Real Sage Advice

Aging Parent Issues Surface During the Holidays

Minneapolis/St.Paul-Baby boomers visiting aging parents during the holidays may be in for a  shocking surprise, warns Certified Senior Advisor Lisa Dunn.  The pristine house and yard of the past now look shabby and neglected.  Dirty dishes fill the sink and the kitchen table is covered in crumbs. Unopened bills are stacked haphazardly all over the countertops. Mom seems unfocused and Dad is having trouble getting around.  It’s clear that help is needed but what should family members do?

Dunn encourages clients to take advantage of the time when everyone is gathered together to initiate a conversation with parents and family members about “what if” scenarios and health and financial concerns.

Eldercare Link, one of the nation’s leading free eldercare referral services agrees.  CEO Robert Brooks says that historically, the week after Thanksgiving generates more requests from anxious family members than any other week of the year.

The holidays are a good time, the organization says, for family members to be alert for signs that elderly relatives may need help - physical, mental or financial.  The most important thing, they say, is to look for signs of change in mood, health and living conditions.  Checking in with people who visit the relative frequently can indicate whether there have been recent changes. .                                                                                                  

Some signs to look for include:

-Personal hygiene problems

-Home in disarray or needing to be cleaned

-Weight loss or weight gain - check for spoiled food or insufficient food at home

-Failure to manage medications or medical appointments

-Increased difficulty with mobility (such as climbing stairs or using a bathtub)

-Changes in judgment, mood or overall behavior

-Increased forgetfulness-check for unopened mail or unread newspapers

-Missed bill payments or other financial difficulties

-Unusual or extravagant purchases that are out of character

-Decreased social activities or failing to maintain friendships

Experts warn that it isn’t necessary to panic if you recognize a few changes. Some are simply part of the aging process. Slowing down doesn’t automatically mean that your parents are ready move to an assisted living facility or in with you.

This is a good time Dunn says to talk about concerns and ask parents what kind of help they would like. Start researching the options. There are many organizations that can provide expert advice about a range of senior services ranging from home health aides, visiting nurses, Meals on Wheels and Adult Day Care to financial planning and legal issues.

Guilt

I met with a family who was interested in learning more about the best way to help their Mom move into a senior community.  I got a call from the daughter after the consultation and she said "I just feel so bad about pushing my mom into moving." I asked what specifically she felt "bad" about.  She explained she knew it would be hard for her mom to leave her home.  The daughter had been making daily trips to her mother's home to help her with small daily tasks, but it was clear that her mother needed more than the daughter could provide. I said, "Ohhhh, so you're feeling guilty." I  don't know anyone quite more skilled in providing lessons on guilt than our own mothers.  I suspect someday they will find a guilt gene.

Like stress, guilt can be positive and motivate us to do better, but it can also cause unwarranted anxiety and an endless array of sentences that start with "I should have...". 

Here are a few tips on dealing with that guilt:

1. First, ask yourself, have I done what I can reasonably do? In this case, the daughter had done everything she could.
2. If I continue on this current path will it cause harm to me, my elder, or my family? If the daughter had continued her daily trips, knowing her mother needed more care, it would have been her mother's safety and quality of life that would have suffered.  Imagine the guilt the daughter would have felt if her mother would have ended up hurt!
3. Is it reasonable for me to have the expertise in senior housing, long term care insurance, real estate, Medicare or Medicaid to provide assistance to my elder? Unless you're a REALTOR specializing in seniors, an elder law attorney, licensed social worker, the answer is no!
4. List all of your current responsibilities and the people in your life that count on you.  Ask a close friend to look at your list to see if it seems reasonable, or if it seems you are taking on more than most people.  A source of guilt can come from our own unrealistic expectations of what we can accomplish in a day and still pay attention to our own health. The daughter was a 57 year old woman who was working full time, taking care of two teenage children (and their activities), a volunteer, a wife, a sister, and trying to take care of an aging parent.  Talk about a plate that's just too full!

As someone who's grappling with the guilt of moving an elder, ask yourself.  Would I rather feel a little guilty now and know my elder is safe or would I rather wait until some harm comes to my elder because we didn't act.   

MediCARE or MediCAID Who pays for what?

The following post is offered by Toby Mullenger, Family Advisor for A Place for Mom.  Toby has earned a place in my Golden Rolodex for senior professionals to whom  I refer my clients and their families.  Toby's an expert at helping elders and their families navigate the senior housing and health care maze.

Sidebar: Why is a REALTOR including a post about Medicaid and Medicare?  It’s all about ensuring elders have a good financial plan in place BEFORE we liquefy their assets in their home. It’s important to take into considerations such as current health care needs and financial assets.  When a senior makes a move from their home, it’s more than just the sale of a home.  We really need to develop a move plan that takes into consideration the seniors long-term goals.

Ever notice that little deduction on your paycheck for Medicare?  That’s because you are paying into a federal insurance program that is designed to pay for some of your primary medical costs once you turn 65 years of age. 

Medicaid, on the other hand, is administered by your State Government and is based on your needs, both financially and medically.  Though the laws differ somewhat from state-to-state, typically if you are 65 years old, have “spent down” most of your assets, and you require various types of medical attention (such as a hospital visit or nursing home admission) you would be eligible for Medicaid.  Many people will never be eligible for the Medicaid program because of the very low income guidelines established by each state. 

The primary confusion families have when searching for senior housing options is, “which one pays for what?”  Well, often times, neither pays for anything.  Medicare is not designed to pay for long-term care.  In a nursing home for instance, Medicare will only pay for up to 100 days, and that is under very limited circumstances.  By contrast, Medicaid will pay for long-term care but only after you have spent most of your assets and you require a certain level of medical care.  While there are a few states that allow Medicaid to pay for assisted living, most do not.  Your local family advisor with A Place For Mom will be knowledgeable about the current laws and regulations that govern senior housing and healthcare in your area.

Don’t be too hard on yourself if you are not an expert on Medicare and/or Medicaid. Both programs can be very complex and confusing.  The following are some very general differences between the two:

MEDICAID

·         Individual must be over 65, disabled or blind.

·         Financial and medical based health program

·         Individual must meet financial and medical guidelines.

·         Individual state by state differences create a different program in each state.

·         Requires mandatory contribution of all beneficiaries’ income.

·         Pays for long term care.

MEDICARE

·   Generally individual must be over 65 to be eligible.

·   Federal insurance program for seniors.

·   Need to have contributed to Medicare system to be eligible.

·   Co-payment required by beneficiary.

·   Federally controlled, uniform application across the country.

·   Pays for primary hospital, homecare and related medical services deemed necessary. 

Sandwich Generation Unhappy

Last night on the news there was a report that in America the 40 our work week is all but obsolete.  The new work week is 50+ hours per week. An article in USA today reports that women from mid-30's to mid-50's are the least likely to report being happy.  Later marriages, later child-bearing, working more hours, and living longer are contributing to a situation were women in this age bracket are becoming part of a perfect storm.  As many Americans are one crisis away from a bankruptcy, women in this age group are one crisis away from a break-down. When normal day to day functioning feels so out of control, a crisis inevitably would send her into a tail spin. Sandwich generation is a cute name for a very serious situation.  We have 60 year olds taking care of a 92 year old parent and a 16 year old child.  In fact, Minnesota has the largest percentage of non-professional caretakers in the nation, and we all owe them a debt of gratitude.  Without them, we would have even more seniors living unsuccessfully at home.  If even 1% of the caretakers in Minnesota decided to stop caretaking, it would completely overwhelm our health care system.

Here are some statistics from the USA article I referenced above:

CAREGIVING TAKES ITS TOLL Caregivers say their lives have become more difficult in a number of ways: 90% More stress or worry 69% Less time spent with family and friends 51% Now taking more medications 37% Less time spent at work 10% More frequent use of alcohol or prescription drugs

If you know of someone who is being 'sandwiched" by all their responsibilities, encourage them to reach out for help.  The Senior Linkage Line is a great resource that can offer help finding respite for caretakers.  1-800-333-2483

Twin Cities Makes National News

Inman news, a national e-newsletter published an article about the Twin Cities market late yesterday.  Here it is:

Home sales in the Twin Cities, Minn., area were down for the seventh straight month in October, as near-record inventory finally cut into home prices, according to reports from two Twin Cities-area Realtor associations.

Realtors recorded 3,895 sales of existing single-family homes, condominiums and townhouses last month, down 19.6 percent from 4,843 sales in October 2005. During that period, the median home price in the 13-county region slipped from $230,000 to $228,000 -- a 0.9 percent decline.

Some 7,894 new listings were added to the market in October, which is 4 percent below a year ago, marking the second consecutive month of year-over-year declines, after 14 months of record highs, according to the Saint Paul Area Association of Realtors.

Despite the drop in inventory levels, there were still 30,491 active listings at the end of October, which is a 24.3 percent increase from the same time last year.

The Housing Supply Outlook declined slightly to 7.5 months, which means it will take the current inventory of homes 7.5 months to sell through completely. The market is considered balanced when there is roughly a 5-month supply of homes available for purchase.

"Both the slight drop in median sales price and the continual decrease in housing inventory illustrate the market's attempt to correct itself. With the region's strong economy, continued job growth, and continued historically low mortgage interest rates, the market will find its balance soon," said June Wiener, president of the Saint Paul Area Association of Realtors.

For the entire year, the Minneapolis Area Association of Realtors expects median price growth to settle somewhere between 1 and 2 percent, down considerably from the 6 percent to 12 percent growth seen in recent years. The group also said sales will continue their annual winter decline in the coming months until reemerging from hibernation in early 2007.

Statistics for this report were provided by the Saint Paul Area Association of Realtors and the Minneapolis Area Association of Realtors.

Be careful of what you ask for!

I was watching the CBS news this evening with my husband with the intention of catching a special report they were airing titled "Aging in the Shadows".  Because of my health care background and now my experience of working with seniors to transition to senior housing I'm in a position to offer a unique perspective. One, I hope won't go unnoticed.  Tonight NBC was warning viewers of the dangers of unregulated assisted living facilities.  They shared a tragic story of a man who died in an accident at the facility.  Please understand the following comments are not in any way to dismiss the pain due to the loss of a loved one; especially when you believe them to be in a safe place.  My heart goes out to any family in these circumstances.  Unfortunately, these accidents also occur in highly regulated nursing homes. My point?  Regulations will not stop accidental deaths. 

Today assisted living communities in Minnesota enjoy very little regulation.  Let me explain what this means to you as a consumer.  First and foremost it means affordability.  Ask any health care professional what regulations do to the cost of health care. There are entire teams that are responsible for the implementation and ongoing maintenance to ensure facilities are complying with the thousands of regulations they must follow.  Not too long ago a nursing home in Minnesota was given a citation for not properly posting the recipe for toast.  No Kidding.  This is what happens when industries are given broad sweeping regulations.

Secondly, it means you can find a community that has very few services, to communities that offer a full spectrum of medical services. This increases the possibility of finding a community that offers what you require in a price range that meets your budget. If prices are inflated due to increased regulations, I will show you a percentage of the population that will not be able to afford private-pay assisted living, and will instead end up in nursing homes on Medicaid.  This means you and I pay for it.

Third, this flexibility has led to a decrease in nursing home beds.  Ask anyone, this is a good thing.

Fourth, due to the aging baby boomers, health care is on it's toes in a competitive way never before seen.  This increased demand will drive creative solutions in housing and health care options in 10 years that we don't have today.  Over-regulation of this industry will hand-cuff creative solutions and cripple the health care industry.

This flexibility in the industry is the very thing that must give you, as consumers pause.  For this is what makes it dangerous for you to make a decision about what is a proper home for my mother/father/loved-one? Am I equip to assess his/her needs and ask the correct questions of the senior community?  Do I have a good understanding of the point at which a particular community would no longer be safe for my elder? 

I propose a third-party independent assessment of the needs of the patient a pre-requisite to being admitted to a senior assisted living community. These communities are under pressure to lower their vacancy rates. They are a business and they are competitive (which is the very free-market system that keeps the downward pressure on prices) and they cannot be objective about placements. 

I think safety requirements are a good idea, and there's no reason to not look at some broad-safety kinds of requirements (yes, I know. In health care EVERYTHING can be tied to the safety of the patient.  That's what makes regulations by over zealous politicians so dangerous, and expensive to the consumer). Let's put together a consortium of assisted living facilities to build those safety requirements before the politicians do it for us.

My greatest fear is that in two years regulating assisted living communities will become the next big political platform, and no matter which party is elected, it will be our elders who loose.

Savings

Whether you're moving, a senior, or just a Twin Cities resident gearing up for the holifrazzle season where we eat too much, spend too much, and just plain try to do too much I have a little gem I'd like to share.  If you're not familiar with John Ewoldt and the Minneapolis Star and Tribune, you need to be.  He's a columnist the shares the hottest sales around the Twin Cities and I'm proud to say I'm a regular reader.  Hit some of these sales before the holiday races begin and you'll come out ahead!! 

Dementia Test

Friday Fun!  Get out a pen, and answer the following questions. You'll find the answers below.

1. What do you put in a toaster?

2. Say "silk" five times.
Now spell "silk."
What do cows drink?

3. If a red house is made from red bricks
and a blue house is made from blue bricks
and a pink house is made from pink bricks
and a black house is made from black bricks,
what is a green house made from?

4. Twenty years ago, a plane is flying at 20,000 feet over Germany.

If you will recall, Germany at the time was politically divided into West Germany and East Germany.
Anyway...during the flight, TWO of the engines fail.
The pilot, realizing that the last remaining engine is also failing, decides on a crash landing procedure.
Unfortunately that engine fails before he has time and the plane fatally crashes smack in the middle of "No man's land" between East Germany and West Germany.
Where would you bury the survivors?
East Germany! or West Germany or in "No man's land"?

5. If the hour hand on a clock moves 1/60 of a degree every minute then how many degrees will the hour hand move in one hour?

6. Do not use a calculator.
You are driving a bus from London to Miford Haven in Wales.
In London, seventeen people get on the bus.
In Reading, six people get off the bus and nine people get on.
In Swindon, two people get off and four get on. In Cardiff, 11 people get off and 16 people get in.
In Swansea, three people get off and five people get on.
In Carmathen, six people get off and three get on.
You then arrive at Milford Haven.
What was the name of the bus driver?

Answers:

1. Bread.
   If you said "toast"...then give up now and go do something else.
2. Cows drink water.
   If you said "milk", please do not attempt the next question.
   Your brain is obviously over stressed and may even overheat.
3. Greenhouses are made from glass.
   If you said" green bricks,"
   what the devil are you still doing here reading these questions?????
4. You don't...of course...bury survivors.
   If you said ANYTHING else...you are a real dunce and you must NEVER try to rescue anyone from a plane crash.
   Your efforts would not be appreciated.
5. One degree
   If you said "360 degrees" or anything other than "one degree," you are to be congratulated on getting this far,but you turn your pencil in and exit the room.
6. Oh...for crying out loud!
   Don't you remember?
   It was YOU!!

Overcome Seniors' Objections to Moving Part II

One of the objections I often hear from elder clients about moving is: "I own my house. I can’t afford a monthly payment!" It may be a mistake to think that staying put is cheaper on a month-to-month basis than either purchasing a new home or renting. It’s DEFINETELY a mistake to think because there’s no monthly payment, it’s not costing anything to live in the property!

Think about this.  Henry, an 86 year old widow is thinking about moving because his daughter wants him to move. He shares his concerns about having to pay a monthly payment.

Henry owns his home and it’s worth $250,000, What will Henry do with that money once he sells? Presumably he will place it in a low-risk investment vehicle such as a money market account. Henry may earn 4% on those dollars in today’s market. For example, after Henry sells the house for $250,000, he will net about $227,000 after paying commissions, title and closing costs. Henry invests that $227,000 dollars, and there is an earning of $756.00 per month in interest. That’s $756.00 per month that Henry is not receiving because those dollars are tied up in the house. Add that to other expenses of living in the home:

Item	Cost Per Month
Homeowners Insurance	$77.00
Taxes	$208.00
Maintenance (lawn care, snow removal)	$75.00
Mechanical Repairs (A yearly estimate broken down by month)	$100.00
Utilities	$210.00
Lost Equity on $227,000	$756.00
Total Cost to Own	$1426.00

As you can see, although Henry doesn’t pay a monthly mortgage, he has typical homeowner expenses, plus the expense of opportunity lost with that interest money. Henry is not living for free.

Now, let’s say Henry does decide to move and wants to rent an apartment in an independent living community for seniors. In this example the house has been sold, Henry has net $227,000 and is drawing $756.00 interest on that money every month.

Item	Cost per month
Rent	$1500
Property Insurance	$20.00
Utilities	$75
Subtotal	$1595 to rent
Subtract Investment Return	-$756.00
Total to Rent	$839.00

Because Henry is drawing $756.00 per month interest from the proceeds of his old house, his rent is substantially lower. In this example, it is less expensive for Henry to sell his home and rent.

Use these formulas to help seniors you know see how expensive it is to stay put!

Retirement Calculator

So, it's time for you to retire.  You've worked hard, saved and are ready for new pursuits!  How much of your savings can you afford to spend?  Are you destined for 4 star restaurants or Ramen noodles? Check out this Retirement Calculator.

Make sure you read the assumptions this caluclator makes  No guarantee is implied.