Progressively Falling Apart

Are we progressively falling apart, or less dramatically, is the more significant question “what really is aging?”  In the last year I have had three surgeries that required anesthesia. Friends of mine have had breast cancer, melanoma, falling incidents, accidents, and broken bones. Harrumph…is this what getting older is all about?

Progressive frailty is a reality as we age.  The consequences for each of us and society are enormous.  But, is this really just individual angst or is this a more global problem for our society with far-reaching consequences?

What are the numbers for aging?  In What Happens When We All Live to 100?

 Since 1840, life expectancy at birth has risen about three months with each passing year. In 1840, life expectancy at birth in Sweden, a much-studied nation owing to its record-keeping, was 45 years for women; today it’s 83 years. The United States displays roughly the same trend. When the 20th century began, life expectancy at birth in America was 47 years; now newborns are expected to live 79 years. If about three months continue to be added with each passing year, by the middle of this century, American life expectancy at birth will be 88 years. By the end of the century, it will be 100 years.

There is nothing wrong with the opportunity to live longer with what is known as a much better “health span” than previous generations experienced.  With an improved health span, we may live a higher quality of life, filled with opportunities for social relationships, travel, physical activities, volunteerism, and retirement second careers.  The costs of healthcare will be reduced and disabilities associated with aging can be thwarted. The need for caregiving for those who will ultimately suffer from Alzheimer’s and dementia, however, will likely increase even with healthier bodies.

The human body does not vigorously support aging.  We seem to have been built for the energetic tasks of the young with strong vigorous bodies, early and rapid development of intelligence prior to our second decade, adept reflexes as young people, and metabolisms that flourish in our 20s.  As we age our energy decreases, our arteries harden, our bones thin, our appetites become misaligned with the calories we burn, and our hormones desert us.

With the improvements in health care, reductions in crime and violence (due to an aging population, modern crime fighting techniques, and surveillance technology ubiquitous in this world), prevention of pandemic diseases, emphasis on lifestyle enhancements, we are living in a period when the elderly may soon outnumber the young.

In an aging society, with increasing debt, who will lose in the foreseeable  budget stalemates?  Will Medicare and Social Security be available for us throughout our lifetime and that of our children and their children as they age? Budget management disputes will reduce the share that goes to the young.  My children are in their 30s.  Two of them have not yet contributed to Social Security as of now.  All three do not have traditional pensions from a company or the government.  One of them does contribute to a 401k.  Depending on the information available from the news media, nearly one-third to one-half of the people in the US have no money at all saved for retirement, yet will likely live well beyond today’s average.  Currently Americans spend 22% of their life retired and that will likely increase.

How will we share the money as Americans when we are competing for the same dollar?  In Crowding Children Out of Government Budget:Our Children’s Shrinking Share this prospect pits the interest of the young and the aging snobbishly against each other. In the United States, with the decline in fertility rates and improved health care, politics is being dominated by a graying Congress and older, white male politicians, lawmakers, and judges.  Americans 65 years or older could be 108 million in 2050.  As we become an aging society with fewer young folks to work and support aging parents and grandparents, how will society spend each dollar?  The national debt is increasing and a dollar can really only be spent once or it will add to the debt burden of future generations.

In the Urban Institute’s “Kids Share” report, released annually,  while there was an increase in 2012 in federal spending on children, spending is expected to decline from 10.2 percent in 2013 to about 7.8 percent by 2024.  Local and state governments have already reduced spending dramatically on education, health budgets, and social welfare since 2008.

What is causing this?  How are these choices being made? We can suppose this long-term reduction in the next ten years may be due to health care costs in the budget for the elderly crowding out the funds available to spend on the young.  In addition, the implication exists that because the majority of the elderly are white and the majority of infants are and will be minorities, there will be generational tugs on the budget due to the inability of the Americans in positions of wealth and political power to empathize with the needs of these disparate groups in our country.

 What does this mean to us on a daily basis, now and in the future?

It means something different to each of us yet the issues are surprisingly similar for the young and the elderly.

Everyone needs health care.  Where I live in a beach resort area surrounded by rural farmland, there are fewer choices since my State of Maryland supplemental retirement insurance requires that Medicare be the primary coverage.  Here on the Eastern Shore, there are few doctors at all.  Fewer take Medicare.  I am well insured but my choices, like many in the future, are reduced by the options available.  Preventive health care for young children is crucial to raising a healthy next generation.

Everyone needs a home.  As we age, and everyone is actually aging as long as we are alive, we need to live in a place that supports the totality of our needs.  The young need the outdoors, recreation, a healthy physical environment that is crime free and provides a safe setting in which to grow.  Aging adults need options that permit a transition to less mobility, quality social opportunities, adapted cultural and recreational activities, and transportation options.

Everyone needs nutritional food.  The young, particularly for low-income and struggling families, have had their SNAP benefits and allocations reduced by the Congress and state legislatures.  This will result in increased consumption of unhealthy foods to get by economically and the consequences in long-term health problems related to diabetes, high blood pressure, and obesity will be substantial.  Older Americans need to be able to afford and have access to healthy food buying options and be able to budget for food along with their medicine and living expenses.

The black cloud on all of the aging adults in this country is the poorly understood options for what we do if we have a catastrophic health or mental health crisis and cannot live on our own.  Everyone I know assumes that their insurance will cover everything or government will take care of them or that they will have their own resources which will be sufficient for any eventuality.  Some believe their children will step in to be caregivers.  For some lucky few, these beliefs may be in consistent with reality.  For the majority these assumptions are just WRONG!

Even with issues related to just an accident, if you exceed your cap on your insurance policy (usually one million dollars), who pays?  A million dollars sounds like a lot but my friend Valerie was hit by a car in a crosswalk getting her daily walk.  She was in intensive care for three weeks and then transitional care.  She reached the cap quickly!  When she was recovered enough to go to a rehabilitation facility, she could not be weight-bearing due to leg and pelvic injuries.  She also had swallowing difficulties.  Medicare only covers 21 days in a rehabilitation center.  She is not eligible for Medicaid due to her pension. Her supplemental health policy would not guarantee full coverage if she exceeded than the 21 days.

Another friend of mine had a significant stroke.  After a long period of hospitalization he went to an acute care facility which Medicare covered for a short while. He was not eligible for Medicaid so he remained at his own expense in a private care facility since he was basically bedridden.  He went through all of his personal resources after a couple of years.  At that point he was moved to a Medicaid facility which was much less desirable and where he ultimately died penniless.  He was a bachelor and thankfully he did not cause his wife or family to go bankrupt.

My parents were both in end-of-life facilities.  My mom after a lengthy illness was transferred to an acute care facility for 18 months. After she exceeded the days which were covered by Medicare, to stay at that facility, she had to pay privately.  I was able to pay from her resources, $7000 a month for her care.  At the same time my dad was in a secure assisted-living facility for three years prior to his death due to a form of dementia.  Assisted living must be paid through private resources(with the exception of medicine management and OT and PT if necessary) and I was able to pay from his resources, $3500 a month for his assisted-living facility.  Both of them passed away before their money ran out.

Since that point I have tried to become an advocate among my friends for an increased understanding of the costs of future care.  In the here and now, everyone I know sees themselves living indefinitely in their current state of health, physically and cognitively.  Many say, “I would do away with myself if I had to go to a facility for care.”  Well, in many cases, this shattering life-care event comes with no warning…an accident, a cascading and rapid health event, or the stalker of our minds, dementia which comes like a fog and blinds us to our future.

For me, the creeping accumulation of progressive health problems may steal my life as I would choose to live it.  Maybe, unbeknownst to me, a catastrophic event will end my wonderful retirement life of travel, friends, family, and grandchildren.  I have planned for some of these events through a long-term care policy, excellent health care coverage, a large whole life insurance policy (which I can cash in as needed), and looking at options for compassionate end of life decisions.

My spouse of ten years has refused to consider having this discussion.  Nearly two weeks ago, he injured his back.  Now this is not a new issue. He has had back problems since 1965.  They were resolved by medication, simple disc surgery, and epidurals.  This time is different.  He has been in bed, unable to sit, for two weeks.  He is now, after two weeks of physical therapy, an epidural, acupuncture, and medication, able to walk.  He still cannot sit.  I have been taking care of him these two weeks.  The doctors want to do extensive back surgery with no guarantee of outcome.

The issues of my friend in the accident and my spouse have motivated me to continue to espouse the necessity for knowledge of your options, an understanding of the costs, and a plan in your treasure chest for what you and your family will do, since for every older person, there is an end game.  Very rarely is it spontaneous.  My 95-year-old mother-in-law went from making Lefse and cooking for Thanksgiving to having a massive life ending brain hemorrhage that took her life in about 26 hours.

Most of us will melt away of this and that…..

My message to everyone, is to please not drift ahead to the inevitable future without directions, a map, your life plan GPS, and your five, ten, and 25 year financial plans in hand.


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