Living a Long Life

Living A Long Life Preparing for Longevity The fastest growing segment of the American population is over the age of 85.2 In contrast, a hundred years ago the average person lived into their late 40’s to early 50’s.1 Each subsequent generation since then has lived longer than the previous. The majority of us will live longer than our mothers and fathers will live.

As we live longer, the need to plan for longevity in retirement is critical. Have we saved enough?

Will we be able to sustain our current lifestyle?

How do we account for the additional years we may live and the fact that we may need more reserves to fund caregiving needs as we age? Have we taken the right financial and legal steps? Have we thought about medical preparedness, made the best housing decisions, and engaged our family in necessary conversations? Engaging in this planning process now may make all the difference down the road for ourselves and our families.

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The Greatest Component of Frailty Risk We all want to live as long as we can. And yet, we o en fail to fully consider the inherent risks of aging.

According to the New England Journal of Medicine (2000) over 4 in 10 people who live to 85 will become frail enough to need full-time care.

Each additional year lived has an exponential impact on function and independence.

The reality we often seem to miss is that AGE is the most predictive factor in physical and cognitive frailty. According to the Alzheimer’s Association, 1 in 3 Americans over the age of 85 has Alzheimer’s.3 Some of these individuals live long enough to experience the devastating consequences of the disease. Others may die before the disease becomes severely impairing. Frailty is inevitable, assuming we live long enough.

In fact, longevity itself plays the largest role in estimating the risk of frailty.

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Thinking Differently Thinking differently about aging can help us plan better for ourselves and our families. We inherently want to associate the risk of frailty solely with chronic illness or disease, especially when we perceive ourselves as healthy. We understand that we may live longer than the previous generation, and perhaps even healthier.

Consequently, we may think that chronic illness may not be in our future as we make healthy choices. However, this does not account for the fact that the longer we live, the greater our chances of needing assistance at some point.

If we are able to make this shift in our thinking we will be better able to plan for the road ahead.

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Perceived Risk Our parents most o en define what aging might look like for us.

Watching their aging process shapes the lenses through which we see our own future.

If our parents lived into their late 80’s, 90’s or beyond, and experienced a loss of independence, we are far more likely to embrace this view of aging. If, however, they died quickly without reaching the age at which they would inevitably experience frailty, this then becomes the dominant view of how our own life might unfold. The reality is we all see life through a set of lenses that are shaped by own experiences.

Caring for a frail loved one also dramatically shapes our view of aging. Caregivers intimately understand the impact of what a loved one’s loss of independence means for the family.

They have lived the physical, emotional, and financial stress, and may even experience shortened life spans associated with this stress.4 Due to this personal experience, caregivers are the first to prepare for a time in life when they may need to be cared for.

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Protecting Others Many people believe their own personal risk of age-related frailty is low. They are comfortable “rolling the dice,” so to speak. A er all, they feel the odds are in their favor, so “why waste effort” planning for something that “may never happen”?

Unfortunately, this perspective largely misses the point. The challenges of an unforeseen need for care are not born by the person who becomes frail - he or she will receive the assistance they need one way or another. Instead it is the spouse and family who are at risk. Most who proactively plan for this stage of life do so out of an inherent desire to protect others and not themselves.

We all want our families to live as freely as possible, without unnecessary burden. Planning for the potential consequences of living a long life is a gift to those we cherish. It means taking steps that allow our loved ones to live with less burden, be more autonomous, grow and thrive, and live with more margin in their lives to give generously to those they love.

Preparing for Longevity Beginning to consider preparations for aging (long before they are urgent) can make all the difference for those we love. While it may feel premature while we are still young (50’s-60’s) and fully independent, it is wise to begin the process of long-term planning. Some decisions may not be acted on for years, while others can be costly if delayed or postponed.

The following lists are not intended to be exhaustive of all the decisions associated with aging. They are, however, intended to initiate planning that is often overlooked or neglected until proactive choices are no longer available. Hopefully, by starting the discussion early we will not fall victim to a human tendency to take action only when crisis hits. Best wishes in your preparation for Living A Long Life.

1. Sources: Department of Health and Human Services, National Center for Health Statistics, Centers for Disease Control and Prevention; National Vital Statistics Reports, Web: www.dhhs.gov ; www.cdc.gov.

2. U.S. Department of Health & Human Services, https://www.nia.nih.gov/espanol/about/living-long-well-21st-century-strategic-directions-research-aging/introduction 3. Alzheimer’s Association, Alz.org 4. Accelerated Telomere Erosion Is Associated with a Declining Immune Function of Caregivers of Alzheimer’s Disease Patients, J. Immunol., Sep 2007; 179: 4249 – 4254.

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Housing/Lifestyle Considerations: Home entry walkways or ramps – rather than stairs Zero-threshold entry doors Roll-up access to all parts of bathroom - sink, toilet, and shower should be walker/wheelchair accessible Zero-threshold shower - or roll-in shower if possible Wide hallways (48”) and doors (36”) - to accommodate walkers and wheelchairs Grab bars, door handles (not knobs), and easy-toopen cabinet pulls Minimize or eliminate stairs - inside and outside home Main floor laundry Ensure adequate lighting - in all areas of home Avoid throw rugs - or other tripping hazards High speed internet - for “connected” medical equipment Consider “connected” lighting - controlled by remote or phone Consider video monitoring equipment Appliances adapted for aging - large displays, safety features/alerts Close proximity to medical care Visit retirement communities - before you may NEED to move Vehicles should be as easy as possible to get in and out of - neither too low or too high Decide ahead of time at what point you will relinquish driving privileges Determine to stop using ladders

Legal Considerations: Establish Powers of Attorney - for health and finance Create Health Care Directives Update or create wills Create any trusts needed Complete a FIVE WISHES document (www.agingwithdignity.org/five-wishes) Provide all documents to Powers of Attorney (P.O.A) Provide all documents to legal and financial advisors Make a list of all advisors - with contact information Make a list of all legal documents - include stored locations Provide both lists (above) to Powers of Attorney and all advisors (legal, tax, financial) Store legal documents in a fireproof location (wills, trusts, powers of attorney, heath care directives, etc.)

Store other important documents (insurance policies, financial account documentation, passports, vehicle registration, military papers, birth certificates, marriage certificates, children’s birth certificates, and also copies of: health insurance card, social security card, and driver’s license) Consider digitally-encrypted document storage Review ALL legal documents and beneficiary designations - every time there is a significant life change for you or your representatives, powers of attorney, or executors Destroy any OLD documents (wills, powers of attorney, etc.)

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Financial Considerations: Make a list of all financial accounts and insurance policies - include account numbers, passwords, websites, contacts and associated advisors Provide this list to your Financial Power of Attorney Provide the above list (without passwords) to your financial, legal and accounting advisors Create a list of monthly bills - provide them to your Power of Attorney Establish a sustainable retirement budget with your Financial Planner Establish a realistic budget for age-related “frailty care� - include realistic expectations for inflation, varying costs of care and durations of need Trouble test a variety of cost scenarios for caregiving needs - use modelling software (with your Financial Planner and Long-Term Care Planning Expert) to evaluate sustainable income Evaluate if caregiving costs could compromise income sustainability - for self and partner Establish funding sources for potential care needs these resources should not be needed for income needs Evaluate Long-Term Care Insurance - vs. self-funding with your own income (seek the assistance of an LTC insurance expert) Clearly define attitudes/goals about leaving financial legacies - to heirs or charities Evaluate if care costs could compromise legacy planning goals - inheritance or charitable goals (this can also be modelled with the assistance of your Financial Planner)

Medical Considerations: Make a list of all physicians - include contact info Keep an updated list of all medications Keep an updated list of all current health conditions Collect all medical records - ask for a copy at each visit Inform Health Care P.O.A. of the location of this information Establish any online portals to medical records – provide list of websites and passwords to health care power of attorney (P.O.A) Provide a list of portals (& passwords) to your Health Care P.O.A. Provide a copy of your insurance to your Health Care P.O.A – Medicare Cards, Medicare Supplemental Coverage, and Long-Term Care Insurance Create a POLST (if ever needing Hospice services) provide a copy to your Health Care P.O.A. Understand your Skilled Nursing Facility (rehab) options - many Medicare HMO’s may limit which facilities you can use Understand all of your “frailty care” options Home Care, Assisted Living, Adult Family Homes, and Memory Care Understand mobile medical alerts systems - prior to a crisis Understand automated medication dispensers most individuals need medication assistance in their frailty years Follow home safety guidelines to minimize fall risks (www.stopfalls.org)

Family (Or Support System): Share your aging goals and desires Discuss potential for caregiving needs Define concrete goals and boundaries for family involvement - recognizing that family often wants to do more than they will be able Define safeguards to caregiver burnout - recognize that caregivers most often give more than is healthy for themselves Define plans for supplemental care or respite care Define when facility care is appropriate (Assisted Living, Adult Family Homes, or Memory Care) Select a small group to be a support system – these are individuals who can fully take over all caregiving in an acute situation or in the event of caregiver burn-out Determine to plan in a way that offers your family more freedom and autonomy When appropriate agree to disagree Tell family OFTEN that you LOVE them Attempt to mend broken relationships (The most profound regrets people have late in life are relational)

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