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Do our bodies simply wear out after too much usage? Or is the schedule of our aging programmed into our DNA? The research on these questions is active and ongoing. Whether the answer is wear ‘n tear, or DNA, or probably a little of both, the reality is that the aging process may be prolonged, but is inexorable. Sooner or later, we all must face it.

Aging is a normal process, and we can observe the effects of aging as its progression impacts all of our various bodily systems. Specifically -

• The Nervous System - The synapses fire at a slower rate which results in reduced balance and coordination. In the brain itself, memory and quick decision-making become less efficient.
• The Musculoskeletal System - These effects are typically noticed first, i.e.
  • Loss of muscle tone and mass throughout your body, including the heart muscle and those affecting the bladder,
  • Loss of bone density, which often is viewed as a woman’s issue, but does affect older men as well, and
  • Reduced flexibility and range of movement as joints wear and tendons loose elasticity.
• The Gastrointestinal System - With aging, metabolism slows down and the digestive process becomes less efficient. Although fewer calories are needed, the system’s ability to extract nutritional value out of the calories that are ingested is diminished.
• The Cardiovascular System - Plaque builds up in the blood vessels, requiring the weakening heart muscle to pump harder. The blood pressure rises while the ability of the blood to absorb oxygen diminishes.
• The Respiratory System - The reduced efficiency of the lungs to supply oxygen starts being felt while climbing stairs or being involved in any energetic activity.
• The Immune System - With the changes to our biochemistry, hormone production diminishes and the immune system begins to atrophy.

However, there are a number of actions that can be taken to delay these changes and diminish their impact on our lives. They are further specified in -

• wikiSenior Basics and
• wikiSenior Medical Information.

Also, for an interesting diversion and a lot more facts, look at 50 Fascinating Aging Facts for a number of helpful links.

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As a country, America’s self image has always tried to stake out the high ground. We are there to “Do Good”. We are for “Freedom” and against the “Oppressors”. We are quick to condemn “Injustice”. We consider ourselves to be a nation built upon moral principles.

Are we?

At the end of 2010, our Congress struggled with, and finally passed, healthcare reform, i.e. the Patient Protection and Affordable Care Act. Those against these changes kept to the theme that “socialized medicine is bad”. Apparently, they would prefer their medical treatment to be asocial, and that is exactly what a twelve-minute exam gets you.

Last year, a very interesting book was published named The Healing of America. It is a delightfully readable description of this very complex subject. Its author, T. R. Reid, is a Washington Post correspondent with a problematic shoulder. To get his shoulder fixed, and to discover the realities of medical practices in today’s world, he traveled to France, Germany, Japan, Great Britain, Canada, and India. In each country, he sought out the finest doctors and medical practitioners and asked for their advice. He also assessed the cost and the timeliness of the various remedies that were proposed. From this first-hand medical marathon, he developed an assessment of the national medical experiences from a patient’s point of view.

Then, he compared these systems to the medical practices found in America. He discovers that the myth we have the best healthcare in the world is challenged by the statistics. America ranks – 24^th for healthy life expectancy, 37^th in healthcare system performance, and 47^th for average life expectancy at birth. The only measure in which we can claim that we are number one is cost.

Rather than be negative, however, Mr. Reid presents a very clear and concise description of the various types of health systems in the world and compares them to what America is doing. The comparisons are both instructive and revealing. In addition, he adds the systems that Taiwan and Switzerland have recently enacted. He argues that America should be able to study these systems, pick the best elements from each, and change to these more effective practices.

But the book ends where it begins, i.e. with the sobering message that more than 20,000 Americans in the prime of life die each year because they cannot afford healthcare. At the beginning and end, the question is a moral one. How moral a nation are we if we allow this to happen?

For more information go to -

• The author’s website
• The wikipedia summary
• Business Week’s review
• Amazon listing

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Is there is a rowing machine in your storage covered with dust? Or a jump rope? Or weights? Or any number of other items meant to get you to move? We all seem to have them. We all know we should move our muscles. We all know we would sleep better if we did. We know a lot . . . but it is so easy to say, “Tomorrow, when we have time.”

But there are some basics to maintaining our health, at whatever age, that we should not put off until tomorrow. No doctor can do it for us. We have to do it for ourselves. It simply requires commitment and a positive attitude.

1. Move - How you do it doesn’t matter. Walk, swim, dance, or jog. It all moves the muscles, lubes the joints, and stirs the blood. Exercise lets our body know that we appreciate and need it. It circulates all those biochemicals that keep things in balance. Thirty minutes is good. An hour is better. Ten minutes is better than nothing. When the weather is ugly, a steady walk through the mall, without rest stops, is quite effective. As the Nike ad says, “Just do it!”
2. Sleep - For some reason, gray hair and sleep don’t seem to mix. Whether it is the urge to make a run to the bathroom, some memories that just won’t quit, or concerns about a relative or friend, there always seems to be some obstacle to a solid night’s sleep. But those obstacles invariably fade after a day of vigorous movement. And if those thoughts just won’t quit, get up and read something boring for 30 – 45 minutes to tire your eyes. Keep trying things until you find a routine that works for you. Sleep has too many health benefits to ignore.
3. Eat – We seem to have become a nation of poor eating habits. With all the quick-fix food items out there, it is easy to simply “grab something.” The excuses are legion . . . ”One little bite won’t hurt. Just a taste.” ”It’s not like you do it everyday.” ”Oh, I just need this now.”

   But the reality is that we do need to read the labels and balance our meals. Fruits and vegetables, fish and fowl, fiber and vitamins – all need to be a part of our regular diet. But it can be difficult to make the effort when you are eating alone. Without a social component, there is a strong temptation at dinner to just get it over with.

   Everyone’s situation is unique. But we all have the obligation to find a solution that works for us. Some eat their main meal at lunch. Others join a group that meets regularly and includes a meal. Still others may arrange to have meals delivered (e.g. Meals-On-Wheels). Whatever your solution, it is imperative that you take the effort to find one and make it happen.

4. Wash – If you are not going out each day, you may be tempted to “take a pass” on the daily regimen of ablutions. But our skin, teeth, and feet need the respect of daily care. Don’t use a harsh soap that will dry your skin. Flossing is not an option; it must be done at least once a day. Your feet need special care since your mobility and balance depends on them; keep your toenails properly trimmed.
5. Monitor and Medicate – In 2011, Medicare will expand its coverage for preventative care. We should all know our numbers, i.e. blood pressure, waist size, HDL, LDL, TSH, and blood sugar. We should all have a stress test, an annual flu shot, and a colonoscopy every ten years. Most of us should take a daily multivitamin and baby aspirin. No one should smoke.
6. Smile – This is the key to making everything else work. Without a smile and a positive attitude, no one will make the effort to do all of the other things properly. We all can become experts for excuses and delays. But with a positive attitude, people create a purpose to their days, enjoy the surprises they encounter, cope with the difficulties, and aggressively engage life. You owe it to yourself, and to everyone around you, to smile.

Just doing these basic things each day will go a long way toward preserving our health. Aging still advances, but we improve our ability to handle those advances. “Just do it!”

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It is almost “Medicare review time” (November 15th – December 31st), that time of year when it is possible to adjust your enrollments in either Part C or Part D plans. You may be asking, “Is this the year I should choose Medicare Advantage (Part C), or should I enroll (or continue) in traditional Medicare (Parts A and B)?”

Medicare Advantage is the name given to the private insurance programs that were started with the idea of privatizing all of Medicare. There are some similarities and some bold differences between traditional Medicare and the Advantage plans. Do these differences make an Advantage plan the right choice for you?

Only you can decide, but here are some things for you to consider.

*Location – As private insurance plans, Advantage plans are controlled at the state level. What holds true in Connecticut doesn’t necessarily apply in Colorado. You have to look at the details for your individual state. In addition, you have to consider your distance to the physical locations where the services are provided. Go to the Medicare site to learn about the plans where you live.

*Structure – Traditional Medicare is a fee-for-service plan run by the government and accepted nearly everywhere. There is no “gatekeeper” aspect to traditional Medicare. You can go to any doctor that is accepting new Medicare patients.

Medicare Advantage private plans can take many forms, e.g. – HMO’s where you choose from a specific list of doctors and hospitals, PPO’s which allow use of some out-of-network providers at a higher cost, PFFS’s which will allow any doctor or hospital that will accept their terms, and SNP’s which limit membership to people with special needs. Typically, all care requires pre-approval by a physician in the plan who acts as its gatekeeper.

*Coverage – Traditional Medicare covers most specific “medically necessary” treatments. In addition, the 2010 health legislation finally added a number of preventative health measures as well.

The Medicare Advantage plans must provide coverage for the same treatments provided by traditional Medicare. However, they do not have to cover every treatment in the same way. For example, they may pay less for skilled nursing care but offer more coverage for preventative care, prescription drug coverage, and vision and dental as well.

*Costs – Here is where it gets interesting. That same tag line form the Watergate era applies here, “Follow the Money.”

For traditional Medicare, most people have already earned the Part A coverage (hospitals) and there is no additional charge. There is an additional monthly charge for Part B (doctors). Although this official charge for 2011 will be $115.40, most enrolled seniors will only pay the 2008 rate of $96.40 since the rate is locked whenever there is no cost-of-living increase for Social Security. You should also look at the costs of Medigap policies and the Medicare Drug plan (Part D) when comparing traditional Medicare to an Advantage plan that includes these benefits.

For Medicare Advantage, the rates (and their coverages) vary by plan. Because they are private programs, these plans can charge what they want. They can set their own rates, deductibles, and co-pays. They can also change these fees each year. If the plan becomes unprofitable, these plans can simply go out of business.

In addition to the premiums you will pay for an Advantage plan, traditional Medicare also pays these private firms a set amount each month per person enrolled to compensate for the coverage they provide. To help launch these programs, this amount paid has exceeded the amount paid for a person enrolled in the traditional Medicare. It was about $1,100 last year. That discrepancy is scheduled to be phased out over the next few years, so there is some concern that these plans will either raise their rates or drop extra coverages. Reading this article will provide you with some interesting insights on these developments.

*Performance – As you would expect, the performance level of these various plans can vary by location. Ask people you trust around your neighborhood to discover if there are any organizations that it may be wise to avoid. The Wikipedia article on Medicare gives a good description of the big picture and some links that may help your search for performance information. Its section on Medicare Advantage plans is especially helpful.

*Conclusions – Generally, the few rules of thumb you can follow are -

• If you live in a rural area, stick with Traditional Medicare Parts A & B. It is likely that Part C will cost you too much time and gas money.
• If you are in reasonably good health and live in an urban area, you may be able to save some money with a Medicare Advantage plan, especially one with an HMO structure that is well managed.
• If you health is deteriorating and you are facing major costs, you are probably safer with Traditional Medicare.

If you want to learn more details on what happens during this annual change period, visit this site for more details.

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When you reach age 65, you find that traditional Medicare offers very extensive medical coverage . . . up to a point.  Medigap plans provide coverage for those times when you go beyond those points.

Medigap plans are supplements to the traditional Medicare Parts A & B.  These plans offer coverage of the medical charges that are not covered by Parts A & B.  Although the companies involved vary state by state, the coverage provided by plans themselves, listed A through N, are fixed by the federal government.  (Note: Plans E, H, I and J are no longer being sold, but they can be retained by those that already have them.)  Although different companies may charge different amounts for different plans, the coverage provided by the plans themselves is uniform throughout.  With the new changes coming in 2011, the specifics of these plans will undoubtedly by modified, but their overall thrust will likely remain unchanged.

During the past decade, Congress introduced Medicare Part C, aka Medicare Advantage, in an attempt to reduce costs.  These plans offered broader coverage but limited the choice of doctors and hospitals.  Ironically, Congress legislated higher payments for these plans in an effort to entice people to change to them.  On the flip side, the amounts paid to doctors with traditional Medicare patients were reduced.  When physicians stopped accepted new Medicare patients as a consequence, Congress relented and reversed the cuts to traditional Medicare.  Your doctor should welcome your new Medicare status.

Now, with the new health care legislation, Congress is eliminating the price advantage of Part C while adding coverage for many preventative care measures to the traditional plans.  As a consequence, you will be able to keep your own doctors, and Medigap will likely live on.

Of all the Medigap plans, Plan F has been the most popular.  But that does not mean that is the one

you

should choose.  The different plans are for different situations, and you have to spend the time to determine what is best for your lifestyle, health, and wallet.  For example, some plans offer coverage for medical expenses while traveling abroad.  If you are not a traveler, it makes no sense to pay for that feature.

Some sites to visit for further information are -

Guide by Medicare

AARP Medigap description of plans

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What kind of pet person are you? There are bird-lovers, dog-lovers, cat-lovers, and goldfish-lovers. Everyone has their own particular favorite that was usually established during their youth. People that have had pets can even be classified as such. For example, we have dog-people, cat-people, and bird-people. Are you a certain pet-person?

If you are, maybe you are currently pet-less and rethinking that decision. Obviously, there are a number of pros and cons to such a decision, but the choice of the type of pet has a lot to do with most of them. There are a wide variety of pets that seniors may choose.

Dogs -
Dogs need and give love. Many studies indicate that having a dog really can help a senior’s health and attitude. Not only do they offer companionship, but their needs serve as an ongoing encouragement for some good exercise as well. Also, they are probably the best security system available on the market today.

If you are particular about breeds, you can contact the American Kennel Club and get a list of local breeders. Be prepared to open your wallet, however, since many breeds now go for $1,500 or more.

Another approach is to take a visit to the local animal shelter. These pets often have that wonderful price of ‘free’, although small donations are very welcome. These pets can vary widely, so you must look carefully to find the right dog for you. The people in the shelters understand animals and can provide you with a wealth of information. Don’t be afraid to ask. Before you “take the plunge”, consider -

• Age - If a dog is older than 18 months, it will not only be housebroken, its teeth will have grown in and it will also be less inclined to eat your slippers. If a dog is older than six, you may find not only health problems but an inability to adapt to new surroundings.
• Size - Golden Retriever mixes and Labrador mixes are great, but if you are going to walk the dog, you may need a smaller dog (who won’t pull you over when it chases after a squirrel). However, if you aren’t used to having a small dog around, you probably shouldn’t get a dog weighing less than 25 pounds. You don’t want to trip over the little thing because you didn’t see it.
• Allergies - If you have avoided dogs because you are allergic, look for dogs that don’t shed. Many terriers and poodles have this trait.
• Temperament - Undoubtedly, the vast majority of dogs have better temperaments than many people. A few, however, may have experienced poor treatment and developed a nasty streak as a consequence. Pay attention to how the dog reacts to you, since initially you are a stranger.

Cats -
“For a balanced ego, a person that has a dog to adore him should have a cat to ignore him.” That old quote is harsh, but contains an element of truth. Cats are much more independent than dogs. As long as they are properly fed and stroked occasionally, cats require far less attention than dogs. They quickly learn how to use a litter box and can amuse themselves for hours with a favorite toy. This independence allows a cat to tolerate much longer absences from their owners than dogs.

If you are looking for a cat at a shelter, many of the same cautions for dogs apply to cats. Their sizes, however, are much smaller. They compensate for their small size by their pronounced ability to quickly leap out of the way.

Other Critters -
For the most part, other small animals kept as pets live in defined enclosures. This reality makes them far less intrusive than dogs or cats. They each offer their own special qualities that can both divert and delight. They still require care, however, and someone else must mind them if you take a trip.

If you do live alone, having another living creature around the mansion has distinct benefits for all involved. Yes, they do require you to expend extra effort and care, but that is a gift. Answering needs is what life is all about.

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Ever since the passage of the Health Care Reform Act on April 23rd, I’ve been looking for a good summary of its components. Of course, any legislation with that many pages will be difficult to summarize, but someone had to take a swing at it. I guess no one will be surprised that it was the AARP that took up the challenge.

At the link, AARP User’s Guide to Health Care Reform, you will find a summary that doesn’t take that long to read. It does, however, have a sufficient sweep and level of detail, that you can develop a sense of the legislation.

Three things to note -

1. Medicare will finally start to cover its most foolish lack, i.e. some preventative services. Catching conditions sooner rather than later should always reduce the cost of their care.
2. The Part-D Donut Hole will be phased out over the next decade.
3. The overpayments for Medicare Advantage Plans will be phased out.

Every senior should read this summary. Thanks AARP, you did a good job!

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Although some individuals are still covered by company and union health plans once they start Turning Age 65, fewer and fewer people have that opportunity. By far, Most US citizens discover that they have come under the Medicare umbrella. Whatever other insurance they may consider, it is all influenced by Medicare. Or, if your income level provides that alternative, Medicaid. (A few qualify for both.)

What do these choices mean?

Original Medicare Part-A provides hospitalization coverage for no charge. It doesn’t cover everything, but it does cover a lot. The key words for coverage are “medically necessary” procedures, i.e. those required to keep you alive and functioning. Once you get in to “elective” or “experimental” procedures, you are no longer covered. For example, it does not cover private rooms, private nurses, or even TV and phones in the room because they are not “medically necessary”. Basically, during each year it covers hospital stays for -

• days 1 - 60 after $1,068 deductible,
• days 61 - 90 at $267/day,
• days over 90 at $534/day, which are deducted from a 60-day pool of “lifetime reserve days”, and
• days beyond the pool of “lifetime reserve days” at full coverage.
• Charges for blood as well as home, hospice, of skilled nursing facility care are determined separately.

Original Medicare Part-B provides coverage for doctors, lab work and other medical services. There is a monthly charge for this coverage which amounts to $96.40 during 2010. The coverage is limited to the Medicare-approved amount for the Medicare-approved services. For example, a colonoscopy is limited to once every ten years, or two years for high-risk patients. Basically, after an annual deductible of $135, Part-B covers -

• 80% of doctors services and medical devices,
• 100% of clinical lab and home health services, and
• other “medically necessary” services after a co-pay or co-insurance deductible.

Original Medicare Supplement policies, Medigap fill in some of the gaps left by deductibles and co-pays. The coverage offered by these policies is strictly formulated by Medicare and specified by the letters A through N. (Plans E, H, I, and J are being phased out.) Until now, F has been the most popular. Although the coverage of each lettered plan is specific, the companies and charges vary by state.

Medicare Advantage, i.e. Part C plans, are privately run HMO alternatives to Original Medicare. Your care is generally restricted to the doctors and facilities that are members of that organization. Essentially, the government pays your Medicare allocation directly to these plans. The plans then set up their own internal rules for coverage as well as any additional charges that may apply. These plans vary on a state-by-state basis, and must be reviewed in that context.

Medicare Part-D Drug Plans, which also vary state-by-state, provide coverage for prescription drugs. Unless you have other drug insurance, you must sign up for one of these plans within four months of turning 65 to avoid being charged a late penalty.

Medicaid programs offer more extensive coverage to people with limited income and resources. This program is jointly funded by both federal and state governments, so it also varies state-by-state.

Go to the government’s Medicare Web Site for more information and for links to individual state programs.

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For most people turning 65, Medicare offers welcome relief. Pre-existing conditions are no longer an issue, and the vast majority of hospitals and doctors accept it. A very brief description of this program follows. Of course, this is the view from 2009, before any changes (hopefully for the better) that are currently being discussed in Congress.

Start at Age 65:
One of the confusions surrounding the Medicare program is that it is somehow linked to Social Security. It is not. It is a different program. Specifically -

• The start date for social security benefits is variable, depending upon your birth year, the start date for Medicare is fixed at age 65.
• Although most people should wait until their full retirement age (or beyond) before they start taking Social Security benefits, there is only one reason to delay Medicare, i.e. your retirement benefits from your employer includes private health insurance that covers more than Medicare. The reality is that there are not many of those plans left.

“Parts is parts”:
That quote from an old commercial referred to chicken, but it could also apply to Medicare since it also has parts. The different parts of the Medicare program cover different aspects of coverage - hospitalization, doctors, private Advantage plans, and drugs. Specifically -

• Part A - covers stays at facilities (hospitals, clinics, skilled nursing, etc.) You do not pay any additional fee to enroll in or benefit from this program.
• Part B - provides payments to doctors and other service providers such as physical therapists. You must pay an additional monthly fee to be part of this program. In 2009, the fee is $96.40/mo.
• Part C - usually called Medicare Advantage, these are private plans (HMO’s, PPO’s, or PFFS’s) that are subsidized by Medicare and replace the Medicare Part A and Part B programs. These plans vary by state. The coverage rules of these plans are determined by the individual plan operators, not Medicare. To enroll in these plans, you must first sign-up for Medicare. Once you enroll in these plans, you are excluded from Medicare A and B, and it is quite difficult to return.
• Part D - offers coverage for prescription and generic drugs. These are also private plans which vary by state and require a separate fee. They operate separately from the other parts of Medicare.

MediGap (Medicare Supplement) Plans:
Medicare doesn’t cover all medical expenses. For example, there are deductibles for hospital stays and co-pays for doctor visits. To address these shortfalls, many private insurance companies offer MediGap policies that cover the gaps. These plans vary by state. Although Medicare does specify the coverage rules of these plans, labeled “A” through “J”, they do not administer them.

Decisions to Make:
Among these various options, the decisions a person must make include -

1. Do I enroll in Medicare Part B? Most people choose this, but it does require the monthly payment of an additional fee.
2. If enrolled in Medicare A & B, should I abandon them and enroll in one of the private Advantage programs? Because you usually cannot reverse this decision once made, your coverage is no longer controlled by Medicare, and you can no longer choose your own doctors or hospitals for the less expensive plans, only about 15% of the people make this choice.
3. Do I enroll in Medicare Part D? Since you pay a penalty for enrolling after the initial six month grace period, most people do enroll despite the infamous “donut hole” in the coverage.
4. Is there any reason to wait until the changes being discussed in Congress occur? The short answer is NO.

To learn more about Medicare, go to the Medicare web site which is well put together and offers a wealth of information.

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Retirement comes with a mixed blessing . . . Time. All of a sudden, you gain a lot more control over your time and how you use it. Of course, there are legions of pundits at the ready to tell you just how you should use it, but I often wonder how many of these people have tried it themselves. This is especially true when it come to exercise, both physical and mental. We all know that we should do both, but which form is best?

One mental exercise that I have tried is the crossword puzzle in the New York Times. When I was still working, I sometimes tried it during the commute home when I didn’t have any task that was left over from work. Now, without the commute, I can do it any day I want.

My encounter with the NY Times Crossword began as a mild diversion that was completely mysterious at first. I didn’t even realize that there was a theme to the three or four long answers in each puzzle. Like most things, however, you soon develop a sense of its rhythm and discover that its level of difficulty increases throughout the week.

On Monday and Tuesday, both the clues and their answers are reasonably straightforward. The answers typically consist of one word. The clues usually have only one or two meanings. Sometimes, Monday can seem tougher than Tuesday, but usually it is the other way around. If you are new to crosswords, don’t try anything other than Monday or Tuesday, or you will quickly become discouraged.

On Wednesday, the clues start to become both more subtle and more diverse. For example, a question mark at the end of a clue indicates a fairly bizarre connection, e.g. the answer for the clue, ‘Homeland plot?’, could be ‘acre’. Also, the answers start to require multiple words, e.g. the answer for ‘Just for laughs’ could be ‘in fun’. Nonetheless, you are still working with one letter per box.

That can change on Thursday. On that day, a variety of tricks may start to appear. A box may require a symbol, or multiple letters, or an entire word. You begin to recognize this is happening when nothing seems to fit. Of course, that meaning has to work both directions, across and down. It is that double requirement that helps you uncover the secret. At this point, you recognize that the trickster that created this puzzle is really trying to fool you.

On Friday, you encounter the classic tough puzzle. All of the clues either have multiple meanings or are extremely obscure. Many of the answers require phrases rather than words. Whenever you finish a Friday puzzle, you start to feel that you are really are learning how to wrestle with this trickster, especially if you do it in ink.

Saturday’s puzzles are like Friday’s, but the answers are longer. Sunday’s puzzles are twice the size of the daily ones, but include elements of each day of the week.

Solving crosswords can not only be a diversion, it can also be a social, cooperative effort. My wife and I often share one, challenging each other with those difficult clues. It is not rocket science, but it is definitely an exercise for your brain cells. At our age, that can’t hurt!

You can find the crossword in any issue of the Times. I access it by just buying the paper. But you can also try a free puzzle online. You can also sign up for an annual online subscription if you get hooked.

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