valuables but not a home, car, income-producing property, or personal property. In addition, "income" refers to earned and unearned income for work performed, social security benefits, pensions, retirement account withdrawals, and valuable gifts.
Social security is income for insured workers, spouses, former spouses, children, grandchildren, and surviving parents. You can become eligible at any age for Social Security benefits if you are a disabled worker or a spouse caring for a retired, disabled or deceased worker's child or adult disabled child. At fifty, a worker's surviving disabled spouse may apply, at sixty, a worker's surviving spouse may apply, and at 62, a retired worker, retired spouse, and a worker's surviving dependent parents may apply for the program.
In addition, divorced spouses can receive benefits if they were married for at least ten years. There is also no limit on resources or income for this benefit program, and beneficiaries who have reached retirement age but continue to work will still receive full benefits.
This Medicaid program helps seniors pay for certain health care costs. To apply, you must be 65 years old or older to avoid incurring penalties. You may apply before you are 65 years old without penalties if you are disabled and have been receiving Social Security disability payments for two years. The program is split into four parts (Part A - D) and certain resource and income limits apply to specific parts; however, there is no limit for overall application to the program.
There is no limit on resources or income for the basic Medicare program. However, for extra help an applicant must show that they have less than $13,440 in resources ($26,860 for a couple). In order to apply for a low income subsidy, an individual must make $1,396.25 per month maximum ($1,891.25 for a couple).
This program offers a full range of health care services and benefits, including many options that are not provided by Medicare. It includes home care, unlimited nursing home care, prescription drugs, dentistry, eyeglasses, hearing aids, and more. You can apply at any age but must be disabled or blind if you are under the age of 65.
Resources are limited at $14,550 for an individual and $21,550 for a couple. Exceptions for resources include $1,500 for a burial, a home, and certain personal effects. The income limits for Medicaid are $808 per month for an individual and $1,192 for a couple. There are ways to spend down on resources and income in order to qualify for Medicaid, but you should speak to an elder law attorney about your options.
The Diabetes Prevention Program is a new system that is aimed at helping the elderly who are at risk to suffer from Type 2 diabetes help keep track of their weight and manage any pre-symptoms of the disease. Known as a "lifestyle modification program," this simple system is showing amazing results for its participants and has the potential to help millions of seniors across the country.
Diabetes Prevention Program
The Centers for Disease Control (CDC) began to roll out a national Diabetes Prevention Program in 2012. Now, 527 organizations around the country that includes healthcare providers, community groups, colleges, churches, and employers offer this program in every state, often in multiple sites. The newest development in the program is an experimental online version, and it may be the largest national health effort that no one has ever heard of.
The results for the participants in the Diabetes Prevention Program have been impressive. A large clinical trial in 2002 showed that this type of program and the resulting weight loss reduced the incidences of diabetes by 58% in 1,000 participants in the trial compared to those who did not. For people over the age of sixty, that number rose to 71%.
The CDC estimates that in its first two years nearly 50,000 Americans have enrolled in one of its diabetes prevention programs. They are aimed at people who have blood glucose levels, weight, or other factors that suggest that they may have an increased risk of developing diabetes. Not intended as a diet or as a fad, this prevention program is aimed at helping people lose weight, adopt new habits, and look at eating healthy and exercising as a new way of life.
How the Program Works
Participants in the program meet once per week in a room at a local YMCA, church, or other common site. They step on a scale and show the program leader their logs where they record what they have eaten for the past week in addition to the amount of exercise that they have gotten. Then, the participants sit around a table and discuss what worked for them and what did not over the previous week. It gives the participants a chance to get suggestions in addition to offering advice to others.
Most participants of the program are in their fifties and sixties; however, it is not uncommon to see someone in their eighties taking part. The curriculum involves sixteen weekly sessions and monthly follow-ups for a year. The goal of these programs, in addition to an hour and a half of exercise per week, is significant weight loss. At a four percent reduction in body weight, there is a reduced chance of diabetes. This program aims to get participants down between five and seven percent.
Why This Program Works
Experts believe that this prevention program is working for a variety of reasons. For one, seniors tend to be more engaged in these types of programs. They realize the direct effects that a prevention program like this one can have. Another reason is that many seniors see the effects of diabetes in their friends and loved ones. Almost ten percent of the U.S. population has Type 2 diabetes, and for people over the age of 65, over one-quarter of the population has the disease. With 86 million Americans that are pre-diabetic, the need for diabetes prevention programs will continue to grow.
According to researchers at Georgetown University and Penn State University, over seventy percent of seniors in America over the age of 65 will need some type of long-term care in their lifetime, either at an assisted living facility or nursing home. However, according to a new study only a fraction of those people should be purchasing long-term care insurance, and the authors boldly claim that "individuals should not buy insurance." So how should an elder decide if long-term health insurance is the right course of action?
Long-Term Care Insurance Study
According to the study published by Boston College's Center for Retirement Research, only nineteen percent of men and 31% of women should purchase long-term care insurance. The reasons for this bold statement come from a variety of factors. In addressing the discrepancy between men and women, females are statistically likely to live longer so they are also more likely to need to purchase the insurance.
In addition, relatively few people incur enough wealth in their lifetimes that the catastrophic financial burden of long-term care would have such an effect as to need protection from it. Moreover, because of the structure of Medicare and Medicaid most seniors can rely on those government-sponsored programs for the majority of their long-term care.
In order to quantify the odds of needing long-term care insurance, the researchers used government data to calculate the monthly probability of people over the age of 65 transitioning among various stages of health. This regression showed that 44% of men and 58% of women will eventually need some type of nursing home care. However, most of those stays were only short spells. Men spend on average only a year in a nursing home and women on average stay for a year and four months.
Because many short-term stays in nursing home facilities are covered by Medicare - those that last 100 days or less following a hospital stay of three days or more - half of all men and forty percent of women fall into the window where Medicare pays their costs. If a stay lasts longer, Medicaid pays for those who run out of money.
Who Should Buy Coverage?
According to the Boston College study, seniors with significant assets should most seriously consider purchasing long-term care insurance. If a couple's assets exceed a couple hundred thousand dollars or more they should look into purchasing a policy. Specifically, the target market for long-term care insurance is people who have a sizeable amount of household financial assets and would be unlikely to qualify for Medicaid, but who have little enough that long-term care would be catastrophic to their finances.
It is important to note that this study only looked at the numbers for single individuals, who make up over 75% of nursing home residents. And while nineteen percent of men and 31% of women can benefit from the purchase of this type of coverage, only thirteen percent of seniors in America over the age of 65 have bought a policy.
With the number of elderly people in the United States growing at a fast rate, it is becoming common knowledge that most seniors wish to stay out of nursing homes and similar facilities as long as possible. In addition, research has shown that seniors who stay in their own homes or communities tend to stay the healthiest, physically and mentally, longer on average than those who do not. As a result, one of the hottest new trends in real estate is having the added amenity of an in-law apartment.
For domestic and foreign buyers alike, a growing trend in real estate amenities is to have an in-law unit - an apartment carved out of an existing home or a separate dwelling built on the property meant specifically for aging parents and in-laws. The benefit is tri-fold: the adult children get the peace of mind of having their parents nearby, the elderly parents get to remain out of nursing home facilities, and the extra accommodations are adding value to the property.
Otherwise known as accessory dwelling units, in an analysis of real-estate listings the units with in-law apartments were priced on average around sixty percent higher than similar properties without them. The analysis covered all new listings that occurred in major cities over the last four years. Putting aside the jokes about living with an in-law, in 2012 a survey of 550 homeowners with one or more living parents a total of 32% of respondents stated that they expected to have an aging parent live with them in the future.
Until recently, many homeowners were not allowed to build in-law units on their properties because of local regulations that made them illegal or too complex to build. However, efforts by lobbyists for the AARP and other elder organizations have resulted in loosened regulations in many states.
Responding to the Need
Architects and home builders have responded by creating a variety of options for in-law units. One option is a stand-alone unit that is built on the property. Another option builds a unit onto an existing home, and some are attached to the main home but have their own separate entrance. Community developers are now focusing on building neighborhoods that have large single-family homes in additional to smaller residences that are designed for empty-nesters and aging parents.
Adult children and their parents have gone about implementing an in-law unit in a few different ways. Some elderly parents pay for the renovation or construction themselves, while some adult children that can afford it will pay for it themselves. In addition, some parents pay rent to live in the in-law unit while other parents do not.
Dealing with the Transition
Many adult children and senior parents that have made the move to in-law apartments have found that there is a transition period, but having family that close makes it easier. One of the biggest issues is downsizing furniture and possessions from a larger home into a smaller space. Another issue for some is dealing with the health problems of some parents. Many children are unaware of the effort it takes to keep up with the health demands of the elderly. Still, most families that have utilized the in-law apartments agree that the benefits of having family close by far outweigh any issues that come with aging.
For many seniors around the country who still live at home, the biggest challenge in keeping from going hungry is not having the money to buy food or being able to prepare it, but being able to chew. The first of its kind, a pilot program is aimed at researching and helping fix seniors' oral health. Being called "eye-opening," the program is offering firsthand knowledge of what experts had only guessed at being elderly dental concerns.
Oral Health Study
The nonprofit food delivery service Citymeals-on-Wheels joined with the Columbia University College of Dental Medicine to conduct the study on seniors' oral health. The pilot program has been funded by a $50,000 grant from the National Institutes of Health, and it involves both phone interviews in addition to dental house calls for low-income seniors. Many of the participants in the study have not seen a dentist in years, and some in decades.
Before this study, very few researchers focused on the dental health of homebound seniors, and the majority of dental research has been primarily focused on the needs of children. However, in the first phase of their study, the program found that over forty percent of the 300 participants interviewed said that they had difficulty eating and researchers believe that the actual number may be even higher.
How the Program Works
The program begins with the phone interview, which is meant to elicit basic information like what a participant can or cannot eat. This in turn informs the researchers about possible issues with nutrition and dental health. For example, a participant who says that they cannot chew meat may have a protein deficiency. The researchers also asked participants if they modify their food to make it more edible because pureeing foods can dilute the nutrition.
The home visits then allow for both a dental examination of the homebound senior in addition to direct observation of their specific challenges regarding oral care and mobility. This not only allows researchers to pinpoint the root of some hunger problems, but it also allows them to make referrals for treatment to the seniors as needed.
Highlighting Problems in Elderly Oral Care
The research being performed by the pilot program is also serving to highlight the multiple challenges that the elderly face when getting oral care. Many are unable to leave their homes without the help of others. Once out of the house, many still need help driving or getting to some form of public transportation to see a dentist for their oral needs.
Another huge barrier to elderly oral care is the accessibility of insurance. A lot of seniors lose dental coverage after they retire, and routine geriatric dental care like cleanings, fillings, and dentures are not covered well by Medicare and Medicaid, if covered at all. But even home dental care cannot be taken for granted. A lot of homebound seniors have issues with grip strength, making things like holding a toothbrush or opening bottle of toothpaste difficult.
There are also many misconceptions that seniors have regarding dental care. The researchers are using the home visits as a chance to educate seniors about their oral health and dental care. The final step in this pilot program will be to see whether the interviews and home visits had an effect, and if the seniors that participated in the program see an increase in their dental health and nutrition.
As people age and children leave the house, many parents entering retirement age use the opportunity to downsize their home and belongings. Rather than downsizing all at once, a growing trend among seniors is to do so in steps over a period of years. In earlier generations, the elderly usually downsized all at once and only once. Now, an overwhelming number of older people are taking a more gradual approach to downsizing, choosing to reduce a house or career but not doing so all at once.
Trends in Downsizing
Rather than selling the house and moving to a warmer climate, many downsizing elders are opting to stay in the same neighborhood or at least the same town. A survey by the AARP's Public Policy Institute found that 87% of those age 65 years old and older, and 71% of those ages 50 to 64, preferred to stay close to their longtime neighborhoods instead of making the traditional choice of packing up and moving to a resort area or assisted living facility.
As the elderly are living longer, healthier, and more productive as they age the opportunity to retire and downsize multiple times increases. In addition, there are signs that the more gradual approach involving many moves is becoming established behavior.
Reasons for Multi-Step Downsizing
Researchers have said that multi-step retirement may be more common for the Baby Boomer generation for a variety of factors. First, there are more two-earner families doing significant work. More women hold jobs that they find aspirational, thus delaying a final major downsizing or making smaller steps in downsizing.
Another reason is for multiple step downsizing is that as seniors live longer, they feel the need to continue to work in some capacity in order to have enough money. Many seniors retire, rethink their finances, downsize, go back to work, and then retire again. On the other hand, some seniors feel their mortality and just jump on something for a while before really downsizing.
Examples of Downsizing
One couple who had just retired thought that they should prepare for the future by moving from their large family home into something smaller, a few miles away from their original home. After a couple of decades, the couple decided to downsize again into a retirement facility with the amenities and help that they need.
Another couple cut back their working hours once at retirement age and took an exciting opportunity to work abroad. Upon returning, they moved into a smaller home that was also less expensive. After a few years of not working, the couple decided to go back and take part-time jobs. A few more years later the couple decided to retire for good.
A third couple had already taken some smaller steps to retire when the husband had a triple bypass surgery. Since then, the couple has traveled around the country in a recreational vehicle for six months at a time and alternating six months at home. They travel around the area of their campgrounds and are trying to see a baseball game at every major league park.