Hiking the Retirement Journey
J. James Cotter, PhD
VCU’s Department of Gerontology
School of Allied Health Professions
Knowledge Needed for Hiking
•
•
•
•
Lay of the land
Equipment
How to stay fit and safe
Route selection
Essential Gear
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
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
Trends in an Aging Society
•
•
•
•
•
•
More personal responsibility
Increasing lifespan
Limited government programs
Growing diversity
Redefining aging
Changing technology
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
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
Growth of 65+ Population in
Virginia
1600
1400
1200
1000
800
600
400
200
0
1995
2000
2005
2015
2025
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
Changing view of “old”
• Dychtwald’s
● Traditional
Middlescence
groupings
• Middlescence - 40-60
● Young-old =
• Late adulthood - 60-80
65-75
• Old Age
- 80-100
● Old = 75-85
● Oldest-Old =
85+
• Raise retirement age
• Age 70?
• Age 75?
Generations
Cohort
Era
Age -2000 Age -2020
Swing
1900-25
75-100
95-120
Silent
1925-45
55-75
75-95
Baby Boom
1946-64
34-54
54-74
Gen Xers
1965-79
21-35
41-55
1980-2000
0-20
20-40
Milleniums
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
Life Expectancy
National Vital Statistics Report, Vol. 47, No. 28, December 13, 1999
National Research Council, 1988
90
80
70
60
50
40
30
20
10
0
At birth
At 65
1900
1920
1940
1960
1980
1997
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.
70000
60000
50000
40000
30000
20000
10000
0
1900 1999
Changing structure of society
• Traditional aging pyramid
• New aging pyramid
100
100
80
80
60
60
40
40
20
20
0
0
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.
Gear: A language book:
Ethnic Diversity and the Aged
100%
80%
Asian/Other
Hispanic
60%
Black
40%
White
20%
0%
Aged
1990
General
1990
Aged
2050
General
2050
http://www.prb.org/Content/NavigationMenu/PRB/AboutPRB/Reports_on_America/ReportonAmericaTwoCenturies.pdf
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
Gerontographics Life-stage
Model
Healthy
Indulgers
(18%)
Ailing
Outgoers
(29%)
Healthy
Hermits
(36%)
Frail
Recluses
(17%)
Moschis, American Demographics, 1996
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
% aged reporting ADL limitation
100
80
60
40
20
0
65-69
70-74
75-84
85+
Adapted from Admin. on Aging, 1997
Anti-Aging Medicine
14th Annual
International Congress
On Anti-Aging Medicine
April 7-9, 2006
Orlando, 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 indepth features on the future of medicine appearing in Time and U.S.
News and World Report.
http://www.worldhealth.net/
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
Then: Getting out to a new, hip joint
Now : Dr. Kevorkian
Now : Getting a new hip joint
Equipment
Gear: 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
How many legs on that threelegged stool? You may need 6.
Assets
Social
Security
Employment
Medical Pensions
Coverage
Public
Benefits
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
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
Labor Force Participation Rates
(adapted from Atchley & Barusch, 2004)
100
80
60
40
%
1950
2008(proj)
Difference
20
0
-20
-40
Men 55- Men 65+
64
Women
55-64
Women
65+
Financing Health Care for Older
Persons
• Medicare
– ‘Medigap’ Policies
– HMOs
– Prescription Drugs
• Medicaid
– Long-term care
• Long-term care Insurance
• Medical Savings Accounts
Home
Apartment Complex
Meals on Wheels
Retirement Center
Outpatient Health
Care
Case Mgmt
Home Health Care
Map:
Health Care
Transitions
Hospital
Hospice
Assisted Living
Nursing Home
LTC Continuum - HCBS
• Home and Community-based
Services
– Adult Day Care
– Home health Care
– Homemaker/Personal Care
– Social Support Services
• Home-delivered meals
• Transportation
Continuum of Care
Institutional
• Residential / Medical
– Nursing Facilities
– Sub-acute Care
– Inpatient Hospice
• Residential / Assisted
– Board and Care
– Assisted Living
– CCRCs
Paying for Nursing Homes,
2000 (%s)
8.1
10.3
4.5
27
48.1
Source: Shi & Singh, 2005.
2.2
Pocket
Other Pub
Medicaid
Medicare
Private/Ins
Other private
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)
The Elderly Poor Spend a Greater
Portion of Their Income on Health
The Elderly Poor Spend a Greater
Portion of Their Income on Health
30
25
%
20
15
10
5
0
<$10
$10-$19
$20-$39
$40-$69
$70+
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
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
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
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
Food Preparation
• Nutrition knowledge
– What foods to eat
– How to prepare foods
• Alcohol
The new Food Pyramid: MyPyramid.gov
Essential Gear 2: A Buddy
Changing Family Structure
100%
Married couples with
own children
Married couples
without own children
Family - other
80%
60%
40%
Living alone
20%
0%
Other non-family
1970 1980 1990 2000
•Source: US Census, 2000
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
21st century (cont’d)
• Economics
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–
–
–
–
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
21st Century Aging
• Health
–
–
–
–
prevention is key,
disability  dependence
influence of lifestyle
influence of lifetime access to health care
Route Selection
• New vocation – avocation –
activities
• Changing role
– Grandparent, caregiver, companion
• Gear – Camera and binoculars
– Enjoy the journey; scope out the
path ahead
Train Wreck 5: Elder Wasteland
• What does a person do with 25-45
years of retirement?
• What will you do?
Stay up with technology:
The two most important devices for
21st century living
Ten Tips For Healthy Aging
1. Eat a balanced diet.
2. Exercise regularly.
3. Get regular check-ups.
4. Don't smoke. It's never too late to quit.
5. Practice safety habits at home to
prevent falls and fractures.
From the National Institute on Aging
Ten Tips For Healthy Aging
6. Always wear your seatbelt when traveling.
7. Avoid overexposure to the sun and the cold.
8. If you drink, moderation is the key. And when you
drink, let someone else drive.
9. Keep personal and financial records in order to
simplify budgeting and investing. Plan long-term
housing and financial needs.
10.Keep a positive attitude toward life. Do things
that make you happy.