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Inside This Year’s Planner

When BusinessWest and the Healthcare News first started publishing an annual Senior Planning Guide, the idea wasn’t to create a roadmap to the end of life, though it could, in some sense, be described as such.

The goal is to make sure you get your plans in order — from where you or your loved ones will live to how finances will be distributed — so you don’t have to worry so much, and instead enjoy the senior years to the fullest, or to help your aging parents enjoy them.

After all, the retirement years should be an enjoyable time, highlighted by special moments with family and friends, the freedom to engage in a range of activities, maybe even a chance to develop new interests and hobbies.

But to make the most of that time, proper planning — estate planning, financial planning, plans for care — is critically important. According to the U.S. Census Bureau, the number of Americans age 65 and older — which was 35 million in 2000, just 12% of the population — will reach 73 million by 2030, or 21% of U.S. residents. That’s a lot of people. And a lot of planning. And a lot of living left to enjoy.

Achieving your goals — and your desires for your loved ones — requires careful thought, and that’s where our annual Senior Planning Guide, presented by UMassFive Financial & Investment Services, comes in. So let’s sort through some of the confusion and get those conversations — and the rest of your life — started.

View this  year’s digital Senior Planning Guide HERE

Wellness for Life

Sharing a Life

Journaling Is a Therapeutic Exercise — for All Those Involved

Savvy Seniors Freeze It

Nutrition-minded Older Adults Should Heed These Tips

The Emotional Bank Account

How Seniors Can Maintain Mental Wellness

A Whole Year of Fun

Older Adults Have Plenty of Ways to Stay Physically Active

Estate & Financial Planning

Estate Planning: An Introduction

Goals, Strategies Can Vary with Each Stage of Life

Creating an Estate Plan

The Process Begins by Understanding the Key Documents

Decisions, Decisions

How to Choose a Medicare Plan

Preparing a Will

It Can Be a Dreaded Task, but It’s an Important One

A Task Better Left to a Professional

Being in Charge of an Estate Can Be Unsettling for All Involved

Roadblocks to Equality

LGBTQ+ Elders Face Unique Planning Challenges

Let’s Not Fight over This Stuff

Distributing Tangible Personal Property Can Cause Conflict

Caregivers & Adult Children

A Gentle Reminder

Don’t Lose Yourself in Caring for Others

Reading the Signs

Six Indications It Might Be Time for Memory Care

Having the Talk

Ten Tips on How to Approach a Difficult Topic

Four Steps to Emotional Wellness

Caregivers Must Understand the Importance of Self-care

It’s Not About Dying

How Hospice Care Supports the End-of life Journey

Senior Resources

Business of Aging

Peace of Mind

By Mark Morris

 

Heidi Cornwell says families looking for a senior-living community should consider its continuum of care.

Heidi Cornwell says families looking for a senior-living community should consider its continuum of care.

Between now and 2030, 10,000 Americans each day, on average, will reach age 65. That type of growth affects all the industries that serve the senior population — and, not surprisingly, senior living is one industry paying close attention to this trend.

Kimball Farms Life Care provides independent and assisted living as well as dedicated memory-care services. In 2020, the Lenox facility received more inquiries about its residential offering than in any year prior. Heidi Cornwell, marketing and sales director for Kimball Farms, said potential residents are doing more online research to educate themselves about senior community living.

“Many people are ‘shopping around’ earlier because they saw their own parents ill-prepared for this part of their life journey,” Cornwell said. She also noted that, as people live longer, they are moving into senior at a later age.

As a continuing-care retirement community (CCRC), Kimball Farms offers increasing levels of care for those who need it. Residents can easily move from independent living to assisted living, giving the individual and their families greater peace of mind.

For residents who develop dementia or Alzheimer’s disease, Kimball Farms offers memory-care services through its Life Enrichment Program (LEP). Cornwell explained that the program is centered around a philosophy know as habilitation, which increasingly emphasizes a person’s remaining skills instead of the skills they have lost.

For example, if a sandwich is placed in front of a person with dementia, they may not be able to process what to do with it. “However, if someone sits across from them with a sandwich, picks it up, and takes a bite, that is the only queuing they need to understand what to do,” Cornwell said, adding that they can then enjoy their lunch without any further assistance.

“We are so grateful to our residents and their families because they worked with us to find creative and innovative ways to stay engaged and informed, while at the same time keeping everyone healthy.”

Singing is another good example of emphasizing a remaining skill. “The individual may not sing along to a song by themselves, but if an activities person or nurse sings with them, they can sing with pride and remember every word.”

The LEP puts its focus on maximizing quality of life for each resident. Regular routines and programs built around the interests of the individual keep them busy all day and into the evening. As a result, the residents thrive, Cornwell said, noting that the stimulation helps residents with dementia maintain the abilities they still have for as long as possible.

“We place no expectations on them, but encourage them to be the best person they can be,” she said. “We celebrate the good days, bolster self-esteem, and we treat them with the utmost dignity and respect.”

 

Safe Spaces

As research on dementia has evolved, caregivers have increased their understanding on how to manage the condition. Embracing the skills that remain for those with dementia can encourage feelings of acceptance and personal success. That’s important, Cornwell said, because, even though the disease can have an effect on a person’s ability to communicate or recall recent events, they still have a sense of the quality of life they desire.

Or, as she put it, “although they may no longer be able to dance, they still enjoy the music.”

Kimball Farms social worker Jackie Trippico leads what is known as Reminisce Group. This weekly activity begins with staff presenting a specific topic and asking residents to recall a significant memory related to that theme. Cornwell said one popular reminiscence involved talking about a trip to an ice-cream parlor.

Providing comfortable spaces is also part of the program. Kimball Farms’ memory-care neighborhood is a secure, self-contained community. Private apartments are modeled after a typical home with an open floor plan, while residents also have access to a secure outdoor courtyard so they can garden, see visitors, or take part in other activities. The staff ratio is higher than traditional assisted living, and they have all been trained in specialized dementia care.

When COVID-19 hit last year, families could no longer make in-person visits to residents in LEP. Cornwell said the activities professionals and nursing team quickly adapted to using tablets to arrange virtual visits or phone calls so families could stay informed on the care and well-being of their loved ones. Celebrating special occasions simply became virtual events.

“Zoom birthday and anniversary parties, as well as Skype holiday festivities, became our new normal,” she explained.

As COVID vaccine levels rise, Kimball Farms is able to welcome families to visit by appointment. Cornwell reported that residents and their families have been thrilled to resume the personal visits.

“We are so grateful to our residents and their families because they worked with us to find creative and innovative ways to stay engaged and informed, while at the same time keeping everyone healthy.”

As more Americans reach their senior years and live longer than previous generations, the demand for memory-care facilities to treat dementia and Alzheimer’s disease will continue to increase.

According to Seniors Housing Business magazine, from 2013 through 2018 (the latest figures available), the number of new memory-care units increased by 55%.

Cornwell advises those who are looking at senior-living options to consider the continuum of care a community offers. Healthy seniors who may choose independent living in senior housing to downsize from their homes need to think about future needs as well, she said.

“The community they choose should be a place that will provide them with the best quality of life, for the rest of their life, with increasing levels of care when and if they need it.”

Senior Planning

Take care to prepare

What was once a demographic ripple has become a full-blown wave — and it’s getting bigger.

According to the U.S. Census Bureau, in 2000, the number of adults age 65 and older was 35 million, or 12.4% of the total population. In 2016, the number of seniors had risen to 49.2 million or 15.2% of the population.

By 2030, the bureau estimates, more than 20% of U.S. residents will have passed their 65th birthdays, and by 2035, that demographic will outnumber children younger than 18 — an unprecedented swing.


View the PDF flipbook HERE

 

What does all this mean?

It means it’s time to prepare — the sooner, the better.

As the Baby Boom generation continues to march into their retirement years — at the rate of 10,000 per day — Americans are living longer than ever. But what that life will entail, post-65, can wildly vary depending on lifestyle preferences, health status, finances, and more.

The questions are myriad. What levels of care are available, and what do they include? How will I pay for all of this, especially if I, or my parents, live well past 80 or 90? How do I approach mom or dad with my concerns that they might not be able to live alone anymore? What’s an estate plan, and what documents do I need to worry about?

It’s a lot to think about, and no single guide can answer all those questions. But hopefully, this special section will sort through some of the confusion and get those conversations started.

Law

Prepare for the Unexpected

Jack Ferriter says it’s never too early to talk to an attorney

Jack Ferriter says it’s never too early to talk to an attorney about a healthcare proxy and living will.

Medical decisions aren’t always cut and dry. The way Jack Ferriter sees it, why entrust them to just anyone?

“A healthcare proxy is someone who stands in your shoes to make medical decisions for you, but only if you’re unable to make those decisions,” said Ferriter, who practices business and estate law at Ferriter Law in Holyoke.

The term ‘healthcare proxy’ also refers to the document that specifies who will make those critical decisions for an individual if they can’t make them on their own — for instance, in a medical emergency that has them unconscious or otherwise incapacitated.

For instance, Ferriter explained, “if a surgeon says, ‘do you want this operation?’ and you can shake your head to say ‘yes’ or ‘no,’ the doctor will go with your answer. But if you’re unable to make that decision — or even if you’re unwilling, if you say, ‘I don’t know; please ask my wife, who’s my healthcare proxy’ — then the surgeon would ask your healthcare proxy whether you should have the operation.”

A 2017 study in the journal Health Affairs revealed that one-third of Americans have a healthcare proxy, which is far too low, say estate-planning attorneys and doctors.

“When somebody comes in here and they’re asking for an estate plan, we will always include a will, a power of attorney, and a healthcare proxy and a living will,” Ferriter told BusinessWest. “Everyone should have them. It’s not just for people 65 and older. Anybody could get hit by the proverbial bus and need somebody else to make medical decisions with a healthcare proxy, or financial decisions with power of attorney.”

In a recent blog post, Springfield-based law firm Bulkley Richardson noted that it examined whom its own clients had named as their healthcare proxies, and found that, not surprisingly, a spouse was most common, followed by an adult child.

“Where a child was named, gender, birth order, and whether the child was the parent’s ‘unofficial favorite’ often did not seem to matter,” the firm noted. “Geographic proximity to the parent signing the document, emotional maturity, and perceived alignment with the parent’s preferences seemed to determine who was named.  If a child was in a medicine-related profession, that was often a major factor in the selection.”

“Anybody could get hit by the proverbial bus and need somebody else to make medical decisions with a healthcare proxy, or financial decisions with power of attorney.”

Ferriter recommends that clients name two people — a primary and secondary healthcare proxy — because the designation comes into play at urgent and unexpected times.

“If it’s 2 in the morning and the surgeon is trying to reach your healthcare proxy and doesn’t have the right number, or has a home number that’s going into a machine and needs an answer, or if somebody’s out of the country, it’s always good to have a secondary healthcare proxy so the surgeon can call the secondary one and say, ‘should we do this operation or not?’”

He recommends that cell-phone numbers are used, not landlines, but even then, ringers are sometimes turned off, or phones lose their charge, and no one wants the wrong person to make life-and-death decisions because of a dead battery.

Wishes Granted

In addition to the healthcare proxy, Ferriter recommends clients prepare a living will as well.

“You go down the list and check off or initial each line — you do not wish to be resuscitated, you do not wish to be artificially fed, you do not wish to be artificially kept alive,” he noted.

However, the living will in itself is not a binding legal document in Massachusetts (however, it is in Connecticut and some other states). So why prepare one? Perhaps its greatest value comes in the guidance it gives one’s doctors and healthcare proxy.

“I find it’s a good guide for your conversation with your healthcare proxy and with your family. You go down the list and say, ‘here’s what I want, here’s what I don’t want, and even though this is not legally binding in Massachusetts, I just want you to know so that, if you are making the decisions for me, you’ll have my answers ahead of time.’”

And for those who worry about the finality of the living will, Ferriter pointed out that language on the form states that the living will is to be followed only if there’s no reasonable chance of recovery.

“I know these questions are kind of scary. If you’re 55 years old and it says ‘do not resuscitate,’ you’re afraid that if you walk out my front door and have a heart attack, they’re not going to resuscitate you. But they would, because it says ‘only if there’s no reasonable chance of recovery.’ So if you’re 105 years old in a nursing home and your heart stops, they’re probably not going to paddle you. But if you’re 55 years old and you have a heart attack outside a lawyer’s office, I’m sure they would absolutely paddle you, and wouldn’t even ask anybody.”

A third document related to critical-care decisions that has emerged in recent years is the MOLST document, which stands for medical orders for life-sustaining treatment. And, unlike a living will, MOLST is absolutely a binding document.

“MOLST differs from the most common type of palliative-care planning — advanced directive orders, which usually include a living will or other expression of wishes. Those orders generally designate a surrogate decision maker, or healthcare proxy, to act on behalf of an incapacitated patient,” the Massachusetts Medical Society (MMS) notes.

“Living-will instructions — when presented by a healthcare proxy — are generally recognized as evidence of patient preferences, but are not recognized by Massachusetts law. In contrast, a completed MOLST form travels with the patient at all times, may be faxed or reproduced, and is an official part of a patient’s medical record.”

Ferriter noted that the MOLST isn’t technically a legal document, but a medical one.

“We don’t do them here in the office because the medical orders are done with a physician or a medical professional. Those are your orders, and those are binding in Massachusetts because you’ve had advice from a physician.”

But MOLST is not typically a document prepared absent an impending, planned event, like, say, open-heart surgery.

“Typically, they happen if you are going into the hospital for some kind of serious procedure. My experience is that physicians don’t offer to do medical orders with their patients, but if you ask for them, they’ll do them, and if you’re going in for a serious operation, they may bring it up at that point,” Ferriter said. “You can’t sit at home and fill out medical orders by yourself because you’re not making an informed decision. And it’s usually your primary-care doctor who does it — someone who knows you well — even though the surgeon is doing the surgery.”

MOLST covers resuscitation efforts, breathing tubes and ventilation, artificial nutrition and hydration, and dialysis, the MMS notes.

“MOLST has priority over the healthcare proxy, because it’s your actual wish, as if you had shaken your head ‘yes’ or ‘no’ at the time of the actual procedure,” Ferriter said.

Don’t Put It Off

While many people will never have need of a MOLST, he went on, it’s hard to argue that they won’t need the other documents at some point — and the sooner, the better.

“We tell clients that as soon as you get married or buy a house, have a child, or even graduate from college, it’s not that expensive to do a will, power of attorney, healthcare proxy, and living will,” he noted. “For a single person, it’s less than $300, and for a couple, it’s less than $500.

“A lot of times, older couples will come in upon retirement,” he went on. “Most of the time, they had a previous version of these documents, but things have changed. They had it done in their 30s and 40s, now they’re in their 60s, so we update those.”

Individuals or couples with children will also want to include guardianship documents and perhaps establish a trust in case neither is around to care for them.

“When I have people in their 30s and 40s come in, it’s usually because one of the parents has passed away, or maybe a grandparent has passed away. There’s usually something that pushes them to come in,” Ferriter said, adding that, in truth, it shouldn’t take a big life change to start thinking about who will make important decisions in case crisis strikes.

When folks come in to get their estate plan done, I tell them, ‘you should sit around a dining room table with your family and have a frank coversation about what you want. It can be a difficult conversation, but it’s always better to have it at the dining-room table than around a hospital bed.’”

Joseph Bednar can be reached at [email protected]