“Living Apart Together” couples need to discuss caregiving, health issues with family, each other

Published on February 14, 2022 in Rhode Island News Today

With divorce rates soaring since the 1990s, and aging baby boomers 50 and older having doubled in number, this trend, along with longer life expectancy and those becoming widowed, has resulted in many older adults forming new partnerships later in life. Researchers call this new phenomenon, “Living Apart Together’ (LAT),” as an historically new form of family that allows an intimate relationship without sharing a residence. And it is gaining popularity as an alternative form of commitment. 

According to Couple Therapies, Inc., a 2016 national survey by legal scholar Cynthia Grant Bowman, as many as 9% of older American couples have Living Apart Together (LAT) relationships.

A year after the death of my oldest sister, Mickey, in 2008, my brother-in-law, Justin, an endodontist who had become a widower, found love and began to date Ruth, also widowed. Over 10 and a half years (from their late 60s to late 70s), the couple shared companionship by LAT, traveled to interesting locations for his medical conferences, even traveling overseas to France and Italy. Both enjoyed dining out, attending theater, and enjoying music. “Our relationship was wonderful for this stage in our lives,” recalls Ruth. “At our age in life, and both having grown children, it was just easier to maintain our own homes and our separate lives, but we did many things together,” she said. 

Like Justin and Ruth, millions of older persons are discovering the benefits of LAT. It allows couples to enjoy autonomy in their own living space and to maintain pre-existing relationships with their friends and children. LAT couples are able to be in a loving, long-term, intimate relationship where they have emotional support without having to cohabitate or be married. Often, and especially for those who have been widowed, there is a desire to show respect to their loved one but not engaging in a formalization of the relationship through the legal and religious act of marriage.

LAT is being studied by researchers at the University of Missouri (UM) who say that while the trend is well understood in Europe, it is lesser known in the United States. This means that with increased longevity, it becomes challenging as to how LAT partners can engage in family caregiving or decision-making, and how it could affect family needs.

“What has long been understood about late-in-life relationships is largely based on long-term marriage,” said Jacquelyn Benson, an expert of older adult relationships from the University of Missouri (UM), in a Feb. 9, 2017, statement discussing their LAT partnered research. “There are now more divorced and widowed adults who are interested in forging new intimate relationships outside the confines of marriage. Recent research demonstrates that there are other ways of establishing long-lasting, high-quality relationships without committing to marriage or living together. However, U.S. society has yet to recognize LAT as a legitimate choice. If more people—young and old, married or not—saw LAT as an option, it might save them from a lot of future heartache,” she says.

In this UM study, “Older adults developing a preference for living apart together,” Benson and Marilyn Coleman, Curators Professor of Human Development and Family Science, interviewed adults who were at least 60 years old and in committed relationships but lived apart. The researchers found that couples were motivated by desires to stay independent, maintain their own homes, sustain existing family boundaries, and remain financially independent. Couples expressed challenges defining their relationships or choosing terms to properly convey the nature of their relationships to others, they say, many citing that traditional dating terms such as ‘boyfriend’ and ‘girlfriend’ to be awkward terms to use at their ages.

“While we are learning more about LAT relationships, further research is needed to determine how LAT relationships are related to issues such as health care and caregiving,” Benson said. “Discussions about end-of-life planning and caregiving can be sensitive to talk about; however, LAT couples should make it a priority to have these conversations both as a couple and with their families. Many of us wait until a crisis to address those issues, but in situations like LAT where there are no socially prescribed norms dictating behavior these conversations may be more important than ever,” she says.

Another UM research study, “Living apart together relationships in later life: Constructing an account of relational maintenance,” Benson found that if more people—young and old, married or not—saw ‘Living Apart Together’ as an option, it might save them from a lot of future heartache. However, caregiving needs might cause such couples to change living arrangements.

These couples choosing to “live apart” are tested when their partner requires caregiving. “While autonomy is paramount for these couples, participants in the study also emphasized the importance of having a flexible mindset about their relationships, especially when one partner needs additional care,” she says, noting that certain family issues that become important in your later years, like caregiving or medical decision-making, could be difficult to navigate for the LAT couples and their relatives.

“The societal standard for elder caregiving in the United States is to expect spouses and adult children to step in as primary caregivers; however, we do not know-how these expectations apply in LAT arrangements,” Benson said in a statement releasing the findings Jan. 8, 2018, study. “In our research we are learning that, while living apart seems to be almost universally viewed as a necessity for maintaining relationship satisfaction for these couples, paradoxically couples also are willing to make changes in living arrangements to provide caregiving support to one another,” she said. She found that for most of these couples, living apart and being independent was considered ideal.  Participants in the study recognized that keeping separate homes was the simplest strategy for safeguarding their autonomy, she said.

Benson cautioned against making any conclusions about actual caregiving behaviors. “Most of the individuals we interviewed had not been tested by the realities of caregiving [yet] within their current LAT partnerships. It will be important to follow LAT partners over time to see if their willingness transforms into action and understand the mechanisms that explain these care provision decisions,” she said. Benson called for further research to better understand repartnering in later life.

Medicare slow to fix equity issue for seniors’ access to at-home COVID test kits

Published on Feb. 7 in Rhode Island News Today

Today home test kits were made available in a variety of ways – but, for Medicare recipients, it was a different story, being forced to go thru a different purchasing and payment process than those having private insurance, or no insurance. That process required the oldest and most at-risk population to take more than several steps, put up their own money, do a lot of paperwork, to seek reimbursement.

The White House made changes in testing so that at-home tests are now fully covered by health insurances. Those insured can pick up their test kits in a store and have them paid for at the time of purchase by their insurance, at no cost to the person. They aren’t required to visit their physician or get a prescription to obtain the free test. They have a limit of 8 test kits per month.

But, when the program began, this was not the plan for those insured through the government’s Medicare and Medicare Advantage plans.

Red Tape… Upfront Charges for COVID-1

Jane, a 65-year old Medicare beneficiary from Warwick went through the steps to get a kit after a relative she had seen found out she was exposed to COVID.  Before Medicare announced easing up on the purchasing process of COVID-19 test kits, she expressed frustrations to this writer about the regulatory hoops she faced because she was on Medicare – purchasing the test kits and getting reimbursed for the upfront charges. “First, I had to request a prescription from my physician and say that I had either been exposed to someone who had COVID, or I was having symptoms, myself,” recalls the frustrated Medicare beneficiary.  “Once my physician sent the prescription over to CVS, I was notified that it would take a couple of days before I could pick up the kits and that I would only be given two kits per prescription”, she fumed, knowing that sometimes it takes 4 or 5 days of testing to test positive, but was only eligible to receive two, and she might have to go through the whole process again in a few days.

“Three days later CVS finally left me a message saying these kits were in. I used the drive-up window for pickup and the cashier asked me for $46,” Jane remembered.  “When questioning this charge, a pharmacist came to the window to assist and told me that I had to pay for the kits upfront and then seek reimbursement,” she added.

Paying for the kits, Jane went home, and called Blue Cross, her Medicare supplement company and was told she needed to request a copy of the prescription which took hours to finally request with the back and forth phone calls to her busy doctor’s office. It was almost two weeks later she finally got a copy of the receipt detailing her $46 payment for the kits. She was then able to upload the copy of the prescription and a copy of her receipt to a BCBS reimbursement screen on her computer (or she could have printed the form out and mailed the whole package in). At press time, Jane is still waiting for her reimbursement, being told it will take from 4 to 6 weeks to receive a check.

It’s better late than never, says Jane, when she heard that Medicare would now cover free over-the-counter COVID-19 tests. “Not everyone can put out $46 and wait two months to get it back, home health tests were made available in a variety of ways – but, for Medicare recipients, there was a different process. More concerning was all the steps I had to take to complete the process they had originally intended for us to do. How many people would really complete all those steps?” she says. “We talk a lot about equity, but seniors need equitable healthcare processes, too.”

Just days ago, the Centers for Medicare & Medicaid Services (CMS) announced that beneficiaries in either Original Medicare or Medicare Advantage will be able to get over-the-counter COVID-19 tests at no cost starting in early spring, estimated to be in April. Under the new CMS initiative, Medicare beneficiaries will be able to access up to eight over-the-counter COVID-19 tests per month for free. Tests will be available through eligible pharmacies and other participating entities. This policy will apply to COVID-19 over-the-counter tests approved or authorized by the U.S. Food and Drug Administration (FDA). A prescription will not be required.

CMS Unveils New Medicare Benefit

According to CMS, this new initiative will enable payment from Medicare directly to participating pharmacies and other participating entities to allow Medicare beneficiaries to pick up tests at no cost. This is the first time that Medicare has covered an over-the-counter test at no cost to beneficiaries.

CMS’s announcement follows last month’s announcement that the Biden-Harris Administration would be requiring commercial health insurance companies to cover at-home COVID tests for free.

Until the new benefit kicks in, Medicare beneficiaries can access free tests through a number of channels established by CMS, too. Now, they can request four free over-the-counter tests for home delivery at covidtests.gov. Or beneficiaries can access COVID-19 tests through health care providers at over 20,000 free testing sites nationwide. Many cities and towns are also giving out free test kits at drive-up handout programs as the state receives supplies.

CMS’s Feb. 3 statement noted that Medicare beneficiaries can also access lab-based PCR tests and antigen tests performed by a laboratory when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional at no cost. In addition to accessing a COVID-19 lab test ordered by a health care professional, people with Medicare can also already access one lab-performed test without an order, also without cost sharing, during the public health emergency, says CMS.

In addition, CMS says that Medicare Advantage plans may offer coverage and payment for over-the-counter COVID-19 tests as a supplemental benefit in addition to covering Medicare Part A and Part B benefits. Medicare beneficiaries covered by Medicare Advantage should check with their plan to see if it includes such a benefit.

Finally, all Medicare beneficiaries with Part B are eligible for the new benefit, whether enrolled in a Medicare Advantage plan or not.

“AARP applauds today’s announcement that will guarantee access to at-home over-the-counter COVID-19 tests at no cost for Medicare’s 64 million beneficiaries and we thank [Health and Human Resources]Secretary Becerra and CMS Administrator Brooks-LaSure for their diligence in addressing this issue. Expanded access to no-cost testing will help protect seniors who have been hit hardest by the pandemic and ensure they can remain connected with their loved ones and community.,” says AARP Executive vice president and Chief Advocacy and Engagement Officer Nancy LeaMond in a statement issued with CMS’s Feb. 3rd announcement of the new Medicare benefit.

“Every American should have an easy way to get at-home COVID tests. We know that people 65 and older are at much greater risk of serious illness and death from this disease – they need equal access to tools that can help keep them safe. The cost of paying for tests and the time needed to find free testing options are barriers that could discourage Medicare beneficiaries from getting tested, leading to greater social isolation and continued spread of the virus, adds LeaMond.

Successfully Advocating the Seniors

Last month, Senators Sherrod Brown (D-OH) and Debbie Stabenow (D-MI) along with 17 of their  Senate colleagues including Rhode Island Democratic Senators Reed and Sheldon Whitehouse wrote to HHS Secretary Becerra and  CMS Administrator Brooks-LaSure urging them to expand Medicare coverage of free at-home rapid COVID-19 testing.

Aging groups also joined the Senators in pushing Medicare to offer the new testing kick benefit.  “It is clear that regular testing is a crucial part of managing the spread of COVID-19. That’s why AARP has been calling for coverage of at-home tests, says AARP’s LeaMond, noting that the nation’s largest aging advocacy group “will continue to watch for details about when and how at-home COVID tests are made available to those in Medicare.”

Thankfully CMS quickly heeded their calls.

For more information, please see these Frequently Asked Questions, https://www.cms.gov/files/document/covid-19-over-counter-otc-tests-medicare-frequently-asked-questions.pdf (PDF)

Stay tuned for free N95 masks to be made available to all coming up soon.

Senate Aging Committee: Seniors urged to prepare for making financial decisions

Published in RINewsToday on January 31, 2022

Over two weeks ago, U.S. Senators Bob Casey (D-PA) and Tim Scott (R-SC), Chairman and Ranking Member of the U.S. Senate Special Committee on Aging, urged seniors and people with disabilities to make a New Year’s resolution to prepare for anticipated financial decisions.

The hearing highlighted the importance of President Joseph Biden’s Dec. 2021 executive order to enhance customer experiences across federal agencies and align services to support people at critical decision points in their lives, like turning 65. This executive order expands retirees’ ability to claim Social Security benefits online, receive updates on their application status and access personalized online tools for Medicare enrollment and coverage options.

At this Senate Aging Committee hearing held on Jan. 13, the Senators released a bipartisan report entitled, “Financial Literacy in Retirement: Providing Just-in-Time Information and Assistance to Older Americans and People with Disabilities” along with a brochure for consumers to help them navigate these decisions.

This Senate Aging Committee report examines the real-time information and help older Americans and people with disabilities need as they face changes in their lives, known as “just-in-time” financial literacy.

“This year, more than 10,000 Americans will turn 65 every day. Around kitchen tables all across the country, retirees and seniors are asking: ‘Should I take my Social Security or should I wait?’ and ‘Do I need to sign up for Medicare, or can I wait?’ These are not simple decisions,” said Casey. “As we begin 2022, I urge seniors to make a New Year’s resolution: take stock of your finances and get prepared for these upcoming decisions, says the Pennsylvania Senator in a statement.

Adds Scott, “Financial literacy is key to making the most out of the financial opportunities our country has to offer. And much like education, it never loses its power — no matter your stage of life,” noting that the report will empower seniors to make wise financial decisions, laying the groundwork for security and peace of mind in their golden years.

The 26-page report identifies the six common decisions that require, and can benefit from, this kind of financial literacy: claiming Social Security, enrolling in Medicare, annuitizing a 401(k), giving to charity, downsizing a home, and responding to a natural disaster.

Putting the spotlight on Financial Literacy in Retirement

Four witnesses testified at the one hour and 18-minute hearing.

In her testimony, Gerri Walsh, President of the Washington, DC-based Financial Industry Regulatory Authority, applauded the timeliness of the hearing because “financial literacy in America is low and has declined over time.”  She cited a 2009 study that found 42 percent of American adults demonstrated high levels of financial literacy, this figure deceasing to 34 percent in 2018. “Despite increasing low levels of financial literacy, 71 precent of Americans believe they have a high level of financial knowledge, suggesting widespread over confidence,” she told the attending Senators.

According to Cindy Hounsell, JD, President of the Washington, DC-based Women’s Institute for a Secure Retirement, many workers are not knowledgeable about issues they will face during their retirement.  The impact of future inflation and taxes is not known by most and is not included in financial planning for retirement. This can have an impact on retirement income. Individuals also are oftentimes confused about how much income they will need to cover their expenses in retirement.  Many retirees struggle to plan how they will draw down assets.  Longevity risk is poorly understood and not widely planning for.  Finally, women assume they will keep working beyond age 65 but will end up retiring earlier than expected due to job loss due to health issues, or caregiving.

“As a nation with an aging population, we need to educate the public on strengthening existing retirement programs wherever possible,” said Hounsell, “That means focusing especially on the links to both Social Security and Medicare, employer-sponsored retirement programs and emergency saving initiatives, and educating average workers about how these systems work to prevent penalties and loss of benefits,” she added.

Workers Not Knowledgeable About Retirement Issues

According to Hounsell, many workers are not knowledgeable about issues they will face during their retirement.  The impact of future inflation and taxes is not known by most and is not included in financial planning for retirement.  This can have an impact on retirement income. Individuals also are oftentimes confused about how much income they will need to cover their expenses in retirement. Many retirees struggle to plan how they will draw down assets.  Longevity risk is poorly understood and not widely planning for. Finally, women assume they will keep working beyond age 65 but will end up retiring earlier than expected due to job loss, health issues, or caregiving.

Dorothea Bernique, founder and executive director of North Charleston, South Carolina-based Increasing H.O.P.E. a financial training center, reported that 14.9 percent of the South Carolina households have income below the federal poverty threshold and have a lack of basic financial knowledge, this resulting in a very low well-being score of 18 percent in the state.

Bernique noted that lack of basic financial knowledge can result in seniors not having the ability to make choices during retirement. “Hence this is how our seniors end up as greeters at the nearest Walmart when they should be enjoying the golden years of their lives,” she said.

Finally,  Patti Szarowicz, a certified Aging and Disability Resource Connection (ADRC) Counselor at the Atlanta Regional Commission Area on Aging,  stated that she plays a critical role in assisting seniors navigate complex systems.  She helps callers to locate the nearest senior center and to find rides to medical appointments, to identify financial assistance in paying bills, securing home and community-based services and respite support groups for caregivers.

“I can hear the pain and despair in the voices of callers, who say things like, ‘I’m in trouble, and I don’t know what to do. Please call me back, I’m going to be homeless,’” she says.

Szarowicz called on Congress to support ADRCs to hire additional councilors, allocate more funding to enhance user-friendly technology for documenting client data and better integration across technology systems used, which includes telephone, resource database and client management systems. Public awareness of the national network of Area Agencies on Aging is also key to directing people to unbiased guidance for resources.

Take advantage of the Senate Aging Committee’s resources to make financial decisions, in your retirement years. You won’t regret it. 

To obtain a copy of the Senate Aging Committee report, go to https://www.aging.senate.gov/imo/media/doc/Financial%20Literacy%20Booklet.pdf.

To obtain a copy of the brochure, go to https://www.aging.senate.gov/imo/media/doc/Financial%20Literacy%20Brochure.pdf

Contact financial_literacy@aging.senate.gov to request printed copies of the brochure.

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