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July 2014

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Ten Worst States for Retirement

It’s hard to be flexible on a fixed income. That’s why some of America’s prettiest, most vibrant locations are also some of the toughest on retirees.  They’re usually more expensive, for example, with higher rents and more expensive restaurants. Tax rates also tend to be higher in urban areas. They also may not be as safe, according to http://www.bankrate.com/.  The company recently released its 2014 ranking of the 10 worst states for retirement.

Bankrate ranked each state based on a variety of factors that everyone should consider before making a move into — or out of — their home state. They include a specialized cost-of-living index for retirees, crime statistics, tax rates and comprehensive weather data that factor in sunshine and humidity. Also new this year: Bankrate beefed up its ranking for health care quality, and consulted an extensive survey called the Gallup-Healthways’ Well-Being Index. The index gauges the level of satisfaction residents report about their surroundings.

The states that fell to the bottom of our list still have a lot to offer. In fact, many are home to the top tourism destinations in the world. The problem, in the end, is that choosing a good place to retire isn’t as easy as picking a vacation spot. Costs matter more. The local culture and infrastructure also matter.

The sources and the methodology used for the study can be seen below.

Sources: Agency for Healthcare Research and Quality; Healthways; the Council for Community and Economic Research; the FBI; the Tax Foundation, and the National Oceanic and Atmospheric Administration.

Source methodology: Bankrate collected the latest available statistics on cost of living, violent and property crime, health care quality, state and local taxes, wellness and weather (humidity, percent available sunshine and temperature). States were then given standardized scores, with more points going to a lower cost of living, lower crime rate, lower tax burden, stronger health care, better wellness grades and better weather. The scores were combined to create a composite score

Here, in descending order, are 10 of the lowest-ranking states for retirees based on Bankrate’s criteria.

Kentucky:  The states low cost of living is easy on the budget.  The biggest problem for Kentucky residents is the state’s health care system and low wellness scores.

The Agency for Healthcare Research and Quality, or AHRQ, gave Kentucky’s health care system its fifth-lowest score in the nation as part of its most recent quality report. The agency, which is part of the Department of Health and Human Services, has found numerous issues with Kentucky’s health care. It noted, for example, especially high rates of adults who didn’t receive timely care even though they needed it “right away” for an illness or injury.  Gallup-Healthways, which tracks emotional and physical well-being as part of an extensive national survey, gave Kentucky its second-lowest score behind West Virginia.

Maryland:  The primary knock on Maryland is that it’s more expensive to live there than in many other states. The cost of living for retirees is especially high, and residents pay one of the highest tax rates in the country.

According to the latest analysis from the Council for Community and Economic Research, retirees can expect to pay $1.12 more than the national average for a movie ticket and $9.58 more for a trip to the beauty parlor. Medications like Lipitor and ibuprofen also are higher than the national average.

The Tax Foundation calculates that Maryland residents pay 10.6 percent of their combined income in various state and local taxes. Its analysis, which includes property and sales taxes, says that Maryland is the seventh-highest taxing state in the country. Maryland also posted low scores for health care quality, and its crime rate is above the national average.

Oklahoma Oklahoma sank into Bankrate’s bottom 10, thanks to low scores in three main areas. Gallup-Healthways gave the Sooner State its ninth-lowest score in the country. It’s not surprising that the index, which asks residents about their emotional and physical health as well as how safe they feel, placed Oklahoma so low.

Oklahoma’s crime rate is one of the highest in the nation, with 3,870 violent and property crimes per 100,000 people. It also has one of the worst health care systems in the country, according to a government analysis.

The Agency for Healthcare Research and Quality gave Oklahoma the fourth-lowest score in the nation in terms of health care quality. The agency noted, for example, that the state has a poor record of delivering mammograms to women between 50 and 74. Patients at Oklahoma hospitals also gave their doctors and health clinics below-average satisfaction scores.

Louisiana:  Louisiana is a relatively cheap place to live, with a light tax burden and low cost of living. It’s everything else that’s pushed the Pelican State to the bottom of this year’s list.

Crime is a problem in Louisiana, with relatively high property and violent crimes. It also posted poor health care quality scores and a low ranking on the Gallup-Healthways’ wellness survey.

The weather can also be tough to endure, especially over the summer. Overall, Louisiana is the second-most humid state in the country, ranking just behind Mississippi. The average morning humidity is 90 percent in Lake Charles, Louisiana. In New Orleans, it’s 86 percent.

Alabama:  Like several other Southern states, Alabama was hit by poor health care quality and low scores from a Gallup-Healthways’ survey that showed weak emotional and physical health among residents.

Dan Witters, a Gallup research director who directed the Gallup-Healthways’ Well-Being Index, says states with low scores tend to follow similar patterns.

“The food they eat, basic access to health care, income, access to dentistry — it’s all really crummy. Rates of smoking are a lot higher,” Witters said. “That stuff permeates throughout the community. It’s consistent.”

In addition, Alabama’s crime rate is higher than average, and its weather is typically uncomfortably hot and humid.

Hawaii:  If it weren’t for the sky-high cost of living, Hawaii would be one of the best states in the country for retirees. Its remoteness, popular beaches, wildlife and culture make America’s 50th state a top tourism destination.  It also makes it tough to afford — especially for anyone on a fixed income.

The Council for Community and Economic Research, which tracks consumer prices around the country, found Hawaii to be the most expensive state in the country for retirees. A loaf of bread, for example, costs an average of $2.80 in Honolulu, according to the council’s 2013 analysis. That’s $1.30 higher than the national average. The city’s gas stations charged an average of $4.19 a gallon last year, compared with a national average of $3.44. And a trip to the beauty parlor costs an average of $52 in Honolulu, about $18 higher than the national average.

Arkansas:  Arkansas is certainly easy on the wallet. It’s the seventh-cheapest place to live for retirees, according to the Council for Community and Economic Research.

But  Arkansas struggled in every other category. It had the third-highest crime rate, the sixth-lowest rating for wellness and the eighth-lowest health quality scores. It also had above-average state and local taxes, with a combined rate of 10.3 percent, according to the Tax Foundation. It’s also one of the most humid states in the country, which can make Arkansas an uncomfortable place to live during the summer.

Alaska:  Alaska, which is heavily supported by the oil and gas industry, asks very little of its taxpayers. The state and local tax burden is the second-lowest in the country, just behind Wyoming, according to the Tax Foundation.  It’s a rare bright spot, given the number of challenges facing many of the state’s retirees.  Alaska receives some of the lowest scores in the nation for health care quality. It’s also one of the most expensive states, with a cost of living that’s behind only Hawaii.

It’s frigid In Anchorage.  Temperatures are consistently below freezing from November to February. Sunshine is a rarity in some parts of the state. Juneau, for example, gets less sunshine than any other city monitored by the National Oceanic Atmospheric Administration

West Virginia:  The Mountain State puts pressure on its retirees in a number of ways. Its health care system, for example, is considered by the government to be one of America’s worst, and its wellness score is at the bottom of the heap.

The Agency for Healthcare Research and Quality, which monitors state health care systems, gave West Virginia its second-lowest rating in the country. The agency noted such problems as high rates of “potentially avoidable” hospitalizations for chronic conditions and high rates of poor communication between patients and doctors.

Dr. Ernest Moy, who directs AHRQ’s state snapshot report, says states with low-quality health care tend to fail at disease prevention and management. They may not have strong vaccination or anti-smoking programs, for example. Doctors in those states may not recommend as strongly as others that patients take steps to prevent disease. And patients may not be as interested in or capable of following their doctor’s orders.

It’s really a cultural problem that cuts into health care quality, Moy says, and retirees should consider that before they move.  “If you go into an environment where most people don’t get preventive services, well, you might not want to get preventive services either,” Moy says.

New York:  This is probably not a surprise for anyone who lives (and pays taxes) in New York City. The Big Apple is home to nearly half of the state’s residents, and the city’s high taxes and cost of living has pushed the entire state into the very bottom of Bankrate’s ranking of worst states for retirees.

It takes a lot of infrastructure to cram 8.4 million people into New York’s five boroughs. Residents help pay for the extensive subway system, police force, parks staff and other services with a tax rate that’s second to none.

“Higher spending is the biggest driver” for New York’s 12.6 percent tax rate, says Elizabeth Malm, an economist at the Tax Foundation.  Besides the hefty tax bill, residents also deal with the fourth-highest cost of living in the country. The government also gives New York relatively low scores for health care quality, and New York received low scores in the Gallup-Healthways’ wellness survey.

The weather also can be pretty rough, with frigid winters and the potential for hurricanes later in the year.

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 AARP Report Shows Gradual Improvement in State Long-Term Care Performance

While states are making measureable progress in improving long-term services and supports (LTSS) – which includes home care services, family caregiver supports, and residential services such as nursing homes – widespread disparities still exist across the country, with even top performing states requiring improvement. Further, the pace of change remains slow, threatening states’ ability to meet the needs of the aging population.

AARP released a report last month titled,  Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities and Family Caregivers. It evaluates 26 indicators in five key dimensions that make up the LTSS system in each state. This state-by-state report updates the original 2011 LTSS Scorecard.

The highest ranked states – Minnesota, Washington, Oregon, Colorado  –  can offer lessons for possible solutions, but they too have opportunities for improvement. Leading states have implemented laws and policies that build stronger Medicaid programs and support family caregivers. These laws include paid sick leave, nurse delegation of health maintenance tasks, and devoting more Medicaid dollars to home and community based services. Top states also have lower use of nursing homes and minimize disruptive transitions between care settings, providing lessons for lower-ranked states.

“Americans want to live independently in their homes and communities as they age,” says AARP Senior Vice President for Public Policy Susan Reinhard. “States are starting to step up to meet this challenge, but more must be done in a short time to meet the changing needs of a growing older population. By addressing the findings in the Scorecard, states have the power to affect positive change both immediately and in the long run so older residents and their family caregivers can access the quality long-term services and supports they require.”

The LTSS Scorecard evaluates performance in five key dimensions:  (1) affordability and access, (2) choice of setting and provider, (3) quality of life and quality of care, (4) support for family caregivers, and (5) effective transitions. New indicators this year include length of stay in nursing homes and use of anti-psychotic drugs by nursing homes, raising serious concerns about the quality of institutionalized care.

Even facing tight budgets following the Great Recession, all states made progress in at least one of the Scorecard’s 26 indicators. In particular, more than half of the states (29) improved their laws and supports for family caregivers – including expanding family and medical leave requirements and laws requiring sick days, and allowing nurses to delegate health maintenance tasks to home care workers – and, 28 states improved the functioning of Aging and Disability Resource Centers, which help residents navigate available services and supports. At the same time, the cost of LTSS remains unaffordable for middle income families.

The single strongest predictor of overall LTSS system performance is the reach of a state’s Medicaid LTSS safety net. Nearly half the states (24) increased the percentage of Medicaid LTSS dollars that support home and community-based services – the care setting that most Americans prefer. However, widespread disparity exists across the states on this important indicator. While the five top-ranked states dedicate 62.5 percent of Medicaid LTSS dollars to HCBS, the lowest-ranking five only devote 16.7 percent.

“The report underscores the importance of public policies, including those that support providing care for people in their own homes and communities,” said Melinda K. Abrams, Vice President for Health Care Delivery System Reform at The Commonwealth Fund. “Without strengthening such services, we put millions of frail elderly and disabled at risk for frequent emergency room visits, hospital stays or poor quality of care.”

Further, states with more effective transitions – both those that help people move out of institutions and back to the community as well as those between care settings – performed better overall in the Scorecard.

The Scorecard’s authors warn of the demographic imperative to hasten progress. “In just 12 years, the leading edge of the Baby Boom Generation will enter its 80s, placing new demands on the LTSS system.  This generation, and those that follow, will have far fewer potential family caregivers to provide unpaid help,” the report reveals.

“This scorecard shows that all states have work to do on improving their systems of care, including assessing people’s needs in a uniform way, helping people transition back home after a medical intervention, and increasing the affordability of services regardless of who pays,” said Bruce Chernof, President and CEO of The SCAN Foundation.  “As recognized by last year’s federal Commission on Long-Term Care, the responsibility for realizing these kinds of improvements means greater action by both state and federal leaders.”

The full LTSS State Scorecard, along with an interactive map of state rankings and information, is available at www.longtermscorecard.org.

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Aging Boomers Expected to Occupy 10.7 million Households Over Next Decade

The aging of the baby-boomer generation over the next decade will increase the number of households aged 65 and over by some 10.7 million, increasing the demand for households that enable seniors to age in place.

From 2015 to 2025, the number of households aged 70 and older will increase by approximately 8.3 million and account for more than two-thirds of household growth, according to the Joint Center for Housing Studies (JCHS) of Harvard University’s latest State of the Nation’s Housing Report. The number of householders aged 60 to 69 is also projected to rise by 3.5 million, adding to the overall aging of the population.

“For those staying in place they’re looking to modify those homes to deal with changes [in mobility],” said Chris Herbert, research director for Harvard Joint Center for Housing Studies, during a JCHS webinar last month. Seventy-eight percent of home owners aged 65 and older intend to age in their homes, which points to a growing need for home care and other services, Herbert said. “We need to find ways to deliver services to people that are affordable,” he added.

Those in their 50s are facing a very different future than those who currently own and have retired in their homes.

Since 2002, the real median annual incomes among households in their 50s — the peak earning years for this group as they look to retire over the coming decade — have fallen by $9,100 among 50 to 54 year-olds and by $5,700 among 55 to 59 year-olds.

“There’s worry about those in their 50s getting to retirement and many have lost homes to foreclosure, or had to refinance to make ends meet — living rent-free for retirement is key for wealth,” Herbert said.

The growing aging population also points to a need for rental units that are for single persons or married couples, said Daryl Carter, chairman of the National Multi Housing Council and CEO of Avanath Capital Management.  “The number of baby boomers renting is increasing,” Carter said, adding that occupancy in affordable rental communities among all age groups is around 98%.

To read the full 43-page report, click here.

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Forbes Article Reports on New Senior Housing Alternatives

Reimagining what a community looks like and applying technology to meet home health care needs can help seniors stay in their homes longer, according to The National Aging in Place Council (NAIPC), Forbes reports.  While 90% of adults over 65 want to stay in their homes, many end up moving into senior living communities, Forbes says, citing a 2011 AARP study.

Three innovative models can help boomers who want to remain in their homes for as long as possible and those over 80 who also want to stay in their homes but have greater health needs, NAIPC said during a recent annual NAIPC meeting in Washington D.C.

In the technology model, a combination of digital tools to keep tabs on seniors’ health can give seniors with health issues the added support they need to stay in their homes, Forbes reports, noting telemedicine support program Full Circle America.

“My patients were telling me, ‘Don’t you ever think of putting me in a nursing home,’” Dr. Allan Teel tells Forbes about why he founded the founded Full Circle America. “But there were not very many options for these very fragile but very proud people.”

The program has reduced the number of daily hours someone needs for personal care and supervision from 24 to just two, with an additional 22 hours of monitoring via webcam and volunteers, Teel tells Forbes.

While the cost of the program ranges from $100 to $400 depending on the level of care needed, plus the start-up cost of $500 and extra $200 a month for the telemedicine service, it falls well below the price tag of an assisted living or nursing home, which can cost between $5,000 and $10,000 monthly, Teel tells Forbes.

The Village Model creates a network of support between seniors in their community, Forbes says, noting Washington, D.C.’s Capitol Hill Village (CHV) program.

“[CHV] is part of the Village-to-Village Movement, which helps members who live on or near Capitol Hill maintain their homes, secure transportation and find in-home care. CHV also sponsors classes and social activities for its members,” Forbes says.

The program has an annual fee of $530, or $800 per household, Forbes says.

Another model that may help more seniors age in place is an affordable-housing concept, wherein those 60 and older are offered subsidized housing to live in a community that needs their help.

One such purpose-driven model is Generations of Hope, which pairs families raising foster children with older residents who volunteer at least six hours per week doing such things as babysitting, tutoring, gardening or serving as a crossing guard.

“The strength of this model is that the families with children (or in the case of the veterans and young adults) who have special needs get extra support, while the older residents who choose to live in the community benefit from a greater sense of purpose and connection,” Mark Dunham, external affairs counsel for Generations of Hope, tells Forbes.

Read the article here 

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Research Shows New Path for Treating Memory Loss

Giving old mice blood from young ones makes them smarter and improves such functions as exercise capacity, according to reports from two research teams that point to new ways to study and potentially treat human diseases of aging.

In one study, researchers at Stanford University and the University of California, San Francisco found that blood transfusions from young mice reversed cognitive effects of aging, improving the old mice’s memory and learning ability. The report was published in the journal Nature Medicine in May. 

Two other reports appearing in Science from researchers at Harvard University found that exposing old mice to a protein present at high levels in the blood of young mice and people improved both brain and exercise capability. An earlier report by some of the same researchers linked injections of the protein to reversal of the effects of aging on the heart.

Researchers cautioned that much more work is needed to figure out how the findings might apply to humans. Many promising results obtained in mouse tests for various treatments through the years later turned out not to be effective in people.

But they said the reports offer compelling evidence that certain factors present in blood may play an important role in how people age and offer potential avenues to slow or reverse the process and improve health.

“These are really exciting papers,” said Brian Kennedy, chief executive officer of the Buck Institute for Aging Research in Novato, Calif., who wasn’t involved in the studies. “We’re finding more and more potential strategies to target age-related tissue decline and aging itself.”

The reports come amid a surge of interest in the potential for treating the aging process itself to improve health among the elderly and increase human life span. Heart disease and cancer, two leading killers, both are considered diseases of aging and some scientists think targeting the aging process may make more headway against the ailments than treating each of them individually.

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