Monday, October 19, 2015

Market Trends in Financing for Senior Housing Options

Recently I was reading an issue of The Senior Care Investor, a subscription-based news service that reports on the "World of Senior Care Mergers, Acquisitions, and Finance," and doing so since 1948. 

For approximately the last three years, most of the M & A activity has been in assisted living (AL) and memory care (MC).  Senior Care Investor reports that CCRCs are "beginning to make a comeback" as the housing market recovers and prospective residents are again able to use equity in their homes to finance transitions into CCRCs.  The most recent issue also indicates some development money is returning to the skilled nursing facility market, even as overall M & A activity in senior housing is lower in 2015 than in 2014.  

I've been watching quite a bit of activity over the last few years in conversions of nonprofit senior housing operations to "for profit" and there is more evidence of that in the latest report. But the most recent issue (Issue 9, Volume 27) also reports on a "rare for-profit to not-for-profit deal," with a New Mexico-based company, Haverland Care LifeStyle Group, purchasing a new AL/MC community in Oklahoma.  

Also, the Senior Care Investor reports on a faith-based, not-for-profit CCRC provider that has decided to sell an entrance fee model (one that's in transition to an "all rental" model) that will offer independent living, AL, MC units and nursing home beds.  What happens when senior housing operations are fully "private pay" AND "rental" models AND disconnected from a faith-based organization?  Can they maintain their tax-exempt status? In other words, if the public is paying market rates (and thus higher rates based on any market increases) with no promises of future care if the residents run out of money, is that senior housing enterprise still a nonprofit operation entitled to be treated as exempt from federal income taxes?   

October 19, 2015 in Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Property Management, Retirement, State Statutes/Regulations | Permalink | Comments (1)

Monday, October 12, 2015

Livable Communities=Good Economy

AARP ran an article on the impact that livable communities have on local economies. The Livability Economy Livable Communities bring financial benefits to homeowners, business and local governments. covers a new report from AARP on The Livability Economy: People, Places and Prosperity.

This 28 page report focuses on 4 domains for livability: compactness, transportation, diversity of housing and land use integration.  This is how livability is explained in the report

Livability is a high-level performance measure of neighborhood design factors that are critical to high quality of life for people of all ages. The Livability Economy identifies a framework based on these design factors that includes four essential livability outcomes, and documents how communities have benefited economically by focusing on these outcomes ....

October 12, 2015 in Consumer Information, Current Affairs, Housing, Retirement | Permalink | Comments (0)

Friday, October 2, 2015

Planning Well For The End of Life (as a Foundation)

I've long been fascinated by the history of Atlantic Philanthropies (AP), starting when I first became aware of the behind-the-scenes role of the founder, Chuck Feeney, in funding extraordinary educational endeavors in Ireland, and, as I soon learned, also funding important social and health advocacy movements around the world.  The end of AP as a multi-million dollar grant-making foundation is near at hand, although not the end of its impact.

Linked here is the latest report from the CEO of AP, Christopher Oechsli, with linked reports on AP's final grants, including its support for a groundbreaking National Dementia Strategy in Ireland.

October 2, 2015 in Current Affairs, Dementia/Alzheimer’s, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, International, Retirement | Permalink | Comments (0)

Thursday, October 1, 2015

Life Expectancy and Income: A New Report

The National Academies Press has issued a new report, The Growing Gap in Life Expectancy by Income: Implications for Federal Programs and Policy Responses.  Here is a description from the book

he U.S. population is aging. Social Security projections suggest that between 2013 and 2050, the population aged 65 and over will almost double, from 45 million to 86 million. One key driver of population aging is ongoing increases in life expectancy. Average U.S. life expectancy was 67 years for males and 73 years for females five decades ago; the averages are now 76 and 81, respectively. It has long been the case that better-educated, higher-income people enjoy longer life expectancies than less-educated, lower-income people. The causes include early life conditions, behavioral factors (such as nutrition, exercise, and smoking behaviors), stress, and access to health care services, all of which can vary across education and income.

Our major entitlement programs ? Medicare, Medicaid, Social Security, and Supplemental Security Income ? have come to deliver disproportionately larger lifetime benefits to higher-income people because, on average, they are increasingly collecting those benefits over more years than others. This report studies the impact the growing gap in life expectancy has on the present value of lifetime benefits that people with higher or lower earnings will receive from major entitlement programs. The analysis presented in The Growing Gap in Life Expectancy by Income goes beyond an examination of the existing literature by providing the first comprehensive estimates of how lifetime benefits are affected by the changing distribution of life expectancy. The report also explores, from a lifetime benefit perspective, how the growing gap in longevity affects traditional policy analyses of reforms to the nation?s leading entitlement programs. This in-depth analysis of the economic impacts of the longevity gap will inform debate and assist decision makers, economists, and researchers.

You can download the report as a pdf for free, read the report online, or purchase a hard copy of the report for $64.  Click here for more information.

October 1, 2015 in Current Affairs, Federal Statutes/Regulations, Retirement, Social Security | Permalink | Comments (0)

Wednesday, September 30, 2015

Do Tontines Have a Valid Role in Modern Retirement Planning?

Jeff Guo, writing for the Washington Postrecently offered a provocative look at "tontines" as a theoretical retirement planning alternative to "annuities." Apparently these are advocated by some modern legal and financial experts:

Economists have long said that the rational thing to do is to buy an annuity. At retirement age, you could pay an insurance company $100,000 in return for some $5,000-6,000 a year in guaranteed payments until you die. But most people don’t do that. For decades, economists have been trying to figure out why....

 

But there’s also some evidence that people just irrationally dislike annuities. As behavioral economist Richard Thaler wrote in the New York Times: “Rather than viewing an annuity as providing insurance in the event that one lives past 85 or 90, most people seem to consider buying an annuity as a gamble, in which one has to live a certain number of years just to break even.”

 

Here is where tontines come in.  If people irrationally fear annuities because them seem like a gamble on one's own life, history suggests that they irrationally loved tontines because they see tontines as a gamble on other people's lives.

 

A simple modern tontine might look like this:  At retirement, you and a bunch of other people each chip in $20,000 to buy a ton of mutual funds or stocks or whatever.  Every year, the group withdraws a predetermined amount and divides it among the remaining survivors.  You might get a bonus one year, for instance, because Frank and Denise died....

 Want to know more?  Read It's Sleazy, It's Totally Illegal, and Yet It Could Become The Future of Retirement.  Hat tip to David Pearson for sharing this story. 

September 30, 2015 in Consumer Information, Crimes, Estates and Trusts, Ethical Issues, Federal Statutes/Regulations, Retirement, State Statutes/Regulations | Permalink | Comments (0)

Friday, September 25, 2015

Does An Inheritance Improve Your Retirement Security?

The Center for Retirement Research at Boston College released an issue brief this month on How Do Inheritances Affect the National Retirement Risk Index?

You might immediately conclude that receiving an inheritance would definitely improve one's retirement security, but the answer really is the classic law school "it depends" answer.  "The bottom line is that, while anything that boosts households’ assets is beneficial to their financial situation, inheritances are not likely to be decisive in determining retirement preparedness for many households."  The report notes that the very wealthy have achieved retirement security so an inheritance won't make much difference.

On the one hand, past research has shown that higher-income households – who are less likely to be unprepared for retirement – are more likely to receive inheritances and to receive larger amounts than their lower-income counterparts. On the other hand, the anticipated inheritance receipts of low- and middle-income households represent a much larger percentage of their current wealth, suggesting that inheritances could potentially be more influential in boosting their retirement security.

A pdf of the report is available here. Key findings from the report are available here.

 

 

September 25, 2015 in Current Affairs, Retirement | Permalink | Comments (0)

Friday, September 11, 2015

2015 Aegon Retirement Readiness Survey

Transamerica Center for Retirement Studies  announced the release of the 2015 Aegon Retirement Readiness Survey, Inspiring a World of Habitual Savers. The 60 page report is available as a pdf here. An infographic that accompanies the report is available here.  Materials from a webinar, many other infographics and country-by-country reports (as well as previous surveys and reports) can all be accessed from here. You can also access their May, 2015 report on Retirement Throughout the Ages: Expectations and Preparations of American Workers and supporting materials here.

September 11, 2015 in Current Affairs, International, Retirement | Permalink | Comments (0)

Tuesday, September 8, 2015

New Report on Housing in Retirement

Merrill Lynch, in conjunction with AgeWave released a new report on housing in retirement. Home in Retirement: More Freedom, New Choices covers six hot topics in housing for retirement, including relocation, popular locations for retirement, renovation, health issues and housing and "choices and challenges" in housing and retirement. The report opens with this paragraph

Today’s retirees have more freedom and options when choosing where and how they want to live in retirement. With the possibilities presented by unprecedented longevity, and often fewer work and family obligations than before retirement, according to the study two-thirds (65%) of retirees say they are living in the best home of their lives. However, retirees today also face challenges, and must consider how their needs may change throughout a 20-, 30-, or even 40-year retirement.

The 22 page report is available for download as a pdf here.

September 8, 2015 in Current Affairs, Housing, Retirement | Permalink | Comments (0)

Monday, August 31, 2015

Social Security Fast Facts

The Pew Research Center on August 18, 2015 released the FactTank  5 facts about Social Security (the FactTank is "[r]eal-time analysis and news about data from Pew Research writers and social scientists."). So what are those 5 facts? Here you go!

  1. Social Security touches more people than just about any other federal program.
  2. Social Security is, and always has been, an inter-generational transfer of wealth.
  3. Right now, Social Security has plenty of assets.
  4. But since 2010, Social Security’s cash expenses have exceeded its cash receipts. 
  5. Social Security’s combined reserves likely will be fully depleted by 2034....

August 31, 2015 in Cognitive Impairment, Current Affairs, Federal Statutes/Regulations, Retirement, Social Security | Permalink | Comments (0)

Tuesday, August 25, 2015

Subtle Messages in Webinar on "Managing" the Aging Academic Workforce?

An interesting approach to the topic of aging faculties in higher education recently came across my virtual desk in the form of an advertisement for an upcoming webinar (with an interesting price tag to match).  The title of the program is "Managing and Supporting an Aging Workforce," offered by Academic Impressions (a company I'm not familiar with) on November 15, 2015 from 1 to 2:30 p.m. EST. 

The brochure advises "Given the nature of this topic, this online training is appropriate for human resources professionals, department chairs, deans, and senior administrators who deal with faculty and personnel issues."

Here's the description, which strikes me as charting a careful approach to helping (encouraging?) older faculty members make the decision to retire, without running afoul of age discrimination laws.

Experienced academic and administrative employees are the pillars for many institutions in higher education. However, with many faculty and staff members working well into their 60’s and 70’s, administrators face the challenge of supporting an aging workforce while having the appropriate policies and procedures in place.

Learn how to better balance the interests of your employees with the needs of your institution. This webcast will cover:

  • Laws governing discrimination and how to remain in compliance
  • Appropriate steps for dealing with diminishing capabilities
  • Performance reviews, policies, and procedures

August 25, 2015 in Current Affairs, Discrimination, Ethical Issues, Federal Statutes/Regulations, Retirement, State Statutes/Regulations, Webinars | Permalink | Comments (0)

Monday, August 10, 2015

Will "Single Seniors" Change the Face of Long-Term Living and Supports?

The Public Policy Institute (PPI) of California recently profiled demographic changes likely to affect that state in coming decades, including the impact of a projected increase, to 20%, of the proportion of the population aged 65+.  One especially interesting component is the impact of seniors who are likely to be "single," especially those without the assistance of  children, spouses, or other close family members, a trend that seems likely to be true nationwide. From PPI's report (minus charts and footnotes):

Family structures in this age group will also change considerably—in particular, marital status will look quite different among seniors in 2030 than it does today.... The fastest projected rates of growth are among the divorced/separated and never married groups. Between 2012 and 2030, the number of married people over age 65 will increase by 75 percent—but the number who are divorced or separated will increase by 115 percent, and the number who are never married will increase by 210 percent....

 

Another significant change will be in the number of seniors who have children. Those who have never been married are much less likely to have children than those who have been married at some point. As a result, seniors in the future will be more likely to be childless than those today.... In 2012, just 12 percent of 75-year-old women had no children. We project that by 2030, nearly 20 percent will be childless. Since we know that adult children often provide care for their senior parents, these projections suggest that alternative non-family sources of care will become more common in the future.

Thus, just as we're making noise about supporting seniors' preference to "age at home," we may be over-assuming that family members will be available to provide key care without direct cost to the states.  Hmmm.  That's problematic, right?

More from the California PPI report, including some conclusions: 

California's senior population will grow rapidly over the next two decades, increasing by an estimated 87 percent, or four million people.  This population will be more diverse and less likely to be married or have children than senior are today.  The policy implications of an aging population are wide-ranging.  We estimate that about one million seniors will have some difficulties with self-care, and that more than 100,000 will require nursing home care. To ensure nursing home populations do not increase beyond this number, the state will need to pursue policies that provide resources to allow more people to age in their own homes....

 

The [California In-Home Service & Supports] IHSS program provides resources for seniors to hire workers, including family members, to provide support with personal care, household work, and errands. One benefit of hiring family members is that they may provide more culturally competent care. Medi-Cal is already the primary payer for nursing home residents, and the state could potentially save money by providing more home- and community-based services that support people as they age, helping to keep them out of institutions. Finally, the projected growth in nursing home residents and in seniors with self-care limitations will require a larger health care workforce. California’s community college system will be a critical resource in training qualified workers focused on the senior population.

The San Diego Union-Tribune follows up on this theme in California Will Have More Seniors Living Alone, by Joshua Stewart.

August 10, 2015 in Consumer Information, Dementia/Alzheimer’s, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Retirement, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Wednesday, August 5, 2015

PBS News Hour: Why Foreign Retirees Are Flocking to Mexico

In recent weeks, I've been doing background research on "cross-border retirement" issues and therefore I was interested to read that ElderLawGuy Jeffrey Marshall's brother has retired to Mexico and "loves it." 

For some, the reasons may include comparative costs for a range of services, including support for "independent" living, or more skilled care, as documented by the PBS News Hour program on "Why Foreign Retirees Are Flocking to Mexico." The program interviews retirees in central Mexican communities near Lake Chapala.  The program compares "average cost for independent living" in U.S. retirement communities of "about $2,500 per month, with one Mexican community's prices for "rent, all utilities, connections for internet, television ... plus three meals a day" at "just a little over $1,000 a month." 

But, as the program touches on (only briefly), Medicare benefits don't apply in Mexico (although, perhaps they should?).  And there are also important questions about reciprocity in care for Mexican retirees who may have spent many working years in the U.S.

August 5, 2015 in Consumer Information, Ethical Issues, Health Care/Long Term Care, Housing, International, Retirement | Permalink | Comments (0)

Friday, July 31, 2015

Which is More Terrifying? "Dying Early" or "Living Long" (and Doing Financial Planning Necessary for the Latter)?

The New York Times recently carried a column that probably hit home with many -- if, that is, one could bring oneself to read it.  While some people keep postponing "the conversation" discussion about how they want to die, there is plenty of evidence many people are also avoidant of conversations about financial planning for a long life. 

Educating consumers to be better purchasers seems a sensible idea, but an example from recent history illustrates the problem with that. For a long time, the simple investment advice given to consumers has been “buy an index fund.” Index funds are such standardized products — mirroring the Standard & Poor’s 500-stock index does not require much management — that just about all of them were initially low cost while offering wonderful diversification.

 

Consumers have been buying index funds, and the market has responded by providing hundreds of them. Nearly all E.T.F.s are index funds.

 

But the market has also responded by charging high fees for this standardized product. In 2004, Ali Hortacsu and Chad Syverson, economists at the University of Chicago, found that index funds had as much variability in fees as their more labor-intensive actively managed counterparts. And these fees are nothing to be scoffed at — paying 1 percent more every single year in fees can compound over a lifetime to noticeably lower returns.

For more on the problem with financial advice -- with encouragement to "face up to something [you too] may have been dreading," read Why Investing Is So Complicated, and How to Make it Simpler, by Sendhil Mullainathan. 

My thanks to Prof. Laurel Terry and Jack Bennett, Esq. for sharing this column.

July 31, 2015 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Estates and Trusts, Property Management, Retirement | Permalink | Comments (0)

Monday, July 27, 2015

Law Reform: A Proposed Remedy for "Deeply Toxic" Damage to Higher Ed Caused by Abolition of Mandatory Retirement

Bentley University Professors  Beverley Earle and Marianne Delbo Kulow have a nicely provocative article in the Spring 2015 issue of the Southern California Interdisciplinary Law Journal, titled The "Deeply Toxic" Damage Caused by the Abolition of Mandatory Retirement and its Collision with Tenure in Higher Education: A Proposal for Statutory Repair.  From the introduction:

There are very few positions that offer the level of protection that tenure does. One such position is a federal judgeship, which is distinguishable because of the very public nature of the work. If a judge performs inadequately, community backlash may quickly develop that could usher in a publicly coerced retirement. For example, a state judge, who recently gave a lenient sentence to a convicted rapist of a minor who committed suicide, has announced his retirement following pubic outrage.Tenured faculty members, unlike judges, labor in the relative isolation of the classroom, where feedback comes at the end of the semester and then only via student evaluations. This creates the first of two problems for higher education in the United States stemming from the abolition of mandatory retirement: the difficulty of removing a tenured professor for poor performance.

 

In most universities, only egregiously poor performance by a tenured professor is flagged for termination; outdated, boring, or barely adequate, teaching may not sufficiently stand out to warrant a more intense review.  There is also a slow feedback loopdue to minimal, if any, post-tenure peer classroom evaluations and skepticism about student evaluations of teaching. Therefore, often many semesters pass before there is sufficient evidence to persuade a professor or her superiors that the tenured professor's employment status should be reevaluated. Inadequacies in scholarship can be even more difficult to discern, given the common time lag between research and publication, as well as the variations between disciplines in frequency, length, and format of publications.

 

The second distinct challenge faced by higher education caused by the coupling of the abolition of mandatory retirement with the institution of tenure is the prospect of stagnant departments: no new faculty may be hired because there are no vacancies....

The authors' proposed reforms include "expiration" of tenure for professors reaching age 70, while permitting continued employment opportunities on the same evaluative standards as non-tenured faculty. 

July 27, 2015 in Current Affairs, Discrimination, Ethical Issues, Federal Statutes/Regulations, Retirement, Statistics | Permalink | Comments (0)

Monday, July 20, 2015

A "Behavioral Economic Case for Paternalistic" Retirement Laws: Paul Secunda

Marquette Law Professor Paul Secunda always has interesting perspectives, and that is again true with his recent article, The Behavioral Economic Case for Paternalistic Workplace Retirement Plans, to be published in an upcoming issue of the Indiana Law Journal.  From his SSRN abstract:

Dependence on 401(k) retirement accounts continues to cause a massive retirement crisis in the United States by leaving most workers unprepared for retirement. The voluntary, inaccessible, employer-centered, expensive, and consumer-driven nature of these plans has combined to make retirement a type of corporate-inspired elder abuse in America.



Behavioral economics considers the utility of permitting individual choice in decision-making settings. Many, however, have been misled to believe that more choice is always better.  Yet, according to one prominent commentator, this consumer-driven paradigm will lead to forty-eight percent of current workers between the ages of fifty and sixty-four being poor when they reach retirement.  Behavioral economic workplace research instead strongly suggests that a better approach would be to use “choice architecture” to nudge workers into well-diversified, low-fee default retirement accounts set up by government-regulated private retirement funds. 



Such a successful paternalistic workplace retirement model already exists. The Australian Superannuation Guarantee is a mandatory, universal, private, and comparatively inexpensive workplace retirement scheme.  It also aligns the interests of retirement fund managers with fund participants.  Most Australian employees do not exercise choice with regard to how their retirement contributions are invested.  Employer contributions default into an individual’s MySuper retirement account operated by the country’s best money managers, who invest worker funds in a diversified manner, while charging very low investment fees. 



As part of my Stewart Lecture remarks, I outline here a vision for the transformation of the American 401(k) retirement system into an efficient and sustainable superannuation model based on behavioral economic insights from the Australian workplace retirement system.

July 20, 2015 in Consumer Information, Current Affairs, Ethical Issues, Federal Statutes/Regulations, International, Retirement | Permalink | Comments (0)

Friday, July 17, 2015

Women's Financial Experiences-Survey from Prudential

Prudential has released its findings from its 8th biennial survey of women on their financial experiences and behaviors. Financial Experience & Behaviors Among Women covers 2014-2015. The foreword offers this insight

Women still have a number of identifiable financial goals, of course. High on their list: having enough money to maintain their lifestyle throughout retirement, to cover health care expenses and to reduce personal debt. They also don’t want to become a financial burden to loved ones or outlive their savings. And they define financial success as achieving a comfortable, financially secure retirement. The difference is simply that they no longer attach as high a degree of importance to these goals as they did a few years ago.

The report discusses the "confidence" of women to achieve their goals, their use of financial advisors and their understanding of financial products. Perhaps somewhat unsurprising, the foreword also mentions that "[o]ne of the biggest perceived impediments to reaching financial goals is not having enough disposable income to dedicate toward them, cited by about half of women. But they also admit to a lack of familiarity with financial products and the sense that they simply don’t know what to consider when evaluating their options."

Page 11 of the report discusses differences between the generations. For example, the report notes that 65% of baby boomers reported confidence that they will be able to maintain their style of living through retirement.

July 17, 2015 in Current Affairs, Retirement | Permalink | Comments (0)

Sunday, June 28, 2015

In Divorce of 90+ Year Olds, Nebraska High Court Confirms Award of Alimony to Pay Nursing Home Fees

In Binder v, Binder, decided June 26, 2015, the Nebraska Supreme Court affirmed an award against the husband for alimony in the amount of $3,200 per month. This was the amount necessary to cover the wife's balance due each month for her nursing home care.  The divorcing couple, each in their mid 90s, had been married for 32 years, a second marriage for both.  Married in their 60s, they had no children together. The husband had at least one child from a prior marriage; his son leased the husband's farmland for more than 25 years to continue operations.

The husband argued that the alimony award, exceeding his own $2,800/mo income from Social Security and rental of his farming property, was an abuse of discretion as it lowered his income below "poverty thresholds" set by state guidelines for child support awards.  The Court ruled, however, that in the absence of minor children, the guidelines were inapplicable. Nonetheless, the Court also addressed the "reasonableness" of the award and concluded:

In reviewing an alimony award, an appellate court does not decide whether it would have awarded the same amount of alimony as the trial court. Instead it decides whether the trial court's award is untenable such as to deprive a party of a substantial right or just result.  The main purpose of alimony is to assist a former spouse for a period necessary for that individual to secure his or her own means of support. Reasonableness is the ultimate criterion.

 

Applying these factors, we cannot say that the amount of alimony is an abuse of discretion. Glenn sought to dissolve his nearly 32–year marriage to Laura after she began incurring expenses for essential nursing home care that are well beyond her means. Laura did not work outside the home during the marriage, she is not employed now, and there is no evidence that she has untapped earning capacity. Similarly, Glenn is retired and has no wage income. But while Laura has exhausted nearly all her assets, Glenn has the power to dispose of more than 200 acres of farmland. The land is not irrelevant to alimony even though it is Glenn's premarital property. A court may consider all of the property owned by the parties—marital and separate–in decreeing alimony. 

 

As to disputes over matters such as Laura's contributions to the marriage, we note that the district court was in the best position to judge the witness' credibility. Although our review is de novo, if credible evidence is in conflict on a material issue of fact, an appellate court considers and may give weight to the circumstance that the trial judge heard and observed the witnesses and accepted one version of the facts than another. This rule is particularly apt here because both Laura and Glenn had some trouble testifying and the record does not show to what extent their difficulties were cognitive, auditory, or other.

In reading the decision, I'm struck by questions of what -- or even who -- was driving the divorce, and to what extent the parties' decisions were affected by Medicaid eligibility issues.  For more history, as well as comments by the husband's attorney, see "Retired Farmer Must Pay More in Alimony Than Monthly Income," in the Omaha World-Herald.

June 28, 2015 in Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Housing, Medicaid, Property Management, Retirement, State Cases | Permalink | Comments (0)

Thursday, June 18, 2015

What Do We (and Should We) Mean by "Assisted Living?"

Earlier this week I recommended Atul Gawande's book, Being Mortal: Medicine and What Matters in the End,  and I offered an excerpt from his discussion of how doctors are impacted by practical limits on their goals as solvers of problems.  But the book is about more than just medicine. Another compelling chapter traces attempts to avoid "nursing homes" and the once cutting edge trend of "assisted living" as an alternative:

The idea spread astoundingly quickly.  Around 1990, based on [Keren Brown] Wilson's successes, Oregon launched an initiative to encourage the building of more homes like hers.  Wilson worked with her husband to replicate their model and to help others do the same.  They found a ready market. People proved willing to pay considerable sums to avoid ending up in a nursing home, and several states agreed to cover the costs for poor elders.

 

Not long after that, Wilson went to Wall Street for capital, to build more places.  Her company, Assisted Living Concepts, went public.  Others sparing up with names like Sunrise, Atria, Sterling, and Karrington, and assisted living became the fastest growing form of senior housing in the country.  By 2000, Wilson had expanded her company from fewer than a hundred employees to more than three thousand.  It operated 184 residents in eighteen states.  By 2010, the number of people in assisted living was approaching the number in nursing homes. 

 

But a distressing thing happened along the way.  The concept of assisted living became so popular that developers began slapping the name on just about anything.  The idea mutated from a radical alternative to nursing homes into a menagerie of watered-down versions with fewer services.  Wilson testified before Congress and spoke across the country about her increasing alarm at the way the ideas was evolving....

For more, see Chapter 4 of Being Mortal, titled "Assistance." The other intriguingly-named chapters are "The Independent Self," Things Fall Apart," "Dependence," "A Better Life," "A Better Life," "Letting Go," "Hard Conversations," and "Courage."

June 18, 2015 in Consumer Information, Current Affairs, Ethical Issues, Federal Statutes/Regulations, Health Care/Long Term Care, Housing, Medicaid, Property Management, Retirement, State Statutes/Regulations | Permalink | Comments (0)

Tuesday, June 16, 2015

Northern Ireland Advocate Calls for Overhaul of Adult Social Care Legislation

During the last two years I have had the fascinating opportunity to work on two major studies of laws and government policies affecting older persons and their families in Northern Ireland, studies initiated by the Commissioner for Older People for Northern Ireland (COPNI). The earlier study looked at safeguarding systems.  Now the second study has been made public, with Northern Ireland Commissioner Claire Keatinge using the work to recommend major reforms of Adult Social Care laws in her country. COPNI Claire Keatinge Launch of Call for Reform of Adult Social CareThe formal launch of her "call for change" occurred on June 16 in Belfast. 

Two of my four research colleagues, Dr. Joe Duffy (far left, who led the research team) and Dr. Gavin Davidson, (far right) both of Queens University Belfast, were present for the launch, with Joe giving introductory remarks to the audience of government officials and community stakeholders.  The fourth member of our team is Dr. Subhajit Basu of the University of Leeds in England.  Our research evaluated government policies and law in more than ten nations, looking for legal trends, best practices and cutting edge social care programs.

Significantly, in addition to recommending a comprehensive legislative framework and funding structure to coordinate services for all adults in need of assistance, one key recommendation announced by Commissioner Keatinge (left center above) and highlighted in our investigative report, is to implement a "Support Visit" for any interested person age 75 years or older, by an appropriately trained health and social care worker.  This recommendation, which draws upon Denmark's successful experience with a "preventative home visitor" program, would create an opportunity for a psychosocial dialogue aimed at advance planning.  The goal is to help individuals and family members anticipate needs in the event of functional impairment, thus reducing the need for crisis planning. 

I've become a big fan of Commissioner Keatinge; she is clear, creative, realistic, and determined to see Northern Ireland become a world leader in recognizing not just the needs but the contributions made by older adults.  She does so from a platform of respecting older persons' contributions, citing research to demonstrate that over the next several decades, older adults will contribute more than £25 billion to the Northern Ireland economy through formal work, volunteering, and their roles as caretakers for both adults and children.

It had been an honor for me to work on this social care reform project.  The work has given me -- and Dickinson Law students serving as research assistants, Ryan Givens and Tucker Anderson (who used his ability to speak and translate Danish to help in our field research) -- important new perspectives on proactive ways to identify and address potential needs triggered by age-related changes in demographics.  Frankly, in the U.S. we spend far more time (and arguably too much time) on issues of medical care.  This report is a reminder that many health-care crises could be avoided or mitigated through more proactive implementation of social care networks.

For more on the Duffy, Davidson, Basu, Pearson report (June 2015), see Review of Legislation & Policy Guidance Relating to Adult Social Care in Northern Ireland.

For more on Commissioner Claire Keatinge's call for reform, see Commissioner Calls for Overhaul of Adult Social Care.

See here, for more on Denmark's approaches to services, communication and programming for older people.

Special thanks to Ryan and Tucker for their research, proofreading, editing and translation skills! 

June 16, 2015 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Health Care/Long Term Care, Housing, International, Retirement, Science, Social Security, Statistics | Permalink | Comments (0)

Thursday, June 11, 2015

Another Report on Retirement Security Preparedness

The Government Accountability Office (GAO) released a report dated May, 2015 on Retirement Security: Most Households Approaching Retirement Have Low SavingsThe 51 page report is available here.  The GAO offered this summary:

Many retirees and workers approaching retirement have limited financial resources. About half of households age 55 and older have no retirement savings (such as in a 401(k) plan or an IRA). According to GAO's analysis of the 2013 Survey of Consumer Finances, many older households without retirement savings have few other resources, such as a defined benefit (DB) plan or nonretirement savings, to draw on in retirement (see figure below). For example, among households age 55 and older, about 29 percent have neither retirement savings nor a DB plan, which typically provides a monthly payment for life. Households that have retirement savings generally have other resources to draw on, such as non-retirement savings and DB plans. Among those with some retirement savings, the median amount of those savings is about $104,000 for households age 55-64 and $148,000 for households age 65-74, equivalent to an inflation-protected annuity of $310 and $649 per month, respectively. Social Security provides most of the income for about half of households age 65 and older...

Studies and surveys GAO reviewed provide mixed evidence about the adequacy of retirement savings. Studies range widely in their conclusions about the degree to which Americans are likely to maintain their pre-retirement standard of living in retirement, largely because of different assumptions about how much income this goal requires. The studies generally found about one-third to two-thirds of workers are at risk of falling short of this target. In surveys, compared to current retirees, workers age 55 and older expect to retire later and a higher percentage plan to work during retirement. However, one survey found that about half of retirees said they retired earlier than planned due to health problems, changes at their workplace, or other factors, suggesting that many workers may be overestimating their future retirement income and savings. Surveys have also found that people age 55-64 are less confident about their finances in retirement than those who are age 65 or older

Highlights of the GAO report are available here.

June 11, 2015 in Consumer Information, Current Affairs, Retirement, Social Security | Permalink | Comments (0)