Sunday, November 22, 2015

Smaller nursing homes provide more personalized care


Some innovations in nursing home care are reported by Constance Gustke on the “Persona; Business” page of the New York Times Saturday, p. B5, “Putting the ‘Home’ Back in Nursing Homes”, or (online) “Small residences for the elderly provide more personal, homelike care”, link here. The article describes residences for no more than ten people, and as the practice of adopting private homes as “group homes” for the elderly needing some combination of assisted living and nursing care.  But the care may be more expensive ($1100 a month in a Michigan facility, which sounds like more than a conventional nursing home would be, close to round-the-clock care with aides). The option may help keep the extremely frail "home".


Update: December 2

Vox has a piece by Valery Hazanov, Dec. 2, "What working in a nursing home taught me about life, death and America's cultural values", link here.  Valery says that childless people have a particularly tough time in nursing homes.  When someone is in pain, then the pain is a preoccupation, unless the person has interest in things outside the self, maybe preferably family members and people, but an interest in art, culture, literature, music, chess, and the like certainly helps.  

Tuesday, November 10, 2015

New research shows other ways Alzheimer's progresses, with a "flowing" protein; On course to bankrupt Medicare


CNBC (which hosted a GOP presidential debate, however unevenly) has a major article “Alzheimer’s: A Disease on Course to Bankrupt Medicare”, link here. This article has been widely tweeted today.

There is a lot of attention not only to beta-amyloid, but also to “tau”, a “contagious” protein (rather like a prion) that can develop inside neurons and move to other neurons.

There is also work on whether to give people with no symptoms but with a family history of Alzheimer’s (or certain positive diagnostic tests) preventive medication.

I have certainly wondered if the increase in Alzheimer’s is mostly the result of people (especially women) living longer and not dying of cancer and heart disease as early as they did when I was growing up, when extreme disability was often viewed through a personal moral lens.  Everyone dies of something.   But now, with much longer periods of disability at the end of life, social and extended familial support becomes even more important, even though people have fewer children and even attempt marriage at all (although same-sex marriage might actually reverse that a bit).

In the meantime, if people live forever with disability, yes, Medicare will go bankrupt.  You can see the math without doing it.

Monday, November 02, 2015

Seniors looking to downsize could take advantage of the "McMansion" fad, but need due diligence


A factor that may encourage some seniors to downsize is the practice in many affluent suburban areas of tearing down old homes and building “McMansions”, when local zoning allows it and builders find enough customers who can afford the homes (which happens in northern Virginia).

A senior who believes his older home might be of interest (particularly after a real estate agent or builder suddenly contacts him or her) needs to do a lot of due diligence.  He may owe capital gains taxes if he in turn rents (but some of the gain might be exempt if he lived in the home). If the home was inherited, it could get complicated (whether or not there is a trust or grantor trust).  The homeowner will need to talk to a tax attorney – which could cost a little just for the consultation time if the situation is at all complicated (which is likely). It doesn’t appear that older seniors can stretch out the profits by purchasing annuities, unless I’m missing something.

Seniors contemplating downsizing need to "do the math" and think like insurance companies selling annuities.  Does the money you clear from selling your home pay for rent for the rest of your life expectancy?

Another point to remember is that, if a home is really a target for a tear down in the more immediate future, the land price should rise quickly, meaning the owner can get more money by holding out.

It's also well to note that many financial planners advise seniors to be wary of invitations to place "pocket listings" on the theory that these require less time and disruption of the seller. The Washington Blade has a cautionary piece by Tim Savoy here.
  
More details on this matter may be forthcoming this winter.