Monday, June 30, 2008

A chat about whether eldercare is a new demographic issue, and how the US compares to other countries


I had another conversation about eldercare and health care with an insurance and law professional today. I thought I would pass on the comment that he believed that health care is “the political issue,” particularly whether the country could ever embrace single payer (which he seemed to support from a political and social perspective). He also had an interesting perspective on the demographics of eldercare.

I said that the longer lifespans and fewer children would create, in a demographic storm, new concerns about filial responsibility, and could even cause us to rethink our whole concept of what generates family responsibility. I said I thought this had exploded in the past ten years. He said really it’s been going on for decades. Eldercare was a big issue in the 50s. What relieved the pressure was Lydnon Johnson’s “Great Society” and the implementation of Medicare in 1965. Before then, adult children had sometimes been pursued for their parents’ medical and nursing home expenses. This became infrequent, relatively speaking, once Medicare was passed. Then the sense of social awareness changed. For perhaps 25-30 years adults did not perceive responsibility for their parents as a high priority in comparison to their own children or themselves. But as lifespans started to lengthen, sometimes with increased frailty (and cognitive problems like Alzheimer’s) the demographics started to get serious, getting the attention of some conservatives. But now it is mainly custodial care that is an issue, not normal medical care, because of Medicare – although even then, seniors without supplementary medical insurance or prescription drug coverage (Part D or a substitute) can get into trouble.

I mentioned that even in Canada and Britain and generally the rest of Europe, nursing home care is not covered by single payer. He said, well it is, for people who don’t have enough money. It comes down to whether the government will pay nursing home care for people who do have some money. Germany and Japan do seem more generous.

Friday, June 20, 2008

RNCentral offers communications tips for caregivers


Jessica Merritt, writing on RNCentral.com, has a posting “50 Communications Tips for Caregivers.” The link is here. The reference was passed to me by email this morning by one of its associates. The list applies both to professional (practical) nurses and to home caregivers and family members.

Some of the tips refer to simplifying the environment, such as eliminating distractions (like television or pets) when talking to the person. Some refer to using body language. Some refer to treating the person as an adult. Other material on this topic, however (such as a PBS film on this reviewed on my TV blog in April – check my profile) suggest that the caregiver be willing to humor the person or talk in his or her own “language.”

The posting pays some attention to short term memory loss, which may occur with Alzheimer’s, natural aging, circulatory system problems, or even as a side effect sometimes of some medications.

These recommendations may be easier for someone who has chosen nursing or caregiving as a career.

Wednesday, June 18, 2008

Getting signed up for Medicare Part D; also, Part B Supplement



Okay, here is how things turn out for me at least. It seems that Medicare starts deducting my Part B Premium the same month that I become eligible for Medicare, which is the first day of the month of my 65th birthday. The premium is now $96.40.

That leaves two other items: prescription drugs, and Part B Supplement.

It turns out, for me, that through AARP and United Heath Care I get a reasonable Part D benefit at age 65 for $33.70 a month, preferred. This will pay for “tier 1” generics by mail with no copay, and “tier 2” for $15 copay. It does not get rid of the notorious “doughnut hole” (topologists call it a coffee cup). This is supposed to be the Part D preferred from United Health Care. The number that I used to get to all of this was 1-888-867-5564. I am an AARP member, but I’m not sure if that was necessary. At this number, I was enrolled in Part D by phone, with the $33.70 to be deducted from social security in addition to the $96.40. It is possible for the deductions to start late, and for social security to have to deduct twice in a subsequent month if missing the first month, but coverage is effective on the first day of the month of that magical birthday.

My employer offered a “replacement” “Retiree RX Plan” for about $240 a month, much more expensive, because it does not take into account the fact that I am starting at 65. One is not allowed to have both Part D and a replacement plan.

The Medicare Supplement is a different animal. This is a separate policy sold by a private insurance company. In my case, it’s still United Health Care, but it can be a (“non profit”) Blue Shield plan. Starting at about age 65, I get the Part A deductible (if there is a hospital stay) and the 20% Part B copay (but not the small deductible) covered as an “option B.” This I have to pay for myself (as with an EFT on a checking account). It cannot be deducted from the Social Security payment because it is not administered by Medicare or Social Security. The AARP Health Care Options enrollment card does read “Medicare Supplement Coverage.”



Medicare does provide a booklet that gives a step-by-step analysis of how the beneficiary proceeds. The most important decision (on p 2) seems to deal with whether to keep Part B (with its copays and Medicare premiums) or replace it with a Medicare Advantage Plan or some other Medicare Health Plan. If the recipient does keep Part B, he or she usually should purchase a Supplement Plan right at age 65.

Wednesday, June 11, 2008

Trusts and estate planning


Living Trust Attorney LTD is a small law firm dedicated to estate planning in Northern Virginia. The firm gives public seminars, typically once a month, on some topics related to estate planning, such as living trusts, endorsements on life insurance policies, and “segregating” instead of “comingling” inheritances.

I had intended to attend last night and did not because of heavy thunderstorms in the area.

The website is called “Trust Bishop” and is here. The website has the interesting tagline “Personal attention is not boilerplate!” One of the major themes of the site is to explain the value of trusts (relative to wills). Trusts may in some cases enable persons to ensure that their wishes will be followed after they are gone. It may cost more money (relative to the size of potential inheritance) to set them up, than do simple wills.

The colloquial term for the enforcement of post-mortem wishes is the “dead hand”. In some cases, recipients of inheritances may be required to fulfill certain behavioral obligations in order to get or keep the money. The general impression I have is that this practice is more common in Britain than in the United States, and it was often a theme in some Victorian novels. A screenwriter and entertainment attorney friend of mine in Los Angeles had discussed the practice with me one time when sharing an unpublished manuscript with me, in which this was a major plot element. It has occurred in a few commercial movies

The visitor may want to explore the content particularly at the “Trust Administration” and “FAQ” buttons on the website.

Tuesday, June 10, 2008

"Details" takes up adult child responsibility for parents in flippant style


Sitting in the barber shop this morning I spotted the Holiday 2007 issue of "Details", with the picture of Jonathan Rhys-Myers on front, and found a nice flippant essay inside (on p. 86) by Kayleen Schaefer, “It’s time to cut your parents off. Mom and Dad are living it up well into their sixties, and guess who will pay for it.” I couldn’t find the archive online, so I’ll just comment on the print version. One does visit the public library sometimes, even in the Internet age, or get a paid print subscription. Magazines still need people to buy them, you know.

The article quotes a financial planner Austin Frye from Aventura, FL, as saying “One of the concerns of the earning male today is that he has two generations to take care of. When he reaches his forties, he’s taking care of his children, and he’s taking care of his folks.”

The comment sounds sexist, but, come on, this is "Details", mind you. (They almost published me in 1998.) The emphasis on the article was that Mom and Dad are likely to be living it up in their sixties when they could have thirties years of medicine-prolonged life ahead of them. If they didn’t provide safely for their own retirements, they could gut the lives of their kids. Suze Orman (women’s financial planning guru who often appears on Oprah) is referred to as saying, cut your parents off if you have to. This sounds like parental financial recklessness from the retiring baby boomers is a well-known problem. The article even accuses some parents of using their adult kids as "ATM machines." Perhaps, although it wasn’t the baby boomers, buy and large, who fell for the subprime mortgages; it was younger working adults. Perhaps the tone and substance of the article overreaches reality; there are plenty of "post-working-class" retired people sliding into poverty (with adult children of varying levels of prosperity) who never had the chance to "live it up."

The article is very flippant, but the implications are dead serious. The text of the article doesn’t mention poor laws or filial responsibility laws, but in 28 states adult children could eventually be held legally responsible for providing for their parents even if their parents behave wastefully. Adult children in their prime career years (whatever the economy, which obviously is challenged right now) have every reason to watch what their parents do and assume they will have to take responsibility for it.

This is, as I’ve noted, particularly troubling for LGBT people. The culture of the gay community a two or three decades ago was one of urban segregation from the “family responsibility” created by others, and “escape” from the gratuitous emotions expected in blood-relation family-centered culture. LGBT people may resent the idea of supporting the marriages of others (even their parents) when they do not experience the same level of support in their own lives. But that sounds like the dimension of the problem that is evolving. Family responsibility now goes in both generational directions and involves much more than taking "responsibility" for the children one "chooses" to sire.

Sunday, June 01, 2008

Should retirement strategy focus more on moderate income workers, and cut back on tax-free matches?


Okay, maybe it isn’t so bad that people retire long before their life expectancies, according to a “Financial Futures” column by Martha M. Hamilton in The Washington Post today, on the Business front page, F1. In a column called “A System that Needs to be Retired: Saving the Savings System,” (link) the writer reports on a plan by Theresa Ghilarducci (“When I’m Sixty-Four” The Plot Against Pensions and the Plan to Save Them”). She would require everyone to save 5% of their incomes in funds that would be professionally managed, up to a max (of about $100000 a year). She would give each person a $600 refundable tax credit and eliminate the pre-tax benefit for 401K contributions and matches by employers. Apparently this plan would supplement social security rather than “privatize” it.

The argument is that such a scheme helps moderate income workers save properly. Current plans emphasizing pre-tax matches by employers for 401K “defined contribution” plans benefit high income professionals and profitable companies. Big surprise, that’s just capitalism! If you make it feasible for people to really “retire” in their 60s, unemployment will be lower.

I’ll say this, I’m 64, just like that baby in the 1982 movie “The World According to Garp” (as in the title of the Ghilarducci book above), and for me, the matching contributions some years ago were a minty lifesaver. When the company froze its defined benefit pensions, it increased the pre-tax 401K match. Of course, you can say, tax policies may be favoring the freezing of pensions just as demographics are.

Ms. Hamilton holds "financial features" discussions at the Post website; the next one appears to be scheduled for June 3 (look up her name on the site for events).