Aging

How to Avoid Being Eaten by Cats: Part One


You’re childless and in your forties - so who’s going to look after you when you’re old? Step one: Get your healthcare in order.



 

What are the consequences of not having children, or not having a partner? According to a 2011 Department of Health and Human Services report based on the 2010 Census, women can expect to live about 20 years after the age of 65. And as of 2010, about 29 percent of over-65s who weren’t institutionalized lived alone – that’s over 8 million women – and 47 percent of women over 75 lived alone.

This could be you.

So does that mean you’re doomed to wither away unnoticed, only to be found eaten by your own cats when the neighbors call about the smell?

Two things happened since I turned 40 that made me consider how to avoid this fate. First, my mother – who was widowed in 2000 after 40 years or marriage – went from living independently in a retirement community to dying slowly in a nursing home because of dementia. As an only child, I stepped in to take away her keys and sell her car. And then I found her a nursing home, handled the paperwork, the insurance claims, the auction house and the movers. I hauled out the junk, rehoused her cat, and attempted to settle her in and make her calm and comfortable in a shared room 250 miles from everything she knew. She was terrified, angry, and frustrated by the draining away of her mind. I visited every day at first, then five or six days a week for the rest of her life, which was less than two years. I brought her homemade food, drove her to visit friends and relatives, and took her sightseeing when she could still walk on her own and handle steps. I bought her clothes and showed pictures of new babies in the family. I watched her die.

My boyfriend helped me stay sane through all of this. But barely a year later, we split up. And a couple of things came to mind. The experience with my mother raised the question: “Who’s going to do all that stuff for me when the cheese slips off my cracker?” And the split with my boyfriend gave the answer: “With no kids and probably no husband, I’ll be lucky to end up in a nursing home. Who’s going to do the paperwork to get me in?”

So let’s look at aging alone square in the eye. Aging is not for the faint of heart, nor the faint of lungs, nor brain. The elephant in the room is healthcare. So what can you do now to make that stuff easier and avoid being at the mercy of someone who doesn’t love you?

1. Long-term care insurance so you don’t go broke right away

In a piece for CBS’s Moneywatch, financial expert Larry Swedroe points out that “Medicare and private health insurance programs don’t pay for the majority of long-term care services” that at least 60 percent of seniors ultimately need. So invest in long-term care insurance – you may need help with bathing, dressing or eating, or if you have any kind of cognitive impairment like dementia. Long-term care is covered in a nursing home, but it’s also covered in assisted living, adult day care and even at home. It also protects your assets and ensures you have choices about who provides your care, and where.

In a Wall Street Journal story, Mark Meiners, professor of health administration and policy at George Mason University, argues that “the important thing to understand is that there are a wide range of policies offering different degrees of security, but all preferable to taking the chance of being financially decimated.”

My mother’s financial adviser advised her to buy one of these policies when she was already over 60, so the premium was $8,000 a year. But the money it saved her was astronomical. Her nursing home bills ran upwards of $7,000 a month for a shared room in the locked dementia unit of a respected but hardly luxurious nursing home. You could check into a very nice hotel for what they charged per night. (If I can walk and don’t need a diaper, I may well do that when I hit about 80.) Mom’s LTC policy paid about half of the tab every month.

Obviously, every situation is different, but just to give you a ballpark, John Hancock estimates that for a 35-year-old woman living in Pennsylvania who wants a benefit of $250/day for three years, the premium will be $108/month or $1,200 annually. Wait till you’re 55 to buy the same policy and the premium doubles to $213.75 a month or $2,375 annually.

Those on either end of the wealth spectrum may not need to buy LTCI. Those with little savings will qualify for Medicaid, while people fortunate enough to have at least $5 million can self-insure their assets, according to Byron Udell, founder and CEO of AccuQuote. But for those of us in between…

One thing to look for is the waiting period between official, demonstrable need and payout of benefits on an LTCI policy – it’s usually 90 days (so for a stay of a couple of months, you often won’t collect). And in case you expire suddenly before ever filing a claim – and lose all those premiums you paid – some insurers have products that address that issue.  There are tandem plans for couples that transfer the benefits for an abruptly deceased spouse to the other spouse, and a few companies are experimenting with hybrid insurance that will pay out benefits that aren’t needed for long-term care as a life-insurance benefit to beneficiaries.

Steve Vernon of CBS MoneyWatch warns that, whatever you end up choosing, don’t wait till you’re already of retirement age. Somebody is going to have to take responsibility for your well-being, and you can make that person’s life very, very stressful if you don’t make good choices now.

Check out Vernon’s excellent tutorial on how to shop for LTCI. Read this. And also go to: eQuote, the National Association of Insurance Commissioners, and the American Association for Long-Term Care Insurance.

2. Health care proxy, agent, surrogate: someone to watch over you

You have a living will, right? RIGHT?? A health care proxy is like a living will for non-life-or-death health decisions that you aren’t in a condition to make. The exact legal ins and outs of such a document vary from state to state, but the general idea is that it’s an official appointment of someone you trust to take charge of your care if you can’t.

Your state healthcare association website, elder law attorneys, hospitals and hospice programs should have information on health care proxy, health care power of attorney, or medical power of attorney laws and forms (for example, here’s the information for New York, Ohio, Illinois, Pennsylvania, Connecticut and Massachusetts – and LawDepot.com has a general living will/health care proxy form, as does doyourproxy.org), and legal site nolo.com provides a nice overview. When you’ve made it out, copies should go to your primary care physician, your family, and anyone else named in the proxy document.

3. Will someone feed you free of charge?

Don’t make assumptions about who might be your caregivers when you can’t take care of yourself. Think of who would be willing to make meals for you, take you to doctor’s appointments, maybe even bathe or feed you. It’s a big time commitment – one I couldn’t make to my own mother because I had to work full time. And friends and siblings who care for an elderly nonparent – even if they do it full time — aren’t covered by the Family and Medical Leave Act, the federal legislation that entitles eligible workers to take unpaid leave for specified family and medical reasons while keeping their jobs (and employer-provided insurance coverage).

At the end of your life, the last thing you want is to be dependent on people who don’t really care about your well-being. Even people who have children can suffer that fate, unfortunately. A recent study found that childless disabled seniors weren’t getting any less care than their peers with kids.

So let’s figure out how to age safely, wisely and happily, even if it is alone. I’ll be looking at other aspects of this trend in DAME in the upcoming weeks.

But maybe you’re way ahead of me: If you’re childless and getting into your 40s, what steps have you taken to prepare for your old age?

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