Greg Nicholaides

By Sharon Jayson – Kaiser Health News

Oct. 21, 2019

AUSTIN, Texas — Dennis and Chris Cavner, in their early 70s, are preparing to move less than two blocks away into a 2,720-square-foot, ranch-style house they bought this year. But first a renovation is underway, taking the 45-year-old property all the way back to its studs. When the work is finished, these baby boomers are confident the move will land them in their forever home.

“We wanted to find a house that we could live in literally for the rest of our lives,” Dennis Cavner said. “We were looking specifically for a one-story house and one that had a flat lot, to age in place.”

For most of American history, people have moved in with relatives or gone to a care facility to live out their final years. Baby boomers don’t want either, and those with resources have generally created the modern idea of remaking old age to fit their lifestyle and retrofitting their homes for aging in place. Design and construction firms are coming up with safety features that look good as well. Think of it as the age-defying home.

Aging in place is a major financial commitment, one that may be at odds with retirees’ plans to downsize their lives and budgets and squirrel away cash in anticipation of rising health care costs. The Cavners are rebuilding this house — assessed at $700,000 around the time of the sale — from a shell. The remodel could easily cost $300,000 in the hot Austin market.

Leaving nothing to chance, the Cavners are paying for a number of modifications they might never need. For instance, neither uses a wheelchair, but contractors are making all doorways 3 feet wide — just in case. The master bath roll-in shower, flat and rimless, will provide room to maneuver. In the kitchen, drawers, rather than cabinets, will allow easy access in a wheelchair.

The Cavners are closely watching details of the renovation, but this dramatic late-life relocation wasn’t a hard decision.

For some seniors, aging in place might amount to simple modifications, such as adding shower grab bars or replacing a standard toilet with one that sits taller. But many seniors anticipate a financial crunch as they try to plan for their future on a fixed income, uncertain how far their savings and retirement funds will stretch.

Yet many houses aren’t suited to “aging in place,” said Abbe Will, associate project director of the Remodeling Futures Program at Harvard.

“Currently, a lot do not have single-floor living — especially in certain parts of the country. There are lots of stairs and multistory homes when land is more valuable,” she said. And “many homeowners don’t necessarily have the funds to do aging in place.”

Home modifications and costs vary widely — starting with those simple safety features in the bathroom or lever doorknobs throughout the house — to more extensive changes, such as widening doorways or lowering light switches to wheelchair height. Will said simple retrofits, such as grab bars, “could be several hundred dollars,” but a “whole bathroom remodel would be in the thousands or tens of thousands.”

In a recent survey of 1,000 people age 65 and older by the California-based nonprofit SCAN (formerly the Senior Care Action Network), 80% of respondents were concerned about their ability to age in place. The driver appears to be financial: About 60% said they have less than $10,000 in savings (including investments and retirement plans).

“We don’t know what’s coming down the pipeline as we age,” said sociologist Deborah Thorne of the University of Idaho, lead author of a study that found skyrocketing bankruptcy rates among those 65 and older.

The research, recently published in the journal Sociological Inquiry, finds the share of older Americans filing for bankruptcy has never been higher. “And bankrupt households are more likely than ever to be headed by a senior — the percent of older bankrupt filers has increased almost 500 percent since 1991,” the study found.

The Harvard report also cited the burden of debt among those ages 65 to 79, with nearly half of those homeowners carrying a mortgage in 2016. And people are carrying substantially more student loan and credit card debt into retirement as well.

James Gaines, an economist with the Real Estate Center at Texas A&M University, attributes the increase “to the labor market and employment downsizing and letting older people go first. It can force them into retirement whether they’re ready for it or not. Retirement income may not be enough to carry their debts, and they don’t have enough savings.” 

“The leading edge of baby boomers has not hit 75 yet,” said Jennifer Molinsky, lead author of the Harvard report. “When you think about the next five, 10 or 15 years when they’re in their 80s, you’re really going to see the needs shift.”

Molinsky said just what financially challenged seniors should do about housing “is a good question and is a tough question.” Many states have loan and grant programs for home modifications if individuals have a documented disability, she said, yet “what we need more of are programs that help you do this before you need it.”

Molinsky said communities need to create housing near city centers so seniors don’t have to drive. And in the suburbs, communities need to offer more multifamily options, including condos and apartments to buy and rent.

“We just need options,” she said. “It’s important to think about housing options that help people stay in that community. Low-income people need housing that’s affordable. Some people want to trade that single-family home for a condo. Others want to reassess their money and sell their home for a rental. Not everybody wants the same thing.”

Don and Lynn Dille, both 75, built their Austin home with the intention of staying there for a long time. After living in California, Virginia and elsewhere in Texas, they moved to Austin in 2012 and, within a year, began drawing plans with an architect for an energy-efficient home to age in place. Their home was featured this summer in Austin’s annual Cool House Tour for its design making the most of natural light, cross-ventilation and solar panels, as well as wider-than-normal doorways and level floors for wheelchair use.

One key feature of the construction acknowledges that they might need live-in help down the road to avoid long-term nursing care. Just as the Cavners may convert a bedroom and bath on the opposite side of their new home into caregiver quarters, the Dilles constructed a second floor above their detached garage that could convert into living space.

“We think having a separate apartment where we could have a caretaker or part-time help to maintain our property makes us able to stay where we’d like to be and be independent,” said Don Dille, who retired from the federal government.

The renovations are meant to meet very personal needs, but that doesn’t mean they wouldn’t appeal to others and even add to the resale value down the road.

For his part, Cavner, an investment adviser and co-founder of a new health care startup, said he believes what they’re spending to renovate the house for the years ahead will prove a sound investment: “The modifications we’re making are not going to make it less desirable. It will feel more spacious.”

By Sabrina Tavernise and Abby Goodnough

The New York Times

Jan. 30, 2020

WASHINGTON — Life expectancy increased for the first time in four years in 2018, the federal government said, raising hopes that a benchmark of the nation’s health may finally be stabilizing after a rare and troubling decline that was driven by a surge in drug overdoses.

Life expectancy is the most basic measure of the health of a society, and declines in developed countries are extremely unusual. But the United States experienced one from 2015 to 2017 as the opioid epidemic took its toll, worrying demographers who had not seen an outright decline since 1993, during the AIDS epidemic.  An uptick in what have become known as “deaths of despair” (younger people dying from overdoses, suicide and alcoholism) has drawn considerable attention from politicians and policymakers.

The 2018 data, released in a recent report, confirmed the first decline in drug deaths in 28 years, an important improvement after decades of rises.  The increase in life expectancy it helped produce was small, just over a month, and demographers cautioned that it was too early to tell if the country had turned the corner with opioid overdoses, which have claimed nearly 500,000 lives since the late 1990s.

“It’s good news, but we don’t know yet if it’s the beginning of a new trend,” said Elizabeth Arias, a demographer at the National Center for Health Statistics, which released the report.  Still, the rise was welcome news in states like Ohio, which in 2018 had the biggest decline in overdose deaths in the country.

The last time life expectancy in the United States flat-lined for several years was in the 1960s, when the mass habit of smoking, particularly among men, began showing up in the mortality statistics, said Dr. Samuel Preston, a demographer at the University of Pennsylvania. But from 1968 to 2010, life expectancy went up by an average of about two years a decade, he said, a substantially slower rate than in European countries, but twice as fast as the increase in 2018.  Life expectancy at birth rose to 78.7 years in 2018 from 78.6 the previous year. It peaked at 78.9 in 2014, but has fallen or been flat since then.

Dr. Preston pointed out that the small rise in 2018 merely put the country back where it was in 2010, amounting to nearly a decade of stagnation, rare for a wealthy country.  Improvements in cancer mortality rates represented the single largest share of the life expectancy gain in 2018, about 30 percent. Next came the decline in so-called unintentional injuries, which include deaths from car accidents and drug overdoses. That category accounted for about 25 percent of the gain, a change that was driven almost entirely by a decline in drug deaths, Dr. Arias said.

Recent widespread efforts to expand access to opioid addiction medications, clean needles and naloxone — the drug used to revive people overdosing on opioids — may be having an impact.  “Good things are happening that hadn’t before, like sheriffs, hospitals and others who now use naloxone telling me, ‘We saved a life,’” said Shane Hudson, president and chief executive of CKF Addiction Treatment in Salina, Kan. His clinic is treating 117 people with medication for opioid addiction, up from 35 two years ago.

Deaths from overdoses dropped by 4.1 percent in 2018, to 67,367 from 70,237 in 2017. The decrease was largely driven by a dip in deaths from prescription opioid painkillers, which set off the opioid epidemic in the late 1990s before heroin and, later, fentanyl moved in. Provisional data suggests those deaths continued to fall in 2019, likely in part because of restrictions on prescribing.

But the death rate from fentanyl rose by 10 percent in 2018, and early data suggests it kept rising last year, though not as sharply as before. There were more overdose deaths in 2018 than in any year on record except 2017, and nearly 70 percent involved opioids.

A separate federal report, also released Thursday, found that the rate of drug overdose deaths dropped in 14 states in 2018, climbed in five and stayed about the same in the rest. The five states whose rates climbed were California, Delaware, Missouri, New Jersey and South Carolina. Ohio saw the biggest drop, to 3,980 overdose deaths in 2018 from 5,111 in 2017.

Another bright spot in the data was cancer mortality. The overall cancer death rate dropped by 2.2 percent in 2018, a substantial decline. Rebecca Siegel, the scientific director of surveillance research at the American Cancer Society in Atlanta, said the new data appeared to extend gains from 2017, when the overall cancer mortality rate drop was the largest since record-keeping began around 1930.

These improvements were driven largely by a decline in the mortality rate for lung cancer, the leading cause of cancer death. Continued drops in the country’s smoking rate and advances in treatment, such as more precise tumor classification, better surgical techniques, and improved drug therapies, contributed to the progress, Ms. Siegel said.

Despite this good news, the United States lags far behind most European countries in life expectancy. John Haaga, a demographer who retired from the National Institute on Aging in December, said that when he first started his job in 2004, life expectancy in the United States was about equal to that of Portugal, a much poorer country. Over his career, Portugal gained four years while the United States gained only one. He pointed out that life expectancy was longer in Costa Rica, Cuba and Slovenia.

The increase in life expectancy might have been greater if not for rising mortality due to influenza and pneumonia — the death rate grew by 4.2 percent — as well as suicide and nutritional deficiencies. But while there has been increased concern about suicide as a public health crisis, the growth in reported cases — to 48,344 in 2018 from 47,173 in 2017 — was relatively small. The suicide rate grew by 1.4 percent overall, with a larger rise for men than women.

Jill Harkavy-Friedman, a vice president at the American Foundation for Suicide Prevention, said the nation needed to invest far more in research to understand emerging patterns. “I’ve been a researcher in this area for 30 years and I can tell you the conversation and the funding has definitely changed,” she said, “but it’s still nowhere near the level of funding for any other public health problem of this scope.”

A federal report last fall found that the suicide rate among adolescents was at its highest level in 20 years, although the total number of teenagers who died by suicide in 2017 was fewer than 2,500. Jane Pearson, chairwoman of the Suicide Research Consortium at the National Institute of Mental Health, said there was no definitive explanation as of yet for the climbing suicide rate.

By Alessandra Malito

Nov 2, 2019

Retirement can be about relaxing, but make sure your money is in the right accounts first. A year into retirement, 55% of Fidelity participants haven’t touched their accounts. 

Millions of workers contribute to a 401(k) plan so they can have more money when they retire — and then sometimes, when they get to that point in their lives, they don’t touch those accounts for another few years.

More than half of workers, 55% are choosing to leave their assets in their former employer’s 401(k) plan a year into retirement, according to Fidelity data on its workplace retirement accounts. Four years ago, that figure was 45%. They may be leaving their accounts in place because their 401(k) plans have low fees or they want to stay with the same administrators and managers of the plan (in this case, Fidelity and their former employers), said Dave Gray, head of workplace retirement offerings and platforms.

Some retirees may also not be sure what to do with that money, such as rolling it over into another account or consolidating all of their 401(k) plans.

As with most financial planning, the decision on whether to keep 401(k) assets in a former employer’s plan or roll it over into an individual retirement plan or other investment vehicle is a personal one. Participants must consider fees tacked on to any account they choose, as well as investment options available in those plans. Not all 401(k) plans have the same fund choices, which may make one more favorable for your needs than another.

People shouldn’t roll over an account or consolidate just to do so, but after reviewing costs and features, it might make sense, said Patrick Beagle, owner and president of WealthCrest Financial Services in Springfield, Va. “I see clients all the time who have several plans,” he said. “If they intend to work past 70, I strongly urge them to stay in a 401(k), and consolidate all the old into the new so they can defer distribution on the whole lot.”

Retirees should review alternatives, such as individual retirement accounts, which offer more investment choices than 401(k) plans do, said Glenn Downing, founder and principal of Cameron-Downing in Miami. “401(k) plans are great accumulation vehicles, but can be cumbersome for distributions,” he said. It’s important to analyze not just the number of funds available but the quality of those funds.

Some retirees may not touch their 401(k) plans because they don’t need the money yet. Wealthier clients avoid withdrawing from 401(k) plans until they’re 70½ years old, which is around the time they must withdraw required minimum distributions or face a penalty of 50% of whatever amount they were supposed to withdraw.

Before rolling over a 401(k) into another type of account, participants should ask themselves if they can replace the same fund choices (or quality of fund choices) for the same price, and if they think they’ll ever need to borrow money from their retirement assets for current expenses, advises George Papadopoulos, a financial adviser at the Fee-Only Planner in Novi, Mich. Retirees should review not only fees but features of the plan, including loans and how much someone can withdraw without penalty.

There are times when they should keep their assets parked in a 401(k), too, such as if they intend to leave the workforce between 55 and 59½ years old, said Matthew Fatz, a financial adviser at Thrive Wealth in Wayne, Pa. Under the Internal Revenue Service’s “Rule of 55,” employers who have been laid off, fired or otherwise left their job after 55 can take money out of their current 401(k) plan without incurring the 10% penalty others would face for withdrawing from an account before they’re 59½ years old. “If you know you’ll need to use your 401(k) or 403(b) for living expenses prior to 59½, you might consider leaving the assets in the plan even if fees are higher or investment options are less than ideal.”

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There are many variables to consider when deciding what to do with your 401(k) assets which is why Greg Says recommends consulting with a licensed certified financial planner (CFP).