Hiking the Retirement Journey

1
Hiking the Retirement Journey

• J. James Cotter, PhD
• VCUs Department of Gerontology
• School of Allied Health Professions

2
Knowledge Needed for Hiking

• Lay of the land
• Equipment
• How to stay fit and safe
• Route selection

3
Essential Gear

• Maps health care
• Social Security card
• An address book
• Good food and Water
• Sunglasses and Sunscreen
• Layered clothing / comfortable walking shoes
• Special First Aid Kit
• Camera and binoculars
• Compass and Flashlight
• A language book

4
Trends in an Aging Society

• More personal responsibility
• Increasing lifespan
• Limited government programs
• Growing diversity
• Redefining aging
• Changing technology

5
Issues you will confront

• The financing of retirement and medical care
• Changes in the organization and delivery of
  health care services.
• Especially long-term care
• including informal caregiving
• The need for health promotion
• Diverse clients and diverse workforce

6
Challenges in Caring for an Aging Population

• Transitions of health and care settings
• Importance of self-management
• Importance of lifestyle
• Interaction between physical and social
• Effects of deconditioning

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Growth of 65 Population in Virginia
thousands
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Map 1 Aging and the new aging

• 40 - Age discrimination
• 50 - AARP discounts
• 60 - Older Americans Act
• 65-67 - Medicare and Social Security
• 75 - frailty marker
• 85 - the old-old

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Changing view of old

• Traditional groupings
• Young-old 65-75
• Old 75-85
• Oldest-Old 85

• Dychtwalds Middlescence
• Middlescence - 40-60
• Late adulthood - 60-80
• Old Age - 80-100

• Raise retirement age
• Age 70?
• Age 75?

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Generations
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Redefining Aging

• 84 of all Americans say they would be happy to
  live to be 90
• What defines old age?

Decline in physical ability - 41 Decline in
mental functioning - 32 Reaching a specific age
- 14 National Council on Aging survey, 2001
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Life Expectancy
National Vital Statistics Report, Vol. 47, No.
28, December 13, 1999 National Research Council,
1988
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Number of Centenarians

• Jeanne Calment, died in 1997 at the age of 122.
• A 65 year old must live 57 more years to catch
  her record.

14
Changing structure of society

• Traditional aging pyramid

• New aging pyramid

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How long have YOU got? More than you thought.

• http//www.livingto100.com
• The average life expectancy for men is 80 years,
  for a women - 85.

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Gear A language bookEthnic Diversity and the
Aged
http//www.prb.org/Content/NavigationMenu/PRB/Abou
tPRB/Reports_on_America/ReportonAmericaTwoCenturie
s.pdf
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A New Diversity

• Family structure/ Marital status
• Religious beliefs
• Education
• Income/Wealth
• Work/ Employment

• Age
• Ethnicity/Race
• Gender
• Physical abilities
• Sexual orientation

Based on Griggs, 1995
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Gerontographics Life-stage Model
Moschis, American Demographics, 1996
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From acute to chronic

• in 1995 for the first time more people died of
  chronic disease than from acute disease.
• Val Halmandaris, National Association of Home Care

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aged reporting ADL limitation
Adapted from Admin. on Aging, 1997
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Anti-Aging Medicine
14th AnnualInternational CongressOn Anti-Aging
Medicine April 7-9, 2006Orlando, Florida, The
American Academy of Anti-Aging Medicine
Anti-aging medicine, which promises the baby
boomers a 100 year plus youth filled life span,
is the hottest topic in health care with recent
in-depth features on the future of medicine
appearing in Time and U.S. News and World Report.
http//www.worldhealth.net/
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Baby Boomers Then and Now
Then Watching John Glenn's historic flight with
your parents.
Now Watching John Glenn's historic flight with
your kids
Then The Grateful Dead
Now Dr. Kevorkian
Then Getting out to a new, hip joint
Now Getting a new hip joint
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EquipmentGear Your Social Security card

• Social Security
• Pension or 401(k)
• Assets your house and savings
• Medicare
• Private health insurance or Medigap
• Health Care Providers
• Maybe Medicaid later

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How many legs on that three-legged stool? You may
need 6.
Assets
Public Benefits
Social Security
Employment
Pensions
Medical Coverage
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Avoid a Poverty Stricken Old Age

• Increase personal savings rate from ZERO
• Median credit card debt 1900
• (http//moneycentral.msn.com/content/Banking/cr
  editcardsmarts/P74808.asp)
• Savings rate is a .05 Negative .05 !
• Pensions to 401(k)s
• Rising costs from increased personal
  responsibility in medical care

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To Privatize or Not to Privatize?

• Will NOT solve the shortfall in Social Security
  makes it worse.
• Rate of return in the stock market is higher but
  is inconsistent
• Philosophical Should government be in the
  retirement business?
• Amount of money invested (7.5) will not be
  returned in equivalent benefits
• Social Security is supportive of women and low
  income earners
• Life insurance, disability insurance, retirement

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Labor Force Participation Rates(adapted from
Atchley Barusch, 2004)

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Financing Health Care for Older Persons

• Medicare
• Medigap Policies
• HMOs
• Prescription Drugs
• Medicaid
• Long-term care
• Long-term care Insurance
• Medical Savings Accounts

29
Map Health Care Transitions
Home
Meals on Wheels
Apartment Complex
Retirement Center
Outpatient Health Care
Assisted Living
Hospital
Case Mgmt
Nursing Home
Hospice
Home Health Care
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LTC Continuum - HCBS

• Home and Community-based Services
• Adult Day Care
• Home health Care
• Homemaker/Personal Care
• Social Support Services
• Home-delivered meals
• Transportation

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Continuum of CareInstitutional

• Residential / Medical
• Nursing Facilities
• Sub-acute Care
• Inpatient Hospice
• Residential / Assisted
• Board and Care
• Assisted Living
• CCRCs

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Paying for Nursing Homes, 2000 (s)
Source Shi Singh, 2005.
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Medicare Weve Got You Covered well 50 anyway

• Medicare pays 56 of its beneficiaries total
  health care expenditures
• 1,180 / yr on average in out-of-pocket costs --
  Kaiser Family Foundation
• Extra amount needed in retirement if no employer
  health insurance - 200,000 (WSJ, March 7, 2006)

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The Elderly Poor Spend a Greater Portion of Their
Income on Health
The Elderly Poor Spend a GreaterPortion of Their
Income on Health

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How much LTC insurance will I need? Theres the
rub.

• Predicting lifelong disability
• What if its never needed?
• Lifetime risk at 6539, at 8549
• Predicting future long-term care system
• What if services developed are not covered?
• Predicting future long-term care costs
• What will be the cost of a nursing home in 2032?
  - 190,000/year

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The 2030 Problem
Caring for Aging Baby Boomers Knickman, J.R.
Snell, E.K. (2002). HSR Health Service Research,
374.

• Aging shocks
• Uncovered cost of Rx
• Uncovered cost of medical care
• High cost of private insurance for medical care
• High and uncovered costs of LTC

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Staying Fit and Safe

• Maintaining your health
• Prevention is key
• Gear walking shoes
• Your health is your lifestyle
• Diet, including water, and exercise
• Specific issues
• Gear Sunscreen and Sunglasses
• Gear Special first aid kit

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Healthier Older Population

• Fries (1984), Compression of morbidity
• Palmore (1986), relative health of elderly has
  improved
• Rogers (1990), living longer and healthier
• Manton (1995), significant decreases in
  prevalence of 16 medical conditions
• Cassel (2000), declining or postponing disease

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Food Preparation

• Nutrition knowledge
• What foods to eat
• How to prepare foods
• Alcohol

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The new Food Pyramid MyPyramid.gov
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Essential Gear 2 A Buddy
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Changing Family Structure

• Source US Census, 2000

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Older People of the 21st Century

• Diversity plan for multiple groups of senior
  citizens Characteristics
• smaller families
• suburbs
• women in the work force
• social movements

Silverstone, Gerontologist, 1996
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21st century (contd)

• Economics
• diminished and elusive security,
• competition,
• skills still needed,
• flexible work arrangements
• lifetime of poverty
• Social support - Multiple scenarios of
  reconfigured families and peer support networks

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21st Century Aging

• Health
• prevention is key,
• disability ? dependence
• influence of lifestyle
• influence of lifetime access to health care

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Route Selection

• New vocation avocation activities
• Changing role
• Grandparent, caregiver, companion
• Gear Camera and binoculars
• Enjoy the journey scope out the path ahead

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Train Wreck 5 Elder Wasteland

• What does a person do with 25-45 years of
  retirement?
• What will you do?

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Stay up with technologyThe two most important
devices for 21st century living
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Ten Tips For Healthy Aging

• Eat a balanced diet.
• Exercise regularly.
• Get regular check-ups.
• Don't smoke. It's never too late to quit.
• Practice safety habits at home to prevent falls
  and fractures.
• From the National Institute on Aging

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Ten Tips For Healthy Aging

• Always wear your seatbelt when traveling.
• Avoid overexposure to the sun and the cold.
• If you drink, moderation is the key. And when you
  drink, let someone else drive.
• Keep personal and financial records in order to
  simplify budgeting and investing. Plan long-term
  housing and financial needs.
• Keep a positive attitude toward life. Do things
  that make you happy.