Tuesday, July 18, 2017

Are states getting tougher on driver's license renewals for seniors?

One piece of practical information that older people may need would be the ease of renewal of driver’s licenses.

Many states require in-person renewals and vision tests more often after a particular age.  It is a good idea to have a regular vision examination at intervals more frequent than those required by the BMV rules for your state (or, in particular, any state you would move to). 

Here are three references:  “Claims Journal”,  “GHSA”, and IIHS.

A few states, like North Carolina, have laws that allow DMV to restrict drivers’ licenses based on doctors’ reports or even reports from the public about unsafe driving.

A few states, like Oklahoma and Alabama, have very few or no restrictions on older drivers.  These tend to be states that are more rural, socially conservative, have fewer (really) big cities, and, particularly, more exposed to natural disasters, especially tornadoes.

One question that comes up is driving after recovering fullyfrom a stroke  (or WebMD).  The available literature suggests that this can be done.  Yet I remember reading somewhere, like in Virginia, that there is a minimum waiting period of six months.

Seniors, generally economically and physically better off at the moment, who value their independence often have a practical disincentive against overuse of doctor visits and Medicare, to avoid being caught up in endless appointments and restrictions.  “Them Republicans” seem to know that and want to take political advantage of it.

Friday, July 14, 2017

The "skin in the game" argument for healthcare -- especially for seniors

Here’s an interesting perpective in the Washington Post by Paul Waldman on the “skin in the game” problem with respect to health insurance, link.

Now, I’ve applied the idea of “skin in the game” to a different issue, not just “free speech” but “the privilege of being listened to”.

What I do find in the health area as a senior, is that if you go to the doctor for a minor problem, you may be dragged in to endless appointments and tests, which can be disruptive. They may not be necessary.  Or they may save your life. Yet, as a senior, I know every one of us will "die of something". 

In the past, older people often did live into their 80s and 90s based on pure momentum with little medical care, if they had good enough genetics.  On my father’s side, a grandfather hardly ever saw a doctor until he lay down and died at age 89 after breakfast one Saturday morning on a farm.

In the old days, there was simply less we could do about a lot of things, so massive screenings for things wasn’t attempted.  If you got aggressive colon cancer you had a colostomy and soon died anyway (that’s what happened to a piano teacher). But if colonoscopies had been available then, there was little that could be done.  Likewise, coronary bypass surgery became more common in the 80s, but wasn’t attempted on much older people until the late 90s, as with my mother (I was shocked she was eligible for it).  Chemotherapy for cancer was well established by the mid 70s, but a lot of it wasn’t very effective for a couple more decades. 

Health care costs a lot more now because we can do a lot more to save lives for the people who need it.  But not everyone ever needs it. 

Wednesday, July 12, 2017

NYTimes surveys problems with LGBT retirees, but mixed housing concepts (popular in Minnesota) seem like a way to go to me

Tammy La Gorce has an important research piece on p. 6 of Sunday Business July 9 2017 for LGBT retirees: “Finding a welcoming, affordable place to grow old” with the subtitle “Lesbian, gay, bisexual, and transgender retirees ace numerous housing challenges”, link .

One problem might be qualifying for a standard apartment if not needing the special services.  As I covered June 24, there are special HUD rules for qualifying for subsidized rent in 55+ (or 62+) centers that usually offer extra services, including some meals and social services.  At least one retirement center in northern Virginia has a fully equipped stage theater for plays, often high school or local groups.

Another issue might be that an LGBT retiree might not fit into the social climate of some retirement places (probably more likely to be a problem for men than women).

Some places in New York City appealing to LGBT retirees are said to have long waiting lists.

In Washington DC, the DC Center for the LGBT Community has sponsored activities for retirees and there is some increased interest in the problem with events planned in Arlington by AGLA. A couple years ago, the Arlington library screened an independent film on LGBT retirees.

One observation is that some apartment buildings in some cities (like Minneapolis) have a certain percentage of units set aside for subsidized housing and for retirees.  In Minnesota, when I lived there, it seemed there was more interest in modern high rises having very mixed populations, ranging from U of M graduate students or medical students all the way to retirees and some people with disabilities.  This seemed to be a welcoming environment.

Update: July 15

I'm told personally that LGBT retirees tend to stay "in the closet" in suburban retirement homes.

Saturday, July 08, 2017

People with million dollar nest eggs wind up on Medicaid if they are in nursing homes with dementia long enough

In Massachusetts, a woman retires with $600,000 in savings, inherits a house through a trust, sells it, moves to an apartment, at age 76, in 1998.  In 2016 she dies at 94, after about three years supported by Medicaid in a nursing home.

A New York Times story in Business Day by Ron Lieber Saturday gives a tale of how increased longevity, especially for women, in increasing the likelihood of dementia and how a very comfortable nest egg can disappear.  The link is here.  But all of this follows years of corporate employment culture (until about the time of 9/11) where it had become acceptable and expected to “retire” after 55 with corporate downsizings and mergers (as happened with me).  The narrative also covers the filial piety of her adult children. All of this despite having long term care insurance and lots of retirement pros helping. (Is that the kind of job I was supposed to take?)

This is one reason why Medicaid cuts proposed by the GOP have become controversial.  Medicare doesn’t pay nursing home costs (except for short stays in skilled nursing facilities when you will get better), but Medicaid pays for it when assets are spent down enough – and the rules for giving away assets to adult kids to qualify for Medicaid have understandably gotten much stricter in the past 15 years.

Saturday, June 24, 2017

DC Housing Expo does provide information on how to qualify for subsidized senior housing; could change under Trump in October

Continuing a discussion that I started here April 21, I visited the Washington DC Housing Expo, 9th Annual, this morning at the Convention Center downtown.

I visited an area about senior housing.  I was told that HUD has rules for “Section 8” and for some subsidized senior housing, especially apartments for 55+.  Often they are less expensive than comparable apartments for the general population as a result of subsidy, and typically offer one meal a day, and referrals to other properties for assisted living should that become necessary.

Most properties have a monthly income range, minimum to maximum yearly, for qualification.  Income could include social security (probably before Medicare taxes), pensions, any annuities already set up with financial institutions or life insurance companies, and allow counting of 0.06% per month of provable assets (that would be 0.72% a year), toward qualification.  The typical maximum is around $55000 a year for subsidized housing.

Consultants were concerned about what happens in a GOP Congress and Trump presidency for the FY that starts in October 2017.  But if subsidies were reduced, it’s conceivable that the formula for counting personal assets would become more generous, based on the ideology of more self-sufficiency.

There were some attorneys present.  Generally, the “open market” for apartment buildings does not really have an industry standard for counting a retiree’s personal assets, the way it does for mortgages.  A retiree with substantial cash could find it easier to purchase a property with cash than rent.   But some landlords would be willing to work with pre-arranged savings accounts with automatic withdrawals for rent.

For what look like desirable modern, secure and well-supervised properties, from a very preliminary look, for both rent and purchase, prices look substantially less in places like North Carolina (either Raleigh-Durham or Charlotte), Texas (Austin or DFW), and more upscale midwestern cities like Minneapolis (where rent for a modern property appears to be about 2/3 of what it would be in Washington or close-in suburbs).

Use of personal assets for qualification of retirees seems to be somewhat problematic because it could be spent, could lose value in equity markets, or be challenged if inherited (the “English novel” or “Cousin Rachel” problem).  Landlords prefer to see the ability to earn income dynamically last as long as possible (as population ages) rather than coast on benefits and savings.  Wealth inequality has some subtle downsides indeed.

I’ll get into this more on Wordpress soon.  No, I don't want to live in a tiny house (ladder loft and kitchen).

Update: July 15

I'm told personally that the waiting lists for subsidized 55+ apartments are generally long.

Thursday, June 22, 2017

Senate health care bill: dwindling of Medicaid could lead states to use filial responsibility laws in some nursing home situtions

Criticism of the Senate “Better Care Reconciliation Act of 2017” (Issues blog) includes the likelihood of cuts of Federal support to Medicaid in coming years, which could mean that more seniors who depend on Medicaid for nursing home care would no longer receive it, in many “red” or less generous states.

That could mean a much greater burden on adult children.  “Lookback periods” were strengthened about 12 years ago limiting senior giveaways to qualify for Medicaid for nursing home care.  States having filial responsibility laws might be more likely to go after adult children.  (In more recent years, this has happened only once to my knowledge, in Pennsylvania in May 2012, covered here then).

I’ll put Saraah Kiff’s “VoxCare” analysis of the Senate bill and all the discussion of Medicaid here.   I notice the language "repeal the individual mandate and replace it with nothing."

Monday, June 19, 2017

Retirees in older homes should realizing that old wiring gets dangerous

Retirees who “age in place” a lot of times live in older homes.  And with expanded life spans, even second generations are likely to be of retirement age and living in old homes.

I’m not big on all the review site hype, but Angie’s List does have some good advice on electrical sfatey and preventing electrical fires.

A particular risk can be aluminum wiring, which was sometimes installed in the late 1970s and early 80s and then was discontinued because of safety issues.

Wiring becomes unstable over the years, sockets can wear out (and become hot), major fuse circuits can wear out or be from a group known to  be deficient, and sometimes new appliances (especially some security systems) can require re-wiring.   Here’s the article.