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Andrew Banoff

2/18/16

Our aging society (75+) will double by the year 2050.  The over 85 segment is the fastest growing group among our elderly and these are the people most likely to have or get dementia.

Interestingly, as you grow older your life expectancy also extends.  And the good news is that only one in ten will end their days in a nursing home, but 2/3 will need some form of care.

The major issue is coordinating care that is received from so many sources.  There is a lack of this coordination in spite of the many agencies and retirement options available.  But in spite of this plentitude of resources it is the oldest daughter that most frequently provides the care and whatever coordination that occurs.

Medicare doesn’t provide for long-term care with the notable exception that Medicare will cover hospice care for the last six months of life.

Prior to a hospice stay there are a variety of options including the following: continuing care retirement communities (“CCRCs”); independent living communities (“ILs”); assisted living communities (“AL”);  assisted living with memory care; and nursing homes.  Assisted living communities are notable for offering twice the space at one-half the cost of nursing homes. CCRS offer all levels of care, but require a substantial entry fee as well as a requisite degree of wellness to get in and then you may have to wait for an opening.  But once admitted the monthly or yearly fee is constant regardless of the level of care needed.  This is probably the best of all possible worlds for those who can afford it.  

As noted, the number of Alzheimer’s cases is growing as the population ages.  It is calculated to triple by the year 2050.  About 50% of those with mild dementia will advance to full blown Alzheimer’s disease.

A previous speaker pointed out that what is good for your heart is also good for the mind.  Diet, exercise, friendships and an active love life do matter.  Once Alzheimer is developed there is no cure as of yet.  There are a few drugs that may retard the development and degree of symptoms, but that is all we have.

On the issue of long term care insurance; it is now almost impossible to get and those with it will face increasing premiums and decreasing levels of care.  Plus, it is phasing out of insurance options.     

Q&A

Q.  How do tests determine whether you have or are likely to get Alzheimer?

A.  Memory scores; physical indications of early onset dementia; vascular problems, or severe heart disease have a high correlation with Alzheimer.

Q.  Do you ever see us getting free long-term care insurance?

A.  Not in its present form.  The solution is simple.  Drop all forms of Medicaid, extend Medicare to all people and the cost of that will be covered by the money saved on the Medicaid.

Q.  Have you studied memory gain as well as memory loss?

A.  ½ the population will not have memory loss.  We do not understand much about the brain.

Q.  Will caregivers to the demented inevitably face depression?

A.  Spousal caregivers will often die first because of the stress.  Other family caregivers and professional caregivers have a very high rate of depression.  But it should be noted that caregivers often form a powerful bond with those they care for.

Q  Long term care premiums are full of surprises.  What is in the future?

A.  Many long term care providers may go out of business or be sold.  If they go out of business there may be some state protection, but if sold the premiums are likely to go up and the level of care go down. 

Q. How can you protect your financial nest egg?

A.  Less costly and most protective care is home care.  This can be provided at much lower cost.

Q.  How do they come up with life expectancy projections?

A.  It is all done statistically and may not apply to individual cases.

Q.   How do you know what continuous care programs are good?

A.   All around here are good, but you should visit and talk to those receiving the care.

Q.  Is geriatric care helpful to Alzheimer patients?

A.  Yes.  Specialists can be the most helpful, but all internists are knowledgeable. 

Q.  Do you recommend hospital or home care?

A.  It all depends on the individual.

Q.  How do you handle taking Medicare and Medicaid?

A.  90% of Fairfield doctors take Medicare.  10% take Medicaid.  We have employee doctors so they don’t care about Medicare or Medicaid.