In working with older clients, we are fortunate to get to know many interesting, wonderful people. We also learn a lot by working with them, talking to them and being part of their lives. Because we often work with clients and their families over an extended period of time during major life changes and some emotional circumstances, we often see their wisdom in practice. Here are just a few of the many life lessons our clients have demonstrated to us.

1. Wisdom doesn’t automatically come with age. Age gives you the chance to learn, develop and grow as a person…but not everyone does so.

2. Quality of life is very subjective and the concept of it changes. What you think might not be a good quality of life now as a healthy person might change as you age or live with disease. As humans, we adapt remarkably well to all kinds of circumstances and many people surprise others and themselves with their tenacity.

3. Laughter really can be the best medicine, especially in the toughest circumstances.

4. You always have something of value to give to someone else. Many times it is just a kind word, a bit of help or a listening ear…

5. Listen more than you talk.

6. No one has the perfect family or relationship. We are all different and we all have “issues”. But, if you are lucky enough to have a supportive family/partner, work hard to foster good relationships and appreciate how precious this is.

8. Illness or disability shouldn’t define you.

9. Everyone has a story. You can learn a lot (or just have a lot of fun) by stopping to listen to it.

10. If you are in a “caring profession” or service job, you have the ability to make things much better (or worse) for someone every day. If you are burnt out, take a break.

11. Don’t be judgmental. You don’t always know the story behind what is going on and you also don’t know what path your own life might take.

12. You can’t plan for everything, but you’ll be able to deal with the unexpected a lot better if you do some planning. This particularly applies to things like advance care planning, estate planning and general financial/life organization. It also helps those you love deal with the unexpected better.

For more on this topic, check out The Legacy Project: “The Legacy Project has systematically collected practical advice from over 1500 older Americans who have lived through extraordinary experiences and historical events. They offer tips on surviving and thriving despite the challenges we all encounter”. You can watch videos from a number of the elders on YouTube, such as this one on the importance of listening:

What lessons have your elders taught you? What wisdom would you share with someone younger?

That time of year is here…Medicare’s annual open enrollment. So, we thought we would answer some common Medicare questions we receive from Florida seniors and their caregivers. You might also want to check out our previous article on What to Expect from Medicare in 2014.

Do I need to switch Medicare D plans during open enrollment? What if I am happy with my plan? No, you do not necessarily need to switch Medicare plans during open enrollment but we highly recommend everyone do a review to make sure there aren’t better options. Your plan may be changing or even going away in 2014. And, each year new plans come on the market and pricing changes. If you’ve had any health changes, a review is especially necessary. Various studies continue to show that many people are in the wrong (read: more expensive) plan. We have found over the years that a lot of people see a plan advertised or hear about a plan and go with it. And, many people don’t take advantage of the annual enrollment period because they don’t have any major concerns with their current plan and don’t feel like going through the hassle of comparing. Those are legitimate thoughts, but it may truly be worth your while to compare (or get help from someone).

What if I have a major change during the year when it’s not open enrollment time? For a lot of changes such as a new diagnosis or medication, there isn’t anything you can do but bear with your current plan’s coverage until the next open enrollment period (this is the good thing about having a yearly opportunity to change and lots of options). However, if you find that a drug is not covered or your costs are very high due to some health change, you may be able to work with your medical team and advocates on some temporary solutions. Can you doctor prescribe an alternative medicine? Can you request a plan exception due to medical necessity? Will the drug company offer special financial help if it’s not covered? Additionally, there are some changes which place you in to a SEP (Special Enrollment Period) for Medicare such as moving into/out of or residing in a nursing home, moving to an area that your plan does not cover, or changing employer coverage or losing creditable coverage. There are many of these SEPs, each with specific rules and timeframes. Seek help from a Medicare Advocate, like our Aging Wisely staff.

What if all these costs are too much for me and I’m struggling financially? There are a lot of options for special help. It is important to find out if you are eligible for assistance such as Medicaid or VA benefits. There are also Medicare savings programs for eligible seniors…these offer benefits like help covering premiums. These are generally accessed through the Florida Medicaid office. Pull together your financial information/records to seek out eligibility for these programs. You will have to provide information on income and assets (bank accounts, investments, etc.).

How do Medicare Advantage plans work? Medicare Advantage plans combine various aspects (parts) of Medicare in to one private plan. These can be HMOs, PPOs or fee-for-service style plans. The companies are paid a yearly amount for each enrollee and they provide/manage the various benefits for you. This can be a more simplified and cost-effective way to receive Medicare benefits, but can also have disadvantages. Most plans have a network of providers (or doctors may choose not to accept them even if there is no formal network). For some a Medicare Advantage Plan makes sense when relatively healthy, but may limit choice if medical needs are more substantial. Medicare Advantage Plans are also sometimes called “Part C”, which is a bit confusing because they are not really another “part” of Medicare such as Part A, B and D…but a different way for receiving the usual Medicare benefits via a private company.

For answers to all your Florida Medicare questions, contact Aging Wisely at 727-447-5845. Our expert care managers can provide a full Medicare analysis package for future/current retirees or help you with your specific Medicare advocacy issue. We also assist with benefits and resource access, covering programs ranging from Medicaid and VA benefits to state and community-based programs of all types.

As we discussed in our previous blog post, “Focus on LGBT Elders“, LGBT seniors face the same aging issues as all seniors but with some added challenges. This makes planning issues both more complex and especially important to address correctly. In addition, laws, program eligibility and other factors are in a state of flux (with some major changes still forming after this year’s Supreme Court decision on DOMA). Here, we will address some key considerations and tips for eldercare planning to help you age wisely.

1. For same-sex couples, the variation between state laws with regards to marriage can have major impacts. People may not initially think about how this impacts retirees/elders, but the differences can be significant in regards to retirement benefits and various forms of eligibility. The good news is that the treasury and IRS announced this year that all legal same-sex marriages will be recognized for federal tax purposes regardless of the state in which the couple now resides (did not apply to civil unions/domestic partnerships). This means that employer plans (spousal benefits, healthcare plans, etc.) covered under ERISA will have to recognize those marriages under the terms of their benefits. However, there are a lot of complexities with these rulings, including the fact that governmental and church plans do not fall under ERISA. We would suggest planning regular appointments to review financial, estate and tax issues since these laws and rulings are developing.

2. It is essential to get good advice on estate planning. We strongly encourage everyone to complete key legal documents related to estate planning, with the help of an experienced attorney. Because inheritance laws are typically based on “traditional” family structures, you need to ensure you have the proper documentation to reflect your preferences/plans. Meet with an experienced attorney for advice on estate planning and estate tax issues.

3. Do advance care planning. You should complete essential healthcare planning documents including a living will and power of attorney for healthcare/designation of healthcare surrogate. A durable power of attorney (for financial and other decision-making) is also an essential part of eldercare planning. In addition, talk to medical providers about completing paperwork for designating persons you would like to have access to your healthcare information (HIPPA forms). The healthcare surrogate document is typically triggered by incapacity but many people have a partner/friend assist with managing healthcare prior to being incapacitated. Having current documents in place can help clarify things for healthcare providers, and the process of completing these documents is also a good time to talk with your designated decision maker(s) about your beliefs and preferences. Some of the backup systems/laws in place governing healthcare access (such as Florida’s proxy statute) are set up based on nuclear family preference, causing potential barriers for LGBT persons and their caregivers who have not made legal provisions.

*We can refer you to elder law and estate planning attorneys in the Tampa Bay area with the knowledge and experience to help you.

4. Look at your long-term care options. Consider long-term care insurance and if you are in a same-sex partnership, find out how the insurance provider treats coverage for couples in your situation. Look at your financial preparation for long-term care needs and learn a bit about the options for getting care and related costs/programs to help. Understand program eligibility rules and how programs treat same-sex partnerships in these rules. Consider an eldercare consultation with a professional geriatric care manager, particularly if you or your loved one has a chronic or progressive diagnosis.

Our Aging Wisely eldercare planning advice is smart planning for anyone to consider in the realm of retirement and later life planning. However, due to some of the additional complexities for LGBT elders, these planning issues take on special significance. Additionally, we highly emphasize having expert input and reviewing these issue regularly. The Supreme Court DOMA decision this year and the recent rulings by the IRS and Department of Treasury are two major examples of how things are evolving. 

Contact Aging Wisely’s Senior Care Consultant at 727-447-5845 for help with your questions or concerns. For more about how we can help, our mission and resources, click the link below for our October Monthly Mission flier:

Aging Wisely, your advocacy partner, with information, resources and assistance

Recent estimates suggest that there are at least 1.5 million lesbian, gay and bisexual people 65 and older in the U.S., and this population will double by the year 2030 (SAGE). While confronted with the same challenges that all elders face related to aging, LGBT elders also face unique barriers and inequalities which can impact successful aging. Some of the primary issues that national advocacy organizations and studies have identified include:

Issues of economic security:  For LGBT older adults, a lifetime of employment discrimination and other factors contributes to disproportionately high poverty rates. Major laws and social safety net programs fail to protect LGBT elders equally to their heterosexual peers, particularly in benefits access for same-sex couples.

Health disparities: LGBT older adults experience health disparities across four general areas: access to health care, HIV/AIDS, mental health, and chronic physical conditions. Health insurance coverage and financial issues may affect proper access to preventative care and ongoing health maintenance.

Social isolation and discrimination: LGBT older people are twice as likely to live alone, twice as likely to be single, and 3-4 times less likely to have children—and quite a number are estranged from members of their biological families. Living alone is one risk factor in isolation/depression and LGBT older people may also face isolation related to discrimination.

Discrimination and unmet needs within aging services: Many mainstream aging services do not account for special needs of diverse clients. Elders may also face discrimination from both service providers and other participants (i.e. residents in care facilities). For example, one study of LGBT seniors in long-term care facilities found that only 22% of respondents felt they could be open about their LGBT identities with facility staff, 89% predicted that staff would discriminate based on their sexual orientations and/or gender identities, and 43% reported instances of mistreatment. Additionally, many systematic issues in aging and healthcare programs as well as legal issues create special barriers to LGBT elders (ranging from Social Security and retirement benefits to Medicare/health insurance and all types of eligibility based on state marriage laws).

There are a number of issues we need to address societally and more specifically within aging services to better serve this growing population. It is vital that all seniors have resources they can trust to treat them with dignity and respect, to help them manage the challenges of aging. 

Our next blog post will delve more specifically into eldercare planning issues and tips for LGBT elders and caregivers. Good planning and working with sensitive, experienced providers is essential. All elders need to get expert advice, but this is particularly important for LGBT elders in light of some of the key issues raised above and different legal and systematic challenges. If you need help with planning, assessments, advice or resources, give us a call today at 727-447-5845.

Aging Wisely:

Our ethics: Our professional geriatric care managers treat clients with respect, as complete individuals with their own history, narrative and unique cultural identity.

Our mission is to enable every individual we work with to live the most fulfilling life possible, focusing on their physical, mental, spiritual, family and financial well-being.

Resources:

SAGE (Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders)

National Resource Center on LGBT Aging

Improving the Lives of LGBT Older Adults report