The Business of Aging

Cool New Cell Phone for Seniors. And Smart Product Development.

A collegue sent me information on a new "Senior Cell Phone" called Jitterbug.

The company GreatCall created Jitterbug to "provide Baby Boomers and their parents with perfectly simple cell phones and services that work the way they want them to".

The company's mission is to "simplify technology and make it available to everyone. Jitterbug's products, services and systems are centered on simplicity, personalization and ease of use".

The company was founded by Arlene Harris (45-year veteran in wireless and creator of the SOS emergency phone) and Martin Cooper ("Father of the first mobile cellular phone.").

This is a great idea. I remember shopping for a cell phone for my aging mom a few years back and could not find anything even close to user friendly at Verizon Wireless or any other major wireless company.

Case and point. The results for a  Google search (today) for "Verizon cell phone senior"  mostly returns information on Verizon "calling plans"  for seniors.  This confirms how the folks at Verizon think - it's not about the product, it's about the calling plan.  And for most cell phone users this is correct - the products are all pretty much all the same - shoppers are really buying calling plans. But the senior care market is different.   The only user-friendly senior cell phone in the search results is the Jitterbug phone.

Kudos to GreatCall for developing such a phone.  This is a great example of a company who undertands our country's demographics and their needs. 

By the way, an interesting and related blog post our readers may find interesting is Sony confirms that they are tuned out.  Not to pick on Sony but this blog post offers some interesting perspectives on "identifying new products that consumers actually want ."  

The Bias Against In-Home Care: Things Heating up in Florida.

Fact:  If you qualify for Medicaid (the state-federal partnership that provides health coverage and nursing home care to the poor) and get sick or disabled enough to require substantial care, you have little problem gaining admission to a nursing home. But obtaining Medicaid-supported services at home, such as visits from an aide, is substantially harder and often involves a long waiting list, even though it may cost the government less.  In fact, even if you do NOT qualify for medicaid there is a bias toward residential care versus in-home care. For example, long term care insurance policies often have a higher daily benefit for "confined care" (e.g., assisted living or nursing home) versus "non-confined care" (in-home care) meaning families pay more out of pocket for in-home care - again, even though this option often saves the Government (and family) money.

So it was with interest I read a news story about Florida Medicaid recipients want out of nursing homes.

The debate?

A group of residents on Medicaid in Florida are claiming the state is illegally forcing them to live in nursing homes when they should be able to live where they choose. They claim that nursing homes, afraid of losing money, have successfully pressured politicians to make qualifying for community care more difficult. They have filed a federal lawsuit seeking class-action status on behalf of nearly 8,500 institutionalized Floridians.

What one Medicaid resident said:

"I can't choose what meal I want, I can't have a visitor after 8 o'clock - it's just like a prison without bars," he said. "People are making decisions for and about me that don't even know me or even care about me. All they care about is the money they're getting for me."

And some very influential people are supporting them:

"There are very, very, very few people who cannot be cared for outside in the community," said Stephen Gold, a Philadelphia disability lawyer who, along with AARP attorneys and others, is representing the group. "Why should the state give a damn whether you put the money in the left pocket of the nursing home or the right pocket of the community?"

"There's a lot of concern that the nursing home industry is very powerful in many states and has made sure that a lot of Medicaid dollars go to institutional care as opposed to home and community-based care," said Toby Edelman, an attorney at the Center for Medicare Advocacy.

What does the State of Florida say?

The Florida Agency for Health Care Administration, the Florida Department of Elder Affairs and Gov. Charlie Crist's office - the three defendants - all declined to comment on the litigation. So did the attorney general's office, which is representing the defendants.  But In court filings, the defendants have claimed the plaintiffs lack standing because they haven't proven that treatment professionals deemed community-based care appropriate for each patient.

"Plaintiffs are not alleging that Florida's Medicaid program has failed to cover their medically necessary services," the defendants wrote. "Instead, plaintiffs want this court to second-guess the manner by which Florida's elected officials and policymakers have chosen to make those services available in light of the state's available resources."

Sadly, many nursing homes (and assisted living facilities) are excellent facilities and very well managed but a lot are not and they tend to be the ones getting media attention.

The message to the nursing homes and assisted living facilities? Do a much better job with your public and community relations, admit the shortcomings of the industry, pressure the poor performing institutions to get their act together and work with residents, their families, the government and other "patient" advocacy groups to improve the laws to better support the needs of families and the elderly/disabled.

Yes, a tall order but if the industry does not voluntarily change then it will be forced to change by legislation.

How do I know this?

Because the aging Baby Boomers will soon insist these changes take place and they have the numbers to make it happen.

Employers Should Bet Future on Older Workers?

I just read a recent opinion piece by William J. Rothwell (professor of workforce education and development at Penn State University) and Diane Spokus ( faculty member in health policy and administration at Penn State) titled  Employers Should Bet Future on Older Workers.

The question to employers that Rothwell and Spokus ask is this: 

“Employers are facing a future workforce different from the past. There are fewer younger workers, and older workers are becoming more sought-after. How many employers are really prepared to attract, manage, develop and retain older workers, and how many employers are prepared to re-think age-old stereotypes about older people?”

In their commentary, Mr. Rothwell and Ms. Spokus present two myths (and explanations) regarding older workers:

1. Myth One: It costs more to retain older workers than it does to recruit younger workers: Many older workers may receive higher salaries, but when hidden replacement costs are factored in for the higher turnover of younger workers during their early years of employment, the actual cost savings is in keeping with experienced employees.
2. Myth Two: The costs for health and other benefits cost more for older workers: In fact, older workers have fewer acute illnesses, while younger workers have more dependents. So the reality is that overall benefits may work out to be the same for older as for younger workers.

I have no idea if #1 or #2 are in fact myths and I'm not sure it even matters.

Here is why.

As the authors correctly point out, more Baby Boomers are living longer and there are fewer younger workers entering the U.S. workforce.  OK.  While both of these points are correct, the "fewer younger workers entering the U.S. workforce" is not why Baby Boomers will stay in the workforce longer. This is a global economy so you cannot look at the U.S. workforce in a vacuum. You have to look at the global workforce and globally, there are plenty of educated younger workers available for employment. 

But I digress.

There is only one reason we are likely to see more older workers in the U.S. workforce and it isn't complicated:

Most Boomers have no choice. And many that do have a choice are choosing to work.

People are living longer. Those who have not saved enough for retirement must continue to work. Especially with the housing slump and falling stock market.  And many who can retire don't want to. For this reason, I do not believe we'll see a mass exodus of older workers from the workforce and I don't think we will face a labor shortage on any broad scale.

So what does this mean for employers and older workers?

According to Mr. Rothwell and Ms. Spokus, older workers need to "take responsibility for their own development" and employers should "revise human resources policies to provide flexible work schedules and job sharing opportunities for older workers" and also invest in training for older workers and those who manage them.

I agree (and I think it is already happening). 

BTW, Mr. Rothwell and Ms. Spokus have a book titled Working Longer: New Strategies for Managing, Training, and Retaining Older Employees that you might find interesting. 

Assisted Living for Individuals with Alzheimers. Do Your Homework. Manage Expectations.

My mom has advanced Alzheimer's disease (AD). In the early stages of her dementia we kept her in her home. Something I highly recommend for any senior who wants to remain at home, be safe and can still communicate this preference. Eventually, as my mom's needs increased, we hired a 'companion' from a local home care company. The one I used was Comforcare - excellent agency but it's a franchise business model so quality may vary by location.

Initially the companion visited my mom for a few hours each day (about $20 per hour and covered by most Long Term Care insurance policies) but as my mom's needs increased we increased the hours. Eventually, we hired a full-time live in from the agency for about $200 per day. Sounds like a lot and it is but quality residential care (e.g., assisted living) can be more than this in some locations.

Eventually, my mother's needs became more than what a single caregiver in the home could effectively manage. At this point we moved her to an assisted living facility. But wait, how can you place someone with AD into "assisted living" if they can't care for themselves?

As it turns out, most assisted living facilities have a dedicated floor for residents with AD. If a family can afford it, it's a better option than a nursing home (way better). If you do choose this option, in addition to the obvious questions to ask a facility , make sure the AD section is on a ground floor, residents can walk outside on their own (fenced in area of course), the staff is trained in AD, rooms have sensors to detect at-night wandering, there is plenty of stimulation, residents can get out once in a while (via a bus with a lift) and daily schedules are flexible.  One such facility that I am familiar with that meets all of these requirements is Aegis Senior Living - in particular, the Aptos, CA location. This is a very impressive facility. They "get it" when it comes to assisted living for AD.     

Now, here is where it gets interesting and why you need to do your homework when considering assisted living for people with AD.

Assisted living facilities do not typically provide one-on-one care. So if you need assistance getting dressed, going to the bathroom, getting to-and-from meals, etc. your going to have to pay extra for these services or hire an outside agency (like Comforcare) to provide "supplemental" care. And as your needs increase an assisted living facility may ask you to provide 24/7 supplemental care. So it is not uncommon to be paying close to or in excess of $100,000 a year for care in some areas.  In my experience the good assisted living facilities will be very clear about this but the not-so-good ones will be vague about it. Remember, when you take a tour of an assisted living facility the tour guide is a sales person. They get paid to place residents.

So what can a family do that can't afford this option? They typically end up spending all of the elder's money on care and then qualify for Medicaid. True, you can "spend down" or "gift" assets to other family members to qualify for medicaid faster but the laws make it very difficult to do this - and part of me understands and accepts the reasons why. 

Crazy isnt it? Yes it is. The sad truth is that families of AD patients get a double whammy because they need to spend so much more on supplemental care. And to make matters worse, the tax code and LTC insurance companies do not distinguish between elders with AD and those without so you are subject to the same daily maximums and restrictions.

I don't blame anyone for our imperfect system but as one Geriatric Care Manager recently told me "when congressional leaders have to begin caring for loved ones with AD I think the rules will be changed".

I hope you are right Nancy and I have a feeling changing this imperfect system is the final legacy the Baby Boomers will leave us with. They have the numbers and the influence to do so.

At least I hope so.

Reverse Mortgages: Buyer Beware? Things Getting Better.

According the National Council on Aging,  reverse mortgages can be used by over 13 million Americans to pay for long-term care expenses at home, allowing many to remain independent and in their homes longer.

The NCOA describes reverse mortgages as:

 "Reverse mortgages are loans that allow homeowners aged 62 and over to convert home equity into cash while living at home for as long as they want. Borrowers continue to own their homes, and do not need to make any monthly payments. Instead, they can choose to receive the funds as a lump sum, line of credit, or as monthly payments (for up to life). The loan comes due only when the last borrower moves out, dies or sells the home."

However, many seniors can be taken advantage of by unscrupulous lenders and confusing contracts.

For this reason, I recommend reading a recent Fortune Magazine article titled  Unlocking your home equity.

The bottom line? Do your homework.  The Fortune article states:

• Reverse mortgages are available only to people age 62 and older
• The amount you can borrow depends on your age, the value of your home, and interest rates.
• You can choose to receive your money in a lump sum, monthly installments, or a line of credit.
• There are no monthly payments to make - and therefore you don't have to meet an income requirement to qualify.
• The debt is settled with the proceeds from the sale of your home. If your house sells for less than what you owe the federal government covers any shortfall.
• Reverse mortgages are a very expensive way to borrow. Reverse mortgages are "rising debt" loans: The interest you owe is tacked onto the balance, eventually becoming a substantial portion of your overall debt, and you end up owing interest on the interest, compounding the cost.
• Borrowers are also hit with an avalanche of upfront charges.
• In the past some reverse-mortgage brokers pressured borrowers to buy investments like deferred annuities with the proceeds of their loans. A new law prohibits lenders from requiring borrowers to buy investments or insurance products as a condition of getting the loan.

Read the article and do your homework.