Thursday, August 11, 2016

Senior housing: How much will it cost?

"Aging is not lost youth but a new stage of opportunity and strength." --- Betty Friedan, American writer, feminist, activist. Author of "The Feminine Mystique." (1921-2006)

Senior housing definitions:
Independent Living: Communities for independent seniors that offer the conveniences of on-site recreation plus educational and social opportunities.

Assisted Living: Residential housing, assistance in daily activities, and some healthcare.

Continuing Care: Provide a continuum of care in one location from private units to assisted living and skilled nursing care
Skilled nursing care: Care in a hospital-like setting. Nursing, physical therapy, occupational therapy, and speech therapy are considered skilled care by Medicare.

Alzheimer’s Care or Memory Care: Fosters residents' individual skills and interests in an environment that helps to diminish confusion and agitation in a secure environment.

Adult day Care: Day-time care including meals in an organized setting with activities and services meant to promote well-being.

Adult family homes: Licensed residential homes with up to six residents. Services include room, board, laundry and necessary supervision along with help with daily living. 

As we age, most of us expect to remain in our homes and hope to be there until the end. The reality is that according to national surveys, 70 percent of us over age 65 will likely need some kind of long-term care and will die in a hospital.

At the start, those care services may be provided at home with drop-in help for bathing and meal preparation. As aging progresses, most of us will likely move to some sort of senior housing – independent living, assisted living, memory care or an adult family home.

Unless you are very low-income, you or your family will be paying for all or some of those services. Those costs can range up to more than $90,000 a year for skilled nursing services in a hospital-like setting following a stroke or other debilitating health challenge.

Finding senior services for a loved one and investigating housing options and costs can feel overwhelming for families.
The good news is that help is available, says Staci Levison,  a supervisor with a community services agency in my area of SW Washington state. Advisors there can help families get started with research and connect them with the best combination of local senior services. The service is free.

But there are challenges, in finding the right care at the right cost. In the Portland-Vancouver, Wash. area market (as in most other locations around the country) the demand for senior housing in certain categories is out-stripping supply. That means monthly rents and rates are increasing.

Low-income senior housing is in particular short supply.  “The reality is that the more income you have the better your chances are of finding senior housing,” Levison said. But with the help of community services specialists, families can get started on tailoring local support resources with the individual senior’s needs. These specialists know what questions families need to ask and what local services are available.

As with most housing searches, availability and cost are big factors for families.

What are those basic costs?

According to Washington Community Living Connections, the cost of one year of in-home senior assistance services can be as low as $20,000 a yea in the Portland, Ore. area. That is for three hours a day for bathing assistance, meal preparation and light housework.

On the other end of the scale, a year of skilled nursing care in a semi-private private room in Washington state will likely cost $93,000 a year, according Community Connections.

Such costs will drain away the assets of a senior, leaving them dependent on Medicaid and Social Security income.


Online, reports that there are 52 certified assisted living facilities in the Vancouver area with basic monthly rates starting at $1,993 a month. Monthly rates for the 19 Alzheimer’s care facilities in the Vancouver area range start at $1995 to $2995.

In all there are at least eight categories of adult care. Among those are adult family homes that are licensed residential units with up to six beds. Services in adult family homes include room, board, laundry and necessary supervision along with help with daily living. In the five-county Southwest Washington area there are 300 adult family homes, Levison said.

Monthly rates for these facilities can range from a low of about $2,500 a month for a private room with basic services to as much as $5,500 to $6,000 a month for hospice-level care, said Victoria Kovtun, owner of Harmony Senior  Homes in Vancouver, Wash.

“There is a lot of need in the community for low-income family home care, but unfortunately (for cost reasons) it is difficult for operators to accommodate more than two per facility,” she said. “Many homes won’t take low-income clients.”

Senior Housing outlook

Demand for senior housing is growing as baby boomers age into their 70s.
“Back in the 1970s, many seniors ended up in nursing homes in a hospital bed,” said Levison. “That’s changed. Now an array of services can be combined to allow people to age in place. In addition, there are more alternative housing options and more support for family care givers.”

As with all life’s challenges, she encourages families to plan ahead. Here are here recommended first steps:

-Take stock of the personal situation of your senior.
-Assess the needed level of care.
-Look at the current financial picture and what might change.
-Work with a senior living advisor in your area to find solutions to the challenges your family might face.

Those advisors also are available through private services such as A Place for Mom, Assisted Living Locators, Adult Living Solutions.

Along with costs and services, family may also be considering location of the care facility, said Monika Gartner, Portland-area owner of Care Service Options. “Location to and from work is very important for a family member who is employed and wants to check in with a loved one to or from work." she said.

In their book, "What You Really Need to Know for the Second Half of Your Life," the staff at Vancouver, (Wash.) law firm, Phelan Webber & Associates, points out that a socially active life style is beneficial at all stages of aging.

Depending on the personality and care needs of a loved one, families may be able to arrange in-home companionship through Meals on Wheels, drop-in care services and families visits.

When the time comes, even though an elderly person may resist a move to a care facility, a good transition to a group home or assisted living facility may lower stress levels for everyone and provided that needed socialization for the senior, the Phelan experts say.

At the point where such a move is necessary, an assessment is required from a nurse to determine the patient's level of care needs. The level of care will then dictate the needed level of services in a care facility. That translates into how much it will cost.

Eldercare locator: click here.
HUD information for senior citizens, click here.
Long-term care choices from Medicare, click here.

Friday, July 22, 2016

Five steps to retirement before you stop working

"Planning is bringing the future into the present so that you can do something about it now." --- Alan Lakein, author of "How to Get Control of Your Time and Your Life." In his 70s, he lives in Santa Cruz, Ca.

Editor's note: This five-step retirement planning post has made earlier appearances at But its value is so compelling, I am providing this updated version. For both singles and marrieds, we provide a road map for retirement planning. If married, do a separate version as if one of you has died. Remember that half  of American women over age 65 are single and financially on their own. Share these steps with your children, especially your daughters.

People tend to put off retirement planning until their 50s. Most of us are too busy with family and work until then to think about seems like far away retirement in our 60s. Even then, some may ignore the whole issue until it is too late. Others may experience a growing sense of panic about the future with more questions than answers.

How much income will I have once I stop working?
Where will that money come from?
How long can I expect to work after age 60?
When and how should I begin taking Social Security benefits?

All this may seem like a black hole.

Here are five steps that will tell you where you stand and what you need to do between now and that day when you walk away from that full-time job.

STEP 1: To know where you want to go, you need to know where you are. So your first step is to put together a current household budget.

Figure out how much it is costing you and your family to live month-to-month. List your monthly rent or mortgage payment, estimated monthly food costs. Add up insurance fees and utilities costs.  Include what you are spending on transportation, clothing, medical services, entertainment and travel and credit card payments over a year, then average by month.  Don’t forget taxes. This current baseline cost-of-living budget will determine where you want to be down the road in retirement.

STEP 2:  Visit the Social Security Administration web site at and set up an account using your Social Security number. Calculate -- based on your own work history -- what estimated benefits you will receive at age 62, at 66 and 70. You will learn that benefits increase by 8 percent for every year you delay taking them up to age 70.
But don’t stop there because there are other ways to claim benefits based on your marital history, your age and whether you are widowed or divorced. For instance, you may be able to receive benefits on a spouse’s Social Security account while letting your own account remain untouched. All this can quickly get complicated but definitely worth figuring out.
Keep in mind that if you start benefits at 62 rather than at full retirement age of 66 or 67, your benefit amount will be permanently reduced up to 30 percent.
For personal assistance, schedule a face-to-face meeting with Social Security rep at a local office to better understand your options for how and when to claim.  Social Security is an important revenue stream for retirees and should carefully be planned out.

STEP 3: Consider what other sources of income you might have in retirement. Will you be tapping into a retirement savings account such as tax-deferred work-related 401(k) plan or a self-directed Individual Retirement Account? How much do you plan to withdraw?
Will you receive revenue from a rental property? Do you expect to inherit money or property? Do you hope to ease into retirement by working part-time after you step away from the full-time job?

STEP 4: By now, you should be feeling better about where that retirement money will come from.  Based on your research, so far, determine what your annual income likely will be in retirement, if you stop working cold turkey at say, age 62 or 66.

STEP 5: Put together an estimated retirement household expense budget similar to the current budget you have already formulated. Will your cost of living decrease in retirement from what it is now? Or will it be pretty much the same as your current budget? Some costs for such things as clothes and transportation likely will drop while others related to travel and medical expenses may increase.

Now for the BIG QUESTION: How does your estimated retirement cost-of-living budget match up with your estimated retirement income? If retirement expenses outstrip retirement income there is a lot you can do in your 50s to make sure things match up in your 60s. For instance:

Realistically, could you keep working into your late 60s?
Can you delay claiming Social Security benefits? Could you claim benefits on an ex-spouse before claiming them on your own account?

Could you pay off your mortgage before you retire? Could you downsize to a smaller, less expensive place, a different town?

These strategies can help stretch your retirement savings.

You now have a good picture of where you stand and what your income will be in retirement, depending on the age that you retire. You now have the basic information to form a plan and make changes, if needed.

If estimated retirement income does NOT cover your estimated retirement expenses, you have two choices: Either aggressively save more money for retirement or reduce your living expenses before you retire to match your expected income.

You may be surprised that retirement looks better than you thought. Either way, you have eliminated the black hole.

Sunday, June 12, 2016

RMDs: What they are, how they work and what to do

"In this world nothing can be said to be certain, except death and taxes." - Benjamin Franklin (1706-1790), among the nation's Founding Fathers, postmaster, scientist, inventor and diplomat.

Required minimum distributions:
- What: Withdrawals mandated by federal tax law from tax-deferred retirement accounts such as traditional IRAs and 401(k)s.
- Why: These are tax-deferred savings, not tax-free.
- When: At age 70 1/2.
- Impact: RMDs are taxed as ordinary income, so plan ahead.
- Withdrawal schedule: Calculated over a 27-year life expectancy beginning at 70 ½.
- Failure to make the withdrawal: The amount not withdrawn is taxed at 50 percent.

Managing RMD withdrawals:
- Use online calculators to figure when and how you take your annual required distribution. Or talk with your CPA and/or financial adviser to make sure you are on the right track.

- Review the tax impact of annual RMD income.
- Look into inheritance and beneficiary rules for IRAs and 401(k)s.
- Give IRA/401(k) money directly to charity to satisfy the annual RMD requirement.
- Make your first withdrawal before April 1 of the year you are 701/2.
- Seek professional estate planning advice to manage the RMD transition.
- Remember, the money will last longer than you might think.

People celebrating their 70s birthdays this year -- as the vanguard of the baby boomer generation is doing – must start taking withdrawals from their tax-deferred retirement savings accounts in the next nine to 21 months, depending on when they become 70 1/2.

These annual withdrawals -- known as required minimum distributions (RMDs) -- are mandated by federal tax law. Their purpose is to let the government start collecting taxes on the savings/investments earned inside these tax-deferred accounts such as traditional IRAs and 401(k)s.

RMDs are taxed as ordinary income based on your individual tax bracket. The good news is that withdrawal rates as mandated by the IRS are relatively painless.

Here’s how it works:
You must take your first RMD for the year in which you turn age 70 ½. However, the first payment can be delayed until April 1 of the year following the year in which you turn 70 ½. All subsequent years, you can make your withdrawal by Dec. 31 of that year.

You are required to take an annual minimum distribution as determined by an IRS tax formula. The formula is based on the value of your account at year’s end.

To figure the withdrawal amount, use an IRS worksheet at or an online calculator at web sites such as, or  The AARP calculator offers a nice graphic showing that your peak annual withdrawals will not occur until you are in your 90s. That is because withdrawals are projected over a 27-year-life expectancy to age 100. That leaves money in the account pretty much up until the end of your life.

Here are examples:
You have $200,000 in a traditional IRA and expect an average 5 percent return on the remaining tax-deferred investment going forward. At 701/2 your first annual withdrawal will be $9,549. By age 80 your annual withdrawal amount has increased to $11,848. At 90 it is up to $16,384 a year. Here’s the good news --- at age 95, even after all those annual withdrawals, your account still will have $136,000 in it, if it indeed it earns 5 percent a year, as expected.

Or let’s say you have $1 million socked away in your traditional IRA. At 70 1/2 you are required to withdraw a minimum of $38,250. At age 80, your annual MRD is up to$57,183 and by 90 you are required to withdraw $79,074.
But again there is money left in the account that has been earning an average of 5 percent a year and is still tax-deferred. At age 90, your account balance is $867,446, according to the calculator.

Yes, you may be paying more in income tax as you make these increasing withdrawals but there is peace of mind in knowing how this works and that the government gets those taxes at a slow rate. However, if you forget to make the MRD withdrawals, there is a harsh 50 percent tax penalty.

Next financial planning steps?
Once you figure what the projected MRD formula will likely be, start thinking about tax and inheritance strategies.  According experts, IRA accounts inherited by husbands and wives are treated differently in the tax code than IRAs inherited by children or other heirs. Surviving spouses can roll IRAs into their own accounts. If your IRA money goes to your children or other heirs and they want to continue the tax-deferred benefit, each must “roll his portion of the IRA into a separate account known as an inherited IRA, which comes with its own set of rules,” said advisers at Visit your favorite CPA for estate planning and tax advice on this one.

Ways to manage the RMD transition:
-RMD withdrawals must be in cash. In advance of taking the annual distribution move a little more of your investment portfolio to cash. That way you avoid selling stocks or mutual funds to meet the RMD requirement at an inconvenient time. Click here for IRS link.

-Use a charitable distribution from your IRA to satisfy all or part of your annual MDR requirement. If you withdraw the money yourself, then donate, you will pay taxes on the distribution. If you don’t need the RMD cash, this is a great way to give “more” to your favorite charity. There may be reasons why this is not the best idea because of tax issues. So click here for a thorough look at this strategy at

-Because they are taxed as ordinary income, RMD withdrawals can push you into a higher tax bracket. When added to your other income including Social Security, the tax bill can go up. If your total income exceeds certain thresholds, you could see as much as 85 percent of your Social Security benefit subjected to tax, experts say.

Bottom line: There is a lot to think about when setting up your RMDs. Naming beneficiaries, understanding inheritance rules and arranging charitable donations are worth looking into. My advice: Start studying up on RMDs now and talk to a tax professional who understands estate planning law. Good luck.

For more:, click here, click here.
ABCs of RMDS: Required Minimum Distribution  Rules for Retirement. click here.
Estimate your RMD distributions in retirement, click here.
RMD table at, click here.
AARP, click here.

Thursday, May 12, 2016

Volkssporting: Get out and see something, meet new people

"An early-morning walk is a blessing for the whole day." -  Henry David Thoreau (1817-1862)
"The best remedy for a short temper is a long walk."  - Jacqueline Schiff (1985-present)
"If I could not walk far and fast, I think I should just explode and perish."  - Charles Dickens (1812-1870)

What: Noncompetitive organized walking.
Started: Germany 1968.
Today: Volkssporting clubs exist in 40 countries.
U.S. association: American Volkssport Association.
U.S. membership: 250 chartered clubs.
Mission: To promote and organize walking and other noncompetitive events that encourage physical fitness, fun and friendship.
Web site: for club listings, new walker’s packets.
Membership cost: $6.50

Editor's note: I wrote this story recently for The Columbian newspaper, Vancouver, Wash.

On any given day, Joe Titone, Vancouver, Wash. is out for a walk.
As president of the All Weather Walkers volkssport club in Vancouver, Titone helps organize noncompetitive walking events for his 45 club members.
“Walking is a healthy activity…we just give it a bit of organization to get people seeing new parts of our area,” Titone said. “And there’s the great social aspect to it.”
Titone’s favorite walks are inside Portland, Ore.'s Forest Park and a trail around the lower end of Lacamas Lake at Round Lake near Camas, Wash.
Round Lake, Camas, Wash.
All Weather Walkers is part of a national and international phenomenon known as volkssporting that began in Germany in 1968. In the U.S., volkssporting involves 250 clubs that sponsor 3,000 walking events a year.
These events are non-competitive for speed or distance but members of the American Volkssport Association may choose to record points toward Achievement Award incentives using an AVA journal.
For Jan Veeder, volkssport walking is about healthy exercise and as with Titone, she likes meeting new people. As a member of the Border Crossers, a Longview-based volkssport walking group, Veeder does local walks but also likes stepping out for regional events around the Pacific Northwest. She fondly remembers meeting friends for a weekend of walking in the Columbia Gorge.
“You don’t have to worry about whether it is a safe place to walk or what the terrain will be like,” said Veeder, who is 69 and widowed. “But the real appeal is meeting people. It’s incredible.” Two years ago, Veeder met a group of walkers from Italy and a large contingent from Canada at the Gorge event.
“Volkssport walking is a great way to see different places and earn badges for your accomplishments,” she said. “It is a way to stay motivated.”
According to the American Volkssport Association, nearly 400,000 people took part in AVA events during a recent two-year period.
Someday, Veeder would like to make a volkssport event part of a trip to Europe where thousands of enthusiastic walkers turnout to explore such locations as the Irish countryside or Italy’s gorgeous Cinque Terre coastline.
In fact, Walking Adventures International offers volkssport walking-travel opportunities in all 50 states and 58 countries on seven continents. The company’s Great Circle Route provides guided walking tours in the United Kingdom and Europe that “explore history, gardens, culture and natural wonders along the trails.”
Tom Baltes, 61, and his wife, Louise, Vancouver, began volkssporting in Europe when he was serving in the military in the 1980s. Their children were just babies. Baltes remembers pushing them along in strollers while out on volkssport walks.
“We liked getting the exercise while seeing the countryside at these events,” Baltes said. “The atmosphere was very festive. We’ve been hooked ever since.”
Now as president of the 90-member Vancouver USA Volkssporters, Baltes is kept busy organizing walks such as a recent half marathon at Clark College that was expected to attract as many as 140 walkers. Participants could choose from four planned routes of differing lengths and terrain.
The noncompetitive aspects of volkssporting appeal to Joe Titone, 76.
“We usually organize a walk from 8 a.m. to 1 p.m. where walkers can arrive any time during that time frame to do a walk at their own pace,” Titone said. “There is no large group doing a mass ‘start,’” he said. “Walkers can pick up a map at the beginning, do the walk and give themselves credit for distance and time. If they want, they can get a stamp in their journal at the end of the walk, or not bother.”
Local club Web sites make it easy to keep up with a walking calendar and stay in touch. A national Web site,, lists clubs by state and city with contact information for each.
Is there a volkssporting “look”?
For many, volkssport attire may include a floppy trekking hat for sun protection, loose hiking clothing and sturdy footwear, along with one or two walking poles.
Titone agrees that many walkers use retractable walking poles for balance and to avoid falling on uneven ground.
 “Even if the trail is flat, a pile of leaves can hide an exposed tree root,” he said. “I’ve saved myself from falling more than once.” cont.

Siouxon Creek, near Amboy, Wash.
Both Titone and Baltes would like to see more young people joining the ranks of volkssporting, which has seen a drop off in U.S. participation in the past several years.
“Worldwide, walking is extremely popular,” Titone said. “In Germany if an event doesn’t attract 5,000 people they are disappointed. In the U.S, a good turnout may be in the hundreds.”
Baltes, who is the newly elected Northwest AVA deputy-regional director, expects ongoing improvements to the way volkssporting is promoted and managed.
“The national association is doing ongoing strategic planning to find out what appeals to younger families and younger people, generally,” Baltes said. “Over the next two years, we expect to see a number of improvements including better use of modern technology…social media and apps for online registration and event updates. It is an ongoing process.”

                                                                                  FOR MORE:
International walking tours:
Evergreen State Volkssport Association, click here.
Walk Oregon (and SW Washington), click here.
AVA news blog, click here.

Wednesday, March 16, 2016

Managing your 401(k) rollover -- stay in boring stocks, leave them alone

"Never buy anything from someone who is out of breath," Burton Malkiel, (1932 -   ), author of "A Random Walk Down Wall Street."

It is one thing to save enough money to retire and yet another to confidently live on that savings as long as possible into your last years. Two key questions come into play: What earnings can you expect from your 401(k) rollover investments to help pay the bills and what are the management fees taking a bite out of those savings?

With baby boomers by the tens of thousands retiring every day as they mark their 65th birthdays, the burning question is how to how to manage your retirement savings for the long haul.

Here are few facts to inform your investment strategy:

-- Last year (2015), 66 percent of large-cap stock mutual fund managers underperformed the S&P 500. And according to a semi-annual SPIVA score card produced by McGraw Hill Financial, over the five-year period ending Dec. 31, some 84 percent of large-cap managers failed to beat the S&P 500, an index of the 500 largest publicly held companies in the U.S. Actively managed mid-cap and small-cap funds also lagged the S&P over the same time frames. Your funds DID NOT keep up with the broader market.

-- According to research at The Motley Fool, the average expense ratio (percentage of a fund’s assets going to operating costs) for an actively managed mutual fund is about 1.5 percent a year. That means that even if shares in the mutual fund decline or struggle to gain altitude, fund managers are taking a 1.5 percent annual pay check from the assets rain or shine. Bill Barker, writing for Motley Fool, suggests that as time goes by “you as a potential or actual mutual fund investor should be aware that it is likely going to become more and more expensive to own an actively managed mutual fund.”

-- On average, the S&P 500 stock index has produced a 10.3 percent return each year from 1957 through 2003. The return includes both dividend payouts and increasing stock prices. But last year, plunging oil prices, the strengthening U.S. dollar and China’s slowing economy contributed to a lackluster year for stocks. The S&P 500 produced an anemic 1.5 percent total return over 2014. So in a year with meager increased stock valuations and a mutual fund expense ratio of over 1.5 percent, you would only be breaking even or losing ground.

-- Financial advisers often suggest moving your savings into “safe” investment categories as you approach retirement. That typically has meant getting away from stocks and into bonds. But as the Federal Reserve raises interest rates (which it is doing), your bond fund investments will likely lose value. So beware of this outdated advice. And be particularly aware of funds with an upfront “load” or commission that comes off the top before your money actually even starts making any return. For more, click here.

What sectors have done the best best over the past couple of decades? In the stock arena, consumer staples businesses – companies that produce always-in-demand household necessities such as toilet paper, soap and toothpaste – did the best while high-flying technology companies did the worst.

So how do you handle that rollover? Keep in mind that a boring investment portfolio is a good thing. That buying and holding may be the best strategy and that successful investing is not so much about picking winners but staying the course. Patience and discipline can be rewarding. "The key to making money in stocks is not to get scared out of them," said Peter Lynch, author of "One Up on Wall Street."

As we head into another chaotic year, what advice do the experts have for managing your rollover retirement savings?
Plan your household retirement budget with minimum withdrawals from your retirement nest egg, say in the 2 percent range. Keep a sharp eye on mutual fund expense ratios and remember that a low-cost S&P 500 stock index fund with minimal management fees will likely beat most actively managed funds with higher management fees.

Take a look at reliable but boring companies selling consumer staples as a long-term earnings opportunity. Avoid turnover in your portfolio. Expect to be uncomfortable with the ups and downs of markets.

Even if you have a trusted financial adviser, educate yourself on basic investment strategies. Here are some reading recommendations:

“A Random Walk Down Wall Street,” by Burton Malkiel.
“One Up on Wall Street,” by Peter Lynch.
“The Future for Investors,” by Jerry Siegel.
“Irrational Exuberance,” by Robert Shiller.

Wednesday, February 24, 2016

Rheumatoid arthritis -- Everything I have learned in the past six weeks.

“When in doubt, nap.” – anonymous quote from “64 inspirational quotes from chronic pain sufferers” at

The pain first showed up during the holidays in the back of my thighs, really my lower butt. It felt like pulled muscles from what I thought might be the workouts I had been doing with a trainer who was helping me improve my core strength and balance.

Within a few days, the pain had migrated as well to my shoulders and neck. It was shockingly painful to roll over in bed. I couldn’t push myself up or lift my arms without grimacing with pain.
What the hell was going on? Where had this come from?

I found myself some nights at three a.m., sitting in a chair in the family room, sipping tea, befuddled by the pain in my arms from just reaching for the cup. Man, this hurt. I couldn’t bend over to tie my shoes or dry my feet after a shower without pain. I shuffled getting to the kitchen. Lifting my arms to put dishes hurt like hell.

A visit to my physician’s assistant, covering for my regular doctor, generated a preliminary diagnosis of polymyalgia rheumatica. She started me on prednisone, a synthetic corticosteroid drug effective as an immunosuppressant.

With the drug, the pain abated, but not much. I was still shuffling around like an old woman with my anxiety quotient through the roof. Was my life over? Is this it? I started reading up on polymyalgia rheumatica.

It didn’t help that Glenn Frey, co-founder of the Eagles had just died at age 67. Cause? Complications from rheumatoid arthritis. Wow, this is serious.  During those several nights of sleepless pain, I began frantic Google searches -- arthritis, rheumatoid arthritis, polymyalgia rheumatica --- their symptoms and outcomes. Coping methods, medications. Just reading about prednisone and other powerful drug treatments was scary enough for their multiple side effects.

No cure.
Depression, irritability.
Weight gain.
Weight loss.
Shortens your life.
All alarming.

“An autoimmune disorder, rheumatoid arthritis occurs when your immune system mistakenly attacks your own body’s tissues,” the Mayo Clinic Web site explained. “In addition to joint problems, RA sometimes can affect other organs of the body such as skin, eyes, lungs and blood vessels.”  Something called “giant cell arthritis” can cause blindness, stroke.
Treatment focuses on controlling symptoms and preventing joint damage.

This was all news to me. I knew people got arthritis but not me, not this suddenly and not at my age, 69.
It turns out that RA can begin at any age, but usually after age 40 and is more common in women, especially those with Northern European genetics. That’s me. If there is a family history of RA, the risk of the disease increases. Sure. My father had multiple ailments, arthritis among them.

You are not supposed to read up on all this on the Internet but what else was I supposed to do at 3:24 a.m.? Listening to the BBC on public radio gets tiresome. Hey, I’m a reporter.

It took more than two weeks to see a rheumatologist associated with the clinic where I get medical care. That medical care until now had been nothing more than an annual physical.

For women my age, I saw myself at the top of the active chart -- still downhill skiing, working like a dog around my yard, jogging, going to a trainer, riding horses, traveling and rafting rivers. This sudden leap into apparent old age was a shock. Much too abrupt. But after asking me a lot of questions, my rheumatologist gave me hope.

Her working diagnosis was not polymyalgia rheumatica, but a “drug-induced” toxic rheumatoid arthritis reaction. She tells me that I will recover but it will take time, maybe months or longer. Say what? Here’s my story:

Based on her analysis and my own investigations, the stars aligned against me regarding triggers for the onset of this affliction over the past holidays.

While visiting my dentist for a routine teeth-cleaning before Christmas, she discovered gum disease around a back lower molar and recommended I have my last remaining impacted wisdom tooth extracted. Meanwhile, she prescribed Clindamycin (an antibiotic) to knock down the gum infection. Without a second thought, I started popping those pills as my hectic holiday schedule ramped up. Within a couple of days, I began experiencing flu-like symptoms…muscle ache, head ache, fatigue. I had to force myself to complete the 10-day regimen. Clindamycin killed off the gum infection but also messed with the good bacteria in my gut. (Click here for more on side effects of this drug.)

It turns out that the trillions of microbes in my body may play an important role in regulating my health (according to research at NYU). “The immune system, primed to attack foreign microbes, possesses the extraordinary ability to distinguish benign or beneficial bacteria from pathogenic bacteria, said the researchers. “This ability may be compromised, however, when the gut’s microbial ecosystem is thrown off balance.” Does this increase the possible onset of rheumatoid arthritis…they don’t know. More research to come. More on this appeared earlier in Science magazine, click here.

Secondly, I came back from a trip to Italy last fall in love with Italian cooking. In the following weeks, I was eating a lot of eggplant and tomatoes. Turns out that some people believe the chemical solanine in nightshade vegetables (eggplant, tomatoes, potatoes and peppers) may exacerbate or trigger arthritis. But according to the Arthritis Foundation,, there is no formal research supporting this and some people may actually benefit from nightshades, the foundation said.

Yes, I have a family history of arthritis but I don’t know if my father’s chronic afflictions were rheumatoid or something else. He died at 80 from congestive heart failure. My mother died at 98 from old age. She had a touch of arthritis in her hands but nothing alarming and certainly not a primary focus of her health care.

So where did this leave me? My rheumatologist is giving me a working diagnosis of inflammatory rheumatoid arthritis caused by “the ongoing use of possibly toxic medication.”  That would be the Clindamycin, followed up by Amoxicillin, prescribed when I had the wisdom tooth out. She has put me on another drug called Methotrexate, which has been used for years to treat arthritis inflammation. The bad news? It can mess up your liver, so you get blood tests every so often to make sure that's not happening.

At the same time I am cutting back on prednisone by 30 percent. We are in a holding pattern on that. In the past nearly three weeks, I’m marginally better, although there was a setback last week when we went down too quickly on the prednisone.

Meanwhile, I am taking Aleve, an over the counter anti-inflammatory, two or three times a day, while trying to protect my stomach from its ulcerative side effects. Generic ingredient in Aleve -- Naproxen sodium. I must check in with blood tests to make sure the methotrexate is not damaging my liver.

Suddenly there are five medications on my bathroom counter instead of one. I am constantly mentally checking on how I’m feeling --- is the pain worse or better, today? Will it stay away or come back, what should I eat to avoid stomach pain. About 20 percent of my brain power is being used up processing and worrying about this condition.

I knew nothing about rheumatoid arthritis until now. It turns out 1.3 million Americans are afflicted with this disease, some of whom are a lot younger than I am.

According to the Arthritis Foundation, arthritis of some type affects 50 million Americans, two thirds of whom are under 65. Some 200,000 cases are diagnosed a year. It is a miserable chronic condition with 100 different variations. Afflictions such as gout, fibromyalgia, lupus, psoriasis, scleroderma, all fall under the arthritis umbrella.

By happenstance, I learned that a former editor of mine has what I have only much worse. He explained that his body literally “freezes up” during an arthritis “flare.” He goes by ambulance to the hospital where he is infused with drugs that within a few hours “loosen” him up. He hates the prednisone for its side effects but as we agreed, “it is what it is” when it comes to the challenges of aging and of rheumatoid arthritis.

My new massage therapist, a younger woman, maybe in her 40s, “lives” with an ongoing rheumatoid arthritis condition. Some days are OK, some days are not, she said wistfully.

What helps? Exercise, diet, rest, stress reduction. I am learning about NSAIDs (non-steroidal anti-inflammatory drugs) and DMARDs, disease-modifying anti-rheumatic drugs.

This is not a poor-me story but a new revelation in a long string of revelations in my life. I cope with stuff by learning about it. I’ve learned a lot in six weeks. For those who may be newly diagnosed like me, you will find comfort is a massive amount of information online. Just don’t get sidetracked by some of the off-beat myths about causes and treatments.  A good rheumatologist can do wonders. Mine seems to be on top of things.

Having said that, I realize that I am in charge of how I manage this, long term. Taking prednisone and methotrexate is only part of the picture. I will need to find my own day to day management program that includes how I take care of myself mentally,  a daily diet that helps, not hurts, and how much rest I get. Right now, I'm still trying to get my head around all this. My doctor told me this week that any signs of improvement could still months away,

On my reading list: Jenny Lawson's "Let's Pretend This Never Happened, released in 2012.
"Living with Rheumatoid Arthritis," by Tammi Shlotzhauer.
"Rheumatoid Arthritis: The First Year," by MEA McNeil.

Here are some of the resources that I’ve found:
Arthritis Foundation, click here.
Mayo Clinic, click here.
American College of Rheumatology, click here.
National Institute of Arthritis and Musculoskeletal and Skin Diseases, click here.
Healthline, click here.
Centers for Disease Control and Prevention,
click here.

Monday, February 1, 2016

Bowie, Rickman, Duke! How much time do we have left?

"Organizing is what you do before you do something, so that when you do it, it is not all mixed up," - A.A. Milne, English author best known for his books about Winnie-the-Pooh. (1882-1956).

Get your affairs in order: estate planning basics
1. Make a will.  In a will, you state who you want to inherit your property.
2. Consider a trust. If you hold your property in a living trust, your survivors won't have to go through probate court, a time-consuming and expensive process.
3. Health care directives. Write out your wishes for health care.
4. Assign Power of Attorney. With a durable power of attorney for finances, you can give a trusted person authority to handle your finances and property if you become incapacitated and unable to handle your own affairs.
5.Beneficiary forms. Name beneficiaries for bank accounts and retirement plans makes the account automatically "payable on death" to your beneficiary.
6. Funeral expenses. Set up a payable-on-death expense account at your bank and deposit funds into it to pay for your funeral and related expenses.
7.Final arrangements. Make your wishes known regarding organ and body donation and disposition of your body -- burial or cremation.
8. Documents. Make sure your attorney-in-fact and/or your executor has access to your important documents.

The deaths earlier this year of pop star David Bowie, actor Alan Rickman and the co-founder of the Eagles rock band, Glenn Frey have baby boomers asking themselves, “just how much time do I have left?”
Alan Rickman
Patty Duke
Bowie and Rickman were both 69. Frey, 67. Actress Patty Duke, who died in March of a ruptured intestine, was 69.
Even though we may have parents who are living into their 80s and 90s, these high profile deaths remind us that we are on the downhill curve. The first baby boomers born in 1946 will celebrate their 70th birthdays this year. Yikes!

Estate planners say baby boomers could do themselves and their heirs a big favor and “get their affairs in order” even if they think they’ve got lots of time left.

But planning for your final years and ultimate death is not an easy topic for many. According to Forbes magazine, 55 percent of Americans do not even have a last will, leaving their heirs vulnerable to costly court fees and legal battles.
“How many people like to talk about death and dying,” asks Margaret Phelan, an estate planning attorney in Vancouver,
Wash. “People think they have time that this is not going to happen to them today. That’s why we have two crystal balls in our conference room. It would be a lot easier if we knew the future, but we don’t.”

Phelan says basic estate planning is a good idea for anyone over age 18, but especially important for baby boomers who may be in a blended marriage, who may own significant real estate and hold substantial assets in retirement investment funds. “Or you may have a relative with special needs, you may want to avoid probate court or you may wish to donate to a special charity,” she said. 

While it is easy to delay estate planning, the experts say getting the basics in place is doing everyone a big favor. Here are questions to ask yourself:
Do I have a will spelling out how I want my assets distributed at my death?
Is my will up-to-date? Has it been revised in the past five years?
Do I have medical care directives spelling out how I would like my end-of-life care to be managed if I no longer can make those decisions? Have I named someone to act on my behalf with a durable power of attorney for health care?
For those in a late in life second marriages -- Do I have a written “personal property memorandum” spelling out how my tangible assets are to be distributed among children and step-children at my death?

Average life expectancies
The average life expectancy in the U.S. is 78.8 years, a record high, according to the Disease Control and Prevention’s National Center for Health Statistics. Life expectancy for females is 82 years, for men, almost 77.
Among the leading causes of death? Heart disease, cancer, chronic lower respiratory diseases, stroke and diabetes. The bottom line is that we all die of something.

Meanwhile, seven out of 10 Americans say they would prefer to die at home, according to a 2010 Frontline report. The reality is that nearly 70 percent of us die in a hospital, nursing home or long-term care facility where other people may participate in treatment and care-taking decisions. Yet, only 20 to 30 percent of Americans say they have an advance directive spelling out their end-of-life wishes such as a living will.

Professionals say that organizing the basics of estate planning may cost as little as a few hundred dollars or several thousand dollars depending on the complexity of the documents.
In many areas, those with lower annual income may seek discounted or free estate planning consulting services through the local bar association or senior center.

Phelan cautions against using online forms for wills and other documents.
“I’m not a fan of these forms because they are not state specific and they may ask for information such as Social Security numbers that you do not want in the public record,” she said. “The biggest problem is that in filling these out, people often make mistakes. Those mistakes may not be discovered until there is a crisis or someone has died.”

Finding an attorney

How do you find an attorney to help with your estate planning? Seek out those who administer the plans that they draft. Ask them how many plans they do annually and how long they’ve been specializing in this work. Ask how you can get to know them through a seminar or work shop at no cost.
“I would run from anyone who quotes you a fee without first knowing what they will be doing for you,” Phelan said. “You really want someone who does both the planning and the administration of estate plans.”
The National Academy of Elder Law Attorneys NAELA, founded in 1994, is a place to start when searching for a qualified local professional. Searches can be done by zip code or by city.

First steps to a plan

To get started, Phelan advises her clients to make a list of what they own in terms of real estate assets, investments, bank accounts, life insurance policies or other holdings such as savings plans for grandchildren.
Then she asks them to think about who they trust to make decisions for them while they are alive and who they would want to make decisions to settle their estate when they die.
Phelan, who has been in practice for 30 years, feels so strongly about these issues that with her law partner, Karen Webber, she co-wrote a book, “What You Really Need to Know for the Second Half of Life,” that outlines the basic elements of estate planning.

For those worried about attorneys’ fees for the cost of estate planning, Phelan likes to ask this question, “How much will it cost if you don’t have a plan in place?”

To do nothing, means there’s no power of attorney and no appointed executor for a will, she said. There’s the cost of going through probate court and expense of any challenges to the settlement.
“Usually there’s a huge savings by doing an estate plan rather than doing nothing," she said.
By the way, David Bowie left an estate worth $100 million to be divided among his wife and children.

For more:
National Institute on Aging, click here.
"Plan Your Estate," from NOLO, click here.
“What You Really Need to Know about the Second Half of Your Life” by Phelan-Webber, click here. 
The Wall Street Journal Complete Estate-planning Guidebook, click here.
Retirement Mobilization Toolkit, American Institute of CPAs, click here.

Helpful Web sites: