A recent University of Massachusetts Medical School Rural Health Scholars reported that 16 percent of the Martha’s Vineyard population is over 65 years old, and that age group will comprise more than one-third of the Island population by 2030. The impending demographic shift is so dramatic, some refer to it as “the Silver Tsunami.”
The same survey concluded that a top priority for Island health care providers should be to “recruit geriatricians and mental health providers.”
Abe Seiman of Oak Bluffs came to the same conclusion after interviewing personnel at the Martha’s Vineyard Hospital, Windemere, Island Healthcare, and Vineyard Medical Services.
“We don’t have enough therapists to service the Island, and I think there’s a particular lack of options for seniors,” Mr. Seiman told The Times. To help fill this void, Mr. Seiman created Practical Solutions, a counseling service for seniors who are grappling with a dizzying array of choices and questions instead of the tranquil simplicity they’d hoped for in their “golden years.”
Mr. Seiman, 72, and his wife have been homeowners in Oak Bluffs since 1962. He retired here six years ago, after a long career in the health care industry, primarily in geriatric care and elderly housing. He has M.S.W. and M.B.A. degrees. He also worked as a counselor in private practice in his native Long Island.
Combining his business and counseling experience, Mr. Seiman started Practical Solutions to provide answers to questions. These include: How do I protect my assets? How can I care for my spouse with dementia without losing my mind? What Medicare plan do I chose, and what the hell does a doughnut hole have to do with it?
A search of the Medicare website, Medicare.gov, showed an Oak Bluffs resident over 65 years old would have a selection of 28 Medicare plans, widely varying in cost and coverage. While there are online resources like the Medicare Rights Center, a nonprofit organization dedicated to explaining the intricacies of Medicare to the masses, obtaining the information requires a degree of computer saavy that many elders lack. And no website can allay the stress of making a decision that could affect the rest of a person’s life.
“Medicare can be very complicated and overwhelming,” Mr. Seiman said. “Choosing a plan can be a big source of anxiety. After working as a nursing home administrator for 30 years, I know the ins and outs of Medicare and Medicaid pretty well. You can get Medicare at age 65 and in some instances 62, but it won’t cover home health aides, nursing homes, or assisted living, which are all the services you’d need if you break a hip,” he said.
Many seniors live in constant worry that their assets can be gobbled up by a nursing home or the costs of home health care. One way to protect a lifetime of accumulated assets is to divest them into a trust, and to make their heirs the trustees, Mr. Seiman said.
“A transfer of assets into a trusteeship can be a complicated process, and for many people, it’s a very hard sell,” he said. “It can be a very wise business decision, but at the same time, it’s a very emotional decision and that’s where my counseling experience comes in. Giving up control can be very difficult. Many people are afraid that could mean losing their home someday, but you have a clause in the trust that stipulates that you can stay in your home for life, unless a court orders that you’re too impaired to live there.”
Mr. Seiman said there’s a time factor in the weighty decision, which can add to the stress. “Unless it’s done five years before you need full time care, it won’t protect your assets. If you own a home, and you need full time care and haven’t transferred your house [into a trust], MassHealth puts a lien on it.”
Mr. Seiman also said that most people don’t realize that it’s also possible to negotiate deals with nursing homes ahead of time. “Forty years ago, a lot of private nursing homes would only do private pay,” he said. “But if you want to go to a nursing home that says they don’t take Medicaid, you can negotiate to pay two and a half years upfront at market rate, if they agree to take Medicaid after that. It’s a competitive business, and many of them are open to making deals. You have to know what’s negotiable, what’s not.”
Mr. Seiman said that whether it be a transfer of assets into a trust, or a negotiated deal with a nursing home, a lawyer should always be consulted. “There are a couple of lawyers on the Island that I could recommend with confidence,” he said.
Aging ain’t easy
There are emotional conflicts unique to aging. Friends, spouses, and loved ones die with increasing regularity, and loss becomes a constant. So does physical and mental decline. Couples who were forced to spend time apart during their working years can struggle when they’re suddenly together 24/7, and that dream house they bought 40 years ago has become a daily obstacle course.
“I can go to someone’s home and show them how to make it safer,” Mr. Seiman said, adding he’s informed by his experience planning and staffing the Martin Luther Terrace Apartments, a senior living development in Deer Park, N.Y.
“I oversaw the development of a 100-unit senior living complex, and I’m very familiar with all the Americans with Disabilities Act (ADA) regulations. I can show you what height the sinks should be, how wide the doorways need to be, what ramping you need for wheelchairs, and also how to improve the overall safety of the home,” he said.
Diminished memory is a natural function of aging. But a forgotten appointment, lost house keys, or a charred chicken dinner can leave an elderly person, or his or her spouse, fearing the worst. As part of Practical Solutions, Mr. Seiman said he can help determine if that forgetfulness is significant.
“I can test someone and tell how severe their memory loss is, and counsel them how to deal with it,” he said. “In mild cases, it can be a simple as putting up signs around the house, like a reminder to turn off the stove.”
Talking to an adult with Alzheimer’s is like talking to a child, and it can be incredibly frustrating, he said. “I always encourage the caregiver to take time off, to get out of the house and be with friends, to give themselves permission to take a break from it. It’s better for everyone if they do,” he said.
There are less dramatic factors of aging that also take a heavy emotional toll. “It can be very hard when a spouse retires and two people suddenly find themselves together all the time. You can drive each other crazy, and I speak from personal experience — just ask my wife,” he joked.
Ultimately, the goal in counseling elders is to reconnect them with a sense of self-worth, which can be difficult to maintain in today’s society. “The decline in personal self-worth with the elderly is very significant,” he said. “Long ago, elders were thought of as sources of wisdom. In today’s world, that’s often not the case. When you were a parent, you were an authority; when you get old, everyone thinks what you have to say is passé. But there’s one thing you have to know about the elderly: They all have opinions, and they don’t mind expressing them.”
According to the Martha’s Vineyard Health Aging Task Force, 47 percent of households age 65 and over have incomes of less than $30,000 per year. With that in mind, Mr. Seiman said while his services are not free, he will work with clients for what they can pay. “I don’t want money to keep people from using the service,” he said. “It could be $20 a session, it could be $10 a session. I’m not doing this to get rich. I just want to help fill a big need on the Island.”
For more information on Practical Solutions, call 508-696-9030.
Correction: An earlier version of this article stated that Medicare can put a lien on people’s homes when they are in long term care. It is MassHealth (Medicaid) that pays for long term care and that can take that action.