Retirement Planning

July 2003   

Living Wills

Five Wishes Ensures You Get the Care You Want

If you've ever had to make critical health care decisions about a loved one, or just wondered how best to comfort a close friend or relative who was seriously ill, you probably had to face the unsettling questions: Would she have wanted to be kept on life support? He seems to be in so much pain--what would be of comfort to him?

Living wills are designed to help others know how you wish to be treated when you are medically unable to speak for yourself. They can help ease a difficult situation by helping those around you know how best to manage your care.

One of the best is Five Wishes, a document developed by experts in end-of-life care, in consultation with the American Bar Association's Commission on the Legal Problems of the Elderly.

Five Wishes is popular because it is short, easy-to-use, and addresses emotional as well as medical issues. Especially helpful is the fact that each wish contains a number of simply written choices, which you can leave or cross out to indicate your desires.

The first two of the Five Wishes relate to your medical care. They are:

• The person I want to make care decisions for me when I can't. This section allows you to name your health care agent as well as indicate specific decisions you would or would not allow that person to make. (Examples: make decisions on tests, medicine, or surgery, or authorize administration of medication to help with pain.)
• My wish for the kind of medical treatment I want or don't want. The information you provide in this section will help your caregiver know your views on under what circumstances you do or do not want life-support treatments to be used.

The last three wishes deal with emotional and spiritual needs. They help family members and friends understand your wishes regarding ways to be comfortable, how you want to be treated, and things you want your loved ones to know.

The Five Wishes living will meets legal requirements in 35 states. (For a list of states, go to www.agingwithdignity.org or call 850-681-2010.) Copies are $5 each from Aging with Dignity, P.O. Box 1661, Tallahassee, FL 32302-1661.

A Message from the President

July 2003   

The Commitment Never Fades

NEA Retired President, Jim Sproul

Most of the public seems to think that when our careers end, we head out to pasture. It reminds me of how many folks think we got into education to take summers off.

You'll find no better rebuttal to these fables than this month's gathering of Active and Retired members in New Orleans. Active and retired delegates from your state will come together for the NEA Representative Assembly and the NEA-Retired Annual Meeting. Over the course of two weeks, we'll work to build a stronger Association and support public education. We'll debate new business items on such issues as health care and pensions and help refurbish a local school as part of the Outreach to Teach program that links up Retired and Student members. And, as always, we'll be raising funds to support the NEA Fund for Children and Public Education.

This issue of This Active Life suggests some ways you can help make a difference on our vital issues. For example, NEA members have helped to build a strong base of support for repealing the unfair Government Pension Offset and Windfall Elimination Provision (see 'News Briefs'). We now have a majority of members of the House of Representatives as co-sponsors. Please continue to push your members of Congress, especially in the Senate, to support NEA-backed repeal bills (H.R. 594 in the House and S. 349 in the Senate).

Also, this month's Cover Story illustrates the wonderful work of some of our members who are caring for a parent or loved one. Please take the time to offer encouragement and assistance to those performing this labor of love, or consider helping out with a local agency or group offering hospice or respite services.

Then take that summer break. You've earned it.

Note: Thanks for supporting the NEA Fund for Children and Public Education. We raised more than $8,100 at the NEA-Retired regional meetings this spring.

--NEA-Retired President Jim Sproul

People

July 2003   

Linking to Native Americans' Past

Photo by Norman Y. Lono

New Jersey member Claire Garland brings centuries-old Cherokee history to life for today's students and adults--on a new Web site and CD-ROM that evolved from a study of her own family's roots.

Garland and two teacher partners recently received a $5,000 grant from Verizon to design a Web site and CD-ROM around her project, Native Americans in Monmouth County. The popular project tells the history of the region through the experiences of Garland's ancestors, Cherokee Indians who migrated from Georgia up the Appalachian Trail to New Jersey in the early 1800s when their land was confiscated and given to white settlers.

When she started the project, "I was looking for ways to teach my own children about their heritage," she says. Visiting the Neptune Historical Society one day, she found an account book that had been kept by her great-great-grandfather, Isaac. The book was a treasure trove of fascinating details about life in Monmouth County (a sample entry: Ike agrees to take in a young nephew as an apprentice in return for "four quarters of schooling, $100.00, and a freedom suit from head to toe")--and it sparked Garland's interest in learning more details about her family roots.

From there, she scoured tax and marriage records, military archives and other sources, and collected photos from family members. Eventually, she developed curriculum materials and a manuscript she hopes to get published. Before retiring last December, Garland had introduced many of her junior high students to the role of Native Americans in the building of New Jersey. This fall, she'll be teaching teachers how to weave local history into their lessons.

For more information, contact Garland at 732-747-5709 or go to www.Cherokee-Indian-Ike.com.

--John O'Neil

Advocate for the Arts

Helen Inada Fujie knows what it means to give in a time of need. She began teaching in 1940 at Lanai High School and Elementary School, the only school on the island of Maui, Hawaii. A year later, Pearl Harbor was bombed.

"They needed most of our teachers in Lanai to go to Pearl Harbor and Honolulu to help rebuild the school programs," recalls Fujie. "So for part of World War II, only my principal and I remained in Lanai to teach everything from kindergarten to 12th grade. We managed, but I was glad when things got back to normal and I could focus on 7th grade again."

Since retiring in 1980, Fujie has continued to contribute to her community--as a substitute teacher and, more recently, as a volunteer with the Lanai Art Program, a gallery and school where she does everything from conducting tours to teaching painting. The program is dedicated to preserving and promoting Hawaiian art.

"I love it," says Fujie. "I'm there every weekend and everything I do is exciting. Whether I'm showing visitors a gallery or teaching kids about art, it's all very satisfying."

That's not all she's doing for the arts. A fiction writer in her spare time, Fujie had three short stories selected for a book, Hawaii's Best Spooky Tales, that has drawn readers from around the world.

Fujie has put so much time into helping the gallery that the County of Maui presented her with a special award for volunteerism in 2002. "I'm lucky to have so much in my life," says Fujie. "I could never stop being active with the Art Program. I'll do it till I die, no doubt about it."

--Matt Simon

Barnstorming Through Retirement

Stanley Nowak spent 33 years as a library media specialist in Buffalo, New York. The year he started his career, he got his license to do what he loves best--piloting small airplanes. Now retired, Nowak spends most of his spare time flying on his own or with his wife, or instructing flight students.

"The sensation of flying is just spectacular, and every flight keeps you 100 percent mentally and physically aware," says Nowak. "I like that challenge."

A career-long Association member, Nowak served 18 years as treasurer of the Buffalo Teachers Federation and now works parttime as the Association's chief bookkeeper. He also keeps in touch with young people as a sports official.

But flying remains his passion. Nowak is chief pilot in the Niagara Frontier Flying Club and has logged 5,000 hours in the air. Just how much time is that, compared to other pilots his age? "Probably about twice as much as the average pilot, but I have more opportunity because I teach," he explains.

This summer, Nowak plans to fly to Kitty Hawk, North Carolina, to take part in the 100th anniversary celebration of the Wright Brothers' first powered flight. "It's hard to describe to people who don't have the bug to fly, but I get the same thrill from taking off in an airplane that I got 30 years ago," he says.

--Matt Simon

NEA-Retired News Briefs

July 2003   

Members to Congress: Repeal Unfair Social Security Provisions

Photo by Chris Madaloni

Fran Valenzuela, a member of the Texas State Teachers Association-Retired, had a very personal reason for her recent appearance on Capitol Hill.

"My husband put 47 years of his life into the Social Security retirement system. I taught for 32 years. Three days after I retired, my husband died, and I don't get a penny [from Social Security]."

Valenzuela was among a contingent of NEA members, from Texas and elsewhere, who showed up in force at a May 1 hearing of the Social Security subcommittee of the House Ways and Means Committee. The topic? Two laws--the Government Pension Offset (GPO) and the Windfall Elimination Provision (WEP)--that cost retired public employees their earned benefits.

The GPO reduces a public employee's Social Security spousal or survivor benefits by an amount equal to two-thirds of his or her public pension. Therefore, an educator whose spouse works in the private sector and pays into Social Security--such as Valenzuela--will not be eligible for the full survivor benefit if her spouse predeceases her. The WEP reduces benefits public employees earned in an earlier career or in a second job. For example, a teacher who entered the profession after working in the private sector, or a support professional who supplements his income by working parttime in a private sector job, might lose a significant amount of the Social Security benefits earned in those private sector jobs.

Retired and Active NEA members packed the hearing room, many wearing T-shirts reading, "Good educators never retire�They can't afford to." Donna New Haschke, president

of TSTA, read excerpts from letters written by more than 500 members calling for repeal of GPO and WEP. One was from 86-year-old member Mary Hall of Spring Branch, Texas, who said she couldn't afford to retire because she will lose her Social Security spousal benefit when she begins collecting her state pension.

After the hearing, Valenzuela buttonholed Texas Rep. Kevin Brady, who told her he knew all about the Social Security provisions--thanks, in part, to NEA members. "He said, �I've been getting many calls from your local teachers,'" said Valenzuela. "That goes to show we're having an impact. It takes thousands of people to make them change their minds."

--John O'Neil

Fight for Repeal

You can make a difference and provide for fair Social Security benefits for all public employees by:

• Getting informed--Find out more about the Government Pension Offset and Windfall Elimination Provision, and why they should be repealed, by going to www.nea.org/lac/socsec.
• Getting active--Help whip up support for the NEA-backed Social Security Fairness Act, which has been introduced in both the House (H.R. 594) and Senate (S. 349). Ask your members of Congress to support these bills.
• Speaking out--If you are personally affected by the Social Security offset provisions, make your story known. Contact your elected leaders, write a letter to the editor of your local newspaper, and provide testimony to your local or state affiliates.

In Michigan

In May, delegates to the Michigan Education Association (MEA) Representative Assembly overwhelmingly passed a measure that will automatically enroll Active members in the MEA-Retired program.

"We're delighted," said Barbara Stockman, a retired board of directors member from Michigan's Region 9. "This means that we will have a seamless organization from students to retirees." Under the All-Inclusive Membership (AIM) initiative, Active members will pay a fee of $10 per year for 20 years to automatically become pre-retired members of MEA-Retired.

MEA's Chuck Agerstrand says the vote shows that Active and Retired members have common concerns and goals. "Our Retired members have seen an erosion of their health care benefits with higher copays and deductibles, for example. More and more Active members see that these same issues will affect them when they retire. Clearly, a strong selling point [of AIM] is that we'll have more collective clout." AIM will take effect in 2004.

In Wisconsin

Wisconsin developed the first workers' compensation and unemployment compensation laws. The WEA Trust, a non-profit created by the Wisconsin Education Association Council, is now bidding to make the state a national leader in reining in health care costs. In April, the Trust launched "The New Wisconsin Idea," a set of four reforms aimed at increasing efficiency in the health care system. How big is the challenge? Health care costs are rising at two or three times the rate of employees' wages. Yet, "A lot of the supposed solutions being offered are nothing more than cost shifting to the employees," says Amir Zaman of the Trust.

The new reforms promise to save money via centralized transaction processing and a statewide prescription drug formulary. Staff members of the Trust are now meeting with editorial boards and legislators, among others, to increase their awareness of the health care cost crisis and the need for action.

My Contribution

July 2003   

Making Noise, Making a Difference

Indiana activist Jack Spindler pushes for reform on prescription drug prices.

Photo by Cathie Rowand/The Journal Gazette

"Why are drug prices in Canada approximately half of the American cost?" Jack Spindler thundered in an op-ed published in the Fort Wayne News-Sentinel. "Because a Canadian health ministry board negotiates prices with the manufacturing companies. U.S. citizens regularly pay double the price and thereby subsidize the populations of other countries."

Indiana member Spindler, former president of the Fort Wayne Education Association, writes and speaks out persuasively and often. As a result, he's pulling in much-needed support for seniors as they battle outrageous prices for prescription drugs.

Spindler wrote the op-ed after participating in a bus trip from Indiana to Windsor, Ontario, to purchase prescription drugs. The trip was sponsored by the United Auto Workers and United Senior Action of Indiana. "Because of the cost of my expenses for prescription drugs, I wanted to see the setup firsthand, talk to the doctors, and make sure it was a good operation all around."

Throughout the two-day trip, Spindler took copious notes. When he returned, he drafted an 800-word piece describing the group's experiences and why Canadians were able to purchase drugs for a significant savings. It was published with the headline, "Canada shows U.S. a prescription solution," and Spindler has been fielding phone calls ever since from reporters and individuals seeking more information on how to bring down prescription drug costs.

A few months later, Spindler landed in the newspapers again--this time as a source for a local columnist's piece on ways to cut drug costs. The story included quotes from Spindler and his photo (see above).

Although not everyone is comfortable taking a highly public stance, Spindler notes that your local media are a great avenue for bringing attention--and action--to issues important to seniors. If you're unsure about a high profile, start by writing a letter to the editor. "The letters section is one of the most widely read," says Spindler. "Keep your letter short: state your position, provide one or two examples, and give a conclusion." Once your confidence is up, call or visit a local columnist or editor to suggest a news tip or issue to cover.

Spindler's tenure as a local leader, which called upon him to speak regularly to the media as well as interview candidates for public office, helped build his comfort with speaking out. "I'm confident because of my Association experience," he says. "As you get more comfortable speaking out, it becomes easier."

Spindler has cut his annual drug costs in about half and now uses a Canadian mail-order firm to supply his medications. But he'll continue pressing for across-the-board price cuts. "We need to have negotiated fair drug prices for us all," he says.

--John O'Neil

For More

For background on prescription drug pricing and ideas for cutting costs, contact:

Families USA
202-628-3030
www.familiesusa.org

Medicare Rights Center
212-869-3850
www.medicarerights.org

Alliance for Retired Americans
202-974-8222
www.retiredamericans.org

Member Profiles

July 2003   

Mary Kouts
Pre-Retired

Background
I've been an ESP in the Phoenix Union High School District in Phoenix, Arizona for 34 years. I'm now working parttime as a substitute teacher coordinator.

I helped start the ESP local in Arizona and have served as ESP director at large. I was also the first ESP to hold a state Association office when I was elected Arizona Education Association state treasurer for three years.

Why ESPs Should Get Active in NEA
ESPs can have a big impact on their jobs by getting active in NEA--particularly as lobbyists. We especially need retired ESPs to become more active. When I first started working, I never thought about retirement, but retirement issues such as insurance should be on your mind from the moment you begin your career. We need more retired ESPs to get involved in educating new employees about retirement issues. Right now, most NEA-Retired members in Arizona are teachers. We need to tap into the wealth of experience ESPs have, as well.

Greg Abbott
Recently Retired

Background
I taught fourth and fifth grade for 30 years at Mabel Rush Elementary School in Newberg, Oregon.

I served as president of my local Association for 12 years and am currently vice president of NEA-Retired Oregon.

How I'm Spending My Time
When I was active, I worked with three other teachers to start the Twin Rocks Outdoor School, which takes about 100 fifth graders and their parents to the Oregon coast for three days a year. Now that I'm retired, I'm keeping up with the outdoor school. I've also taken up walking and am getting ready to participate in a charity half-marathon to raise money to fight diabetes. I still volunteer one day per week at my old school. It's a good mix of work and leisure.

Jo Ann Kenner
Active Retired

Background
I taught elementary school language arts for 34 years in Cook County, Illinois. During that time, I've been a local Association president and vice president and a regional officer. I also served nationally on the NEA Resolutions Committee.

Why Did You Get Involved with the Association?
During my career, I got involved because almost every year there was some federal budget issue that affected teachers, and we needed lobbyists. Now I stay active lobbying to preserve the pensions and insurance of future education retirees. It's also a great social outlet. When I first joined NEA-Retired, I saw a lot of my former teachers. Now I get to keep working regularly with my former colleagues. Staying active keeps you young!

Letters

July 2003   

The Scoop on Fraud Alerts

The May Cover Story ("Watch Out! What You Can Do to Protect Yourself Against Fraud and Identity Theft") says that you may have a fraud alert placed on your credit report for seven years. How is this done? When I contacted Equifax, their Web site indicated that a fraud alert is free for 30 days and then requires a payment.

Judi and Rollie Myers
Dewey, Arizona

Editor--All three major credit bureaus--Equifax, Experian, and TransUnion--will place verified identity theft victims into seven-year fraud alert programs. For those who suspect credit fraud, systems vary. Equifax offers a six-month fraud alert, Experian issues a temporary 90-day security alert, and TransUnion provides a one-year alert. All short- and long-term alerts are free and cause victims to be automatically opted out of pre-approved credit offers for two years. The three bureaus began an initiative in April 2003 to share information on fraud alerts. Eventually, contacting one credit bureau will result in credit fraud protection from all three bureaus. Thanks to editorial intern Cheryl Ross for digging into the matter.

Contributions

Jack Spindler, who is featured on page 14, is a great example of how NEA-Retired members can influence the public by working with the media. Spindler, a former local president in Fort Wayne, Indiana, wrote an op-ed piece for his local newspaper calling for reforms in prescription drug pricing. The newspaper later featured him in a staff-written account on this issue.

Don't underestimate your ability to contribute to the public debate on critical issues. You have insightful and passionate things to say about everything from the nation's health care crisis to proposals to "reform" public education. (After all, who better to comment on public schools than those who have given their career to them?)

This Active Life wants to serve as a forum for members to express their issues and concerns. We'd like to hear more from you. In particular:

• Write a Letter to the Editor to comment on--or take issue with--something you read in the magazine.
  You can also write us about your opinion about education topics that may not be directly covered in the magazine, such as school reform.
• Suggest names of NEA-Retired members in your community or state whose activism or hobbies merit mention in the People section or other pages.
• Tell us about notable accomplishments in your local that stem from Retired and Active members working together in concert.

We'd especially appreciate hearing from you over the next month if you'd like to contribute to three upcoming stories:

• Mentoring. What kinds of experiences have you had mentoring younger members as they enter and proceed through the teaching and ESP ranks? What have you--and your mentees--learned from the experience?
• Grandparenting. Many grandparents are playing a role raising grandchildren. What are the joys and pitfalls of this arrangement? How has it altered your ideas about life in retirement?
• Getting Your Finances in Order. What tips can you offer on getting your financial life in order? What ways have you found to cut expenses and stick to your budget?

Please send your ideas to John O'Neil, Editor, This Active Life, NEA Communications, 1201 16th St., N.W., Washington, DC 20036; 202/822-7223; joneil@nea.org.

NewsFlashes

Don't Call on Me
Some relief in the offing this month for Americans badgered by pesky telemarketers. Beginning July 1, the Federal Trade Commission (FTC) launches a national "Do Not Call" list to protect consumers from nuisance calls. All telemarketers (with a few notable exceptions) will be required to purchase the registry and will be fined if they call a number on the list. Your name will remain in the registry for five years. The FTC had not finalized the list rollout at press time, so check www.ftc.org/donotcall for details on when telephone users in your region may sign up for the service. More good news: the FTC's rules also force telemarketers to take new steps to cut down annoying hangups that result from their automated dialing systems.

Social Security's Good News
The annual report issued recently by Social Security trustees contained good news--though you had to dig to find it. The Administration's press release provided this spin: "Social Security Not Sustainable for the Long Term." But as Fred Brock of the New York Times astutely pointed out, the report actually extended two key deadlines often cited as evidence of Social Security's dim prospects. Social Security now expects tax revenues to fall below expenses in 2017, and it predicts that the Social Security Trust Fund will be depleted in 2042. The trustees' report in 1995 had predicted the fund would be depleted in 2030. An increase in Social Security taxes of under two percent, split between employers and workers, could eliminate the gap, Brock writes. As Election 2004 approaches, expect much more spinning about the real status of Social Security as Democrats and Republicans craft competing proposals. You can get the straight scoop on Social Security from the National Commission to Preserve Social Security and Medicare (800/966-1935; www.ncpssm.org).

Health

July 2003   

Weighing the Cautions on Hormone Replacement Therapy

Recent widely reported findings from a large clinical trial on hormone replacement therapy (HRT) have many women concerned--especially those who have been on an HRT regimen. Should you stop taking hormones based on the latest scientific findings?

Photo by ComStock

First, some background. About 20 million American women are on some form of estrogen therapy. Previous studies had shown estrogen treatments to be effective at calming some of the negative symptoms of menopause, such as hot flashes and sleep disturbances, and they also had been shown to help against osteoporosis and heart disease.

Last year, however, the Women's Health Initiative (WHI) suspended its massive study when it found that using a particular combination hormone therapy had increased the subjects' risks for developing breast cancer, heart attack, stroke, and blood clots in the lungs and legs.

The WHI study, which involved more than 16,000 women ages 50-79 in a randomized trial, assessed the effects of using a combined therapy of estrogen and progestin that is currently taken by an estimated six million American women. The study did find positive side-effects from taking the combination: reductions in the number of women reporting colorectal cancer and hip or other fractures. But the study was stopped after it was concluded that the long-term risks to study participants outweighed the benefits.

More recently, WHI released findings showing that, for most subjects, hormone replacement therapy did not substantially improve some of the short-term effects of menopause, such as hot flashes or sleep disturbances.

What do the latest findings from the WHI study mean for you?

First, it's important to recognize that the WHI study examined only one kind of HRT, and the risks documented by the study worsened after the fourth year of using the drug. For many women, the adverse symptoms of menopause don't last that long, and the WHI study found that using a hormone therapy for two to three years may offer more benefits than risks for you.

If you're currently using a hormone replacement therapy, you'll want to review with your doctor the specific purposes for using an HRT, as well as factors in your personal health profile that should be considered. (For example, your family's history of heart disease and cancer should factor into a decision to use an HRT.) You'll probably want to review your choice with your doctor every year, since conditions may change. If you do decide to discontinue using HRT, talk to your doctor about whether to stop gradually.

Make lifestyle changes, if necessary, to give yourself added protection against heart disease and osteoporosis. These might include exercising regularly, eating a balanced, nutritious diet, and using medications to control high blood pressure or to combat bone loss.

Finally, to combat hot flashes, avoid caffeine and spicy foods. Keep the thermostat down and dress in layers to better regulate how warm you feel.

--John O'Neil

For more background on the WHI study and recommendations regarding hormone replacement therapies, go to: www.whi.org.

Quick Tips

Get Informed
For reader-friendly background on the WHI study and its implications, contact the National Heart, Lung, and Blood Institute at 301-592-8573 or www.whi.org. You can find fact sheets on hormone replacement therapy at www.webmd.com.

Talk With Your Doctor
Your doctor can review your health profile and help you better understand the various options for dealing with symptoms of menopause.

Cover Story

July 2003   

Taking Care

How caregivers nurture their loved ones--and care for themselves. NEA-Retired members share their stories.

By John O'Neil

Photo by Norman Y. Lono

In 60 years together, Eleanor and Vic Daut traveled the world, getting their passports stamped in Scandinavia, Germany, Austria, Switzerland, the United Kingdom, and the Caribbean islands.

But their life since Vic suffered a stroke in 1992 has been an altogether different kind of journey. Vic has had a series of health setbacks since the stroke and now spends three-fourths of his time in bed. He broke his hip recently and needs help feeding himself and using the bathroom. Eleanor cares for Vic, with the part-time help of a nurse's aide.

"Our life together before the stroke was so active," says Eleanor, who taught special needs students in Bergen County, New Jersey, before retiring in 1994 to care for Vic. "We traveled all over the world and had a home in Florida where we vacationed. Vic also spent a lot of time working with me. I was the yearbook advisor, and Vic was the one providing support at all the flea markets and spaghetti dinners" raising money for school programs.

Now it's Eleanor providing the support, navigating the rewarding but stressful role of primary caregiver. "It's a 24-hour-a-day job, even if you have help," she says. "It's hard to make schedules to do anything. I still get up at night and go to Vic's room to check on his breathing."

Eleanor and Vic are backed up by excellent retiree health coverage negotiated years ago by her local, the Bergen County Vocational Technical Education Association. Daut herself served as negotiator and president during her teaching career. "Everything we've needed [for Vic's care] was provided by the fringe benefits we bargained for," including a hospital bed for home and a custom wheelchair. Other NEA-Retired members serving as caregivers also cite the health benefits bargained by the Association for helping them through an extremely challenging period.

As Americans live longer, more seniors require assistance with activities of daily living (ADL), such as dressing, eating, or bathing. With costs of nursing facilities and home health care rising sharply, informal caregivers, such as spouses, sons, and daughters, are picking up much of the slack. The number of households where at least one person over 50 needs help performing ADLs is expected to grow from 23 million to 39 million by 2007, according to the Family Caregiver Alliance. About 16 percent of family caregivers are retired, and 20 percent spend 40 or more hours per week providing care. Caregiving falls predominantly on women; about 7 of 10 unpaid caregivers are female.

Barbara Axelrod is a typical caregiver. In 2000, she retired from her teaching job in New Jersey and moved to Silver Spring, Maryland, to care for her mother, Ray, now 92. At first, Ray just needed a little help, but she's battled health problems since then that have created limitations for her. "Until she was hospitalized in December [for an infection], she was climbing trails in a local park," Axelrod says. But the illness took a lot out of her. Ray was in the hospital 12 days and lost 12 pounds. Though she needed the medical care, Ray rebelled at the hospital environment, Axelrod says. "At home we take her out for walks or sit outside. She likes her own bed and having family come to visit her in her home." A home health aide helps out daily, allowing Axelrod to run errands and take some time for herself.

Caregiving is an expression of love that can strengthen the bond between those giving and receiving the care. But it can be a strain for caregivers as they try to cope with myriad demands--from the emotional pain of witnessing a spouse's or parent's slow slide into dementia to the physical challenge of hoisting a loved one in and out of bed. The caregiver's own health sometimes falls by the wayside--with serious consequences.

Caregivers use prescription drugs for the treatment of insomnia, anxiety, and depression at rates two to three times the general population, according to the Family Caregiver Alliance. Depression is a common problem; about one-half of women and one-third of men who are caregivers experience depression.

Florida member John Haass fought depression while caring for his wife, Carol, who suffered from an unusual infection that baffled doctors and severely limited her activities for almost two years. John took on increasing responsibilities for Carol's care, from helping her to the bathroom to giving her IV antibiotics, all the while trying to navigate the Byzantine world of hospitals, nursing homes, and insurance coverage.

The stress became too much. "I became quite depressed and had to go on antidepressants and have four or five sessions with a psychologist," says Haass. "We had been married for 48 years and were best friends, and it just tore me up that there didn't seem to be anything they could do about it. We thought we were fighting a disease that was going to kill her in the end." (Carol's condition, and her self-sufficiency, have improved considerably since last fall.)

Many caregivers also confront money problems and the confusing gaps in insurance coverage when one is shifted between hospital care, nursing homes, and home care. Medicare and Medicaid severely limit coverage of medical supplies and services for home care, and all private health insurance plans have gaps and exclusions.

Anne Burks, who cares for her husband, Bill, credits the Georgia Association of Educators (GAE) with ensuring that its members have access to strong retiree health care. She's enrolled in a premium plan that has covered many of Bill's expenses that might otherwise have to be paid out of pocket. "GAE is the reason we have this health insurance, and that has been a blessing. The bills have not hurt us as they would some other people."

NEA-Retired and the family of local retired members also are there for caregivers. Burks says GAE-Retired members provided support as she coped with her husband's decline into dementia. She continued to take Bill to state retired meetings--an activity that helped to sustain her--and members kept an eye out for him as Anne participated in the sessions. "I've gotten wonderful support from my family, my church, and my friends in the Association," she says.

John Haass got letters and calls from leaders in FEA-Retired and offers of assistance. "We try to help one another out," he says. "When people ask, �What can I do to help,' you've got to say, �Can you take the shopping list or sit with Carol for a bit while I take a walk?'"

Your local and state Retired organizations also stand with NEA-Retired by providing speakers at Association meetings and other information on caregiving issues. And NEA Member Benefits offers a range of policies to protect caregivers and their loved ones, including Medicare Supplements and long-term care insurance. (For more on long-term care insurance, see "Should You Buy?").

If you're currently a caregiver, or soon will be, other members offer these tips for getting by:

• Educate yourself. You're going to have to learn a lot about the medical issues facing the person for whom you'll provide care--as well as the care options and insurance coverage that may apply. Michigan member Delphine Rogers' husband, Dick, was diagnosed with amyotrophic lateral sclerosis (Lou Gehrig's disease) in 1999. She read whatever she could on the disease, did research on the Internet, consulted the local chapter of the ALS foundation, and interviewed occupational and healing touch therapists. That helped her better understand what Dick was experiencing as the disease advanced--helping her care for Dick and easing her stress. She was beginning to research options for hospice care when Dick passed away this past February.
• Speak up with health professionals. "Being a patient advocate is really important," stresses John Haass. "You've got to be involved in everything; you can't just say, �We'll turn it over to the doctors at the hospital or the home health care aide.'" That means asking questions and--if necessary--getting second opinions or taking your concerns up the chain of command. When Carol Haass was hospitalized, John observed her condition declining dramatically one day. Hospital staff were awaiting the results of a lung scan when John, desperate, noticed a surgeon who had operated on Carol previously come through the wing. John grabbed him and insisted he see Carol, and the doctor ordered her into intensive care immediately. John shudders to think what may have happened if they had continued waiting for test results.
• Pursue other outlets. When possible, keep up with hobbies or other outlets to recharge your batteries. Haass, who continued to serve as president of Gulf Coast UniServ-Retired during Carol's illness, says the duties helped shift his focus and "got him out of the hospital for a while." New Jersey member Eleanor Daut volunteers with a dispute resolution committee that supports the local courts by working out community complaints and disputes before they end up in front of a judge. Axelrod takes Hebrew and Yiddish classes and is considering piano lessons. "You've got to get out of the house," she says.

For many caregivers, the increasing demands are balanced by the deepening of their relationships as they enter a new phase of love and understanding. Says Daut: "Vic and I spend our time reflecting upon the past and all the traveling we did and the great times we've had. We're never very far from one another. By caring for Vic for 11 years, I've been his left- and right-hand helper as he was for me earlier in my career. I know God will never give me more than I can handle as his caregiver."

"Caregiving is a journey into the unknown," adds Axelrod. "You never know what each day will bring."

Do you have tips on making the most out of your role as a caregiver? Please send them to John O'Neil, This Active Life, NEA, 1201 16th St., Suite 710; joneil@nea.org. We'll consider using them in a future story.

Should You Buy Long-Term Care Insurance?

An only child, Kentucky member Ann Caldwell knew she would need to help support her mother in her old age. When she began visiting residents of nursing homes (through a program organized by her church), what she found alarmed her.

"I saw a lot of places I didn't want my mom to be in," she recalls. With nursing home costs rising, she wanted to make sure her mother would be "in the best place possible."

Caldwell turned to an increasingly popular solution--long-term care (LTC) insurance. She bought a policy for her mother that pays $80 per day toward the $152 per day cost for her care at a small local nursing home. Her mother has a private room, and there is one staff person for every five residents. Her mother, 84, has been at the facility for close to two years, and Caldwell says the insurance was a wise investment.

Most people are aware of the rising cost of hospitalization and treatment for acute illness. Fewer realize that expenses for long-term care in a nursing facility or at home also are increasing rapidly--and that health insurance, Medicare, and Medicaid pay only a fraction of the costs. The average daily cost for nursing home care, for example, is $137. Medicare covers no more than 100 days in a nursing home for rehabilitation and nursing services, following a recent hospitalization. Medicaid pays a portion of nursing home costs, but individuals must pay costs out of pocket until their assets are scarce enough to qualify for the program.

LTC insurance policies attempt to fill in some of these gaps in coverage. A typical policy provides a "daily benefit amount" for covered services, which may include a room at a nursing facility, adult day care, or costs for medical equipment or beds. Your premium will be affected by the level of benefit you choose, among other factors.

United Seniors Health Council suggests that LTC makes the most sense for those who can pay the premiums without unduly affecting their lifestyle and who have assets (not including home and cars) of at least $75,000 and annual retirement income of at least $25,000.

Policies vary widely, however, and determining whether LTC insurance is for you--and which policy might be best for your situation--requires diligent research. Some tips when considering options for financing long-term care:

• Don't be pressured. Some agents use scare tactics or push you to make a hasty decision. Take your time and get the policy terms in writing.
• Research your options. LTC insurance helps relieve the burden of long-term care costs. But there may be other sources of money you could use--such as a reverse mortgage or a disability or life insurance policy that could be converted.
• Shop around. If you do decide to buy an LTC policy, make sure to compare policies from several different reputable companies. Make a list of the kind of features you want in a policy--such as home care coverage and inflation protection that increases benefits to reflect future costs--and make sure each policy you consider has all the qualities you're seeking. If necessary, consult an objective geriatric care or case manager to guide you.

Other resources to consider:

NEA Member Benefits' long-term care insurance developed especially for NEA members. To find out more, call 800-637-4636 or go to www.neamb.com.

Insuring Your Future: What Caregivers Need to Know About Long-Term Care Insurance, from the Family Caregiver Alliance at www.caregiver.org.

A Shopper's Guide to Long-Term Care Insurance, from the National Association of Insurance Commissioners (NAIC), walks you through the ins and outs of LTC policies and includes a handy glossary of terms. For more, contact NAIC, 2301 McGhee St., Suite 800, Kansas City, MO 64108; 816-842-3600; www.naic.org.

--J.O.

For More

The National Alliance for Caregiving offers fact sheets and other publications providing tips for caregivers on a wide variety of topics. Contact: National Alliance for Caregiving, 4720 Montgomery Lane, Suite 642, Bethesda, MD 20814; www.caregiving.org.

The Family Caregiver Alliance is an authoritative source of statistics, research, and resources on caregiving. Its Web site (www.caregiver.org) includes a clearinghouse of concise publications and fact sheets as well as news on caregiving research and legislation. Contact: Family Caregiver Alliance, 690 Market Street, Suite 600, San Francisco, CA 94104; 415/434-3388.

The Eldercare Locator, a nationwide service supported by the U.S. Administration on Aging, will help you find agencies and other resources in your community. To learn more, call 800-677-1116 or go to www.eldercare.gov.

Books

July 2003   

These new releases advise you on shrewd investing, living well, and maximizing your brain's power.

Don't Leave Your Brain Behind

Everyone jokes about those "senior moments," but what's really behind our tendency to forget things as we age? Why do older adults tend to wake up more often during the night? What's really happening to the brain during the onset and progression of Alzheimer's?

The answers to such questions are being shaped by an explosion of new findings from neuroscience, the study of the brain. Keep Your Brain Young distills some of the key findings from this new literature in a reader-friendly guide.

Co-authored by neuroscientists Guy McKhann at Johns Hopkins University and Marilyn Albert at Harvard Medical School, the book surveys a broad range of topics, including: learning and memory, nutrition and the brain, and medical problems such as Alzheimer's, Parkinson's, and strokes. Each section provides appropriate background for the lay-reader and commonsense suggestions on how to keep the brain functioning in top form.

The book's treatment of memory--why it begins to fade and how to keep it sharp as long as possible--is especially strong. It describes the critical distinctions between old and new memories, how different areas of the brain process and store them, and how these facts relate to aging. (First-stage Alzheimer's patients, the authors point out, are often able to recall old memories quite accurately but are unable to easily learn or process new memories.)

So how do you preserve your memory as long as possible? The authors suggest a number of specific strategies and ways of organizing things for later recall. (One example: make a point of remembering something, such as directions, by repeating them to yourself out loud.) The book also gives the lowdown on herbal supplements believed effective against memory loss.

Keep Your Brain Young (296 pp.; $15.95; ISBN 0-471-43028-5) is published by John Wiley & Sons (www.wiley.com).

Where to Retire?

What would you get if you rated American towns and cities based on their appeal to retirees, looking at such factors as climate, transportation, cultural amenities, access to quality heath care, and other measures? Retire in Style crunches the numbers and comes up with...Boulder, Colorado as the top-rated place to retire in the United States.

Retire in Style, written by award-winning geographer Warren Bland, draws upon facts (such as the cost of living and climate data) and more-subjective "quality of life" measures to profile 50 affordable places to retire. Boulder won the top rating, but communities from Burlington, Vermont to San Luis Obispo, California, are reviewed in the handy guide. A helpful appendix provides addresses for numerous chambers of commerce you can write to for more information.

Retire in Style (281 pp.; $22.95; ISBN 0-9700908-0-3) is published by Next Decade Press (www.nextdecade.com).

Quick Reads

Smart Investing
The bear market has many retirees worried about how to protect their nest egg. Martin Weiss' The Ultimate Safe Money Guide is written for those over 50. Weiss offers strategies on when to buy and sell stocks, the pros and cons of annuities, and what to consider when buying insurance. The book is filled with helpful worksheets and charts comparing offerings and terms from different providers. The Ultimate Safe Money Guide (340 pp.; $14.95; ISBN 0-471-43047-1) is available from John Wiley & Sons (www.wiley.com).

Ask the Expert

July 2003   

Buying Prescription Drugs Online

Q: I've read that many people are now obtaining prescription drugs outside of the United States. How are they doing this?
Beginning in the 1990s, many seniors and others living in border states started crossing the border to fill their prescription at Canadian and Mexican pharmacies for as much as 70 percent less than the prices charged by U.S. companies. Today an estimated 1 million Americans use the Internet to import prescription drugs by mail order.

Q: Why do prescription drugs cost so much less in other countries?
Pharmaceutical prices are usually (but not always) much lower in Canada than here, even for drugs manufactured in the United States. This is mainly because Canada, like many other Western governments, regulates drug prices, while we don't. In addition, patent laws in Canada are different, and some lower-cost generic versions of brand-name drugs come to the market more quickly.

Q: How many Internet sites offer this type of service?
The American Association of Retired Persons (AARP) estimates that there are 80 to 90 Internet sites that sell prescription drugs at lower Canadian prices. But a higher number of fraudulent Web sites also are operating.

Q: Why are there so few legitimate online distributors?
The federal Food, Drug, and Cosmetic Act of 1987 makes it illegal to import prescription drugs, whether they are made in the United States or not. The U.S. government cannot guarantee the performance of drugs imported from other countries and, as such, cannot assist if health problems occur with the imported pharmaceuticals. Employers or groups that "aid and abet" the importation of prescription drugs can be found criminally liable.

Q: If it's illegal, then why do so many people take the risk to buy online?
The cost of prescription drugs in the United States is prohibitively expensive, especially for retirees on fixed budgets. While the Food and Drug Administration (FDA) says it has the right to pursue individuals who import prescription drugs, it also says "our highest enforcement priority would not be actions against consumers."

Q: What should I do?
The FDA offers these tips to consumers who buy health products online:

• Check with the National Association of Boards of Pharmacy to determine if the site is a licensed pharmacy in good standing (www.nabp.net; 847-698-6227).
• Don't buy from sites that offer to prescribe a prescription drug for the first time without a physical exam, sell a prescription drug without a prescription, or sell drugs not approved by the FDA. Also, avoid sites that advertise a "new cure" for a serious disorder or that claim the government, the medical profession, or research scientists have conspired to suppress a product.
• Talk to your health care professional before using any medication for the first time.

--Doug Terwilliger
NEA Member Benefits

Quick Tips

Consider the Source
Check with the National Association of Boards of Pharmacy (www.nabp.net) to determine if an online source for prescription drugs is a licensed pharmacy in good standing.

Avoid Suspicious Sites
Steer clear of sites that offer to prescribe a drug without first requiring a physical exam. Also avoid sites that promise a "new cure" for a serious disorder or make other suspicious marketing claims.

Consult a Doctor
Be sure to talk to your health care professional before using any medication for the first time.

10-Minute Activist

July 2003   

Why We Need Prescription Drug Coverage

The rising costs of prescription drugs threaten the health and financial well-being of many NEA-Retired members and seniors nationwide. Some of our members spend hundreds of dollars per month from their modest pensions on the drugs they need to stay healthy. Others have crossed the borders into Canada or Mexico in pursuit of cheaper drugs. Some ration their pills or forgo treatment altogether.

No retiree should be forced to make health decisions based only on the affordability of prescription drugs. Almost one-half of seniors have incomes less than twice the poverty level. Yet, presently, Medicare does not cover most outpatient prescription drugs. Consequently, seniors must too often pay for prescription drugs at the expense of food or other necessities.

Therefore, NEA supports the creation of a universal, comprehensive, affordable, and accessible prescription drug benefit for all Medicare beneficiaries, which includes cost protections for senior and other low-income beneficiaries. Several members of Congress have introduced prescription drug proposals--including the use of discount cards; creation of government-subsidized private health insurance plans; and addition of a prescription drug benefit to Medicare.

NEA supports legislation like the Medicare Reform Act introduced last year by Senators Bob Graham of Florida and Zell Miller of Georgia. Highlights of last year's Graham-Miller plan include: $25 per month prescription drug coverage premium with no deductible; government funding for at least 50 percent of prescription drug costs; $4,000 annual limit on out-of-pocket expenses, and reduced or no premiums for incomes near the poverty line. NEA is working to support a similar bill this year.

Any drug plan should be standardized and reliable and should offer Medicare beneficiaries comparable benefits regardless of where they live. Relying only on private insurers and allowing market forces to determine coverage would likely result in spotty, inconsistent plans that would not provide seniors the benefits they urgently need.

Congress' budget resolution proposes $266.3 billion in Fiscal Year 2004 for Medicare--an increase of $17.8 billion over last year's level. Importantly, it supports an allocation of $400 billion over 10 years for a Medicare prescription drug benefit, which is a small step in the right direction.

NEA is pushing hard for the passage of a meaningful comprehensive Medicare prescription drug plan and is working closely with key members of Congress to make this happen as soon as possible.

--Alfred Campos
NEA Government Relations

What You Can Do

Stay Informed
For NEA's position on particular prescription drug legislation that may be introduced this Congress, make sure to check the NEA's Legislative Action Center at www.nea.org/lac/fedupdat.html

Alert the Media
Write a letter to the editor of your local newspaper or call your local radio talk show to explain the importance of the prescription drug issue and what must be done about it. Talk about your personal hardships trying to deal with rising drug costs.