Whenever I’m depressed about the state of the long term care (LTC) system in America, my mind wanders to other countries. What’s it like in Uganda, France, or Kazakhstan? Is it better, worse, or about the same?  Apparently, Howard Gleckman heard my cry. A senior research associate for the Urban Institute (and author of “Caring for our Parents”), he tackled this topic (in response to a Washington Post piece) in a recent column for Kaiser Health News.

Starting with a nutshell history, Gleckman states that, even just 20 years ago, most developed countries approached LTC in much the same way that our current Medicaid system operates. If you’re poor enough or sick enough, you’ll get the care you need. But if you are a person of modest means, well – give us a ring when you’re broke or too sick to manage on your own. Not really a great system, and certainly not financially sustainable.

Purchasing private long term care insurance has yet to turn the system around for the US, despite a strong government push towards this solution. Even today, only 7 million Americans have a policy.

European countries built on their existing national health systems to integrate a social insurance approach to paying for long term care, rather than the welfare bent so familiar to American citizens. But countries like Germany and the Netherlands have been forced to reduce benefits in response to rapidly increasing costs… so I guess the grass isn’t necessarily greener there.

In Japan, the creation of a national long term care insurance system – funded by taxes and premiums based on income – successfully covers 90% of the cost of care for their 65+ citizens. Despite this achievement, Japan is also struggling to keep up with the rising costs of LTC like their European friends mentioned above.

So who’s got it right?  The Washington Post seemed to think England had done a bang-up job, but Gleckman disagrees, stating, they “may face the biggest mess of all.”  Entrenched in a failing welfare model and in need of reform (sound like any place we know?), the United Kingdom has struggled for more than a decade to improve its LTC system.

I’m afraid, Mr. Gleckman, that I’m just as depressed as I was before I found your article. It seems that long term care is and will be the elephant in the room for years to come, both here and abroad. The global population is aging as rapidly as the costs for care are exploding. Nothing, especially health care, is getting cheaper, and seniors aren’t getting any younger. Maybe no one has it right yet (has anyone checked that island where good health and longevity seems to be the norm?), but someone needs to figure it out soon.

SFL followers, what are your ideas for improving the massively flawed LTC system? Any thoughts on how we got in this mess in the first place?

-Michelle Seitzer

This guest blog post is contributed by Boomerater, a free online resource for Baby Boomers helping you find everything from an investment advisor to great vacation ideas. Seniors for Living’s properties are featured in Boomerater’s Assisted Living directory.

Is one of your 2010 resolutions to find new ways to lower costs and save money?  Boomerater members have good news you can use; try these seven tips offered on Boomerater.com.

Tip 1: Save through online discount sites.

“My favorite site online to save money is www.dealslip.com! They have tons of great online coupon codes for 500+ stores.“ Learn more about other online discount sites.

Tip 2:  In addition to saving money, how about finding it?

“At http://missingmoney.com/main/index.cfm you can search for money you may have forgotten in banks, with utilities, rent deposits, etc. It doesn’t cost anything to see if you have ‘found’ money waiting to be claimed.”

Tip 3:  Your memberships can save you 10 – 15% on products and services.

“AAA is a great way to save money. Most people initially get the service for emergency road assistance, but a lot of national companies will give you a discount when you give them your AAA number. We have saved at Target, UPS, Marriot, Barnes & Noble, and Hertz. We never book a hotel without asking first if they offer the AAA discount.  We also have an AARP membership and often save when using their card.”

Tip 4: Bartering can be a real money saver.

“I started by swapping my landscaping services with members of my church (we publish a list of anyone willing to barter services.) I also tried Craig’slist but didn’t see anything in my area I wanted to trade for. ITEX is a more flexible alternative. You sell a product or service and get ITEX virtual $$ in your account. Then you can use those $$ to buy another product or service from an ITEX member. I have traded landscaping for computer services, and have gotten new clients in the process. The only drawback is they charge a 6% fee to both parties in the deal.”  Find out how other Boomers are saving by bartering.

Tip 5:  Explore ways to save when paying bills and managing finances.

“If you don’t have a mortgage, or pay very little on yours, you may be able to bunch itemized deductions into every other year, taking the standard deduction in the non-bunching year. When you drop non-cash items off to charity, you can deduct the value of items in good condition if you itemize. See goodwill industries website for help with valuation.  Also, if you are in the range where your social security payments are starting to be included in your taxable income, your effective marginal tax rate is higher than you may know. See if you can do something to either stay below it, or go way above it some year to avoid it in future years.  Lastly, many people pay too much on investments – yours may have built in expenses you don’t know about.”

Tip 6:  Cut your phone bill.

“I don’t really have much of a clue about phone networks, but I know they aren’t very cheap. My son showed me a site called FishText.com which is 90% cheaper than normal networks. It may not seem like great savings, but it just gives me that little extra change in my pocket!”

Tip 7:  Frugal shopping pays off.

“I was recently laid off. Very little savings and no clue about frugal shopping. Now I am a pro. Amazing how need can be such a strong motivator!  I save $92 a month on my prescription and my neighbor saves over a hundred. We have a nationwide discount card. I save $70 a month on groceries and save $37 on pet food. To me, saving on these things is like earning money every month.” Learn more about other tips on how to save on prescriptions.

Add your own money saving tips, or learn advice from Boomers about finances, travel, family and relationships, shopping, interests and passions, health and fitness and careers at Boomerater.com.

heating for seniors

As we ease into cooler weather, increased home energy costs can be a burden to many seniors already surviving on limited incomes. But, did you know that many state and local governments have assistance programs for the elderly? These programs may differ slightly from one another and there may be an age or income requirement; there also may be a maximum dollar or percentage amount provided.

The simplest way to find out if your area offers a discount is to call your local providers for services such as water, electricity and gas. Additionally, the Low Income Home Energy Assistance Program (LIHEAP) may yield some financial help. State LIHEAP programs can provide more information.

Another approach to saving on seniors’ energy bills is the Weatherization Assistance Program (WAP). This program helps low income citizens improve the energy efficiency of their homes. Qualified persons may get a free energy audit and home repairs. Consult your state Weatherization Assistance Program for additional information.

See which programs you or your senior loved ones qualify for, and get signed up!

Although my husband is only a reservist in the United States Coast Guard, we still take advantage of every perk, discount, or resource that serving in the military has to offer – and we constantly share those opportunities with anyone we know who might also be eligible.

Ted Gumley has created a successful business by sharing one valuable opportunity for senior veterans and their spouses: the Aid & Attendance program. I recently had the pleasure of speaking with Mr. Gumley, a World War II veteran who has owned a number of assisted living facilities and now serves as CEO of Senior Care for Veterans.

Senior Care for Veterans is a private company with 15+ years of experience that consults and assists as to the criteria required to qualify for VA pension through Aid & Attendance, a non-service connected disability pension that can help cover the costs of long term care for qualified veterans and surviving spouses. According to Ted, most veterans don’t know anything about this valuable benefit; in fact, while 33% of all senior citizens in the U.S. are entitled to Aid & Attendance, only an estimated 5% of those eligible are actually receiving benefits. Of those enrolled the program serves 7% of surviving spouses and 34% of veterans eligible.

The $3.3 billion pension program is housed at the VA (Veterans Administration), but the VA is legally prohibited from advertising it. In addition, the fractured nature of the VA and cut backs in personnel contribute to the difficulty of processing benefits for program enrollees, so the VA counts on companies in the private sector to help applicants navigate the confusing and inconsistent requirements needed to secure funding.

And just how much funding can be secured? Eligible applicants can receive up to $1,948 per month or $23,376 per year. “People have cried on the phone because they are so happy to receive the help,” says Ted. It’s not hard to see why – in today’s harsh economic climate with funding for seniors being slashed nationwide and the cost of long term care increasing rapidly, this pension program is a lifesaver for countless seniors and the family members struggling to pay for their care.

Senior Care for Veterans has helped more than 15,000 vets and their surviving spouses receive the financial help to which they are entitled, at a 99% success rate. They have worked in 42 states advising assisted living facilities and home health agencies in guiding applicants through the process too.

–Michelle Seitzer

With many state governments in fiscal crisis mode, seniors and their advocates are also in a state of panic. Funding cuts across the board could significantly impact vital programs and services for seniors. Often among the cuts are senior centers — for many, that means losing their “lifeline.” As a hub of senior services in the local community, seniors, particularly those isolated and alone, rely on these centers for nutritious meals, exercise, flu shots, activities and social contact.

Tami Luhby, a senior writer for CNN Money.com, explores the impact that slashed government funding would have on the seniors who come to the Fox Point Senior Center in Providence, Rhode Island. She states that Rhode Island isn’t alone: at least 45 states are projecting budget deficits for the current and future fiscal years, and are forced to cut funding for many programs and services that seniors and other vulnerable populations need desperately.

Senior center directors across Rhode Island are “scrambling to maintain services in the face of funding cuts,” and they are doing so in a number of ways (i.e. reducing hours, eliminating activities, letting go of staff). This “doing more with less” is not the ideal way of managing the centers, but Corinne Calise Russo, director of the state Department of Elderly Affairs, affirmed the necessity of these difficult cuts: they had to be done to maintain other critical services such as adult day care and home care. Russo says, “No seniors will be left without meals or assistance.” Enter the big “but”: they might have to seek those services elsewhere. Russo maintains, “There was no other place to go for this funding. There were no other options.”

While some centers may be able to go on with limited services, some may have to shut their doors altogether. This worries Lori Silvia, Fox Point’s executive director. “People become isolated when they don’t have services like this,” Silvia said. “They just sit in their apartments. We don’t want to see that happen.”

Senior centers are indeed a vital part of every local community, and not just for the seniors who frequent them. Lawmakers and other elected officials need to know just how vital these centers are, despite the daunting financial challenges presented in their ledgers. Reach out to your local state representatives and senators and let them know what the senior center means to you and your community. No matter what happens, they need to hear from their constituents. And you never know: your voice could make the difference.

What’s happening in your state/community?  Are senior centers nearby in danger of closing? Reducing services?  How has it impacted your community?

- Michelle Seitzer

It might be hard to believe, but we’re halfway through 2009 already.

The mid-year is always a good time to evaluate then and now, so let’s take a look at an article on www.seniorhousingnews.com, which posted in January. The article listed 10 senior housing issues predicted to be hot topics; the list included (to name a few) reverse mortgages, senior housing entities filing for bankruptcy, and the emergence of innovative housing models (remember the March blog on GrandParent Family Apartments?).

An item that I found interesting was issue #4, which predicted that 2009 would reveal “more children moving back home with their senior parents or moving parents into the children’s home.  The unemployed are more likely to care for elderly parents at home, instead of putting them in more expensive retirement homes or assisted living communities. They also might pull parents out of facilities and move them back home to cut costs.”

I wouldn’t doubt that this trend is on the rise, and in her article “When Mom Moves In: Statistics, Trends and Benefits” posted on March 5^th of this year, Linda Lowen affirms its truth. The article states that, according to US Census Bureau statistics released in September 2008, “The number of parents, siblings and other relatives who live with adult heads of households grew 42% from 2000 to 2007.”

Intergenerational households aren’t a new phenomenon, but the numbers clearly show a sharp rise in the percentage of family members moving in, whether it’s to save dollars, provide care & support, or both. In some cases, grandparents move in to help take care of their grandchildren. Whatever the reasons, these arrangements may save dollars that would be spent on residential care, but sometimes, especially in difficult caregiving situations, the costs are often beyond what dollars can measure.

Item #7, which proposed the emergence of innovative senior housing models, also caught my eye because of the examples suggested: “[will we see]…small bands of seniors bonding in 4 flats?  Privately held small apartment buildings self managed by seniors that live there?  More co-ops?  College dormitory style living?  The return of the travel trailer?  So many choices…”

Necessity is the mother of invention, right? With the exploding senior and baby boom generation (it is projected that the 60+ crowd will represent 25.1% of the population in 2030), it will take more than just nursing homes and retirement communities to fill the need, so I wouldn’t be surprised if these and other innovative models emerge on the scene.

Seniors for Living followers, I want to hear from you! What do you think about these innovative housing models (or have ideas to add)? Have you noticed an increase in the number of intergenerational households? What other senior housing industry trends have you observed?

-Michelle Seitzer

This guest blog post is contributed by Boomerater.com, a free online resource for Baby Boomers.  The site can help you find everything from a financial advisor in New York to the latest gadgets and gizmos. Seniors for Living contributes to Boomerater’s search for senior housing section.

A new Q&A discussion from Boomerater’s forums appears here each Friday. This week’s topic is about how to save money when buying prescription drugs.

Boomerater Question: I can’t afford the rising costs of my prescriptions. I have friends in the same boat who have stopped taking their meds, or are splitting pills, or are taking them every other day. I know this can be dangerous so I’m asking if anyone can offer cost-cutting tips.

Responses from other Boomerater members:

• Whatever you do, don’t change how often you take your medications. DO opt for generics whenever you can. Also, check out the price at your local grocery store pharmacies for generics. The cost of my meds went from a $20 co-pay per month at a national drug store chain to $9.99 for three months at the grocery. Plus, it does not even go through my health insurance plan. For two prescriptions I am saving almost $400 per year.
• I saved a lot of money going to the grocery pharmacy for my generic prescriptions… one word of advice –  you will need to have your doctor convert your 30-day prescriptions to 90 days to take advantage of the supermarket pharmacy deals.
• Pill splitting is OK for some prescriptions but can be dangerous for others, especially time-released drugs. You should talk to your doctor. And as mentioned already, if you can take generics you will save a lot of money.
• Check out the generic $4 prescription program at Wal-Mart and other chains. If you’re not sure whether your drug is available in generic form, the U.S. Food and Drug Administration has a generic equivalency tool at http://www.fda.gov/cder/info/consumer_generic.htm. You can find further details in a piece Phil Moeller wrote for U.S. News & World Report on Tips to Cut Your Drug Costs at http://www.usnews.com/blogs/the-best-life/2008/12/9/tips-to-cut-your-drug-costs.html.

Do you have tips of your own to share? To post your reply to this question on Boomerater, go to: Cost-Cutting Tips for Prescription Drugs.

An innovative housing project proposed for Milwaukee’s North Side will help grandparents who are caring for their grandchildren. With a price tag of $10 million, Villard Square would not be the first of its kind in this newest senior housing trend, following major metropolitan areas such as New York, Chicago and Boston. Chris Laurent of Gorman & Co. development firm states the project’s goal: placing children from broken homes into a stable environment.

Many of these children have been entrusted to their grandparent’s care because their parents are either in prison, battling drug addiction, or have other problems. According to the 2000 Census, approximately 7,052 Milwaukee grandparents found themselves in this challenging role. With these challenges in mind, developers are building in a number of on-site supportive services, such as parental counseling, to Villard Square.

New York City opened GrandParent Family Apartments in 2005, where 94 children (ranging from ages two to twenty) live with their 60-80 year-old grandparents. Older residents of this complex enjoy senior-friendly features like wide hallways and emergency pull-cords in their rooms, and on-site tutoring services and a playroom appeal to the children. Social workers are also available to work with the children and their grandparents, fostering better communication and supporting the entire family in this new arrangement.

The city of Milwaukee and others who have already developed projects such as these should be commended for their vision and their desire to meet a growing need in today’s society. While living in an apartment complex with hundreds of children in need of tutoring or social work interventions may not sound like the retirement of your dreams, it is nonetheless a harsh reality facing many seniors today. In my home state of Pennsylvania, several state lawmakers have sponsored legislation for a number of programs to assist these second-generation parents, who have many needs of their own and yet must attend to the needs of their children’s children.

I suspect that Villard Square and GrandParent Family Apartments may become the norm in the next decade, and I hope that other cities and towns will be sensitive to these new family arrangements and offer whatever support they can.

What are your thoughts about projects like Villard Square? Do you know someone who is raising their grandchildren? What kind of support do you feel that government or community organizations can and should provide? Share your comments here!

- Michelle Seitzer

Some Relief for Social Security Beneficiaries

The passage of the economic recovery bill means just a little bit of cash ($250 for individuals, $500 for couples who receive Social Security benefits) will go to seniors in May.  According to a recently published AARP Bulletin, the “so-called senior payment” does not require any additional paperwork; beneficiaries will receive the money in the same way they get Social Security (direct deposit or mailed check).

This payment was not included in the House’s version of the bill but was championed in the Senate by Max Baucus (D-Montana, chairman of the Senate Finance Committee) and Sheldon Whitehouse (D-RI).  AARP supported this provision in the legislation, citing research “showing that older people tend to spend such payments immediately.”

Visit the Social Security Administration website for more information.

Highlights of the Stimulus bill for older Americans, as per the National Council on Aging:

The act includes:

· $100 million for senior nutrition programs;

· $120 million for the Senior Community Service Employment Program (SCSEP);

· $87 billion to increase the federal Medicaid match to states (a 6.2 percent increase from Oct. 1, 2008 through Dec. 31, 2010);

· a one-time payment of $250 to Social Security, Supplemental Security Income (SSI) and certain veterans by the end of May; and

· the package also extends the Medicare Savings Program Qualified Individual (QI-pays Part B premiums for eligible beneficiaries) program through Dec. 31, 2010.

Elderly at Risk?

The rebate check and the boost in program funding is not enough to outweigh the other provisions in the stimulus package that may hurt vulnerable seniors, according to an opinion piece by Betsy McCaughey.

Her piece outlines the “hidden” health provisions in the legislation that could mean many seniors will not get the help they need.  For example:

“Medicare now pays for treatments deemed safe and effective. The stimulus bill would change that and apply a cost-effectiveness standard set by the Federal Council (464).

The Federal Council is modeled after a U.K. board discussed in Daschle’s book. This board approves or rejects treatments using a formula that divides the cost of the treatment by the number of years the patient is likely to benefit. Treatments for younger patients are more often approved than treatments for diseases that affect the elderly, such as osteoporosis.

In 2006, a U.K. health board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other eye. It took almost three years of public protests before the board reversed its decision.”

McCaughey, a former Lieutenant Governor of New York and an adjunct senior fellow at the Hudson Institute, asserts that there was not enough scrutiny of the legislation before final passage, stating the stimulus is “dangerous to your health and the economy” and “the elderly will bear the brunt”.

While I understand that this is an opinion piece, I am concerned for the possible implications these system changes could bring, particularly to vulnerable seniors. We’ve all heard the sound bytes in the news this past week – we know there are a wide range of opinions on the bill and whether it will help or hurt the struggling economy and the American people. I imagine the 1000+ page document, formally called the American Recovery and Reinvestment Act of 2009, is full of items that probably needed further scrutiny. In my opinion, seniors are already marginalized in our society, so I am curious to see what the outcome of these provisions will be. I hope for the best, but in the meantime, I hope that senior-focused advocacy and service organizations will be prepared to carry the load in times of need.

What’s your read on the stimulus package as it pertains to seniors?  Share your thoughts here.

- Michelle Seitzer

Dale Carter, one of SFL’s guest bloggers, helped her mother transition out of her home to a retirement community.  She created her blog, “Transition Aging Parents,” to share lessons learned from that experience.  She writes about issues, products and services that will aid daughters/sons in helping their aging parents…

Here’s a great resource for seniors and family members with Medicare coverage: “My Medicare Matters.” Sponsored by The National Council on the Aging and the Access to Benefits Coalition, “My Medicare Matters” is a user-friendly portal providing Internet-based educational tools that help those with Medicare Part D assess their coverage options and create a “personalized” comparison of available prescription drug plans. I recently used this tool to review my mother’s current Medicare drug plan.  We were surprised how easy it was to use and how quickly it identified immediate cost savings!

You will find this tool useful:
* To educate yourself on Medicare plans, requirements and terminology
* To determine if you can save money right now on prescriptions with your current Medicare prescription drug plan
* To review and compare drug plan choices during Open Enrollment each year, November 15 through December 31

In preparing to use this tool to generate a “personalized” drug plan comparison, I suggest the following:
1.    If you are unfamiliar with Medicare programs, I recommend a review of Medicare programs and terminology.
a.    Go to http://mymedicarematters.org/
b.    Click on “Learn About Medicare.”
c.    Follow the links on the left hand side.  (Get a grasp of the major concepts. Read the detailed definition for any term you’re unfamiliar with.   Take your time.  There is an incredible amount of information there.)
d.    If you have limited time, pay close attention to “What Medicare Costs” and also “Medicare Savings Program.”  (This includes qualifications for extra help.)
2.    Obtain the personal information you will need to use the tool:  Medicare Number and effective date, date of birth, Zip code, county, name of current drug plan, names of all medications, dosage, and quantity (per month).

Now you’re ready to use the tool. Here are easy-to-follow instructions:
1.    Go to http://mymedicarematters.org/

2.    Click on “Learn About Choosing Plans.”

3.    Click on “7 Simple Steps” on the left hand side and follow the prompts.

4.    “Step 5 – Picking a Plan” is where you will spend most of your time. (Important key concept: the site advises choosing the plan with the lowest overall annual cost.  You may initially think choosing the lowest premium will save you the most. But don’t overlook a high deductible or a potentially large expense when in the coverage gap.)

a.    Print out instructions for using Medicare.gov’s Prescription Drug Plan Finder.  Then click on “Medicare.gov’s Prescription Drug Plan Finder.”
b.    Click on “Find and Compare Plans.”
c.    Click on “Begin Personalized Search.”
d.    Enter required information and follow the prompts to view your current coverage and other prescription plans in your area.
e.    Next, enter all current drugs, dosage and quantity (per month). (Note: Once you have done this entry, you will be given an ID number for the drug list.  Record that number for future reference.)
f.    Now you will view a detailed cost breakdown using your current drug plan, as well as comparable prices through other available drug plans in your area.
g.    This is a key step to immediate cost savings! Click “Lower this Cost” for your current plan.  You will get a list of ways to save on current prescriptions, including suggested alternative drugs. If your doctor believes that the alternative drugs are acceptable, you may be able to begin saving money immediately.
h.    The remaining steps will help you change drug plans (usually during open enrollment).  On your “Personalized Plan List,” click on the “Estimated Annual Cost” and choose “sort.”  Choose up to three plans (including your current plan) to compare and click “compare.”

You now have your “personalized” drug plan comparison.  Print it out and review it carefully.  It contains a tremendous wealth of information.  My mother and I plan to use this tool each and every year during mid-November.  Why?  There may be changes due to congressional or state legislation, changes in prescription plans, and also changes in a person’s financial situation and medications. Prepare now by scheduling a follow-up check on your calendar.