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The Periodic Midlife/Longlife Update E-newsletter - Dec 2005
The Periodic Midlife/Longlife Update E-newsletter is devoted to sharing information and enhancing excellence in ongoing faith and holistic formation for maturing adults from midlife through end of life.
Bill Prather, Founder and Director of Partners In Pastoral Care seeks to provide members with an ongoing flow of practical information that leaders/models can use directly with adults of all ages. Training is also offered through the educational arm of Partners in Pastoral Care.
All opinions expressed herein are those of the author. Permission is granted to reproduce this issue in whole or in part as long as its source is identified.
What Senior Leaders should know about Medicare’s new drug benefit
Review of a “must have” book
An “after the holidays” activity: Promoting Personal Health Power
1. Beginning this month, those 65 or older can enroll in Medicare’s prescription drug benefit program, known as Medicare Part D. Unfortunately, the program is the most confusing in the history of Medicare, according to consumer advocates. You as a leader/pastor of Longlifers will be a great blessing to your congregants if you understand some of the most important questions that will be asked and make the opportunity for your elder community to find security in factual answers.
The first question that most elders ask is: How much are the monthly premiums, and what do they cover?
The costs were disclosed by the government last month and are dependent upon where the person lives and the plan they choose. Medicare says the national average premium is expected to be $32.20 a month, or $386.40 a year, in 2006. Premiums are expected to increase yearly.
The 2003 law that created the program specifies that, after a $250 annual deductible, Medicare pays 75% of covered drug costs between $251 and $2,250. Once one has incurred $3,600 in annual out-of-pocket expenses, Medicare will pay 95% of additional drug costs. Since these are ballpark figures, each plan will offer its own fee breakdown.
My mother just received a letter from the pharmaceutical company “Merck,” telling her that she would no longer be on their supplemental medication program because Medicare will begin to pay for one of the drugs she takes. This caused me to ask the question of what kinds of drugs will the plans cover?
Every plan must cover at least two medications in each class of drugs. (In six of the drug classes, virtually all medications must be covered.) Be aware that some drugs, such as certain anti-anxiety and anti-seizure medications, are excluded from Medicare by law.
Beyond those similarities, no two plans are alike. In addition to covering different drugs, each plan will have its own list of participating pharmacies.
Most of those elders I have been talking with are very confused about one thing: Should they buy Medicare drug coverage? In my opinion, for those who take just a few low-cost drugs, the coverage will cost more than the benefit. On the other hand, if a person can afford the premiums, the benefit can serve as insurance in the event that they need more expensive drugs in the future. Also, if they decline to sign up at first but subsequently change their mind, they will pay a premium penalty of 1% of the average national premium for every month they delay enrollment.
Those whose income in 2005 was below $14,355 for individuals ($19,245 for couples) may be eligible for an average of $2,100 in assistance paying the premium. Also, an individual must have less than $11,500 in assets, excluding home and car ($23,000 for couples).
Since the enrollment period begins November 15, 2005 and ends May 15, 2006, you have time to assess the needs of those turning 65 in the congregation and surrounding community, and then designing a dynamic ministry program surrounding this issue. There is plenty of time for elders to sign up for coverage, so advise them not to be overly concerned or worried that they will lose out. Each state has numerous companies who are going to be providers, so it is a matter of which plan fits the needs of each individual.
You can start by getting involved in the process for your own needs, first! You can begin by calling 800 – MEDICARE or searching at www.medicare.gov for Medicare private drug plans in your area. When you do this for yourself, you will be able to develop a more informative program, benefiting your audience. There is certainly enough information to be extremely confusing on this site, alone. But if you click the link titled “Want to learn more about the Medicare prescription drug program?” you will arrive at another home page with links to basic information, things to consider when looking for a plan including cost and coverage, common situations, cost estimator (which is a quick tool to give you a sense of the savings you can get by joining a plan) and lists by state of plans.
There is also an all important Medicare Prescription Drug Finder, which is an interactive tool that allows a person to narrow their search for a plan based on your personal preferences such as cost, coverage and convenience for buying the specific prescriptions needed in your local area.
There is also a link to a formulary drug finder which allows you to find out which plans in your area have formularies that cover the drugs you have been taking. I believe it would be an impossible task to select the appropriate plan for a person without working on this site.
There is also a link on the first home page called “Demo of Prescription Drug Finder.” If you click on this link, it will talk you through the use of the drug finder program. The demo is a 10-minute movie which demonstrates the workings of the program. It can be paused and restarted, but I would recommend watching the program twice before attempting to apply your information to the program.
You will be prompted to run a general search or, better yet, to run a personalized search. You will enter your information, including your Medicare number, date of birth and ZIP code. You will then have the opportunity to search for plans available in your area, and compare perhaps 40 to 55 plans from different companies. You will be given the opportunity to enter each drug, strength and the 30-day dosage you are taking. The finder will then present a list of plans which offer those drugs and rank the companies by annual cost, considering the monthly premium, co-pay and deductible and whether there is additional coverage during the $2,250 to $5,100 coverage gap.
For you that do not have Internet access may use the computer in your local library. Also here is an opportunity for intergenerational ministry to take place. I would hope that attorneys, accountants or financial planners in the congregation or faith community at large would be willing to plug into the program your or others under your care, information and prescriptions and for ministry sake help complete the program. Although the following folks will not do as an exhaustive work there are numerous representatives from Medicare, even the pharmacist from your local pharmacies, who will come and give your group detailed information and answer all those questions that are on the minds of your Senior community—and they will do so without cost.
There is a great piece, The Medicare & You 2006 handbook, that has information about private Medicare drug plans that are available. You can download a free copy of Medicare Drug Coverage 101: Everything You Need to Know about the New Medicare Prescription Drug Benefit, from www.medicarerights.org.
Former Senator Bob Dole has written a new educational pamphlet entitled, “Pick the Plan That’s Best for You,” which explains the details of enrolling in a Medicare drug plan in language that is easy to understand. He gave a speech on November 15 th on the subject. This can be found on a web cast on the Florida Council on Aging Web site at www.fcoa.org or through his web site.
2. Faith and Mental Health: Religious Resources for Healing
It’s not often that a book with such breadth, stature and excellence arrives, so when it does, we all do well to respectfully take notice. This book is of general interest for professionals and practitioners who work with people of faith in any capacity, but it is of particular importance, to the point of being mandatory reading, for any of us who care for and about senior adults, their spiritual development, and their mental health.
Dr. Harold G. Koenig, M.D. is professor of psychiatry and behavioral sciences, and associate professor of medicine at Duke University Medical Center. He is director and founder of Duke’s Center for the Study of Religion/Spirituality and Health. I have referenced Dr. Koenig’s work in past issues of this newsletter; however, I believe this is the first time I have reviewed an entire book.
This book is a research compendium destined to be the definitive “go to” reference for anyone interested in mental health issues in general, and particularly those associated with faith-based organizations, i.e., churches and church-sponsored or affiliated programs.
Dr. Koenig has long pioneered solid research looking at the connections between faith and health in general. He is responsible for making such topics respectable and legitimate points of investigation for medical and behavioral science researchers, topics formerly held at arm’s length by the conventional research establishment. Any piece of work authored by Harold G. Koenig deserves our attention; this book delivers without reservation.
In his book, Dr. Koenig identifies the entire universe of research studies that have investigated “mental health and faith” in the last century—a monumental task. He states that 850 such studies exist. He then brings order to this body of work by organizing these studies and their findings under headings that offer not only a framework for better understanding, but also give the book a cohesiveness that heightens its clarity. This organization is the masterstroke that transforms what would otherwise be a strictly academic treatise into a readable and compelling work. I was never bored while reading this book as I so often am with other academic works. I found myself riveted to its pages as the author revealed yet more evidence of the impact of faith on mental health.
Dr. Koenig captured me with an easy writing style combined with an unparalleled excellence of scholarship and depth of resource. Never did he try to “sell” his own perspective; he remained the consummate and detached scholar while at the same time giving the reader an experience that speaks as much to one’s heart as to one’s head. Dr. Koenig is not only a great researcher and scholar, but he is also a great communicator.
While the book does not differentiate between ages, Dr. Koenig does reference many studies that involve senior adults. Here is a sampling:
Loss of Spouse
One researcher found that the importance of religion and spiritual beliefs/practices were strong predictors of psychological well-being in persons between 65 and 87 who had recently lost their spouse. This relationship was found independent of the person’s other social supports and physical health.
Transcendence
Elders who transcended losses due to aging, through their faith experienced high levels of life satisfaction (happiness). Further, no one who demonstrated such transcendence experienced overall low life satisfaction.
Optimism
Older adults who had a close relationship with God were more optimistic. Those older adults who were more optimistic had better overall health.
Sense of Meaning
Older adults who derive a sense of meaning in life from their religion tend to have higher levels of life-satisfaction, self-esteem, and optimism.
Quality of Life(QOL)
QOL refers to a person’s overall level of functioning, including psychological well-being, social relationships, and ability to independently care for physical needs. One research team studied older persons with rheumatoid arthritis (RA). More advanced RA was associated with more depression, greater pain, poorer self-ratings of health, and greater physical role limitations. Spirituality, however, was associated with greater well-being and better health perceptions (in older RA patients) even after controlling for other predictors of well-being, such as disease activity, functional disability, and age.
Forgiveness
Increased religious involvement increases forgiveness. This finding was especially true with advancing age. Investigators conclude that “forgiveness is tied intricately to religion/spirituality.”
Prayer
Praying for the benefit of others has been shown to increase mental health and well-being, an effect that may be partly explained by an increased sense of meaning in life.
Social Support
Informal interpersonal contact was the strongest predictor of life-satisfaction (happiness) in later life adults. Interpersonal contact, however, produced this effect only if friendships were church-based.
Pain
Praying tends to predict a greater reduction in pain over the long term than is experienced by those who do not pray.
Depression
Subjects who indicated that religion was not very important were almost six times more likely to remain chronically depressed. This was especially true of older women (vs. men). Among depressed women who indicated that religion was not important, none recovered completely from depression. Among women who indicated religion was very important, 50% recovered completely. Positive religious coping predicted lower depression six months later, independent of other potentially influential factors. Levels of depression were significantly higher in older men.
This is but a taste of what this book offers. The overall conclusion of the book is clear— religious beliefs and practices have a profound and positive impact on every measure of mental health. Dr. Koenig offers specific ways that FBOs (faith-based organizations) can assist in this vital work. While mental health is not the primary goal of religion, there now remains no question that religion, its practices and beliefs, mightily increase the mental wellness of adults, and especially older adults.
This is a monumental book, a veritable tour de force of research related to mental health and faith. It is relevant and readable, interesting and vitally confirmatory for anyone ministering with believers of all ages through counseling. This book is the work of a master scholar; it is destined to rank as the definitive statement on faith and mental health. I recommend you get this book, read it, and keep it handy on your shelf both for reference and for comfort.
A great deal of our work here at Partners In Pastoral Care involves helping pastors assess the needs of not only the individual congregation but also the community at large. After assessments are made, we give foundational, practical, attainable, and impacting ideas, suggestions and detailed plans for successful pastoral care ministry. Call our office or e-mail us for 2006 – 2007 available dates.
3. This presentation and activity may best be given after the holidays when, especially, Midlifers and Longlifers are feeling a “letdown, the blues or depression.” Also, I deal with the subject of handling change, since issues such as tradition may not be the same this holiday season for many. I have titled the presentation: Promoting Personal Health Power. With little effort you will be able to create an interesting visual, as well.
The Lecture: Certainly we all want to be healthy and happy, yet achieving these requires our concentrated action. To become healthy we need to exercise some willpower within us. I call this inner strength personal health power. Personal health power rests squarely on what we believe about ourselves and how we see ourselves at every stage. Personal health power is not a behavioral competency, but an attitudinal and self-perceptual competency. Yet, our attitudes and our self-perception are the "mothers" of our behavior— what we do! Personal power has everything to do with how we appraise and evaluate ourselves at this "seasoning" time of life, and how these appraisals affect our abilities to bring healthy and constructive change into our lives. Do we see ourselves as sufficiently resourceful and appropriately capable of tackling the many modifications required for the many life changes that mature living brings so that life can flow through us in abundance?
Healthy mature life change requires strength, and strength is derived from personal health power. All change, especially change in senior living, requires an attitude of "charting our own course," or self-empowerment, of being able to influence events, and being resourceful. Change demands self-control and self-discipline, two highly valued and central ingredients of personal health power. In our new, fast-paced world, change demands that we each act as our own quality centers of health promotion; personal health power gives us the fuel we need to address the many changes that challenge us in our life journey.
PAT'S STORY: (Give the hand-out, break into groups of 4-6 and instruct participants to read and discuss among themselves any problems and solutions.) Pat is a most faithful and generous woman. All through her life she was faithful to the church. She regularly attended services and other activities, she dutifully brought up her five children in the faith, and she supported in body, mind and checkbook the work of the church. It would be hard to find a more devoted Christian than Pat.
At age 74 she found herself in a predicament. Her husband Dick had died over a year ago and she felt lost, unable to cope with the things that her husband had formerly taken care of. Dick was a formidable man, successful, strong, capable, and somewhat controlling. He was clearly the man of the house and Pat was comfortable in letting him run the finances of the household, as well as many other tasks that needed doing. Dick was the primary decision maker of the couple. It's not that Pat was submissive; on the contrary, she was quite proactive and even opinionated when it came to the domestic matters of the house: the children, health care, food preparation, interior decorating, etc. Yet Dick provided the strong power that could deal with the world; after all, he was a successful person and well-acquainted, even savvy, with things of the world.
Pat could not be considered as acting independently; rather, she postured herself very comfortably to be somewhat dependent upon Dick. Clearly, however, this posture was not serving her well now that Dick was gone. Along with Pat’s sorrow over Dick's death, she was also becoming somewhat angry. "A strange emotion to feel," she mused. "I was rarely angry at Dick when he was alive, so why should I be angry now?" she puzzled. Yet anger was most certainly mixed in with the avalanche of other emotions that she was feeling now that she was without him.
Report Findings: (After calling the group back together, ask them to share some of their thoughts and insights into Pat’s story. Do not be surprised if there are those in the groups who have the same feelings as Pat. Let them express fully.)
Close of Presentation: Pat’s emotional discomfort grew to such intensity that one of her daughters suggested that she consult a counselor. What emerged for Pat through counseling was that she had allowed her own sense of self to diminish over the course of her marriage. To some degree she forfeited her own self in the face of the strength of Dick's personality. Pat not only relied upon Dick, she had gradually, ever so slowly, yet without question, given up her own sense of self-agency.
INSIGHT ACTIVITY: Creating Self-Agency — My experience has indicated that it is important that the introduction be reviewed and the participants allowed to ask questions before giving specific direction as to the exercise.
(Copy the following and give a sheet to each participant)
CREATING SELF-AGENCY
Webster defines "agency" as: (a) the capacity, condition, or state of acting or exerting power, or (b) a person or thing through which power is exerted or an end is achieved.
Having self-agency means that we have within ourselves the power to act in our own behalf, and to exercise influence in such a way that our own needs and wants are expressed. The notion of self-agency may sound selfish to a committed Christian; it may sound as though we are violating humility and adaptability and becoming prideful, self-centered and vain. Yet, when we overlook our own needs, we can contort humility into self-repression, or adaptability into self-forfeiture. Where is the line between these? This is part of our journey with Jesus as we grow spiritually.
Spiritual development does not mean self-repression nor self-forfeiture; it does not mean submission not servitude. On the contrary, spiritual development requires that we see ourselves as we actually are in the splendor of God's creation, that we conceive of ourselves in the richness and the abundance of our inheritance as children of God. Spiritual development requires that we act with self-agency. If we are to be as healthy as we can be, we need to practice self-agency.
DIRECTIONS : Below are listed self-descriptive sentences on a 10-point scale. Rate each sentence the way you genuinely see yourself along with each of the 10-point scales. Place your numerical response (1-10) in the space next to the sentence.
LOW 1 2 3 4 5 6 7 8 9 10 HIGH
____ I enjoy acting on my own
____ I'm quite resourceful
____ I practice self-control and self-discipline
____ I act with confidence
____ I'm my own person
____ I acknowledge and use my own personal strengths
____ I value my own internal suggestions more than other persons
____ I’m sure of my own ideas
____ I practice self-directed thinking
____ I can make decisions on my own
MY TOTAL SCORE ________
If you scored between...
85 – 100 “Look our world, here I come”
70 – 85 You express yourself clearly and directly
50 – 70 “You win some, you lose some”
35 – 50 You could be more assertive
20 – 35 Who are you leaning on?
0 – 20 Watch out, a strong wind can knock you over
Bible citations of interest:
Cor. 2: 3
Phil. 3: 4-9
2 Cor. 12: 8-9
Rev. 3: 8
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