STAGE 1-- DRAWING ON THE EXPERIENCE OF OTHERS

By Ron Iverson, Copyright 2007

Following are examples of drawing on the experience of others--misconceptions which caused problems.  Knowing the problems ahead of time, will help provide information to those seeking solutions in this series of articles in the blueprint.

Experience Example No. 2.   "I thought I'd be able to retire around age 55, but it's not possible."

Early retirement, seems to be available to only the wealthy, or those who are very well prepared ahead of time.  As recently as a decade ago, this ambition was achievable, but, as retirement problems begin to surface, early retirement seems to only mean availability for another job, and a forced "double and triple dipping" scenario.

As Maynard G. Krebs, the consummate hippie on Gilligan's Island, exclaimed forty years ago, "Work?!"  Yes-work.  No matter what measures are taken to "correct" all the economic and entitlement problems facing America's retirees, one thing is certain,  "WORK" will become a huge part of a new "four-legged stool" of retirement.   Downscaling, thrift, and cost-cutting, all become a part of most retiree's thinking, but "work" will be commonplace for many.

Work will be of major necessity, and  "subsistence wages" will take on a new, real, and unwelcome meaning for a great number of the retired masses.  Working for wages has already surfaced as a survival tool for many of America's retired people.  More and more "retireds" are finding that their mere existence, excluding the frills of a fancy retirement, is dependent on having a job, assuming they can work.  And then, assuming that they are happy with the type of work and wages available to them.

Additionally, the factor of staying with an employer who offers group health up to age 65, and perhaps even longer, is no small item.  Those who have retired early, and lost group health benefits can attest that the incredible cost of individual private health insurance, from age 55 on up, results in a nasty surprise to early retirement planning.   

Experience Example No. 3  "We were led to believe that moving to a warmer climate would be cheaper."

A common demographic paradox is that America's senior citizens have found a new way of life in the Sun Belt.  However, while the living is easier, the cost of living is no easier.  Lower winter heating bill savings can be eaten up by high air conditioning and utility bills.  In addition, sales taxes, higher state income and property taxes, and the inflation of normal "cost of living" scenarios all create retirement problems. 

The Sun Belt states have already experienced the imbalances of swollen retiree numbers.  Most states are in a continuing battle to stay ahead of the situation facing their own budget problems, created in part by Medicaid nursing home and home care costs, and trying to provide general economic planning for the retired hordes.  It's only the beginning.

In Article No. 7 we will continue the experience of others in discussing Social Secutiry and Medicare. 

LONG DISTANCE CAREGIVING STATISTICS

* 7 million Americans provide 80% of the care to ailing or vulnerable family members.

* There are approximately 3.3 million long distance caregivers.

* Caregivers live an average of 480 miles from the people for whom they care.

* Caregivers spend an average of 4 hours traveling to that person.

* Caregivers, on average, spent 35 hours of care each month (just short of one work week) giving care.

* 15 million days are missed from work each year because of long distance care giving.

* The average age of a long distance caregiver is 46 years old.

* The number of long distance caregivers will DOUBLE over the next 15 years.

* The average age of the care recipient is 78 years old.

Source:  Long Distance Caregiver Project-Alzheimer's Association LA and Riverside, Los Angeles, CA (May 15, 2002, National Web Seminar by Judith Delaney, MFT, Clinical Coordinator)

Understanding the Need to Prepare for Long Distance Care Giving--For Both Elders and Their Loved Ones

Part 2, by Ronald J. Iverson, copyright 2007

Author's note:  This article (Part 2) enables the reader to understand the need for preparedness for those who may be called on to facilitate long--distance care giving.  The need for "coordinated caregiving" for both those in need and their children will become a significant part of the American healthcare scene as we face the needs of 76 million baby boomers, their elders, and their children in the 21st century.

As we said in Part 1, while the physical medicine needs of older people are covered by Medicare, Medicaid, Medicare Supplemental and Medicare Advantage plans, there is still a missing factor--that of being prepared for the moment when those needs surface--a pre-planned system of coordinated care.

A Long Term Care policy awaits the moment that Home Care/Home Health Care, Assisted Living, or Nursing Home/Alzheimer's Care is needed.  But, how does that implementation come about for "Mom or Dad" who are living in Phoenix, while son Jimmy is an engineer in Seattle, and daughter Sally is an accountant in Kansas City? 

Jimmy and Sally probably don't have any idea about how to prepare for these events, and lose more than a few nights' sleep worrying about what to do.  

The Problem

In America, our healthcare and healthcare delivery systems are among the worlds' best.

However, coordination of those systems is splintered, and implementing all the parts of the care often results in confusion, uncertainty, and paperwork fatigue...for an older person... 

...and even for the young or middle-aged adult.

For the elderly, the problem is multiplied, especially if they try to coordinate all the necessary components on their own.  Even though Medicare has several wonderful features, understanding the various parts can be very confusing for the retiree.  For instance, with Medicare alone, the elderly person may be confronted with initiating and combining the benefits of these six features:

1)  Medicare Part A

2)  Medicare Part B

3)  Medicare Part D

4)  Medicare Supplement policies

5)  Medicare Advantage plans

6)  or Retiree Group Health programs that coordinate with Medicare

The beneficiary or patient, may well be challenged as to how these several benefit components are initiated, activated, and coordinated.

Then, to this, add the various parts of Long Term Care, or Short Term Care, (which go beyond medical needs) and how each fits into the "care" element of needed benefits. Or, if some of the benefits of insurance are missing, how does the patient fit Medicaid into the picture.

Add to the above, the concern, or even fears, of what diseases or accidents the elderly may contract.  A heart attack, stroke, or accident, are sudden events, needing sudden answers.  Cancer and Alzheimer's are only a few examples of problems, which often go undetected until the day of diagnosis, but then, become equally as immediately important as the preceding examples.

At this point, the elderly have a serious problem on their hands. 

If they have nobody to help them coordinate all the benefit features, the problems can become bewildering, upsetting, time-consuming, and sometimes overwhelming.

Even with a loving son or daughter to help them with these problems, the hurdles are no easier for the children or siblings, who want to offer all the support and care they can, but in reality are challenged themselves with what to do first... or even... what to do next.

The Challenge

The challenge will be to inform 40 million people over 65, and 78 million baby boomers that the problem of care coordination exists. 

And... that the problem of preparation for such time as a serious medical or care need arises... can be solved.

For instance, could you currently solve the above problems for yourself, or your loved one(s)? 

Could you do the necessary tasks comfortably?

Could you do them for a loved one a thousand miles away...or even next door?

Could you do all the tasks needed on a moment's notice, perhaps after an alarming phone call?

Would you even know what questions to ask a doctor or nurse, and hope that a few minutes of telephone time would yield complete and correct answers?

More than likely, the truthful answer is "No."

But... there is a solution.
 
The Solution--Bundling and Preparation--A Practical Solution

Under the direction of CEO Dan Tobin, MD (Director of The Life Institute and Adjunct Assistant Professor of Psychiatry, Dartmouth Medical School), Care Support of America and its affiliated training centers have been involved in testing care coordination and support for over 10,000 patients, working with major health insurance companies and institutions.  The result was the development of the "Your Support Nurse" program, which utilizes advanced illness counseling and care coordination, as developed by Dr. Tobin.

The system combines emotional support and practical guidance in a powerful and affordable program for seniors, families and caregivers.  "Your Support Nurse," already in use among thousands of people nationwide, offers demonstrated success in alleviating emotional distress and enhancing quality of life.

The program follows an eight-element process designed to:

1)  Help seniors and caregivers better understand chronic illness.
2)  Guide extended planning as the disease progresses.
3)  Coordinate care by linking medical, as well as non-medical services.
4)  Coach on questions to ask the physician.
5)  Direct searches on disease information and treatment.
6)  Help seniors and caregivers with problem resolution as issues arise.
7)  Provide emotional support to seniors, families and caregivers.
8)  Provide telephonic and real-time access to registered support nurses.

Who Should Care About Care Coordination?

For simplicity's sake, let's round off some numbers.  Currently in the United States, there are roughly 40 million people over age 65.  Also, there about 78 million "Baby Boomers."  So, combined, that leaves 120 million people who need to be aware of the complexities of caregiving, whether it be at home, across town, or across the nation.  And during the next 25 years, the boomers will pass into the "over age 65" strata, thereby constituting nearly 80 million people on Social Security, Medicare, and Medicaid (when adjusted for deaths in both demographic groups).

Sounds incredible and unbelievable doesn't it?  Yes, but it's true.  We are at a point in our history when there is one elderly person for every two "children."  The pressure on our health care system will be incredible.  The pressure of how and when to communicate with a loved one during their time of need will increase proportionately simply due to the numbers involved, or, the new demographic.

To understand the needs currently, we have to look at both the over 65 and under 65 demographics.  Since there are 40 million elderly today, and 80 million boomers, the need for care giving, long distance or local, and loving are immense.
So, who should pay attention?

1)  As we know, the under 65 person is concerned about their parent or parents.  They are likely candidates to investigate caregiving in general and long-distance caregiving, in particular.

2)  Secondly, people in the over 65 group, in all likelihood, are searching for peace-of-mind solutions for themselves.  They are the ones who have something at stake in setting up preparations for events they may very well find difficult to handle in the not too distant future.  For instance, people who have lived together for 30-50 years,and have managed thousands of situations between them during that period of time, become concerned about possible health problems for each other.  As we already know, the expectance of an instance of bad health or a serious accident increases with age.

3)  So, the retiree, elderly, or seniors themselves, have an acute concern for these events taking place.  How does one spouse react to the care-giving needs of another?  How do they even know where to start, and how do their concerns for the best possible care for their spouse affect their everyday thinking and worrying? The two member household, looks for a solution to the needs and concerns of the life-long mate.

4)   While the two member household is a significant entity, the single member household is probably even more in need, because there is no partner to help them with the matters that arise regarding their care.  So, the single retiree has an even greater stake in preparing for events such as an accident or a bundling of care and medical needs, which can be counted on to allow the retiree to seek and receive the best of care. 

5)  In either case, the individual, couple, or long-distance "child" can benefit with a pre-planned coordinated care inventory solution, which the family can use to prepare for advancing illness, and the development of plans to resolve existing problems.

How, Then, Can Care Support of America, and "Your Support Nurse" Help?

1)  When a person becomes a member, their account is established by the CSA Support Center.

2)  The member's health profile and supports that are in place are recorded in the member's account in order to prepare for, and coordinate, future support needs.

3)  Membership includes a comprehensive assessment, identification of areas where the family can prepare for advancing illness, and development of plans to resolve existing problems.

4)  "Your Support Nurse" will help the member and caregiver understand an illness, its' treatment, and offer suggestions and address what questions to ask the doctor.

5)  As part of the plan development, an inventory is taken of current insurance coverages.

6)  This assistance is available to the member or caregiver by calling "Your Support Nurse" at the CSA Support Center.

7)  Support Nurses are available to visit the member's home to evaluate medical and non-medical needs.

8)  Access to the CSA website for additional information, or telephonic communication with Your Support Nurse as needed, is a part of the program.

To contact CSA and the "Your Support Nurse" program, seniors, boomers, or concerned adult children can call toll free to 1-866-439-7103, or find additional information at: www.YourSupportNurse.com. 

For further information regarding significant Long-Distance Caregiving problems, the National Institute on Aging has prepared a comprehensive booklet entitled "So Far Away--Twenty Questions for Long-Distance Caregivers."  Published in January, 2006, by the National Institutes of Health, U.S. Department of Health and Human Services, the 44-page publication presents a very interesting and appropos discussion relating to the problems we have discussed.  You may order a copy by calling the Office of Communications and Public Liaison at 1-301-496-1752 and asking for the booklet by name, or by NIH Publication No. 06-5496. 

Understanding the Need to Prepare for Long Distance Care Giving--For Both Elders and Their Loved Ones.

Part 1, by Ronald J. Iverson, copyright 2007

Author's Note:  Before a problem can be solved, it must be identified and defined.  Likewise, once it is identified and defined, it must be understood--by both the elderly person and their children.  This is not an insignificant matter.  These factors--Identification, Definition and Education--serve as the basic platform for any understanding of the long distance care giving needs of Americans, as we navigate through the 21st century. 

The Background of the Problem

Two generations of people in America have a problem today, but, even if they do know it, they are not quite sure how to identify it.  To understand current care problems, both local and long distance, we would do well to go back in time, study the past, and find solutions for the present and the future. So...let's start at the beginning.

For centuries, parents have raised their children.  And, those children, in turn, raised more children, thereby making their own parents, "grand-parents."  Further generations created "great-grand-parents," and so on.  Family lineage is a normal human function.

In most cultures, families normally stayed close to one another, or lived together, perhaps even in the same family home.  Geography was not a problem, because, if they did move, family members seldom traveled far from their traditional roots.

But things change.  World exploration, the Industrial Revolution, the rise of nations and nationalities, and a movement from agrarian living to the rise of cities, all contributed to this change.  In America, such factors as "Manifest Destiny," "Westward Expansion" and "Urban Living," preceded contemporary definitions of "The Sun Belt," "The 'Burbs," "The Golden Years," "The Greatest Generation," and "Baby Boomers."

So, after a whirlwind, three paragraph history lesson, where do we find ourselves today...in America?

Well...we find ourselves all over the map.  Long after the phrase "Ellis Island" ceased to be a common household phrase, several generations of Americans find themselves living apart--sometimes a long way apart--from their families.  The necessary call to "go where the jobs are," has precipitated most of this geographical separation.

As our society became more mobile, seldom did the aging parent, or grand-parent, live in the same house, let alone the same city, same county, or even the same state as "the kids."  At the same time, every decade of our existence has seen a lengthening of the "average" age of people. Not only has this demographic factor become a case of longevity, but, in reality, a case of "extended" longevity.

And, with that extended longevity, a "care issue" surfaces. 

We would like to think that "old age" indeed leads to "The Golden Years", and in many ways it has.  But the fact is, that for many people, it has only extended the lifetime of the day that an older person needs help--help with normal activities of daily living-- with what were once common, routine everyday tasks.  Thus, the need for help, or care, or care giving, becomes another step in a lifetime of the normal elderly person.

In fact, many Americans find themselves with more parents than children.  It is not unusual in America today, that both Mom and Dad are retired or elderly, but in addition, Grandma and Grandpa, as well as two possible sets of  Great-Grandrents, who may be living, and not always in the best of health.  When one considers the magnification of this circustance with each spouse in a marriage, the possible combinations can escalate. 

In Canada, this situation was identified in 2007, with 36% of "middle age" individuals having more parents than children.  Can America be far behind, if not yet there already? 

As America gets older, the issue of children taking care of their parents or grandparents, and how they accomplish that from a thousand miles away, or even next door, has become a common "household" problem for millions of Americans. An issue which takes us to the present day.

In most cases, no matter how far "the kids" live from their elderly parents, older children have a love and compassion for the welfare and well being of their parents.  Phone calls may be made weekly, or twice weekly, or even daily.  E-mailing has become popular.  Vacation time may well be spent "going to see Grandma and Grandpa," and an occasional flight is in order for the older folk to "come visit the Grandchildren."

Then, someplace along the line, things begin to change.  Somebody notices that the older parent is "acting differently," or experiencing physical problems.  Falling down is a common harbinger of things to come.  Forgetfulness may set in.  Communication with the parents' neighbors may become routine.  "Just checking in," is a common phrase.  To be sure, concern and compassion are still in vogue for most intergenerational families. 

Others are geographically closer.  For instance, the term "sandwich generation" is set aside for those who, for a variety of reasons (including simple family love, caring and compassion, or finances) have accepted familial responsibilities, and find themselves caring for older parents and rearing their own children--in the same home.  Everyone should be so lucky.

The services of Medicare, Medicaid, and Social Security normally provide government financial support for the parent or grand-parent.  Long Term Care Insurance, Short Term Care Insurance, and Medicare Supplements all contribute to the financial and "peace-of-mind" status of the older person.

But one thing is missing in the mix.  Certainly, Medicare and Medicare Supplements or Medicare Advantage plans, provide for payment of the physical or medicinal needs of the elderly.  Long Term Care and Short Term Care Insurance can help with the financial burden of "care" needs of the older patient.  But something is still missing.  What could it be?

The answer is found In a phrase, "Preparation for the implementation of care needs," or more to the point, "Preparation for the implementation and coordination of care and medical needs for the elderly, as experienced by their loved ones."

It's just that simple.  While the physical medicine needs are covered by Medicare and a Medicare Supplemental or Medicare Advantage policies, standing by to be used when needed, there is a missing factor--that of being prepared for the moment when those needs surface.  And Long Term Care policies are available for utilization of care needs.  But, how does the younger adult respond to implementation of those plans, or for scary medical situations which may arise, when they are a thousand miles away?

Part Two of this series will identify the problems, challenges and solutions to this background of coordinating care needs for elders and their loved ones.

STAGE 1  -START YOUR PLAN BY DRAWING ON THE EXPERIENCE OF OTHERS-

By Ron Iverson, Copyright 2007

First, let's compile a short list of the experience of others--some misconceptions which caused problems--and find some solutions in this series of the blueprint.  Take a look at what to expect, face it, prepare for it, solve it, and move forward.  In other words, educate yourself and start to solve these problems for yourself now.

Experience Example No. 1.  "We thought we'd have enough savings to live comfortably in our retirement, but that doesn't seem to be the case."
 
INADEQUATE SAVINGS--  Starting savings plans, no matter how late in life, is one
solution to the inadequacies of Social Security and Pension income. However, savings rates for average Americans during the last decade have been shamefully low.  In fact, according to the US Department of Commerce, personal savings rates in June of 2005, hit ground zero.   Many feel that the normal cost of living and tax burdens prohibit savings.

In the retirement saving arena many people--most of the masses--lag far behind.  In December, 2002, a Congressional Research Service analysis of Census Bureau data discovered that "More than half the paid workers ages 25 to 64 don't own retirement savings accounts of any kind.  Of older workers ages 55 to 64, three out of four lived in households with retirement savings of zero to $56,000." 

The truth is that traditional savings plans are falling behind, as a source of income for retiring Americans.  In fact, would it be proper to say that many American families spend more than their income in any (every) given year?  In light of the ease with which Americans are able to obtain multiple high limit credit cards, today's consumer has fallen into a "buy now, pay later" mindset.    

An "Allstate Financial Reality Check" found that 78 percent of boomers felt they were ready for retirement and 69 percent said they knew how much money they would need to maintain their desired lifestyle.  However, the problem is that $30,000 (total) was considered as the "necessary amount."

In May of 2005, The Fidelity Retirement Index found that "the typical American household has saved $18,750 for retirement and expects to cover the majority of retirement costs through Social Security and pension benefits." 

As you can see, creating a position of inadequate savings is not exactly good news for people expecting a comfortable retirement scene expected to last as long as three decades.