3GenFamily Blog

What’s all the fuss about the Medicare Prescription Drug Program?

Open enrollment started on November 15th and runs to December 31st. This is the time when anyone can change from one plan to another without paying a premium penalty. If your parent is already enrolled in a program, you may be wondering why you need to worry about this.

Medicare and health care advocates in every state are trying to get the word out that the rates are changing. There are major rate increases coming to the most subscribed plans, while some of the smaller plans are decreasing rates. Here in California rates in some plans are increasing by 31%.

All seniors should reevaluate their Medicare Drug plans to see if it still makes sense to stay where they are.  They can check Medicare’s website for help with choosing a plan that covers the specific prescriptions that they need at a cost they can afford. It is important to do it now before the enrollment period ends.

Can there really be that much of a difference?

Yes.

This year doing nothing could be very expensive for your parent. Monthly premiums could increase substantially. Or, you may discover that required medications are not covered by your plan. 

And, of course, there is the highly confusing problem of the “donut hole.” I don’t know who invented this “cute” name but it is a gap in coverage that can take a lot out of your pocketbook.  Here’s how it works:

You enroll in a plan and pay a monthly premium. You pay for your prescriptions until the deductible is reached. Once you have met the deductible of $265, the basic prescription drug plan will pay 75% of your drug costs and you will pay the remaining 25% until your total drug costs reach $2,400.

Then, you are responsible for 100% of your drug costs between $2,401 and $5,451.25. This gap in coverage, the “donut hole”, requires that you pay $3050.25 out of your own pocket before Medicare pays any more for you.

While this is happening, you are still paying your monthly premium. If you get to December 31st without going past $5451.25 prescription costs, there is no additional help. You start the new year meeting the deductible again.

Once your total drug costs reach $5,451.25, the basic prescription drug plan will pay 95% of your additional prescription costs and you will pay up to 5% (or a small co-payment) of your remaining drug costs for the rest of the calendar year.

Each insurance company that offers Medicare Drug coverage has the option to add benefits. Each company can also determine which drug they will or won’t cover. Some companies will pay for certain generic drugs during the coverage gap while others pay nothing.

There are so many plans, with different options,  that vary from state to state, that you need to evaluate before you sign up.  It’s just plain confusing!

Fortunately, every state has Health Insurance Counseling and Assistance Programs. You can find someone in your area to provide free counseling about the plans that would be right for you. You can attend workshops on choosing the best plan.

Before you contact the Health Insurance Counseling and Assistance Program in your area, it’s a good idea to figure out your total drug costs for the past year and make a list of your regular prescriptions so you can compare it with the list of approved drugs for each plan.

It’s work to do this, I know. It is so tempting to just stay with the plan your parent already has.

Don’t do it! Make time now for your parent (or yourself) to find the best plan that is available. You’ll be glad you did.

It wasn’t until Dad mailed me the collection notice that I realized he was losing his ability to track and pay his medical bills. He had complained during our phone chats on several occasions that the hospital had messed up his billing. They kept phoning him to get him to pay his bill.

He insisted that he had paid the bill– $124.34.  The hospital billing staff asked him to send a copy of the cancelled check. But, Dad adamantly refused to go through the work of getting the cancelled check. It was the hospital’s mistake for losing the payment.

I was dumbfounded by his vehement refusal to deal with a straightforward problem. Ironically, in his younger days, my father had been a stickler for financial details. As a young adult, I would have gotten a scalding rebuke for failing to take action on something like this.

His unusual behavior was a warning that his dementia was beginning to impair his judgement, while his anemia left him so fatigued that even a trip to the bank seemed like an overwhelming task. I didn’t recognize it for what it was. I thought he was just being obstinate.

Being 3000 miles away, I tried to get my father to read his checkbook to tell me the check number for that hospital bill. Then, I went online to see if that check had cleared.  The check number he gave me had been cashed but it wasn’t anywhere near the correct amount for the bill. I looked for another check with the amount $124.34. I didn’t see any in that month that matched.

I told my father that the only thing to do was pay the bill. He refused. No amount of reasoning worked. So I made a deal with him — I would pay the bill and he would reimburse me.

Grudgingly, he agreed.

My father had already signed a power of attorney giving me the authority to handle his finances and one for health care, too. So, I began learning first hand about Medicare,  supplemental heath coverage and prescription drug benefits.

Dad had to sign a form to allow me to access his online medical insurance claims and to speak for him to the insurance representatives. I left instructions for them to phone me first since Dad’s hearing was poor.

I paid the bill. Dad eventually reimbursed me. The collection notices and phone calls stopped.

It wasn’t until a couple of months after my father’s death that I found the entry in his checkbook. Dad was right all along. He had paid the hospital within days of receiving the bill.  But, he was so certain he remembered the correct check number that he never looked it up. I was too far away at that time to double check it myself.

The story doesn’t end there.

Another billing mistake almost happened today. I started to pay a doctor’s bill for my father’s estate and discovered that it was more than it should have been. 

The doctor is supposed to bill Medicare first. After Medicare determines what it will pay, the doctor sends the bill to the supplemental insurance.

Only after the supplemental insuror has completed the claim, should the doctor bill the patient for any balance due. But this latest bill didn’t show any payment from the supplemental insurance, so I checked the online claims information.

The supplemental insuror had rejected the claim because documentation was missing.  Well, sometimes paperwork does get lost.  You need to follow up to get another copy sent.

I called and spoke to the medical billing person in the doctor’s office.  She pulled up the records on her computer. She stated that my father owed this amount of money. I asked if she sent it to the supplemental carrier.

She said, “Yes.” And promptly read my father’s account number for the insurance.

I asked her, “Why do the online records say your claim was rejected for lack of documentation? The amount you are billing doesn’t appear to include any payment from the supplemental insurance.” 

People do make mistakes (including me). Where there is an honest mistake, you can hear the surprise in the person’s voice. “How did that happen?” Sometimes, they laugh self consciously.

There was no surprise in this woman’s voice. There was no admission of a mistake. “We understand your concern . . . we will make sure it gets handled.” She was billing my Dad for the entire amount rather than resubmit the bill to the insuror with the information that was needed. Efficient but totally lacking in ethics.

I wish I could say this was the only mistake I have found. Unfortunately, billing mistakes have happened so many times in the past 9 months of settling my father’s estate.

How many elderly patients pay too much because they don’t have the patience or focus to follow up?

If you have been wondering how you can help your aging parents, discuss helping them with tracking medical bills. Have your parents collect everything (bills, medicare statements, supplemental insurance statements) in a folder. Set up online access to insurance if its available.  Make a regular date to go over the bills each month before anyone writes checks.

You may need to make phone calls for your parents. Be aware that privacy rules prevent the insurors from talking with you about your parents’ account unless your parents have given permission in writing.

You’ll be providing peace of mind and possibly saving money for your parents, too.

The court reporter was readying her equipment while waiting for the next case to begin. The bailiff brought in the defendant. The court reporter glanced up to see the next man on trial. Imagine the her shock to see that the defendant being brought into criminal court was her mother’s court appointed guardian!

This man was accused of embezzling from his nephew’s trust account.  Was this the same man who was managing her mother’s affairs through the county’s Public Guardian Office? Yes, it was.

This true story made the front page of our local newspaper last week. The woman’s mother has Alzheimer’s Disease. Unfortunately, the mother never completed a power of attorney or health care directive before she became ill and unable to speak for herself.

But that’s only part of the story. The other part, that the newspaper barely mentioned, is about siblings battling over what’s best for their parent. Mom has one son and five daughters. The son was taking care of his mother, but the sisters disagreed with what he was doing.

The adult siblings ended up in court fighting over who should care for their mother. The judge chose to place Mom under the care of the Public Guardian’s Office rather than with one of her children. It doesn’t make sense . . . unless you have been involved in a dispute among siblings.

Despite educational and career advancement after years away from the family homestead, brothers and sisters all too often fall back into the old roles they occupied at age 9 or 10 when they return home to help mom or dad. All of the silly, and ugly, unresolved issues begin to surface. Old behavior patterns and ways of communicating arise like time magically reversed itself.

Unlearning those old behavior patterns takes a lot of work. That work must be done together as a family as well as individually. Career, young families, and misunderstandings occupy brothers’ and sisters’ lives, too.  “Why do we need to re-hash that old stuff?” someone questions.

So the old patterns persist. And a judge, seeing dissention that may never end in the siblings lifetimes, chooses a neutral party to manage Mom’s affairs. The county didn’t know about their employee’s little problem.

I can’t say who was right or wrong. But, I know that these are gut wrenching experiences. Hurtful comments from siblings about actions, or lack of action, can leave you feeling incredibly wounded even retaliatory. Siblings may stop speaking to each other altogether, retreating to the safety of their own lives.

You can’t always make the other person understand what you were trying to do, but there is something you can do to heal the hurt.

Jack Canfield, creator of the Chicken Soup for the Soul series,  in his all encompasing book, The Success Principles, offers a 6 step process for getting rid of those negative feelings.

“The following steps are all integral to forgiving:

1. Acknowledge your anger and resentment.
2. Acknowledge the hurt and pain it created.
3. Acknowledge the fears and self-doubts that it created.
4. Own any part you may have played in letting it occur or letting it continue
5. Acknowledge what you were wanting that you didn’t get, and then put yourself in the other person’s shoes and attempt to understand where he or she was coming from at the time, and what needs the person was trying to meet — however inelegantly — by his or her behavior.
6. Let go and forgive the person.”

You may be wondering why anyone needs 6 steps. Why not just jump to the last one?

If the hurt goes deep, your inner self won’t be able to ”just let go”.  It is most important to go through each step and acknowledge all of your feelings not just ignore or suppress them. Take as much time as you need.

You can write out your feelings and thoughts for each step, or pretend you are talking to the person. What you don’t have to do is actually confront the other person. Your job is healing yourself.

Interestingly enough, when you heal your hurt, your relationship with the other person may actually get better. I’ve seen that happen in our extended family.

The newspaper story ended on a happy note, by the way. The court reporter and her family reached an agreement wth the county Public Guardian’s Office. Their mom is safe, now being cared for in a facility not far away from her family. She’s not really aware of what has happened.  And that may be a blessing.

With the start of a new school year at universities and colleges in the US, there have been a flurry of news reports and newly released books discussing the problems that “helicopter parents” are causing. These parents are so named because they are still hovering around trying to take care of their students who are attending college.

But, it is not just a parent problem. It is a child problem, too. For many of these college freshmen, this is the first extended time away from family. If they are not used to using a coin laundry, locating and taking public transportation or foraging for food on their own, freshman year becomes a struggle to learn about living alone along with studying and adjusting to a new social structure.

Some students are natural adventurers, but others are not. The result is a very homesick son or daughter who just wants to give up and come home. Meanwhile, the parents, who really do want their children to succeed in college and in life, offer to help in ways that can range from minor to ridiculous. 

Paul Wruble in his blog at TuitionCoach.com suggests a solution that is straightforward and makes enormous sense. Your child needs practice being away from home. During high school (and even before), your student should participate in summer camps, student trips, visit distant relatives and go on trips with others. 

Any activity (it doesn’t have to be expensive) that allows your child to learn about living away from your immediate home environment offers an opportunity for your son or daughter to test drive independence. By little bits, your child gains confidence and, seeing that confidence,  you let go.

Summer camps or student travel programs are too expensive? What about marching band, chorus, speech and debate, science clubs, robotics clubs, sports and other school and community organizations that have trips funded by contributions from the community? And, of course, there is Scouting, Campfire, YMCA/YWCA camps and activities. Many organizations have scholarships for students whose families can’t afford the fees.

Let your child find the program that excites him or her. Don’t do the work, but don’t take “I don’t know” for an answer.

One of the skills my son and I worked on while visiting some college campuses and attending college interviews was using public transit. How do you look up schedules? How do you purchase a ticket from the machine or add money to ticket? How do you use the airline self-service kiosk?

We didn’t rent a car while we were in Boston. We walked everywhere except for the taxi to and from airport. In Pittsburgh, our hotel had a shuttle that dropped us off and picked us up.

Right before making the final decision on which college to attend, Number One Son took solo trips to two campuses on the East Coast. One trip was to attend a special event for newly admitted students. The college arranged for sharing dorm rooms with current students and had planned meals and events.

The other was a solo trip to a campus because he could not make their planned event. My son arranged to meet the brother of a friend who is attending that college and toured the campus on his own. He stayed on his own in a motel close to campus. An important note for parents: some states (New York in this case) have rules about students under the age of 18 staying alone in a motel room. I had to fax a permission letter to the manager of the motel before my son arrived.

The airport in upstate New York was fogged in when he arrived at that last destination, so they landed at another airport and traveled the rest of the way by bus.  The trip back also had its weather problems. My son learned first hand how difficult travel could be to that location.  He eventually decided that he wanted a less remote college.

None of this made saying goodbye at the airport on August 31st any easier for me or my husband when it was time for our son to begin college on the East Coast. But, we knew that he had done this trip before and could do it again.

It was during a phone call five years ago with my Dad’s primary care doctor that the “D” word first came up. Dad was in the hospital, again.

He had gastro-intestinal bleeding which the specialists had finally stopped — but not before a series of delirious outbursts about certain marital secrets that had his second wife shouting that she would have him committed to an institution!

As Dr. R explained, people who have lost a lot of blood can become very incoherent. The problem goes away once the patients’ blood levels are stabilized. “Oh, by the way, you know that your father has dementia, right?” the doctor asked.

Whoa! That stopped me in mid-sentence.  Was my father’s second wife right? My father needed to be institutionalized?

“Are you going to commit him to a mental institution? I asked with considerable trepidation. The doctor laughed nervously.  I took that to mean no. 

Dr. R explained that she was seeing some signs of dementia but that they were mild. She rattled off a litany of symptoms. I had noticed many of those behavioral issues, too, but I didn’t know what to make of them.

The questions I should have asked the doctor were, “What is your recommendation for dealing with my father’s dementia?”  and “What can I do to help him?”

The doctor’s diagnosis of dementia seemed like a cruel joke. To be truthful, it frightened me. I had terrible visions of my irascible father becoming a vegetable.

But no matter how frightening this seems, the most important thing NOT to do is pretend it will go away on its own. Taking the initiative to learn as much as you can about dementia can give you the knowledge to ask the right questions.

But, where do you start?

A great place to start is wth the basics: the 7 stages of dementia.  Here is a link to the list of stages.  Not everyone has all of the symptoms. Like my father, a person with mild dementia can continue to function in familiar surroundings. Denial is very common in the early stages of dementia. The person may become anxious, though.

This is the time for the family to plan for the next stages. My Dad was certain that the next day would be his last. As he envisioned it, he would go to sleep and just not wake up. It didn’t exactly happen that way.

Researchers have indicated that patients with dementia can live from 3 to 9 years after the initial onset of symptoms. Patients who develop symptoms at a younger age tend to live longer than those who are advanced in years when they develop symptoms.

Patients who continue to live in their community seem live longer than those in a nursing home or hospital, but this may be because patients who live in the community are in better health generally.

It is important to note that Alzheimers’ disease is only one cause of dementia. There are actually a number of causes including stroke, depression, or a major shock like loss of blood. 

 It is important to understand what is causing those symptoms for your loved one.  By keeping an open mind and a positive attitude, you can help your elder and the doctor find the right combination of medical and nutritional therapies for the best possible outcome. 

Other great resources include:

HealthCentral.com resource on Alzheimer’s,

The Dementia Caregiver’s Toolbox

HeartSpring’s section on Alzheimer’s

So what happened to my Dad?

His dementia seemed to be related to his vascular condition rather than Alzheimer’s. The doctor added Vitamins B6, B12, Folic Acid and E to his regimen of drug prescriptions. These nutrients are very helpful for cardio-vascular support as well as mental acuity. My father had a heart bypass operation a number of years ago and currently had a pacemaker.  His dementia seemed to be related to these other medical issues. 

His relationship with his second wife, however, was never the same. They eventually were divorced.

So, I became his caregiver for the last two years of his life.

We stood for a long moment at the entrance to airport security. At eight thirty five p.m., the usual bustle of this busy airport had slowed to a trickle of passengers and flight crews tired and happy to be home.  There were also a few travelers preparing to take a “red eye”, one of those late evening flights of last resort when you absolutely need to be at your destination at a certain time.

My tall, curly haired 18 year old was preparing to board a late night flight alone to the East Coast to begin college.  He had traveled on his own last Spring on a decision making trip to choose between two great schools.  But, this felt so different from other times he has travelled.

“Try to get some sleep on the plane going to Chicago,” I reminded him for the third time.

“OK, Mom,” he said gently.

“We’re so proud of you. You’ll have a great time at school,” my husband beamed.

“Thanks, Dad, ” my son grinned.

As Number One Son walked through the airport security checkpoint with his new backpack stuffed to the top with necessary electronic gear, a bag of sandwiches and a pair of underwear and socks (in case his luggage got delayed), I felt a gargantuan lump in my throat.  I looked up at the so very familiar face of my husband. He was struggling with his emotions, too.

Wow, I was having “separation anxiety” and my son’s plane hadn’t even left the airport!  Even though my face was smiling, deep down my heart was crying. Will he be ok?Had I imparted every bit of knowledge and wisdom to him? Was he prepared?

Worse yet, was I prepared? As parents, we forged a  great relationship with our son by keeping lines of communication open, setting clear boundaries and, most important,  keeping a sense of humor. (My secret resource for parent/child humor was reruns of “The Cosby Show.)

Now, the situation that was so easy and comfortable was abruptly shifting – flying away on an airplane to the East Coast. My years of dedicated caregiving had paid off. My son had “made it” into one of his top choice colleges — he worked to get great grades and SAT scores. He polished his essays until they shined.  He was successful in his extracurriculars. But instead of a jackpot, I have sadness, questions and worries.

Did I do my job to prepare him to be competent in the adult world? What part do I play now in my son’s college life?

The “experts” have voluminous advice about letting go. The morning talk shows have been warning about the dire problems caused by “helicopter parents” who continue to control their college students lives even while they are away at school. Certainly, I don’t want to be like that!

The good news for us is Number One Son has been using his alarm clock on his own for quite a while. He knows how to cook a basic meal, clean a house, and do his own laundry.  He successfully managed his homework and outside activities schedule on his own. And yet, he would often solicit my husband’s and my opinions on various decisions before making them. Our son also had mentoring relationships with several of his high school teachers.

Suddenly, our son is away from home and his support system. How is this going to work? Where do we fit in his life now?

 My very astute husband pointed out, ” this isn’t so much about letting go as it is about redefining the relationship we have with our son.” How do we make that happen?

Luckily, I found this great book:

You’re On Your Own (But I’m Here if You Need Me) : Mentoring Your Child During the College Years

The author, Marjorie Savage, has been working with parents of college students for a number of years as the parent liaison at the University of Minnesota. Inside the 12 chapters of this easy to ready book, Savage offers understanding and insights that begin with the summer before college,  and include the culture shock of school (and the corresponding empty-nest upset for parents), the freshman 15, course loads, extracurricular activities,  and life after college. She gives parents an informed and common sense guide to establishing the right level of parental involvement.

I have found it to be a great resource in puzzling out the best way to forge our new relationship with our 18 year old. I urge you to check it out.

When I launched 3GenFamily Blog on Wordpress.com, it was with the intention of sharing a wide variety of issues  and ideas about long distance caregiving to help others traveling the same road.  I’ve tried to focus on substantive information rather than just telling stories of life caring for an elder with dementia.

When I first started searching for answers to my questions, I didn’t always find them. Sometimes I just didn’t know what search terms to use. To make things easier for others, I have tried to use phrases in my titles and content that I would have searched.

So, it was a very pleasant surprise to discover that HealthCentral.com’s website — OurAlzheimers.com – named 3GenFamily Blog a Top Alzheimer’s Site for 2007. 

Thank You!

If you are a caregiver or family member of someone with dementia, Alzheimer’s being the most common form, please check out the resources available on all of the top sites in the link above.  There is great information and commentary on the sites. Check them out!

Is your family like most others? Have your parents (or you) done some estate planning (see below for resources) and then filed the documents away to gather dust and cobwebs until they are needed?

Why do I ask? Because if an illness or accident suddenly happened, you just might discover that those documents are out of date and don’t do the job they were supposed to do!

In spite of the changes that my Dad made in recent years to his documents, he didn’t update all of them.  Now as his executrix, I am discovering that some of the documents don’t do what he and my mom originally wanted.

As you may know from my previous posts, my father was frugal beyond belief. He never understood why attorneys got paid so much and tried to avoid using them whenever he could. But, he didn’t totally ignore estate planning.

Urged on by my mother, he got the requisite documents done. And, life events (my mom’s death, remarriage, divorce) forced him to update his will, financial power of attorney and medical power of attorney several times.

But, he never got help with the total picture. So now, I’m looking at estate taxes that wouldn’t have to be paid if Dad had just gotten someone to review his entire estate periodically.

No, not Federal Estate tax. Congress changed the law to increase the amount that is exempt from tax. I’m dealing with NJ Estate tax.

You see, when Congress changed the the federal tax, it threw the states into a tizzy at the prospect of losing desperately needed tax revenue. Every state has dealt with it differently. NJ did something unique — kept the tax rules that were in effect in  2001.

So what should my Dad have done?

Sit down every few years and double check that all of these estate planning documents still met his needs. And, he really should have had an attorney look at them.

What documents am I talking about?

1. Your will - Everyone should have one even if you think you don’t have many assets.  The laws of Intestacy (dying without a will) in your state will dictate how your property should be distributed. But, it may not be the way you would want it. Why chance it?

2.  Name beneficiaries for all bank accounts, IRAs and  securities — The accounts will go to the person you name rather than into your estate and may save grief later. My father had several accounts that did not have beneficiary designations. Bank employees seem to be totally clueless about this. 

3. Buy life insurance if people depend on you for support — Keeping small policies in force for elderly parents could help pay the funeral and other expenses if they are paid up policies. Accident policies are a waste of money for most seniors because the majority of our elders die from medical problems, not accidents. My father had 3 accident policies that were worthless.

4. Make out a Living Will or medical power of attorney — I discussed the importance of this in my previous post about getting a Living Will.

5. Make a financial power of attorney — When my father was rushed to the hospital and bounced in and out of rehab for 3 months, I was able to step in to pay his bills  and handle his affairs because the power of attorney was in place. It’s a good idea to talk with your parent about bills and taxes before a crisis happens.  Know what’s due when and where the banking records are.

6. Plan for children with special needs — Along with the will, you may need other arrangements to care for a special needs child. Don’t assume that the executor will know what you intended. Few of us read minds very well. Siblings don’t always get along. Spell it out.

7. Let your executor know where everything is located – Whether you use a specially designed estate planning organizer or just a spiral bound notebook, mark down where all of the documents are. Organize and label them. Write down the names  and addresses of your attorney, accountant, banks and other key contacts.  Document everything that is pertinent to your finances and life.

Here are a few resources to help

Wills and Estate Planning Information at NOLO.com

“Get Organized Now” on the Nolo Press website

Find an attorney who specializes in Elder Law

Estate Planning 101 from FindLaw.com

Don’t put off asking your parents about this. You aren’t prying. You are helping them achieve their final wishes. 

Do be respectful if you are not designated to handle their affairs. Circumstances change. Your aging parents may need your help in the future if the other person can’t be there. You want to remain on good terms with your family.

Most important, toss away the urge to daydream happily about your future inheritance. If you are in charge of the estate, your elders come first.  You may need to make decisions to spend that money for home health care,  assisted living or a nursing home. Your focus must remain on doing your utmost to meet your parents’ needs.

After it’s all over, you’ll be very glad you did. (more about the tough decisions I faced in the next post)

How much money does a 83 year old need to have in savings to avoid running out of money in retirement?

In a previous post (Is Your Parent Afraid of Running Out of Money in Retirement -Part 1), I described how my 83 year old father was living in abject terror of having his money run out before he died.  While doing research trying to understand what was bothering my Dad, I stumbled across an article about “Bag Lady” syndrome.

The fear of running out of money and being forced to live on the streets is not uncommon. But, it usually affects women who often depend on and defer to the men in their lives. They have a feeling of being powerless to prevent becoming a Bag Lady.  Men’s fears usually have to do with losing jobs, etc.

I tried to reassure Dad that he was comfortably set.  Running summaries of his savings accounts and graphing his frugal spending habits, with colorful charts and graphs showing almost horizontal lines extending ten years, did not diminish his fear.

In spite of all my logical arguments that his finances were in good shape, he continued to worry. My father understood, in the core of his being, that once you start spending principal it’s gone and so is the interest you could earn by investing that money.

Dad was managing to live within his modest budget except for certain hospital and medical bills. He had to use his savings to pay for them. The hospital is especially aggressive about collecting its money. If you don’t pay the bill within a certain period of time, the hospital sends it to a collection agency to hound you until you make arrangements to pay. A delinquency because of hip replacement surgery gets treated the same way as a car loan.

So, how much money does an 83 year old need to have in savings to avoid running out of money in retirement?

Like a zen riddle (What is the sound of one hand clapping?), I have turned this question over and over in my mind looking for an answer.  My extensive research on the Internet  turned up the same cryptic response again and again.

There is no single answer that fits all retirees. 

Because cost of living (New York vs. North Carolina) and spending habits (tuna vs. caviar) vary wildly, every major financial website offers a retirement savings calculator that allows each person to insert the dollar amounts for her unique situation. You can play with a variety of scenarios and come up with charts that provide peace of mind or many sleepless nights.

Even if the numbers are all positive, you don’t have an iron clad guarantee.

The cruel, ugly truth is that– even if all of the other calculations are accurate– no one can predict if you will have a prolonged medical crisis that will suck savings out of your accounts faster than . . . [insert your favorite phrase here].

(This is not intended to frighten you. It is time that someone said it. Now, we can look at the steps you can take to deal with it.)

Figure out your elderly parent’s regular monthly expenses and how to cover them without tapping into the principal. You may need the help of a fee based certified financial planner to decide how to invest the savings.

Here are some additional strategies that can help:

1 . Supplemental medical insurance - Medicare pays 80%. The supplemental coverage picks up some amount between 50-90% of the balance. What’s left is a very small co-pay that is so much easier to manage.

2. Prescription drugs - Ask the doctor to prescribe an older, low cost drug or a generic rather than the latest patent wonder drug. Use the mail order prescription service from your supplemental insurance if there’s one to get the lowest possible price.

3. Regular checkups - The doctor can identify problems early so that your parent does not need a trip to the emergency room. If you are the person named as medical power of attorney (see previous post), become familiar with your parent’s medication. Ask questions. Some doctors ignore a senior’s complaint as just “old age.” Don’t settle for that answer.

4. Exercise - Studies agree that daily exercise , just short walks of 10 to 20 minutes, contributes to better health and faster recovery after an illness. Even 80 year olds can benefit from basic strength training and balance exercises.

5. Sleep - Lack of sleep contributes to decreased immunity. Exercise often helps with sleep problems. If aging has changed your parent’s sleep cycles, encourage her to take a regular nap during the day. (40 and 50 year olds can benefit from power naps, too!)

4. Fruit, vegetables and water - Helping our elders have a regular supply of fresh and tasty produce and non-chlorinated water ready when they are hungry or thirsty is one of the lowest cost ways to boost health and vitality. (Check out Jack LaLanne’s website to see what good nutrition and exercise can do for a 90 year old if you don’t believe me.)

5. Supplements - I personally believe in vitamin and mineral supplements. Ask the doctor or pharmacist for advice. In a future post, I’ll discuss which common prescription drugs deplete certain nutrients from the body. The results can be disastrous but the solution costs just pennies in most instances.

6. Family, friends and fun - Ok, you knew this. Studies show that people live longer, healthier lives if they have regular social contact with family and friends. This is particularly important to remember if your parent is living alone in his own home. Oprah, CNN, even Larry King with his wide range of topics, are not substitutes for real, in person, human social interaction. Pets can help, too, if your parent can manage their care. Help your parent get out of the house on a regular basis. Even adult day care can be a spirit lifter for many seniors.

My father died recently. Yes, he made it to the finish line without running out of money.

The last three months of his life were grueling for both of us. His ultimate medical crisis arrived. 

More about those final months in the next posts.

One of the Yahoo Groups I regularly read has had an ongoing discussion about health care in the USA. One of the posts talked about the need for a medical power of attorney or Living Will as it’s sometimes called.

K lives in New England. She told us what happened when her mother, who did not have a medical power of attorney, had a stroke and required hospitalization and then rehabilitation.  The hospital was willing to allow K to make the important medical decisions without any legal documents. But, when it came time to release K’s mother to the rehab facility, there was only one that would accept her. And, K was required to go to court to become her mother’s legal guardian for that one to accept her mom!

In my Dad’s case, each time he was sent to the hospital, the hospital would not share details of my father’s condition until I faxed them copies of his medical power of attorney. Then, I was issued a confidentiality code which the nurses would ask me for before telling about his current status.

Both rehab facilities my father stayed at, also required that I fax copies of all of these forms.  The nurses at these skilled nursing facilities didn’t require a secret code, but  my Dad’s chart had information on it about his medical power of attorney and who they were allowed to share information with about his condition.

The medical community takes these documents very seriously.

So, when should you get a Living Will or medical power of attorney drawn up for your parent? TODAY!

And, get one for yourself and spouse while you are at it. We can’t predict when a medical crisis will occur for any particular person.  Being prepared will make all the difference.

Here is a more complete explanation of medical powers of attorney. 

If your family has an attorney, s/he is the best resource for getting these documents drawn up. Some hospitals and senior centers also provide help in making a Living Will.  You can also purchase forms or software to help in getting one completed. The laws vary from state to state about the requirements for signatures and witnesses so it is a very good idea to work with someone knowledgeable of your state’s laws.

Start today.

I am so grateful that my father had one in place when he was sent to the hospital. It made all the difference.

Here’s additional information that can help:

Wills and Estate Planning Information at NOLO.com