Making it through your later years, one transition at a time

Dec 4, 2018

If you look back on your life, you can probably pick out a few major transitions: from high school to college or maybe from one job to another. The transitions experienced as we reach our later years can sometimes be more complex.

Carol Levine joins us today on "Take Care" to discuss common transitions in old age, including Medicare. Levine is the director of the Families and Health Care Project at the United Hospital Fund, called “Next Step in Care.” She is also the author of the recent AARP book, “Navigating Your Later Years for Dummies.” 

Levine said a lot of the transitions people face as they get older are occasioned by a change in their health status or ability to live on their own. Rarely are they things that one chooses to do on their own.

“It’s a kind of emotional transition as well as a practical transition,” Levine said.

These transitions, especially when it comes to health care, can be rushed and result in plenty of confusion and mistakes. To make these transitions as smooth as possible, Levine suggested planning ahead for as many possibilities as one can think of.

"Once you start the planning, it's a little easier to go on to the next step."

“The main thing to do is to anticipate, to the best you can, something that might happen or that you know will happen and to involve other people in thinking about that transition,” Levine said.

The process is easiest when it’s discussed with others, like a family member, physician, religious leader or friend, who can help weigh the pros and cons of each possibility, she said. That conversation is best to have as early as possible.

“Once you start the planning, it’s a little easier to go on to the next step,” Levine said. “It should be something that emerges more naturally from the situation you’re in and the outcome you expect.”

That communication can help get everyone on the same page, as there is often a disconnect between the older person who says they do not need help and their family who says they do.

A common mistake people can make in this period of transition, Levine said, is to come home from a hospital stay expecting to be perfectly healthy with no additional recovery period needed.

“The transition is not just going out the hospital door,” Levine said. “It is a longer period that you have to adjust to some of the limitations that the treatment may have created.”

Levine suggested anticipating what one needs at home and for how long, planning to take as long as it needs to recover and adapt to living under new health conditions.

When it comes to moving out of a long-time home, there are numerous options, including moving in with family members, downsizing, or moving into a nursing home or independent living facility. Which option is best depends on the person’s physical and financial condition and their personality, Levine said. This is why it is important to take a personal inventory to know what to expect in the future.

"Understanding yourself at this age is really important."

“Understanding yourself at this age is really important because it can help you through your choice of options,” Levine said. “There’s no clear-cut answer. It really is a choice that you and your family have to make together.”

Should the choice be moving in with family, it can be just as difficult and stressful on the family as it is on the older person. Because of this, Levine said family members should expect a lot of work, some degree of gratitude and less oversight when it comes to health care, which may require branching out to other resources.

“You have to get used to the idea that this is a responsibility that you need to find the sources of help that are available,” Levine said. “Don’t lose your identity by becoming overwhelmed by caregiving.”

Moving on to Medicare

One common transition as people retire is switching from their previous health insurance plan to Medicare -- a vast, government-run insurance program.

A senior may have been on an Affordable Care Act-based insurance plan, an employer-based insurance plan or Medicaid before turning 65. Regardless of how we make that transition to Medicare, though, Levine said it can be a very complicated process, especially when deciding on a plan.

“It’s not a decision you make quickly,” Levine said. “It’s a difficult decision, but it’s one that’s important to care about.”

A senior can keep their employer-based insurance and transition to Medicare when they retire. Or they might be on Medicaid and decide to keep it and add Medicare, known as dual enrollment. Then, there are the plans within Medicare: A – hospital, B – doctor bills, D – optional, prescription drugs and C – all rolled in together (with some other options).

Applying for these plans is done during different enrollment periods around a person’s 65th birthday, and though there is often an option to sign up early, Levine cautions it is probably best to only sign up early if one plans to leave their employer insurance.

Many seniors transitioning to Medicare worry their current doctor will not be covered by Medicare. For those who are unsure, Levine recommended asking their doctor if they take original Medicare for the best immediate information.

No matter what Medicare decisions a person makes, Levine said counselors and family members can help to decide what is best for each situation.

“There’s a lot of ifs, and that’s why you really need some guidance,” Levine said.