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Navigating Your Later Years For Dummies

Carol Levine, AARP

ISBN: 978-1-119-48162-1 August 2018 384 Pages

Description

Long-Term Care: Planning for Finance, Medical, and Living Expenses

We’re living exciting bonus years—decades that our parents and grandparents didn’t have. But how to navigate this complex terrain? Questions abound around long-term care planning: Where to live? How to get the best medical care? What to do about advance directives, wills and trusts, and estate planning? And how to pay for it all after you retire? Getting accurate information and answers wasn’t easy. Until now.

AARP's Navigating Your Later Years For Dummies helps you and your family understand the growing range of opportunities. Even more importantly, it helps you chart the next steps to live the life you choose, as independently as you choose, no matter your specific circumstances and needs. This book:

  • Covers home modifications so that you can stay at home safely for as long as you like
  • Lays out the opportunities and costs associated with independent living, assisted living and other options
  • Gives you a range of driving and transportation alternatives
  • Helps you navigate the healthcare system, Medicare, and Medicaid
  • Sorts out the various sources of care at home
  • Reviews the legal documents you should prepare and update
  • Helps you determine whether you need long-term care insurance
  • Gives you guidance on talking with your family about sensitive issues, including your wishes as you age

With this new comprehensive book, you’ll get the credible information and resources you need to face the challenges facing us as we live the life we choose. Here, finally, is a roadmap for you and your family to best understand, and plan ahead.

Introduction 1

About This Book 1

Foolish Assumptions 3

Icons Used in This Book 4

Beyond the Book 4

Where to Go from Here 4

Part 1: Getting Started With Navigating Your Later Years 5

Chapter 1: Looking Ahead: The Big Picture 7

Planning for the Future Starts with You 7

Navigating the Roadblocks of Planning 8

Reasons for resistance 9

The benefits of planning 9

Unraveling the Meaning of Long-Term Care 10

Defining long-term services and supports 11

Understanding what Medicare covers 12

Discovering How Your Options Are Changing 13

Looking at why changes are being made 13

Keeping up with insider language 15

Meeting Your Changing Needs 16

Location, location, location 17

Timing and flexibility 18

Getting Professional Advice 19

Chapter 2: A Personal Inventory: Past, Present, and Future 21

Looking at the Present — and the Future 22

Healthcare needs 22

Family, friends, and professionals 24

Personality characteristics 25

Attitudes about money 26

Creating a Plan Based on Your Profile 28

Drawing a CareMap to Visualize Your Profile 29

Chapter 3: Finding Services 31

Where to Turn for Help 31

Organizing your research 33

Federal government programs 34

State and local programs 36

Community-based organizations 38

Taking Your Research to the Next Level: Site Visits for Housing 40

Tips for your tours 40

Federal and state regulations 41

Chapter 4: Making Decisions: A Family Affair 43

Holding Family Meetings 44

Who should be included? 44

When should you get together? 45

What should be on the agenda? 45

Being Considerate of Others 47

Allocating responsibilities 48

Bringing in the outer circle 50

Dealing with Conflict 51

Mediators and counselors 51

Consensus and compromise 52

Part 2: Choosing Where to Live 53

Chapter 5: Staying in Your Home 55

Staying at Home in Your Community 55

Dealing with Two Major Hazards 56

Preventing falls 57

Preventing burns 59

Modifying a Home 60

Categorizing types of home modifications 60

Checking out accessibility 61

Finding a contractor 63

Getting help paying for home modifications 63

Seeking Help at Home 65

Allocating tasks to family 65

Searching for services 66

Finding help for other chores 66

Putting technology to use 67

Preparing for an Emergency 68

Creating a support network 69

Making an emergency plan 69

Putting together a disaster kit 71

Chapter 6: Under One Roof: Generations Living Together 73

Multigenerational Living: Everything Old Is New Again 74

Why different generations are living together 74

Defining family households by generation 75

Considering family reactions before making a decision 76

Where Should We All Live? Considering the Options 78

Having a relative move in with you 79

Preparing to move into your parent’s home 81

Making fair financial arrangements 82

Making the Move 84

Getting started 84

Planning ahead 85

Sorting and packing 85

Settling in 86

Checking In over the Long Haul 86

Chapter 7: Downsizing for Now and Later 87

The Emotional Aspects of Downsizing 88

Downsizing and Home Renovations 89

Getting Started 90

Putting together important papers 90

Sorting and decision making 90

Donating or selling items 92

Hiring professional help 93

Making the Move 93

Chapter 8: Assisted and Independent Living and Other Group Settings 95

What Is Assisted Living? 96

Interpreting industry and government language 96

Getting to know what assisted living offers 98

Checking out healthcare services 100

Finding more information on assisted-living facilities 100

Evaluating the Cost of Assisted Living 102

Choosing from the menu of cost plans 103

Asking questions to create a monthly budget 104

Beyond the Brochure: What to Look for When You Visit 106

Making notes about the common areas 106

Checking out the residential units 107

Investigating continuing care 107

Pitfalls to Avoid 108

Unnecessary trips to the ER 108

Additional costs or a move after a hospital stay 108

Exclusion from social activities or dining room seating by other residents 109

Failing to read the contract 109

Independent Living and Other Options for Group Living 110

Independent living for seniors 110

Affinity or niche communities 110

Cohousing arrangements 111

House sharing 112

Group homes 112

Chapter 9: Beyond Your Home: Living in a Community 113

Understanding Why Community Matters 114

Defining age-friendly communities 114

Looking at livable-community initiatives 115

Taking a Walk Around Your Community 116

Looking at sidewalks and surrounding areas 117

Checking for places to stop, shop, and chat 118

Rating your community 118

Finding Community Services 119

Considering NORCs and Village Networks 121

Navigating NORCs 122

Joining a Village 123

Chapter 10: Getting Around: Transportation Options 125

Judging Whether Driving Is Still Safe 125

Watching for warning signs of unsafe driving 126

Starting the conversation 127

Making Your Car Fit You 128

Increasing safety with new technology 129

Choosing a new vehicle 130

Modifying vehicles 131

Knowing When It’s Time to Give Up the Keys 132

Finding Alternatives to Driving 133

Public transportation and paratransit options 134

Private options 135

Part 3: Legal and Financial Planning 139

Chapter 11: Unraveling the Rules of Medicare and Medicaid 141

The Distinction between Medicare and Medicaid 142

Looking at Medicare Basics 143

Are you eligible for Medicare? 143

What’s included in Original Medicare 145

What you get with Medicare Advantage plans 147

Prescription drug coverage 148

Durable medical equipment coverage 150

Home healthcare services 151

Medicaid Ground Rules 152

Are you eligible for Medicaid? 153

What services Medicaid offers 155

How Medicaid works with home- and community-based programs 156

Medicaid managed long-term care 157

Coordinating Benefits 158

PACE programs 159

Coordination with other health insurance 160

Chapter 12: Paying for Care: Long-Term Care Insurance and Other Options 161

Reviewing the Ups and Downs of Long-Term Care Insurance 162

Traditional long-term care insurance 164

Group and employer-based long-term care insurance 165

Hybrid long-term care insurance 165

Short duration long-term care insurance 166

Asking questions when considering any type of long-term care insurance 167

Continuing to pay rising premiums 168

Getting your claims paid for 169

Receiving Money through Annuities 170

Using Disability Insurance 172

Selling Your Policy: Life Settlements 172

Considering a Reverse Mortgage 174

Chapter 13: Financial Matters: Money Management, Wills, Trusts, and More 177

Managing Money 178

Opening joint bank accounts 178

Granting financial powers of attorney 180

Where There’s a Will 182

Taking inventory of your assets 183

Considering types of wills 184

Choosing the executor 184

Taking the final steps 185

Settling the Estate with Probate 186

Reviewing the Rules on Estate Taxes 188

Establishing a Trust 189

Pros and cons of living trusts 190

Special-needs trusts 191

Considering Guardianship 191

Part 4: Managing Your Healthcare 193

Chapter 14: Choosing Good Medical Care 195

Checking on the Special Medical Needs of Older Adults 196

Identifying common chronic conditions 196

Dealing with multiple ailments 197

Finding the Right Specialist to Manage Care 198

Considering the need for a geriatrician 199

Finding a geriatrician 200

Navigating Hospitals 201

Where to go for emergencies and non-emergencies 201

Being admitted to the hospital 203

Planning for a hospital stay 204

Polypharmacy: Too Many Drugs? 206

Using caution with certain drugs 207

Getting medications right 208

Other risks and questions 209

Chapter 15: Demystifying Home Care 211

Examining Varieties of Home Care 211

Surveying Services from a Home Healthcare Agency 213

Defining different kinds of home care agencies 214

Choosing a home care agency 215

Paying for Home Care 216

Looking at Medicare’s rules for eligibility for home healthcare services 216

Understanding Medicaid home care 220

Other kinds of insurance 221

Hiring home care workers on your own dime 222

Working with Home Care Aides 223

Paying Family or Friends to Provide Care 224

State programs 224

Long-term care insurance 225

Caregiver contracts 225

Is There a Doctor in the House? 226

Chapter 16: Understanding the Different Roles of Nursing Homes 227

Beginning with Nursing Home Basics 228

Defining nursing homes 228

Moving from a hospital to short-term rehab 229

Comparing nursing homes for a long stay 231

Visiting Nursing Homes 232

Checking off important points 233

Noting policy details 236

Checking Out New Models of Nursing-Home Care 237

Eden Alternative 238

Green House Project 238

Beatitudes 239

Responding to Residents’ Problems in Nursing Homes 239

Chapter 17: Getting the Healthcare You Want (And Avoiding What You Don’t Want) 241

Talking about Future Healthcare Decisions 242

Realizing the importance of advance planning 242

Making wishes known with advance directives and living wills 243

Dealing with the Rules of Advance Directives 243

Finding the forms for advance directives and living wills 244

Putting all your wishes down on paper 244

Choosing a healthcare proxy 245

Adding do not resuscitate (DNR) orders 246

Keeping your advance directive accessible 246

Choosing Physician Orders for Life-Sustaining Treatment (POLST) 247

Understanding Care Options for Serious Illness: Palliative Care and Hospice 248

Palliative care 248

Hospice 249

Part 5: Services for Special Groups 253

Chapter 18: LGBT Older Adults 255

Recognizing LGBT Aging and Health Issues 255

Physical conditions 256

Mental health risks 257

Knowing Legal Protections and Their Limits 258

The U.S Supreme Court and same-sex marriage 259

Obama presidential memorandum on hospital visitation 261

Keeping Legal Documents at the Ready 263

Finding LGBT-Friendly Providers and Facilities 264

Finding healthcare providers 265

Considering independent- or assisted-living facilities and nursing homes 266

Looking at LGBT-specific options 267

Chapter 19: Services for Veterans 269

Getting into the VA System 270

Comparing the VA to other healthcare systems 270

Understanding eligibility for VA healthcare 271

Supporting Veterans and Their Families 273

Shared decision making 273

Caregiver support 274

Noting VA Options for Older Veterans 275

Receiving pensions 276

Using Aid and Attendance and Housebound programs 277

Finding the Right Residential Setting or Nursing Home for Veterans 279

Veterans’ medical foster homes 279

Community living facilities (nursing homes) 280

State-operated veteran homes 280

The domiciliary program 281

TRICARE for Life 281

Using Other Resources to Navigate the VA System 282

Chapter 20: Family Caregivers 283

Defining Family Caregivers 284

Family caregivers by the numbers 284

What family caregivers do 286

Family caregivers’ rights and obligations 287

Becoming a Family Caregiver 290

Identifying yourself as a family caregiver 290

Readying yourself for negotiation 291

Checking Out Different Types of Family Caregivers 292

Family caregivers who are employed 292

Long-distance family caregivers 295

Multicultural caregivers 296

Looking at Your Caregiving Experience through a CareMap 297

Looking for Help 299

Family and friends 299

Federal programs 300

State programs 302

Community-based organizations 302

Internet resources 303

Part 6: The Part of Tens 305

Chapter 21: Ten Myths about Aging and Future Care 307

Serious Memory Lapses Are Normal in Older Adults 307

Older People Fall: Not Much You Can Do about It 308

Antibiotics Are the Best Drugs for Older Adults with Coughs and Colds 309

Americans Dump Their Older Relatives in Nursing Homes 310

Medicare Pays for All Long-Term Care 311

Hospice Is Just a Place Where People Go to Die 312

Millionaires Take Advantage of Medicaid 313

If I Need Care, I’ll Wind Up in a Nursing Home 314

Assisted-Living Facilities Are Regulated Like Nursing Homes 315

Long-Term Care Insurance Covers All Your Needs 316

Chapter 22: Ten Resources with State-by-State Information 317

Identifying Local Services through Area Agencies on Aging 318

Assessing Assisted-Living and Rehabilitation Facilities 319

Finding Services and Housing Options through Eldercare Locator 320

Getting Support for Family Caregivers 320

Modifying Your Home with Rebuilding Together 321

Getting Information on Medicaid in Your State 321

Calculating Costs 321

Finding Your State’s Advance Directives 322

Solving Problems through an Ombudsman 322

Resolving Complaints through BFCC-QIOs 323

Part 7: Appendixes 325

Appendix A: Glossary 327

Appendix B: Resources 339

Index 347