The New Age of . . . Old Age

Do you know where your 90-year-old parents are tonight?

This will become the slogan for anxious baby boomers in our new Era of Longevity. The wonders of modern medicine, combined with better diet and exercise, assure that masses of people will reach advanced old age--both a blessing and a worry for their children.

People in their 60s preparing to retire to Leisure World will be grappling with the health and financial worries of their own parents.

And they will need lots of help.

“Today’s adults in their 40s and 50s represent the first generation who will be likely to spend more years taking care of their parents than taking care of their children,” says “Aging, Parents and Common Sense,” a guidebook by the Equitable Foundation and a group called Children of Aging Parents.

“This responsibility involves a host of questions and choices, ranging from medical care to living arrangements, to finances, and to judgments about whether we need to intervene in our parents’ lives.” We are facing something new in human history: mass aging. Always there have been individuals who reached hoary ages of 90, 100 and above. But never in such huge numbers. And that is the mixed blessing for baby boomers. When this century ends, 80% of Americans who have reached age 50 will have at least one living parent. At age 60, a surprising 44% of people will have a living parent, according to research by Neal Cutler, professor of financial gerontology at Widener University in Chester, Pa.

But in our society, longevity is accompanied by separation and independence.

“The elderly often live alone, without family members close by--in fact, they are likely to live several miles away or in other states,” says the federal Administration on Aging. “Even when adult sons and daughters do live nearby, both are likely to work. At the same time, more and more caregivers are elderly themselves, with 72-year-olds caring for 95-year-olds, or an 85-year-old husband providing around-the-clock care to an 83-year-old wife.”

May is Older Americans Month, with the federal government proclaiming the slogan “Living Longer, Growing Stronger in America.” The slogan is inspiring, but let’s add to the glowing words some useful tips.

Long-Distance Caregiving: In our mobile society of job-hoppers, adult children find themselves worrying from hundreds or even thousands of miles away about their parents.

But there are resources to help. A good starting point is the Eldercare Locator, a toll-free national service from the federal Administration on Aging, (800) 677-1116. Tell the operator your parent’s county of residence, the city and the ZIP code, and the nature of the problem. You will get referrals for useful local agencies, ranging from the Alzheimer’s Assn. to Meals on Wheels.

There are also professionals such as geriatric social workers or nurses who can be hired to help. An assessment may cost anywhere from $150 to $400. The professional will sit down with your parent or parents, discuss their health, financial and social needs, and recommend action. The National Assn. of Professional Geriatric Care Managers will put you in touch with a case manager who lives near your parents. Call (520) 881-8008, or write 1604 N. Country Club Road, Tucson, AZ 85716.

You are not alone in your worries. A good source of general advice is Children of Aging Parents, (800) 227-7294; 1609 Woodbourne Road, Suite 302A, Levittown, PA 19057-1511.

Money, Money: The burdens of old age, both health and financial, fall heaviest on women. They live longer but have lower incomes and smaller pensions than men do. About 10 million people older than 65 live alone, and 75% of them are women. Social Security has some lesser-known benefits that can be vital for women.

A divorced woman who was married for at least 10 years can get a spousal benefit based on her ex-husband’s work. It doesn’t matter whether her ex-husband is still working. As long as he has reached retirement age and qualifies for Social Security, the divorced wife is entitled to her spousal benefits. She can receive an amount equal to 50% of his benefit when she turns 65, or a reduced benefit of 37.5% at age 62. She qualifies for the benefit only if she is unmarried.

A widow can collect benefits as early as age 60 (at 50 if she is severely disabled), when she would receive an amount equal to 71.5% of her deceased husband’s benefit. At age 65, she would get his full benefit.

A woman who has reached age 62 may find it economically worthwhile to apply for early Social Security benefits based on her own job record, even if her husband is still working. When he retires later, she may be entitled to a higher benefit as a spouse.

Let’s say Jane Smith takes early retirement at age 62, entitling her to a reduced benefit (80% of what she would have received had she waited until age 65) of $320 a month, instead of $400.

Her husband, John, retires three years later, at 65, and begins drawing his full benefit of $1,200 a month. Jane’s Social Security benefit would be boosted to $520, as a spouse. The family Social Security income would be $1,720.

And most important, Jane will have enjoyed three years of cash payments on her own record. If she waited until John retired, she would have received a higher spousal benefit of $600. But it would take 12 years, until she is 77, to catch up with the money she could have gotten by taking benefits on her own. This doesn’t even include any interest she would have earned on those three years of benefits.

The booklet “Social Security: What Every Woman Should Know” is available at any Social Security office or by calling (800) 772-1213.

Painful Decisions: A great fear is that when health does fail, the future will bring days of pain near the end of life, an agonizing stay in the hospital or nursing home, hooked to tubes and pumps when the chances of full recovery seem infinitesimal. Parents and children must discuss this possibility. Talk to your member of the clergy about religious and spiritual issues and obligations.

And people should arm themselves with two documents, to make decisions when they cannot make their wishes known.

The first, with the widest application, is a health care proxy, formally known as a Durable Power of Attorney for Health Care. This allows you to appoint an agent--another trusted person, a family member or friend--to make medical decisions if you are unable to do so. This covers all sorts of medical procedures. The document takes effect only if you are incapable of making your wishes known.

The second, and much better-known document, is the living will, or Natural Death Declaration. It applies only in extreme situations. The living will allows you to authorize doctors to withhold or withdraw “any treatment (except those necessary for comfort or for relief from pain) that prolongs the process of dying or irreversible coma if you become terminally ill or permanently unconscious,” according to the state Health Insurance Counseling and Advocacy Program.

Forms for both documents are available in many office supply or stationery stores, at hospitals, or through the California Medical Assn. If you fill out both forms, the Durable Power of Attorney for Health Care takes precedence.

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Now, some inquiries from readers:

Question: I left a hospital job nine months ago and did not continue my health insurance because it was too expensive. I am now in business for myself. I just turned 60, am absolutely healthy and need some low-cost individual insurance to tide me over for the next five years. Isn’t there something out there for self-employed people (no employees) whose business isn’t very profitable yet? I don’t know where to start. Please point me in the right direction.

Answer: Congratulations on your good health. You need insurance as protection against the catastrophic big bills of a major illness or accident. As a general rule, buy the policy with the highest deductible you can afford.

Bruce Jugan, an independent insurance broker in Montebello, recommends the Blue Cross PPO network. He tells customers to look for low-cost insurance with a limit on out-of-pocket spending that can act as a safety net.

Alison Gordon, a broker in West Hollywood, likes the Blue Shield Preferred Plus or Select Plus plan. She advises clients to save money on insurance by finding a plan with a good network of doctors, and staying within the network whenever possible.

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Q: I am considering leaving my present position as a full-time regular employee of a small company to do independent consulting. I’m unsure if I am eligible under the law to receive Cobra medical benefits after I leave the company, since the company has just over 20 employees. How and at what point are the 20 employees counted, such that the company must offer Cobra to me?

A: The federal Consolidated Omnibus Budget Reconciliation Act (Cobra) guarantees that you can continue your health coverage after leaving a job, provided you pay the full cost, plus a 2% administration fee. The law applies to any firm with 20 or more employees on the payroll on more than 50% of the working days in the past year. Employees are defined as full- or part-time workers, and anyone else, such as independent contractors, eligible to participate in the company’s health plan.

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Q: My father, who is 74, has cataracts and would like to have laser surgery. He was told by his present physician at Kaiser that his eye (left one) was inoperable. But when he requested that another doctor check him so he could have a second opinion, his first doctor would not refer him. I understand there is laser surgery that can correct the problem of cataracts if it is detected soon enough.

A: A Kaiser spokesman says your father should have no problem getting another doctor to review his case. He can go back to his health center and ask the member services office there to arrange for him to see another doctor. Or he can call member services from home at (800) 464-4000 and request a referral to another doctor. Your father belongs to the Fontana Center, but as a Kaiser member he can go to any other Kaiser facility in Southern California and ask to see a doctor about his eyes. Riverside may be the closest, the spokesman says.

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Tip of the Month: Enjoy Older Americans Month, and look for the perks that come with age. Anyone who is at least 80 can get a finely engraved birthday greeting from the president. A couple married 50 years also is entitled to a congratulatory card.

Send a postcard a month in advance of the happy event, with the name, age and address of the person or couple to be honored to the President, c/o Greeting Office, the White House, Washington, DC 20560.

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This column appears every second Monday in Health. Send your questions, worries, tips, successes or failures in living with the health insurance revolution to Benefits Bob Rosenblatt, Health, Los Angeles Times, Times Mirror Square, Los Angeles, CA 90053. Or e-mail: Bob.Rosenblatt@latimes.com.