Prime Time (45 page)

FIDELITY
(
www.fidelity.com
). Fidelity offers a more all-encompassing financial service that may be attractive to baby boomers. The Fidelity Retirement Income Advantage program starts with Monte Carlo modeling and goes further, notes Savage, “providing the framework for planning, investing, withdrawing, and reassessing all your retirement assets, from Social Security and pension checks to IRA rollover assets and other savings, whether invested with Fidelity or elsewhere.”
⁵

VANGUARD
(
www.vanguard.com
). The Vanguard Group manages some of the largest funds, specializes in index funds, and has provided a type of Monte Carlo modeling to its clients for years. As of this writing, fees for its services range from free to $1,500, depending on the size of the account. The standard fee covers a one-time consultation with a certified financial planner, who is supposed to help you examine your choices and develop a plan, using both Vanquard and non-Vanguard investments. A complete and ongoing money-management service is also available, at a higher cost.

Professional Advice

Terry Savage points out that even with all these amazing tools and services available online for people who, like me, are challenged in technological and financial domains, there is nothing like a trusted, certified, experienced professional to help make sense of it all. To find such a person, Savage suggests going to the website for certified financial planners (CFP),
www.cfp.net
. There you will find a search engine that gives you a list of CFPs in your area and lets you check a planner’s credentials and find out if they have anything questionable in their history. Some CFPs charge an hourly fee for creating and updating a plan; plus, they receive commissions on products they sell, such as life insurance or mutual funds. Fee-only planners receive no commissions on sold products. Fee-only planners are credentialed through the National Association of Personal Financial Advisors (NAPFA). NAPFA members can be reached at
www.napfa.org
.

Never give any financial adviser the power to make independent decisions without your knowledge. If you don’t understand what is being offered, ask questions—and keep asking—until you do, and be sure you understand all the risks. You can check out any financial professional’s disciplinary history at
www.FINRA.org
, the website of the Financial Industry Regulatory Authority.

One last word of advice from Terry Savage: “If it sounds too good to be true, it usually is! There’s nothing wrong with keeping a significant portion of your money in what I call ‘chicken money’ investments, such as short-term, insured bank CDs or money market accounts. You won’t get rich with these low-yielding investments—but you won’t get poor either! They give you peace of mind so you can invest the balance of your money for growth and income.”

Long-Term Care

It may surprise you to learn that 80 percent of older people are fully independent. The 2005 National Health Interview Survey revealed that only 7 percent of people between the ages of seventy-five and eighty-four and only 25 percent of those over eighty-four depend on someone for their personal care. Still, elderly women over sixty-five are three times as likely as elderly men to be widowed, sickly, indigent, and in need of assistance from their children—usually this means their female children since, like all forms of care, caring for elderly parents falls predominantly to women. One English study found that women spent nineteen minutes in the most arduous care of elderly relatives for every minute their husbands spent.
⁶

It is possible that you will not be able to afford long-term-care insurance. Many Americans cannot buy this type of insurance because it is expensive and their savings may be gone by the time they need such care. I saw, up close and personal, what lack of long-term care can do to a family. I had an uncle who developed Parkinson’s disease. His was a very protracted illness that ended up draining all the family’s savings. This is why you should try, if at all possible, to have your estate planning include insurance coverage for long-term incapacity, including assisted living, nursing homes, and in-home care, which Medicare does not cover long-term. If you’re old and impoverished, the state will put you in a Medicaid-funded nursing home. If at all possible, it is wise to identify an attorney, accountant, or estate planner who can work with you to develop a plan to cover long-term care when rising insurance premiums may be more than you can afford. For information on long-term-care insurance policies, go to
www.MagaLTC.com
—independent agents, specializing in this type of insurance. Different strategies can include reverse mortgages or living trusts. The younger you are when you take out long-term-care insurance, the less expensive the premiums will be.

Mary Madden is a sixty-two-year-old Atlanta businesswoman who is dating a man she met online. She told me, “I just recently got long-term care, and I asked when I got it if I got married what it would take to put someone else on it. Turns out the other person can be included pretty easily. Because that’s what worries me—the long-term care if we ended up together and one of us got sick. If you are getting married at this point in your life, you need to make sure everyone has long-term-care insurance because otherwise it could jeopardize what you leave your children. So I talked to my life insurance agent and we moved things around so I would have long-term care.”

You can go to
AoA.gov
for information on many elder care services, including housing and seniors’ rights, and Medicare.gov/nhcompare for information on the quality and performance of every nursing home in the country that is certified by Medicare or Medicaid.

Making Your Will

Many people put off making a will. It does, after all, require facing the time when you’ll no longer be around. My estate planner, with whom I started working thirty years ago, when my children were very young, tells me that many of her clients have to be dragged kicking and screaming into the process, whereas I see it as a fascinating, ever-evolving exercise that forces me to imagine what my children and grandchildren will become and which of my organizational efforts I want to endow if I am able and in what form. So, if you haven’t already, get to work on a will or a revocable living trust and make sure that all legal documents, deeds to your house, insurance policies, and so forth are with a lawyer or in a safe-deposit box that has a signer you trust.

Durable Power of Attorney

Another document you need is a durable power of attorney. This gives the authority to make legal decisions to a child or other trusted individual should you be incapacitated. In this way, you make it possible for them to avoid legal hassles with banks, doctors, and so on. This document should be created in conjunction with your will, or the person to make these decisions can be the “successor trustee” of your revocable trust. Think carefully about the person you choose for this responsibility; it should be someone who loves and understands you, and who will be available in an emergency situation.

Palliative Care

Knowing from my own family experience the agony an ill person and their loved ones can go through as disease wends its way through all facets of their lives, I was eager to find out about a relatively new field of care known as palliative care, which has grown up in the last decade or so. Palliative care provides emotional, spiritual, and practical care for patients who are ill but not necessarily terminal; a serious illness can take a toll not only on the patient herself but on her family as well. By the year 2009, more than 1,530 U.S. hospitals (62 percent) were providing palliative care.

I assumed palliative care was the same as hospice care, the value of which I had witnessed when a beloved aunt was dying. The hospice worker enabled my aunt to actually look forward to the experience. My aunt called me the night she died to say goodbye and tell me she’d put on her favorite lipstick and nightgown and “was ready to die.” But when I interviewed Dr. Diane Meier, who heads the Center to Advance Palliative Care (CAPC) at Mount Sinai School of Medicine in New York, she made clear that hospice and palliative care are different.

“Hospice is one version of palliative care specifically for the terminally ill,” Dr. Meier explained. “And, in fact, to get hospice in this country, your doctor has to sign a piece of paper saying you are dying within six months, and you—the patient—also have to sign a piece of paper saying you are willing to give up life-prolonging treatment in return for hospice care. It’s not human nature to accept the reality of death, nor to give up the hope that more treatment will prolong your life. As a result, the majority of people don’t start getting hospice until the last few weeks of their lives, and more than 60 to 70 percent of Americans who die never get hospice at all because of those barriers, those eligibility barriers. Late referral means that people and their families miss out on the care and support they desperately need during the typically many-year duration of a serious illness. This is why palliative care outside of hospice is not limited to the dying.”

Palliative care, Dr. Meier went on, is “for anyone living with a serious illness who may have years to live but have consequences of their illness: distress due to psychological, physical, practical, or spiritual issues, as well as family burdens.” As with hospice care, palliative care can be provided at home, in a nursing home, or in a hospital. I learned from Dr. Meier that palliative care teams look at the patient’s entire situation, including their ability to access transportation, manage their pain, understand what is happening to them, and arrange for massage therapy; workers will also help members of the family handle their own stress. “Thanks to modern medicine, we can keep you going for a very long time with some pretty debilitating illnesses,” continued Dr. Meier. “So palliative care developed as a field in an attempt to focus on the quality of all this extra time. It gives the patient this sense that no matter what happens, you’re going to walk with them and be with them and listen to what matters to them—the patient is at the center. This kind of support and attention is profoundly reassuring and, unfortunately, in the absence of palliative care, is not something that characterizes modern medical care in this country. Most people with advanced illness have six specialists and no quarterback, no one really in charge. And even if they once had a quarterback, a primary care physician, once the serious illness develops, that person often recedes into the background, is out of the loop, is no longer controlling the care, and the patient is sort of left to the hospitalist, the oncologist, the cardiologist, or the neurologist, who does not see him- or herself as a primary care physician or as the person who is going to keep walking with that patient and family no matter what happens. They’re the specialist. They treat the heart failure, they treat the cancer, they treat the Parkinson’s disease, but the needs of the patient go far beyond the disease-specific issues.”

Even though palliative care is currently offered in 70 percent of our large hospitals, not enough patients are accessing it, because doctors have not been trained to understand its value and patients and their families have not yet learned to ask for it. This is more important than ever now: A recent study showed that cancer patients who get palliative care along with standard cancer treatment actually lived quite a bit longer than patients who received only standard care. If palliative care can help patients feel better, perhaps it’s not surprising that it also prolongs life!

Where and How Will You Live?

Then there’s the issue of where you live. Maybe it’s time to make changes to your home that will make it easier and safer for you as you age. Having had a hip and a knee replacement, I know that in a few years’ time I will want a home without stairs. I’m aware of the hazards of falling at my age, so I’ve gotten rid of all throw rugs that might slip. I also make sure there’s nothing lying about at night that I could trip over. Ted Turner has installed grab rails in the showers and baths of his homes and was generous enough to offer to do the same for me. I’ve known too many people who’ve fallen in the shower, and I don’t intend to be one of them.

There are a variety of housing arrangements for people who cannot or no longer want to live alone and be responsible for all that it entails—cleaning, cooking, gardening, and so forth. There are independent senior communities with private apartments and twenty-four-hour emergency-call services, as well as social activities. Continuing-care retirement communities agree under contract to provide residents with housing and services for life; these usually require a one-time entrance fee and monthly payments. Assisted living facilities can be nursing homes or part of a retirement community; they cost on average $32,000 a year. A semi-private room in a nursing home costs $65,000 a year. As I said, Medicare covers the expenses for only a limited time, while someone recovers from an accident or surgery. Start saving and budgeting!

Only 5 percent of people over sixty-five are in special-care institutions, and that number has been dropping since 1982. Dr. Marion Perlmutter told me, “I think we are moving away from institutionalization, which is good. People do much better at home if they can stay at home. What we know now about the memory system is that it is so context-dependent. If I can’t remember something I was going to do when I was in the next room, all I have to do is go back into the other room and that context reminds me. Well, if you move to a nursing home, you have lost the entire context of your life. It’s so disorientating. and they get into this vegetative state. But this isn’t a necessity of old age. We know that now.”