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How to Pick an Executor for Your Estate

By Rodney A. Brooks – Monday, April 8, 2024

It’s difficult to pick an executor or trustee to implement your wishes after your death. Your favorite child is usually your favorite for a reason, but that doesn’t mean that s/he is best suited to be your executor. And an attorney or trust firm may be a safe choice, but fees could make that too expensive for your taste.

Make sure your legacy doesn’t include confusion, arguments or hard feelings.  Here are some options to help you make the best choice for you and your family.

Of course, the first thing you’ll do is get a will (or a trust) on paper and get professional help. Most experts don’t recommend a do-it-yourself estate plan.

The next step is picking an executor for your will and your wishes. Here are some things to consider.

Executor? Or Trustee?

Do you need an executor or a trustee? Daniel Razvi, attorney and senior partner at Higher Ground Financial Group in Frederick, Maryland, says: “If you have real estate, you’ll probably need a trust instead of a will. But the executor and trustee are generally the same person.”

A will directs the distribution of your assets after death, trusts are effective once the assets are transferred into the trust. Your assets are legally transferred to the trust, except retirement accounts. You are the trustee until your death, then the person you select is responsible for management and distribution of your assets.

How about one of your children? 

“Most often I see my clients choosing their kids or one of their kids to be a trustee or executor,” Razvi says. “But not everybody wants their kids to be trustees. It needs to be somebody that you feel can take care of money honorably and well, somebody that can follow your instructions. Anybody you choose is legally required to follow your instructions, but it’s nice if they don’t have to be compelled to do so by a court.”

It’s also important to have a backup, says Jennifer Belmont Jennings, an attorney and Certified Financial Planner at MGD Law in St. Louis, Missouri. That can be a corporate entity, but larger banks may not be interested in smaller estates. There are, however, smaller trust companies you can hire, she says.

Third party or family member

A third-party trustee or executor may be expensive, so you may want to stick with a family member.“Banks and the lawyers will do it for you, but they’ll charge a fee,” Razvi says. “So, usually you pick a family member that may not charge a fee.”

Family Member Fallout

Sometimes selecting one family member or another can cause hard feelings and damage family relationships.For families concerned about that Razvi recommends split roles, which does not necessarily mean co-executors. “You can assign different roles in your estate plan to different people,” he says. “And you can make your kids back up for each other.” For example, name one child the executor and name the other as the administrator of the healthcare power of attorney who can make decisions for you when you are incapacitated.

It’s not easy

Keep in mind that the job of executor or trustee is not easy. “It is a job,” says Belmont Jennings. “It’s work. It’s not easy. “You might be working on selling the house, getting it ready, having to deal with the clutter, having to distribute assets to people.

“You’re hiring the lawyer to file the paperwork if you’re doing stuff with a court. You’re responsible for getting the tax return prepared for the year of death. It’s your responsibility.” That’s why for some families a family member who does that for a living might be a more natural choice rather than a “favorite child.”

Co-executors?

Having co-executors can be a bad idea.Co-executors are a bad idea, says Razvi. “It’s very unwise to have two people simultaneously,” he says. “You don’t want to have multiple people being the trustee or the executor at the same time because they would have to agree on everything. And they can override each other.”

“It’s better to have one person listed and then usually the document will say ‘and if this person is unable or unwilling to serve as executor or trustee, then I will appoint this person.’”

Healthcare directives and Healthcare POA

A healthcare directive and healthcare power of attorney are critical in your choice.It is important that you pick someone who you trust because ultimately, they will make the decision on whether to pull the plug. “It’s really important from that standpoint to make sure you have people you trust and are able to express your wishes, because a lot of families do argue over that,” says Belmont Jennings.

“You have one saying no, they wouldn’t want to live this way. And you have one that says no, they told me that this is what they want. If it’s not written down in a way that complies with state statutes, it’s a lot more complicated and it’s a lot more stressful for your family. They’re fighting and they’re spending your money on lawyers.”

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Don’t Resist Resistance Training

By Kathleen Doheny – Wed., April 3, 2024

You may remember the 1977 film Pumping Iron, which brought resistance (AKA strength) training into the mainstream.  It was often the favored workout of the young. Muscular gym bros and (later) young women joined the trend.

Resistance Training for Seniors

No longer. Researchers have found so many benefits to resistance training that experts say it’s become a vital part of an exercise program for all ages and body sizes and both genders.

What is Resistance Training?

Resistance training is a form of exercise meant to increase muscular strength as well as endurance. It can involve using weights (free weights or machines), resistance bands or your own body weight to provide the resistance.

Forget Aesthetics, Think Health

Although muscle sculpting is considered the primary goal of resistance training, that’s not accurate, says Mark D. Peterson, PhD, MS, the Charles E. Lytle, Jr. Research Professor at the University of Michigan-Medicine, Ann Arbor. He coauthored a 2019 position statement from the National Strength and Conditioning Association about the benefits of resistance training for older adults.

The benefits go far beyond aesthetics, he says. “Prevention of osteoporosis for women is one of the main reasons we recommend it,” Peterson says. That’s also important for men as they age, he added.

As muscles become stronger, another benefit is prevention of falls, saying “If you can prevent falls, because you are stronger, you can prevent fractures.”

Paige Waehner, a certified personal fitness trainer who wrote Strength Training for Seniors, summarized other benefits: improved sleep, increase in the feel-good hormone dopamine, decreased pain, better ability to walk up and down stairs, get in and out of a vehicle or carry groceries.

Mayo Clinic experts add to that list, saying that strength training can also enhance quality of life by increasing the ability to do things and be mobile, and decreasing symptoms of depression.

Resistance Training: First Steps

Someone who has never done resistance training should seek “hands-on” guidance, Peterson advises. Check out experts at your community recreation center, the Y, or your gym – it’s much better than self-prescribing. The pro can also check your form, to be sure you’re doing the moves correctly.

In general, Mayo Clinic suggests picking a weight heavy enough to tire your muscles after doing 12-15 reps; but expert input is suggested before starting.

How Much Resistance Training? 

Adults should aim for 150 minutes or more of moderate intensity aerobic physical activity a week and 2 days of muscle-strengthening activity, according to the Federal Physical Activity Guidelines for Americans.  “Those workouts don’t have to be long,” Waehner says. “You can work all the muscle groups in about 10 minutes and that’s enough to get the benefits out of resistance training.”

Do I Have to Wear Myself Out?

The old “no pain, no gain” attitude is out, Peterson points out.  Think lower weights, higher volume: “For most people, low to moderate effort with strength training is enough.” He recommends progression, with increasing the effort as you go along. He’s honest – most people tell him they notice the most benefits early in the program and then the results seem to taper down.

Resistance Training Results 

Improvement in strength can be achieved with just 2 or 3 sessions a week of 20 or 30 minutes, according to Mayo Clinic.  Exactly how soon results will be evident can vary from person to person.

Does Resistance Training Help Weight Loss?

Peterson notes that it’s not necessarily effective for weight loss, but it does help your body’s muscle-fat ratio. “Because you increase your muscle mass, it decreases your overall relative fat stores.”

Paige looks at it this way: “When you lift weights, your muscles respond by building more muscle fibers, so you can build lean muscle tissue. Muscle burns more calories than fat, so the more you have, the more overall calories you burn. That means you are on the road to weight loss.”

Staying Motivated

“Motivation is one of the hardest parts of this whole thing,” Peterson says. Especially if you do the workout at home. “There’s a million reasons to walk right past those hand weights.”

One key to stay motivated: Accountability to others, whether a friend, partner, or part of a community that supports you. It can be in person or online, Peterson says.

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When Your Doctor Retires

By Kathleen Doheny  Wed., Nov. 1, 2023

Your doctor for many years is hanging up his or her stethoscope. How do you find a new doctor and manage the transition? 

You saw the signs. You should have seen it coming. But then, here it is in black-and-white, the letter making the breakup official. “Dr. X regrets to inform you that s/he is retiring after 40 years of practice.  Dr. X is sorry to go, has enjoyed taking care of you and wishes you the best of health moving forward.”

Act Fast

It may leave you in a frantic quandary: How do you find a new doctor, one as good as this beloved primary care doctor (or your favorite specialist)?  Or, alternatively, how you do find a new doctor when you’re dissatisfied with the one you have?

In either case, action immediate action is crucial, according to the experts we interviewed.

“Find your new doctor before exiting your old doctor,” says Trisha Torrey, founder of the Alliance of Professional Healthcare Advocates and, more recently, of Every Patient’s Advocate. She wrote “You Bet Your Life: Mistakes Every Patient Makes.”

Even though your current doctor may not actually exit for a couple months, don’t delay, she says, as the necessary pre-exit actions take time. 

If you are in a large healthcare system, your doctor may refer you to a partner or other colleague. Your insurance provider may also provide you with a list of other doctors in the network, says Caitlin Donovan, senior director of the Patient Advocate Foundation, a nonprofit organization in Hampton, VA, offering case management and financial assistance to those with chronic, life-threatening diseases.

Do Your Research

Still, do some of your own research. Many people ask friends for suggestions, then find out too late that the doctors they suggested don’t accept their insurance. Torrey says, “I say, start with your insurance, and then ask your friends.”

As you’re working your way through the list of potentials, be sure you can get access to your medical records so they can be transferred. Sometimes a letter telling you about the retirement or move will include an authorization form you can return to them for release of medical records.

Transferring records seems simple in this digital world, but it’s not always, Torrey says. Her suggestions: work ahead; get a thumb drive and take it to your retiring doctor’s office and ask them to download it. “Keep your own copies, too,” Donovan says, once you’ve transferred them.

As you narrow down the list of candidates, what else?

  • Study the reviews. Torrey suggests scrutinizing them in a way that might be new to you. “You’re not looking for someone who is nice,” she notes.  “Nice doesn’t always equal competent.”  If a doctor got 5 stars – for what? Office cleanliness? Friendly staff? What about the quality of patient care, callback times, and other crucial information?
  • Read the negative ones, too. Donovan was searching for a new doctor and found a negative view that sealed the deal for her. “A disgruntled patient was complaining she didn’t want to take the COVID vaccine,” she remembers, and this doctor wouldn’t give her an exemption. Donovan read further and found out the patient was a hospital nurse and had offered no reason she couldn’t get the vaccine. The doctor’s refusal to grant an exemption convinced Donovan this doctor shared her views.
  • Be aware of the shortage. According to the Association of American Medical Colleges, by 2034, there may be up to 124,000 fewer doctors available. Pandemic burnout took its toll. A survey of more than 3,500 doctors by the Physician Foundation found that 8% closed their practices due to COVID. So the doctor you want may not be accepting new patients. If that’s the case, Torrey suggests: Contact your previous doctor, if possible, and see if he or she will ask the new doctor to accept you as an exception.
  • Think about the practical aspects, Donovan says. For her, proximity is important, as she doesn’t have time to drive 45 minutes to an appointment.
  • Ask the questions important to you: How does your office communicate between appointments? Is it possible to email questions between appointments? Do you offer virtual appointments? What is the doctor’s approach to medical conditions – treat quickly with medication or try lifestyle or other approaches first? How do you handle prescription refills?
  • At the First appointment: Notice if your styles mesh. Donovan says she likes a no-nonsense approach, but also likes ‘’someone who will get chatty with me.” Others may need the opposite, perhaps a little coddling but no small talk.

It’s very likely that all of us, at some future point, will get a farewell letter from our long-time medical professional.  Acting quickly, obtaining records, and doing research are key to a smooth transition.

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Whether You’re Dealing with High Blood Pressure or Want to Avoid It in the Future, Here are the 25 Best Foods to Eat

Yep, dark chocolate is on the list.

Erica Sweeney – Parade

MAR 14, 2024

About half of American adults have high blood pressure, and most people with the condition don’t have it under control, putting them at risk for a stroke, heart attack, and other health problems. Changing your diet is one way to help you manage your blood pressure. 

Your body needs certain minerals, known as electrolytes, to regulate blood pressure and other physiological functions, says Kate Patton, RD, a registered dietician at Cleveland Clinic’s Center for Human Nutrition. Sodium and potassium are two minerals that you need to control blood pressure. “The average American diet tends to be fairly high in sodium and low in potassium,” she says. “Over time, this imbalance can lead to high blood pressure.” 

Sodium is necessary for hydration, but consuming too much triggers the body to hold onto extra fluid, resulting in higher blood pressure. So, Patton says eating a low-sodium diet of 1,500 mg to 2,300 mg per day and foods rich in potassium and magnesium can keep blood pressure in check.

The Best Foods for High Blood Pressure

1. Berries

Strawberries, blueberries, raspberries, and other varieties of berries have been shown to have positive effects on blood pressure and HDL cholesterol. Berries are rich in antioxidants, fiber, vitamin C, potassium, and many other nutrients.

2. Beets

These vibrant red veggies and their juice are high in nitrates, which are converted into nitric oxide when digested. Nitric oxide relaxes and expands blood vessels, which lowers blood pressure. 

3. Spinach

Cooked spinach contains a wealth of potassium, which is great for your blood pressure levels. Research shows diets rich in spinach can help manage high blood pressure.

4. Bananas 

Bananas are rich in potassium, and some research has shown that eating fruits daily can keep your blood pressure low. Bananas also contain fiber and magnesium, which offer plenty of health benefits.

5. Kiwis

These fuzzy fruits contain 5% of your recommended daily value of potassium. Research shows that people who eat three kiwis a day had lower blood pressure than those who ate an apple a day after eight weeks.

6. Pomegranates

Pomegranates are thought to reduce levels of angiotensin-converting enzyme (ACE), a protein that helps control the size of blood vessels which helps lower blood pressure. Research shows that pomegranate juice can help lower blood pressure, at least on a short-term basis. 

7. Garlic 

Research shows that garlic encourages the body’s production of nitric oxide, which helps expand and relax the blood vessels, lowering blood pressure. Garlic has also been shown to lower blood pressure for people with hypertension. 

8. Artichokes 

Artichokes are rich in the blood pressure-lowering minerals potassium and magnesium. Research shows that eating artichokes could potentially lower blood pressure for people with hypertension, and people who included them in their diets for 12 weeks saw significant improvements.

9. Other fruits and vegetables

Adding more fresh or frozen fruits and vegetables of all kinds to your diet can help lower your blood pressure, Patton says. And research shows it could help you avoid developing hypertension. The DASH diet, an acronym for Dietary Approaches to Stop Hypertension, suggests eating four to five servings each of fruits and vegetables every day. 

10. Whole grains 

Whole grains, including brown rice and quinoa, can help you maintain healthy blood pressure, Patton says. Eating more whole grains has been shown to reduce blood pressure and help you maintain a healthy weight.

11. Oats and barley 

Whole grain oats and barley, which are rich in dietary fiber, are especially good for your blood pressure. Eating these grains has specifically been shown to lower blood pressure.

12. Nuts

Nuts – especially tree nuts like almonds, walnuts, and pistachios – are rich in unsaturated fats, fiber, and minerals that help control blood sugar, blood pressure, and cholesterol. Research shows replacing saturated fats with walnuts and vegetable oil can improve blood pressure. Just make sure you’re choosing unsalted nuts.

13. Seeds 

Unsalted flaxseeds, pumpkin seeds, and others are great sources of antioxidants, healthy fats, protein, and other nutrients. Research shows flaxseed consumption, in particular, can help lower blood pressure. 

14. Fermented foods 

Fermented foods, like kombucha and kimchi, contain probiotics, which support healthy gut bacteria. If you have high blood pressure, research shows that adding more probiotic-rich foods to your diet may help lower your blood pressure.

15. Yogurt 

Yogurt, particularly Greek yogurt, contains an abundance of potassium and calcium. And research shows that people who eat more yogurt tend to have lower blood pressure and are less at risk for developing hypertension. 

16. Low-fat milk 

The DASH diet suggests consuming two to three servings of low-fat dairy per day. Dairy products contain a wealth of calcium, magnesium, and potassium, all of which keep your blood pressure in check. Just opt for skim or 1% milk as well as other low-fat dairy.

17. Beans and lentils

Legumes, including different kinds of beans and lentils, are healthy in so many ways. They’re fiber and protein-rich and contain potassium and magnesium. Studies show that people who consumed a cup of legumes daily for 10 weeks were able to decrease their blood pressure.

18. Spices 

Too much salt may cause your blood pressure to go up, but other seasonings can help keep it in check. Spices, like black pepper, cinnamon, and turmeric, not only flavor your favorite dishes, but they can offer health benefits, including lower blood pressure. 

19. Green tea 

Rich in antioxidants, green tea has been shown to offer other health benefits, including improved brain health and a lower risk for cardiovascular disease. Some research has shown that it can help lower your blood pressure, too.

20. Salmon 

Salmon is rich in omega-3 fatty acids, which offer cardiovascular benefits. It’s also a great lean protein source and rich in potassium, which can help you manage your blood pressure and reduce your risk for stroke.

21. Mackerel 

Like salmon, other fatty fish like mackerel and sardines are rich in omega-3s, which have been shown to lower blood pressure. The American Heart Association recommends eating two servings of fish a week, especially fatty fish.

22. Amaranth 

Similar to quinoa, amaranth is an ancient whole grain that’s packed with magnesium. It contains more than a third of your recommended daily value, and that’s great for your blood pressure.

23. Tomatoes

Tomatoes are a great source of vitamin C, antioxidants, and vitamins and minerals like potassium. Tomatoes and tomato products also contain lycopene, a natural compound that gives them their red color. Lycopene has been shown to help lower blood pressure.

24. Lean meats 

The DASH diet recommends eating at most one six-ounce serving of lean meat, such as skinless chicken or turkey or lean beef, a day. Patton says it’s best to avoid eating too much deli and processed meat, which can be high in sodium.

25. Dark chocolate 

Rich in antioxidants and minerals, dark chocolate tends to have less sugar and fat than milk chocolate. Research suggests that chocolate containing 50% to 70% cocoa was better than a placebo in lowering blood pressure. 

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Medicare Households Spend More on Health Care Than Other Households

Nancy Ochieng, Juliette Cubanski, and Anthony Damico – Kaiser Family FoundationPublished: Mar 14, 2024

Medicare provides health insurance coverage to 66 million adults, including 59 million adults aged 65 and older and more than 7 million adults under age 65 with disabilities. While the vast majority (91%) of Medicare beneficiaries give their Medicare coverage an overall positive rating, health care cost-related problems are not uncommon. Medicare beneficiaries contribute to the cost of their health care coverage through monthly premium payments, deductibles, and other cost-sharing requirements. Additionally, people on Medicare may face additional premiums for Medicare Part D prescription drug coverage and supplemental insurance. Further, there is no limit on out-of-pocket spending for beneficiaries in traditional Medicare, and beneficiaries often incur out-of-pocket costs for services not covered under traditional Medicare, such as dental, hearing, and vision services. Medicare Advantage plans have a cap on out-of-pocket costs and typically offer reduced cost-sharing for no premium, but enrollees can still have substantial expenses.

In 2022, the Consumer Price Index (CPI) for all Urban Consumers, a closely tracked measure of price inflation, increased to its highest annual rate since 1981, which translated to higher costs for housing, food, transportation, and other household expenditures, including health care costs. The inflation rate has come down since then, but prices for many household expenses are still substantially higher than they were previously. In this analysis, we assess the financial burden of health care spending among households where all members are covered by Medicare (referred to as Medicare households) compared to households where no members are covered by Medicare (referred to as non-Medicare households), based on data from the 2022 Consumer Expenditure Survey. We also assess trends in household spending and the financial burden of health care spending over the 10-year period from 2013 to 2022.

The health spending burden was twice as large among Medicare households than non-Medicare households in 2022.

Average health-related expenses accounted for 13.6% of Medicare households’ total spending in 2022 compared to 6.5% for non-Medicare households.

Medicare households spent more on health care than non-Medicare households in 2022, both as an annual dollar amount and as a share of total household spending. Medicare households spent an average of $7,000 on health care, accounting for 13.6% of their total household spending ($51,800), while non-Medicare households spent $4,900 on their health care, accounting for 6.5% of their total household spending ($74,100). Health care expenses include health insurance premiums, medical services (e.g., hospital and physician services), prescription drugs, and medical supplies (e.g., crutches, eyeglasses, hearing aids).

The larger burden of health care spending among Medicare households than non-Medicare households is a function of both lower average total household spending for Medicare households than non-Medicare households and higher health care use, which results in higher health care spending by Medicare households.

Across all household spending categories, housing accounted for the largest share of total spending for both Medicare and non-Medicare households (35.3% for Medicare households and 32.5% for non-Medicare households). Across other major categories of household spending – transportation, food, and other expenses such as education and clothing – Medicare households devoted a smaller share of their household spending (and less in dollar terms) to these items than non-Medicare households. This may be a function of both smaller average family sizes in Medicare households than non-Medicare households (1.4 vs. 2.6 people), as well as lower median household income ($31,700 vs $76,600).

In 2022, nearly 3 in 10 Medicare households spent 20% or more of their total household spending on health-related expenses, compared to 7% of non-Medicare households.

Consistent with the higher average health care spending burden among Medicare households compared to non-Medicare households, a larger share of Medicare households than non-Medicare households spent 20% or more of their total household spending on health-related expenses than non-Medicare households – nearly 3 in 10 (29%) Medicare households versus 7% of non-Medicare households. Nearly three out of four Medicare households (74%) spent 10% percent or more of their total household spending on health expenses, compared to a quarter (25%) of non-Medicare households.

Health care spending by Medicare households increased by 53% between 2013 and 2022, but health care as a share of total household spending changed very little over these years.

In 2022, Medicare households spent an average of $7,000 on health care – $2,400 or 53% higher than the amount spent on health care in 2013 ($4,600). With total household spending by Medicare households growing at nearly the same rate as the growth in health care spending over these years, health care as a share of total household spending was nearly the same in 2022 (13.6%) as in 2013 (13.5%).

Similarly, non-Medicare households also spent more on health care in 2022 ($4,900) than in 2013 ($2,800), a 71% ($2,100) increase. Health care as a share of total household spending for non-Medicare households was somewhat higher in 2022 (6.5%) than in 2013 (5.4%).

Focusing on household spending trends between 2019 and 2022 shows the dual effects of the COVID-19 pandemic and price inflation.

Between 2019 and 2020, spending by Medicare households on food and transportation fell, likely reflecting stay-at-home policies established at the outset of the COVID-19 pandemic, and total household spending declined somewhat. By contrast, between 2021 and 2022, total household spending increased substantially, reflecting increases in all categories of household spending, as price inflation hit its highest level since 1981 in 2022. This was true for both Medicare households and non-Medicare households.

Discussion

The health care spending burden was twice as large for Medicare households than for non-Medicare households in 2022, measured by average health care spending as a share of total household spending, and a larger share of Medicare households spent at least 20% of their household budgets on health care than non-Medicare households. Of note, this analysis underestimates the health care spending burden for households that incur long-term care facility costs because the Consumer Expenditure Survey does not include people who reside in facilities. This exclusion is more likely to affect the spending burden estimates for Medicare households than non-Medicare households since spending on long-term care facilities is a significant share of average out-of-pocket health care costs for people with Medicare.

With health care use increasing with age and with most Medicare beneficiaries living on relatively low incomes and modest financial assets to draw upon in retirement, it’s not unexpected that health care is a bigger cost burden for Medicare households. This cost burden has important implications for policy debates, including the level of cost-sharing and premiums in Medicare. Policies aimed at improving financial protections for Medicare beneficiaries have been proposed in recent years. The Inflation Reduction Act of 2022 includes several provisions that lower prescription drug costs for people with Medicare, including a cap on Medicare beneficiaries’ out-of-pocket spending under the Medicare Part D benefit; a limit on insulin cost sharing to $35 a month in Medicare Part B and Part D; and expanded eligibility for full Part D Low-Income Subsidies. Policy makers have also considered other proposals that would improve the affordability of health care for Medicare beneficiaries, such as expanding income eligibility thresholds for the Medicare Savings Programs to enable more people to qualify for these financial supports and adding an out-of-pocket cap on cost sharing for benefits covered under traditional Medicare. Adopting such changes, however, would require additional federal spending.