Q: As health care costs skyrocket, how can we cut our expenses by preventing illness?
A: It's true that pennies of prevention can be worth dollars of cure. Screening tests, like those for diabetes, colorectal cancer, and high blood pressure; annual flu shots; and counseling about smoking, obesity, and alcohol misuse can delay the onset of disease or catch it in its earliest stages, when it's easier — and less expensive — to treat. But a report from AARP and the Centers for Disease Control and Prevention shows that many older people aren't being screened, vaccinated, or counseled. For Americans 50 to 64, lack of health insurance may be the greatest barrier to service. Medicare recipients — the majority of people 65 and up — can get recommended preventive services with no out-of-pocket costs. Certain obstacles, however, such as a lack of transportation, may make it difficult for some people to receive care. Access to preventive services is the first step to smaller health care expenditures — and better health.
Q: A nursing home recently sued my friend for $10,000, to pay for her father's end-of-life care. She had signed no papers and had no say in his choices or expenditures — is she responsible?
A: In 30 states "filial responsibility" laws, while seldom enforced, say that adult children must care for parents who can't afford care for themselves. For most families, that's a no-brainer; the 42 million unpaid family caregivers in the United States are proof. But some long-term care facilities that can't get payment for services — through the resident's funds or through Medicaid — are turning to the resident's children for restitution. Everyone with a parent in assisted living or a nursing home should understand the laws in the state their parent lives in; check out the info at aarp.org/filial. And if you find yourself at the wrong end of a suit, discuss your situation with an attorney immediately.
Q: I've considered a reverse mortgage if I need more money in retirement. Has the drop in housing prices closed that option?
A: Reverse mortgages are still available — but generally at a higher price. The mortgage-market collapse in 2008-2009, which reduced the equity in many homes, also led to lower loan limits and more expensive mandatory mortgage insurance for this type of loan. These changes are in addition to the other substantial costs for a reverse mortgage, like the origination and servicing fees and interest. And just as with "forward" mortgages, borrowers must pay taxes and homeowners insurance or face foreclosure. AARP's experts on reverse mortgages suggest that when you're considering tapping your home equity, see if a less costly alternative to these complex loans is available. If a reverse mortgage still seems like the best idea, make sure you can answer yes to these questions: Do I fully understand how these loans work? Do I really need one? Can I afford one?