Hiking the Retirement Journey

1. Hiking the Retirement Journey J. James Cotter, PhD VCU’s Department of Gerontology School of Allied Health Professions

2. Knowledge Needed for Hiking • Lay of the land • Equipment • How to stay fit and safe • Route selection

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

4. Trends in an Aging Society • More personal responsibility • Increasing lifespan • Limited government programs • Growing diversity • Redefining aging • Changing technology

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

6. Challenges in Caring for an Aging Population • Transitions of health and care settings • Importance of self-management • Importance of lifestyle • Interaction between physical and social • Effects of deconditioning

7. Growth of 65+ Population in Virginia thousands

8. Map 1: Aging and the new aging • 40 - Age discrimination • 50 - AARP discounts • 60 - Older Americans Act • 65-67 - Medicare and Social Security • 75 - frailty marker • 85 - the old-old

9. Changing view of “old” • Traditional groupings • Young-old = 65-75 • Old = 75-85 • Oldest-Old = 85+ • Dychtwald’s Middlescence • Middlescence - 40-60 • Late adulthood - 60-80 • Old Age - 80-100 • Raise retirement age • Age 70? • Age 75?

10. Generations

11. Redefining Aging • 84% of all Americans say they would be happy to live to be 90 • What defines old age? • Decline in physical ability - 41% • Decline in mental functioning - 32% • Reaching a specific age - 14% • National Council on Aging survey, 2001

12. Life Expectancy National Vital Statistics Report, Vol. 47, No. 28, December 13, 1999 National Research Council, 1988

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

14. Changing structure of society • Traditional aging pyramid • New aging pyramid

15. How long have YOU got? More than you thought. http://www.livingto100.com • The average life expectancy for men is 80 years, for a women - 85.

16. Gear: A language book:Ethnic Diversity and the Aged http://www.prb.org/Content/NavigationMenu/PRB/AboutPRB/Reports_on_America/ReportonAmericaTwoCenturies.pdf

17. A New Diversity • Age • Ethnicity/Race • Gender • Physical abilities • Sexual orientation • Family structure/ Marital status • Religious beliefs • Education • Income/Wealth • Work/ Employment Based on Griggs, 1995

18. Healthy Indulgers (18%) Ailing Outgoers (29%) Healthy Hermits (36%) Frail Recluses (17%) Gerontographics Life-stage Model Moschis, American Demographics, 1996

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

20. % aged reporting ADL limitation Adapted from Admin. on Aging, 1997

21. Anti-Aging Medicine 14th AnnualInternational CongressOn Anti-Aging Medicine April 7-9, 2006Orlando, Florida, The American Academy of Anti-Aging Medicine … Anti-aging medicine, which promises the baby boomers a 100 year plus youth filled life span, is the hottest topic in health care with recent in-depth features on the future of medicine appearing in Time and U.S. News and World Report. http://www.worldhealth.net/

22. Baby Boomers: Then and Now Then: Watching John Glenn's historic flight with your parents. Now : Watching John Glenn's historic flight with your kids Then: The Grateful Dead Now : Dr. Kevorkian Then: Getting out to a new, hip joint Now : Getting a new hip joint

23. EquipmentGear: Your Social Security card • Social Security • Pension or 401(k) • Assets – your house and savings • Medicare • Private health insurance or Medigap • Health Care Providers • Maybe Medicaid later

24. How many legs on that three-legged stool? You may need 6. Assets Public Benefits Social Security Employment Pensions Medical Coverage

25. Avoid a Poverty Stricken Old Age • Increase personal savings rate from ZERO • Median credit card debt $1900 (http://moneycentral.msn.com/content/Banking/creditcardsmarts/P74808.asp) • Savings rate is: a – .05% Negative .05% ! • Pensions to 401(k)s • Rising costs from increased personal responsibility in medical care

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

27. Labor Force Participation Rates(adapted from Atchley & Barusch, 2004) %

28. Financing Health Care for Older Persons • Medicare • ‘Medigap’ Policies • HMOs • Prescription Drugs • Medicaid • Long-term care • Long-term care Insurance • Medical Savings Accounts

29. Map: Health Care Transitions Home Meals on Wheels Apartment Complex Retirement Center Outpatient Health Care Hospital Assisted Living Case Mgmt Nursing Home Hospice Home Health Care

30. LTC Continuum - HCBS • Home and Community-based Services • Adult Day Care • Home health Care • Homemaker/Personal Care • Social Support Services • Home-delivered meals • Transportation

31. Continuum of CareInstitutional • Residential / Medical • Nursing Facilities • Sub-acute Care • Inpatient Hospice • Residential / Assisted • Board and Care • Assisted Living • CCRCs

32. Paying for Nursing Homes, 2000 (%s) Source: Shi & Singh, 2005.

33. Medicare: We’ve Got You Covered – well 50% anyway • Medicare pays 56% of its beneficiaries total health care expenditures • $1,180 / yr on average in out-of-pocket costs -- Kaiser Family Foundation • Extra amount needed in retirement if no employer health insurance - $200,000 (WSJ, March 7, 2006)

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

35. How much LTC insurance will I need? There’s the rub. • Predicting lifelong disability • What if its never needed? • Lifetime risk at 65=39%, at 85=49% • Predicting future long-term care system • What if services developed are not covered? • Predicting future long-term care costs • What will be the cost of a nursing home in 2032? - $190,000/year

36. The 2030 Problem: Caring for Aging Baby Boomers Knickman, J.R. & Snell, E.K. (2002). HSR: Health Service Research, 37:4. • Aging shocks: • Uncovered cost of Rx • Uncovered cost of medical care • High cost of private insurance for medical care • High and uncovered costs of LTC

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

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

39. Food Preparation • Nutrition knowledge • What foods to eat • How to prepare foods • Alcohol

40. The new Food Pyramid: MyPyramid.gov

41. Essential Gear 2: A Buddy

42. Changing Family Structure • Source: US Census, 2000

43. Older People of the 21st Century • Diversity: “plan for multiple groups of senior citizens” Characteristics • smaller families • suburbs • women in the work force • social movements Silverstone, Gerontologist, 1996

44. 21st century (cont’d) • Economics • diminished and elusive security, • competition, • skills still needed, • flexible work arrangements • lifetime of poverty • Social support - Multiple scenarios of reconfigured families and peer support networks

45. 21st Century Aging • Health • prevention is key, • disability  dependence • influence of lifestyle • influence of lifetime access to health care

46. Route Selection • New vocation – avocation – activities • Changing role • Grandparent, caregiver, companion • Gear – Camera and binoculars • Enjoy the journey; scope out the path ahead

47. Train Wreck 5: Elder Wasteland • What does a person do with 25-45 years of retirement? • What will you do?

48. Stay up with technology:The two most important devices for 21st century living

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

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