Seniors in nursing homes and assisted living centers will be among the first Americans vaccinated, following recommendations last week by a federal advisory panel. Older adults living at home will need to wait a while longer.Many uncertainties remain. Among them: What side effects can older adults anticipate and how often will these occur? Will the vaccines offer meaningful protection to seniors who are frail or have multiple chronic illnesses?Here’s a look at what’s known, what’s not and what lies ahead.
As the pandemic wreaks havoc on our mental and physical health, it is also quietly reshaping how Americans will face retirement and old age in the years to come.The virus is bringing sweeping change, mainly by “accelerating developments already under way,” says physician and entrepreneur Bill Thomas. For example, “isolation of older people has long been a problem, but Covid is focusing attention on the issue and adding urgency” to address it.
In this Wall Street Journal Article, writer Anne Tergesen reports on some of the effects that the COVID virus could have on aging and society. Among her findings:
More will age at home.
Older people will benefit from a technology boom.
Lifespans will decline. (Though perhaps only for the short term)
We will have a better handle on what we want to do with our time.
We will plan for death.
We will embrace healthier lifestyles.
We need to save more to retire.
The 401(k) will morph into a multipurpose account.
Aliria Rosa Piedrahita de Villegas carried a rare genetic mutation that had all but guaranteed she would develop Alzheimer’s disease in her 40s. But only at age 72 did she experience the first symptoms of it.
Now researchers are studying Aliria’s donated brain to try and unlock the genetic secrets that may have delayed the disease’s onset.
Few things sound as bad as being in the hospital alone. Healthcare workers have become surrogate mothers, fathers, friends, and children, in this new-normal of self-sequestered living. To exacerbate matters, hospitals are often in need of critical medical documents such as emergency contacts, healthcare directives, DNR (Do Not Resuscitate) Orders and the like.
To help with the latter problem, the American Bankers Association (ABA) has released its Mind On Your Loved Ones App that allows family members to store this critical information on their smart phone or tablet, and share it with medical professionals and hospitals if they cannot be present.
Having this information in the hands of those we’ve entrusted to carry out our wishes if we’re unable to speak for ourselves is important. Even more so now that we cannot be assured that our loved ones will be at our side if current events prevent it.
Mind Your Loved Ones, known as MYLO, is a mobile app that gives individuals the ability to store their own and their loved one’s critical medical information, health care directives, and other related data on their Apple or Android phones, iPads® or tablets. ABA members can download the app at a discounted price.
In the video below, Robert Powell, editor of The Street’s Retirement Daily, and Angie O’Leary, head of wealth management with RBC Wealth Management, talked about the need to plan ahead for the possibility of dementia and the type of plans to put in place.
According to O’Leary, the plan should include having key legal documents – a power of attorney, healthcare directive, and will – in place as well as having assets properly titled and beneficiary designations current. Consider too, she said, the benefits of a trust and professional executor services, as well as supplemental insurance, including long-term care options.
O’Leary also noted the need to understand early warning signs and, after a diagnosis, acting swiftly to protect the family from financial missteps, abuse and liability.
Having a plan is essential, and key legal documents—a power of attorney, healthcare directive, and will—should be in place.
If you are struggling through the financial transitions of aging, Wealth and Honor is here to provide you with resources to help you and your family through it.
It’s a suitable Valentine story that is as saccharine sweet as it is painfully tragic. Richard and Alma Shaver were childhood friends and high school sweethearts who eloped at eighteen. They were described as soulmates who were madly in love with one another. Richard became an engineer, they raised three daughters, Alma led Girl Scout troops and became the go-to person in the neighborhood for emergency contact.
The symbol for Alzheimer’s
A few years back, Alma was diagnosed with Alzheimer’s disease and the silent thief lay siege to Alma’s mind. She went from forgetting recently completed tasks to not recognizing her children, and ultimately not recognizing Richard. It was more than he could take.
On a warm day last June, while Alma was sleeping, Richard went upstairs to their bedroom and shot his beloved wife dead. Then he lay down beside her and shot himself.
It was not the ending that his family had hoped for, but they console themselves that they are not having to endure a murder trial. They held a memorial service and celebrated the happier lives that they had known with their parents. Perhaps this family’s tragedy and other less-tragic but equally painful deaths caused by this disease will lead to more open discussions on death with dignity laws.
On this day for lovers, embrace your partner, and tell him or her that you will be there for them if they are visited by the silent thief, but that you will not participate in a tragic end to their life or yours. It only perpetuates the pain for those we may leave behind.
With the new year, I’ve entered my 36th year in the financial services industry. Just writing this fact feels strange. I’ve never characterized myself as a veteran of the industry, feeling instead that I’ve just hit my stride. The years however tell me differently and it’s easy to understand how senior professionals can feel marginalized. I chose a doctor several years my junior so that as I aged, he’d still be in practice. Understandably now, clients want to know who my back up is “just in case.”
The financial planning industry has done an admiral job of preparing people for two pivotal moments: Retirement – that magic age when one stops earning a paycheck, travels the world, plays golf every day, and enjoys a life of leisure; and Death – the final moment beyond which our assets and legacy are left to our heirs. It has done a poor job of equipping advisors to address the financial planning issues of the period in between. Sure, advisors sell long term care insurance to forty and fifty-somethings for this period, and others sell annuities to seniors skittish about the financial markets, but these are product solutions aimed at the senior market, not financial planning discussions. In a similar way, a walker solves an issue with balance and prevents falls, but a walker is not a comprehensive plan for health and wellness throughout life.
While there are several common financial planning issues for every age demographic, there are also many unique financial planning needs of the senior market.
Common Financial Planning Issues
Ensuring adequate cash flow throughout life.
Evaluating and addressing risks to financial independence.
Determining the financial impact of major life events.
Minimizing income tax.
Allocating investment resources to accomplish current and future goals.
Defining a plan for the distribution of accumulated assets at death.
Financial Issues Unique to Seniors
Plan for downsizing or home modification
Relocation plan if distant from family
Plan for continued social engagement
Family business succession
Identity and fraud protection
Annual Medicare elections
Developing a dependency plan to include
Living arrangements
Persons in charge of financial decisions
Persons in charge of healthcare decisions
Transportation needs
It’s tempting to ask how a plan for continued social engagement is a financial planning issue. With social isolation a major contributor to poor health among seniors[1], and healthcare costs absorbing a significant portion of a senior’s resources, a plan for social engagement as we age should be an integral part of the financial planning conversation with seniors.
Annual Medicare elections are another example of an often-confusing labyrinth of decisions that can have significant financial impact for years.
Identity theft and elder financial fraud are estimated to cost seniors between $3 and $30 Billion a year[2], and nearly everyone I know over age 70 has been targeted. A plan that includes identity theft protection as well as vulnerabilities to undue influence inside of familial relationships needs to be included.
Plans for living arrangements, whether aging in place, or facility care, should be discussed long before the actual need arises. Just as saving for retirement doesn’t begin at age 65, neither should plans for where someone lives out the remainder of their life be delayed until the 11th hour.
Family meetings to discuss an aging client’s dependency plan should be also be held long before a dependency event occurs. It helps assure family members that a plan is in place, informs them as to who-does-what-when, and when done early enough and under the direction of the aging client, preserves his or her seat of honor at the head of the table.
Family Business Succession has been a central component of financial and estate planning for years and is the least neglected area of financial planning for seniors among those who own a multi-generational family enterprise. Still, nearly 60% of the small business owners surveyed by Wilmington Trust, do not have a succession plan in place[3].
In conclusion, financial planning does not end at retirement. As one client reminded me years ago, “retirement is just another word for thirty years of unemployment.” It doesn’t look the same for all seniors but when practiced with integrity, it can be extremely beneficial to the entire family, and rewarding for the financial planner who chooses to serve this market.
[1] National Institute on Aging. (2020). Social isolation, loneliness in older people pose health risks. [online] Available at: https://www.nia.nih.gov/news/social-isolation-loneliness-older-people-pose-health-risks [Accessed 7 Jan. 2020].
[2] Consumer Reports. (2020). Financial Elder Abuse Costs $3 Billion a Year. Or Is It $36 Billion?. [online] Available at: https://www.consumerreports.org/cro/consumer-protection/financial-elder-abuse-costs–3-billion—–or-is-it–30-billion- [Accessed 7 Jan. 2020].
The U.S. Centers for Medicare and Medicaid Services is investigating a New Jersey hospital after an investigative article from ProPublica, an independent, non-profit newsroom that produces investigative journalism in the public interest, published an article on October 9, 2019 in which several of the hospital’s Transplant team discussed keeping a comatose transplant patient alive “because of worries about the transplant program’s survival rate.”
After suffering from congestive heart failure for years, Darryl Young, a Navy veteran and former truck driver with three children, received a heart transplant on Sept. 21, 2018. Since the transplant, Young had suffered from pneumonia, strokes, seizures and a fungal infection. The Newark transplant team believed that he would never wake up or recover function. Yet they wanted to do all they could to keep his new heart beating.
ProPublica’s investigation found that Newark Beth Israel’s transplant team was worried about the possibility of being disciplined by CMS after six out of 38 patients who received heart transplants in 2018 died before their one-year anniversary. That translated to an 84.2% survival rate, considerably worse than the 91.5% national probability of surviving a year for heart transplant patients, according to the Scientific Registry of Transplant Recipients, which tracks and analyzes outcomes for the government.
If a program’s survival rate falls too far under its expected rate, which is calculated by a CMS algorithm, the agency could launch an audit. If the audit uncovered serious problems, CMS could pull a program’s Medicare certification, meaning that the federal health care insurer would stop reimbursing for transplants.
In recordings of transplant staff meetings discussing Darryl Young’s prognosis, senior staff are heard discussing the importance of keeping Young alive, even if it meant not informing his family of his deteriorating condition so that decisions to remove him from life support could be made.
Spurred by a ProPublica investigation, CMS will carry out an inquiry.
Chen, C. (2019). Feds to Investigate Hospital Alleged to Have Kept Vegetative Patient Alive to Game Transplant Survival Rates — ProPublica. [online] ProPublica. Available at: https://www.propublica.org/article/feds-to-investigate-hospital-alleged-to-have-kept-vegetative-patient-alive-to-game-transplant-survival-rates [Accessed 5 Nov. 2019].
At least 2 million older adults would benefit from home-based primary care, according to Health Affairs. Because these patients have difficulty getting to an office visit, they frequently end up in emergency rooms or hospitals.
Per-patient savings range from $1,000 to $4,000 annually through reduced hospital and nursing home stays, emergency room trips and specialist visits, according to research cited by the American Academy of Home Care Medicine.
According to the American Academy of Home Care Medicine, the CMS Independence at Home Demonstration, part of the Affordable Care Act, estimated that Medicare would save $10 to $15 billion total over a 10-year period if home-based primary care were extended nationally to those on Medicare who are homebound.
An increasing number of Americans ages 50 and older are in cohabiting relationships, according to a new Pew Research Center analysis of the Current Population Survey. In fact, cohabiters ages 50 and older represented about a quarter (23%) of all cohabiting adults in 2016. One reason could be the adult children’s rejection to their older parent’s marriage, especially if the relationship formed soon after the death of the other parent. Approximately 23% of cohabiters over age 65 are widowed.
However, as with many things in life, what seems simple — living together — is often quite complex. Unmarried couples, of all sexual orientations, can face a variety of problematic and emotionally difficult issues because estate planning laws are written to favor married couples.
Unmarried partners need to consider the following issues related to estate planning and living together:
Medical incapacity: In the absence of a durable power of attorney for healthcare, non-married individuals may be treated as “legal strangers” and unable to make healthcare decisions on behalf of their partner.
Living arrangements: If the wealthier partner dies or becomes incapacitated with no provision for the other partner to remain in the home (by a will or title) the other partner can be forced from the home by blood kin.
Dying without a will: Intestacy laws (state laws that determine where a deceased’s property goes when there is no will) are not favorable to unmarried partners.
Employer Retirement Plans: Plans like 401k’s, profit sharing, and pension plans, as well as group life insurance plans are governed by a federal law known as ERISA. This law requires that a spouse be the beneficiary of these plans in the event of the employee’s death unless waived by the spouse. No such protection is afforded unmarried partners unless the partner is listed on the Plan’s beneficiary form.
Seniors in nursing homes and assisted living centers will be among the first Americans vaccinated, following recommendations last week by a federal advisory panel. Older adults living at home will need to wait a while longer.Many uncertainties remain. Among them: What side effects can older adults anticipate and how often will these occur? Will the vaccines offer meaningful protection to seniors who are frail or have multiple chronic illnesses?Here’s a look at what’s known, what’s not and what lies ahead.
