stay put or move onspomo.weebly.com/uploads/5/0/6/9/50694751/... · someone in a parkinson's...
TRANSCRIPT
Stay Put Or Move On:
To Age in Place or Move to a Continuing
Care Retirement Community
Margaret Riley Aline [email protected] [email protected]
spomo.weebly.com
Copyright 2020
Course Objectives
1. To look ahead at the challenges coming as we age.
2. To explore the options and opportunities available to address those challenges in ways that promote independence and quality of life.
3. To help you begin the process of deciding which options make the most sense / have the greatest appeal.
Copyright 2020
Your Goals for this Class
Let’s start with what you’ve told us
brought you to Stay Put or Move On?
Copyright 2020
How Did You Hear about the Class?
Friends (Majority)
“. . . From a friend at the UNC Wellness Center who was moving to Carolina Meadows.
. . . Someone in a Parkinson's disease caregivers group mentioned the class. . . . I
heard about this course through a neighbor who was very pleased with the help that it
provided her . . . Aline told my wife and I about the class . . . A good friend who has a
great deal of credibility told us about this class.”
OLLI Catalog
“. . . From Olli fall term catalog. You are so popular I had to go on the waitlist at 9:10
on the date of registration!
Copyright 2020
What motivated you to take this class?
. . . Aging, one year at a time.
. . . . I am 67 now, and I anticipate there will come a time when I will need
assistance either in my home or in a community or facility of some sort.
. . . I need to put $ down on 3 retirement communities before my friend who
agreed to be my healthcare power of attorney will let me officially put her down
as my healthcare power of attorney
. . . I am a financial planner + I am 52 years old and starting to think about what
options I want for myself.
. . . A desire to educate myself on my options when I get to the point at which I
can no longer safely live by myself.
. . . I hope to spare my two sons the headaches of responding to a succession of
crises as I had to do with my own parents then living across the country
Copyright 2020
What do you hope to gain from/take
away from this class?. . . A clearer perspective of what it would be like to live in a retirement
community. My fears are that the locations may be excellent at
marketing, but not live up to the promise of creating a sense of home.
. . . greater clarity about what would be good options for not just my
husband and me as a couple, but for either of us as a widow/widower
. . . I want to know the cost... how much $ to get in, the monthly costs
when in for people who live independently (meals, etc),
. . . I’d like to understand the different contracts for the
communities. I’d like to compare the cost of the different facilities, and
match what you get to what I want.
Copyright 2020
Who, besides yourself, will be the
beneficiary of the information in this class?
. . . My wife
. . . My husband
. . . Only me
. . . My children
. . . My brother, my sister
Copyright 2020
Do you have Long Term Care Insurance?
46% of you have LTC Insurance.
Copyright 2020
A bit of housekeeping. . . .
Copyright 2020
This Photo by Unknown Author is licensed under CC BY-SA
How to use the SPOMO website
Copyright 2020
How to use the SPOMO website
Copyright 2020
How to use the SPOMO website
Copyright 2020
Last Day of Course - March 31
Copyright 2020
• After our last site visit we will revisit your survey answers to see if we addressed your interests
• We’ll also conduct a brief exercise designed to share your thoughts about both Aging in Place and moving to a Continuing Care Retirement Community
Stay Put Or Move On
Focus on the two most popular options:
1. Aging-in-Place
Staying in your home indefinitely
80% of adults say they prefer this option (AARP 2018)
2. Continuing Care Retirement Communities
Independent Living + Assisted Living + Skilled Nursing
We’ll also touch upon other alternatives. . . . .
Copyright 2020
Your plan may look different from mine
However, there are needs that should be addressed
in every viable eldercare plan:
Community
Opportunities to live a Healthy Lifestyle
Help with Activities of Daily Living
Access to Assisted Living or Skilled Nursing Service
when needed
Copyright 2020
Aging: Ready or Not
Where did all that time go?
10,000 people in the U.S. turn 65 every day (Pew
Research)
Globally, in ~3 years, the number of people 65 and
older will outnumber children under 5 (AARP)
The PLANNERS (all of you) will get out ahead of this
aging thing, sign up for SPOMO, become better
informed, make a choice, put your plan in place.
Copyright 2020
This Photo by Unknown Author is
Stages of Elderhood
Young Old: 65 - 74 yrs of age
This stage is about making a plan that includes finding, or creating,
a supportive community for the care you’ll need as you age
Middle Old: 75 - 84 yrs of age
Putting your plan in place. Timing is most important: You almost
can’t be too early but you can be too late
Oldest Old: 85+
Appreciating your forethought!Copyright 2020
Where to Begin?
What we’d all like to know:
How long will I live?
How healthy will I be?
Will there be “an event” affecting me or my mate (stroke, life-altering
diagnosis, dementia)?
What are my best options for navigating whatever may come?
What we can all do:
Become informed / stay informed
Find what makes most sense / appeals to you
Make a plan
Set the plan in motion
Copyright 2020
How Long Will I Live?
The Social Security Administration Benefits
Planner estimates a:
Woman reaching age 65 can expect to live to age 87 with a 50
percent chance of living past 90.
Man reaching age 65 can expect to live to age 84 with a 50
percent chance of living beyond 87.
For a couple, there’s a 50 percent chance that one spouse
will live beyond age 94 with a 10 percent chance of living
beyond 100.
Copyright 2020
How Long Will I Live?
Life Expectancy Calculators
1. Living to 100 life expectancy calculator
2. Blue Zones Vitality Test (requires your
email address)
3. Dean Foster’s “How Long Will I Live”
4. MetLife’s Longevity Calculator
5. Social Security Admin Life Expectancy
Calculator Copyright 2020
Aging Calculators Sample Output
Copyright 2020
MetLife Longevity Calculator
How Healthy Will I Be?
“Most of us want to be healthy until the end, not live to 100 and be a decrepit wreck.”
“Longevity has a strong genetic component, but how healthy you are as you age is largely up to you!”
(Dr Harvey J. Cohen, Director, Center for the Study of Aging and Human Development, Duke University)
Copyright 2020
How Healthy Will I Be? Exercise!
Copyright 2020
How Healthy Will I Be? Exercise!
Copyright 2020
A 2017 study that tracked the activity levels of 7,985 adults
over age 45 found that those who had the greatest amount of
sedentary time had almost double the mortality risk of those
who spent less time in a chair. The good news? Taking a break
every 30 minutes significantly lowers your risk, according to
the study
What’s more, a remarkable 2018 JAMA Network Open study
found that not exercising increases your risk of premature
death more than cardiovascular disease, diabetes and even
smoking.
Mastering Time: A Key to Successful
Aging
Key Takeaways
Only 25% of longevity is inherited
75% of differences in lifespan are due to
other factors which may be modifiable
Copyright 2020
How Healthy Will I Be? Social Relationships
Forbes Magazine: (November 29, 2017) The Risks of Social Isolation for Older Adults:
Socially-isolated older adults are likely to be sicker and die sooner, and have higher health care expenses, than seniors who retain their social connections. A new study by researchers from the AARP Public Policy Institute, Stanford University, and Harvard finds that Medicare spends an estimated $6.7 billion more each year on seniors who have little social contact with others.
=====================================================
Aging Life Care Association (Spring 2018):
Some studies suggest that the impact of isolation and loneliness on health and mortality are of the same order of magnitude as such risk factors as high blood pressure, obesity, and smoking.
Copyright 2020
Aging Well –Blue Zone Habits
Stay physically active
Build community – people coming together for
their mutual benefit
Cultivate social networks
Get Involved
Develop a Sense of Purpose
Eat Healthy
Copyright 2020
How Healthy Will I Be?
As Time Goes By …
79% of women and 58% of men 65 and older will need some
form of assistance with the Activities of Daily Living (ADLs).
33% of those will need assistance for an average of 2 - 4 years*
Bathing
Dressing
Eating
Transferring (getting in and out of a bed/chair)
Walking
Toilet hygiene (including continence)
Copyright 2020
*(Kemper, et. al., Penn State Univ., 2005)
Needing help as we age
0
5
10
15
20
25
30
35
40
45
50
Bathing Dressing Eating Transferring Walking Toileting
Perc
ent
Activities of Daily Living
65 - 74
75 - 84
85 +
Source:
MetLife
2010
Copyright 2020
How Healthy Will I Be?
Instrumental ADLs
Managing finances
Handling transportation (driving or navigating public transit)
Shopping
Preparing meals
Using the telephone and other communication devices
Managing medications
Housework and basic home maintenance
Together, ADLs and IADLs represent the capabilities that people usually need to live independently
Copyright 2020
0
10
20
30
40
50
60
70
80
90
Need Care < 1 Yr 1 - 2 Yr 2 - 5 Yr > 5 Yr
Pe
rce
nt
Years of Care Needed
Men
Women
(Avg - 2.2 Yrs)
(Avg – 3.7 Yrs)
Source:Depart. of Health Policy Penn State 2005
How Healthy Will I Be?
Years of Long Term Care
Copyright 2020
Serious stuff …
Leaves you wondering
Copyright 2020
Which of Those Percentages
Will YOU Fall Into?
As a man, will you be in the 58%
who’ll need assistance with ADLs,
or among the 42% who won’t?
As a woman, will you be among
the 79% who’ll need assistance, or
the 21% who won’t?Copyright 2020
Copyright 2020
Aging in Place
“It ain’t what you don’t know that gets
you into trouble. It’s what you know for
sure that just ain’t so.”
Mark Twain
Aging in Place Beliefs
87% of adults 65 and older prefer to Age in Place*
Currently, any of us living independently in a private home
is “Aging in Place”
Your home and your neighborhood meet your needs
Everything is fine –for now
But - health and mobility will decrease as we age
* AARP Public Policy Institute 2014
Copyright 2020
Review: Successful Aging in Place
Need to educate yourself about the issues
It’s not just about the house
It’s not for everyone
It requires forethought and planning to arrange for in-
home assistance and services
Think of it as Continuing Care at Home (CCaH)
But it may require care outside the home, e.g., Assisted
Living and/or Skilled Nursing
Copyright 2020
What’s Ahead
Some of us will be faced with a sudden event –
diagnosis/illness - but for most, aging will be a steady,
gradual continuing series of losses
Loss of mobility
Decline in senses: hearing, sight, smell, taste, etc.
Eventually these losses will accumulate to the point
where we can no longer manage solely on our own
We’ll need assistance in various forms
Copyright 2020
Progression of Need
Active AdultNeed a Lot of
Care
Need More
Help/CareNeed a Little
Help
Assistive Technologies
Home Modifications
Care Manager
Companion Home Care
Skilled Home Care
Assisted Living
Skilled CareCopyright 2020
Cycle of Care
Assisted Living2
Active Adult
Event
Hospital1
Rehab1Home Care2
Skilled Care2
1 Medicare2 Long Term CareCopyright 2020
Questions To Ponder
As your health declines and your needs increase:
• Will your home meet your needs ?
• Will your community meet your needs ?
Will your home need to be modified to accommodate changes
in health or mobility?
How will you get around when you can’t drive any more?
How will you stay socially active to minimize isolation?
When you need in-home care where will you get it?
When you can no longer receive care at home, what then?
How much will care cost?
Copyright 2020
This Photo by Unknown Author is
licensed under CC BY-SA
How will I pay for all this care?
Medicare
Medicaid
Long Term Care Insurance
Out of Pocket
Copyright 2020
Medicare
Medicare is health insurance
Covers you if you get sick (e.g., heart attack,
stroke) or get injured (e.g., break a hip)
Pays for your recovery
When you reach point of full recovery or no
further improvement or recovery is possible:
Medicare Coverage Ends !
( Medicare does not cover continuing or ongoing care,
help or assistance needs - i.e., long term care )Copyright 2020
MedicaidFor individuals 65 and older, Medicaid does cover long-term care, in
approved skilled care facilities, if the low financial asset and income
limits are met.
• Covers most skilled nursing/nursing home care
• Covers community and some home-based care
“The NC Medicaid program provides healthcare insurance to anyone who
cannot afford private health insurance. Typical Medicaid beneficiaries
are pregnant women, children, the elderly, the blind, disabled people
and adults who come from poor and low-income backgrounds.” (NC
DHHS)
Coverage in North Carolina will be less than in many other states
however, since NC has not accepted the Medicaid expansion offered
under the Affordable Care Act.
Copyright 2020
Find more info at:
https://medicaid-help.org/index.html
Long Term Care
When you need assistance with one or more of the
activities of daily living (ADL’s)
• Bathing
• Continence
• Dressing
• Eating
• Toileting
• Transferring
Long term care insurance policies typically provide
benefits when you need assistance with 2 ADLs
Copyright 2020
Speaking of Long Term Care Insurance. .
. .
If you’d like to learn more there’s an OPTIONAL class scheduled for:
Date:
Time:
Location:
Speaker: Name and Bio
Copyright 2020
LTC Insurance
Time to buy is in your 50’s – possibly 60’s
• Annual premiums are lower
• Less likely to be declined coverage due to
health
Buying is difficult after age 70
• Annual premiums much higher
• Very likely to be declined coverage due to
healthCopyright 2020
Annual Costs - Example
Age CoupleSingle
Male
Single
Female
50 $ 4,400 $2,700 $3,300
60 $ 5,700 $3,400 $5,300
65 $ 7,600 $4,500 $7,200
70 $ 12,400 $7,300 $11,800
75 $ 18,600 $12,600 $17,700
Source: Genworth LTC Calculator
NO inflation escalator
Benefit: $ 250 per day – 5 years (Maximum Benefit = $456,250)
Copyright 2020
Assisted Living/Skilled Care
What your grandparent’s knew as nursing homes have changed substantially
In your grandparent’s day, long term care services were provided by nursing homes
Today, most long term care services are provided by Assisted Living communities
The term “nursing home” is being replaced by the term “Skilled Care” facility
Skilled care focuses on rehab or bedridden patients requiring 24/7 monitoring by nurses Copyright 2020
Skilled Care
Most of us will not need long term skilled care services
• Unless bedridden and requiring 24/7 monitoring (e.g.,
on a ventilator, Stage IV wound treatment, continual
infusion of antibiotics, extreme pain management,
etc.)
Many of us will need short term skilled care services –
primarily for rehab following surgery
Many of us will likely need long term care services to help
with the activities of daily living (ADLs)
Copyright 2020
2019 Annual Costs – Durham, NC
Copyright 2020
Source:
Genworth Annual Cost Survey (2019)
COMMUNITY: The Key to Aging Well Community results from a network of support and coordinated services
designed to:
1. Promote independent living
2. Provide a continuum of care, as needed, over time
Two forms:
1. Real: people and resources within a specific area
2. Virtual: people and resources drawn from different areas
Community is what is expected, to varying degrees, in ILRCs, CCRCs, and
NORCs
It is what you will want to find/create if you choose Aging in Place/CCaH
as your preferred option
Copyright 2020
Community
When is worst time to be looking to find or create
community?
When you need it !
You’re feeling pressured to put something in place
The options may be limited due to time
Difficult to make an informed decision
Could be more costly than if there were more time to
explore the options and make a considered choice
Copyright 2020
Three Options for Aging with Community
1. Aging in Place/CCaH
In your current home or in an “intentional community”: Co-Housing 55 + NORC
You, your children and family members create and manage a community of support and care drawn from within the community
Supplemented by home care services, Assisted Living and/or Skilled Nursing at another location (when required)
Copyright 2020
Three Options for Aging with Community(continued)
2. Moving to an ILRC
Supplemented by home care services, Assisted Living
and/or Skilled Nursing possibly at another location
3. Moving to a planned community that provides a
continuum of care – Life Plan Community / CCRC
Supplemented by home care services
Copyright 2020
All Possibilities, however …
1. Aging in Place/CCaH
A 2017 study by the Center for Retirement Research at Boston College, "How Much Long-Term Care Do Adult Children Provide?” found:
Adult children aren’t always involved in providing care for parents, but when they do provide care, they devote an average of 77 hours per month to this activity – or about two weeks of full-time work.
On average, they spent, “35 per cent of their budget on parental care”
The cost of in-home care when intensive (12-24 hour skilled care IVs, ventilator, changing sterile dressings, etc.) can be more expensive than Assisted Living or a CCRC.
Copyright 2020
All Possibilities, however …
2. Independent Living Retirement Community (ILRC)
Less costly than a CCRC, but doesn’t offer the full continuum of care found in CCRCs. In most cases, Assisted Living and Skilled Nursing Care would involve moving to a different location or community
3. Life Care / Continuing Care Retirement Community (CCRC)
Addresses all the prescriptions for community and aging well, provides the complete range of health care services, but also the most expensive option
Copyright 2020
COMMUNITY:
The Key to Aging Well
Whether a planned aging, NORC, or community design of your own, the health, physical, and psychological challenges of aging are best served by community:
• A network of support and interconnected services
“Getting by on my/our own” carries a high risk for diminished independence and quality of life
Even devoted family members can be overwhelmed and worn down -physically, emotionally, and financially - by the demands of caring for an aging person or parents.
Manage the Risk
Whether Aging in Place/CCaH, ILRC, CCRC, or
other
• Plan where the help you’ll need will
come from for a gradual decline, or
sudden, significant health issue
The SPOMO Process
Apply what you’re learning
Do your own research
Find out what makes most sense for you
Make it into a plan
Put it on a timeline!
Set your plan in motion
Copyright 2020
Copyright 2020
Start making your plan
Copyright 2020