Retirement Living News

September 2007

HEADLINES  (Click on headline to read story)

• Florida Still Leads As a Retirement Destination 
  But is Losing Ground to Other States
• Medicare to Stop Paying for Some Hospital Errors
• Survey Findings Present 'The New Old Age'
• NCSL Survey Shows Changes in State Tax Budgets for FY2008
• Study Finds Job Loss Near Retirement Doubles Heart Attack Risk
• New Book: The New Retirement-The Ultimate Guide to the Rest of Your Life  (Second Edition)

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NEWS STORIES

Florida Still Leads As a Retirement Destination 
But is Losing Ground to Other States 

In the retirement destination popularity contest, Florida still gets the most 60-plus people moving to the state, but that number is decreasing. The U.S. Census Bureau's annual American Community Survey (ACS) shows that Florida has dropped from a high of 26.3 percent of all 60-plus migrants reported in the 1980 census to 19.1 percent in the 2000 census report to 16.6 percent in the 2005 ACS report. Texas has jumped to the number two position after being the fourth most popular destination in the 2000 census, and Arizona has dropped to number three. Georgia has traded places with North Carolina as the fifth and sixth most popular destinations. Nevada, which previously was number seven, has now dropped to number 11. 

In-migration does not tell the whole story since migration streams go both ways. Another look at the net change of both in and out migration reveals perhaps a more important picture of population change. Florida and Arizona maintain their positions in the net rankings from the 2000 census while North Carolina, Nevada and South Carolina slip from their previous third, fourth, and fifth places. The table below lists the top states by net migration, according to the ACS. 

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Medicare to Stop Paying for Some Hospital Errors

Under new Medicare regulations, hospitals will no longer receive higher payments for the additional costs associated with treating patients for certain hospital-acquired infections and medical errors. The new rules will give hospitals a powerful new incentive to improve patient care, according to Consumers Union, the nonprofit publisher of Consumer Reports. 

"Every year, millions of Americans suffer needlessly from preventable hospital infections and medical errors," said Lisa McGiffert, Director of Consumers Union's Stop Hospital Infections' campaign. "These new rules are a good beginning for Medicare to use its clout to mobilize hospitals to improve care and keep patients safe." The consumer advocate organization has an ongoing program to protect consumers and seek public disclosure of hospital-acquired infection rates. http://www.StopHospitalInfections.org, 

Under the rules adopted by the Centers for Medicare and Medicaid Services (CMS), payments will be withheld from hospitals for care associated with treating certain catheter-associated urinary tract infections, vascular catheter-associated infections, mediastinitis after coronary artery bypass graft (CABG) surgery, and five other medical errors unrelated to infections (bed sores, objects left in patients' bodies, blood incompatibility, air embolism, and falls). The new rules will go into effect in October 2008. 

To comply with a 2005 law passed by Congress, CMS evaluated a number of serious, preventable health care acquired conditions and identified these eight for the first round of non-payment due to the high volume of patients affected, the high cost of treating patients, and the existence of prevention guidelines. The agency intends to consider other hospital-acquired infections and medical errors for non-payment in future years. 

The new Medicare regulations include protections to prevent hospitals from billing patients when payments are withheld and to minimize avoidance of patients perceived to be at risk for infections. "We are pleased that the rules clearly state that hospitals cannot bill patients for the amount that Medicare refuses to pay," said McGiffert. "CMS will need to make sure these protections are enforced so patients are treated fairly. And the agency should be on the lookout for hospitals that try to game the system by falsifying codes to avoid nonpayment."

Catheter-associated urinary tract infections are the most common infection developed by patients in hospitals. The Centers for Disease Control and Prevention (CDC) has reported that there are 561,667 catheter-associated urinary tract infections per year. According to a study in the American Journal of Medicine, the annual cost of urinary tract infections in hospitals is as much as $451 million. 

Bloodstream infections are high in volume and cost, and are preventable. The CDC has reported that there are 248,678 cases of central line associated bloodstream infections every year. The Institute for Healthcare Improvement estimates that approximately 14,000 people die every year from central line- related bloodstream infections. 

CMS failed to address the incidence of infections caused by methicillin-resistant staphylococcus aureus (MRSA), a virulent antibiotic resistant bacterium. According to CMS, over 95,000 Medicare patients had MRSA infections in 2005, running up hospital charges of almost $3 billion. MRSA was not selected for nonpayment because of coding issues and because CMS does "not believe there is a consensus among public health experts that MRSA [infection] is preventable." 

"CMS needs to take strong action to curb the spread of this powerful superbug," said McGiffert. "Many hospitals do not share the attitude that MRSA infections cannot be prevented and CMS should be on the front lines with them fighting this deadly and costly problem." 

Hospital-acquired infections are a leading cause of death in the United States. The Centers for Disease Control and Prevention (CDC) estimates that 2 million patients suffer from hospital infections every year and nearly 100,000 of them die. Research shows that hospitals could prevent many infections through stricter adherence to proven infection control practices. 

A copy of the new CMS regulations can be found here (begin at page 290): http://www.cms.hhs.gov/AcuteInpatientPPS/downloads/CMS-1533-FC.pdf.
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Survey Findings Present 'The New Old Age' 

Seventy is the new 50, according to the 2007 HSBC Future of Retirement survey. The survey was conducted HSBC, an insurance holding company, and Oxford University's Institute of Ageing. "Older people are healthy, active, and in control of their own lives to a much later age," says the report. Such findings support the services senior living providers offer residents, such as exercise and continuing education classes, field trips, and social events. 

Nearly three quarters (72%) of U.S. survey respondents ages 70-79 say they often feel able to do the things they want to do; more (74%) say they are looking forward to the future. 

Survey findings are presented by country (21 countries in all) and by "mature" vs. "transitional" economy categories. For example, people in their 60s in countries with mature economies feel more in control of their lives (measured by a 10-point control index scale) than people in their 50s. 

The Future of Retirement survey included 21,000 individuals in 21 countries and territories across five continents. To read more results, go to www.ageingforum.org.
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NCSL Survey Shows Changes in State Tax Budgets for FY2008

In its summer survey of state legislatures, the National Conference of State Legislatures (NCSL) reported that Florida tax revenues, as projected in March revenue estimates, will be insufficient to fund the FY2008 budget as passed. A special session is expected in September to make decisions about budget cuts.

This and other tax information is contained in the NCSL State Budget & Tax Actions 2007: Preliminary Report just released. Forty-five states provided budget information for the report. California, Illinois, Michigan, North Carolina and Wisconsin had not completed their budgets by the time the report was written in late July so their tax changes are not included. 

States made relatively few tax changes in 2007. As a whole, the 41 reporting states have cut personal income and sales taxes, and increased healthcare and tobacco taxes. No state enacted a major tax increase in order to reduce local property taxes. Although a number of states have enacted property tax reduction packages, they have either been funded by appropriations or have been mandated upon local governments. 

The final issue of this report is to be published in early 2008 and will capture all property tax data and information reported by the states to NCSL. 

Twenty states cut income taxes while three increased them. Louisiana will reduce income taxes by increasing its allowance of federal itemized deductions. South Carolina will cut income taxes by removing the tax liability at its lowest income tax brackets. Nebraska changed its standard deduction and tax brackets. New Mexico cut taxes through a variety of reductions aimed primarily at low-income and middle-income taxpayers. 

Eighteen states cut sales taxes while six reported changes that will increase sales tax revenue. South Carolina exempted groceries from its sales tax beginning in November. Arkansas also reduced the tax on groceries. Two sales tax holidays in Florida will largely account for a sales tax reduction in that state. Georgia, Louisiana, Oklahoma, Tennessee and Texas will also provide sales tax holidays in 2008. 

Tobacco and alcohol taxes were increased more than any other kind of tax in 2007. Seven states increased them and one state slightly reduced the tax. Tennessee tripled its tax on cigarettes, Indiana is adding a 40-cent increase, and Iowa raised cigarette taxes by $1 per pack. Louisiana extended a wholesaler discount that will reduce its tobacco tax collections. Arkansas was the only state that increased its alcoholic beverage tax.
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Study Finds Job Loss Near Retirement Doubles Heart Attack Risk

Involuntary job loss near retirement more than doubles the risk of heart attack and stroke, according to researchers at the Yale School of Medicine. The results are based on 10-year observations of 4,301 individuals between ages 51 and 61, of whom 582 had lost their jobs during that period. The study is the extension of an earlier study, in which the same sample was tracked for six years. That research indicated heightened risk of stroke, but not a definitive link between job loss and heart attacks. 

"With longer follow-up of heart attack and stroke events, we were able to better assess the association between employment separation and the medical outcomes," says William T. Gallo, the lead author of the study and associate research scientist in the Department of Epidemiology and Public Health at the Yale School of Medicine. 

The researchers used 10 years of data from the nationally representative Health and Retirement Survey in their research. Starting with a sample of employed individuals, they identified 582 workers who were either laid off or left jobless because of a business closing. The study compared their risk of heart attack and stroke to a group that included 3,719 workers who remained employed. In considering the effect of job loss, the researchers also took into account other risk factors such as smoking, high blood pressure, obesity and depressive symptoms.

"Job loss is associated with a range of stressful outcomes, including loss of pay and non-wage benefits, limited access to medical care, and severance of identification and work-based social support," says Gallo. "Older individuals could be at increased risk for stress after being let go from work. We know that workers over 50 may have difficulty finding new positions, which frequently offer lower compensation than the pre-separation job did. This can obviously affect their later pension amount." 

Gallo says that physicians that treat individuals who lose jobs as they approach retirement should consider the loss of employment a credible risk factor for adverse vascular health changes. Similarly, policy makers should also be aware of the risks of job loss, so that intervention programs can be implemented to ease the multiple burdens of unemployment. 

Co-author Elizabeth Bradley says, "We do a lot of downsizing in our country and older individuals are often affected. We need to recognize not only the economic consequences, but also the health consequences." The study results were published in Occupational and Environmental Medicine (October 2006).
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New Book: The New Retirement--The Ultimate Guide to the Rest of Your Life (Second Edition)

When the first edition of The New Retirement - The Ultimate Guide to the Rest of your Life was published in 2004 it became a best seller among people planning their retirement. It wasn't long before the authors, Jan Cullinane and Cathy Fitzgerald, realized that they would need a second edition that would include the latest research, emerging locations and communities, up-to-date financial information, and new anecdotes from people who are "walking the walk." 

The new edition now includes more information on relocating outside the United States (Costa Rica, Mexico and Panama) and information on specific communities/areas/lifestyles within the U.S. A very useful appendix is loaded with forms and worksheets that can help you to decide what you want out of your retirement and whether you should relocate or not. The book also contains a wealth of resources (Web sites and publications) to help you make important decisions. 

To order a copy of the book from Amazon, click here. 
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