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Sunday, August 25, 2019

Disappearing Health Care Coverage



Jobs that until now offered generous retiree health care benefits are doing an about-face to save money.


Workers are taking on more and more of the costs of being retired as employers shift the risk away from corporations.

"Employer-sponsored retiree health coverage once played a key role in supplementing Medicare," say Tricia Neuman and Anthony Damico of the Kaiser Family Foundation. "Any way you slice it, this coverage is eroding.”

In 1988, 66 percent of large firms that offered health coverage also provided retiree health plans. By 2015, that number had shrunk to a mere 23 percent.


The disappearing benefit: Employers have been cutting out retiree health coverage. (Kaiser Family Foundation)

Health Savings Accounts to the Rescue 


If you qualify, there is one way to counter the erosion of medical benefits. Health Savings Accounts (HSAs) are available to Americans not yet on Medicare who are covered by high-deductible health insurance plans. You fund an HSA with your own money, but it’s tax-free going in and tax-free coming out, as long as you use it for an eligible health-related expense. The annual limit for a single adult is currently $3,500, or $7,000 for a family, with a $1,000 catch-up contribution available for those 55 and older.

The money is held by an administrator, many of which offer low-cost investment options such as market index funds. You can spend your HSA on deductibles, premiums, copayments, medical equipment and the like. Or, save your receipts to be refunded (or not) later, and let your (tax-free) account grow over time. Get HSA basics here, or go to the IRS for complete HSA rules.

Check here for some of the best HSA fund administrators and general advice. Oh, and if you don’t have the extra cash to put into an HSA, but you qualify and have a traditional individual retirement account (IRA), use the one-time rollover option to fund your HSA. Why? You’ve just sheltered that money from tax liability when it’s withdrawn in exchange for agreeing to use it for medical costs. And health care expenses, like death and taxes, are a certainty.



Many Americans are under the impression that Medicare will pay their health care costs when they retire, so why worry? That impression is a mistaken one.

"The drop in retiree health coverage has important implications for retiring boomers who are approaching their Medicare years with a different set of insurance needs and choices than their parents' generation," the Kaiser analysts write.

The Medicare Part A deductible for hospital services is $1,364 for 2019, and you’ll pay $341 of coinsurance for every day over 60 that you’re in the hospital. Medicare Part B, for physician and other outpatient services, has a $185 deductible, and you must pay for 20 percent of services.

Those numbers may not faze retirees with large nest eggs, but for those who haven’t feathered their nest, chronic illness or a single acute medical event can create a financial crisis.

Kaiser’s employer survey revealed that the drop in employer-sponsored health care has come at the expense of those least able to bear it. Among the largest employers (5,000 or more employees), 42 percent continue to offer retiree health benefits. This number drops to 20 percent for companies with 200 to 999 workers. The highest rates of coverage were in state and local government (73 percent), communications and utility firms (62 percent) and finance (49 percent). The former two are highly unionized. But if you’re a low-wage earner in retail (12 percent covered) or agriculture and construction (15 percent covered), it’s much less likely you’ll have employee health care benefits in retirement.

Ripple Effects


It’s bad enough for the retirees themselves, but these reductions in benefits have far-reaching consequences. Left with holes in their coverage, many retirees opt for Medigap policies and pay the monthly premiums. This drives up costs for the federal government, in turn. People with Medigap policies tend to use more health care services because trips to the doctor or clinic are fully covered. Today, 1 out of every 4 Medicare enrollees has a Medigap policy.

Legislated limits on Medigap plans may well follow. A broad consortium of policymakers from right, left and center ideologies have advocated to prohibit Medigap plans from covering deductibles. If this happens, an increasing number of retirees may look to Medicare Advantage for relief. These plans offer smaller provider networks and caps on annual spending. But they’re also pricier for the government.

The trend in reduced retiree benefits is not likely to reverse. However, it’s important to keep in mind that Medicare is not a panacea and health care is not solved once Americans turn 65. If anything, the growing number of older adults will drive changes in health care delivery in the near future.

When States Default


Almost a quarter of Americans are not covered by Social Security. Instead, they depend on pension funds, many of which include health care benefits. But these benefits are eroding.

It’s no secret that many public pension plans are in trouble. During the Great Recession, many states and local governments reduced employer contributions, effectively borrowing from those funds.

The problem varies in intensity across the states. By the end of 2015, pension funds in Kentucky, New Jersey and Illinois had 40 percent or less of the assets they required to meet their obligations. Puerto Rico was even worse: the U.S. territory was 1.57 percent funded. The total gap for post-employment benefits in all 50 states is near $600 billion, according to government data gathered by Eaton Vance Corp.

Some states are acting preemptively and denying health care coverage to new employees. This can take hiring from difficult to near impossible. In Butner, North Carolina, new recruits for correctional facilities jobs no longer get health care benefits in retirement. Roughly 30 percent of the county’s correctional officer positions were unfilled in May 2019, according to Charles Johnson, corrections official. The entire state will end retiree health care for new hires in 2021.

Kansas already tells retirees to pay the full cost of health care, sending monthly premiums as high as $1,000. Three-quarters of enrolled retirees have since dropped out, according to Duane Goossen, the state’s acting secretary of administration. But the plan worked. Liability dropped from $6.1 trillion down to $508,000.

North Carolina Treasurer Dale Folwell expects eliminating health care benefits for future retirees will strengthen the state’s finances. With $28.5 billion in unfunded retiree health care liability, North Carolina was desperate. “It’s not emotional and it’s not political,” says Folwell. “It’s mathematical.”



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Blog posting provided by Society of Certified Senior Advisors

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Are You Spending Enough in Retirement?



Worried that their money may not last as long as they do, many retired adults underspend their nest eggs.


It may seem crazy that some people don’t spend enough in retirement. After all, most of us worry that we won’t have enough amassed to get us through the years after we stop working. The percentage of people with pensions is declining, investment returns are expected to be reduced in coming years, and retirees may live longer in the future. So what gives?

How Much is Enough?


Most of us have calculated how much we think we’ll need to retire. We may have used the rule of thumb to save 25 times our salary at the end of our career. Others have followed the 4 percent rule, which holds that a portfolio invested in 60 percent stocks and 40 percent bonds can safely yield 4 percent (increased annually for inflation) over a 30-year retirement period.

Say you have $1 million saved up when you retire at age 65. Using the 4 percent rule, you would withdraw $40,000 the first year, adjusting that figure upward every year thereafter to cover inflation. Add to that Social Security, a pension and any other sources of income for your total annual budget in retirement.

Following the 4 percent rule has been touted as a good way to make your savings last, and there’s a lot of research to support that. Many online calculators use the approach to project how much you’ll be able to safely spend. However, today’s financial professionals may use a more conservative 3 percent estimate, due to low bond yields and projections that future stock market returns may not match historic levels. But in the same way that your budget today doesn’t reflect what it was 10, 20 or 30 years ago, your budget in retirement is unlikely to remain static.


Financial Planning Software


Like many, you may have used online calculators to figure out how your savings stack up against projected spending in retirement. There are endless variations on the theme available, from BlackRock’s new LifePath tool, which produces an estimate based strictly on your age and total savings, to Personal Capital, a robust wealth management tool that provides Monte Carlo simulations for future predictions.

These tools are great for do-it-yourselfers who want estimates at their fingertips. However, it’s wise to use a financial advisor or financial planner for these important calculations. These professionals have industry software that is not available on the internet, and can provide a detailed analysis and projections. Combined with the professional’s experience and knowledge, the result is a comprehensive plan that can be altered over time to accommodate changing circumstances.

Not every professional and their approach is a good fit for every client, however. In addition to varying personal styles, there is a wide range of industry software that financial planners can choose from. You may want to ask if a professional uses goals-based software that estimates whether or not you can save certain amounts toward retirement or a college fund, for example, or a program based on cash flow that accounts for every dollar spent. Does the professional assume straight-line spending, or use Monte Carlo simulations? Does the software include tax brackets and deductions, and can it plan around your state’s tax rules?

For a chart of the “Financial Planning Software Landscape” and a detailed discussion of the many iterations available, check out industry guru Michael Kitces’s blog on the subject. It can help you find the software you prefer, which you can use to search out a financial professional who syncs with your style and needs.




Retirement Budget Patterns


“This is my 35th year in practice, and I can tell you none of my clients has ever spent on a straight line,” says Neal Van Zutphen, a certified financial planner (CFP) with the firm Intrinsic Wealth Counsel in Tempe, Arizona. “Your spending habits and your spending needs will change over time.”

This is an important concept, because the tendency is for spending in retirement to go down as we age. CFP Michael K. Stein has termed these three stages the Go-Go years, the Slow-Go years and the No-Go years, and we teach these terms in the Society of Certified Senior Advisors' Working with Older Adults class.

Research seems to back up this pattern. In its Consumer Expenditure Survey, the Bureau of Labor Statistics found that the mean spending for households headed by 55- to 64-year-olds was $65,000 in 2017. That number fell to $55,000 for households headed by 65- to 75-year-olds, and then dropped again to $42,000 for those headed by someone aged 76 or more.

That trend has shown up in a spending patterns study by J.P. Morgan Asset Management. Reviewing customer data, the firm found that the decline was accentuated for retirees with $1 million to $3 million in assets, according to Katherine Roy, chief retirement strategist.

“It appears that the more you have, the steeper the spending decline in real terms,” Roy says. The impact on retirees is profound. Roy estimates that financial planning tools designed to cover a 30-year retirement “could overstate spending in late retirement by 30 percent or more.”

Which Profile Fits Your Spending?


However, this may not be true for everyone. When the firm grouped its customers according to their spending patterns, the data showed a surprising result. Clients were put into 1 of 4 categories: health care spenders, globe-trotters, homebodies or foodies.

Although there is overlap for everyone, it may be important to figure out which group fits you best, according to Wade Pfau, a professor at the American College of Financial Services and director of retirement research at McLean Asset Management. The first three groups saw very little to no reduction in their spending habits over time. The biggest group, the 39 percent of retirees who fell into the food and drink category, saw their spending decline as they got older.

What About Health Care?


Hold on, you may be thinking, what about the cost of medical treatment and prescription drugs as I get older, and what if I need a nursing home or move into assisted living? Most of us are aware that those involve substantial expenses.

It’s true that increases in spending in the later years of retirement are almost always related to health care, according to the Health and Retirement Study, a project of the National Institute on Aging and the University of Michigan. However, according to David Blanchett, head of retirement research at Morningstar, those in their 70s and 80s usually spend less than their younger counterparts.

“The real change in annual spending through retirement is clearly negative,” says Dr. Blanchett. He feels that financial advisors need to communicate that information to their clients. “They can say, ‘The most common assumption is that you’re going to increase your spending by inflation, but here’s the deal: The average person doesn’t do that.’”

Dr. Blanchett offers a fix for calculations that overestimate spending as we age: Run the program with the assumption that spending goes up by one percentage point less than inflation.

“How does that change how you can spend your money?” Dr. Blanchett asks. “One thing it can do is free up money when you can most enjoy it. Take that cruise when you’re 65 or 70 because you’re probably not going to be able to take it when you’re 80.”

Barriers to Spending


There are other barriers to adequate spending besides faulty projections. Some people have enough saved for a more lavish lifestyle but find it nearly impossible to spend beyond daily needs. Financial writer Michael Kitces refers to this as a “consumption gap” in his Nerd’s Eye View blog.

"Where I have seen it be a problem is on the behavioral front," says Jeffrey Farrar, managing director of Procyon Partners in Wilton, Connecticut. He says that some clients obsess over an arbitrary net worth number and fail to enjoy their wealth.

Or, as Luis Rosa, founder and CFP at Build a Better Financial Future in Las Vegas, says, “Do you want to be the richest person in the graveyard?” He uses this question to jumpstart conversations with clients who are overly frugal.

The failure to spend may be largely psychological. After a lifetime of saving, clients may be loath to see their balance go down. They may have an irrational fear about running out of money before they die. After all, says David Nash, owner of Magister Wealth in San Antonio, “You are advocating against the good habits that gave them this enviable circumstance.”

Running calculations to show they have plenty of money may not be the answer. "You can't satisfy an emotion with a number in your bank account," says Jeffrey Stoffer, founder of Stoffer Wealth Advisors in San Rafael, California. "The emotion is fear and it doesn't just go away when you hit a magic number."

Financial professionals can use various tactics to assuage the worry these clients feel around spending their money. First, discuss the big picture using a financial plan. This can drive home the point that sacrificing their lifestyle doesn’t really buy them anything. Second, use a random Monte Carlo simulation to project balances in even the worst of circumstances. Finally, suggest an annuity for clients with anxiety around spending. Having a fallback every month that pays for essentials can help them view the rest of their portfolio as “fun money.”

The Very Wealthy


Another category of retirees who may not be spending enough are those whose estates will exceed the estate tax exemption when they die. Currently, that stands at a whopping $11.4 million. But there’s a kicker. There are no guarantees the exemption won’t be reduced, perhaps significantly, in the future. The top estate tax rate may rise, too. If you died today, Uncle Sam would take 40 percent after the exemption, but that number was 55 percent as recently as 2001, when the exemption was $675,000.

Instead of paying the government upon death, these lucky retirees should be distributing wealth to loved ones and favored charities while they are still alive. Working with a financial professional, they may choose to donate cash, appreciated securities and/or property. Vehicles such as donor-advised funds or a private foundation may be useful to administer funds.




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Blog posting provided by Society of Certified Senior Advisors

www.csa.us

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Taking It to the Road



It’s the height of road travel season, and we bring you three of our favorite trips, along with tips for planning!


You’ve been meaning to take that trip, but things keep getting in the way. The garden needs attention, your porch is crying out for some fresh paint and your list of “little” jobs to do around the house is longer than the one for groceries. And here you thought retirement meant free time to do what you wanted! Well, the doctor says you need to hit the road.

“Travel serves many purposes,” according to Gregory Jantz, Ph.D. and a mental health expert in Edmonds, Washington. “Any time we change our environment, we have the potential to change our perspective. And when you change your perspective, you may find pleasure in things that maybe you didn’t know you’d enjoy.”

So make sure the oil’s been changed recently and load up the car or RV for a road trip this summer, doctor’s orders! Now, where to go? How about one of these three classic trips to put a new spin on your perspective?

Trip 1: Pacific Coast Highway


With more than 650 miles of Pacific Ocean coastline, California State Route 1 is perhaps the premier beach route in all of North America. Jaw-dropping vistas await you from Mendocino County in the north, to the road’s southern terminus in Orange County. You’ll travel through the famous seaside town of Carmel, and wine country is only a short side trip away.

Your first stop has to be Fort Bragg Beach, which has the distinction of being made of glass. Literally. After being used as a dump and suffering years of neglect, the beach was completely cleaned up and reopened. The only reminder of its past is the sea glass sand, made from bottles and jars smashed up and pounded smooth by the waves.

Next, visit Point Reyes National Seashore. Sitting just north of San Francisco, more than 7,000 protected acres of rocky sand and seagrass hills await. Head to the lighthouse or take a dip in the waves, which may hold the region’s colony of elephant seals.

Ah, San Francisco! You’ll travel the Golden Gate Bridge by car along your route, but stop and rent a bicycle to take you back over, meandering along the ocean until you catch a ferry back. Take a trolley to Fisherman’s Wharf and gobble up some heavenly fresh sourdough bread while you watch the sea lions cavort. Or take a trip to Alcatraz, the notorious former island prison in the bay. For a fun twist, rent a three-wheeled motorcycle with audible guided tour included and hit some iconic spots that are a little less-known.

Next, you may want to plan a stop at Moss Beach Distillery. Fans of Unsolved Mysteries will be on the hunt for its Prohibition-days ghost, the Blue Lady, who is said to haunt the building. But all can appreciate its stunning location on a cliff overlooking a scenic, secluded beach — one of hundreds along your route.

You’ll know you’ve arrived in Big Sur when you spot the open-spandrel arch bridge that has been featured in a host of commercials and TV shows. The view from the Bixby Bridge is indeed stunning, and if it makes you a tad peckish, there are a bevy of seriously good eateries in town to satisfy your appetite.

You may normally turn up your nose at a group tour, but it would be a tragic mistake to miss Hearst Castle. The home of newspaper baron William Randolph Hearst, the adjoining cottages hosted dozens of starlets and other famous icons of the day who socialized at meals served in the main house, which is a fantastic museum on its own. By all means, wander down to the tile-enclosed Roman pool where Howard Hughes, Joan Crawford and Charlie Chaplin stroked the water. And guess what?! Join The Foundation at Hearst Castle for a mere $950 minimum, and you can be one of the first to enjoy one of five pool nights this summer … the first time the pool has been open to the public.

It’s not over yet! Spend your next-to-last day at historic Santa Monica Pier. Ride a carousel pony, check out the aquarium, or walk the beach while engaging in some people-watching. Tomorrow, you’ll take the last leg of the highway to Capistrano Beach. Stop by the mission in San Juan Capistrano, and get a ridiculously touristy souvenir at the Trading Post. Opened in 1947, it’s been around longer than most of us!

Apps for Travelers


Embrace technology with applications that enhance your travel experience. The Furkot road trip planner can help you find great places to go and even book your stays all across the U.S. and around the world. It can calculate driving time, plan a route and suggest overnight stops. You can also play around with the itinerary you create and make last-minute changes. But wait, there’s more! Furkot can schedule motorcycle rides, biking holidays and walking tours as well.

Roadtrippers is another service that helps map your route and find the best places to visit and stay. You can even access Roadtrippers Magazine on the homepage to get ideas for trips you’d like to take. A quick look at recent issues reveals where to find a luminescent super bloom, a look at the world’s first open-air augmented reality planetarium and where to ski on the Fourth of July.



Trip 2: The Badlands


That’s right, scenic South Dakota. If you’re raising an eyebrow at this rural Midwestern destination, you just don’t know what you’re missing. The nation’s rolling prairies have their own stark beauty as you drive twisting roads through this remote corner of the Mount Rushmore State, home to the Black Hills.

From Rapid City, it’s an hour over to Wall, home to Wall Drug. If souvenirs aren’t your thing, check out the giant animated T-Rex. Then hit the Western Art Gallery restaurant for some homemade doughnuts, a hot bison burger and a five-cent cup of Joe to fuel your next leg. Admission is free, and so is ice water, which is an irresistible draw in mid-August.

Stay on Highway 240 south to Badlands National Park and the Badlands Loop Scenic Byway. You’ll see some of the most gorgeous canyon lands in the country, and they’re far from empty. Keep an eye out for bison, pronghorn antelope, deer, prairie dogs, hawks and eagles as you motor through. Spots marked “scenic overlook” are not to be missed in this uncrowded jewel of a park. Catch the evening program at 9 p.m., when grandkids can meet Smokey the Bear, gaze at stars and learn how the park was formed.

Take a turn down I-90 to Highway 79 and you’ll hit Sturgis, famed for the annual gathering of motorcyclists (some behaving badly). Then move on to Bear Butte State Park, perhaps for some hiking on ground sacred to Native Americans — it’s like going to church outdoors.

Only half an hour in the other direction you’ll hit Deadwood, a total time warp. The town is a trip 200 years back to the Old West. Wild Bill Hickok and Calamity Jane called the town home, and both are buried in the Mt. Moriah Cemetery there.

Next, travel down Highway 385, turn onto Highway 16, and follow the signs to Mount Rushmore National Memorial. You’ll see presidents Washington, Jefferson, Roosevelt and Lincoln painstakingly carved into the side of the mountain. Boardwalk trails lead to the base of the mountain for a closer look at these bigger-than-life heroes in American history. You can even taste Thomas Jefferson’s ice cream recipe at local Carver’s Cafe.

Take Iron Mountain Road as you leave, a winding, scenic route with one-lane tunnels and gorgeous mountains views. You’re headed to Custer State Park, and on the way you may see bison roaming freely in the prairies. Stay at State Game Lodge, just like Calvin Coolidge did in 1927. Sign up for a Buffalo Safari Jeep Tour for an off-road adventure into the native lands.

Trip 3: Blue Ridge Parkway, Plateau Region


This four-day trip covers a long weekend, or stretch your journey by covering more of the Parkway if you have the time. Use the Interactive Parkway Map to plan your trip. It not only shows you the route, but can identify lodging, food, local art galleries, breweries and more. Your usual navigation apps (Waze, Google Maps) won’t reliably guide you on this federally-maintained scenic byway because it isn’t fully mapped in those systems, and cell coverage is iffy. So write down your route, and bring along a print copy of the Blue Ridge Parkway Directory and Travel Planner.

Let’s get started! We begin in Asheville, North Carolina, home of the Biltmore Hotel. From there, we travel to a charming overnight destination in Virginia, the Grassy Creek Cabooses. Traveling through the plateau region offers vista after vista of stunning mountains and valleys on a paved ribbon of road where you’ll average about 40 mph. Shaded rhododendron and mountain laurel hug the ground under a canopy of deciduous trees, interspersed with clearings. This area of the country is still largely rural and unspoiled.

At the Grassy Creek Cabooses, historic cabooses from old trains are sprinkled about an enormous meadow, offering seclusion and comfort. You can hop in the Jacuzzi tub in your private bathroom or grill up dinner while taking in one of the renowned sunsets over the mountains as the bird chatter dies down for the night.

The next morning on your way to Floyd, be sure to stop off at the historic Mabry Mill, made for photographs. Nearby, Puckett Cabin and the Blue Ridge Music Center are also worthy of a stop. You’ll find stunning overlooks in between. In the town of Floyd, you’ll return to Wi-Fi service, but don’t waste a lot of time on email. Instead, check out the exhibit at the local Floyd Center for the Arts, a boon for the local crafting community. The town itself is highly walkable and boasts delicious craft beer, galleries with handcrafted furniture, the Cocoa Mia homemade chocolate emporium and a huge vintage store with floors full of antiques and goods to bring cheer to the heart of upcyclers. Check in at the Hotel Floyd before setting out to Villa Appalaccia, where you’ll find a winery and excellent dining options.

Head back south along the Parkway toward the last stop of your trip at Primland Resort in Dan, Virginia. This 11,000 acre luxury retreat grows food for the restaurant at its onsite garden. Choose a vegan dinner, or plan to track your own game entree with a guided hunting trip earlier in the day. Quaff a moonshine cocktail, or choose a locally produced wine or beer. The sustainable resort has its own observatory where you can view the moons of Jupiter, or take a plunge in the chlorine-free pool after a long hike about the grounds. Enjoy, because tomorrow you are headed back to civilization!




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Blog posting provided by Society of Certified Senior Advisors

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Is Telemedicine Right for You?



Telemedicine is becoming more popular. But why would you want to use the service?


While there is a common misconception that older adults are reluctant to use new technology, 2017 data from the Pew Research Center suggests that the idea is becoming outdated. Those on the younger side of old age have Internet and broadband use rates nearly equal to the population as a whole. Nowhere is this becoming more obvious than in the realm of health care, where telemedicine can improve the efficiency, cost and outcome of medical care.

What is telemedicine, you ask? The term is applied to any form of medical care that is delivered remotely, via a technological instrument such as a telephone or computer. It’s a growing industry. Recent research expects an increase of 14 percent in its adoption rate each year over the period spanning 2014 to 2020.

Health care technology is still in its infancy, but recent iterations have expanded into behavior monitoring and smart home applications. However, the bulk of services are delivered as expedited consult services and post-discharge health maintenance. Older adults have proven accepting of these services, but what do doctors think of this new way of delivering medical opinions? One pair of physicians detailed why they view telemedicine as a better service than most doctors initially think.

Greed Enters Telehealth


Whenever a new technology enters the marketplace, fraudsters are never far behind, especially when big government payouts are part of the package. Such is the case with telemedicine and Medicare.

The federal agency paid out more than $1.2 billion in bogus claims after five companies pushed medical braces on unsuspecting Medicare beneficiaries and charged the government. The telemedicine providers convinced people to get knee, back, shoulder and wrist braces without any evaluation, and channeled the orders through over 100 companies.

“The international call center allegedly paid illegal kickbacks and bribes to telemedicine companies to obtain DME [durable medical equipment] orders for these Medicare beneficiaries,” the U.S. Department of Justice release noted. “The telemedicine companies then allegedly paid physicians to write medically unnecessary DME orders. Finally, the international call center sold the DME orders that it obtained from the telemedicine companies to DME companies, which fraudulently billed Medicare. Collectively, the CEOs, COOs, executives, business owners and medical professionals involved in the conspiracy are accused of causing over $1 billion in loss.”

The companies were Video Doctor USA, AffordADoc, Web Doctors Plus, Integrated Support Plus and First Care MD. Charges have been filed in New Jersey, South Carolina, Florida, Texas, Pennsylvania and California.


Remote Physicals


Aditi Joshi and Judd Hollander, a pair of physicians at JeffConnect, have been examining patients for years. Recently, they’ve added telemedicine to their repertoire for physical exams. The duo perceives skepticism from others in the medical community, but they argue that remote exams are much more effective than commonly thought.

Compared to a traditional exam in the office, the two write, “[Remote exams] are more cost effective, give information that cannot be gleaned from invasive testing and are a check on our increasingly low threshold to order a battery of tests.” They also argue for the use of remote physical exams on the basis that “the great majority of an examination is possible through video” and the alternative may be no exam or one by telephone only.

Renowned 19th century doctor William Osler remarked that 95 percent of the diagnosis is in the patient history. Joshi and Hollander write, “He might have loved telemedicine, where we listen to and observe our patients.” Also, the close, uninterrupted video conference allows doctors to see the patient in the home environment … something they would never discover in an office visit.

Benefits for Older Adults


Telehealth offers benefits to all sections of the population, but its greatest advantages may be for folks who are older. Let’s take a look at what elders have to gain by using the technology to receive medical services.


  1. Less waiting. Retirees may have several health issues, and sitting around in the offices of specialists, as well as their primary care physician, is not on anyone’s list of pleasurable activities. Telemedicine is as close as your computer.
  2. Lower costs. Doctors usually charge less for a remote health visit than one in their office. In addition, you don’t have to pay for gas or put miles on your car like you do for an office visit.
  3. Works for those who don’t drive. Many seniors are house-bound or dependent on relatives and friends to get around. Telemedicine can take place right in the home, at any time and in any weather.
  4. Access to specialists. Older adults in rural communities may have trouble getting to specialist who are not available locally. Chronic conditions can impede travel, barring many elders from receiving timely care.
  5. Reduced hospital readmissions. Many hospitals are starting to use real-time data monitoring for patients discharged with heart failure, chronic obstructive pulmonary disease (COPD), a heart attack, pneumonia, or a hip or knee replacement. Nurses become aware of potential problems immediately, and can contact the patient to prevent further decline. The University of Virginia Medical Center in Charlottesville adopted such a system and noted a resulting readmission rate of only 10 percent, compared to a national average of 17.5 percent.
  6. Staying out of the hospital longer. Patients who are monitored remotely after discharge can stay out of the hospital longer through quicker response and intervention, according to recent studies. One such study showed that if all hospitals used remote monitoring for heart-failure patients who are sent home, about a half-million readmissions could be prevented each year. 
  7. Better quality of life. In one study, a two-month telemedicine program for cardiac patients resulted in less depression and anxiety. The patients also had 38 percent fewer hospital admissions and 31 percent fewer readmissions than a control group. 
  8. Longer aging in place. Telehealth keeps older adults out of the hospital and in their home, according to data from one Pennsylvania nonprofit that runs senior living communities. The percentage of residents that moved into nursing homes was reduced from 20 percent to 12 percent when the nonprofit used monitoring devices that alerted nurses immediately by text when a fall had occurred.
  9. Lower stress for caregivers. Whether in a community living setting or in the home, older adults may need a caregiver to help out. Telemedicine can relieve some of the stress associated with caregiving in two ways. First, telemedicine offers caregivers better access to providers for guidance regarding care. Second, it helps relieve caregivers of time spent readying their charge for doctor visits and driving to the physician’s office and back. 


Like online banking, telemedicine appears to be here to stay, and that’s a good thing for America’s older adult population. Increased access to medical care and quicker response times lead to better health outcomes. Furthermore, older adults are increasingly comfortable with electronic communication. The next time a winter storm is howling outside and you have a doctor’s appointment, call the office to see if it offers remote appointments. It may save you time and money while providing a valuable service.


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Blog posting provided by Society of Certified Senior Advisors

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Recovering Brain Function at Any Age



A neuroscientist has discovered a mental fountain of youth: how to re-wire the older adult brain for substantially improved cognition and memory.


Neuroscientist Michael Merzenich has spent a lifetime studying brain plasticity. He noticed that rat brains age in much the same way human ones do. Merzenich and his team built a brain-training program designed to help the elderly rat brains perform faster and more accurately.

Study Shows Lasting Gains


His training program came partly from a study, partly organized by neuroscientist Karlene Ball, that looked at 3,000 adults aged 65 and up for 10 years. They were divided into four groups: a control group,  one that performed memory training, another that did reasoning training, and a last one that did speed training. The groups trained for 10 hours the first month, and about half in each training group was asked to train an additional four hours at the end of years one and three. That’s it: 18 hours of training over 10 years.

As the average participant passed from 74 years old to 84, an amazing thing happened. Each group not only improved function in its target skill after training, but improvements lasted throughout the duration of the decade-long research period. In fact, the people who had trained still had about three years more protection against decline in the ability after 10 years than the control group.

Furthermore, one approach in particular seemed to offer additional benefits. The speed training group showed transfers to real-life abilities, including:

  • 38% less risk of onset of depressive symptoms
  • 30% less risk of deepening of depressive symptoms
  • 68% stronger feeling of confidence and control
  • 48% less risk of at-fault car crashes


Rats Get Younger Brains


So, how did Merzenich and his colleagues attempt to rewire the rat brains?

“The rat listened to a series of frequencies, and every time the rat heard the target frequency, the rat could get a food reward,” he writes. “As the rat got better and better at noticing the target sound amidst distractor sounds, we made the sounds faster, and less different — to improve auditory precision and speed.”

Brain health in the older rats was improved nearly to that of young rats, according to photos of brain function. But how can humans benefit from this knowledge?

Brain Training


Merzenich started with auditory exercises, then paired with Ball for visual workouts. The end result is BrainHQ, an online platform and app with dozens of activities that target different brain systems. It may be available for free at your library. But you don’t have to use the brain program.

Start with these seven examples from everyday life that can enhance brain function:


  1. Put together a jigsaw puzzle. Choose one with a minimum of 500 pieces, or whatever is challenging for you. You’ll engage visual processing and manipulation.
  2. Learn how to play a musical instrument. It’s a complete brain workout!
  3. Play ball. Throwing a ball up and catching it hones visual, tactile and hand-eye coordination responses.
  4. Do a timed word game. For example, choose a word with three syllables and see how many words you can make with the letters it contains in five minutes. 
  5. Knit or crochet. If you already know how, push yourself to get faster and better.
  6. Turn the volume down on your TV. See if you can follow along by concentrating harder. It can teach your brain to ignore the “static” that sets in with age.
  7. Perform a task with the hand that is not dominant. Start by brushing your teeth, then move on to a more complex task, such as eating.


We no longer have to sit back and accept that our aging brains will merely continue to devolve. Just like our bodies need physical exercise, our brains need mental gymnastics to perform optimally. So get your head out of its mental recliner and take it to the gym! You can stay mentally alert longer than you may have thought.




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Famous and 65

Look who's turning 65 this month


August 12 - François Hollande, 24th President of France


As a socialist, Hollande served as President of the French Republic from 2012 to 2017. He was able to pass many successful reforms, including giving full rights to the LGBT community to marry and adopt. He also reformed labor laws and credit training programs and withdrew French forces from Afghanistan.

On the military front, Hollande supported intervention in Libya, and sent troops to Mali and the Central African Republic in order to provide stability to the nations. His enthusiasm for Saudi Arabian-led interference in Yemen was not supported and drew condemnation from all political sides. However, Hollande presided over France as it became the world’s most oft-toured country as it showcased open markets, regulatory efficiency and limited government intervention. Paris hosted the United Nations Climate Change Conference in 2015 and made a successful bid for the 2024 Summer Olympics.

Alas, a 10 percent unemployment rate and several acts of terrorism led to his fall in popularity. Near the end of his tenure he held the dubious distinction of most unpopular president in the Fifth Republic of France. He therefore decided not to run in 2017.



August 16 - James Cameron, film director and writer


Canadian James Cameron is best known for his work on two seminal films: Titanic and Avatar. But his work on films began much earlier, when he taught himself the art of special effects by reading everything he could at the University of Southern California library. He quit his job as a truck driver after seeing Star Wars in 1977. He soon found work in the entertainment industry, moving from special effects director to director for the sequel to Piranha in 1982.

Although he was unsuccessful in his directorial debut (he managed to get fired), he did have a nightmare when he got food poisoning during shooting in Rome. In the dream, a robot hitman was sent from the future to kill him, and the idea for the wildly successful Terminator series was born.

During the 1980s, Cameron was working on screenplays for The Terminator, Aliens, and the first draft of Rambo: First Blood Part II at the same time. He also wrote the screenplay for the 1989 thriller The Abyss, based on speculations during a high school biology class.

Cameron is an avid environmentalist and vegan. He resides part of the year in California and the other part in New Zealand, where he advocates for and produces plant-based foods. What’s the best thing someone can do to fight climate change? “Stop eating animals,” Cameron says.



August 20 - Al Roker, weatherman


Ever-jovial weatherman Al Roker has become much more: a television personality, actor and author.  He even holds the world record for an uninterrupted live weather report, going 34 hours straight in 2014. In 2018, his 40 years on NBC were celebrated as the Today Show Plaza was officially named the Rokerfeller Plaza to honor him.

Roker was born in Queens, and loved his high school Cartooning & Illustration Club, since he planned to become a cartoonist. However, he majored in communications and began his career in Syracuse, NY before moving to Washington, D.C. for a weathercasting position.

His career got a bump when David Letterman asked him to participate in an elevator race on air. Soon, Roker was forecasting for Weekend Today. He began substituting on the Today show when Willard Scott was out, going full time in 1996. Roker is often shown conducting interviews, and was famously blown off his feet during on-the-spot reporting on Hurricane Wilma in 2005.

Roker also hosts the Macy’s Thanksgiving Day Parade with some from some of his colleagues. Starting in 2009, Roker co-wrote several mysteries about a celebrity chef turned sleuth. He’s also published The Morning Show Murders.

The once-girthy Roker is famous for getting a gastric bypass in 2002 after a slew of diet failures. Eight months post-surgery, the weatherman was 100 pounds lighter. In 2010, he ran the ING New York City Marathon.


Click below for the other articles in the August 2019 Senior Spirit


Sources:

https://www.wikipedia.org

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