Help for Planning for the ‘Fourth Quarter’ of Life

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There is no shortage of financial planners, organizations, books, and websites focusing on helping people plan ahead for the moment they can retire. And in the last decade or so, a great number of resources have also evolved to help planning for the end of life — a currently popular euphemism for “death.”

Yet little attention has been paid to planning for those in-between years: the 10 to 20 years most people live between retiring and coming face-to-face with mortality.

That is, until now. Working in collaboration, a group of seniors, geriatricians, university researchers, social workers, communication experts, and home care specialists recently produced Plan Your Lifespan, which focuses on helping people plan for events that commonly occur as they reach later life: hospitalizations, falls, and memory loss.

The group emphasizes that its focus differs drastically from hospice and end of life planning, instead concentrating on events that can impact seniors’ abilities to live independently at home. The goal is to help people plan for health emergencies rather than simply react to them by offering a tool that allows informed choices about life-changing issues with cooler heads in cooler times.

Planning From the Bottom Up

A closer look at the planning that went into the architecture of Plan Your Lifespan reveals fastidious attention to reality. To begin, researchers convened focus groups composed of 62 adults who were all age 65 or older. Participants discussed a range of topics — from long-term planning to decision-making in general, to barriers and resources they foresee as affecting their abilities to remain living at home as they age.

The first question asked was a broad and open one: “What event do you think might impact your independence?”

Responses included:

  • Getting Alzheimer’s disease — a concern that frequently tops the list when seniors get talking
  • Being hospitalized
  • Falling at home or losing the abilities to function physically
  • Facing the death of a spouse or partner, and
  • Becoming unable to care for their own homes.

Participants were next asked for reasons that seniors typically did not plan ahead for the often-overlooked fourth quarter of life. Responses ranged from the ostrich-like (“We’re in fairly good health now, so we’re not worried”) to the doomed fatalist (“I don’t have to plan for my old age because I don’t believe I’ll live to have one”). In between, there were those who expressed more subtle worries: being afraid of outliving their savings, being unable to talk with spouses or adult children about the looming issues, hoping that procrastinating would simply help the concerns disappear, and being overwhelmed about how or where to start planning.

Based on this guidance, was recently brought to life.

Taking the Site for a Spin

The very notion of life planning dredges up feelings of drudgery and obligation for most people. But those who take advantage of the Plan Your Lifespan website — users can either register or sign in or use the resource as a guest — may be pleasantly surprised at how reassuring and empowering it can be.

Imagine you are have a visit to the doctor, who basically gives you a clean bill of health, but warns that your blood pressure has climbed to a level where it needs monitoring. If this sparked a concern about planning for the possibility of a future hospitalization, you could click on the “Hospitalizations” tab.

That brings up the weighty question: “What if I am hospitalized?” Users are assured they will get help learning about what resources are available, how they can connect with local in-home services that might be needed after the hospitalization and what options might be available, as well as given the opportunity to specify a preference.

“How great would it be if we could get seniors to pick out their own SNF in advance?,” enthused Lee Lindquist, a geriatrician on staff at Northwestern Medicine, a member of the team that conceived Plan Your Lifespan, who recently demonstrated it for a group of paid and unpaid caregivers. She caught herself then, and stopped to explain that SNF is an acronym for “skilled nursing facility” — then emphasized that another benefit of the site is that it gets people familiar with the lingo that may be bandied about and thrown at them when they become involved in dealing with healthcare systems.

Specifying a SNF in advance would be great — unless of course, the chosen SNF had no space available when it was required, or other facts such as the specifics of care needed made it impossible to receive it in the facility of choice. Still, there is something strengthening to consumers about feeling they have choices, and learning about possible options is never wasted knowledge.

The site then offers a simple chart of various types of physical therapy and specifies where each commonly takes place — outpatient gym, home, rehabilitation hospital, and nursing home or skilled nursing facility — along with basic information about whether Medicare may help foot the bill. When researching care facilities to choose among, users are ported to the Nursing Home Compare feature operated by Medicare, which includes some information about the quality of care experienced in each.

There is also guidance for people deciding whether or not they feel ready to make the transition from hospital to home — along with a brief instructive video by a fellow name Bill, who talks about regaining his strength through at-home physical therapy after an extensive hospital stay. The site offers a search for a paid caregiver through a link to the Home Care Association of America, which delivers options based on ZIP code. It also defines “villages” — grassroots networks of local community resources — provided through a link to the Village to Village Network, as well as links to local Area Agencies on Aging, which also may be able to provide local connections for help. And finally, it sketches out when and whether a social worker might be of help during a transition from hospital to home.

Finally, the Hospitalizations section contains helpful steering on other related practical matters — such as getting help with caring for pets, mowing the lawn or shoveling snow, and having medications delivered.

Other sections of the site similarly cover Falls, Memory Loss & Alzheimer’s, Finances, and Talking to Others.

Help in Getting the Conversation Started

The section on Talking to Others was added after initial researchers discovered the disconnect between members of the focus groups’ expectations and reality. “What we heard from a lot of the people in the focus groups was something like: ‘I’ll move in with my son or daughter if I can’t take care of myself’ — even though they had never discussed the possibility with the son or daughter,” Lindquist says.

To that end, Plan Your Lifespan includes guidance for both sides — the older person who may need care and those who might be called upon to deliver it — in helping get started with the fraught conversations about planning future care.

Lindquist emphasizes the benefit of using the site as a conversation starter after learning about and recording choices. Older people can email their final results to family members or others who may be involved in their future care — or seniors and their caregivers can go through the site together.

For Luddites or those who simply prefer to plan on paper, there is also a paper version available, though the authors lament that paper users do not get the benefits of seeing the instructional videos or easy access to the links when seeking resources.

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