A Letter to Our Grandchildren

Dear beloved grandchildren,

As I get older, I think more about what I want to leave you in the way of advice. Of course, I have been doing some of that all along. My son Evan thinks that I “opine” too much, but I thought it might help to have things in writing that you can read now and then, when you are ready, able, and interested.

There are so many topics to tell you about, but let’s start with your health. Without good health, your ability to do many things will be limited. So, here goes! Continue reading…

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The Benefits of Phased Retirement

Until relatively recently, employees in the U.S. typically transitioned directly from full time work to full time retirement. That practice had at least four major drawbacks:

  1. Some employees wanted to stop working full time but for financial reasons felt a need to continue earning.
  2. Some employees found their work meaningful apart from the income it produced, and wanted to continue their employment – but not on a full time basis.
  3. Some employers wanted to retain skilled employees, for direct application of their skills and for mentoring their ultimate replacements.
  4. And, for government, when workers continue employment they typically require a lower level of government benefits and continue to pay taxes.

Flexible work opportunities for older employees allow two basic forms of phased retirement. Continue reading…

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Regulation of Long-Term Care Insurance in Massachusetts

The time may come when any one of us will need outside help with certain basic activities, referred to collectively as the activities of daily living or ADLs.   Long-term care insurance (LTCI) is a resource for covering some or all of the costs of providing the care needed in that unfortunate situation.  It is not for everyone.  It is a suitable type of insurance for those who simultaneously want to protect any assets they may have accumulated and can afford paying the premiums year after year either indefinitely or until the need to make a claim arises.  The initial premiums can be larger or smaller, depending upon the amount of coverage purchased.  Any costs of care paid through this type of insurance do not become a burden on the public budget.   

Eleven years ago, my wife and I bought LTCI.  At the time we were utterly unaware that stability of premiums was a significant issue.  And for nearly six years it wasn’t, at least not for us. 

Then suddenly things changed.  Early in 2008, we learned that the Massachusetts Division of Insurance (DOI) had approved our company’s filing for a 72.8 percent annual premium increase.

The benefits were not increasing at all, only the premiums.  Continue reading…

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Setting Generational Priorities

In the mid-1980s, just as I was becoming interested in health care for the elderly and the future of Medicare, Samuel Preston, a distinguished social scientist at the University of Pennsylvania, give a 1984 presidential address to the Population Association of America. His topic was the growing disparity between health and other resources for children and for the elderly. In 1970, he said, poverty among children under 14 was 37 percent less than poverty among the elderly. But by 1982 the incidence of  poverty among children was 56 percent greater than among the elderly. And, he added, “let’s be clear that the transfers from the working-age generation are also transfers away from children, since the working ages bear far more responsibility for child rearing than do the elderly.”

Preston’s address and the position he took set off a great debate, Continue reading…

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Why the Elderly Should Support Health Care Rationing

On the face of it, it would seem preposterous to argue that the over 65 population should support health care rationing. After all, both Democrats and Republicans regularly pledge to protect Medicare from any changes and attack the other party for threatening the program. And in a 2012 Pew Foundation poll, over 65ers by a 3:1 ratio said that government policies should favor older people over younger.

I believe, however, that there are four strong considerations that would point us over 65ers towards at least considering the possibility of supporting the concept of rationing: Continue reading…

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Memory Loss

Talking to my friends and looking at my own reactions, I believe that memory loss is one of the most feared disabilities of aging.  Since, as we age, most of us experience some degree of memory loss, it is easy to wonder if what we are experiencing are the first steps to dementia.  Witnessing someone with Altzheimer’s Disease can be a really unsettling experience, particularly if is a genetic relative.  I have Parkinson’s Disease which has a much higher incidence of dementia than the general population, so my memory failings can be very disconcerting.  Our memories and ability to function mentally constitutes the essence of who we are, defining our personalities and our abilities.  For a few, memory loss is massive and devastating and is accompanied by loss of many other functions such as their ability to function socially, behave appropriately, make sound judgments, solve problems and take care of oneself. The loss of that complex of functions we label dementia.  For most memory loss is much less severe and is part of the normal process of aging.  It can be annoying, frustrating and worrisome (Am I developing Altzheimer’s Disease?), but it is circumscribed.  This post is mainly about normal memory loss, but I will start with describing dementia. Continue reading…

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Response to Unreasonable Health Choices: Smoking cigarettes over age 65

In her May 6 post about “Unreasonable Health Choices,” Sissela Bok poses the question of why people make unreasonable choices, using cigarette smoking as one example, since everyone knows that smoking is bad for your health.  In fact, during our lifetimes we have witnessed a revolution regarding attitudes and practices of smoking.  When I was growing up the detritus of cigarettes was an accepted part of our household. Both my parents smoked, as did many of their peers.  They were able to quit at age 55 (dad) and 71 (mom), and most of their friends did the same.  By contrast, I suspect that it is rare for the followers of Over 65 to even know a friend who smokes, let alone to have visitors smoke in their homes.

What caused this dramatic shift? Continue reading…

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How HIPAA Interferes with Caregiving for the Elderly

Although it was not the intent of the law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) has been interpreted and misapplied as a barrier to communication with the very people who have a deep and often lifelong relationship with elderly  patients  and who will be responsible for managing or providing care in the community. When a family member asks almost any question relating to a family member’s care and treatment, this is what they too often are likely to hear: “I can’t tell you because of HIPAA.”  End of conversation.  Continue reading…

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Acceptance

Aging requires the acceptance of some inevitable truths about oneself and about life. We are no longer able to imagine an infinite future. Our mortality is assured. Progressively, we will lose our energy, our friends, our cherished activities and the identity we once knew.  If you are like me, you don’t suddenly arrive at this point, it comes upon you in small fragments of experience which often you would just as soon deny.

We want to think of ourselves as we always were, and, in fact, for most of our lives, aging occurs so gradually that we can maintain that illusion, until some physical or emotional event teaches us otherwise. Over the age of 60 or so, aging progressively accelerates so that this year no longer looks like two years ago. Interestingly, in some surveys of elderly people, most of them said that they still thought of themselves as they once were and couldn’t figure out who the person in the mirror was. Continue reading…

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