This Week: Small Business Week and Elder Law Month

An Irish Ruin

An Irish Ruin

This is an interesting combination topic – don’t you think?  Perhaps you might be thinking that I am taking this whole “theme” thing a bit too far.  Putting together the “Happy Small Business Week” (which I learned about from my Google page on Monday) and Elder Law Month. . . .  Isn’t this a bit of a stretch?!

Why no, not at all!  In fact many folks in the second half of life are shunning retirement in favor of . . . . “risky startups.”  Read the January 7, 2014 Bloomberg article about this here.  It’s no surprise to learn that job opportunities for folks over 55 are “limited” but it was surprising for me to learn that the number of people aged 55-64 has been increasing, with a full 23.4% of them starting their own businesses in 2012.  What is prompting people to do this?  Many have discovered that the retirement benefits that many of our parents enjoyed are simply not on the table anymore.  Couple that with a lifelong yearning to work for yourself, and there you have the boomer startup!  The Small Business Administration is well aware of this trend and has targeted free resources available for this cohort.

Last month I was pleased to present the CLE program at the monthly meeting of the Elder Law Section of the Colorado Bar Association.  My friend and colleague Rick Mishkin gave me a very kind introduction and revealed publicly my secret desire to be a talk show host . . . .!   He was generous enough to update the title of the solo/small firm disability and death planning presentation I have given a few times now to “The Death You Need to Plan for Should Be Your Own.”  As it was the elder law section, which is an interdisciplinary group, there were a few professional fiduciaries who attended the program and a couple of them (one of them a finance person and the other a professional guardian) noted that the materials I shared were helpful to them as sole proprietors who wanted to have some succession or disaster planning in place.  A bar staffer told me the materials would be available on the bar website. I am happy to share these resources with other solo professionals who are so inclined.

Among the small business startups by those underemployed boomers or boomers who just aren’t ready to be retired can be found more than a few businesses targeted at the elder care services field.  There are businesses that are founded on services that most family members that traditionally were largely provided by family members.  With our modern-American and far-flung families, many elders have come by necessity to rely on service providers for many services and support.  In fact, the Eldercare Locator, a public service of the U.S. Administration on Aging has a handy website that can help locate local providers of services including information on Alzheimer’s Disease, health insurance, transportation, housing options, legal assistance and long-term care.  Many of those service providers are baby boomers who found that the service their parent(s) needed was not really available, and so many unique forms of assistance for elders were born from this necessity.

The boomers have a vested interest in how these business developments they are involved in turn out.  They are the “silver tsunami,” which is necessitating a reexamination of resource allocation in services that will be made available to the biggest ever cohort of elders in our country (and many other nations worldwide) has seen.  There are many dimensions of what has been called “the 2030 problem” of meeting the challenges to public policy placed on caregivers and public finances; and to focus only on economic challenges (like issues around raising tax rates while tending to economic growth of service costs at the expense of other forms of social investment along with tending to the well-being of future generations of workers) may be misleading in its simplicity (or not).  This topic is not at all an easy one to identify and discuss, let alone come up with what might be “solutions.”

Another excellent online resource is the American Society on Aging.  On their site is a tab called “business and aging.”  Turns out there are a few discussions of the topic outlined above – how long should a boomer work; will there be enough caregivers to go around when we need them; and what about long-term care insurance issues . . . ?  My favorite item on this site is a video by Katy Fike, Ph.D., a member of the ASA’s Board of Directors entitled “Ten Innovations that Could Change the Way We Age.”  Spoiler alert: one of them is the Google self-driving car!  I think we Boomers have a lot to look forward to in our old age.

©Barbara Cashman  2014

Longevity Planning – Planning for Long Life and Likely Disability


denver elder law

Lucina’s Spring Blossom

As you have undoubtedly noticed, Americans are living longer than ever before.  One of the side effects of this longevity is a fairly strong likelihood that an incident or period of incapacity or disability will accompany that long life.  Yes, we baby boomers seem to think that if we just continue to exercise and eat right, somehow we will get a ticket to longevity that ensures our vital longevity.  After all, we boomers practically grew up with Jack LaLanne!  Long before Hans und Franz of SNL fame, there was the blue-jumpsuited “Godfather of Fitness” (I learned of this moniker this only as I did a bit of web research).  LaLanne died in 2011 at age 96, with nary a gray hair on his head!

So what about this longevity issue – I am thinking of it in the context of the death denial and youth glorification convergence . . .?  I’ve written about it before.  Death strikes fear in people’s minds, and even in our hearts.  For many it is a major anxiety producing thing to consider, let alone contemplate.  Ernest Becker wrote about this in The Denial of Death.  A favorite book of mine stands in contrast to this well-recognized fear, in Who Dies, authors Stephen and Ondrea Levine take a completely different approach to this fear and address it in the context of conscious living and conscious dying.

So how we view this life and death experience, in terms of what we fear and what we embrace, what we can know and what remains mystery, this is far from a “standard” human response.  I might be getting off-topic here, but let’s face it, with this kind of a topic it’s hard to know where things will lead!  I don’t think we’ve always lived like this – with such “faith” in medical science as something that will somehow protect us from the ravages of illness, old age and eventual death.  I am pretty certain that our scientific progress in understanding more of how our bodies function, age and eventually die, has brought about a thinking that we can somehow “manage” death.

And so we hold death at bay, we call it the enemy and we make our lives a struggle against the inevitable.  Well, if that is the sum of a life’s purpose . . .  I would say “that ain’t much!”  When many of us are ill and eventually die, we often employ that language of warfare.  Example: John Doe fought bravely in his struggle against metastatic prostate cancer.   On this topic of battlefield euphemisms, my friend Liz sent this excellent article to me from “The New Old Age.”  Bottom line is, the militaristic language, the fighting words we see so often and hear in conversation do nothing to empower our lives and our sense of purpose in our lives.  I would argue that this language and its approach rob us of our purpose, disempowering us by making us random and senseless victims of our lives in our death.  Remember the announcement of the war on cancer by President Nixon?  Most recently we have the war on Alzheimer’s announced by President Obama.

So back to the longevity planning theme and the fear of illness, frailty, disability . . . .  life on its own uncertain terms.  The fear of disability is more troubling in many respects than the fear of death.  Much of it springs from youth glorification, an extension of that anxiety around death which often includes processes, occurrences and diseases that often precede death.  Is the glorification of youth simply an extension of the denial of death?  I am not asserting that the American cultural obsession with the denial of death is a recent occurrence or produced by the baby boomer generation.  No, it goes back further than that.

I have written previously about the fear many of us have of getting Alzheimer’s or some form of dementia.  I think there is also plenty of evidence that people fear incapacity at least or perhaps more than the fear of dementia.  Of course, dementia is only one form of incapacity, so the questions may blur the distinctions. There are of course a myriad of other fears which surround aging.  Many of them don’t have to do with losing capacity so much as retaining it in our old age.  I enjoyed reading Roger Angell’s article “This Old Man” in The New Yorker.  It is a story about all those human needs and desires we carry with us into whatever age we find ourselves.  There is no handbook on how to behave when you find out that your 85 year old mother, who has been widowed for less than two years, has started dating on the internet.  And what about physical intimacy in the assisted living or nursing home?  I’ll write more about our cultural fear of aging soon.

©Barbara Cashman  2014

The Death Certificate as Proof of Having Lived

Proof of Having Lived

Proof of Having Lived

Death certificates as we know them are a fairly modern invention.  Like other records (baptism and marriage), they were commonly kept by local churches but with the rise of public health as a government concern, the records began to be documented by governments.  Now the records are kept by state departments of vital statistics – where birth and death records can be found.  Access to these publicly-held documents vary from state to state.  Some states (like Colorado) restrict access to such documents.

As a probate lawyer, I typically collect a death certificate from a client on whose behalf I am opening an estate or trust administration.  You might be surprised to know that you don’t need a death certificate to do this, you just need a date of death.  No “proof” is required as in the form of a death certificate.

Keeping track of life and death with these documents – that totally begs the question of why we are born and why we all must one day die. This might lead to a bigger question.  How do we know we exist? Well, that depends. . . . that is where the word consciousness comes into play.

I do find very interesting the works of neuroscientists like Antonio Damasio and their very informative, but usually brain-centric notion of human consciousness. I think it is fascinating how our use of newly-found technological implements and measuring devices is being used (as in a large blunt instrument) to quantify and measure brain activity that sometimes passes for. . . .  consciousness.

Alright, I’m really getting off-topic here, so I’ll rein myself back in. We’re talking about the death certificate, that document that the U.S. started maintaining as vital records around 1900.  This is a much easier topic than discussing the nature of consciousness!

So, I’ll start with the usefulness of the certificate.  A Colorado certificate is broken into five different sections: information about the decedent (date of birth, death, social security number, occupation, years of education, etc.); names of parents of decedent and the “informant;” the method of disposition (signed by a funeral director or the like); information about the certifier (name of certifier, exact time of death, date of filing certificate, etc.); and the cause of death.  In the April 7, 2014 isuse of The New Yorker, Kathryn Schulz has a very readable article about death certificates entitled Final Forms – here’s a link.  Thankfully, I think we are largely beyond the days of the “vanity death certificate” where an otherwise not very socially acceptable cause of death was “prettied up.”

Based on its public health history, the death certificate can be particularly useful in explaining the cause of death.  This cause of death can sometimes assist in bringing criminal charges or pursuing civil remedies after a person has died.  An explanation of the cause of death usually includes different items. A Colorado death certificate has a space for “immediate cause of death” which contains, interestingly, an admonition to the certifier to not specify the “mode of dying” alone, but its cause. For example, for someone who died of aspiration pneumonia, it might list first “acute respiratory failure” then followed by “acute pulmonary embolisms and aspiration pneumonia.”

I think of the quote from Death Comes for the Archbishop, by Willa Cather:

I shall not die of a cold, my son.  I shall die of having lived.

The death certificate is most of the time more specific than this quote.  However, I have seen listed as a cause of death on a couple death certificates in the last few years something known as “global geriatric decline.”  This strikes me as quite similar to the quote above about dying as a result of “having lived” (a really long time).

Each state has its own form, but the U.S. Centers for Disease Control has a form that is a standard.  In case you’re tired of reading and would rather watch TV, here’s a link to a Frontline program on Death in America.

Who can sign a death certificate?

A physician, a coroner, two registered nurses (if certifying in a hospital), and other specified personnel (with exceptions for disasters).

What does the death certificate say?

The signing authority basically verifies the identity of the person and the cause of death.  This can sometimes be a tricky matter.  I recently read what I would consider a fairly badly written death certificate of someone who died in a skilled nursing facility.  It stated three causes: global geriatric decline (which perhaps may include that broken heart of the survivor who sees their spouse of 50+ years predecease them) (in case you think I’m making this up, here’s a link to an FAQ about “broken heart syndrome” from Johns Hopkins School of Medicine.

What about an autopsy – how often is that performed?

Not very often! Recent figures from the CDC, from 2007, indicate that autopsies were performed in just eight percent of all deaths.  Autopsies are invasive, and while a decedent’s cause of death may be evidently caused by some form of poisoning, a toxicology report may be used to clarify what poison caused the death.

I have been asked by a surviving adult child about what is done with the information listed under the cause of death – specifically whether a life insurance company might use the information to deny life insurance coverage to the adult child of the decedent.  Due to the nature of the cause listed, I responded with a “no,” but now that I’m writing this post there are several science fiction movie plots that are coming to mind . . .  is that in our future?  I know there were many such concerns with the beginning of the Human Genome Project.  At least some of them have been resolved. . . .

So, to conclude, the death certificate is useful in many ways.  But don’t get me wrong, I don’t think the death certificate is proof of being alive at some point, just of having lived. . .   and one last reminder on this topic – April is donate life month.  If you haven’t yet signed up to be an organ donor through your DMV, here is a link with more information about those lifesaving donations.

 ©Barbara Cashman  2014

April 16, 2014 is National Healthcare Decisions Day!

Bridge on the Maigue at Adare Manor

Bridge on the Maigue at Adare Manor

What, you say you haven’t yet seen the greeting card celebrating this event?  Well, it might contain a warm greeting along the lines of “thank you” if someone you love has executed a health care power of attorney or other important medical decision-making document.  It could express this sentiment of gratitude for the peace of mind that comes from advance planning so as to preempt any emergencies that often give rise to stress and conflict.

Really – I don’t think the greeting card idea is that far-fetched . . . !

Okay, back to the title of this post.  You can visit the national site for the 7th Annual National Healthcare Decisions Day here.  You can also visit the Colorado local Life Quality Institute’s link to their very informative page about advance planning and that page has Colorado specific documents.  Keep in mind that each state has its own laws around advance planning and patient self-determination, so it’s good to have a state-appropriate document!

Some of you have heard about the Denver Death Café, a place to chat about end-of-life issues and mortality.

A good resource to help people get started in the often difficult conversation around end-of-life wishes is The Conversation Project, started by journalist Ellen Goodman.  The project recognizes the important fact that most people recognize that making sure family members aren’t burdened by difficult decisions around end-of-life care, but that not nearly as many of the folks who think the conversation is important have actually had that conversation.

Each of us knows our days are numbered, but like so many people, we get caught up in our daily life tasks and we often neglect the important tasks in favor of the urgent ones.  One easy way to get started in Colorado is to go on the DMV site and add an emergency contact to your driving record.  Once you do this, you might consider becoming an organ donor if you don’t already have that little heart on your driver’s license.  The next step is a conversation with family members about the “what if’s” and the “this is what I want when . . . “If you start small, it may not seem like such a daunting task.  Besides, there is lots of support available to you if you are inclined to have the conversation.

We are all familiar with the expression “carpe diem” the Latin term for seize the day.  Its origin (according to Wikipedia) traces back to Book 1, number 11 of the Odes, written (in Latin) by the poet Horace.  The expression has come to mean “embrace life” because how much time we have left is uncertain.  I think the broad usage of this expression, which appears on bumper sticker and T-shirts, is an important message but that it has perhaps become watered down to suit the purposes of advertising. . . .

So I will introduce a “new” ancient term for purposes of my blog post today about paying attention to opportunities: kairos.  Kairos is a definition of time.  We are all familiar with the English words based on its Greek counterpart chronos, but very few are aware of kairos, this other term for time.  I have to say at this point that I am grateful for having studied a few foreign languages in my life, as I have been able to develop a sense for how the world is viewed differently by the speakers of a particular language.  We so often mistake our world for what we call it and how we name it.  We often forget all the myriad ways of apprehending and encountering all the familiar as well as the unfamiliar.

As Wikipedia points out:

The ancient Greeks had two words for time, chronos and kairos. While the former refers to chronological or sequential time, the latter signifies a time lapse, a moment of indeterminate time in which everything happens. What is happening when referring to kairos depends on who is using the word. While chronos is quantitative, kairos has a qualitative, permanent nature. Kairos also means weather in both ancient and modern Greek. The plural, καιροί (kairoi (Ancient Gk. and Mod. Gk.)) means the times.

This idea of time is a new concept for most of us – that there is a notion of time that is non-linear, and of a quality as opposed to quantity.  Most of us live by chronos, chronological time, but there are other aspects and qualities of time.  English does not carry the distinctions that are implicit in other languages.  In this respect of counting, of numbered days, chronos (NOT to be confused with Kronos or Cronus for you mythology lovers) may be a harbinger of death, as it is finite for each of us in this life.

But what about kairos, what kind of time, the quality of our existence, not its measure?  For many of us, this simply doesn’t count because it doesn’t “add up” and we can’t readily exchange it as the reducible currency of so much of our modern existence.  How many instances of “right now” are there in an hour? What is the present as something measurable if we are always counting the past and measuring the future?  Kairos represents the quality of time as immeasurable, an eternal right now that is the only time that we really have.  The chronological time is what we count, not what we experienced or will experience.

I have written about kairos in a previous blog post and will undoubtedly write more about it in the future.  In the meantime, take this opportunity to live in kairos and have the difficult conversation on this day!

©Barbara Cashman 2013

New Colorado Law Regarding Joint Filing of Tax Returns for All Married Couples

denver elder law

my violets


I will start with a reminiscence. Back when I was in law school (alas, the previous century. . . !) I think I can remember at least one thing from my family law class.  That was the axiom “a marriage valid where celebrated is valid everywhere.”  That was thanks to the Full Faith and Credit Clause of the United States Constitution, which states

Full faith and credit shall be given in each state to the public acts, records, and judicial proceedings of every other state. And the Congress may by general laws prescribe the manner in which such acts, records, and proceedings shall be proved, and the effect thereof.

U.S. Const., Art. IV, section 1.  You U.S. history mavens may recall that the Articles of Confederation included a part of this language, but it didn’t [like the rest of the Articles, and the Confederacy as a whole] go quite far enough, so James Madison’s request for supplemental language at the Constitutional Convention was adopted.  If you really want to go crazy on this one, read The Federalist Papers, No. 42. . . .

It may not sound like such a pronouncement would really be necessary, but that conclusion would skip over much of our history.  In our present context of “domestic relations,” remember that Colorado, along with a handful of other “frontier” states, has for many years recognized common law marriage.  That was an issue for tax filing for those couples, as those common law marriages weren’t valid in other states.  Hence, the Revenue Ruling.  In Colorado, it remains one of the indicia of common law marriage – that a couple is “holding out” as married for federal tax purposes.  In case you’re wondering, I will cheerfully decline this opportunity to explain in any detail the legal significance of a “Revenue Ruling” by the Internal Revenue Service.  Under our administrative law system, I will cite Wikipedia:

A Revenue Ruling is “an official interpretation by the [Internal Revenue] Service that has been published in the Internal Revenue Bulletin. Revenue Rulings are issued only by the National Office and are published for the information and guidance of taxpayers, Internal Revenue Service officials, and others concerned.”26 C.F.R. sec. 601.601(d)(2)(i)(a).   Revenue Rulings are published “to promote correct and uniform application of the tax laws by Internal Revenue Service employees and to assist taxpayers in attaining maximum voluntary compliance by informing Service personnel and the public of National Office interpretations of the internal revenue laws, related statutes, treaties, regulations, and statements of Service procedures affecting the rights and duties of taxpayers.” 26 C.F.R. sec. 601.601(d)(2)(iii). See, generally, Mitchell Rogovin & Donald L. Korb, “The Four R’s Revisited: Regulations, Rulings, Reliance, and Retroactivity in the 21st Century: A View From Within”, 46 Duquesne Law Review 323, 330 (2008).

The federal Defense of Marriage Act changed all that Full Faith and Credit status quo. It was a reaction to the passage of state laws recognizing same gender marriage and “tweaked” if you will, the Full Faith and Credit Clause.  The old IRS Revenue Ruling from 1958 [Rev. Rul. 58-66] was re-engineered in light of the decision in United States v. Windsor, 570 U.S.___, 133 S. Ct. 2675 (2013) which held parts of the Defense of Marriage Act unconstitutional.    You can read the new Rev. Ruling 2013-17 here.  This Rev. Ruling basically reinterprets “husband” and “wife” to include same-sex spouses for purposes of the Internal Revenue Code.  The IRS also has a helpful FAQ on their website that basically says, if you were married somewhere in a domestic or foreign jurisdiction whose laws recognize the marriage of same-sex spouses, then you can file jointly.

I don’t usually say this in a blog post but this post is NOT to be used as any kind of tax advice, as this is educational information only about the new Colorado law.  Based on my reading, for educational purposes only as I have said – this in NOT tax or legal advice for your particular situation – the bottom line for Colorado same-gender partners is – you have to be married outside Colorado to avail yourselves of the joint filing benefits, as a Colorado civil union will not get you there.  I do not mean this to minimize the importance of the new statute to clarify an otherwise rather murky situation.

So what about the details of this bill signed into law by Gov. Hickenlooper on Feb. 27, 2014 (SB 14-109, entitled “Concerning the State Income Tax Filing Status of Two Taxpayers Who May Legally File a Joint Federal Tax Return.” )? Well, you can read it here.  It basically says that if federal law allows you, as a married couple, to file jointly for tax purposes (according to the Rev Rulings), then you can file jointly for Colorado purposes.  If you don’t meet the standard under federal law, then no Colorado joint filing is available. Fairly straightforward, but also very complicated.  I really thought this would be a short post . . .  I tried!  thanks to T and P for “calling for the question.”

  ©Barbara Cashman  2014

PS No blog post next week. . . .

Longevity Planning for Childless Adults

Fall at Monet Garden, DBG

Fall at Monet Garden, DBG

Okay, I’ve written about several different scenarios in the estate and disability planning context, along with identifying some of the difficult conversations and decisions people need to make while they have the luxury of time to carefully consider things, not in the midst of crisis or catastrophe.  Many older adults, individuals as well as couples, do not have children.  Without children, there is no automatic safety net (whether you consider that accurate or not, that is the subject of another blog post!) for persons doing disability or longevity planning and no “natural bounty” for their estate planning.  Some of my clients have been childless adults who have provided care for an aging parent.  Some of them have asked themselves – who will provide this care for me?

I am going to focus on the longevity and disability planning angle here.  This topic came to me via Professor Rebecca Morgan’s post in the Elder Law Prof Blog entitled “Who Are the Caregivers for Elders Without Children?”  Her short post cites to a NY Times post of Feb. 14, 2014 entitled “The Childless Plan for Their Fading Days.”  This topic was discussed by my study group (a small group of women estate and elder law attorneys) in the context of new Colorado legislation that is focused on a subgroup within that childless segment of elders, the elders who are in frail health and have lost the capacity for decision-making and who do not have family members or others.  These are folks who have no named proxy or surrogate decision makers (like an agent under a health care power of attorney) and are “friendless.”   This is a challenge for persons receiving care in institutions as well as those residing in their own homes.  Unlike many other states, Colorado does not currently have an Office of the Public Guardian, but one is being examined through a Public Guardian Advisory Committee.  You can read a good 2005 study entitled “Wards of the State: A National Study of Public Guardianship” here.

If you are an elder without children, there are many questions that must be asked and answered in order to put together a “safety net.”  One of the questions posed in the NY Times article above is “what are those childless people doing with all that extra money?”  Those of us with children are familiar with the economics of child-rearing!  Of course many parents hope to leave an inheritance of some kind to their offspring.  Interesting though that so many baby boomers with kids, who as a class are the recipients of the largest transfer of inherited wealth, don’t plan on leaving their kids a dime – they plan on spending it before they die.

This intersection of financial planning and disability planning known as longevity planning is a tightrope walk because none of us can see into the future to determine how much money we will need, for what kind of living expenses (or global travel) – let alone how long we will live….  A growing number of Americans are opting out of the view that doctors should do everything possible to keep a patient alive. You can read the Pew Research Center’s 2013 report on this topic here.

But here’s a good place for a single person with no kids to get started:

  • Identify who will be the agent under a health care power of attorney.  This person will be the one who can give informed consent for medical care in the event the person, known as the principal for POA purposes, and should be well-informed of the principal’s health care values, end-of-life wishes and so on.
  • The health care agent would be well-informed to know of the principal’s desires about “aging in place” or staying at home and receiving care if such is needed.  In the relatively rare event that the health care POA does not work for its intended purpose (to avoid the need for initiating guardianship proceedings), the agent is typically nominated as guardian.
  • Bottom line here is to make it easy for people to be able to help – and the most important step is identifying those people and providing them with the information they need in the event they need to act as agent.
  • Financial matters can be a bit more challenging of several different levels, but there may be more options available to people now that there are more persons employed as professional fiduciaries who take care of a person’s bills, manage their investment portfolios and lots of activities in-between.

Childless persons can be creative about who they tap for these types of jobs.  Friends who are age-mates might be problematic, but most people have nieces, nephews, friends, neighbors and other community members who would be willing to serve in these roles.  It is best when a person initiates this conversation on their own, when such services are not needed, as if there is an emergency and someone “swoops in” to assist in a pinch – this may not always be for the right reasons or for reasons which serve the principal’s needs and interests.  Best to follow that Boy Scout motto and be prepared!

“If the only prayer you said in your whole life was, thank you, that would suffice.”

― Meister Eckhart

 ©Barbara Cashman  2014

What’s a Boomer to Do? A look at Continuing Care Retirement Communities


dad's gone fishing

dad’s gone fishing

A few months back I had some friends over for brunch.  They were all baby boomers coming up soon on retirement age.  One of them, Mark, encouraged me to write a post about all the continuing care retirement communities (CCRCs) that are sprouting up and what people might want to know about this type of living arrangement.  This is a broad topic, especially for us boomers who love to exercise our independence and self -expression.  Let’s face it, the medical-model of the nursing home, or SNF (skilled nursing facility) as folks in my line of work are prone to call it, is no longer the predominant model of infirm or old-age care.  Some would argue whether it ever occupied that status. This post is about considering options.

Many of us are by nature planners, and retirement planning and estate planning go hand-in-hand, just as does disability or life-care planning.  Maybe there are too many hands here. . . !  My point is that the disability aspect comes into play as a result of increased longevity in our country.  While we are lengthening our days considerably, we have no way of knowing whether our retirement savings will outlast us, nor do we know whether we will need any assistance from others – family members or hired professionals – to help us pay our bills and assist with our day-to-day living.  This topic is huge, so I am narrowing it to just the FAQs about CCRCs.

The American Association of Homes and Services for the Aging defines a Continuing Care Retirement Community (CCRC) as “an organization that offers a full range of housing, residential services, and health care in order to serve its older residents as their needs change over time.”  The focus is not on the medical needs of older persons but rather on helping people maintain a sense of independence and community.  There are still many people who cling to the idea that the only way to maintain their independent lifestyle is to live on their own is a house that may be difficult and even dangerous for an older person to maintain.  The growth of independent living, assisted living and CCRC-type communities attest to the relaxation of that otherwise inflexible approach to an independent lifestyle.

Well, these CCRC’s have been around for many years, even if many of them fell on some pretty lean times over the last decade or so.  Belt-tightening seems to be easing and optimism often appears less guarded these days.  Here’s a recent post about the market boom of a boomer market in assisted living developments.

Many families are undoubtedly going to continue with their multigenerational living arrangements, and you can read my blog post about that topic here.    In the Denver metro area of Colorado, there are several CCRCs.  Each one has different arrangements for how to enroll, pay rent, buy into, and generally become a member of the community.  For the vast majority of us who have little or no long term care insurance, these living arrangement can provide a certain amount of peace of mind.  Check out the AARP’s article about CCRCs here.

What is a CCRC?

A CCRC is a community which is designed for people aged 60+ (the age often varies) and provides a continuum of residence-based care.  Beginning with independent living, one can expect private, low-maintenance housing – as in an apartment or cottage home along with a built-in community.  The “continuing care” part comes into play in the event a person needs or wants additional services like housekeeping, transportation, and security.  You can expect community attracting spots like a fitness center, performing arts center, along with various dining venues.  There are also plenty of activities to keep people socially engaged like classes, field trips and the like.

What about the “care” in CCRC?

As far as the care part goes, this often encompasses on-site care that including assisted living, memory care, skilled nursing, and rehabilitation services.  It is by nature a continuum, designed to offer services in the event they are needed in a nearby setting.  These care include in-home services, assisted living, memory care, skilled nursing, and rehabilitation services.  This can simplify things especially for a spouse of life partner of a person who needs more care and services.

How does someone go about finding an appropriate CCRC?

CCRCs began to crop up as not-for-profit based communities, often sponsored by faith communities or other similar affiliations for people.  Many CCRCs have cropped up in more recent years that are for-profit institutions.  There is a listing of many of these types of communities under the guise of the Commission on Accreditation of Rehabilitation Facilities, and another acronym is CCAC for Continuing Care Accreditation Commission (in case you might have wondered about the nature of “rehabilitation” in the facility) along with important standards to consider.  Keep in mind that there are many types of CCRCs and many homes are not yet accredited and there are different types and levels of accreditation.

Why are the location and setting of a CCRC important?

CCRCs can offer a full-service lifestyle right on campus. This can be very important for a couple to maintain an independent lifestyle but still allow a spouse who may suffer from health challenges to receive care within the community while providing support for a caregiver spouse.  Many residents  appreciate having easy access to greater community amenities such as cultural, recreational, spiritual, and retail offerings. Additionally, residents often choose a location that allows them to maintain close ties with family and friends.

Do I have to rent or can I own a home at a CCRC?

Some CCRCs offer equity, but most do not involve a real estate transaction. If you are looking carefully at these options or considering them for another, read the contract very carefully.  There is no “standard” type of contract for these living arrangements. Many communities offer an entrance fee plan, guaranteed by a contract or residency agreement that entitles residents to occupy their chosen cottage or apartment and use the common area amenities, programs and services. The one-time entrance fee – which is usually partially or fully refundable – also assures residents access to the on-site continuum of health care.   I am familiar with one local facility that had a $10,000 “fee” chargeable to a resident’s move from a two-bedroom unit to a more affordable (from a monthly rent standpoint) one-bedroom unit after the spouse passed away.  Keep in mind there are typically monthly service fees that come into play as well, depending on one’s circumstances.  If you are considering a move to a CCRC, for yourself or a loved one, please take the time to carefully read the contract so that there are no surprises.

CCRCs are a relatively recent development in living arrangements that are designed to encompass different living arrangements in a single community, thereby obviating the need for someone to move to a different residence or facility as their care needs increase.  It will be interesting to see how they evolve in the coming years.

 ©Barbara Cashman

Conscious Living, Engaged Elderhood and Spirituality


Happy Thanksgiving!

Okay, it’s Thanksgiving week, which means many of us will be spending time with family and others on whom we depend for love and support.  It is a perfect time to talk about end-of-life issues and other big questions so important to our living of life. There is also that detail that we’re getting close to the end of the year, which means it’s  list-making time . . . .  As a self employed person, I make every effort to start this in November! So, in this post I’ll combine that conscious living topic with a list.  On the top of  the list for my purposes here is a quote from a favorite poet of mine, e.e. cummings, who observed

unbeing dead isn’t being alive.

Aging and community, makes me think about the topic of aging as a spiritual practice.  Lewis Richmond is an author who has written about that very topic, and he has a great youtube video about this you can watch here. Conscious aging is really about what we do with our lengthening days, what is the purpose of our longevity and how will we spend it?  These are big questions that I’ve blogged about before and will again in the future.  What I like about Richmond’s message is its simplicity.  He defines the spiritual practice of aging as

paying close attention to the things that really matter.

Conscious aging and engaged elderhood can help us get to a place where we want to be at the end of our lives, a place where we are not burdened with regrets in our backward look at our life, our “life review.”  That reminds me of that 1991 Albert Brooks film “Defending Your Life.”  Will we wait till the end, after it’s all over and too late to make changes, or can we live and age consciously and make adjustments as we go along.  The answer is of course as unique as each of us, each of our lives.  Fortunately, if we are inclined to think about making these changes in our lives, there are many models and lots of support.

So, on that topic of living consciously and without regret, here’s an interesting list from an AARP article from 2012.   The author, Bonnie Ware, worked for many years in palliative care (though it sounds more like hospice to me) and so spent time with many folks during the final weeks and months of their lives.  The theme of this article resonated with me as I had recently explained to a couple clients the therapeutic benefits of estate planning and considering one’s own mortality in the story of Alfred Nobel and how he came to fund the renowned prizes named for him.  Hint: he got to read his own erroneously published obituary, and so he could dramatically change the course of his legacy.  Yes, I wrote a blog post about it and you can read it here.    So back to the list. I think this  list can be used as a great jumping off point for the search for meaning in our lives.

1. I wish I’d had the courage to live a life true to myself, not the life others expected of me.

Ware lists this as the most common regret of all.  I think we tend to idealize this and forget that this one requires real courage to live in and to enact during our lives.  We often don’t think about how difficult it is until we sense that we are not on that path to ourselves, which is a path uniquely our own and which can’t be defined by others or external standards or measurements.

2. I wish I hadn’t worked so hard.

The author worked with older people and  noted that “this came from every male patient that I nursed.”

3. I wish I’d had the courage to express my feelings.

This is essentially the courage to become who we already are.  Sounds like I have tenses mixed up – but I don’t!  On that topic of expressing feelings, I think of Dr. Ira Byock’s four things: I love you, please forgive me, I forgive you, and thank you.

4. I wish I had stayed in touch with my friends.

This regret is also about the choices people have made, conscious or unconscious, about how their time was spent.  I liked Ware’s observation under this point: “that is all that remains in the final weeks: love and relationships.”  I think this is an important point that we can be reminded of if we choose to embrace our mortality and the uncertainties of life.  Perhaps it is really all that we had all along, all we had that mattered and when we strip away all the things that we accumulate in our identities, the love is what remains.

5. I wish I had let myself be happier.

Might sound odd, but Ware notes that many folks didn’t realize until nearly the end that happiness is a choice.  This seems to be such a huge secret for so many people.

In closing, I found a nice list of books for older adults, those in the “second half” of their lives here.    I also liked the tab under “mystery” which is offered as a means to develop a heightened sense of wonder in the face of a mainstream reductionist approach to living.  Wonder and uncertainty, the beauty of the present unfolding is far preferable for many of us than the tidy certainties we tell ourselves to explain away nearly every beautiful wonder of this world. I think Ware’s article confirms this in many important ways.  May each of us have a meaningful Thanksgiving!

©Barbara Cashman 2013

Disabled adults, Special Needs Trusts and Medicaid: the Importance of Planning

Storm near Barr Lake, August 2013

Life can be complicated, especially if you are a parent or guardian of a disabled person who receives government benefits.  If you don’t make any plan or make an estate plan which fails to adequately address a disabled beneficiary’s receipt of government benefits, an inheritance can jeopardize a disabled recipient’s qualifications for needs-tested (income or asset-based) government benefits.  Sometimes a parent’s estate plan will effectively disinherit the disabled adult child, leaving a request encouraging a nondisabled adult child to “do the right thing.”  At the other end is a devise or inheritance left outright to a disabled beneficiary.  This post-mortem planning can create a lot of stress for everyone involved, and it can interfere with the grieving process and put strains on the ties between siblings and other family members.  In my estate administration practice, I have seen both of these scenarios play out.  I don’t recommend either as a viable choice for a thoughtful planner.  So – what are the alternatives?

I recently read the June 2013 issue of Bifocal (a really interesting e-zine published by the American Bar Association’s Commission on Law and Aging), which had a good article about pooled trusts.  These types of special needs trusts offer flexibility for families of modest means in planning for disabled family members.  Read it here.

So what would “modest means” be for purposes of a pooled SNT?  I recently spoke with Megan Brand, executive director of the Colorado Fund for People with Disabilities.  (CFPD is the longest-standing, locally administered pooled trust in Colorado.)  Her rule of thumb for a disabled young adult is to encourage a pooled SNT where there is less than $150,000 set aside for such person’s benefit.  If you’d like to learn more about the different types of trusts and planning for the needs of disabled family members and loved ones, I encourage you to attend the Colorado Guardianship Association’s  next educational presentation on Tuesday, September 10, 2013 at Porter Place,1001 E. Yale Avenue from 8:30 am – 10:15 am.  Megan will present on Pooled Trust, Individual Trust, Supplemental Needs Trusts, Disability Trusts, Special Needs Trusts Income Trusts,  1st Party, 3rd Party… What does all of this mean?  How do they differ? How are they the same?  What trust is the best fit for my client or family member?  Once they have a trust, what can it be used for and how do we actually make the purchase happen?   To register online for this program, click here.

Here’s a link to another helpful article about the importance of planning and considering the impact on SSI and Medicaid qualification of the disabled person.  But don’t be fooled into thinking that special needs planning involves merely trusts!  Trusts are important documents but it is a good idea to look at the big picture and talk with someone (like an elder law attorney) about how best to devise a plan assist a disabled person with financial, medical and personal care planning.  Another good resource is Hal Wright’s 2013 book entitled “The Complete Guide to Create a Special Needs Life Plan.”  I checked it out from my local library.    This book is a thoughtful approach (by a Certified Financial Planner) about how to devise a plan for a disabled child to ensure access to services to meet those special needs to maintain emotional, financial and other important resources.  At the top of his list of importance are the following three components of an estate plan: preparation of appropriate legal documents; establishment of an SNT; and getting guardianship and/or conservatorship status in place.  If you’ve been thinking about what you need to do to put a plan in place for a disabled adult – please don’t wait until it’s too late to plan.

©Barbara Cashman 2013

Fear and Boredom in Retirement

Okay, at first blush you might think this is some kind of takeoff on that Hunter S. Thompson novel, but no, not at all (just the same number of syllables) – it’s just my sometimes warped sense of humor.  I’m on a roll – I delivered documents to a client for signing today and made jokes about my lack of appropriate “execution” attire to my two witnesses.

A few weeks back I was talking to a retired teacher who lives in my neighborhood.  She mentioned in an offhand sort of way that retirement was boring.  I didn’t really know her well enough to ask a deeper question in response, and the conversation proceeded to other topics.  I think boredom is a big problem for many retired people.  I think of my favorite high school teacher who died several months after retirement.  I know that death soon after retirement is an extreme example of what I ‘m talking about here, but the bigger questions is – what do we do with our time that is remaining?  What is boredom anyway – is it a psychological or emotional phenomenon, a cultural phenomenon – could it lead to an early demise?  I think the answer is “yes” to all of the above.  In the July/August 13 issue of Scientific American Mind article by James Danckert entitled Descent of the Doldrums,  the author (a professor of cognitive neuroscience)  identifies two types of subgroups for the study of boredom in people: (1) agitated boredom in which people tend to rely heavily on external stimulation, where the expectation is that the world is to deliver their entertainment rather than attempting to amuse themselves; and (2) apathetic boredom, which goes by the colloquial term “couch potato” which is essentially disengagement.

The first type, which can include ADHD and traumatic brain injuries tends to be more troubling at least externally  because it can manifest in risky behavior that can lead to disastrous consequences.  But I wonder about the second type of boredom and elders.  Asking oneself “is this all there is?” after reaching the promised land of retirement – only to find it isn’t what it was cracked up to be . . . .can also lead to an early demise but is probably driven more by internal factors.  A 2009 article in the International Journal of Epidemiology concluded that “those who report being bored are more likely to die younger than those who are not bored.” . . . . Finding renewed interest in social and physical activities may alleviate boredom and improve health, thus reducing the risk of being “bored to death.”

So lumping these two articles together, I make the connection that the higher degree of boredom, the greater likelihood that a person would show depressive symptoms and low motivation – an interesting boredom and depression link here – and the increased risk of cardiovascular disease and premature death.

I also found a 2007 article with a similar title interesting   and it discusses the individual differences as well as gender factors (men are more likely to be bored than women) that contribute to the wide gulf of feelings  that are or flow from boredom.  I tend to think (as a mother of teenagers) that the always on, networked environment that surrounds young people and those of us who identify as “digital immigrants” contributes to boredom as an inability to entertain ourselves.  Its implications for being able to relate to other human beings on an emotional level is a topic I have blogged about previously in a GriefLink   post  .

So we can think of many behaviors associated with the state of boredom and many reasons that can contribute to a sense of boredom – but what is it and why should we care?  On a big picture level, boredom is essentially a disconnection from the present tense, being engage in your life as a purposeful activity.  Many of us suffer through jobs we don’t like or find meaningful and we might look forward to that far away notion of our retirement like a ship on the horizon coming to rescue us.  Funny thing is that once many people transition to be retirees, it is as if something flips – our orientation to the present is still distant from our perception and experience of life, even as that ship takes us away from the island, the island becomes the backward-looking focal point against which experiences are measured.  A good recent literary example of this phenomenon is found in the 1983 book “The River Why” by David Duncan.  He writes of a “lifelong dream” that turns out to be hollow and meaningless.

I liked what Robert Sardello wrote about soul boredom and fear in his book Love and the World:

One feels boredom when there is a desire for new experiences, while at the same time new experiences are not allowed to enter.  I feel bored when I want to do something but do not know what to do because the prospect of doing something really threatens old conceptions.  Boredom may be the primary malady of the age.

R. Sardello, Love and the World (2001) at 103.

In some ways, certain forms of dementia are a process of forgetting who we are in our personal identity.  For some people this can manifest as an inability to remember the past as well as anticipate the future –  which means there is only the present moment, with no other relational context.    So – what to do with the boredom and emptiness, the hollowness of interior when you arrive at a place that looked so completely different when it was a far away goal?  This crisis of meaning is a wonderful opportunity to examine a life’s purpose, the journey so far.

©Barbara Cashman 2013