We all are used to saying – and hearing – that we as a society have great respect for our older citizens. After all, we’ve set up great programs to help those in need as they age. Medicare is terrific, providing insurance for those who need health care (and who doesn’t). Social Security has helped millions and millions of Americans sustain themselves after their work years were no longer possible, or as a supplement to savings. Sure, there are problems with both of those programs. But this blog is not about those two programs, per se. It’s about looking into the future and deciding whether we want to put our money where our mouths are.
The life expectancy for men is about 78 years and for women about 80. But according to the Society of Actuaries Retirement Participant 2000 tables, a 65-year old man has a 20% chance of living to 90 and a 65-year old woman a 32% chance of living that long. Furthermore, a married man and woman have almost a 20% chance that one of them will live to be 95. Think about the implications of that. With the average social security benefit being in the neighborhood of $1230/month, can our society afford those payments, particularly as we see health care costs rise? And what about the need many of those longer-living folks have for maintenance care, not medical or skilled care, just the activities of daily living. You know: eating, bathing, dressing, toileting, transferring, etc. How can we possibly manage?
Fifty years ago or so, there were about 15 or 16 people working for every retiree. More recently, in 2005, that number dropped to just over 3, including all of the immigrants. And the latest data show that in the next 20 years that number could drop to just 2 workers for every retiree! Two! And I’m not even mentioning how much longer each retiree will live or the health care they will require.
In Japan, these numbers are so much more alarming but show us what our future might look like. In Japan they anticipate that in 20 years there will be just 1 worker for each retiree, and their life expectancy is even higher than ours in the US. What they’ve done over the last 10 years or so is increase their revenue by raising the premium rates for employee and national pension programs like ours. They certainly put their money where their values are. It’s probably not enough but they seem to be confronting the problems.
But what about here? Are we willing to see our parents (or our own) benefits drop in relation to our needs? Will you be able to sustain yourself until you’re in your 90’s? We keep talking about our unwillingness to pass along our debt to our children. Yet we don’t seem to be willing to pay more to do so. We keep saying that we need to cut, cut, and cut some more. Sure, let’s cut where we can. But why is it that we are so unwilling to contribute more to social security? We keep saying that it’s OUR money. Nope, it’s now ours, any more so than the money we spend to defend our nation. The money we contribute toward Medicare and Social Security is money to help our parents and grandparents. We’ve got to stop talking as if the money we pay is ours and start allowing the rate and the maximum amount of our annual contribution to rise. It’s the only hope we have to sustain the future.
We all know of senior citizens who play ball, ski, run marathons, and work out religiously well into their 80’s. We tell them they don’t “act their age.” But of course, they do. They are 70 or 80 years of age but have managed to stay very active and are in great shape. They laugh – disdainfully actually – when you tell them “they don’t look 80.” That’s because they don’t have any sense of chronology. Through good genes, some luck, a lot of hard work, and great motivation they do what they love. Similarly, many of these people often continue to work in their chosen field well past what anyone would call a retirement age.
At the same time, there are many others who, for whatever reason, cannot play sports or do the same kinds of activity even if they wanted to do so. They may have health problems, injuries, or other limitations. They may be equally motivated and live a normal life despite these limitations. They also just may not enjoy physical exercise or exertion and prefer a more sedate life. Some may be disabled and have been for some time so they’ve chosen a different path for themselves, one that allows them to do the things they enjoy without physical restraints.
So when we are speaking with our aging parents one of the key factors to consider is the degree to which they want to and can be active. Then you can help them reach that level. Come to think of it, when we're thinking ourselves about how we plan to live the rest of our lives, this might be a pretty good way to view it.
For several weeks I tested a new device called the Sonamba, a unique home monitoring system for caregivers. The system, built by Pomdevices, is designed to “keep seniors safe at home by keeping track of their daily activity, medication routines and appointments.” At first glance I would say that the system is everything it’s cracked up to be. As a boomer who went through the whole eldercare process with both my parents and inlaws, and as the author of the Baby Boomer’s Guide to Caring for Aging Parents, I can say that I wish this system was available years ago. I encourage those whose parents are living independently to investigate whether the Sonamba is right for you.
Pomdevices calls the Sonamba a “Wellbeing Monitoring System for seniors living independently.” Any unit claiming to be used for this purpose must be multi-purpose, and indeed, Sonamba is just that. At its basic level, it serves as a Personal Emergency Response system, complete with panic button that upon activation alerts caregivers and 911 via cellular connectivity. The button can be worn around the neck or on the wrist. It can also be mounted on a wall if appropriate. Multiple units that are all coordinated can be placed in different rooms for those seniors who have greater mobility and often move around their house.
But Sonamba is much more than an emergency response system and, in fact, is a device that many of our parents can use. It serves as a medication and appointment reminder that the senior or the caregiver can easily program directly on the unit or remotely by computer. These reminders can include the specifics about upcoming appointments and which medications need to be taken and when. As an electronic reminder it can replace all those notebooks, calendars, and lists so many of our parents have. In my testing I programmed a few appointments and different meds, some to be taken just once a day, others multiple times. And each med was to be taken at different hours. As each designated hour came, the unit alerted me with a “ding” that was sufficiently loud and distinct for me to hear it in another room. I was even able to hear it on another floor of my townhouse. The face of the unit showed the reminder on screen and listed which medication I needed to take, as well as how many pills if I chose to enter that information. The alert chimed every minute and if I did not take the medication (or rather, if I did not clear the alert), my caregiver would be notified, prompting a follow up. Since caregivers can check in on the unit remotely, my caregiver could also know when doctor appointments are scheduled and when medicine regimens change. One suggestion I had for the manufacturer was to provide a flashing light, not just a sound and a screen display. Many seniors are hard of hearing so a distinctive and highly visual cue is important. The manufacturer is looking at ways to include that functionality in their next version.
There are other excellent features of the Sonamba that are quite important, some of which are unique to this system. The system periodically sends status alerts to caregivers telling them whether all is well or that the built-in sensor noted unusual levels of activity in the coverage area. This level can be too much or too little, based on how much activity existed during a learning period of approximately one week. When I went out I simply pressed the “Away” button so the unit knew not to expect any activity. And when I returned I pressed the “Home” button to restart the monitoring.
The unit is extremely user-friendly and allowed me to type in brief messages to the caregivers I designated in the system. The unit has a touchscreen interface that works well using either my fingers or a separate stylus.
Physically, the unit looks very much like a desktop electronic photo frame and indeed, when the system is not operating as a monitor it shows a rotating photo album. I easily uploaded several of my personal pictures from my computer so having the unit on a table was a nice addition to the room.
As PomDevices says, the Sonamba is “designed to be a part of everyday living — empowering seniors as well as their caregivers to live life on their own terms.” I can easily see this device in our parents’ homes, allowing us as caregivers to know that meds are being taken correctly and that in an emergency we — and the paramedics — will be notified.
Holidays, anniversaries, and celebrations are particularly difficult times for older people. This is especially true for Christmas and Thanksgiving, two holidays that are particularly family-focused. If you’re not together, a visit, even a short one, on this special day, will be highly appreciated. It will also you give a unique insight into how your parent is really coming along since emotions will likely be running high. If you won’t be together, it’s a great time to make a call, being careful to find a time when you can devote yourself exclusively to your parent. It is different than other calls at other times so be aware of that.
But for most families, holidays are when the family gathers together. And often it’s at the parents’ home. As your parents age, there’ll likely come a time when the site of this gathering shifts. Your parent may no longer be able to handle the chores involved, which means they are no longer the chief cook or host. This can be seen as a loss of status, especially in families where there is competition. Before changing the venue, talk to your parents and explain the facts (your house is larger, more centrally located, easier for everyone to get to, etc.) and your needs (too much work for your parents, too much worry for you, etc.). You may find that parents want the site to change because of the same reasons, but don’t want to say so. And sometimes they may not even want to go to a family gathering but cannot say so.
Important: if a decision has already been made, whether about where to have the family gathering, or any other decision for that matter, don’t pretend the decision has not been made.
When you’re there, this is your opportunity to really pay attention to what your parent is going through. If you’re at her home, it’s a great time to be a snoop, of sorts. You can check out the pantry to see how well stocked it is. Even though it’s the holiday, you should be able to judge how well she shops when the family is not there. It’s also a great time to help Mom fill her shelves with things she needs. When you go shopping for the big holiday meal, bring her along – assuming she can and wants to go – and go down all the aisles with her. Make it an outing and get her involved with the shopping. Then be sure to get not only the groceries needed for the meal, but also the things she’ll need after you’ve all gone home.
A word of caution here: with all the emotion around holidays, you need to do everything you can to be supportive, patient, and non-confrontational. The best way to do so, I have found, is to focus on the details. Try to be as organized as you can., and that alone will help reduce the stress.
At an AARP-sponsored forum on the challenges of family caregiving a recurring theme was the discrepancy between the huge numbers of people currently providing care to seniors and disabled persons versus the invisibility of them. How could it be that in the neighborhood of 50 million people who provide daily care to loved ones go unnoticed by corporations and government policy makers? Yet when we look at the policies at most employers, there is little support for caregivers. Most don’t permit flexible schedules for caregivers; they don’t allow parents to be on health care plans, and they don’t provide support groups for employees who are active caregivers.
What we need in this country is an “Occupy Eldercare” movement.
We need for these caregivers to speak out and change government and corporate rules and regulations. We need hospitals to pay greater attention to the needs of the caregivers, not just to the patients. We need for caregivers to be a part of the patient’s health record so they can know about and be prepared for the care needed. We need for hospitals to provide greater assistance to patients about to be released. Most aging is slow, more a chronic-type condition rather than acute. Yet our medical insurance system does not cover this type of care. We need our society to provide more financial options to people who need care, not just to those who need medical care.
Planning ahead for the coming problems is always an important way to minimize the impact of the problem. When you feel you have everything organized you tend to feel less stress. Yet we don’t seem to provide much help to our citizens until the crisis occurs. By then it’s often too late. What are you supposed to do when the hospital discharge person (sometimes called the “bouncer”) announces to you that your mother is going to be released from the hospital tomorrow and you know you don’t have the support system set up to provide the care she needs? We need greater educational resources and we need it early on.
We need for caregivers to not be invisible. Yes, we need an Occupy Eldercare movement. Want to join? Visit my Facebook page and “like” my eldercare posting. Then let’s see how many of you come out of the closet and start changing the world.
Never before have so many people lived so long, never before have so many children seen their parents become so dependent on them for care, and never before have so many had to be caregivers to their parents while still caring for their own children at home – members of the new “Sandwich Generation.” They are sandwiched between two forces like between two pieces of bread. The top slice represents their parents’ needs and the bottom slice represents their children’s needs. Sometimes, an added pulling force is a retired spouse with dreams of travel and free time.
Many caregivers living today can recollect memories of grandmom coming to live with Mom and Dad. Perhaps she was “acting funny” or getting confused. Or, it was whispered, she was getting “senile”. Perhaps, also, she was reaching the ripe old age of 70. In those early decades of the 20th century, the elderly were those who had escaped death from heart attacks, strokes, TB, and cancer, and lived to an old age of 65 or 70. How times have changed.
Today’s elderly are protected, medicated, regulated, and monitored sufficiently to reach their 80’s, 90’s, and beyond. In these later years, many fall victim to other disabilities like dementia and Alzheimer’s, Parkinson’s, strokes, osteoporosis, and frailty. Their dependency on others occurs at later ages, but it surely occurs and in far greater numbers.
Although many exceptions can be singled out, most caregivers today are between the ages of 50 and 64. These are the children of the elderly. Few Americans will escape this call to be a caregiver. The group just now facing this responsibility are the “baby boomers,” the largest segment of people in the country. This group is 78 million strong. The first “baby boomers” are just reaching their retirement age of 66 years of age; the youngest of them are about 46. In another 10 years, some of the youngest boomers may be caregivers for some of the first baby boomers.
Looking farther into the 21st century we see a new challenge looming. This new challenge is for a system to deal with chronic care. By definition, this means care for conditions that are not curable and will be long-lasting, usually with specific health consequences. Longer life expectancy means that the number of elderly persons is increasing and among elderly Americans, chronic conditions such as heart disease, crippling arthritis, pulmonary disease, and mental confusion or dementia will be commonplace.
Often, these chronic conditions do not require hospitals or medical care. In fact, most people with chronic conditions – estimated to be over 100 million Americans – live and work among us and are struggling to remain independent and continue in the work force. But not all can do so, and as many as 50 million require some assistance to lead normal lives. Some 25% of those, over 12 million, are unable to live without involving caregivers in their lives.
The services these 12 million chronically ill and dependent persons will need will not all be medical, but assistance with daily living and activities. Some of the providers of these services will be paid medical personnel in the home. But many services will be provided by volunteers, family, community, and government agencies. Today’s caregivers must learn how to access various services and orchestrate the care each can provide. They will be involved with:
- Social services for transportation and homemaking assistance
- Custodial services for safety and day care
- Rehabilitation services for speech or mobility
- Psychological services for depression or feelings of isolation, and
- Family services for shopping, housekeeping, cooking, banking, driving, and bathing.
A startling statistic is that the average woman will spend 17 years caring for her children, and 18 or more years caring for her aging parents. Her tasks will increase in time and intensity over those years. They may begin as grocery shopping, driving, cooking, housekeeping, and banking chores, and develop into providing housing and personal care with bathing, feeding, and assistance with walking.
The sandwich generation will experience many strong forces pulling them from opposite ends. Indeed, about 15% of all caregivers switched from full-time jobs to part-time work to care for a loved one and another 12% have left the work force to be a full-time caregiver. The trend will not lower these numbers nor decrease the impact on families.
Caregiving roles vary significantly from one caregiver to another. What starts out as an occasional need for a driver, companion, or cook often progresses to a need for one to bathe, dress, medicate, or toilet an aging parent. What starts out as a caregiving role as a visitor two or three times a week may ultimately become, for many, a live-in caregiver’s role shared by husband, wife, and children.
Former First Lady Rosalynn Carter once said: There are only four kinds of people in the world—those who have been caregivers, those who currently are caregivers, those who will be caregivers and those who need caregivers.” Caregiving is in the future for all of us in one way or another. Any assistance we can get in dealing with this ever growing issue is essential to the wellbeing of the caregiver and the care recipient.
Most of us say to ourselves, “I never would have fallen for the Bernie Madoff Ponzi scheme that bilked billions of dollars from unsuspecting investors.” Yeah right. I suspect many of us would have if we just had enough money to make it worthwhile for Bernie to come after us. So what about the smaller-time bandits who are trying to squeeze the little they can from the less-than-rich? And what about our older parents who seem perfectly ripe for the kinds of con jobs that are going on now?
Scams and financial fraud are ever-present. And as citizens we should be aghast at how many people are affected. What galls me most is how many of these scams play directly to our senior population. Many older people don’t have that built-in suspicion the rest of us have since they grew up in a more innocent time when you could actually leave your door unlocked. And many don’t have the technological savvy to know what they can and cannot do when they get on their computers or cell phones.
A recent survey from the Investor Protection Trust found that over 7 million seniors had been scammed. That’s about 20% of the American population over 65. Scandalous.
The good news is that there is a movement to address this. The Prevent Elder Financial Abuse Call-in Program was created to help our parents avoid being ripped off. Several organizations have sponsored this program and set up telephone hotlines to help. Here are the numbers to call if you have concerns or questions:
- General finance questions: (888) 227-1776
- Medical questions: (888) 303-0430
- Financial abuse: (888) 303-3297
For more information about the call-in program, go to www.investorprotection.org
But as children of aging parents, there are other things we can and must do to prevent our parents from being victims.
- Talk to your parents about these conmen calling or emailing with great opportunities. Warn them and remind them that “if it sounds too good to be true, it IS too good to be true.
- Talk to your parents about protecting their online activity. Be sure there are anti virus software programs on their computers and remind them to never give out their credit card info on a link they received in an email. If unsure, they should separately go to the website they are purchasing from, not the link they got in the email.
- Be a snoop! I don’t mean pry into their personal files or drawers. But pay attention and ask a lot of questions about what they’re doing on the computer, where they’re investing, how they’re investing, and beg them to tell you about any opportunities they are considering investing in.
We welcome the kinds of programs sponsored by investorprotection.org. And we hope that many more people write about it and talk about fraud and abuse against our seniors so that we can stop these thieves before they strike.
We’ve all heard the statistics: the Social Security trust fund will run out of money in the year … (fill in your own blank). And the expenses for Medicare will bankrupt the country at some point (again, fill in your own year).
I’m not a Chicken Little but I do agree there is legitimate concern. And it’s not just that I, myself, am getting pretty close to being a recipient of those government programs. I don’t envy policy makers who are struggling to come up with the best solution. It’s complicated. And I don’t believe it’s selfish of those who want to lower taxes on the wealthiest among us. They honestly believe that by lowering or keeping the taxes low for wealthy people, that will lead to more jobs being created. The argument is that those are the folks who create small businesses and therefore hire people. Hiring people and creating businesses will then grow the economy.
I have two responses to that. One, I ask, “How’s that working for you?” Not so well, eh? The Bush tax cuts have been in place for several years and yet jobs are just not being created are they? Maybe it’s time to start a new tactic and stop pretending that tax savings spur job growth. Tax savings enable wealthier people to spend more (which could help growth) but mostly, save more. That has no effect on the economy.
My second response is based on a report recently that said most job growth does not
come from small businesses. This report said that about half of job growth actually comes from large companies. And another portion comes from public service jobs. So the thinking that by lowering taxes for small businesses the economy will grow is wrong. Or at least half wrong.
How does that tie into the tough choices we have to make for Medicare and Social Security? I hope the connection is obvious. Unless we fix those two programs, we won’t be able to grow our economy enough to keep the programs strong and effective. And that will severely hurt what this blog is all about, that is, "caring for your aging parents."
My solution? Twofold.
- Raise the upper limit of earnings from which FICA is taken. Right now it’s about $106,000 meaning that every dollar earned after that figure is not taxed for social security. I ask why? Oh yeah, I understand it’s about the formula tying the tax collected to your eventual payout. But that’s artificial. Medicare is not capped at that salary. Social Security should not be either. Based on the numbers I’ve read, raising the salary cap on FICA will solve close to half of the problem.
- Raise the age of eligibility for Social Security. It was done with my generation – I can’t qualify for full benefits until I’m 66, as opposed to the 65 it was when the program began – so why not do it again? If we gradually raise the age to 69, we could solve the other half of the problem. Or close.
A lot of policy wonks agree so I hope the legislators accept this thinking. And, by the way, in the spirit of full disclosure, my family would suffer a little from raising the salary cap. I’m willing to accept that loss and it won’t stop me from creating a new job with my small business.