Saturday, July 31, 2010

Debt crisis mathematical projections could stimulate talk of means testing for seniors

The Saturday July 31 Washington Post has an editorial that appears to me to have serious implications for the “means testing” debate (Boehner's proposals, discussed here earlier) regarding future entitlement reform, especially for Social Security and Medicare. The print title (p. A14) is “Dangerous curve ahead: The more we delay, the harder it will be to avoid a debt crisis”, with online title “CBO’s deficit forecast shows the need for early action”. The link is here and there is a secondary link to a graph “Federal debt as a percentage of gross domestic product” with a matterhorn-like (“Paramount mountain”) slope at the end. It looks like a great illustration for SOL algebra tests!

Rescinding Bush tax cuts for the wealthy and allowing alternative minimum taxes to continue only go so far. CNN has discussed the possibility that Bush tax cuts from 2001-2003 for everyone could expire soon (at the end of 2010). Obama has said that families making less than $250000 a year would not see increases. Per child tax credits could drop. Estate taxes (as noted here in May) could come back.

Wednesday, July 28, 2010

Less reputable employers raid 401(k)'s; so do some collection agencies

AOL’ s Walletpop is reporting that some smaller, less stable employers have been raiding their associates’ 401(k) plans, with over 1500 cases known every year. The story is titled “Is your boss stealing from your retirement account?” link here. The article recommends making the effort to monitor your 401(k) account carefully, which may take some initiative and effort. The AOL link is here.

Another site with information is the Investor Protection Trust, link here. Some less stable employers have reportedly held up deposits to 401(k) accounts to pay other bills, an illegal practice. .

There is a YouTube video about a collection agency “stealing” a 401(k) account as well as bank accounts (in a case where a collection agency has “bought” a debt).

Tuesday, July 27, 2010

"Villages" will help people "age in place"

On Monday, July 26, USA Today ran a story (by Haya El Nasser) “’Villages’ let elderly grow old at home: neighborhood networks provide services, support, peace of mind”, on page 3A, with link here

In a number of urban and suburban communities in several states (Colorado, Nebraska, Massachusetts), people have formed “villages” to which residents pay a membership fee from $25 to $600 a year, to receive some in-home services from volunteers and sometimes paid staff.

Julie Maggioncalda, a University of Pennsylvania geriatric social worker intern with the Capital Village in Washington DC, commented on the demographics, and said “we simply don’t have enough space, and if we don’t have a village, the burden will fall on families.”

Strategically, public policy could encourage the housing industry to develop even more “step down” communities where seniors without extended families enter independent living in a modern, secure apartment or condominium, and then have services available later to purchase if they need them. In Sunbelt cities where seniors often move, unsold condos (from the housing bust) could sometimes be converted into such communities, and would probably then sell. Why isn’t that a “win-win”? Sounds like an idea for Donald Trump!

Monday, July 26, 2010

ABC demonstrates defibrillator use for everyone

This morning, Monday, July 26, ABC Good Morning America with Dr. Richard Besser, in the “How to save a life” series, demonstrated the use of a defibrillator for sudden cardiac arrest. Defibrillators have become commonplace in public places like shopping malls, airline terminals and even public schools.




MSNBC has a similar story from July 19 here.

Zoll has a site of Automatic External Defibrillator Training here (with many videos requiring Real Player, Media Player or QuickTime) and emphasizes that chest-compression CPR may be necessary even after the defibrillator works. The Pilot episode of “Smallville” in 2001 had the young Clark demonstrating CPR as it was taught then (on Lex), but recommendations may have changed since then.

One of my screenplays, “The Sub”, has an early sequence where a student saves a substitute teacher’s life with an AED. Although my website caused a considerable ruckus for other reasons, the Fairfax County School System the following year placed AED’s in schools and posted a training video where a male teen student was the “subject”.

In elderly people, anecdotally, sudden cardiac arrest may be more common in men than women, possibly because men do not seek treatment as soon for coronary artery disease, or possibly because of physiology, which seems to protect some elderly women from sudden death.

For patients with DNR orders, however, defibrillator use may not be appropriate.

Wikipedia attribution link for AED picture.

Friday, July 23, 2010

Boehner's "Modest Proposal" on Social Security and Medicare (means testing?)

On July 14, I wrote her about Ohio congressman Boehner’s idea to means test social security benefits, and that to me leads logically to another question about Medicare. Indeed, we have a Modest Proposal, or maybe an immodest one.

For the very wealthy, one could suggest means testing Medicare, too (although I don’t think any European country does this), almost the way we do Medicaid (with the look-back-period laws).

But you could also look at estates and recoup a deceased person’s costs, according to some kind of formula with floors and rates, perhaps something built in not to penalize longevity too much.

But I don’t think European countries do that either. But logically, once you start means testing, you get into the “to each according to his needs” mentality.

I still remember the rants of the radical Left in the early 1970s (as with the People’s Party of New Jersey, for example) railing against “inherited wealth”.

Tuesday, July 20, 2010

Federal court restricts financial planners from setting up high fee "retail" 401(k) plans

AOL this morning (July 20) gave a reference to a Daily Finance story about a federal court opinion in California on Tibble v. Edison International (CV 07-5359), sharply certainly the capacity of investment companies from steering 401(k) participants into “retail class” investment funds rather than “institutional class” which offer much lower fees but which in the past have often demanded higher minimums. The link is here.

Employers should be sensitive to this decision in helping set up 401(k) plans.

I found a PDF for the complaint here (at Spencer Fane).

Monday, July 19, 2010

High-end senior communities with "buy-in" usually presume seniors will live there independently before needing assisted living

On July 1 2010 here, I discussed the concept that some senior facilities have rather significant entrance fees, which are partially refundable as the senior lives there for a long time.

The general concept of these upscale facilities is that the senior (more often than not a widowed female) lives in the modern, urban or suburban, high rise or planned community residence (typically in a one or two bedroom apartment if affordable) in a regular “independent living” arrangement, and then can move immediately to assisted living or to nursing care in the same or associated facility if the need arises. Such properties sometimes offer assisted living to non residents without entrance fees, but current residents get first service, and often assisted living units are not available for the “outside”. These properties tend to be very large, and often have origins in faith-based groups and sometimes are run technically as not-for-profit. However one feels about religious denominations, many have been pro-active in building senior residences in a private but non-profit market. Generally one does not need to belong to a particular church to enter a residence, however.

Other variations on this concept is that independent-living units are sold as condos rather than rented with entrance fees. This is sometimes possible even with non-profit groups.

Seniors typically need considerable cash (or investments easily converted to cash, or an easily sold home) to enter.

This kind of arrangement should be distinguished from lower-cost “independent senior apartments offered in many states, where there are income ranges allowed (mostly based on typical social security and pension combinations), but no direct opportunity to find assisted living. These typically are more likely to be found away from major cities and be garden-style complexes.

The opportunity to move into a high-end independent living facility can be particularly useful to seniors is families with fewer children or grandchildren able or inclined to become directly involved in caregiving. The senior has adapted to a community-oriented (rather than single family home) lifestyle before needing more help, and the adult children remain more independent (or the extended family) and take care of themselves, since, while more money has been spent, help is provided in an efficient manner in the community. Emotional, psychological and ethical controversy surrounding notions about the extended family unit go away. But of course the senior needs to have the money in the first place, a proposition that becomes more difficult in these sorts of economic times. That makes lifelong financial planning even more critical.

Some high-end facilities are reported to offer the ability to turn over the deed to a house in lieu of or as part of entrance fee, which could mean that adult children living there would have to leave or pay rent.

One term used for such communities is CCRC, Continuing Care Retirement Community.

Picture: Goodwin House, Falls Church, VA

Sunday, July 18, 2010

Virginia pastor invents portable care hut as alternative to nursing homes

There is a new innovation in senior housing, the “Med Cottage”. This consists of a small dwelling unit constructed on property adjacent to a home with medical monitoring equipment to house someone in need of nursing care and keep the person close to family members. The main website is here.

This is the innovation of pastor Kenneth Dupin in Salem Virginia, and was reported by Fredrick Kunkle in the Washington Post on May 9, 2010, as for example here.

The idea is controversial with zoning in some communities. The portable unit can be constructed and placed for about $70000 or rented for about $2000 a month.

The idea works for families that already have a home and some cohesion and nearby presence. It is possible to hire outside companies to monitor the patient remotely.

It was also reported on p 6 of the July-August 2010 AARP Bulletin.

Update:

The Washington Post reported on July 21 on p A18 in a story by Frederick Kunkle about N2Care's housing units, "First MED Cottage jumps from blueprint into back yard; Va. company debuts prototype dwelling for sick or older relatives", sometimes derisively called "granny pods", link here.

Friday, July 16, 2010

Supreme Court not willing to help in disputes where companies cut pensions to workers with discontinuous service

Back in April, 2010 the Supreme Court, in a case Conkright v. Frommert  (link)  determined that judges must defer to calculations made by plan administrators, even if administrators may have erred in making calculations.

There is a case where a Xerox employee had been shown a worksheet predicting a pension of about $2480 a month, but had been warned it could be inaccurate if his service had not been continuous. He had been laid off a short time in the late 1980s during the Reagan-era takeover and merger mania. As a result, the resulting pension, when actually delivered, had been only a little more than $5 a month!

The AARP Bulletin had a story May 3, 2010 by Holly Yeager, “Supreme Challenge to Pension Payouts: The High Court sides with companies over workers and retirees”, link here.

Thursday, July 15, 2010

New research on diagnosing Alzheimers published, hightening privacy concerns

Medical researchers at the Alzheimer's Association International Conference on Alzheimer's Disease 2010 (AAICAD 2010) are presenting reports based on the collaborative work of the National Institute of Aging and of the Alzheimer’s Association in Hawaii this week.

Included are changes in diagnostic criteria (originally defined back in 1984) able to diagnose precursors to Alzheimers in early stages, as well as genetic information related to the appearance of Alzheimer’s at various ages, especially after age 65.

Concerns exists that genetic or other imaging tests could be used to deny health insurance or particularly long term care insurance. Provisions in the recent health care reform law urged by the Obama administration may not completely address long term care concerns. The information could also be misused for employment discrimination.

Families could use the information in anticipating the likelihood for the need for future care, as to the effect on adult children or on plans to remain at home or possibly to downsize and live in retirement communities where help is more readily available if needed.

The link for the story is here.

Update: July 17

The New York Times, in the series "The Vanishing Mind" has a story by Gina Kolata "Drug Trials Test Bold Plan to Slow Alzheimer’s", link here.

Wednesday, July 14, 2010

Ohio Congressman Boehner wants to eliminate social security benefits for the "unneedy" (or undeserving) to pay for "The War"

A website called “Campaign for America’s Future” notes a proposal by Rep. John Boehner, R-Oh, 8th, to raise the retirement age to 70 and limit social security benefits to those who need them. It wasn’t clear if this proposal could apply to those already receiving benefits or those over full retirement age as legally defined now. Boehner also wants to tie COLA’s to price index rather than wages. The piece on that site by Robert Borosage was “Boehner: Cut Social Security to Pay for War”. The link is here. The article reads “And now the one Obama policy Republcans support -- escalation in Afghanistan -- should be paid for by the elderly -- raising the retirement age and cuttng Social Security.”

Today Patrice Hill mentioned Boehner’s “modest proposal” in a front page (July 14) Washington Times article “Both parties mull raising retirement age; House leaders get frank about social security cost” (web url) here.

Hill quotes Boehner: "If you have substantial non-Social Security income while you're retired, why are we paying you at a time when we're broke?" he said. "We just need to be honest with people."

Presumably, if you have an asset base you have income from it, although that is harder in a low interest rate environment. What if you have inheritance, or stand to get one?

I always looked at the FICA tax as a kind of annuity premium. I want it back. Likewise, the Medicare tax was a kind of health savings account. Just simply expropriating the benefit sounds now like Communism, an odd thing to hear from a Republican. How does Boehner define “substantial”? Is it like the notorious “social security offset” in so many corporate defined benefit pensions (now being frozen or in trouble anyway).

Obama had said before inauguration, though, this was one can we couldn’t kick down the road forever.

I couldn’t find these comments on Boehner’s website yet.

Of course, one can tie this report to the "demographic winter" idea promulgated by the Right.

There are indeed some people who don’t “need” the social security benefit. Consider the article in the July 14 Washington Post about the late Yankee owner George Steinbrenner and his heirs, who could “save millions from a one-year lapse in the estate tax”, link here .

What did they say in those Fort Eustis Army eyebrow barracks (not a bay, not Special Troops) in 1969? “From each according to his ability, to each according to his needs”. Quote from “The Walrus.”

Tuesday, July 13, 2010

Propose reducing future social security benefits for those not yet 55

Thomas N. Bethel has a story on p 16 of the 2010 July-August AARP Bulletin, “Social Security: Where do we go from here?”, link here.

Bethel discusses a proposal by Rep. Paul Ryan of Wisconsin to reduce benefits for those 55 or younger in 2011, replacing some of the FICA tax with a privatized annuity fund with some strict regulation to keep it conservative. But there is no guarantee that the private part would replace the loss of benefits. But that seems to be the most specific serious proposal to reduce benefits to hit the streets so far, to stop “kicking the can down the road.”

Seniors show an increasing dependency on social security because of the economy.

64% of social security beneficiaries were retired workers in 2009. Just 5% where stay-at-home spouses, but widows, widowers and parents (even) made up 9%.

Monday, July 12, 2010

Sibling rivalry can affect eldercare (new book, more debate)

Francine Russo has a piece “When the other sibling cares for an aging parent” in the “Women on the Web” site here, as she presents her book from Random House “They’re your parents too; how siblings can survive their parents’ aging without driving each other crazy”.

Her essay puts her in the position of the more distant sister, “grown up and independent”. She says “I had no idea that I was entering a new developmental crisis in the life of my original family, or that there even was such a crisis lying in wait..”

It seems that the least externally female competitive (sometimes one who didn’t marry) winds up with the problem in her lap.

One could wonder about the same problem for an only child.

Wednesday, July 07, 2010

Scams against elderly increase, among some contractors as well as within families; banks said to become more vigilant

Dan Morse has an important story in the Washington Post, “In D.C. and across the nation, scams against senior citizens are on the rise”, Wednesday July 7, link here. The report is in line with recent stories in the New York Times about financial institutions helping supervise geriatric care, and with the aggressive position taken by geriatric care management companies against elder financial abuse. Whereas earlier stories emphasized financial abuse from within the family, this one talks about phony contractors bilking seniors with shoddy work or fraudulent liens, in a few cases even foreclosures.

Banks are required to report suspected elder abuse (to state departments of Adult Protective Services, which protect legally incapacitated adults of any age) in the District of Columbia and 17 states, but these do not include Maryland and Virginia, where reporting is voluntary.

The story again mentions the notorious New York City Brooke Astor case.

Tuesday, July 06, 2010

"Virtual Dementia Tour" used to train caregivers to walk in others' shoes

The Health & Science section of the Washington Post on July 6 has a piece (p E6) by Leslie Tamura, “Caregivers get a virtual feel for what dementia might be like”, link here.

At a Sunrise facility in McLean, VA, some employees (as well as the journalist) were given the Virtual Dementia Tour, where they put on special clothing including goggles, headphones (beeping white noise), corn-grain filled shoes and bubbly gloves to simulate the sensory handicaps that often come with aging. One of the effects is that under such conditions it is hard for anyone to remember precisely a list of tasks to be done.

The V.D.T. was created by P. K. Beville, at one time a clinical psychology post-graduate student who studied the relationship of caregivers to aging parents starting in the 1980s and has sold the kits since 2003.

YouTube video by VDTSWD

Monday, July 05, 2010

Banks get into geriatric care management; recap on ROTH

Kelly Greene has an article on the recent interest in banks and financial advisors in providing geriatric care management services, as in this Wall Street Journal article on June 26, 2010 under “Family Value”, link here.

Banks will be pro-active when they discover evidence of elder financial abuse, and like geriatric care managers can look for specific kinds of evidence of abuse in audits.

Banks also find that they can attract other kinds of business by offering these services.

Greene had a long article on Roth IRA’s in the June 20-21 Weekend Wall Street Journal, 2009 page R1, and it seems to have dropped off online.  I found it lying around the basement today. The article discusses the removal of income limits Jan 1 2009 (was discussed here in a post June 23, 2009). The three advantages of ROTH IRA’s seem to be here (1) tax free withdrawal given minimum holding periods (2) no required distributions at 70-/12 (3) heirs don’t owe income tax on withdrawals.

Friday, July 02, 2010

Extreme longevity (esp past age 105 or so) seems to be largely about genetics

Rob Stein has an article on p A4 of the Washington Post on Friday July 2 on extreme longevity, and recent research indicates that genetics is a very important factor, especially for females, and for those who live past 105 or 110. In fact, 90% of centenarians did not have a significant disability or health issue at age 93. The story is (web url) here.

Oprah Winfrey and Dr. Oz have presented programs about longevity in “blue zones”, where people eat a lot of anti-oxidants. Longevity seems common in Seventh Day Adventists; one man age 94 was still practicing surgery. In 2008, Barbara Walters had presented a special on longevity and predictions that one could live to 150 see my TV reviews blog, April 1, 2008).

The abstract for the recent Science Magazine article, many articles, is here.


NBC Nightly News covered longevity in the July 1 broadcast.


Thursday, July 01, 2010

Should people consider paying large entrance fees when moving into retirement communities?

Some assisted living centers and retirement communities have relatively large entrance fees, which can be $100000 to $200000 or so. In some cases the monthly rent is somewhat less, however, and partial refunds, based on the number of months of residency, are possible if the resident either moves out or passes away.

A good example is provided by the Goodwin House in northern Virginia, with link to the financial options page here. It talks about a “declining formula” but it appears that the resident and family actually have a financial incentive for the person to live longer, which sounds like a morally good thing.