Sustainability--Retirement--Extended Lifetimes--Quality of Life--Relative Terms

Sustainability has become a key word this year.  President Obama mentions it in connection with the economy and preserving the ecology of the planet by developing alternative fuels and lifestyles that do not destroy our environment.

In this context we need to pay attention to the long-term impact of our solutions.  We don't want to begin relying on new car batteries that will further harm the environment when they wear out.  One aspect of sustainability is keeping in mind an extended time frame.

Sustainability is important to keep in mind when thinking about retiring--especially in today's economy in the USA.  Improvements in medicine, nutrition, and health have extended life expectancy.  To maintain a high quality of life (not necessarily a very expensive lifestyle) to age 100, for example, it is important to create a flow of income adequate to support that quality of life (including inflation) either before retirement age or to supplement any retirement income that a person has access to.

After World War II, social security was developed to make sure that wage earners could have some supplementary income in case their pensions from work plus their savings were not enough to provide basic needs.  Medicare came out of a similar concern.  More recently, most companies have decided not to fund pensions directly and have turned to 401K plans where companies and employees purchase stocks, bonds, or mutual funds to plan for retirement.  In the last few years, when the stock market took a nose dive, on paper, people have lost between 75% and 50% of the money they had invested.  Of course they did not realize these loses yet because they do not manifest until the stocks, bonds, or mutual funds are actually sold.  While the concept of dollar cost averaging (the concept that every dollar invested in the stock market will increase in value over an extended period of time) is still valid, some people do not have 40 more years to wait for the value to rise to the point where they need it to be.

News reports in the last few days have talked about "a jobless economic recovery."  Claiming that while there are indications of economic recovery, new jobs--or jobs of equal value to the jobs that have been lost--are not being created.  These same reports speak to a 10% unemployment rate for the country.  Unemployment rates do not include those whose benefits have run out and who, while possibly still unemployed, are now "off the radar."

My mother's highest salary in the public school system was about $22,000 per year as a supervisor.  When she retired, two supervisors were hired to do what she did and they each earned about $60,000 per year.  The economy shifted and her generation operated under a much lower ceiling for pay.

In today's economy we may be facing a reversal.  Excluding the super-high-incomes of certain executives of what have historically been multi-million dollar companies, many salaries have been in a six-figure range.  There appear to be fewer six-figure salaried positions available today.  The salary for many jobs seems to have dropped significantly.

As baby boomers continue to age and as the next generation advances in their careers, openings for leadership jobs will continue to shrink.  While no one practices age discrimination, some people are calling for a particular type of training or experience that older workers will not have.  Other companies are paying only entry-level wages for higher responsibility positions.

A challenge for baby boomers happens when, for whatever reason, the job or business they are used to ceases to exist and they have to begin planning for a sustainable retirement.  Social security (for as long as it lasts) will help and needs to be supplemented.  Supplementary income can be much less than baby boomers used to get in their previous jobs.  At the same time, many of these baby boomers are especially concerned with the quality of life they experience--at home and at work.  With age comes a desire for less stress, a shorter commute, regular hours, and quality time outside of work.  Six-figure jobs frequently don't offer these added benefits. 

Some people work best as employees and others enjoy earning their income directly--through sales or running their own business.  Planning for retirement differs for these two types of earners and both need to create effective, workable, and sustainable plans to enjoy a good quality of life for the lifetime left to them.  Planning for a 100-year lifetime does not seem to be too unreasonable in the near term, especially if the person planning is currently age 50 or less.

All of these terms are relative--we will each be thinking of what quality of life means to us and how much income we will need to cover planned and unplanned expenses as we age.  What we do need to plan for is a network of income resources that will be sustainable as we age.  This usually means that we need several streams of income, each of which can last for a long time.

Aging, Quality of Care, Quality of Life--Healthcare Oversight of Continuous Care Retirement Communities

Healthcare for the aging--a worry for baby boomers with aging parents and for young adults with aging baby boomers for parents--and a huge and growing worry for Medicare.

Hospitals, Rehabilitation Facilities, Nursing Homes, and Continuous Care Retirement Communities (CCRCs) are all part of the health care system for the aging in the USA.

Much of my day today has been invested in reviewing information available on the World Wide Web comparing nursing homes, and hospitals.  Medicare has made some additions to its http://www.medicare.gov website where you can choose to compare hospitals and nursing homes. The government data for nursing homes associated with CCRCs appears to be inadequate--sometimes focused on only Medicare-related services rather than including the entire range of service provided by the CCRC to include skilled nursing care.

Continuous care retirement communities (CCRCs) today include independent living units, assisted living units, memory care units, and skilled nursing care units. So far the government surveys do not focus on the overall community.  Instead they focus on sub-elements of one unit.  For example, they may look at the Medicare wing (19 beds) of a Skilled Nursing Facility (with 70 beds).

CRCC Oversight

CCRCs are accredited today by the  Continuing Care Accreditation Commission (CCAC) which is wholly owned by the Commission for Accreditation of Rehabilitation Facilities (CARF).  In many states, this is wholly voluntary and there is no mandate for accreditation by any organization. In the accreditation process, the service provider pays the Commission to conduct an in depth survey of the facility and what it offers.  The Commission treats  service providers in much the same way a university treats its students.  Providers pay for the surveys as students pay tuition to the university for a course.  Service providers may or not pass the standards to be accredited just as students may not pass the standards set for course or degree completion by the university.

The CCAC was acquired by the CARF in 2003 and is the nation's only accrediting body for CCRCs and other types of continuums of care referred to by the commissions as "aging services networks."  (You can see more detail on the CCAC website listed above.)    


This accreditation is at least a step in the right direction of allowing the public to make more informed decisions about healthcare.  CCRCs are not inexpensive and a major concern about any such place is ongoing quality of care and quality of life.  That's not easy to measure, especially on surveys where not enough residents may be willing or able to complete the survey.  At the same time, even if they had a mandate, governmental oversight agencies may not look at (or even for) a clear picture of the quality of care and quality of life afforded at a CCRC.


We are still in a "buyer beware" situation.  The information available over the world wide web (Internet) is at least helpful in making more informed decisions.  The information needed may not be readily available, however, and may require some depth of research (and time investment) to uncover information crucial to making the informed decisions.

CCRC Decision-making


One thing that CCRCs seem to be doing--in the footsteps of lots of other organizations--is trying to consider themselves as either unique (one of a kind) or too similar (much like) another organization. The CCRC my mother lives in has decided to move to 12-hour shifts for its employees dealing with residents in assisted living and the skilled nursing facility.


In my personal experience of working 12-hour shifts, it is not a healthy option for anyone involved.   While on duty at the Pentagon many years ago, my group decided to go on 12-hour shifts.  We would start either at Noon or at Midnight and work that shift for several days (four, I think). This meannt that we would work from Midnight to Noon for four days, have two days off, then work from Noon to Midnight for four days and have three days off.  While we had time off, I remember sleeping the first two days after the Midnight to Noon shift and not being able to sleep for awhile when we switched to the Noon to Midnight shift.  (There were military reasons for the starting times, by the way.)  Nursing homes and hospitals usually like a 7AM to 7PM shift and a 7PM to 7AM shift.


At the end of a twelve-hour shift, and even more so at the end of several days of that shift, we were not at our best.  The constant switch of our internal clocks really messed people up--we react to lightness and darkness and it takes time to recover.  A 34-year-old major working with me had a stroke and died after we were on the new schedule for a few months.  He left a wife and two children.  No one functioned at his or her best and decisions made when we were not at our best could (in an emergency situation) not have been the best ones to take.  (We didn't have that problem during the time I am referring to.)


Many hospitals and now CCRCs are advocating the 12-hour day shift schedule, talking about how much time-off people will have in the course of 14 days and the continuity of care patients or residents will receive by seeing the same people on the same shifts.  The CCRCs say that it has been successful in hospitals so they want to implement it.  In my experience, what this shift schedule does is insure continuity of worse care for the people being cared for and continuity of a feeling of jet-lag and frustration on the part of the care-givers.  It is good for schedulers and may help in financing plans.  In hospitals I have seen diminished quality of care from caregivers toward the end of their 12-hour days.  CCRC's usually do not have the same intensity of responsibility seen by nursing staff in hospitals and they have their own concerns at the CCRC.


At the end of my day I am aware that I have touched the "tip of the iceberg" and have lots more to learn about ensuring the quality of care and quality of life offered by CCRCs to my family.  It's also something I have to think about in my own future as well.