Articles Posted in Uncategorized

In this month’s newsletter, I share with you advice from my colleague Renee N. Duba, a certified financial planner with Sonder Private Wealth Management. Inc. In a recent article about the impact of inflation on purchasing power, authors at Sonder observed that, in 1916, nine cents could buy a quart of milk. Fifty years later, nine cents would buy only a glass of milk. Now, more than 100 years later, nine cents will buy only about 7 tablespoons of milk. That’s a different and yet very vivid way of looking at long-term cost increases, of which we’re all aware. For details on how inflation affects seniors, in particular, I have invited Renee to share with us the following information about retirement and Medicare.

While the United States has not seen skyrocketing prices for basic goods and services for many years, it is important for families to understand how inflation affects long-term financial security. Most adults recognize that rates of inflation for education and healthcare run much higher than the overall rate of inflation in our economy, as measured by the Consumer Price Index (CPI). Yet, while the funding of education for our children is a finite endeavor, funding our healthcare needs is not. Like an old car that has ever-increasing repair needs, our bodily health tends to require ever-increasing health care consumption as we advance in years.

Healthcare costs in the United States are the highest in the developed world. For example, the U.S. pays more for doctors and drugs than in 10 other developed nations. On average, Americans spend $1,443 per person on pharmaceuticals, compared to a global average of $749. As a certified financial planner, I wish to enlighten ADSLA’s readers specifically about Medicare Parts B and D, their long-term impact on your retirement income, and how you can best plan now to achieve financial security during your retirement years.

Being older CAN have its advantages. Among them are these potentially money-saving tips from the IRS, for those of you who have not already done your taxes.

If you and/or your spouse are 65 years old or older, you can get a higher standard deduction amount if you do not itemize your deductions. And if either you or your spouse is blind, you can get an even higher standard deduction amount.

One suggestion I would add about the Standard Deduction for Seniors: If you are unsure which path is better for you, prepare your taxes both ways: Both with itemizing deductions and without itemizing deductions and compare your results. Naturally, you’ll want to choose the path that reduces your tax burden or increases your Refund.

I recently enrolled in the Certified Dementia Communications Specialist program offered by two of my colleagues in the senior living industry, Tami Neumann and Cathy Braxton of the Silver Dawn Training Institute. As a senior housing consultant and Certified Geriatric Care Manager, I am almost always hired by the children of the senior. The senior is usually a Person With Dementia (PWD). The child of the senior often asks me to interact with his or her loved one, particularly if the senior needs to be convinced that it is time to move to a long term care community.

What I found invaluable about the Silver Dawn Institute Program is that it is based upon the basic rules of improv, which are: 1) relinquishing your agenda; 2) making your partner look good; 3) Using “Yes…and”; and 4) the gifts.

I recently used the rules of improv to assist the adult child of a person with dementia. Here is what happened:

I recall having a conversation 5 or more years ago with a colleague who was an Admissions director of a high–end assisted living community.   It was around the time when I observed assisted living communities were going beyond providing “stand-by” assistance with activities of daily living (ADLs = bathing, dressing, toileting, transferring, walking and eating) and providing “hands on” care to residents in need.  Hands on care typically had been handled at the intermediate nursing care level, when a resident needed 24-hour supervision and “hands on” care with ADLs.  My colleague looked across the desk at me and said, “Andrea, the days of skilled nursing as you and I know it are dead.”  I remember that my immediate, gut reaction was, “You are crazy. Nursing homes will never disappear.”

A recent article published in Crain’s Chicago Business (August 21, 2017), titled “Out with nursing homes, in with home health care,” showcased the fact that Northwestern-owned Lake Forest Hospital, located in the affluent suburb of Lake Forest, Illinois, has plans to replace its hospital but will not include plans for building a new long-term care unit.  The reasons cited were that the “Northwestern Medicine may have found the one market where investment in long–term care has not paid off.” A spokesperson from Northwestern’s partner law firm said that “Only the sickest patients end up in nursing homes.  People 65 and up tend to find home health care and assisted living more comfortable.”

Given such trends, nursing homes may start to diminish in a community as wealthy as Lake Forest.  But nursing homes will probably always exist in one form or another.  I have to admit that among the many senior housing placements that I have completed in the past few years, the number of assisted living placements is way up, and the number of nursing home placements has decreased.   I recently reviewed some pricing for assisted living in a northwest suburb that featured help with ostomy or catheter care (a service the assisted living communities wouldn’t touch a few years ago because it was considered a skilled nursing service), hands on service with ADLs, a 2 person assist in transferring, medication assistance including help related to diabetes, chemo or radiation therapy or dialysis, and assistance with a feeding tube.  The price for this kind of care in a studio assisted living apartment is under $6,500 a month.  That pricing is well under the price of nursing home care, which on the lowest end can start at $7,000-$8,000 per month in the Chicago metro area.  So why wouldn’t someone opt for assisted living in the comfort of a private apartment vs. a semi-private room in a nursing home setting?

My father suffered a stroke at the age of 86. He had received diagnoses of Parkinson’s and Alzheimer’s at the age of 84. As the diseases can have similar symptoms, it was very difficult to pinpoint which disease was causing his behaviors. At times he was depressed, moody, lethargic, and verbally abusive.

After the stroke, he required skilled nursing home care.  That prevented my mother from bringing him home. My mother felt an obligation to place him at a nursing home that was owned by the hospital where he had practiced as a physician for many years. That was our first mistake. We assumed that since he practiced at the hospital well into his 80’s that he would have decent care. Much to our family’s dismay, it was quite the opposite.

My story is no different than anyone else’s nursing home nightmare. But at the time, I was not yet in the eldercare industry and didn’t know any better. I didn’t know that checking the ratio of the staff to residents, observing the staff’s attitude, and watching for possible language barriers were critical components in the selection of a community.

An article posted in National Real Estate Investor has predicated that active senior living communities and Continuing Care Retirement Communities will be the most profitable in the future senior housing market.

I was trained in a faith-based, Continuing Care Retirement Community (CCRC) that offered independent living, assisted living, and a nursing home all on one campus.  A CCRC will allow the senior to move between the various levels of care without having to move out of the building or complex, thus saving the senior and his/her family the stress and heartache of having to move a second time.  In the case of a couple, if a husband or wife requires a different level of care, placement at a CCRC will allow them to remain together in the same home.  If a resident needs short term rehabilitation, most of the skilled nursing areas of CCRCs are certified by Medicare.  The necessary rehabilitation programs are offered right there without having to temporarily move to another community.  Therefore, I wasn’t surprised to see the posted article’s author predicating that CCRCs will be one of the most profitable options for senior housing.

REAL LIFE STORY

Many of us, including our loved ones, have terrifying memories of visiting Grandma or Grandpa at a nursing home. We have visions of the residents sitting slumped over in wheel chairs, the dismal aesthetics, unpleasant odors, terrible food, a dying roommate and the ever popular bingo game as the daily activity. These sorts of thoughts, whether exaggerated or fully accurate, will deter a loved one from considering a move to a retirement community.

Yesterday’s nursing homes focused on taking care of the sick. In contrast, the CCRCs of today not only seek to offer lovely aesthetics but also seek to maintain a senior’s independence by offering many a la carte services that allow the senior to stay in his/her independent living apartment. For instance, a senior may be independent for all practical purposes, but might feel more psychologically secure if someone stood by while he or she is taking a shower. These types of a la carte services can help delay a premature move to a higher level of care and allow a senior to remain in his/her own apartment for as long as possible. However, if a senior needs more care in the future, a true CCRC will offer assisted living and skilled nursing to address future health care needs without moving. Thus the senior and his or her family will avoid the trauma of a second move and the loss of friendships the senior has cultivated.

From the financial aspect, many CCRCs have shunned the typical rental arrangement and converted to Life Care Contracts, meaning that if a resident is at some point unable to meet the financial obligations of paying his/her monthly fee, the senior’s care will be subsidized by the rest of the residents. In other words, care is guaranteed “for life.” Here is a brief, oversimplified, explanation as to how it works: