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People over age 65 exhibit a vast range of abilities both mental and physical. Unfortunately, ageism (the negative stereotyping of older adults) links advancing years with decline in a manner that disregards individual capability. From degrading birthday cards to discrimination in the workplace, 82% of older adults report experiencing ageism in their everyday life.

Most insidious is internalized ageism, when we look down on ourselves, often without realizing it. Blaming age when we can’t remember a word (“a senior moment”). Feeling flattered when we’re told “You don’t look [your age]!” Not considering an interesting activity at the senior center because we “don’t want to be around all those old people.”

It turns out such negative age beliefs can significantly reduce life expectancy. Multiple studies across many years and many cultures have shown that people with negative beliefs about aging die as many as seven and a half years earlier than those with positive age beliefs. (The studies accounted for the influences of income, education, and health status.)

Those with negative age beliefs are less likely to engage in healthy behaviors. “If it’s all downhill from here, why bother?” Those who are age positive are more proactive about retaining the health they have.People with internalized ageism test higher for C-reactive protein in the blood (a marker of chronic inflammation). Those with a history of age-positive attitudes have lower levels.Also, people with negative age beliefs don’t seem to invest as much psychologically in living a gratifying life. Those who are age positive usually have a sense of purpose or meaning.

In other research, people briefly shown age-positive messages (e.g., depicting older adults as wise or accomplished) had improved scores in subsequent tests of memory, blood pressure, walking, and balance. Those exposed to negative concepts of aging (e.g., being senile, dependent) had worse memory recall and a heightened stress response afterwards.

What can be done to reduce internalized ageism? Other cultures celebrate people who have achieved advanced age. Despite decades of ageist messaging in the United States, we can turn things around within ourselves. Keep an ageism journal. Note each remark you hear that centers on someone’s age. Was it positive or negative? If negative, was it based on ageism (a stereotype) or an individual’s actual ability? Stay alert to your own ageist thinking. Reframe your self-talk to avoid stereotypes.

Identify five things that you enjoy about being older. Acknowledge them. Add more age positivity to your life and start reaping the benefits!

Want to work with age-positive professionals?
Give us a call at 703-440-CARE (2273).

Deciding how to divide assets among one’s children is often challenging. The challenges only multiply in a step- or blended family situation. Today, about one-quarter of all marriages include stepchildren. Among remarried couples, almost two-thirds involve children from a previous relationship.

Blended families can look like any other family, but the dynamics are very different, emotionally and legally.

Traditionally, for a couple with children, when one spouse dies, all the assets of the couple go to the surviving spouse, presumably to help them with living costs and medical and supportive care in their elder years. Upon the death of that spouse, the remaining resources get divided among the children, per the original documents prepared by the couple.

In a blended family, there may be two sets of children, or more, and the surviving spouse may be relatively young. Age affects how long children from a first union might have to wait for their share of an inheritance. Tensions can arise if the stepparent remarries. Or if the stepchildren feel the stepparent is overspending assets or not maintaining the house. Plus, nothing in a previously written will can stop a surviving spouse from changing the terms later. Indeed, stepchildren can be written out in an update.

Options to consider

• A trust is one way to direct the flow of funds for years after you pass away. Hire a professional to prepare and to administer it. Having third-party administration helps eliminate potential conflict among siblings and families.
• Establish a life insurance policy. Name how much each child, as beneficiary, is to receive. Or, name the stepparent as beneficiary and specify the other assets to be immediately divided as you wish. With this arrangement, no ongoing contact or cooperation is required between the surviving spouse and the stepchildren.
• Give gifts while you are still alive. There are ways to provide for first-union children, or all children, before you pass away. Then leave the remainder to the surviving spouse.

These are complicated arrangements with significant tax implications. Be sure to consult with an estate-planning attorney who has experience dealing with step- and blended families.

A successful, harmonious transfer of wealth is most likely if you can meet face to face to talk with your heirs about the decisions you have made. You might do this one on one or with everyone together. Or have separate meetings with children from each union. If this does not appeal, consider writing a letter (to be read now or upon your passing) that explains your thoughts and asks for everyone’s cooperation and understanding.

Are there tensions in your blended family? We can help.
Give us a call at 703-440-CARE (2273).

Are you reflecting on life and its lessons? With so many options for self-publishing, writing a memoir may appeal. The process generates a new perspective on the meaning of one’s life. The end result lets future generations learn about you and their forebears. Find writing kits and courses online, such as Writers.com.

One thought to consider: Creating a chronological review can be unwieldy. It suggests you’ll present things with accuracy. Besides, recounting dates, locations, and events is just not fun or inspirational! Plus, you may have concerns about offending someone in the way you tell your stories. That can leach the joy out of the project.

You may find it more meaningful to tell your story in terms of the lessons you have learned. This is sometimes called an “ethical will.” You want to bequeath your wisdom to the next generation. In an ethical will, you tell the stories of how you came to hold the personal values you now cherish.

Using this format, think about major challenges or crossroads in your life. When you ran into trouble or things didn’t transpire as expected, how did you resolve the situation? What did you learn? For instance, one chapter might be “How I learned the power of forgiveness.” Another could be “The time I got fired, or how I learned to value myself.” A third might be “When one door shuts, it allows another to open.” There’s self-discovery in this process. Sharing your transformations and challenges also reveals your humanity. It enables younger family members to understand that everyone can stumble. Sharing how you picked yourself up shines a light forward for them. Consider a kit from FeetToTheFireWriters.com (tagline: You provide the memories. We help you grow).

You can include apologies, acknowledging regret and describing what you might have done if you had had the maturity and insight you now possess. You can also express gratitude to specific others, like a thank-you note for what you received.

Creating an ethical will is a gift to your family as well as yourself. Noted psychologist Erik Erikson observed that identifying the meaning of one’s life is the primary task of the elder. Reflecting on the past within the context of what you have learned can help you get a new perspective on the disparate threads that weave the integrated story of how you became who you are.

And don’t feel limited to writing. These days you can create collage books, audiobooks, video memoirs, a PowerPoint. You can write a poem or compose a song. Explore the options!

As you reflect on the past, consider life plans for your future.
Contact the experts in aging well: 703-440-CARE (2273)

A “screening” is a general test to look for signs of a problem. Because early detection makes a huge difference in your ability to recover from any disease or condition, Medicare and Medicare Advantage plans use screening tests for many health issues. Often these tests are 100% covered—no copayments. But you must fit eligibility criteria. The criteria usually involve age, symptoms, and/or a family history that puts you at risk.

If a screening reveals that you actually have a condition, all subsequent treatments and tests are subject to your usual copayments. Screening tests are used only to help a doctor conclusively determine if there is a problem.

All the ins and outs of eligibility are too complicated to outline here. Plus, they can change. Use this table to give you a sense of what’s covered. Talk to your doctor about whether a screening test is appropriate. This table lists the most common free screenings.

Want to learn more about staying healthy and aging well?
Give us a call at 703-440-CARE (2273).

Do you feel defensive when your kids visit? Notice them exchanging knowing glances when you don’t recall a date or name?

Perhaps you feel reluctant to approach them when you do have concerns, because they overreact. So you keep your distance. That isn’t good, either.

It’s a fine line between feeling that your adult children love you and want to protect you, and feeling smothered or even invalidated by them in terms of your competence and self-sufficiency.

Noted geriatrician and author Atul Gawande, MD, observes that while adult children worry most about safety, older adults worry about autonomy and independence. Put another way: Adult children think in terms of “caring for.” Older adults prefer to be “cared about.”

How to find a middle ground. Ideally, you and your children work together as a team to maximize your independence and control of your life while also realistically addressing the challenges of aging. The essential ingredient is candid communication that respects each other’s concerns.

The uncomfortable truth is that adult children often are the first to notice a real problem. But they don’t have the expertise to put the signs in perspective.

You, like most older adults, may not see the problem because you have accommodated, perhaps unconsciously, over time.

Start with an Aging Life Care™ Manager facilitating a conversation. Families who work with an Aging Life Care Manager find that an objective assessment of an expert in aging gives both you—the older adult—and your children a better understanding of how serious any concerns may or may not be. Everyone comes away with a better context for understanding normal aging.

An Aging Life Care Manager can provide knowledge and resources, as well as supportive facilitation. This typically results in a more productive discussion of future scenarios.

The earlier you have this conversation with your kids, the better. You don’t want to have it in the middle of a health crisis. Nor do you want things to escalate to the point that you are avoiding your children.

Create a plan for peace of mind. Working with an Aging Life Care Manager, you and your family can develop proactive plans for addressing potential problems while simultaneously ensuring that you get to live life on your terms.

Would you like help talking with your kids about aging?
Give us a call at 703-440-CARE (2273).

It might feel scary to tell others if you’ve been diagnosed with dementia or even just mild cognitive impairment (MCI). Start with those you think will be the most supportive. Perhaps close family and friends.

Common reactions. People will vary in how they respond to the news. Some will be genuinely caring and ask how you are doing and how they can help. Lean into those relationships. Others may respond with denial (“No, not you!” “You’re too young …”). They may need to hear some facts about neurocognitive disorders. Some people may react by pulling away. Ouch. This is disappointing. Do your best to not take it personally. They may need time to adjust. Or they may simply lack information about your condition and have unfounded fears. Again, education may be helpful.

What to say. Choose a quiet time and place where you can talk one on one. Or you might want to write a letter or email.

• Give them a context. Let them know about the diagnosis and its stages. People conjure up extreme images and don’t realize there are many months or even years to have good times together.
• Tell them what you can still do and suggest modifications if needed. Perhaps you’d like to continue playing golf, but need them to manage keeping score or not worry about scoring at all. Or you’d like to continue meeting for lunch, but maybe get takeout and go to a park. A restaurant might be too distracting for conversation.
• Let them know how they can help. Be specific.
  • Do you want to continue doing things for yourself? Tell them that letting you find your way feels respectful. Ask for their patience if you fumble.
  • Perhaps you’d like help with computer tasks or rides for errands.
  • Maybe you’d just like someone to talk to as you process these changes.
  • You may want to ask that they look for ways to support your partner.
• Have information ready for them. Many people are underinformed about conditions they haven’t had. Give them a website or pamphlet to read.

Continue to engage with life. You still have the ability to enjoy life and live with meaning and purpose. Stay committed to the hobbies and activities you love. Look for an early-dementia support group. You may find new friends—people who understand what you are going through—and new ideas for living well. 

Looking for early dementia resources?
Give us a call at 703-440-CARE (2273).

Your healthcare power of attorney (HCPOA) is an individual you trust to speak for you when you are unable to voice your own decisions: A car accident, surgery, coma, dementia.

In such circumstances, doctors need someone who knows you well and has had conversations with you to guide them in terms of the medical procedures you would or would not want.

The “platinum rule.” When selecting someone to fulfill this role, you want them to follow the platinum rule: “Do unto others that which they would want to be done to them.” Regarding life support, you want your HCPOA to represent your wishes separate from what they would want for themselves:

• Would you want to be put on a ventilator (breathing machine)?
• Would you want tube feeding?
• Would you want CPR?

A lot of conversation is required about medical care, quality of life, and even what is a “good death” from your point of view. Your HCPOA needs to know what your priorities would be if the result of a procedure might be life with less quality (e.g., only 11%–28% of older adults survive CPR, and 30% of them end up with brain disability).

The duties of an HCPOA are often short term and in hospital settings. But in the case of dementia, these duties could last for months or years and involve long-term care choices. Beyond someone who understands your values and quality of life priorities, you want an individual who is comfortable talking with doctors and asking questions, and who is persistent and will advocate for your wishes if there is pushback. Also a person who has a steady head during a crisis and can communicate well with your relatives. They don’t have to live close by, but they do need to be available by phone. You must name them in your advance healthcare directive, and they must agree to take on this role!

You can choose a succession of decision-makers so someone else is prepared in case your first choice is not available. Having two people share the role, however, is not recommended. It can stall a decision that needs to be made quickly.

If you are a “solo ager” (no children). Most people pick a younger family member. (Peers may not be available because of their own health challenges.) If you do not have younger relatives you want to entrust with this responsibility, an Aging Life Care™ Manager can guide you in selecting a professional and refer you to an attorney to draw up the legal paperwork.

Want help picking an HCPOA?

Give us a call at 703-440-CARE (2273).

Life plan communities—sometimes called “continuing care retirement communities” (CCRCs)—are private communities that offer residents a full range of care levels, depending on need. For those in independent living, amenities such as a golf course, gym, pool, and tennis and pickle ball courts are typically provided. Some communities even offer college-level classes, a salon, and grocery store.

For those needing more care, there are advanced support facilities on campus for assisted living, memory care, and skilled nursing care. Residents move among the facilities as their care needs change. One chief advantage of a CCRC is that a couple can remain on the same campus even if one of the pair eventually needs to go up in level of care. (The monthly maintenance and service fees go up when care needs go up.) Generally, the cost of care in a CCRC tends to be below “market rate” (what would be charged outside the community).

Are there any drawbacks? While a CCRC is an attractive blend of housing and medical care, it’s not for everyone. Applicants must complete a medical exam to determine their level of care, as well as a confidential financial assessment. The entry fees are steep. (According to AARP, the average is $402,000 but the range is wide: $40,000–$2,000,000). Consider: This is not a real estate purchase. You don’t own your domicile. You can’t sell or rent it. You might think of a CCRC as a lump-sum payment of long-term care insurance with housing included. Be aware: You will be wedded to the community for your future care and housing needs for many years to come. In that light, it’s prudent to check the financial solvency of the organization that owns it. Also the quality of the care they have been providing.

As you can imagine, the contract is full of details. As a rule, the lower the entry fee, the more you will pay in monthly fees. Check carefully the terms of receiving a refund if you decide you don’t like the community or need to leave at some point. You want to compare contracts meticulously when you are shopping.

It’s essential to get professional advice. A CCRC may be exactly the support you are looking for, but these are very complicated arrangements.

• Have an elderlaw attorney review the contract so you understand all the provisions and the flexibility you do and don’t have.
• Get input from your financial planner, accountant, and tax advisor concerning the company’s financial strength, as well as your ability to afford the community over time.
• Check how the community is rated for the quality of its care on Medicare.gov.

Want to explore alternatives as you age?

Call us, the experts in aging well: 703-440-CARE (2273).

Can two households be better than one? In a trend called “living apart together” (LAT), a growing number of older adults are experimenting with committed relationships that also allow for autonomy.

These are people who prefer intimacy and companionship in their lives. At the same time, marriage—or even living together—brings more entanglements than they want to take on. For instance, some have already nursed a spouse through dementia or cancer and done the “in sickness and in health” role; they don’t care to do it again, especially when the window for good health may be limited.

Instead, they agree to be romantically exclusive but keep their own homes.

They may eat most dinners together but sleep over only a few nights a week, alternating houses.

Here are some of the benefits such couples describe:

• Companionship, intimacy, and emotional support
• Freedom and “space” to maintain existing friendships and interests
• Absence of conflict about domestic chores, finances, and other logistics
• Greater focus on the joy of the relationship (“keeping the romance alive”)
• Protection from the responsibilities of caregiving

Experience suggests interested couples should discuss these issues first:

• Finances. How will you pay for expenses relating to your shared activities (groceries, restaurants, concert tickets, travel expenses)?
• Family obligations. How do you spend holidays? Birthdays? Do you expect to interact with each other’s kids, grandkids, etc.?
• Caregiving. What happens when your partner’s health starts to decline? How much are you willing to do or not do? (What sounds good in theory can be difficult to implement, given the emotional bond that develops.) Who will handle the bulk of the caregiving? Adult children? Paid caregivers? (Does your partner realistically have a budget for that?)
• Long-term care. What about decisions regarding assisted living, memory care, or nursing homes? Will you participate in the discussion of your partner’s living arrangements, or will that be up to their family members only?

Looking to age on your own terms?

Consult with the experts in aging well: 703-440-CARE (2273).

If you are used to having an “annual physical” and ask for that, original Medicare won’t pay for it. That is, original Medicare won’t pay doctors to do a general physical exam “to see what turns up”; you’ll pay out of pocket. (Medicare Advantage might have this as an “extra.” Check with your plan.)

Medicare does offer two types of “wellness visits”
Medicare is invested in prevention and in managing chronic conditions, but be careful about the words you use when making an appointment. “Wellness visits” are available through original Medicare and Medicare Advantage. Beyond measuring height, weight, and blood pressure, however, these visits will be more of a conversation than an examination of your body.

The Welcome to Medicare visit happens only once
The Welcome visit is available only the first twelve months after you start Medicare. Think of this visit as setting your baseline, with future annual wellness visits serving as updates of key risk factors. This first visit covers many of the same topics as the annual wellness visit. But it’s a more in-depth look at your medical history, your family history, and your lifestyle habits and risk factors. It also includes extra observational assessments concerning things such as vision, hearing, balance, and your risk for falls.

The annual wellness visit includes discussion of the following:

• Your medical history
• Your lifestyle habits (drinking, smoking, exercise, drug use, opioid use)
• Your mental health (depression, dementia)
• Other health factors such as loneliness, anger, stress, pain, and life satisfaction

These appointments rely on your self-report of how you are doing and what you are doing. From this discussion, you and your doctor may agree on plans to lose weight, quit smoking, or get more exercise over the coming year. And the doctor may order screening tests to rule out other issues. You may also choose to discuss your preferences for end-of-life care so your doctor understands your wishes should you ever be unable to speak for yourself.

If you have a physical concern at any time
By all means, make an appointment if you have worrying symptoms. Get them checked out! Just don’t plan to bring up new aches or pains in the context of a wellness visit. You may end up responsible for 100 percent of the visit.

Want to learn more about Medicare and wellness?
Give us a call at 703-440-CARE (2273).