In the essay entitled Life’s Most Difficult Decisions that is contained in the Envision But Don’t Accelerate topic section I contend that we need to envision all the alternatives that might confront us as we age particularly as it relates to our care and housing.  Not only do we need to envision it but we need to make plans as to how we want to proceed as our need for care and assistance increases over time.  This requires that we make ourselves familiar with all of the care and housing options that might be available to us as we age.  It seemed obvious to me that I better do it for myself if; especially if; I am going to have any creditability behind my admonitions to you.  So I did so.

 As I sat down to write up my experiences in trying to learn about the infrastructure within and around my local community to support the needs of the aging population I was reminded of a song from the Music Man.  The traveling salesmen were singing about their life on the road and the need to know their territory if they were to succeed.  As a former financial planner I knew that I too needed to know the territory within which my clients would live out their financial lives.  I needed know about investment markets and their dynamics; I need to know about the laws and rules that controlled my clients’ financial activities; I needed to know about the infrastructure within the communities where my clients lived and worked so that I could help them utilize these resources to achieve their hopes, dreams and goals.  I learned about the banks, trust companies, custodians, real estate companies – lenders and investors, accounting and bookkeeping services and legal support services just to name a few.  I formed relationships with local professionals in each of these areas to draw upon in support of my clients.  I needed to go through a similar exercise and effort with respect to the needs of the visitors to this website as they age.  So I thought it wise to engage in that exercise here in my local community.  This was particularly important because I was new to the community.  What I have found was both instructive and eye-opening.

It is dangerous to draw broad conclusions from a narrow investigation but I have the feeling that what I have found here in Cowlitz Country, Washington is not dissimilar to the rest of the United States.  What I found is that there is no “one stop” place to go to find out about all the services available to seniors.  And much of what is on offer is directed to low income and disabled seniors or to the terminally ill.  At the other end of the spectrum you will find the retirement communities that can range from stand-alone single family homes to high rise congregate care facilities.  Perhaps the fastest growing segment of this area are the continuing care retirement communities (CCRCs) that provide levels of care or living from independent living all the way through to dementia care facilities; all on one campus.  But what about the people who are still able to live independently, who don’t want to move into a congregate care or retirement community but rather stay in their own home, and can afford to meet their own needs.  Is there any one organization or service provider who can respond to their growing desire and/or need for services to support their independence?  Is there any one place to go to find out who these disparate service providers might be and what services they provide?  Sadly the answer seems to be No!  But that might be changing.

The umbrella under which the service providers to the aging might be gathering is the Older Americans Act of 2006.  This act authorized the establishment, in conjunction with the various states, of Aging and Disability Resource Centers for older adults, individuals of all ages with cognitive and physical disabilities, families, friends and providers.  But again these centers seemed to be focused on the disadvantaged and needed.  These are probably not who will be making up the majority of the visitors to this website; but our visitors may have family members who are and would welcome some direction or pointers on how to proceed to find the help they need.  So it would be well to research and find out about any such centers in your area.  Search the web under the Older Americans Act or Aging and Disability Resource Centers or you might start at www.aoa.gov.  You might also check out the local Community Action Program in your area.  Community Action Programs were authorized in 1968 under the Great Society legislation and exist in every state and the majority of counties within each state.  They provide a myriad of programs some of which are focused on seniors. For instance, here in Cowlitz County, WA they provide an ombudsman service for seniors and meals on wheels. In your search engine type in “community action program” and you will come up with a great number of them.  If you also put the name of your community or county after that phrase you might find the one that services your area.

Many service providers are looking for recipients who can pay for the full cost of their services.  Meals on Wheels is a good example.  This program is under great stress in many areas because of the rising cost of food and fuel -- gas.  And, you will find, one of the great attractions to congregate care retirement facilities is the fact that the residents don’t have to cook three times a day!  AARP has found that 87 to 90% of those they have surveyed want to stay in their homes for life but the burden and tedium of cooking meals along with continuous chore of housekeeping is driving them out.  Most don’t know that they can find many of the same services provided in their homes and not have to move to be free from those burdens and tedium.   Meals on Wheels may deliver to full paying customers and many home health care providers also provide housekeeping services and even gardening services.  Check it out.

So just how do you check it out?  I started within my service club.  There are a number of doctors and other health care professionals who are members so I just asked them if they knew of service providers who worked with seniors in our community.  I got referrals to a few – we are a small community, the county has only 100,000 residents – so there were not too many.  I also went on the website for the National Association of Professional Geriatric Care Managers (www.caremanager.org).  This site gave me the names of a few members who worked for service providers in our community.  So I set about to contact some of these referrals.  But I must say I was greatly disappointed.  They all seemed rather scattered and disorganized and often unresponsive.  The companies and organizations I contacted did not give me a great deal of confidence in their capacity for follow through and oversight.  I hope you find differently in your community but I would start here.

My next contact was a member of my service club who was the community resource person for Community Home Health and Hospice.  I contacted her not because I thought that a hospice provided the kind of services I was looking for and hoping to find but because I thought she could refer me to those other organizations in the community who provided those services.  I was surprised to find out that the home health part of their name covered a range of services from housekeeping to medical services and that they did provide some of the services I was hoping to find.  So you might check out your local hospice provider as well.

This organization stood out from all the others I had contacted heretofore in that they were alert, organized and seemed genuinely excited about what they did.  They also seemed opened to the need I was finding in our community for a one-stop service provider for those seniors who wanted to age gracefully in their own home.  This motivated me to develop a description of what such a service might look like.  See the “Home for Life” service description in this topic section.  I offer this with two thoughts in mind.  One it might be useful in talking with the services providers in your area to show them the breadth of services you might be looking for; if you don’t know what you are looking for it might be hard to find.  And, hopefully, some one might “steal” the idea and set up such a service that could be copied around the country. 

Another big area of need for seniors as they age is for someone to step in and take over or support their personal financial management – bill paying and bookkeeping.  We are all aware of the horror stories that surround this area of life for aging among us.  It is not just those who are out there to take advantage of them but it is the simple failure of their ability – even desire – to pay their bills and keep their accounts straight.  Often it is a family member that is asked to step in (who else can you trust?) but that often leads to jealousy among siblings, errors of inexperience and even out right theft.  It is well to investigate the services that are provided in your area and their cost as well as the protections they provide not only for the person needing the help but to build the confidence and trust of family members in the service provider.  Again, I started with my service club by asking CPAs whether or not they provided this service and bankers if they knew of such service providers in the community.  

I found that many CPAs offered bookkeeping and bill paying services but most were focused on small businesses not individuals.  But my questioning of one CPA led to a series of conversations about what this service should look like and how to offer it at affordable prices.  It is also important to include, where appropriate, children or trusted friends and the financial planner, in the communications loop.  In this way those who need to know and have a role in the over sight of your clients’ affairs can be fully aware of what is going on from time to time in the clients’ financial lives.  Also some trust companies will offer bookkeeping and reporting services for assets kept in trust with their company.   The cost of this service is included in the trustee’s fee which can be high enough to be discouraging – but not always.  I have seen trustee services that are limited to bookkeeping and reporting offered for a half of one percent to 4/10s of one per cent annually.  These companies require that the trust employ investment advisory and accounting services independent of the trust company so the trustee fees are in addition to these fees.  I will be focusing on this area of need more in the Financial Management topic section.

During this aspect of my investigation it occurred to me, as it may have to the reader, that financial planning firms can easily fill most of this role as financial overseer.  With the aggregation capacity of most financial planning software today we can gather into one spot all of a client’s financial activity.  Combine this with the investment management reports we can produce as the client’s investment advisor and we have most of what is needed to oversee the client’s day to day financial life.  What we don’t have is a transaction register for all of the accounts apart from their investment accounts.  So if we combine the capacity of the financial planner with a bookkeeping and bill paying facility we would have the complete package.  The question is, “Would a financial planner want to combine it all in their offices?”   It might be an intriguing business opportunity but one rife with conflicts of interest and the opportunity for excessive liability if something should go wrong.  It might be best for the financial planner to insulate themselves with the services of an independent bookkeeping and bill paying firm, especially one that is headed by a CPA.  The financial planner would be on the lookout for large and unusual cash flows out of the asset accounts of a client and the CPA would be on the lookout for any unusual change in behavior with respect to the client’s normal expenditure habits.  You might be asking yourself, “Do I really want this level of oversight in my life?”  That is a good question but as we age it might be more of comfort than an intrusion.

So what have I learned from all of this investigation?  I have learned there is likely to be significant infrastructure in your community to support many of the needs of the aging and disabled who are financially needed.  There is likely to be an infrastructure to support the needs of the majority of the visitors to this website, if they need in-home or institutional medical care.  There are any number of opportunities to move into congregate retirement and health care facilities.  But there are few services for the healthy and financial well off in your community to relieve themselves of what have become some of the burdens and drudgeries of life as they age such as home and yard maintenance, meal preparation and day-to-day financial management.  (However, one person’s burden and drudgery is another person’s recreation.  As part of this investigation I interviewed a couple who were debating whether or not to move into a continuing care retirement community.  I assumed that one of their motivations would be to free themselves of the drudgery of meal preparation.  But I was wrong!  This aspect of life was recreation for them that they enjoyed sharing together.)  I suspect that there will be growing realization of the local business and professional community that there is an opportunity that lies in this lack of service available to those who can afford it and will increasingly want it.  So the lack of these services now will probably be cured shortly.  You need to remain engaged and involved in your community and, perhaps, serve as a catalyst in bringing about this response.