NewRetirement Retirement News Digest : Health

Retirement Brings Most a Big Health Boost

jberman — Wed, 11 Nov 2009 02:46:00 GMT

Medicine.net, November 9th, 2009

The self-reported health of the newly retired improves so much that most feel eight years younger, a new European study suggests.

This happy news was true of most everyone except a small minority -- only 2% -- who had experienced "ideal" conditions in their working life, anyway.

"The results really say three things: That work puts an extra burden on the health of older workers, that the effects of this extra burden are largely relieved by retirement and, finally, that both the extra burden and the relief are larger when working conditions are poor," said Hugo Westerlund, lead author of a study published online Nov. 9 in The Lancet. "This indicates that there is a need to provide opportunities for older workers to decrease the demands in their work out of concern for their health and well-being."

But of course, added Westerlund, who is head of epidemiology at the Stress Research Institute at Stockholm University in Sweden, "not all older workers suffer from poor perceived health. Many are indeed eminently healthy and fit for work. But sooner or later, everyone has to slow down because of old age catching up."

Last week, the same group of researchers reported that workers slept better after retirement than before. "Sleep improves at retirement, which suggests that sleeping could be a mediator between work and perception of poor health," Westerlund said.

This study looked at what the same 15,000 French workers, most of them men, had to say about their own health up to seven years pre-retirement and up to seven years post-retirement.

As participants got closer to retirement age, their perception of their own health declined, but went up again during the first year of retirement.

More muscle power means lower Alzheimer's risk

jberman — Wed, 11 Nov 2009 02:11:00 GMT

Reuters Health, November 9th, 2009

Older people with stronger muscles are at reduced risk of developing Alzheimer's disease compared to their weaker peers, a new study shows.

Dr. Patricia A. Boyle of Rush Alzheimer's Disease Center in Chicago and her colleagues found that the greater a person's muscle strength, the lower their likelihood of being diagnosed with Alzheimer's over a four-year period. The same was true for the loss of mental function that often precedes full-blown Alzheimer's.

Studies have linked grip strength to Alzheimer's, while a person's weight and level of physical activity also influence risk of the disease. To date, however, no one has studied whether muscle strength in and of itself might play a role in dementia risk, Boyle and her team note in November's Annals of Neurology.

"These findings support the link between physical health and cognition in aging and the importance of maintaining good physical function and strength," Boyle told Reuters Health via E-mail.

The researchers measured the strength of nine muscle groups in the arms and legs of 970 dementia-free men and women 54 to 100 years old (their average age was around 80). They also tested the strength of study participants' breathing muscles.

During follow-up, which lasted about four years, 138 people developed Alzheimer's. These individuals were older and had worse mental function than the rest of the study participants. They also were weaker.

But even after the researchers adjusted for age and education level-which can influence Alzheimer's risk-they found that muscle strength had a strong influence on the risk of the disease. People who ranked in the top 10 percent for muscle strength were 61 percent less likely to develop Alzheimer's than the weakest 10 percent. Stronger people also showed a slower decline in their mental abilities over time.

The relationship between muscle strength and mild mental difficulties, which occurred in an additional 275 people, was similar, with the strongest 10 percent being at 48 percent lower risk than the weakest 10 percent.

Sleep Disturbances Improve After Retirement

jberman — Tue, 03 Nov 2009 01:40:00 GMT

Science Daily, November 1st, 2009

A new study in the journal Sleep shows that retirement is followed by a sharp decrease in the prevalence of sleep disturbances. Findings suggest that this general improvement in sleep is likely to result from the removal of work-related demands and stress rather than from actual health benefits of retirement.

Results show that the odds of having disturbed sleep in the seven years after retirement were 26 percent lower (adjusted odds ratio of 0.74) than in the seven years before retiring. Sleep disturbance prevalence rates among 14,714 participants fell from 24.2 percent in the last year before retirement to 17.8 percent in the first year after retiring. The greatest reduction in sleep disturbances was reported by participants with depression or mental fatigue prior to retirement. The postretirement improvement in sleep also was more pronounced in men, management-level workers, employees who reported high psychological job demands, and people who occasionally or consistently worked night shifts.

Lead author Jussi Vahtera, professor in the department of public health at the University of Turku in Finland, noted that the participants enjoyed employment benefits rarely seen today, including guaranteed job stability, a statutory retirement age between 55 and 60 years, and a company-paid pension that was 80 percent of their salary.

"We believe these findings are largely applicable in situations where financial incentives not to retire are relatively weak," said Vahtera. "In countries and positions where there is no proper pension level to guarantee financial security beyond working age, however, retirement may be followed by severe stress disturbing sleep even more than before retirement."

What Are Friends For? A Longer Life

tsaleen — Tue, 28 Apr 2009 18:38:00 GMT

The New York Times - April 20, 2009

In the quest for better health, many people turn to doctors, self-help books or herbal supplements. But they overlook a powerful weapon that could help them fight illness and depression, speed recovery, slow aging and prolong life: their friends.Researchers are only now starting to pay attention to the importance of friendship and social networks in overall health. A 10-year Australian study found that older people with a large circle of friends were 22 percent less likely to die during the study period than those with fewer friends. A large 2007 study showed an increase of nearly 60 percent in the risk for obesity among people whose friends gained weight. And last year, Harvard researchers reported that strong social ties could promote brain health as we age.

“In general, the role of friendship in our lives isn’t terribly well appreciated,” said Rebecca G. Adams, a professor of sociology at the University of North Carolina, Greensboro. “There is just scads of stuff on families and marriage, but very little on friendship. It baffles me. Friendship has a bigger impact on our psychological well-being than family relationships.”

In a new book, “The Girls From Ames: A Story of Women and a 40-Year Friendship” (Gotham), Jeffrey Zaslow tells the story of 11 childhood friends who scattered from Iowa to eight different states. Despite the distance, their friendships endured through college and marriage, divorce and other crises, including the death of one of the women in her 20s.

Using scrapbooks, photo albums and the women’s own memories, Mr. Zaslow chronicles how their close friendships have shaped their lives and continue to sustain them. The role of friendship in their health and well-being is evident in almost every chapter.

Two of the friends have recently learned they have *** cancer. Kelly Zwagerman, now a high school teacher who lives in Northfield, Minn., said that when she got her diagnosis in September 2007, her doctor told her to surround herself with loved ones. Instead, she reached out to her childhood friends, even though they lived far away.

“The first people I told were the women from Ames,” she said in an interview. “I e-mailed them. I immediately had e-mails and phone calls and messages of support. It was instant that the love poured in from all of them.”

When she complained that her treatment led to painful sores in her throat, an Ames girl sent a smoothie maker and recipes. Another, who had lost a daughter to leukemia, sent Ms. Zwagerman a hand-knitted hat, knowing her head would be cold without hair; still another sent pajamas made of special fabric to help cope with night sweats.

Ms. Zwagerman said she was often more comfortable discussing her illness with her girlfriends than with her doctor. “We go so far back that these women will talk about anything,” she said.

Ms. Zwagerman says her friends from Ames have been an essential factor in her treatment and recovery, and research bears her out. In 2006, a study of nearly 3,000 nurses with *** cancer found that women without close friends were four times as likely to die from the disease as women with 10 or more friends. And notably, proximity and the amount of contact with a friend wasn’t associated with survival. Just having friends was protective.

Bella DePaulo, a visiting psychology professor at the University of California, Santa Barbara, whose work focuses on single people and friendships, notes that in many studies, friendship has an even greater effect on health than a spouse or family member. In the study of nurses with *** cancer, having a spouse wasn’t associated with survival.

While many friendship studies focus on the intense relationships of women, some research shows that men can benefit, too. In a six-year study of 736 middle-age Swedish men, attachment to a single person didn’t appear to affect the risk of heart attack and fatal coronary heart disease, but having friendships did. Only smoking was as important a risk factor as lack of social support.

Exactly why friendship has such a big effect isn’t entirely clear. While friends can run errands and pick up medicine for a sick person, the benefits go well beyond physical assistance; indeed, proximity does not seem to be a factor.

It may be that people with strong social ties also have better access to health services and care. Beyond that, however, friendship clearly has a profound psychological effect. People with strong friendships are less likely than others to get colds, perhaps because they have lower stress levels.

Last year, researchers studied 34 students at the University of Virginia, taking them to the base of a steep hill and fitting them with a weighted backpack. They were then asked to estimate the steepness of the hill. Some participants stood next to friends during the exercise, while others were alone.

The students who stood with friends gave lower estimates of the steepness of the hill. And the longer the friends had known each other, the less steep the hill appeared.

“People with stronger friendship networks feel like there is someone they can turn to,” said Karen A. Roberto, director of the center for gerontology at Virginia Tech. “Friendship is an undervalued resource. The consistent message of these studies is that friends make your life better.”

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Nearly Two-Thirds Face Risky Retirement Due to Long-Term Care Costs

tsaleen — Mon, 06 Apr 2009 14:54:00 GMT

ElderLawAnswers - April 1, 2009

A new report by the Center for Retirement Research at Boston College finds that nearly two-thirds of U.S. households are at risk of being unable to maintain their standard of living in retirement when possible long-term care costs are taken into consideration.

The report, "Long-Term Care Costs and the National Retirement Risk Index," looks at the percentage of households that would fall significantly short of their target retirement income if they do what they can to prepare for the possibility of long-term care costs, on top of health care and other post-retirement expenses.

If those who could afford to do so purchased a comprehensive long-term care insurance policy with a $3,500 annual premium, researchers found that 64 percent of households would still be at risk of a lowered standard of living in retirement. When the researchers assumed that households would instead pay for long-term care using the equity in their homes through a reverse mortgage, 65 percent would still be at risk in retirement.

The report's authors conclude that their findings "raise major concerns about the retirement security of baby boomers and succeeding generations."

For a link to the report, which analyzes 2006 data, click here.

For an Associated Press article on the report, click here.

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Doctors Are Opting Out of Medicare

tsaleen — Fri, 03 Apr 2009 21:54:00 GMT

The New York Times - April 1, 2009

EARLY this year, Barbara Plumb, a freelance editor and writer in New York who is on Medicare, received a disturbing letter. Her gynecologist informed her that she was opting out of Medicare. When Ms. Plumb asked her primary-care doctor to recommend another gynecologist who took Medicare, the doctor responded that she didn’t know any — and that if Ms. Plumb found one she liked, could she call and tell her the name?

Many people, just as they become eligible for Medicare, discover that the insurance rug has been pulled out from under them. Some doctors — often internists but also gastroenterologists, gynecologists, psychiatrists and other specialists — are no longer accepting Medicare, either because they have opted out of the insurance system or they are not accepting new patients with Medicare coverage. The doctors’ reasons: reimbursement rates are too low and paperwork too much of a hassle.

When shopping for a doctor, ask if he or she is enrolled with Medicare. If the answer is no, that doctor has opted out of the system. Those who are enrolled fall into two categories, participating and nonparticipating. The latter receive a lower reimbursement from Medicare, and the patient has to pick up more of the bill.

Doctors who have opted out of Medicare can charge whatever they want, but they cannot bill Medicare for reimbursement, nor may their patients. Medigap, or supplemental insurance, policies usually do not provide coverage when Medicare doesn’t, so the entire bill is the patient’s responsibility.

The solution to this problem is to find doctors who accept Medicare insurance — and to do it well before reaching age 65. But that is not always easy, especially if you are looking for an internist, a primary care doctor who deals with adults. Of the 93 internists affiliated with New York-Presbyterian Hospital, for example, only 37 accept Medicare, according to the hospital’s Web site.

Two trends are converging: there is a shortage of internists nationally — the American College of Physicians, the organization for internists, estimates that by 2025 there will be 35,000 to 45,000 fewer than the population needs — and internists are increasingly unwilling to accept new Medicare patients.

In a June 2008 report, the Medicare Payment Advisory Commission, an independent federal panel that advises Congress on Medicare, said that 29 percent of the Medicare beneficiaries it surveyed who were looking for a primary care doctor had a problem finding one to treat them, up from 24 percent the year before. And a 2008 survey by the Texas Medical Association found that while 58 percent of the state’s doctors took new Medicare patients, only 38 percent of primary care doctors did.

Currently, about 40 million Americans have Medicare insurance, according to medicare.gov. Coverage is provided to those 65 or older, some younger disabled people and people of all ages with end-stage renal disease.

Those approaching Medicare eligibility should talk to their doctors. Even doctors who won’t take new Medicare patients may be willing to allow their existing ones to remain in their care. If they are not, it’s advisable to start looking around. But the search will be easier for people who start early.

“If you have just moved into town and are 64,” said Dr. Jeffrey P. Harris, an internist and the president of the American College of Physicians, “it is easier for you to see a doctor than if you had just moved into town and are 65.”

Before giving up on a doctor who will not accept Medicare, a patient should ask about signing a private contract that stipulates the patient will be responsible for paying the doctor’s fees and lists exactly what those fees are and what they cover. Some doctors may be willing to negotiate and tailor prices to what patients can afford.

For example, a doctor who charges younger patients with employer health coverage $250 for an office visit might be willing to accept $175 from an older patient who pays cash and requires no insurance claims.

“I have a lady of 93 who pays me $5 a visit, and for her that’s real money,” said Dr. Steven D. Knope, an internist and private contract doctor in Tucson. “I charge her because then she listens to what I say.”

How do you find a doctor who accepts Medicare? The Web site www.medicare.gov provides a list of enrolled doctors. Other sources are state medical societies and local hospitals, most of which have online directories of doctors. But that’s no guarantee they will see new patients.

Other options are also available. Roughly 18,000 walk-in, stand-alone urgent care centers in the United States are staffed with doctors who set simple fractures, take X-rays, do minor surgery, diagnose ailments and write prescriptions. By far the majority of these centers take Medicare.

Although they were never intended to provide continuing care, “our primary care practice is growing more than anything else,” said Dr. Franz Ritucci, who is medical director of the American Academy of Urgent Care Medicine and practices at America’s Urgent Care in Orlando, Fla., a chain of walk-in centers that also has clinics in Columbus, Ohio.

The centers are open 12 to 18 hours a day and patients do not need an appointment, though they may have to wait. Some centers allow appointments to see a specific doctor for follow-up.

“If you can hook up with a primary care provider in an urgent care center who is willing” to provide continuing care, said Dr. J. James Rohack, a cardiologist who is president-elect of the American Medical Association, “then yes, it’s an option.”

Type “urgent care centers” into a search engine and thousands come up. In June, the Academy of Urgent Care Medicine plans to add a list of centers it has accredited to its Web site, www.aaucm.org.

Another, more expensive option is concierge or “boutique” care, which comes in two forms. In the most popular kind, doctors accept Medicare and other insurance, but charge patients an annual retainer of $1,600 to $1,800 to get in the door and receive services not covered by Medicare, like annual physicals. Before signing up and paying the retainer, patients should get a written agreement spelling out which services the doctor will bill Medicare for and which the retainer covers. And always check carefully for double-billing.

The other form of concierge medicine — doctors who have opted out of Medicare — is more expensive still. Fees range as high as $15,000 a year and cover office visits, access to the doctor when care is needed, referrals to specialists and thorough annual physicals.

Dr. Knope, the author of “Concierge Medicine: A New System to Get the Best Healthcare,” has this kind of practice in Tucson. His patients sign a contract agreeing to pay $6,000 a year for individuals and $10,000 a year for couples. The fee covers office visits, physical exams and phone consultations, and Dr. Knope will meet patients in the emergency room, see them in the hospital and occasionally make house calls.

A list of about 500 concierge doctors throughout the country is available on Dr. Knope’s Web site, www.conciergemedicinemd.com.

Is the care worth the money? Harold and Margret Thomas, who are in their mid-70s and live in Cincinnati, spend the winter in Tucson. After many phone calls, the couple were unable to find an internist in Tucson who took new Medicare patients, so they signed with Dr. Knope in 1996. Five years ago, when Mrs. Thomas developed a blinding headache, her husband called the doctor at 8 o’clock one night, and he, suspecting an aneurysm, insisted they get to the emergency room immediately.

The doctor met them and ordered an M.R.I. and a CT scan. The tests revealed an aneurysm, and Dr. Knope found a surgeon who quickly operated. Medicare paid for the emergency room, the surgery and the hospital stay.

“If there were a concierge practice in Cincinnati, I’d be part of it there, too,” Harold Thomas said.

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Walgreens giving free care to jobless and uninsured

tsaleen — Fri, 03 Apr 2009 21:48:00 GMT

Yahoo News - March 31, 2009

Drugstore operator Walgreens will offer free clinic visits to the unemployed and uninsured for the rest of the year, providing tests and routine treatment for minor ailments through its walk-in clinics — though patients will still pay for prescriptions.

Walgreens said patients who lose their job and health insurance after March 31 will be able to get free treatment at its in-store Take Care clinics for respiratory problems, allergies, infections and skin conditions, among other ailments. Typically those treatments cost $59 or more for patients with no insurance.

Hal Rosenbluth, chairman of the Take Care Health Systems division, described the plan as something close to an experiment: He said Walgreens isn't sure of patient demand or how much providing the services might cost the company.

It's likely to generate more attention for the clinics, however. Rosenbluth said a typical Take Care patient tells eight other people about his or her experience. So far, about 30 percent of Take Care patients were new customers to Walgreens.

The program is expected to last through the end of 2009. Walgreens runs 341 Take Care clinics in 35 markets around the country, including Chicago, Atlanta, Miami and Cleveland.

Free services will be offered only from 11 a.m. to 3 p.m. Monday through Friday. Walgreens said it will not offer free checkups, vaccinations or other injections because it is focusing on providing services patients might otherwise get at an urgent-care center or even an emergency room.

Patients must present proof they are unemployed, including a federal or state unemployment determination letter and an unemployment check stub. They will have to sign a form at the clinic saying they have lost their jobs and health benefits. If they find a new job or get new health insurance, they will no longer be eligible for free care.

Spouses and children are also eligible for free services if they don't have insurance of their own.

Medical lab operator Quest Diagnostics is participating in the program by offering free tests for step throat and urinary tract infections.

Walgreens bought the Take Care clinics in May 2007. Take Care says it has seen about 1.2 million patients since its launch in November 2005 and estimates that up to 30 percent of them were uninsured.

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8 Tips for Paying for Health Care in Retirement

tsaleen — Wed, 18 Mar 2009 23:55:00 GMT

US News & World Report - March 16, 2009

It’s difficult to predict what your health care expenses will be in retirement. Jack Dickinson, 65, thought he was one of the lucky ones. His 34 years as a General Motors sales and marketing manager came with two gold-plated benefits: a pension and lifetime medical coverage. And Dickinson was lucky indeed--until GM scrapped retiree health care coverage this year for about 100,000 white-collar retirees, him included. The beleaguered auto giant did raise monthly pension payments by $300 to help retirees buy their own coverage. But "it does not replace, by any means, the excellent coverage that GM gave us," says Dickinson, a retiree in Hoover, Ala. "If you go on the open market and try to replace everything, it is not available." Here’s some tips on how to cope with health care expenses in retirement:

Don’t count on employer benefits. Most current employees will never face Dickinson's quandary because they won't be eligible for retiree health insurance through their former employer in the first place. Less than a third of firms with 200 or more workers offered retiree health benefits in 2008, down from the 66 percent that did so in 1988, according to a Kaiser Family Foundation survey. Among small companies, retiree coverage is much more rare: only 4 percent offer it. But even if your employer offers retiree health insurance, don't count on receiving benefits. Retiree health insurance agreements often include clauses that give the company the right to modify or terminate the program at any time. If benefits continue, retirees are likely to face higher premiums, increased out-of-pocket expenses, and tougher eligibility requirements. And there's nothing that safeguards retiree health insurance benefits like the federal Pension Benefit Guaranty Corp., which, in private-sector pension plans, pays workers if a plan or a company fails.

Try to make it to Medicare. How do you protect yourself from crippling medical bills in the face of nonexistent or disappearing health insurance? The answer might seem to be seeking out an employer that provides health care benefits until age 65, when you qualify for Medicare. Sounds simple enough, if you can manage to stay employed with company benefits in this tough economy. If you're laid off, find out if you're eligible for a spouse’s health plan and COBRA continuation coverage through your former company. That coverage lasts up to 18 months. The American Recovery and Reinvestment Act, passed in February, promises employees who were laid off between Sept. 1, 2008, and Dec. 31, 2009, a 65 percent subsidy toward COBRA premiums for up to nine months.

Workers who retire before they qualify for Medicare at age 65 often face the steepest health care costs. The average cost of premiums for employer-provided coverage for retirees under 65 is $13,308 a year, according to a Towers Perrin survey. The typical early retiree is expected to pick up $6,960 of that tab. But retirees who don't have employer-subsidized insurance or coverage through a spouse will pay even more. Costs vary widely for individuals. Those who have bad health habits or chronic illnesses generally pay more--if they can even get coverage.

Plan for Medicare costs. Retirees with Medicare face significant out-of-pocket costs. Major health care expenses include premiums for Medicare Part B (physician and outpatient hospital services) and Part D (prescription drug-related expenses), co-payments, coinsurance, deductibles, and excluded benefits like dental care, eyeglasses, and hearing aids. A couple retiring in 2010 would need nearly $206,000 in 2007 dollars to buy an annuity sufficient enough to cover out-of-pocket health care costs in retirement, according to the Center for Retirement Research at Boston College. A couple retiring in 2040 would need more than $491,000. Other studies come up with similarly large numbers. Fidelity Investments says a 65-year-old couple retiring in 2008 will need approximately $225,000 to cover medical costs in retirement. That doesn't even include over-the-counter medications, most dental services, and long-term care. The Employee Benefit Research Institute figures a married couple will need a staggering $305,000, just to have a 90 percent chance of being able to pay for all out-of-pocket retirement health expenses (the money could be paid in part out of retirement income, however.) Dickinson, who recently signed up for Medicare, runs a website for fellow GM retirees, where he posts tips for navigating the sign-up process. After GM announced retiree health-insurance cuts, the site's traffic quadrupled. "The older retirees losing their benefits are trying to do the gymnastics required to enter the Medicare maze," Dickinson says. "You've got to go to each provider and determine which one has the best coverage for you and at what premium price. It's very confusing."

Consider working longer. Many economists think most people should plan to work well past the current average retirement age, 63, in part to help finance health expenses. Working longer allows you to funnel extra cash into your nest egg, gives your investments more time to recover from recent market losses, and cuts the length of time your retirement stash needs to last. Workers age 50 and older can deposit up to $22,000 in a traditional tax-deferred 401(k) this year, up $1,500 from 2008. Social Security benefits also increase for each year you delay claiming benefits up until age 70. "People simply can't afford to cover their future health-care costs unless they have more assets, and people are responding to that by working longer," says Richard Johnson, an Urban Institute researcher. There is some evidence that continuing to work at a challenging--but not stressful--job or staying active and engaged by volunteering or taking up hobbies can help you stay healthy even longer. "Mental and physical exercise improve overall brain fitness," says Gene Cohen, director of the Center on Aging, Health, and Humanities at George Washington University. "Mastery and a sense of accomplishment can improve mental fitness by boosting the immune system."

Factor in long-term care. What's often the greatest retiree medical expense of all--long-term care—generally isn't covered by Medicare. Last year, a private nursing home room cost an average of $76,460 a year, or $209 per day, according to a Genworth Financial survey. Costs vary considerably by state, and range from an average of $125 a day in Louisiana to $515 in Alaska. More inexpensive options are available, but even they could torpedo most retirees' budgets. The average rate for a home-health aide is $19 an hour. That comes to $43,884 per year for 44 hours a week of care. A private one-bedroom unit in an assisted-living facility typically costs $36,090 annually. And the most frugal long-term care option, adult day care, still runs $15,236 per year, on average, for care five days a week, Genworth Financial found.

Consider long-term care insurance...carefully. Long-term-care insurance can help protect you from some of these catastrophic costs--at a hefty price. AARP estimates that a 65-year-old in good health can expect to pay between $2,000 and $3,000 a year for a policy that covers nursing-home and home care. And Fidelity Investments calculated that a couple, both 65 in 2008, would need $85,000 just to insure against a lifetime of long-term-care expenses. Before you buy long-term care insurance, you should get answers to plenty of questions: how to cancel the policy; what happens if you stop paying the premiums; how many times you can renew; how long coverage lasts; what the maximum payout is (and whether it is indexed for inflation); and what needs to happen before you can begin claiming your benefits. "These policies are written stating very extensively what they will cover, and 20 years later when you start using long-term-care services, there may be some new modality of service that is not covered by your plan," cautions Johnson. You can check up on the financial health of insurers at A.M. Best, Moody's, or Standard & Poor's and with your state insurance department.

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Plan Mentally for Retirement Not Just Financially

tsaleen — Wed, 11 Mar 2009 05:12:00 GMT

Chron Business News - March 9, 2009

Many people entering retirement envision a life of fun and relaxation, but the opposite can be true. Without the social contacts that come from reporting to an office everyday, some retirees feel isolated. Others feel depression from an emptiness that comes with sudden idle time.

Psychologist Nancy Schlossberg's latest of nine books, "Revitalizing Retirement: Reshaping Your Identity, Relationships, and Purpose" says you should spend as much time preparing your psychological portfolio as you do your financial one. In today's recession, which is leaving millions of workers suddenly jobless, her tips also can help unemployed workers develop a plan for moving on.

Schlossberg is professor emerita of the College of Education at the University of Maryland and co-president of TransitionWorks, a consulting company that focuses on helping people adjust to life changes in Adelphia, Md.

Q: Your book discusses the need to develop a psychological portfolio for retirement, what exactly does that mean and why is it important?

A: For many workers, the psychological adjustment to retirement is as difficult as the financial one. I make the case that people go to a financial adviser and consult often yearly, sometimes more frequently. They go to a physician to get a checkup. But no one is checking up on their psychological portfolio because they didn't really have one. It's important, not just for retirement, but for every major change in life — career changes, marriage, divorce. Those things change the way you define yourself, your relationships and often change your sense of purpose.

The more people I interviewed, the more I began to realize three common issues — identity, relationships and purpose — arise when people retire. These issues make up the psychological portfolio that I refer to and should be honestly assessed and managed if one is to be happy.

Q: For many people psychological issues aren't as concrete as financial decisions. Can you explain how to go about assessing these areas and managing them?

A: The major thing people realize after they retire is that their identity has been compromised. While working, they knew who they were — a roofer, a bricklayer, a college professor, an accountant. They had a tag, an identity. People don't think about that. They don't realize that after retirement, the issue of identity is critical.

Finding interests that help you focus on who you are is the key. The book illustrates points with real life examples including a police officer who couldn't figure out who he was after retirement. He was divorced and directionless until he agreed to work in a temporary job helping a family member manage a hotel. The job gave him a new identity and new working relationships. He remarried and 10 years later is still doing the job.

Q: How about relationships and finding a new purpose in retirement. Why are these important issues?

A: Many people feel an intense vacuum after leaving the workplace because their social network of co-workers is gone. They need to find a substitute for work colleagues. Many people find a part-time job that gives them interaction with others. Some find fulfillment in volunteering with a community organization or becoming involved with a church group. They must be sure to find some community of people.

It's also likely that they'll have to renegotiate the relationship with their spouse or life partner. Many men and women find it very trying when they first retire because they're not ready to be with one another 24 hours a day, seven days a week.

Finding a new purpose is integral to the happiness of many retirees. Many people must feel as if they matter and often lose that sense when they no longer work every day. They must place themselves in situations in which they feel appreciated and depended upon. People need to look in their communities for places where they feel they matter. Giving back is one of the best ways to do this — working at a soup kitchen or in some other capacity in which they're helping others.

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Comparison Shop to Trim Health Care Bills

tsaleen — Wed, 11 Mar 2009 04:37:00 GMT

Newsday - March 8, 2009

For a growing number of older Americans, the housing slump has changed the concept of "aging in place" from a lifestyle choice to the only choice.

The nearly frozen residential real estate market in many parts of the country has made it very difficult for seniors to sell their homes when the time comes to move for health or lifestyle reasons.

After Social Security, real estate is the most important financial asset for most seniors. Many have built up substantial equity in their homes that they expected to use in the event they needed to move into a retirement community that offers health care services.

Continuing Care Retirement Community

One type of community feeling the crunch right now is the continuing care retirement community (CCRC), which requires a large upfront payment. This allows seniors to stay in a single location that can meet their health care needs for the remainder of their lives; in this sense, CCRCs are a sort of insurance product funded by the single upfront payment.

"It's usually structured so that you can take equity from the house, make that your entrance fee and then pay monthly, based on need," says Larry Minnix, chief executive of the American Association of Homes and Services for the Aging, an association of nonprofit organizations that offer a continuum of aging services ranging from adult day services to continuing care retirement communities.

Now homes aren't selling, and prices are falling. The S&P/Case-Shiller home-price index of top 20 cities was down 25 percent as of November last year compared with its peak in 2006. At the same time, many older Americans have been hit hard by sharp erosion in their retirement portfolios, another potential source of funding for a move.

CCRC applications are declining, and some communities are responding by providing assistance to would-be home sellers. "Some are suspending or postponing entry fees," Minnix says. "Others are providing bridge loans or retaining real estate specialists to help people prepare and sell their homes. Everyone is trying to get creative in providing help." Some developers also are stressing development of more affordably priced housing units.

Reverse mortgages

Another potential source of help is reverse mortgages. New federal rules that took effect in January make it possible to use these home equity conversion mortgages (HECM) to purchase a new home. While an HECM can't be used for moves into retirement communities where the residents don't own equity (such as CCRCs), the new rule can help facilitate sell-and-buy transactions by giving the seller the flexibility to accept a lower price and still afford a move.

With HECM loans, the percentage of equity you can borrow is roughly 10 percent less than your age. So a 75-year-old individual seeking to buy a $300,000 home could get 65 percent of the equity as a loan - roughly $200,000. The new rules don't permit any other mortgage loans on the new property, so the balance must be funded with cash from the seller's previous home.

Depending on how much cash is generated from the home sale, the HECM can generate cash above the new home's purchase price, allowing the borrower to pocket the difference and add to cash reserves.

An additional positive development: The recently signed economic stimulus bill temporarily lifts the limit on the size of HECM loans from $417,000 to $625,500. The new loan limits are in force for 2009 only.

Staying where you are

Of course, the other option is aging in place. Aging in place is the most attractive choice for many. A 2007 AARP survey found that 89 percent of Americans would like to live in their current homes as long as possible, and the number rose to 95 percent when people older than age 75 were asked the question.

But the survey also showed that very few people have taken steps to modify their homes to accommodate aging. And aging in place also creates challenges for communities to provide the services aging residents will need, such as one-stop shopping locations, shuttle services, age-appropriate fitness and community centers, and even something as basic as sidewalks.

Minnix expects that retirement communities such as CCRCs will play a role in responding to these challenges. Some already are expanding their services to people living in homes in their surrounding areas.

"In the next decade, we'll see a lot more products and services - and maybe even financing mechanisms - for people who want to stay where they are," he says.

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AARP’s Stealth Fees Often Sting Seniors With Costlier Insurance

tsaleen — Sun, 15 Feb 2009 19:15:00 GMT

Bloomberg - December 4, 2008

Arthur Laupus joined AARP because he thought the nonprofit senior-citizen-advocacy group would make his retirement years easier. He signed up for an auto insurance policy endorsed by AARP, believing the advertising that said he would save money.

He didn’t. When Laupus, 71, compared his car insurance rate with a dozen other companies, he found he was paying twice the average. Why? One reason, he learned, was because AARP was taking a cut out of his premium before sending the money to Hartford Financial Services Group, the provider of the coverage.

Laupus stumbled onto something that many members of the world’s largest seniors’ organization don’t know: The group, formerly called American Association of Retired Persons, collects hundreds of millions of dollars annually from insurers who pay for AARP’s endorsement of their policies.

The insurance companies build the cost of these so-called royalties and fees, which amounted to $497.6 million in 2007, into the premiums they charge AARP members, according to AARP’s consolidated financial statement for that year.

AARP uses the royalties and fees to fund about half the expenses that pay for activities such as publishing brochures about health care and consumer fraud -- as well as for paying down the $200 million bond debt that funded the association’s marble and brass-studded Washington headquarters.

In addition, AARP holds clients’ insurance premiums for as long as a month and invests the money, which added $40.4 million to its revenue in 2007.

‘Fatting the Coffers’

“At the end of the day, it’s all about fattening the coffers of the organization,” says Thomas Orecchio, who was chairman of the Arlington Heights, Illinois-based National Association of Personal Financial Advisors until September. AARP, he says, is sponsoring insurance for its members at inflated prices.

“It’s the dirty little secret,” he says.

During the past decade, royalties and fees have made up an increasing percentage of AARP’s income, rising to 43 percent of its $1.17 billion in revenue in 2007 from 11 percent in 1999, according to AARP data.

Laupus, a former teacher in Baltimore, and millions of others joined AARP in the belief it would provide discounts, services and publications. The organization ranks behind only Consumer Reports and the American Red Cross as the most trusted large group that influences U.S. politics and business, a 2007 Harris Poll found.

AARP has helped millions with tax returns, estate planning and health care advice.

‘Turbulent Economy’

With stock markets around the world plunging, savings plans in turmoil and medical costs soaring, older Americans need an organization such as AARP in their corner.

“The turbulent economy puts more people in the difficult situation of being under- or uninsured,” says Iowa Republican Senator Charles Grassley. “That’s why we need to make sure individuals aren’t taken advantage of with misleading marketing, especially by a name brand advocate who carries a high level of trust.”

Grassley sent letters to AARP Chief Executive Officer William Novelli and state insurance commissioners Nov. 3 inquiring into whether the AARP misrepresented what is covered by some health insurance policies it sold. Four days later, Novelli announced AARP would review its marketing and suspend sales of those policies.

AARP’s mission to help seniors has been compromised by its reliance on royalties and fees, says Marilyn Moon, who was director of AARP’s Public Policy Institute from 1986 through 1989.

‘Conflict of Interest’

“There’s an inherent conflict of interest,” she says. “A lot of people there are trying to do good, but they’re ending up becoming very dependent on sources of income.”

Moon is now vice president and director of the health program at American Institutes for Research in Washington.

Novelli, who co-founded a public relations company in 1972, became CEO of AARP in 2001. Since then, the organization has increasingly focused on marketing as a means to increase revenue, Moon says.

AARP officials say the organization always gives priority to the needs of seniors.

“There is no conflict of interest between the marketing of products and services to our members and our policy work,” spokesman Adam Sohn says. “Policy always comes first.”

AARP declined requests to make Novelli available for comment.

‘Benefit From Our Brand’

John Wider, executive vice president of AARP Services Inc., a for-profit subsidiary, says AARP uses royalty revenue to fund its member services. In addition, he says, insurers selling products through AARP find royalty payments are worthwhile because AARP’s endorsement lowers insurance company marketing costs and increases sales.

“There is an efficiency they gain in being able to benefit from our brand,” he says.

Novelli, 67, has broadened AARP’s reach and increased its clout in Washington. The association recently joined with industry and labor groups in a campaign known as Divided We Fail. That effort is seeking ways to ensure health care for all Americans.

Novelli has expanded AARP’s marketing to include 17 types of insurance. The association collects royalties on each of those products. Its membership rose to 40 million from 35 million, and its total revenue grew to $1.17 billion in 2007 from $520 million when Novelli took charge.

Medicare Lobbying

Nowhere were AARP’s conflicting roles more evident than in its lobbying in support of a 2003 bill proposed by President George W. Bush to expand Medicare, the federal health insurance program for people older than 65.

The bill, which for the first time added a prescription drug plan to Medicare, passed by a vote of 220-215 in the House of Representatives and 54-44 in the Senate. Thousands of AARP members complained that the legislation was a bad deal for seniors because it provided incomplete coverage and raised costs for seniors with low income.

After the Medicare bill was signed into law by Bush in December 2003, AARP was able to expand its contract with Minnetonka, Minnesota-based UnitedHealth Group Inc., which underwrites AARP’s Medicare supplemental insurance plan.

AARP increased its annual revenue from royalties by $197 million to $497.6 million from 2003 to 2007.

Not the Least Expensive

AARP advertises that its Medicare supplemental insurance can save people thousands of dollars. While every type of supplemental policy sold by all companies must offer the same exact coverage under federal rules, AARP doesn’t sell the least expensive.

The AARP/UnitedHealth basic policy costs $582 a year more than a lower-cost competitor in New York and $428 more in Los Angeles, according to data on Medicare’s Web page. AARP spokesman Sohn says everyone should shop carefully.

“The products and services AARP makes available are competitively priced,” he says. “Price is not the only factor. Service and features need to be factored in to determine full value.”

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Gadgets for Growing Old at Home

tsaleen — Tue, 13 Jan 2009 22:45:00 GMT

The New York Times - January 13, 2009

At the International Consumer Electronics Show in Las Vegas, I stepped onto an ordinary-looking white bathroom scale. The scale sent a signal via Bluetooth to a control box, which read my weight aloud.

It was my first time on the scale. We had no relationship. I was just data. The machine was just a disembodied voice.

Then Mikael Hvid, application manager at Tunstall Healthcare A/S, which makes the box, stepped onto the scale. After telling Mr. Hvid his weight, the voice compared the figure with previous readings.

Then it got inquisitive.

“Are you more tired than usual?” it asked.

Mr. Hvid was. (This was Las Vegas, after all.) He pressed a “yes” button.

“Are you having trouble sleeping at night?” Ditto.

Mr. Hvid’s weight and answers were all harvested by the box’s software, which stood ready to make them available electronically to whomever he gave access: his primary care doctor, family members, perhaps a pulmonologist, maybe the administrators at his assisted living community.

The control box also works with gadgets measuring blood pressure, oxygen level, activity level and other markers of health. If the person on the scale were my mother, I might instruct the box to alert me if her weight rose or fell by a certain amount, or if her answers to questions suggested trouble. Other devices in the exhibition hall tracked whether a user fell, opened a pill bottle, made coffee, used the bathroom excessively at night or wandered out of the home.

In a nutshell, this was the big idea about aging at this year’s C.E.S.: how to use mostly simple technologies to gather information and detect warning signs, thereby allowing older people to remain in their own homes with fewer trips to the doctor’s office and less need for supervision in a skilled nursing facility.

I imagined my mother’s doctors all having a single report that showed how a change in her medication coincided with changes in weight, blood pressure, mood, sleep pattern and gait, then being able to discuss that information with one another, family members and my mother. That would be a big step forward for her and for many like her.

But then I imagined my mother living with a half-dozen electronic boxes beeping for attention and me getting alerts every time one of the measurements was skewed — me, without the medical expertise to sort the blips from the real problems. I’d call her doctor and become ensnared in a voicemail loop that asked if I was more tired than usual and if I was having trouble sleeping at night.

Yes, and heck yes. With technology like this, I might never sleep again.

These devices were unveiled at a day-long program called the Silvers Summit, the first forum at the C.E.S. dedicated to aging. Participants included hospitals, nonprofit groups, retailers, insurers and dozens of entrepreneurs, many of whom got involved after personally experiencing what it is like to care for an elderly relative in decline. Presenters said the technology is aimed not at old people but at their children.

“The fact that we’re in C.E.S. and we’re not just one booth means we’re getting somewhere,” said Eric Dishman, the global director of product research and innovation at the Intel Digital Health Group. “Seven or eight years ago, no one even talked about aging. Something tipped.”

Topics ranged from mental exercise programs for fending off dementia to phones for people with diminished hearing and dexterity. Most of the devices shown were not covered by insurance, and either in prototype or not widely used.

“Our society does not reimburse for prevention,” said David Stern, chief professional officer for Living Independently, which produces a home monitoring system called QuietCare that is used in assisted living communities. “But there’s a recognition now that people need technology and that if you can keep someone living at home, it costs a lot less than having them in a nursing home.”

Mr. Stern could not say how much QuietCare cost because each facility programs different features into it. Another system on display, GrandCare, costs $2,300 for the basic equipment, then $25 to $50 a month for the company to manage the flow of data. With GrandCare, relatives can upload photographs, appointments or messages to a device in an elder’s home that looks like a television with a touchscreen.

Mr. Stern said the home monitoring technology answered competing needs: “An older person in assisted living wants to maximize independence. But the expectations of family members and state regulators are that she is going to be made secure 24/7. How do you do both? Technology is the answer. It’s the only way they can be secure and independent without someone coming in and checking up on them.”

All vendors said their products were not meant to replace human contact with doctors or family members. But technology has unintended consequences. For some older people, the experience of having blood pressure checked can be the only human touch of the day. An automated home device can take the blood pressure and save the health care system hundreds of dollars, but it does not replace a living, breathing visitor or conversation with fellow patients during otherwise annoying doctor visits.

At one of the forum presentations, Dr. Hyung Tai Kim, a vice president of research at Ascension Health, a Catholic hospital system, identified two potential stumbling blocks for the devices. They called for doctors trained to treat patients in person to make judgments based on data gathered remotely. And current insurance programs do not compensate the doctors for these analyses.

Some of these gadgets will prove useful. Many others will become the home treadmills of the future — developed and purchased in good faith, but in practice unused. Mr. Dishman of Intel described a pillbox that alerted users every day at the same time that they needed to take a pill, even if they had already taken it. As a result, people didn’t use it, he said.

“No one wants to be nagged or be embarrassed by something that makes them look like they can’t take care of themselves,” he said. “We switched to one that was more responsive to whether you already took the pill, and we quadrupled compliance.”

“Those little tweaks go a long way,” he added.

The prototypes are now out there. Let the grumbling and tweaking begin.

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Fit, Not Frail: Exercise as a Tonic for Aging

jberman — Sat, 28 Jun 2008 04:50:00 GMT

The New York Times, June 24 2008

Fact: Every hour of every day, 330 Americans turn 60.

Fact: By 2030, one in five Americans will be older than 65.

Fact: The number of people over 100 doubles every decade.

Fact: As they age, people lose muscle mass and strength, flexibility and bone.

Fact: The resulting frailty leads to a loss of mobility and independence.

The last two facts may sound discouraging. But they can be countered by another. Regular participation in aerobics, strength training and balance and flexibility exercises can delay and may even prevent a life-limiting loss of physical abilities into one’s 90s and beyond.

This last fact has given rise to a new group of professionals who specialize in what they call “active aging” and an updated series of physical activity recommendations for older adults from the American Heart Association and the American College of Sports Medicine. These recommendations are expected to match new federal activity guidelines due in October from the United States Health and Human Services Department.

But you need not — indeed should not — wait for the government. Even if you have a chronic health problem or physical limitation, there are safe ways to improve fitness and well-being. Any delay can increase the risk of injury and make it harder to recoup your losses.

Miriam E. Nelson, director of the John Hancock Center for Physical Activity and Nutrition at Tufts University in Boston and lead author of the new recommendations, observed last fall in The Journal on Active Aging that “with every increasing decade of age, people become less and less active.”

“But,” Dr. Nelson said, “the evidence shows that with every increasing decade, exercise becomes more important in terms of quality of life, independence and having a full life. So as of now, Americans are not on the right path.”

Jim Concotelli of the Horizon Bay Senior Communities in Tampa, who oversees fitness and wellness program development for communities for the elderly in several states, noted this year in The Journal on Active Aging that many older Americans were unfamiliar with exercise activities and feared that they would cause injury and pain, especially if they have arthritis or other chronic problems. Yet by strengthening muscles, he said, they can improve joints and bones and function with less pain and less risk of injury.

The key is start slowly and build gradually as ability and strength improve. Most important is simply to start — now— perhaps under the guidance of a fitness professional or by creating a program based on the guidelines outlined here.

Fidelity: $85k needed for long-term care costs

jberman — Sat, 28 Jun 2008 04:47:00 GMT

The Boston Globe, June 26, 2008

A 65-year-old couple needs $85,000 on average to cover insurance costs for long-term care such as nursing home stays in retirement, according to a study to be released Thursday by Fidelity Investments.

The finding underscores the need to financially prepare for the possibility of eventually needing assistance to get by -- a burden that often falls on elders' adult children, who can jeopardize their own finances by caring for an ailing parent while finding they must cut their work hours.

Setting aside adequate savings heading into retirement can help defuse family tensions should physical or mental illness hit parents who slowly realize they can no longer perform tasks such as household chores, or bathe or dress on their own.

"If you plan adequately and you have the ability to pay for assistance in whatever form that might be, it makes it easier on everybody if you can do that," said Kathleen Kelly, executive director of the Family Caregiver Alliance, a San Francisco-based nonprofit that helps families cope with adults' disabilities. "Families really want to do the right thing, but there are so many pressures on them."

Fidelity, a Boston-based financial services firm whose mainstay is mutual funds, surveyed insurers offering long-term care policies to come up with the estimate that a couple aged 65 this year can expect to need $85,000 to cover annual premiums for long-term care coverage throughout retirement.

Medicare Savings vs. the Lobbyists

jberman — Thu, 26 Jun 2008 09:29:00 GMT

The New York Times, June 25, 2008

To cut costs and reduce fraud in one corner of the sprawling Medicare program, Congress called for competitive bidding on medical equipment that is provided to elderly and disabled Americans and set a sensible schedule for phasing in the program. Demonstration projects were held, the results looked promising, and last year Medicare received competitive bids from companies to supply equipment in 10 metropolitan areas.

With those companies about to start selling their wares next month, Congress has bowed to pressure from the losing bidders. The House approved legislation Tuesday that would terminate the contracts and delay the launch for 18 months. In the Senate, key committee leaders are leaning toward a delay.

This backtracking inevitably makes one wonder if major reform will ever be possible in a medical marketplace dominated by imperfect government bureaucracies and private lobbyists bent on resisting governmental reforms.

There is little doubt that Medicare has been paying far too much for equipment — including wheelchairs, hospital beds, oxygen concentrators, diabetic test kits, and walkers — under fee schedules based on historical charges. According to federal officials, Medicare currently pays $1,825 for a hospital bed that can be bought online for $754, and $4,023 for a power wheelchair that can be bought online for $2,174.

When Medicare awarded competitively bid contracts to some 325 companies to serve the 10 metropolitan areas, it reduced equipment prices by 26 percent on what it would have paid for the same equipment under the current fee schedule. That means that if the contracts were allowed to proceed, beneficiaries would save 26 percent on their co-payments. Medicare would save $125 million the first year and as much as $1 billion a year if the program went nationwide.