June 2, 2020
Home Care Reform’s Outcome a Surprise
Medicaid pays for care for six out of 10 nursing home residents.
To reduce the program’s costs, the Affordable Care Act (ACA) encouraged states to expand the care that people over 65 can receive in their homes or through community organizations. The hope was that they would delay or – even better for them – avoid moving into a nursing home if they had easier access to medical and support services.
Many states historically did not use Medicaid funding to pay for home care. The ACA’s Balancing Incentive Payments Program required the 15 states that chose to participate in the reform, including Nevada, Texas, Florida, Illinois, and New York, to increase spending on home and community care to half of their total Medicaid budgets for long-term care. By the end of the program, the states had met their goals of more balanced spending on home care versus nursing home care.
But four years after the reform went into effect in 2011, the states’ nursing home population had not changed, compared with the states that did not expand their services, according to a University of Wisconsin study for the Retirement and Disability Research Consortium. The researchers said one possible reason the reform didn’t reduce nursing home residence was that people who were never candidates for this care were the ones taking advantage of the alternative forms of care.
The analysis did find other unintended consequences of the shift in Medicaid funds to home and community care. First, somewhat more older people moved out of a family member’s house and were able to live on their own.
Second, as more people moved into their own place, costs may have increased for a different federal program: Supplemental Security Income (SSI) for low-income people. The increase had to do with how this program calculates financial assistance. SSI’s monthly benefits are based on an individual’s income. When retirees decide to live on their own, the housing, meals and other supports the family once provided are no longer counted as income. The drop in a retiree’s income means a bigger SSI check.
On the other hand, the Medicaid reform may have financial benefits for caregiving families, the researchers said.
The greater availability of home and community care for seniors – whether they live with family or on their own – frees up time for their family members to earn more money at paying jobs. …
April 21, 2020
Self-Employment More Prevalent Over 65
Workers of all ages are being affected by the damage COVID-19 is doing to the economy, but people who are loosely attached to the labor force may be more vulnerable.
That’s the situation for a small but growing segment of the U.S. labor market: self-employed people who are 65 and older.
When workers are in their prime, most of them are directly on an employer’s payroll. But a new study finds that self-employment begins to dominate as people work past traditional retirement ages and work as independent contractors, consultants, freelancers, or gig workers.
The detailed Gallup survey designed by the researchers shows that self-employment is more pervasive at older ages than previous data had indicated. Nearly half of all workers in their late 60s are self-employed, and that rises to more than two-thirds of workers in their late 70s. In contrast, only one-fourth of people in their late 50s are self-employed.
The Gallup survey was designed to capture self-employment more fully than the Bureau of Labor Statistics (BLS) does. That’s because the researchers asked detailed questions designed to get a more complete count of the independent contractors who may mistakenly have failed to report themselves as self-employed to the BLS.
In the study, independent contractor is the most common form of self-employment at older ages. This is mainly the province of an elite group who are able and willing to continue working several years after most people have retired. They are often professionals or former managers who said their primary motivations for being self-employed are remaining active or pursuing an interest.
But even at the oldest ages, a significant minority of independent contractors are working mainly for the money. …Learn More
October 3, 2019
The Secret to Feeling Younger
You’re as young as you feel!
This cliché is meant to be uplifting to older people. But it really just begs the question: what, exactly, is it that makes a person feel young?
Having a sense of control over the events in one’s life is the answer that emerged from a 2019 study of 60- to 90-year-olds in the Journal of Gerontology. “[B]elieving that your daily efforts can result in desired outcomes” lines up nicely with what the researchers call “a younger subjective age.”
This makes a lot of sense. Feeling in control becomes important as we age, because it counteracts our growing vulnerabilities – we can’t move as fast, hear as well, or remember as much. Wresting back some control can rejuvenate older people, instill optimism, and improve memory and even longevity, various studies have found. …Learn More
August 15, 2019
Walk? Yes! But Not 10,000 Steps a Day
A few of my friends who’ve recently retired decided to start walking more, sometimes for an hour or more a day.
Becoming sedentary seems to be a danger in retirement, when life can slow down, and medical research has documented the myriad health benefits of physical activity. To enjoy the benefits from walking – weight loss, heart health, more independence in old age, and even a longer life – medical experts and fitness gurus often recommend that people shoot for 10,000 steps per day.
But what’s the point of a goal if it’s unrealistic? A Centers for Disease Control study that gave middle-aged people a pedometer to record their activity found that “the 10,000-step recommendation for daily exercise was considered too difficult to achieve.”
Here’s new information that should take some of the pressure off: walking about half as many steps still has substantial health benefits.
I. Min Lee at Brigham and Women’s Hospital in Boston tracked 17,000 older women – average age 72 – to determine whether walking regularly would increase their life spans. It turns out that the women’s death rate declined by 40 percent when they walked just 4,400 steps a day.
Walking more than 4,400 steps is even better – but only up to a point. For every 1,000 additional steps beyond 4,400, the mortality rate declined, but the benefits stopped at around 7,500 steps per day, said the study, published in the May issue of the Journal of the American Medical Association.
More good news in the study for retirees is that it’s not necessary to walk vigorously to enjoy the health benefits. …Learn More
June 18, 2019
Vignettes Improve Social Security Savvy
There’s an informal rule in journalism: put too many numbers in an article, and readers will drop like flies. A similar phenomenon might also be at work when someone looks at a Social Security statement filled with numbers.
The statement, which is intended to help workers plan for retirement, shows the size of the monthly benefit check increasing incrementally as the claiming age increases. Yet many people still choose to claim their benefits soon after becoming eligible at 62, which means smaller Social Security checks, possibly for decades.
In a recent experiment, a friendlier approach proved effective in helping people process this information: tell a story. Researchers at the Center for Economic and Social Research at the University of Southern California created a fictional 3-minute video of a 62-year-old man talking with a financial adviser about retirement. The researchers showed it to workers between 50 and 60 years old.
Here’s one exchange in the video:
Adviser: [Social Security has] a tradeoff: you can decide to claim earlier. In that case, you would have a lower monthly benefit, but you’d get to enjoy these benefits for a longer period.
Worker: So if I claim sooner, I get less money per month? …Learn More
May 16, 2019
Social, Economic Inequities Grow with Age
Retirement, as portrayed in TV commercials, is the time to indulge a passion, whether tennis, enjoying more time with a spouse, frequent socializing, or civic engagement.
Boston University sociologist Deborah Carr isn’t buying this idealized picture of aging.
“This gilded existence is not within the grasp of all older adults,” she argues in “Golden Years? Social Inequality in Later Life.” “For those on the lower rungs of the ladder,” she writes, retirement is “marked by daily struggle, physical health challenges and economic scarcity.”
Her book, which mines multidisciplinary research on aging, reaches the distressing conclusion that economic inequality not only exists but that it becomes more pronounced as people age and become vulnerable. And this problem will grow and affect more people as the population gets older.
Poverty has actually declined among retirees since the 1960s. But by every measure – health, money, social and family relationships, mental well-being – seniors who have a lower socioeconomic status are at a big disadvantage. They have more financial problems, which creates stress, and they are more isolated and die younger.
Throughout the book, Carr documents the myriad ways the disparities, which begin at birth, reinforce each other as people grow up and grow old.
“Advantage begets further advantage, and disadvantage begets further disadvantage,” Carr concludes. For the less fortunate, “old age can be the worst of times,” she said. …Learn More
April 30, 2019
Medical Costs Slam a Minority of Seniors
As retirees’ health declines, their medical costs go up. These costs include both everyday healthcare expenses and long-term care costs.
The everyday expenses that Medicare does not cover – Part B and Part D premiums, copayments, eyeglasses, and dental care – consume about 20 percent of the incomes of households ages 75 and over. While not exactly good news, 20 percent is “perhaps manageable” for most, concluded researchers at the Center for Retirement Research in a summary of various studies in this area.
The real problem comes for the unlucky minority – about 5 percent of seniors – who spend more than half of their income out of their own pockets for healthcare.
Turning to long-term care, these services are less frequently required but can be very costly. For example, while many nursing home stays are relatively short, a lengthy stay is a potentially crippling expense. One common trigger for a long-term stay is dementia.
The retirees facing the greatest financial risk from health care expenses tend to be those who earned enough to buy a house and put money away in their employer’s retirement plan. They have more to lose if their wealth is eaten up by exorbitant medical costs. The poor, in contrast, are covered by Medicaid, which often pays for Medicare premiums and long-term care. …Learn More