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.