Are you reflecting on life and its lessons? With so many options for self-publishing, writing a memoir may appeal. The process generates a new perspective on the meaning of one's life. The end result lets future generations learn about you and their forebears. Find writing kits and courses online, such as Writers.com.

One thought to consider: Creating a chronological review can be unwieldy. It suggests you'll present things with accuracy. Besides, recounting dates, locations, and events is just not fun or inspirational! Plus, you may have concerns about offending someone in the way you tell your stories. That can leach the joy out of the project.

You may find it more meaningful to tell your story in terms of the lessons you have learned. This is sometimes called an "ethical will." You want to bequeath your wisdom to the next generation. In an ethical will, you tell the stories of how you came to hold the personal values you now cherish.

Using this format, think about major challenges or crossroads in your life. When you ran into trouble or things didn't transpire as expected, how did you resolve the situation? What did you learn? For instance, one chapter might be "How I learned the power of forgiveness." Another could be "The time I got fired, or how I learned to value myself." A third might be "When one door shuts, it allows another to open." There's self-discovery in this process. Sharing your transformations and challenges also reveals your humanity. It enables younger family members to understand that everyone can stumble. Sharing how you picked yourself up shines a light forward for them. Consider a kit from FeetToTheFireWriters.com (tagline: You provide the memories. We help you grow).

You can include apologies, acknowledging regret and describing what you might have done if you had had the maturity and insight you now possess. You can also express gratitude to specific others, like a thank-you note for what you received.

Creating an ethical will is a gift to your family as well as yourself. Noted psychologist Erik Erikson observed that identifying the meaning of one's life is the primary task of the elder. Reflecting on the past within the context of what you have learned can help you get a new perspective on the disparate threads that weave the integrated story of how you became who you are.

And don't feel limited to writing. These days you can create collage books, audiobooks, video memoirs, a PowerPoint. You can write a poem or compose a song. Explore the options!

As you reflect on the past, consider life plans for your future.
Contact the experts in aging well: 203-826-9206

A "screening" is a general test to look for signs of a problem. Because early detection makes a huge difference in your ability to recover from any disease or condition, Medicare and Medicare Advantage plans use screening tests for many health issues. Often these tests are 100% covered—no copayments. But you must fit eligibility criteria. The criteria usually involve age, symptoms, and/or a family history that puts you at risk.
 
If a screening reveals that you actually have a condition, all subsequent treatments and tests are subject to your usual copayments. Screening tests are used only to help a doctor conclusively determine if there is a problem.

All the ins and outs of eligibility are too complicated to outline here. Plus, they can change. Use this table to give you a sense of what's covered. Talk to your doctor about whether a screening test is appropriate. This table lists the most common free screenings.

It might feel scary to tell others if you've been diagnosed with dementia or even just mild cognitive impairment (MCI). Start with those you think will be the most supportive. Perhaps close family and friends.

Common reactions. People will vary in how they respond to the news. Some will be genuinely caring and ask how you are doing and how they can help. Lean into those relationships. Others may respond with denial ("No, not you!" "You're too young …"). They may need to hear some facts about neurocognitive disorders. Some people may react by pulling away. Ouch. This is disappointing. Do your best to not take it personally. They may need time to adjust. Or they may simply lack information about your condition and have unfounded fears. Again, education may be helpful.

What to say. Choose a quiet time and place where you can talk one on one. Or you might want to write a letter or email.

• Give them a context. Let them know about the diagnosis and its stages. People conjure up extreme images and don't realize there are many months or even years to have good times together.
• Tell them what you can still do and suggest modifications if needed. Perhaps you'd like to continue playing golf, but need them to manage keeping score or not worry about scoring at all. Or you'd like to continue meeting for lunch, but maybe get takeout and go to a park. A restaurant might be too distracting for conversation.
• Let them know how they can help. Be specific.
  • Do you want to continue doing things for yourself? Tell them that letting you find your way feels respectful. Ask for their patience if you fumble.
  • Perhaps you'd like help with computer tasks or rides for errands.
  • Maybe you'd just like someone to talk to as you process these changes.
  • You may want to ask that they look for ways to support your partner.
• Have information ready for them. Many people are underinformed about conditions they haven't had. Give them a website or pamphlet to read.

Continue to engage with life. You still have the ability to enjoy life and live with meaning and purpose. Stay committed to the hobbies and activities you love. Look for an early-dementia support group. You may find new friends—people who understand what you are going through—and new ideas for living well. 
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Looking for early dementia resources?
Give us a call at 203-826-9206.

Your health care proxy is an individual you trust to speak for you when you are unable to voice your own decisions: A car accident, surgery, coma, dementia.

In such circumstances, doctors need someone who knows you well and has had conversations with you to guide them in terms of the medical procedures you would or would not want.

The "platinum rule." When selecting someone to fulfill this role, you want them to follow the platinum rule: "Do unto others that which they would want to be done to them." Regarding life support, you want your proxy to represent your wishes separate from what they would want for themselves:

• Would you want to be put on a ventilator (breathing machine)?
• Would you want tube feeding?
• Would you want CPR?

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A lot of conversation is required about medical care, quality of life, and even what is a "good death" from your point of view. Your proxy needs to know what your priorities would be if the result of a procedure might be life with less quality (e.g., only 11%–28% of older adults survive CPR, and 30% of them end up with brain disability).
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The duties of a proxy are often short term and in hospital settings. But in the case of dementia, these duties could last for months or years and involve long-term care choices. Beyond someone who understands your values and quality of life priorities, you want an individual who is comfortable talking with doctors and asking questions, and who is persistent and will advocate for your wishes if there is pushback. Also a person who has a steady head during a crisis and can communicate well with your relatives. They don't have to live close by, but they do need to be available by phone. You must name them in your advance healthcare directive, and they must agree to take on this role!

You can choose a succession of decision-makers so someone else is prepared in case your first choice is not available. Having two people share the role, however, is not recommended. It can stall a decision that needs to be made quickly.

If you are a "solo ager" (no children). Most people pick a younger family member. (Peers may not be available because of their own health challenges.) If you do not have younger relatives you want to entrust with this responsibility, [tacm] can guide you in selecting a professional and refer you to an attorney to draw up the legal paperwork.

Want help picking a proxy?
Give us a call at 203-826-9206.

Life plan communities—sometimes called "continuing care retirement communities" (CCRCs)—are private communities that offer residents a full range of care levels, depending on need. For those in independent living, amenities such as a golf course, gym, pool, and tennis and pickle ball courts are typically provided. Some communities even offer college-level classes, a salon, and grocery store.

For those needing more care, there are advanced support facilities on campus for assisted living, memory care, and skilled nursing care. Residents move among the facilities as their care needs change. One chief advantage of a CCRC is that a couple can remain on the same campus even if one of the pair eventually needs to go up in level of care. (The monthly maintenance and service fees go up when care needs go up.) Generally, the cost of care in a CCRC tends to be below "market rate" (what would be charged outside the community).

Are there any drawbacks? While a CCRC is an attractive blend of housing and medical care, it's not for everyone. Applicants must complete a medical exam to determine their level of care, as well as a confidential financial assessment. The entry fees are steep. (According to AARP, the average is $402,000 but the range is wide: $40,000–$2,000,000). Consider: This is not a real estate purchase. You don't own your domicile. You can't sell or rent it. You might think of a CCRC as a lump-sum payment of long-term care insurance with housing included. Be aware: You will be wedded to the community for your future care and housing needs for many years to come. In that light, it's prudent to check the financial solvency of the organization that owns it. Also the quality of the care they have been providing.

As you can imagine, the contract is full of details. As a rule, the lower the entry fee, the more you will pay in monthly fees. Check carefully the terms of receiving a refund if you decide you don't like the community or need to leave at some point. You want to compare contracts meticulously when you are shopping.
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It's essential to get professional advice. A CCRC may be exactly the support you are looking for, but these are very complicated arrangements.

• Have an elderlaw attorney review the contract so you understand all the provisions and the flexibility you do and don't have.
• Get input from your financial planner, accountant, and tax advisor concerning the company's financial strength, as well as your ability to afford the community over time.
• Check how the community is rated for the quality of its care on Medicare.gov.

Want to explore alternatives as you age?
Call us, the experts in aging well: 203-826-9206.

Can two households be better than one? In a trend called "living apart together" (LAT), a growing number of older adults are experimenting with committed relationships that also allow for autonomy.

These are people who prefer intimacy and companionship in their lives. At the same time, marriage—or even living together—brings more entanglements than they want to take on. For instance, some have already nursed a spouse through dementia or cancer and done the "in sickness and in health" role; they don't care to do it again, especially when the window for good health may be limited.

Instead, they agree to be romantically exclusive but keep their own homes.
They may eat most dinners together but sleep over only a few nights a week, alternating houses.

Here are some of the benefits such couples describe:

• Companionship, intimacy, and emotional support
• Freedom and "space" to maintain existing friendships and interests
• Absence of conflict about domestic chores, finances, and other logistics
• Greater focus on the joy of the relationship ("keeping the romance alive")
• Protection from the responsibilities of caregiving

Experience suggests interested couples should discuss these issues first:

• Finances. How will you pay for expenses relating to your shared activities (groceries, restaurants, concert tickets, travel expenses)?
• Family obligations. How do you spend holidays? Birthdays? Do you expect to interact with each other's kids, grandkids, etc.?
• Caregiving. What happens when your partner's health starts to decline? How much are you willing to do or not do? (What sounds good in theory can be difficult to implement, given the emotional bond that develops.) Who will handle the bulk of the caregiving? Adult children? Paid caregivers? (Does your partner realistically have a budget for that?)
• Long-term care. What about decisions regarding assisted living, memory care, or nursing homes? Will you participate in the discussion of your partner's living arrangements, or will that be up to their family members only?

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Looking to age on your own terms?
Consult with the experts in aging well: 203-826-9206.

If you are used to having an "annual physical" and ask for that, original Medicare won't pay for it. That is, original Medicare won't pay doctors to do a general physical exam "to see what turns up"; you'll pay out of pocket. (Medicare Advantage might have this as an "extra." Check with your plan.)

Medicare does offer two types of "wellness visits"
Medicare is invested in prevention and in managing chronic conditions, but be careful about the words you use when making an appointment. "Wellness visits" are available through original Medicare and Medicare Advantage. Beyond measuring height, weight, and blood pressure, however, these visits will be more of a conversation than an examination of your body.

The Welcome to Medicare visit happens only once
The Welcome visit is available only the first twelve months after you start Medicare. Think of this visit as setting your baseline, with future annual wellness visits serving as updates of key risk factors. This first visit covers many of the same topics as the annual wellness visit. But it's a more in-depth look at your medical history, your family history, and your lifestyle habits and risk factors. It also includes extra observational assessments concerning things such as vision, hearing, balance, and your risk for falls.

The annual wellness visit includes discussion of the following:

• Your medical history
• Your lifestyle habits (drinking, smoking, exercise, drug use, opioid use)
• Your mental health (depression, dementia)
• Other health factors such as loneliness, anger, stress, pain, and life satisfaction

​These appointments rely on your self-report of how you are doing and what you are doing. From this discussion, you and your doctor may agree on plans to lose weight, quit smoking, or get more exercise over the coming year. And the doctor may order screening tests to rule out other issues. You may also choose to discuss your preferences for end-of-life care so your doctor understands your wishes should you ever be unable to speak for yourself.

If you have a physical concern at any time
By all means, make an appointment if you have worrying symptoms. Get them checked out! Just don't plan to bring up new aches or pains in the context of a wellness visit. You may end up responsible for 100 percent of the visit.

Want to learn more about Medicare and wellness?
Give us a call at 203-826-9206.

We tend to think friendships should grow organically. They don't. Particularly in our later years, when we often lose friends—to death, illness, or moving away—we need to be much more intentional about making new ones.

This is especially so for "solo agers," those without children and grandchildren. The younger generations in the family typically make up a large portion of the average older adult's social network.

Making friends requires time and effort. Research has shown it takes fifty hours of contact to become casual friends. Bump that to ninety hours for a real friend, and 200 hours to cultivate a close friendship. Here are some tips to ease the process:

• Look for social activities with continuity. Meeting regularly helps rack up those contact hours with less effort. But more important, we feel more comfortable when activities and people are more familiar. The only way to get past anxiety is to go through it. Regular contact makes a new situation familiar faster.
• People in transition are the most open. Those who have recently moved to town or are going through a life change are typically extra receptive to making new friends.
• Assume people will like you. Research shows we vastly underestimate how much people like us. If you lean into the idea that you are likeable, you will actually behave in a warmer and friendlier manner. It's a self-fulfilling prophecy.
• To get a friend, be a friend. Notice if someone needs assistance, and then offer it. A ride to the airport. A meal after surgery. Helpfulness, support, and compassion rank high among qualities people look for in a friend.
• Small gestures matter. Consider sending a "thumbs up" text when you hear of an accomplishment. Or encouraging words before a challenging event. Even a touch-base "thinking of you" email when you haven't seen someone in a while can be surprisingly meaningful and can open new opportunities for connecting.
• Let people know you like them. While intellectual sparring and trading jokes can be fun, it helps if you can sprinkle in compliments now and then, too. Tell people what you admire about them. We tend to like those whom we feel like us.

While you are at it, it doesn't hurt to look for multigenerational opportunities. Establishing bonds with people in their middle age or younger can broaden one's perspective on life! And may help you feel more connected to the future. Having a younger friend may also come in handy should you need a physical favor, such as moving a chest of drawers.

Ready to interrupt your isolation? Give us a call at 203-826-9206.
We are experts in the process of aging well.

When Medicare first began in 1965, the idea was that it was for everyone over age 65, not just those who were poor. There would be no stigma.

Things are different now. We live longer. Medical costs are rising. In 2003, Congress decided that those with higher incomes should chip in extra to share the load. This extra is called the "income-related monthly adjustment amount" (IRMAA).

There are two areas of Medicare coverage that incur IRMAA fees:

• Part B. Medicare Part B covers nonhospital charges, such as doctor visits or lab work.
• Prescription drug coverage. This is Part D, or in a Medicare Advantage Plan it's sometimes called "Part C." You buy these policies from an insurance company, but the programs are also subsidized by Medicare.

If the Social Security Administration (SSA) determines your income qualifies, it will add a fee to your monthly premium for Medicare Part B and another for prescription drug coverage. These IRMAA fees are deducted from your Social Security payment each month.

What is "higher income"? The SSA looks at your adjusted gross income from two years ago (e.g., from 2022 for your 2024 rate). It adds back in a few tax deductions such as IRA contributions or Social Security payments. This usually higher amount becomes your "modified adjustable gross income" (MAGI). In 2024, IRMAA will likely apply if your 2022 MAGI was more than $102,500 for an individual or $205,000 for a married couple.

A caution about special circumstances: If you have a one-time bump in income (e.g., from the sale of your home or business), you may be assessed a one-year IRMAA fee.

Having trouble paying your IRMAA?

• Request a new initial IRMAA determination. If your MAGI was correct from two years ago but you have experienced a life-changing event, turn in Form SSA-44. Life-changing events include things, such as a spouse's death, a divorce, or a natural disaster that damaged income property. Reduction in work hours, retirement, or loss of a pension also qualify.
• Appeal SSA's decision. If you do not have a life-changing event, you can request a reconsideration if you believe your MAGI was inaccurately calculated by SSA. Or if you filed an adjustment to your tax return of two years ago that needs to be factored in. Contact the local Social Security office to learn more.

Have questions about Medicare?
Give us a call at 203-826-9206.