So…I moved into assisted living.  Here’s how it went.

So…I moved into assisted living. Here’s how it went.

Have you ever wondered what it would be like to live in one of those newfangled senior living facilities that are popping up all over the place?  I was curious too.  So I moved into one.  I have a friend whose company owns a number of these retirement centers and they had just finished building a new one called Aksarben Village in Omaha.  Since it was new and not yet full, I asked him if they had room for a temporary resident.  He pulled a few strings and before I knew it my name was on the door of room 217, I was getting my hair cut at the in-house salon and I was sitting down to meals with my fellow residents.  How did it go, what are these facilities like, what are the pros and cons of assisted living and what can you learn from the experience if you ever need this type of care for yourself or a loved one?

Who’s the new guy?

“Hi, I’m Pat,” she said as I sat down beside her for lunch.  She was friendly and had that gleam in her eye that immediately puts you at ease.  She quickly introduced me to the others at the table, including Dick, Kris, Martha, Dee Dee and Alice.  We spent that first meal talking and laughing and I got to know a little bit about each one.  I heard about kids, pets, spouses and stories from back in the day.  They knew I was writing an article about assisted living facilities, so I asked them what prompted them to move.  Most gave two or three reasons, but a common thread throughout revolved around health.

There aren’t many certainties in life, but this is one: Your health is going to change.  Your mental and physical abilities will look different at 70 or 80 than they did at 50 or 60.  Sometimes the changes are minor and sometimes major, but about two thirds of us will need help coping with those changes.  In the past, as abilities diminished, your choice was either a curtailed lifestyle (e.g. no driving, less cooking, etc.) supplemented by whatever assistance friends and family could provide or a move into a nursing home facility that was very expensive and provided way more care than you needed.

The basic idea of the new retirement living options is that they broaden the spectrum of help available.  They provide a base level of services that cover issues most of us deal with as we age and then provide a laundry list of à la carte services so that people get help where needed while still maintaining their lifestyle and independence.

Care levels

I learned all about these different levels of care during the check in process.  At one end of the spectrum are independent living facilities.  As the name implies, residents basically live independently (similar to renting an apartment), but the facility provides services like housekeeping, home maintenance, some meals, security and a number of other amenities.

Assisted Living, where I stayed, is next on the spectrum and provides much more involved care.  You have your own apartment (equipped with things like zero entry showers and an emergency response system), weekly housekeeping, laundry services, access to onsite medical personnel, transportation to outings or appointments and three restaurant style meals per day in the dining room.  In addition you have a personalized care plan based on an assessment completed at admission and then updated every 30 days.  This personalized care includes things like medication management, breathing treatments, bathing, grooming, using the restroom, mobility, dressing, safety checks and help with things like the phone or email.

People who need more intensive or specialized care—such as those suffering from dementia or Alzheimer’s disease—can move into either a memory care facility or a nursing home.  These facilities have specially trained staff and caregivers who are there to provide care 24 hours per day.

Many facilities (including where I stayed) recognize that people may need all three of these levels of care at some point, so they build them together into a sort of senior living campus.  This allows a person or his/her spouse to move up to the next level of care when needed.

Amenities and Activities

These new facilities are definitely not like nursing homes of old.  For example, where I stayed there was a large movie theater complete with popcorn machine and iPad controls that are connected to cable, Netflix and just about every other streaming service you could imagine.  There was a banquet room, private dining rooms for when family comes to visit and a full service kitchen with chefs who were more than happy to take any special requests.  There is also a workout room, a physical therapy room, billiard room, beauty/barber shop, chapel, library and an activity/craft room.

Residents put these facilities to good use.  Each month the lifestyle coordinator releases a new activity calendar containing church services, workout classes, movie nights, political discussion groups, cooking classes and trips to places like museums, stores and local restaurants.  Partnerships with community organizations provide additional benefits.  For example, the Omaha Public Library rotates new books each month through the library based on resident requests and Hy-Vee does free delivery of groceries each week to any resident that orders them.

Cost

As you can probably imagine, these services are not cheap.  The more care a person needs, the more expensive it gets.  Independent living averages about $2,500 per month nationwide.  Memory care and nursing home care are higher, averaging $6,000-$7000 per month.  Assisted living falls somewhere in the middle with the median cost of care nationwide around $3,600 per month.  Studio apartments where I stayed start at $3,500, but you could spend much more if you wanted a 2 bedroom, 2 bath unit.  The monthly care plan can add additional costs to assisted living.  Where I stayed, services are given a point value and any additional costs are based on the point total.  For example, someone who needs 2 medication reminders per day as well as assistance with shaving and getting dressed would have a point total of 14, which would cost about $285 extra each month.

How to pay

Except in very limited circumstances Medicare does not cover any long-term care costs.  Medicaid does, but to qualify, you basically need to be both sick and poor.  Even then, the amount Medicaid provides is limited, so most private facilities have a minimal number of beds set aside for Medicaid residents.  Because of that, those who want to live in these facilities will need the means to pay for it, which can be a major obstacle.  Most of the people I talked to were covering the costs from a combination of personal savings and payments from long-term care insurance.  Those policies can be expensive, but one month of care will usually cost more than one year of insurance premiums, so having a policy can make financial sense if you end up needing it.  In some cases, adult children were also helping to cover some of the costs so they could have peace of mind that mom and dad were well cared for.

Pros and Cons

One of the first people I met when I arrived at Aksarben Village was Colleen.  She is suffering from mild dementia which affects her short term memory, but was otherwise healthy, sharply dressed and a kick to talk with.  She has six kids and we spent the better part of an afternoon talking about each of them.  On the last day of my stay, I actually got to spend some time visiting with one of her daughters, Sara Wachter.  Her perspective gave me some great insights into the pros and cons of assisted living facilities.

Prior to moving into assisted living, she told me that her mom’s dementia was causing problems like social isolation, missed medications and missed meals.  Even with a big, supportive family the memory loss was creating issues that were impacting Colleen’s health, safety and lifestyle.  Their gerontologist said it was time to make a move so they started exploring options.  “Mom grew up in this part of town, so it was a good fit,” Sara said.  It wasn’t without challenges, however.  Finding out she had to leave her home was initially a shock, but hearing the news from the gerontologist gave it more weight and took the pressure for that decision off Colleen and her family.  Giving up her car was also tough, but since the facility had transportation the kids thought it was for the best.  Expenses were also a concern, but Colleen’s mother lived to be 104 and was in a nursing home, so Colleen purchased a long-term care policy years ago which has helped with the costs.

As Sara and I talked, we saw her mom come down to the front lobby and start chatting with other residents.  Dick Loneman, the driver at the facility, was getting ready to take them for an afternoon at the Joslyn Art Museum.

“Mom has thrived since moving in here,” said Sara.  “The things she couldn’t take care of were all of a sudden being taken care of by someone else.  Now she’s free to enjoy life and doesn’t have the responsibility for all those day to day things that had become so challenging for her.  It’s less stressful for us too, because we know she’s in good hands.”

Does Medicare cover you when you travel?

Does Medicare cover you when you travel?

Quick Note: Sorry things have been quiet around the site for a few weeks. I was on vacation with family and friends and prior to that I was scrambling to get things wrapped up at the office. I’m home and caught up, so it’s back to regularly scheduled programming. Thanks for your patience.

Being on the road made me think of a question that clients often ask me:

“Does Medicare cover me when I travel?”

The answer, of course, depends. And it would be bad enough to get sick or injured on vacation without also finding out that Medicare won’t cover the expenses, so let’s take a look at whether your Medicare will travel with you.

What type of Medicare do you have?

Coverage varies depending on whether you have original Medicare or Medicare Advantage. Original Medicare is just Parts A and B (hospital and outpatient services) supplemented with a Medigap policy. Medicare Advantage is when you have Parts A and B and then also purchase Part C, which is coverage provided by Medicare approved third-party health insurance companies. Each of these types of Medicare works differently depending on where you travel.

Where are you going?

Original Medicare is extremely flexible within the U.S. (which includes all 50 states as well as Washington D.C., Puerto Rico, U.S. Virgin Islands, Guam, American Somoa and the Northern Mariana Islands.). There are no networks or preferred providers with original Medicare, so you can get care at pretty much any facility that accepts Medicare.

Medicare Advantage is a bit less flexible. Coverage is most comprehensive if you get care within the network of the private health insurance company that is providing you Medicare Part C. Generally speaking, the closer you are to home, the better your coverage will be. Having said that, if you’re having a medical emergency you can use your Part C pretty much anywhere in the U.S. and it will be covered. Call your insurance company if you’re unsure if a particular provider is “in network” or “out of network.”

Except in very limited circumstances, neither type of Medicare (original or Advantage) will provide coverage while you’re traveling outside the U.S. They may cover certain services while you’re on a cruise ship or while you’re traveling across Canada on your way to Alaska, but that’s about it. Some Medigap policies cover emergency medical services while traveling abroad, but there are limits to the coverage. They generally pay for 80% of covered services after meeting a $250 deductible with a lifetime maximum of $50,000. Bottom line—if you’re planning a trip abroad, it’s best to buy a separate travel insurance policy with generous health coverage. It’s also a good idea to get a policy that includes evacuation insurance. As you might imagine, it would be very expensive to pluck you from the bottom of the Grand Canyon or from the rain forest in Costa Rica if you are sick or injured. Those costs can run into the tens of thousands of dollars and neither Medicare nor Medigap covers the cost of a medical evacuation.

So before you hit the road, do a little research to make sure you’re covered and your trip will be a lot more enjoyable. Bon Voyage!

~ Joe

Photo Credit: Nick Kelly
Zen and the art of retirement

Zen and the art of retirement

I just finished reading Zen and the Art of Motorcycle Maintenance.  It’s a bestselling classic, but I must confess that I wasn’t a huge fan.  It did have a few great nuggets that made me think, however, and today I’d like to share a short passage from the book that could have a profound impact on how you approach retirement. Consider it Zen and the Art of Retirement.

In the passage, the main character is talking about the problem of value rigidity, which refers to our tendency to cling to certain preconceived ideas of what’s important and what’s not, even when events or circumstances change.  To make matters worse, we sometimes put a high value on things that we shouldn’t and then stubbornly cling to our error.  Here’s the text followed by a few takeaways for your life and retirement.

“All kinds of examples from cycle maintenance could be given, but the most striking example of value rigidity I can think of is the old South Indian Monkey Trap, which depends on value rigidity for its effectiveness. The trap consists of a hollowed-out coconut chained to a stake. The coconut has some rice inside which can be grabbed through a small hole. The hole is big enough so that the monkey’s hand can go in, but too small for his fist with rice in it to come out. The monkey reaches in and is suddenly trapped…by nothing more than his own value rigidity. He can’t revalue the rice. He cannot see that freedom without rice is more valuable than capture with it. The villagers are coming to get him and take him away. They’re coming closer — closer! — now! What general advice…not specific advice…but what general advice would you give the poor monkey in circumstances like this?

Well, I think you might say exactly what I’ve been saying about value rigidity, with perhaps a little extra urgency. There is a fact this monkey should know: if he opens his hand he’s free. But how is he going to discover this fact? By removing the value rigidity that rates rice above freedom. How is he going to do that? Well, he should somehow try to slow down deliberately and go over ground that he has been over before and see if things he thought were important really were important and, well, stop yanking and just stare at the coconut for a while. Before long he should get a nibble from a little fact wondering if he is interested in it. He should try to understand this fact not so much in terms of his big problem as for its own sake. That problem may not be as big as he thinks it is. That fact may not be as small as he thinks it is either. That’s about all the general information you can give him.”

Here are three important takeaways from this story:

Sometimes, especially during times of change or major life transitions (e.g. retirement), we need to revalue things so that we can realign our actions and beliefs with our new life. Said another way, the types of things that are important to us in the new life stage are likely different from the things that were important to us during the previous life stage.  We need to decide what those new things are and elevate them to their proper position.  If we don’t, we’ll cling to things that used to be important to us (e.g. work, certain relationships, houses, how we spend our free time, hometowns, etc.) and our tight grip on those keeps us stuck in the monkey trap, unable to pursue our new plans.

Sometimes holding the tangible thing can cause you to lose the intangible. There’s nothing wrong with having nice things, but everything we own takes some of our time and some of our money.  If we focus too much on the tangible (houses, cars, gadgets, etc.), that leaves little time and money left over for the intangible (travel, experiences, hobbies, relationships, pursuits, etc.).

Sometimes we don’t understand how much we value the intangibles until we lose them. I was reading a study recently that listed out the types of things that were important to retirees.  Number 1 was financial security (no surprise there).  Number 2 was health.  In the story above, the monkey got the rice, but it cost him his freedom.  I don’t know about you, but I’ve definitely made sacrifices to my health as I pursued wealth (a.k.a. career).  I’m sure you have too.  We work hard.  We’re busy.  No time for a healthy lunch.  No time to exercise.  No time to get enough sleep.  We take our health for granted.  In our own way, we’re grabbing for the rice, but if we’re not careful it could cost us a major intangible like our health, and consequently our freedom to pursue many of our retirement plans.  We may take it for granted now, but it will be sorely missed when it’s gone.

How can we avoid monkey traps?

What that question is really asking is this: How can we tell if we’re hanging on to something trivial at the expense of something important?  How can we tell the genuine from the counterfeit?  To answer that, let’s look at an example from the Secret Service.  In addition to protecting the President, the Secret Service is in charge of protecting against counterfeit currency.  When they’re training new agents to recognize counterfeits, they don’t sit them down in a room with a bunch of counterfeit bills and point out the flaws.

Instead they sit them down in a room with currency experts and pristine examples of genuine bills.  They go through every detail.  Why it’s there.  What it represents.  How it deters counterfeiters.  How difficult it is to reproduce.  How to look for it.  They learn what the ink looks like.  They learn what the paper feels like.  They learn what the bill smells like.

By studying what makes a bill genuine, a funny thing happens.  Without ever studying the counterfeits, agents can spot them from a mile away because they know what the genuine bills look like.  We can do something similar.  If we sit down and decide what’s genuinely important to us—what we value above all else—then when imposter opportunities come along, we will be able to recognize them for what they are.  Then rather than shoving our hand inside and grabbing for the rice, we’ll keep right on walking because we have a clear idea of what we really want out of life and we’re taking those plans very seriously.  If we can all do that, then we’ll be well on our way to an intentional, meaningful retirement.

~ Joe

9 proven ways to live a long, healthy life

9 proven ways to live a long, healthy life

If you’re like me, you want to live a long, healthy life, filled with purpose and surrounded by those you love.  What are some practical ways to make that dream a reality?

Best-selling author Dan Buettner, along with a team at National Geographic, think they have the answer.  They scoured the world for communities of people that lived longer, healthier lives and then researched those people to determine what they were doing differently than the rest of us.  His team came up with 9 key traits.

Move naturally.  None of the people studied by Buettner exercised in the way that you and I have come to think of exercise.  They didn’t run marathons, lift weights or do CrossFit.  Instead they moved naturally.  They walked, climbed stairs, gardened and/or road their bike for transportation.  Movement was a regular, natural part of their day.

Have a purpose.  Apparently, if you have a reason to get out of bed in the morning, you’re much more likely to be alive to get out of bed in the morning.  Buettner points out that the people in the Blue Zone of Okinawa Japan have even given this a name.  They call it Ikigai.  It means “a reason for being” or “a reason for getting out of bed in the morning.”  What is your Ikigai?

Find ways to relax and shed stress.  Buettner’s researchers found that when you’re in a hurry and stressed, it triggers an inflammatory response in your body.  That inflammatory response can lead to all sorts of health problems and diseases.  By finding ways to relax and de-stress, Blue Zone people live longer.

Eat less.  Those who live longer tend to eat less than the rest of us.  Buettner points out that it takes your stomach about 30 minutes to tell your brain that you’re full.  Blue Zone people naturally recognize that and stop eating before they’re full.  The Japanese even have a name for it: Hara Hachi Bu.  It’s a Confucian teaching to stop eating when your belly is 80% full.

Eat more plants and less meat.  Blue Zone people aren’t typically vegetarians, but they tend to eat a more plant based diet, especially beans.  They eat meat, but usually only 4-5 times per month.

Drink in moderation.  Those who drink in moderation tend to outlive teetotalers.  The antioxidants and resveratrol in red wine, for example, have been shown to improve artery health and increase good cholesterol (HDL).  Consume too much, however, and the negatives outweigh the positives.

Have faith.  Buettner and his team found that those who attend some sort of faith based service four times per month tended to live, on average, about 14 years longer than those who didn’t.

Live close to and be committed to loved ones.  Blue Zone people tend to live close to their loved ones and they are committed to those relationships.  They have a healthy marriage.  They keep parents and grandparents close by and they help them as they age.  They have their children nearby and have a good relationship with them.

Have a strong social network.  Blue Zone people tend to have strong friendships.  Not only that, but their friends tend to support healthy behaviors and they are a positive influence—both mentally and physically.

On the surface, Buettner’s research seems like common sense—eat right, get exercise, have friends—but I think that misses the main point.  The power of those behaviors only shows up when they become lifestyle habits.  The people in the Blue Zones do those things every day for a lifetime.  So if you want to gain some of the same benefits (regardless of where you live), consider how you can design your lifestyle, environment and daily life to incorporate those 9 things regularly.

If you want to read more about Blue Zones, Buettner has two books based on his research:

~ Joe

Note: I periodically recommend books to readers and I belong to the Amazon Affiliate Program.  That means that, at no additional cost to you, Amazon will pay me a few cents if you purchase a book through one of my links.  Obviously I’m not doing that to get rich, but because I believe in the things I recommend.  Please don’t buy anything unless it will help you accomplish your goals for a meaningful retirement.
Five things that matter more than money in retirement

Five things that matter more than money in retirement

We put a lot of emphasis on saving enough money for retirement, and rightly so.  Money is important, but as I’ve said time and again, retirement is more than a math problem.  One negative side effect of our obsession with our “number” is that we forget (or never decided) what we wanted all that money for in the first place.  With that in mind, here are 5 things that are more important than (or at least just as important as) money to a happy, fulfilling retirement.

1.  Health.  Emerson once said, “The first wealth is health.”  You don’t need to be a millionaire to enjoy a nice walk on a beautiful day.  Conversely, you can have millions, but if you’re constantly in pain or physically unable to do even simple things like walk up stairs or pick up your grandkids, then the options available to you during retirement will be small indeed.

2.  Curiosity.  Thomas Hobbes once said, “Curiosity is the lust of the mind.”  Lust is an emotion or feeling of intense desire.  Curiosity, therefore, is a lust to know “Why?” and “How?”  It’s an intense desire to learn, explore and discover.  It’s a passion to do and be.  It’s an appetite for experiences and an interesting life.  Money can’t buy that.

3.  A willingness to act (a.k.a. Be intentional). Donald Miller once said, “If you happen to be sitting in the theater of your mind, watching through the camera lenses of your eyes and the story you’re watching isn’t very interesting, there’s something you can do about it.  You can edit it.  You can change it.”  You are not a passenger on the plane of your life.  You’re the pilot.  Some initiative and a willingness to be proactive can often go a lot further than a few extra bucks in your bank account.

4.  Relationships.  David Rockefeller once said, “I am convinced that material things can contribute a lot to making one’s life pleasant, but, basically, if you do not have very good friends and relatives who matter to you, life will be really empty and sad and material things cease to be important.”  I can’t add much to that.

5.  Time.  Carl Sandberg once said, “Time is the coin of your life.  It is the only coin you have, and only you can determine how it will be spent.”  Carnegie had more money than you.  Kennedy had more power than you.  Clark Gable (or Grace Kelly) was better looking than you.  Elvis was more popular than you.  Shackleton had a more adventurous life than you.  Would you trade places with any of them?  No, because they ran out of the one commodity that makes any of those things worthwhile: Time.  Time is your most important asset, but you have less of it now than when you started reading this article.  It is your only asset that never grows.  Use it wisely.

~ Joe

Photo by Nick Kelly

What one man’s wilderness adventure can teach you about retirement

What one man’s wilderness adventure can teach you about retirement

Some of you know that my wife is from Alaska.  Her dad (pictured above) was a fighter pilot in the Air Force and Alaska was the final posting.  Until my in-law’s recent move to Washington, we would visit the 49th state almost every year.  It is a beautiful place and I highly recommend it, but it can be a very harsh place too.

Alaska often presents you with unusual situations that don’t come up in the Lower 48.  For example, when playing golf and your ball rolls against a freshly killed moose (unfortunately this is a true story), does the rule book say that you should a) Dislodge your ball and take a drop, b) Take a one stroke penalty and hit again from the fairway or c) Pick up your ball and slowly back away to the next hole because you can hear the moose murdering bear huffing angrily just beyond the tree line?  If you said C, you should start making your summer vacation plans now.

I share my connection to Alaska by way of explaining how I came across a book that I read over the holidays.  On Thanksgiving our post-meal conversation somehow meandered to the topic of the Alaska bush and my father-in-law told me about a book called One Man’s Wilderness.  It is the story of Richard Proenneke who, at age 51, decided he had had enough of “electricity” and “indoor plumbing” and moved out to the bush.  Using a few hand tools, a sharp mind and a strong back, he built himself an amazing little cabin, doing everything from felling the trees to carving the door hinges out of tree stumps. (!?!)  While building the cabin, he had to grow/shoot/catch his food, cut his own firewood, and generally be a backwoods superstar.  He lived that lifestyle from age 51 until he decided it was to time to return to civilization at 86.

His retirement was almost certainly more physical than yours and mine will be (hallelujah!), but something he said really struck me.  He talked about how he needed some money to pay the material cost of his time in the bush (he’d have a pilot periodically fly in certain supplies), but more than the monetary price, he learned that the things he wanted to do had a physical price tag.  From his journal:

“After a supper of navy beans, I sat on my threshold and gazed off toward the volcanic mountains…I thought of the sights I had seen.  The price was physical toll.  Money does little good back here.  It could not buy the fit feeling that surged through my arms and shoulders.  It could not buy the feeling of accomplishment.  I had been my own tour guide and my power had been my transportation.  This great big country was my playground, and I could afford the price it demanded.”

I’ll concede that you probably won’t need to hand carve your own cooking utensils in retirement or build a food cache to keep the neighborhood grizzly out of your supplies, but I’ll bet the things you want to do have a physical price tag in addition to their monetary price tag.  And if you’re like most people, you’re saving so you can afford the monetary price of your retirement dreams, but that won’t matter if you can’t afford the physical price tag.

Yes, you might be able to afford the golf membership, the fancy garden tools or the trip to Spain to hike the Camino de Santiago, but if you can’t afford the physical price that those things demand then they are just as out of reach as they are to a person with no savings.

So as we start the New Year, think about your health and how important that is to everything you want to do in life.  What can you do now to start making deposits into your “health” account so it will be adequate to see you through retirement?

And if you want to read Proenneke’s story (which I highly recommend) you can pick up a copy on Amazon over here: One Man’s Wilderness.

~ Joe